Abstract:
BACKGROUND:Guidelines recommend avoidance of several psychoactive medications such as hypnotics in older adults due to their adverse effects. Older patients on hemodialysis may be particularly vulnerable to complications related to use of these agents, but only limited data are available about the risks in this population. OBJECTIVES:To evaluate the association between the use of psychoactive medications and time to first emergency department visit or hospitalization for altered mental status, fall, and fracture among older patients receiving hemodialysis. DESIGN:Observational cohort study. SETTING:National registry of patients receiving hemodialysis (US Renal Data System). PARTICIPANTS:A total of 60 007 adults 65 years or older receiving hemodialysis with Medicare Part D coverage in 2011. MEASUREMENTS:The predictors were use of sedative-hypnotics and anticholinergic antidepressants (modeled as separate time-varying exposures). The outcomes were time to first emergency department visit or hospitalization for altered mental status, fall, and fracture (modeled separately). RESULTS:Overall, 17% and 6% used sedative-hypnotics and anticholinergic antidepressants, respectively, in 2011. In multivariable-adjusted Cox regression, anticholinergic antidepressant use was associated with a 25%, 27%, and 39% higher hazard of altered mental status, fall, and fracture, respectively, compared with no use. Use of sedative-hypnotics was not associated with adverse outcomes. CONCLUSION:Anticholinergic antidepressants were associated with adverse outcomes in older hemodialysis patients, and alternative treatments should be considered. Sedative-hypnotics were not associated with the risks evaluated in this study, but further investigation of the harms of this class of agents is warranted before their recommendation as a treatment option for insomnia in this population. J Am Geriatr Soc 67:449-454, 2019.
journal_name
J Am Geriatr Socjournal_title
Journal of the American Geriatrics Societyauthors
Ishida JH,McCulloch CE,Steinman MA,Grimes BA,Johansen KLdoi
10.1111/jgs.15740subject
Has Abstractpub_date
2019-03-01 00:00:00pages
449-454issue
3eissn
0002-8614issn
1532-5415journal_volume
67pub_type
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journal_title:Journal of the American Geriatrics Society
pub_type: 杂志文章
doi:10.1111/j.1532-5415.2011.03446.x
更新日期:2011-06-01 00:00:00
abstract::A cohort of 3,595 white women aged 40-77 years was followed for an average of 10 years during which 84 new cases of hip fracture were identified. Triceps skinfold thickness and arm muscle area measured at baseline were examined as possible risk factors for hip fracture controlling for physical activity, height, menopa...
journal_title:Journal of the American Geriatrics Society
pub_type: 杂志文章
doi:10.1111/j.1532-5415.1989.tb01562.x
更新日期:1989-01-01 00:00:00
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journal_title:Journal of the American Geriatrics Society
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更新日期:1999-08-01 00:00:00
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journal_title:Journal of the American Geriatrics Society
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doi:10.1111/j.1532-5415.1999.tb02991.x
更新日期:1999-03-01 00:00:00
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journal_title:Journal of the American Geriatrics Society
pub_type: 杂志文章
doi:10.1111/j.1532-5415.2012.04165.x
更新日期:2012-10-01 00:00:00
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journal_title:Journal of the American Geriatrics Society
pub_type: 杂志文章
doi:10.1111/j.1532-5415.1997.tb04498.x
更新日期:1997-02-01 00:00:00
abstract:OBJECTIVES:To prospectively validate and refine the 5-item "CRASH" screening tool for identifying older drivers needing a behind-the-wheel (BTW) test. DESIGN:Prospective observational study. SETTING:Geriatric and internal medicine primary care clinics affiliated with a tertiary care hospital and a local BTW program. ...
journal_title:Journal of the American Geriatrics Society
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更新日期:2018-02-01 00:00:00
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journal_title:Journal of the American Geriatrics Society
pub_type: 杂志文章
doi:10.1111/j.1532-5415.2008.01815.x
更新日期:2008-08-01 00:00:00
abstract:OBJECTIVES:To assess the effect of chronic renal failure (CRF) on quality of life (QOL). DESIGN:Controlled cross-sectional study. SETTING:All 13 dialysis units in the French Lorraine region and six departments of a Nancy hospital. PARTICIPANTS:One hundred sixty-nine older patients with end-stage renal disease (ESRD)...
journal_title:Journal of the American Geriatrics Society
pub_type: 杂志文章
doi:10.1046/j.1532-5415.2003.51062.x
更新日期:2003-02-01 00:00:00
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journal_title:Journal of the American Geriatrics Society
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doi:10.1111/j.1532-5415.2006.00770.x
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journal_title:Journal of the American Geriatrics Society
pub_type: 杂志文章
doi:10.1111/j.1532-5415.2005.00467.x
更新日期:2005-11-01 00:00:00
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journal_title:Journal of the American Geriatrics Society
pub_type: 杂志文章
doi:10.1111/j.1532-5415.2012.04025.x
更新日期:2012-07-01 00:00:00
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journal_title:Journal of the American Geriatrics Society
pub_type: 杂志文章
doi:10.1111/j.1532-5415.2009.02363.x
更新日期:2009-08-01 00:00:00
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journal_title:Journal of the American Geriatrics Society
pub_type: 杂志文章
doi:10.1111/j.1532-5415.2000.tb03871.x
更新日期:2000-12-01 00:00:00
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journal_title:Journal of the American Geriatrics Society
pub_type: 杂志文章
doi:10.1046/j.1532-5415.2003.51534.x
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journal_title:Journal of the American Geriatrics Society
pub_type: 杂志文章,meta分析
doi:10.1111/jgs.15503
更新日期:2018-10-01 00:00:00
abstract::In 13 elderly patients, 12 of whom had Parkinson's disease, visual hallucinations and delirium developed as a side effect of amantadine hydrochloride (Symmetrel) therapy. The symptoms promptly disappearred when amantadine was discontinued. Thereafter, each parkinsonian patient was treated satisfactorily with levo-dopa...
journal_title:Journal of the American Geriatrics Society
pub_type: 杂志文章
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更新日期:1975-05-01 00:00:00
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pub_type: 杂志文章,多中心研究,随机对照试验
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journal_title:Journal of the American Geriatrics Society
pub_type: 杂志文章,评审
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journal_title:Journal of the American Geriatrics Society
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journal_title:Journal of the American Geriatrics Society
pub_type: 杂志文章,多中心研究
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更新日期:2013-03-01 00:00:00
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更新日期:2020-11-02 00:00:00
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更新日期:2013-04-01 00:00:00
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pub_type: 杂志文章,随机对照试验
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更新日期:2017-03-01 00:00:00
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journal_title:Journal of the American Geriatrics Society
pub_type: 杂志文章
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更新日期:1981-01-01 00:00:00
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journal_title:Journal of the American Geriatrics Society
pub_type: 杂志文章
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更新日期:2015-04-01 00:00:00