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Levinsky M. Can countries shape the association between cumulative adversity and old-age health? Front Public Health 2024; 12:1364868. [PMID: 38813420 PMCID: PMC11133626 DOI: 10.3389/fpubh.2024.1364868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Accepted: 04/24/2024] [Indexed: 05/31/2024] Open
Abstract
Introduction The present study examined the relationships of Lifetime Cumulative Adversity (LCA) and country inequalities, as well as the interactions between them, with the self-rated health (SRH) in old age. Methods Using data from the Survey of Health, Aging and Retirement in Europe (SHARE), the study regressed self-rated health on Lifetime Cumulative Adversity and country-level inequality indices across European countries in two points in time. The analysis also considered adversity-inequality interactions, controlling for confounders. The sample was comprised of 28,789 adults, aged 50 to 80, from 25 European countries and Israel. Results The findings pointed out that LCA is negatively associated with SRH, but democracy and welfare regimes modify the ill effects of LCA on health. These effects are reduced as the LCA level increases. The effects remained significant over two measurement time-points over three years, showing that life-course trajectories may be shaped by individual accumulated risk exposure to stress, along with inequalities at the society level. Discussion The study provides constructive and important guidance for decreasing the harmful effect of lifetime adversity in old age, by the modification of the country's welfare policies.
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Affiliation(s)
- Michal Levinsky
- The Paul Baerwald School of Social Work and Social Welfare, Hebrew University of Jerusalem, Jerusalem, Israel
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2
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Gosselin M, Talbot D, Simard M, Chiu YM, Mésidor M, Boiteau V, Carmichael PH, Sirois C. Classifying Polypharmacy According to Pharmacotherapeutic and Clinical Risks in Older Adults: A Latent Class Analysis in Quebec, Canada. Drugs Aging 2023; 40:573-583. [PMID: 37149556 DOI: 10.1007/s40266-023-01028-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/29/2023] [Indexed: 05/08/2023]
Abstract
INTRODUCTION The simplistic definition of polypharmacy, often designated as the concomitant use of five medications or more, does not distinguish appropriate from inappropriate polypharmacy. Classifying polypharmacy according to varying levels of health risk would help optimise medication use. OBJECTIVE We aimed to characterise different types of polypharmacy among older adults and evaluate their association with mortality and institutionalisation. METHODS Using healthcare databases from the Quebec Integrated Chronic Disease Surveillance System, we selected a community-based random sample of the population ≥ 66 years old covered by the public drug plan. Categorical indicators used to describe polypharmacy included number of medications, potentially inappropriate medications (PIMs), drug-drug interactions, enhanced surveillance medications, complex route of administration medications, anticholinergic cognitive burden (ACB) score and use of blister cards. We used a latent class analysis to subdivide participants into distinct groups of polypharmacy. Their association with 3-year mortality and institutionalisation was assessed with adjusted Cox models. RESULTS In total, 93,516 individuals were included. A four-class model was selected with groups described as (1) no polypharmacy (46% of our sample), (2) high-medium number of medications, low risk (33%), (3) medium number of medications, PIM use with or without high ACB score (8%) and (4) hyperpolypharmacy, complex use, high risk (13%). Using the class without polypharmacy as the reference, all polypharmacy classes were associated with 3-year mortality and institutionalisation, with the most complex/inappropriate classes denoting the highest risk (hazard ratio [HR] [95% confidence interval]: class 3, 70-year-old point estimate for mortality 1.52 [1.30-1.78] and institutionalisation 1.86 [1.52-2.29]; class 4, 70-year-old point estimate for mortality 2.74 [2.44-3.08] and institutionalisation 3.11 [2.60-3.70]). CONCLUSIONS We distinguished three types of polypharmacy with varying pharmacotherapeutic and clinical appropriateness. Our results highlight the value of looking beyond the number of medications to assess polypharmacy.
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Affiliation(s)
- M Gosselin
- Department of Social and Preventive Medicine, Faculty of medicine, Université Laval, Québec, Canada
- Centre d'excellence sur le vieillissement de Québec, Québec, Canada
- VITAM, Centre de recherche en santé durable, Québec, Canada
- CHU de Québec- Université Laval Research Centre, Québec, Canada
| | - D Talbot
- Department of Social and Preventive Medicine, Faculty of medicine, Université Laval, Québec, Canada
- CHU de Québec- Université Laval Research Centre, Québec, Canada
| | - M Simard
- Department of Social and Preventive Medicine, Faculty of medicine, Université Laval, Québec, Canada
- Centre d'excellence sur le vieillissement de Québec, Québec, Canada
- VITAM, Centre de recherche en santé durable, Québec, Canada
- CHU de Québec- Université Laval Research Centre, Québec, Canada
- Institut national de santé publique du Québec, Québec, Canada
| | - Y M Chiu
- VITAM, Centre de recherche en santé durable, Québec, Canada
- Institut national de santé publique du Québec, Québec, Canada
- Faculty of pharmacy, Université Laval, Québec, Canada
| | - M Mésidor
- Department of Social and Preventive Medicine, Faculty of medicine, Université Laval, Québec, Canada
- CHU de Québec- Université Laval Research Centre, Québec, Canada
- Institut national de santé publique du Québec, Québec, Canada
| | - V Boiteau
- Institut national de santé publique du Québec, Québec, Canada
| | - P-H Carmichael
- Centre d'excellence sur le vieillissement de Québec, Québec, Canada
| | - C Sirois
- Centre d'excellence sur le vieillissement de Québec, Québec, Canada.
- VITAM, Centre de recherche en santé durable, Québec, Canada.
- CHU de Québec- Université Laval Research Centre, Québec, Canada.
- Institut national de santé publique du Québec, Québec, Canada.
- Faculty of pharmacy, Université Laval, Québec, Canada.
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Medications for Chronic Conditions and Mortality in Older Adults. Nurs Res 2023; 72:30-37. [PMID: 36053079 DOI: 10.1097/nnr.0000000000000618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND With the population aging, examining the relationship between polypharmacy and mortality based on population data sources is important for clinical management and policy direction. OBJECTIVES This study aimed to examine the association between the number of chronic medications and the risk of mortality in older adults. METHODS This population-based retrospective cohort study used data from the National Health Insurance Research Database in Taiwan for information regarding chronic medication use (over 4 years) in older adults aged 65 years and older. The association between medication use and mortality numbers was analyzed using Cox proportional hazards regression models adjusted for demographic variables and comorbidity. RESULTS The number of medications was significantly associated with high mortality risk. Within polypharmacy, being 65-74 years old, male, living in northern Taiwan, having one type of comorbid disease, and receiving <84 days of refillable chronic prescription were associated with greater mortality risk. Subgroup analyses' results regarding comorbidity showed significant positive associations between the number of medications and mortality in most comorbid diseases except for mental disorders and diseases of the skin and subcutaneous tissue. DISCUSSION General practitioners should know that chronic polypharmacy is associated with increased mortality risk. Recognizing the possible adverse effects of multiple medication use could help physicians optimize drug regimens in the future.
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Miranda A, Ortega D, Caiza P, Pilco G. Pharmaceutical intervention in the pharmacological therapy of elderly patients in San Luis-ECUADOR. Pharm Pract (Granada) 2023; 21:2771. [PMID: 37090454 PMCID: PMC10117302 DOI: 10.18549/pharmpract.2023.1.2771] [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: 10/23/2022] [Accepted: 12/13/2022] [Indexed: 04/08/2023] Open
Abstract
Population's aging leads to a frequent usage of pharmaceutical medications to treat or control various ailments because of aging, increasing the probability of occurrence of problems related to its usage. The primary objective of this study was to conduct pharmaceutical interventions in elderly patients from San Luis - Riobamba, using surveys to identify the sociodemographic characteristics, diseases, and medicines usage. Once the problems related to pharmacological therapy were identified, pharmaceutical interventions were carried our prior the acceptance of each patient. The study had the participation of 422 elderly patients, with the prevalence of females (59.7%), aged between 60 and 70 years (45.5%); we identified that 82.5% of the elderly patients have diseases, finding that joint pain such as Arthritis/Osteoarthritis has the higher incidence (38.8%), and 50% of the surveyed people consume medication to treat the disease. 40.28% (n=170) of the participants conciliate the treatment review to identify any medication-related problem (MRP), finding interactions (21.2%) and adverse effects probability (21.2%), starting from the PRM identified, 170 pharmaceutical interventions were conducted, considering as priority (67.6%) the education on non-pharmacological measures. The pharmaceutical interventions done through the study benefited the elderly patients and will contribute to reduce the appearance of PRM.
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Affiliation(s)
- Aida Miranda
- Master in Pharmacy, professor Facultad de Ciencias, Escuela Superior Politécnica de Chimborazo (ESPOCH), Technology and Pharmaceutical Care Research Group (GITAFEC), Ecuador.
| | - Danny Ortega
- Biochemist pharmacist, Escuela Superior Politécnica de Chimborazo (ESPOCH), Ecuador.
| | - Paola Caiza
- Biochemist pharmacist, Escuela Superior Politécnica de Chimborazo (ESPOCH), Ecuador.
| | - Gisela Pilco
- Master in Pharmacy, professor Facultad de Ciencias, Escuela Superior Politécnica de Chimborazo (ESPOCH), Natural Products and Pharmacy Research Group (GIPRONAF), Ecuador.
