Strigolactones positively regulate chilling tolerance in pea and in Arabidopsis.

Strigolactones (SL) fulfil important roles in plant development and stress tolerance. Here, we characterized the role of SL in the dark chilling tolerance of pea and Arabidopsis by analysis of mutants that are defective in either SL synthesis or signalling. Pea mutants (rms3, rms4, and rms5) had significantly greater shoot branching with higher leaf chlorophyll a/b ratios and carotenoid contents than the wild type. Exposure to dark chilling significantly decreased shoot fresh weights but increased leaf numbers in all lines. Moreover, dark chilling treatments decreased biomass (dry weight) accumulation only in rms3 and rms5 shoots. Unlike the wild type plants, chilling-induced inhibition of photosynthetic carbon assimilation was observed in the rms lines and also in the Arabidopsis max3-9, max4-1, and max2-1 mutants that are defective in SL synthesis or signalling. When grown on agar plates, the max mutant rosettes accumulated less biomass than the wild type. The synthetic SL, GR24, decreased leaf area in the wild type, max3-9, and max4-1 mutants but not in max2-1 in the absence of stress. In addition, a chilling-induced decrease in leaf area was observed in all the lines in the presence of GR24. We conclude that SL plays an important role in the control of dark chilling tolerance.

Enhancing faba bean (Vicia faba L.) genome resources.

Grain legume improvement is currently impeded by a lack of genomic resources. The paucity of genome information for faba bean can be attributed to the intrinsic difficulties of assembling/annotating its giant (~13 Gb) genome. In order to address this challenge, RNA-sequencing analysis was performed on faba bean (cv. Wizard) leaves. Read alignment to the faba bean reference transcriptome identified 16 300 high quality unigenes. In addition, Illumina paired-end sequencing was used to establish a baseline for genomic information assembly. Genomic reads were assembled de novo into contigs with a size range of 50-5000 bp. Over 85% of sequences did not align to known genes, of which ~10% could be aligned to known repetitive genetic elements. Over 26 000 of the reference transcriptome unigenes could be aligned to DNA-sequencing (DNA-seq) reads with high confidence. Moreover, this comparison identified 56 668 potential splice points in all identified unigenes. Sequence length data were extended at 461 putative loci through alignment of DNA-seq contigs to full-length, publicly available linkage marker sequences. Reads also yielded coverages of 3466× and 650× for the chloroplast and mitochondrial genomes, respectively. Inter- and intraspecies organelle genome comparisons established core legume organelle gene sets, and revealed polymorphic regions of faba bean organelle genomes.

Neglecting legumes has compromised human health and sustainable food production.

The United Nations declared 2016 as the International Year of Pulses (grain legumes) under the banner 'nutritious seeds for a sustainable future'. A second green revolution is required to ensure food and nutritional security in the face of global climate change. Grain legumes provide an unparalleled solution to this problem because of their inherent capacity for symbiotic atmospheric nitrogen fixation, which provides economically sustainable advantages for farming. In addition, a legume-rich diet has health benefits for humans and livestock alike. However, grain legumes form only a minor part of most current human diets, and legume crops are greatly under-used. Food security and soil fertility could be significantly improved by greater grain legume usage and increased improvement of a range of grain legumes. The current lack of coordinated focus on grain legumes has compromised human health, nutritional security and sustainable food production.

Ectopic phytocystatin expression increases nodule numbers and influences the responses of soybean (Glycine max) to nitrogen deficiency.

Cysteine proteases and cystatins have many functions that remain poorly characterised, particularly in crop plants. We therefore investigated the responses of these proteins to nitrogen deficiency in wild-type soybeans and in two independent transgenic soybean lines (OCI-1 and OCI-2) that express the rice cystatin, oryzacystatin-I (OCI). Plants were grown for four weeks under either a high (5 mM) nitrate (HN) regime or in the absence of added nitrate (LN) in the absence or presence of symbiotic rhizobial bacteria. Under the LN regime all lines showed similar classic symptoms of nitrogen deficiency including lower shoot biomass and leaf chlorophyll. However, the LN-induced decreases in leaf protein and increases in root protein tended to be smaller in the OCI-1 and OCI-2 lines than in the wild type. When LN-plants were grown with rhizobia, OCI-1 and OCI-2 roots had significantly more crown nodules than wild-type plants. The growth nitrogen regime had a significant effect on the abundance of transcripts encoding vacuolar processing enzymes (VPEs), LN-dependent increases in VPE2 and VPE3 transcripts in all lines. However, the LN-dependent increases of VPE2 and VPE3 transcripts were significantly lower in the leaves of OCI-1 and OCI-2 plants than in the wild type. These results show that nitrogen availability regulates the leaf and root cysteine protease, VPE and cystatin transcript profiles in a manner that is in some cases influenced by ectopic OCI expression. Moreover, the OCI-dependent inhibition of papain-like cysteine proteases favours increased nodulation and enhanced tolerance to nitrogen limitation, as shown by the smaller LN-dependent decreases in leaf protein observed in the OCI-1 and OCI-2 plants relative to the wild type.

