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Smichenko J, Gil E, Zisberg A. Relationship Between Changes in Sedative-Hypnotic Medications Burden and Cognitive Outcomes in Hospitalized Older Adults. J Gerontol A Biol Sci Med Sci 2020; 75:1699-1705. [PMID: 31942612 DOI: 10.1093/gerona/glaa015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Sedative-hypnotic medications (SHMs) are frequently used in hospitalized older patients, despite undesirable effects on cognitive status. Although previous studies found a significant number of patients experience changes in SHM use during hospitalization, it is unclear which pattern of change leads to hospital-associated cognitive decline (HACD). This study tested the association between patterns of SHM change and HACD. METHODS This secondary analysis study included 550 patients age 70+ who were cognitively intact at admission (Short Portable Mental Status Questionnaire [SPMSQ] ≥8). HACD was defined as at least 1-point decline in SPMSQ between admission and discharge. Changes in sedative burden (SB) before and during hospitalization (average SB of all hospitalization days) were coded using the Drug Burden Index sorting study participants into four groups: without SB (n = 254), without SB changes (n = 132), increased SB (n = 82), and decreased SB (n = 82). RESULTS Incidence of HACD was 233/550 (42.4%). In multivariate logistic analysis controlling for demographic characteristics, length of stay, severity of acute illness, comorbidity, SB score at home, pain on admission and depression, the odds of HACD were 2.45 (95% CI: 1.16 to 5.13) among participants with increased SB, 2.10 (95% CI: 1.13 to 3.91) among participants without SB changes, compared with participants with decreased SB. CONCLUSION Older patients whose SB is increased or does not change are at higher risk for acquired cognitive decline than are those whose SB is reduced. Identifying patients with a potential increase in SB and intervening to reduce it may help to fight HACD.
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Affiliation(s)
- Juliana Smichenko
- The Cheryl Spencer Department of Nursing, Faculty of Social Welfare and Health Science, University of Haifa, Mount Carmel, Haifa, Israel
| | - Efrat Gil
- Clalit Health Services, Haifa and West Galilee and Carmel Hospital, Haifa, Israel.,Faculty of Medicine, Technion, Haifa, Israel
| | - Anna Zisberg
- The Cheryl Spencer Department of Nursing, Faculty of Social Welfare and Health Science, University of Haifa, Mount Carmel, Haifa, Israel
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2
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Why Z-drugs are used even if doctors and nurses feel unable to judge their benefits and risks-a hospital survey. Eur J Clin Pharmacol 2019; 76:285-290. [PMID: 31732756 DOI: 10.1007/s00228-019-02783-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Accepted: 10/18/2019] [Indexed: 11/27/2022]
Abstract
BACKGROUND Many patients receive Z-drugs for hospital-associated sleep problems, in spite of well-known risks. The aim of this study was to learn more about the attractiveness of Z-drugs, seen from the doctors' and nurses' perspective. METHODS Using a standardized questionnaire, doctors (63/116) and nurses (73/243) in a German general hospital were surveyed about the risks and benefits of Z-drugs, compared with benzodiazepines. RESULT "Reduced time to get to sleep" was perceived by doctors (51%) and nurses (53%) to be a strong benefit of Z-drugs; "confusion" and "falls" were perceived by ca. 10% of doctors and ca. 15% of nurses to be a frequent problem. Compared with benzodiazepines, respondents more often answered "unable to judge" for Z-drugs; e.g. for doctors, 18% (benzodiazepines) vs. 45% (Z-drugs) were unable to judge "improved daytime functioning" and 12% (benzodiazepines) vs. 37% (Z-drugs) were unable to judge "falls." CONCLUSION Z-drugs seem to be attractive because experiential knowledge overemphasizes their benefits and fails to take risks such as drug-related falls and confusion into account. Difficulties to judge a drug's risk-benefit ratio do not prevent doctors and nurses from using them. Interventions for reducing Z-drug usage should incorporate local quality assurance data about relevant patient risks.
