Criteria Expanded for Inappropriate Drug Use in ElderlyAn update in the July 28 issue of Archives of Internal Medicine expands upon 1991 research outlining criteria for defining potentially inappropriate medication use in elderly persons. The study update examines two additional goals: addressing whether adverse outcomes were likely to be clinically severe, and incorporating clinical information on diagnoses when available. A panel of six nationally recognized experts on the appropriate use of medication in the elderly agreed on the validity of 28 criteria describing the potentially inappropriate use of medication by general populations of the elderly, as well as 35 criteria defining potentially inappropriate medication use in older persons known to have any of 15 common medical conditions. These criteria are meant to serve researchers evaluating the quality of prescribing, drug utilization review systems, and educational efforts. |
These results can be achieved without added staff or an increase in injuries, say researchers at the University of Pennsylvania in Philadelphia, who conducted a 12-month clinical trial at three nursing homes in the Philadelphia area.
The first nursing home served as the control. Staff at the second facility participated in ongoing educational programs on how to minimize the use of restraints. Staff at the third nursing home participated in weekly consultations with a gerontologic nurse in addition to the educational programs.
The most significant reduction in restraint use occurred at the third nursing home. The researchers reported that "relative to baseline, [the] declines were 23% [for the restraint education site], 11% [for the control group], and 56% [for the restraint education-with-consultation site]." The team reported that the declines were achieved without increased staff, increased use of psychoactive drugs, or serious fall-related injuries.
William Thomas initiated the Eden Alternative while serving as medical director at Chase Memorial Nursing Home in New Berlin, New York. "I wondered why nursing homes, which hold themselves out as very caring places, are widely understood to be cold, sterile, and uncaring," said Thomas. "It seemed to me that people who lived in nursing homes were afflicted with three great plagues: loneliness, helplessness, and boredom."
Thomas responded to what he saw by designing a unique "cure" for some of the more dehumanizing aspects of nursing home life. Deciding that companionship was the key to enhanced quality of life for people living in nursing homes, in 1992 he developed an approach that incorporated companion animals such as dogs, birds, and cats, along with plants-and even children-into the surroundings of elderly residents.
The responsibility and decision-making authority of nurses' aides were enhanced in Thomas' model, and the role of middle managers was reduced. The overall results appear to be highly encouraging.
Research to measure the effectiveness of the approach was built into the Eden Alternative from the start. According to Thomas, during the first 18 months of the new model's implementation, the mortality rate was 15% lower than the number of deaths at a comparable nursing facility used as a control. The following year, mortality dropped to 25% below that of the control facility. Rates of urinary tract, upper respiratory, and other infections also improved significantly, and daily medication costs dropped from $3.86 to $1.13 per patient, said Thomas.
The Eden Alternative has been adopted by more than 100 nursing homes nationwide, according to Thomas. For more information, call 607-674-5232.
No More `One-Size-Fits-All' Health CareOne-size-fits-all health care may be nothing but an historical artifact by the year 2005, according to a report issued this summer by the Institute for Alternative Futures (IAF), a nonprofit research and educational organization specializing in developing insights on the future.The IAF report, titled "Clinical Development 2005," predicts that the new millennium will bring customized treatment that relies on data about individuals, including genetic factors, computer simulations that cut clinical development time and costs in half, and outcomes research that produces real-life insights into which therapies work best. The report, underwritten by IMS America, an organization that collects and disseminates health care information, is the result of a collaboration of 30 experts from diverse areas of business, research, academia, and government. "Historically, clinical development has relied on a one-size-fits-all chemical/industrial model," said IAF Vice President Jonathan Peck. "This model simply will not get us where we need to be in medicine-and where we can be by moving toward a perfect-size-for-each-person system. "To date, a specific therapeutic effect in a random population has been regarded as more or less true for different individuals, and has been accepted as good enough," continued Peck. "However, we have the potential to achieve levels of diagnosis and disease treatment never before thought possible by creating customized models that integrate genetics, time-based data, population-based information, and real-world patient input. `Good enough' becomes much better." The report focuses on key strategies in the areas of clinical epidemiology and human genetics, computer simulation, outcomes studies, and community-based studies to spearhead advances in customized health care. For more information about the report, contact IAF at 703-684-5880, or visit the IAF Web site at www.altfutures.com. |
The FDA learned of six asthma patients who developed Churg-Strauss syndrome while taking zafirlukast. Churg-Strauss syndrome is a rare and sometimes fatal disorder that occurs in adult patients; it is characterized by generalized flu-like symptoms and inflammation of blood vessels, particularly in the lungs. If left untreated, the disorder can cause major organ damage and even death. The reported cases of the disease all occurred in patients whose steroidal asthma medications were being gradually lowered or discontinued while receiving zafirlukast.
