Depression treatment is as effective in older (over 65) as in younger adults

Depression in later life, traditionally defined as age older than 65, is associated with disability, increased mortality, and poorer outcomes.

Compared to younger adults with depression:

- cognitive and functional impairment and anxiety are more common in older adults

- older adults with depression are at increased risk of suicide

Depression is associated with cognitive impairment and an increased risk of dementia.

A selective serotonin reuptake inhibitor (SSRI) should be the first line pharmacological treatment for depression for most older adults.

Psychological and drug treatment is as effective in older as in younger adults

References:

Depression in older adults. Rodda et al. BMJ, 2011.

Image source: Vincent van Gogh's 1890 painting At Eternity's Gate. Wikipedia, public domain.

87% of people older than 50 took one or more drug, according to Australian survey

A postal survey included a random sample of 4,500 Australians aged ≥ 50 years between in 2009-2010 and the response rate was 37%.

Medications use was very common, 87% of participants took one or more drug (called medicines in Australia) and 43% took five or more in the previous 24 hours.

Complementary medicines were used by 46% of participants.

The most commonly used medications were:

- antihypertensive agents, 43% of participants
- natural marine and animal products including fish oil and glucosamine, 32%
- lipid-lowering agents, 30%

Doctors recommended 79% of all medications and 93% of conventional medications.

Much medicines use was to prevent future disease by influencing risk factors.

In a 2011 study, 4 medication classes were linked to 67% of drug-related hospitalizations:

- warfarin, 33%
- insulins, 14%
- oral antiplatelet agents, 13%
- oral hypoglycemic agents, 11%

High-risk medications were implicated in only 1.2% of hospitalizations.

50% of these hospitalizations were among adults 80 years of age or older. 65% of hospitalizations were due to unintentional overdoses.

Classification of adverse reactions to drugs: "SOAP III" mnemonic (click to enlarge the image):



Adverse drug reactions (ADRs) affect 10–20% of hospitalized patients and 25% of outpatients.

Rule of 10s in ADR:

10% of patients develop ADR
10% of these are due to allergy
10% of these lead to anaphylaxis
10% of these lead to death

References:

A national census of medicines use: a 24-hour snapshot of Australians aged 50 years and older. Tessa K Morgan, Margaret Williamson, Marie Pirotta, Kay Stewart, Stephen P Myers and Joanne Barnes. MJA 2012; 196 (1): 50-53, doi: 10.5694/mja11.10698

4 medication classes linked to 67% of drug-related hospitalizations

Image source: Wikipedia, public domain.

Unintentional Weight Loss in Older Adults - 2014 review of Am Fam Physician

Unintentional weight loss in persons older than 65 years is associated with increased morbidity and mortality.

What are the causes?

The most common etiologies are:

- malignancy
- nonmalignant gastrointestinal (GI) disease
- psychiatric conditions

Overall, nonmalignant diseases are more common causes of unintentional weight loss in this population than malignancy.

Medication use and polypharmacy can interfere with taste or cause nausea and should not be overlooked. Social factors may contribute to unintentional weight loss.

A readily identifiable cause is not found in 16% to 28% of cases.

What tests may be done?

Recommended tests include a complete blood count, basic metabolic panel, liver function tests, thyroid function tests, C-reactive protein levels, erythrocyte sedimentation rate, glucose measurement, lactate dehydrogenase measurement, and urinalysis.

Chest radiography and fecal occult blood testing should be performed. Abdominal ultrasonography may also be considered.

When baseline evaluation is unremarkable, a three- to six-month observation period is justified.

What are the treatment options?

Treatment focuses on the underlying cause. Nutritional supplements and flavor enhancers, and dietary modification that takes into account patient preferences and chewing or swallowing disabilities may be considered. Appetite stimulants may increase weight but have serious adverse effects and no evidence of decreased mortality.

References:

Unintentional Weight Loss in Older Adults. Gaddey HL1, Holder K2. Am Fam Physician. 2014 May 1;89(9):718-722.
http://www.ncbi.nlm.nih.gov/pubmed/24784334

Image source: Wikipedia, public domain.

AMA Guide to Assessing and Counseling Older Drivers

Motor vehicle injuries are a leading cause of injury-related deaths in the older population (persons 65 years and older). Per mile driven, the fatality rate for drivers 85 years and older is 9 times higher than the rate for drivers 25 to 69 years old.

Physicians play an important role in the safe mobility of their older patients. The AMA encourages physicians to make driver safety a routine part of their geriatric medical services and the guide is freely available as PDF documents here:

AMA Physician's Guide to Assessing and Counseling Older Drivers

For example, dementia is just one of the risks that older drivers face:



Evaluation of driving risk in dementia (click to enlarge the image).

For patients with dementia, the following characteristics are useful for identifying
patients at increased risk for unsafe driving:

- Clinical Dementia Rating scale (Level A)
- caregiver’s rating of a patient’s driving ability as marginal or unsafe (Level B)
- history of crashes or traffic citations (Level C)
- reduced driving mileage or self-reported situational avoidance (Level C)
- Mini-Mental State Examination scores of 24 or less (Level C)
- aggressive or impulsive personality characteristics (Level C)

References:

AMA Physician's Guide to Assessing and Counseling Older Drivers

Evaluation of driving risk in dementia - practice parameter update

Newer airbags less effective in protecting drivers than older airbags?

Video. CNN.com

1 in 40 adults older than 40 years has glaucoma

One in 40 adults older than 40 years has glaucoma with loss of visual function.

Adults have one of the two forms of glaucoma:

- open-angle glaucoma

- angle-closure glaucoma

Diagnosis

At least half of glaucoma cases are undiagnosed. Glaucoma is mostly asymptomatic until late in the disease when visual problems arise. Vision loss from glaucoma cannot be recovered.

Treatment

Glaucoma is treated with daily eye-drop drugs, but adherence to treatment is often unsatisfactory.

Similarities to the pathogenesis of common CNS diseases mean that common neuroprotective strategies might exist. Successful gene therapy has been used for some eye diseases and may be possible for the treatment of glaucoma in the future.

References:
Glaucoma. The Lancet, Volume 377, Issue 9774, Pages 1367 - 1377, 16 April 2011.

Image source: Eyelashes, Wikipedia, Steve Jurvetson, Creative Commons Attribution 2.0 Generic license.