Increasing attention has been focused on the role of nurse practitioners (NPs) and physician assistants (PAs) to enhance the medical care provided to nursing home residents. This collaboration is a relevant and evolving influence on physician practice in the nursing home. The historical perspective, current research, and outcomes of NP and PA nursing home practice are discussed in this article in the context of physician partnership and in the establishment of future research initiatives. (Annals of Long-Term Care: Clinical Care and Aging 2006;14(3):17-24)

Older adults are less likely to be adequately treated for pain as compared with younger persons, despite the high incidence of pain in the older population. Increased potential for drug-drug/drug-disease interactions due to multiple comorbidities and concurrent medications, as well as pharmacokinetic and pharmacodynamic differences in older persons that can contribute to altered drug sensitivity and increased adverse drug reactions present significant challenges. Noncompliance due to misinformation about reactions and fears of addiction or dependence are also barriers to effective treatment. In addition, because of new cardiovascular warning labels on nonsteroidal anti-inflammatory drugs, and the recent withdrawal of two commercially available cyclooxygenase-2 inhibitors, clinicians are faced with the challenge of selecting other safe and effective medications for pain management. This review provides an update on the efficacy, tolerability, and safety of pharmacologic agents common