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Liang CK, Chou MY, Hsu YH, Wang YC, Liao MC, Chen MT, Hsiao PY, Chen LK, Lin YT. The association of potentially inappropriate medications, polypharmacy and anticholinergic burden with readmission and emergency room revisit after discharge: A hospital-based retrospective cohort study. Br J Clin Pharmacol 2023; 89:187-200. [PMID: 35821614 DOI: 10.1111/bcp.15457] [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: 12/08/2021] [Revised: 06/05/2022] [Accepted: 06/30/2022] [Indexed: 11/30/2022] Open
Abstract
AIMS While certain drug-use indicators are known to be associated with clinical outcomes, the relationship is unclear for some highly prevalent conditions in in patients aged ≥65 years. We examine correlations between 3 drug-use indicators and postdischarge healthcare services use by older patients according to the presence of dementia, advanced age and frailty. METHODS This retrospective cohort study analysed data collected from hospital electronic health records between April and December 2017. Potentially inappropriate medications (PIMs) and anticholinergic burden were assessed using the 2015 Beers Criteria and anticholinergic cognitive burden scale (ACBS) score. Minor and major polypharmacy were defined as the use of 5-9 and ≥10 drugs, respectively. Outcomes were set as emergency room revisits and readmissions at 1, 3 and 6 months postdischarge. The correlation between drug-use indicators and outcomes was analysed by multivariable logistic regression. RESULTS The final cohort included 3061 patients for the analysis, and 2930, 2671 and 2560 patients were followed up to 1, 3 and 6 months after discharge. After controlling for confounders, all 3 drug-use indicators were significantly associated with readmission and emergency room revisits except for the relationship between PIMs and readmission within 6 months. These associations were significantly observed among patients without dementia, aged >80 years and with frailty. CONCLUSION PIMs, polypharmacy and anticholinergic burden are common at discharge and correlate with future use of healthcare services. In older patients, the absence of dementia, advanced age and frailty should be given extra consideration with regard to medication safety.
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Affiliation(s)
- Chih-Kuang Liang
- Center for Geriatrics and Gerontology, Kaohsiung Veterans General Hospital, Kaohsiung City, Taiwan.,Aging and Health Research Center, National Yang Ming Chiao Tung University, Taipei City, Taiwan.,Department of Geriatric Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei City, Taiwan.,Division of Neurology, Department of Internal Medicine, Kaohsiung Veterans General Hospital, Kaohsiung City, Taiwan
| | - Ming-Yueh Chou
- Center for Geriatrics and Gerontology, Kaohsiung Veterans General Hospital, Kaohsiung City, Taiwan.,Aging and Health Research Center, National Yang Ming Chiao Tung University, Taipei City, Taiwan.,Department of Geriatric Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei City, Taiwan
| | - Ying-Hsin Hsu
- Center for Geriatrics and Gerontology, Kaohsiung Veterans General Hospital, Kaohsiung City, Taiwan.,Division of Neurology, Department of Internal Medicine, Kaohsiung Veterans General Hospital, Kaohsiung City, Taiwan.,Chia Nan University, Tainan City, Taiwan
| | - Yu-Chun Wang
- Center for Geriatrics and Gerontology, Kaohsiung Veterans General Hospital, Kaohsiung City, Taiwan
| | - Mei-Chen Liao
- Center for Geriatrics and Gerontology, Kaohsiung Veterans General Hospital, Kaohsiung City, Taiwan
| | - Miao-Ting Chen
- Department of Pharmacy, Kaohsiung Veterans General Hospital, Kaohsiung City, Taiwan
| | - Pei-Yu Hsiao
- Department of Pharmacy, Kaohsiung Veterans General Hospital, Kaohsiung City, Taiwan
| | - Liang-Kung Chen
- Aging and Health Research Center, National Yang Ming Chiao Tung University, Taipei City, Taiwan.,Department of Geriatric Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei City, Taiwan.,Taipei Municipal Gan-Dau Hospital, Taipei, Taiwan.,Center for Geriatrics and Gerontology, Taipei Veterans General Hospital, Taipei City, Taiwan
| | - Yu-Te Lin
- Center for Geriatrics and Gerontology, Kaohsiung Veterans General Hospital, Kaohsiung City, Taiwan.,Division of Neurology, Department of Internal Medicine, Kaohsiung Veterans General Hospital, Kaohsiung City, Taiwan.,Department of Pharmacy, Tajen University, Yanpu Township, Pingtung County, Taiwan
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Ouellet N, Bergeron AS, Gagnon E, Cossette B, Labrecque CA, Sirois C. Prescribing and deprescribing in very old age: perceptions of very old adults, caregivers and health professionals. Age Ageing 2022; 51:6827077. [PMID: 36413585 DOI: 10.1093/ageing/afac244] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND although they are major consumers of medications, there is little evidence-based data to guide prescribing and deprescribing of medications for very old adults (80+ years). OBJECTIVES to discover the perceptions of very old adults, caregivers and health professionals in order to further examine the clinical and ethical issues raised by prescribing and deprescribing in very old age. METHODS individual interviews were conducted with very old adults (n = 10) and caregivers (n = 6), whereas group interviews were conducted with health professionals (n = 11). The themes covered included perceptions of medication use, polypharmacy, deprescribing and patient-health professional relationships. Thematic analysis was used to identify areas of convergence and divergence. RESULTS very old adults are satisfied with the medications they are taking, do not see the need to reduce their medication use and consider their doctor as the expert who should make the decisions regarding treatment. The perceptions of caregivers are similar to those of older adults, whereas health professionals believe that very old adults take a lot of inappropriate medications and list multiple barriers to deprescribing. All participants describe a normalisation of medication use with ageing. CONCLUSION there is a dichotomy between the perception of the very old adults/caregivers and that of health professionals regarding the safety of medication in very old age. A cultural change regarding medication use seems essential to optimise therapy and support deprescribing in clinical practice since the potential issues raised by researchers do not resonate with the main stakeholders.
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Affiliation(s)
- Nicole Ouellet
- Département des Sciences Infirmières, Université du Québec à Rimouski, Rimouski, Québec, Canada
| | - Anne-Sophie Bergeron
- Département des Sciences Infirmières, Université du Québec à Rimouski, Rimouski, Québec, Canada
| | - Eric Gagnon
- Centre d'excellence sur le vieillissement de Québec, Québec, Canada.,VITAM - Centre de Recherche en Santé Durable, Centre Intégré Universitaire de Santé et de Services Sociaux, Québec, Canada
| | - Benoit Cossette
- Faculty of Medicine and Health Sciences, University of Sherbrooke, Sherbrooke, Québec, Canada.,Research Center on Aging, Integrated University Health and Social Services Center of Estrie-Sherbrooke University Hospital Center, Sherbrooke, Québec, Canada
| | - Cory A Labrecque
- Faculté de Théologie et de Sciences Religieuses, Université Laval, Québec, Canada
| | - Caroline Sirois
- Centre d'excellence sur le vieillissement de Québec, Québec, Canada.,VITAM - Centre de Recherche en Santé Durable, Centre Intégré Universitaire de Santé et de Services Sociaux, Québec, Canada.,Faculté de Pharmacie, Université Laval, Laval, Québec, Canada
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7
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Li Y, Zhang X, Yang L, Yang Y, Qiao G, Lu C, Liu K. Association between polypharmacy and mortality in the older adults: A systematic review and meta-analysis. Arch Gerontol Geriatr 2022; 100:104630. [DOI: 10.1016/j.archger.2022.104630] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 01/18/2022] [Accepted: 01/21/2022] [Indexed: 01/10/2023]
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8
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Li Y, Zhang X, Yang L, Yang Y, Qiao G, Lu C, Liu K. Association between polypharmacy and mortality in the older adults: A systematic review and meta-analysis. Arch Gerontol Geriatr 2022. [DOI: https://doi.org/10.1016/j.archger.2022.104630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Davies LE, Kingston A, Todd A, Hanratty B. Is polypharmacy associated with mortality in the very old: findings from the Newcastle 85+ Study. Br J Clin Pharmacol 2022; 88:2988-2995. [PMID: 34981552 PMCID: PMC9302636 DOI: 10.1111/bcp.15211] [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: 06/04/2021] [Revised: 12/14/2021] [Accepted: 12/17/2021] [Indexed: 11/28/2022] Open
Abstract
Polypharmacy is common in the very old (≥85 years), where little is known about its association with mortality. We aimed to investigate the association between polypharmacy and all-cause mortality in the very old, over an 11-year time period. Data were drawn from the Newcastle 85+ Study (741), a cohort of people who were born in 1921 and turned 85 in 2006. Survival analysis was performed using Cox proportional hazards models with time-varying covariates, wherein polypharmacy was operationalised continuously. Each additional medication prescribed was associated with a 3% increased risk of mortality (HR: 1.03, 95% CI: 1.00-1.06). Amongst the very old, the risks and benefits of each additional medication prescribed should be carefully considered.
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Affiliation(s)
- Laurie E Davies
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Andrew Kingston
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Adam Todd
- School of Pharmacy, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Barbara Hanratty
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
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Marin-Gomez FX, Mendioroz-Peña J, Mayer MA, Méndez-Boo L, Mora N, Hermosilla E, Coma E, Vilaseca JM, Leis A, Medina M, Catalina QM, Vidal-Alaball J. Comparing the Clinical Characteristics and Mortality of Residential and Non-Residential Older People with COVID-19: Retrospective Observational Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:483. [PMID: 35010742 PMCID: PMC8744689 DOI: 10.3390/ijerph19010483] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/04/2021] [Revised: 12/24/2021] [Accepted: 12/30/2021] [Indexed: 01/08/2023]
Abstract
Nursing homes have accounted for a significant part of SARS-CoV-2 mortality, causing great social alarm. Using data collected from electronic medical records of 1,319,839 institutionalised and non-institutionalised persons ≥ 65 years, the present study investigated the epidemiology and differential characteristics between these two population groups. Our results showed that the form of presentation of the epidemic outbreak, as well as some risk factors, are different among the elderly institutionalised population with respect to those who are not. In addition to a twenty-fold increase in the rate of adjusted mortality among institutionalised individuals, the peak incidence was delayed by approximately three weeks. Having dementia was shown to be a risk factor for death, and, unlike the non-institutionalised group, neither obesity nor age were shown to be significantly associated with the risk of death among the institutionalised. These differential characteristics should be able to guide the actions to be taken by the health administration in the event of a similar infectious situation among institutionalised elderly people.
