Falls causing injury were more than twice as likely in older men taking a particular group of commonly used medicines

 

Using data from The Irish Longitudinal Study on Ageing (TILDA), scientists from Trinity College Dublin, St James's Hospital, Dublin, Ireland and three UK Universities have discovered a significant link between serious falls causing injury in older men and a particular group of commonly used medicines. The findings are published today by the Journal of the American Geriatrics Society. Many medicines which are commonly prescribed for older people for bladder problems, depression, psychosis, insomnia, and respiratory problems, have anti-cholinergic effects. The medications affect the brain by blocking a key chemical called acetylcholine which is involved in passing messages between nerve cells. This can lead to side effects including blurred vision, increased heart rate, sedation and confusion. Previous studies have shown an impact on cognitive function and mortality from taking multiple anti-cholinergic medicines. In this important new study, the researchers led by Dr Kathryn Richardson who carried out the research at the Department of Gerontology in Trinity and at the Faculty of Medicine and Health Sciences at the University of East Anglia, examined whether the use of such medicines increased the risk of subsequent serious falls (which caused injury) in people aged over 65 years in Ireland. Using the TILDA data which recorded the medications the participants were taking and the number and type of falls they had experienced, the team found that falls resulting in injury were more than twice as likely in men taking medicines with potent anti-cholinergic activity. The effect remained even after accounting for differences in health and other risk factors for falls. A greater use of such medicines increased the risk for these men further. There was no such association for women, however. Speaking about the significance of these findings for prescribing practices in older people, lead author Dr Kathryn Richardson, a former PhD student at Trinity, who is now a Research Fellow at the University of East Anglia said: "Our findings indicate the importance for doctors, pharmacists and healthcare professionals to regularly review the appropriateness of medications taken by their older patients. It is however, important that people don't stop taking any medications before speaking with their GP. It is not fully clear why the same link was not found in women and further research is needed to explore this and the reasons behind the findings in men." Dr Richardson continued: "Experiencing a fall can have a devastating impact on older people's lives and is a major contributor to care home admission and hospitalisation, so it is vitally important for us to find ways to reduce the risk of falls or their severity." Senior author and Principal Investigator of TILDA Professor Rose Anne Kenny said: "Falls are one of the leading causes of loss of independence as people get older and the principal reason given for admission into nursing home care in Europe. If early risk factors are identified and modified, falls can be prevented. This paper highlights important new risk factors for falls." Dr Chris Fox, Clinical Reader/Honorary Consultant Psychogeriatrician at the University of East Anglia said: "With the rising levels of frailty in older people we must develop strategies to maintain health and avoid prescribing medicines which could cause a deterioration- such an approach could be simply implemented using tools available" Dr Ian Maidment, Senior Lecturer in Clinical Pharmacy at Aston University said: "After a fall, an older person may never regain the same quality of life. This research helps us to understand how medication is linked to falls. It is vital that doctors, nurses and pharmacists review medication if someone has suffered a recent fall." Story Source: The above post is reprinted from materials provided by Trinity College Dublin. Note: Materials may be edited for content and length. Journal Reference: Kathryn Richardson, Kathleen Bennett, Ian D. Maidment, Chris Fox, David Smithard, Rose Anne Kenny. Use of Medications with Anticholinergic Activity and Self-Reported Injurious Falls in Older Community-Dwelling Adults. Journal of the American Geriatrics Society, 2015; DOI: 10.1111/jgs.13543

Know it's a placebo? Study shows the 'medicine' could still work

 

