It is not uncommon for a resident to try multiple medications to manage anxiety disorder before finding a tolerated and effective psychotropic. An SSRI or SNRI are usually the first-line agent for pharmacotherapy. Concern for anxiety is often brought up by caregivers when patients demonstrate disruptive behaviors related to anxiety such as yelling out, resisting care, becoming frightened with personal care, and repetitive behaviors such as pushing a call light many times a day, pacing, or restlessness. First-line agents in the treatment of anxiety disorders in long-term care include SSRIs and SNRIs. Second-line agents or supporting agents may incude buspirone, mirtazapine, propranolol, and trazodone. Avoid benzodiazepines and anticholinergics. Strategies to address difficult to manage anxiety include reconsidering the first-line agent for appropriate dose and duration, adding an augmenting agent, switching from an SSRI to and SNRI, and considering the possibility of low-grade psychosis and a potential contributing factor to anxiety.

Medication adherence is a major challenge in treating psychiatric conditions, especially conditions that can involve impaired insight and judgement. Conditions requiring strict adherence to antipsychotics may be helped by the use of long-acting injectable medications (LAIs), such as aripiprazole, paliperidone, olanzapine, and risperidone.  Long-acting injectible antipsychotics are best started by those with experience in their use but continuing therapy may be managed by primary providers in areas underserved by mental health specialists. Benefits of LAIs include better adherence when compared to oral therapies, the bypassing of potentially unpredictable gastrointestinal pharmacokinetics, and improved steady-state blood levels of medication.

Drugs for overactive bladder such as tolterodine and oxybutynin and other anticholinergic drugs (diphenhydramine, hydroxyzine) may precipitate delirium and should be used with great caution in residents who are frail, have pre-existing MNCD, have a history of liver disease, or are taking multiple drugs metabolized through the Cytochrome PCY450 system. Urinary incontinence in older patients can have significant psychiatric implications, including depression, anxiety, social isolation, and decreased quality of life. There are six major categories of urinary incontinence, including stress incontinence, urge incontinence, mixed incontinence, overflow incontinence, functional incontinence, and total incontinence. There are two general classes of medications used to treat overactive bladder. These include antimuscarinic (anticholinergic) agents such as oxybutynin and tolterodine and beta-3 adrenergic agonists such as mirabegron and vibegron. The beta-3 adrenergic agents are preferred as they are not anticholinergic and are not included on the Beer’s list.

Chapter 3 investigates the applicable conditions of the Born and Eikonal approximations for scalar wave scattering in random velocity fluctuations characterized by the power spectral density function. The Born approximation leads to the anisotropic scattering coefficient, which represents the directional scattering power per unit volume. The Eikonal approximation leads not only to the angular spectral function that governs narrow-angle ray bending but also to travel–distance fluctuation.

The Mediterranean is ubiquitous in nineteenth-century British literature, but this study is the first to recover and explore the region’s centrality to Romantic and Victorian constructions of the past, the present, and the shape of time itself. Placing regions central to the making of Western cultural heritage, such as Italy and Greece, into context with one another and with European imperialism, Lindsey N. Chappell traces the contours of what she terms “heritage discourse” – narrative that constructs or challenges imperial identities by reshaping antiquity – across nineteenth-century British texts. Heritage discourse functions via time, and often in counterintuitive and paradoxical ways. If assertions of political, cultural, and eventually racial supremacy were the end of this discourse, then time was the means through which it could be deployed and resisted. Chappell shows how historical narratives intervened in geopolitics, how antiquarianism sparked scientific innovation, and how classical and biblical heritage shaped British imperialism.

This chapter will focus on some important theories in micro/nanoscale thermal radiation, which are the basis of this area and become the fundamentals of other chapters in the books. The contents mainly involve electromagnetic wave theory, fluctuation dissipation theorem, and near-field thermal radiation. Brief derivation, solving the process and analysis method will be presented.

Current guidelines still support the use of an SSRI as first choice for the treatment of depression in older adults. Clinicians should keep in mind the old adage “Start low, go slow, but go” with regard to the prescribing of antidepressants in older patients. With older adults, it is a good idea to start at half or quarter of the normal adult starting dose but to increase the dose to well within the therapeutic range for a given antidepressant. Depression is prevalent in older adults in long-term care with estimated prevalence from 11-45%. Depression is associated with poor overall health outcomes and poor quality of life. Interventions are often effective if these patients are identified but treatment can be challenging and require multiple adjustments in medications or treatment strategies.