Anxiety and Depression Symptoms and Every-Night Sleep Medication Use in Older Adults.

OBJECTIVE: To quantify relationship between anxiety and depression symptoms with every-night sleep medication use in the United States. DESIGN: A case-control analysis to measure association between subjects with anxiety and depression symptoms and sleep medication use. SETTING AND PATIENTS: Older adults (N = 7,590) from the National Health and Aging Trends Study. MAIN OUTCOME MEASURE: Sleep medication use every night. RESULTS: Presence of the four anxiety and depression symptoms was associated with nightly sleep medication use. Those who reported "felt down, depressed, or hopeless" almost every day had an odds ratio (OR) of 3.50 (95% confidence interval [CI] 2.28-5.37) compared with those who did not. Those who reported "little interest or pleasure in doing things" almost every day had an OR of 1.86 (95% CI 1.32-2.61) compared with those with symptoms less often. Those who reported "felt nervous, anxious, or on edge" more than half the days had an OR of 3.43 (95% CI 2.68-4.37) compared with those who experienced the symptom less frequently. Those who reported "unable to stop or control worrying" more than half the days had an OR of 2.91 (95% CI 2.25-3.77) compared with those who did not. CONCLUSION: Older adults with anxiety and depression are more likely to use sleep medications every night. Efforts must be undertaken to reduce anxiety and depression to mitigate excess consumption of sedatives.

Federal and Individual Spending on the 10 Costliest Medications in Medicare Part D from 2011 to 2015.

Access to prescription medications is critical as the U.S. population ages. Escalating drug costs have garnered mounting attention from the public with increasing federal scrutiny. The Medicare Part D program will increasingly be relied upon to support the health of our nation's older people. We reviewed the publically available Medicare Part D usage data from 2011 to 2015 to quantify the cost of the 10 costliest medications for Part D, evaluated the number of beneficiaries treated with these medications, and measured beneficiaries' out-of-pocket costs. We observed over the analysis period, an increase in spending for these medications, a reduction in number of patients that received them, with increased out-of-pocket costs for the patient. In 2015 U.S. dollars, the amount Medicare Part D spent on the 10 costliest medications increased from $21.5 billion in 2011 to $28.4 billion in 2015-a 32% increase. The number of beneficiaries who received 1 of the 10 costliest medications fell from 12,913,003 in 2011 to 8,818,471-a 32% drop, with an average annual decrease of 7.9%. Out of pocket spending by patients that use these medications increased over the study period. For beneficiaries without the low-income subsidy, the average out-of-pocket cost share for 1 of the 10 costliest medications increased from $375 in 2011 to $1,366 in 2015-a 264% increase overall and an average 66% increase per year. Specialty medications are a growing portion of the costliest medications. As medication costs continue to escalate, and specialty medications become more common, the U.S. will be increasingly challenged with devising mechanisms to access sustainable, affordable medications for all older adults.

Palliative care for patients with dementia in long-term care.

Seventy percent of people in the United States who have dementia die in the nursing home. This article addresses the following topics on palliative care for patients with dementia in long-term care: (1) transitions of care, (2) infections, other comorbidities, and decisions on hospitalization, (3) prognostication, (4) the evidence for and against tube feeding, (5) discussing goals of care with families/surrogate decision makers, (6) types of palliative care programs, (7) pain assessment and management, and (8) optimizing function and quality of life for residents with advanced dementia.

Long-term care of the aging population with intellectual and developmental disabilities.

The aging population with intellectual and developmental disabilities (I/DD) deserves appropriate health care and social support. This population poses unique medical and social challenges to the multidisciplinary team that provides care. In the past, long-term care (LTC) facilities played an essential role in the livelihood of this population. The likelihood that the geriatric LTC system must prepare for adequately caring for this population is high. This article conveys the need to prepare for the inclusion of the growing aging population with I/DD into long-term care with the general elderly population in the near future.

Bupropion and naltrexone: a review of their use individually and in combination for the treatment of obesity.

BACKGROUND: Bupropion and naltrexone are centrally active drugs that have shown potential efficacy - alone and in combination - for the treatment of obesity. OBJECTIVE: To explore the efficacy and safety of naltrexone and bupropion alone and in a novel combination drug that utilizes sustained-release (SR) formulations of both drugs and to evaluate their efficacy in promoting weight loss. The mechanisms of action of these centrally acting drugs are discussed. Preclinical and clinical studies of bupropion and naltrexone alone and in combination are reviewed. RESULTS/CONCLUSIONS: Both bupropion and naltrexone have been shown individually to induce weight loss. Bupropion has greater efficacy as monotherapy. Naltrexone SR potentiates the effects of bupropion SR; thus, this synergistic combination has the potential for additional weight loss compared to monotherapy. Current Phase III trials will yield further safety and efficacy information regarding these drugs in combination.

Opiates and elderly: use and side effects.

The evaluation of pain and the subsequent issue of pain control is a clinical challenge that all healthcare providers face. Pain in the elderly population is especially difficult given the myriad of physiological, pharmacological, and psychological aspects of caring for the geriatric patient. Opiates are the mainstay of pain treatment throughout all age groups but special attention must be paid to the efficacy and side effects of these powerful drugs when prescribing to a population with impaired metabolism, excretion and physical reserve. In a random chart review of 300 US veterans, 44% of those receiving an analgesic also received opioids. The increasing use of opiates for pain management by healthcare practitioners requires that those prescribing opioids be aware of the special considerations for treating the elderly. This article will address the precautions one must take when using opiates in the geriatric population, as well as the side effects and ways to minimize them.

Individualizing recommendations for weight management in the elderly.

PURPOSE OF REVIEW: This review provides current strategies for weight management in the elderly population as it can be different from young adults due to multiple factors: co-morbidities, polypharmacy, limitation of functional activities, social issues. RECENT FINDINGS: The recommendations for weight management for all age groups include exercise, diet, pharmacotherapy and surgery. In the elderly population, because of changes in age-related body composition, reduced energy requirement and expenditure, the standard young adult recommendations cannot be applied directly. The goal of weight management in the elderly differs from the young adult. The preferred method is maintenance of weight rather than aggressive weight loss with achieving a healthy, functional, and good quality of life. SUMMARY: The growing prevalence of obesity in the elderly population is becoming a major health problem and can affect functional status, can contribute to frailty and decline in activity, as well as worsening co-morbid medical problems. Practical recommendations for weight management in the elderly are challenging because of the obesity paradox in the elderly, and the lack of substantial research in this population. Individualized recommendations should be considered for elderly patients with a focus on the underlying medical problems, functional status and living environments.

Osteoporosis and diabetes.

Osteoporosis is the most prevalent metabolic bone disease in the United States. Although the disease has historically been reported mostly in white women, it can affect individuals of both sexes and all ethnic groups. The presence of osteoporosis related to diabetes is not well acknowledged and the impact of osteoporosis in a diabetic patient is often not considered. Routine screening or initiation of preventive medications for osteoporosis in all patients with type 1 or type 2 diabetes is not recommended at the present time. However, in all patients with diabetes, besides optimal glycemic control, general recommendations regarding adequate dietary calcium intake, regular exercise, and avoidance of other potential risk factors such as smoking should be given. In patients who have positive risk factors for osteoporosis, or in those who present with fractures, evaluation of bone density should be done and respective preventive or therapeutic interventions should be applied.