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Affiliation(s)
- Francesc X. Marin-Gomez
- Health Promotion in Rural Areas Research Group, Gerència Territorial de la Catalunya Central, Institut Català de la Salut, 08772 St. Fruitós de Bages, Spain; (F.X.M.-G.); (J.M.-P.); (J.V.-A.)
- Unitat de Suport a la Recerca de la Catalunya Central, Fundació Institut Universitari per a la Recerca a l’Atenció Primària de Salut Jordi Gol i Gurina, 08772 St. Fruitós de Bages, Spain;
- Faculty of Medicine, University of Vic-Central University of Catalonia (UVIC-UCC), 08500 Vic, Spain;
| | - Jacobo Mendioroz-Peña
- Health Promotion in Rural Areas Research Group, Gerència Territorial de la Catalunya Central, Institut Català de la Salut, 08772 St. Fruitós de Bages, Spain; (F.X.M.-G.); (J.M.-P.); (J.V.-A.)
- COVID-19 Response Unit, Department of Health, Generalitat de Catalunya, 08005 Barcelona, Spain
| | - Miguel-Angel Mayer
- Research Programme on Biomedical Informatics (GRIB), Hospital del Mar Medical Research Institute (IMIM), Universitat Pompeu Fabra, 08003 Barcelona, Spain;
| | - Leonardo Méndez-Boo
- Sistemes d’Informació dels Serveis d’Atenció Primària (SISAP), Institut Català de la Salut (ICS), 08007 Barcelona, Spain; (L.M.-B.); (N.M.); (E.H.); (E.C.); (M.M.)
| | - Núria Mora
- Sistemes d’Informació dels Serveis d’Atenció Primària (SISAP), Institut Català de la Salut (ICS), 08007 Barcelona, Spain; (L.M.-B.); (N.M.); (E.H.); (E.C.); (M.M.)
- Fundació Institut Universitari per a la Recerca a l’Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), 08007 Barcelona, Spain
| | - Eduardo Hermosilla
- Sistemes d’Informació dels Serveis d’Atenció Primària (SISAP), Institut Català de la Salut (ICS), 08007 Barcelona, Spain; (L.M.-B.); (N.M.); (E.H.); (E.C.); (M.M.)
- Fundació Institut Universitari per a la Recerca a l’Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), 08007 Barcelona, Spain
| | - Ermengol Coma
- Sistemes d’Informació dels Serveis d’Atenció Primària (SISAP), Institut Català de la Salut (ICS), 08007 Barcelona, Spain; (L.M.-B.); (N.M.); (E.H.); (E.C.); (M.M.)
| | - Josep-Maria Vilaseca
- Faculty of Medicine, University of Vic-Central University of Catalonia (UVIC-UCC), 08500 Vic, Spain;
| | - Angela Leis
- Research Programme on Biomedical Informatics (GRIB), Hospital del Mar Medical Research Institute (IMIM), Universitat Pompeu Fabra, 08003 Barcelona, Spain;
| | - Manolo Medina
- Sistemes d’Informació dels Serveis d’Atenció Primària (SISAP), Institut Català de la Salut (ICS), 08007 Barcelona, Spain; (L.M.-B.); (N.M.); (E.H.); (E.C.); (M.M.)
| | - Queralt Miró Catalina
- Unitat de Suport a la Recerca de la Catalunya Central, Fundació Institut Universitari per a la Recerca a l’Atenció Primària de Salut Jordi Gol i Gurina, 08772 St. Fruitós de Bages, Spain;
| | - Josep Vidal-Alaball
- Health Promotion in Rural Areas Research Group, Gerència Territorial de la Catalunya Central, Institut Català de la Salut, 08772 St. Fruitós de Bages, Spain; (F.X.M.-G.); (J.M.-P.); (J.V.-A.)
- Unitat de Suport a la Recerca de la Catalunya Central, Fundació Institut Universitari per a la Recerca a l’Atenció Primària de Salut Jordi Gol i Gurina, 08772 St. Fruitós de Bages, Spain;
- Faculty of Medicine, University of Vic-Central University of Catalonia (UVIC-UCC), 08500 Vic, Spain;
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Pagès A, Rouch L, Costa N, Cestac P, De Souto Barreto P, Rolland Y, Vellas B, Molinier L, Juillard-Condat B. Potentially Inappropriate Medication Prescribing Detected by Computer Algorithm among Older Patients: Results from the MAPT Study. PHARMACY 2021; 9:pharmacy9040189. [PMID: 34842835 PMCID: PMC8628967 DOI: 10.3390/pharmacy9040189] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Revised: 11/22/2021] [Accepted: 11/22/2021] [Indexed: 01/05/2023] Open
Abstract
(1) Background: Some medications may be dangerous for older patients. Potentially inappropriate medication prescribing (PIP) among older patients represents a significant cause of morbidity. The aim of this study was to create an algorithm to detect PIP in a geriatric database (Multidomain Alzheimer Preventive Trial (MAPT) study), and then to assess the algorithm construct validity by comparing the prevalence of PIP and associated factors with literature data. (2) Methods: An algorithm was constructed to detect PIP and was based on different explicit criteria among which the European list of potentially inappropriate medications (EU(7)-PIM), the STOPP and START version 2 tools. For construct validity assessment, logistic mixed-effects model repeated measures analyses were used to identify factors associated with PIP. (3) Results: Prevalence of PIP was 59.0% with the EU(7)-PIM list criteria, 43.2% with the STOPP criteria and 51.3% with the START criteria. Age, polypharmacy, and higher Charlson comorbidity index were associated with PIP. (4) Conclusions: Prevalence of PIP and associated factors are consistent with literature data, supporting the construct validity of our algorithm. This algorithm opens up interesting perspectives both in terms of analysis of very large databases and integration into e-prescribing or pharmaceutical validation software.
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Affiliation(s)
- Arnaud Pagès
- Department of Pharmacy, Toulouse University Hospital, 31000 Toulouse, France; (L.R.); (P.C.); (B.J.-C.)
- Institute of Aging, Gérontopôle, INSPIRE Project, Toulouse University Hospital, 31000 Toulouse, France; (P.D.S.B.); (Y.R.); (B.V.)
- Center for Epidemiology and Research in POPulation Health (CERPOP), UMR 1295, Inserm, UPS Toulouse III University, 31000 Toulouse, France; (N.C.); (L.M.)
- Correspondence: ; Tel.: +33-567-776-418
| | - Laure Rouch
- Department of Pharmacy, Toulouse University Hospital, 31000 Toulouse, France; (L.R.); (P.C.); (B.J.-C.)
- Institute of Aging, Gérontopôle, INSPIRE Project, Toulouse University Hospital, 31000 Toulouse, France; (P.D.S.B.); (Y.R.); (B.V.)
- Center for Epidemiology and Research in POPulation Health (CERPOP), UMR 1295, Inserm, UPS Toulouse III University, 31000 Toulouse, France; (N.C.); (L.M.)
| | - Nadège Costa
- Center for Epidemiology and Research in POPulation Health (CERPOP), UMR 1295, Inserm, UPS Toulouse III University, 31000 Toulouse, France; (N.C.); (L.M.)
- Economic Evaluation Unit, Medical Information Department, Toulouse University Hospital, 31000 Toulouse, France
| | - Philippe Cestac
- Department of Pharmacy, Toulouse University Hospital, 31000 Toulouse, France; (L.R.); (P.C.); (B.J.-C.)
- Center for Epidemiology and Research in POPulation Health (CERPOP), UMR 1295, Inserm, UPS Toulouse III University, 31000 Toulouse, France; (N.C.); (L.M.)
| | - Philipe De Souto Barreto
- Institute of Aging, Gérontopôle, INSPIRE Project, Toulouse University Hospital, 31000 Toulouse, France; (P.D.S.B.); (Y.R.); (B.V.)
- Center for Epidemiology and Research in POPulation Health (CERPOP), UMR 1295, Inserm, UPS Toulouse III University, 31000 Toulouse, France; (N.C.); (L.M.)
| | - Yves Rolland
- Institute of Aging, Gérontopôle, INSPIRE Project, Toulouse University Hospital, 31000 Toulouse, France; (P.D.S.B.); (Y.R.); (B.V.)
- Center for Epidemiology and Research in POPulation Health (CERPOP), UMR 1295, Inserm, UPS Toulouse III University, 31000 Toulouse, France; (N.C.); (L.M.)
| | - Bruno Vellas
- Institute of Aging, Gérontopôle, INSPIRE Project, Toulouse University Hospital, 31000 Toulouse, France; (P.D.S.B.); (Y.R.); (B.V.)
- Center for Epidemiology and Research in POPulation Health (CERPOP), UMR 1295, Inserm, UPS Toulouse III University, 31000 Toulouse, France; (N.C.); (L.M.)
| | - Laurent Molinier
- Center for Epidemiology and Research in POPulation Health (CERPOP), UMR 1295, Inserm, UPS Toulouse III University, 31000 Toulouse, France; (N.C.); (L.M.)
- Economic Evaluation Unit, Medical Information Department, Toulouse University Hospital, 31000 Toulouse, France
| | - Blandine Juillard-Condat
- Department of Pharmacy, Toulouse University Hospital, 31000 Toulouse, France; (L.R.); (P.C.); (B.J.-C.)
