Association between citalopram, escitalopram and QTc prolongation in a real-world geriatric setting.

Background: Although the US Food and Drug Administration (FDA) recommended upper limits for citalopram dosing in older adults due to risk of corrected-QT (QTc) prolongation, which was adopted, and extended to escitalopram by Health Canada, the scientific basis is unclear. The objective of this study was to assess the relationship between citalopram/escitalopram dosages and QTc interval in a real-world geriatric setting.

Methods: We reviewed electronic health records at a university-affiliated geriatric health care center, over a 7-year period, to identify patients prescribed citalopram and escitalopram, who had an ECG within 90 days of initiation or dosage change.

Factors affecting access to drug therapy in the elderly.

We conducted a literature search to examine the factors that affect the access of elderly individuals to drug therapy. Factors which influenced access included physical and psychological patient factors (vision, hearing, motor control, swallowing ability, education, cognition, autoagism, any psychiatric disorders present), physician factors (education, agism, lack of adequate research in the elderly, patient and caregiver expectations) and, finally, environmental factors (health insurance and economic issues). All of these factors interact in a complex fashion and may influence optimal drug therapy in the elderly.