A study published today in the Archives of Internal Medicine examines the impact of a safety warning issued by the Food and Drug Administration for commonly prescribed antipsychotic medications. The results show the warnings resulted in a decline in usage among the elderly with dementia, yet raise the question as to whether the FDA's system of communicating these warnings is sufficiently targeted and effective.
A study published today in the Archives of Internal Medicine examines the impact of a safety warning issued by the Food and Drug Administration for commonly prescribed antipsychotic medications. The results show the warnings resulted in a decline in usage among the elderly with dementia, yet raise the question as to whether the FDA’s system of communicating these warnings is sufficiently targeted and effective.
“Because this medication class has limited evidence of benefit among the elderly with dementia and significantly increases their risk of death, the ‘right’ magnitude of decline in usage is not clear,” said University of Rochester Medical Center neurologist Ray Dorsey, M.D., the study’s lead author. “More generally, the study raises larger issues about appropriate prescribing, particularly among the elderly, and the need to improve risk communication to patients and providers.”
Safety issues frequently emerge after a drug has been introduced to the market. These concerns arise either through ongoing clinical research or adverse events reported by post-market surveillance of the drug. The FDA can act upon this information in a number of ways. It can choose to remove the drug from the market or it can issue an advisory to physicians, the strongest of which is a “black box” warning which appears on the drug label.
The authors examined the impact of these warnings on a class of drugs called atypical antipsychotics. In April 2005, the FDA issued an advisory warning that elderly patients with dementia treated with these drugs were at increased risk of death.
READ MORE @ MEDIA-NEWSWIRE
Showing posts with label elderly. Show all posts
Showing posts with label elderly. Show all posts
Tuesday, January 12, 2010
Friday, December 25, 2009
A happy Christmas – alone Before we universally condemn loneliness we should ensure we understand its roots, and that sometimes solitude can be sweet
The meaning of Christmas, and its supposed power to bring friends and family together, is again in evidence this year. Jonathan Freedland admirably called for an end to loneliness, and urged social policy to address it – a sentiment echoed by a Guardian leader.
I do not wish to detract from the importance of addressing chronic loneliness, particularly in the elderly. Many people end up alone, not just over the festive season, but for significantly longer periods, for want of company, and not of their own volition. It is easy to pity them (which is just offensive) and say that we must do more as a society to help them. What is significantly harder is to understand the nature of, and the causes behind, loneliness in various sections of society, and ask whether and where society should act.
Recently, we have begun to regard loneliness, and not just in the elderly, as a purely social problem. In fact, there can be plenty of individual factors that underlie feelings of loneliness – from bereavement to serious medical illnesses. Therefore, trying to address it through political policy without adequate consultation is a cause for concern. After all, do we know that loneliness is largely a social problem? If so, is it just in the elderly or even among younger generations? What engenders it? Apart from a few intuitive ideas invoking the alienation triggered by online worlds, our obsession with communicating via screens, and the intrusiveness of corporate chains, we frankly do not know.
READ MORE @ THE GUARDIAN
I do not wish to detract from the importance of addressing chronic loneliness, particularly in the elderly. Many people end up alone, not just over the festive season, but for significantly longer periods, for want of company, and not of their own volition. It is easy to pity them (which is just offensive) and say that we must do more as a society to help them. What is significantly harder is to understand the nature of, and the causes behind, loneliness in various sections of society, and ask whether and where society should act.
Recently, we have begun to regard loneliness, and not just in the elderly, as a purely social problem. In fact, there can be plenty of individual factors that underlie feelings of loneliness – from bereavement to serious medical illnesses. Therefore, trying to address it through political policy without adequate consultation is a cause for concern. After all, do we know that loneliness is largely a social problem? If so, is it just in the elderly or even among younger generations? What engenders it? Apart from a few intuitive ideas invoking the alienation triggered by online worlds, our obsession with communicating via screens, and the intrusiveness of corporate chains, we frankly do not know.
READ MORE @ THE GUARDIAN
Friday, November 27, 2009
Focus on Pharmacotherapy Studies in Elderly
The NIMH-sponsored New Clinical Drugs Evaluation Unit (NCDEU) meeting is a favored venue for reports and reviews of NIH-funded psychopharmacological studies, and this was true of the recent annual meeting in Hollywood, Fla. The meeting included a workshop on new investigations of antidepressant use in Alzheimer disease and a panel session on the safety of pharmacotherapy in older adults.