- Center for Epidemiology and Research in POPulation Health (CERPOP), UMR 1295, Inserm, UPS Toulouse III University, 31000 Toulouse, France; (N.C.); (L.M.)
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12
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Cashion W, McClellan W, Judd S, Goyal A, Kleinbaum D, Goodman M, Prince V, Muntner P, Howard G. Polypharmacy and mortality association by chronic kidney disease status: The REasons for Geographic And Racial Differences in Stroke Study. Pharmacol Res Perspect 2021; 9:e00823. [PMID: 34339112 PMCID: PMC8328192 DOI: 10.1002/prp2.823] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Accepted: 04/28/2021] [Indexed: 11/18/2022] Open
Abstract
Many Americans take multiple medications simultaneously (polypharmacy). Polypharmacy's effects on mortality are uncertain. We endeavored to assess the association between polypharmacy and mortality in a large U.S. cohort and examine potential effect modification by chronic kidney disease (CKD) status. The REasons for Geographic And Racial Differences in Stroke cohort data (n = 29 627, comprised of U.S. black and white adults) were used. During a baseline home visit, pill bottle inspections ascertained medications used in the previous 2 weeks. Polypharmacy status (major [≥8 ingredients], minor [6-7 ingredients], and none [0-5 ingredients]) was determined by counting the total number of generic ingredients. Cox models (time-on-study and age-time-scale methods) assessed the association between polypharmacy and mortality. Alternative models examined confounding by indication and possible effect modification by CKD. Over 4.9 years median follow-up, 2538 deaths were observed. Major polypharmacy was associated with increased mortality in all models, with hazard ratios and 95% confidence intervals ranging from 1.22 (1.07-1.40) to 2.35 (2.15-2.56), with weaker associations in more adjusted models. Minor polypharmacy was associated with mortality in some, but not all, models. The polypharmacy-mortality association did not differ by CKD status. While residual confounding by indication cannot be excluded, in this large American cohort, major polypharmacy was consistently associated with mortality.
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Affiliation(s)
- Winn Cashion
- Department of EpidemiologyEmory University Rollins School of Public HealthAtlantaGAUSA
| | - William McClellan
- Department of EpidemiologyEmory University Rollins School of Public HealthAtlantaGAUSA
| | - Suzanne Judd
- Department of BiostatisticsUniversity of Alabama at Birmingham School of Public HealthBirminghamALUSA
| | - Abhinav Goyal
- Department of EpidemiologyEmory University Rollins School of Public HealthAtlantaGAUSA
| | - David Kleinbaum
- Department of EpidemiologyEmory University Rollins School of Public HealthAtlantaGAUSA
| | - Michael Goodman
- Department of EpidemiologyEmory University Rollins School of Public HealthAtlantaGAUSA
| | - Valerie Prince
- Department of Pharmacy PracticeSamford University McWhorter School of PharmacyBirminghamALUSA
| | - Paul Muntner
- Department of EpidemiologyUniversity of Alabama at Birmingham School of Public HealthBirminghamALUSA
| | - George Howard
- Department of BiostatisticsUniversity of Alabama at Birmingham School of Public HealthBirminghamALUSA
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Carr E, Federman A, Dzahini O, Dobson RJ, Bendayan R. A multidimensional measure of polypharmacy for older adults using the Health and Retirement Study. Sci Rep 2021; 11:8783. [PMID: 33888728 PMCID: PMC8062687 DOI: 10.1038/s41598-021-86331-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Accepted: 01/07/2021] [Indexed: 02/05/2023] Open
Abstract
Polypharmacy is commonly defined based on the number of medications taken concurrently using standard cut-offs, but several studies have highlighted the need for a multidimensional assessment. We developed a multidimensional measure of polypharmacy and compared with standard cut-offs. Data were extracted for 2141 respondents of the 2007 Prescription Drug Survey, a sub-study of the Health Retirement Study. Latent classes were identified based on multiple indicators of polypharmacy, including quantity, temporality and risk profile. A four-class model was selected based on fit statistics and clinical interpretability: 'High risk, long-term' (Class 1), 'Low risk, long-term' (Class 2), 'High risk, short-term' (Class 3), and 'High risk for drug interactions, medium-term, regular' (Class 4). Classes differed regarding sex, cohabitation, disability and multimorbidity. Participants in the 'low risk' class tended to be male, cohabitating, and reported fewer health conditions, compared to 'high risk' classes. Polypharmacy classes were compared to standard cut-offs (5+ or 9+ medications) in terms of overlap and mortality risk. The three 'high risk' classes overlapped with the groups concurrently taking 5+ and 9+ medications per month. However, the multidimensional measure further differentiated individuals in terms of risk profile and temporality of medication taking, thus offering a richer assessment of polypharmacy.
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Affiliation(s)
- Ewan Carr
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Alex Federman
- Division of General Internal Medicine, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Olubanke Dzahini
- Pharmacy Department, South London and Maudsley NHS Foundation Trust, London, UK
- Institute of Pharmaceutical Science, King's College London, London, UK
| | - Richard J Dobson
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- NIHR Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King's College London, London, UK
- Institute of Health Informatics, University College London, 222 Euston Road, London, UK
- Health Data Research UK London, University College London, 222 Euston Road, London, UK
| | - Rebecca Bendayan
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
- NIHR Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King's College London, London, UK.
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Wauters M, Elseviers M, Vander Stichele R, Dilles T, Thienpont G, Christiaens T. Efficacy, feasibility and acceptability of the OptiMEDs tool for multidisciplinary medication review in nursing homes. Arch Gerontol Geriatr 2021; 95:104391. [PMID: 33819776 DOI: 10.1016/j.archger.2021.104391] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 03/04/2021] [Accepted: 03/09/2021] [Indexed: 12/28/2022]
Abstract
AIM(S) Exploring efficacy, feasibility and acceptability of a complex multifaced intervention (OptiMEDs) supporting multidisciplinary medication reviews in Belgian nursing homes (NHs). METHODS A pilot study in 2 intervention, 1 control NH was held, involving dementia and non-dementia NH residents (>65 years). OptiMEDs provided automated assessment of possible inappropriate medications (PIMs) and patient-specific nurse observation lists of potential side-effects. Medication changes were evaluated one month after the medication review. Feasibility and acceptability was collected via surveys among the health-care professionals. Trial registration NCT04142645, 31/10/2019. RESULTS Participants (n = 148, n = 100 in the intervention NHs) had a mean age of 87.2 years, with 75.0% females and 49.3% non-dementia patients. Prevalence of PIM use was 84.7% and of potential medication side-effects 84.5%, (range 1-19 per resident). One month after the intervention, the medication use decreased in 35.8% and PIM use in 25.9% of surviving intervention NHresidents (n = 88). GPs changed more medications when side-effects were observed (42% when side-effects present versus 12% when no side-effects, p = 0.019). Median workload for nurses was 45 min, 20 for pharmacists, and 8 for GPs. User satisfaction for the OptiMEDs tool was high (n = 33, median score of 8, IQR 6 -8), with GPs (n = 19) showing the highest appreciation. Nurses (n = 9) reported a median score on the System Usability Scale of 70 (IQR 55 - 72), with lower scores for learnability aspects. CONCLUSION The OptiMEDs intervention was feasible and user-friendly, showing decreases in the medication and PIM use; without affecting patient safety. A cluster-randomized trial is needed to explore impact on patient-related outcomes.
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Affiliation(s)
- Maarten Wauters
- Department of Basic and Applied Medical Sciences, Clinical Pharmacology Research Unit, Ghent University, Ghent, Belgium.
| | - Monique Elseviers
- Department of Basic and Applied Medical Sciences, Clinical Pharmacology Research Unit, Ghent University, Ghent, Belgium; University of Antwerp, Centre for Research and Innovation in Care (CRIC), Wilrijk, Belgium
| | - Robert Vander Stichele
- Department of Basic and Applied Medical Sciences, Clinical Pharmacology Research Unit, Ghent University, Ghent, Belgium; RAMIT vzw, Research in Advanced Medical Informatics and Telematics, Ghent, Belgium
| | - Tinne Dilles
- University of Antwerp, Centre for Research and Innovation in Care (CRIC), Wilrijk, Belgium
| | - Geert Thienpont
- RAMIT vzw, Research in Advanced Medical Informatics and Telematics, Ghent, Belgium
| | - Thierry Christiaens
- Department of Basic and Applied Medical Sciences, Clinical Pharmacology Research Unit, Ghent University, Ghent, Belgium
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Visade F, Babykina G, Lamer A, Defebvre MM, Verloop D, Ficheur G, Genin M, Puisieux F, Beuscart JB. Importance of previous hospital stays on the risk of hospital re-admission in older adults: a real-life analysis of the PAERPA study population. Age Ageing 2021; 50:141-146. [PMID: 32687169 DOI: 10.1093/ageing/afaa139] [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: 12/20/2019] [Revised: 04/14/2020] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND consideration of the first hospital re-admission only and failure to take account of previous hospital stays, which are the two significant limitations when studying risk factors for hospital re-admission. The objective of the study was to use appropriate statistical models to analyse the impact of previous hospital stays on the risk of hospital re-admission among older patients. METHODS an exhaustive analysis of hospital discharge and health insurance data for a cohort of patients participating in the PAERPA ('Care Pathways for Elderly People at Risk of Loss of Personal Independence') project in the Hauts de France region of France. All patients aged 75 or over were included. All data on hospital re-admissions via the emergency department were extracted. The risk of unplanned hospital re-admission was estimated by applying a semiparametric frailty model, the risk of death by applying a time-dependent semiparametric Cox regression model. RESULTS a total of 24,500 patients (median [interquartile range] age: 81 [77-85]) were included between 1 January 2015 and 31 December 2017. In a multivariate analysis, the relative risk (95% confidence interval [CI]) of hospital re-admission rose progressively from 1.8 (1.7-1.9) after one previous hospital stay to 3.0 (2.6-3.5) after five previous hospital stays. The relative risk [95%CI] of death rose slowly from 1.1 (1.07-1.11) after one previous hospital stay to 1.3 (1.1-1.5) after five previous hospital stays. CONCLUSION analyses of the risk of hospital re-admission in older adults must take account of the number of previous hospital stays. The risk of death should also be analysed.
