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Lo DF, Gawash A, Shah KP, Emanuel J, Goodwin B, Shamilov DD, Kumar G, Jean N, White CP. Voices of Wisdom: Geriatric Interviews on Self-Management of Type 2 Diabetes in the United States-A Systematic Review and Metasynthesis. J Diabetes Res 2024; 2024:2673742. [PMID: 39035684 PMCID: PMC11260211 DOI: 10.1155/2024/2673742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Revised: 06/23/2024] [Accepted: 06/28/2024] [Indexed: 07/23/2024] Open
Abstract
This review is aimed at unraveling the intricacies of diabetic self-management among geriatric people, drawing on current insights and understanding the complex paths geriatric people navigate. A wide search was conducted in health-oriented databases, including CINAHL, Embase, PsycINFO, MEDLINE, PubMed, Web of Science, and Cochrane Library, while gray literature was excluded. The search combined keywords and subject headings, focusing on the geriatric population, diabetes, self-management, and qualitative research. A three-tiered screening process was employed, with titles and then abstracts initially reviewed. Full-text analysis followed, with disagreements resolved among reviewers. In total, there were 248 participants included across these eight studies. Positive attitudes and perceptions were found to play a significant role in optimizing diabetes self-care outcomes. Support from family and friends was identified as crucial for self-care, while healthcare professionals often lacked adequate support and encouragement. Participants emphasized the importance of listening to their bodies and acknowledging hidden issues. These themes collectively highlight the multifaceted aspects of diabetes self-care and the impact of various factors on the self-management experiences of geriatric individuals with diabetes. The goal of this review is not to objectify self-management as a treatment strategy but to emphasize the importance of cultivating positive attitudes, respecting individual values, and addressing cultural and ethnic differences in healthcare practices to enhance self-management in this population. By embracing cultural diversity, understanding barriers, and respecting individual values, healthcare professionals and policymakers can improve the quality of life for the geriatric population living with diabetes.
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Affiliation(s)
- David F. Lo
- New Jersey Institute for Successful AgingRowan-Virtua School of Osteopathic Medicine, Stratford, New Jersey, USA
- Department of ResearchAmerican Preventive Screening & Education Association (APSEA), Stratford, New Jersey, USA
- Department of BiologyRutgersThe State University of New Jersey, New Brunswick, New Jersey, USA
- Department of ResearchFutures Forward Research Institute, Toms River, New Jersey, USA
| | - Ahmed Gawash
- New Jersey Institute for Successful AgingRowan-Virtua School of Osteopathic Medicine, Stratford, New Jersey, USA
- Department of ResearchAmerican Preventive Screening & Education Association (APSEA), Stratford, New Jersey, USA
| | - Kunal P. Shah
- New Jersey Institute for Successful AgingRowan-Virtua School of Osteopathic Medicine, Stratford, New Jersey, USA
- Department of ResearchFutures Forward Research Institute, Toms River, New Jersey, USA
| | - Jasmine Emanuel
- New Jersey Institute for Successful AgingRowan-Virtua School of Osteopathic Medicine, Stratford, New Jersey, USA
| | - Brandon Goodwin
- New Jersey Institute for Successful AgingRowan-Virtua School of Osteopathic Medicine, Stratford, New Jersey, USA
- Department of ResearchAmerican Preventive Screening & Education Association (APSEA), Stratford, New Jersey, USA
- Department of ResearchFutures Forward Research Institute, Toms River, New Jersey, USA
| | - Don D. Shamilov
- New Jersey Institute for Successful AgingRowan-Virtua School of Osteopathic Medicine, Stratford, New Jersey, USA
- Department of ResearchAmerican Preventive Screening & Education Association (APSEA), Stratford, New Jersey, USA
| | - Gaurav Kumar
- New Jersey Institute for Successful AgingRowan-Virtua School of Osteopathic Medicine, Stratford, New Jersey, USA
| | - Nathan Jean
- Department of BiologyRutgersThe State University of New Jersey, New Brunswick, New Jersey, USA
| | - Christian P. White
- New Jersey Institute for Successful AgingRowan-Virtua School of Osteopathic Medicine, Stratford, New Jersey, USA
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Wang J, Shen JY, Conwell Y, Nathan K, Moskow MS, Brasch JD, Yu F, Simmons SF, Mixon AS, Caprio TV. Implementing Essential Components of Deprescribing in Post-Acute Home Health Care. J Am Med Dir Assoc 2024; 25:105125. [PMID: 38972332 DOI: 10.1016/j.jamda.2024.105125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2024] [Revised: 05/28/2024] [Accepted: 05/28/2024] [Indexed: 07/09/2024]
Affiliation(s)
- Jinjiao Wang
- Elaine Hubbard Center for Nursing Research on Aging, University of Rochester, School of Nursing, Rochester, NY
| | - Jenny Y Shen
- Department of Medicine, University of Rochester Medical Center, Rochester, NY
| | - Yeates Conwell
- Department of Psychiatry, University of Rochester Medical Center, Rochester, NY
| | - Kobi Nathan
- Division of Geriatrics & Aging, Department of Medicine, University of Rochester Medical Center, Rochester, NY; Wegmans School of Pharmacy, St. John Fisher College, Rochester, NY
| | - Marian S Moskow
- Harriet Kitzman Center for Research Support, University of Rochester School of Nursing, Rochester, NY
| | - Judith D Brasch
- Harriet Kitzman Center for Research Support, University of Rochester School of Nursing, Rochester, NY
| | - Fang Yu
- Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, AZ
| | - Sandra F Simmons
- Department of Medicine, Vanderbilt University Medical Center, Center for Quality Aging, Nashville, TN; Geriatric Research, Education and Clinical Center (GRECC), VA Tennessee Valley Healthcare System, Nashville, TN; Division of Geriatrics, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN
| | - Amanda S Mixon
- Department of Medicine, Vanderbilt University Medical Center, Center for Quality Aging, Nashville, TN; Geriatric Research, Education and Clinical Center (GRECC), VA Tennessee Valley Healthcare System, Nashville, TN; Department of Medicine, Division of General Internal Medicine, Vanderbilt University Medical Center, Nashville, TN
| | - Thomas V Caprio
- Division of Geriatrics & Aging, Department of Medicine, University of Rochester Medical Center, Rochester, NY; University of Rochester - Home Care, University of Rochester Medical Center, Rochester, NY; Finger Lakes Geriatric Education Center, University of Rochester Medical Center, Rochester, NY
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Vasilevskis EE, Trumbo SP, Shah AS, Hollingsworth EK, Shotwell MS, Mixon AS, Simmons SF. Medication Discrepancies among Older Hospitalized Adults Discharged from Post-Acute Care Facilities to Home. J Am Med Dir Assoc 2024; 25:105017. [PMID: 38754476 DOI: 10.1016/j.jamda.2024.105017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Revised: 03/29/2024] [Accepted: 04/02/2024] [Indexed: 05/18/2024]
Abstract
OBJECTIVES The epidemiology of medication discrepancies during transitions from post-acute care (PAC) to home is poorly described. We sought to describe the frequency and types of medication discrepancies among hospitalized older adults transitioning from PAC to home. DESIGN A nested cohort analysis. SETTING AND PARTICIPANTS Included participants enrolled in a patient-centered deprescribing trial, for patients (aged ≥50 years and taking at least 5 medications) transitioning from one of 22 PACs to home. METHODS We assessed demographic and medication measures at the initial hospitalization. The primary outcome measure was medication discrepancies, with the PAC discharge list serving as reference for comparison to the participant's self-reported medication list at 7 days following PAC discharge. Discrepancies were categorized as additions, omissions, and dose discrepancies and were organized by common medication classes and risk of harm (eg, 2015 Beers Criteria). Ordinal logistic regression assessed for patient risk factors for PAC discharge discrepancy count. RESULTS A total of 184 participants had 7-day PAC discharge medication data. Participants were predominately female (67%) and Caucasian (83%) with a median of 16 prehospital medications [interquartile range (IQR) 11, 20]. At the 7-day follow-up, 98% of participants had at least 1 medication discrepancy, with a median number of 7 medication discrepancies (IQR 4, 10) per person, 4 (IQR 2, 6) of which were potentially inappropriate medications as defined by the Beers Criteria. Higher medication discrepancies at index hospital admission and receipt of caregiver assistance with medications were 2 key predictors of medication discrepancies in the week after PAC discharge to home. CONCLUSIONS AND IMPLICATIONS Older patients transitioning home from a PAC facility are at high risk for medication discrepancies. This study underscores the need for interventions targeted at this overlooked transition period, especially as patients resume responsibility for managing their own medications after both a hospital and PAC stay.
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Affiliation(s)
- Eduard Eric Vasilevskis
- Division of Hospital Medicine, Department of Medicine, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA; Center for Quality Aging, Vanderbilt University Medical Center, Nashville, TN, USA; Section of Hospital Medicine, Division of General Internal Medicine & Public Health, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA; Center for Health Services Research, Vanderbilt University Medical Center, Nashville, TN, USA; Geriatric Research Education and Clinical Center, VA Tennessee Valley Healthcare System, Nashville, TN, USA.
| | - Silas P Trumbo
- Department of Medicine, University of Central Florida College of Medicine, Orlando, FL, USA
| | - Avantika Saraf Shah
- Center for Quality Aging, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Emily Kay Hollingsworth
- Center for Quality Aging, Vanderbilt University Medical Center, Nashville, TN, USA; Division of Geriatrics, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | | | - Amanda S Mixon
- Section of Hospital Medicine, Division of General Internal Medicine & Public Health, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA; Center for Health Services Research, Vanderbilt University Medical Center, Nashville, TN, USA; Geriatric Research Education and Clinical Center, VA Tennessee Valley Healthcare System, Nashville, TN, USA
| | - Sandra Faye Simmons
- Center for Quality Aging, Vanderbilt University Medical Center, Nashville, TN, USA; Center for Health Services Research, Vanderbilt University Medical Center, Nashville, TN, USA; Geriatric Research Education and Clinical Center, VA Tennessee Valley Healthcare System, Nashville, TN, USA; Division of Geriatrics, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
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Cohen EB, Patwardhan M, Raheja R, Alpers DH, Andrade RJ, Avigan MI, Lewis JH, Rockey DC, Chui F, Iacob AM, Linardi CC, Regev A, Shick J, Lucena MI. Drug-Induced Liver Injury in the Elderly: Consensus Statements and Recommendations from the IQ-DILI Initiative. Drug Saf 2024; 47:301-319. [PMID: 38217833 PMCID: PMC10954848 DOI: 10.1007/s40264-023-01390-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/11/2023] [Indexed: 01/15/2024]
Abstract
The elderly demographic is the fastest-growing segment of the world's population and is projected to exceed 1.5 billion people by 2050. With multimorbidity, polypharmacy, susceptibility to drug-drug interactions, and frailty as distinct risk factors, elderly patients are especially vulnerable to developing potentially life-threatening safety events such as serious forms of drug-induced liver injury (DILI). It has been a longstanding shortcoming that elderly individuals are often a vulnerable population underrepresented in clinical trials. As such, an improved understanding of DILI in the elderly is a high-priority, unmet need. This challenge is underscored by recent documents put forward by the U.S. Food and Drug Administration (FDA) and European Medicines Agency (EMA) that encourage data collection in the elderly and recommend improved practices that will facilitate a more inclusive approach. To establish what is already known about DILI in the elderly and pinpoint key gaps of knowledge in this arena, a working definition of "elderly" is required that accounts for both chronologic and biologic ages and varying states of frailty. In addition, it is critical to characterize the biological role of aging on liver function, as well as the different epidemiological factors such as polypharmacy and inappropriate prescribing that are common practices. While data may not show that elderly people are more susceptible to DILI, DILI due to specific drugs might be more common in this population. Improved characterization of DILI in the elderly may enhance diagnostic and prognostic capabilities and improve the way in which liver safety is monitored during clinical trials. This summary of the published literature provides a framework to understand and evaluate the risk of DILI in the elderly. Consensus statements and recommendations can help to optimize medical care and catalyze collaborations between academic clinicians, drug manufacturers, and regulatory scientists to enable the generation of high-quality research data relevant to the elderly population.
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Affiliation(s)
- Eric B Cohen
- Pharmacovigilance and Patient Safety, AbbVie Inc., North Chicago, IL, USA.
| | - Meenal Patwardhan
- Pharmacovigilance and Patient Safety, AbbVie Inc., North Chicago, IL, USA
| | - Ritu Raheja
- Pharmacovigilance and Patient Safety, AbbVie Inc., North Chicago, IL, USA
| | - David H Alpers
- Department of Medicine, Washington University School of Medicine, St. Louis, MO, USA
| | - Raul J Andrade
- Department of Medicine, IBIMA_Plataforma Bionand, University of Malaga, Malaga, Spain
| | - Mark I Avigan
- Food and Drug Administration, Center for Drug Evaluation and Research, Silver Spring, MD, USA
| | - James H Lewis
- Division of Gastroenterology, Georgetown University, Washington, D.C., USA
| | - Don C Rockey
- Digestive Disease Research Center, Medical University of South Carolina, Charleston, SC, USA
| | - Francis Chui
- Pharmacovigilance, Gilead Sciences Inc., Foster City, CA, USA
| | - Alexandru M Iacob
- Pharmacovigilance and Patient Safety, AbbVie Inc., Ottawa, ON, Canada
| | - Camila C Linardi
- Translational Medicine, Bayer HealthCare Pharmaceuticals LLC, Whippany, NJ, USA
| | - Arie Regev
- Global Patient Safety, Eli Lilly and Company, Indianapolis, IN, USA
| | - Jesse Shick
- Pharmacovigilance, Gilead Sciences Inc., Foster City, CA, USA
| | - M Isabel Lucena
- Department of Pharmacology and Pediatrics, IBIMA_Plataforma Bionand, University of Malaga, Malaga, Spain
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Wang J, Shen JY, Conwell Y, Podsiadly EJ, Caprio TV, Nathan K, Yu F, Ramsdale EE, Fick DM, Mixon AS, Simmons SF. Implementation considerations of deprescribing interventions: A scoping review. J Intern Med 2024; 295:436-507. [PMID: 36524602 DOI: 10.1111/joim.13599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Over half of older adults experience polypharmacy, including medications that may be inappropriate or unnecessary. Deprescribing, which is the process of discontinuing or reducing inappropriate and/or unnecessary medications, is an effective way to reduce polypharmacy. This review summarizes (1) the process of deprescribing and conceptual models and tools that have been developed to facilitate deprescribing, (2) barriers, enablers, and factors associated with deprescribing, and (3) characteristics of deprescribing interventions in completed trials, as well as (4) implementation considerations for deprescribing in routine practice. In conceptual models of deprescribing, multilevel factors of the patient, clinician, and health-care system are all related to the efficacy of deprescribing. Numerous tools have been developed for clinicians to facilitate deprescribing, yet most require substantial time and, thus, may be difficult to implement during routine health-care encounters. Multiple deprescribing interventions have been evaluated, which mostly include one or more of the following components: patient education, medication review, identification of deprescribing targets, and patient and/or provider communication about high-risk medications. Yet, there has been limited consideration of implementation factors in prior deprescribing interventions, especially with regard to the personnel and resources in existing health-care systems and the feasibility of incorporating components of deprescribing interventions into the routine care processes of clinicians. Future trials require a more balanced consideration of both effectiveness and implementation when designing deprescribing interventions.
