Optimum therapy with psychopharmacologic agents in geriatric patients requires an appreciation of the elderly's increased predisposition to emotional disorders and their unique sensitivity to adverse drug-drug interactions. Although nonpharmacologic approaches should be considered, adjunctive use of psychoactive medications can assist the physician to break the "negative cycle" of emotional distress ...

Medication use and its correlates were examined in a randomly selected sample of 178 urban-dwelling elderly people: 89 per cent were currently using medication and 44 per cent were using four or more medications concurrently. Forty percent were using at least one nonprescription medication, usually in combination with prescription medication. ...

The relationship between medication and incontinence was studied retrospectively in 128 elderly patients enrolled in an incontinence study. Patients were taking up to 18 non-topical medications but most of these were unlikely to have a significant urological effect. Nevertheless, 62% of patients were receiving, for other medical problems, up to ...

The role of the physician as guardian of elderly women's mental and physical health reaches far beyond prescribing medications for symptom relief. The role an elderly woman plays in family, community, and society, are integrally related to the symptoms she experiences. Protocols for evaluation should be taught early and consistently ...

OBJECTIVE: To review the impact of pharmacist interventions designed to assist older people in managing their medication regimens. DATA SOURCES: A computer search of literature published between 1975 and 1990 was conducted using MEDLINE. References were also identified from the bibliographies of pertinent articles. STUDY SELECTION: Studies included in the ...

This Grand Rounds will review the problem of alcoholism and prescription drug abuse in the elderly. Several case vignettes will be presented. The pharmacology of alcohol and potentially addictive prescription medications will be reviewed. The clinical presentation of and psychiatric symptoms associated with these disorders will be discussed. The process ...

Acute confusional state is a condition that is commonly encountered in many types of medical practice. Certain patients, especially the elderly, are vulnerable to the disorder, and recognition of this fact can help prevent the development or minimize the severity of the condition. Thorough history taking and evaluation often point ...

"When I first met Mr. K, he had just been discharged from the hospital, where he was treated for congestive heart failure. This was his third admission this year--his physician thought he might not be taking his medications correctly. The doctor had referred him to our home care agency for ...

This study evaluated the reliability of a new medication appropriateness index. Using the index, independent assessments were made of chronic medications taken by 10 ambulatory, elderly male patients by a clinical pharmacist and an internist-geriatrician. Their overall inter-rater agreement for medication appropriateness (ppos) was 0.88, and for medication inappropriateness (pneg) ...

By the year 2030, it is estimated that 17% of the population (52 million people) will be over age 65. Most of these individuals will be taking several medications, and one or more of these medications may be a psychotropic, that is, an antidepressant, anxiolytic, antipsychotic, or lithium. This article ...

A sample of 253 elderly people who had been taking psychotropic medication for at least 3 months were interviewed to establish their levels of morbidity and their subjective health status. The findings were compared with those of a control sample of 484 elderly people in the same area. Those taking ...

Periodontal disease is a generic term encompassing a variety of inflammatory conditions affecting the supporting tissues of the teeth. Periodontitis is inflammation associated with net resorption of supporting alveolar bone and periodontal ligament. Gingivitis is inflammation limited to the covering gingival tissues and does not directly lead to tooth mobility ...

Patient compliance with medication prescriptions in the period immediately following hospital discharge should be of concern to all hospital personnel responsible for the appropriate use of medications, notably Pharmacy and Therapeutics and Quality Assurance Committees. We reviewed the medical records of patients over age 65 discharged from one acute-care hospital. ...

OBJECTIVE: To identify problems with medication knowledge, self-estimated compliance, and recall of medication education in a group of elderly patients. DESIGN: Survey. SETTING: Medicine and geriatric clinics at a county hospital. PATIENTS: Patients greater than or equal to 60 years old and taking at least one prescription medication. MAIN OUTCOME ...

BACKGROUND: Approximately 500,000 persons in the United States suffer a stroke each year; the majority of these individuals are 65 years of age or older. The neurological impairment occurring as the result of stroke can lead to both acute and chronic disability. Further medical complication and disability are often the ...

While functional gastrointestinal complaints are common in the elderly, valid instruments for their assessment are lacking. We have developed the elderly bowel symptom questionnaire (EBSQ) and report its feasibility, reliability, and validity in medical outpatients and a larger sample of the community (aged 65-93). Reliability was measured by a test-retest ...

The paper describes the work of an assessment unit setup to provide a service for frail elderly patients admitted to general medical units at the Royal Infirmary of Edinburgh during the period of April 1989 to March 1990. Patients were selected on the basis of diagnosis, mental and physical function, ...

