Caring for the Elderly in an Inpatient Setting: Managing Insomnia and Polypharmacy

2009 ◽  
Vol 22 (5) ◽  
pp. 494-506 ◽  
Author(s):  
Jenny Kim ◽  
Toyin S. Tofade ◽  
Howard Peckman ◽  
Toyin S. Tofade
Keyword(s):  
The Elderly ◽  
Inpatient Setting ◽  
First Line ◽  
Medication History ◽  
Increased Risk ◽  
Key Points ◽  
Increased Sensitivity ◽  
Care Costs ◽  
Chronic Comorbidities

Caring for the elderly in an inpatient setting can be difficult because of the lack of literature to provide clinical guidelines addressing issues in this population. Insomnia and polypharmacy are common concerns. This article addresses these concerns by highlighting key points from the available literature. Insomnia may be a problem in the elderly because of their increased sensitivity to changes in environment among other factors. First, obtain a sleep history and a comprehensive medical and medication history to identify the cause. Next, treat the underlying cause with nonpharmacological interventions to restore restful and qualitative sleep. When nonpharmacological interventions are not successful, pharmacological means are indicated. Remember to start low, go slow, and treat for a short duration of time (less than 4 weeks) to avoid withdrawal or rebound insomnia. First-line agents are trazodone, triazolam, temazepam, and lorazepam followed by zaleplon and zolpidem. As people age, it is common for them to have multiple chronic comorbidities, which may result in polypharmacy and an increased risk of adverse events. Clinical practitioners should identify and prevent potential complications of polypharmacy. This should prevent further hospitalizations, decrease health care costs, and ultimately improve the quality of care in the elderly.

Assessment of the Therapeutic Effect of Physiotherapy on Minimizing Imbalances of Geriatric Patients

2020 ◽  
Vol 62 (2) ◽  
pp. 86-91
Author(s):  
Justyna Pawlak ◽  
Małgorzata Dudkiewicz ◽  
Łukasz Kikowski
Keyword(s):  
Quality Of Life ◽  
Therapeutic Effect ◽  
Body Mass ◽  
Geriatric Patients ◽  
The Elderly ◽  
Risk Of Falling ◽  
Increased Risk ◽  
Climbing Stairs ◽  
Tinetti Test

Introduction: The progressing aging process and comorbidities worsen the efficiency of the balance system in the elderly, which leads to a weakening of stability and, as a consequence, to falls and injuries. The first ones lead to: worsening of functioning, reduced mobility, an increased risk of disease and mortality, therefore systematic physical activity and shaping the balance using physiotherapy, which can prevent dangerous falls is very important. Aim: Assessment of the therapeutic effect of physiotherapy on minimizing imbalances in geriatric patients. M aterial and Methods: The study group consisted of 46 people, including 32 women (69.6%) and 14 men (30.4%); average age of respondents – 72.5 years. They were patients of the Department of Rehabilitation of Poddębice Health Center, Ltd. The researchers used a self-made questionnaire, body mass to height index (BMI) and the Tinetti Test. Results: Patients with an elevated BMI (89.1%), as well as those taking more than 4 medication (78.3%), have had more falls over the past year (respectively 91.4% and 81.4%). After the use of comprehensive therapy, none of the patients achieved a worse result than before the physiotherapy while 91.3% of the respondents had an increase in the number of points scored in the Tinetti Test. The percentage of patients at high risk of falling reduced from 67.4% to 37%. There was also a decrease in the fear of walking (in 58.7%), falling (in 57.7%) and climbing stairs (in 47.9%). According to 78.3% of respondents, physiotherapy positively affected their independence and quality of life. Conclusions: The use of comprehensive physiotherapy reduces the fear of walking, climbing stairs and falling, which can be a good predictor of prevention. Both polypragmasia and an elevated body mass index (BMI) increase the risk of falling. Comprehensive physiotherapy of geriatric patients helps to improve balance and gait stereotype. Physiotherapy for the elderly helps improve the quality of life, independence, minimize imbalances, and thus reduce the risk of falls. Balance exercises play an important role in preventing falls.

scholarly journals Vulnerability in the elderly

2021 ◽  
Vol 64 (3) ◽  
pp. 62-67
Author(s):  
Ana Popescu ◽  
◽  
Gabriela Soric ◽  
Victoria Federiuc ◽  
Vitalie Ojovanu ◽  
...  
Keyword(s):  
Genetic Factors ◽  
Functional Decline ◽  
The Elderly ◽  
Poor Quality ◽  
Important Target ◽  
Increased Risk ◽  
High Prevalence ◽  
Assessment Measures ◽  
Cognitive Problems