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Affiliation(s)
- Jinjiao Wang
- Elaine, Hubbard Center for Nursing Research on Aging, School of Nursing, University of Rochester, Rochester, New York, USA
| | - Jenny Y Shen
- Department of Medicine, University of Rochester Medical Center, Rochester, New York, USA
| | - Yeates Conwell
- Department of Psychiatry, University of Rochester Medical Center, Rochester, New York, USA
| | - Eric J Podsiadly
- Harriet J. Kitzman Center for Research Support, School of Nursing, University of Rochester, Rochester, New York, USA
| | - Thomas V Caprio
- Department of Medicine, Division of Geriatrics & Aging, University of Rochester Medical Center, Rochester, New York, USA
- UR Medicine Home Care, University of Rochester Medical Center, Rochester, New York, USA
- University of Rochester Medical Center, Finger Lakes Geriatric Education Center, Rochester, New York, USA
| | - Kobi Nathan
- Department of Medicine, Division of Geriatrics & Aging, University of Rochester Medical Center, Rochester, New York, USA
- St. John Fisher College, Wegmans School of Pharmacy, Rochester, New York, USA
| | - Fang Yu
- Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, Arizona, USA
| | - Erika E Ramsdale
- Department of Medicine, Division of Hematology/Oncology, University of Rochester Medical Center, Rochester, New York, USA
| | - Donna M Fick
- Ross and Carol Nese College of Nursing, Penn State University, University Park, Pennsylvania, USA
| | - Amanda S Mixon
- Department of Medicine, Division of General Internal Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Department of Medicine, Center for Quality Aging, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Geriatric Research, Education and Clinical Center (GRECC), VA Tennessee Valley Healthcare System, Nashville, Tennessee, USA
| | - Sandra F Simmons
- Department of Medicine, Center for Quality Aging, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Geriatric Research, Education and Clinical Center (GRECC), VA Tennessee Valley Healthcare System, Nashville, Tennessee, USA
- Department of Medicine, Division of Geriatrics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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Kojima T. Managing geriatric syndromes: Necessity of pharmacists' involvements. Geriatr Gerontol Int 2024; 24:244-245. [PMID: 38168484 DOI: 10.1111/ggi.14792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2023] [Accepted: 12/14/2023] [Indexed: 01/05/2024]
Affiliation(s)
- Taro Kojima
- Department of Geriatric Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
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Hasegawa S, Mizokami F, Mizuno T, Yabu T, Kameya Y, Hayakawa Y, Arai H. Investigation of geriatric syndromes associated with medication in Japan using insurance claims data. Geriatr Gerontol Int 2024; 24:61-67. [PMID: 38084388 DOI: 10.1111/ggi.14755] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 10/25/2023] [Accepted: 11/12/2023] [Indexed: 01/05/2024]
Abstract
AIM Multiple risk factors are involved in geriatric syndrome (GS) occurring in older adults. Although drug therapy often contributes to GS, the specific causes among older adults in Japan remain unclear. In this study, we examined the possible prescribing cascade rate among older outpatients eligible for Late-stage Elderly Health Insurance and elucidated the differences between GS and GS associated with medication (GSAM) trends. METHODS This retrospective study enrolled patients from health insurance claims data in Japan between October 2018 and March 2019; hospitalized patients were excluded. Two groups were identified among the participants with GS: GS (no use of GS-causing medications) and possible-GSAM (p-GSAM; use of GS-causing medications). The collected data were analyzed using the Bell Curve for Excel, and statistical significance was set at P < 0.05. RESULTS In total, 137 781 outpatients were enrolled. Of the 32 259 outpatients who did not use GS-causing medications, 7342 were classified into the GS group. Among 105 522 outpatients who used GS-causing medications, 8347 were classified as having p-GSAM. The mean number of prescriptions was significantly higher in the p-GSAM group than in the GS group (P < 0.01). Furthermore, all GS symptoms showed significant differences, with impaired appetite being the most prevalent in the p-GSAM group than in the GS group (P < 0.01). A possible prescribing cascade was suspected in 2826 (33.9%) of 8347 outpatients in the p-GSAM group. CONCLUSION Impaired appetite in patients taking GS-causing medications might lead to prescribing cascades. Further studies are needed to prevent such prescribing cascades. Geriatr Gerontol Int 2024; 24: 61-67.
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Affiliation(s)
- Sho Hasegawa
- Department of Pharmacotherapeutics and Informatics, Fujita Health University, Toyoake, Japan
- Department of Education and Innovation Training for Pharmacy, National Center for Geriatrics and Gerontology, Obu, Japan
| | - Fumihiro Mizokami
- Department of Education and Innovation Training for Pharmacy, National Center for Geriatrics and Gerontology, Obu, Japan
- Department of Pharmacy, National Center for Geriatrics and Gerontology, Obu, Japan
| | - Tomohiro Mizuno
- Department of Pharmacotherapeutics and Informatics, Fujita Health University, Toyoake, Japan
| | | | - Yoshitaka Kameya
- Faculty of Information Engineering, Meijo University, Nagoya, Japan
| | - Yuji Hayakawa
- Department of Education and Innovation Training for Pharmacy, National Center for Geriatrics and Gerontology, Obu, Japan
- Department of Pharmacy, National Hospital Organization, Nagoya Medical Center, Nagoya, Japan
| | - Hidenori Arai
- National Center for Geriatrics and Gerontology, Obu, Japan
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Al-Azayzih A, Kanaan RJ, Altawalbeh SM, Al-Qerem W, Smadi S. Medication Adherence and Its Associated Determinants in Older Adults with Type 2 Diabetes and Cardiovascular Comorbidities. Patient Prefer Adherence 2023; 17:3107-3118. [PMID: 38050627 PMCID: PMC10693756 DOI: 10.2147/ppa.s437013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 11/14/2023] [Indexed: 12/06/2023] Open
Abstract
Aims of the Study To evaluate medication adherence level and identify predictors of poor medication adherence in elderly patients with Cardiovascular (CVS) diseases and type 2 diabetes in Jordan. Methods This cross-sectional study was conducted on elderly patients who attended King Abdullah University Hospital (KAUH) outpatient diabetes and cardiology clinics from March 6, 2023, to July 6, 2023. Data on age, sex, socio-demographics, biological variables, medication characteristics, and chronic comorbidities were obtained from electronic patients' medical records and a validated questionnaire. Medication adherence levels (low, moderate, and high) were assessed using the Arabic version of the 4-item Morisky, Green, and Levine Medication Adherence Scale-Medication Assessment Questionnaire. Results Data from 506 elderly patients were analyzed. The average age of the participants was 67.93 years (SD = 6.22). 7.9% of patients showed low adherence levels, 33.6% showed moderate adherence level, and 58.5% of patients showed a high level of adherence toward their prescribed medications. Multivariable ordinal logistic regression analysis revealed that single/currently unmarried patients and patients who were living with others were more likely to have a higher adherence level; Odd Ratios (ORs) were 4.75 and 4.10, respectively. Patients who took their medications ≥ 3 and 2 times a day showed higher adherence to their medications than those who only took them once a day.; ORs were 2.15 and 2.36, respectively. Conclusion This study indicated an inadequate level of adherence among patients with type 2 diabetes and cardiovascular comorbidities. This study revealed the necessity of implementing programs to help in raising the awareness among elderly patients with type 2 diabetes and CVDs of the importance of adherence to prescribed long-term medication regimens.
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Affiliation(s)
- Ahmad Al-Azayzih
- Department of Clinical Pharmacy, Faculty of Pharmacy, Jordan University of Science and Technology, Irbid, Jordan
| | - Roaa J Kanaan
- Department of Clinical Pharmacy, Faculty of Pharmacy, Jordan University of Science and Technology, Irbid, Jordan
| | - Shoroq M Altawalbeh
- Department of Clinical Pharmacy, Faculty of Pharmacy, Jordan University of Science and Technology, Irbid, Jordan
| | - Walid Al-Qerem
- Department of Pharmacy, Faculty of Pharmacy, Al-Zaytoonah University of Jordan, Amman, Jordan
| | - Saja Smadi
- Department of Clinical Pharmacy, Faculty of Pharmacy, Jordan University of Science and Technology, Irbid, Jordan
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Bellanca CM, Augello E, Cantone AF, Di Mauro R, Attaguile GA, Di Giovanni V, Condorelli GA, Di Benedetto G, Cantarella G, Bernardini R. Insight into Risk Factors, Pharmacogenetics/Genomics, and Management of Adverse Drug Reactions in Elderly: A Narrative Review. Pharmaceuticals (Basel) 2023; 16:1542. [PMID: 38004408 PMCID: PMC10674329 DOI: 10.3390/ph16111542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 10/23/2023] [Accepted: 10/25/2023] [Indexed: 11/26/2023] Open
Abstract
The European Medicine Agency (EMA) has defined Adverse Drug Reactions (ADRs) as "a noxious and unintended response to a medicine", not including poisoning, accidental, or intentional overdoses. The ADR occurrence differs based on the approach adopted for defining and detecting them, the characteristics of the population under study, and the research setting. ADRs have a significant impact on morbidity and mortality, particularly among older adults, and represent a financial burden for health services. Between 30% and 60% of ADRs might be predictable and preventable, emerging as a result of inappropriate prescription, drug chemistry inherent toxicity, cell-specific drug toxicity, age- and sex-related anomalies in drug absorption, distribution, metabolism, and elimination (ADME), and drug-drug interactions (DDIs) in combination therapies or when a patient is treated with different drugs for concomitant disorders. This is particularly important in chronic diseases which require long-term treatments. Rapid developments in pharmacogenetics/genomics have improved the understanding of ADRs accompanied by more accurate prescriptions and reduction in unnecessary costs. To alleviate the burden of ADRs, especially in the elderly, interventions focused on pharmaceutical principles, such as medication review and reconciliation, should be integrated into a broader assessment of patients' characteristics, needs, and health priorities. Digital health interventions could offer valuable solutions to assist healthcare professionals in identifying inappropriate prescriptions and promoting patient adherence to pharmacotherapies.
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Affiliation(s)
- Carlo Maria Bellanca
- Department of Biomedical and Biotechnological Sciences, Section of Pharmacology, University of Catania, 95123 Catania, Italy; (C.M.B.); (E.A.); (A.F.C.); (G.A.A.); (G.A.C.); (G.C.); (R.B.)
- Clinical Toxicology Unit, University Hospital of Catania, 95123 Catania, Italy
| | - Egle Augello
- Department of Biomedical and Biotechnological Sciences, Section of Pharmacology, University of Catania, 95123 Catania, Italy; (C.M.B.); (E.A.); (A.F.C.); (G.A.A.); (G.A.C.); (G.C.); (R.B.)
- Clinical Toxicology Unit, University Hospital of Catania, 95123 Catania, Italy
| | - Anna Flavia Cantone
- Department of Biomedical and Biotechnological Sciences, Section of Pharmacology, University of Catania, 95123 Catania, Italy; (C.M.B.); (E.A.); (A.F.C.); (G.A.A.); (G.A.C.); (G.C.); (R.B.)
| | - Rosaria Di Mauro
- Dipartimento del Farmaco, ASP Trapani, 91100 Trapani, Italy; (R.D.M.); (V.D.G.)
| | - Giuseppe Antonino Attaguile
- Department of Biomedical and Biotechnological Sciences, Section of Pharmacology, University of Catania, 95123 Catania, Italy; (C.M.B.); (E.A.); (A.F.C.); (G.A.A.); (G.A.C.); (G.C.); (R.B.)
| | | | - Guido Attilio Condorelli
- Department of Biomedical and Biotechnological Sciences, Section of Pharmacology, University of Catania, 95123 Catania, Italy; (C.M.B.); (E.A.); (A.F.C.); (G.A.A.); (G.A.C.); (G.C.); (R.B.)
| | - Giulia Di Benedetto
- Department of Biomedical and Biotechnological Sciences, Section of Pharmacology, University of Catania, 95123 Catania, Italy; (C.M.B.); (E.A.); (A.F.C.); (G.A.A.); (G.A.C.); (G.C.); (R.B.)
- Clinical Toxicology Unit, University Hospital of Catania, 95123 Catania, Italy
| | - Giuseppina Cantarella
- Department of Biomedical and Biotechnological Sciences, Section of Pharmacology, University of Catania, 95123 Catania, Italy; (C.M.B.); (E.A.); (A.F.C.); (G.A.A.); (G.A.C.); (G.C.); (R.B.)
| | - Renato Bernardini
- Department of Biomedical and Biotechnological Sciences, Section of Pharmacology, University of Catania, 95123 Catania, Italy; (C.M.B.); (E.A.); (A.F.C.); (G.A.A.); (G.A.C.); (G.C.); (R.B.)
- Clinical Toxicology Unit, University Hospital of Catania, 95123 Catania, Italy
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Kitaw TA, Haile RN. Prevalence of polypharmacy among older adults in Ethiopia: a systematic review and meta-analysis. Sci Rep 2023; 13:17641. [PMID: 37848565 PMCID: PMC10582100 DOI: 10.1038/s41598-023-45095-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2022] [Accepted: 10/16/2023] [Indexed: 10/19/2023] Open
Abstract
Polypharmacy is a significant concern for older adults. Taking multiple medicines to prevent and treat comorbidities is very common in older adults, potentially leading to polypharmacy. Polypharmacy is associated with the development of geriatric syndromes, including cognitive impairment, delirium, falls, frailty, urinary incontinence, and weight loss. The prevalence of polypharmacy varies according to the literature. There is a paucity of data regarding the prevalence of polypharmacy among older adults. Therefore, this study aimed to estimate the pooled prevalence of polypharmacy among older adults in Ethiopia. A comprehensive search of databases, including PubMed, MEDLINE, EMBASE, Hinari, Cumulative Index to Nursing and Allied Health Literature, International Scientific Indexing, Cochrane library and Web of Science, and Google Scholar, was conducted. STATA statistical software (version 17) was used to analyze the data. Forest plot and I2 heterogeneity test were computed to examine the existence of heterogeneity. Subgroup analysis and sensitivity analysis were done to explore the source of heterogeneity. Publication bias was evaluated by using funnel plots and Egger's test. A random effect model was used to determine the pooled prevalence of polypharmacy. After reviewing 123 studies, 13 studies with a total of 3547 older adults fulfilled the inclusion criteria and were included in this meta-analysis. The result from 13 studies revealed that the pooled prevalence of polypharmacy among older adults in Ethiopia was 37.10% (95CI: 28.28-45.91). A Subgroup Meta-analysis showed that the heterogeneity level was slightly lower among studies done in Oromia region (I2 = 46.62, P-value = 0.154). Higher pooled polypharmacy prevalence was found among older adults with cardiovascular disorders (42.7%) and admitted patients (51.4%). In general, it was found that the pooled prevalence of polypharmacy among older adults in Ethiopia was high. More than one in three older adults take five or more medications at a time. Thus, intervention focusing on rational geriatric pharmacotherapy is significant to prevent unnecessary pill burden, adverse drug events, medical costs, geriatric morbidity, and mortality. Furthermore, enhancing pharmacist roles towards medication therapy management and safety monitoring in older adults is also indicated.
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Affiliation(s)
- Tegene Atamenta Kitaw
- Department of Nursing, College of Health Science, Woldia University, Woldia, Ethiopia.
| | - Ribka Nigatu Haile
- Department of Nursing, College of Health Science, Woldia University, Woldia, Ethiopia
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Mena S, Moullin JC, Schneider M, Niquille A. Implementation of interprofessional quality circles on deprescribing in Swiss nursing homes: an observational study. BMC Geriatr 2023; 23:620. [PMID: 37789286 PMCID: PMC10548671 DOI: 10.1186/s12877-023-04335-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Accepted: 09/20/2023] [Indexed: 10/05/2023] Open
Abstract
BACKGROUND Polypharmacy and potentially inappropriate medications (PIMs) are still frequent among older adults in nursing homes. Deprescribing is an intervention that has been shown to be effective in reducing their use. However, the implementation of deprescribing in clinical practice has not yet been widely evaluated. The Quality Circle Deprescribing Module (QC-DeMo) intervention has been trialled through an effectiveness-implementation hybrid type 2 design. The intervention consists of a quality circle workshop session between healthcare professionals HCPs (physicians, nurses, and pharmacists) within a nursing home, in which they define a consensus to deprescribe specific PIMs classes. The aim of this study was to evaluate the implementation of the QC-DeMo intervention in nursing homes. METHODS This observational study focuses on the implementation part of the QC-DeMo trial. Implementation was based on the Framework for Implementation of Pharmacy Services (FISpH). Questionnaires at baseline and follow-up were used to evaluate reach, adoption, implementation effectiveness, fidelity, implementation, maintenance and the implementation strategies. Other data were collected from the QC-DeMo trial and routine data collected as part of the integrated pharmacy service where the QC-Demo trial was embedded. Implementation strategies included training of pharmacists, integration of the intervention into an existing quality circle dynamic and definition of tailored strategies to operationalise the consensus by each nursing home. RESULTS The QC-DeMo intervention was successfully implemented in 26 nursing homes in terms of reach, fidelity, adoption, implementation and implementation effectiveness. However, the intervention was found to be implemented with low maintenance as none of the nursing homes repeated the intervention after the trial. Implementation strategies were well received by HCPs: training was adequate according to pharmacists. Pre-existing quality circle dynamic facilitated interprofessional collaboration as involvement and support of each HCP was rated as high. HCPs recognized a specific and important role for each HCP in the deprescribing process. The most relevant tailored strategies to implement the consensus defined by each nursing home were identification of the patients by the pharmacist and a systematic review of medication's patients. CONCLUSIONS The implementation of a Quality Circle on Deprescribing is feasible but its maintenance in practice remains challenging. This study explores multiple implementation outcomes to better inform future implementation efforts of these types of interventions. TRIAL REGISTRATION ClinicalTrials.gov ( NCT03688542 ), registered on 26.09.2018.
