Diane Chau

Opiates and elderly: Use and side effects

The evaluation of pain and the subsequent issue of pain control is a clinical challenge that all healthcare providers face. Pain in the elderly population is especially difficult given the myriad of physiological, pharmacological, and psychological aspects of caring for the geriatric patient. Opiates are the mainstay of pain treatment throughout all age groups but special attention must be paid to the efficacy and side effects of these powerful drugs when prescribing to a population with impaired metabolism, excretion and physical reserve. In a random chart review of 300 US veterans, 44% of those receiving an analgesic also received opioids. The increasing use of opiates for pain management by healthcare practitioners requires that those prescribing opioids be aware of the special considerations for treating the elderly. This article will address the precautions one must take when using opiates in the geriatric population, as well as the side effects and ways to minimize them.

Osteoporosis and Diabetes

Osteoporosis is the most prevalent metabolic bone disease in the United States. Although the disease has historically been reported mostly in white women, it can affect individuals of both sexes and all ethnic groups. The presence of osteoporosis related to diabetes is not well acknowledged and the impact of osteoporosis in a diabetic patient is often not considered. Routine screening or initiation of preventive medications for osteoporosis in all patients with type 1 or type 2 diabetes is not recommended at the present time. However, in all patients with diabetes, besides optimal glycemic control, general recommendations regarding adequate dietary calcium intake, regular exercise, and avoidance of other potential risk factors such as smoking should be given. In patients who have positive risk factors for osteoporosis, or in those who present with fractures, evaluation of bone density should be done and respective preventive or therapeutic interventions should be applied.

Bupropion and naltrexone: a review of their use individually and in combination for the treatment of obesity

Background: Bupropion and naltrexone are centrally active drugs that have shown potential efficacy – alone and in combination – for the treatment of obesity. Objective: To explore the efficacy and safety of naltrexone and bupropion alone and in a novel combination drug that utilizes sustained-release (SR) formulations of both drugs and to evaluate their efficacy in promoting weight loss. The mechanisms of action of these centrally acting drugs are discussed. Preclinical and clinical studies of bupropion and naltrexone alone and in combination are reviewed. Results/conclusions: Both bupropion and naltrexone have been shown individually to induce weight loss. Bupropion has greater efficacy as monotherapy. Naltrexone SR potentiates the effects of bupropion SR; thus, this synergistic combination has the potential for additional weight loss compared to monotherapy. Current Phase III trials will yield further safety and efficacy information regarding these drugs in combination.

Individualizing recommendations for weight management in the elderly.

Purpose of reviewThis review provides current strategies for weight management in the elderly population as it can be different from young adults due to multiple factors: co-morbidities, polypharmacy, limitation of functional activities, social issues. Recent findingsThe recommendations for weight management for all age groups include exercise, diet, pharmacotherapy and surgery. In the elderly population, because of changes in age-related body composition, reduced energy requirement and expenditure, the standard young adult recommendations cannot be applied directly. The goal of weight management in the elderly differs from the young adult. The preferred method is maintenance of weight rather than aggressive weight loss with achieving a healthy, functional, and good quality of life. SummaryThe growing prevalence of obesity in the elderly population is becoming a major health problem and can affect functional status, can contribute to frailty and decline in activity, as well as worsening co-morbid medical problems. Practical recommendations for weight management in the elderly are challenging because of the obesity paradox in the elderly, and the lack of substantial research in this population. Individualized recommendations should be considered for elderly patients with a focus on the underlying medical problems, functional status and living environments.

Long-Term Care of the Aging Population with Intellectual and Developmental Disabilities

The aging population with intellectual and developmental disabilities (I/DD) deserves appropriate health care and social support. This population poses unique medical and social challenges to the multidisciplinary team that provides care. In the past, long-term care (LTC) facilities played an essential role in the livelihood of this population. The likelihood that the geriatric LTC system must prepare for adequately caring for this population is high. This article conveys the need to prepare for the inclusion of the growing aging population with I/DD into long-term care with the general elderly population in the near future.

Palliative Care for Patients With Dementia in Long-Term Care

Seventy percent of people in the United States who have dementia die in the nursing home. This article addresses the following topics on palliative care for patients with dementia in long-term care: (1) transitions of care, (2) infections, other comorbidities, and decisions on hospitalization, (3) prognostication, (4) the evidence for and against tube feeding, (5) discussing goals of care with families/surrogate decision makers, (6) types of palliative care programs, (7) pain assessment and management, and (8) optimizing function and quality of life for residents with advanced dementia.