Of patients with Parkinson’s disease (PD), 60% experience psychosis and 80% develop dementia. The use of antipsychotics to manage symptoms in this population is common. It has been established that the use of antipsychotics in patients with dementia is associated with increased mortality, but whether this risk extends to patients with PD is unknown. Weintraub and colleagues performed a retrospective, matched-cohort study of nearly 8,000 patients with idiopathic PD to examine this risk.
They found that patients with PD who started antipsychotic therapy were more than twice as likely to die within six months, compared with those who were not taking antipyschotics. The conventional antipsychotic haloperidol was linked with the highest mortality risk, followed by the atypical antipsychotic agents olanzapine, risperidone, and quetiapine.
In an accompanying editorial, a historical review of antipsychotics and reports of their increase on mortality is described. Limitations of the study are also discussed, such as lack of confidence in the diagnosis of both PD and dementia in the population and whether the diagnosis of psychosis was a contributing factor in the patient’s death, rather than the therapies used to treat it. We also gain appreciation for the challenge of clinicians in managing symptoms in patients with dementia, with or without Parkinson’s disease, and the need for a well-designed prospective study to guide treatment recommendations.
Proton pump inhibitors (PPIs) are widely used for the treatment of gastrointestinal diseases but have also been associated with cognitive decline. Gomm and colleagues performed a prospective, cohort study of almost 74,000 patients, aged 75 years or older and free of dementia to examine the association between the use of PPIs and the risk of dementia in the elderly. The 3,000 patients receiving regular PPI medication had a significantly increased risk of dementia compared with the patients not receiving PPI medication.
Link to JAMA Neurology article abstract (02/15/2016)
PHILADELPHIA – Enclara Pharmacia, the market leader in comprehensive pharmacy management services to the hospice industry, is collaborating with the National Hospice and Palliative Care Organization (NHPCO), the largest membership organization representing hospice and palliative care programs and professionals in the US, to offer a unique educational and engagement opportunity.
The Executive Business Summit “Positioning for the Future" will be presented in conjunction with Turn-Key Health on Wednesday, April 20, 2016, 5:00-6:30 pm, prior to the official opening of NHPCO’s annual Management and Leadership Conference at Gaylord National Resort & Convention Center, National Harbor, Maryland. Extending its role as a nationally recognized thought leader in hospice medication therapy management and enhancing a commitment to create value for its growing portfolio of partners in hospice care, Enclara Pharmacia is co-sponsoring the summit to help executives strategically plan for the future through community-based palliative care programs and services.
“This event presents innovative ways to leverage existing resources and staff to foster organizational growth and build successful partnerships with payers and health systems,” says Andy Horowitz, CEO of Enclara Pharmacia. “Attendees will get a fuller understanding of the value proposition of hospice and palliative care within the post-acute environment, and be better equipped to improve patient care while controlling costs in patient populations with advanced illnesses.”
An interactive panel discussion led by Nancy-Ann DeParle, founding partner of Consonance Capital Partners, and former deputy chief of staff for policy and director of the White House Office of Health Reform, will address trends in healthcare policy, payment models, and collaboration between payers, health systems, and care providers:
Donald Schumacher, NHPCO president and CEO, adds, “The distinguished panel will offer insights into how health systems, ACOs, and Medicare Advantage plans view hospice and palliative care within the healthcare continuum.”
The American Diabetes Association (ADA) recently published a position statement on the management of diabetes at end of life and in those receiving palliative and hospice care. They stress recognition of the prevalence and associated disease burden and cost this disease state has on the aging population in long-term care and skilled nursing facilities.
In this article, the ADA focuses on preventing hypoglycemia and avoidance of sole use of sliding-scale insulin.
Link to Diabetes Care article (2/2016)