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Affiliation(s)
- Stephanie Mena
- Community Pharmacy, Center for Primary Care and Public Health (Unisanté), University of Lausanne, Rue du Bugnon 44, CH-1011, Lausanne, Switzerland.
- School of Pharmaceutical Sciences, University of Geneva, Geneva, Switzerland.
- Institute of Pharmaceutical Sciences of Western Switzerland, University of Geneva, University of Lausanne, Geneva, Switzerland.
| | - Joanna C Moullin
- Faculty of Health Sciences, Curtin University, Curtin School of Population Health, Perth, Australia
| | - Marie Schneider
- School of Pharmaceutical Sciences, University of Geneva, Geneva, Switzerland
- Institute of Pharmaceutical Sciences of Western Switzerland, University of Geneva, University of Lausanne, Geneva, Switzerland
| | - Anne Niquille
- Community Pharmacy, Center for Primary Care and Public Health (Unisanté), University of Lausanne, Rue du Bugnon 44, CH-1011, Lausanne, Switzerland
- School of Pharmaceutical Sciences, University of Geneva, Geneva, Switzerland
- Institute of Pharmaceutical Sciences of Western Switzerland, University of Geneva, University of Lausanne, Geneva, Switzerland
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Wang J, Shen JY, Yu F, Nathan K, Caprio TV, Conwell Y, Moskow MS, Brasch JD, Simmons SF, Mixon AS, Norton SA. How to Deprescribe Potentially Inappropriate Medications During the Hospital-to-Home Transition: Stakeholder Perspectives on Essential Tasks. Clin Ther 2023; 45:947-956. [PMID: 37640614 PMCID: PMC10841554 DOI: 10.1016/j.clinthera.2023.07.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 07/24/2023] [Accepted: 07/31/2023] [Indexed: 08/31/2023]
Abstract
PURPOSE Nearly all older patients receiving postacute home health care (HHC) use potentially inappropriate medications (PIMs) that carry a risk of harm. Deprescribing can reduce and optimize the use of PIMs, yet it is often not conducted among HHC patients. The objective of this study was to gather perspectives from patient, practitioner, and HHC clinician stakeholders on tasks that are essential to postacute deprescribing in HHC. METHODS A total of 44 stakeholders, including 14 HHC patients, 15 practitioners (including 9 primary care physicians, 4 pharmacists, 1 hospitalist, and 1 nurse practitioner), and 15 HHC nurses, participated. The stakeholders were from 12 US states, including New York (n = 29), Colorado (n = 2), Connecticut (n = 1), Illinois (n = 2), Kansas (n = 2), Massachusetts (n = 1), Minnesota (n = 1), Mississippi (n = 1), Nebraska (n = 1), Ohio (n = 1), Tennessee (n = 1), and Texas (n = 2). First, individual interviews were conducted by experienced research staff via video conference or telephone. Second, the study team reviewed all interview transcripts and selected interview statements regarding stakeholders' suggestions for important tasks needed for postacute deprescribing in HHC. Third, concept mapping was conducted in which stakeholders sorted and rated selected interview statements regarding importance and feasibility. A content analysis was conducted of data collected in the individual interviews, and a mixed-method analysis was conducted of data collected in the concept mapping. FINDINGS Four essential tasks were identified for postacute deprescribing in HHC: (1) ongoing review and assessment of medication use, (2) patent-centered and individualized plan of deprescribing, (3) timely and efficient communication among members of the care team, and (4) continuous and tailored medication education to meet patient needs. Among these tasks, developing patient-centered deprescribing considerations was considered the most important and feasible, followed by medication education, review and assessment of medication use, and communication. IMPLICATIONS Deprescribing during the transition of care from hospital to home requires the following: continuous medication education for patients, families, and caregivers; ongoing review and assessment of medication use; patient-centered deprescribing considerations; and effective communication and collaboration among the primary care physician, HHC nurse, and pharmacist.
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Affiliation(s)
- Jinjiao Wang
- Elaine Hubbard Center for Nursing Research on Aging, University of Rochester, School of Nursing, Rochester, New York.
| | - Jenny Y Shen
- Department of Medicine, University of Rochester Medical Center, Rochester, New York
| | - Fang Yu
- Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, Arizona
| | - Kobi Nathan
- Division of Geriatrics and Aging, Department of Medicine, University of Rochester Medical Center, Rochester, New York; Wegmans School of Pharmacy, St. John Fisher College, Rochester, New York
| | - Thomas V Caprio
- Division of Geriatrics and Aging, Department of Medicine, University of Rochester Medical Center, Rochester, New York; University of Rochester Home Care, University of Rochester Medical Center, Rochester, New York; Finger Lakes Geriatric Education Center, University of Rochester Medical Center, Rochester, New York
| | - Yeates Conwell
- Department of Psychiatry, University of Rochester Medical Center, Rochester, New York
| | - Marian S Moskow
- Harriet Kitzman Center for Research Support, University of Rochester School of Nursing, Rochester, New York
| | - Judith D Brasch
- Harriet Kitzman Center for Research Support, University of Rochester School of Nursing, Rochester, New York
| | - Sandra F Simmons
- Department of Medicine, Center for Quality Aging, Vanderbilt University Medical Center, Nashville, Tennessee; Geriatric Research, Education, and Clinical Center (GRECC), Veterans Affairs Tennessee Valley Healthcare System, Nashville, Tennessee; Division of Geriatrics, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Amanda S Mixon
- Department of Medicine, Center for Quality Aging, Vanderbilt University Medical Center, Nashville, Tennessee; Geriatric Research, Education, and Clinical Center (GRECC), Veterans Affairs Tennessee Valley Healthcare System, Nashville, Tennessee; Division of General Internal Medicine and Public Health, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Sally A Norton
- School of Nursing, University of Rochester, Rochester, New York
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Veizi BGY, Taşcı İ, Naharci MI. Geriatric syndromes in the population older than 90 years: The prevalence and association with chronic diseases. Australas J Ageing 2023; 42:472-479. [PMID: 37161641 DOI: 10.1111/ajag.13209] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2022] [Revised: 04/06/2023] [Accepted: 04/12/2023] [Indexed: 05/11/2023]
Abstract
OBJECTIVE The aim of this study was to explore the prevalence of geriatric syndromes and comorbid conditions, as well as their interrelationships, in individuals aged 90 years and over. METHODS This study included participants aged 90 years and older who underwent a comprehensive geriatric assessment in a tertiary geriatric outpatient clinic. Demographic and clinical characteristics were obtained using the electronic medical records. The geriatric syndrome burden was calculated by adding each syndrome, which was then stratified into one of two groups based on the median value: no or low burden (<4) and high burden (≥4). The modified Charlson comorbidity index was used to determine chronic disease burden. RESULTS A total of 235 participants (93.2 ± 2.7 years) were recruited in this study. The mean index score was 7.3, and 46% (n = 107) of participants had a high geriatric syndrome burden. The most common geriatric syndrome was incontinence (69%), followed by polypharmacy (60%) and depression (43%). When compared to patients without such a diagnosis, the prevalence of polypharmacy was significantly higher in patients diagnosed with hypertension, chronic kidney disease, cardiovascular disease, diabetes mellitus and chronic obstructive pulmonary disease (p = 0.02, p = 0.02, p < 0.001, p = 0.008, p = 0.007, respectively). However, no chronic disease was associated with geriatric syndrome burden. CONCLUSIONS We found that the burden of medical conditions in the older population over 90 years of age could influence general health status significantly, with a high prevalence of chronic diseases and geriatric syndromes.
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Affiliation(s)
- Betül Gülsüm Yavuz Veizi
- Department of Geriatrics, Gülhane Faculty of Medicine and Gülhane Training and Research Hospital, University of Health Sciences, Ankara, Turkey
| | - İlker Taşcı
- Department of Internal Medicine, Gülhane Faculty of Medicine and Gülhane Training and Research Hospital, University of Health Sciences, Ankara, Turkey
| | - Mehmet Ilkin Naharci
- Department of Geriatrics, Gülhane Faculty of Medicine and Gülhane Training and Research Hospital, University of Health Sciences, Ankara, Turkey
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14
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Nizet P, Evin A, Brociero E, Vigneau CV, Huon JF. Outcomes in deprescribing implementation trials and compliance with expert recommendations: a systematic review. BMC Geriatr 2023; 23:428. [PMID: 37438697 DOI: 10.1186/s12877-023-04155-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Accepted: 07/05/2023] [Indexed: 07/14/2023] Open
Abstract
BACKGROUND Deprescribing, defined as discontinuing or reducing the dose of medications that are no longer needed or for which the risks outweigh the benefits is a way to reduce polypharmacy. In 2022, the US Deprescribing Research Network (USDeN) published recommendations concerning the measurement of outcomes for deprescribing intervention studies. The objectives of this systematic review were to identify the outcome categories used in deprescribing intervention trials and to relate them to the previously published recommendations. METHODS We searched MEDLINE, Embase, PsychInfo, and the Cochrane library from January 2012 through January 2022. Studies were included if they were randomized controlled trials evaluating a deprescribing intervention. After data extraction, outcomes were categorized by type: medication outcomes, clinical outcomes, system outcomes, implementation outcomes, and other outcomes based on the previously published recommendations. RESULTS Thirty-six studies were included. The majority of studies focused on older adults in nursing homes and targeted inappropriate medications or polypharmacy. In 20 studies, the intervention was a medication review; in seven studies, the intervention was educational or informative; and three studies based their intervention on motivational interviewing or patient empowerment. Thirty-one studies presented a medication outcome (primary outcome in 26 studies), 25 a clinical outcome, 18 a system outcome, and seven an implementation outcome. Only three studies presented all four types of outcomes, and 10 studies presented three types of outcomes. CONCLUSIONS This review provides an update on the implementation of gold standard deprescribing studies in clinical practice. Implementation outcomes need to be developed and specified to facilitate the implementation of these practices on a larger scale and clinical outcome need to be prioritized. Finally, this review provides new elements for future real-life deprescribing studies.
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Affiliation(s)
- Pierre Nizet
- Nantes Université, CHU Nantes, 44000, Pharmacie, France.
- U1246 SPHERE "methodS in Patient-Centered Outcomes and HEalth ResEarch", Université de Nantes, Université de Tours, INSERM, Nantes, France.
| | - Adrien Evin
- Nantes Université, CHU Nantes, Service de Soins Palliatifs Et de Support, 44000, Nantes, France
| | - Emma Brociero
- Nantes Université, CHU Nantes, 44000, Pharmacie, France
| | - Caroline Victorri Vigneau
- U1246 SPHERE "methodS in Patient-Centered Outcomes and HEalth ResEarch", Université de Nantes, Université de Tours, INSERM, Nantes, France
- Nantes Université, CHU Nantes, Service de Pharmacologie Clinique, 44000, Nantes, France
| | - Jean-François Huon
- Nantes Université, CHU Nantes, 44000, Pharmacie, France
- U1246 SPHERE "methodS in Patient-Centered Outcomes and HEalth ResEarch", Université de Nantes, Université de Tours, INSERM, Nantes, France
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15
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Kim J, Boll T, Lewallen K. Teaching Nurse Practitioner Students About Polypharmacy Through a Novel Simulation. Nurse Educ 2023; 48:E100-E102. [PMID: 36730903 DOI: 10.1097/nne.0000000000001312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Affiliation(s)
- Jennifer Kim
- Professor of Nursing (Dr Kim), e-Learning Specialist (Ms Boll), and Assistant Professor of Nursing (Dr Lewallen), Vanderbilt University School of Nursing, Nashville, Tennessee
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16
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Glaser I. [Polypharmacy and Delirium in the Elderly]. PRAXIS 2023; 112:335-339. [PMID: 37042399 DOI: 10.1024/1661-8157/a003998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/19/2023]
Abstract
Polypharmacy and Delirium in the Elderly Abstract: Delirium often occurs in elderly hospitalized patients. Multimorbidity and associated polypharmacy are known risk factors for developing delirium. Moreover, delirium itself often leads to the prescription of additional drugs. This article aims to enlighten the interrelation of delirium and polypharmacy in the context of recent evidence. It also tries to show possibilities of deprescribing.
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17
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Ganidagli S, Ozturk E, Ozturk ZA. Risk factors of poor sleep quality in older adults: an analysis based on comprehensive geriatric assessment. Curr Med Res Opin 2023; 39:701-706. [PMID: 36927301 DOI: 10.1080/03007995.2023.2192124] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/18/2023]
Abstract
OBJECTIVES Sleep quality is associated with many diseases and conditions that affect individuals' health in various ways. We aimed to investigate the association between sleep quality and common geriatric conditions in older adults. METHODS The study included 237 older adults admitted to the geriatric outpatient clinic of a university hospital. All patients underwent comprehensive geriatric assessment (CGA). The Geriatric Depression Scale (GDS), Beck Anxiety Inventory (BAI), European Quality of Life (EQ-5D), Pittsburgh Sleep Quality Index (PSQI), Katz Index of Independence in Activities of Daily Living (ADL) and Lawton and Brody Instrumental Activities of Daily Living (IADL) questionnaires, Tinetti Balance and Gait Assessment (TBGA), and Mini Nutritional Assessment (MNA) were performed on the participants. RESULTS Participants had a mean age of 72.2 ± 6.3 years, and 146 (61.6%) of them had poor sleep quality. Of the participants, 61.2% were female. In the poor sleep quality group, GDS and BAI scores were higher while ADL, IADL, MNA, and EQ-5D index scores were lower. PSQI score had a negative correlation with ADL (r = -.207, p = .01), EQ-5D index (r = -.372, p = .00), MNA (r = -.277, p = .00), and TBGA (r = -.263, p = .41) scores and a positive correlation with GDS (r = .426, p = .00) and BAI (r = .450, p = .00) scores according to the results of correlation analysis. Multivariate logistic regression analysis showed that the presence of diabetes mellitus (DM) and higher GDS and BAI scores were independent variables for poor sleep quality [(p = .48, OR = 1.92; p = .20, OR = 1.11; and p <.01, OR = 1.11, respectively)]. CONCLUSIONS We found that DM and depressive and anxiety symptoms were the risks of poor sleep quality. In addition, participants with poor sleep quality had a worse quality-of-life and nutritional status. Improving sleep quality may be helpful in the management of geriatric syndromes and that sleep quality assessment should be part of CGA.
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Affiliation(s)
- Sencer Ganidagli
- Faculty of Medicine, Department of Internal Medicine, Division of Geriatric Medicine, Gaziantep University, Sahinbey, Turkey
| | - Ercument Ozturk
- Faculty of Medicine, Department of Internal Medicine, Division of Geriatric Medicine, Gaziantep University, Sahinbey, Turkey
| | - Zeynel Abidin Ozturk
- Faculty of Medicine, Department of Internal Medicine, Division of Geriatric Medicine, Gaziantep University, Sahinbey, Turkey
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18
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Kim JL, Lewallen KM, Hollingsworth EK, Shah AS, Simmons SF, Vasilevskis EE. Patient-Reported Barriers and Enablers to Deprescribing Recommendations During a Clinical Trial (Shed-MEDS). THE GERONTOLOGIST 2023; 63:523-533. [PMID: 35881109 PMCID: PMC10028229 DOI: 10.1093/geront/gnac100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Effective deprescribing requires shared decision making between a patient and their clinician, and should be used when implementing evidence-based deprescribing conversations. As part of the Shed-MEDS clinical trial, this study assessed barriers and enablers that influence patient decision making in deprescribing to inform future implementation efforts and adaptations. RESEARCH DESIGN AND METHODS Shed-MEDS, a randomized controlled deprescribing trial, included hospitalized older adults discharging to post-acute care facilities. A trained clinician reviewed each participant's medical history and medication list to identify medications with potential for deprescribing. The study clinician then conducted a semistructured patient-centered deprescribing interview to determine patient (or surrogate) concerns about medications and willingness to deprescribe. Reeve et al.'s (2013) framework was used to categorize barriers and enablers to deprescribing from the patient's perspective, including "appropriateness of cessation," "fear," "dislike of a medication," "influences," and "process of cessation." RESULTS Overall, participants/surrogates (N = 177) agreed with 63% (883 total medications) of the study clinician's deprescribing recommendations. Thematic analysis revealed that "appropriateness" of a medication was the most common barrier (88.2%) and enabler (67.3%) to deprescribing. Other deprescribing enablers were in the following domains: "influences" (22.7%), "process" (22.5%), "pragmatic" (19.4%), and "dislike" (5.3%). DISCUSSION AND IMPLICATIONS Use of a semistructured deprescribing interview conversation tool allowed study clinicians to elicit individual barriers and enablers to deprescribing from the patient's perspective. Participants in this study expressed more agreement than disagreement with study clinicians' deprescribing recommendations. These results should inform future implementation efforts that incorporate a patient-centered framework during deprescribing conversations. CLINICAL TRIALS REGISTRATION NUMBER NCT02979353.
