Topical nonsteroidal anti-inflammatory drugs for management of osteoarthritis in long-term care patients.

Osteoarthritis is common in patients ≥65 years of age. Although nonsteroidal anti-inflammatory drugs (NSAIDs) are often prescribed for osteoarthritis pain, they pose age-related cardiovascular, renal, and gastrointestinal risks. Two topical NSAIDs, diclofenac sodium 1% gel (DSG) and diclofenac sodium 1.

A comparative effectiveness trial between a post-acute care hospitalist model and a community-based physician model of nursing home care.

Introduction: To evaluate whether a designated Post-Acute Care Hospitalist (PACH) (an individual physician charged with care of most residents in the nursing home and with set hours to be in the facility each week) could improve some measureable outcomes in the long-term care setting compared with a traditional cadre of community physicians, a comparative trial was designed to measure multiple cost and care variables.

Methods: Data were collected in a historical prospective study design for 6 months before the institution of a PACH model in a nursing home in the Baltimore area. Similar data were collected in a similar setting in the same region during the same time frame.

Pharmacological management of persistent pain in older persons: focus on opioids and nonopioids.

Managing persistent pain is challenging, particularly in older adults who often have comorbidities and physiological changes that affect dosing and adverse effect profiles. The latest guideline issued by the American Geriatrics Society in 2009 is an important clinical resource on prescribing analgesics for older adults. This guideline helps form an evidence-based approach to treating persistent pain, along with other current endorsements, such as the relevant disease-specific recommendations by the American College of Rheumatology, the European League Against Rheumatism, and Osteoarthritis Research Society International, as well as opioid-specific guidelines issued by the American Pain Society, the American Academy of Pain Medicine, the Federation of State Medical Boards of the United States, and the American Society of Interventional Pain Physicians.

Faith in Practice: End-of-Life Care and the Catholic Medical Professional.

Theological discussions on appropriate courses of care for the very ill can be more difficult if information on options and outcomes is lacking. This article provides an historical review of a change in the paradigm of care in the United States and similar developed countries. End-of-life courses can vary based on underlying disease processes and health system resources.

Safety and efficacy of topical diclofenac sodium gel for knee osteoarthritis in elderly and younger patients: pooled data from three randomized, double-blind, parallel-group, placebo-controlled, multicentre trials.

Background: NSAIDs used for the treatment of osteoarthritis (OA) have dose-related risks for gastrointestinal, cardiovascular and renal adverse events (AEs), particularly in elderly patients. Topical NSAIDs reduce systemic NSAID exposure and may mitigate these risks.

Objective: To evaluate the safety and efficacy of topical diclofenac sodium 1% gel (DSG) versus vehicle in patients aged 25-64 or ≥65 years who have been diagnosed with knee OA.

Osteoporosis is underdiagnosed in skilled nursing facilities: a large-scale heel BMD screening study.

Objective: To investigate the common assertion that osteoporosis is underdiagnosed in the skilled nursing facility setting.

Methods: Skilled nursing facilities participated in a nationwide heel-screening study conducted by their local consultant pharmacists. The nursing facility residents were categorized into 4 age groups: 59 years and younger; 60 to 69 years; 70 to 79 years; and 80 years and older.

The Functional Pain Scale: reliability, validity, and responsiveness in an elderly population.

Objectives: Because of difficulty experienced in assessing pain in frail older patients and the lack of pain assessment tools with standardization in the elderly, the Functional Pain Scale (FPS), an instrument incorporating both subjective and objective components to assess pain, was developed and evaluated.

Design, Setting, Participants, And Measures: One hundred subjects more than 65 years old participated in the validity, reliability, and responsiveness (the clinical sensitivity of the instrument to change) testing of the Functional Pain Scale. Subjects were recruited from a geriatrics inpatient setting, a geriatrics outpatient setting, and a local hospice (residing in their homes).

Principles of perioperative pain management in older adults.

The consequences of poor planning for pain management during surgery of geriatric patients not only affect the immediate well-being of the patient but also have terrible socioeconomic implications. Delays in rehabilitation, increases in hospital lengths of stay, and increased comorbidity can be expected if interventions for pain management are either inadequate or excessive without appropriate monitoring. During surgery, seniors are likely to suffer from acute and chronic pain that must be addressed aggressively in the postoperative period to ensure a rapid functional recovery.

Pain management in older adults: prevention and treatment.

The release of guidelines in 1998 by the American Geriatrics Society on "The Management of Chronic Pain in Older Persons" was a breakthrough in helping to manage pain in this population. Already advances have fostered a need to update recommendations. This article focuses on the treatment strategies available for seniors that are likely to help to fulfill the obligation to relieve pain and suffering in patients.

Developing a physicians' palliative care pain hotline in Maryland.

Physicians have had relatively little formal training in pain management and palliative care. For this reason, a telephone consultation service was offered, the physicians' palliative care pain hotline, that would allow physicians to call a toll-free number and, within 15 minutes, speak to a board-certified physician in hospice and palliative medicine. To our knowledge, this is the first program of its kind.

Geriatric pain. Factors that limit pain relief and increase complications.

Persons age 65 and older are more likely than younger adults to experience chronic pain but less likely to obtain pain relief. Achieving adequate pain management for the older patient is complicated by comorbid diseases, increased risk of adverse drug reactions, and physician factors such as inadequate training in pain medicine and a reluctance to prescribe opioid medications. Nociception appears not to change with age or with the development of dementia, although a person's perception of pain and willingness to report it may change.

Vitamin D vs broad spectrum phototherapy in the treatment of seasonal affective disorder.

Seasonal Affective Disorder (SAD) is prevalent when vitamin D stores are typically low. Broad-spectrum light therapy includes wavelengths between 280-320 nm which allow the skin to produce vitamin D. This study was designed to test the hypothesis that vitamin D deficiency might play a role in SAD.