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Zazzara MB, Villani ER, Palmer K, Fialova D, Corsonello A, Soraci L, Fusco D, Cipriani MC, Denkinger M, Onder G, Liperoti R. Frailty modifies the effect of polypharmacy and multimorbidity on the risk of death among nursing home residents: Results from the SHELTER study. Front Med (Lausanne) 2023; 10:1091246. [PMID: 36817789 PMCID: PMC9929152 DOI: 10.3389/fmed.2023.1091246] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Accepted: 01/06/2023] [Indexed: 02/04/2023] Open
Abstract
Background Frailty, disability, and polypharmacy are prevalent in nursing home (NH) residents, often co-occurring with multimorbidity. There may be a complex interplay among them in terms of outcomes such as mortality. Aims of the study were to (i) assess whether nursing home residents with polypharmacy (5-9 medications) or hyperpolypharmacy (≥10 drugs), have an increased risk of death and (ii) whether any association is modified by the co-presence of frailty or disability. Methods Cohort study with longitudinal mortality data including 4,023 residents from 50 European and 7 Israeli NH facilities (mean age = 83.6 years, 73.2% female) in The Services and Health for Elderly in Long Term care (SHELTER) cohort study. Participants were evaluated with the interRAI-LongTerm Care assessment tool. Frailty was evaluated with the FRAIL-NH scale. Hazard ratio (HR) of death over 12 months was assessed with stratified Cox proportional hazards models adjusted for demographics, facilities, and cognitive status. Results 1,042 (25.9%) participants were not on polypharmacy, 49.8% (n = 2,002) were on polypharmacy, and 24.3% (n = 979) on hyperpolypharmacy. Frailty and disability mostly increased risk of death in the study population (frailty: HR = 1.85, 95%CI 1.49-2.28; disability: HR = 2.10, 95%CI 1.86-2.47). Among non-frail participants, multimorbidity (HR = 1.34, 95%CI = 1.01-1.82) and hyperpolypharmacy (HR = 1.61, 95%CI = 1.09-2.40) were associated with higher risk of death. Among frail participants, no other factors were associated with mortality. Polypharmacy and multimorbidity were not associated with mortality after stratification for disability. Conclusions Frailty and disability are the strongest predictors of death in NH residents. Multimorbidity and hyperpolypharmacy increase mortality only in people without frailty. These findings may be relevant to identify patients who could benefit from tailored deprescription.
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Affiliation(s)
- Maria Beatrice Zazzara
- Fondazione Policlinico Universitario A. Gemelli IRCCS (Istituto di Ricovero e Cura a Carattere Scientifico), Polo Interdipartimentale Scienze Dell'Invecchiamento, Neuroscienze, Testa-collo ed Ortopedia, Rome, Italy,*Correspondence: Maria Beatrice Zazzara ✉
| | - Emanuele Rocco Villani
- Università Cattolica del Sacro Cuore, Polo Interdipartimentale Scienze Dell'Invecchiamento, Neuroscienze, Testa-collo ed Ortopedia, Rome, Italy,Emanuele Rocco Villani ✉
| | - Katie Palmer
- Università Cattolica del Sacro Cuore, Polo Interdipartimentale Scienze Dell'Invecchiamento, Neuroscienze, Testa-collo ed Ortopedia, Rome, Italy
| | - Daniela Fialova
- Department of Geriatrics and Gerontology, 1st Faculty of Medicine, Charles University, Prague, Czechia
| | - Andrea Corsonello
- Unit of Geriatric Medicine, IRCCS INRCA (Istituto Nazionale Ricovero e Cura Anziani), Dipartimento di Medicina Interna e Terapia Medica, Cosenza, Italy
| | - Luca Soraci
- Unit of Geriatric Medicine, IRCCS INRCA (Istituto Nazionale Ricovero e Cura Anziani), Dipartimento di Medicina Interna e Terapia Medica, Cosenza, Italy
| | - Domenico Fusco
- Fondazione Policlinico Universitario A. Gemelli IRCCS (Istituto di Ricovero e Cura a Carattere Scientifico), Polo Interdipartimentale Scienze Dell'Invecchiamento, Neuroscienze, Testa-collo ed Ortopedia, Rome, Italy
| | - Maria Camilla Cipriani
- Fondazione Policlinico Universitario A. Gemelli IRCCS (Istituto di Ricovero e Cura a Carattere Scientifico), Polo Interdipartimentale Scienze Dell'Invecchiamento, Neuroscienze, Testa-collo ed Ortopedia, Rome, Italy
| | - Michael Denkinger
- AGAPLESION Bethesda Ulm, Geriatric Research Ulm University and Geriatric Center Ulm/Alb Donau, Ulm, Germany
| | - Graziano Onder
- Fondazione Policlinico Universitario A. Gemelli IRCCS (Istituto di Ricovero e Cura a Carattere Scientifico), Polo Interdipartimentale Scienze Dell'Invecchiamento, Neuroscienze, Testa-collo ed Ortopedia, Rome, Italy,Università Cattolica del Sacro Cuore, Polo Interdipartimentale Scienze Dell'Invecchiamento, Neuroscienze, Testa-collo ed Ortopedia, Rome, Italy
| | - Rosa Liperoti
- Fondazione Policlinico Universitario A. Gemelli IRCCS (Istituto di Ricovero e Cura a Carattere Scientifico), Polo Interdipartimentale Scienze Dell'Invecchiamento, Neuroscienze, Testa-collo ed Ortopedia, Rome, Italy,Università Cattolica del Sacro Cuore, Polo Interdipartimentale Scienze Dell'Invecchiamento, Neuroscienze, Testa-collo ed Ortopedia, Rome, Italy
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A Systematic Review of the Current Evidence from Randomised Controlled Trials on the Impact of Medication Optimisation or Pharmacological Interventions on Quantitative Measures of Cognitive Function in Geriatric Patients. Drugs Aging 2022; 39:863-874. [PMID: 36284081 PMCID: PMC9626423 DOI: 10.1007/s40266-022-00980-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/19/2022] [Indexed: 11/25/2022]
Abstract
Background Cognitive decline is common in older people. Numerous studies point to the detrimental impact of polypharmacy and inappropriate medication on older people’s cognitive function. Here we aim to systematically review evidence on the impact of medication optimisation and drug interventions on cognitive function in older adults. Methods A systematic review was performed using MEDLINE and Web of Science on May 2021. Only randomised controlled trials (RCTs) addressing the impact of medication optimisation or pharmacological interventions on quantitative measures of cognitive function in older adults (aged > 65 years) were included. Single-drug interventions (e.g., on drugs for dementia) were excluded. The quality of the studies was assessed by using the Jadad score. Results Thirteen studies met the inclusion criteria. In five studies a positive impact of the intervention on metric measures of cognitive function was observed. Only one study showed a significant improvement of cognitive function by medication optimisation. The remaining four positive studies tested methylphenidate, selective oestrogen receptor modulators, folic acid and antipsychotics. The mean Jadad score was low (2.7). Conclusion This systematic review identified a small number of heterogenous RCTs investigating the impact of medication optimisation or pharmacological interventions on cognitive function. Five trials showed a positive impact on at least one aspect of cognitive function, with comprehensive medication optimisation not being more successful than focused drug interventions. More prospective trials are needed to specifically assess ways of limiting the negative impact of certain medication in particular and polypharmacy in general on cognitive function in older patients. Supplementary Information The online version contains supplementary material available at 10.1007/s40266-022-00980-9.
