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Schousboe JT, Langsetmo L, Fink HA, Kado DM, Cauley JA, Taylor BC, Ensrud KE. Balancing fracture risk versus risk of mortality before fracture among women aged 80 years or older. J Am Geriatr Soc 2024; 72:1396-1407. [PMID: 38450585 PMCID: PMC11090747 DOI: 10.1111/jgs.18859] [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: 11/06/2023] [Revised: 02/02/2024] [Accepted: 02/11/2024] [Indexed: 03/08/2024]
Abstract
BACKGROUND Most fractures occur in women aged ≥80 years but competing mortality unrelated to fracture may limit the benefit of osteoporosis drug therapy for some women in late life. Our primary aim was to develop separate prediction models for non-spine fracture (NSF) and mortality before fracture to identify subsets of women with varying fracture versus mortality risks. METHODS Separate prediction models were developed for NSF and mortality before NSF for 4895 women aged ≥80 years enrolled in the Study of Osteoporotic Fractures (SOF) or the Health Aging and Body Composition (HABC) study. Proportional hazards models modified to account for competing mortality were used to identify candidate risk factors for each outcome. Predictors associated with NSF or mortality (p < 0.2) were included in separate competing risk models to estimate the cumulative incidence of NSF and mortality before NSF during 5 years of follow-up. This process was repeated to develop separate prediction models for hip fracture and mortality before hip fracture. RESULTS Significant predictors of NSF (race, total hip BMD, grip strength, prior fracture, falls, and use of selective serotonin reuptake inhibitors, benzodiazepines, or oral/transdermal estrogen) differed from predictors of mortality before NSF (age, walking speed, multimorbidity, weight change, shrinking, smoking, self-rated health, dementia, and use of warfarin). Within nine subsets of women defined by tertiles of risk, 5-year outcomes varied from 28% NSF and 8% mortality in the high-risk NSF/low-risk mortality subset, to 9% NSF and 22% mortality in the low-risk NSF/high-risk mortality subset. Similar results were seen for predictors of hip fracture and mortality before hip fracture. CONCLUSION Considerable variation in 5-year competing mortality risk is present among women in late life with similar 5-year NSF risk. Both fracture risk and life expectancy should inform shared clinical decision-making regarding initiation or continuation of osteoporosis drug therapy for women aged ≥80 years.
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Affiliation(s)
- John T. Schousboe
- Park Nicollet Clinic and HealthPartners Institute, HealthPartners Inc., Minneapolis, MN
- Division of Health Policy and Management, University of Minnesota, Minneapolis, MN
| | - Lisa Langsetmo
- Center for Care Delivery and Outcomes Research, VA Health Care System, Minneapolis, MN
- Department of Medicine, University of Minnesota, Minneapolis, MN
| | - Howard A. Fink
- Center for Care Delivery and Outcomes Research, VA Health Care System, Minneapolis, MN
- Department of Medicine, University of Minnesota, Minneapolis, MN
- Geriatric Research Education and Clinical Center, VA Health Care System, Minneapolis, MN
| | - Deborah M. Kado
- Department of Medicine, Stanford University, Stanford, CA
- Geriatric Research Education and Clinical Center, VA Health Care System, Palo Alto, CA
| | - Jane A. Cauley
- Department of Epidemiology, School of Public Health, University of Pittsburgh, Pittsburgh, PA
| | - Brent C. Taylor
- Center for Care Delivery and Outcomes Research, VA Health Care System, Minneapolis, MN
- Department of Medicine, University of Minnesota, Minneapolis, MN
- Division of Epidemiology & Community Health, School of Public Health, University of Minnesota, Minneapolis, MN
| | - Kristine E. Ensrud
- Center for Care Delivery and Outcomes Research, VA Health Care System, Minneapolis, MN
- Department of Medicine, University of Minnesota, Minneapolis, MN
- Division of Epidemiology & Community Health, School of Public Health, University of Minnesota, Minneapolis, MN
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Sergeant M, Ly O, Kandasamy S, Anand SS, de Souza RJ. Managing greenhouse gas emissions in the terminal year of life in an overwhelmed health system: a paradigm shift for people and our planet. Lancet Planet Health 2024; 8:e327-e333. [PMID: 38729672 DOI: 10.1016/s2542-5196(24)00048-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Revised: 02/14/2024] [Accepted: 03/22/2024] [Indexed: 05/12/2024]
Abstract
Health care contributes 4·4% of global net carbon emissions. Hospitals are resource-intensive settings, using a large amount of supplies in patient care and have high energy, ventilation, and heating needs. This Viewpoint investigates emissions related to health care in a patient's last year of life. End of life (EOL) is a period when health-care use and associated emissions production increases exponentially due primarily to hospital admissions, which are often at odds with patients' values and preferences. Potential solutions detailed within this Viewpoint are facilitating advanced care plans with patients to ensure their EOL wishes are clear, beginning palliative care interventions earlier when treating a life-limiting illness, deprescribing unnecessary medications because medications and their supply chains make up a significant portion of health-care emissions, and, enhancing access to low-intensity community care settings (eg, hospices) within the last year of life if home care is not available. Our analysis was done using Canadian data, but the findings can be applied to other high-income countries.
