Jackson, who specialize in geriatrics and are knowledgeable about the problems, Dr. Also, many drug studies do not include older adults and only recently did the body of published work exploring drug use and appropriateness in those adults begin to grow. She put together a geographically diverse panel of 12 experts, including pharmacists, geriatricians and geriatric psychiatrists, who were familiar with the latest medical literature on the topic and brought their own experience with patients and drugs to the review as well. Ross Maclean, former director of the MCG Center for Health Care Improvement. are not responsible for the accuracy of news releases posted to Eurek Alert!"There was not enough evidence out there that we could pull and analyze," she said. The criteria will require continual updating because health care is changing daily, with new medicines, new findings about old medicines and disease, old medicines being discontinued and more, she said. by contributing institutions or for the use of any information through the Eurek Alert system. 8 In the United States, approximately 26 million people have diabetes mellitus, including 10.9 million adults aged 65 or older.1 The number of those newly diagnosed with diabetes continues to rise, and the Agency for Healthcare Research and Quality reports that over the past decade there has been a 26% increase in the number of patients discharged from hospitals with a primary diagnosis of diabetes.Diabetes Complications The primary goal of diabetes management is to achieve a level of glycemic control that closely mimics that of nondiabetic patients in an effort to prevent the long- and short-term complications associated with the disease.In 2012, the American Geriatrics Society increased its focus on sliding-scale insulin by updating the Beers criteria for potentially inappropriate medication use in the elderly to avoid its use due to a higher risk of patients experiencing hypoglycemia without an improvement in the management of hyperglycemia, regardless of setting.7 The Sliding-Scale Roller Coaster Sliding-scale insulin often fails to individualize insulin requirements and bases insulin doses on glucose levels prior to meals without regard to a patient’s basal metabolic needs, the types and amounts of food to be consumed, a patient’s weight, or other factors influencing insulin demands such as previous insulin needs, insulin sensitivity, or resistance.8 For example, a patient weighing 80 kg would receive the same insulin dose as a patient weighing 65 kg if their blood glucose levels are within the same range.Subsequently, the 80-kg patient may not receive sufficient insulin, placing him or her at increased hyperglycemia risk, and the 65-kg patient may receive a potentially excessive dose that could result in hypoglycemia.Issues related to hypoglycemia, when severe and left untreated, can lead to unconsciousness, seizures, coma, or even death.1 Continued Widespread Sliding-Scale Insulin Use Glycemic control in many hospitalized diabetic patients who are not critically ill remains suboptimal in part due to the continued use of sliding-scale insulin regimens despite more than 40 years’ worth of studies questioning the practice’s effectiveness and numerous diabetic best practice treatment guidelines recommending its discontinuation.3 One of the largest cohort studies done to date found that 76% of general medical inpatients received sliding-scale insulin, with these regimens not only failing to control hyperglycemia but also resulting in more episodes of hypoglycemia and longer hospital stays.
The overall costs related to diabetes treatment place a tremendous burden on the healthcare system, with one in five US healthcare dollars being spent on the condition.Fick, who also directs MCG's Center for Health Care Improvement.A 1997 study, also published in Archives of Internal Medicine, found that 35 percent of ambulatory older adults have had such an adverse event and most of them required medical care as a result; the incidence was even higher in nursing homes where two-thirds of residents experienced such events over a four-year period.Forty-eight medications or classes of medications to avoid in adults age 65 or older have been identified by a national expert panel charged with updating widely used criteria for potentially harmful medications in older adults.Estrogen in older women and the popular over-the-counter antihistamine, Benadryl®, were among those on the list to avoid in the update of the 1997 Beers Criteria, published in the Dec. Nonsteroidal anti-inflammatory agents such as Motrin® and Advil®, or ibuprofen, made a second list of medications to avoid in older adults with certain medical conditions; nonsteroidals and aspirin, known to increase the risk of bleeding, were listed as potentially inappropriate for people with gastric or duodenal ulcers.Researchers also added to this list of conditions that increase patients' risk for adverse drug events; additions included cognitive impairment, depression, Parkinson's disease, anorexia, malnutrition and obesity."We realize that aging is an individualized process and there are some 65-year-olds who are healthy and do fine on these medications," said Dr. Fick, a geriatric clinical nurse specialist and associate professor of medicine at the Medical College of Georgia in Augusta and principal author on the paper.A more recent study published in March 2003 in the Journal of the American Medical Association found that 27.6 percent of adverse drug events in older people were preventable.Another reason for these increased adverse events is how drugs affect people may change as they age."Folks who are on these medications are also much more likely to fall ...they are actually four times more likely to fall and break their hip than people who are not on these medications." Dr.