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Arany S, Cavalcanti L, Phildor D, Watson GE, Kopycka-Kedzierawski DT, Eliav E, Medina-Walpole A, Caprio T. Implementation of a 4Ms approach in age-friendly oral health care at an Academic Specialty Care Dental Clinic. J Am Geriatr Soc 2024. [PMID: 38661080 DOI: 10.1111/jgs.18925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Revised: 03/17/2024] [Accepted: 03/24/2024] [Indexed: 04/26/2024]
Abstract
BACKGROUND Implementing the Age-Friendly Health System (AFHS) framework into dental care provides a significant opportunity to link oral health to healthy aging. This project aimed to implement the AFHS 4Ms (what matters, medications, mentation, and mobility) in the provision of oral health care. This article describes the planning, integration, training development, and outcome measurements supporting a 4Ms approach at an academic dental clinic. METHODS The Eastman Institute for Oral Health (EIOH) implemented screening instruments based on the 4Ms framework recommended for ambulatory care clinics by the Institute for Health Care Improvement (IHI). These ambulatory instruments were integrated into the workflows of a Specialty Care Clinic through the development of a plan-do-study-act cycle, utilization of available clinic resources, and creation of interdisciplinary collaborations. RESULTS This project demonstrated the feasibility of implementing an AFHS checklist and tracking forms in dental practice by integrating available resources and prioritizing the 4Ms elements. This effort necessitated interdisciplinary collaborations between dental, medical, and social service professionals. It also created a new age-friendly focused education and training curriculum for dental residents and faculty. CONCLUSIONS This pilot project is the first to establish dental standards for AFHS implementation, adapting the 4Ms assessment and metrics to oral health. This AFHS underscores key oral health processes, including assessment, planning, and personalized oral health care, adapted to the unique needs of the older adult population, especially those with cognitive impairment.
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Affiliation(s)
- Szilvia Arany
- Eastman Institute for Oral Health, University of Rochester Medical Center, Rochester, New York, USA
| | - Lia Cavalcanti
- Eastman Institute for Oral Health, University of Rochester Medical Center, Rochester, New York, USA
| | - Doris Phildor
- Alzheimer's Association Rochester New York Chapter, Rochester, New York, USA
| | - Gene E Watson
- Eastman Institute for Oral Health, University of Rochester Medical Center, Rochester, New York, USA
- Department of Environmental Medicine, University of Rochester Medical Center, Rochester, New York, USA
- Department of Pharmacology and Physiology, University of Rochester, Rochester, New York, USA
| | - Dorota T Kopycka-Kedzierawski
- Eastman Institute for Oral Health, University of Rochester Medical Center, Rochester, New York, USA
- Department of Dentistry, University of Rochester Medical Center, Rochester, New York, USA
| | - Eli Eliav
- Eastman Institute for Oral Health, University of Rochester Medical Center, Rochester, New York, USA
- Department of Dentistry, University of Rochester Medical Center, Rochester, New York, USA
| | - Annette Medina-Walpole
- Medicine-Division of Geriatrics & Aging, University of Rochester Medical Center, Rochester, New York, USA
- School of Medicine and Dentistry, University of Rochester, Rochester, New York, USA
| | - Thomas Caprio
- Medicine-Division of Geriatrics & Aging, University of Rochester Medical Center, Rochester, New York, USA
- School of Medicine and Dentistry, University of Rochester, Rochester, New York, USA
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Lee GB, Etherton-Beer C, Hosking SM, Pasco JA, Page AT. The patterns and implications of potentially suboptimal medicine regimens among older adults: a narrative review. Ther Adv Drug Saf 2022; 13:20420986221100117. [PMID: 35814333 PMCID: PMC9260603 DOI: 10.1177/20420986221100117] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Accepted: 04/26/2022] [Indexed: 11/15/2022] Open
Abstract
In the context of an ageing population, the burden of disease and medicine use is
also expected to increase. As such, medicine safety and preventing avoidable
medicine-related harm are major public health concerns, requiring further
research. Potentially suboptimal medicine regimens is an umbrella term that
captures a range of indicators that may increase the risk of medicine-related
harm, including polypharmacy, underprescribing and high-risk prescribing, such
as prescribing potentially inappropriate medicines. This narrative review aims
to provide a background and broad overview of the patterns and implications of
potentially suboptimal medicine regimens among older adults. Original research
published between 1990 and 2021 was searched for in MEDLINE, using key search
terms including polypharmacy, inappropriate prescribing, potentially
inappropriate medication lists, medication errors, drug interactions and drug
prescriptions, along with manual checking of reference lists. The review
summarizes the prevalence, risk factors and clinical outcomes of polypharmacy,
underprescribing and potentially inappropriate medicines. A synthesis of the
evidence regarding the longitudinal patterns of polypharmacy is also provided.