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Affiliation(s)
- Myles Sergeant
- Department of Family Medicine, Michael G DeGroote School of Medicine, Hamilton, ON, Canada
| | - Olivia Ly
- Department of Family Medicine, Michael G DeGroote School of Medicine, Hamilton, ON, Canada
| | - Sujane Kandasamy
- Department of Child and Youth Studies, Brock University, St Catherine's, ON, Canada
| | - Sonia S Anand
- Department of Medicine, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada; Department of Health Research Methods, Evidence, and Impact, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada; Population Health Research Institute, Hamilton Health Sciences, McMaster University, Hamilton, ON, Canada.
| | - Russell J de Souza
- Department of Health Research Methods, Evidence, and Impact, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada; Population Health Research Institute, Hamilton Health Sciences, McMaster University, Hamilton, ON, Canada
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de Andrade FK, Nunes RPI, Zanetti MOB, Zanetti ACB, Dos Santos M, de Oliveira AM, Carson-Stevens A, Pereira LRL, Varallo FR. Validated medication deprescribing instruments for patients with palliative care needs: a systematic review. FARMACIA HOSPITALARIA 2024; 48:83-89. [PMID: 37770284 DOI: 10.1016/j.farma.2023.08.004] [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: 01/19/2023] [Revised: 07/28/2023] [Accepted: 08/01/2023] [Indexed: 09/30/2023] Open
Abstract
OBJECTIVES Patients with life-limiting illnesses are prone to unnecessary polypharmacy. Deprescribing tools may contribute to minimizing negative outcomes. Thus, the aims of the study were to identify validated instruments for deprescribing inappropriate medications for patients with palliative care needs and to assess the impact on clinical, humanistic, and economic outcomes. METHODS A systematic review was conducted in LILACS, PUBMED, EMBASE, COCHRANE, and WEB OF SCIENCE databases (until May 2021). A manual search was performed in the references of enrolled articles. The screening, eligibility, extraction, and bias risk assessment were carried out by 2 independent researchers. Experimental and observational studies were eligible for inclusion. RESULTS Out of the 5791 studies retrieved, after excluding duplicates (n = 1050), conducting title/abstract screening (n = 4741), and full reading (n = 41), only 1 study met the inclusion criteria. In this included study, a randomized controlled trial was conducted, which showed a high level of bias risk overall. Adults 75 years or older (n = 130) with limited life expectancy and polypharmacy were allocated to 2 groups [intervention arm (deprescribing); and control arm (usual care)]. Deprescribing was performed with the aid of the STOPPFrail tool. The mean number of inappropriate medications and monthly medication costs were significantly lower in the intervention arm. No statistically significant differences were found in terms of unscheduled hospital presentations, falls, fractures, mortality, and quality of life. CONCLUSIONS Despite the availability of several instruments to support deprescribing in patients with palliative care needs, only 1 of them has undergone validation and robust assessment for effectiveness in clinical practice. The STOPPFrail tool appears to reduce the number of inappropriate medications for older people with limited life expectancy (and probably palliative care needs) and decrease the monthly costs of pharmacotherapy. Nevertheless, the impact on patient safety and humanistic outcomes remain unclear.
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Affiliation(s)
- Frangie Kallas de Andrade
- University of São Paulo (USP), School of Pharmaceutical Sciences of Ribeirão Preto, Ribeirão Preto, São Paulo, Brazil
| | - Raziel Prado Ignacio Nunes
- University of São Paulo (USP), School of Pharmaceutical Sciences of Ribeirão Preto, Ribeirão Preto, São Paulo, Brazil
| | | | | | - Márcia Dos Santos
- University of São Paulo (USP), Central Library, Ribeirão Preto, Brazil
| | - Alan Maicon de Oliveira
- University of São Paulo (USP), School of Pharmaceutical Sciences of Ribeirão Preto, Ribeirão Preto, São Paulo, Brazil.