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Heinemann S, Neukirchen F, Nau R, Hummers E, Himmel W. Patient-reported factors associated with the desire to continue taking sleep-inducing drugs after hospital discharge: A survey of older adults. Pharmacoepidemiol Drug Saf 2019; 28:1014-1022. [PMID: 31179613 PMCID: PMC6618328 DOI: 10.1002/pds.4806] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Revised: 04/26/2019] [Accepted: 04/27/2019] [Indexed: 11/08/2022]
Abstract
Purpose To find out whether any prior experiences with sleep‐inducing drugs before hospitalization and positive experiences with these drugs during hospitalization influence a patient's wish to continue taking sleep‐inducing drugs after hospitalization. Methods We surveyed older hospital patients about use of sleep‐inducing drugs before, during, and after hospitalization and compared these answers with their hospital chart using the kappa statistic. The association between the wish to continue these drugs after discharge and the perceived benefits, experience of side effects, and prior experience with sleep‐inducing drugs was determined by multivariable logistic regression. Results Agreement between patient responses and the hospital file was high (κ = 0.7). Seventeen percent (83/483) of the participants reported prior experience before their hospital stay; 45% received a sleep‐inducing drug during hospitalization; 17% wished to continue taking them after discharge. Of the 400 patients who had no prior experience with sleep‐inducing drugs, 147 (37%) became first‐time users in the hospital, and 27% (40/147) of these wished to continue this medication after discharged. Strong predictors for this wish were the reduction of sleep onset problems (adjusted odds ratio, 6.26; 95% confidence interval, 2.38‐16.44) and any prior experience with sleep‐inducing drugs (4.08; 1.97‐8.48). Conclusions Many older patients become first‐time users of sleep‐inducing drugs in the hospital. Especially the experience of sleep onset improvements influences the wish to continue sleep‐inducing drug use after discharge. Avoiding first‐time use should become a goal of hospital policy and be taken into account when weighing the benefits and risks of sleep‐inducing drugs.
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Affiliation(s)
- Stephanie Heinemann
- Department of General Practice, University Medical Center, Göttingen, Germany
| | - Freya Neukirchen
- Department of General Practice, University Medical Center, Göttingen, Germany
| | - Roland Nau
- Department of Geriatrics, Evangelisches Krankenhaus Göttingen-Weende, Göttingen, Germany.,Institute of Neuropathology, University Medical Center, Göttingen, Germany
| | - Eva Hummers
- Department of General Practice, University Medical Center, Göttingen, Germany
| | - Wolfgang Himmel
- Department of General Practice, University Medical Center, Göttingen, Germany
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Sedative-hypnotic initiation and renewal at discharge in hospitalized older patients: an observational study. BMC Geriatr 2018; 18:278. [PMID: 30428839 PMCID: PMC6234671 DOI: 10.1186/s12877-018-0972-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2018] [Accepted: 11/02/2018] [Indexed: 01/25/2023] Open
Abstract
Background Sedative-hypnotics (SHs) are widely used in France but there are no available data addressing their prescription specifically in hospitalized older patients. The objective is thus to determine the cumulative incidence of sedative-hypnotic (SH) medications initialized during a hospital stay of older patients, the proportion of SH renewal at discharge among these patients and to study associated risk factors. Methods We conducted a retrospective observational study in six internal medicine units and six acute geriatric units in eight hospitals (France). We included 1194 inpatients aged 65 and older without SH medications prior to hospitalization. Data were obtained from patients’ electronic pharmaceutical records. Primary outcome was the cumulative incidence of SH initiation in the study units. Secondary outcomes were the proportion of SH renewal at discharge and risk factors for SH initiation and renewal at discharge (patient characteristics, hospital organization). A Cox regression model was used to study risk factors for SH initiation. A mixed effects logistic regression was used to study risk factors for SH renewal at discharge. Results SH initiation occurred in 21.5% of participants 20 days after admission. SH renewal at discharge occurred in 38.7% of patients who had initiated it during their stay and were discharged home and in 56.0% of patients discharged to rehabilitation facilities. Neither patients’ characteristics nor hospital organization patterns was associated with SH initiation. SH initiation after the first six days after admission was associated with a lower risk of SH renewal in patients discharged to rehabilitation facilities (OR = 0.19, 95% CI: [0.04–0.80]). Conclusions Hospitalization is a period at risk for SH initiation. The implementation of interventions promoting good use of SHs is thus of first importance in hospitals. Specific attention should be paid to patients discharged to rehabilitation facilities. Electronic supplementary material The online version of this article (10.1186/s12877-018-0972-3) contains supplementary material, which is available to authorized users.
