Summary
What is Known and objective
Hot days are increasingly common and are often associated with increased morbidity and mortality, especially in the elderly. Most heat‐related illness and heat‐related deaths are preventable.
Comment
Medicines may accentuate the risk of dehydration and heat‐related illness, especially in elderly people taking multiple medicines, through the following mechanisms: diuresis and electrolyte imbalance, sedation and cognitive impairment, changed thermoregulation, reduced thirst recognition, reduced sweat production, and hypotension and reduced cardiac output.
What is new and conclusion
Commonly used medicines that may significantly increase the risk include diuretics, especially when combined with an angiotensin converting enzyme (ACE) inhibitor or an angiotensin II receptor blocker (ARB), anticholinergics and psychotropics. Initiation of individualized preventive measures prior to the start of the hot weather season, which includes a review of the patient and their medicines to identify thermoregulatory issues, may reduce the risk of heat‐related illness or death.
Our findings suggest that the TOP 5 program, or an adaptation of the TOP 5 program, such as ours, has potential to improve the health and care of people with dementia and their carers by using patient centerd nonpharmacological approaches and avoiding the unnecessary use of antipsychotics for behavioral and psychological symptoms of dementia. Longer-term follow-up would help to establish whether the apparent benefits persist.
Abstract:Multiple medicine use is common in older Australians, with statins (hydroxymethylglutaryl coenzyme A reductase inhibitors) being among the most commonly prescribed. While there is significant evidence that statins are of benefit in people at higher levels of cardiovascular risk, the risk-benefit ratio is less assured in those 80 years and older. High doses or high-potency statins in elderly people may not increase effectiveness, but may increase the risk of adverse effects such as muscle-related aches, pains and weakness. Hence, statin use in the elderly requires frequent review and consideration of their therapeutic goals, quality of life, risk-benefit ratio and life expectancy. This paper outlines steps to consider when an older person who is prescribed a statin experiences unexplained muscle-related aches and pains or weakness.
ObjectivesTo evaluate the impact of a patient-specific national programme targeting older Australians and health professionals that aimed to increase use of emollient moisturisers to reduce to the risk of skin tears.DesignA prospective cohort intervention.ParticipantsThe intervention targeted 52 778 Australian Government’s Department of Veterans’ Affairs patients aged over 64 years who had risk factors for wound development, and their general practitioners (GPs) (n=14 178).Outcome measuresAn interrupted time series model compared the rate of dispensing of emollients in the targeted cohort before and up to 23 months after the intervention. Commitment questions were included in self-report forms.ResultsIn the first month after the intervention, the rate of claims increased 6.3-fold (95% CI: 5.2 to 7.6, p<0.001) to 10 emollient dispensings per 1000 patients in the first month after the intervention. Overall, the intervention resulted in 10 905 additional patient-months of treatment. The increased rate of dispensing among patients who committed to talking to their GP about using an emollient was six times higher (rate ratio: 6.2, 95% CI: 4.4 to 8.7) than comparison groups.ConclusionsThe intervention had a sustained effect over 23 months. Veterans who responded positively to commitment questions had higher uptake of emollients than those who did not.
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