Geriatric patient treatment

Other Uses in Geriatric Patient Treatment of antipsychotic-induced adverse effects Side Effects ... 

Aniracetam (6), launched in 1993 in both Japan and Italy for the treatment of cognition disorders, is in Phase II trials in the United States as of this writing. In clinical studies it has been shown to cause some improvement in elderly patients with mild to moderate mental deterioration (63), and in geriatric patients with cerebral insufficiency (64). In a multicenter double-blind placebo-controUed trial involving 109 patients with probable AD, positive effects were observed in 36% of patients after six months of treatment (65), a result repeated in a separate study of 115 patients (66). A review of the biological and pharmacokinetic properties, and clinical results of aniracetam treatment in cognitively impaired individuals is available (49). 

Recommend treatment approaches for special populations of patients with bipolar disorder, including pediatric patients, geriatric patients, and pregnant patients. 

The prevalence of obesity in older adults is increasing therefore, it should not be surprising that more cardiovascular risk factors are present in this group of individuals. Additionally, obesity is a major predictor of functional limitation and mobility problems in older persons. Age alone should not prejudice the clinician from treating geriatric patients, whereas the benefits of cardiovascular health and functionality should be considered. Treatments should be initiated that minimize adverse effects on bone health and nutritional status and should include dietary and activity modifications.6... 

For some bedridden or geriatric patients, or others with chronic constipation, bulk-forming laxatives remain the first line of treatment, but the use of more potent laxatives may be required relatively frequently. Agents that may be used in these situations include milk of magnesia and lactulose. 

Horne R and Weinman J (1999) Patients beliefs about prescribed medicines and their role in adherence to treatment in chronic physical illness. J Psychosom Res 47(6) 555-567 Kannisto V, Lauritsen J, Thatcher AR et al. (1994) Reductions in mortality at advanced age several decades of evidence from 27 countries. Population and development review 20(4) 793-810 Lazarou J, Pomeranz BH, Corey PN (1998) Incidence of adverse drug reactions in hospitalized patients a meta- analysis of prospective studies. JAMA 279(15) 1200-1205 LeSage J (1991) Polypharmacy in geriatric patients. Nurs Clin North Am 26(2) 273-290 Pitkala KH, Strandberg TE, Tilvis RS (2001) Is it possible to reduce polypharmacy in the elderly ... 

Of particular importance in the geriatric patient Delirium, possible antagonism of cholinergic drug therapy in the treatment of Alzheimer s disease. 

Madhusoodanan S, Brenner R, Araujo L, et al. Efficacy of risperidone treatment for psychoses associated with schizophrenia, schizoaffective disorder, bipolar disorder, or senile dementia in 11 geriatric patients a case series. J din Psychiatry 1995 56 514-518. 

Viukari J, Salo H, Lamminsivu U, et al. Tolerance and serum levels of haloperidol during parenteral and oral haloperidol treatment in geriatric patients. Acta Psychiatr Scand 1982 65 301-308. 

In summary, it remains unclear whether ECT has differential efficacy in the psychotic versus nonpsychotic depressive subgroups, both in terms of acute response and propensity for relapse. In addition, although evidence supports superior outcomes in geriatric patients, rate and extent of recovery are not clear when comparing ECT with pharmacological treatment in this age group (1,49). 

Rada RT, Kellner R. Thiothixene in the treatment of geriatric patients with chronic organic brain syndrome. J Am Geriatr Soc 1976 24 105-107. 

Deficiency of vitamin K A true vitamin K deficiency is unusual because adequate amounts are generally produced by intestinal bacteria or obtained from the diet. If the bacterial population in Ihe gut is decreased, for example by antibiotics, the amount of endogenously formed vitamin is depressed, and can lead to hypoprothrombinemia in the marginally malnourished individual (for example, a debilitated geriatric patient). This condition rcaj require supplementation with vitamin K to correct the bleeding tendency. In addition, certain second generation cephalosporins (for example, cefoperazone, cefamandole, and moxalactam) cause hypoprothrombinemia, apparently by a warfarin-like mechanism. Consequently, their use in treatment is usually supplemented with vitamin K. 

The elderly are also more likely to suffer from chronic disease and multiple disease states and therefore receive long-term treatment with medications. Considering the high medication utilization of geriatric patients, it is pertinent to focus on geriatric dosing and dosage forms. 

Ananth TV, Deutsch M, Ban TA. Senilex in the treatment of geriatric patients. Curr Ther Res Clin Exp 1971 13(5) 316-21. 

Leckman J, Ananth TV, Ban TA, Lehmann HE. Pentylenetetrazol in the treatment of geriatric patients with disturbed memory function. J Clin Pharmacol New Drugs 1971 ll(4) 301-3. 

O Brien WM. Long-term efficacy and safety of tohnetin sodium in treatment of geriatric patients with rheumatoid arthritis and osteoarthritis a retrospective study. J Clin Pharmacol 1983 23(7) 309-23. 

Increasingly, our society is composed of greater numbers of elderly individuals, defined as 65 and older. Currently, the elderly constitute nearly 20 percent of the population. Consequently, psychotherapists are faced with diagnostic and treatment dilemmas specific to this population. Presented here are patterns and risks of medication use in the elderly (figure B-2) and age-specific factors contributing to adverse effects (figure B-3). Also discussed are recommended adjustments for use of psychotropics in the geriatric patient. 

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