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Ma W, Wang H, Wen Z, Liu L, Zhang X. Potentially inappropriate medication and frailty in older adults: A systematic review and meta-analysis. Arch Gerontol Geriatr 2023; 114:105087. [PMID: 37311369 DOI: 10.1016/j.archger.2023.105087] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 05/18/2023] [Accepted: 06/03/2023] [Indexed: 06/15/2023]
Abstract
OBJECTIVES The purpose of this study was to systematically assess existing studies to demonstrate the association between potentially inappropriate medication (PIM) and frailty. DESIGN Systematic review and meta-analysis. METHODS We searched major electronic databases (PubMed, Web of Science, the Cochrane Library, Embase, CINHAL, PsycInfo, China National Knowledge Infrastructure, China Biology Medicine disk, Weipu, and Wanfang) from their inception until February 25, 2023 (data updated on May 4, 2023), for observational studies investigating PIM and frailty. I2 was used to measure the heterogeneity between studies quantitatively. A random effect model calculated pooled effect size owing to high heterogeneity. Subgroup analysis was conducted to explore sources of heterogeneity. Additionally, the studies' quality was evaluated using the Newcastle Ottawa Scale (a modified Newcastle Ottawa Scale was used to evaluate cross-sectional studies). RESULTS Twenty-four studies were included for systematic review, 14 of which were included in the meta-analysis. After pooling the effect size, the odds ratio with PIM as the dependent variable was 1.12 (95%CI: 1.01-1.25), and that with frailty as the dependent variable was 1.75 (95%CI: 1.25-2.43), indicating a bidirectional association between PIM and frailty. CONCLUSIONS PIM and frailty interact with each other and have a bidirectional association, thus providing additional information for early clinical identification and prevention of frailty, and medication safety management.
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Affiliation(s)
- Wenlian Ma
- School of Nursing, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Hongyan Wang
- Dean Office, Sichuan Nursing Vocational College, Chengdu, China
| | - Zhifei Wen
- School of Nursing, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Linfeng Liu
- Dean Office, Sichuan Nursing Vocational College, Chengdu, China
| | - Xiangeng Zhang
- Dean Office, Sichuan Nursing Vocational College, Chengdu, China.
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Pereira F, Meyer-Massetti C, Del Río Carral M, von Gunten A, Wernli B, Verloo H. Development of a patient-centred medication management model for polymedicated home-dwelling older adults after hospital discharge: results of a mixed methods study. BMJ Open 2023; 13:e072738. [PMID: 37730411 PMCID: PMC10514617 DOI: 10.1136/bmjopen-2023-072738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 09/01/2023] [Indexed: 09/22/2023] Open
Abstract
OBJECTIVE This study aimed to investigate medication management among polymedicated, home-dwelling older adults after discharge from a hospital centre in French-speaking Switzerland and then develop a model to optimise medication management and prevent adverse health outcomes associated with medication-related problems (MRPs). DESIGN Explanatory, sequential, mixed methods study based on detailed quantitative and qualitative findings reported previously. SETTING Hospital and community healthcare in the French-speaking part of Switzerland. PARTICIPANTS The quantitative strand retrospectively examined 3 years of hospital electronic patient records (n=53 690 hospitalisations of inpatients aged 65 years or older) to identify the different profiles of those at risk of 30-day hospital readmission and unplanned nursing home admission. The qualitative strand explored the perspectives of older adults (n=28), their informal caregivers (n=17) and healthcare professionals (n=13) on medication management after hospital discharge. RESULTS Quantitative results from older adults' profiles, affected by similar patient-related, medication-related and environment-related factors, were enhanced and supported by qualitative findings. The combined findings enabled us to design an interprofessional, collaborative medication management model to prevent MRPs among home-dwelling older adults after hospital discharge. The model comprised four interactive fields of action: listening to polymedicated home-dwelling older adults and their informal caregivers; involving older adults and their informal caregivers in shared, medication-related decision-making; empowering older adults and their informal caregivers for safe medication self-management; optimising collaborative medication management practices. CONCLUSION By linking the retrospective and prospective findings from our explanatory sequential study involving multiple stakeholders' perspectives, we created a deeper comprehension of the complexities and challenges of safe medication management among polymedicated, home-dwelling older adults after their discharge from hospital. We subsequently designed an innovative, collaborative, patient-centred model for optimising medication management and preventing MRPs in this population.