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Nissan R, Gezin I, Baha M, Gomon T, Hershkovitz A. Medication regimen complexity index and rehabilitation outcomes in post-acute hip fracture patients study: a retrospective study. Int J Clin Pharm 2022; 44:1361-1369. [PMID: 36198839 DOI: 10.1007/s11096-022-01442-3] [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: 01/17/2022] [Accepted: 06/09/2022] [Indexed: 11/05/2022]
Abstract
BACKGROUND Polypharmacy is a common problem amongst the elderly population. The complexity of the drug regimen refers not only to a simple medication count, but also to the number of daily doses, frequency, and special instructions given for their use. Medication regimen complexity may affect health outcomes, including an increase in hospitalization rates, drug non-adherence, and mortality rates. AIM To assess whether the admission medication regimen complexity index score is associated with rehabilitation outcomes in hip fracture patients; secondary- to assess whether changes in the medication regimen complexity index scores during rehabilitation are associated with rehabilitation outcomes. METHOD A retrospective study of 336 hip fracture patients admitted to a post-acute rehabilitation hospital. Primary rehabilitation outcome was assessed via the discharge functional independence measure score. Secondary outcomes included functional independence measure score changes, length of stay and discharge destination. RESULTS Patients with low admission medication regimen complexity index scores attained significantly higher admission and discharge motor functional independence measure scores (40.1 vs. 37.1, p = 0.044; 57.1 vs. 52.9, p = 0.014, respectively), a higher motor functional independence measure score effectiveness (36.1 vs. 31.3, p = 0.030) and a higher rate of favorable motor functional independence measure effectiveness score (58.1% vs. 42.0%, p = 0.004). A multiple linear regression analysis revealed that the admission medication regimen complexity index score was not associated with the discharge functional independence measure score (standardized coefficient = - 0.058; p = 0.079). CONCLUSION A high medication regimen complexity which usually implies severe comorbidity should not be considered a barrier for the rehabilitation of older patients.
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Affiliation(s)
- Ran Nissan
- Beit Rivka Geriatric Rehabilitation Center, Petach Tikva, Israel
| | - Irridea Gezin
- Beit Rivka Geriatric Rehabilitation Center, Petach Tikva, Israel
| | - Michael Baha
- Rehabilitation Ward, Loewenstein Hospital Rehabilitation Center, Ra'anana, Israel.,Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Tamara Gomon
- Rehabilitation Ward, Loewenstein Hospital Rehabilitation Center, Ra'anana, Israel
| | - Avital Hershkovitz
- Beit Rivka Geriatric Rehabilitation Center, Petach Tikva, Israel. .,Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel.
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Salini S, Giovannini S, Covino M, Barillaro C, Acampora N, Gravina EM, Loreti C, Damiano FP, Franceschi F, Russo A. Frailty Network in an Acute Care Setting: The New Perspective for Frail Older People. Diagnostics (Basel) 2022; 12:diagnostics12051228. [PMID: 35626383 PMCID: PMC9140447 DOI: 10.3390/diagnostics12051228] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 05/10/2022] [Accepted: 05/12/2022] [Indexed: 02/01/2023] Open
Abstract
The incidence of elderly patients who come to the emergency room is progressively increasing. The specialization of the physician units might not be adequate for the evaluation of this complexity. The present study aimed to present a standard procedure, called ‘The Geriatric Frailty Network’, operating at the Policlinico Gemelli IRCCS Foundation, which is configured specifically for the level II assessment of frail elderly patients. This was a retrospective study in 1191 patients aged over 65, who were evaluated by the Geriatric Frailty Unit directly after emergency department admission for one year. All patients underwent multidimensional geriatric evaluation. Data were collected on demographics, co-morbidity, disease severity, and Clinical Frailty Scale. Among all patients, 723 were discharged directly from the emergency room with early identification of continuity of care path. Globally, 468 patients were hospitalized with an early assessment of frailty that facilitated the discharge process. The geriatric frailty network model aims to assist the emergency room and ward doctor in the prevention of the most common geriatric syndromes and reduce the number of incongruous hospitalizations.
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Affiliation(s)
- Sara Salini
- Department of Aging, Neurological, Orthopaedic and Head-Neck Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (C.B.); (N.A.); (E.M.G.); (C.L.); (A.R.)
- Correspondence: (S.S.); (S.G.)
| | - Silvia Giovannini
- Department of Geriatrics and Orthopaedics, Università Cattolica del Sacro Cuore, 00168 Rome, Italy;
- UOS Riabilitazione Post-Acuzie, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
- Correspondence: (S.S.); (S.G.)
| | - Marcello Covino
- Emergency Department, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (M.C.); (F.F.)
