scholarly journals Drug-Induced Delirium among Older People

2021 ◽  
Author(s):  
Fabiana Rossi Varallo ◽  
Alan Maicon de Oliveira ◽  
Ariane Cristina Barboza Zanetti ◽  
Helaine Carneiro Capucho ◽  
Leonardo Régis Leira Pereira ◽  
...  
Keyword(s):  
Older People ◽  
Predictive Models ◽  
Current Evidence ◽  
Contributing Factors ◽  
Drug Induced ◽  
Geriatric Population ◽  
Inappropriate Drugs ◽  
Second Generation Antipsychotics ◽  
Management Plans ◽  
Clinical Conditions

Although underdiagnosed, delirium is a common and potentially preventable problem in older patients, being associated with morbimortality. Drugs have been associated with the development of delirium in the geriatric population and may be considered the most easily reversible trigger. Polypharmacy, prescription of deliriogenic, anticholinergic and potentially inappropriate drugs are contributing factors for the occurrence of the disturb. Furthermore, changes in pharmacokinetic and pharmacodynamic parameters, which are intrinsic of the aged process, may contribute for cognitive impairment. Identification and reversal of clinical conditions associated with delirium are the first step to treat the disturbance, as well as mitigation of environmental factors and the exposition to deliriogenic drugs. Current evidence does not support the prescription of antipsychotics and benzodiazepines for the treatment of delirium. However, the judicious use of first- or second-generation antipsychotics can be considered in severe cases. Multi-component non-pharmacological, software-based intervention to identify medications that could contribute to delirium, predictive models, tools, training of health professionals and active actions of pharmacovigilance may contribute to the screening, prevention, and management of delirium in older people. Besides, it is also important to improve the report of drug-induced delirium in medical records, to develop properly risk management plans and avoid cascade iatrogenesis.

Older people’s news dependency and social connectedness

2021 ◽  
pp. 1329878X2110064
Author(s):  
Caroline Fisher ◽  
Sora Park ◽  
Jee Young Lee ◽  
Kate Holland ◽  
Emma John
Keyword(s):  
Older People ◽  
Social Isolation ◽  
News Media ◽  
Digital Literacy ◽  
Social Connectedness ◽  
Aged Care ◽  
Capital City ◽  
Contributing Factors ◽  
Older Citizens

Social isolation has become a growing issue, particularly among older citizens. The ‘digital divide’ has been identified as one of the contributing factors leaving many older citizens behind. While increasing digital literacy among seniors has been identified as one of the remedies, less attention has been paid to the role of news media on the wellbeing and connectedness of older people. Through the lens of the uses and gratifications theory, this article reports on the findings of a survey of 562 news consumers aged 50 years and above who live in Canberra, the capital city of Australia. The analysis highlights the important role of news in reducing feelings of social isolation, particularly for those who spend more time alone and older people with cognitive impairment. Older participants who had difficulty concentrating and learning new tasks were also more dependent on news. We suggest this is due to the habitual, predictable and concise nature of news. These findings contribute to our understanding of the role of news in the wellbeing of older people and point to the need for policymakers and those in the aged care sector to ensure access to news for older citizens to improve the quality of life.

scholarly journals Reasons for inpatients not to seek clarity at Dr George Mukhari Academic Hospital, Pretoria

2014 ◽  
Vol 6 (1) ◽  
Author(s):  
Langalibalele H. Mabuza ◽  
Olufemi B. Omole ◽  
Indiran Govender ◽  
John V. Ndimande
Keyword(s):  
South Africa ◽  
Prior Knowledge ◽  
Effective Communication ◽  
Self Esteem ◽  
Tertiary Hospital ◽  
Bad News ◽  
Academic Hospital ◽  
Management Plans ◽  
Clinical Conditions