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Affiliation(s)
- Filipa Pereira
- Abel Salazar Institute of Biomedical Sciences, University of Porto, Porto, Portugal
- School of Health Sciences, HES-SO Valais/ Wallis, Sion, Switzerland
| | - Carla Meyer-Massetti
- Clinical Pharmacology and Toxicology, Clinical of General Internal Medicine, Inselspital, University Hospital of Bern, Bern, Switzerland
- Institute for Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
| | - María Del Río Carral
- Institute of Psychology, Research Center for the Psychology of Health, Aging and Sports Examination (PHASE), University of Lausanne, Lausanne, Switzerland
| | - Armin von Gunten
- Service of Old Age Psychiatry, Lausanne University Hospital, Lausanne, Switzerland
| | - Boris Wernli
- Swiss Centre of Expertise in the Social Sciences (FORS), University of Lausanne, Lausanne, Switzerland
| | - Henk Verloo
- School of Health Sciences, HES-SO Valais/ Wallis, Sion, Switzerland
- Service of Old Age Psychiatry, Lausanne University Hospital, Lausanne, Switzerland
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Potentially inappropriate medication use based on two deprescribing criteria and related factors in patients with terminal cancer: A cross-sectional study. J Geriatr Oncol 2023; 14:101472. [PMID: 36931198 DOI: 10.1016/j.jgo.2023.101472] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Accepted: 03/06/2023] [Indexed: 03/17/2023]
Abstract
INTRODUCTION We aimed to estimate the nationwide prevalence of potentially inappropriate medication (PIM) use in patients with terminal cancer according to two deprescribing criteria for patients with a limited lifespan. MATERIALS AND METHODS This cross-sectional study evaluated the prevalence of PIM use using two datasets: national claims data and single-tertiary hospital data. In the claims data, patients with terminal cancer were defined as patients with cancers who died between April and June 2018 and were prescribed opioid analgesics or megestrol or were hospitalized for >90 days before the date of death. Using hospital data, patients who were enrolled in hospice care in 2019 were identified. PIM was defined according to the adjusted criteria from the Screening Tool for Older Persons' Prescriptions in frail adults with limited life expectancy (STOPPFrail) versions 1 and 2 and oncological palliative care deprescribing guidelines (OncPal) guidelines. RESULTS From the national claims data and single-tertiary hospital data, 1,558 patients and 1,243 patients were included in the analysis, respectively. In both datasets, over 60% of patients used five or more medications (claims data: 67.7%; hospital data: 63.9%), and approximately half of them used at least one PIM (claims data: 51.5%; hospital data: 43.2%). Lipid-lowering agents, acid suppressors, and hypoglycemics were common PIMs. Polypharmacy, age, and comorbid conditions, including diabetes, were associated with PIM use. DISCUSSION Approximately two-thirds and half of the patients with terminal cancer were exposed to polypharmacy and at least one PIM based on the STOPPFrail and OncPal criteria, respectively; therefore, deprescribing PIM in patients with terminal cancer is an urgent issue.
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Murphy M, Bennett K, Wright M, O’Reilly M, Conroy M, Hughes C, McLean S, Cadogan CA. Potentially inappropriate prescribing in older adults with cancer receiving specialist palliative care: a retrospective observational study. Int J Clin Pharm 2023; 45:174-183. [PMID: 36378404 PMCID: PMC9664032 DOI: 10.1007/s11096-022-01506-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 10/14/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND Older adults (≥ 65 years) with cancer receiving palliative care often have other health conditions requiring multiple medications. AIM To describe and assess the appropriateness of prescribing for older adults with cancer in the last seven days of life in an inpatient palliative care setting. METHOD Retrospective observational study of medical records for 180 patients (60.6% male; median age: 74 years; range 65-94 years) over a two-year period. Medication appropriateness was assessed using: STOPPFrail, OncPal deprescribing guideline and criteria for identifying Potentially Inappropriate Prescribing in older adults with Cancer receiving Palliative Care (PIP-CPC). RESULTS 94.5% of patients had at least one other health condition (median 3, IQR 2-5). The median number of medications increased from five (IQR 3-7) seven days before death, to 11 medications on the day of death (IQR 9-15). The prevalence of PIP varied depending on the tool used: STOPPFrail (version 1: 17.2%, version 2: 19.4%), OncPal (12.8%), PIP-CPC (30%). However, the retrospective nature of the study limited the applicability of the tools. Increasing number of medications had a statistically significant effect on risk of PIP across all tools (STOPPFrail (version 1: 1.29 (1.13-1.37), version 2: 1.30 (1.16-1.48)); OncPal 1.13 (1.01-1.27); PIP-CPC 0.70 (0.61-0.82)). CONCLUSION This study found that the number of medications prescribed to older adults with cancer increased as time to death approached, and the prevalence of PIP varied with the application of different tools. The study also highlights the difficulties of examining PIP in this patient cohort.