Two studies were developed, in part, in response to growing concern about both safety and lack of efficacy of antipsychotics for behavior symptoms in patients with dementia. These were the Depression in Alzheimer’s Disease Study–2 (DIADS-2) sertraline (Zoloft) trial, the citalopram (Celexa) versus antipsychotics nested study in the Clinical Antipsychotic Trials of Intervention Effectiveness–Alzheimer’s Disease (CATIE-AD), and the recently initiated Citalopram for Agitation in Alzheimer’s Disease (CITAD).
In describing the rationale and design of the CITAD study, Bruce Pollock, MD, Center for Addiction and Mental Health, questioned the premise for using antipsychotics in this population. “The neuropharmacologic rationale for using dopamine antagonists in elders with dopaminergic deficits is questionable,” Pollock indicated. “Agitation in Alzheimer disease is commonly derived from anxious, impulsive, and compulsive symptoms, which may be responsive to serotonergic agents.”
READ MORE @ PSYCHIATRIC TIMES
Two studies were developed, in part, in response to growing concern about both safety and lack of efficacy of antipsychotics for behavior symptoms in patients with dementia. These were the Depression in Alzheimer’s Disease Study–2 (DIADS-2) sertraline (Zoloft) trial, the citalopram (Celexa) versus antipsychotics nested study in the Clinical Antipsychotic Trials of Intervention Effectiveness–Alzheimer’s Disease (CATIE-AD), and the recently initiated Citalopram for Agitation in Alzheimer’s Disease (CITAD).
In describing the rationale and design of the CITAD study, Bruce Pollock, MD, Center for Addiction and Mental Health, questioned the premise for using antipsychotics in this population. “The neuropharmacologic rationale for using dopamine antagonists in elders with dopaminergic deficits is questionable,” Pollock indicated. “Agitation in Alzheimer disease is commonly derived from anxious, impulsive, and compulsive symptoms, which may be responsive to serotonergic agents.”
READ MORE @ PSYCHIATRIC TIMES
Monday, November 23, 2009
Psychotropic Drugs Boost Fall Risk in the Elderly
A new analysis of studies including nearly 80,000 people aged 60 and older confirms that certain types of widely prescribed drugs, such as antidepressants and sedatives, can increase their risk of falling.
Falls often have serious consequences for older people, such as injuries leading to disability and admission to a nursing home, or even death.
While prescription drugs are recognized as contributing to fall risk among older people --who are likely to be on lots of medications -- discovering just which drugs are the problem is still a "challenge," Dr. Carlo A. Marra of the University of British Columbia in Vancouver and colleagues note in the Archives of Internal Medicine.
To update a review of studies on this subject published in 1996, Marra and his team identified 22 studies published between 1996 and 2007 including 79,081 people 60 and older, some of whom lived independently, and some of whom were institutionalized. They analyzed the risk of falling associated with nine classes of drugs.
Three classes turned out to significantly boost fall risk: sedatives and hypnotics, typically prescribed as sleeping aids; antidepressants; and benzodiazepines, which include tranquilizers like Xanax and Valium.
READ MORE @ ABC NEWS
Falls often have serious consequences for older people, such as injuries leading to disability and admission to a nursing home, or even death.
While prescription drugs are recognized as contributing to fall risk among older people --who are likely to be on lots of medications -- discovering just which drugs are the problem is still a "challenge," Dr. Carlo A. Marra of the University of British Columbia in Vancouver and colleagues note in the Archives of Internal Medicine.
To update a review of studies on this subject published in 1996, Marra and his team identified 22 studies published between 1996 and 2007 including 79,081 people 60 and older, some of whom lived independently, and some of whom were institutionalized. They analyzed the risk of falling associated with nine classes of drugs.
Three classes turned out to significantly boost fall risk: sedatives and hypnotics, typically prescribed as sleeping aids; antidepressants; and benzodiazepines, which include tranquilizers like Xanax and Valium.
READ MORE @ ABC NEWS
Thursday, October 8, 2009
Government under pressure to publish antipsychotic review
10 leading dementia organizations, including the Alzheimer’s Research Trust, are demanding that the government publishes its long-delayed review into the widespread misuse of antipsychotic – or ‘chemical cosh’ – drugs.
Earlier this year, an Alzheimer’s Research Trust-funded study published in Lancet Neurology found that antipsychotic drugs double risk of death for many patients if used over a three year period. As many as 100,000 people with dementia are routinely prescribed antipsychotics in UK care homes. This could mean 23,500 people dying prematurely, according to a 2008 report by Paul Burstow MP.
The issue will be discussed by Rebecca Wood, Chief Executive of the Alzheimer’s Research Trust, at a Conservative Party Conference fringe event on dementia research with Shadow Health Minister Stephen O’Brien MP, and the author of the Lancet Neurology study Prof Clive Ballard of King’s College London and Alzheimer’s Society (‘Dementia Decade: a cure by 2020?’, Wednesday, 12.45, Marquee 2, MICC, Manchester).