Dementia is a devastating personal tragedy, a cause of tremendous family strife, and a significant societal dilemma both medically and economically. Appropriate evaluation and therapy of medical complications, underlying causes of intellectual compromise, and non-cognitive behavioral disturbances are important goals. Comprehensive psychological, social, and legal support complement the medical management ...

OBJECTIVE: To describe and compare drug-use patterns among black and nonblack community-dwelling elderly. DESIGN: Survey. SETTING: Five-county urban and rural region in Piedmont, NC. PARTICIPANTS: Stratified probability household sample of 4164 community residents aged 65 or older from the Piedmont Health Survey of the Elderly (65 percent women, 54 percent ...

This paper describes a study in which 70 elderly patients were assessed for risk factors in their medication regimen. They were separated into three study groups, including two levels of teaching intervention focused on the home medication administration system, and a control group. The intervention utilizing a follow-up telephone call ...

Insomnia and daytime sleepiness in an elderly patient may be a normal consequence of aging, the result of a primary sleep disorder, or an adverse effect of medication or medical illness. Effective management requires a differential diagnosis. Adjustment sleep disorder, primary snoring, inadequate sleep hygiene, and mood disorders are common ...

Of the 622 patients admitted to a geriatric medical unit during the period November 1985 to October 1986, 211 (33.9%) had been discharged from hospital within the previous year. Of these, 117 (55.5%) had previously been admitted to the geriatric medical unit (18.8% of all admissions). The reasons for readmission ...

The concept of "worried wellness" is poorly defined for research purposes, and little is known about the worried-well elderly. To study the incidence of worried wellness in the elderly and define the clinical utility of the term, researchers conducted a structured interview with 733 independently living community elderly and 250 ...

Dysphagia in the elderly is most often oropharyngeal or hypopharyngeal in location and neuropathologic in etiology. Aging itself, although causing demonstrable structural and functional changes in the esophagus, does not cause any clinically relevant esophageal dysphagia. A variety of pathologic conditions seen in the geriatric population affect the esophagus and ...

Estimates from the National Medical Expenditure Survey imply that in 1987 only two-thirds of elderly Medicare beneficiaries held the amount and type of insurance that is generally recommended to supplement Medicare, namely, 57.7% with private hospital/medical insurance from one source and 6.6% with only Medicaid. Of the remainder, 19.8% had ...

Over a period of 16 years, the annual admissions to the Merton part of the St George's Department of Geriatric Medicine increased, then decreased, before rising again. Examination of the mean length of stay and bed turnover indicated that patient management was continually changing. However, this was not confirmed by ...

In an attempt to assess the service provided by a geriatric department for the elderly population within its District, a census of the elderly patients occupying general medical beds in the same District was undertaken. These patients were assessed according to five criteria which identified patients as 'geriatric'. Sixty-one per ...

An informal impression that there was a shortage of facilities for elderly patients who presented, with a routine illness, to a weekend duty doctor was studied by interviewing duty doctors and providers. The duty doctors stated that the major problems were the deficit in support from friends, relatives and neighbours ...

The purpose of this study was to identify associations between the use of commonly taken medications and groups of medications and the risk of falls in elderly people living in the community. A stratified random sample of 1358 persons aged 65 years and over was selected from the 15,000 members ...

Heart failure commonly occurs in the elderly age group. Treatment mainly centres on the use of digoxin and diuretics. In intractable heart failure other agents ie inotropic agents and vasodilators may be considered. Routine maintenance on diuretic and digoxin should not be encouraged. A conscious effort to tail off these ...

1. Physiological changes normally seen in elderly patients affect the pharmacodynamics of medications and may contribute to adverse effects. 2. A large number of medications can potentially cause confusion as an adverse effect in the vulnerable elderly patient. 3. Inadequate patient education contributes to noncompliance and errors in self-administration of ...

This article presents important factors related to hearing impairment, medical concerns related to hearing, hearing handicap, and epidemiological principles as considerations in selection of a protocol in adult/elderly hearing screening (18 yr and older). I encourage protocol validation which incorporates a series of criteria: medical conditions, rates of failure for ...

A prospective study of elderly Australians commenced in 1988 in Dubbo, NSW. Its goals are to identify predictors of mortality, hospitalisation and placement in long-term care, with special focus on risk factors for cardiovascular disease. The study population were non-institutionalised subjects, comprising 1237 males and 1568 females 60 years and ...