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Affiliation(s)
- Melanie Murphy
- School of Pharmacy and Biomolecular Sciences, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Kathleen Bennett
- Data Science Centre, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | | | | | | | - Carmel Hughes
- School of Pharmacy, Queen’s University Belfast, Belfast, UK
| | | | - Cathal A. Cadogan
- School of Pharmacy and Pharmaceutical Sciences, Trinity College Dublin, Dublin 2, D02PN40 Ireland
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Identification of Potentially Inappropriate Medications in Frail Older Adults Residing in Long-Term Care: A Retrospective Chart Review Study. Drugs Real World Outcomes 2022; 10:97-106. [PMID: 36436174 PMCID: PMC9943820 DOI: 10.1007/s40801-022-00342-2] [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] [Accepted: 10/30/2022] [Indexed: 11/28/2022] Open
Abstract
INTRODUCTION Deprescribing is associated with positive health outcomes for older adults in long-term care (LTC), however deprescribing is not universally implemented. OBJECTIVE The primary aim of this study was to estimate the prevalence of potentially inappropriate medications (PIMs) prescribed to frail older adults in Irish long-term care facilities (LTCFs), as identified by the Screening Tool of Older Persons Prescriptions in Frail adults with limited life expectancy, version 2 (STOPPFrail v2). METHODS A retrospective chart review was conducted in two publicly funded LTCFs in Ireland. Eligible participants were those (1) ≥ 65 years of age; (2) resident in a LTCF; (3) eligible as per the STOPPFrail v2 criteria by the site's Medical Officer; and (4) receiving regular medication. Data collected included age, sex, drug, dose, frequency, regular/pro re nata prescribing and indication/relevant diagnoses. Rates of polypharmacy (taking five or more medications) and excessive polypharmacy (taking 10 or more medications) were calculated. STOPPFrail v2 was used to identify PIMs; however, clinical measurements were not taken. Descriptive and association statistics were calculated. RESULTS Of the 103 residents, 89 were ≥ 65 years of age and categorised as frail and were therefore eligible for inclusion in the study. Of those eligible, 85 (95.5%) had polypharmacy and 57 (64%) experienced excessive polypharmacy. The mean number of regular medications was 10.8 (± 3.8), total medications 17.7 (± 5) and diagnoses 5.5 (± 2.5). The mean number of PIMs per resident was 4.8 (± 2.6). Of the eligible participants, 59.6% had at least one medicine without a documented indication, while 61.8%, 42.7% and 30.3% had at least one PIM from the vitamin D, antihypertensives and proton pump inhibitors drug classes, respectively. CONCLUSION Medication and PIM use was high among LTC residents, with inappropriate polypharmacy of concern. Lack of clear indication for prescribing medications appears to be an issue in LTC, potentially affecting healthcare professionals' engagement with deprescribing. The prevalence of PIMs may be overestimated in the antihypertensives/antidiabetic classes due to the lack of clinical measurements.
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Chae HW, Kim Y, Suh Y, Lee J, Lee E, Lee E, Choi JY, Kim KI, Lee JY. Prevalence of potentially inappropriate medications based on the STOPPFrail criteria in frail older patients with limited life expectancy: a cross-sectional study. BMC Geriatr 2022; 22:367. [PMID: 35477358 PMCID: PMC9044865 DOI: 10.1186/s12877-022-03067-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 04/11/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The recently developed Screening Tool of Older Persons' Prescriptions in Frail adults with a limited life expectancy (STOPPFrail) criteria can be helpful for screening medications (PIMs), but it is yet to be widely used in clinical practice. Herein, we aimed to investigate the prevalence of PIMs based on the STOPPFrail criteria (STOPPFrail-PIM) among frail older adults with limited life expectancy admitted to the geriatric center. METHODS This was a retrospective cross-sectional study conducted in the geriatric center at an academic tertiary care hospital in Korea. We evaluated frail older adults with limited life expectancy who received comprehensive geriatric assessment (CGA) admitted between 1 January, 2019 and 30 June, 2020. Frail older adults with limited life expectancy were identified by geriatricians with retrospective records and the prevalence of STOPPFrail-PIMs was analysed by trained pharmacists. Descriptive analysis, t-test, and chi-square test were conducted using IBM SPSS software version 25.0. RESULTS Among 504 older adults who underwent CGA after admission, 171 frail older adults with limited life expectancy were identified by geriatricians and included in the study. An average of 11.3 ± 4.7 medications were administered regularly to each patient before admission. Overall, 97.1% (166/171) had at least one STOPPFrail-PIM, and the mean number of STOPPFrail-PIM was 4.2 ± 2.8. Drugs without clear clinical indication (A2) were the most frequent pre-admission STOPPFrail-PIM, followed by lipid-lowering therapies (B1) and neuroleptic antipsychotics (D1). The number of STOPPFrail-PIM was significantly lower at discharge than that at admission, with the decrease being the highest for A2 at 94.7%. CONCLUSIONS Most frail older adults with limited life expectancy had at least one STOPPFrail-PIM at admission, and the rate of STOPPFrail-PIM decreased significantly at discharge after the geriatric multidisciplinary team care. Further studies are needed to investigate the association between the use of STOPPFrail-PIM and adverse consequences in frail older adults.
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Affiliation(s)
- Hyun-Woo Chae
- Department of Pharmacy, Seoul National University Bundang Hospital, 166 Gumi-ro, Bundang-Gu, Seongnam-Si, Gyeonggi-Do, 13620, Republic of Korea
| | - Yoonhee Kim
- Department of Pharmacy, Seoul National University Bundang Hospital, 166 Gumi-ro, Bundang-Gu, Seongnam-Si, Gyeonggi-Do, 13620, Republic of Korea
| | - Yewon Suh
- Department of Pharmacy, Seoul National University Bundang Hospital, 166 Gumi-ro, Bundang-Gu, Seongnam-Si, Gyeonggi-Do, 13620, Republic of Korea.,College of Pharmacy & Research Institute of Pharmaceutical Sciences, Seoul National University, 1 Gwanak-ro, Gwanak-gu, Seoul, 08826, Republic of Korea
| | - Junghwa Lee
- Department of Pharmacy, Seoul National University Bundang Hospital, 166 Gumi-ro, Bundang-Gu, Seongnam-Si, Gyeonggi-Do, 13620, Republic of Korea
| | - Eunsook Lee
- Department of Pharmacy, Seoul National University Bundang Hospital, 166 Gumi-ro, Bundang-Gu, Seongnam-Si, Gyeonggi-Do, 13620, Republic of Korea
| | - Euni Lee
- College of Pharmacy & Research Institute of Pharmaceutical Sciences, Seoul National University, 1 Gwanak-ro, Gwanak-gu, Seoul, 08826, Republic of Korea
| | - Jung-Yeon Choi
- Department of Internal Medicine, Geriatric Centre, Seoul National University Bundang Hospital, 166 Gumi-ro, Bundang-Gu, Seongnam-Si, Gyeonggi-Do, 13620, Republic of Korea
| | - Kwang-Il Kim
- Department of Internal Medicine, Geriatric Centre, Seoul National University Bundang Hospital, 166 Gumi-ro, Bundang-Gu, Seongnam-Si, Gyeonggi-Do, 13620, Republic of Korea. .,Department of Internal Medicine, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea.