Behavioral cues to expand a pain model of the cognitively impaired elderly in long-term care.

BACKGROUND: The purpose of this study was to determine the relationship between hypothesized pain behaviors in the elderly and a measurement model of pain derived from the Minimum Data Set-Resident Assessment Instrument (MDS-RAI) 2.0 items. METHODS: This work included a longitudinal cohort recruited from Medicare-certified longterm care facilities across the United States. MDS data were collected from 52,996 residents (mean age 83.7 years). Structural equation modeling was used to build a measurement model of pain to test correlations between indicators and the fit of the model by cognitive status. The model evaluates the theoretical constructs of pain to improve how pain is assessed and detected within cognitive levels. RESULTS: Using pain frequency and intensity as the only indicators of pain, the overall prevalence of pain was 31.2%; however, analysis by cognitive status showed that 47.7% of the intact group was in pain, while only 18.2% of the severely, 29.4% of the moderately, and 39.6% of the mildly cognitively impaired groups were experiencing pain. This finding supports previous research indicating that pain is potentially under-reported in severely cognitively impaired elderly nursing home residents. With adjustments to the measurement model, a revised format containing affective, behavioral, and inferred pain indicates a better fit of the data to include these domains, as a more complete measure of the pain construct. CONCLUSION: Pain has a significant effect on quality of life and long-term health outcomes in nursing home residents. Patients most at risk are those with mild to severe cognitive decline, or those unable to report pain verbally. Nursing homes are under great scrutiny to maintain standards of care and provide uniform high-quality care outcomes. Existing data from federally required resident surveys can serve as a valuable tool to identify indicators of pain and trends in care. Great responsibility lies in ensuring pain is included and monitored as a quality measure in long-term care, especially for residents unable to communicate their pain verbally.

A study of longitudinal data examining concomitance of pain and cognition in an elderly long-term care population.

PURPOSE: To examine if a concomitant relationship exists between cognition and pain in an elderly population residing in long-term care. BACKGROUND/SIGNIFICANCE: Prior research has found that cognitive load mediates interpretation of a stimulus. In the presence of decreased cognitive capacity as with dementia, the relationship between cognition and increasing pain is unknown in the elderly. PATIENTS AND METHODS: Longitudinal cohort design. Data collected from the Minimum Data Set-Resident Assessment Instrument (MDS-RAI) from the 2001-2003 annual assessments of nursing home residents. A covariance model was used to evaluate the relationship between cognition and pain at three intervals. RESULTS: The sample included 56,494 subjects from nursing homes across the United States, with an average age of 83 ± 8.2 years. Analysis of variance scores (ANOVAs) indicated a significant effect (P < 0.01) for pain and cognition, with protected t test revealing scores decreasing significantly with these two measures. Relative stability was found for pain and cognition over time. Greater stability was found in the cognitive measure than the pain measure. Cross-legged effects observed between cognition and pain measures were inconsistent. A concomitant relationship was not found between cognition and pain. Even though the relationship was significant at the 0.01 level, the correlations were low (r ≤ 0.08), indicating a weak association between cognition and pain. CONCLUSION: Understanding the concomitance of pain and cognition aids in defining additional frameworks to extend models to include secondary needs, contextual factors, and resident outcomes. Cognitive decline, as with organic brain diseases, is progressive. Pain is a symptom that can be treated and reduced to improve resident quality of life. However, cognition can be used to determine the most appropriate method to assess pain in the elderly, thereby improving accuracy of pain detection in this population.

Assessment and management of chronic pain in the older adult.