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Kauffmann L, Heinemann S, Himmel W, Hußmann O, Schlott T, Weiß V. [Non-pharmacological treatment of hospital patients with sleeping problems - the nurse perspective]. Pflege 2018; 31:291-300. [PMID: 30325264 DOI: 10.1024/1012-5302/a000639] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Non-pharmacological treatment of hospital patients with sleeping problems - the nurse perspective Abstract. BACKGROUND Elderly patients suffer from sleep disturbances during hospitalization. These patients often receive hypnotics and sedatives; despite of the known risks and although non-pharmacological treatments are available. AIM The study investigates the experiences of nurses when using non-pharmacological treatments for elderly patients with sleeping problems. METHODS Semi-structured interviews with 13 nurses from a general hospital were analyzed according to Mayring's qualitative content analysis. RESULTS Nurses used a variety of non-pharmacological treatments for elderly inpatients with sleeping problems: (1) structural measures (regulation of temperature and light), (2) organizational measures (more time for conversation during the nightshift), (3) nursing measures (asking about night-time routines) and (4) household remedies. From the nurses' perspective, the more intensive contact required when applying non-pharmacological treatments can lead to higher patient satisfaction and a lower bell frequency during the night shift. Barriers result from limited time and personnel, a lack of standards and individual patient needs. CONCLUSION Nurses know several kinds of non-pharmacological treatments to help elderly inpatients sleep better. A lack of resources as well as a lack of professional consensus about the treatment of temporary sleeping disturbances can be an obstacle to their use. A professional climate should restrict the use of drugs for sleeping problems as far as possible.
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Affiliation(s)
- Lea Kauffmann
- 1 Stabsstelle Pflegewissenschaft, Medizinische Hochschule Hannover.,2 Institut für Allgemeinmedizin, Universitätsmedizin Göttingen
| | | | - Wolfgang Himmel
- 2 Institut für Allgemeinmedizin, Universitätsmedizin Göttingen
| | - Olaf Hußmann
- 3 Pflegedirektion, Evangelisches Krankenhaus Göttingen-Weende
| | - Thilo Schlott
- 4 Fachbereich Pflege und Gesundheit, Hochschule Fulda
| | - Vivien Weiß
- 2 Institut für Allgemeinmedizin, Universitätsmedizin Göttingen
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Bourcier E, Korb-Savoldelli V, Hejblum G, Fernandez C, Hindlet P. A systematic review of regulatory and educational interventions to reduce the burden associated with the prescriptions of sedative-hypnotics in adults treated for sleep disorders. PLoS One 2018; 13:e0191211. [PMID: 29357377 PMCID: PMC5777652 DOI: 10.1371/journal.pone.0191211] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Accepted: 12/29/2017] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND The burden of Sedative-Hypnotics (SHs) has been known since the 1980s. Yet, their consumption remains high. A systematic review of the literature should help to assess efficient interventions to improve the appropriate use of SHs in sleep disorders. OBJECTIVES To identify and assess regulatory and educational interventions designed to improve the appropriate use of SHs for insomnia treatment. METHODS We conducted a systematic review of the literature according to PRISMA guidelines. A systematic search covering the period 1980-2015 was carried out in Medline, Web of Science, Embase and PsycInfo. We included studies reporting the implementation of regulatory or educational strategies directed towards patients and/or healthcare professionals to improve the appropriate use of SHs to treat insomnia in the community, hospitals and nursing homes. RESULTS Thirty-one studies were included: 23 assessed educational interventions (recommendations by mail/email, computer alerts, meetings, mass media campaigns, prescription profile), 8 assessed regulatory interventions (prescription rule restriction, end of reimbursement). The most recent was implemented in 2009. Restrictive prescription rules were effective to reduce the consumption of targeted SHs but led to a switch to other non-recommended SHs. Among educational interventions, only 3 studies out of 7 reported positive results of mono-faceted interventions; whereas, 13 out of the 16 multi-faceted interventions were reported as efficient: particularly, the active involvement of healthcare professionals and patients and the spread of information through mass media were successful. The risk of bias was high for 24 studies (mainly due to the design), moderate for 3 studies and weak for 4 studies. CONCLUSION Educational multifaceted studies are presented as the most efficient. But further better designed studies are needed to make evidence-based results more generalizable.