| | - Andrew Carson-Stevens
- PRIME Centre Wales, Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, UK
| | - Leonardo Régis Leira Pereira
- University of São Paulo (USP), School of Pharmaceutical Sciences of Ribeirão Preto, Ribeirão Preto, São Paulo, Brazil
| | - Fabiana Rossi Varallo
- University of São Paulo (USP), School of Pharmaceutical Sciences of Ribeirão Preto, Ribeirão Preto, São Paulo, Brazil
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de Andrade FK, Ignacio Nunes RP, Barboza Zanetti MO, Barboza Zanetti AC, Dos Santos M, de Oliveira AM, Carson-Stevens A, Leira Pereira LR, Rossi Varallo F. Validated medication deprescribing instruments for patients with palliative care needs palliative care: A systematic review. FARMACIA HOSPITALARIA 2024; 48:T83-T89. [PMID: 38016841 DOI: 10.1016/j.farma.2023.08.010] [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: 01/19/2023] [Accepted: 08/01/2023] [Indexed: 11/30/2023] Open
Abstract
OBJECTIVES Patients with life-limiting illnesses are prone to unnecessary polypharmacy. Deprescribing tools may contribute to minimizing negative outcomes. Thus, the aims of the study were to identify validated instruments for deprescribing inappropriate medications for patients with palliative care needs and to assess the impact on clinical, humanistic, and economic outcomes. METHODS A systematic review was conducted in LILACS, PUBMED, EMBASE, COCHRANE, and WEB OF SCIENCE databases (until May 2021). A manual search was performed in the references of enrolled articles. The screening, eligibility, extraction, and bias risk assessment were carried out by two independent researchers. Experimental and observational studies were eligible for inclusion. RESULTS Out of the 5,791 studies retrieved, after excluding duplicates (n = 1,050), conducting title/abstract screening (n = 4,741), and full reading (n = 41), only one study met the inclusion criteria. In this included study, a randomized controlled trial was conducted, which showed a high level of bias risk overall. Adults 75 years or older (n = 130) with limited life expectancy and polypharmacy were allocated to two groups [intervention arm (deprescribing); and control arm (usual care)]. Deprescribing was performed with the aid of the STOPPFrail tool. The mean number of inappropriate medications and monthly medication costs were significantly lower in the intervention arm. No statistically significant differences were found in terms of unscheduled hospital presentations, falls, fractures, mortality, and quality of life. CONCLUSIONS Despite the availability of several instruments to support deprescribing in patients with palliative care needs, only one of them has undergone validation and robust assessment for effectiveness in clinical practice. The STOPPFrail tool appears to reduce the number of inappropriate medications for older people with limited life expectancy (and probably palliative care needs) and decrease the monthly costs of pharmacotherapy. Nevertheless, the impact on patient safety and humanistic outcomes remain unclear.
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Affiliation(s)
- Frangie Kallas de Andrade
- Facultad de Ciencias Farmacéuticas de Ribeirão Preto, Universidad de São Paulo (USP), São Paulo, Brasil
| | | | | | | | - Márcia Dos Santos
- Biblioteca Central, Universidad de São Paulo (USP), Ribeirão Preto, São Paulo, Brasil
| | - Alan Maicon de Oliveira
- Facultad de Ciencias Farmacéuticas de Ribeirão Preto, Universidad de São Paulo (USP), São Paulo, Brasil.
| | - Andrew Carson-Stevens
- Centro PRIME de Gales, División de Medicina de la Población, Facultad de Medicina, Universidad de Cardiff, Cardiff, Reino Unido
| | | | - Fabiana Rossi Varallo
- Facultad de Ciencias Farmacéuticas de Ribeirão Preto, Universidad de São Paulo (USP), São Paulo, Brasil
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Nguyen-Soenen J, Weir KR, Jungo KT, Perrot B, Fournier JP. Does missing data matter in the revised Patients' Attitudes Towards Deprescribing questionnaire? A systematic review and two case analyses. Res Social Adm Pharm 2024; 20:296-307. [PMID: 38168621 DOI: 10.1016/j.sapharm.2023.12.010] [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: 10/26/2023] [Revised: 12/10/2023] [Accepted: 12/22/2023] [Indexed: 01/05/2024]
Abstract
BACKGROUND The revised Patients' Attitudes Towards Deprescribing (rPATD) questionnaire was developed to capture beliefs and perceptions of patients about deprescribing. In general, handling of missing data is underreported in survey studies. Underlying mechanisms related to missing data may impact the findings from survey studies. OBJECTIVES The aim of this study was to assess the missing data in studies using the rPATD questionnaire through a systematic review and datasets from two studies. METHODS First, this review updated a systematic review on the rPATD (and other versions). We searched Medline via OVID, EMBASE, Scopus, Web of Science until 31st January 2023. Missing data reporting and methods to handle them were collected. Second, data from two deprescribing studies were analyzed using three methods of missing data handling: complete case analysis, personal mean substitution, and multiple imputation. We compared the scores from each domain and the associations of the domains with two questions from the rPATD to highlight how using different methods can influence the interpretation of study findings. RESULTS We identified 49 studies: 31 (63 %) from this study and 18 (37 %) from the original systematic review. The question or domain with the most missing data could be identified in 9 studies (18.4 %). Missing data management was reported in 19 studies (38.8 %). In one case analysis, the "Burden" domain was significantly associated with the question "I would like to try stopping one of my medicines to see how I feel without it" using complete case analysis (p = 0.044) or multiple imputation (p = 0.038), but not when using personal mean substitution (p = 0.057). CONCLUSIONS Missing data and methods used to handle missing data were underreported in studies using the rPATD questionnaire. The methods should be chosen carefully as our analyses from two distinct studies suggest that they may impact the interpretation of the findings from the questionnaire.