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Affiliation(s)
- Jennifer L Kim
- Center for Quality Aging, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- School of Nursing, Vanderbilt University, Nashville, Tennessee, USA
| | - Kanah M Lewallen
- Center for Quality Aging, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- School of Nursing, Vanderbilt University, Nashville, Tennessee, USA
| | - Emily K Hollingsworth
- Center for Quality Aging, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Avantika S Shah
- Center for Quality Aging, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Sandra F Simmons
- Center for Quality Aging, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Geriatric Research, Education, & Clinical Center (GRECC), VA Tennessee Healthcare System, Nashville, Tennessee, USA
| | - Eduard E Vasilevskis
- Geriatric Research, Education, & Clinical Center (GRECC), VA Tennessee Healthcare System, Nashville, Tennessee, USA
- Section of Hospital Medicine, Division of General Internal Medicine & Public Health, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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Wang J, Shen JY, Conwell Y, Podsiadly EJ, Caprio TV, Nathan K, Yu F, Ramsdale EE, Fick DM, Mixon AS, Simmons SF. How "age-friendly" are deprescribing interventions? A scoping review of deprescribing trials. Health Serv Res 2023; 58 Suppl 1:123-138. [PMID: 36221154 DOI: 10.1111/1475-6773.14083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
OBJECTIVE To assess how age-friendly deprescribing trials are regarding intervention design and outcome assessment. Reduced use of potentially inappropriate medications (PIMs) can be addressed by deprescribing-a systematic process of discontinuing and/or reducing the use of PIMs. The 4Ms-"Medication", "Mentation", "Mobility", and "What Matters Most" to the person-can be used to guide assessment of age-friendliness of deprescribing trials. DATA SOURCE Published literature. STUDY DESIGN Scoping review. DATA EXTRACTION METHODS The literature was identified using keywords related to deprescribing and polypharmacy in PubMed, EMBASE, Web of Science, ProQuest, CINAHL, and Cochrane and snowballing. Study characteristics were extracted and evaluated for consideration of 4Ms. PRINCIPAL FINDINGS Thirty-seven of the 564 trials identified met the review eligibility criteria. Intervention design: "Medication" was considered in the intervention design of all trials; "Mentation" was considered in eight trials; "Mobility" (n = 2) and "What Matters Most" (n = 6) were less often considered in the design of intervention. Most trials targeted providers without specifying how matters important to older adults and their families were aligned with deprescribing decisions. OUTCOME ASSESSMENT "Medication" was the most commonly assessed outcome (n = 33), followed by "Mobility" (n = 13) and "Mentation" (n = 10) outcomes, with no study examining "What Matters Most" outcomes. CONCLUSIONS "Mentation" and "Mobility", and "What Matters Most" have been considered to varying degrees in deprescribing trials, limiting the potential of deprescribing evidence to contribute to improved clinical practice in building an age-friendly health care system.
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Affiliation(s)
- Jinjiao Wang
- Elaine Hubbard Center for Nursing Research on Aging, School of Nursing, University of Rochester, Rochester, New York, USA
| | - Jenny Y Shen
- Department of Medicine, University of Rochester Medical Center, Rochester, New York, USA
| | - Yeates Conwell
- Department of Psychiatry, University of Rochester Medical Center, Rochester, New York, USA
| | - Eric J Podsiadly
- Elaine Hubbard Center for Nursing Research on Aging, School of Nursing, University of Rochester, Rochester, New York, USA
| | - Thomas V Caprio
- Division of Geriatrics & Aging, Department of Medicine, University of Rochester Medical Center, Rochester, New York, USA
| | - Kobi Nathan
- St. John Fisher College, Wegmans School of Pharmacy, Rochester, New York, USA
| | - Fang Yu
- Arizona State University, Edson College of Nursing and Health Innovation, Phoenix, Arizona, USA
| | - Erika E Ramsdale
- University of Rochester Medical Center, Department of Medicine, Division of Hematology/Oncology, Rochester, New York, USA
| | - Donna M Fick
- Penn State University, Ross and Carol Nese College of Nursing, University Park, Pennsylvania, USA
| | - Amanda S Mixon
- Division of General Internal Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Sandra F Simmons
- Division of Geriatrics & Center for Quality Aging, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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20
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Umegaki H, Nagae M, Komiya H, Watanabe K, Yamada Y, Sakai T, Tajima T. Clinical significance of geriatric conditions in acute hospitalization. Geriatr Gerontol Int 2023; 23:50-53. [PMID: 36495022 DOI: 10.1111/ggi.14523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2022] [Revised: 10/31/2022] [Accepted: 11/22/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Geriatric conditions (GCs) are common in the elderly population, but their clinical significance in acute care is not well understood. In this study, we first investigated the cross-sectional associations of GCs with frailty and polypharmacy at the time of admission to an acute care geriatric ward. Then, to clarify the clinical significance of GCs in acute care, we prospectively examined the association of GCs with the incidence of hospital-acquired complications and consequences after discharge. METHODS Participants were 184 patients (40.2% men: mean age 85.0 ± 6.0 years) hospitalized in an acute care geriatric ward at a university hospital. We examined the cross-sectional associations of GCs with frailty and polypharmacy by multiple regression analysis, and then the associations of GCs with the incidence of hospital-acquired complications, falls and death within 3 months of discharge by multiple logistic regression analysis. RESULTS GCs were associated with frailty and use of polypharmacy, independent of multiple morbidity. GCs were also associated with readmission within 3 months of discharge; however, there was no significant association with the incidence of hospital-acquired complications, falls, or mortality after discharge. CONCLUSIONS These findings suggest that GCs are clinically significant in the hospitalized elderly and further research on GCs is warranted. Geriatr Gerontol Int 2023; 23: 50-53.
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Affiliation(s)
- Hiroyuki Umegaki
- Department of Community Healthcare and Geriatrics, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Masaaki Nagae
- Department of Community Healthcare and Geriatrics, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Hitoshi Komiya
- Department of Community Healthcare and Geriatrics, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Kazuhisa Watanabe
- Department of Community Healthcare and Geriatrics, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yosuke Yamada
- Department of Community Healthcare and Geriatrics, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Tomomichi Sakai
- Department of Community Healthcare and Geriatrics, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Tomihiko Tajima
- Department of Community Healthcare and Geriatrics, Nagoya University Graduate School of Medicine, Nagoya, Japan
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Kwak MJ, Cheng M, Goyal P, Kim DH, Hummel SL, Dhoble A, Deshmukh A, Aparasu R, Holmes HM. Medication Complexity Among Older Adults with HF: How Can We Assess Better? Drugs Aging 2022; 39:851-861. [PMID: 36227408 PMCID: PMC9701093 DOI: 10.1007/s40266-022-00979-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/19/2022] [Indexed: 11/03/2022]
Abstract
Medical management of heart failure (HF) has evolved and has achieved significant survival benefits, resulting in highly complex medication regimens. Complex medication regimens create challenges for older adults, including nonadherence and increased adverse drug events, especially associated with cognitive impairment, physical limitations, or lack of social support. However, the association between medication complexity and patients' health outcomes among older adults with HF is unclear. The purpose of this review is to address how the complexity of HF medications has been assessed in the literature and what clinical outcomes are associated with medication regimen complexity in HF. Further, we aimed to explore how older adults were represented in those studies. The Medication Regimen Complexity Index was the most commonly used tool for assessment of medication regimen complexity. Rehospitalization was most frequently assessed as the clinical outcome, and other studies used medication adherence, quality of life, healthcare utilization, healthcare cost, or side effect. However, the studies showed inconsistent results in the association between the medication regimen complexity and clinical outcomes. We also identified an extremely small number of studies that focused on older adults. Notably, current medication regimen complexity tools did not consider a complicated clinical condition of an older adult with multimorbidity, therapeutic competition, drug interactions, or altered tolerance to the usual dose strength of the medications. Furthermore, the outcomes that studies assessed were rarely comprehensive or patient centered. More studies are required to fill the knowledge gap identifying more comprehensive and accurate medication regimen complexity tools and more patient-centered outcome assessment.
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Affiliation(s)
- Min Ji Kwak
- Joan and Stanford Alexander Division of Geriatric and Palliative Medicine, McGovern Medical School, The University of Texas Health Science Center at Houston, 1133 John Freeman Blvd, JJL S80-J, Houston, TX, 77030, USA.
| | - Monica Cheng
- Division of Geriatrics, University of California San Francisco, San Francisco, CA, USA
| | - Parag Goyal
- Department of Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Dae Hyun Kim
- Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Harvard Medical School, Boston, MA, USA
| | - Scott L Hummel
- Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, MI, USA
- Section of Cardiology, VA Ann Arbor Health System, Ann Arbor, MI, USA
| | - Abhijeet Dhoble
- Division of Cardiovascular Medicine, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Ashish Deshmukh
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Rajender Aparasu
- Department of Pharmaceutical Health Outcomes and Policy, University of Houston, Houston, TX, USA
| | - Holly M Holmes
- Joan and Stanford Alexander Division of Geriatric and Palliative Medicine, McGovern Medical School, The University of Texas Health Science Center at Houston, 1133 John Freeman Blvd, JJL S80-J, Houston, TX, 77030, USA
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22
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Wang J, Shen JY, Yu F, Conwell Y, Nathan K, Shah AS, Simmons SF, Li Y, Ramsdale E, Caprio TV. Medications Associated With Geriatric Syndromes (MAGS) and Hospitalization Risk in Home Health Care Patients. J Am Med Dir Assoc 2022; 23:1627-1633.e3. [PMID: 35490716 PMCID: PMC9547843 DOI: 10.1016/j.jamda.2022.03.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 03/18/2022] [Accepted: 03/20/2022] [Indexed: 12/01/2022]
Abstract
OBJECTIVES Polypharmacy is common in home health care (HHC). This study examined the prevalence of medications associated with geriatric syndromes (MAGS), its predictors, and association with subsequent hospitalization in HHC. DESIGN Analysis of HHC electronic medical records, the Outcome and Assessment Information Set (OASIS), and Medicare HHC claims. SETTING AND PARTICIPANTS A total of 6882 adults ≥65 years old receiving HHC in 2019 from a large, not-for-profit home health agency serving multiple counties in New York State. MEASURES MAGS use was identified from active medications reconciled during HHC visits (HHC electronic medical records). MAGS use was operationalized as count and in quartiles. Hospitalization during the HHC episode was operationalized as a time-to-event variable (ie, number of days from HHC admission to hospitalization). We used regression analyses to identify predictors of MAGS use, and survival analyses to examine the association between MAGS and hospitalization. RESULTS Nearly all (98%) of the HHC patients used at least 1 MAGS and 41% of all active medications used by the sample were MAGS. More MAGS use was found in HHC patients who were community-referred, taking more medications, and having more diagnoses, depressive symptoms, and functional limitations. Adjusted for covariates, higher MAGS quartiles were not independently associated with the risk of hospitalization, but higher MAGS quartiles combined with multimorbidity (ie, having ≥10 diagnoses) were associated with a 2.3-fold increase in hospitalization risk (hazard ratio 2.24; 95% confidence interval: 1.61-3.13; P < .001), relative to the lowest quartile of MAGS use and having <10 diagnoses. CONCLUSIONS AND IMPLICATIONS More than 40% of medications taken by HHC patients are MAGS. Multimorbidity and MAGS use collectively increased the risk of hospitalization by up to 2.3 times. HHC clinicians should carefully review patients' medications and use information about MAGS to facilitate discussion about deprescribing with patients and their prescribers.
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Affiliation(s)
- Jinjiao Wang
- Hubbard Center for Nursing Research on Aging, University of Rochester, School of Nursing, Rochester, NY, USA
| | - Jenny Y Shen
- University of Rochester Medical Center, Department of Medicine, Rochester, NY, USA
| | - Fang Yu
- Arizona State University, Edson College of Nursing and Health Innovation, Phoenix, AZ, USA
| | - Yeates Conwell
- University of Rochester Medical Center, Department of Psychiatry, Rochester, NY, USA
| | - Kobi Nathan
- Division of Geriatrics & Aging, Department of Medicine, University of Rochester Medical Center, Rochester, NY, USA; St. John Fisher College, Wegmans School of Pharmacy, Rochester, NY, USA
| | - Avantika S Shah
- Division of Geriatrics, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA; Department of Medicine, Vanderbilt University Medical Center, Center for Quality Aging, Nashville, TN, USA
| | - Sandra F Simmons
- Division of Geriatrics, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA; Department of Medicine, Vanderbilt University Medical Center, Center for Quality Aging, Nashville, TN, USA; Geriatric Research, Education and Clinical Center (GRECC), VA Tennessee Valley Healthcare System, Nashville, TN, USA
| | - Yue Li
- Department of Public Health Sciences, University of Rochester Medical Center, Rochester, NY, USA
| | - Erika Ramsdale
- Department of Medicine, Division of Hematology/Oncology, University of Rochester Medical Center, Rochester, NY, USA
| | - Thomas V Caprio
- Division of Geriatrics & Aging, Department of Medicine, University of Rochester Medical Center, Rochester, NY, USA; University of Rochester Medical Home Care, University of Rochester Medical Center, Rochester, NY, USA; Finger Lakes Geriatric Education Center, University of Rochester Medical Center, Rochester, NY, USA
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23
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Morley CP, Schad LA, Cerio H, McNamara SE, Wojtowycz MA, Smith NH, Noviasky JA, Ulen KR, Townsend K, Amidon J, Brangman SA. Longitudinal Evaluation of a Deprescribing Protocol in Skilled Nursing Facilities. Sr Care Pharm 2022; 37:523-531. [DOI: 10.4140/tcp.n.2022.523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Objective: To determine whether a deprescribing effort reduced several key classes of medications, and the overall number of medication classes per patient, among long-term residents of skilled nursing facilities (SNFs). Design: Retrospective, longitudinal
pre/post evaluation. Data from before and during the implementation of the deprescribing effort (2017 through 2019) were compared with data from the post-intervention year (2020). Setting and Patients: Long-term resident data reported through annual comprehensive reviews
conducted at two SNFs located in central New York State between 2017 and 2020 (N = 12,144). Interventions: Multifaceted, interdisciplinary deprescribing effort to reduce medications in SNF residence including clinician education, guideline development, and individual chart
reviews began in 2019. Results: The mean number of medications prescribed per resident was lower at both facilities after the intervention (mean = 1.74 at both facilities) versus preintervention (1.90 at Facility 1, 1.86 at Facility 2). Significant decreases were observed
in the usage rates for diuretics (-4.2%; P = 0.001), opioids (-3.8%; P = 0.001), and antipsychotics (-2.4%; P = 0.010). The raw antidepressant usage rate increased by 1.5% after the intervention but the change was not significant. Effects were robust to covariate adjustment.
Conclusion: A combined, comprehensive approach to deprescribing was associated with a reduction in the overall number of medication classes per resident and in several key classes of medications. Additional research with more data and covariate control is in progress for verification
of these findings.