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Affiliation(s)
- Fabien Visade
- University of Lille, EA2694—Evaluation des Technologies de Santé et des Pratiques Médicales, Lille F-59000, France
- Department of Geriatrics, Lille Catholic Hospitals, University of Lille, Lomme F-59160, France
| | - Genia Babykina
- University of Lille, EA2694—Evaluation des Technologies de Santé et des Pratiques Médicales, Lille F-59000, France
| | - Antoine Lamer
- University of Lille, EA2694—Evaluation des Technologies de Santé et des Pratiques Médicales, Lille F-59000, France
| | | | | | - Grégoire Ficheur
- University of Lille, EA2694—Evaluation des Technologies de Santé et des Pratiques Médicales, Lille F-59000, France
| | - Michael Genin
- University of Lille, EA2694—Evaluation des Technologies de Santé et des Pratiques Médicales, Lille F-59000, France
| | - François Puisieux
- University of Lille, EA2694—Evaluation des Technologies de Santé et des Pratiques Médicales, Lille F-59000, France
| | - Jean-Baptiste Beuscart
- University of Lille, EA2694—Evaluation des Technologies de Santé et des Pratiques Médicales, Lille F-59000, France
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Pagès A, Roland C, Qassemi S, Abdeljalil AB, Houles M, Romain M, Toulza O, Belloc A, McCambridge C, Voisin T, Cestac P, Juillard-Condat B. Impact of a Pharmacist-included Mobile Geriatrics team intervention on potentially inappropriate drug prescribing: protocol for a prospective feasibility study (PharMoG study). BMJ Open 2020; 10:e040917. [PMID: 33268421 PMCID: PMC7713213 DOI: 10.1136/bmjopen-2020-040917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION Research has shown that potentially inappropriate drug prescription (PIDP) is highly prevalent in older people. The presence of PIDPs is associated with adverse health outcomes. This study aims to evaluate the impact of a PHARmacist-included MObile Geriatrics (PharMoG) team intervention on PIDPs in older patients hospitalised in the medical, surgical and emergency departments of a university hospital. METHODS AND ANALYSIS The PharMoG study is a prospective, interventional, single-centre feasibility study describing the impact of a PharMoG team on PIDPs in older hospitalised patients. Pharmacist intervention will be a treatment optimisation (clinical medication review) based on a combination of explicit and implicit criteria to detect PIDPs. The primary outcome is the acceptance rate of the mobile team's proposed treatment optimisations related to PIDPs, measured at the patient's discharge from the department. This pharmacist will work in cooperation with the physician of the mobile geriatric team. After the intervention of the mobile geriatric team, the proposals for improving therapy will be sent to the hospital medical team caring for the patient and to the patient's attending physician. The patient will be followed for 3 months after discharge from the hospital. ETHICS AND DISSEMINATION This study was approved by the South-West and Overseas Territories II Ethics Committee. Oral consent must be obtained prior to participation, either from the patient or from the patient's representative (trusted person and/or a family member). The results will be presented at national and international conferences and published in peer-reviewed journals. TRIAL REGISTRATION NUMBER NCT04151797.
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Affiliation(s)
- Arnaud Pagès
- Department of Pharmacy, Toulouse University Hospital, Toulouse, France
- Institute of Aging, Gérontopôle, INSPIRE project, Toulouse University Hospital, Toulouse, France
- Centre for Epidemiology and Population Health Research (CERPOP), UMR 1027, Inserm, University of Toulouse (UPS), Toulouse, France
| | - Christel Roland
- Department of Pharmacy, Toulouse University Hospital, Toulouse, France
| | - Soraya Qassemi
- Department of Pharmacy, Toulouse University Hospital, Toulouse, France
| | | | - Mathieu Houles
- Department of Geriatrics, Toulouse University Hospital, Toulouse, France
| | - Marjolaine Romain
- Department of Geriatrics, Toulouse University Hospital, Toulouse, France
| | - Olivier Toulza
- Department of Geriatrics, Toulouse University Hospital, Toulouse, France
| | - Audrey Belloc
- Department of Research and Innovation, Toulouse University Hospital, Toulouse, France
| | | | - Thierry Voisin
- Centre for Epidemiology and Population Health Research (CERPOP), UMR 1027, Inserm, University of Toulouse (UPS), Toulouse, France
- Department of Geriatrics, Toulouse University Hospital, Toulouse, France
| | - Philippe Cestac
- Department of Pharmacy, Toulouse University Hospital, Toulouse, France
- Centre for Epidemiology and Population Health Research (CERPOP), UMR 1027, Inserm, University of Toulouse (UPS), Toulouse, France
| | - Blandine Juillard-Condat
- Department of Pharmacy, Toulouse University Hospital, Toulouse, France
- Centre for Epidemiology and Population Health Research (CERPOP), UMR 1027, Inserm, University of Toulouse (UPS), Toulouse, France
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17
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Correlation of physical, psychological, and functional factors with independent medication adherence in Korean older adults with chronic illness: Using the 2017 national survey of older Koreans. Arch Gerontol Geriatr 2020; 90:104130. [PMID: 32562957 DOI: 10.1016/j.archger.2020.104130] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Revised: 05/01/2020] [Accepted: 05/23/2020] [Indexed: 12/24/2022]
Abstract
PURPOSE To identify the differences in sight, hearing, cognitive function, depression, and activities of daily living and the relationships between the research variables according to the independent medication adherence of Korean older adults with chronic illness. METHODS Data were taken from the 2017 National Survey of Older Koreans. The sample comprised 8333 household-dwelling participants aged 65 and older, who had one or more chronic diseases. RESULTS Korean older adults were, on average, diagnosed with 3.21 chronic illnesses and taking 4.55 doctor-prescribed medications. There were significant differences in age, education level, living arrangement, perceived subjective health states, number of diagnosed chronic diseases, number of prescription medications being taken, level of discomfort with daily living due to decline in sight and hearing, cognitive function, depression, and levels of activities of daily living according to independent medication adherence. For Korean older adults with independent medication adherence, cognitive function had significant correlations with perceived subjective health states, depression, and daily living activities. For those with partially-dependent or dependent medication adherence, lower cognitive function was associated with greater discomfort due to hearing, and depression had significant correlations with perceived subjective health states, number of prescription medications being taken, and discomfort due to decline in sight and hearing, but significant correlation with level of cognitive function. CONCLUSION Nursing intervention should be planned to enhance the medication adherence of Korean older adults. Specifically, cognitive function, depression, and activities of daily living must be considered along with the patient's health.
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Masnoon N, Shakib S, Kalisch Ellett L, Caughey GE. Predictors of unplanned hospitalisation in the older population: The role of polypharmacy and other medication and chronic disease-related factors. Australas J Ageing 2020; 39:e436-e446. [PMID: 32056359 DOI: 10.1111/ajag.12769] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Revised: 12/19/2019] [Accepted: 12/20/2019] [Indexed: 01/30/2023]
Abstract
OBJECTIVE To identify demographic and medication-related predictors of unplanned hospitalisation and combine them into a hospitalisation risk score. METHODS Patients aged ≥65 years from an outpatient multimorbidity clinic were included. Hospitalisation predictors within a year of clinic discharge were identified using logistic regression. A risk score was developed. The area under the curve (AUC) was used to assess its predictive ability, compared to that of the medicines count (definition of polypharmacy). RESULTS A total of 598 patients were included (median age of 80.0 years). 58.0% (n = 347) were hospitalised within a year of clinic discharge. The AUC for the risk score incorporating age, medicines count, heart failure (HF), atherosclerotic disease and systemic steroids was 0.67 [95% CI 0.62-0.71], compared to 0.62 [95% CI 0.58-0.67] for the medicines count. CONCLUSION A hospitalisation risk score incorporating demographics, medicines, namely steroids, and diseases such as HF had increased predictive ability compared to the medicines count, providing guidance for developing future polypharmacy tools.