With an overview of the existing literature, we highlight a number of key gaps
in the literature. Directions for future research may include a longitudinal
investigation into the risk factors and outcomes of extended polypharmacy,
research focusing on the patterns and implications of underprescribing and
studies that evaluate the applicability of tools measuring potentially
inappropriate medicines to study settings.
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Affiliation(s)
- Georgie B Lee
- Epi-Centre for Healthy Ageing, Institute for Mental and Physical Health and Clinical Translation (IMPACT), School of Medicine, Deakin University, HERB-Building Level 3, C/- University Hospital Geelong, 285 Ryrie Street, P.O. Box 281, Geelong, VIC 3220, Australia
| | | | - Sarah M Hosking
- Institute for Mental and Physical Health and Clinical Translation (IMPACT), School of Medicine, Deakin University, Geelong, VIC, Australia
| | - Julie A Pasco
- Institute for Mental and Physical Health and Clinical Translation (IMPACT), School of Medicine, Deakin University, Geelong, VIC, Australia
| | - Amy T Page
- WA Centre for Health and Ageing, The University of Western Australia, Crawley, WA, Australia
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Suarez-Durall P, Osborne MS, Chan C, Enciso R, Mulligan R. Opioids and older adults: Increasing trends in opioid usage in a dental population compared to a National Database (NHANES). SPECIAL CARE IN DENTISTRY 2022; 42:445-455. [PMID: 35279860 PMCID: PMC9543923 DOI: 10.1111/scd.12709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 12/17/2021] [Accepted: 02/19/2022] [Indexed: 11/26/2022]
Abstract
Aim To examine self‐reported opioid prevalence at a dental school clinic for patients ≥65 years old as compared to national data, comparing gender, ethnicity/race and older adult age groupings. Methods and results Self‐reported prescription opioid medication use was extracted from the medical record for dental patients ≥65 years old who visited the school's general dental clinic (GDC) in 2012 or 2017. This data was compared to the National Health and Nutrition Examination Survey (NHANES) data for 2011–2012 and 2017–18. There was a significant increase in prevalence of opioid use in adults ≥65 between 2012 (4.5%) and 2017 (6.5%) and for ages 65–79 (from 4.7% to 6.3%) and ≥80 (3.4% to 7.9%), women (4.8% to 7.0%), and African Americans (4.7% to 8.4%) in the GDC. Older adults at the GDC reported less opioid use than the NHANES national average for both periods no matter the gender or the age with variable results for race/ethnicity. Conclusion The prevalence of older adults taking opioids in our general dental school clinic population increased significantly in 2017 as compared to 2012 but was lower than the national average for the respective periods. Awareness of existing opioid usage in older adult patients and its higher adverse risk potential is critical when prescribing analgesics for dental pain for this age group.