| | - Ju-Yeun Lee
- Department of Pharmacy, Seoul National University Bundang Hospital, 166 Gumi-ro, Bundang-Gu, Seongnam-Si, Gyeonggi-Do, 13620, Republic of Korea. .,College of Pharmacy & Research Institute of Pharmaceutical Sciences, Seoul National University, 1 Gwanak-ro, Gwanak-gu, Seoul, 08826, Republic of Korea.
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Marseau F, Prud'Homm J, Bouzillé G, Polard E, Oger E, Somme D, Osmont MN, Scailteux LM. The Trigger Tool Method for Routine Pharmacovigilance: A Retrospective Cohort Study of the Medical Records of Hospitalized Geriatric Patients. J Patient Saf 2022; 18:e393-e400. [PMID: 33949842 DOI: 10.1097/pts.0000000000000820] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The main objective was to assess the feasibility of the trigger tool method for the retrospective detection of adverse drug reactions (ADRs) in the Rennes University Hospital. The secondary objective was to describe the performance of the method in terms of positive predictive values (PPVs) and severity or preventability of ADRs. METHODS Using the Rennes University Hospital clinical data warehouse, pharmacovigilance experts performed a retrospective review of a random sample of 30 inpatient hospital medical records per month using the triggers "fall" and "delirium" to identify related ADRs among patients 65 years and older in 2018 in the geriatrics department. Using the Z test, we compared the proportion of medical records with a positive (identified) trigger related to an ADR, which were reviewed within 20 minutes using the reference of 50% reviewed within 20 minutes. RESULTS Among the 355 medical records reviewed, 222 had at least 1 trigger and 98 at least 1 related ADR. Among the 222 positive trigger medical records, 99.6% were reviewed in under 20 minutes (P < 0.001). The pharmacovigilance assessment took 3 months. The PPVs reached 53.9% (46.0%-61.7%) for falls and 21.0% (14.3%-27.5%) for delirium. Among the ADRs, 80% were serious and 53% were preventable. CONCLUSIONS Given the low PPV of the triggers used and the considerable need for technical and human resources, the trigger tool method cannot be used as a routine tool at the pharmacovigilance center. However, it could be implemented occasionally for specific purposes such as monitoring the impact of risk minimization measures to prevent ADRs.
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Affiliation(s)
- Floriane Marseau
- From the Pharmacovigilance, Pharmacoepidemiology, and Drug Information Centre, Department of Clinical Pharmacology, Rennes University Hospital, Rennes, France
| | | | | | - Elisabeth Polard
- From the Pharmacovigilance, Pharmacoepidemiology, and Drug Information Centre, Department of Clinical Pharmacology, Rennes University Hospital, Rennes, France
| | | | | | - Marie-Noëlle Osmont
- From the Pharmacovigilance, Pharmacoepidemiology, and Drug Information Centre, Department of Clinical Pharmacology, Rennes University Hospital, Rennes, France
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Heinrich CH, Hurley E, McCarthy S, McHugh S, Donovan MD. Barriers and enablers to deprescribing in long-term care facilities: a 'best-fit' framework synthesis of the qualitative evidence. Age Ageing 2022; 51:6514232. [PMID: 35077555 DOI: 10.1093/ageing/afab250] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION older adults are at risk of adverse outcomes due to a high prevalence of polypharmacy and potentially inappropriate medications (PIMs). Deprescribing interventions have been demonstrated to reduce polypharmacy and PIMs. However, deprescribing is not performed routinely in long-term care facilities (LTCFs). This qualitative evidence synthesis aims to identify the factors which limit and enable health care workers' (HCWs) engagement with deprescribing in LTCFs. METHODS the 'best-fit' framework approach was used to synthesise evidence by using the Theoretical Domains Framework (TDF) as the a priori framework. Included studies were analysed qualitatively to identify LTCF barriers and enablers of deprescribing and were mapped to the TDF. Constructs within domains were refined to best represent the LTCF context. A conceptual model was created, hypothesising relationships between barriers and enablers. RESULTS of 655 records identified, 14 met the inclusion criteria. The 'best-fit' framework included 17 barriers and 16 enablers, which mapped to 11 of the 14 TDF domains. Deprescribing barriers included perceptions of an 'established hierarchy' within LTCFs, negatively affecting communication and insufficient resources which limited HCWs' engagement with deprescribing. Enablers included tailored deprescribing guidelines, interprofessional support and working with a patient focus, allowing the patients' condition to influence decisions. DISCUSSION this study identified that education, interprofessional support and collaboration can facilitate deprescribing. To overcome deprescribing barriers, change is required to a patient-centred model and HCWs need to be equipped with necessary resources and adequate reimbursement. The LTCF organisational structure must support deprescribing, with communication between health care systems.