OBJECTIVE: To review the assessment and recommended management of mild to moderate chronic pain in the older adult. DATA SOURCES: Medline search using the terms pain, older adult, and analgesics, current national guidelines, and authors' case experiences. DATA SYNTHESIS: Assessing pain in cognitively intact and impaired older adults is essential to safe use of psychoactive medications. Following the guidelines of the American Geriatrics Society for persistent pain in the older adult provides guidance to the safe use of analgesics and other psychoactive drugs. Dosing of acetaminophen should be limited to avoid liver toxicity, and topical analgesics are preferred for focal pain. Full-dose nonsteroidal anti-inflammatory drugs should not be used for more than short periods, in order to avoid gastrointestinal, renal, and cardiovascular complications. Potentially inappropriate opioid analgesics and safer alternatives are encouraged. A description of other psychoactive medications for neuropathic pain and the role of vitamin D and depression in chronic pain is provided. CONCLUSION: The assessment of pain and use of analgesics in the older adult should benefit and not increase drug-related morbidity and mortality.

Medication interventions for fall prevention in the older adult.

OBJECTIVE: To review fall epidemiology, risk factors, assessments and intervention methods, and outcomes in order to provide guidance to pharmacists. DATA SOURCES: Recently published articles listed in Medline and resources on the Agency for Healthcare Research and Quality website (www.ahrq.gov) identified using the search terms falls, medications and falls, fall risk factors, and falls interventions and outcomes; personal data in preparation for publication consideration by the authors; and bibliographies from gathered articles. DATA SYNTHESIS: Falls may result from multiple risk factors that should be considered to both prevent falls and intervene when a fall has occurred. Careful consideration of the total psychoactive drug load, especially psychotropic drugs, and well-planned recommendations for tapering, discontinuing, and/or replacing drugs implicated in increasing fall risk are presented. A fall risk assessment method that incorporates fall history and risk factors, current disease states and conditions, and medications that may increase fall risk is provided. Two cases with interventions and outcomes are detailed. Because anemia may increase fall risk, adequate assessment of the cause(s) of anemia and conservative recommendations to correct it may decrease fall risk. Adequate vitamin D and calcium intake also may be essential to both decrease falls and fall-related fracture risk. Suggested alternatives and tapering for drugs implicated in increasing falls are considered. Osteoporosis risk assessment is a further area requiring delineation for possible pharmacist assistance to the patient and prescriber to reduce the risk of both fall-related and nontrauma fractures. Interventions to change medications may reduce falls by up to 70%. Additional fall-related resources on the Internet are provided. CONCLUSION: Pharmacists can play an important role by identifying patients who may have fall risk factors and history and by providing information for drug changes that may reduce fall risk.

Psychotropic and psychoactive drugs and hospitalization rates in nursing facility residents

The purpose of this study was to determine if there were any differences in hospitalization rates due to total psychoactive drug «load» between those using and not or formerly using psychotropic and psychoactive medications in a skilled nursing facility; to determine if the diagnosis of dementia and the change in use and load of psychotropic and psychoactive drugs influenced hospitalization rates. Methods: An observational retrospective cohort study was conducted of patient chart, facility disposition changes and consultant pharmacist reports data from a skilled nursing facility of more than 100 beds. Some177 patients resident for 30 or more days over a 19 month period of 2978 patient-months data were tabulated. A monthly repeated-measures assessment method that incorporated all conditions, diseases and medication changes was done on each resident to determine patient demographics, medication usage, and hospitalizations. Results: The rates of hospitalization ranged from 0.04 to 0.07 per patient/month for any psychoactive usage in those with and without dementia as a diagnosis. The rate of hospitalization during the study period for those with no current psychotropic nor regular psychoactive usage was 0.02 and 0.03/pt./month for those respectively with and without the diagnosis of dementia, yet 86% of this sample had used psychotropics or other psychoactive drugs before the period of observation. Conclusion: Preliminary evidence is offered that suggests psychotropics and psychoactive drugs and the total «load» of these drugs may be associated with an increase in the rate and risk of all hospitalizations within a single skilled nursing facility (AU)