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Affiliation(s)
- Piedad Suarez-Durall
- Department of Geriatrics, Special Needs and Behavioral Sciences, Herman Ostrow School of Dentistry, University of Southern California, Los Angeles, CA, USA.,Leonard Davis School of Gerontology of University of Southern California, Los Angeles, CA, USA
| | - Maile S Osborne
- Department of Geriatrics, Special Needs and Behavioral Sciences, Herman Ostrow School of Dentistry, University of Southern California, Los Angeles, CA, USA
| | - Chan Chan
- Dental Public Health & Community Outreach, Herman Ostrow School of Dentistry of University of Southern California, Los Angeles, CA, USA
| | - Reyes Enciso
- Department of Geriatrics, Special Needs and Behavioral Sciences, Herman Ostrow School of Dentistry, University of Southern California, Los Angeles, CA, USA
| | - Roseann Mulligan
- Leonard Davis School of Gerontology of University of Southern California, Los Angeles, CA, USA.,Dental Public Health & Community Outreach, Herman Ostrow School of Dentistry of University of Southern California, Los Angeles, CA, USA
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Martins UCDM, Ramalho-de-Oliveira D, Nascimento MMGD, Nascimento YA, Oliveira GCBD, Cid AS, Lima MG. Potentially inappropriate medication use in a comprehensive therapy management service: clinical outcomes and interventions. BRAZ J PHARM SCI 2022. [DOI: 10.1590/s2175-97902022e19191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Nair S, Sundar S, Cheeti S, Bajpai A, Deepika S, Thunga G, Rashid M, Acharya RV. Prevalence And Predictors Of Potentially Inappropriate Medication Use Among Elderly Patients Using Updated Beers Criteria 2019: A Single Centered Retrospective Analysis. Curr Drug Saf 2021; 17:24-33. [PMID: 33902417 DOI: 10.2174/1574886316666210423113916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2020] [Revised: 12/11/2020] [Accepted: 12/30/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND Inappropriate medication use poses a sizable health safety hazard in the elderly owing to aging-associated physiological and anatomic changes. Inappropriate drug prescribing and polypharmacy in this population elevates the risk of adverse drug reactions (ADR). To assess the prevalence and predictors of Potentially Inappropriate Medication (PIM) use in elderly patients according to updated Beers Criteria 2019. METHOD Medical Records of 402 patients aged ≥65 years admitted a tertiary care hospital from June 2018 to May 2019 were analyzed. The patients who experienced at least one PIM based on the 2019 Updated Beers Criteria were considered as cases and others as control. Data were presented as descriptive statistics and logistic regression was performed to assess the factors affecting the outcomes. RESULT The mean age was found to be 73.7 ±6.4 years in the test and 70.5±5.5 years in the control group. The prevalence of PIMs to be used with caution was found to be 54%. Whereas the prevalence of PIMs to be avoided and to be used with reduced dose was found to be 45% and 1% respectively. The most prescribed PIMs were aspirin, diuretics, long-acting sulfonylureas, and proton pump inhibitors (PPIs). Increasing age, polypharmacy, and the number of drugs in medication history were significantly (P<0.05) correlated with a substantial risk of PIM use. The risk of developing serious and moderate drug-drug interactions (DDIs) was significantly high in the test group (P<0.05) when compared to the control group. CONCLUSION A high prevalence of PIMs was observed in this study. Age, polypharmacy and ≥3 drugs in medication history were identified as risk factors for PIM use and were at a higher risk of developing DDIs. Continuous medication review by clinical pharmacists can aid in reducing the occurrence of PIMs amongst geriatrics.