Rebecca Wood, Chief Executive of the Alzheimer’s Research Trust, said:
"While the Department of Health prevaricates, thousands of people are being put at risk through the misuse of antipsychotics. After so many delays, the government must take swift and decisive action."
READ MORE @ ALZHEIMER'S RESEARCH TRUST
Earlier this year, an Alzheimer’s Research Trust-funded study published in Lancet Neurology found that antipsychotic drugs double risk of death for many patients if used over a three year period. As many as 100,000 people with dementia are routinely prescribed antipsychotics in UK care homes. This could mean 23,500 people dying prematurely, according to a 2008 report by Paul Burstow MP.
The issue will be discussed by Rebecca Wood, Chief Executive of the Alzheimer’s Research Trust, at a Conservative Party Conference fringe event on dementia research with Shadow Health Minister Stephen O’Brien MP, and the author of the Lancet Neurology study Prof Clive Ballard of King’s College London and Alzheimer’s Society (‘Dementia Decade: a cure by 2020?’, Wednesday, 12.45, Marquee 2, MICC, Manchester).
Rebecca Wood, Chief Executive of the Alzheimer’s Research Trust, said:
"While the Department of Health prevaricates, thousands of people are being put at risk through the misuse of antipsychotics. After so many delays, the government must take swift and decisive action."
READ MORE @ ALZHEIMER'S RESEARCH TRUST
Monday, August 10, 2009
Certain drugs may increase risk of falling
In elderly men and women, certain medications can increase the risk of falling, new research shows.
Findings from a 4-year study conducted in France suggest the risk of falling is 1.4 times greater among elderly men and women taking a long-acting benzodiazepine, compared with age-matched men and women not using this type of anti-anxiety medication.
Dr. Annick Alperovitch, at INSERM in Paris, and colleagues also found a moderately increased risk of falling among elderly men and women who regularly used mood- and behavior-altering "psychotropic" medications.
Their findings, reported in the journal BMC Geriatrics, identified similar risk among elderly individuals reporting regular use of tranquilizers, muscle relaxants and anti-spasmodics, and some antihistamines that block nerve responses (so-called "anticholinergics").
READ MORE @ REUTERS
Findings from a 4-year study conducted in France suggest the risk of falling is 1.4 times greater among elderly men and women taking a long-acting benzodiazepine, compared with age-matched men and women not using this type of anti-anxiety medication.
Dr. Annick Alperovitch, at INSERM in Paris, and colleagues also found a moderately increased risk of falling among elderly men and women who regularly used mood- and behavior-altering "psychotropic" medications.
Their findings, reported in the journal BMC Geriatrics, identified similar risk among elderly individuals reporting regular use of tranquilizers, muscle relaxants and anti-spasmodics, and some antihistamines that block nerve responses (so-called "anticholinergics").
READ MORE @ REUTERS
Friday, July 10, 2009
Elderly patients boost sales of dangerous antipsychotics
Bill Wiggins believes a powerful antipsychotic medication helped save his wife, Kathye.
Helen Shields believes one of these drugs helped kill her mother, Helen Marciniszyn.
Two families, two drugs, two stories that capture the extremes of a debate about using these medicines to treat the diseases of aging when there are no other effective alternatives.
Kathye Wiggins took Johnson & Johnson's Risperdal. Marciniszyn took AstraZeneca's Seroquel. Both drugs are atypical antipsychotics, a category of psychotropic drugs that also includes Zyprexa from Eli Lilly & Co., Abilify by Bristol-Myers Squibb Co., and Pfizer Inc.'s Geodon.
The federal government approved atypicals in the 1990s to treat schizophrenia and bipolar disorder. Since then, they have become popular for treating disorders including autism and Alzheimer's, despite mixed evidence that they help and ample evidence that they hurt.
Doctors prescribe atypicals for these illnesses because they may calm people and help them sleep. Also, patients with Alzheimer's and dementia can lose touch with reality, as schizophrenics do, so, in theory, atypicals could help.
Sales of atypicals rose to $14.36 billion in 2008 from $8.4 billion in 2003, according to data provider IMS Health.
Elderly patients have been a major source of that growth. Studies suggest that 20 percent to 30 percent of nursing-home residents take an atypical, despite not having a psychosis diagnosis.
READ MORE @ PHILADELPHIA INQUIRER
Helen Shields believes one of these drugs helped kill her mother, Helen Marciniszyn.
Two families, two drugs, two stories that capture the extremes of a debate about using these medicines to treat the diseases of aging when there are no other effective alternatives.