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Affiliation(s)
- Elsa Bourcier
- Sorbonne Université, INSERM, Institut Pierre Louis d’épidémiologie et de Santé Publique, IPLESP UMR-S1136, Paris, France
- Service de pharmacie, Hôpital Saint-Antoine, Assistance Publique - Hôpitaux de Paris, Paris, France
- Faculté de pharmacie, Université Paris-Sud, Châtenay-Malabry, France
| | - Virginie Korb-Savoldelli
- Faculté de pharmacie, Université Paris-Sud, Châtenay-Malabry, France
- Service de pharmacie, Hôpital Européen Georges Pompidou, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - Gilles Hejblum
- Sorbonne Université, INSERM, Institut Pierre Louis d’épidémiologie et de Santé Publique, IPLESP UMR-S1136, Paris, France
| | - Christine Fernandez
- Sorbonne Université, INSERM, Institut Pierre Louis d’épidémiologie et de Santé Publique, IPLESP UMR-S1136, Paris, France
- Service de pharmacie, Hôpital Saint-Antoine, Assistance Publique - Hôpitaux de Paris, Paris, France
- Faculté de pharmacie, Université Paris-Sud, Châtenay-Malabry, France
| | - Patrick Hindlet
- Sorbonne Université, INSERM, Institut Pierre Louis d’épidémiologie et de Santé Publique, IPLESP UMR-S1136, Paris, France
- Service de pharmacie, Hôpital Saint-Antoine, Assistance Publique - Hôpitaux de Paris, Paris, France
- Faculté de pharmacie, Université Paris-Sud, Châtenay-Malabry, France
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Schumacher L, Dobrinas M, Tagan D, Sautebin A, Blanc AL, Widmer N. Prescription of Sedative Drugs During Hospital Stay: A Swiss Prospective Study. Drugs Real World Outcomes 2017; 4:225-234. [PMID: 28936700 PMCID: PMC5684046 DOI: 10.1007/s40801-017-0117-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
BACKGROUND In recent years, the number of prescriptions for sedative drugs has increased significantly, as has their long-term use. Moreover, sedative use is frequently initiated during hospital stays. OBJECTIVES This study aimed to describe new prescriptions of sedative drugs during hospital stays and evaluate their maintenance as discharge medication. METHODS This observational prospective study took place in an internal medicine ward of a Swiss hospital over a period of 3 months in 2014. Demographic (age, sex, diagnosis, comorbidities) and medication data [long-term use of sedative drugs, new regular or pro re nata ('as needed') prescriptions of sedative drugs, drug-related problems] were collected. Sedative medications included: benzodiazepines, Z-drugs, antihistamines, antidepressants, neuroleptics, herbal drugs, and clomethiazole. McNemar's test was used for comparison. RESULTS Of 290 patients included, 212 (73%) were over 65 years old and 169 (58%) were women; 34% (n = 98) were using sedative drugs long term before their hospital stay, and 44% (n = 128) had a prescription for sedative drugs at discharge-a 10% increase (p < 0.05). Sedative drugs were newly prescribed to 37% (n = 108) of patients during their stay. Among these, 37% (n = 40) received a repeat prescription at discharge. Over half of the sedative drugs were prescribed within 24 h of admission. Drug-related problems were detected in 76% of new prescriptions, of which 90% were drug-drug interactions. CONCLUSION This study showed that hospital stays increased the proportion of patients who were prescribed a sedative drug at discharge by 10% (absolute increase). These prescriptions may generate long-term use and expose patients to drug-related problems. Promoting alternative approaches for managing insomnia are recommended.
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Affiliation(s)
- Laurence Schumacher
- Clinical Pharmacy Services, Pharmacie des Hôpitaux de l'Est Lémanique, Boulevard Paderewski 3, 1800, Vevey, Switzerland
| | - Maria Dobrinas
- Clinical Pharmacy Services, Pharmacie des Hôpitaux de l'Est Lémanique, Boulevard Paderewski 3, 1800, Vevey, Switzerland
| | - Damien Tagan
- Internal Medicine Department, Hôpital Riviera-Chablais, Vaud-Valais, Vevey, Switzerland
| | - Annelore Sautebin
- Internal Medicine Department, Hôpital Riviera-Chablais, Vaud-Valais, Vevey, Switzerland
| | - Anne-Laure Blanc
- Clinical Pharmacy Services, Pharmacie des Hôpitaux de l'Est Lémanique, Boulevard Paderewski 3, 1800, Vevey, Switzerland.
