PubMed Health⌕ Search

Biomedical subjects

J R Mort

Publications and source records attributed to J R Mort.

12 recordsLinked to original sources
PubMed2000

Prescribing potentially inappropriate psychotropic medications to the ambulatory elderly.

BACKGROUND: Psychotropic agents account for 23% to 51% of all inappropriate medications prescribed based on 1991 inappropriate medication criteria for nursing home residents. The criteria were revised to apply to all people older than 65 years. This study used the revised criteria in ambulatory settings to quantify potentially inappropriate prescription of psychotropic agents and identify associated characteristics. METHODS: The 1996 public use data files of the National Ambulatory Medical Care Survey and the National Hospital Ambulatory Medical Care Survey were analyzed for inappropriate prescription of psychotropic medications for the elderly in office-based settings and outpatient departments. Disease-independent and disease-dependent criteria were analyzed. RESULTS: Elderly patients were prescribed a psychotropic agent in 8. 7% of all visits, antidepressant and antianxiety agents being the most frequently prescribed medications. Commonly, elderly patients receiving psychotropic agents were female, white, aged between 65 and 74 years, and received health care in a metropolitan area. Potentially inappropriate psychotropic agents were prescribed in 27. 2% of all visits involving a psychotropic agent for the elderly. Disease-independent criteria (eg, antidepressant agents and long-acting benzodiazepines) accounted for most of the potentially inappropriate prescriptions. Factors positively associated with potentially inappropriate prescriptions included older age, "seen before" status, and antidepressant drug class, while enrollment in Medicaid, antipsychotic drug class, living in the Northeast region, and receiving health care in a metropolitan area were negatively associated. CONCLUSIONS: Potentially inappropriate prescription of psychotropic agents is very common for the elderly patient in the ambulatory setting. By focusing on the agents most frequently involved (eg, amitriptyline and long-acting benzodiazepines), provider characteristics (eg, location), and patient characteristics (eg, age), the greatest impact on potentially inappropriate prescribing can be achieved.

Adverse Drug Reaction Reporting Systems↗
PubMed2000

Inappropriate prescribing for the elderly: beers criteria-based review.

OBJECTIVE: To review currently available literature applying the Beers criteria for inappropriate medication use in the elderly to prescribing practices in various settings. DATA SOURCE: Key words including inappropriate, Beers, medication, prescribing, elderly, geriatric, and criteria were used to search MEDLINE records from January 1992 to June 1999. DATA EXTRACTION: Eight relevant studies were found that applied the Beers criteria in various healthcare settings. DATA SYNTHESIS: Each study was examined for methodologic issues, criteria used, prevalence, nature and extent of inappropriate medication use, and factors associated with their use. Despite the methodologic differences, the review revealed some consistent patterns across healthcare settings. This review has shown that: (1) most of the researchers modified the Beers criteria to examine inappropriate medication use in the elderly; (2) studies using patient-based prevalence showed that between nearly one in four (23.5%) and one in seven (14.0%) elderly patients received an inappropriate medication as defined by either the Beers list of 20 inappropriate medications or the Modified Beers list; (3) the majority of these patients received one inappropriate agent; and (4) long-acting benzodiazepines, dipyridamole, propoxyphene, and amitriptyline were among the most frequently prescribed inappropriate medications. Univariate analyses indicated that women, patients >80 years old, and Medicaid patients appeared to receive more inappropriate medications than others; however, multivariate analyses found that only a higher number of medications was consistently associated with inappropriate medication use. CONCLUSIONS: Inappropriate prescribing or use trends are noteworthy because they were observed despite methodologic differences. The findings can be instrumental in developing targeted interventions to influence future prescribing practices. More research is needed to address the national trends and healthcare impact of inappropriate drug use in the elderly.

Aged↗
PubMed1996

Managing dementia-related behavior in the community.

Inappropriate use or insufficient monitoring of psychotropic agents can have deleterious effects in dementia patients. HCFA regulations serve as a useful guide to the appropriate use of psychotropic agents for dementia patients in the community. A sizeable portion of caregivers are not trained to correctly identify the adverse effects of psychotropic agents. Acting in an advisory role, the pharmacist is a key member of the patient management team.

Anti-Anxiety Agents↗
PubMed1996

Comparison of psychotropic agent use among rural elderly caregivers and noncaregivers.

