Background Falls and resulting fractures are a leading cause of morbidity/mortality in the elderly. With the withdrawal of certain selective COX2 inhibitors in 2004, narcotic analgesics have increasingly been recommended as first-line therapy in guidelines for the treatment of chronic pain. Objectives To evaluate the changes in types of medications prescribed for pain pre- and post-withdrawal of certain selective COX2 inhibitors in 2004 and to determine if there was an association with fall events among elderly patients with a diagnosis of osteoarthritis. Design A nested case-control design using electronic medical records compiled between 2001–2009. Setting Electronic medical records for care provided in an integrated health system in rural Pennsylvania over a nine year period (2001–9), the midpoint of which rofecoxib (Vioxx) and valdecoxib (Bextra) were pulled from the market. Participants 13,354 patients, aged 65–89, with a diagnosis of osteoarthritis (OA). Measurements The incidence of falls/fractures was examined in relation to analgesics prescribed: narcotics, COX2 inhibitors, or nonsteroidal anti-inflammatory drugs (NSAIDs). The comparison sample of no fall patients was matched 3:1 to fall patients according to age, gender and comorbidity. Results Narcotic analgesic prescriptions were associated with a significantly increased risk of falls/fractures. The odds ratio of experiencing a fall/fracture was higher in patients prescribed narcotic analgesics than those prescribed a COX2 inhibitor (3.3, 2.5–4.3) or NSAID (4.1, 3.7–4.5). Conclusion The increased use of narcotic analgesics is associated with an increased risk of falls/fractures in elderly patients with osteoarthritis, an observation that suggests the current guidelines for the treatment of pain, which include first-line prescription of narcotics, should be re-evaluated.

Use of over-the-counter (OTC) medications is becoming more of a problem in the older adult population as the push to deregulate prescription medications grows. This article summarizes the side effects, adverse reactions, and medication interactions older adults face when using some common OTC medications.

It has previously been shown that medical students perform poorly when assessing older adults with recurrent falls. To address this and teach students about other geriatric syndromes, a standardized patient, played by one of nine actresses, aging during the course of an afternoon, was developed. The patient is first aged 75 with falls, then 80 with memory problems, then 82 with an acute confusional state. The third-year students interact with the patient on a one-to-one basis. After seeing and examining her, the students write up the case and then meet with the supervising physician after each section to discuss the case. This intervention was well accepted, scoring 5.95 on a 7-point Likert-type scale. At the end of the clinical year, the students participated in an eight-case clinical skills examination that included a 79-year-old man with falls. Using the actor's checklists, the performances of the 42 medical students who had participated in the standardized patient experience were compared with those of the 128 who had not. Over the eight cases, there was no difference in the three domains of communication, information gathering, and physical examination, but in the geriatric case, the students who had participated in the experience performed significantly better in all three domains. The intervention students were also three times as likely to examine the subject's gait (60% vs 20%). A 3-hour interactive session substantially improved specific geriatric competencies. One can only wonder what more dedicated time could accomplish.

OBJECTIVES: To determine the influence of homocysteine on mobility decline in older adults. DESIGN: Prospective cohort. SETTING: Einstein Aging Study, community‐based aging study. PARTICIPANTS: Five hundred seventy‐four older adults without dementia (mean age 80.2 ± 5.4, 61% women). MEASUREMENTS: Mobility decline defined using gait velocity measurements at baseline and annual follow‐up visits. Linear mixed effects models were used to adjust for age, sex, education, and other potential confounders. RESULTS: Higher homocysteine levels were associated with slower gait velocity at baseline. Adjusted for age, sex, and education, a one‐unit increase in baseline log homocysteine levels was associated with a 2.95‐cm/s faster mobility decline per year (P=.01) over a median follow‐up of 1.4 years. The 140 subjects in the highest quartile of homocysteine had a faster rate of mobility decline (1.75 cm/s per year faster, P=.01) than the 434 subjects in the lowest three quartiles of homocysteine (≤15 μmol/L). The association between homocysteine and mobility decline remained robust even after adjusting for multiple confounders and accounting for the presence of clinical gait abnormalities. CONCLUSION: Higher homocysteine levels are associated with greater risk of mobility decline in community‐residing older adults.