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Affiliation(s)
- Nashwa Masnoon
- Quality Use of Medicines and Pharmacy Research Centre, School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, SA, Australia.,Department of Pharmacy, Royal Adelaide Hospital, Adelaide, SA, Australia
| | - Sepehr Shakib
- Discipline of Pharmacology, Adelaide Medical School, University of Adelaide, Adelaide, SA, Australia.,Department of Clinical Pharmacology, Royal Adelaide Hospital, Adelaide, SA, Australia
| | - Lisa Kalisch Ellett
- Quality Use of Medicines and Pharmacy Research Centre, School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, SA, Australia
| | - Gillian E Caughey
- Discipline of Pharmacology, Adelaide Medical School, University of Adelaide, Adelaide, SA, Australia.,Department of Clinical Pharmacology, Royal Adelaide Hospital, Adelaide, SA, Australia.,School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, SA, Australia.,South Australian Health and Medical Research Institute, Adelaide, SA, Australia
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19
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Arai S, Ishikawa T, Kato H, Koshizaka M, Maezawa Y, Nakamura T, Suzuki T, Yokote K, Ishii I. Multidrug use positively correlates with high-risk prescriptions in the Japanese elderly: a longitudinal study. J Pharm Health Care Sci 2019; 5:20. [PMID: 31497309 PMCID: PMC6717964 DOI: 10.1186/s40780-019-0150-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Accepted: 07/29/2019] [Indexed: 12/24/2022] Open
Abstract
Background There is a lack of evidence that multidrug use triggers adverse events. Therefore, the main purpose of this study was to clarify the relationship between the total number of drugs and number of high-risk prescriptions administered to Japanese elderly patients. Methods Using hospital electronic medical records (EMR), we evaluated the prescriptions of outpatients aged 65 years or older. We defined prescriptions of potentially inappropriate medications (PIMs) and overlapping prescription of drugs with the same mechanism of action (DSAs) as high-risk prescriptions. We analyzed the relationship among total number of drugs and high-risk prescriptions. In addition, we performed a secondary research to determine whether the hospitalization rate and concomitant medication contents differ depending on the high-risk prescriptions. Results Data for 13,630 outpatients were analyzed. A significant positive correlation between the numbers of total drugs and PIMs was found. The prescription frequency of individual PIMs rose as the total number of prescription drugs increased. The odds ratio (OR) of overlapping DSAs was significantly higher in patients using 5 or more drugs. In addition, there were significantly more prescriptions of laxatives among patients with overlapping prescriptions of anticholinergic drugs. The use of almost all PIMs was not an independent risk factor for hospitalization; instead, the number of PIMs was an independent risk factor for hospitalization [OR 1.18 (95% CI, 1.12–1.26)]. Conclusions The number of PIMs and overlapping DSAs were high in patients receiving multidrug treatment. To avoid adverse events and hospitalization, it might be useful to review prescriptions and consider the number of PIMs and overlapping DSAs.
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Affiliation(s)
- Sayaka Arai
- 1Pharmacy of Chiba University Hospital, Chiba, Japan.,2Geriatric Medical Center, Chiba University Hospital, 1-8-1 Inohana, Chuo-ku, Chiba City, Chiba, 260-8677 Japan
| | - Takahiro Ishikawa
- 2Geriatric Medical Center, Chiba University Hospital, 1-8-1 Inohana, Chuo-ku, Chiba City, Chiba, 260-8677 Japan.,3Endocrinology, Hematology and Gerontology, Chiba University Graduate School of Medicine, Chiba, Japan.,4Department of Diabetes, Metabolism and Endocrinology, Chiba University Hospital, Chiba, Japan
| | - Hisaya Kato
- 2Geriatric Medical Center, Chiba University Hospital, 1-8-1 Inohana, Chuo-ku, Chiba City, Chiba, 260-8677 Japan.,3Endocrinology, Hematology and Gerontology, Chiba University Graduate School of Medicine, Chiba, Japan.,4Department of Diabetes, Metabolism and Endocrinology, Chiba University Hospital, Chiba, Japan
| | - Masaya Koshizaka
- 3Endocrinology, Hematology and Gerontology, Chiba University Graduate School of Medicine, Chiba, Japan.,4Department of Diabetes, Metabolism and Endocrinology, Chiba University Hospital, Chiba, Japan
| | - Yoshio Maezawa
- 3Endocrinology, Hematology and Gerontology, Chiba University Graduate School of Medicine, Chiba, Japan.,4Department of Diabetes, Metabolism and Endocrinology, Chiba University Hospital, Chiba, Japan
| | | | | | - Koutaro Yokote
- 2Geriatric Medical Center, Chiba University Hospital, 1-8-1 Inohana, Chuo-ku, Chiba City, Chiba, 260-8677 Japan.,3Endocrinology, Hematology and Gerontology, Chiba University Graduate School of Medicine, Chiba, Japan.,4Department of Diabetes, Metabolism and Endocrinology, Chiba University Hospital, Chiba, Japan
| | - Itsuko Ishii
- 1Pharmacy of Chiba University Hospital, Chiba, Japan
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Tevik K, Selbæk G, Engedal K, Seim A, Krokstad S, Helvik AS. Mortality in older adults with frequent alcohol consumption and use of drugs with addiction potential - The Nord Trøndelag Health Study 2006-2008 (HUNT3), Norway, a population-based study. PLoS One 2019; 14:e0214813. [PMID: 30990815 PMCID: PMC6467384 DOI: 10.1371/journal.pone.0214813] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Accepted: 03/20/2019] [Indexed: 12/19/2022] Open
Abstract
Background The aim of this study was to investigate whether frequent drinking, use of drugs with addiction potential and the possible combination of frequent drinking and use of prescribed drugs with addiction potential were associated with all-cause mortality in older adults. Methods We used data from the Nord-Trøndelag Health Study (HUNT3 2006–08), a population-based study in Norway. A total of 11,545 (6,084 women) individuals 65 years and older at baseline participated. We assessed frequent drinking (≥ 4 days a week), occasional drinking (i.e. a few times a year), never drinking and non-drinking in the last year. Drugs with addiction potential were defined as at least one prescription of benzodiazepines, z-hypnotics or opioids during one year for a minimum of two consecutive years between 2005 and 2009. This information was drawn from the Norwegian Prescription Database. The main outcome was all-cause mortality with information drawn from the Norwegian Cause of Death Registry. Follow-up continued until death or latest at 31 December 2013. Logistic regression analyses were used to investigate all-cause mortality since date of study entry and exact age at time of death was unknown. Results The adjusted logistic regression analyses showed that frequent drinking was not associated with all-cause mortality compared to occasional drinking. Men who reported to be never drinkers and non-drinkers in the last year had higher odds of mortality compared to those who drank occasionally. Use of prescribed drugs with addiction potential was associated with increased mortality in men, but not in women. No association was found between the possible combination of frequent drinking and use of prescribed drugs with addiction potential and mortality. Conclusion Neither frequent drinking nor the possible combination of frequent drinking and use of prescribed drugs with addiction potential were associated with all-cause mortality in older women and men. Use of prescribed drugs with addiction potential was associated with higher odds of mortality in men. This finding should lead to more caution in prescribing drugs with addiction potential to this group.
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Affiliation(s)
- Kjerstin Tevik
- Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway
- General Practice Research Unit, Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
- * E-mail:
| | - Geir Selbæk
- Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway
- The Research Centre for Age-related Functional Decline and Disease, Innlandet Hospital Trust, Ottestad, Norway
- Faculty of Medicine, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Knut Engedal
- Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway
- Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway
| | - Arnfinn Seim
- General Practice Research Unit, Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Steinar Krokstad
- HUNT Research Centre, Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, (NTNU), Levanger, Norway
- Psychiatric Department, Levanger Hospital, Nord-Trøndelag Hospital Trust, Levanger, Norway
| | - Anne-S Helvik
- Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway
- General Practice Research Unit, Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
- St. Olavs University Hospital, Sluppen, Trondheim, Norway
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Zhang X, Dou Q, Zhang W, Wang C, Xie X, Yang Y, Zeng Y. Frailty as a Predictor of All-Cause Mortality Among Older Nursing Home Residents: A Systematic Review and Meta-analysis. J Am Med Dir Assoc 2019; 20:657-663.e4. [PMID: 30639171 DOI: 10.1016/j.jamda.2018.11.018] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Revised: 11/09/2018] [Accepted: 11/20/2018] [Indexed: 01/11/2023]
Abstract
OBJECTIVES We performed a meta-analysis based on prospective cohort studies to synthesize the pooled risk effect and to determine whether frailty is a predictor of all-cause mortality. DESIGN Systematic review and meta-analysis. SETTING PubMed, EMBASE, and the Cochrane Library were systematically searched in October 2018. A random effects model was applied to combine the results according to the heterogeneity of the included studies. PARTICIPANTS Older nursing home residents. MEASUREMENTS Mortality risk due to frailty. RESULTS Fourteen studies (9076 participants) were included in this meta-analysis. Pooled results demonstrated that nursing home residents with frailty were at an increased risk of mortality [pooled hazards ratio (HR) = 1.88, 95% confidence interval (CI) = 1.57, 2.25, I2 = 47.8%, P < .001] compared to those without frailty. Results of subgroup analyses showed that frailty was significantly associated with the risk of mortality among older nursing home residents when using FRAIL-NH (pooled HR = 2.10, 95% CI = 1.60-2.77, P < .001) and Frailty Index (pooled HR = 1.74, 95% CI = 1.40-2.18, P < .001) to define frail people, whereas when using the diagnosis criteria of CSHA-CFS for frailty, the pooled HR was 2.82 (95% CI = 0.79-10.10, P = .111). In addition, the subgroup analysis for length of follow-up showed that studies with a follow-up period of 1 year or more (pooled HR = 1.83, 95% CI = 1.52, 2.21, P < .001) reported a significantly higher rate of mortality among individuals with frailty, compared to those without frailty. Similar results were also found in studies with a follow-up period of less than 1 year (pooled HR = 2.67, 95% CI = 1.43, 5.00, P = .002). CONCLUSIONS AND IMPLICATIONS Frailty is a significant predictor of all-cause mortality in older nursing home residents. Therefore, there is an urgent need to screen for frailty in nursing home residents and carry out appropriate multidisciplinary intervention strategies to prevent poor outcomes and reduce the rate of mortality among older nursing home residents.
