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Pharmacology Update: Prescribing
PHARMACOLOGY UPDATE: PRESCRIBING Ann Schmidt Luggen, PhD, GNP
Reference
Goody Prescribing Eating dark chocolate may be protective of the cardiovascular system and keep those who are healthy, healthier. Dark chocolate contains rich-flavonoids, and a high flavonoid intake confers a beneficial effect on endothelial function in healthy adults (the study subjects were young, healthy adults). Chocolate led to a significant increase in resting and hyperemic brachial artery diameter throughout this study.1 Flow-mediated dilation increased significantly. Aortic augmentation index was significantly decreased due to chocolate throughout the study. Pulse wave velocity of the carotid-femoral pulse, a measure of endothelial function, did not change to a significant extent. The study concluded that consumption of dark chocolate exerts a beneficial effect on endothelial function and may exert a protective effect on the cardiovascular system. Further studies are warranted to assess long-term effects.
Reference
1. Simon SR, Chan KA, Soumerai SB, et al. Potentially inappropriate medication use by elderly persons in U.S. health maintenance organizations: 2000-2001. JAGS 53: 227-32. See also Research Activities, Agency for Healthcare Research and Quality, May 2005. ANN SCHMIDT LUGGEN, PhD, GNP, is a professor of nursing at Northern Kentucky University in Highland Heights, and a geriatric nurse practitioner at Evercare. She serves as NCGNP section editor for Geriatric Nursing. 0197-4572/05/$ - see front matter © 2005 Mosby, Inc. All rights reserved. doi:10.1016/j.gerinurse.2005.08.011
RESEARCH REVIEW: DRIVING SAFETY FOR OLDER ADULTS Barbara Resnick, PhD, CRNP, FAAN, FAANP
1. Vlachopoulos C, Aznaouridis K, Alexopoulos N, et al. Effect of dark chocolate on arterial function in healthy individuals. Am J Hyper 2005;18:785-91. ANN SCHMIDT LUGGEN, PhD, GNP, is a professor of nursing at Northern Kentucky University in Highland Heights, and a geriatric nurse practitioner at Evercare. She serves as NCGNP section editor for Geriatric Nursing. 0197-4572/05/$ - see front matter © 2005 Mosby, Inc. All rights reserved. doi:10.1016/j.gerinurse.2005.09.001
PHARMACOLOGY UPDATE: PRESCRIBING Inappropriate Prescribing According to a recent report, and despite a decade of consensus-based recommendations, the use of inappropriate drugs in older adults continues.1 In this study, 29% of health maintenance organizations (HMOs) elderly patients received at least 1 of 33 potentially inappropriate medications. Five percent of these older adults were prescribed at least 1 of 11 drugs that “should always be avoided in elderly patients.” This study was supported by the Agency for Healthcare Research and Quality and analyzed phar-
300
macy data for nearly 160,000 elderly patients from 10 geographically diverse HMOs.
According to estimates from the Insurance Institute of Highway Safety,1 there are 23 million current drivers over age 65; 20 years from now, 25% of drivers will be over 65. Adults over age 85 are 9 times more likely to be in a fatal car accident than persons between 25 and 69 years of age. Dobbs, Heller, and Schopflocher2 concluded that drivers over 65 years with cognitive impairment made more hazardous errors than both “normal” older drivers over 65 years and “normal” younger drivers between 30 and 40 years of age. Fifty percent of the errors occurred during lane changes and merges and while approaching intersections. A recent study in the Journal of Neurology and Neurosurgical Psychiatry3 adds to our understanding of driving safety among older adults with cognitive impairment. Uc et al3 identified specific problems that seem to occur among older adults with cognitive changes when they continue to drive. Specifically, these investigators explored visual search and recognition of roadside targets and safety errors during a landmark and traffic sign identification task in drivers with Alzheimer’s disease. There were 33 drivers with probable Alzheimer’s disease of mild severity included in the study and 137 neurologically normal older adults. All of these individuals underwent a battery of visual and cognitive tests and were asked to report detection of specific landmarks and traffic
Geriatric Nursing, Volume 26, Number 5
Reference
Goody Prescribing Eating dark chocolate may be protective of the cardiovascular system and keep those who are healthy, healthier. Dark chocolate contains rich-flavonoids, and a high flavonoid intake confers a beneficial effect on endothelial function in healthy adults (the study subjects were young, healthy adults). Chocolate led to a significant increase in resting and hyperemic brachial artery diameter throughout this study.1 Flow-mediated dilation increased significantly. Aortic augmentation index was significantly decreased due to chocolate throughout the study. Pulse wave velocity of the carotid-femoral pulse, a measure of endothelial function, did not change to a significant extent. The study concluded that consumption of dark chocolate exerts a beneficial effect on endothelial function and may exert a protective effect on the cardiovascular system. Further studies are warranted to assess long-term effects.
