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Abstract
We describe the development and implementation of a home-based palliative care consult service for Veterans with advanced illness. A retrospective chart review was performed on 73 Veterans who received a home-based palliative care consult. Nearly one-third were 80 years of age or older, and nearly one-third had a palliative diagnosis of cancer. The most common interventions of the consult team included discussion of advance directives, completion of a “do not resuscitate” form, reduction/stoppage of at least 1 medication, explanation of diagnosis, referral to home-based primary care program, referral to hospice, and assessment/support for caregiver stress. The home-based consult service was therefore able to address clinical and psychosocial issues that can demonstrate a direct benefit to Veterans, families, and referring clinicians.
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Affiliation(s)
- Adam G. Golden
- University of Central Florida College of Medicine, Orlando, FL, USA
- Orlando Veterans Affairs Medical Center, Orlando, FL, USA
| | - Charles Antoni
- Orlando Veterans Affairs Medical Center, Orlando, FL, USA
| | - Denise Gammonley
- University of Central Florida, College of Health and Public Affairs, Orlando, FL, USA
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Golden AG, Xu P, Wan TTH, Issenberg SB. Estimating the Net Career Income of a Geriatrician and a Nurse Practitioner: Still Want to Be a Doctor? South Med J 2016; 109:409-14. [PMID: 27364024 DOI: 10.14423/smj.0000000000000484] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVES With a continual shortage of geriatricians, adult-gerontology primary care nurse practitioners have assumed a greater role in the delivery of outpatient care for older adults. Given the long duration of physician training, the high cost of medical school, and the lower salaries compared with subspecialists, the financial advantage of a career as a geriatrician as opposed to a nurse practitioner is uncertain. This study compares the estimated career earnings of a geriatrician and an adult-gerontology primary care nurse practitioner. METHODS We used a synthetic model of estimated net earnings during a 43-year career span for a 22-year old person embarking on a career as a geriatrician versus a career as an adult-gerontology primary care nurse practitioner. We estimated annual net income and net retirement savings using different annual compound rates and calculated the financial impact of forgiving medical student loans, shortening the duration of physician training, and reinstituting the practice pathway for geriatric medicine certification. RESULTS Career net incomes for the geriatrician did not match the nurse practitioner until almost age 40. At 65 years of age, the difference between the geriatrician and nurse practitioner was 30.6%. A higher annual compound rate was associated with an even smaller percentage difference. Combining all three health policy interventions lowered the break-even age to 28 and more than doubled the difference in career earnings. CONCLUSIONS Small estimated differences in net career earnings exist between geriatricians and adult-gerontology primary care nurse practitioners. Health policy interventions had a dramatic positive effect on geriatricians' lifetime net earnings in calculated estimates.
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Affiliation(s)
- Adam G Golden
- From the Orlando Veterans Affairs Medical Center, Orlando, Florida, the College of Medicine, the Department of Statistics and the College of Health and Public Affairs, University of Central Florida, Orlando, and the Gordon Center for Research in Medical Education, Miller School of Medicine, University of Miami, Miami, Florida
| | - Peixin Xu
- From the Orlando Veterans Affairs Medical Center, Orlando, Florida, the College of Medicine, the Department of Statistics and the College of Health and Public Affairs, University of Central Florida, Orlando, and the Gordon Center for Research in Medical Education, Miller School of Medicine, University of Miami, Miami, Florida
| | - Thomas T H Wan
- From the Orlando Veterans Affairs Medical Center, Orlando, Florida, the College of Medicine, the Department of Statistics and the College of Health and Public Affairs, University of Central Florida, Orlando, and the Gordon Center for Research in Medical Education, Miller School of Medicine, University of Miami, Miami, Florida
| | - Saul Barry Issenberg
- From the Orlando Veterans Affairs Medical Center, Orlando, Florida, the College of Medicine, the Department of Statistics and the College of Health and Public Affairs, University of Central Florida, Orlando, and the Gordon Center for Research in Medical Education, Miller School of Medicine, University of Miami, Miami, Florida
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Sheahan WT, Martinez SQ, Golden AG. Testosterone Replacement Therapy: Playing Catch-up With Patients. Fed Pract 2015; 32:26-31. [PMID: 30766069 PMCID: PMC6363308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
As patients seek treatment for low testosterone, it is important for primary care providers to understand the risks and benefits of the therapy and the off-label promotions of its advocates.
