Medicine-On-Time Shown To Reduce Likelihood Of Nursing Home Admission By 66 Percent

In a new study published in The American Journal of Geriatric Pharmacotherapy, researchers from the University of South Carolina School of Public Health found that the use of the Medicine-On-Time medication delivery technology reduced the likelihood of nursing home admission by 66 percent.


The study assessed the impact of a medication adherence management program on nursing home admissions. Medicine-On-Time's medication management system helps ensure that medications are taken properly through the use of patient-specific customized packaging.


This study found that the pharmacy-based calendar card dispensing system and coordinating service, which was designed to facilitate medication adherence, can reduce medication management issues, address problems as they arise, and reduce nursing home admissions of community dwelling, nursing home-eligible patients. With nearly 1.5 million residents in nursing homes, the widespread implementation of a medication management system could potentially save the healthcare system billions of dollars per year by avoiding unnecessary nursing home admissions.

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Long-term Ecstasy Use 'Raises Risk of Brain Damage and Alzheimer's' | Society | The Guardian

by Denis Campbell, health correspondent - The Guardian

Long-term Ecstasy users risk brain damage, memory loss and an increased chance of developing Alzheimer's disease, new research suggests.

Dutch researchers used MRI scans to study the brains of 10 men in their mid-20s who had taken an average of 281 ecstasy tablets over the previous six and a half years, and seven peers who had taken other drugs.

They found that the hippocampus - the part of the brain controlling memory - was 10.5% smaller among the ecstasy users, and their overall grey matter 4.6% less.

"These data provide preliminary evidence that Ecstasy users may be prone to incurring hippocampal damage", and may help explain the memory loss witnessed among such people in previous studies, the co-authors wrote in the Journal of Neurology, Neurosurgery and Psychiatry.

"Hippocampal atrophy is a hallmark for disease of progressive cognitive impairment in older patients, such as Alzheimer's disease", they added.

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Weekly Exenatide Misses Endpoint in Key Trial

By John Gever, Senior Editor, MedPage Today

An investigational once-weekly formulation of the injectable diabetes drug exenatide (Bydureon) failed to show noninferiority to daily liraglutide (Victoza), the trial's sponsors said.

In the open-label trial called DURATION-6, patients taking 2 mg of exenatide weekly showed a 1.3-point reduction in glycated hemoglobin (HbA1c) levels after 26 weeks, compared with a 1.5-point decrease in patients receiving liraglutide at 1.8 mg daily, according to a joint statement from Eli Lilly, Alkermes, and Amylin Pharmaceuticals, which are co-developing the once-weekly drug.

"Bydureon did not meet the prespecified primary endpoint of noninferiority to Victoza," the statement said.
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Clearing the Fog in Nursing Homes - NYTimes.com

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By PAULA SPAN

“What’s people’s biggest fear? Being a ‘zombie’ in a nursing home,” said Laurel Baxter, the Awakenings project manager.

Any visitor can see what she means. Even in quality nursing homes, some residents sit impassively in wheelchairs or nod off in front of televisions, apparently unable to interact with others or to summon much interest in their lives. Nursing home reformers and regulators have long believed that this disengagement results in part from the overuse of psychotropic medication to quell the troublesome behaviors that can accompany dementia — yelling, wandering, aggression, resisting care. For nearly 25 years, federal law has required that psychotropic drugs (which critics call “chemical restraints”) be used only when necessary to ensure the safety of a resident or those around her.

The drugs can cause serious side effects. Since 2008, the Food and Drug Administration has required a so-called black box warnings on their packaging, cautioning that they pose an increased mortality risk for elderly patients. Nevertheless, a national survey reported that in 2004 about a quarter of nursing home residents were receiving antipsychotic drugs. (Among the antipsychotic drugs most commonly used in nursing homes are Risperdal, Seroquel and Zyprexa.)

Though they may be prescribed less frequently following the F.D.A.’s warnings, these drugs are still overused in long-term care, said Dr. Mark Lachs, chief of geriatrics at Weill Cornell Medical College. And once the pills are prescribed, residents keep taking them. “They get perpetualized, like insulin,” he told me, even though the behaviors they’re meant to soothe may wane anyway as dementia progresses.