Background: Healthcare practitioners should provide patients with information regarding their clinical conditions. Patients should also feel free to seek clarity on information provided. However, not all patients seek this clarity.Objectives: To explore the reasons inpatients gave for not seeking clarity on information that was received but not understood.Methods: This was a qualitative arm of a larger study, titled ‘Are inpatients aware of the admission reasons and management plans of their clinical conditions? A survey at a tertiary hospital in South Africa’, conducted in 2010. Of the 264 inpatients who participated in the larger study, we extracted the unstructured responses from those participants (n = 152) who had indicated in the questionnaire that there was information they had not understood during their encounter with healthcare practitioners, but that they had nonetheless not sought clarity.Data were analysed thematically.Results: Themes that emerged were that inpatients did not ask for clarity as they perceived healthcare practitioners to be ‘too busy’, aloof, non-communicators and sometimes uncertain about patients’ conditions. Some inpatients had unquestioning trust in healthcare practitioners,whilst others had experiences of bad treatment. Inpatients had poor self-esteem, incapacitating clinical conditions, fear of bad news and prior knowledge of their clinical conditions. Some inpatients stated that they had no reason for not seeking clarity.Conclusion: The reasons for not seeking clarity were based on patients’ experiences with the healthcare practitioners and their perceptions of the latter and of themselves. A programme should be developed in order to educate inpatients on effective communication with their healthcare practitioners.

Role of cGMP in relaxation of vascular and other smooth muscle

1989 ◽  
Vol 67 (4) ◽  
pp. 251-262 ◽  
Author(s):  
Kanji Nakatsu ◽  
Jack Diamond
Keyword(s):  
Smooth Muscle ◽  
Muscle Relaxation ◽  
Smooth Muscles ◽  
Phosphodiesterase Inhibitors ◽  
Current Evidence ◽  
Smooth Muscle Relaxation ◽  
Drug Induced ◽  
Intracellular Cgmp ◽  
Tissue Content

The hypothesis that the relaxant action of many drugs on vascular and other smooth muscle is mediated by increases in intracellular cGMP, the "cGMP hypothesis," is gaining wide acceptance. While much information supporting this idea can be found in the literature, there is also a significant amount of information indicating that an elevation in the tissue content of cGMP is by itself insufficient to cause smooth muscle relaxation. The literature is reviewed with reference to the criteria that need to be fulfilled to consider cGMP as the second messenger mediating relaxation of smooth muscle by a drug; i.e., activation of guanylate cyclase, elevation of tissue content of cGMP, potentiation by phosphodiesterase inhibitors, antagonism by inhibitors of cGMP synthesis, and production of relaxation by cGMP analogues. For each criterion, key observations supporting the hypothesis are considered, followed by examples of important observations not consistent with the hypothesis. It is concluded that in some smooth muscles, for example, rat myometrium and vas deferens, cGMP is not a mediator of drug-induced relaxation. In other smooth muscles, including vascular smooth muscle, cGMP appears to play an important role in the relaxation process; but current evidence suggests that other factors are also important and that the cGMP hypothesis may need to be modified.Key words: cGMP, vascular relaxation, smooth muscle relaxation, vasodilators.

scholarly journals Sleep disordered breathing at the extremes of age: the elderly

Breathe ◽  
2016 ◽  
Vol 12 (1) ◽  
pp. 50-60 ◽  
Author(s):  
Alison McMillan ◽  
Mary J. Morrell
Keyword(s):  
Risk Factors ◽  
Older People ◽  
Sleep Disordered Breathing ◽  
Treatment Options ◽  
Current Evidence ◽  
List Type ◽  
Pressure Therapy ◽  
Age Related ◽  
The Impact ◽  
Disordered Breathing

Key pointsSleep disordered breathing (SDB) is common and its prevalence increases with age. Despite this high prevalence, SDB is frequently unrecognised and undiagnosed in older people.There is accumulating evidence that SDB in older people is associated with worsening cardio- cerebrovascular, cognitive and functional outcomes.There is now good evidence to support the use of continuous positive airway pressure therapy in older patients with symptomatic SDB.Educational aimsTo highlight the prevalence and presentation of sleep disordered breathing (SDB) in older people.To inform readers about the risk factors for SDB in older people.To explore the impact of SDB in older people.To introduce current evidence based treatment options for SDB in older people.Sleep disordered breathing (SBD) increases in prevalence as we age, most likely due to physiological and physical changes that occur with ageing. Additionally, SDB is associated with comorbidity and its subsequent polypharmacy, which may increase with increasing age. Finally, the increased prevalence of SDB is intrinsically linked to the obesity epidemic. SDB is associated with serious outcomes in younger people and, likewise, older people. Thus, identification, diagnosis and treatment of SDB is important irrelevant of age. This article reviews the age-related changes contributing to SDB, the epidemiology and the risk factors for SDB in older people, the association of SDB with adverse outcomes, and diagnostic and treatment options for this population.

