[Assessment of drug treatment in geriatrics with the new FORTA criteria]. / Bewertung von Medikamenten in der Geriatrie mit der neuen FORTA-Klassifikation.

BACKGROUND: Multimorbidity in the elderly often leads to inappropriate and harmful polypharmacy. Various approaches have been used to prioritize components of drug treatment, especially as on negative lists like the Beers list. A new approach is the FORTA assessments system ( Fit f OR The Aged) in which drugs are graded as positive (A, should be given), intermediate (B or C), and negative (D should not be given). METHODS: In this pilot study of 46 patients in a geriatric ward medication was assessed on admission and at discharge, using the FORTA criteria. All changes in the number of prescribed drugs, the distribution of FORTA criteria, and the number of drug interactions were recorded. RESULTS: The use of FORTA resulted in a decrease in the total number of prescirbed drugs from 7.3 ± 2,9 to 6.7 ± 2,3 (p = 0.06), and an increase in positively assessed drugs (A / B) from 59 ± 20 to 77 ± 38 % (p < 0.01), as well as a decrease in negatively assessed drugs (D) from 7 ± 12 to 5 ± 9 % (p = 0.06). The number of drugs assessed as intermediate (C) did not change significantly. Under-treatment decreased from 65 to 39 % (p < 0.01), over-treatment from 65 % to 20 % (p < 0.01). The number of drug interactions decreased from 79 to 54 (p < 0.01). CONCLUSION: This uncontrolled pilot study indicates that the FORTA criteria can be used in day-to-day clinical care: it describes the quality of changes in drug treatment in a geriatric ward in a plausible way. This study has provided basic uncontrolled data which should be validated in controlled studies comparing the quality of treatment with or without the use of the FORTA criteria. (DKRS-ID: DRKS00000531).

The M3 muscarinic acetylcholine receptor expressed in HEK-293 cells signals to phospholipase D via G12 but not Gq-type G proteins: regulators of G proteins as tools to dissect pertussis toxin-resistant G proteins in receptor-effector coupling.

The M(3) muscarinic acetylcholine receptor (mAChR) expressed in HEK-293 cells couples to G(q) and G(12) proteins and stimulates phospholipase C (PLC) and phospholipase D (PLD) in a pertussis toxin-insensitive manner. To determine the type of G protein mediating M(3) mAChR-PLD coupling in comparison to M(3) mAChR-PLC coupling, we expressed various Galpha proteins and regulators of the G protein signaling (RGS), which act as GTPase-activating proteins for G(q)- or G(12)-type G proteins. PLD stimulation by the M(3) mAChR was enhanced by the overexpression of Galpha(12) and Galpha(13), whereas the overexpression of Galpha(q) strongly increased PLC activity without affecting PLD activity. Expression of the RGS homology domain of Lsc, which acts specifically on Galpha(12) and Galpha(13), blunted the M(3) mAChR-induced PLD stimulation without affecting PLC stimulation. On the other hand, overexpression of RGS4, which acts on Galpha(q)- but not Galpha(12)-type G proteins, suppressed the M(3) mAChR-induced PLC stimulation without altering PLD stimulation. We conclude that the M(3) mAChR in HEK-293 cells apparently signals to PLD via G(12)- but not G(q)-type G proteins and that G protein subtype-selective RGS proteins can be used as powerful tools to dissect the pertussis toxin-resistant G proteins and their role in receptor-effector coupling.

Geropsychiatric consultation for African-American and Caucasian patients.

We assessed differences in the referral rates of African-American and Caucasian elderly for geropsychiatric consultation. Reasons for referral, assigned diagnoses, and interventions made were also compared. A retrospective chart review of psychiatric consultations was completed for patients aged 65 years and older for a 2-year period. Significantly more consultations were requested Caucasian elderly (6.2%) than for African-American elderly (3.8%). African-American elderly were referred for evaluation of psychosis significantly more often and for assessment of suicide potential significantly less often than Caucasians. Consultants diagnosed African-American elderly with psychotic disorders, specifically schizophrenia, and dementia significantly more often than Caucasians. Caucasian elderly were significantly more often diagnosed with mood disorders, especially depressive disorders. Interventions/recommendations made for Caucasian and African-American elderly did not differ for the most part. Recommendations for legal measures were suggested for African-American elderly more often than for Caucasians. Differences between Caucasian and African-American elderly were observed in consultation referral rates, reasons for referral, and psychiatric diagnoses made. The potential impact of cultural variables and the racial and age differences between hospital staff and patients may account for some of these findings. Further awareness of the needs of African-American elderly is required.