Kathye Wiggins took Johnson & Johnson's Risperdal. Marciniszyn took AstraZeneca's Seroquel. Both drugs are atypical antipsychotics, a category of psychotropic drugs that also includes Zyprexa from Eli Lilly & Co., Abilify by Bristol-Myers Squibb Co., and Pfizer Inc.'s Geodon.
The federal government approved atypicals in the 1990s to treat schizophrenia and bipolar disorder. Since then, they have become popular for treating disorders including autism and Alzheimer's, despite mixed evidence that they help and ample evidence that they hurt.
Doctors prescribe atypicals for these illnesses because they may calm people and help them sleep. Also, patients with Alzheimer's and dementia can lose touch with reality, as schizophrenics do, so, in theory, atypicals could help.
Sales of atypicals rose to $14.36 billion in 2008 from $8.4 billion in 2003, according to data provider IMS Health.
Elderly patients have been a major source of that growth. Studies suggest that 20 percent to 30 percent of nursing-home residents take an atypical, despite not having a psychosis diagnosis.
READ MORE @ PHILADELPHIA INQUIRER
Tuesday, April 21, 2009
Comorbidity: Psychiatric Comorbidity in Persons With Dementia
The assessment and treatment of psychiatric symptoms in persons with cognitive dysfunction are becoming increasingly important. Prevalence estimates of dementia in the United States range from 5% in those aged 71 to 79 years to 25% to 50% in those 90 or older. Up to 90% of patients with dementia have psychiatric comorbidities.1,2
Physicians who treat patients with dementia must remember that dementia is not merely a problem with memory. The presence of one or more additional cognitive disturbances, including aphasia, apraxia, or agnosia, is required to make the diagnosis according to DSM-IV-TR criteria. Furthermore, some patients may present with changes in personality or deficits in executive function rather than memory impairment, which complicates the initial diagnosis.3 Additional mental and behavioral disturbances often affect patients and caregivers as much as memory deficits and may influence quality of life, the need for institutionalization, mortality, and caregiver burden.2,4,5
This article emphasizes neuropsychiatric disturbances with the greatest prevalence and morbidity in persons with dementia. It also addresses comorbid depressive and anxiety disorders, as well as psychological and behavioral disturbances associated with dementia—psychosis and agitation/aggression.3,6
READ MORE @ PSYCHIATRIC TIMES
Physicians who treat patients with dementia must remember that dementia is not merely a problem with memory. The presence of one or more additional cognitive disturbances, including aphasia, apraxia, or agnosia, is required to make the diagnosis according to DSM-IV-TR criteria. Furthermore, some patients may present with changes in personality or deficits in executive function rather than memory impairment, which complicates the initial diagnosis.3 Additional mental and behavioral disturbances often affect patients and caregivers as much as memory deficits and may influence quality of life, the need for institutionalization, mortality, and caregiver burden.2,4,5
This article emphasizes neuropsychiatric disturbances with the greatest prevalence and morbidity in persons with dementia. It also addresses comorbid depressive and anxiety disorders, as well as psychological and behavioral disturbances associated with dementia—psychosis and agitation/aggression.3,6
READ MORE @ PSYCHIATRIC TIMES
Tuesday, March 10, 2009
Aripiprazole Boosts Efficacy of Antidepressants in Older Patients With Major Depressive Disorder: Presented at AAGP
Adjunctive aripiprazole appears to be effective in relieving the symptoms of depression in patients aged 50 years or older, according to research presented at the American Association for Geriatric Psychiatry (AAGP) 22nd Annual Meeting.
J. Craig Nelson, MD, University of California San Francisco School of Medicine, San Francisco, California, and colleagues presented the findings here on March 6. According to the researchers, the treatment effect of selective serotonin-reuptake inhibitors is generally minimal in elderly patients with major depressive disorder. The current study sought to determine whether adjunctive aripiprazole might benefit this population when added to standard antidepressant treatment.
Aripiprazole is an atypical antipsychotic currently approved for use only as an adjunct to antidepressant medication.
READ MORE 2 DOCTOR'S GUIDE
J. Craig Nelson, MD, University of California San Francisco School of Medicine, San Francisco, California, and colleagues presented the findings here on March 6. According to the researchers, the treatment effect of selective serotonin-reuptake inhibitors is generally minimal in elderly patients with major depressive disorder. The current study sought to determine whether adjunctive aripiprazole might benefit this population when added to standard antidepressant treatment.
Aripiprazole is an atypical antipsychotic currently approved for use only as an adjunct to antidepressant medication.