scholarly journals A review on drug induced skin disorders: pathophysiology and therapeutics

2020 ◽  
Vol 6 (5) ◽  
pp. 715
Author(s):  
Priyanka N. ◽  
R. Srinivasan
Keyword(s):  
Adverse Drug Events ◽  
Treatment Approach ◽  
Current Evidence ◽  
Fixed Dose ◽  
Positive Outcomes ◽  
Skin Disorders ◽  
Drug Induced ◽  
Common Drug ◽  
Online Library ◽  
Risk And Benefit

<p class="abstract"><span lang="EN-US">Drugs are the central part of treatment of various disorders. The consequence of drug use may be either positive outcomes (clinical effect of the drug) or negative outcomes (adverse drug events). That is, it contains both risk and benefit. In recent years multiple disorders treated with many drugs by monotherapy or by fixed-dose therapy existing in the market which leads to increased drug-related problems one among that is drug-induced disorders. Morbidity and mortality have increased due to drug-induced disorders. This study was aimed to describe the various drugs induces skin disorders, its pathophysiology, diagnosis and treatment approach. We completed a review of the current evidence for various drug-induced skin disorders its causative drugs and therapeutic intervention of drug-induced skin disorders. A review through Medline, Embase, Pubmed, Wiley online library and selected studies related to drug-induced skin disorders. This is the comprehensive review of drug- induced skin disorders, designed to address prospectively its etiopathogenesis and clinical management. Penicillin, sulfa, phenyl-butazone, Tetracycline are the most common drug induces various skin disorders. There is not much significant differences in the clinical, histopathological or immuno-pathological features between various skin disorders and drug induced skin disorders. Hence knowing the etiopathology, and differential diagnosis is important to a proper treatment approach.</span></p>

scholarly journals Can We Apply WHOQOL-AGE to Asian Population? Verifying Its Factor Structure and Psychometric Properties in a Convenience Sample From Taiwan

2020 ◽  
Vol 8 ◽  
Author(s):  
Chung-Ying Lin ◽  
Jung-Der Wang ◽  
Li-Fan Liu
Keyword(s):  
Older People ◽  
Psychometric Properties ◽  
Measurement Invariance ◽  
Factor Structure ◽  
Educational Level ◽  
Age Groups ◽  
Asian Population ◽  
Geriatric Population ◽  
Cross Sectional ◽  
Convenience Sample

Objectives: To translate and validate a recently developed quality of life instrument (WHOQOL-AGE) on geriatric population into Chinese.Method: Using cross-sectional observational design, the WHOQOL-AGE was conducted among older people through interview. Confirmatory factor analysis (CFA) was used to examine the factor structure and multigroup CFA used to examine the measurement invariance.Results: Through convenience sampling, 522 older adults (mean age = 73.42) participated in the study. Among them, 194 were males, 213 had an educational level at primary school or below, 398 were residing in the community, and 307 were aged 70 years or above. A bifactor structure (items Q1–Q8 are embedded in the factor 1; items Q9–Q13 embedded in the factor 2; and all the items embedded in an additional construct of QoL) was confirmed by the CFA in both the entire sample (χ2 = 25.4; df = 51; p = 0.999) and the subgroup sample with age 70 years or above (χ2 = 25.28; df = 51; p = 1.000). Multigroup CFAs results supported the measurement invariance for the WHOQOL-AGE across genders, having different educational levels, living in different settings and age groups. It also shows good known-groups validity.Conclusions: The promising psychometric properties of the WHOQOL-AGE were found in our convenience sample of older Taiwanese. The supported measurement invariance indicates that the older people in different conditions of gender, educational level, and living setting interpret the WHOQOL-AGE similarly. However, our results should be interpreted with cautious because of the sample representativeness.