Despite the severity of Churg-Strauss syndrome, the FDA is not currently recommending that patients discontinue their asthma medication, saying the benefits of the drug far outweigh any of its known or potential risks and that currently available data do not demonstrate that the drug actually caused the condition.
Accolate's manufacturer, Zeneca Pharmaceuticals, also notified health professionals of the possible side effect and has revised the labeling for the drug to warn providers of the potential problem and to urge them to monitor their patients carefully.
Zafirlukast, which was approved in September 1996, is the first in a new class of nonsteroidal asthma prophylaxis drugs for patients 12 years of age and older.
The report described the case of a four-year-old child with hemophilia who was infected with the hepatitis C virus by his mother. The mother, who reported pricking her finger on at least two occasions while administering home infusion therapy to the child, was unaware that she harbored the virus. The report's authors said the accidental infection points out the need for better training in standardized infusion practices for family members who administer home infusion therapy.
"Patients and their families...should receive training with a standardized curriculum before initiation of home infusion therapy," said CDC officials, adding that infection control practices should be regularly evaluated at the home through follow-up visits by health professionals with specialized training.
New Web Site Addresses Managed Care IssuesAstra Merck Inc. has launched a new electronic magazine for medical professionals and others working in the managed care arena. "Between Rounds," www.betweenrounds.com bills itself as "a meeting place for providers and managed care organizations where light replaces heat `between rounds' of the sometimes contentious debate over health system change."The site offers an editorial mix ranging from serious discourse on economic and political issues in managed care to lighter articles on career development and tourism. In the premier issue, leaders in health care debate the move by Congress to legislate managed care benefits, and a psychiatrist tells physicians how to beat the stress of health system change. The site provides links to a glossary to enable lay readers to comprehend some of the medical and technical terms used in the text. For more in-depth information on managed care, visit the Web site of InterStudy Publications, which produces directories and analyses of the managed care industry. InterStudy has tracked trends in health maintenance organization (HMO) services, enrollment changes, and profitability for 25 years, and publishes a biannual national HMO survey. Its Web site is located at www.hmodata.com. Information on financing and marketing of HMOs and HMO products such as point-of-service and open access plans can be found at the Health Market Survey Web site at www.hsurvey.com/news. |
Results for the total sample showed a significantly elevated odds ratio for self-reported infertility associated with the occupational handling of chemotherapeutic drugs prior to the onset of infertility, the investigators reported in the June issue of the Journal of Occupational and Environmental Medicine.
They urged compliance with 1986 Occupational Safety and Health Administration guidelines for the handling of chemotherapeutic agents to reduce the risk of infertility associated with the use of these drugs, noting that "this worker population, with a mean age of 37, is in the prime of reproductive life."
Investigators photographed the lenses of 3,600 people ranging in age from 49 to 97 and collected information from them about potential risk factors for cataracts, including any history of inhaled beclomethasone or budesonide use. Use of inhaled corticosteroids was reported by 370 of the study participants. Compared to non-users, the prevalence of nuclear cataracts was 1.5 times higher and the prevalence of posterior subcapsular cataracts was 1.9 times higher in this group.
The researchers reported a strong dose-response relationship, with the risk of posterior subcapsular cataracts increasing with higher cumulative doses of beclomethasone.
Elderly Population May Triple by 2020 in Some StatesAlthough projections indicate that all states will see rising numbers of people age 85 and over in the next few years, rates of growth will vary considerably among states. Some of the most rapid growth in the population age 85 and over is projected to occur in the western, southwestern, and southeastern states.
The states with the lowest projected growth in population age 85 and over are Iowa, Nebraska, North Dakota, and South Dakota, with projected growth rates of less than 60% between 1993 and 2020. |
The list of editors of this excellent first resource for understanding geriatric patient care reads like a who's who of leaders in the field of geriatrics. Given this fact, it's no surprise that this book provides a truly comprehensive overview of the information necessary for understanding and managing the geriatric patient, including reference information in pathophysiology, epidemiology, and ethics as they relate to the aging patient.
Pharmaocotherapy of disease, however, is covered only superficially for most disease states and conditions, leaving students to look to pharmacy therapeutics textbooks for more complete information on the pharmacotherapy of common diseases affecting the elderly.
Tables, graphs, charts, and visual aids are effectively presented, and the easy-to-use index is detailed enough to make finding a particular topic fairly uncomplicated. The book is organized into six parts: Basics of Gerontology, Context of Care in Geriatric Medicine, Clinical Approach to the Geriatric Patient, Medical Disorders, Neurologic and Psychiatric Disorders, and Ethics and Health Policy Issues for Older Adults.
Overall, Geriatric Medicine is an excellent general reference on geriatrics that would make a very useful addition to any school of pharmacy's library
Reviewer: David P. Elliott, PharmD, FASCP
Associate Professor of Clinical Pharmacy
West Virginia University-Charleston Division
Charleston, West Virginia