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Affiliation(s)
- Sreedharan Nair
- Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education, Pharmacy Practice, India
| | - Syam Sundar
- Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education, Pharmacy Practice, India
| | - Srilakshmi Cheeti
- Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education, Pharmacy Practice, India
| | - Aditi Bajpai
- Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education, Pharmacy Practice, India
| | - S Deepika
- Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education, Pharmacy Practice, India
| | - Girish Thunga
- Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education, Pharmacy Practice, India
| | - Muhammed Rashid
- Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education, Pharmacy Practice, India
| | - Raviraja V Acharya
- Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education, Pharmacy Practice, India
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Hajj A, Azzo C, Hallit S, Salameh P, Sacre H, Abdou F, Naaman N, Khabbaz LR. Assessment of drug-prescribing perception and practice among dental care providers: a cross-sectional Lebanese study. Pharm Pract (Granada) 2021; 19:2234. [PMID: 33777263 PMCID: PMC7979316 DOI: 10.18549/pharmpract.2021.1.2234] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Accepted: 02/28/2021] [Indexed: 12/04/2022] Open
Abstract
Background: Dentists play an essential role in providing high-quality dental care, taking
into consideration the clinical context and concomitant medications taken by
the patients. Objective: This study aimed to assess drug-prescribing perception and practices in
addition to drug-related educational needs among Lebanese dentists; it also
evaluated the need for interprofessional collaboration between dentists and
pharmacists. Methods: An exploratory cross-sectional study using an online questionnaire targeted a
sample of dentists from all Lebanese districts. Participants gave their
consent by accepting to complete the survey (ethics approval reference:
USJ-2016-63). The questionnaire consisted of closed-ended questions
exploring: 1) drug-prescribing perception, 2) drug-prescribing practice, and
3) collaboration with pharmacists regarding their respective roles in
providing appropriate counseling to patients. Two indexes were created: the
first evaluated self-confidence in prescribing medications, and the second
assessed dentists’ confidence in pharmacists. Logistic regressions
were performed, taking each index as a dependent variable. Results A total of 137 dentists completed the survey (59% females; mean age:
42.17; SD: 13.78 years). The majority had a fair to good perceived knowledge
in pharmacology and therapeutics (80.3%), only 30.7% reported
to be sufficiently equipped to prescribe safely. Dentists exhibited
particularly low perceived knowledge about prescribing in elderly patients,
dosing, medication use in pregnancy, drug interactions, and adverse
reactions. Dentists specialized in periodontics had the lowest odds of
having self-confidence in prescribing drugs (aOR=0.25; p<0.001).
Also, 64.3% declared that they routinely check a reference source
before prescribing, and 78% relied on pharmaceutical companies and
medical representatives to get information on medications. While 61%
declared that pharmacists should provide oral care counseling, only half of
them encouraged their patients to talk to their pharmacists about their
medications. Only 15% considered that patients are getting enough
counseling from the pharmacist, with a global confidence index below the
median value, suggesting the need for more collaboration, especially with
periodontists who exhibited the lowest confidence in pharmacists
(aOR=0.45). Conclusions Lebanese dentists reported some lack of knowledge and confidence in
prescribing practices. Education, training, and close collaboration between
pharmacists and dentists are essential to overcome these problems and avoid
potential harm to patients.
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Affiliation(s)
- Aline Hajj
- PharmD, PhD. Laboratory of Pharmacology, Clinical Pharmacy and Drug Quality Control, Faculty of Pharmacy, Saint-Joseph University . Beirut ( Lebanon ).
| | - Christel Azzo
- PharmD. Laboratory of Pharmacology, Clinical Pharmacy and Drug Quality Control, Faculty of Pharmacy, Saint-Joseph University . Beirut ( Lebanon ).
| | - Souheil Hallit
- PharmD, PhD. Faculty of Medicine and Medical Sciences, Holy Spirit University of Kaslik (USEK) . Jounieh ( Lebanon ).
| | - Pascale Salameh
- PharmD, PhD. School of Medicine, University of Nicosia . Nicosia ( Cyprus ).
| | - Hala Sacre
- PharmD. National Institute of Public Health, Clinical Epidemiology, and Toxicology-Lebanon (INSPECT-LB) . Beirut ( Lebanon ).
| | - Frederic Abdou
- PharmD. Laboratory of Pharmacology, Clinical Pharmacy and Drug Quality Control, Faculty of Pharmacy, Saint-Joseph University . Beirut ( Lebanon ).
| | - Nada Naaman
- DDS, PhD. Faculty of Dental medicine, Saint-Joseph University . Beirut ( Lebanon ).
| | - Lydia R Khabbaz
- PharmD, PhD. Laboratory of Pharmacology, Clinical Pharmacy and Drug Quality Control, Faculty of Pharmacy, Saint-Joseph University . Beirut ( Lebanon ).