“If a place is understaffed, if it takes particularly unruly patients, you can see how it happens,” Dr. Lachs added. “Behavioral interventions are far more time-consuming than giving a pill.”

Nevertheless, Ecumen’s Awakenings project emphasizes nondrug responses. “Medications have a place, but that shouldn’t be the first thing you try,” said Eva Lanigan, director of nursing at the Two Harbors facility.

So the home trained its entire staff (housekeepers, cooks, dining room servers, everyone) in a variety of tools to calm and reassure its 55 residents: exercise, activities, music, massage, aromatherapy. It taught people the kind of conversation known as “redirecting” — listening to elders and responding to them without insisting on facts that those with dementia can’t absorb or won’t recall.

“The hands-on, caring part is the most important,” Ms. Lanigan said. “Sometimes, people just want a hug. You sit and hold their hand.”

At the same time, consulting with a geriatric psychiatrist and a pharmacist, the home began gradually reducing the doses of antipsychotics and antidepressants for patients whose families agreed. Among them: the woman with the mysterious cries.

As Dr. Lachs pointed out, behavioral interventions are labor-intensive. Two Harbors hired an additional nurse to oversee those efforts, and Ms. Lanigan was available to answer staff questions around the clock. Ecumen estimates that introducing the program to a 60-bed nursing home cost an additional $75,000 a year for two full-time employees.

The results startled even the believers, however. Every resident on antipsychotics (about 10) was able to stop taking them, and 30 to 50 percent of those taking antidepressants also did well without them. When drugs still seemed necessary, “we tried to reduce them to the lowest dose possible,” Ms. Lanigan said.
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Nursing Home Med Errors Vary by Form of Drug

By Michael Smith, North American Correspondent, MedPage Today

Residents in nursing and old age homes are four times as likely to get an incorrect dose of medication if it's in liquid rather than pill form, researchers reported.

In a study in 55 British homes, errors included such things as incorrect measurements and not shaking a suspension, according to David Phillip Alldred, PhD, of the University of Leeds in Leeds, England, and colleagues.

Errors also were more likely with inhalers and other drug formulations, compared with pills or tablets dispensed using a monitored dosage system, Alldred and colleagues reported online in BMJ Quality and Safety.

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Take Up Tai Chi And And Cut Back On Meds To Reduce Risk Of Falling, Elderly Advised

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Written by: Catharine Paddock, PhD

Taking up Tai Chi and cutting back on medication could form part of a multiple intervention approach to helping elderly people reduce their risk of falling, according to recently updated guidelines from the American Geriatrics Society and the British Geriatric Society, summarized this month in the Journal of the American Geriatrics Society.

In their first update since 2001, the guidelines for preventing falls in the elderly now recommend that interventions be "multifactorial" and include an exercise component and assess feet, footwear, fear of falling, ability to go about daily living, and other factors.

The guidelines also say that fall screening and prevention should be a routine part of healthcare for the elderly.

The new panel that updated the guidelines included members from previous panels and new members with considerable expertise, both in practical and published work, in preventing falls and caring for older people.

Dr Mary Tinetti of Yale University School of Medicine in New Haven, Connecticut in the US, was one of the panel co-chairs. She told the press that:

"Falls are one of the most common health problems experienced by older adults and are a common cause of losing functional independence."

"Given their frequency and consequences, falls are as serious a health problem for older persons as heart attacks and strokes," she added.

The panel searched and reviewed the literature published between May 2001 and April 2008 for systematic literature reviews, meta-analyses, randomized controlled trials of fall prevention interventions, controlled before-and-after studies, and cohort studies.

They also reviewed randomized controlled trials published between April 2008 and July 2009 and found no reason to change their conclusions and recommendations.

The new guidelines say that doctors should decide whether to assess risk of falling by first asking patients if they have fallen recently or are unsteady when walking.

If patients say they have not experienced a fall recently and are not unsteady when walking then they do not need a risk assessment.

But if they answer yes, then doctors should go ahead with a risk assessment and look for other known problem areas like muscle weakness, poor balance or blood pressure that drops too much on standing.

If this risk assessment shows these problems, patients should then receive interventions as advised in the guidelines.

Tinetti said that they found the most effective fall prevention trials were those involving multiple interventions instead of only one.