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Affiliation(s)
- XiaoMing Zhang
- Department of Emergency, The Affiliated Baoan Hospital of Southern Medical University, The People's Hospital of Baoan ShenZhen, Shenzhen, China.
| | - QingLi Dou
- Department of Emergency, The Affiliated Baoan Hospital of Southern Medical University, The People's Hospital of Baoan ShenZhen, Shenzhen, China
| | - WenWu Zhang
- Department of Emergency, The Affiliated Baoan Hospital of Southern Medical University, The People's Hospital of Baoan ShenZhen, Shenzhen, China
| | - CongHua Wang
- Department of Emergency, The Affiliated Baoan Hospital of Southern Medical University, The People's Hospital of Baoan ShenZhen, Shenzhen, China
| | - XiaoHua Xie
- Department of Nursing, The First Affiliated hospital of ShenZhen University, The Second People's Hospital of ShenZhen, Shenzhen, China
| | - YunZhi Yang
- Department of Nursing, The Affiliated Baoan Hospital of Southern Medical University, The People's Hospital of Baoan ShenZhen, Shenzhen, China
| | - YingChun Zeng
- The Third Affiliated Hospital of Guangzhou Medical University, Research Institute of Gynecology & Obstetrics, Guangzhou, China
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22
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Zhang X, Wang C, Dou Q, Zhang W, Yang Y, Xie X. Sarcopenia as a predictor of all-cause mortality among older nursing home residents: a systematic review and meta-analysis. BMJ Open 2018; 8:e021252. [PMID: 30420343 PMCID: PMC6252774 DOI: 10.1136/bmjopen-2017-021252] [Citation(s) in RCA: 76] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVES This study aims to review the evidence of sarcopenia as a predictor of all-cause mortality among nursing home residents. DESIGN Systematic review and meta-analysis of observational cohort studies. DATA SOURCES PubMed, EMBASE and the Cochrane Library databases were searched for relevant articles. PARTICIPANTS Nursing home residents. PRIMARY AND SECONDARY OUTCOME MEASURES All-cause mortality. DATA ANALYSIS Summary-adjusted HRs or risk ratios (RRs) were calculated by fixed-effects model. The risk of bias was assessed by Newcastle-Ottawa Scale. RESULTS Of 2292 studies identified through the systematic review, six studies (1494 participants) were included in the meta-analysis. Sarcopenia was significantly associated with a higher risk for all-cause mortality among nursing home residents (pooled HR 1.86, 95% CI 1.42 to 2.45, p<0.001, I2=0). In addition, the subgroup analysis demonstrated that sarcopenia was associated with all-cause mortality (pooled HR 1.87,95% CI 1.38 to 2.52, p<0.001) when studies with a follow-up period of 1 year or more were analysed; however, this was not found for studies with the follow-up period less than 1 year. Furthermore, sarcopenia was significantly associated with the risk of mortality among older nursing home residents when using bioelectrical impedance analysis to diagnosis muscle mass (pooled HR 1.88, 95% CI 1.39 to 2.53, p<0.001); whereas, it was not found when anthropometric measures were used to diagnosis muscle mass. CONCLUSION Sarcopenia is a significant predictor of all-cause mortality among older nursing home residents. Therefore, it is important to diagnose and treat sarcopenia to reduce mortality rates among nursing home residents. PROSPERO REGISTRATION NUMBER CRD42018081668.
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Affiliation(s)
- Xiaoming Zhang
- Department of Emergency, The Affiliated Baoan Hospital of Southern Medical University, People's Hospital of Baoan Shenzhen, Shenzhen, China
| | - Conghua Wang
- Department of Emergency, The Affiliated Baoan Hospital of Southern Medical University, People's Hospital of Baoan Shenzhen, Shenzhen, China
| | - Qingli Dou
- Department of Emergency, The Affiliated Baoan Hospital of Southern Medical University, People's Hospital of Baoan Shenzhen, Shenzhen, China
| | - Wenwu Zhang
- Department of Emergency, The Affiliated Baoan Hospital of Southern Medical University, People's Hospital of Baoan Shenzhen, Shenzhen, China
| | - Yunzhi Yang
- Department of Nursing, The Affiliated Baoan Hospital of Southern Medical University, People's Hospital of Baoan Shenzhen, Shenzhen, China
| | - Xiaohua Xie
- Department of Nursing, The Affiliated Hospital of Shenzhen University, The Second People's Hospital of Shenzhen, Shenzhen, China
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23
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Ivanova I, Elseviers M, Wettermark B, Schmidt Mende K, Vander Stichele R, Christiaens T. Electronic assessment of cardiovascular potentially inappropriate medications in an administrative population database. Basic Clin Pharmacol Toxicol 2018; 124:62-73. [DOI: 10.1111/bcpt.13095] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Accepted: 07/08/2018] [Indexed: 12/29/2022]
Affiliation(s)
- Ivana Ivanova
- Clinical Pharmacology Research Unit; Heymans Institute of Pharmacology; Ghent University; Ghent Belgium
| | - Monique Elseviers
- Clinical Pharmacology Research Unit; Heymans Institute of Pharmacology; Ghent University; Ghent Belgium
- Centre For Research and Innovation in Care (CRIC); University of Antwerp; Wilrijk Belgium
| | - Bjorn Wettermark
- Public Healthcare Services Committee Administration; Stockholm County Council; Stockholm Sweden
- Department of Medicine; Unit for Clinical Epidemiology; Centre for Pharmacoepidemiology; Karolinska Institutet; Stockholm Sweden
| | - Katharina Schmidt Mende
- Academic Primary Health Care Center; Stockholm County Council; Huddinge Sweden
- Department of Neurobiology, Care Sciences and Society; Division of Family Medicine; Karolinska Institute; Huddinge Sweden
| | - Robert Vander Stichele
- Clinical Pharmacology Research Unit; Heymans Institute of Pharmacology; Ghent University; Ghent Belgium
| | - Thierry Christiaens
- Clinical Pharmacology Research Unit; Heymans Institute of Pharmacology; Ghent University; Ghent Belgium
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Saarelainen L, Tolppanen AM, Koponen M, Tanskanen A, Tiihonen J, Hartikainen S, Taipale H. Risk of death associated with new benzodiazepine use among persons with Alzheimer disease: A matched cohort study. Int J Geriatr Psychiatry 2018; 33:583-590. [PMID: 29143367 DOI: 10.1002/gps.4821] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Accepted: 09/27/2017] [Indexed: 12/25/2022]
Abstract
OBJECTIVE To investigate the risk of death associated with new benzodiazepine and related drug (BZDR) use in a nationwide cohort of persons with Alzheimer disease (AD). METHODS The register-based MEDALZ cohort, including all community-dwelling Finns diagnosed with AD during 2005 to 2011 (n = 70 718), was used. Clinically verified AD diagnoses were obtained from the Special Reimbursement Register. Drug use periods were modeled from BZDR purchases, derived from the Prescription Register. To study new users, persons who had any BZDR use during the year preceding the AD diagnosis were excluded. For each person initiating BZDR use (n = 10 380), 2 nonusers (n = 20 760) were matched on age, gender, and time since AD diagnosis. The outcome was 180-day mortality, and BZDR use was compared with nonuse with Cox regression. Multivariable analyses were adjusted for Charlson comorbidity index, socioeconomic position, hip fractures, psychiatric disorders, substance abuse, stroke, and other psychotropic drug use. RESULTS During the follow-up, 5 excess deaths per 100 person-years occurred during BZDR use in comparison to nonuse, and mortality rates were 13.4 (95% confidence interval [CI], 12.2-14.5) and 8.5 (95% CI, 7.9-9.1), respectively. Benzodiazepine and related drug use was associated with an increased risk of death (adjusted hazard ratio = 1.4 [95% CI, 1.2-1.6]), and the association was significant from the initiation of use. Benzodiazepine use was associated with an increased risk of death, whereas benzodiazepine-related drug use was not. CONCLUSIONS Benzodiazepine and related drug use was associated with an increased risk of death in persons with AD. Our results support treatment guidelines stating that nonpharmacological approaches should be the first-line option for symptomatic treatment of AD.
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Affiliation(s)
- Laura Saarelainen
- Kuopio Research Centre for Geriatric Care, University of Eastern Finland, Kuopio, Finland.,School of Pharmacy, University of Eastern Finland, Kuopio, Finland
| | - Anna-Maija Tolppanen
- School of Pharmacy, University of Eastern Finland, Kuopio, Finland.,Research Centre for Comparative Effectiveness and Patient Safety, University of Eastern Finland, Kuopio, Finland
| | - Marjaana Koponen
- Kuopio Research Centre for Geriatric Care, University of Eastern Finland, Kuopio, Finland.,School of Pharmacy, University of Eastern Finland, Kuopio, Finland
| | - Antti Tanskanen
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.,Impact Assessment Unit, National Institute for Health and Welfare, Helsinki, Finland.,Department of Forensic Psychiatry, Niuvanniemi Hospital, Kuopio, Finland
| | - Jari Tiihonen
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.,Department of Forensic Psychiatry, Niuvanniemi Hospital, Kuopio, Finland.,Stockholm County Council, Stockholm, Sweden
| | - Sirpa Hartikainen
- Kuopio Research Centre for Geriatric Care, University of Eastern Finland, Kuopio, Finland.,School of Pharmacy, University of Eastern Finland, Kuopio, Finland.,Department of Psychiatry, Kuopio University Hospital, Kuopio, Finland
| | - Heidi Taipale
- Kuopio Research Centre for Geriatric Care, University of Eastern Finland, Kuopio, Finland.,School of Pharmacy, University of Eastern Finland, Kuopio, Finland.,Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
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25
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Blain L, Flanagan P. Exploring the practical application of the concept of frailty in pharmacy practice. Can Pharm J (Ott) 2017; 151:13-16. [PMID: 29317931 DOI: 10.1177/1715163517744229] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Affiliation(s)
- Lori Blain
- Abbotsford Home Health (Blain), Abbotsford, Lower Mainland Pharmacy Services, British Columbia
| | - Priti Flanagan
- Abbotsford Home Health (Blain), Abbotsford, Lower Mainland Pharmacy Services, British Columbia
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26
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Leelakanok N, Holcombe AL, Lund BC, Gu X, Schweizer ML. Association between polypharmacy and death: A systematic review and meta-analysis. J Am Pharm Assoc (2003) 2017; 57:729-738.e10. [DOI: 10.1016/j.japh.2017.06.002] [Citation(s) in RCA: 101] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Revised: 05/27/2017] [Accepted: 06/01/2017] [Indexed: 12/30/2022]
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Poier PH, Godke F, Foggiatto JA, Ulbricht L. Development and evaluation of low-cost walker with trunk support for senior citizen. Rev Esc Enferm USP 2017; 51:e03252. [PMID: 29019531 DOI: 10.1590/s1980-220x2016020103252] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2016] [Accepted: 04/24/2017] [Indexed: 12/26/2022] Open
Abstract
OBJECTIVE Develop and evaluate a low-cost walker with trunk support for senior citizens. METHOD Two-stage descriptive study: development of a walker with trunk support and evaluation with fourth age senior citizens. RESULTS Twenty-three fourth age senior citizens were selected. The evaluated criteria were the immediate influence of the walker on the static stabilometry with baropodometer and the evaluation of gait with accelerometers monitoring time and amplitude of the hip movement. There was a significant decrease in the body oscillation of senior citizens with the use of the developed walker, and there were changes in the joint amplitudes of the hip, but they were not significant. CONCLUSION Using low-cost materials, it was possible to develop and equipment that met resistance and effectiveness requirements. The walker interfered in the balance of the senior citizens, reducing significantly the static body oscillation.