- Department of Translational Medicine and Surgery, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Christian Barillaro
- Department of Aging, Neurological, Orthopaedic and Head-Neck Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (C.B.); (N.A.); (E.M.G.); (C.L.); (A.R.)
| | - Nicola Acampora
- Department of Aging, Neurological, Orthopaedic and Head-Neck Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (C.B.); (N.A.); (E.M.G.); (C.L.); (A.R.)
| | - Ester Manes Gravina
- Department of Aging, Neurological, Orthopaedic and Head-Neck Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (C.B.); (N.A.); (E.M.G.); (C.L.); (A.R.)
| | - Claudia Loreti
- Department of Aging, Neurological, Orthopaedic and Head-Neck Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (C.B.); (N.A.); (E.M.G.); (C.L.); (A.R.)
| | - Francesco Paolo Damiano
- Department of Geriatrics and Orthopaedics, Università Cattolica del Sacro Cuore, 00168 Rome, Italy;
| | - Francesco Franceschi
- Emergency Department, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (M.C.); (F.F.)
- Department of Translational Medicine and Surgery, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Andrea Russo
- Department of Aging, Neurological, Orthopaedic and Head-Neck Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (C.B.); (N.A.); (E.M.G.); (C.L.); (A.R.)
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Gokcekuyu BM, Akin S, Kontas EM, Zararsiz GE, Ozer FF, Soysal T, Durmus NS. Validation of the five-item version of the Geriatric Depression Scale (GDS-5) in a Turkish elderly population. Psychogeriatrics 2022; 22:382-390. [PMID: 35332628 DOI: 10.1111/psyg.12827] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 01/15/2022] [Accepted: 03/02/2022] [Indexed: 12/11/2022]
Abstract
BACKGROUND Late-life depression is a geriatric syndrome which should be taken seriously. Many clinical scales have been developed for the screening of geriatric depression. Most of these have been validated at different times and in diverse populations. A five-question version of the Geriatric Depression Scale (GDS-5) was developed in 1997. This test has been validated and used in different populations. In the present study, we plan to validate the GDS-5 for the Turkish elderly population. METHODS Patients aged 60 years and older who applied to the Geriatrics Clinic of our hospital between November 2018 and November 2019 were included in the study. We compared the effectiveness of Yesavage Geriatric Depression Scale-30 (YGDS-30) and GDS-5 in screening depression, based on Diagnostic and Statistical Manual of Mental Disorders Fifth Edition (DSM-5) depression criteria. RESULTS Four hundred participants were included in the study. A significant positive correlation was found between the DSM-5 scale and the GDS-5 scale (rho = 0.726, P <0.001). According to DSM-5, YGDS-30 and GDS-5, 112 participants (28%), 154 patients (%38.5) and 199 patients (%49.8) were diagnosed with depression respectively. When the cut-off value was taken as ≥2, the sensitivity, specificity, positive predictive and negative predictive values for the GDS-5 scale were determined as 96%, 68%, 54%, and 98%, respectively. We obtained these diagnostic measures with 95% confidence intervals. CONCLUSION This study demonstrated the validity and reliability of the GDS-5 for Turkish elderly populations. This five-question scale will be significant in daily use to screen for depression in elderly individuals with multiple problems.
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Affiliation(s)
- Bilge Muge Gokcekuyu
- Division of Geriatrics, Department of Internal Medicine, Erciyes School of Medicine, Erciyes University, Kayseri, Turkey
| | - Sibel Akin
- Division of Geriatrics, Department of Internal Medicine, Erciyes School of Medicine, Erciyes University, Kayseri, Turkey
| | - Eymen Mustafa Kontas
- Department of Internal Medicine, Erciyes School of Medicine, Erciyes University, Kayseri, Turkey
| | - Gozde Erturk Zararsiz
- Department of Biostatistics, Faculty of Medicine, Erciyes University, Kayseri, Turkey
| | - Firuzan Firat Ozer
- Division of Geriatrics, Department of Internal Medicine, Erciyes School of Medicine, Erciyes University, Kayseri, Turkey
| | - Tuba Soysal
- Division of Geriatrics, Department of Internal Medicine, Erciyes School of Medicine, Erciyes University, Kayseri, Turkey
| | - Nurdan Senturk Durmus
- Division of Geriatrics, Department of Internal Medicine, Erciyes School of Medicine, Erciyes University, Kayseri, Turkey
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Oya N, Ayani N, Kuwahara A, Kitaoka R, Omichi C, Sakuma M, Morimoto T, Narumoto J. Over Half of Falls Were Associated with Psychotropic Medication Use in Four Nursing Homes in Japan: A Retrospective Cohort Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19053123. [PMID: 35270813 PMCID: PMC8910089 DOI: 10.3390/ijerph19053123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 03/04/2022] [Accepted: 03/05/2022] [Indexed: 12/10/2022]
Abstract
Medication use can increase the risk of falls and injuries in nursing homes, creating a significant risk for residents. We performed a retrospective cohort study over one year to identify the incidence of drug-related falls with and without injury among four Japanese nursing homes with 280 beds. We evaluated the relationship between potential risk factors for falls and fall-related injuries while considering well-known risks such as ADLs and chronic comorbidities. By collaboratively reviewing care records, we enrolled 459 residents (mean age, 87) and identified 645 falls, including 146 injurious falls and 16 severe injurious falls requiring inpatient care, incidence: 19.5, 4.4, 0.5 per 100 resident-months, respectively. Medication influenced around three-quarters of all falls, >80% of which were psychotropic drugs. Regularly taking ≥5 medications was a risk factor for the initial falls (HR 1.33: CI 1.00−1.77, p = 0.0048) and injuries after falls (OR 2.41: CI 1.30−4.50, p = 0.006). Our findings on the incidence of falls with and without injury were similar to those in Western countries, where the use of psychotropic medication influenced >50% of falls. Discontinuing unnecessary medication use while simultaneously assessing patient ADLs and comorbidities with physicians and pharmacists may help to avoid falls in nursing homes.
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Affiliation(s)
- Nozomu Oya
- Department of Psychiatry, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto 602-8566, Japan; (N.O.); (A.K.); (R.K.); (C.O.); (J.N.)
| | - Nobutaka Ayani
- Department of Psychiatry, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto 602-8566, Japan; (N.O.); (A.K.); (R.K.); (C.O.); (J.N.)