She said while previous studies had suggested it is more effective to focus on single interventions, they are confident a multiple intervention approach is better because they looked not only at what was recommended but also what was actually carried out.

"We're confident that multifactorial interventions is the best course of action," stressed Tinetti.

The new guidelines suggest not only that doctors should design "multifactorial" interventions, but these also:

• Include exercise for balance, gait and strength training. A good example is Tai chi or physical therapy.


• Include "environmental adaptation" to reduce factors that increase risk of falling in the home and when carrying out daily activities.


• Include cataract surgery where needed, but not as an individual approach.


• Aim to reduce medication regardless of number of drugs prescribed: this is a departure from the 2001 guideline which said this need only apply to patients on four or more drugs.


• Pay particular attention to drugs that affect the brain, for instance sleeping pills and antidepressants.


• Focus on raising low blood pressure and managing heart rate and rhythm abnormalities.

Tinetti said:

"There is emerging evidence that the rate of serious fall injuries, such as hip fractures, is decreasing modestly in areas in which fall prevention is integrated into clinical practice."

"By making fall prevention part of the clinical care of older adults this trend can continue," she added.

"Summary of the Updated American Geriatrics Society/British Geriatrics Society Clinical Practice Guideline for Prevention of Falls in Older Persons."
Panel on Prevention of Falls in Older Persons, American Geriatrics Society and British Geriatrics Society.
Journal of the American Geriatrics Society, Volume 59, Issue 1, pages 148-157, published online 13 January 2011.
DOI: 10.1111/j.1532-5415.2010.03234.x

Additional source: Wiley-Blackwell (press release, 13 Jan 2011).

Two Medicines Taken Together Improve Control of Blood Pressure

ScienceDaily (2011-01-12) -- New research shows that starting treatment of blood pressure with two medicines rather than the one produces better and faster results and fewer side effects -- findings that could change clinical practice world-wide.

Common Painkillers Linked to Increased Risk of Heart Problems

ScienceDaily (2011-01-11) -- Commonly used painkillers for treating inflammation can increase the risk of heart attacks and strokes, according to an analysis of the evidence.

Drugging Dementia Patients Serious Problem, Panel Says

By Joyce Frieden, News Editor, MedPage Today

As baby boomers age, the nation faces a crisis in care for an ever-expanding population of dementia patients and over-medication will be a big problem, panelists said at a Senate Aging Committee forum on Wednesday.


There are currently about five million patients with Alzheimer's disease and other forms of dementia, and 11 million family members are caring for these patients, Patricia Grady, PhD, director of the National Institute of Nursing Research, said at the forum.

"We're facing the increasing age of the population," Grady said. "The urgency and the tempo is really increasing. Those in this field have a feeling we're headed in a very fast train toward the end of a cliff."

Over-medication occurs often with dementia patients, according to the panelists, who noted that patients' way of complaining about physical illness is often mistaken by caregivers and family members as aggressiveness or unruly behavior.

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FDA Panel Rejects Prostate Drugs for CA Prevention from MedPage Today

An FDA advisory panel has voted overwhelmingly that GlaxoSmithKline's dutasteride (Avodart) and Merck's finasteride (Proscar) should not be used to prevent prostate cancer because the drugs are linked to a higher incidence of high-grade tumors.

Although the 5-alpha reductase inhibitors were shown to prevent low-risk cancers better than placebo, clinical trials painted a disturbing link between both drugs and an increased incidence of higher-risk prostate cancers.

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AoA November Newsletter

Table of Contents

Top Story

November Is National Family Caregivers Month

AoA News

AoA’s National Family Caregiver Support Program Celebrates 10 Years

November is National Alzheimer’s Disease Awareness Month

Message from Assistant Secretary Kathy Greenlee on Veterans Day 2010

AoA Recognizes Native American Heritage Month

Population Data on Older American Indian Adults Featured in AoA’s November
Widget

Eldercare Locator Takes on a New Look for a Rapidly Aging Population

2010-2011 Influenza Campaign

Other HHS News

Medicare Open Enrollment

AHRQ Launches New Website for Men

Hospitalizations for Medication and Illicit Drug-related Conditions on the Rise
among Americans Ages 45 and Older

More News

Scholarship Opportunity for Graduate Students

NCOA to Sponsor Webinar on Vision and Aging

Additional National Observances in November

Medical Marijuana Raises Tough Questions in Nursing Homes - NYTimes.com

Image via WikipediaBy NUSHIN RASHIDIAN AND ALYSON MARTIN

Every night before bed, Norma Winkler, 82, opens a small jar of cannabis oil and measures out a quarter-teaspoon to mix with homemade applesauce. Soon after she eats it, she drifts off to sleep.

