From the Editor
Beyond Geriatric Syndromes
W
e spend a lot of time and effort in these pages covering the most common conditions—often referred to as geriatric syndromes—encountered by the oldest of our patients. Appropriate for our readers, the focus of most articles is on medication management for these conditions. As the number of older adults continues to increase, the conditions we are routinely accustomed to seeing increasingly are going to be interspersed with less-common conditions. This challenges consultant pharmacists to expand their knowledge base and to be more effective members of the health care team treating these conditions. Although the impending impact of the baby boomers on our daily practice is just beginning, now is the time to get prepared. As many readers are already aware, this will also involve a number of new medications in the specialty pharmacy arena. Multiple myeloma is primarily a disease of older adults, with the median age of diagnosis of 69 years. Recent advances in treatment have increased survival. In an “In Practice” contribution in this issue, Tali M. Johnson, an expert in cancer treatment at the National Cancer Institute and a previous contributor to the journal, provides an evidence-based review of the treatment and management of multiple myeloma. Be prepared to see patients with this condition; this review will be a great foundation. In a clinical review in this issue, Daniel Sturm, an assistant professor and physician assistant at Butler University, and colleagues provide an overview of one of the most common autoimmune disorders, multiple sclerosis. Although often diagnosed early in life, up to 10% of cases occur after 50 years of age. This is another condition that consultant pharmacists increasingly are going to encounter in their practices, and this review should provide a valuable source of information on the epidemiology, pathophysiology, and management of this progressive neurologic disease.
On the research front, Darren Triller and colleagues from a New York state quality improvement organization present their findings of a study designed to assess the impact of a multidisciplinary warfarin safety intervention in the nursing facility setting. This is an excellent example of a well-designed evaluation and provides great insight into implementing a quality-improvement initiative in the long-term care setting. The results are intriguing and timely as providers weigh the different options for anticoagulation in older adults. There are quite a few findings beyond their primary study outcome, so take some time to look at the other important results of this interesting analysis. Overactive bladder is a prevalent condition in older adults. Traditional management involves the use of antimuscarinic agents and nonpharmacologic measures such as Kegel exercises and timed toileting. Recently, a new alternative was approved by the Food and Drug Administration—OnabotulinumtoxinA, a botulinum toxin A product commonly referred to by its brand name, Botox—administered by injection into the detrusor muscle. The case study illustrates an application of use of this new option for overactive bladder as well as the management strategy needed to avoid adverse events with selected, common, concomitant therapy. Finally, student Kaitlin A. Raley and mentor Amber M. Hutchison explore a clinical controversy that has been brewing over the last decade or more: the use of statins in older adults with dementia. It is a key issue, and pharmacists should be knowledgeable about this subject. This Student Forum provides an up-to-date discussion of the risks and benefits, helping you educate yourself, colleagues, and patients and caregivers on the topic. The summer months are a great time to catch up on some writing, so we would welcome a discussion of how we can get your ideas into print. In particular, we are looking for timely subject matter for our “In Practice” series, which is geared to helping pharmacists apply their knowledge in real-life situations. We look forward to hearing your ideas. H. Edward Davidson, PharmD, MPH Editor-in-Chief Doi:10.4140/TCP.n.2014.426.
426
The Consultant Pharmacist JULY 2014 Vol. 29, No. 7
Beyond Geriatric Syndromes
W
e spend a lot of time and effort in these pages covering the most common conditions—often referred to as geriatric syndromes—encountered by the oldest of our patients. Appropriate for our readers, the focus of most articles is on medication management for these conditions. As the number of older adults continues to increase, the conditions we are routinely accustomed to seeing increasingly are going to be interspersed with less-common conditions. This challenges consultant pharmacists to expand their knowledge base and to be more effective members of the health care team treating these conditions. Although the impending impact of the baby boomers on our daily practice is just beginning, now is the time to get prepared. As many readers are already aware, this will also involve a number of new medications in the specialty pharmacy arena. Multiple myeloma is primarily a disease of older adults, with the median age of diagnosis of 69 years. Recent advances in treatment have increased survival. In an “In Practice” contribution in this issue, Tali M. Johnson, an expert in cancer treatment at the National Cancer Institute and a previous contributor to the journal, provides an evidence-based review of the treatment and management of multiple myeloma. Be prepared to see patients with this condition; this review will be a great foundation. In a clinical review in this issue, Daniel Sturm, an assistant professor and physician assistant at Butler University, and colleagues provide an overview of one of the most common autoimmune disorders, multiple sclerosis. Although often diagnosed early in life, up to 10% of cases occur after 50 years of age. This is another condition that consultant pharmacists increasingly are going to encounter in their practices, and this review should provide a valuable source of information on the epidemiology, pathophysiology, and management of this progressive neurologic disease.
On the research front, Darren Triller and colleagues from a New York state quality improvement organization present their findings of a study designed to assess the impact of a multidisciplinary warfarin safety intervention in the nursing facility setting. This is an excellent example of a well-designed evaluation and provides great insight into implementing a quality-improvement initiative in the long-term care setting. The results are intriguing and timely as providers weigh the different options for anticoagulation in older adults. There are quite a few findings beyond their primary study outcome, so take some time to look at the other important results of this interesting analysis. Overactive bladder is a prevalent condition in older adults. Traditional management involves the use of antimuscarinic agents and nonpharmacologic measures such as Kegel exercises and timed toileting. Recently, a new alternative was approved by the Food and Drug Administration—OnabotulinumtoxinA, a botulinum toxin A product commonly referred to by its brand name, Botox—administered by injection into the detrusor muscle. The case study illustrates an application of use of this new option for overactive bladder as well as the management strategy needed to avoid adverse events with selected, common, concomitant therapy. Finally, student Kaitlin A. Raley and mentor Amber M. Hutchison explore a clinical controversy that has been brewing over the last decade or more: the use of statins in older adults with dementia. It is a key issue, and pharmacists should be knowledgeable about this subject. This Student Forum provides an up-to-date discussion of the risks and benefits, helping you educate yourself, colleagues, and patients and caregivers on the topic. The summer months are a great time to catch up on some writing, so we would welcome a discussion of how we can get your ideas into print. In particular, we are looking for timely subject matter for our “In Practice” series, which is geared to helping pharmacists apply their knowledge in real-life situations. We look forward to hearing your ideas. H. Edward Davidson, PharmD, MPH Editor-in-Chief Doi:10.4140/TCP.n.2014.426.
426
The Consultant Pharmacist JULY 2014 Vol. 29, No. 7