- Department of Psychiatry, Maizuru Medical Center, Kyoto 625-8502, Japan
- Correspondence: ; Tel.: +81-75-251-5612
| | - Akiko Kuwahara
- Department of Psychiatry, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto 602-8566, Japan; (N.O.); (A.K.); (R.K.); (C.O.); (J.N.)
| | - Riki Kitaoka
- Department of Psychiatry, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto 602-8566, Japan; (N.O.); (A.K.); (R.K.); (C.O.); (J.N.)
| | - Chie Omichi
- Department of Psychiatry, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto 602-8566, Japan; (N.O.); (A.K.); (R.K.); (C.O.); (J.N.)
- Department of Psychiatry, Shiga University of Medical Science, Otsu 520-2192, Japan
| | - Mio Sakuma
- Department of Clinical Epidemiology, Hyogo College of Medicine, Nishinomiya 663-8501, Japan; (M.S.); (T.M.)
| | - Takeshi Morimoto
- Department of Clinical Epidemiology, Hyogo College of Medicine, Nishinomiya 663-8501, Japan; (M.S.); (T.M.)
| | - Jin Narumoto
- Department of Psychiatry, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto 602-8566, Japan; (N.O.); (A.K.); (R.K.); (C.O.); (J.N.)
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Villani ER, Fusco D, Franza L, Onder G, Bernabei R, Colloca GF. Characteristics of patients with cancer in European long-term care facilities. Aging Clin Exp Res 2022; 34:671-678. [PMID: 34590240 PMCID: PMC8894167 DOI: 10.1007/s40520-021-01972-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2021] [Accepted: 08/20/2021] [Indexed: 11/30/2022]
Abstract
Purpose Up to 26% of residents in nursing homes (NHs) are affected by cancer. Their care represents a challenge, because NHs are not usually considered a setting focused on oncologic management and care. The aim of this paper is to describe socio-demographic and clinical features of patients with cancer residing in European NHs. Methods Cross-sectional study based on data from the Services and Health for Elderly in Long TERm care (SHELTER) study. Participants were assessed through the interRAI-LTCF, which includes cancer assessment. Results Among 4140 participants (mean age 83.4 years; female 73%), 442 (10.7%) had cancer. Patients with cancer had a higher prevalence of do-not-resuscitate directives compared to those without cancer (21.1% vs 16.5%, p = 0.019). Variables directly associated with cancer were male sex (adj OR 1.67, 95% CI 1.36–2.05), pain (adj OR 1.43, 95% CI 1.16–1.77), fatigue (adj OR 1.25, 95% CI 1.01–1.55), polypharmacy (adj OR 1.59, 95% CI 1.21–2.08) and falls (adj OR. 1.30, 95% CI 1.01–1.67). Dementia was inversely associated with cancer (adj OR 0.74, 95% CI 0.58–0.94). Symptomatic drugs such as opioids (23.5% vs 12.2, p < .001), NSAIDS (7.2% vs 3.9%, p = 0.001), antidepressants (39.1% vs 33.8%, p = 0.026) and benzodiazepines (40.3% vs 34.3, p = 0.012) were all prescribed more in participants with cancer compared to those without cancer. Conclusions Cancer patients are prevalent in European NHs and they show peculiar characteristics. Studies are needed to evaluate the impact of a supportive care approach on the management of NHs residents with cancer throughout all its phases, until the end-of-life care
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Affiliation(s)
- Emanuele Rocco Villani
- Department of Geriatrics, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica Sacro Cuore, Largo Francesco Vito n°8, 00168, Rome, Italy.
| | - Domenico Fusco
- Department of Geriatrics, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica Sacro Cuore, Largo Francesco Vito n°8, 00168, Rome, Italy
| | - Laura Franza
- Department of Emergency Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Graziano Onder
- Department of Geriatrics, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica Sacro Cuore, Largo Francesco Vito n°8, 00168, Rome, Italy
| | - Roberto Bernabei
- Department of Geriatrics, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica Sacro Cuore, Largo Francesco Vito n°8, 00168, Rome, Italy
| | - Giuseppe Ferdinando Colloca
- Department of Geriatrics, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica Sacro Cuore, Largo Francesco Vito n°8, 00168, Rome, Italy
- Dipartimento di Scienze Radiologiche, Radioterapiche ed Ematologiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
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Du L, Koscik RL, Chin NA, Bratzke LC, Cody K, Erickson CM, Jonaitis E, Mueller KD, Hermann BP, Johnson SC. Prescription Medications and Co-Morbidities in Late Middle-Age are Associated with Greater Cognitive Declines: Results from WRAP. FRONTIERS IN AGING 2022; 2:759695. [PMID: 35822000 PMCID: PMC9261362 DOI: 10.3389/fragi.2021.759695] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Accepted: 12/02/2021] [Indexed: 11/13/2022]
Abstract
The present study investigated: 1) sex differences in polypharmacy, comorbidities, self-rated current health (SRH), and cognitive performance, 2) associations between comorbidities, polypharmacy, SRH, and objective measures of health, and 3) associations of these factors with longitudinal cognitive performance. Analyses included 1039 eligible Wisconsin Registry for Alzheimer’s Prevention (WRAP) participants who were cognitively unimpaired at baseline and had ≥2 visits with cognitive composites, self-reported health history, and concurrent medication records. Repeated measures correlation (rmcorr) examined the associations between medications, co-morbidities, SRH, and objective measures of health (including LIfestyle for BRAin Health Index (LIBRA), and depression). Linear mixed-effect models examined associations between medications, co-morbidities, and cognitive change over time using a preclinical Alzheimer’s cognitive composite (PACC3) and cognitive domain z-scores (executive function, working memory, immediate learning, and delayed recall). In secondary analyses, we also examined whether the number of medications interacted with co-morbidities and whether they modified age-related cognitive trajectories. The number of prescribed medications was associated with worse SRH and a higher number of self-reported co-morbidities. More prescribed medications were associated with a faster decline in executive function, and more comorbidities were associated with faster PACC3 decline. Those with a non-elevated number of co-morbidities and medications performed an average of 0.26 SD higher (better) in executive function and an average of 0.18 SD higher on PACC3 than those elevated on both. Associations between medications, co-morbidities, and executive function, and PACC3 suggest that persons with more co-morbidities and medications may be at increased risk of reaching clinical levels of impairment earlier than healthier, less medicated peers.