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Functional Status among Polymedicated Geriatric Inpatients at Discharge: A Population-Based Hospital Register Analysis. Geriatrics (Basel) 2021; 6:geriatrics6030086. [PMID: 34562987 PMCID: PMC8482227 DOI: 10.3390/geriatrics6030086] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Revised: 08/27/2021] [Accepted: 08/30/2021] [Indexed: 12/22/2022] Open
Abstract
This study explored and compared the functional status of polymedicated and non-polymedicated geriatric inpatients at hospital discharge. We used a cross-sectional registry of geriatric patients' hospital records from a multi-site public hospital center in Switzerland. The analysis included all inpatients aged 65 years old or more admitted between 1 January 2015 and 31 December 2017 (n = 53,690), of whom 67.5% were polymedicated at hospital discharge, 52.1% were women (n = 18,909), and 42.7% were 75-84 years old (n = 15,485). On average, the polymedicated patients' hospital lengths of stay were six days longer, they presented with more than three comorbidities, and they were prescribed more than nine medications at hospital discharge (p < 0.001). They showed more frequent general mobility decline (43.2% vs. 41.9%), gait disorders (46.2% vs. 43%), fatigue (48.6% vs. 43.4%) and dependence on lower-body care (49.7% vs. 47.6%), and presented a higher malnutrition risk (OR = 1.411; 95%CI 1.263-1.577; p < 0.001). However, the non-polymedicated inpatients had proportionally more physical and cognitive impairments. The comparison of the functional status of polymedicated and non-polymedicated geriatric inpatients at hospital discharge is important for clinicians trying to identify and monitor those who are most vulnerable to functional decline, and to design targeted strategies for the prevention of functional impairment and related adverse health outcomes.
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Anfinogenova ND, Trubacheva IA, Popov SV, Efimova EV, Ussov WY. Trends and concerns of potentially inappropriate medication use in patients with cardiovascular diseases. Expert Opin Drug Saf 2021; 20:1191-1206. [PMID: 33970732 DOI: 10.1080/14740338.2021.1928632] [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: 10/21/2022]
Abstract
Introduction: The use of potentially inappropriate medications (PIM) is an alarming social risk factor in cardiovascular patients. PIM administration may result in iatrogenic disorders and adverse consequences may be attenuated by limiting PIM intake.Areas covered: The goal of this review article is to discuss the trends, risks, and concerns regarding PIM administration with focus on cardiovascular patients. To find data, we searched literature using electronic databases (Pubmed/Medline 1966-2021 and Web of Science 1975-2021). The data search terms were cardiovascular diseases, potentially inappropriate medication, potentially harmful drug-drug combination, potentially harmful drug-disease combination, drug interaction, deprescribing, and electronic health record.Expert opinion: Drugs for heart diseases are the most commonly prescribed medications in older individuals. Despite the availability of explicit and implicit PIM criteria, the incidence of PIM use in cardiovascular patients remains high ranging from 7 to 85% in different patient categories. Physician-induced disorders often occur when PIM is administered and adverse effects may be reduced by limiting PIM intake. Main strategies promising for addressing PIM use include deprescribing, implementation of systematic electronic records, pharmacist medication review, and collaboration among cardiologists, internists, geriatricians, clinical pharmacologists, pharmacists, and other healthcare professionals as basis of multidisciplinary assessment teams.
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Affiliation(s)
- Nina D Anfinogenova
- Cardiology Research Institute, Tomsk National Research Medical Center, Russian Academy of Sciences, Russian Federation
| | - Irina A Trubacheva
- Cardiology Research Institute, Tomsk National Research Medical Center, Russian Academy of Sciences, Russian Federation
| | - Sergey V Popov
- Cardiology Research Institute, Tomsk National Research Medical Center, Russian Academy of Sciences, Russian Federation
| | - Elena V Efimova
- Cardiology Research Institute, Tomsk National Research Medical Center, Russian Academy of Sciences, Russian Federation
| | - Wladimir Y Ussov
- Cardiology Research Institute, Tomsk National Research Medical Center, Russian Academy of Sciences, Russian Federation
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Jaramillo-Hidalgo J, Lozano-Montoya I, Tornero-Torres O, Tejada-González P, Fuentes-Irigoyen R, Gómez-Pavón FJ. Prevalence of potentially inappropriate prescription in community-dwelling patients with advanced dementia and palliative care needs. Rev Esp Geriatr Gerontol 2021; 56:203-207. [PMID: 34001344 DOI: 10.1016/j.regg.2021.03.001] [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: 11/30/2020] [Revised: 03/10/2021] [Accepted: 03/12/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To establish the prevalence of potentially inappropriate prescription (PIP) in older people with advanced dementia, monitored by a Geriatric Home Care Unit (GHC), as well as the associated risk factors and costs. METHODS Community-dwelling patients ≥65 years with an advanced dementia diagnosis (GDS-FAST≥7a) and poor 1-year vital prognosis (Frail-VIG≥0.6) were included. Pharmacotherapy history was reviewed retrospectively, collecting functional and cognitive status, on the first GHC visit, of patients assessed January 2016-January 2019. Potentially inappropriate medication was defined following STOPP-Frail criteria. RESULTS 100 patients included (76% women, 89.15±5.8 years). Total medications prescribed 760 (7.63±3.4 drugs per patient). 85% patients were given at least one drug considered to be PIP. 26% (196) of the total drugs registered were PIPs. Patients who were prescribed an inappropriate drug showed a higher number of total prescribed drugs (7.92±3.42 vs 6.00±2.24; p 0.04) and a higher frequency of polypharmacy (84.7% vs 60%; p 0.025). Risk of receiving inappropriate medication increased by 24% for each additional drug prescribed (OR 1.24; 95% CI 1.01-1.52; p 0.04). The costs associated with PIP were 113.99 euros per 100 patients/day; 41,606.35 euros per 100 patients/year. CONCLUSIONS Prescription of PIP to community-dwelling patients with severe dementia and poor vital prognosis is common and is associated with high economic impact in this population group.