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Corrêa CDTSDO, Sousa P, Reis CT. Patient safety in dental care: an integrative review. CAD SAUDE PUBLICA 2020; 36:e00197819. [PMID: 33084835 DOI: 10.1590/0102-311x00197819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Accepted: 06/29/2020] [Indexed: 11/22/2022] Open
Abstract
Adverse events pose a serious problem for quality of healthcare. Dental practice is eminently invasive and involves close and routine contact with secretions; as such, it is potentially prone to the occurrence of adverse events. Various patient safety studies have been developed in the last two decades, but mostly in the hospital setting due to the organizational complexity, severity of the cases, and diversity and specificity of the procedures. The objective was to identify and explore studies on patient safety in Dentistry. An integrative literature review was performed in MEDLINE via PubMed, Scopus via Portal Capes, and the Regional Portal of the Virtual Health Library, using the terms patient safety and dentistry in English, Spanish, and Portuguese, starting in 2000. The research cycle in patient safety was used, as proposed by the World Health Organization to classify studies. We analyzed 91 articles. The most common adverse events were allergies, infections, diagnostic delay or failure, and technical error. Measures to mitigate the problem highlight the need to improve communications, encourage reporting, and search for tools to assist the management of care. The authors found a lack of studies on implementation and assessment of the impact of proposals for improvement. Dentistry has made progress in patient safety but still needs to transpose the results into practice, where efforts are crucial to prevent adverse events.
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Affiliation(s)
| | - Paulo Sousa
- Escola Nacional de Saúde Pública, Universidade NOVA de Lisboa, Lisboa, Portugal.,Comprehensive Health Research Centre, Universidade NOVA de Lisboa, Lisboa, Portugal
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Li G, Andrews HF, Chihuri S, Lang BH, Leu CS, Merle DP, Gordon A, Mielenz TJ, Strogatz D, Eby DW, Betz ME, DiGuiseppi C, Jones VC, Molnar LJ, Hill LL. Prevalence of Potentially Inappropriate Medication use in older drivers. BMC Geriatr 2019; 19:260. [PMID: 31601189 PMCID: PMC6785868 DOI: 10.1186/s12877-019-1287-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Accepted: 09/20/2019] [Indexed: 01/03/2023] Open
Abstract
Background Potentially Inappropriate Medication (PIM) use has been studied in a variety of older adult populations across the world. We sought to examine the prevalence and correlates of PIM use in older drivers. Methods We applied the American Geriatrics Society 2015 Beers Criteria to baseline data collected from the “brown-bag” review of medications for participants of the Longitudinal Research on Aging Drivers (LongROAD) study to examine the prevalence and correlates of PIM use in a geographically diverse, community-dwelling sample of older drivers (n = 2949). Proportions of participants who used one or more PIMs according to the American Geriatrics Society 2015 Beers Criteria, and estimated odds ratios (ORs) and 95% confidence intervals (CIs) of PIM use associated with participant characteristics were calculated. Results Overall, 18.5% of the older drivers studied used one or more PIM. The most commonly used therapeutic category of PIM was benzodiazepines (accounting for 16.6% of the total PIMs identified), followed by nonbenzodiazepine hypnotics (15.2%), antidepressants (15.2%), and first-generation antihistamines (10.5%). Compared to older drivers on four or fewer medications, the adjusted ORs of PIM use were 2.43 (95% CI 1.68–3.51) for those on 5–7 medications, 4.19 (95% CI 2.95–5.93) for those on 8–11 medications, and 8.01 (95% CI 5.71–11.23) for those on ≥12 medications. Older drivers who were female, white, or living in urban areas were at significantly heightened risk of PIM use. Conclusion About one in five older drivers uses PIMs. Commonly used PIMs are medications known to impair driving ability and increase crash risk. Implementation of evidence-based interventions to reduce PIM use in older drivers may confer both health and safety benefits. Trial registration Not applicable.
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Affiliation(s)
- Guohua Li
- Department of Anesthesiology, Columbia University College of Physicians and Surgeons, New York, NY, USA. .,Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA. .,Center for Injury Epidemiology and Prevention, Columbia University Irving Medical Center, 622 West 168th St, PH5-505, New York, NY, 10032, USA.