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Affiliation(s)
- Lianlian Du
- Wisconsin Alzheimer’s Institute, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, United States
- Department of Biostatistics and Medical Informatics, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, United States
| | - Rebecca Langhough Koscik
- Wisconsin Alzheimer’s Institute, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, United States
- Wisconsin Alzheimer’s Disease Research Center, Madison, WI, United States
- Department of Medicine, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, United States
- *Correspondence: Rebecca Langhough Koscik,
| | - Nathaniel A. Chin
- Wisconsin Alzheimer’s Disease Research Center, Madison, WI, United States
- Department of Medicine, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, United States
| | - Lisa C. Bratzke
- School of Nursing, University of Wisconsin—Madison, Madison, WI, United States
| | - Karly Cody
- Wisconsin Alzheimer’s Institute, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, United States
- Wisconsin Alzheimer’s Disease Research Center, Madison, WI, United States
- Department of Medicine, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, United States
| | - Claire M. Erickson
- Wisconsin Alzheimer’s Institute, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, United States
- Wisconsin Alzheimer’s Disease Research Center, Madison, WI, United States
- Department of Medicine, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, United States
| | - Erin Jonaitis
- Wisconsin Alzheimer’s Institute, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, United States
- Wisconsin Alzheimer’s Disease Research Center, Madison, WI, United States
- Department of Medicine, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, United States
| | - Kimberly D. Mueller
- Wisconsin Alzheimer’s Institute, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, United States
- Wisconsin Alzheimer’s Disease Research Center, Madison, WI, United States
- Department of Medicine, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, United States
- Department of Communication Sciences & Disorders, University of Wisconsin—Madison, Madison, WI, United States
| | - Bruce P. Hermann
- Wisconsin Alzheimer’s Institute, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, United States
- Department of Neurology, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, United States
| | - Sterling C. Johnson
- Wisconsin Alzheimer’s Institute, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, United States
- Wisconsin Alzheimer’s Disease Research Center, Madison, WI, United States
- Department of Medicine, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, United States
- Madison VA GRECC, William S. Middleton Memorial Hospital, Madison, WI, United States
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Potentially inappropriate medication prescribing among elderly patients with cardiovascular diseases. VOJNOSANIT PREGL 2022. [DOI: 10.2298/vsp200623118s] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Background/Aim. The growing number of older adults means higher medicine utilization. The aim of the study was to determine the frequency and identify risk factors of potentially inappropriate medication (PIM) in the elderly population with cardiovascular diseases. Methods. The retrospective, cross-sectional study was performed in 2018, and the relevant data were collected during the period from January 2016 to December 2017. The study sample included 1,500 patients over 65 years with cardiovascular disease who had medical records at the Institute for Gerontology and Palliative Care, Belgrade. Assessment of PIM was done by standard international criteria such as the American Geriatrics Society 2015 updated Beers Criteria for PIM use in older adults. Results. PIM frequency in the elderly population was 70.3%. In relation to gender, it was more frequent in female elders. The mean number of prescribed drugs was similar for 2016 and 2017, 7.2 and 7.3, respectively. The most common were: medium-acting benzodiazepines (70.9%), central ? blockers (23.98%), and antipsychotics (typical and atypical) (20.94%). The most common comorbidity was noted in a group labeled with the International Disease Classification I00-I99, which includes heart and blood vessel diseases [n = 2,658 (36.9%)]. The most common diagnoses belonged to the subgroups I10-I15 [hypertensive diseases, n = 1,298 (18%)], I20-I25 [ischemic heart diseases n = 542 (7.5%)], I30-I52 [other forms of heart disease, n = 705 (9.8%)], I60-I69 [cerebrovascular diseases, n = 94 (1.3%)], and I80- I89 [diseases of veins, lymph vessels, and lymph nodes n = 12 (0.17%)]. The risk factors for PIM were: polypharmacy, gender, nicotine use, cognitive status, nutrition state, and the number of diseases registered in the study sample. Conclusion. Cardiovascular diseases in the elderly population are associated with a high prevalence of PIM. Creating health recommendations for prescribing drugs to the elderly that would emphasize these factors could reduce the prevalence of PIM in this population.
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Relationship between frailty and drug use among nursing homes residents: results from the SHELTER study. Aging Clin Exp Res 2021; 33:2839-2847. [PMID: 33590468 DOI: 10.1007/s40520-021-01797-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Accepted: 01/13/2021] [Indexed: 12/28/2022]
Abstract
BACKGROUND 1.5-8% of older adults live in nursing homes (NHs), presenting a high prevalence of frailty and polypharmacy. AIMS To investigate the association of frailty with polypharmacy and drug prescription patterns in a sample of European Nursing Home (NH) residents. METHODS Cross-sectional study based on the data from the Services and Health for Elderly in Long TERm care (SHELTER) study. 4121 NH residents in Europe and Israel. Residents' clinical, cognitive, social, and physical status were evaluated with the InterRAI LTCF tool, which allows comprehensive, standardized evaluation of persons living in NH. Polypharmacy and hyperpolypharmacy were defined as the concurrent use of ≥ 5 and ≥ 10 medications. Frailty was defined according to the FRAIL-NH scale. RESULTS Of 4121 participants, 46.6% were frail (mean age 84.6 ± 9.2 years; 76.4% female). Polypharmacy and hyperpolypharmacy were associated with a lower likelihood of frailty (Odds Ratio = 0.72; 95% CI = 0.59-0.87 and OR = 0.75; 95% CI = 0.60-0.94, respectively). Patterns of drug prescriptions were different between frail and non-frail residents. Symptomatic drugs (laxatives, paracetamol, and opioids) were more frequently prescribed among frail residents, while preventive drugs (bisphosphonates, vitamin D, and acetylsalicylic acid) were more frequently prescribed among non-frail residents. CONCLUSIONS Frailty is associated with less polypharmacy and with higher prevalence of symptomatic drugs use among NH residents. Further studies are needed to define appropriateness of drug prescription in frail individuals.