READ MORE 2 DOCTOR'S GUIDE
Friday, January 23, 2009
More Americans Skipping Necessary Prescriptions, Survey Finds
One in seven Americans under age 65 went without prescribed medicines in 2007 as drug costs spiraled upward in the United States, a nonprofit research group said on Thursday.
That figure is up substantially since 2003, when one in 10 people under 65 went without a prescription drug because they couldn’t afford it, according to the Center for Studying Health System Change in Washington, D.C.
The current figure may be even higher because of the recent economic downturn, said Laurie E. Felland, a senior health researcher at the center and lead author of the study.
“Our findings are particularly troublesome given the increased reliance on prescription drugs to treat chronic conditions,” she added. “People who go without their prescriptions experience worsening health and complications.”
The people who were least able to afford medicine were often those who needed it most, Ms. Felland said: uninsured, working-age adults suffering from at least one chronic medical condition. Almost two-thirds of them in the survey said they had gone without filling a prescription.
READ MORE @ NY TIMES
That figure is up substantially since 2003, when one in 10 people under 65 went without a prescription drug because they couldn’t afford it, according to the Center for Studying Health System Change in Washington, D.C.
The current figure may be even higher because of the recent economic downturn, said Laurie E. Felland, a senior health researcher at the center and lead author of the study.
“Our findings are particularly troublesome given the increased reliance on prescription drugs to treat chronic conditions,” she added. “People who go without their prescriptions experience worsening health and complications.”
The people who were least able to afford medicine were often those who needed it most, Ms. Felland said: uninsured, working-age adults suffering from at least one chronic medical condition. Almost two-thirds of them in the survey said they had gone without filling a prescription.
READ MORE @ NY TIMES
Thursday, October 2, 2008
Depression linked to higher death rates from all causes among elderly with diabetes
2-year study looked at more than 10,000 Medicare beneficiaries with diabetes
In a large group of Medicare beneficiaries with diabetes, depression was associated with a higher death rate from all causes during a two-year study period. The findings are published in the October 2008 Journal of General Internal Medicine.
Lead author Dr. Wayne Katon, professor of psychiatry and behavioral sciences at the University of Washington (UW), noted that previous research indicates that depression and diabetes is a potentially lethal mix among young to middle-aged patients. Depression also puts patients at greater risk of complications from their diabetes. This more recent study suggests that depression is also a risk factor for mortality in older patients with diabetes. Most Medicare beneficiaries, like the ones in this study, are over age 65. The mean age of the participants was 75.6 years.
The study tracked 10,704 Medicare beneficiaries with diabetes who were enrolled in a disease management program in Florida. They were surveyed at the start of the study with a health assessment questionnaire. Evidence of depression among members of the group came from physician diagnosis, patient reports of having a prescription for an antidepressant in the year before the survey, or patient answers to a brief screening test. For the next two years, the research team recorded the death and cause of death of participants through bi-monthly checks of Medicare claims and eligibility files, or from phone calls with the participants' families.
READ MORE @ EUREKALERT
In a large group of Medicare beneficiaries with diabetes, depression was associated with a higher death rate from all causes during a two-year study period. The findings are published in the October 2008 Journal of General Internal Medicine.
Lead author Dr. Wayne Katon, professor of psychiatry and behavioral sciences at the University of Washington (UW), noted that previous research indicates that depression and diabetes is a potentially lethal mix among young to middle-aged patients. Depression also puts patients at greater risk of complications from their diabetes. This more recent study suggests that depression is also a risk factor for mortality in older patients with diabetes. Most Medicare beneficiaries, like the ones in this study, are over age 65. The mean age of the participants was 75.6 years.
The study tracked 10,704 Medicare beneficiaries with diabetes who were enrolled in a disease management program in Florida. They were surveyed at the start of the study with a health assessment questionnaire. Evidence of depression among members of the group came from physician diagnosis, patient reports of having a prescription for an antidepressant in the year before the survey, or patient answers to a brief screening test. For the next two years, the research team recorded the death and cause of death of participants through bi-monthly checks of Medicare claims and eligibility files, or from phone calls with the participants' families.
READ MORE @ EUREKALERT
Wednesday, October 1, 2008
AHRQ Study: Conventional Antipsychotics May Pose Risk To Elderly
Elderly patients who are prescribed a conventional, or first-generation, antipsychotic medication are at an increased risk of death from cardiovascular or respiratory diseases, as compared to those who take an atypical, or second-generation, antipsychotic medication, according to a study funded by the Agency for Healthcare Research and Quality.