| | - Howard F Andrews
- Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York, NY, USA.,Department of Biostatistics, Columbia University Mailman School of Public Health, New York, NY, USA
| | - Stanford Chihuri
- Department of Anesthesiology, Columbia University College of Physicians and Surgeons, New York, NY, USA.,Center for Injury Epidemiology and Prevention, Columbia University Irving Medical Center, 622 West 168th St, PH5-505, New York, NY, 10032, USA
| | - Barbara H Lang
- Department of Anesthesiology, Columbia University College of Physicians and Surgeons, New York, NY, USA.,Center for Injury Epidemiology and Prevention, Columbia University Irving Medical Center, 622 West 168th St, PH5-505, New York, NY, 10032, USA
| | - Cheng Shiun Leu
- Department of Biostatistics, Columbia University Mailman School of Public Health, New York, NY, USA
| | - David P Merle
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA
| | - Abigail Gordon
- Department of Anesthesiology, Columbia University College of Physicians and Surgeons, New York, NY, USA
| | - Thelma J Mielenz
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA.,Center for Injury Epidemiology and Prevention, Columbia University Irving Medical Center, 622 West 168th St, PH5-505, New York, NY, 10032, USA
| | | | - David W Eby
- University of Michigan Transportation Research Institute, Ann Arbor, MI, USA.,The Center for Advancing Transportation Leadership and Safety (ATLAS Center), Ann Arbor, MI, USA
| | - Marian E Betz
- Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, CO, USA
| | - Carolyn DiGuiseppi
- Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Vanya C Jones
- Department of Health, Behavior, and Society, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Lisa J Molnar
- University of Michigan Transportation Research Institute, Ann Arbor, MI, USA.,The Center for Advancing Transportation Leadership and Safety (ATLAS Center), Ann Arbor, MI, USA
| | - Linda L Hill
- Department of Family and Preventive Medicine, University of California San Diego, La Jolla, CA, USA
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Blanco-Reina E, Valdellós J, Aguilar-Cano L, García-Merino MR, Ocaña-Riola R, Ariza-Zafra G, Bellido-Estévez I. 2015 Beers Criteria and STOPP v2 for detecting potentially inappropriate medication in community-dwelling older people: prevalence, profile, and risk factors. Eur J Clin Pharmacol 2019; 75:1459-1466. [PMID: 31338540 DOI: 10.1007/s00228-019-02722-0] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2019] [Accepted: 07/11/2019] [Indexed: 12/12/2022]
Abstract
PURPOSE To comparatively assess the prevalence rates of potentially inappropriate medications (PIMs) obtained by the former and latest versions of American Geriatrics Society Beers Criteria (AGS BC) and screening tool of older person's potentially inappropriate prescriptions (STOPP), and analyze the factors of influence on PIM. METHODS Cross-sectional study including 582 community-dwelling older adults over the age of 65. Sociodemographic, clinical, functional, and comprehensive drug therapy data were collected. The primary endpoint was the percentage of patients receiving at least one PIM. RESULTS A total of 3626 prescriptions were analyzed. PIMs were detected in 35.4% and 47.9% of patients according to the STOPP v1 and the 2012 AGS BC, respectively. This percentage rose to 54% when 2015 AGS BC were used and reached 66.8% with STOPP v2. The kappa coefficient between STOPP v2 and its former version was lower than the one between the updated Beers Criteria and their former version (0.41 vs 0.85). The agreement was good (0.65) between both latest criteria. The number of medications, psychological disorders, and insomnia were predictors of PIM. A novel finding was that bone and joint disorders increased the odds for PIM by 78%. CONCLUSIONS The 2015 AGS BC showed high sensitivity and good applicability to the European older patients. Both updated tools identified some pharmacological groups (benzodiazepines, PPIs, and opioids, among others) and certain health problems (insomnia, psychological disorders, and osteoarticular diseases) as factors of influence on PIM. Based on these findings, interventions aimed at promoting appropriate use of medications should be developed.
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Affiliation(s)
- Encarnación Blanco-Reina
- Pharmacology and Therapeutics Department, School of Medicine, Instituto de Investigación Biomédica de Málaga-IBIMA, University of Málaga, Campus de Teatinos, Boulevard Louis Pasteur, 32, 29071, Málaga, Spain.