Ms. Winkler, who lives in Rhode Island, where medical marijuana is legal, has endured chronic back pain since a car accident fractured her skull and spine at age 15. Operations haven’t helped, and other medicines don’t touch the pain that can keep her up through the night.

“It’s really been a lifesaver for me,” Ms. Winkler said of her cannabis oil. “I used to walk into the walls sometimes. I was so tired because I didn’t sleep.”

Today, she’s healthy enough to remain independent in her home and to operate the jewelry factory she owns. But she worries about what will happen if she needs institutional care. Would a long-term care facility allow her to use this particular medicine?

“I wouldn’t go if they didn’t allow me to take it,” Ms. Winkler said.
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Marijuana, Once Divisive, Brings Some Families Closer - NYTimes.com

Image via WikipediaBy JOHN LELAND

To the rites of middle-age passage, some families are adding another: buying marijuana for aging parents.

Bryan, 46, a writer who lives in Illinois, began supplying his parents about five years ago, after he told them about his own marijuana use. When he was growing up, he said, his parents were very strict about illegal drugs.

“We would have grounded him,” said his mother, who is 72.

But with age and the growing acceptance of medical marijuana, his parents were curious. His father had a heart ailment, his mother had dizzy spells and nausea, and both were worried about Alzheimer’s disease and cancer. They looked at some research and decided marijuana was worth a try.

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The Safety of Tiotropium — The FDA’s Conclusions

Theresa M. Michele, M.D., Simone Pinheiro, Sc.D., and Solomon Iyasu, M.D., M.P.H. - New England Journal of Medicine

Chronic obstructive pulmonary disease (COPD) is a leading cause of death worldwide, and the rate of COPD-related death is increasing.¹ No current drug therapy alters the progressive decline in lung function that characterizes this disease. In 2004, the Food and Drug Administration (FDA) approved the use of tiotropium delivered by the HandiHaler device, the first long-acting anticholinergic bronchodilator for treatment of COPD. Trials supporting tiotropium’s approval demonstrated sustained bronchodilation over a 24-hour period. More recent studies have shown that treatment with the tiotropium HandiHaler reduces COPD exacerbations. Concerns have been raised, however, about tiotropium’s safety. In particular, disparate sources have identified stroke, cardiovascular events, and death — which have been studied as individual or composite end points — as possible adverse outcomes.

Dilation Of Blood Vessels Restores Muscle Synthesis In Elderly

University of Texas Medical Branch at Galveston researchers believe they've found a way to use widely available blood pressure drugs to fight the muscular weakness that normally accompanies aging.

The discovery draws on research linking the loss of muscle mass with age-related changes in the behavior of the hair-thin blood vessels, or capillaries, which supply muscles with the amino acids they need for growth.

"When a young person eats food, insulin secretion causes the blood vessels in the muscle to dilate, so a lot of blood goes into the muscle and a lot of amino acids are available to build muscle proteins," said UTMB professor Elena Volpi, senior author of a paper on the work ("Pharmacological vasodilation improves insulin-stimulated muscle protein anabolism but not glucose utilization in older adults") now available in the "Online Ahead of Print" section of the journal Diabetes. "Older people's blood vessels have far less response to insulin, but we found that if you give them a drug that causes them to dilate, you can increase the nutritive flow to the muscles and completely restore normal growth."

Drugs that induce blood vessels to widen, called vasodilators, are commonly used to control high blood pressure and prevent angina. The UTMB study used sodium nitroprusside, a drug used in hospitals and administered intravenously.
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What to Tell Alzheimer’s Patients After a Trial Goes Awry - NYTimes.com

Image via CrunchBaseby Gina Kolata

Dr. Joel Ross, the founder and chief executive of the Memory Enhancement Centers of New Jersey, makes his living enrolling subjects in drug company clinical trials that are testing drugs for Alzheimer’s disease, among others.

