Chronic Obstructive Pulmonary Disease in Older Adults: Part II: Considerations for Inhaler Selection.

Inhaler administration for patients with chronic obstructive pulmonary disease (COPD) can be challenging, as it requires correct recall and execution of multiple steps. Older adults may have a higher risk of incorrectly administering inhalers versus the general population due to age-related visual, cognitive, and functional impairments. The Global Initiative for Chronic Obstructive Lung Disease (GOLD) 2018 report states that in addition to advanced age, use of multiple inhalers and lack of previous inhaler education can negatively impact technique. Improper inhaler use can lead to poor disease control, increased acute care utilization, and reduced quality of life. Therefore, regular evaluation of technique is emphasized by the GOLD guidelines to improve patient outcomes. Health care professionals on geriatric interdisciplinary teams can work together to achieve proper technique and evaluate for age-related limitations that may guide the choice of inhalers in older adults with COPD. [Journal of Gerontological Nursing, 44(10), 10-15.].

Implications of Recent Drug Approvals for Older Adults.

More than 100 medications were approved by the US Food and Drug Administration as new drugs or for new indications in 2014 and 2015. Several of the new drugs may benefit older adults, but adverse events and pharmacokinetic changes due to aging must be considered. This article will focus on three recently approved drugs that are marketed for chronic conditions that can affect older adults: suvorexant, for treatment of insomnia; edoxaban, for prevention of stroke and systemic embolism in patients with nonvalvular atrial fibrillation and for treatment of venous thromboembolism; and droxidopa, for treatment of symptomatic neurogenic orthostatic hypotension. Information about indications, mechanisms of action, dosing, efficacy, and safety are reviewed. The place of each agent in therapy for older adults is also discussed.

An Update on Geriatric Medication Safety and Challenges Specific to the Care of Older Adults.

The prescribing of drug therapies in older adults presents a number of safety challenges. The increased complexity of chronic care for older adults has led to polypharmacy and potentially inappropriate medication use, which can contribute to drug-induced diseases, adverse drug reactions, drug interactions, cognitive impairment, falls, hospitalization, and mortality. In this review, the authors discuss recent medication safety literature pertaining to the classes of medications commonly prescribed to older adults: anticholinergics, psychiatric medications, and antibiotics. Safety concerns associated with the use of these medications and the implications for long-term care practitioners are reviewed. The information provided can be used to inform and improve geriatric care delivered by practitioners across health care environments.

Impact of pharmacist-conducted medication reconciliation at discharge on readmissions of elderly patients with COPD.

PURPOSE: Beginning in fiscal year 2015, the Centers for Medicare and Medicaid Services will measure all-cause readmissions for patients admitted for exacerbation of chronic obstructive pulmonary disease (COPD). Hospitals will incur a payment penalty for unplanned 30-day readmissions. Elderly patients frequently present a challenge because of polypharmacy, which contributes to a greater risk for medication-related readmissions. OBJECTIVE: To determine whether pharmacist-conducted medication reconciliation at discharge decreased medication discrepancies and reduced 30-day readmissions for elderly patients with COPD. METHODS: Patients aged 65 years and older admitted for a COPD exacerbation between January 31, 2012, and February 29, 2012, were included. The pharmacist reviewed the discharge form for discrepancies. Patients who were readmitted within 30 days of discharge were identified. The rate of 30-day readmission was compared with baseline data. Length of stay and cost for admission versus readmission were also assessed. RESULTS: A total of 29 patients were admitted for a COPD exacerbation; 6 medication discrepancies were identified and reported to prescribers. Four patients were readmitted within 30 days of discharge. The 30-day readmission rate was lower than the baseline rate (16.0% vs 22.2%). When comparing admissions with readmissions, a slight reduction in average length of stay and slight increase in cost was observed. CONCLUSIONS: Pharmacist-conducted medication reconciliation at discharge decreased discrepancies for elderly patients admitted for exacerbation of COPD. The 30-day readmission rate could be decreased further by expanding pharmacist responsibilities during transitions of care. This includes patient counseling, tracking outpatient adherence, selecting affordable medications, and expanding the process to include other chronic disease states.

Advancements in the treatment of head lice in pediatrics.

Head lice infestations occur commonly each year in children of all socioeconomic statuses. However, head lice have become more of a nuisance as resistance to first-line agents, such as permethrin 1% and pyrethrins, has increased. Newer topical products provide unique mechanisms of action without current signs of resistance. As with older agents, proper application of products must be emphasized to ensure that treatment is effective. In addition, nonpharmacologic measures should be taken to avoid reinfestation in the patient and to prevent the spread of lice to close personal contacts.