El propósito de este estudio fue determinar si había diferencias en las tasas de hospitalización debido a la carga de agentes psicoactivos en una residencia de ancianos entre los que utilizan psicotropos con los que no o los habían usado antes; determinar si el diagnóstico de demencia y el cambio en el uso y carga de medicamentos psicotrópicos y psicoactivos influye en las tasas de hospitalización. Métodos: Se realizó un estudio observacional de una cohorte retrospectiva de historiales de pacientes, cambios de situación en la residencia e informes del farmacéutico en una residencia de ancianos avanzada de más de 100 camas. Se tabularon datos de 177 residentes de 30 días o más durante un periodo de 19 meses, tabulándose un total de 2978 pacientes-mes. Se realizó un método de medidas repetidas de cambios de situaciones clínicas, enfermedades y medicación, para determinar la demografía, el uso de medicamentos y las hospitalizaciones de cada paciente. Resultados: Las tasas de hospitalización variaron de 0,04 a 0,07 por paciente/mes para el uso de cualquier psicoactivo en los que tenían o no diagnóstico de demencia. La tasa de hospitalización durante el periodo de estudio para los que no usaban actualmente psicotropos o psicoactivos fue de 0,02 y 0,03 por paciente/mes para los que tenían diagnóstico de demencia y los que no, respectivamente, aunque el 86% de esta muestra había usado psicotropos o psicoactivos antes del periodo de observación. Conclusión: Se ofrece evidencia preliminar que sugiere que los psicotropos y psicoactivos y la carga total de estos medicamentos puede estar asociada al aumento en la tasa y el riesgo de hospitalizaciones en una residenciad e ancianos avanzada (AU)

Assessment of psychotropic and psychoactive drug loads and falls in nursing facility residents.

OBJECTIVE: To determine if there were any differences in fall risk and actual falls between those who were prescribed and those who were not prescribed psychotropic and psychoactive medications in a skilled nursing facility. DESIGN: An observational, retrospective cohort study of prospective patient data in a skilled nursing facility. SETTING: A public skilled nursing facility of more than 100 beds. PATIENTS: Patient charts and consultant pharmacists' drug regimen review monthly report records for 177 patients who were residents for 30 or more days over a 19-month period during 1996-1997 were tabulated. INTERVENTIONS: A fall risk using an assessment method that incorporated patient fall history, conditions, diseases, and medications associated with falls was performed on each resident. MAIN OUTCOME MEASURES: Patient demographics, medication usage, fall risk, and fall occurrences. RESULTS: Falls occurred in 107 of 177 (60.5%) residents over the study period. There were 428 documented falls. Fall rates appeared to be directly related to the number of psychotropic drugs, but not other psychoactive medications, until two or more were used concurrently. CONCLUSIONS: Preliminary evidence suggests multiple psychotropic and psychoactive drugs may increase the risk of falls in a skilled nursing facility in proportion to the total load of these agents. Minimization of inappropriate prescribing of psychotropic and psychoactive medications in elderly nursing facility residents, as mandated by current federal guidelines, may affect the risk of falls in nursing facility patients.

Psychotropic and psychoactive drugs and hospitalization rates in nursing facility residents.

UNLABELLED: The purpose of this study was to determine if there were any differences in hospitalization rates due to total psychoactive drug "load" between those using and not or formerly using psychotropic and psychoactive medications in a skilled nursing facility; to determine if the diagnosis of dementia and the change in use and load of psychotropic and psychoactive drugs influenced hospitalization rates. METHODS: An observational retrospective cohort study was conducted of patient chart, facility disposition changes and consultant pharmacist reports data from a skilled nursing facility of more than 100 beds. Some177 patients resident for 30 or more days over a 19 month period of 2978 patient- months data were tabulated. A monthly repeated- measures assessment method that incorporated all conditions, diseases and medication changes was done on each resident to determine patient demographics, medication usage, and hospitalizations. RESULTS: The rates of hospitalization ranged from 0.04 to 0.07 per patient/month for any psychoactive usage in those with and without dementia as a diagnosis. The rate of hospitalization during the study period for those with no current psychotropic nor regular psychoactive usage was 0.02 and 0.03/pt./month for those respectively with and without the diagnosis of dementia, yet 86% of this sample had used psychotropics or other psychoactive drugs before the period of observation. CONCLUSION: Preliminary evidence is offered that suggests psychotropics and psychoactive drugs and the total "load" of these drugs may be associated with an increase in the rate and risk of all hospitalizations within a single skilled nursing facility.

A senior care clerkship for pharmacy students.