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Affiliation(s)
- Christopher P. Morley
- 1State University of New York Upstate Medical University, Department of Public Health and Preventive Medicine, Syracuse, New York
| | - Laura A. Schad
- 1State University of New York Upstate Medical University, Department of Public Health and Preventive Medicine, Syracuse, New York
| | - Halle Cerio
- 1State University of New York Upstate Medical University, Department of Public Health and Preventive Medicine, Syracuse, New York
| | - Sarah E. McNamara
- 2State University of New York Upstate Medical University, Department of Geriatrics, Syracuse, New York
| | - Martha A. Wojtowycz
- 1State University of New York Upstate Medical University, Department of Public Health and Preventive Medicine, Syracuse, New York
| | | | - John A. Noviasky
- 4State University of New York Upstate Medical University, Department of Pharmacy, Syracuse, New York
| | - Kelly R. Ulen
- 4State University of New York Upstate Medical University, Department of Pharmacy, Syracuse, New York
| | | | | | - Sharon A. Brangman
- 2State University of New York Upstate Medical University, Department of Geriatrics, Syracuse, New York
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24
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Recent Updates on Risk and Management Plans Associated with Polypharmacy in Older Population. Geriatrics (Basel) 2022; 7:geriatrics7050097. [PMID: 36136806 PMCID: PMC9498769 DOI: 10.3390/geriatrics7050097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 09/08/2022] [Accepted: 09/09/2022] [Indexed: 11/17/2022] Open
Abstract
The concept of polypharmacy encompasses adverse drug reactions and non-adherence factors in elderly individuals. It also leads to the increased use of healthcare services and negative health outcomes. The problem is further alleviated by the odds of potentially inappropriate medications (PIM), which lead to the development of drug-related problems. Since polypharmacy is more commonly observed in the elderly population, urgency is required to introduce operative protocols for preventing and managing this problem. The family medicine model of care can be associated with favorable illness outcomes regarding satisfaction with consultation, treatment adherence, self-management behaviors, adherence to medical advice, and healthcare utilization. Hence, interventions built on family medicine models can provide significant support in improving the outcomes of the older population and their quality of life. In this regard, the authors have taken up the task of explaining the accessible resources which can be availed to improve the application of health care services in the field of geriatric medicine.
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25
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Elsorady KE, Matter LM, Abdelrahim DS. Potentially Inappropriate Prescriptions and Hospital Outcome among Geriatric Patients. JOURNAL OF GERONTOLOGY AND GERIATRICS 2022. [DOI: 10.36150/2499-6564-n558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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26
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Pietraszek A, Agrawal S, Dróżdż M, Makuch S, Domański I, Dudzik T, Dudek K, Sobieszczańska M. Sociodemographic and Health-Related Factors Influencing Drug Intake among the Elderly Population. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19148766. [PMID: 35886617 PMCID: PMC9325201 DOI: 10.3390/ijerph19148766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 07/05/2022] [Accepted: 07/15/2022] [Indexed: 11/16/2022]
Abstract
Excessive drugs intake among the elderly population, including self-medication, constitutes an important public health problem. Polypharmacy may lead to numerous adverse health effects, which become more prevalent when combined with biological changes in seniors. In this cross-sectional study, 500 Polish adults aged ≥60 years (M = 67.9 ± 4.2) were asked to complete a questionnaire via telephone calls, allowing us to identify sociodemographic and health-related factors influencing the daily medications consumption. Our findings revealed that all of the participants were receiving medications; 60.2% of them receive at least 1 to 3 drugs per day (301/500). The most commonly used medications included antihypertensive drugs and analgesics (51.0% and 46.0%, respectively). Taking into account clinical conditions, independent predictors of receiving over 3 medications per day turned out to be (1) coronary artery disease (OR = 6.77; CI 95%, 2.86–16.1), (2) diabetes (OR = 3.23, CI 95%, 1.75–5.95), (3) asthma (OR = 4.87, CI 95%, 2.13–11.1), (4) heart failure (OR = 3.38, CI 95%, 1.59–7.19) and (5) gastroesophageal reflux disease (OR = 1.93, CI 95%, 1.03–3.62). Participants suffering from depression were more likely to take drugs for hypertension (OR = 1.70, CI 95%, 1.04–2.78), while those with anxiety and social loneliness took more painkillers (OR = 2.59, CI 95%, 1.58–4.26 and OR = 2.08, CI 95%, 1.38–3.13, respectively). The most significant sociodemographic factors increasing the drugs intake among the population included in our study were high body mass and subsequent increased BMI values (OR = 2.68, CI 95%, 1.50–4.77). Furthermore, living in a city with over 400,000 inhabitants increased the likelihood of taking antidepressants (OR = 2.18, CI 95%, 1.20–3.94). Our study revealed factors increasing the risk of excessive medications intake and hence, increased susceptibility to some iatrogenic diseases among the elderly population. These factors should be considered by primary care physicians while prescribing appropriate drugs to elderly patients.
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Affiliation(s)
- Alicja Pietraszek
- Clinical Department of Geriatrics, Wroclaw Medical University, Skłodowskiej-Curie Str. 66, 50-369 Wroclaw, Poland;
- Correspondence: ; Tel.: +48-71-784-24-28; Fax: +48-71-327-09-15
| | - Siddarth Agrawal
- Department and Clinic of Internal Medicine, Occupational Diseases, Hypertension and Clinical Oncology, Wroclaw Medical University, Borowska Str. 213, 50-556 Wroclaw, Poland;
| | - Mateusz Dróżdż
- Faculty of Medicine, Wroclaw Medical University, Jana Mikulicza-Radeckiego 5, 50-345 Wroclaw, Poland; (M.D.); (I.D.); (T.D.)
| | - Sebastian Makuch
- Department of Clinical and Experimental Pathology, Wroclaw Medical University, K. Marcinkowskiego Str. 1, 50-368 Wroclaw, Poland;
| | - Igor Domański
- Faculty of Medicine, Wroclaw Medical University, Jana Mikulicza-Radeckiego 5, 50-345 Wroclaw, Poland; (M.D.); (I.D.); (T.D.)
| | - Tomasz Dudzik
- Faculty of Medicine, Wroclaw Medical University, Jana Mikulicza-Radeckiego 5, 50-345 Wroclaw, Poland; (M.D.); (I.D.); (T.D.)
| | - Krzysztof Dudek
- Faculty of Mechanical Engineering, Wroclaw University of Science and Technology, Str. I. Łukasiewicza 5, 50-371 Wroclaw, Poland;
| | - Małgorzata Sobieszczańska
- Clinical Department of Geriatrics, Wroclaw Medical University, Skłodowskiej-Curie Str. 66, 50-369 Wroclaw, Poland;
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27
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Springer SP, Cernasev A, Barenie RE, Axon DR, Scott D. “I Think Deprescribing as a Whole Is a Gap!”: A Qualitative Study of Student Pharmacist Perceptions about Deprescribing. Geriatrics (Basel) 2022; 7:geriatrics7030060. [PMID: 35735765 PMCID: PMC9222850 DOI: 10.3390/geriatrics7030060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 05/25/2022] [Accepted: 05/30/2022] [Indexed: 11/16/2022] Open
Abstract
Introduction: Older adults often manage multiple medications simultaneously, contributing to significant pill burden. Pill burden is a major concern for both patients and providers alike, and student pharmacists may play a role in decreasing that burden. Few studies exist evaluating student pharmacists’ roles in and perceptions of deprescribing in the healthcare team. Thus, the aim of this study was to explore student pharmacist perceptions regarding deprescribing in their pharmacy curricula. Methods: This study used a focus group discussion (FGD) methodology to facilitate discussion on deprescribing among student pharmacists. The theory of planned behavior (TPB) informed the conceptualization of this study, data collection, and thematic analysis. Student pharmacists enrolled in three different colleges of pharmacy across various geographical regions of the U.S. were recruited to participate in the study. Data collection occurred in the Fall of 2021, and recruitment proceeded until thematic saturation was achieved. The audio recordings were transcribed verbatim, and the transcripts were uploaded into Dedoose®, a qualitative software that facilitated the data analysis. The inductive codes were grouped into categories based on similarities that resulted in the themes. Results: Three colleges, totaling 1366 student pharmacists across different geographic regions of the U.S., were invited to participate in this study (UTHSC, N = 682; UNE, N = 158, University of Arizona, N = 526). Twenty-six student pharmacists participated in four FGDs. Of 26 participants, fourteen self-identified as male and two declined to state their gender identity. The mean age was 24 years old, with participants ranging from 21 to 37 years old. Thematic analysis revealed two major themes: (1) student pharmacists indicated that they possessed limited information about the deprescribing process, which is best illustrated by the following quote: “I think deprescribing as a whole is a gap!”; and (2) student pharmacists recommended increasing emphasis on deprescribing in pharmacy curricula. Conclusions: Student pharmacists identified few educational experiences on deprescribing in their curriculum while demonstrating a strong desire for more emphasis on deprescribing in the pharmacy curricula. This study highlights an opportunity to improve the integration of deprescribing education into pharmacy curricula, and colleges of pharmacy should evaluate whether, where, and to what extent the incorporation of this topic into their curricula is appropriate.
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Affiliation(s)
- Sydney P. Springer
- Department of Pharmacy Practice, University of New England School of Pharmacy, Westbrook College of Health Professions, 716 Stevens Ave, Portland, ME 04013, USA;
| | - Alina Cernasev
- Department of Clinical Pharmacy and Translational Science, University of Tennessee Health Science Center, College of Pharmacy, 301 S. Perimeter Park Dr., Suite 220, Nashville, TN 37211, USA
- Correspondence:
| | - Rachel E. Barenie
- University of Tennessee Health Science Center, College of Pharmacy, Memphis, TN 38163, USA;
| | - David R. Axon
- Department of Pharmacy Practice & Science, College of Pharmacy, University of Arizona, 1295 N Martin Ave, Tucson, AZ 85721, USA;
| | - Devin Scott
- Teaching and Learning Center, Department of Academic, Faculty and Student Affairs, University of Tennessee Health Science Center, 920 Madison, Suite 424, Memphis, TN 38163, USA;
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28
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Li CY, Arthur P, Downer B, Velozo CA, Kuo YF, Tzeng HM, Ottenbacher KJ. Examining the Clinical Utility of the Brief Interview for Mental Status. Res Gerontol Nurs 2022; 15:124-130. [PMID: 35604887 PMCID: PMC9377165 DOI: 10.3928/19404921-20220428-02] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The Brief Interview for Mental Status (BIMS) is used to identify delirium and needed supports in patients living in skilled nursing facilities (SNFs) and long-term care facilities (LTCFs). We analyzed 3,537,404 patients discharged from acute hospitals to SNFs or LTCFs with factor and Rasch analyses to examine the clinical utility of the BIMS. More than 40% of the sample had maximum scores, indicating a ceiling effect. "Repetition of three words" was the easiest and the only misfit item (Outfit = 3.14). The ability of the BIMS to distinguish individuals into two cognitive levels (with person strata of 1.48) was limited. Although the BIMS is a widely used screening tool for cognitive impairment, we found it lacked sensitivity for approximately one half of patients admitted to SNFs/LTCFs. Our results suggest the BIMS should be interpreted with caution, particularly for patients with mild cognitive impairment. [Research in Gerontological Nursing, 15(3), 124-130.].
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29
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Hollingsworth EK, Shah AS, Shotwell MS, Simmons SF, Vasilevskis EE. Older Patient and Surrogate Attitudes Toward Deprescribing During the Transition From Acute to Post-Acute Care. J Appl Gerontol 2022; 41:788-797. [PMID: 35164584 PMCID: PMC8867732 DOI: 10.1177/07334648211015756] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/20/2023] Open
Abstract
Attitudes toward deprescribing among hospitalized older patients transitioning to post-acute care in the United States are less known. This study describes older patients' and their surrogate's attitudes using all items of the Patient Attitudes Toward Deprescribing (PATD) questionnaire and compares perceived pill burden to the actual count of total daily pills and potentially inappropriate medications (PIMs). Overall, 93% of participants were willing to deprescribe if their physician agreed. Compared to patients, surrogates had 64% reduced odds (95% CI: 0.18-0.74) of believing that all of the care recipient's medications were necessary and 61% reduced odds (95% CI: 0.17-0.88) of attributing cost as a factor in deprescribing. Perceptions of medication burden were associated with patients' total daily pills (median 16) and PIMS (median 7), yet 61% agreed that all their medicines were necessary. Patients and surrogates typically express a willingness to deprescribe but have differing perceptions of medication appropriateness.
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Affiliation(s)
| | | | | | - Sandra Faye Simmons
- Vanderbilt University Medical Center, Nashville, TN, USA
- VA Tennessee Valley Healthcare System, Nashville, USA
| | - Eduard Eric Vasilevskis
- Vanderbilt University Medical Center, Nashville, TN, USA
- VA Tennessee Valley Healthcare System, Nashville, USA
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30
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Bekić S, Babič F, Pavlišková V, Paralič J, Wittlinger T, Majnarić LT. Clusters of Physical Frailty and Cognitive Impairment and Their Associated Comorbidities in Older Primary Care Patients. Healthcare (Basel) 2021; 9:healthcare9070891. [PMID: 34356270 PMCID: PMC8304880 DOI: 10.3390/healthcare9070891] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2021] [Revised: 07/10/2021] [Accepted: 07/12/2021] [Indexed: 11/16/2022] Open
Abstract
(1) Objectives: We aimed to identify clusters of physical frailty and cognitive impairment in a population of older primary care patients and correlate these clusters with their associated comorbidities. (2) Methods: We used a latent class analysis (LCA) as the clustering technique to separate different stages of mild cognitive impairment (MCI) and physical frailty into clusters; the differences were assessed by using a multinomial logistic regression model. (3) Results: Four clusters (latent classes) were identified: (1) highly functional (the mean and SD of the “frailty” test 0.58 ± 0.72 and the Mini-Mental State Examination (MMSE) test 27.42 ± 1.5), (2) cognitive impairment (0.97 ± 0.78 and 21.94 ± 1.95), (3) cognitive frailty (3.48 ± 1.12 and 19.14 ± 2.30), and (4) physical frailty (3.61 ± 0.77 and 24.89 ± 1.81). (4) Discussion: The comorbidity patterns distinguishing the clusters depend on the degree of development of cardiometabolic disorders in combination with advancing age. The physical frailty phenotype is likely to exist separately from the cognitive frailty phenotype and includes common musculoskeletal diseases.
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Affiliation(s)
- Sanja Bekić
- General Medical Practice, 31000 Osijek, Croatia;
- Faculty of Medicine, University Josip Juraj Strossmayer, 31000 Osijek, Croatia
| | - František Babič
- Department of Cybernetics and Artificial Intelligence, Faculty of Electrical Engineering and Informatics, Technical University of Košice, 04201 Košice, Slovakia; (V.P.); (J.P.)
- Correspondence:
| | - Viera Pavlišková
- Department of Cybernetics and Artificial Intelligence, Faculty of Electrical Engineering and Informatics, Technical University of Košice, 04201 Košice, Slovakia; (V.P.); (J.P.)
| | - Ján Paralič
- Department of Cybernetics and Artificial Intelligence, Faculty of Electrical Engineering and Informatics, Technical University of Košice, 04201 Košice, Slovakia; (V.P.); (J.P.)
| | - Thomas Wittlinger
- Department of Cardiology, Asklepios Hospital, 38642 Goslar, Germany;
| | - Ljiljana Trtica Majnarić
- Department of Internal Medicine, Family Medicine and the History of Medicine, Faculty of Medicine, University Josip Juraj Strossmayer, 31000 Osijek, Croatia;
- Department of Public Health, Faculty of Dental Medicine and Health, University Josip Juraj Strossmayer, 31000 Osijek, Croatia
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31
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Borda MG, Castellanos-Perilla N, Tovar-Rios DA, Oesterhus R, Soennesyn H, Aarsland D. Polypharmacy is associated with functional decline in Alzheimer's disease and Lewy body dementia. Arch Gerontol Geriatr 2021; 96:104459. [PMID: 34225098 DOI: 10.1016/j.archger.2021.104459] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 05/28/2021] [Accepted: 06/09/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND In dementia, a number of factors may influence functional decline in addition to cognition. In this study, we aimed to study the potential association of the number of prescribed medications with functional decline trajectories over a five-year follow-up in people diagnosed with mild Alzheimer's disease (AD) or Lewy Body dementia (LBD). METHODS This is a longitudinal analysis of a Norwegian cohort study entitled "The Dementia Study of Western Norway". We included 196 patients newly diagnosed with AD (n=111) and LBD (n=85), followed annually for 5 years. We conducted linear mixed-effects models to analyse the association of the number of medications with functional decline measured by the Rapid Disability Rating Scale - 2. RESULTS The mean prescribed medications at baseline was 4.18∓2.60, for AD 3.92∓2.51 and LBD 4.52∓2.70. The number of medications increased during the follow-up; at year five the mean for AD was 7.28∓4.42 and for LBD 8.11∓5.16. Using more medications was associated with faster functional decline in AD (Est 0.04, SE 0.01, p-value 0.003) and LBD (Est 0.08, SE 0.03, p-value 0.008) after adjusting for age, sex, comorbidity, neuropsychiatric symptoms, and cognition. For each medication added during the follow-up, functional trajectories worsened by 1% for AD and 2% for LBD. The number of medications was not associated with cognitive decline. CONCLUSION We found that higher number of medications was related to a faster functional decline, both in AD and LBD. With disease progression, there was an increase in the number of medications. Prescription in dementia should be carefully assessed, possibly improving the functional prognosis.
