Several new therapies were submitted to the FDA for approval in 2004-2005, with an emphasis on agents potentially useful in conditions experienced by older adults. These agents include trospium for overactive bladder, eszopiclone for insomnia, and inhaled insulin, pramlintide, exenatide, and insulin detemir for diabetes mellitus. The mechanism of action, therapeutic application, side effects, and monitoring of these new drugs will be examined here, with some discussion of how they compare to other similar therapies. Additionally, this review will provide considerations for use of these products in older adults where data is available to support conclusive recommendations. Cautious use is recommended with all new medications in older adults, given the limitations of clinical trial data in this special population. (Annals of Long-Term Care: Clinical Care and Aging 2006;14[5]:20-27)

Mental illness and cardiovascular disease are seen both individually and concomitantly with significant frequency in the elderly, with two of the most prevalent mental disorders being depression and psychosis. Proper pharmacologic treatment of both conditions using antidepressant and antipsychotic agents includes an understanding of various pharmacokinetic and pharmacodynamic considerations (eg, drug absorption, distribution, metabolism, excretion), as well as the direct effect these agents may have on elderly persons, who are often more sensitive to the therapeutic effects as well as the adverse effects of these drugs. Cardiotoxic effects (such as QT interval prolongation), increased cerebrovascular events, metabolic dysfunction, and increased risk of death have been attributed to some of these medications. The coadministration of psychoactive and cardiovascular-related medications is also common in this population, and adds particular complexity to the task of choosing an appropriate

The role of the attending physician in facilitating admissions to long-term care (LTC) facilities has diminished in recent years for many reasons. The Centers for Medicare & Medicaid Services has issued regulations concerning the important and distinct roles that both the medical director and the attending physician should play in developing admission policies and determining if an individual is suitable for admission to a particular LTC facility. Each facility needs to determine what types of individuals can be safely cared for based on staffing levels, training, and the availability of required ancillary services. The attending physician’s preferred role encompasses pre-screening concerns, initial ordering of medications, special rehabilitative or treatment needs, special equipment requirements, and advance directive/Do-Not Resuscitate planning. Communication between health care providers, the referring hospital, the nursing facility attending physician, the resident and legal next-o