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Affiliation(s)
- Javier Jaramillo-Hidalgo
- Servicio de Geriatría, Hospital Central de la Cruz Roja San José y Santa Adela, Av/Reina Victoria, 24, 28003 Madrid, Spain; Facultad de Medicina, Universidad Alfonso X el Sabio, Av de la Universidad, 1, 28691- Villanueva de la Cañada, Madrid, Spain.
| | - Isabel Lozano-Montoya
- Servicio de Geriatría, Hospital Central de la Cruz Roja San José y Santa Adela, Av/Reina Victoria, 24, 28003 Madrid, Spain; Facultad de Medicina, Universidad Alfonso X el Sabio, Av de la Universidad, 1, 28691- Villanueva de la Cañada, Madrid, Spain
| | - Olga Tornero-Torres
- Servicio de Farmacia, Hospital Central de la Cruz Roja San José y Santa Adela, Av/Reina Victoria, 24, 28003 Madrid, Spain
| | - Pilar Tejada-González
- Servicio de Farmacia, Hospital Central de la Cruz Roja San José y Santa Adela, Av/Reina Victoria, 24, 28003 Madrid, Spain
| | - Raquel Fuentes-Irigoyen
- Servicio de Farmacia, Hospital Central de la Cruz Roja San José y Santa Adela, Av/Reina Victoria, 24, 28003 Madrid, Spain
| | - Francisco J Gómez-Pavón
- Servicio de Geriatría, Hospital Central de la Cruz Roja San José y Santa Adela, Av/Reina Victoria, 24, 28003 Madrid, Spain; Facultad de Medicina, Universidad Alfonso X el Sabio, Av de la Universidad, 1, 28691- Villanueva de la Cañada, Madrid, Spain
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12
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Ailabouni NJ, Marcum ZA, Schmader KE, Gray SL. Medication Use Quality and Safety in Older Adults: 2019 Update. J Am Geriatr Soc 2021; 69:336-341. [PMID: 33438206 PMCID: PMC11057223 DOI: 10.1111/jgs.17018] [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: 08/18/2020] [Revised: 12/09/2020] [Accepted: 12/17/2020] [Indexed: 11/29/2022]
Abstract
Improving the quality of medication use and medication safety are important priorities for prescribers who care for older adults. The objective of this article was to identify four exemplary articles with this focus in 2019. We selected high-quality studies that moved the field of research forward and were not merely replication studies. The chosen articles cover domains related to aspects of suboptimal prescribing and medication safety. The first study used a nationally representative sample of Medicare beneficiaries to examine the continuation of medications with limited benefit in patients admitted for cancer and non-cancer diagnoses in hospice (domain: potentially inappropriate medications). The second study, a retrospective cohort study of older adults in Ontario, Canada, assessed the association between prescribing oral anticoagulants in an emergency department relative to not prescribing anticoagulants in the emergency department and their persistence at 6 months (domain: underuse of medications). The third study, a cluster randomized trial in Quebec, Canada, evaluated the effect of conducting electronic medication reconciliation on several outcomes including adverse drug events and medication discrepancies (domain: medication safety). Lastly, the fourth study, a retrospective study using national inpatient and outpatient Veteran Health Administration combined with clinical and Medicare Claims data, examined the effects of intensification of antihypertensive medications on older adults' likelihood for hospital re-admission and other important clinical outcomes (domain: medication safety). Collectively, this review succinctly highlights pertinent topics related to promoting safe use of medications and promotes awareness of optimizing older adults' medication regimens.