| | | | | | | | | | - Gabriel Ariza-Zafra
- Geriatrics Department, Complejo Hospitalario Universitario de Albacete, Albacete, Spain
| | - Inmaculada Bellido-Estévez
- Pharmacology and Therapeutics Department, School of Medicine, Instituto de Investigación Biomédica de Málaga-IBIMA, University of Málaga, Campus de Teatinos, Boulevard Louis Pasteur, 32, 29071, Málaga, Spain
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Al-Azayzih A, Alamoori R, Altawalbeh SM. Potentially inappropriate medications prescribing according to Beers criteria among elderly outpatients in Jordan: a cross sectional study. Pharm Pract (Granada) 2019; 17:1439. [PMID: 31275497 PMCID: PMC6594439 DOI: 10.18549/pharmpract.2019.2.1439] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Accepted: 05/26/2019] [Indexed: 11/14/2022] Open
Abstract
Background Due to aging, along with its associated physiological changes, older adults are extremely vulnerable to be afflicted with multiple chronic conditions (multimorbidity). Accordingly, prescribing a large number of drugs to older adults would be inevitable. Resulted complex drug regimens can lead to prescribing of Potentially Inappropriate Medications (PIMs) with subsequent negative health and economic outcomes. Objectives The main objective of this study is to investigate the prevalence and predictors of PIMs prescribing among Jordanian elderly outpatients, using the last updated version of the American Geriatrics Society (AGS) Beers Criteria (2015 version). Methods A Unicenter, cross-sectional study were data was assessed using medical records of included study subjects conducted over three months period from beginning of October to the end of December 2016 at King Abdullah University Hospital, Al Ramtha, Jordan. Our study included patients aged 65 years or above who visited the outpatient clinics at King Abdullah University hospital (KAUH) and were prescribed at least one oral medication during the study period. PIMs were identified for these patients and further classified according to the 2015 AGS Beers Criteria. We measured the prevalence of PIMs prescribed among elderly outpatients in Jordan. Results A total of 4622 eligible older adults were evaluated in this study, of whom 62.5% (n=2891) were found to have at least one PIM prescribed during the three months study period. 69% of identified PIMs were medications to be used with caution in elderly, 22% were medications to avoid in many or most older adults, 6.3% were medications to be avoided or have their dosage adjusted based on kidney function in older adults, 2.04% medications were to avoid in older adults with specific diseases/syndromes, and 1.6% were potentially clinically important non-anti-infective drug-drug interactions to be avoided in older adults. Female gender and polypharmacy were found to be significant predictors of PIMs use among elderly. Conclusions Potentially Inappropriate Medication prescribing is common among Jordanian elderly outpatients. Female gender and polypharmacy are associated with more PIMs prescribing and so need further attention.
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Affiliation(s)
- Ahmad Al-Azayzih
- Department of Clinical Pharmacy, Faculty of Pharmacy, Jordan University of Science and Technology. Irbid, (Jordan).
| | - Rawan Alamoori
- Department of Clinical Pharmacy, Faculty of Pharmacy, Jordan University of Science and Technology. Irbid, (Jordan).
| | - Shoroq M Altawalbeh
- Department of Clinical Pharmacy, Faculty of Pharmacy, Jordan University of Science and Technology. Irbid, (Jordan).
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Thomas RE, Thomas BC. A Systematic Review of Studies of the STOPP/START 2015 and American Geriatric Society Beers 2015 Criteria in Patients ≥ 65 Years. Curr Aging Sci 2019; 12:121-154. [PMID: 31096900 DOI: 10.2174/1874609812666190516093742] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Revised: 02/07/2019] [Accepted: 04/20/2019] [Indexed: 06/09/2023]
Abstract
BACKGROUND Polypharmacy remains problematic for individuals ≥65. OBJECTIVE To summarise the percentages of patients meeting 2015 STOPP criteria for Potentially Inappropriate Prescriptions (PIPs), 2015 Beers criteria for Potentially Inappropriate Medications (PIMs), and START criteria Potential Prescribing Omissions (PPOs). METHODS Searches conducted on 2 January 2019 in Medline, Embase, and PubMed identified 562 studies and 62 studies were retained for review. Data were abstracted independently. RESULTS 62 studies (n=1,854,698) included two RCTs and 60 non-randomised studies. For thirty STOPP/START studies (n=1,245,974) average percentages for ≥1 PIP weighted by study size were 42.8% for 1,242,010 community patients and 51.8% for 3,964 hospitalised patients. For nineteen Beers studies (n = 595,811) the average percentages for ≥1 PIM were 58% for 593,389 community patients and 55.5% for 2,422 hospitalised patients. For thirteen studies (n=12,913) assessing both STOPP/START and Beers criteria the average percentages for ≥1 STOPP PIP were 33.9% and Beers PIMs 46.8% for 8,238 community patients, and for ≥ 1 STOPP PIP were 42.4% and for ≥1 Beers PIM 60.5% for 4,675 hospitalised patients. Only ten studies assessed changes over time and eight found positive changes. CONCLUSION PIP/PIM/PPO rates are high in community and hospitalised patients in many countries. RCTs are needed for interventions to: reduce new/existing PIPs/PIMs/PPO prescriptions, reduce prescriptions causing adverse effects, and enable regulatory authorities to monitor and reduce inappropriate prescriptions in real time. Substantial differences between Beers and STOPP/START assessments need to be investigated whether they are due to the criteria, differential medication availability between countries, or data availability to assess the criteria.