OBJECTIVE: This paper describes a 200-hour senior care clerkship for pharmacy students over a five-year period from 1998-2003. SETTINGS: This clerkship used community long-term resources of a 160+ bed skilled nursing facility, adult day care, and senior citizen centers involving medicine, pharmacy, and nursing preceptors. PRACTICE DESCRIPTION: The facility consultant pharmacist was the primary preceptor of students. He conducted pharmacy rounds and daily patient case reviews three times per week. He provided monthly drug regimen review (DRR) and quarterly drug utilization review (DUR) to the skilled nursing facility and, as needed, consultation and therapeutic recommendations to the adult day care center and the senior citizen center. PRACTICE INNOVATION: A 200-hour clerkship was developed with multidisciplinary preceptor experiences to orient internal and external PharmD students to long-term care adult consultation with the attending physicians and nurses in the three sites. Each student prepared for physician rounds by performing an intensive DRR process for selected nursing facility patients. This included a preliminary discussion with the charge nurse on the unit and the consultant pharmacist. As directed, each rotation group proposed and completed one DUR project and written report. The overall goal was to enable the student to serve as a consultant pharmacist and, upon graduation, become a certified geriatric pharmacist. Rotation-specific objectives, evaluation instruments, and DRR and DUR processes are described. MAIN OUTCOME MEASUREMENTS: Documentation of contact time, completion of DRR and DUR activities, and interprofessional communication activities. RESULTS: There were 96 students who completed a 200-hour clerkship over five, 40-hour weeks during a five-year period from 1998 to 2003. Students evaluated some 10,000 patient-months of skilled nursing facility drug therapy and completed 20 DUR projects. All former students who have provided verbal feedback on their clinical training in this rotation have indicated that the rounds and conference contact with the medical director and med passes with the nurse were the key components in that they contributed most to effective interprofessional communication beyond what the consultant pharmacist preceptor offered. CONCLUSIONS: A senior care clerkship can be enhanced with medical director preceptorship in conjunction with the facility consultant pharmacist and nursing staff. This clerkship offered an experiential training that enabled pharmacy students to more effectively communicate with attending physicians and nurses, provide senior pharmacy care, and orient students to the opportunity for geriatric pharmacist certification.

Discovery of protein-protein interactions using a combination of linguistic, statistical and graphical information.

BACKGROUND: The rapid publication of important research in the biomedical literature makes it increasingly difficult for researchers to keep current with significant work in their area of interest. RESULTS: This paper reports a scalable method for the discovery of protein-protein interactions in Medline abstracts, using a combination of text analytics, statistical and graphical analysis, and a set of easily implemented rules. Applying these techniques to 12,300 abstracts, a precision of 0.61 and a recall of 0.97 were obtained, (f = 0.74) and when allowing for two-hop and three-hop relations discovered by graphical analysis, the precision was 0.74 (f = 0.83). CONCLUSION: This combination of linguistic and statistical approaches appears to provide the highest precision and recall thus far reported in detecting protein-protein relations using text analytic approaches.

Adverse outcomes associated with inappropriate drug use in nursing homes.

BACKGROUND: Little empirical evidence exists regarding the influence and outcomes of inappropriate medication use among elderly nursing home residents. OBJECTIVE: To identify the prevalence of inappropriate medication use among elderly patients in Georgia nursing homes using the Beers criteria and identify the relationship between inappropriate drug use and the likelihood of an adverse health outcome. METHODS: A cohort design was used to review 1117 patient medical records in 15 Georgia nursing homes with a high risk of polypharmacy. Prevalence of inappropriate medication use among elderly patients, as defined by the Beers criteria, was estimated. The adverse health outcomes of hospitalizations, emergency department visits, or deaths were identified from Medicaid claims data. RESULTS: A total of 519 (46.5%) patients received at least one inappropriate medication and 143 (12.8%) patients experienced at least one adverse health outcome. Logistic regression revealed that the total number of medications taken (OR 1.139, 95% CI 1.105 to 1.173) significantly increased the likelihood of receiving an inappropriate drug, while having a diagnosis of "dementia" (OR 0.748, 95% CI 0.565 to 0.991) decreased the likelihood. Inappropriate medication use increased the likelihood of experiencing at least one adverse health outcome more than twofold (OR 2.34, 95% CI 1.61 to 3.40). Propoxyphene use alone was significantly associated with the occurrence of an adverse health outcome (OR 2.39, 95% CI 1.54 to 3.71). CONCLUSIONS: Inappropriate drug use was common in our study cohort. Inappropriate use of medication in the elderly, particularly propoxyphene, is associated with a higher risk of adverse health outcomes.

Pharmacist interventions in geriatric nursing facility NSAID therapy: a one-year follow-up study of costs and outcomes.