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Affiliation(s)
- Nagham J. Ailabouni
- Quality Use of Medicine and Pharmacy Research Centre, UniSA: Clinical & Health Sciences, University of South Australia, Adelaide, Australia
- Department of Pharmacy, University of Washington, Seattle, Washington
| | - Zachary A. Marcum
- Quality Use of Medicine and Pharmacy Research Centre, UniSA: Clinical & Health Sciences, University of South Australia, Adelaide, Australia
- Department of Pharmacy, University of Washington, Seattle, Washington
| | - Kenneth E. Schmader
- Department of Medicine (Geriatrics), School of Medicine, Duke University Medical Center, Durham, North Carolina
- Geriatric Research Education and Clinical Center, Durham Veterans Affairs Medical Center, Durham, North Carolina
| | - Shelly L. Gray
- Department of Pharmacy, University of Washington, Seattle, Washington
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Alves MKL, Oliveira NGN, Pegorari MS, Tavares DMDS, Rodrigues MCS, Bolina AF. Evidence of association between the use of drugs and community-dwelling older people frailty: a cross-sectional study. SAO PAULO MED J 2020; 138:465-474. [PMID: 33053050 PMCID: PMC9685580 DOI: 10.1590/1516-3180.2020.0205.r1.06082020] [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] [Received: 05/01/2020] [Accepted: 08/06/2020] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND The scientific literature has shown that an association between polypharmacy and frailty exists. However, few studies have also considered drug interactions and the use of potentially inappropriate medications. OBJECTIVE To evaluate the association between the use of drugs and frailty among community-dwelling older people. DESIGN AND SETTING Cross-sectional study carried out among 580 older people in Uberaba (MG). METHODS Data were collected at these older people's homes using instruments validated in Brazil. Descriptive, bivariate and binary logistic regression analyses were performed (P < 0.05). RESULTS Most of these individuals were classified as pre-frail (55.7%), while 13.1% were frail. It was found that 31.7% of them presented polypharmacy, 41.7% had drug interactions and 43.8% were using potentially inappropriate medications. In the initial model, polypharmacy (odds ratio, OR = 1.91; confidence interval, CI = 1.27-2.86) and use of potentially inappropriate medications (OR = 2.45; CI = 1.68-3.57) increased the chance that these older people would be pre-frail or frail. In the final adjusted model, use of potentially inappropriate drugs remained associated with the outcome (OR = 2.26; CI = 1.43-3.57). CONCLUSION Use of potentially inappropriate medications was the independent variable that explained the occurrence of frailty in a representative sample of community-dwelling older adults.
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Affiliation(s)
- Marcos Kaic Lopes Alves
- BSc. Pharmacist, Universidade de Brasília – Campus Darcy Ribeiro (UnB), Brasília (DF) Brazil.
| | | | - Maycon Sousa Pegorari
- PhD. Physiotherapist and Adjunct Professor, Physiotherapy Course, Universidade Federal do Amapá (UNIFAP), Macapá (AP), Brazil.
| | - Darlene Mara dos Santos Tavares
- PhD. Nurse and Associate Professor, Department of Nursing Education and Community Health Nursing Undergraduate Program, Universidade Federal do Triângulo Mineiro (UFTM), Uberaba (MG), Brazil.
| | - Maria Cristina Soares Rodrigues
- PhD. Nurse and Pharmacist, Associate Professor, Universidade de Brasília – Campus Darcy Ribeiro (UnB). Brasília (DF), Brazil.
| | - Alisson Fernandes Bolina
- PhD. Nurse and Adjunct Professor, Universidade de Brasília – Campus Darcy Ribeiro (UnB), Brasília (DF), Brazil.
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14
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Fournier A, Anrys P, Beuscart JB, Dalleur O, Henrard S, Foulon V, Spinewine A. Use and Deprescribing of Potentially Inappropriate Medications in Frail Nursing Home Residents. Drugs Aging 2020; 37:917-924. [PMID: 33047252 DOI: 10.1007/s40266-020-00805-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/27/2020] [Indexed: 01/19/2023]
Abstract
BACKGROUND The STOPPFrail criteria were developed to assist physicians in deprescribing medications among frail patients approaching end of life. We aimed to measure the prevalence of potentially inappropriate medications (PIMs) and to describe changes over time, using STOPPFrail, in frail nursing home residents (NHRs) with limited life expectancy included in a medication review trial. METHODS We conducted a post-hoc analysis of the COME-ON study, a cluster-controlled trial that evaluated the effect of a complex intervention on appropriateness of prescribing in Belgian nursing homes. We identified NHRs eligible for the application of STOPPFrail based on functional status, comorbidities, level of care and survival. PIM use was measured at baseline and at 8 months. Changes over time were compared in the control group (CG) and intervention group (IG). RESULTS At baseline, 308 NHRs met the STOPPFrail eligibility criteria, of whom 196 (64.1%) had one or more PIM. At 8 months, among the 218 NHRs who were alive, there was an absolute reduction in the prevalence of PIMs of 9.1% in the CG (p < 0.05) and 10.2% in the IG (p < 0.05). We found large reductions for some medications (e.g. proton pump inhibitors) but no reduction for others (e.g. calcium). The percentage of NHRs with one or more PIM discontinued without a new PIM initiated was higher in the IG than the CG but the difference was not significant (35.1% vs 23.6%, p = 0.127). CONCLUSION Among frail NHRs with poor survival prognosis, a significant and encouraging decrease in PIM prevalence over time was observed, probably facilitated by medication reviews. The overall prevalence of PIMs remained high, however.
