Suvorexant May Prevent Delirium in Hospitalized Patients

Topics: Delirium | Geriatric Psychiatry | Suvorexant

REVIEW OF: Hatta K et al, J Clin Psychiatry 2017;78(8):e970–e979; Hatta K et al, J Clin Psychiatry 2019;81(1):19m12865 Delirium is an acute confusional state that occurs frequently in older hospitalized patients, especially those with serious illness in the ICU. We try our best to prevent it because it is associated with worse medical outcomes, inc

A Timely Look at Community Reinforcement for Seniors With Unhealthy Alcohol Use

Topics: Alcohol | Alcohol use disorder | Geriatric Psychiatry | Motivational Interviewing | Psychotherapy

Review of: Andersen K et al, Addiction 2020;115(1):69–81 During the COVID-19 pandemic, when every personal contact requires risk-reward deliberations, understanding the impact of relationships on health is crucial. This timely study, conducted from 2014 through 2016, investigated whether social networks reduce drinking among older adults with alcoh

Listening to Depression: The Importance of Addressing Hearing Loss

Topics: Geriatric Psychiatry | Hearing loss | Research Update

REVIEW OF: Marques T et al, Eur Arch Otorhinolaryngol 2021; Epub ahead of print STUDY TYPE: Randomized open-label controlled trial Age-related hearing loss is associated with depression, poorer physical and social functioning, and decreased quality of life, but can hearing aids reverse those trends? This study examined the effects of “aural rehabili

Lemborexant and Sleep Architecture in the Elderly

Topics: Free Articles | Geriatric Psychiatry | Hypnotics | Lemborexant | Sleep | Sleep Disorders

REVIEW OF: Moline M et al, J Clin Sleep Med 2021. Epub ahead of print. TYPE OF STUDY: Randomized, double-blind, parallel-group study As we age, sleep architecture worsens in ways that reduce sleep quality, particularly after age 55. Unfortunately, most hypnotics either do not improve sleep quality (eg, the z-hypnotics) or slightly worsen it (eg, t

Six Tips for Working With Older Adults

Topics: Benzodiazepines | Depression | Geriatric Psychiatry | Medical Comorbidities

In the US, 1 in 7 adults are over the age of 65, and the growth in this population is far outpacing the growth in geriatric psychiatrists. As a result, general clinicians are increasingly called on to provide the majority of care for older adults. In this article I’ll share some tips for working with this population. Tip 1: Communication Many olde

Rest Easy: Benzos, Z-Drugs, and Dementia

Topics: Anxiety | Benzodiazepines | Dementia | Deprescribing | Generalized Anxiety Disorder | Geriatric Psychiatry | Hypnotics

Review of: Osler M and Jorgensen MB, Am J Psych 2020;177(6):497–505 Study TYPE: Epidemiologic case-control Few psychotropics stir controversy like the benzodiazepines. While they work well for anxiety and insomnia, their risks of abuse and dependence have always nagged at us. More recently, some research has suggested that long-term use increase

Is Ramelteon an Effective Hypnotic?

Topics: Belsomra | Benzodiazepines | Geriatric Psychiatry | Hypnotics | Lemborexant | Melatonin | Sleep | Suvorexant

Ramelteon (Rozerem) stands out from other hypnotics in several ways: It is not a controlled substance and has no risk of addiction or ­withdrawal. It is relatively safe in the elderly. It has a low risk of falls and complex sleep behaviors. However, ramelteon’s use has been limited by its high cost and modest efficacy. Now that it’s gone ge

Nuplazid: Novel Mechanism, Modest Benefits

Topics: Dopamine | Geriatric Psychiatry | Neurology | Novel Medications | Nuplazid | Parkinson’s

Psychosis can be a paralyzing dilemma for patients with Parkinson’s disease (PD). Most antipsychotics worsen the motor symptoms of PD, while the dopaminergic drugs that treat PD can worsen the psychosis. Psychosis afflicts up to 60% of patients with PD, and it is the leading cause of nursing home placement in these patients (Hacksell U et al, Neuroche

Antipsychotics Fall Short in Delirium

Topics: Dopamine | Geriatric Psychiatry | Neurology | Novel Medications | Nuplazid | Parkinson’s

Review: Oh ES et al, Ann Intern Med 2019;171(7):474–484; Nikooie R et al, Ann Intern Med 2019;171(7):485–495 Study type: Systematic reviews of randomized controlled trials and prospective studies Delirium is common and costly. With an incidence rate approaching 50% in hospitalized older adults, the condition poses a burden that is anticipated

Lithium in Geriatric Depression

Topics: Depression | Depressive Disorder | Geriatric Psychiatry | Lithium | Psychopharmacology | Treatment-Resistant Depression

REVIEW OF: Buspavanich P et al, J ­Affect Disord 2019;251:136–140 TYPE OF STUDY: Prospective, non-randomized controlled trial Augmentation with lithium has long been established as an effective strategy for refractory depression, but how does it fare in geriatric patients? There is a dearth of evidence on lithium in the geriatric population, which

The Aging Brain: Preventing Cognitive Decline

Topics: Cognitive Decline | Dementia | Geriatric Psychiatry

We’ve all been there. A 63-year-old patient comes to you with a chief complaint of memory loss. She tells you that she has a hard time remembering people’s names and forgets where she puts her keys. She lives and drives on her own without a problem, but asks, “Isn’t there some memory pill I can take?” What advice can we give her? The first

Screening Tests for Cognitive Decline

Topics: Cognitive Decline | Dementia | Geriatric Psychiatry

Screening tests can also help distinguish normal aging from a Neurocognitive Disorder. The popular Mini Mental Status Exam is being replaced by more sensitive tests like the Montreal Cognitive Assessment (MOCA) and the Saint Louis University Mental Status Examination (SLUMS). Both of these can be completed in 10 minutes and are normed for Mild and Major

Moderate Alcohol Use Associated With Reduced Risk of Dementia

Topics: Alcohol Use | Dementia | Geriatric Psychiatry | Research Update

Review of: Sabia S et al, BMJ 2018;362:k2927 Type of study: Prospective cohort study Excessive alcohol use is neurotoxic, but some studies have found that moderate alcohol intake might actually reduce the risk of dementia. Most of these studies, however, have focused on geriatric patients. What about the cumulative impact of alcohol over one’s lifet