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Affiliation(s)
- William T Sheahan
- is the medical director for the Home Based Primary Care program; is an endocrinologist; and is the associate chief of staff for Geriatrics & Extended Care; all at the Orlando VAMC. Dr. Martinez and Dr. Golden are both associate professor of internal medicine at the University of Central Florida College of Medicine in Orlando
| | - Suzanne Quinn Martinez
- is the medical director for the Home Based Primary Care program; is an endocrinologist; and is the associate chief of staff for Geriatrics & Extended Care; all at the Orlando VAMC. Dr. Martinez and Dr. Golden are both associate professor of internal medicine at the University of Central Florida College of Medicine in Orlando
| | - Adam G Golden
- is the medical director for the Home Based Primary Care program; is an endocrinologist; and is the associate chief of staff for Geriatrics & Extended Care; all at the Orlando VAMC. Dr. Martinez and Dr. Golden are both associate professor of internal medicine at the University of Central Florida College of Medicine in Orlando
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Golden AG, Silverman MA, Heller A, Loyal M, Cendan J. Potential Conflicting Interests for Surgeons in End-of-Life Care. Am J Hosp Palliat Care 2014; 32:763-6. [PMID: 25070078 DOI: 10.1177/1049909114543321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Thirty-day mortality represents a variable that is commonly used to measure the quality of surgical care. The definition of 30-day mortality and the application of a risk adjustment to its measurement may vary among different organizations comparing physician quality. In the midst of this confusion, conflicting interests arise for surgeons who must weigh the potential benefit of surgical interventions to individual patients versus the potential loss of access by future patients should 30-day mortality ratings be adversely affected. Similarly, surgeons may become adversely impacted by the lack of compensation from avoiding "high-risk" cases, but might face a more severe financial impact if they have a higher mortality rating compared to their peers.
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Affiliation(s)
- Adam G Golden
- Orlando Veterans Affairs Medical Center, Orlando, FL, USA University of Central Florida College of Medicine, Orlando, FL, USA
| | | | - Andrew Heller
- Orlando Veterans Affairs Medical Center, Orlando, FL, USA
| | | | - Juan Cendan
- University of Central Florida College of Medicine, Orlando, FL, USA
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Golden AG, Gammonley D, Hunt D, Olsen E, Issenberg SB. The attitudes of graduate healthcare students toward older adults, personal aging, health care reform, and interprofessional collaboration. J Interprof Care 2013; 28:40-4. [DOI: 10.3109/13561820.2013.830595] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Abstract
Potentially avoidable hospitalizations are associated with high costs and an increased risk for iatrogenic conditions in older adult patients. Although care managers may be aware of the common potential pitfalls that may arise in the transfer of patients to and from the hospital defining best practice models has been difficult. Many current models of geriatric care have had little or no impact on lowering the rates of hospitalizations and rehospitalizations when formally studied. Health care reform legislation mandates initiatives involving new models of coordinated or guided care such as the medical home model and the accountable care organization. These new models too will face significant challenges in their attempt to provide the financial incentives and systematic changes needed to successfully address transitional care in older adults.
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Affiliation(s)
- Adam G Golden
- Department of Clinical Sciences, University of Central Florida, College of Medicine, Orlando, FL 32803, USA.
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Antoni C, Silverman MA, Nasr SZ, Mandi D, Golden AG. Providing Support Through Life's Final Chapter for Those Who Made It Home. Mil Med 2012; 177:1498-501. [DOI: 10.7205/milmed-d-12-00315] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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Affiliation(s)
- Adam G Golden
- University of Central Florida College of Medicine, Orlando, USA.