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Affiliation(s)
- Paloma Hohmann Poier
- Universidade Tecnológica Federal do Paraná, Programa de Pós Graduação em Engenharia Mecânica e de Materiais, Curitiba, PR, Brazil
| | - Francisco Godke
- Universidade Tecnológica Federal do Paraná, Departamento de Mecânica, Curitiba, PR, Brazil
| | - José Aguiomar Foggiatto
- Universidade Tecnológica Federal do Paraná, Programa de Pós Graduação em Engenharia Mecânica e de Materiais, Curitiba, PR, Brazil
| | - Leandra Ulbricht
- Universidade Tecnológica Federal do Paraná, Programa de Pós-Graduação em Engenharia Biomédica, Curitiba, PR, Brazil
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Wauters M, Klamer T, Elseviers M, Vaes B, Dalleur O, Degryse J, Durán C, Christiaens T, Azermai M, Vander Stichele R. Anticholinergic Exposure in a Cohort of Adults Aged 80 years and Over: Associations of the MARANTE Scale with Mortality and Hospitalization. Basic Clin Pharmacol Toxicol 2017; 120:591-600. [PMID: 27995743 DOI: 10.1111/bcpt.12744] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2016] [Accepted: 12/02/2016] [Indexed: 12/25/2022]
Abstract
Anticholinergics are frequently prescribed for older adults and can lead to adverse drug events. The novel MARANTE (Muscarinic Acetylcholinergic Receptor ANTagonist Exposure) scale measures the anticholinergic exposure by incorporating potency and dosages of each medication into its calculations. The aims were to assess prevalence and intensity of the anticholinergic exposure in a longitudinal cohort study of community-dwelling patients aged 80 years and over (n = 503) and to study the impact on mortality and hospitalization. Chronic medication use at baseline (November 2008-September 2009) was entered and codified with the Anatomical Therapeutic Chemical classification. Time-to-event analysis until first hospitalization or death was performed at 18 months after inclusion, using Kaplan-Meier curves. Cox regression was performed to control for covariates. Mean age was 84 years (range 80-102), and mean number of medications was 5 (range 0-16). Prevalence of anticholinergic use was 31.8%, with 9% taking ≥2 anticholinergics (range 0-4). Main indications for anticholinergics were depression, pain and gastric dysfunction. Female gender, the level of multi-morbidity and the number of medications were associated with anticholinergic use. Mortality and hospitalization rate were 8.9% and 31.0%, respectively. After adjustment for the level of multi-morbidity and medication intake, multi-variable analysis showed increased risks of mortality (HR 2.3, 95% CI: 1.07-4.78) and hospitalization (HR 1.7; 95% CI: 1.13-2.59) in those with high anticholinergic exposure. The longitudinal study among Belgian community-dwelling oldest old demonstrated great anticholinergic exposure, which was associated with increased risk of mortality and hospitalization after 18 months.
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Affiliation(s)
- Maarten Wauters
- Heymans Institute of Pharmacology, Clinical Pharmacology Research Unit, Ghent University, Ghent, Belgium
| | - Therese Klamer
- Division of Pharmacoepidemiology & Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands
| | - Monique Elseviers
- Heymans Institute of Pharmacology, Clinical Pharmacology Research Unit, Ghent University, Ghent, Belgium.,Centre For Research and Innovation in Care (CRIC), University of Antwerp, Wilrijk, Belgium
| | - Bert Vaes
- Department of Public and Primary Health Care, Catholic University of Leuven, Leuven, Belgium.,Institute of Health and Society, Catholic University of Louvain, Louvain-le-Neuve, Brussels, Belgium
| | - Olivia Dalleur
- Institute of Health and Society, Catholic University of Louvain, Louvain-le-Neuve, Brussels, Belgium
| | - Jan Degryse
- Department of Public and Primary Health Care, Catholic University of Leuven, Leuven, Belgium.,Institute of Health and Society, Catholic University of Louvain, Louvain-le-Neuve, Brussels, Belgium
| | - Carlos Durán
- Heymans Institute of Pharmacology, Clinical Pharmacology Research Unit, Ghent University, Ghent, Belgium.,Ecuadorian Center for Clinical Research, Health Information and Assessment (CIEC), Yachay Public Company, Quito, Ecuador
| | - Thierry Christiaens
- Heymans Institute of Pharmacology, Clinical Pharmacology Research Unit, Ghent University, Ghent, Belgium
| | - Majda Azermai
- Heymans Institute of Pharmacology, Clinical Pharmacology Research Unit, Ghent University, Ghent, Belgium
| | - Robert Vander Stichele
- Heymans Institute of Pharmacology, Clinical Pharmacology Research Unit, Ghent University, Ghent, Belgium
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Wauters M, Elseviers M, Vaes B, Degryse J, Dalleur O, Vander Stichele R, Christiaens T, Azermai M. Too many, too few, or too unsafe? Impact of inappropriate prescribing on mortality, and hospitalization in a cohort of community-dwelling oldest old. Br J Clin Pharmacol 2016; 82:1382-1392. [PMID: 27426227 DOI: 10.1111/bcp.13055] [Citation(s) in RCA: 79] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2016] [Revised: 06/09/2016] [Accepted: 06/18/2016] [Indexed: 12/15/2022] Open
Abstract
AIMS Little is known about the impact of inappropriate prescribing (IP) in community-dwelling adults, aged 80 years and older. The prevalence at baseline (November 2008September 2009) and impact of IP (misuse and underuse) after 18 months on mortality and hospitalization in a cohort of community-dwelling adults, aged 80 years and older (n = 503) was studied. METHODS Screening Tool of Older People's Prescriptions (STOPP-2, misuse) and Screening Tool to Alert to Right Treatment (START-2, underuse) criteria were cross-referenced and linked to the medication use (in Anatomical Therapeutic Chemical coding) and clinical problems. Survival analysis until death or first hospitalization was performed at 18 months after inclusion using Kaplan-Meier, with Cox regression to control for covariates. RESULTS Mean age was 84.4 (range 80-102) years. Mean number of medications prescribed was 5 (range 0-16). Polypharmacy (≥5 medications, 58%), underuse (67%) and misuse (56%) were high. Underuse and misuse coexisted in 40% and were absent in 17% of the population. A higher number of prescribed medications was correlated with more misused medications (rs = .51, P < 0.001) and underused medications (rs = .26, P < 0.001). Mortality and hospitalization rate were 8.9%, and 31.0%, respectively. After adjustment for number of medications and misused medications, there was an increased risk of mortality (HR 1.39, 95% CI 1.10, 1.76) and hospitalization (HR 1.26, 95% CI 1.10, 1.45) for every additional underused medication. Associations with misuse were less clear. CONCLUSION IP (polypharmacy, underuse and misuse) was highly prevalent in adults, aged 80 years and older. Surprisingly, underuse and not misuse had strong associations with mortality and hospitalization.
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Affiliation(s)
- Maarten Wauters
- Clinical Pharmacology Research Unit, Ghent University, Heymans Institute of Pharmacology, Ghent.
| | - Monique Elseviers
- Clinical Pharmacology Research Unit, Ghent University, Heymans Institute of Pharmacology, Ghent
| | - Bert Vaes
- Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Louvain Drug Research Institute, Brussels.,Department of Public and Primary Health Care, Catholic University of Leuven, Leuven
| | - Jan Degryse
- Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Louvain Drug Research Institute, Brussels.,Department of Public and Primary Health Care, Catholic University of Leuven, Leuven
| | - Olivia Dalleur
- Clinical Pharmacy Research Group, Louvain Drug Research Institute, Université Catholique de Louvain, Brussels.,Cliniques universitaires Saint-Luc, Université catholique de Louvain, Pharmacy, Brussels, Belgium
| | - Robert Vander Stichele
- Clinical Pharmacology Research Unit, Ghent University, Heymans Institute of Pharmacology, Ghent
| | - Thierry Christiaens
- Clinical Pharmacology Research Unit, Ghent University, Heymans Institute of Pharmacology, Ghent
| | - Majda Azermai
- Clinical Pharmacology Research Unit, Ghent University, Heymans Institute of Pharmacology, Ghent
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