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Physical Performance in Older Cohorts: A Comparison of 81-Year-Old Swedish Men and Women Born Twelve Years Apart-Results from the Swedish Study "Good Aging in Skåne". J Aging Res 2021; 2021:8813992. [PMID: 34194845 PMCID: PMC8203370 DOI: 10.1155/2021/8813992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 02/11/2021] [Accepted: 05/26/2021] [Indexed: 11/19/2022] Open
Abstract
Materials and Methods Birth cohorts of both sexes drawn from the Swedish study “Good Aging in Skåne” for the years 1920–22 and 1932–34 were compared. Walking, the step test, the chair stand test, and the handgrip strength test were used as proxies for the physical performance. The results were adjusted for lifestyle habits and common chronic geriatric diseases. Results Both men and women in the later-born cohort walked more quickly and completed the chair stand test faster, and women were also quicker in the step test. No significant differences were found in the grip test, in either the male or female cohorts. Discussion. Normative reference values for physical tests of subjects of different ages can be misleading unless cohort effects are considered. Furthermore, age-related trajectories can also be misinterpreted if cohort effects are neglected which, in the longer perspective, could affect health care planning. Conclusion Birth cohort effects should be considered when comparing walking speed, number of steps, chair stands, and the step test, in men and women of older age.
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Iduye S, Risling T, McKibbon S, Iduye D. Optimizing the InterRAI Assessment Tool in Care Planning Processes for Long-Term Residents: A Scoping Review. Clin Nurs Res 2021; 31:5-19. [PMID: 34056955 PMCID: PMC8652361 DOI: 10.1177/10547738211020373] [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] [Indexed: 11/16/2022]
Abstract
The aim of this review was to chart and report on existing literature that discusses how the interRAI assessment tool drives care-planning processes for residents in long-term-care settings. This scoping review was informed by the Joanna Briggs Institute guidelines for scoping reviews and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews guideline. Relevant studies were obtained from databases search of CINAHL (EBSCO), MEDLINE (Ovid), PsycINFO (EBSCO), Academic Search Premier (EBSCO), Embase (Elsevier), ProQuest Nursing and Allied Health Database (ProQuest), Sociological Abstracts (ProQuest), and Social Services Abstracts (ProQuest). Of the 17 included studies, five (29.4%) addressed interRAI’s minimum dataset component as a clinical data-collection tool; five (29.4%) addressed interRAI’s assessment scales and its clinical-assessment protocols as viable health-assessment tools; four (23.5%) considered interRAI’s assessment scales in terms of whether this tool is capable of predicting residents’ health risks; one (5.9%) addressed the effects of interRAI’s care plans on residents’ health outcomes; and the remaining two studies (11.8%) used interRAI’s quality-indicator function for both the performance of and improvements in the quality of care. The scoping review finds that there is no substantial evidence that supports the implementation of interRAI care plans for consistent health outcomes.
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Affiliation(s)
- Steve Iduye
- University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Tracie Risling
- University of Saskatchewan, Saskatoon, Saskatchewan, Canada
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Aljeaidi MS, Tan EC. The association between polypharmacy and cognitive ability in older adults: A national cohort study. Res Social Adm Pharm 2021; 18:2505-2509. [PMID: 33985890 DOI: 10.1016/j.sapharm.2021.04.018] [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: 01/13/2021] [Revised: 04/16/2021] [Accepted: 04/20/2021] [Indexed: 01/08/2023]
Abstract
BACKGROUND Polypharmacy, the use of multiple medications by one individual, may be associated with adverse health outcomes including poor cognition. However, it remains unclear whether a longitudinal relationship exists. OBJECTIVES To investigate the association between polypharmacy and 3-year cognitive ability in older adults. METHODS A longitudinal cohort study of older adults 65 years and older, residing in the community, who participated in waves 12 (2012), 13 (2013) and 16 (2016) of the Household Income and Labour Dynamics (HILDA) Survey was conducted. Polypharmacy was defined as the regular use of 5 or more prescription medications. Cognitive ability was assessed using backwards digit span test (BDS), 25-item version of the National Adult Reading Test (NART-25) and symbol-digit modalities test (SDM). Linear regression was used to test the longitudinal association between polypharmacy and cognitive test scores at 3 years. All analyses were adjusted for age, sex, education, comorbidities, socioeconomic and lifestyle factors, and baseline cognitive test scores. RESULTS A total of 2141 participants (mean age 72.9 years, 54.4% female) were included in the study sample. Polypharmacy was present in 27.3%. After adjusting for potential confounders, polypharmacy was negatively associated with cognitive ability at 3 years: BDS: -0.067 (95% CI = -0.353 to -0.051), NART-25: -0.071 (95% CI = -1.428 to -0.294), SDM: -0.073 (95% CI = -2.960 to -0.696). CONCLUSION Polypharmacy was associated with poorer cognitive ability at 3 years, even after adjusting for comorbidities and other confounders. Future research should consider the long-term impact of polypharmacy on cognitive ability, and identify strategies to optimise medication use and cognition in older adults.
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Affiliation(s)
- Muhamad S Aljeaidi
- Medical School, The University of Western Australia, Perth, WA, Australia
| | - Edwin Ck Tan
- The University of Sydney, Faculty of Medicine and Health, School of Pharmacy, Sydney, Australia; Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, Australia; Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden; Stress Research Institute, Department of Psychology, Stockholm University, Stockholm, Sweden. https://twitter.com/edwincktan
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High-resolution ultrasound changes of the vagus nerve in idiopathic Parkinson's disease (IPD): a possible additional index of disease. Neurol Sci 2021; 42:5205-5211. [PMID: 33821361 PMCID: PMC8642255 DOI: 10.1007/s10072-021-05183-5] [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: 01/28/2021] [Accepted: 03/13/2021] [Indexed: 12/13/2022]
Abstract
Background and rationale Histopathological studies revealed degeneration of the dorsal motor nucleus of the vagus nerve (VN) early in the course of idiopathic Parkinson’s disease (IPD). Degeneration of VN axons should be detectable by high-resolution ultrasound (HRUS) as a thinning of the nerve trunk. In order to establish if the VN exhibits sonographic signs of atrophy in IPD, we examined patients with IPD compared with age-matched controls. Material and methods We measured the caliber (cross-sectional area, CSA) and perimeter of the VN in 20 outpatients with IPD (8 females and 12 males; mean age 73.0 + 8.6 years) and in age-matched controls using HRUS. Evaluation was performed by blinded raters using an Esaote MyLab Gamma device in conventional B-Mode with an 8–19 MHz probe. Results In both sides, the VN CSA was significantly smaller in IPD outpatients than in controls (right 2.37 + 0.91, left 1.87 + 1.35 mm2 versus 6.0 + 1.33, 5.6 + 1.26 mm2; p <0.001), as well as the perimeter (right 5.06 + 0.85, left 4.78 + 1.74 mm versus 8.87 + 0.86, 8.58 + 0.97 mm; p <0.001). There were no significant correlations between VN CSA and age, the Hoehn and Yahr scale, L-dopa therapy, and disease duration. Conclusion Our findings provide evidence of atrophy of the VNs in IPD patients by HRUS. Moreover, HRUS of the VN represent a non-invasive easy imaging modality of screening in IPD patients independent of disease stage and duration and an interesting possible additional index of disease.