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Golden AG, Martin S, Silva MD, Roos BA. Care Management and the Transition of Older Adults From a Skilled Nursing Facility Back Into the Community. ACTA ACUST UNITED AC 2011; 12:54-9. [DOI: 10.1891/1521-0987.12.2.54] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
After hospitalization, many older adults require skilled nursing care. Although some patients receive services at home, others are admitted to a skilled nursing facility. In the current fragmented health care system, hospitals are financially incentivized to discharge frail older adults to a facility for postacute care as soon as possible. Similarly, many skilled nursing facilities are incentivized to extend the posthospitalization period of care and to transition the patient to custodial nursing home care. The resulting overuse of institution-based skilled nursing care may be associated with various adverse medical, social, and financial consequences. Care management interventions for more efficient and effective skilled nursing facility use must consider the determinants involved in the decisions to admit and maintain patients in skilled nursing facilities. As we await health care reform efforts that will address these barriers, opportunities already exist for care managers to improve the current postacute transition processes.
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Golden AG, Qiu D, Roos BA. Medication Assessments by Care Managers Reveal Potential Safety Issues in Homebound Older Adults. Ann Pharmacother 2011; 45:492-8. [DOI: 10.1345/aph.1p643] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Background Over-the-counter (OTC) medications, benzodiazepines, and barbiturates are not covered under many Medicare drug benefit plans; hence, their use by homebound older adults is largely unreported. Furthermore, the tiered design of Medicare drug formularies may in fact promote the use of older but potentially inappropriate medications. Little is known about the use of these medications in the homebound older adult population. Objective: To determine the prevalence of the use by homebound older adults of OTC drugs, dietary supplements (vitamins, minerals, and herbal products), Part D-excluded medications (benzodiazepines and barbiturates), and potentially inappropriate medications (according to Beers criteria). Methods: Patients were enrollees in a home and community-based Medicaid waiver provider. All clients were older than 65 and were dually eligible for Medicare and Medicaid. All clients met Florida Medicaid's medical and financial criteria for nursing home placement. The medication list was obtained by geriatric care managers during a home assessment. Results: A total of 3911 older adults (mean [SD] age 83.6 [8.0] years) were taking an average of 9.9 [4.8] drugs. Of these individuals. 74.5% were using an OTC medication, 41.9% were using a dietary supplement, 29.6% were using a benzodiazepine or barbiturate, and 25.2% were using at least 1 potentially inappropriate medication. Conclusions: Based on data gathered by a geriatric care management assessment, we found that most of the homebound older adults enrolled in our study used medications not included in their Medicare drug benefit. The use of potentially inappropriate medications was also common in this population. Future drug safety initiatives involving the elderly will benefit from engaging care managers in identifying and addressing the potential hazards posed by commonly used prescribed and nonprescribed medications.
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Affiliation(s)
- Adam G Golden
- Department of Clinical Sciences, University of Central Florida College of Medicine, Orlando, FL; Geriatrics and Extended Care, Orlando Veterans Affairs Medical Center, Orlando
| | - Dingxi Qiu
- College of Engineering, University of Miami, Coral Gables, FL
| | - Bernard A Roos
- Neurology, and Exercise and Sport Sciences; Director, Geriatrics Institute, Miller School of Medicine, University of Miami; Geriatric Research, Education, and Clinical Center, Bruce W. Carter Veterans Affairs Medical Center; Stein Gerontological Institute, Miami Jewish Health Systems, Miami
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Golden AG, Fass J, Tewary S, Stefanacci RG, Roos BA. Cost consideration by Medicare Part D plans may promote the use of potentially inappropriate medications. J Am Geriatr Soc 2010; 58:979-81. [PMID: 20722823 DOI: 10.1111/j.1532-5415.2010.02835.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Golden AG, Tewary S, Qadri S, Zaw K, Ruiz JG, Roos BA. The Positive Attitudes and Perceptions of Care Managers About Advance Directives. Am J Hosp Palliat Care 2010; 28:98-101. [PMID: 20834034 DOI: 10.1177/1049909110375941] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
In a previous intervention, we found that reminders from care managers failed to increase the number of their homebound older adult clients with advance directives. Thus, in the current study, we looked at the perceptions and attitudes of care managers about the need to discuss advance directives with their clients. Ninety-five care managers serving community-based nursing home—eligible older adults completed an 18-question survey, which found that care managers overwhelmingly believe it is important to address advance directives. Only 3.2% reported that discussing advance directives is time consuming. No attitudinal barriers were identified. Given their positive attitudes about advance directives, care managers need educational interventions that will provide the knowledge and skills to interact effectively with clients who are resistant to addressing end-of-life issues.