The new study, "Potential Causes of Higher Mortality in Elderly Users of Conventional and Atypical Antipsychotic Medications," which was recently posted online in the Journal of the American Geriatrics Society, adds to growing evidence that conventional antipsychotics may not be safer than atypical anitpsychotics for the elderly. Researchers had previously identified that such second-generation medications may pose increased mortality. The new study compares specific causes of death among elderly patients newly started on conventional versus atypical antipsychotics.
READ MORE @ U.S. MEDICINE
The new study, "Potential Causes of Higher Mortality in Elderly Users of Conventional and Atypical Antipsychotic Medications," which was recently posted online in the Journal of the American Geriatrics Society, adds to growing evidence that conventional antipsychotics may not be safer than atypical anitpsychotics for the elderly. Researchers had previously identified that such second-generation medications may pose increased mortality. The new study compares specific causes of death among elderly patients newly started on conventional versus atypical antipsychotics.
READ MORE @ U.S. MEDICINE
Wednesday, September 24, 2008
Statins Increase Risk Of Postoperative Delirium In Elderly Patients, Study Suggests
The use of statins is associated with a 28% increased risk of postoperative delirium in elderly patients, found University of Toronto professor Dr. Donald Redelmeier and colleagues in a retrospective cohort analysis involving more than 280 000 patients.
Ontario's Institute for Clinical Evaluative Sciences (ICES) looked at elderly patients who underwent elective surgery in Ontario and who had received 2 or more prescriptions for statins in the year before surgery, including at least one prescription in the 90 days preceding surgery. Many patients took multiple medications, underwent abdominal, musculoskeletal or urogenital surgery which had a mean duration of about 115 minutes.
Delirium, in addition to causing anxiety in patients and families, contributes to longer hospital stays, a prolonged need for intensive care, and can disrupt and delay care.
READ MORE @ SCIENCE DAILY
Ontario's Institute for Clinical Evaluative Sciences (ICES) looked at elderly patients who underwent elective surgery in Ontario and who had received 2 or more prescriptions for statins in the year before surgery, including at least one prescription in the 90 days preceding surgery. Many patients took multiple medications, underwent abdominal, musculoskeletal or urogenital surgery which had a mean duration of about 115 minutes.
Delirium, in addition to causing anxiety in patients and families, contributes to longer hospital stays, a prolonged need for intensive care, and can disrupt and delay care.
READ MORE @ SCIENCE DAILY
Saturday, September 13, 2008
Medicare: A Bush Disaster That My Life Depends on
I began needing drugs to stay alive one day in the early 1990s, though I did not realize it at the time. I was still a decade away from officially becoming an old person by US government standards, although I'd already started getting my mailings from AARP. I had spent the afternoon in the Plaza Hotel bar in New York City, meeting with an actor who'd said he wanted to make a film from a book I'd written. (To no one's surprise, it never happened.) I'd had a few bourbons without eating anything, and afterward I stopped off at a falafel place. Then I began to vomit blood.
I went to the doctor. He gave me the first of what was to become a series of yearly tests, snaking a fiber-optic device down my throat to look at my upper digestive tract. He announced that I had Barrett's syndrome, a dangerous precancerous condition in the cells of the lower esophagus, caused by years of acid reflux. But fortunately for me, the doctor said, there was a pill, still relatively new at the time, that could save me from a terrible fate -- a little purple pill. With that, I became one of the millions of people who take Prilosec and a crop of other prescription drugs for acid reflux, stomach ulcers, and heartburn.
READ MORE @ ALTERNET
I went to the doctor. He gave me the first of what was to become a series of yearly tests, snaking a fiber-optic device down my throat to look at my upper digestive tract. He announced that I had Barrett's syndrome, a dangerous precancerous condition in the cells of the lower esophagus, caused by years of acid reflux. But fortunately for me, the doctor said, there was a pill, still relatively new at the time, that could save me from a terrible fate -- a little purple pill. With that, I became one of the millions of people who take Prilosec and a crop of other prescription drugs for acid reflux, stomach ulcers, and heartburn.
READ MORE @ ALTERNET
Wednesday, August 27, 2008
Anti-psychotic drug use in the elderly increases despite drug safety warnings
Three regulatory warnings of serious adverse events slowed the growth of use of atypical antipsychotic drugs among elderly patients with dementia, but they did not reduce the overall prescription rate of these drugs, found a research analysis of prescription drug claims data in Ontario http://www.cmaj.ca/press/pg438.pdf. The rate of use of these drugs actually increased 20% from the month prior to the first warning in September 2002 to the end of the study period in February 2007.
About 70% of people receiving antipsychotic drugs lived in nursing homes, and approximately 40% were aged 85 or older.
READ MORE @ EUREKALERT
About 70% of people receiving antipsychotic drugs lived in nursing homes, and approximately 40% were aged 85 or older.
