Older Population Pivots to Cannabis for Health Reasons


CME NUGGETS

Ed Susman

Mr. Susman is a freelance medical writer based in Florida, USA. He travels worldwide to report from medical conferences, writing regularly for wire services, internet websites, and medical journals such as the Journal of the National Cancer Institute and AIDS.

For comments, edwardsusman@cs.com


ORLANDO, Florida – People over 65 in the state of Colorado – where marijuana is legal for both medical and recreational use – are likely to use cannabis products for relief of pain and other health issues – and many of them are recent users, researchers reported here at the 2018 annual scientific meeting of the American Geriatric Society.

In a survey conducted statewide in Colorado, 196 persons over the age of 65 discussed their use of marijuana, and 46 percent of the respondents said they have used cannabis – 14 percent said they used it for health purposes only; 25 percent said they used it for heath and recreational purposes; 7 percent used marijuana for recreational purposes only, and 54 percent said they did not use cannabis at all, reported Brian Kaskie, PhD, associate professor of public health at the University of Iowa, Iowa City.

When questioned about health outcomes associated with marijuana use, Dr. Kaskie said the participants in the survey reported “improvement in overall well-being, quality of life and pain relief.”

The individuals in the study were about 73 years old and 65 percent were women; 88 percent were retired; 24 percent were college graduates and another 24 percent had some college and 33 percent had some post college graduate study. About 24 percent had a history of opioid use in the previous year; 55 percent of the participants were in current partnerships; 23 percent were widowed.

If the patients had used marijuana products in the previous year, more than 75% said visits to the doctor, emergency room visits and hospital visits had not changed from the previous year.

Participants were recruited in each of Colorado’s 16 Area Agencies on Aging at senior centers, wellness clinics, health clinics and at marijuana dispensaries. The study was funded by the Colorado Department of Public Health and Environment.

Positive about HIV and aging

Men who have been diagnosed with human immunodeficiency virus (HIV) infection do not appear to have any more negative views about aging than people who do not have infection with the virus which causes AIDS.

“Contrary to what was hypothesized, HIV status was not predictive of subjects’ perception of aging,” said Joseph Schnitter, BA, a medical student at the Icahn School of Medicine at Mt. Sinai School of Medicine, New York. “This suggests that despite the challenges of living with HIV, these men do not hold negative views of aging more than those without HIV.”

Schnitter and colleagues recruited 164 men from seven doctors offices and two clinics to undergo a battery of mental health questionnaires. There were 85 men who were HIV-positive, 5 men who were unsure of their HIV status and 74 men who were HIV-negative in the study. They ranged in age from 50 to 97 years. About 40.9 percent of the men were non-Hispanic whites; 27.4 percent were non-Hispanic blacks, and 19.5 percent of the group were Hispanic/Latino.

When compared with men who were not infected with HIV, the men carrying the infection did not have a self perceived age differential (p=.968); had no difference on the Levy Image of Aging (p=.233); on the AAQ Psychological Loss (p=.820); had no difference on the AAQ psychological gain (p=.257) and on the AAQ Physical Change (p=.960), Schnitter said.

“We didn’t even seen anything that could be considered a trend toward a difference in perception between men with HIV and men without HIV infection,” he said.

Understanding people’s views on aging, he suggested, is an unexplored means of improving health outcomes in this population.

Pimavanserin safe in combination

Treatment with the pimavanserin – a new treatment for psychosis associated with Parkinson’s disease – appears to be safe in combination with patients also taking anti-depressant selective serotonin reuptake inhibitors (SSRI).

“This combination appears to be well tolerated in Parkinson’s disease patients,” said James Norton, PhD, senior director of medical affairs at Acadia Pharmaceuticals, San Diego, California, at his poster presentation.

In addition, despite small numbers of patients, there appears to be a benefit in scores on the Parkinson’s disease adapted Scale for the Assessment of Positive Symptoms (SAPS-PD), the researchers reported. Compared with placebo, patients on pimavanserin achieved a 2.34 point decline in the scale (p=.010) among the 189 patients who were not taking the anti-depressants.

When the researchers looked at just those patients taking both pimavanserin and the SSRIs and compared them with placebo patients on SSRIs, there was a drop of 4.32 points on the scale (p=.003), after 6 weeks. There were 36 patients on the concomitant medications and 41 patients on SSRIs plus placebo.

“What we see here it that there may be a benefit with combination of these drugs,” Dr. Norton said, “But we saw no signal of harm with the combination.”

In the full population, 69.1 percent of patients taking pimavanserin experienced some adverse events compared with 67.4 percent of patients on placebo. If the patients were on SSRIs, 73.7 percent of those on pimavanserin reported adverse events, compared with 73.2 percent of the patients on placebo and SSRIs. Of the 287 patients evaluated for safety, 11 individuals taking pimavanserin discontinued due to treatment emergent adverse events compared with 5 placebo patients, the researchers reported.

Dr. Norton said the post hoc analysis was performed on the suggestion of one of the investigators who thought there could be a benefit among those taking both medications. The study was a pooled analysis of two 6-week, randomized, double-blind, placebo controlled studies of pimavanserin 34 mg.

“The results of this analysis further support previous findings that the combination of pimavanserin and SSRIs may have additive beneficial effects, suggesting a possible enhancement of anti-psychotic effect in patients treated with concomitant SSRIs,” he said.

Hip fracture pneumonia risk

Older patients undergoing hip fracture surgery have a greater risk of developing post-surgery pneumonia if they receive general anesthesia rather than a spinal block during the procedure.

Of 66 patients, 70 years of age or older who underwent general anesthesia for hip fracture surgery, 12 percent were hospitalized with pneumonia compared with 6 percent of 211 patients who were given spinal anesthesia for the operation (p<.01), said Jorge Ojeda-Jimenez, MD, a resident in orthopedics at Hospital Universitario de Canarias, Santa Cruz de Tenerife, Canary Islands, Spain.

At his poster presentation, Dr. Ojeda-Jimenez said, “In elderly patients with hip fracture operated under general anesthesia, occurrence of pneumonia is more frequent when compared with other modalities of anesthesia, regardless of their comorbidities, time to surgery and use of aspirin.

“Pneumonia is also more common among persons with swallowing problems and general could play a synergistic role with dysphagia in developing respiratory tract infections,” he said. “We suggest close monitoring of these high risk patients in order to early diagnose and treat respiratory complications.”

The prospective study followed elderly patients admitted to the orthopedic surgery wards for treatment of hip fracture between January 2017 and January 2018. About 70 percent of the patients involved in the study were women; the average age of the cohort was 82 years. About 18 percent of the patients had been in institutions before being taken to the hospital for hip fractures. About 58 percent of the population was able to perform activities of daily living independently; 28 percent were ambulatory. The time from the hip fracture to surgery was an average of 66 days; the average length of stay in hospital was 16 days, Dr. Ojeda-Jimenez reported; 48 percent of the patients were diagnosed with dementia.

July 2018 Health and Lifestyle

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