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Affiliation(s)
- Adam G. Golden
- Geriatric Research, Education, and Clinical Center and Research Service, Bruce W. Carter Department of Veterans Affairs Medical Center, Miami, Florida, USA, Geriatrics Institute, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Sweta Tewary
- Geriatric Research, Education, and Clinical Center and Research Service, Bruce W. Carter Department of Veterans Affairs Medical Center, Miami, Florida, USA
| | - Syeda Qadri
- Stein Gerontological Institute, Miami Jewish Health Systems, Miami, Florida, USA
| | - Khin Zaw
- Geriatric Research, Education, and Clinical Center and Research Service, Bruce W. Carter Department of Veterans Affairs Medical Center, Miami, Florida, USA, Geriatrics Institute, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Jorge G. Ruiz
- Geriatric Research, Education, and Clinical Center and Research Service, Bruce W. Carter Department of Veterans Affairs Medical Center, Miami, Florida, USA, Geriatrics Institute, University of Miami Miller School of Medicine, Miami, Florida, USA, Stein Gerontological Institute, Miami Jewish Health Systems, Miami, Florida, USA
| | - Bernard A. Roos
- Geriatric Research, Education, and Clinical Center and Research Service, Bruce W. Carter Department of Veterans Affairs Medical Center, Miami, Florida, USA, Geriatrics Institute, University of Miami Miller School of Medicine, Miami, Florida, USA, Stein Gerontological Institute, Miami Jewish Health Systems, Miami, Florida, USA
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Golden AG, Ma Q, Nair V, Florez HJ, Roos BA. Risk for fractures with centrally acting muscle relaxants: an analysis of a national Medicare Advantage claims database. Ann Pharmacother 2010; 44:1369-75. [PMID: 20606016 DOI: 10.1345/aph.1p210] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND In older adults, both muscle relaxants and benzodiazepines are associated with sedation and cognitive impairment. Although benzodiazepines have been linked to falls and fracture injuries, no studies have examined the risk of fracture associated with muscle relaxants. OBJECTIVE To determine whether muscle relaxants identified in the Beers criteria are associated with an increased risk of fracture injuries and to compare this risk to that with benzodiazepine use. METHODS We conducted a case-control study using both medical and pharmacy claims data from 1.5 million enrollees in the Medicare Advantage plans of a large health maintenance organization. We matched 8164 cases of fractures with 8164 controls based on age, sex, health plan, and comorbidities. We measured the use of muscle relaxants, short-acting benzodiazepines, and long-acting benzodiazepines. Adjusted odds ratios were estimated using conditional logistic regression. RESULTS After adjusting demographic and clinical covariates, muscle relaxants, long-acting benzodiazepines, and short-acting benzodiazepines were associated with a high risk of fracture injuries, with odds ratios of 1.40 (95% CI 1.15 to 1.72; p < 0.001), 1.9 (95% CI 1.49 to 2.43; p < 0.001), and 1.33 (95% CI 1.15 to 1.55; p < 0.001), respectively. CONCLUSIONS An elevated risk of fracture injuries was noted among older adults using muscle relaxants. Our findings provide evidence of an association between the risk of fractures and the use of centrally acting muscle relaxants in older adults. This association supports current recommendations advising extreme caution in prescribing muscle relaxants to older adults.
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Affiliation(s)
- Adam G Golden
- Geriatrics Institute, Miller School of Medicine, University of Miami, Miami, FL, USA.
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Golden AG, van Zuilen MH, Mintzer MJ, Issenberg SB, Silverman MA, Roos BA. A fourth-year medical school clerkship that addressed negative attitudes toward geriatric medicine. J Am Geriatr Soc 2010; 58:746-50. [PMID: 20398156 DOI: 10.1111/j.1532-5415.2010.02774.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Despite extensive educational efforts, many medical students still have negative attitudes toward the field of geriatric medicine and the care of older adult patients. This article describes a fourth-year geriatric clerkship that addressed this issue by providing opportunities for students to actively discuss many of the negative stereotypes that exist regarding geriatric medicine. Emphasis was also placed on personalizing the course content to show the relevance of geriatric medicine to all medical students. During the 2008/09 academic year, 150 students completed the rotation. Although no students expressed an interest in pursuing a career as a geriatrician, they expressed a highly favorable evaluation of this personalized geriatric clerkship and voted this clerkship "the most outstanding clinical course" at the medical school.
