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Introduction Neuropsychiatric disorders affect millions of older adults. Despite this, there are relatively few older adults included in clinical trials evaluating treatments for psychiatric disorders. Citalopram has been evaluated in older adults with neuropsychiatric disorders and has largely been found beneficial, making the 2011 US Food and Drug Administration (FDA) safety advisory on citalopram extremely impactful. Methods A literature search was completed using the PubMed database. Results were limited to clinical trials conducted in older adults that were published in English. Results Review of the literature confirms the efficacy of citalopram in depression, anxiety, depression associated with Parkinson disease, and behavioral and psychological symptoms of dementia. Additionally, no adverse cardiac outcomes have been described related to citalopram. Discussion The FDA's evidence for applying this safety advisory to citalopram is minimal and largely based on surrogate markers, such as the QTc interval rather than clinical and safety outcomes. Citalopram is known to increase the QTc, but this increase has not been linked to adverse cardiac outcomes. The evidence for efficacy and against adverse outcomes suggests that a reevaluation of the dosing restrictions in older adults with neuropsychiatric disorders is needed.

The patient is a 75-year-old male who was admitted to the long-term care unit because of advancing dementia and was being treated with mirtazapine to improve his mood and stimulate his appetite. This case report outlines an interesting occurrence of hypertriglyceridemia followed by hyperglycemia, which resembled diabetes mellitus and required insulin therapy. The patient continued to have elevated triglyceride levels that persisted despite discontinuation of mirtazapine therapy.

With the recent updates to the Diagnostic and Statistical Manual of Mental Disorders (5th edition; DSM -5), there are many questions on how to care for older adults with generalized anxiety disorder (GAD) and other psychiatric conditions. The current article reviews the new changes to the DSM-5 for diagnosis of GAD, discusses new anxiety assessment scales that are validated in older adults, evaluates pharmacological agents that have been studied in older adults for GAD treatment, and provides monitoring recommendations to help those who provide care to older adults experiencing GAD. [ Journal of Gerontological Nursing, 41 (4), 10–20.]

The diagnosis and management of urinary tract infections (UTIs) among residents of post-acute and long-term care (PALTC) settings remains challenging. Nonspecific symptoms, complex medical conditions, insufficient awareness of diagnostic criteria, and unnecessary urine studies all contribute to the inappropriate diagnosis and treatment of UTIs in PALTC residents. In 2017, the Infection Advisory Subcommittee at AMDA—The Society for Post-Acute and Long-Term Care Medicine convened a workgroup comprised of experts in geriatrics and infectious diseases to review recent literature regarding UTIs in the PALTC population. The workgroup used evidence as well as their collective clinical expertise to develop this consensus statement with the goal of providing comprehensive guidance on the diagnosis, treatment, and prevention of UTIs in PALTC residents. The recommendations acknowledge limitations inherent to providing medical care for frail older adults, practicing within a resource limited setting, and prevention strategies tailored to PALTC populations. In addition, the consensus statement encourages integrating antibiotic stewardship principles into the policies and procedures used by PALTC nursing staff and by prescribing clinicians as they care for residents with a suspected UTI.

Approximately half the nation's feral hog population resides in Texas, creating a health risk for domesticated livestock and damaging ecosystems. However, biologists know little about the distribution of their intestinal helminths. We collected intestines from wild hogs slaughtered at a private livestock processing facility in South Texas that accepts hogs from over 20 holding facilities across the state. We found a 26% infection prevalence that was not related to host gender or weight. However, female hogs tended to harbor a greater parasite prevalence and diversity than males. We collected five species of nematodes: 153 Oesophagostomum dendatum, 150 Oesophagostomum quadrispinulatum, 64 Globocephalus urosubulatus, 6 Ascaris suum, and 1 Metastrongylus. We collected one species of acanthocephalan: 64 Macracanthorhynchus hirudinaceus. This is the first wide-scale geographic survey of intestinal parasites of feral hogs in Texas and the first published record of O. quadrispinulatum and M. hirudenaceus from feral hogs in Texas. Thus, our findings set the stage for further collaborative studies on infection patterns as they relate to feral hog control and livestock risk management.

Introduction The objective of this article is to provide an academic toolkit for use by colleges/schools of pharmacy to prepare student pharmacists/residents for academic careers. Methods Through the American Association of Colleges of Pharmac (AACP) Section of Pharmacy Practice, the Student Resident Engagement Task Force (SRETF) collated teaching materials used by colleges/schools of pharmacy from a previously reported national survey. The SRETF developed a toolkit for student pharmacists/residents interested in academic pharmacy. Results Eighteen institutions provided materials; five provided materials describing didactic coursework; over fifteen provided materials for an academia-focused Advanced Pharmacy Practice Experiences (APPE), while one provided materials for an APPE teaching-research elective. SRETF members created a syllabus template and sample lesson plan by integrating submitted resources. Submissions still needed to complete the toolkit include examples of curricular tracks and certificate programs. Discussion and conclusions Pharmacy faculty vacancies still exist in pharmacy education. Engaging student pharmacists/residents about academia pillars of teaching, scholarship and service is critical for the future success of the academy.

