Anti-psychotic drugs link to pneumonia

I have been warning against this for many years, but I also counsel on the effective use of vitamin A in high dose for short term use to prevent and correct pneumonia.

Nettle tea is also very helpful in the strengthening of the lungs.

Perhaps some of the readers of the Annals of Internal Medicine will take heed.

Anti-psychotic pneumonia warning
The use of anti-psychotic drugs in the elderly doubles the risk of potentially fatal pneumonia, say Dutch researchers.

A study of almost 2,000 patients found the increased risk starts soon after treatment begins and concluded that patients should be closely monitored.

An expert review published in 2009 found the drugs are overused in many cases and are responsible for up to 1,800 deaths in the UK every year.

Ministers have said they want to see a significant cut in their use.

The latest research published in the Annals of Internal Medicine compared the health records of 258 over-65s with pneumonia with 1,686 patients without the infection.

“ This paper yet again gives us evidence why we should not prescribe them unless absolutely necessary ” Professor Steve Field, Royal College of GPs

Of those with pneumonia, a quarter died within a month.

When they looked at prescribed drugs, they found current use of anti-psychotics was associated with a roughly two-fold increase in the risk of pneumonia.

Those on the newer types of anti-psychotic drugs were slightly less likely to have the infection than those on the older class of drugs but were still at significant increased risk.

The risk was found to start soon after treatment and increased the higher the dose of drugs the patient was prescribed.

Evidence

The researchers from Erasmus University Medical Center in Rotterdam said: "Clinicians who start treatment with anti-psychotic drugs should closely monitor patients, particularly at the start of therapy and if high doses are given."

Last year's UK review found that around 180,000 dementia patients a year are given the drugs in care homes, hospitals and their own homes to manage aggression but only around 36,000 would actually benefit from them.

Measures suggested in the report and accepted by the government included better monitoring of prescribing practices and ensuring that, where necessary, they were prescribed for short periods of time.

Professor Steve Field, chair of the Royal College of GPs said: "Anti-psychotics are prescribed too frequently without doctors thinking about the consequences.

"This paper yet again gives us evidence why we should not prescribe them unless absolutely necessary and if you do you should closely monitor the patient."

Story from BBC NEWS:http://news.bbc.co.uk/go/pr/fr/-/2/hi/health/8599443.stm

Published: 2010/04/05 23:49:58 GMT, © BBC MMX

Drugs Slow Elders' Recovery

These reports are of high interest to me because they relate to a situation in my own family. It is highly important to understand that as you age your ability to metabolize drugs and other substances, as well as clear their metabolites through your liver and kidneys becomes impaired.
In my mother's situation she was - for the last six years of her life - grossly over medicated, and that list of drugs included several that the research showed definitively that they should not be administered to the elderly, and especially not to elderly women.
Regardless of the data presented, neither the care center or my brother, who had POA, made any effort to act for the best interest of my mother's health and quality of life.

Sedating Drugs May Slow Elders' Recovery By Ed Susman, Contributing Writer, MedPage Today, January 15, 2010

Elderly patients sedated with morphine or haloperidol (Haldol) were less likely to to be discharged to their homes than patients given other sedatives, according to research presented here.
MIAMI BEACH -- Elderly patients sedated with morphine or haloperidol (Haldol) in surgical intensive care units were less likely to to be discharged to their homes and more likely to be discharged to a nursing facility than patients given other sedatives, often resulting in a poorer quality of life, researchers reported here.
Patients who received morphine were 2.57 times more likely to be discharged to a nursing home, rehabilitation center, or a skilled nursing facility (P=0.029), Carrie Miller, MS, CRNP of the Hospital of the University of Pennsylvania in Philadelphia, told attendees at the annual meeting of the Society of Critical Care Medicine.
Patients who were given haloperidol were 12.46 times more likely to be discharged to one of those facilities rather than to their home.
Similarly, the risk of having a significantly reduced function from baseline admission was five times greater if the patient had received haloperidol (P=0.044) and 2.76 times more likely if the patient had received morphine (P=0.011), Miller said.
"While older adults frequently require medications to treat pain, anxiety, and delirium, little is know about the effects these medication have on older adults' functional ability or quality of life," Miller said.
To shed some light on the question, she and her colleagues evaluated 114 patients in three surgical ICUs. Mean age was about 75, some 60% were men, and 85% were white. Overall, 37% were undergoing general surgical procedures, while 35% had undergone vascular procedures and 16% were trauma patients.
Patients' level of consciousness and delirium status were assessed daily and information about medication use was gleaned from the ICU flow sheet and the computerized administration record.
The most frequently used narcotic in the surgical ICU was fentanyl (Duragesic), administered to 77 patients; the most frequently used sedative was midazolam (Versed); and the most frequently used antipsychotic was haloperidol.
Miller and her colleagues noted that use of propofol (Diprivan) appeared to be associated with better outcomes as far as discharge to one's home was concerned.
They noted that there was "considerable discrepancy" between medication usage and dosage recorded on the patients' flow sheet and medication administration record. "Researchers and clinicians should consider that administered prn medications may not always be recorded on the nursing flow sheet," they concluded.
The study did not control for confounding variables such as the severity of illness or comorbidities that may have affected outcomes, Miller said.
"This is an interesting study," said Suzan Streichenwein, MD, a private practice geriatric psychiatrist in West Palm Beach, Fla. "It would be valuable for future studies to include the severity of illness or more specific details about the type of surgery relative to the dosages of morphine used and its influence on the discharge functional outcomes.
"Tests diagnosing mild cognitive impairment and/or dementia preop versus postop as well as the time period under anesthesia in relation to outcomes would also be helpful," said Streichenwein, who was not involved in the study.
Streichenwein told MedPage Today that other possible confounding factors require further studies in this area.