READ MORE @ EUREKALERT
Friday, June 20, 2008
Falls, depression and antidepressants in later life
Older people are at high risk for falls and subsequent injuries. Those who have depression have an increased risk of falls and the medications they take for depression increase their risk even more, New Zealand and Australian researchers reported in the open-access journal PLoS ONE.
"People with depression and those taking antidepressants, especially SSRIs, are 50% more likely to fall than other older people," said Ngaire Kerse, lead author of the study and associate professor in the Department of General Practice and Primary Healthcare at the School of Population Health in the University of Auckland, New Zealand. "Falls are very common and risk factors for falls are easy to identify. We need to emphasise fall prevention during treatment of depression in older people."
In a study of 21,900 older Australians, over age 60, who responded to a survey sent out by their GP, 24 percent reported at least one fall during the last 12 months, 11% had injured themselves with falling and 8% had needed to see a doctor because of a fall.
About one quarter of the group reported symptoms of depression and 12% were taking some form of antidepressant. While using antidepressants was a significant risk for falls, the highest risk (66% increase in falls) was seen when older people used SSRIs, the most frequently prescribed antidepressant (6% of people took this medication).
"This risk associated with SSRIs has been reported before but not in such a large group of older people living in the community," Kerse said. "More than 60% of women aged over 80 with depression and taking an SSRI fell in the last year. This means that falls prevention strategies must really be thought of when prescribing antidepressants for older people."
READ MORE @ EUREKALERT
"People with depression and those taking antidepressants, especially SSRIs, are 50% more likely to fall than other older people," said Ngaire Kerse, lead author of the study and associate professor in the Department of General Practice and Primary Healthcare at the School of Population Health in the University of Auckland, New Zealand. "Falls are very common and risk factors for falls are easy to identify. We need to emphasise fall prevention during treatment of depression in older people."
In a study of 21,900 older Australians, over age 60, who responded to a survey sent out by their GP, 24 percent reported at least one fall during the last 12 months, 11% had injured themselves with falling and 8% had needed to see a doctor because of a fall.
About one quarter of the group reported symptoms of depression and 12% were taking some form of antidepressant. While using antidepressants was a significant risk for falls, the highest risk (66% increase in falls) was seen when older people used SSRIs, the most frequently prescribed antidepressant (6% of people took this medication).
"This risk associated with SSRIs has been reported before but not in such a large group of older people living in the community," Kerse said. "More than 60% of women aged over 80 with depression and taking an SSRI fell in the last year. This means that falls prevention strategies must really be thought of when prescribing antidepressants for older people."
READ MORE @ EUREKALERT
Wednesday, June 18, 2008
FDA Orders Warning Label on Older Antipsychotics
The U.S. Food and Drug Administration is cautioning physicians that certain types of antipsychotic drugs can boost the death risk of seniors with dementia.
Doctors sometimes use antipsychotics to help treat behavioral problems in demented patients.
But from now on these older, so-called "conventional" antipsychotics -- which include drugs such as thorazine and prolixin -- will carry a new black box warning alerting physicians of the danger, FDA officials announced Monday.
"We issued letters to all the manufacturers of antipsychotic drugs, both conventional and atypical, requiring them to update their labeling with new language for a box warning about an increased risk of death in elderly patients with dementia," Dr. Thomas Laughren, director of the FDA's Division of Psychiatry Products at the Center for Drug Evaluation and Research, said during an afternoon teleconference.
This is a new warning for conventional antipsychotics, but it is not new for another class of the medications, called atypical antipsychotics. Back in 2005, the FDA ordered warning labeling for those medications, which include newer drugs such as Zyprexa and Risperdal. That labeling warned of a higher risk for heart attack and pneumonia for elderly patients with dementia who received atypical antipsychotics.
READ MORE @ WASHINGTON POST
Doctors sometimes use antipsychotics to help treat behavioral problems in demented patients.
But from now on these older, so-called "conventional" antipsychotics -- which include drugs such as thorazine and prolixin -- will carry a new black box warning alerting physicians of the danger, FDA officials announced Monday.
"We issued letters to all the manufacturers of antipsychotic drugs, both conventional and atypical, requiring them to update their labeling with new language for a box warning about an increased risk of death in elderly patients with dementia," Dr. Thomas Laughren, director of the FDA's Division of Psychiatry Products at the Center for Drug Evaluation and Research, said during an afternoon teleconference.
This is a new warning for conventional antipsychotics, but it is not new for another class of the medications, called atypical antipsychotics. Back in 2005, the FDA ordered warning labeling for those medications, which include newer drugs such as Zyprexa and Risperdal. That labeling warned of a higher risk for heart attack and pneumonia for elderly patients with dementia who received atypical antipsychotics.