OBJECTIVES: To document costs and outcomes occurring with acceptance or rejection of ongoing pharmacists' interventions regarding therapy with a nonsteroidal anti-inflammatory drug (NSAID) versus acetaminophen (APAP) therapy in treating osteoarthritis in a long-term care facility in the sixth year of observation. DESIGN: A nonrandomized observational prospective cohort study with all patients resident for 30 or more days over the 12-month study period receiving NSAID or APAP therapy for osteoarthritis. SETTING: A skilled nursing facility with more than 100 beds. PATIENTS: All patients had a monthly drug regimen review, receiving full-dose NSAIDs (not low-dose aspirin alone) on a continuous basis, and were selected for intervention. A control group of patients receiving APAP on a continuous basis also was selected for comparison of outcomes. INTERVENTIONS: Patients receiving NSAIDs had (1) periodic hemoglobin and hematocrit determinations; (2) physical assessment of lower eyelid, nailbed, and stool color; (3) and a recommendation to replace NSAID with APAP or to add gastroprotective pharmacotherapy if the NSAID was continued. Patients not receiving an NSAID for osteoarthritis and continuously taking APAP served as a control group. MAIN OUTCOMES MEASURES: Cost-analysis calculations were performed for existing regimens versus cost savings that would be experienced with recommended pharmacotherapeutic interventions. RESULTS: Fourteen intervention subjects and sixteen control patients were identified. In the three patients for whom the pharmacist's recommendations were accepted within three months (11 NSAID-use months), there were three substitutions of APAP therapy observed over an additional 26 patient-months. Five of 11 patients in the NSAID group for whom pharmacists' recommendations were rejected developed gastrointestional (GI) bleeding, necessitating six hospitalizations. Two of these patients died over the study period. No group for whom APAP was accepted nor control-group patients experienced suspected GI bleeding. Total costs of the control group analgesic therapy was $756.74, or $47.30 per patient. Cost savings for APAP substitution in the intervention rejection group would exceed $91,000, while cost savings with the addition of hemoglobin and hematocrit determinations would exceed $84,200. Cost savings from addition of gastroprotectives to the NSAID would have been misoprostol, $73,000; omeprazole, $71,400. CONCLUSIONS: Refusal to accept pharmacists' intervention recommendations regarding alternatives to NSAID pharmacotherapy in this nursing facility population is associated with sustained and considerable costs, morbidity, and mortality.

Updating the Beers criteria for potentially inappropriate medication use in older adults: results of a US consensus panel of experts.

BACKGROUND: Medication toxic effects and drug-related problems can have profound medical and safety consequences for older adults and economically affect the health care system. The purpose of this initiative was to revise and update the Beers criteria for potentially inappropriate medication use in adults 65 years and older in the United States. METHODS: This study used a modified Delphi method, a set of procedures and methods for formulating a group judgment for a subject matter in which precise information is lacking. The criteria reviewed covered 2 types of statements: (1) medications or medication classes that should generally be avoided in persons 65 years or older because they are either ineffective or they pose unnecessarily high risk for older persons and a safer alternative is available and (2) medications that should not be used in older persons known to have specific medical conditions. RESULTS: This study identified 48 individual medications or classes of medications to avoid in older adults and their potential concerns and 20 diseases/conditions and medications to be avoided in older adults with these conditions. Of these potentially inappropriate drugs, 66 were considered by the panel to have adverse outcomes of high severity. CONCLUSIONS: This study is an important update of previously established criteria that have been widely used and cited. The application of the Beers criteria and other tools for identifying potentially inappropriate medication use will continue to enable providers to plan interventions for decreasing both drug-related costs and overall costs and thus minimize drug-related problems.

Drug-related problems in older adults.

Older adults are extremely vulnerable to medication misadventures. By conducting thorough medication reviews, pharmacists can identify drug-related problems and recommend targeted interventions. Pharmacists can provide medication consulting for older adults in virtually all practice settings, including community pharmacies, nursing facilities, and hospitals.

Beta-blockers are poorly tolerated by the elderly: myth or reality?

beta-blocker therapy can reduce mortality and risk of major cardiovascular events in older patients. Even though ss-blockers can provide benefits nearly equal to those experienced by younger patients, the drugs remain underutilized by the elderly. Consequently, underuse contributes to higher mortality and hospitalization rates among these patients. This derives, in part, from many factors that include physiologic changes accompanying aging, presence of comorbid diseases, use of multiple medications, issues of drug tolerability, and poor patient compliance; however, education can overcome some of these to facilitate more widespread use among elderly patients.