| | - Nicolas Widmer
- Clinical Pharmacy Services, Pharmacie des Hôpitaux de l'Est Lémanique, Boulevard Paderewski 3, 1800, Vevey, Switzerland.,Division of Clinical Pharmacology, Lausanne University Hospital, Lausanne, Switzerland
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Pek EA, Remfry A, Pendrith C, Fan-Lun C, Bhatia RS, Soong C. High Prevalence of Inappropriate Benzodiazepine and Sedative Hypnotic Prescriptions among Hospitalized Older Adults. J Hosp Med 2017; 12:310-316. [PMID: 28459898 DOI: 10.12788/jhm.2739] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Benzodiazepines and sedative hypnotics are commonly used to treat insomnia and agitation in older adults despite significant risk. A clear understanding of the extent of the problem and its contributors is required to implement effective interventions. OBJECTIVE To determine the proportion of hospitalized older adults who are inappropriately prescribed benzodiazepines or sedative hypnotics, and to identify patient and prescriber factors associated with increased prescriptions. DESIGN Single-center retrospective observational study. SETTING Urban academic medical center. PARTICIPANTS Medical-surgical inpatients aged 65 or older who were newly prescribed a benzodiazepine or zopiclone. MEASUREMENTS Our primary outcome was the proportion of patients who were prescribed a potentially inappropriate benzodiazepine or sedative hypnotic. Potentially inappropriate indications included new prescriptions for insomnia or agitation/anxiety. We used a multivariable random-intercept logistic regression model to identify patient- and prescriber-level variables that were associated with potentially inappropriate prescriptions. RESULTS Of 1308 patients, 208 (15.9%) received a potentially inappropriate prescription. The majority of prescriptions, 254 (77.4%), were potentially inappropriate. Of these, most were prescribed for insomnia (222; 87.4%) and during overnight hours (159; 62.3%). Admission to a surgical or specialty service was associated with significantly increased odds of potentially inappropriate prescription compared to the general internal medicine service (odds ratio [OR], 6.61; 95% confidence interval [CI], 2.70-16.17). Prescription by an attending physician or fellow was associated with significantly fewer prescriptions compared to first-year trainees (OR, 0.28; 95% CI, 0.08-0.93). Nighttime prescriptions did not reach significance in initial bivariate analyses but were associated with increased odds of potentially inappropriate prescription in our regression model (OR, 4.48; 95% CI, 2.21-9.06). CONCLUSIONS The majority of newly prescribed benzodiazepines and sedative hypnotics were potentially inappropriate and were primarily prescribed as sleep aids. Future interventions should focus on the development of safe sleep protocols and education targeted at first-year trainees.Journal of Hospital Medicine 2017;12:310-316.
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Affiliation(s)
| | - Andrew Remfry
- Department of Medicine, University of Toronto, Ontario
| | - Ciara Pendrith
- Institute of Health System Solutions and Virtual Care, Women's College Hospital, Toronto, Ontario
| | - Chris Fan-Lun
- Leslie Dan Faculty of Pharmacy, University of Toronto, Ontario
| | - R Sacha Bhatia
- Department of Medicine, University of Toronto, Ontario; Women's College Hospital Institute for Health Systems Solutions and Virtual Care, Toronto, Ontario; Division of Cardiology, Women's College Hospital and University Health Network, Toronto, Ontario; Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario
| | - Christine Soong
- Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario; Division of General Internal Medicine, Sinai Health System, Toronto, Ontario; Centre for Quality Improvement and Patient Safety, University of Toronto, Toronto, Ontario
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Feasibility and Psychometric Properties of the Adjusted DSWAL-QoL Questionnaire for Dysphagic Patients with Additional Language and/or Cognitive Impairment: Part I. Dysphagia 2017; 32:401-419. [DOI: 10.1007/s00455-016-9770-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Accepted: 12/15/2016] [Indexed: 02/08/2023]
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10
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Youn S, Hann CWC, Park B, Lee S, Kim C, Yi K, Chung S. The Sleeping Pill Prescription Rate for Inpatients at a General Hospital. SLEEP MEDICINE RESEARCH 2016. [DOI: 10.17241/smr.2016.00045] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Development and validation of the Psychotropic Education and Knowledge (PEAK) test on psychotropic drugs for nurses in an acute geriatric care setting. Eur Geriatr Med 2016. [DOI: 10.1016/j.eurger.2016.02.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Lagalle M, Ruet A, Villart M, Azouvi P, Michelon H. Use of psychotropic drugs in physically disabled patients: One-shot prevalence and medical practice assessment in a physical and rehabilitation medicine ward. Ann Phys Rehabil Med 2015; 58:357-8. [PMID: 26585584 DOI: 10.1016/j.rehab.2015.10.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2015] [Revised: 10/20/2015] [Accepted: 10/20/2015] [Indexed: 12/01/2022]
Affiliation(s)
- M Lagalle
- Service de Pharmacie, Hôpital Raymond-Poincaré, Hôpitaux Universitaires Paris Île-de-France Ouest, Assistance Publique-Hôpitaux de Paris, 104, boulevard R.-Poincaré, 92380 Garches, France
| | - A Ruet
- Service de Médecine Physique et de Réadaptation, Hôpitaux Universitaires Paris Île-de-France Ouest, Assistance Publique-Hôpitaux de Paris, 104, boulevard R.-Poincaré, 92380 Garches, France
| | - M Villart
- Service de Pharmacie, Hôpital Raymond-Poincaré, Hôpitaux Universitaires Paris Île-de-France Ouest, Assistance Publique-Hôpitaux de Paris, 104, boulevard R.-Poincaré, 92380 Garches, France
| | - P Azouvi
- Service de Médecine Physique et de Réadaptation, Hôpitaux Universitaires Paris Île-de-France Ouest, Assistance Publique-Hôpitaux de Paris, 104, boulevard R.-Poincaré, 92380 Garches, France
| | - H Michelon
- Service de Pharmacie, Hôpital Raymond-Poincaré, Hôpitaux Universitaires Paris Île-de-France Ouest, Assistance Publique-Hôpitaux de Paris, 104, boulevard R.-Poincaré, 92380 Garches, France.