READ MORE @ WASHINGTON POST
Sunday, May 11, 2008
Several Therapies Show Promise for Vascular Depression
New treatments for a type of depression in the elderly related to blood vessels -- called vascular depression -- are under development, and researchers have discovered why some patients with this condition fail to respond to current medications.
Details of the findings were to be presented Wednesday during a news conference by researchers taking part in U.S. National Institute of Mental Health symposiums at the annual meeting of the American Psychiatric Association, in Washington, D.C.
Vascular depression is a recently recognized type of depression that usually develops in patients older than age 60. The condition is associated with loss of blood supply to the brain.
"Mental health practitioners and patients should be aware of the relationship between vascular problems and depression, and should understand the value of preventing vascular changes that might lead to difficult-to-treat depressions, for example, through early recognition and treatment of high blood pressure," Dr. John Newcomer, of Washington University in St. Louis, said in a prepared statement.
READ MORE @ WASHINGTON POST
Details of the findings were to be presented Wednesday during a news conference by researchers taking part in U.S. National Institute of Mental Health symposiums at the annual meeting of the American Psychiatric Association, in Washington, D.C.
Vascular depression is a recently recognized type of depression that usually develops in patients older than age 60. The condition is associated with loss of blood supply to the brain.
"Mental health practitioners and patients should be aware of the relationship between vascular problems and depression, and should understand the value of preventing vascular changes that might lead to difficult-to-treat depressions, for example, through early recognition and treatment of high blood pressure," Dr. John Newcomer, of Washington University in St. Louis, said in a prepared statement.
READ MORE @ WASHINGTON POST
Monday, May 5, 2008
Common Medications Could Cause Physical Impairment in the Elderly
Two new studies show that anticholinergics, a commonly prescribed group of drugs, may cause elderly people to "slow down" in their daily physical activities.
The two reports from researchers at Wake Forest University School of Medicine support findings released a few weeks ago that anticholinergic drugs -- which treat a variety of diseases and conditions, including acid reflux, Parkinson's disease and urinary incontinence -- may cause older people to lose their thinking skills more quickly than those who don't take the medicines.
Anticholinergic drugs work by stopping acetylcholine, a chemical that enhances communication between nerve cells in the brain, from binding to its receptors in nerve cells.
In the first Wake Forest study, older adults taking anticholinergics became more likely to walk more slowly and to need help in other daily activities.
READ MORE @ WASHINGTON POST
The two reports from researchers at Wake Forest University School of Medicine support findings released a few weeks ago that anticholinergic drugs -- which treat a variety of diseases and conditions, including acid reflux, Parkinson's disease and urinary incontinence -- may cause older people to lose their thinking skills more quickly than those who don't take the medicines.
Anticholinergic drugs work by stopping acetylcholine, a chemical that enhances communication between nerve cells in the brain, from binding to its receptors in nerve cells.
In the first Wake Forest study, older adults taking anticholinergics became more likely to walk more slowly and to need help in other daily activities.
READ MORE @ WASHINGTON POST
Wednesday, April 30, 2008
Antipsychotic Drugs Linked to Pneumonia in Elderly
Nursing home patients who take antipsychotic drugs are 60 percent more likely to develop pneumonia in the short term than those who don't take the drugs, a new study shows.
The risk is greatest during the first week after patients start taking the medications and gradually decreases, say Dutch researchers.
"The risk of developing pneumonia is not associated with long-term use, but is the highest shortly after starting the drug," said study authors Dr. Rob van Marum and Dr. Wilma Knol. They warned that "all antipsychotic drugs may be associated with pneumonia in elderly patients."
This is the first study to show an association between pneumonia risk and the use of antipsychotic drugs, which are frequently used to treat psychosis and behavioral problems in elderly patients with dementia and delirium.
The study was published in the current issue of theJournal of the American Geriatrics Society.
READ MORE @ WASHINGTON POST
The risk is greatest during the first week after patients start taking the medications and gradually decreases, say Dutch researchers.
"The risk of developing pneumonia is not associated with long-term use, but is the highest shortly after starting the drug," said study authors Dr. Rob van Marum and Dr. Wilma Knol. They warned that "all antipsychotic drugs may be associated with pneumonia in elderly patients."
This is the first study to show an association between pneumonia risk and the use of antipsychotic drugs, which are frequently used to treat psychosis and behavioral problems in elderly patients with dementia and delirium.
The study was published in the current issue of theJournal of the American Geriatrics Society.
READ MORE @ WASHINGTON POST
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