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Affiliation(s)
- Anne Fournier
- Louvain Drug Research Institute, Clinical Pharmacy Research Group, Université Catholique de Louvain, Avenue Mounier 72/B1.72.02, 1200 Woluwe-Saint-Lambert, Brussels, Belgium.,Cliniques Universitaires Saint-Luc, Pharmacy Department, Université Catholique de Louvain, Brussels, Belgium
| | - Pauline Anrys
- Louvain Drug Research Institute, Clinical Pharmacy Research Group, Université Catholique de Louvain, Avenue Mounier 72/B1.72.02, 1200 Woluwe-Saint-Lambert, Brussels, Belgium
| | - Jean-Baptiste Beuscart
- Univ. Lille, CHU Lille, ULR 2694 - METRICS : Évaluation des technologies de santé et des pratiques médicales, 59000, Lille, France
| | - Olivia Dalleur
- Louvain Drug Research Institute, Clinical Pharmacy Research Group, Université Catholique de Louvain, Avenue Mounier 72/B1.72.02, 1200 Woluwe-Saint-Lambert, Brussels, Belgium.,Cliniques Universitaires Saint-Luc, Pharmacy Department, Université Catholique de Louvain, Brussels, Belgium
| | - Séverine Henrard
- Louvain Drug Research Institute, Clinical Pharmacy Research Group, Université Catholique de Louvain, Avenue Mounier 72/B1.72.02, 1200 Woluwe-Saint-Lambert, Brussels, Belgium.,Institute of Health and Society, Université Catholique de Louvain, Brussels, Belgium
| | - Veerle Foulon
- Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium
| | - Anne Spinewine
- Louvain Drug Research Institute, Clinical Pharmacy Research Group, Université Catholique de Louvain, Avenue Mounier 72/B1.72.02, 1200 Woluwe-Saint-Lambert, Brussels, Belgium. .,CHU UCL Namur, Pharmacy Department, Université Catholique de Louvain, Yvoir, Belgium.
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15
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Ferguson C, Thomson W, Smith M, Kerse N, Peri K, Gribben B. Medication taking in a national sample of dependent older people. Res Social Adm Pharm 2020; 16:299-307. [DOI: 10.1016/j.sapharm.2019.05.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Revised: 05/01/2019] [Accepted: 05/19/2019] [Indexed: 01/17/2023]
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16
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Gaubert-Dahan ML, Sebouai A, Tourid W, Fauvelle F, Aikpa R, Bonnet-Zamponi D. The impact of medication review with version 2 STOPP (Screening Tool of Older Person's Prescriptions) and START (Screening Tool to Alert doctors to Right Treatment) criteria in a French nursing home: a 3-month follow-up study. Ther Adv Drug Saf 2019; 10:2042098619855535. [PMID: 31217947 PMCID: PMC6558549 DOI: 10.1177/2042098619855535] [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: 10/16/2018] [Accepted: 05/13/2019] [Indexed: 11/28/2022] Open
Abstract
Background: Improving medication appropriateness is a priority of French national
campaigns in nursing homes. A pilot study was conducted to evaluate the
impact of a medication review in a French nursing home with a 3-month follow
up. Method: A medication review was conducted in 2015 using version 2 STOPP and START
criteria. The number and type of drugs meeting a STOPP that were
reintroduced and the number and type of drug meeting a START that were
stopped during follow up were measured. An expert committee adjudicated
whether 3-month hospitalizations and deaths were related to medication
review. The impact of medication review on the cost related to drug
consumption was calculated for 3 months. Results: The 52 residents (age 84 ± 9 years, 83% female) fulfilled, on average, 2 ±
1.4 of the STOPP criteria and 0.7 ± 0.6 of the START criteria. A total of
101 drugs were stopped and 34 drugs were started. Five deaths occurred
during follow up and were judged as not related to medication review. Five
drugs stopped were reintroduced in five residents for a rebound effect or a
symptom occurrence and one resident had stopped a START medication (aspirin)
for a minor adverse drug reaction. At 3 months, a gain of 20.21 ± 31.34
euros per resident was observed. Conclusion: The medication review using version 2 STOPP and START criteria and involving
the physician in charge seems useful for detecting and correcting
inappropriate prescribing in a nursing home.
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Affiliation(s)
- Marie-Line Gaubert-Dahan
- CMLS Les Ormes, Groupe Hospitalier Intercommunal Le Raincy-Montfermeil, 13 Place Jean Mermoz 93 370 Montfermeil, France
| | - Abdellatif Sebouai
- Groupe Hospitalier Intercommunal Le Raincy-Montfermeil, Pôle Gériatrie-SSR, Montfermeil, France
| | - Wafaa Tourid
- Groupe Hospitalier Intercommunal Le Raincy-Montfermeil, Service de Pharmacie, Montfermeil, France
| | - Francis Fauvelle
- Groupe Hospitalier Intercommunal Le Raincy-Montfermeil, Service de Pharmacie, Montfermeil, France
| | - Raoul Aikpa
- Groupe Hospitalier Intercommunal Le Raincy-Montfermeil, Pôle Gériatrie-SSR, Montfermeil, France
| | - Dominique Bonnet-Zamponi
- Observatoire du Médicament des Dispositifs Médicaux et de l'Innovation Thérapeutique, Paris, France
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Espaulella Panicot J, Sevilla-Sánchez D. [Usefulness of STOPP-Pal criteria: Linked value practices]. Rev Esp Geriatr Gerontol 2019; 54:125-126. [PMID: 30971343 DOI: 10.1016/j.regg.2019.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Accepted: 03/18/2019] [Indexed: 06/09/2023]
Affiliation(s)
- Joan Espaulella Panicot
- Unidad Territorial de Geriatría y Cuidados Paliativos, Consorci Hospitalari de Vic/Hospital Universitari de la Santa Creu de Vic, Vic, Barcelona, España; Grupo de Investigación en Cronicidad de la Cataluña Central (C3RG), Vic, Barcelona, España.
| | - Daniel Sevilla-Sánchez
- Grupo de Investigación en Cronicidad de la Cataluña Central (C3RG), Vic, Barcelona, España; Servicio de Farmacia Territorial, Consorci Hospitalari de Vic/Hospital Universitari de la Santa Creu de Vic, Vic, Barcelona, España
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