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Affiliation(s)
- Jérôme Nguyen-Soenen
- SPHERE - UMR INSERM 1246, Nantes Université, Université de Tours, France; Département de Médecine Générale, Faculté de Médecine, Nantes Université, France.
| | - Kristie Rebecca Weir
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland; Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Katharina Tabea Jungo
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland; Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA; Center for Healthcare Delivery Sciences (C4HDS), Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Bastien Perrot
- SPHERE - UMR INSERM 1246, Nantes Université, Université de Tours, France; Direction de la recherche, Plateforme de Méthodologie et Biostatistique, CHU Nantes, Nantes, France
| | - Jean-Pascal Fournier
- SPHERE - UMR INSERM 1246, Nantes Université, Université de Tours, France; Département de Médecine Générale, Faculté de Médecine, Nantes Université, France
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6
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Alwidyan T, McCorry NK, Black C, Coulter R, Forbes J, Parsons C. Prescribing and deprescribing in older people with life-limiting illnesses receiving hospice care at the end of life: A longitudinal, retrospective cohort study. Palliat Med 2024; 38:121-130. [PMID: 38032069 PMCID: PMC10798021 DOI: 10.1177/02692163231209024] [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: 12/01/2023]
Abstract
BACKGROUND Although prescribing and deprescribing practices in older people have been the subject of much research generally, there are limited data in older people at the end of life. This highlights the need for research to determine prescribing and deprescribing patterns, as a first step to facilitate guideline development for medicines optimisation in this vulnerable population. AIMS To examine prescribing and deprescribing patterns in older people at the end of life and to determine the prevalence of potentially inappropriate medication use. DESIGN A longitudinal, retrospective cohort study where medical records of eligible participants were reviewed, and data extracted. Medication appropriateness was assessed using two sets of consensus-based criteria; the STOPPFrail criteria and criteria developed by Morin et al. SETTING/PARTICIPANTS Decedents aged 65 years and older admitted continuously for at least 14 days before death to three inpatient hospice units across Northern Ireland, who died between 1st January and 31st December 2018, and who had a known diagnosis, known cause of death and prescription data. Unexpected/sudden deaths were excluded. RESULTS Polypharmacy was reported to be continued until death in 96.2% of 106 decedents (mean age of 75.6 years). Most patients received at least one potentially inappropriate medication at the end of life according to the STOPPFrail and the criteria developed by Morin et al. (57.5 and 69.8% respectively). Limited prevalence of proactive deprescribing interventions was observed. CONCLUSIONS In the absence of systematic rationalisation of drug treatments, a substantial proportion of older patients continued to receive potentially inappropriate medication until death.