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Affiliation(s)
- Adam G Golden
- Geriatric Research, Education, and Clinical Center and Research Service, Bruce W. Carter Veterans Affairs Medical Center, Miami, Florida 33125, USA.
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Golden AG, Tewary S, Dang S, Roos BA. Care management's challenges and opportunities to reduce the rapid rehospitalization of frail community-dwelling older adults. Gerontologist 2010; 50:451-8. [PMID: 20185522 DOI: 10.1093/geront/gnq015] [Citation(s) in RCA: 66] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Community-based frail older adults, burdened with complex medical and social needs, are at great risk for preventable rapid rehospitalizations. Although federal and state regulations are in place to address the care transitions between the hospital and nursing home, no such guidelines exist for the much larger population of community-dwelling frail older adults. Few studies have looked at interventions to prevent rehospitalizations in this large segment of the older adult population. Similarly, standardized disease management approaches that lower hospitalization rates in an independent adult population may not suffice for guiding the care of frail persons. Care management interventions currently face unique challenges in their attempt to improve the transitional care of community-dwelling older adults. However, impending national imperatives aimed at reducing potentially avoidable hospitalizations will soon demand and reward care management strategies that identify frail persons early in the discharge process and promote the sharing of critical information among patients, caregivers, and health care professionals. Opportunities to improve the quality and efficiency of care-related communications must focus on the effective blending of training and technology for improving communications vital to successful care transitions.
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Affiliation(s)
- Adam G Golden
- Bruce W. Carter Veterans Affairs Medical Center, Geriatric Research, Education, and Clinical Center and Research Service, Miami, Florida 33125, USA.
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18
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Abstract
We studied the prevalence of specific barriers that prevent indigent homebound older adults from obtaining advance directives and tested the effectiveness of clinical reminders for lowering the number of clients without advance directives. Case managers interviewed 1569 clients to determine whether they had an advance directive. All 530 clients without advance directives were contacted 3 months later to determine if advance directives had been obtained. Clients who still did not have advance directives were asked to list 1 or more reasons they did not have advance directives. About 57.8% of the barriers identified may reflect reluctance on the part of clients to address their own mortality. Reminders by the case managers were ineffective at lowering the number of homebound older adults without advance directives. Further studies are needed to identify and design strategies for convincing this population of homebound elderly to establish advance directives.
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Affiliation(s)
| | | | | | | | - Michael A. Silverman
- Miami Miller School of Medicine and Miami Jewish Home and Hospital, Miami, Florida
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Golden AG, Daiello LA, Silverman MA, Llorente M, Preston RA. University of Miami Division of Clinical Pharmacology Therapeutic Rounds: medications used to treat anorexia in the frail elderly. Am J Ther 2003; 10:292-8. [PMID: 12845394 DOI: 10.1097/00045391-200307000-00010] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Weight loss and anorexia are common problems that are associated with increased morbidity and mortality in the growing frail elderly population. Orexigenic agents are often prescribed in an attempt to improve appetite and lean muscle mass. Much of the data regarding their benefit comes from studies involving younger patients with illnesses such as acquired immunodeficiency syndrome or cancer. This article reviews the use and potential adverse events associated with these medications in frail elderly patients. This article also discusses the effects of the different antidepressants and antipsychotics on weight gain and appetite.
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Affiliation(s)
- Adam G Golden
- Department of Internal Medicine, Orlando Regional Healthcare, Orlando, Florida 32806, USA.