Background: Aging process involves an increased risk for the development of vulnerability, because senescence is a process characterized by a multitude of changes that influence the living conditions and health of the individuals. In geriatrics, the term “vulnerability” implies a multidimensional aspect, among which, multimorbidity, functional incapacity, socio-economic and cognitive problems in the elderly. The main objective of the article is to systematize data from the literature through the analysis of the concept and prevalence of vulnerability, assessed by the score Vulnerable Elders Survey-13 (VES-13) in the elderly. For this purpose, publications from the database GoogleSearch, PubMed, Hinari, etc. were analyzed. The information was systematized, highlighting the main aspects of the contemporary vision of the last 5 years.A series of studies (USA, Brazil, etc.) revealed a high prevalence of vulnerability in the elderly according to the VES-13 score, it was estimated in respondents aged > 65 years, between 40-50% of cases were vulnerable people, with a score ≥ 3 p. The vulnerability of the elderly results from different conditions, correlated with each other, especially biological, social and genetic factors. There was a functional decline between 13 and 24% of cases, especially in the elderly over 75 years, and an association with health problems, mobility and low autonomy in over 50% of cases, with a poor quality of life and increased risk of institutionalization. Conclusions: Vulnerability assessment measures are important for identifying older people at high risk of deteriorating health, which is an important target for interdisciplinary intervention.

The Role of Novel Bone Forming Agents in the Treatment of Osteoporosis

2020 ◽  
pp. 089719002096122
Author(s):  
Hansita B. Patel ◽  
Lynsie J. Lyerly ◽  
Cheryl K. Horlen
Keyword(s):  
Elderly Population ◽  
Cost Effective ◽  
The Elderly ◽  
Bisphosphonate Therapy ◽  
Evidence Based ◽  
First Line ◽  
Treatment Of Osteoporosis ◽  
Cost Effective Treatment

Osteoporosis is a growing epidemic that leads to significant morbidity and mortality among the elderly population due to associated fractures that lead to disabilities and reduced quality of life. Bisphosphonates are well-established as a first-line and cost-effective treatment for osteoporosis. Unfortunately, clinicians are often uncertain as to how to select treatments when bisphosphonates are ineffective as initial treatment or contraindicated. Romosozumab and abaloparatide are 2 alternative agents that have been recently FDA approved for the treatment of osteoporosis in postmenopausal women at high risk for fracture or patients who have failed or are intolerant to other osteoporosis therapies. Currently, the National Osteoporosis Foundation (NOF) has no formal recommendations in regard to these 2 novel agents. The purpose of this review is to help guide pharmacists on how to ensure appropriate utilization of these 2 novel bone-forming agents as potential alternatives to bisphosphonate therapy by providing evidence-based recommendations according to the current literature and key counseling points.

scholarly journals Depression, quality of life, and medical resource utilization in sickle cell disease

2017 ◽  
Vol 1 (23) ◽  
pp. 1983-1992 ◽  
Author(s):  
Soheir S. Adam ◽  
Charlene M. Flahiff ◽  
Shital Kamble ◽  
Marilyn J. Telen ◽  
Shelby D. Reed ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Health Care ◽  
Sickle Cell Disease ◽  
Medical Resource ◽  
Life Outcomes ◽  
Cell Disease ◽  
Medical Resource Utilization ◽  
Key Points ◽  
Care Costs

Key Points Depression was found in 35.2% of adult SCD patients and was strongly associated with worse physical and mental quality-of-life outcomes. Total health care costs for adult SCD patients with depression were more than double those of SCD patients without depression.