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Affiliation(s)
- Miguel Germán Borda
- Centre for Age-Related Medicine (SESAM), Stavanger University Hospital, Stavanger, Norway; Semillero de Neurociencias y Envejecimiento, Ageing Institute, Medical School, Pontificia Universidad Javeriana. Bogotá, Colombia; Faculty of Health Sciences, University of Stavanger, Stavanger, Norway.
| | - Nicolás Castellanos-Perilla
- Centre for Age-Related Medicine (SESAM), Stavanger University Hospital, Stavanger, Norway; Semillero de Neurociencias y Envejecimiento, Ageing Institute, Medical School, Pontificia Universidad Javeriana. Bogotá, Colombia
| | - Diego Alejandro Tovar-Rios
- Centre for Age-Related Medicine (SESAM), Stavanger University Hospital, Stavanger, Norway; Universidad Del Valle, Grupo de Investigación en Estadística Aplicada - INFERIR, Faculty of Engineering, Santiago De Cali, Valle Del Cauca, Colombia.; Universidad Del Valle, Prevención y Control de la Enfermedad Crónica - PRECEC, Faculty of Health, Santiago De Cali, Valle Del Cauca, Colombia
| | - Ragnhild Oesterhus
- Centre for Age-Related Medicine (SESAM), Stavanger University Hospital, Stavanger, Norway; The Hospital Pharmacy Enterprise of Western Norway, Bergen, Norway
| | - Hogne Soennesyn
- Centre for Age-Related Medicine (SESAM), Stavanger University Hospital, Stavanger, Norway
| | - Dag Aarsland
- Centre for Age-Related Medicine (SESAM), Stavanger University Hospital, Stavanger, Norway; Department of Old Age Psychiatry, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
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Sahingoz Erdal G, Kocoglu H, Karandere F, Kasapoglu P, Isiksacan N, Hursitoglu M. The Effect of Polypharmacy on the Charlson Comorbidity Index and Katz Index in Aging People with and without Diabetes Mellitus. Eurasian J Med 2021; 53:85-89. [PMID: 34177288 DOI: 10.5152/eurasianjmed.2021.20070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Objective The prevalence of diabetes mellitus is growing worldwide, as well as in the aging population, and its comorbidity and mortality rates are higher in aging people than they are in young people. It has been observed that the number of drugs used increases in aging patients, especially in diabetic patients. This study aimed to investigate the relationship between polypharmacy and modified Charlson Comorbidity Index (CCI) and Katz Index of Independence in Activities of Daily Living (Katz ADL) scores in aging diabetic and non-diabetic patients. Materials and Methods This prospective study included 184 diabetic and 62 non-diabetic subjects who were ≥65 years old. Comorbidity was determined with CCI, and dependency on daily basic activities was assessed with Katz ADL. Results CCI and the number of drugs were significantly higher in diabetic groups (P = .001). In all subjects and in the diabetic group, there was a negative correlation between CCI and Katz ADL (r = -0.343, P = .001; r = -0.383, P = .001, respectively); there was a positive correlation between CCI and number of drugs (r = 0.430, P = .001; r = 0.248, P = .001, respectively). Conclusion We found an increase in the number of drugs taken by the aging patients, positively correlated with the CCI score. The increase in the number of drugs used is closely related to the insufficiency in daily life activity and comorbidity, and this predicts 10-year survival. Patients should be directed to special centers or physicians who will be scheduled for multidisciplinary treatment for the prevention of polypharmacy, especially in the aging.
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Affiliation(s)
- Gulcin Sahingoz Erdal
- Department of Internal Medicine, Bakırköy Dr Sadi Konuk Training And Research Hospital, İstanbul, Turkey
| | - Hakan Kocoglu
- Department of Internal Medicine, Bakırköy Dr Sadi Konuk Training And Research Hospital, İstanbul, Turkey
| | - Faruk Karandere
- Department of Internal Medicine, Bakırköy Dr Sadi Konuk Training And Research Hospital, İstanbul, Turkey
| | - Pinar Kasapoglu
- Department of Biochemistry, Bakırköy Dr Sadi Konuk Training And Research Hospital, İstanbul, Turkey
| | - Nilgun Isiksacan
- Department of Biochemistry, Bakırköy Dr Sadi Konuk Training And Research Hospital, İstanbul, Turkey
| | - Mehmet Hursitoglu
- Department of Internal Medicine, Bakırköy Dr Sadi Konuk Training And Research Hospital, İstanbul, Turkey
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Akkawi ME, Mohd Taufek NH, Abdul Hadi AD, Nik Lah NNNF. The Prevalence of Prescribing Medications Associated with Geriatric Syndromes among Discharged Elderly Patients. J Pharm Bioallied Sci 2021; 12:S747-S751. [PMID: 33828372 PMCID: PMC8021066 DOI: 10.4103/jpbs.jpbs_305_19] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Revised: 02/06/2020] [Accepted: 03/29/2020] [Indexed: 01/02/2023] Open
Abstract
Introduction: A geriatric syndrome is a group of signs and symptoms that occur in older people and do not fit into a discrete disease. Several medications were reported to be associated with the incidence of geriatric syndromes. Objective: The objective of this study was to investigate the prevalence and pattern of medications associated with geriatric syndromes (MAGSs) among the discharged elderly patients (≥65 years old). Materials and Methods: This is a cross-sectional study that was conducted at a Malaysian teaching hospital from October to December 2018. The discharge medications of geriatric patients were reviewed to identify MAGSs using Beers criteria, Lexicomp drug information handbook, and the United States Food and Drug Administration (USFDA) drug inserts. Chi-square test was used to compare MAGS prescribed between categories. Spearman’s rank-order correlation was used to test the correlation between the presence of MAGS and the number of discharge medications. A binomial logistic regression was applied to determine the predictors of prescribing MAGSs. Results: A total of 400 patients (mean ± standard deviation [SD] age, 72.0 ± 5.0 years) were included, and 45.3% of them were females. The most common diseases were hypertension followed by diabetes mellitus. The mean ± SD number of discharge medications per patient was 4.2 ± 2.5. The MAGSs were prescribed in 51.7% of the patients, and 54 patients were discharged with more than one MAGSs. The most commonly prescribed MAGSs were opioid analgesics, vasodilators, and β-blockers, which are associated with falls, depression, and delirium. Polypharmacy was found in 138 patients, and it was significantly associated with the presence of MAGSs (P < 0.001). No significant differences were found in prescribing MAGSs based on the patients’ gender, race, and age. Conclusion: The prescribing of MAGSs occurred in half of the discharged elderly patients. Physicians should be aware of the medications that are associated with special side effects in the elderly patients, and should switch to safer alternatives when possible.
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Affiliation(s)
- Muhammad Eid Akkawi
- Department of Pharmacy Practice, Faculty of Pharmacy, International Islamic University Malaysia, Kuantan, Pahang, Malaysia
| | - Nor Hidayah Mohd Taufek
- Department of Pharmacy Practice, Faculty of Pharmacy, International Islamic University Malaysia, Kuantan, Pahang, Malaysia
| | - Azfar Diyana Abdul Hadi
- Department of Pharmacy Practice, Faculty of Pharmacy, International Islamic University Malaysia, Kuantan, Pahang, Malaysia
| | - Nik Nur Nadia Fatin Nik Lah
- Department of Pharmacy Practice, Faculty of Pharmacy, International Islamic University Malaysia, Kuantan, Pahang, Malaysia
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Adverse drug reactions in older adults: a narrative review of the literature. Eur Geriatr Med 2021; 12:463-473. [PMID: 33738772 PMCID: PMC8149349 DOI: 10.1007/s41999-021-00481-9] [Citation(s) in RCA: 55] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Accepted: 02/26/2021] [Indexed: 12/21/2022]
Abstract
Aim To summarize the classification and occurrence of ADRs and identify risk factors and strategies to reduce and prevent ADRs in older adults. Findings In frail, multimorbid older adults, who are often treated with polypharmacy, ADRs are frequently associated with health burden and hospitalization. Multiple age-related risk factors, including changes in pharmacokinetics, multimorbidity, polypharmacy, and frailty can increase the risk of ADRs, and different strategies have been suggested to prevent the onset of ADRs. Message A multidimensional and holistic approach combining pharmaceutical interventions with a global evaluation of health needs and priorities can reduce the burden of ADRs in older adults. Purpose Adverse drug reactions (ADRs) represent a common and potentially preventable cause of unplanned hospitalization, increasing morbidity, mortality, and healthcare costs. We aimed to review the classification and occurrence of ADRs in the older population, discuss the role of age as a risk factor, and identify interventions to prevent ADRs. Methods We performed a narrative scoping review of the literature to assess classification, occurrence, factors affecting ADRs, and possible strategies to identify and prevent ADRs. Results Adverse drug reactions (ADRs) are often classified as Type A and Type B reactions, based on dose and effect of the drugs and fatality of the reaction. More recently, other approaches have been proposed (i.e. Dose, Time and Susceptibility (DoTS) and EIDOS classifications). The frequency of ADRs varies depending on definitions, characteristics of the studied population, and settings. Their occurrence is often ascribed to commonly used drugs, including anticoagulants, antiplatelet agents, digoxin, insulin, and non-steroidal anti-inflammatory drugs. Age-related factors—changes in pharmacokinetics, multimorbidity, polypharmacy, and frailty—have been related to ADRs. Different approaches (i.e. medication review, software identifying potentially inappropriate prescription and drug interactions) have been suggested to prevent ADRs and proven to improve the quality of prescribing. However, consistent evidence on their effectiveness is still lacking. Few studies suggest that a comprehensive geriatric assessment, aimed at identifying individual risk factors, patients’ needs, treatment priorities, and strategies for therapy optimization, is key for reducing ADRs. Conclusions Adverse drug reactions (ADRs) are a relevant health burden. The medical complexity that characterizes older patients requires a holistic approach to reduce the burden of ADRs in this population.
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Brinker LM, Konerman MC, Navid P, Dorsch MP, McNamara J, Willer CJ, Tinetti ME, Hummel SL, Goyal P. Complex and Potentially Harmful Medication Patterns in Heart Failure with Preserved Ejection Fraction. Am J Med 2021; 134:374-382. [PMID: 32822663 PMCID: PMC8811797 DOI: 10.1016/j.amjmed.2020.07.023] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 06/28/2020] [Accepted: 07/01/2020] [Indexed: 12/20/2022]
Abstract
BACKGROUND Complex medication regimens, often present in heart failure with preserved ejection fraction, may increase the risk of adverse drug effects and harm. We sought to characterize this complexity by determining the prevalence of polypharmacy, potentially inappropriate medications, and therapeutic competition (where a medication for 1 condition may worsen another condition) in 1 of the few dedicated heart failure with preserved ejection fraction programs in the United States. METHODS We conducted chart review on 231 patients with heart failure with preserved ejection fraction seen in the University of Michigan's Heart Failure with Preserved Ejection Fraction Clinic between July 2016 and September 2019. We recorded: 1) standing medications to determine the presence of polypharmacy, defined as ≥10 medications; 2) potentially inappropriate medications based on the 2016 American Heart Association Scientific Statement on drugs that pose a major risk of causing or exacerbating heart failure, the 2019 Beers Criteria update, or a previously described list of medications associated with geriatric syndromes; and 3) competing conditions and subsequent medications that could create therapeutic competition. RESULTS The prevalence of polypharmacy was 74%, and the prevalence of potentially inappropriate medications was 100%. Competing conditions were present in 81% of patients, of whom 49% took a medication that created therapeutic competition. CONCLUSION In addition to confirming that polypharmacy was highly prevalent, we found that potentially inappropriate medications and therapeutic competition were also frequently present. This supports the urgent need to develop patient-centered approaches to mitigate the negative effects of complex medication regimens endemic to adults with heart failure with preserved ejection fraction.
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Affiliation(s)
- Lina M Brinker
- Department of Internal Medicine, University of Michigan, Ann Arbor
| | - Matthew C Konerman
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor
| | - Pedram Navid
- Department of Medicine, Weill Cornell Medicine, New York, NY
| | - Michael P Dorsch
- Department of Clinical Pharmacy, College of Pharmacy, University of Michigan, Ann Arbor
| | - Jennifer McNamara
- University of Michigan Frankel Cardiovascular Center Administration, University of Michigan, Ann Arbor
| | - Cristen J Willer
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor; Department of Computational Medicine and Bioinformatics, University of Michigan, Ann Arbor; Department of Human Genetics, University of Michigan, Ann Arbor
| | - Mary E Tinetti
- Department of Medicine, Yale University School of Medicine, New Haven, CT
| | - Scott L Hummel
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor; Section of Cardiology, Ann Arbor Veterans Affairs Health System, Ann Arbor, Mich
| | - Parag Goyal
- Department of Medicine, Weill Cornell Medicine, New York, NY.
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Edelman LS, Drost J, Moone RP, Owens K, Towsley GL, Tucker-Roghi G, Morley JE. Editorial: Applying the Age-Friendly Health System Framework to Long Term Care Settings. J Nutr Health Aging 2021; 25:141-145. [PMID: 33491025 PMCID: PMC7780207 DOI: 10.1007/s12603-020-1558-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Accepted: 12/03/2020] [Indexed: 12/13/2022]
Affiliation(s)
- L S Edelman
- John E. Morley, MD, BCh, Division of Geriatric Medicine, Saint Louis University, SLUCare Academic Pavilion, Section 2500, 1008 S. Spring Ave., 2nd Floor, St. Louis, MO 63110, USA, , Twitter: @drjohnmorley
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Thillainadesan J, Mudge AM, Aitken SJ, Hilmer SN, Cullen JS, Yumol MF, Close JCT, Norris CM, Kerdic R, Naganathan V. The Prognostic Performance of Frailty for Delirium and Functional Decline in Vascular Surgery Patients. J Am Geriatr Soc 2020; 69:688-695. [PMID: 33151550 DOI: 10.1111/jgs.16907] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 09/10/2020] [Accepted: 10/07/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND Frailty in older vascular surgery patients is associated with increased mortality, hospital stay, and morbidity. The association of frailty with hospital-acquired geriatric syndromes such as delirium and functional decline has not been well studied. OBJECTIVES To investigate the association between frailty and hospital-acquired geriatric syndromes in older hospitalized vascular surgery patients, and to evaluate the prognostic performance of the frailty index (FI) and the Clinical Frailty Scale (CFS) for delirium and functional decline. DESIGN Prospective cohort study. SETTING Acute care academic hospital. PARTICIPANTS Patients aged 65 years or more admitted to a tertiary vascular surgery unit (N=150). MEASUREMENTS Frailty was assessed using the FI and CFS. The adjusted association of frailty status with delirium and functional decline was assessed using logistic regression analysis. The prognostic performance of FI and CFS was determined by assessing C-statistic and positive and negative predictive values (PPV and NPV). RESULTS Of 150 participants, FI identified 34 (23%) and CFS identified 45 (30%) as frail. Frailty was an independent predictor of delirium (FI adjusted odds ratio, odds ratio (OR) = 5.66, 95% confidence interval (CI) = 1.53-21.03; CFS adjusted OR = 4.07, 95% CI = 1.14-14.50), but not functional decline. FI and CFS showed acceptable prognostic performance for delirium (C-statistic 0.74), but not functional decline (C-statistic 0.63-0.64). For both outcomes, the FI and CFS had high NPV (86-96%), and low PPV (22-29%). CONCLUSION Frail older vascular surgery patients are more likely to develop hospital-acquired geriatric syndromes. The FI and CFS have acceptable prognostic performance for predicting delirium but not all individuals who are identified as frail develop delirium. Ongoing research is needed to identify interventions that improve outcomes in patients who screen positive for frailty.