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Golden AG, Petropoulos JB, Silverman MA, Musson N, Hamdan K. The use of oral nutritional supplements and anorexigenic medications in homebound older adults. J Am Geriatr Soc 2003; 51:724-6. [PMID: 12752857 DOI: 10.1034/j.1600-0579.2003.00225.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Abstract
Benzodiazepines are disproportionately prescribed to older adults. Elderly adults with comorbid medical and psychiatric conditions, elderly adults taking multiple medications, and elderly women are the most likely adults to continuously use benzodiazepines. These are also the groups of elderly who are likely to experience adverse effects, including falls, accidents, and motor vehicle crashes. Despite recommendations for short-term treatment and the potential risks of long-term use, some patients continue to receive benefit for extended time periods, occasionally years. Future research needs to be directed at improved identification of which patients will benefit from intermittent versus continuous treatment while minimizing risk for adverse side effects. In order to advance the study of the risks and benefits of benzodiazepine use, we have proposed a set of definitions for classification of use. These definitions can be used to develop clinical guidelines based on empirically derived clinical research models.
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Affiliation(s)
- M D Llorente
- Department of Psychiatry and Behavioral Sciences, University of Miami School of Medicine, Florida, USA
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Golden AG, Silverman MA, Preston RA. Prescribing medications for geriatric patients in the managed care setting. Am J Manag Care 2000; 6:610-8; quiz 619-21. [PMID: 10977468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Affiliation(s)
- A G Golden
- Department of Medicine, University of Miami School of Medicine, FL, USA.
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Golden AG, Silverman MA, Preston RA. University of Miami division of clinical pharmacology therapeutic rounds: issues in prescribing for geriatric patients and emerging practice guidelines. Am J Ther 1999; 6:341-8. [PMID: 11329119 DOI: 10.1097/00045391-199911000-00009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The geriatric population accounts for over 12% of the United States population and consumes over 25% of all prescription medications. Polypharmacy and patient noncompliance are often encountered in caring for these patients. These issues along with a variety of age-related physiologic changes and the presence of multiple medical illnesses place the elderly at an increased risk for adverse drug reactions. Especially worrisome is the use of long-acting benzodiazepines and anticholinergic medications in this population. The problem of adverse drug reactions is a common clinical problem that is of great public concern as the number of older persons in the United States continues to grow. In response, a variety of proactive measures have been developed. These measures include the development of consensus criteria for inappropriate medications, federal government regulation, expansion of the role of clinical pharmacists, and computer-assisted prescribing protocols.
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Affiliation(s)
- A G Golden
- Division of Gerontology and Geriatric Medicine, Miami, FL, USA
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Abstract
OBJECTIVES Little is known about the prescribing of medications in the growing population of homebound older adults. We report on the prevalence and pattern of inappropriate medications in a nursing home-eligible, homebound population. DESIGN A cross-sectional design. SETTING A managed care plan for individuals meeting nursing home eligibility. PARTICIPANTS 2193 homebound people older than age 60. MEASUREMENTS We reviewed the pharmacy profiles of all older homebound enrollees. We identified the average number of medications per patient and the most commonly prescribed classes of drugs. The medication profiles were also analyzed in the context of the 26 drugs/groups listed as inappropriate by the explicit criteria of Beers [Arch Intern Med 1997; 157:1531-1536]. RESULTS A total of 2193 people aged 60 to 106 (mean 82.8 +/- 8.8) were taking an average of 5.3 +/- 2.9 drugs (range 0-22). Cardiac drugs and benzodiazepines were the medications most commonly prescribed. We found 1152 of the total 11,689 prescriptions (9.9%) to be inappropriate. Eight hundred seventy-one (39.7%) of these 2193 residents had at least one inappropriate prescription, and 230 (10.4%) had two or more. Of particular concern were 285 people prescribed excessive doses of temazepam and zoldipem, 211 people taking first-generation antihistamines, 115 taking doxepin or amitriptyline, 106 taking an ergoloid, 98 taking dipyridamole, and 85 prescribed a long-acting benzodiazepine. CONCLUSIONS Our study revealed a high prevalence of psychotropic medications and inappropriate drug use among older homebound residents, a group that is at the highest risk for adverse drug reactions. Because this group is not subject to oversight by regulatory agencies, further interventional studies and provider education will be important.
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Affiliation(s)
- A G Golden
- Department of Medicine, University of Miami School of Medicine, Miami Geriatric Research, Education, and Clinical Center, Veterans Affairs Medical Center, Florida 33125, USA
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Levene N, Golden AG, Rivarola CH. Pulmonary surgery for tuberculosis in diabetic patients. J Ky Med Assoc 1967; 65:763-4 passim. [PMID: 6065497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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