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13
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Medication discrepancies in older patients admitted to non-geriatric wards: An exploratory study. Eur Geriatr Med 2015. [DOI: 10.1016/j.eurger.2014.10.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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14
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Azermai M, Bourgeois J, Somers A, Petrovic M. Inappropriate use of psychotropic drugs in older individuals: implications for practice. ACTA ACUST UNITED AC 2013. [DOI: 10.2217/ahe.13.17] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Frailty at old age and institutionalization in nursing homes are often associated with multiple chronic diseases (multimorbidity) requiring multiple medications (polypharmacy). Among these chronic conditions, mental health problems (e.g., dementia, depression and insomnia) are common. Psychotropic drugs are frequently used as a treatment approach for these conditions, and the prevalence of their use is high among community-dwelling older adults, but even higher in nursing homes. Furthermore, within the problem of polypharmacy and inappropriate prescribing, psychotropic drugs (defined in this article as antipsychotics, benzodiazepines and antidepressants) constitute a significant proportion. The use of psychotropics in older adults remains controversial given the risk of adverse effects, in contrast to the limited effectiveness. Guidelines advise a thorough risk–benefit analysis before the initiation of psychotropics, in addition to time-limited use and discontinuation. In the future, serious efforts should be undertaken to tackle the burden of inappropriate psychotropic prescribing in older adults by incorporating a multidisciplinary approach and by offering credible alternatives.
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Affiliation(s)
- Majda Azermai
- Heymans Institute of Pharmacology, Division of Clinical Pharmacology, Ghent University, De Pintelaan 185 (1 Blok B), 9000 Gent, Belgium.
| | - Jolyce Bourgeois
- Heymans Institute of Pharmacology, Division of Clinical Pharmacology, Ghent University, De Pintelaan 185 (1 Blok B), 9000 Gent, Belgium
| | - Annemie Somers
- Department of Pharmacy, Ghent University Hospital, Gent, Belgium
| | - Mirko Petrovic
- Heymans Institute of Pharmacology, Division of Clinical Pharmacology, Ghent University, De Pintelaan 185 (1 Blok B), 9000 Gent, Belgium
- Department of Geriatrics, Ghent University Hospital, Gent, Belgium
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15
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The validation and psychometric properties of the Dutch version of the Swallowing Quality-of-Life Questionnaire (DSWAL-QOL). Dysphagia 2012; 28:11-23. [PMID: 22572839 DOI: 10.1007/s00455-012-9408-y] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2011] [Accepted: 04/14/2012] [Indexed: 10/28/2022]
Abstract
The aim of this work was to evaluate the psychometric properties of the Dutch version of the Swallowing Quality-of-Life Questionnaire (DSWAL-QOL). A cross-sectional survey of 295 dysphagic patients and 124 healthy controls was studied to evaluate the validity and reliability of the DSWAL-QOL, and 50 patients were recruited for the test-retest reliability. Construct validity was validated through principal component analysis and a correlation study between the DSWAL-QOL and the SF-36. The psychometric properties of the DSWAL-QOL were found to be largely similar to those of the original SWAL-QOL, except the Sleep scale; the composite Symptoms score reaffirms its validity in this study. The DSWAL-QOL was able to differentiate between dysphagic and nondysphagic patients and is sensitive to disease severity as measured by known-groups validity, based on different food and liquid textures. The DSWAL-QOL is a clinically valid and reliable tool for assessing the quality of life in Dutch-speaking dysphagic patients, regardless of the cause or severity of the dysphagia.
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