Delirium and its Pharmacological Causes in Older People, Part Two

2021 ◽  
Vol 36 (11) ◽  
pp. 534-547
Author(s):  
George A. DeMaagd ◽  
Daneen R. DeMaagd ◽  
Ashok Philip
Keyword(s):  
Older People ◽  
Patient Outcomes ◽  
Age Groups ◽  
Evaluation Process ◽  
Diagnostic Process ◽  
Drug Induced ◽  
Younger Patients ◽  
Poor Patient ◽  
Drug Classes

Delirium is a syndrome that can arise from many causes or underlying conditions, and though it has been reported in younger patients, it is more prevalent in older people, though it can occur in other age groups as well. Identifying delirium is challenging in older people because of the coexistence of underlying dementia or depression, which may further complicate the presentation. Drug-induced delirium is one of the major causes of delirium, and evaluation of this potential cause or contribution is an important component of the evaluation process, since it can lead to poor patient outcomes. Part one of this three part series reviewed the epidemiology, pathophysiology, evaluation, diagnostic process, and causes of delirium in older people, with a focus on the pharmacological causes. Part two of this series continues to review drugs and drug classes that can cause or contribute to delirium in older people.

Delirium and Its Pharmacological Causes in Older People, Part 1

2021 ◽  
Vol 36 (10) ◽  
pp. 477-488
Author(s):  
George A. DeMaagd ◽  
Daneen R. DeMaagd ◽  
Ashok Philip ◽  
Carli Ferrara Coalter
Keyword(s):  
Older People ◽  
Patient Outcomes ◽  
Age Groups ◽  
Evaluation Process ◽  
Diagnostic Process ◽  
Drug Induced ◽  
Younger Patients ◽  
Poor Patient

Delirium is a syndrome that can arise from many causes or underlying conditions, and though it has been reported in younger patients, it is more prevalent in older people, though it can occur in other age groups as well. Identifying delirium is challenging in older people because of the coexistence of underlying dementia or depression, which may further complicate the presentation. Drug-induced delirium is one of the major causes of delirium, and evaluation of this potential cause or contribution is an important component of the evaluation process, since it can lead to poor patient outcomes. This article will review the epidemiology, pathophysiology, evaluation, diagnostic process, and causes of delirium in older people, with a focus on the pharmacological causes.

Optimizing pharmacotherapy for older patients

2017 ◽  
pp. 183-188 ◽  
Author(s):  
Denis O’Mahony
Keyword(s):  
Older People ◽  
Adverse Drug Events ◽  
Economic Consequences ◽  
High Risk Population ◽  
Potentially Inappropriate Medications ◽  
Inappropriate Drugs ◽  
Prescribing Omissions ◽  
The Relationship ◽  
Global Population ◽  
Inappropriate Medications

The prevalence of complex multimorbidity is increasing steadily in tandem with global population ageing. Complex multimorbidity is in turn intimately associated with polypharmacy, the relationship being one of cause-and-effect. Polypharmacy commonly leads to prescription of inappropriate drugs, resulting in a substantially higher risk of drug-related problems, principally adverse drug–drug and drug–disease interactions. These problems become manifest in the form of common geriatric symptoms such as falls, acute confusion, and incontinence and commonly result in increased healthcare utilization, including hospitalization, with obvious economic consequences. In addition, adverse drug reactions and adverse drug events lead to death in older people. The challenge of optimization of pharmacotherapy in older people with complex multimorbidity is a major one. There is increasing evidence that avoidance of potentially inappropriate medications (PIMs) and potential prescribing omissions (PPOs) using validated PIM and PPO criteria lists leads to better and safer pharmacotherapy in this high-risk population.

scholarly journals Managing the challenge of drug-induced liver injury: a roadmap for the development and deployment of preclinical predictive models

2019 ◽  
Vol 19 (2) ◽  
pp. 131-148 ◽  
Author(s):  
Richard J. Weaver ◽  
Eric A. Blomme ◽  
Amy E. Chadwick ◽  
Ian M. Copple ◽  
Helga H. J. Gerets ◽  
...  
Keyword(s):  
Liver Injury ◽  
Predictive Models ◽  
Drug Induced ◽  
Drug Induced Liver Injury
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