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Affiliation(s)
- Tahani Alwidyan
- Department of Clinical Pharmacy and Pharmacy Practice, Faculty of Pharmaceutical Sciences, The Hashemite University, Zarqa, Jordan
| | - Noleen K McCorry
- School of Medicine, Dentistry and Biomedical Sciences, Queen’s University Belfast, Belfast, Northern Ireland, UK
| | | | | | - June Forbes
- Northern Ireland Hospice, Belfast, Northern Ireland, UK
| | - Carole Parsons
- School of Pharmacy, Queen’s University Belfast, Belfast, UK
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Thorpe C, Niznik J, Li A. Deprescribing research in nursing home residents using routinely collected healthcare data: a conceptual framework. BMC Geriatr 2023; 23:469. [PMID: 37542226 PMCID: PMC10401751 DOI: 10.1186/s12877-023-04194-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 07/24/2023] [Indexed: 08/06/2023] Open
Abstract
BACKGROUND Efforts are needed to strengthen evidence and guidance for appropriate deprescribing for older nursing home (NH) residents, who are disproportionately affected by polypharmacy and inappropriate prescribing. Given the challenges of conducting randomized drug withdrawal studies in this population, data from observational studies of routinely collected healthcare data can be used to identify patients who are apparent candidates for deprescribing and evaluate subsequent health outcomes. To improve the design and interpretation of observational studies examining determinants, risks, and benefits of deprescribing specific medications in older NH residents, we sought to propose a conceptual framework of the determinants of deprescribing in older NH residents. METHODS We conducted a scoping review of observational studies examining patterns and potential determinants of discontinuing or de-intensifying (i.e., reducing) medications for NH residents. We searched PubMed through September 2021 and included studies meeting the following criteria: conducted among adults aged 65 + in the NH setting; (2) observational study designs; (3) discontinuation or de-intensification as the primary outcome with key determinants as independent variables. We conceptualized deprescribing as a behavior through a social-ecological lens, potentially influenced by factors at the intrapersonal, interpersonal, organizational, community, and policy levels. RESULTS Our search in PubMed identified 250 potentially relevant studies published through September 2021. A total of 14 studies were identified for inclusion and were subsequently synthesized to identify and group determinants of deprescribing into domains spanning the five core social-ecological levels. Our resulting framework acknowledges that deprescribing is strongly influenced by intrapersonal, patient-level clinical factors that modify the expected benefits and risks of deprescribing, including index condition attributes (e.g., disease severity), attributes of the medication being considered for deprescribing, co-prescribed medications, and prognostic factors. It also incorporates the hierarchical influences of interpersonal differences relating to healthcare providers and family caregivers, NH facility and health system organizational structures, community trends and norms, and finally healthcare policies. CONCLUSIONS Our proposed framework will serve as a useful tool for future studies seeking to use routinely collected healthcare data sources and observational study designs to evaluate determinants, risks, and benefits of deprescribing for older NH residents.
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Affiliation(s)
- Carolyn Thorpe
- Center for Health Equity Research and Promotion, Veterans Affairs (VA) Pittsburgh Healthcare System, Pittsburgh, PA, USA
- Division of Pharmaceutical Outcomes and Policy, University of North Carolina at Chapel Hill, Eshelman School of Pharmacy, Chapel Hill, NC, USA
| | - Joshua Niznik
- Center for Health Equity Research and Promotion, Veterans Affairs (VA) Pittsburgh Healthcare System, Pittsburgh, PA, USA.
- Division of Pharmaceutical Outcomes and Policy, University of North Carolina at Chapel Hill, Eshelman School of Pharmacy, Chapel Hill, NC, USA.
- Division of Geriatric Medicine and Center for Aging and Health, University of North Carolina at Chapel Hill, School of Medicine, 5003 Old Clinic CB#7550, Chapel Hill, NC, 27599, USA.
| | - Anna Li
- Division of Pharmaceutical Outcomes and Policy, University of North Carolina at Chapel Hill, Eshelman School of Pharmacy, Chapel Hill, NC, USA
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Engell AE, Bathum L, Andersen JS, Thompson W, Lind BS, Jørgensen HL, Nexøe J. Factors associated with statin discontinuation near end of life in a Danish primary health care cohort. Fam Pract 2022; 40:300-307. [PMID: 35950318 DOI: 10.1093/fampra/cmac090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Long-term preventive treatment such as treatment with statins should be reassessed among patients approaching end of life. The aim of the study was to describe the rate of discontinuation of statin treatment and factors associated with discontinuation in the 6 months before death. METHODS This study is a retrospective cohort study using national registers and blood test results from primary health care patients. Patients in the Copenhagen municipality, Denmark who died between 1997 and 2018 and were statin users during the 10-year period before death were included. We calculated the proportion who remained statin users in the 6-month period before death. Factors associated with discontinuation were tested using logistic regression. RESULTS A total of 55,591 decedents were included. More patients continued treatment (64%, n = 35,693) than discontinued (36%, n = 19,898) the last 6 months of life. The 70 and 80 age groups had the lowest odds of discontinuing compared to the 90 (OR 1.59, 95% CI 0.93-2.72) and 100 (OR 3.11, 95% CI 2.79-3.47) age groups. Increasing comorbidity score (OR 0.89, 95% CI 0.87; 0.90 per 1-point increase) and use of statins for secondary prevention (OR 0.89, 95% CI 0.85; 0.93) reduced the likelihood of discontinuation as did a diagnosis of dementia, heart failure, or cancer. CONCLUSION A substantial portion of patients continued statin treatment near end of life. Efforts to promote rational statin use and discontinuation are required among patients with limited life expectancy, including establishing clear, practical recommendations about statin discontinuation, and initiatives to translate recommendations into clinical practice.