You don't think you're hungry, then a friend mentions how hungry he is or you smell some freshly baked pizza and whoaaa, you suddenly feel really hungry. Or, you've had surgery and need a bit of morphine for pain. As soon as you hit that button you feel relief even though the medicine hasn't even hit your bloodstream. These are two examples of the oft-studied placebo effect that demonstrate the amazing and still somewhat confounding powers of the human brain. Now, CU-Boulder graduate student Scott Schafer, who works in Associate Professor Tor Wager's Cognitive and Affective Neuroscience Lab in the Department of Psychology and Neuroscience, has conducted an intriguing piece of research to advance knowledge about how and when the placebo effect works -- or doesn't. In short, he discovered that the placebo effect still works even if research participants know the treatment they are receiving to ease pain has no medical value whatsoever. Here's the hitch: The subjects need ample time -- in this case four sessions -- to be conditioned to believe the placebo works. Then, even after it is revealed that the treatment is fake, they continue to get pain relief. When participants are told the truth about the treatment after only one session, they don't show a continued placebo effect. The findings suggest that reinforcing treatment cues with positive outcomes can create placebo effects that are independent of reported expectations for pain relief. Wager, the senior author of the study, explains: "We're still learning a lot about the critical ingredients of placebo effects. What we think now is that they require both belief in the power of the treatment and experiences that are consistent with those beliefs. Those experiences make the brain learn to respond to the treatment as a real event. After the learning has occurred, your brain can still respond to the placebo even if you no longer believe in it." Schafer, Wager, and co-author Luana Colloca, of the University of Maryland Baltimore, had their paper "Conditioned Placebo Analgesia Persists When Subjects Know They Are Receiving a Placebo" published in the May issue of The Journal of Pain, a peer-reviewed scientific publication. Schafer, 33, said his advisor helped him refine his area of research around placebos. "My general interests are specifically in how we learn to predict the environment around us," he said. "Digging into how placebos occur and when and why they arise is really interesting." To conduct the research, Schafer and Colloca applied a ceramic heating element to research subjects' forearms. They applied enough heat to induce strong pain sensations, though not enough to burn the skin. Interestingly, Schafer ended up having to turn some potential test subjects away because of a higher than normal pain tolerance on their forearms. Turns out, some of these people were food servers accustomed to carrying hot plates of food to hungry diners. After applying heat of up to 117.5 degrees Fahrenheit to the research subjects who passed the initial screening, Schafer applied what the subject thought was an analgesic gel on the affected skin then -- unbeknownst to the research subject -- turned down the temperature. To aid in the charade, the subject was asked to read drug forms and indicate whether they had liver problems or were taking other medications prior to receiving the treatment.. In fact, the treatment was Vaseline with blue food coloring in an official-looking pharmaceutical container. "They believed the treatment was effective in relieving pain," Schafer said. "After this process, they had acquired the placebo effect. We tested them with and without the treatment on medium intensity. They reported less pain with the placebo." For Schafer, the research findings could open doors to new ways to treat drug addiction or aid in pain management for children or adults who have undergone surgery and are taking strong and potentially addictive painkillers. "If a child has experience with a drug working, you could wean them off the drug, or switch that drug a placebo, and have them continue taking it," Schafer said. Schafer believes the brain plays a key role in subjects for whom the placebo gel worked, and that more research is warranted. "We know placebos induce the release of pain-relieving substances in the brain, but we don't yet know whether this expectation-independent placebo effect is using the same or different systems," Schafer said. Story Source: The above post is reprinted from materials provided by University of Colorado at Boulder. Note: Materials may be edited for content and length. Journal Reference:     Scott M. Schafer, Luana Colloca, Tor D. Wager. Conditioned Placebo Analgesia Persists When Subjects Know They Are Receiving a Placebo. The Journal of Pain, 2015; 16 (5): 412 DOI: 10.1016/j.jpain.2014.12.008

How to get teens, young adults with chronic conditions to take their medications

 

November 14, 2014

American Society of Nephrology (ASN)

Many young patients with chronic conditions don’t take their medications correctly, but two new studies point to ways to address such medication non-adherence. "Young adult patients are at a critical point in their educational, psychological, and professional development that will shape their future life. Increasing the survival of their transplants will lead to higher levels of education and employment rates, which will be financially beneficial to society," said one researcher.

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Many young patients with chronic conditions don't take their medications correctly, but 2 new studies point to ways to address such medication non-adherence. The studies will be presented at ASN Kidney Week 2014 November 11-16 at the Pennsylvania Convention Center in Philadelphia, PA.

In one study, researchers led by Frederick Kaskel, MD, PhD (Albert Einstein College of Medicine) and Oleh Akchurin, MD (Weill Cornell College of Medicine) looked to see how young patients are using smart phones to help them take their medications. They surveyed patients at a pediatric kidney clinic. The researchers found that the majority of teens continued to use traditional techniques of improving medication adherence, such as filling pillboxes and incorporating medications into their daily routines. Ninety-three percent of surveyed teens had a smart phone in their personal possession, but only 29% were aware about medical mobile apps, even though 50% said they used cell phones for some kind of reminders to take medications. Boys were more likely to use cell phones to remember to take medications than girls and the prevalence of 100% self-reported medication adherence was higher in teens who used cell phones for reminders.

"This study demonstrates that a number of inner city teenagers with kidney disorders are utilizing their cell phones for the management of medication administration even in the absence of organized program promoting such use," said Dr. Akchurin. "Further research efforts are required to fully describe the contemporary pattern of smart phone-based technology use in medication adherence in this population in order to allow health care providers a meaningful way to incorporate these existing practices into daily clinical activity."

In another study of kidney transplant recipients aged 17 to 30 years, Jeroen Bastiaan van der Net, MD, PhD, Paul Harden, FRCP (Oxford University Hospital, in the UK) and their colleagues found that patients who were involved in a dedicated Young Adult Service were 4 times less likely to experience loss of function of their donated organ than young adult patients who were not involved in this service. Key features of a successful Young Adult Service are a dedicated team comprised of a key physician, nurse practitioner, and youth worker; Young Adult Clinics for patients within a community setting such as a sports club or university; and peer interactions through social events such as bowling or other activities.

"Young adult patients are at a critical point in their educational, psychological, and professional development that will shape their future life. Increasing the survival of their transplants will lead to higher levels of education and employment rates, which will be financially beneficial to society," said Dr. Harden.

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Story Source:

The above story is based on materials provided by American Society of Nephrology (ASN). Note: Materials may be edited for content and length.

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