Reference
1. Simon SR, Chan KA, Soumerai SB, et al. Potentially inappropriate medication use by elderly persons in U.S. health maintenance organizations: 2000-2001. JAGS 53: 227-32. See also Research Activities, Agency for Healthcare Research and Quality, May 2005. ANN SCHMIDT LUGGEN, PhD, GNP, is a professor of nursing at Northern Kentucky University in Highland Heights, and a geriatric nurse practitioner at Evercare. She serves as NCGNP section editor for Geriatric Nursing. 0197-4572/05/$ - see front matter © 2005 Mosby, Inc. All rights reserved. doi:10.1016/j.gerinurse.2005.08.011
RESEARCH REVIEW: DRIVING SAFETY FOR OLDER ADULTS Barbara Resnick, PhD, CRNP, FAAN, FAANP
1. Vlachopoulos C, Aznaouridis K, Alexopoulos N, et al. Effect of dark chocolate on arterial function in healthy individuals. Am J Hyper 2005;18:785-91. ANN SCHMIDT LUGGEN, PhD, GNP, is a professor of nursing at Northern Kentucky University in Highland Heights, and a geriatric nurse practitioner at Evercare. She serves as NCGNP section editor for Geriatric Nursing. 0197-4572/05/$ - see front matter © 2005 Mosby, Inc. All rights reserved. doi:10.1016/j.gerinurse.2005.09.001
PHARMACOLOGY UPDATE: PRESCRIBING Inappropriate Prescribing According to a recent report, and despite a decade of consensus-based recommendations, the use of inappropriate drugs in older adults continues.1 In this study, 29% of health maintenance organizations (HMOs) elderly patients received at least 1 of 33 potentially inappropriate medications. Five percent of these older adults were prescribed at least 1 of 11 drugs that “should always be avoided in elderly patients.” This study was supported by the Agency for Healthcare Research and Quality and analyzed phar-
300
macy data for nearly 160,000 elderly patients from 10 geographically diverse HMOs.
According to estimates from the Insurance Institute of Highway Safety,1 there are 23 million current drivers over age 65; 20 years from now, 25% of drivers will be over 65. Adults over age 85 are 9 times more likely to be in a fatal car accident than persons between 25 and 69 years of age. Dobbs, Heller, and Schopflocher2 concluded that drivers over 65 years with cognitive impairment made more hazardous errors than both “normal” older drivers over 65 years and “normal” younger drivers between 30 and 40 years of age. Fifty percent of the errors occurred during lane changes and merges and while approaching intersections. A recent study in the Journal of Neurology and Neurosurgical Psychiatry3 adds to our understanding of driving safety among older adults with cognitive impairment. Uc et al3 identified specific problems that seem to occur among older adults with cognitive changes when they continue to drive. Specifically, these investigators explored visual search and recognition of roadside targets and safety errors during a landmark and traffic sign identification task in drivers with Alzheimer’s disease. There were 33 drivers with probable Alzheimer’s disease of mild severity included in the study and 137 neurologically normal older adults. All of these individuals underwent a battery of visual and cognitive tests and were asked to report detection of specific landmarks and traffic
Geriatric Nursing, Volume 26, Number 5