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Affiliation(s)
- Anna E Engell
- Department of Clinical Biochemistry, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark
| | - Lise Bathum
- Department of Clinical Biochemistry, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark
| | - John S Andersen
- Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Wade Thompson
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark.,Hospital Pharmacy of Funen, Odense University Hospital, Odense, Denmark.,Department of Anesthesiology, Pharmacology, and Therapeutics, University of British Columbia, Vancouver, BC, Canada
| | - Bent S Lind
- Department of Clinical Biochemistry, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark.,Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Henrik L Jørgensen
- Department of Clinical Biochemistry, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark
| | - Jørgen Nexøe
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark
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Roux B, Rakheja B, Sirois C, Niquille A, Pétein C, Ouellet N, Spinewine A, Sibille FX, Laroche ML. Attitudes and beliefs of older adults and caregivers towards deprescribing in French-speaking countries: a multicenter cross-sectional study. Eur J Clin Pharmacol 2022; 78:1633-1646. [PMID: 35896803 DOI: 10.1007/s00228-022-03368-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 07/21/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE Successful deprescribing requires understanding the attitudes of older adults and caregivers towards this process. This study aimed to capture these attitudes in four French-speaking countries and to investigate associated factors. METHODS A multicenter cross-sectional study was conducted by administrating the French version of the revised Patients' Attitudes Towards Deprescribing (rPATD) questionnaire in Belgium, Canada, France, and Switzerland. Community-dwelling or nursing home older adults ≥ 65 years taking ≥ 1 prescribed medications and caregivers of older adults with similar characteristics were included. Multivariate logistic regressions were carried out to examine factors associated with willingness to deprescribe. RESULTS A total of 367 older adults (79.3 ± 8.7 years, 63% community-dwelling, 54% ≥ 5 medications) and 255 unrelated caregivers (64.4 ± 12.6 years) of care recipients (83.4 ± 7.9 years, 52% community-dwelling, 69% ≥ 5 medications) answered the questionnaire. Among them, 87.5% older adults and 75.6% caregivers would be willing to stop medications if the physician said it was possible. Reluctance to stop a medication taken for a long time was expressed by 46% of both older adults and caregivers. A low score for the factor "concerns about stopping" (older adults: aOR: 0.21; 95% CI: 0.07-0.59), and a high score for the factor "involvement" (older adults: aOR: 2.66; 95% CI: 1.01-7.07; caregivers: aOR: 11.28; 95% CI: 1.48-85.91) were associated with willingness to deprescribe. CONCLUSIONS A significant proportion of older adults and caregivers of French-speaking countries are open to deprescribing. Despite this apparent willingness, deprescribing conversations in clinical practice remains marginal, emphasizing the importance of optimizing the integration of existing tools such as rPATD.
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Affiliation(s)
- Barbara Roux
- Centre of Pharmacovigilance and Pharmacoepidemiology, Department of Pharmacology-Toxicology and Centre of Pharmacovigilance, University Hospital of Limoges, Limoges, France
| | | | - Caroline Sirois
- Faculty of Pharmacy, Laval University, Quebec, Canada.,Centre of Excellence On Aging of Quebec, Quebec, Canada.,Centre de recherche sur les soins et les Services de premieres lignes de l'Université Laval, Quebec, Canada
| | - Anne Niquille
- Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland.,Community Pharmacy, Institute of Pharmaceutical Sciences of Western Switzerland, University of Geneva, Geneva, Switzerland
| | - Catherine Pétein
- Clinical Pharmacy Research Group, Louvain Drug Research Institute, UCLouvain, Brussels, Belgium
| | - Nicole Ouellet
- Department of Health, University of Quebec at Rimouski, Rimouski, Canada
| | - Anne Spinewine
- Clinical Pharmacy Research Group, Louvain Drug Research Institute, UCLouvain, Brussels, Belgium.,Pharmacy Department, CHU UCL Namur, Yvoir, Belgium
| | - François-Xavier Sibille
- Department of Geriatric Medicine, CHU UCL Namur, Yvoir, Belgium.,Institute of Health and Society, UCLouvain, Brussels, Belgium
| | - Marie-Laure Laroche
- Centre of Pharmacovigilance and Pharmacoepidemiology, Department of Pharmacology-Toxicology and Centre of Pharmacovigilance, University Hospital of Limoges, Limoges, France. .,Unité VIESANTE - UR 24134 (Vieillissement, Fragilité, Prévention, e-Santé), IFR OMEGA HEALTH, Université de Limoges, Limoges, France.