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Affiliation(s)
- Janani Thillainadesan
- Department of Geriatric Medicine, Concord Hospital, Concord, Australia.,Concord Clinical School, Faculty of Medicine and Health, University of Sydney, Concord, Australia.,Centre for Education and Research on Ageing, and Ageing and Alzheimers Institute, Concord Hospital, Concord, Australia
| | - Alison M Mudge
- Internal Medicine Research Unit, Royal Brisbane and Women's Hospital, Herston, Australia.,School of Clinical Medicine, University of Queensland, Brisbane, Australia
| | - Sarah J Aitken
- Concord Clinical School, Faculty of Medicine and Health, University of Sydney, Concord, Australia.,Centre for Education and Research on Ageing, and Ageing and Alzheimers Institute, Concord Hospital, Concord, Australia.,Concord Institute of Academic Surgery, Vascular Surgery Department, Concord Hospital, Concord, Australia.,Department of Vascular Surgery, Concord Hospital, Concord, Australia
| | - Sarah N Hilmer
- Kolling Institute of Medical Research, Sydney Medical School, University of Sydney and Royal North Shore Hospital, St Leonards, Australia
| | - John S Cullen
- Department of Geriatric Medicine, Concord Hospital, Concord, Australia.,Concord Clinical School, Faculty of Medicine and Health, University of Sydney, Concord, Australia.,Centre for Education and Research on Ageing, and Ageing and Alzheimers Institute, Concord Hospital, Concord, Australia
| | - Minna F Yumol
- Department of Geriatric Medicine, Concord Hospital, Concord, Australia
| | - Jacqueline C T Close
- Falls, Balance and Injury Research Centre, Neuroscience Research Australia, Randwick, Australia.,Department of Aged Care, Prince of Wales Hospital, Randwick, Australia
| | - Christina M Norris
- Falls, Balance and Injury Research Centre, Neuroscience Research Australia, Randwick, Australia.,Department of Aged Care, Prince of Wales Hospital, Randwick, Australia
| | - Richard Kerdic
- Department of Vascular Surgery, Concord Hospital, Concord, Australia
| | - Vasi Naganathan
- Department of Geriatric Medicine, Concord Hospital, Concord, Australia.,Concord Clinical School, Faculty of Medicine and Health, University of Sydney, Concord, Australia.,Centre for Education and Research on Ageing, and Ageing and Alzheimers Institute, Concord Hospital, Concord, Australia
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Aprahamian I, Morley JE. Editorial: To Drug or Not to Drug: The Geriatrician Dilemma of Polypharmacy. J Nutr Health Aging 2020; 24:809-811. [PMID: 33009528 DOI: 10.1007/s12603-020-1451-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- I Aprahamian
- John E. Morley, MB, BCh, Division of Geriatric Medicine, Saint Louis University, SLUCare Academic Pavilion, Section 2500, 1008 S. Spring Ave., 2nd Floor, St. Louis, MO 63110, , Twitter: @drjohnmorley
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Does Deprescribing Improve Quality of Life? A Systematic Review of the Literature. Drugs Aging 2019; 36:1097-1110. [DOI: 10.1007/s40266-019-00717-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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Sanz-Tamargo G, García-Cases S, Navarro A, Lumbreras B. Adaptation of a deprescription intervention to the medication management of older people living in long-term care facilities. Expert Opin Drug Saf 2019; 18:1091-1098. [PMID: 31524003 DOI: 10.1080/14740338.2019.1667330] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Objectives: Inappropriate prescription is a problem related to aging and deprescription could be a possible strategy. The aim of this study was to adapt the available evidence on deprescribing to the medication management of older people living in long-term care facilities. Methods: The authors carried out a bibliographic search based on the most prevalent drugs in our context to develop a specific deprescribing intervention. A committee of experts reviewed this intervention which was later validated through an interobserver variability study. Finally, the authors evaluated it in a sample of patients through a controlled before-after study. Results: The authors included 119 subjects living in a public elderly long-term care center and 122 controls living in a center with similar clinical characteristics. The authors evaluated 852 medications, identifying a total of 175 (20.5%) potentially inappropriate medications and 162 (92.5%) drugs were deprescribed (1.4 per patient). The application of the intervention meant an annual saving of 9.525.25 €. Conclusion: The implementation of a deprescribing intervention aimed at the most prevalent drugs prescribed in a particular setting improves the appropriateness of pharmacotherapy in the patients.
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Affiliation(s)
| | | | - Andrés Navarro
- Pharmacy Service, General University Hospital of Elche , Alicante , Spain
| | - Blanca Lumbreras
- Department of Public Health, History of Science and Ginecology, University Miguel Hernandez , Alicante , Spain.,CIBER of Epidemiology and Public Health , Spain
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Abstract
Introduction: With the majority of elderly persons consuming multiple drugs, inappropriate drug use is a major issue in geriatric medicine. Areas covered: We reviewed PubMed, Embase, and Cochrane from inception to 1 May 2019 for potentially inappropriate use of medications, polypharmacy, and age-dependent changes in pharmacokinetics and pharmacodynamics. We selected to highlight new aspects that have emerged in recent years: appropriate monitoring of drug adherence and the introduction of Big Data analysis in advancing geriatric pharmacology. Expert opinion: There are major gaps in the pharmacological treatment of the elderly. Most drugs were designed and tested in adults, with no pharmacokinetic and pharmacodynamic data on changes in old age. This void must be corrected through systematic and well-designed research programs. Potentially inappropriate use of medications (PIM) in the elderly is a serious issue in advanced age. Analysis of PIM shows relatively low predictive value in real life medicine. Most physicians continue to prescribe to the elderly medicines which should not be given at all, or not combined. Polypharmacy is a complex issue in old age, and in many cases treating physicians are not conducting critical assessment of the need for numerous medications.
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Affiliation(s)
- Gideon Koren
- a Maccabi-Kahn Institute of Research and Innovation , Tel Aviv , Israel.,b Ariel University , Ariel , Israel.,c Technion Institute of Technology , Haifa , Israel
| | - Galia Nordon
- c Technion Institute of Technology , Haifa , Israel
| | | | - Varda Shalev
- a Maccabi-Kahn Institute of Research and Innovation , Tel Aviv , Israel.,d Tel Aviv University , Tel Aviv , Israel
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Drug-Induced Mitochondrial Toxicity in the Geriatric Population: Challenges and Future Directions. BIOLOGY 2019; 8:biology8020032. [PMID: 31083551 PMCID: PMC6628177 DOI: 10.3390/biology8020032] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/22/2018] [Revised: 02/04/2019] [Accepted: 02/12/2019] [Indexed: 12/22/2022]
Abstract
Mitochondrial function declines with age, leading to a variety of age-related diseases (metabolic, central nervous system-related, cancer, etc.) and medication usage increases with age due to the increase in diseases. Drug-induced mitochondrial toxicity has been described for many different drug classes and can lead to liver, muscle, kidney and central nervous system injury and, in rare cases, to death. Many of the most prescribed medications in the geriatric population carry mitochondrial liabilities. We have demonstrated that, over the past decade, each class of drugs that demonstrated mitochondrial toxicity contained drugs with both more and less adverse effects on mitochondria. As patient treatment is often essential, we suggest using medication(s) with the best safety profile and the avoidance of concurrent usage of multiple medications that carry mitochondrial liabilities. In addition, we also recommend lifestyle changes to further improve one’s mitochondrial function, such as weight loss, exercise and nutrition.
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Vasilevskis EE, Shah AS, Hollingsworth EK, Shotwell MS, Mixon AS, Bell SP, Kripalani S, Schnelle JF, Simmons SF. A patient-centered deprescribing intervention for hospitalized older patients with polypharmacy: rationale and design of the Shed-MEDS randomized controlled trial. BMC Health Serv Res 2019; 19:165. [PMID: 30871561 PMCID: PMC6416929 DOI: 10.1186/s12913-019-3995-3] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Accepted: 03/06/2019] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Polypharmacy is prevalent among hospitalized older adults, particularly those being discharged to a post-care care facility (PAC). The aim of this randomized controlled trial is to determine if a patient-centered deprescribing intervention initiated in the hospital and continued in the PAC setting reduces the total number of medications among older patients. METHODS The Shed-MEDS study is a 5-year, randomized controlled clinical intervention trial comparing a patient-centered describing intervention with usual care among older (≥50 years) hospitalized patients discharged to PAC, either a skilled nursing facility (SNF) or an inpatient rehabilitation facility (IPR). Patient measurements occur at hospital enrollment, hospital discharge, within 7 days of PAC discharge, and at 60 and 90 days following PAC discharge. Patients are randomized in a permuted block fashion, with block sizes of two to four. The overall effectiveness of the intervention will be evaluated using total medication count as the primary outcome measure. We estimate that 576 patients will enroll in the study. Following attrition due to death or loss to follow-up, 420 patients will contribute measurements at 90 days, which provides 90% power to detect a 30% versus 25% reduction in total medications with an alpha error of 0.05. Secondary outcomes include the number of medications associated with geriatric syndromes, drug burden index, medication adherence, the prevalence and severity of geriatric syndromes and functional health status. DISCUSSION The Shed-MEDS trial aims to test the hypothesis that a patient-centered deprescribing intervention initiated in the hospital and continuing through the PAC stay will reduce the total number of medications 90 days following PAC discharge and result in improvements in geriatric syndromes and functional health status. The results of this trial will quantify the health outcomes associated with reducing medications for hospitalized older adults with polypharmacy who are discharged to post-acute care facilities. TRIAL REGISTRATION This trial was prospectively registered at clinicaltrials.gov ( NCT02979353 ). The trial was first registered on 12/1/2016, with an update on 09/28/17 and 10/12/2018.
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Affiliation(s)
- Eduard E. Vasilevskis
- Vanderbilt University Medical Center, Center for Quality Aging, Nashville, TN USA
- VA Tennessee Valley Healthcare System, Geriatric Research Education and Clinical Center, Nashville, TN USA
- Vanderbilt University Medical Center, Section of Hospital Medicine, Nashville, TN USA
- Vanderbilt University Medical Center, Center for Clinical Quality and Implementation Research, Nashville, TN USA
| | - Avantika S. Shah
- Vanderbilt University Medical Center, Center for Quality Aging, Nashville, TN USA
| | | | | | - Amanda S. Mixon
- Vanderbilt University Medical Center, Center for Quality Aging, Nashville, TN USA
- VA Tennessee Valley Healthcare System, Geriatric Research Education and Clinical Center, Nashville, TN USA
- Vanderbilt University Medical Center, Section of Hospital Medicine, Nashville, TN USA
- Vanderbilt University Medical Center, Center for Clinical Quality and Implementation Research, Nashville, TN USA
| | - Susan P. Bell
- Vanderbilt University Medical Center, Center for Quality Aging, Nashville, TN USA
- Division of Geriatrics, Vanderbilt University Medical Center, Nashville, TN USA
- Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, TN USA
| | - Sunil Kripalani
- Vanderbilt University Medical Center, Section of Hospital Medicine, Nashville, TN USA
- Vanderbilt University Medical Center, Center for Clinical Quality and Implementation Research, Nashville, TN USA
| | - John F. Schnelle
- Vanderbilt University Medical Center, Center for Quality Aging, Nashville, TN USA
- Division of Geriatrics, Vanderbilt University Medical Center, Nashville, TN USA
- VA Tennessee Valley Healthcare System, Geriatric Research Education and Clinical Center, Nashville, TN USA
- Vanderbilt University Medical Center, Center for Clinical Quality and Implementation Research, Nashville, TN USA
| | - Sandra F. Simmons
- Vanderbilt University Medical Center, Center for Quality Aging, Nashville, TN USA
- Division of Geriatrics, Vanderbilt University Medical Center, Nashville, TN USA
- VA Tennessee Valley Healthcare System, Geriatric Research Education and Clinical Center, Nashville, TN USA
- Vanderbilt University Medical Center, Center for Clinical Quality and Implementation Research, Nashville, TN USA
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Improving Care Transitions for Hospitalized Veterans Discharged to Skilled Nursing Facilities: A Focus on Polypharmacy and Geriatric Syndromes. Geriatrics (Basel) 2019; 4:geriatrics4010019. [PMID: 31023987 PMCID: PMC6473365 DOI: 10.3390/geriatrics4010019] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2018] [Revised: 01/31/2019] [Accepted: 02/05/2019] [Indexed: 11/17/2022] Open
Abstract
Geriatric syndromes and polypharmacy are common in older patients discharged to skilled nursing facilities (SNFs) and increase 30-day readmission risk. In a U.S.A. Department of Veterans Affairs (VA)-funded Quality Improvement study to improve care transitions from the VA hospital to area SNFs, Veterans (N = 134) were assessed for geriatric syndromes using standardized instruments as well as polypharmacy, defined as five or more medications. Warm handoffs were used to facilitate the transfer of this information. This paper describes the prevalence of geriatric syndromes, polypharmacy, and readmission rates. Veterans were prescribed an average of 14.7 medications at hospital discharge. Moreover, 75% of Veterans had more than two geriatric syndromes, some of which began during hospitalization. While this effort did not reduce 30-day readmissions, the high prevalence of geriatric syndromes and polypharmacy suggests that future efforts targeting these issues may be necessary to reduce readmissions among Veterans discharged to SNF.
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Simmons SF, Bonnett KR, Hollingsworth E, Kim J, Powers J, Habermann R, Newhouse P, Schlundt DG. Reducing Antipsychotic Medication Use in Nursing Homes: A Qualitative Study of Nursing Staff Perceptions. THE GERONTOLOGIST 2018; 58:e239-e250. [PMID: 28575301 DOI: 10.1093/geront/gnx083] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2017] [Indexed: 11/12/2022] Open
Abstract
Background and Objectives The purpose of this study was to use qualitative methods to explore nursing home staff perceptions of antipsychotic medication use and identify both benefits and barriers to reducing inappropriate use from their perspective. Research Design and Methods Focus groups were conducted with a total of 29 staff in three community nursing homes that served both short and long-stay resident populations. Results The majority (69%) of the staff participants were licensed nurses. Participants expressed many potential benefits of antipsychotic medication reduction with four primary themes: (a) Improvement in quality of life, (b) Improvement in family satisfaction, (c) Reduction in falls, and (d) Improvement in the facility Quality Indicator score (regulatory compliance). Participants also highlighted important barriers they face when attempting to reduce or withdraw antipsychotic medications including: (a) Family resistance, (b) Potential for worsening or return of symptoms or behaviors, (c) Lack of effectiveness and/or lack of staff resources to consistently implement nonpharmacological management strategies, and (d) Risk aversion of staff and environmental safety concerns. Discussion and Implications Nursing home staff recognize the value of reducing antipsychotic medications; however, they also experience multiple barriers to reduction in routine clinical practice. Achievement of further reductions in antipsychotic medication use will require significant additional efforts and adequate clinical personnel to address these barriers.
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Affiliation(s)
- Sandra F Simmons
- Center for Quality Aging, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN.,Division of Geriatrics, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN.,Geriatric Research, Education and Clinical Center (GRECC), VA Tennessee Valley Healthcare System, Nashville
| | | | - Emily Hollingsworth
- Center for Quality Aging, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN.,Division of Geriatrics, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN
| | - Jennifer Kim
- School of Nursing, Vanderbilt University, Nashville, Tennessee
| | - James Powers
- Division of Geriatrics, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN.,Geriatric Research, Education and Clinical Center (GRECC), VA Tennessee Valley Healthcare System, Nashville
| | - Ralf Habermann
- Division of Geriatrics, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN
| | - Paul Newhouse
- Geriatric Research, Education and Clinical Center (GRECC), VA Tennessee Valley Healthcare System, Nashville.,Center for Cognitive Medicine, Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, Tennessee
| | - David G Schlundt
- Department of Psychology, Vanderbilt University, Nashville, Tennessee
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Campbell AM, Coley KC, Corbo JM, DeLellis TM, Joseph M, Thorpe CT, McGivney MS, Klatt P, Cox-Vance L, Balestrino V, Sakely H. Pharmacist-Led Drug Therapy Problem Management in an Interprofessional Geriatric Care Continuum: A Subset of the PIVOTS Group. AMERICAN HEALTH & DRUG BENEFITS 2018; 11:469-478. [PMID: 30746018 PMCID: PMC6322592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Accepted: 08/01/2018] [Indexed: 06/09/2023]
Abstract
BACKGROUND Drug therapy problems, which are adverse events involving medications that can ultimately interfere with a patient's therapeutic goals, occur frequently in older adults. If not identified, resolved, and prevented through clinical decision-making, drug therapy problems may negatively affect patient health outcomes. OBJECTIVE To quantify the impact of pharmacist interventions on the care of older adults by identifying the most common drug therapy problems, the medications most often involved in these problems, and the actions taken by pharmacists to resolve these problems. METHODS This retrospective chart review included individuals seen by a geriatric pharmacist in one geriatric practice, where 4 pharmacists provide continuous, comprehensive medication management across 2 outpatient geriatric clinics, skilled-nursing facilities, and assisted-living facilities. The individuals were seen between August 2014 and November 2015. For all patient care encounters during this time frame, pharmacists used the Assurance System to document each drug therapy problem, the medications involved, the patient's care setting (ie, outpatient clinic, assisted-living facility, skilled-nursing facility), the actions taken to resolve any drug therapy problems, and the estimated 90-day impact on the patient and the healthcare system. RESULTS A total of 3100 drug therapy problems were identified during 3309 patient-pharmacist encounters for 452 patients (mean age, 81.4 years), 48.7% of whom were seen in the skilled-nursing facility. The most common drug therapy problem was dose too low, followed by dose too high, and warfarin was the most common drug associated with drug therapy problems. Pharmacists provided 4921 interventions, often more than 1 intervention per drug therapy problem, for 275 different medications. Laboratory monitoring and dose change were the most common interventions, with an estimated annual financial savings between $268,690 and $270,591. CONCLUSION Older patients are a vulnerable patient population who often receive unsafe medication regimens, which can result in adverse drug reactions and other critical problems. When integrated into interprofessional geriatric care teams, pharmacists' interventions provide an invaluable qualitative and monetary resource to the medication-based management of patients with well-recognized, high-risk geriatric syndromes as they transition to and through various levels of care.