None of the clinicians had relevant financial disclosures.
Primary source: Society of Critical Care Medicine
Source reference:
Balas M, et al "Narcotic, sedative and antipsychotic medication use in older surgical intensive care unit patients" SCCM 2010; Abstract 1000.
© 2004-2010 MedPage Today, LLC. All Rights Reserved

Call to end exclusion of elderly from drug trials

This news story caught my eye because I have become concerned about this very issue over the past six or seven years. In my way of thinking it is important to set up specific drug trials not just for Elders but for children and women too.

In 2003 my mother suffered a closed head injury, and as a result of her fall and the TBI she developed expressive aphasia.

Expressive aphasia is condition  and an acquired disorder of language due to brain damage. Most aphasias and related disorders are due to stroke, head injury, cerebral tumors, or degenerative diseases.  People may lose the ability to produce speech, to comprehend speech, to repeat, and to hear and read words in many nuanced ways. Language difficulties can also be affected by pharmaceutical drugs often over used in faculties that care for Elders.

Speech and language therapy is the mainstay of care for people with with aphasia. The timing and nature of the interventions for aphasia vary widely. Blinded studies are limited, and recovery of many degrees is expected.  Studies also indicate that speech and language therapy does improve clinical outcomes in aphasia, but individualized programs are important. 

The potential for functional recovery from primarily expressive aphasia after stroke is excellent. A neurologist should be key in evaluation and care, as well as speech therapy.

After her injury, my mother was placed in a 5 Star facility in Naples, Florida.  She was loaded up with an over abundance of psychotropic drugs, including  Zyprexa, yet did not have a neurologist or speech therapy prescribed.

Zyprexa is questionable for the elderly, especially for use in elderly women, and it can precipitate diabetes.  The case in point is that regardless of the number of drugs prescribed, and failure of the center to evaluate the drugs for interaction, no one except me questioned the use of this drug in my mother's care.  Zyprexa has an unusually difficult time being excreted by older women and as a result has a longer half-life.

Another drug being given to my mother, not prescribed by a neurologist, was Neurontin, and it is implicated in the development of impaired speech. And yet another one of the several SSRIs perscribed has a known side effect of suicidal thinking.  My mother tried to jump out of a window.  The outcome: more drugs to sedate her further.

The house psychiatrist diagnosed my mother as depressed.  Yet when I asked how he diagnosed her with the aphasia, he could not answer.  He just prescribed more drugs.

I contacted a colleague in the pharmaceutical research section dealing with psychotropic durgs at the FDA for an opinion on the list of drugs prescribed to my mother.  He was shocked, and especially noted the severe issues indicated by the drug interaction profile.

The care center supplying pharmacy never conducted a thorough interaction profile. 

The attending GP, a whining DO from a near by town, most likely interested in the Medicare reimbursement more than my mother's condition, whined to my brother after I talked with him, saying he did not like the questions I was asking.

The director of nursing threatened forced relocation if my mother was taken off any of the drugs.  Since the bill went to Medicare I am sure reimbursement was more the concern than my mother's well being.  And of course there is the issue of staff convenience.

Well, my mother died last summer.  She won't be forced now to take any more drugs, but for six years which must have been agonizing for her, she was over drugged and could not communicate.

My little brother, who held POA, a player in the insurance/finance business, made absolutely no effort to see that my mother was taken to a nationally recognized neurologist in Naples.  Nor would acknowledge my concerns over the drugs and her treatment.  He failed to get her even the most clearly established care for  the aphasia, but was concerned over the cost of the drugs.

He also failed to tell the care center that my mother had a daughter, and didn't make any effort to contact me about this incident until three months after it happened.

Read the complete areticle here - http://news.bbc.co.uk/2/hi/health/8487509.stm