Medication management, antidepressant drugs, and the elderly: an overview.

1. Several factors may affect an elderly client's use of medications: polypharmacy, potentially leading to interactions; over-the-counter drugs taken without a physician's knowledge; noncompliance or poor compliance with medication regimens; and ageist beliefs. 2. Psychiatric nurses must be aware that the signs and symptoms they observe may be the result of normal physical or biological aging, psychosocial changes, disease-related changes, medication side effects, or a drug interaction. 3. Nurses must ask two questions when psychotropic drugs are used with elderly clients: What will be the onset, duration, magnitude, and characteristic action of a specific drug in an individual; and What are the characteristics of an "ideal" medication?     

International Conference on Population Aging. Keynote address

This is the keynote address of H.E.Dr. Vincent Tabone, President of Malta, at the International Conference on Aging, which was held in San Diego in September 1992. He states that the conference celebrates the tenth anniversary of the Vienna International Plan of Action, and provides an opportunity to evaluate progress and plan future direction. Dr. Tabone, as Minister of Foreign Affairs, first introduced the question of aging at the UN General Assembly over twenty years ago; the United Nations Secretariat established its first program in the field of aging in 1970. At the World Assembly on Aging in 1982, all members adopted the International Plan of Action, which defined guidelines for policies and programs in support of the aging populations. As a direct result of this, and in support of the needs of developing countries, the UN signed an agreement with the government of Malta that established the International Institute on Aging as an autonomous body under the auspices of the UN; it is the major expression of the Vienna Plan of Action. Concern for aging populations has developed enough maturity and momentum to oversee its own progress. Although current events may relegate the social and economic implications of the aged to the sphere of rhetoric, they demand thinking in terms of generations and transcend all political boundaries. This conference will evaluate progress toward deflecting a situation where the elderly constitute an increasing proportion of the population, without adequate and appropriate provision for their livelihood, and could have direct bearing on encouraging and ensuring the continuity of the family's vital and traditional role in preserving the dignity, status, and well-being of its aging members. A nation which begrudges its dues to the elderly, the successful products of society and triumphs of life, denies its past. This conference is a reaffirmation of commitment to the United Nations Principles for Older Persons, an omen of the review of the Global Targets on Aging for the year 2001 by the General Assembly at its forty-seventh session in October, and a stepping stone in the path toward integrating the elderly more fully into the mainstream of society. The year 1992 is a year for solidarity between the generations.     

Effective boards: how executive directors define and develop them

There is growing recognition in the nonprofit field that the executive director has a key role in determining whether the board of directors will function effectively. To aid executives in this vital role, two recent studies defined a "good board" from the point of view of two samples of executive directors of community agencies, then sought factors related to board performance as measured by this definition. In interviews, executives whose boards scored higher than their peers on this performance measurement related how they work with their boards in such areas as recruitment of new members, financial management, fundraising, and leadership development.     

HIV testing of health care workers

Until recently, nothing much beyond education and the dispensing of condoms was being done to control the spread of AIDS. We have not yet taken sufficient measures to prevent the spread of this disease. Instead, we insist on protecting the privacy of the HIV-positive individual. However, we ignore the right to privacy by mandating testing for syphilis, which is not nearly as serious a disease as AIDS. Now, mandatory testing of health care workers is being proposed more frequently.     

Eliminating smoking from the workplace

Employers are more readily realizing that a nonsmoking policy in the workplace is a more effective way to run their businesses. They are recognizing costs such as productivity losses, increased health and life insurance costs, employer liability for diseases jointly linked to smoking and occupational exposures, absenteeism, passive smoking-induced health care costs among nonsmokers, workers' compensation, and fire losses. Concomitantly, employees are supporting policies that limit smoking to achieve a clean air environment. Former Surgeon General Koop's goal of "a smokefree society by the year 2000" is being recognized by more and more segments of society.     

Clinical program renovation management

The day-to-day management of medical practice is so heavily influenced by tactical imperatives that few physicians have the time to think strategically. Traditionally, the difference between tactics and strategy is not a major concern of most physician executives. The realm of tactics is the short run, when managers must make do with the fixed resources at hand. Strategy addresses the long run, when all resources and markets are variable. A tactical focus is understandable, maybe even acceptable, in industries where nothing challenges traditional approaches to production of an established product or service. However, medical care in the 1990s is changing so fast that a physician executive must devote an incredible amount of time and effort just to stay confused about what is going on.     

Immigrant fertility: an examination of social characteristics and assimilation

"This study compares the fertility patterns of foreign-born and native-born women in Canada and examines whether [the] same set of social characteristics accounts for differential fertility among both the groups. The study also assesses the importance of social characteristics and assimilation on immigrant fertility behavior. Two generations of currently married/cohabiting women with spouse present are analyzed using multiple regressions. The results reveal similar effects on fertility of social characteristics for foreign-born and native-born, while in the case of younger generations the effects are stronger."