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10
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Weir KR, Ailabouni NJ, Schneider CR, Hilmer SN, Reeve E. Consumer Attitudes Towards Deprescribing: A Systematic Review and Meta-Analysis. J Gerontol A Biol Sci Med Sci 2022; 77:1020-1034. [PMID: 34390339 PMCID: PMC9071395 DOI: 10.1093/gerona/glab222] [Citation(s) in RCA: 44] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Harmful and/or unnecessary medication use in older adults is common. This indicates deprescribing (supervised withdrawal of inappropriate medicines) is not happening as often as it should. This study aimed to synthesize the results of the Patients' Attitudes Towards Deprescribing (PATD) questionnaire (and revised versions). METHODS Databases were searched from January 2013 to March 2020. Google Scholar was used for citation searching of the development and validation manuscripts to identify original research using the validated PATD, revised PATD (older adult and caregiver versions), and the version for people with cognitive impairment (rPATDcog). Two authors extracted data independently. A meta-analysis of proportions (random-effects model) was conducted with subgroup meta-analyses for setting and population. The primary outcome was the question: "If my doctor said it was possible, I would be willing to stop one or more of my medicines." Secondary outcomes were associations between participant characteristics and primary outcome and other (r)PATD results. RESULTS We included 46 articles describing 40 studies (n = 10,816 participants). The meta-analysis found the proportion of participants who agreed or strongly agreed with this statement was 84% (95% CI 81%-88%) and 80% (95% CI 74%-86%) in patients and caregivers, respectively, with significant heterogeneity (I2 = 95% and 77%). CONCLUSION Consumers reported willingness to have a medication deprescribed although results should be interpreted with caution due to heterogeneity. The findings from this study moves toward understanding attitudes toward deprescribing, which could increase the discussion and uptake of deprescribing recommendations in clinical practice.
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Affiliation(s)
- Kristie Rebecca Weir
- University of South Australia, UniSA: Clinical and Health Sciences, Quality Use of Medicines and Pharmacy Research Centre (QUMPRC), Adelaide, SA, Australia
- University of Sydney, Sydney School of Public Health, Faculty of Medicine and Health, Sydney, NSW, Australia
| | - Nagham J Ailabouni
- University of South Australia, UniSA: Clinical and Health Sciences, Quality Use of Medicines and Pharmacy Research Centre (QUMPRC), Adelaide, SA, Australia
| | - Carl R Schneider
- University of Sydney, School of Pharmacy, Faculty of Medicine and Health, Sydney, NSW, Australia
| | - Sarah N Hilmer
- University of Sydney, Kolling Institute of Medical Research, Royal North Shore Hospital, Sydney, NSW, Australia
- Department of Clinical Pharmacology, Royal North Shore Hospital, St Leonards, NSW, Australia
- Department of Aged Care, Royal North Shore Hospital, St Leonards, NSW, Australia
- University of Sydney, Northern Clinical School, Faculty of Medicine and Health, Sydney, NSW, Australia
| | - Emily Reeve
- University of South Australia, UniSA: Clinical and Health Sciences, Quality Use of Medicines and Pharmacy Research Centre (QUMPRC), Adelaide, SA, Australia
- Dalhousie University and Nova Scotia Health Authority, Geriatric Medicine Research, Faculty of Medicine, and College of Pharmacy, Halifax, Canada
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11
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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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12
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Tjia J, Lund JL, Mack DS, Mbrah A, Yuan Y, Chen Q, Osundolire S, McDermott CL. Methodological Challenges for Epidemiologic Studies of Deprescribing at the End of Life. CURR EPIDEMIOL REP 2021; 8:116-129. [PMID: 34722115 PMCID: PMC8553236 DOI: 10.1007/s40471-021-00264-7] [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] [Indexed: 12/01/2022]
Abstract
Purpose of Review To describe approaches to measuring deprescribing and associated outcomes in studies of patients approaching end of life (EOL). Recent Findings We reviewed studies published through 2020 that evaluated deprescribing in patients with limited life expectancy and approaching EOL. Deprescribing includes reducing the number of medications, decreasing medication dose(s), and eliminating potentially inappropriate medications. Tools such as STOPPFrail, OncPal, and the Unnecessary Drug Use Measure can facilitate deprescribing. Outcome measures vary and selection of measures should align with the operationalized deprescribing definition used by study investigators. Summary EOL deprescribing considerations include medication appropriateness in the context of patient goals for care, expected benefit from medication given life expectancy, and heightened potential for medication-related harm as death nears. Additional data are needed on how EOL deprescribing impacts patient quality of life, caregiver burden, and out-of-pocket medication-related costs to patients and caregivers. Investigators should design deprescribing studies with this information in mind.