The incidence of falling injuries leading to medical treatment was described by sex, age, marital status, education, amount of daily motion, self-perceived health, mechanism of fall and severity of injury. Material was collected regarding persons aged 65 years or over seeking medical treatment due to a fall during a period ...

Stimulated whole salivary flow rate (SWSFR) was measured in a group of elderly subjects who were examined for the use of xerostomia-inducing medications. SWSFR was significantly reduced in elderly subjects using one of these medications when compared with control subjects (0.94 vs 1.52 ml/min). Increasing use of up to four ...

Gait problems are frequently encountered in elderly patients. Assessment can be made with tests that do not require complex equipment or excessive amounts of time. Most gait disorders result from the interplay of many factors but can respond to medical management, physical therapy, gait training, and correct use of adaptive ...

A community survey of identifiable symptomatic shoulder disorders in a sample of 644 elderly people over age 70 (318 male and 326 female) revealed a prevalence of 21%. Shoulder disorders were more common in women (25%, versus 17% in men). Approximately 70% of the cases of shoulder pain involved the ...

Primary care physicians seeing a growing number of elderly demented patients must consider a number of problem areas when treating such patients. This article offers the mnemonic FICS'M (Family, Intellectual status, Continence, Sleep, and Mobility) to help physicians address treatable problems associated with dementing illnesses. Strategies are offered to minimize ...

The effects of different psychotropic medications were examined for the control of behavior problems associated with dementia in three elderly nursing home residents. A reversal design was used in which the medications were introduced and withdrawn, and their effects were assessed on various resident behaviors using behavioral and motor performance ...

This paper describes the development and testing of a medication reminder card specifically designed for elderly persons on complex drug regimens. The need for such a system was confirmed by a survey of approximately 100 Canadian hospital pharmacy departments where no system provided at discharge by respondents met with our ...

Dry mouth in the elderly is a common occurrence with multiple etiologies. It is not a normal phenomenon of aging and, therefore, an attempt at elucidating its cause should be made. Sjögren's syndrome may occur, and it is diagnosed by labial biopsy. Medications are also frequently associated with dry mouth, ...

Constipation occurs frequently in the elderly and is often multifactorial in origin. A search for an underlying cause is necessary, and can often be found by taking an adequate history and performing a thorough physical examination. A minority of patients require further investigation, guided by the clinical setting. Management should ...

Patients with serious illnesses who donate their blood for autologous use create anxiety for many phlebotomists. Donor room staff were surveyed at three donor centers, using confidential questionnaires, to identify their concerns and to evaluate factors associated with reduced anxiety toward autologous donors. Among respondents (n = 93), 58 percent ...

Many elderly persons take medications that their physicians do not know about. The reasons include multiple prescribers, errors in prescriber records, and lack of patient-to-physician communication on medication use. This study assessed the use of mailed cues (postcards) to prompt elderly patients to bring all medications to physician office visits. ...

Underlying medical illness and drug interactions may make the use of psychotropic agents problematic in some physically ill patients. This overview, published in two parts, discusses six major classes of psychotropic medications (cyclic antidepressants, monoamine oxidase inhibitors, benzodiazepines, neuroleptics, lithium, psychostimulants, and carbamazepine) and examines their use in the setting ...

Dizziness and falls are a common cause of morbidity and mortality in the elderly. The pathophysiological mechanisms leading to these symptoms are legion and such patients may present in a multiplicity of medical and surgical outpatient departments. A working knowledge of the management of these disorders is therefore of value ...

We aimed to investigate whether regular flushing of peripheral intravenous cannulae used for intermittent injections with heparin-saline, in a unit for acute medicine for the elderly, reduced the incidence of complications necessitating cannula removal. We wanted to see if this could also prolong the time that cannulae may remain functional ...

The elderly are the prime users of all medication and especially self-medication using Over-the-Counter (OTC) drugs. This group also has the greatest risk from misuse or interaction of multiple medications. To minimize the risk, information about OTC consumption must be provided to the elderly. This research reports on the importance ...

This study was undertaken to determine if there is an association between medication use and the presence or absence of bacteriuria in elderly ambulatory women. Of 198 women who participated in three urine culture surveys (every 6 months) during the 18-month study period, 66 (34.4%) had bacteriuria on at least ...

Because many elderly men with chronic illnesses such as diabetes have multiple causes contributing to their impotence and may still retain an interest in sexual activity, those who still are unable to adequately perform sexually after treatment of their medical problems should be informed of the alternative methods of treatment ...