Sepsis in older adults has many challenges that affect rate of septic diagnosis, treatment, and monitoring parameters. Numerous age-related changes and comorbidities contribute to increased risk of infections in older adults, but also atypical symptomatology that delays diagnosis. Due to various pharmacokinetic/pharmacodynamic changes in the older adult, medications are absorbed, metabolized, and eliminated at different rates as compared to younger adults, which increases risk of adverse drug reactions due to use of drug therapy needed for sepsis management. This review provides information to aid in diagnosis as well as offers recommendations for monitoring and treating sepsis in the older adult population.

Background and Charges According to the Bylaws of the American Association of Colleges of Pharmacy (AACP), the Professional Affairs Committee is to study issues associated with the professional practice of pharmacy as they relate to pharmaceutical education, and to establish and improve working relationships with other organizations in the field of health affairs. The Committee is encouraged to address related agenda items relevant to its Bylaws charge and to identify issues for consideration by subsequent committees, task forces, commissions, or other groups. President Patricia Chase established the themes of Access, Affordability and Accountability for the 20142015 standing committees. (1) The 2014-2015 Professional Affairs Committee (PAC) was charged with examining the contributions of experiential education to the development of "practice-ready" pharmacy school graduates who are educated and trained for current and future practice. Experiential education, comprised of Introductory Pharmacy Practice Experiences (IPPEs) and Advanced Pharmacy Practice Experiences (APPEs) and represents up to 30% of the pharmacy school curricula, are the entry points for student pharmacists into pharmacy and patient care practice. Specifically, the 2014-2015 Professional Affairs Committee is charged to: (1) Describe the elements that should be present for access to exemplary experiential sites; (2) Identify how student pharmacist readiness for and contributions to experiential education should be considered to illustrate the value to experiential practice sites; and (3) Recommend strategies to the academy to demonstrate its accountability that graduates are "practiceready." Members of the 2015 PAC include individuals representing multiple disciplines across various colleges and schools of pharmacy, as well as professional staff representation from the American Pharmacists Association (APhA), the American Society of Health-Systems Pharmacy (ASHP) and the National Association of Chain Drug Stores (NACDS). The committee began its work by reviewing pertinent background information and resource materials and participating in a conference call to develop an initial strategy for addressing committee charges. The committee members met for a day and a half in Crystal City, Virginia on October 27-28, 2014 to discuss the various facets related to the committee charges, as well as to develop a process and strategies for addressing the charges. Following the process development and delegation of assignments related to the committee charges, the PAC communicated via electronic communications as well as through personal exchanges via telephone and email. In developing the strategy to address their charges, the PAC considered numerous factors that contribute to the current needs, future needs and contributions of "practice-ready" pharmacists. Examination of pertinent issues relevant to both experiential education and pharmacy practice were explored from the perspectives of access, value (the PAC examined the value of experiential education as an applicable aspect of affordability) and accountability. The continued evolution of the healthcare environment, including implications for pharmacists and team-based care from the Patient Protection and Affordable Care Act (PPACA), (2) the expanding role of pharmacists in a dynamically-changing health care system, (3, 4 5 6) and emerging interprofessional, collaborative practice models, such as Patient Centered Medical Homes (4, 7 8) and Affordable Care Organizations, (9) were discussed. The Accreditation Council for Pharmacy Education (ACPE) release of Draft Standards 2016 (10) and the Guidance Document to Draft Standards 2016, (11) which was finalized February 2015, (12,13) are other important aspects that should forecast the content and impact of experiential education. The recently revised Joint Commission of Pharmacy Practitioners (JCPP) Vision for Pharmacists' Practice (14) and the recently approved Pharmacist Patient Care Model, (15) which describes a consistent process of care in the delivery of patient care services by pharmacists, are additional avenues that must be included in all aspects of pharmacy education. …

Objective To assess change in knowledge and awareness of upper respiratory-tract infections (URTIs), and appropriate antibiotic use in community-dwelling older adults. Design Single group, pre- and post-test study. Setting Two independent senior living communities in Baltimore City and Baltimore County, Maryland. Participants Older adults eligible to receive housing or other social services as defined by the study sites. Intervention Use of an interactive trivia game to educate older adults about URTIs. A 15-item pre- and postsurvey was administered to assess change in knowledge. Outcome measures Average change in pre- and postsurvey scores. Results Thirty-two seniors participated in the game intervention, with 18 completing both surveys. There was no significant difference in the total mean pre- versus postsurvey scores. Average scores of pre- and postsurveys were 9.28 and 9.17, respectively, out of 15 points (95% confidence interval 0.65 +/- 1.414; P = 0.76). Upon review of individual survey questions, two specific areas showed a significant improvement on postsurvey scores compared with baseline. Participants showed significant improvement, however, in knowledge regarding symptoms that may require the use of an antibiotic (P = 0.02) and symptomatic management of URTI symptoms (P = 0.045). Conclusions Based on survey results, we learned more about older adults' knowledge regarding URTIs, antibiotic use, and strategies to provide education to community-dwelling geriatric adults. The game was effective in teaching older adults about symptom management and symptoms that may require an antibiotic.