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Affiliation(s)
- Jennifer Tjia
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, 368 Plantation Street, AS6-2065, Worcester, MA 01605, USA
| | - Jennifer L Lund
- Department of Epidemiology, UNC Gillings School of Global Public Health, UNC Chapel Hill, Chapel Hill, NC, USA
| | - Deborah S Mack
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, 368 Plantation Street, AS6-2065, Worcester, MA 01605, USA
| | - Attah Mbrah
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, 368 Plantation Street, AS6-2065, Worcester, MA 01605, USA
| | - Yiyang Yuan
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, 368 Plantation Street, AS6-2065, Worcester, MA 01605, USA
| | - Qiaoxi Chen
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, 368 Plantation Street, AS6-2065, Worcester, MA 01605, USA
| | - Seun Osundolire
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, 368 Plantation Street, AS6-2065, Worcester, MA 01605, USA
| | - Cara L McDermott
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Washington, Seattle, WA, USA
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13
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Weir KR, Ailabouni NJ, Schneider CR, Hilmer SN, Reeve E. Considerations for systematic reviews of quantitative surveys: Learnings from a systematic review of the patients' Attitudes Towards Deprescribing questionnaire. Res Social Adm Pharm 2021; 18:2345-2349. [PMID: 34340909 DOI: 10.1016/j.sapharm.2021.07.024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 07/17/2021] [Accepted: 07/29/2021] [Indexed: 12/31/2022]
Abstract
This commentary looks at the process of conducting a systematic review of surveys and validated questionnaires. Surveys and other questionnaire style tools are often used in the field of social and administrative pharmacy, to capture beliefs, attitudes and experiences of patients and healthcare professionals (including pharmacists). Currently, there is little guidance available on how to conduct a systematic review of these types of studies. Considerations related to the process of a systematic review are highlighted, including identification of articles, data extraction, assessing quality of articles and synthesis and analysis of data.
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Affiliation(s)
- Kristie Rebecca Weir
- University of South Australia, UniSA: Clinical and Health Sciences, Quality Use of Medicines and Pharmacy Research Centre (QUMPRC), Adelaide, SA, Australia; University of Sydney, Sydney School of Public Health, Faculty of Medicine and Health, Sydney, NSW, Australia.
| | - Nagham J Ailabouni
- University of South Australia, UniSA: Clinical and Health Sciences, Quality Use of Medicines and Pharmacy Research Centre (QUMPRC), Adelaide, SA, Australia
| | - Carl R Schneider
- University of Sydney, School of Pharmacy, Faculty of Medicine and Health, Sydney, NSW, Australia
| | - Sarah N Hilmer
- University of Sydney, Kolling Institute of Medical Research, Royal North Shore Hospital, Sydney, NSW, Australia; Departments of Clinical Pharmacology and Aged Care, Royal North Shore Hospital, St Leonards, NSW, Australia; University of Sydney, Northern Clinical School, Faculty of Medicine and Health, Sydney, NSW, Australia
| | - Emily Reeve
- University of South Australia, UniSA: Clinical and Health Sciences, Quality Use of Medicines and Pharmacy Research Centre (QUMPRC), Adelaide, SA, Australia; Dalhousie University and Nova Scotia Health Authority, Geriatric Medicine Research, Faculty of Medicine, and College of Pharmacy, Halifax, Australia
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14
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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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15
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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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16
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Hattori Y, Abe T, Kojima T, Hamada S, Ogawa S, Ura N, Akishita M. Potential prescribing omissions may have no influence on cause of death in care‐dependent older adults with percutaneous endoscopic gastrostomy tube. Geriatr Gerontol Int 2020; 20:961-966. [DOI: 10.1111/ggi.14009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 07/02/2020] [Accepted: 07/20/2020] [Indexed: 01/21/2023]
Affiliation(s)
- Yukari Hattori
- Department of Geriatric Medicine, Graduate School of Medicine The University of Tokyo Bunkyo‐ku Japan
| | | | - Taro Kojima
- Department of Geriatric Medicine, Graduate School of Medicine The University of Tokyo Bunkyo‐ku Japan
| | - Shota Hamada
- Research Department, Institute for Health and Policy Association for Health Economics Research and Social Insurance and Welfare Tokyo Japan
- Department of Home Care Medicine, Graduate School of Medicine The University of Tokyo Bunkyo‐ku Japan
| | - Sumito Ogawa
- Department of Geriatric Medicine, Graduate School of Medicine The University of Tokyo Bunkyo‐ku Japan
| | | | - Masahiro Akishita
- Department of Geriatric Medicine, Graduate School of Medicine The University of Tokyo Bunkyo‐ku Japan
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