There is a paucity of evidence in this area and clinical decision-making requires evidence from other populations. Saliva management issues in this population are most likely to be related to dysphagia. Treatment options include behavioural/compensatory therapies which should be tried in all cases, with adjunct pharmaceutical therapies or surgical options to reduce saliva volume as clinically appropriate. CONCLUSION AND FUTURE DIRECTIONS: This group of people is complex and requires a multi-disciplinary team to guide decision-making. High quality control studies looking at the effectiveness of dysphagia therapy and guidelines regarding botulinum toxin injections are recommended.
While medicine use in the older population is high, adherence to prescribed regimens is often suboptimal. Older people may be unintentionally non-adherent due to difficulties managing and manipulating medicines. Dose administration aids are medicine packaging systems designed to reduce unintentional non-adherence by simplifying management of oral medicines and enabling people to see if they have taken their medicines. Evidence suggests dose administration aids can improve medicine adherence but the size of this benefit is unclear and there is little evidence from controlled trials in older people or people taking multiple medicines. There is no conclusive evidence that they improve health outcomes. Use of an aid is limited to medicines suitable and stable for repackaging. Other limitations include reduced user medicine knowledge and autonomy, risk of filling discrepancies and incorrect use, and increased complexity at transitions of care. Upon consideration of a dose administration aid, a comprehensive assessment of the patient's medication management and a review of their medicines is required. Dose administration aids are best combined with other medication management strategies, such as medicine lists and education, and are most effective in people who are motivated to take their medicines and who have the required physical and cognitive capacity to use an aid.
The purpose of this study was to determine the proportion of patients admitted to a major tertiary teaching hospital in Australia aged 50 years and older with a confirmed neck of femur or vertebral minimal trauma fracture, who are commenced on colecalciferol supplementation by discharge, and to describe the doses prescribed. Methods: A subanalysis of a retrospective audit of electronic medical files for patients admitted with a minimal trauma fracture of the hip or vertebra between January 1, 2016, and June 30, 2016, was conducted. Results: A total of 406 patients were screened and 64 patients were included in the audit. In this subanalysis of these 64 patients eligible for inclusion, 38 were not on any vitamin or mineral supplementation at admission. Of these, 26 patients (68.4%) had their serum colecalciferol levels measured, and 21 patients (55.2%) overall were initiated on colecalciferol. Conclusion: Over half of patients with a minimal trauma fracture were commenced on colecalciferol therapy, but a noteworthy proportion of patients remain untreated. Patients with colecalciferol levels are more likely to be initiated on therapy compared with those of whom levels were not taken during admission. This is a missed opportunity for intervention that may place patients at a higher risk of subsequent fracture; therefore, effective strategies should be implemented to address this treatment gap in the future.
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