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Giovannini S, Coraci D, Brau F, Galluzzo V, Loreti C, Caliandro P, Padua L, Maccauro G, Biscotti L, Bernabei R. Neuropathic Pain in the Elderly. Diagnostics (Basel) 2021; 11:diagnostics11040613. [PMID: 33808121 PMCID: PMC8066049 DOI: 10.3390/diagnostics11040613] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 03/18/2021] [Accepted: 03/25/2021] [Indexed: 02/06/2023] Open
Abstract
Neuropathic pain due to a lesion or a disease of the somatosensory system often affects older people presenting several comorbidities. Moreover, elderly patients are often poly-medicated, hospitalized and treated in a nursing home with a growing risk of drug interaction and recurrent hospitalization. Neuropathic pain in the elderly has to be managed by a multidimensional approach that involves several medical, social and psychological professionals in order to improve the quality of life of the patients and, where present, their relatives.
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Affiliation(s)
- Silvia Giovannini
- Department of Aging, Neurological, Orthopaedic and Head-Neck Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy; (D.C.); (F.B.); (V.G.); (C.L.); (P.C.); (L.P.); (G.M.); (L.B.); (R.B.)
- Correspondence: ; Tel.: +39-063015-4341
| | - Daniele Coraci
- Department of Aging, Neurological, Orthopaedic and Head-Neck Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy; (D.C.); (F.B.); (V.G.); (C.L.); (P.C.); (L.P.); (G.M.); (L.B.); (R.B.)
- Department of Neurosciences, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Fabrizio Brau
- Department of Aging, Neurological, Orthopaedic and Head-Neck Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy; (D.C.); (F.B.); (V.G.); (C.L.); (P.C.); (L.P.); (G.M.); (L.B.); (R.B.)
- Department of Geriatrics and Orthopaedics, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Vincenzo Galluzzo
- Department of Aging, Neurological, Orthopaedic and Head-Neck Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy; (D.C.); (F.B.); (V.G.); (C.L.); (P.C.); (L.P.); (G.M.); (L.B.); (R.B.)
- Department of Geriatrics and Orthopaedics, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Claudia Loreti
- Department of Aging, Neurological, Orthopaedic and Head-Neck Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy; (D.C.); (F.B.); (V.G.); (C.L.); (P.C.); (L.P.); (G.M.); (L.B.); (R.B.)
| | - Pietro Caliandro
- Department of Aging, Neurological, Orthopaedic and Head-Neck Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy; (D.C.); (F.B.); (V.G.); (C.L.); (P.C.); (L.P.); (G.M.); (L.B.); (R.B.)
| | - Luca Padua
- Department of Aging, Neurological, Orthopaedic and Head-Neck Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy; (D.C.); (F.B.); (V.G.); (C.L.); (P.C.); (L.P.); (G.M.); (L.B.); (R.B.)
- Department of Geriatrics and Orthopaedics, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Giulio Maccauro
- Department of Aging, Neurological, Orthopaedic and Head-Neck Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy; (D.C.); (F.B.); (V.G.); (C.L.); (P.C.); (L.P.); (G.M.); (L.B.); (R.B.)
- Department of Geriatrics and Orthopaedics, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Lorenzo Biscotti
- Department of Aging, Neurological, Orthopaedic and Head-Neck Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy; (D.C.); (F.B.); (V.G.); (C.L.); (P.C.); (L.P.); (G.M.); (L.B.); (R.B.)
- Presiding Officer of Geriatric Care Promotion and Development Centre (C.E.P.S.A.G), Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Roberto Bernabei
- Department of Aging, Neurological, Orthopaedic and Head-Neck Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy; (D.C.); (F.B.); (V.G.); (C.L.); (P.C.); (L.P.); (G.M.); (L.B.); (R.B.)
- Department of Geriatrics and Orthopaedics, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
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Pazan F, Wehling M. Polypharmacy in older adults: a narrative review of definitions, epidemiology and consequences. Eur Geriatr Med 2021; 12:443-452. [PMID: 33694123 PMCID: PMC8149355 DOI: 10.1007/s41999-021-00479-3] [Citation(s) in RCA: 131] [Impact Index Per Article: 43.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2020] [Accepted: 02/25/2021] [Indexed: 12/22/2022]
Abstract
BACKGROUND The number of older adults has been constantly growing around the globe. Consequently, multimorbidity and related polypharmacy have become an increasing problem. In the absence of an accepted agreement on the definition of polypharmacy, data on its prevalence in various studies are not easily comparable. Besides, the evidence on the potential adverse clinical outcomes related to polypharmacy is limited though polypharmacy has been linked to numerous adverse clinical outcomes. This narrative review aims to find and summarize recent publications on definitions, epidemiology and clinical consequences of polypharmacy. METHODS The MEDLINE database was used to identify recent publications on the definition, prevalence and clinical consequences of polypharmacy using their respective common terms and their variations. Systematic reviews and original studies published between 2015 and 2020 were included. RESULTS One hundred and forty-three definitions of polypharmacy and associated terms were found. Most of them are numerical definitions. Its prevalence ranges from 4% among community-dwelling older people to over 96.5% in hospitalized patients. In addition, numerous adverse clinical outcomes were associated with polypharmacy. CONCLUSION The term polypharmacy is imprecise, and its definition is yet subject to an ongoing debate. The clinically oriented definitions of polypharmacy found in this review such as appropriate or necessary polypharmacy are more useful and relevant. Regardless of the definition, polypharmacy is highly prevalent in older adults, particularly in nursing home residents and hospitalized patients. Approaches to increase the appropriateness of polypharmacy can improve clinical outcomes in older adults.