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Affiliation(s)
- Ashley M Campbell
- Assistant Professor, Pharmacy Practice and Science, University of Arizona College of Pharmacy, Tucson
| | - Kim C Coley
- Professor, Pharmacy and Therapeutics, University of Pittsburgh School of Pharmacy, PA
| | - Jason M Corbo
- Clinical Pharmacy Specialist, South Texas Veterans Health Care System, San Antonio
| | - Teresa M DeLellis
- Assistant Professor, Pharmacy Practice, Manchester University College of Pharmacy, Natural & Health Sciences, Fort Wayne, IN
| | - Matthew Joseph
- Clinical Pharmacist, Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center (UPMC)
| | - Carolyn T Thorpe
- Associate Professor, Pharmaceutical Outcomes and Policy, University of North Carolina Eshelman School of Pharmacy, and Research Health Scientist, VA Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System
| | - Melissa S McGivney
- Associate Dean for Community Partnerships and Associate Professor, Pharmacy and Therapeutics, University of Pittsburgh School of Pharmacy
| | | | - Lora Cox-Vance
- Chief, Geriatrics and Extended Care, Chillicothe VA Medical Center, OH
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47
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Ates Bulut E, Soysal P, Isik AT. Frequency and coincidence of geriatric syndromes according to age groups: single-center experience in Turkey between 2013 and 2017. Clin Interv Aging 2018; 13:1899-1905. [PMID: 30323576 PMCID: PMC6174888 DOI: 10.2147/cia.s180281] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Background Geriatric syndromes are complex clinical manifestations that are not an isolated disease in older adults and have common risk factors within themselves. The syndromes are significant causes of mortality, morbidity, and increased health care costs. Objective To determine the frequency of geriatric syndromes such as malnutrition, dementia, depression, falls, polypharmacy, urinary incontinence, pressure ulcer, sarcopenia, and frailty in community-dwelling older adults. Methods A total of 2,816 patients, who applied to geriatric outpatient clinic and were evaluated by comprehensive geriatric assessment, were included in this cross-sectional retrospective study. Falls in the last year and urinary incontinence were recorded. Polypharmacy was accepted as concurrent use of more than four drugs. Diagnosis of dementia and depression was defined according to Diagnostic and Statistical Manual of Mental Disorders Fifth Edition diagnostic criteria. In addition, frailty and sarcopenia were evaluated according to Fried's physical frailty scale and European Working Group on Sarcopenia criteria, respectively. Results The frequency of polypharmacy was 54.5%, urinary incontinence 47.6%, malnutrition 9.6%, depression 35.1%, dementia 21.6%, falls 33.6%, sarcopenia 31.7%, and frailty 28.3%. When all the participants were divided into three groups (60-69, 70-79, ≥80 years), all syndromes were significantly increased with age, except for depression. While 20% of cases in 60-69 years age group did not have any syndromes, 48% of cases in ≥80 years had more than four syndromes simultaneously. Conclusion The frequency and coincidence of geriatric syndromes, except for depression, increases with age. Therefore, clinicians other than geriatricians taking care of older people should be aware of these syndromes as well as their treatment mechanisms.
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Affiliation(s)
- Esra Ates Bulut
- Department of Geriatric Medicine, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey,
| | - Pinar Soysal
- Department of Geriatric Medicine, Faculty of Medicine, Bezmialem Vakif University, Istanbul, Turkey
| | - Ahmet Turan Isik
- Department of Geriatric Medicine, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey,
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48
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Petersen AW, Shah AS, Simmons SF, Shotwell MS, Jacobsen JML, Myers AP, Mixon AS, Bell SP, Kripalani S, Schnelle JF, Vasilevskis EE. Shed-MEDS: pilot of a patient-centered deprescribing framework reduces medications in hospitalized older adults being transferred to inpatient postacute care. Ther Adv Drug Saf 2018; 9:523-533. [PMID: 30181860 PMCID: PMC6116773 DOI: 10.1177/2042098618781524] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Accepted: 05/07/2018] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Polypharmacy is common in hospitalized older adults. Deprescribing interventions are not well described in the acute-care setting. The objective of this study was to describe a hospital-based, patient-centered deprescribing protocol (Shed-MEDS) and report pilot results. METHODS This was a pilot study set in one academic medical center in the United States. Participants consisted of a convenience sample of 40 Medicare-eligible, hospitalized patients with at least five prescribed medications. A deprescribing protocol (Shed-MEDS) was implemented among 20 intervention and 20 usual care control patients during their hospital stay. The primary outcome was the total number of medications deprescribed from hospital enrollment. Deprescribed was defined as medication termination or dose reduction. Enrollment medications reflected all prehospital medications and active in-hospital medications. Baseline characteristics and outcomes were compared between the intervention and usual care groups using simple logistic or linear regression for categorical and continuous measures, respectively. RESULTS There was no significant difference between groups in mean age, sex or Charlson comorbidity index. The intervention and control groups had a comparable number of medications at enrollment, 25.2 (±6.3) and 23.4 (±3.8), respectively. The number of prehospital medications in each group was 13.3 (±4.6) and 15.3 (±4.6), respectively. The Shed-MEDS protocol compared with usual care significantly increased the mean number of deprescribed medications at hospital discharge and reduced the total medication burden by 11.6 versus 9.1 (p = 0.032) medications. The deprescribing intervention was associated with a difference of 4.6 [95% confidence interval (CI) 2.5-6.7, p < 0.001] in deprescribed medications and a 0.5 point reduction (95% CI -0.01 to 1.1) in the drug burden index. CONCLUSIONS A hospital-based, patient-centered deprescribing intervention is feasible and may reduce the medication burden in older adults.
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Affiliation(s)
- Alec W. Petersen
- Center for Quality Aging, Vanderbilt University
Medical Center, Nashville, TN, USA
| | - Avantika S. Shah
- Center for Quality Aging, Vanderbilt University
Medical Center, Nashville, TN, USA
| | - Sandra F. Simmons
- Center for Quality Aging, Vanderbilt University
Medical Center, Nashville, TN, USA
- Division of Geriatrics, Vanderbilt University
Medical Center, Nashville, TN, USA
- Geriatric Research Education and Clinical
Center, VA Tennessee Valley Healthcare System, Nashville, TN, USA
| | | | | | - Amy P. Myers
- Pharmaceutical Services, Vanderbilt University
Medical Center, Nashville, TN, USA
| | - Amanda S. Mixon
- Geriatric Research Education and Clinical
Center, VA Tennessee Valley Healthcare System, Nashville, TN, USA
- Section of Hospital Medicine, Vanderbilt
University Medical Center, Nashville, TN, USA
- Center for Clinical Quality and Implementation
Research, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Susan P. Bell
- Center for Quality Aging, Vanderbilt University
Medical Center, Nashville, TN, USA
- Division of Geriatrics, Vanderbilt University
Medical Center, Nashville, TN, USA
- Division of Cardiovascular Medicine, Vanderbilt
University Medical Center, Nashville, TN, USA
| | - Sunil Kripalani
- Section of Hospital Medicine, Vanderbilt
University Medical Center, Nashville, TN, USA
- Center for Clinical Quality and Implementation
Research, Vanderbilt University Medical Center, Nashville, TN, USA
| | - John F. Schnelle
- Center for Quality Aging, Vanderbilt University
Medical Center, Nashville, TN, USA
- Division of Geriatrics, Vanderbilt University
Medical Center, Nashville, TN, USA
- Geriatric Research Education and Clinical
Center, VA Tennessee Valley Healthcare System, Nashville, TN, USA
| | - Eduard E. Vasilevskis
- Vanderbilt Center for Health Services Research,
Center for Quality Aging, Division of General Internal Medicine and Public
Health, Geriatric Research Education and Clinical Center, VA Tennessee
Valley, 2525 West End Ave, Suite 450, Nashville, TN 37203, USA
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Tan ECK, Sluggett JK, Johnell K, Onder G, Elseviers M, Morin L, Vetrano DL, Wastesson JW, Fastbom J, Taipale H, Tanskanen A, Bell JS. Research Priorities for Optimizing Geriatric Pharmacotherapy: An International Consensus. J Am Med Dir Assoc 2018; 19:193-199. [PMID: 29361432 DOI: 10.1016/j.jamda.2017.12.002] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Revised: 11/29/2017] [Accepted: 12/05/2017] [Indexed: 02/07/2023]
Abstract
Medication management is becoming increasingly challenging for older people, and there is limited evidence to guide medication prescribing and administration for people with multimorbidity, frailty, or at the end of life. Currently, there is a lack of clear research priorities in the field of geriatric pharmacotherapy. To address this issue, international experts from 5 research groups in geriatric pharmacotherapy and pharmacoepidemiology research were invited to attend the inaugural Optimizing Geriatric Pharmacotherapy through Pharmacoepidemiology Network workshop. A modified nominal group technique was used to explore and consolidate the priorities for conducting research in this field. Eight research priorities were elucidated: quality of medication use; vulnerable patient groups; polypharmacy and multimorbidity; person-centered practice and research; deprescribing; methodological development; variability in medication use; and national and international comparative research. The research priorities are discussed in detail in this article with examples of current gaps and future actions presented. These priorities highlight areas for future research in geriatric pharmacotherapy to improve medication outcomes in older people.
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Affiliation(s)
- Edwin C K Tan
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, Australia; Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden.
| | - Janet K Sluggett
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, Australia; NHMRC Cognitive Decline Partnership Center, Hornsby Ku-ring-gai Hospital, Hornsby, NSW, Australia
| | - Kristina Johnell
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden
| | - Graziano Onder
- Department of Geriatrics, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Monique Elseviers
- Center for Research and Innovation in Care (CRIC), University of Antwerp, Antwerp, Belgium; Department of Clinical Pharmacology, University of Ghent, Ghent, Belgium
| | - Lucas Morin
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden
| | - Davide L Vetrano
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden; Department of Geriatrics, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Jonas W Wastesson
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden
| | - Johan Fastbom
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden
| | - Heidi Taipale
- Kuopio Research Center of Geriatric Care, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland; Karolinska Institutet, Department of Clinical Neuroscience, Stockholm, Sweden
| | - Antti Tanskanen
- Karolinska Institutet, Department of Clinical Neuroscience, Stockholm, Sweden
| | - J Simon Bell
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, Australia; NHMRC Cognitive Decline Partnership Center, Hornsby Ku-ring-gai Hospital, Hornsby, NSW, Australia; Kuopio Research Center of Geriatric Care, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
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50
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Tabue-Teguo M, Grasset L, Avila-Funes JA, Genuer R, Proust-Lima C, Péres K, Féart C, Amieva H, Harmand MGC, Helmer C, Salles N, Rainfray M, Dartigues JF. Prevalence and Co-Occurrence of Geriatric Syndromes in People Aged 75 Years and Older in France: Results From the Bordeaux Three-city Study. J Gerontol A Biol Sci Med Sci 2017; 73:109-116. [PMID: 28541397 DOI: 10.1093/gerona/glx068] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2016] [Accepted: 04/10/2017] [Indexed: 11/13/2022] Open
Abstract
Background Geriatric syndromes (GSs) are often the result of cumulative insults to multiple organ systems and are considered common in older adults. However, their frequency and co-occurrence are not well known in the elderly population. This study aimed to determine the prevalence of several GSs and to analyze the co-occurrence of these syndromes in a general population of elderly individuals. Methods A cross-sectional analysis of 630 adults aged 75 years or older participating in the 10-year follow-up of the Bordeaux sample of the French Three-City Study was conducted. The following 10 GSs were assessed: physical frailty, dementia and cognitive impairment, depressive symptoms, polymedication, social isolation, thinness, falls, dependence, sensory deficit, and incontinence. The prevalence of the 10 GSs was estimated, and multiple correspondence analysis (MCA) models were used to explore the mutual associations between these GSs. Results The mean age of the participants was 83.3 years; 69% were women, and 80.5% [95% confidence interval (CI) = 76.3-82.7] had at least one GS. The most frequent GSs were polymedication (50.6% 95%CI = 46.7-54.5) and falls (43.1% 95%CI = 38.4-46.1). The MCA models identified two major dimensions of the 10 GSs: "Dementia-Dependence-Incontinence" and "Frailty-Depression-Isolation." Conclusions GSs were very common in this French elderly population and were grouped into two major dimensions: the "Dementia-Dependence-Incontinence" and "Frailty-Depression-Isolation."
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Affiliation(s)
- Maturin Tabue-Teguo
- INSERM U 1219, Université de Bordeaux, France.,Institut de Santé Publique d'Epidémiologie et de Développement (ISPED), Université de Bordeaux, France.,Institut des Maladies Neurodégénératives Clinique, Centre Hospitalier Universitaire de Bordeaux, France.,Centre Hospitalier Villeneuve-sur-Lot, France
| | - Leslie Grasset
- INSERM U 1219, Université de Bordeaux, France.,Institut de Santé Publique d'Epidémiologie et de Développement (ISPED), Université de Bordeaux, France
| | - José Alberto Avila-Funes
- INSERM U 1219, Université de Bordeaux, France.,Institut de Santé Publique d'Epidémiologie et de Développement (ISPED), Université de Bordeaux, France.,Department of Geriatrics, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Robin Genuer
- INSERM U 1219, Université de Bordeaux, France.,Institut de Santé Publique d'Epidémiologie et de Développement (ISPED), Université de Bordeaux, France
| | - Cecile Proust-Lima
- INSERM U 1219, Université de Bordeaux, France.,Institut de Santé Publique d'Epidémiologie et de Développement (ISPED), Université de Bordeaux, France
| | - Karine Péres
- INSERM U 1219, Université de Bordeaux, France.,Institut de Santé Publique d'Epidémiologie et de Développement (ISPED), Université de Bordeaux, France
| | - Catherine Féart
- INSERM U 1219, Université de Bordeaux, France.,Institut de Santé Publique d'Epidémiologie et de Développement (ISPED), Université de Bordeaux, France
| | - Hélène Amieva
- INSERM U 1219, Université de Bordeaux, France.,Institut de Santé Publique d'Epidémiologie et de Développement (ISPED), Université de Bordeaux, France.,Institut des Maladies Neurodégénératives Clinique, Centre Hospitalier Universitaire de Bordeaux, France
| | - Magali González-Colaço Harmand
- INSERM U 1219, Université de Bordeaux, France.,Institut de Santé Publique d'Epidémiologie et de Développement (ISPED), Université de Bordeaux, France
| | - Catherine Helmer
- INSERM U 1219, Université de Bordeaux, France.,Institut de Santé Publique d'Epidémiologie et de Développement (ISPED), Université de Bordeaux, France
| | - Nathalie Salles
- Pôle gérontologie clinique, Centre Hospitalier Universitaire de Bordeaux, France
| | - Muriel Rainfray
- INSERM U 1219, Université de Bordeaux, France.,Institut de Santé Publique d'Epidémiologie et de Développement (ISPED), Université de Bordeaux, France.,Pôle gérontologie clinique, Centre Hospitalier Universitaire de Bordeaux, France
| | - Jean François Dartigues
- INSERM U 1219, Université de Bordeaux, France.,Institut de Santé Publique d'Epidémiologie et de Développement (ISPED), Université de Bordeaux, France.,Institut des Maladies Neurodégénératives Clinique, Centre Hospitalier Universitaire de Bordeaux, France
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