Radiofrequency exposure in young and old: different sensitivities in light of age-relevant natural differences

2015 ◽  
Vol 30 (4) ◽  
Author(s):  
Mary Redmayne ◽  
Olle Johansson
Keyword(s):  
Age Groups ◽  
Well Being ◽  
The Elderly ◽  
Ageing Population ◽  
Economic Implications ◽  
Population Means ◽  
Increased Risk ◽  
Study Results ◽  
Comparative Risk

AbstractOur environment is now permeated by anthropogenic radiofrequency electromagnetic radiation, and individuals of all ages are exposed for most of each 24 h period from transmitting devices. Despite claims that children are more likely to be vulnerable than healthy adults to unwanted effects of this exposure, there has been no recent examination of this, nor of comparative risk to the elderly or ill. We sought to clarify whether research supports the claim of increased risk in specific age-groups. First, we identified the literature which has explored age-specific pathophysiological impacts of RF-EMR. Natural life-span changes relevant to these different impacts provides context for our review of the selected literature, followed by discussion of health and well-being implications. We conclude that age-dependent RF-EMR study results, when considered in the context of developmental stage, indicate increased specific vulnerabilities in the young (fetus to adolescent), the elderly, and those with cancer. There appears to be at least one mechanism other than the known thermal mechanism causing different responses to RF-EMR depending upon the exposure parameters, the cell/physiological process involved, and according to age and health status. As well as personal health and quality-of-life impacts, an ageing population means there are economic implications for public health and policy.

scholarly journals Oral Rehabilitation Using the Lip Muscle Trainer: A Narrative Review

2021 ◽  
Vol 11 (3) ◽  
pp. 139-144
Author(s):  
Ali Mohamed Ali Ismail ◽  
Keyword(s):  
Defense Mechanism ◽  
The Elderly ◽  
The Body ◽  
Narrative Review ◽  
Body Parts ◽  
First Line ◽  
Oral Rehabilitation ◽  
Future Studies ◽  
Instructions For Use

A lot of time is spent on exercising the body parts while the lips are neglected, despite the evidence on the wide-ranging effects of lips on overall health and quality of life. Oral rehabilitation by Patakara lip muscle trainer leads to a strong lip closure which can stand as the first-line defense mechanism against many oral dysfunctions related to aging. In the absence of a narrative review presented on this trainer, this paper focuses on the components, instructions for use, and oral health indications of the Patakara lip muscle trainer. This trainer could enhance many oral dysfunctions in the elderly as oral breathing, snoring, halitosis, dry mouth, and oral/gastrointestinal dysfunction, but future studies are needed in this field.

scholarly journals Chronic Insomnia in the Elderly: Current Approaches to Diagnosis and Treatment

2018 ◽  
Vol 7 (2) ◽  
pp. 135-161
Author(s):  
A.I. Melehin
Keyword(s):  
Sleep Disorders ◽  
Geriatric Patients ◽  
Behavioral Therapy ◽  
The Elderly ◽  
Cognitive Behavioral ◽  
Chronic Insomnia ◽  
Structural Components ◽  
Quality Of Sleep ◽  
First Line

The article shows that in the treatment of chronic insomnia in geriatric patients, it is recommended to use a step-by-step treatment and start with steps aimed at the elimination of somatic, environmental and psychological barriers which affect the quality of sleep. An algorithm for the evaluation of sleep disorders at a later age firstly desctibed. The specifics of the clinical and psychological evaluation of the quality of sleep in geriatric patients presented. Evidence on the effectiveness of pharmacological and non-pharmacological approaches for the treatment of chronic insomnia at a later age presented on the basis of a number of foreign studies. It is recommended to use multicomponent cognitive-behavioral psychotherapy as a first-line treatment of chronic insomnia at a later age Types, forms and structural components of cognitive-behavioral therapy of chronic insomnia in the elderly are detailed. Practical difficulties and reccomentations for the use of medical approach in the treatment of sleep disorders in the elderly are also presented.

Cardiovascular Disease

2018 ◽  
Author(s):  
Mara Caroline ◽  
Ryan Bradley ◽  
Mimi Guarneri
Keyword(s):  
Cardiovascular Disease ◽  
Elderly Population ◽  
Cardiovascular Health ◽  
The Elderly ◽  
Nutrient Deficiencies ◽  
Comorbid Conditions ◽  
Increased Risk ◽  
Increased Susceptibility

The older population is challenging to treat for numerous reasons, including comorbid conditions and increased susceptibility to adverse drug reactions, limiting medical therapy. They are at increased risk for loneliness and depression, which strongly impacts their cardiovascular outcomes, and they also have different values, usually prioritizing quality of life over mortality objectives. Finally, the elderly are underrepresented in cardiovascular clinical trials, thus limiting the applicability of guideline recommendations. This chapter emphasizes the importance of a comprehensive assessment of individual circumstances when assessing cardiovascular health in the elderly population. The chapter focuses on the role of nutrition, resiliency, and exercise for the prevention and treatment of cardiovascular disease. Nutrient deficiencies commonly seen with cardiovascular drugs are also discussed, as well as specific integrative strategies for optimizing dyslipidemia, atrial fibrillation, and heart failure in this population.