OBJECTIVE: To determine the prescription and over-the-counter (OTC) psychotropic medication and social drug (alcohol and caffeine) use patterns of community-based elderly caregivers of patients with dementia and elderly noncaregivers. DESIGN: Cross-sectional study design in which characteristics of psychotropic medication and social drug use were collected including the specific agent, frequency, dose, and reason for use. SETTING: A rural, sparsely populated agricultural area in the midwest region of the US. SAMPLE: Thirty elderly caregivers of patients with dementia were recruited through a public health agency and homemaker health aid service. Thirty elderly noncaregivers were recruited through the senior citizens center in a neighboring rural community. Data were collected by interview. RESULTS: A significantly greater number of caregivers used OTC psychotropic agents (43%) than did noncaregivers (3%; p < 0.001). In all cases these agents were used for sleep. The combined number of caregivers using prescription and OTC psychotropic products (63%) also achieved statistical significance compared with the control group (10%; p < 0.001). Caffeine was used by all members of both groups and alcohol was consumed by eight caregivers and seven noncaregivers. CONCLUSIONS: A greater percentage of rural caregivers of patients with dementia in this study took psychotropic agents compared with the noncaregiver group. OTC products for sleep were the most frequently used agents.

Aged↗
PubMed1991

Tips on communicating with the elderly.

All the concepts examined in the student research project were rated as useful by practitioners. Application of these concepts could improve interactions with your elderly patients, and ultimately, their health care.

Communication↗
PubMedDate not supplied

Psychotropic prescribing for the elderly in office-based practice.

This study employed data from the National Ambulatory Medical Care Survey (NAMCS) 1995 to (1) determine the prevalence of the prescribing of psychotropic drugs for elderly patients by office-based physicians in the United States; (2) estimate the prevalence of the prescribing of potentially inappropriate psychotropic drugs in this patient population; and (3) identify any factors that predict such prescribing. For the purposes of this study, previously developed consensus criteria were adopted defining inappropriate psychotropic drugs as those that should be avoided in the elderly. According to the NAMCS data, psychotropic medications were prescribed in an estimated 12.02 million visits by elderly patients (95% confidence interval [CI], 11.07-12.97 million). The psychotropic medications most frequently prescribed for elderly patients by office-based physicians were antidepressants and antianxiety agents. The occurrence of visits at which psychotropic medications were prescribed was greater in patients who were over 84 years of age, female, white, or from the western United States. Primary care physicians prescribed the majority of these psychotropic drugs, and most visits to psychiatrists by elderly patients resulted in the prescribing of psychotropic drugs. Office-based physicians prescribed at least one potentially inappropriate psychotropic medication in 2.03 million visits by the elderly (95% CI, 1.70-2.36 million), or 16.87% of visits by the elderly involving prescriptions for psychotropic drugs. The most frequently prescribed potentially inappropriate psychotropic drugs were amitriptyline and long-acting benzodiazepines such as diazepam, chlordiazepoxide, and flurazepam. Logistic regression analyses revealed that inappropriate prescribing of psychotropic drugs for elderly patients was associated with particular patient characteristics (visit due to an injury), drug characteristics (number of medications prescribed and the drug being an antidepressant or antianxiety agent), and physician characteristics (psychiatric specialty and location in the South or Northeast). The patterns of psychotropic prescribing found in the ambulatory setting raise concerns about the quality of care being received by elderly patients with psychiatric illnesses.

Aged↗
PubMedDate not supplied

Nightmare cessation following alteration of ophthalmic administration of a cholinergic and a beta-blocking agent.

OBJECTIVE: To document the termination of nightmares brought about by an alteration in the ophthalmic administration of beta-blocking and cholinergic agents. PATIENT: A 75-year-old man residing in a long-term care facility experienced nightly nightmares of approximately one-year duration. INTERVENTION: Other potential causes for the nightmares were eliminated. The administration of the ophthalmic agents was evaluated and the resident was then instructed to alter administration to include closure of his eyes for one or two minutes after administration. OUTCOME: Following the alteration in administration the nightmares were not present and have not reappeared in the ensuing year. CONCLUSIONS: Ophthalmic application of beta-blocking and cholinergic agents is used for the treatment of glaucoma and has been reported to cause a wide variety of central nervous system effects. Researchers have documented reduced systemic absorption and enhanced ocular retention time with specific modifications in the administration of the ophthalmic products. Based on this research the suggestion has been made that systemic adverse effects may be reduced by altering administration through use of lid closure and lacrimal occlusion. This case validates this hypothesis and provides strong evidence for the need to counsel all patients receiving ophthalmic agents on proper administration, including techniques to reduce absorption in order to avoid undesirable systemic effects.

Aged↗