So when Eli Lilly announced last week that its promising Alzheimer’s drug was making patients worse and that it was halting two large clinical trials, it seemed likely that Dr. Ross would hear from family members of his patients. Are other experimental Alzheimer’s drugs safe? they might ask. Should they get their family members out of those Alzheimer’s studies?

Not a single family member called. And Dr. Ross is not sure why.

If a study of an experimental breast cancer drug was ended because it made the cancer grow and spread, women in other breast cancer studies of similar drugs would be calling their doctors and asking what to do.

But Alzheimer’s is different. “It may reflect the incredible desperation surrounding Alzheimer’s disease,” said Baruch Brody, director of the Center for Medical Ethics and Health Policy at Baylor College of Medicine.
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A Caution on Antacids for Older Patients - The New Old Age Blog - NYTimes.com

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By PAULA SPAN

They’re among the most widely prescribed medications in the world. They’re reasonably safe for most people to take. That’s why drugs that reduce stomach acid — used to combat heartburn, acid reflux and ulcers — don’t get much scrutiny from doctors, or from patients.

“When patients were admitted to our geriatric wards, a lot of them didn’t have clear indications for taking these drugs,” said Dr. Ian Logan, a Scottish physician and co-author of a recent editorial on acid suppressants in the journal Age and Ageing. “And they’d remained on them for a lot longer than they should have.” One of his patients had been taking an acid-reducer for 15 years.

Dr. Logan and two colleagues with Britain’s National Health Service decided to sound the alarm — rather, to sound it once more, as researchers began discovering problems with these drugs years ago. “They do have significant side effects, especially in older patients,” Dr. Logan told me in an interview.
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Drug Info Pamphlets Inconsistent from MedPage Today

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By Kristina Fiore, Staff Writer, MedPage Today

The content, formatting, and word count of leaflets pharmacies hand out with medicines are inconsistent and should be subject to FDA guidance, researchers say.

Among written instructions given out with prescriptions of lisinopril (Prinivil, Zestril) and metformin (Fortamet, Glucophage, Glumetza, Riomet), about half failed to include directions on use and raised questions about comprehensibility, Almut G. Winterstein, PhD, of the University of Florida, and colleagues reported in the Aug. 9/23 issue of Archives of Internal Medicine.

"Private sector initiatives to provide useful [consumer medication information] have failed," they wrote. "Research is needed on effective information selection and presentation in terms of effects on comprehension, retention, and appropriate patient actions to derive optimal drug benefit."

The FDA regulates label information and guides that accompany drugs with safety concerns but not the content and format of consumer medication information (CMI) documents. The agency does, however, have a set of eight standards for CMI leaflets:

• State drug name and indication
• List contraindications
• Include directions about use
• Note precautions and potential harms
• List symptoms of possible adverse reactions
• Include general information and encourage patients to ask questions
• Be scientifically accurate
• Be comprehensible and legible

To assess the consistency of these documents, "professional shoppers" filled prescriptions for lisinopril and metformin in a national sample of 365 independent and chain pharmacies.

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Glucosamine Fails to Ease Aching Backs from MedPage Today

By Michael Smith, North American Correspondent, MedPage Today

Although it is widely used, glucosamine has no effect on chronic low back pain and degenerative lumbar osteoarthritis, researchers said.

In a large randomized double-blind trial, patients getting both glucosamine and placebo had similar changes in pain-related disability after six months of treatment and six months of follow-up, according to Philip Wilkens, MChiro, of Oslo University Hospital in Norway, and colleagues.

There was also no difference in pain itself, health-related quality of life, and the use of other medications or therapies for pain, Wilkens and colleagues said in the July 7 issue of the Journal of the American Medical Association.

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Drug Makers Share Data From Failed Trials - WSJ.com

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By SHIRLEY S. WANG

Drug makers' attempts to find treatments for Alzheimer's disease have produced scant results and a long string of busts. Now a broad effort is under way to learn something from those failures.

A group of major pharmaceutical companies will share pooled data from failed clinical trials in an attempt to figure out what is going wrong in the studies and what can be done to improve drug development.
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