scholarly journals Recommendations for a Combined Laparoscopic and Transanal Approach in Treating Deep Endometriosis of the Lower Rectum—The Rouen Technique

2021 ◽  
Vol 11 (5) ◽  
pp. 408
Author(s):  
Şerban Nastasia ◽  
Anca Angela Simionescu ◽  
Jean Jacques Tuech ◽  
Horace Roman
Keyword(s):  
Circular Stapler ◽  
First Line ◽  
Lower Rectum ◽  
Complete Excision ◽  
Deep Endometriosis ◽  
Invasive Approach ◽  
Transanal Approach ◽  
Plasma Energy ◽  
Increased Risk

The complete excision of low rectovaginal deep endometriosis is a demanding surgery associated with an increased risk of intra- and postoperative complications, which can impact the quality of life. Given the choices of optimal surgery procedures available, we would like to emphasize that a minimally invasive approach with plasma medicine and a transanal disc excision could significantly improve surgery for deep endometriosis, avoiding the lateral thermal damage of vascular and parasympathetic fibers of roots S2–S5 in the pelvic plexus. The management of low rectal deep endometriosis is distinct from other gastrointestinal-tract endometriosis nodules. Suggestions and explanations are presented for this minimal approach. These contribute to individualized medical care for deep endometriosis. In brief, a laparoscopic transanal disc excision (LTADE; Rouen technique) was performed through a laparoscopic deep rectal dissection, combined with plasma energy shaving, and followed by a transanal disc excision of the low and mid-rectal deep endometriotic nodules, with the use of a semi-circular stapler. LTADE is indicated as the first-line surgical treatment for low and mid-rectal deep endometriotic nodule excisions, because it can preserve rectal length and innervation. This technique requires a multidisciplinary team with surgical colorectal training.

THE COYOACAN COHORT STUDY: DESIGN, METHODOLOGY, AND PARTICIPANTS’ CHARACTERISTICS OF A MEXICAN STUDY ON NUTRITIONAL AND PSYCHOSOCIAL MARKERS OF FRAILTY

2013 ◽  
pp. 1-9
Author(s):  
L. RUIZ-ARREGUI ◽  
J.A. ÁVILA-FUNES ◽  
H. AMIEVA ◽  
S.A. BORGES-YÁÑEZ ◽  
A. VILLA-ROMERO ◽  
...  
Keyword(s):  
Physical Activity ◽  
The Elderly ◽  
Biological Data ◽  
Community Dwelling ◽  
Face To Face ◽  
Clinical Evaluations ◽  
Increased Risk ◽  
Cohort Study Design ◽  
The Mean

Background:“Frailty” has emerged as a condition associated with an increased risk of functionaldecline among the elderly, which may be differentiated from aging, disability, and co-morbidities. Objective: TheMexican Study of Nutritional and Psychosocial Markers of Frailty among Community-Dwelling Elderly hasemerged to help answer many questions about frailty among the older adults. This report presents the design ofthe study and baseline data of its participants. Design: The “Coyoacan cohort” is a longitudinal observationalstudy developed in Mexico City. Participants:A representative sample of 1,294 non-institutionalized men andwomen aged 70 years and older were randomly recruited to undergo a face-to-face interview and acomprehensive geriatric assessment (including clinical evaluations and blood samples) between 2008 and 2009.Measurements:Data collected included socio-demographic and economic characteristics, medical history, oralhealth, drug use, cognitive function and mood, nutritional status, physical performance and functional status,physical activity, quality of life, social networks, and biological data. Frailty was defined as the presence of ≥3 ofthe following components: slowness, poor muscle strength, low physical activity, exhaustion and unintentionalweight loss. Results: A total of 1,124 participants completed the interview. The mean age was 79.5 ± 7.1 years,and 55.9% were female. Nine hundred and forty-five subjects completed the clinical evaluation and 743 bloodsamples were collected. The baseline prevalence of frailty was 14.1%. Conclusions:Understanding the medical,biological, and environmental factors that contribute to the phenomenon of frailty is the goal of the currentresearch in the field.

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