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Affiliation(s)
- Roger E Thomas
- Department of Family Medicine, Faculty of Medicine, Health Sciences Centre, 3330 Hospital Drive NW, University of Calgary, Calgary, Alberta, T2N 4N1, Canada
| | - Bennett C Thomas
- Independent Researcher, 1604 21 Avenue, NW, Calgary, Alberta, T2M1M1, Canada
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Bazargan M, Smith JL, King EO. Potentially inappropriate medication use among hypertensive older African-American adults. BMC Geriatr 2018; 18:238. [PMID: 30290768 PMCID: PMC6173851 DOI: 10.1186/s12877-018-0926-9] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Accepted: 09/23/2018] [Indexed: 12/30/2022] Open
Abstract
Background Inappropriate use of medications, particularly among minority older adults with co-morbidity, remains a major public health concern. The American Geriatrics Society (AGS) reports that Potentially Inappropriate Medication (PIM) continues to be prescribed for older adults, despite evidence of poor outcomes. The main objective of this study was to examine the prevalence of PIM use among underserved non-institutionalized hypertensive older African-American adults. Furthermore, this study examines potential correlations between PIM use and the number and type of chronic conditions. Methods This cross-sectional study is comprised of a convenience sample of 193 hypertensive non-institutionalized African-American adults, aged 65 years and older recruited from several senior housing units located in underserved areas of South Los Angeles. The updated 2015 AGS Beers Criteria was used to identify participants using PIMs. Results Almost one out of two participants had inappropriate medication use. While the average number of PIMs taken was 0.87 drugs, the range was from one to seven medications. Almost 23% of PIMs were due to drugs with potential drug-drug interactions. The most common PIM was the use of proton pump inhibitors (PPI) and Central Nervous System (CNS) active agents. Nearly 56% of PIMs potentially increased the risk of falls and fall-associated bone fractures. The use of PIMs was significantly higher among participants who reported a higher number of chronic conditions. Nearly 70% of participants with PIM use reported suffering from chronic pain. Conclusions The major reason for high levels of polypharmacy, PIMs, and drug interactions is that patients suffer from multiple chronic conditions. But it may not be possible or necessary to treat all chronic conditions. Therefore, the goals of care should be explicitly reviewed with the patient in order to determine which of the many chronic conditions has the greatest impact on the life goals and/or functional priorities of the patient. Those drugs that have a limited impact on the patient’s functional priorities and that may cause harmful drug-drug interactions can be reduced or eliminated, while the remaining medications can focus on the most important functional priorities of the patient.
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Affiliation(s)
- Mohsen Bazargan
- Charles R. Drew University of Medicine and Science, 1731 East 120th Street, Los Angeles, CA, 90005, USA. .,University of California, Los Angeles, USA.
| | - James L Smith
- Charles R. Drew University of Medicine and Science, 1731 East 120th Street, Los Angeles, CA, 90005, USA
| | - Ebony O King
- Charles R. Drew University of Medicine and Science, 1731 East 120th Street, Los Angeles, CA, 90005, USA.,University of California, Los Angeles, USA
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