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Affiliation(s)
- Farhad Pazan
- Clinical Pharmacology Mannheim, Medical Faculty Mannheim, Ruprecht-Karls-Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Martin Wehling
- Clinical Pharmacology Mannheim, Medical Faculty Mannheim, Ruprecht-Karls-Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany.
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Gerreth P, Gerreth K, Maciejczyk M, Zalewska A, Hojan K. Is an Oral Health Status a Predictor of Functional Improvement in Ischemic Stroke Patients Undergoing Comprehensive Rehabilitation Treatment? Brain Sci 2021; 11:brainsci11030338. [PMID: 33799980 PMCID: PMC8002018 DOI: 10.3390/brainsci11030338] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2020] [Revised: 03/02/2021] [Accepted: 03/04/2021] [Indexed: 01/07/2023] Open
Abstract
The study's aim was a clinical observation concerning the influence of oral health on functional status in stroke patients undergoing neurorehabilitation. This pilot cross-sectional clinical study was performed in 60 subacute phase stroke patients during 12 weeks of treatment. The program was patient-specific and consisted of neurodevelopmental treatment by a comprehensive rehabilitation team. The functional assessment was performed using the Barthel index (BI), Berg balance scale (BBS), functional independence measure (FIM), and Addenbrooke's cognitive examination III (ACE III) scales. Oral health was assessed according to World Health Organization (WHO) criteria, and it was presented using DMFT, DMFS, gingival index (GI), and plaque index (PlI). Significant improvement in many functional scales was noticed. However, important differences in most dental parameters without relevant changes in GI and PlI after the study were not observed. Reverse interdependence (p < 0.05) was shown between physical functioning (BI, FIM, or BBS) with GI and PlI results, and most dental parameters correlated with ACE III. Using multivariate regression analysis, we showed that ACE III and BI are predictive variables for DMFT, just as FIM is for DS (p < 0.05). The present research revealed that poor oral health status in patients after stroke might be associated with inpatient rehabilitation results.
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Affiliation(s)
- Piotr Gerreth
- Private Dental Practice, 57 Kasztelanska Street, 60-316 Poznan, Poland;
- Postgraduate Studies in Scientific Research Methodology, Poznan University of Medical Sciences, 10 Fredry Street, 60-701 Poznan, Poland
| | - Karolina Gerreth
- Department of Risk Group Dentistry, Chair of Pediatric Dentistry, Poznan University of Medical Sciences, 70 Bukowska Street, 60-812 Poznan, Poland;
| | - Mateusz Maciejczyk
- Department of Hygiene, Epidemiology and Ergonomics, Medical University of Bialystok, 2C Adama Mic kiewicza Street, 15-022 Bialystok, Poland;
| | - Anna Zalewska
- Experimental Dentistry Laboratory, Medical University of Bialystok, 24A Marii Sklodowskiej-Curie Street, 15-276 Bialystok, Poland;
| | - Katarzyna Hojan
- Department of Occupational Therapy, Poznan University of Medical Sciences, 6 Swiecickiego Street, 60-781 Poznan, Poland
- Department of Rehabilitation, Greater Poland Cancer Centre, 15 Garbary Street, 61-866 Poznan, Poland
- Correspondence:
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Parkinson's disease and virtual reality rehabilitation: cognitive reserve influences the walking and balance outcome. Neurol Sci 2021; 42:4615-4621. [PMID: 33661481 DOI: 10.1007/s10072-021-05123-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Accepted: 02/05/2021] [Indexed: 10/22/2022]
Abstract
INTRODUCTION Parkinson's disease (PD) is a neurodegenerative pathology characterized by motor and non-motor symptoms that often lead to several impairments. Many studies show the efficacy of different rehabilitation protocols aimed to improve balance and gait functions in PD patients. However, multiple factors may influence rehabilitation outcome. Recently, it has been observed as the cognitive reserve (CR) may influence the rehabilitation outcome, helping to address the patient toward technological or conventional rehabilitation. Our study investigated how CR may affect motor rehabilitation outcomes in PD patients who undergo virtual reality (VR) rehabilitation, aimed at improving walking and balance. MATERIALS AND METHODS Thirty patients affected by idiopathic PD were enrolled. Patients underwent 12 sessions VR training, over 6 weeks (45 min). Six-Minute Walk Test (6MWT) and Berg Balance Scale (BBS) were used to assess walking and balance, respectively. CR was assessed by Cognitive Reserve Index questionnaire (CRIq). RESULTS Significant correlations between CR and change from baseline in walking and balance measures were found, with a significant positive correlation between CRIq and 6MWT (r=0.50, p=0.01) and between CRIq and BBS (r=0.41, p=0.04). DISCUSSION Our results showed that PD patients with higher CR treated with VR improved significantly more in their balance and walking distance than those with lower CR. The current study suggests that VR when aimed to improve balance and walking in PD patients is more effective in patients with higher CR.
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Shibasaki K, Asahi T, Kuribayashi M, Tajima Y, Marubayashi M, Iwama R, Akishita M, Ogawa S. Potential prescribing omissions of anti-osteoporosis drugs is associated with rehabilitation outcomes after fragility fracture: Retrospective cohort study. Geriatr Gerontol Int 2021; 21:386-391. [PMID: 33641245 DOI: 10.1111/ggi.14145] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Revised: 01/11/2021] [Accepted: 02/14/2021] [Indexed: 12/18/2022]
Abstract
AIM We investigated the association between rehabilitation outcomes and polypharmacy, potentially inappropriate medications and potential prescribing omissions in older adults with fragility fractures. METHODS In total, we registered 217 older adults with fragility fractures (hip or vertebral) retrospectively and examined the association between rehabilitation outcome and polypharmacy, potentially inappropriate medications and potential prescribing omissions. Polypharmacy was defined as five or more drugs. Potentially inappropriate medications and potential prescribing omissions were defined by the Beers criteria (2015) and the screening tool to alert to treatment criteria version 2, respectively. The outcome was functional independence measure gain (functional independence measure at discharge - functional independence measure at admission). RESULTS Multiple regression analyses revealed no association between functional independence measure gain and polypharmacy (crude: β = 0.058, P = 0.858; adjusted model: β = 0.013, P = 0.869) or potentially inappropriate medications (crude: β = 0.100, P = 0.144; adjusted model: β = 0.084, P = 0.260). However, there was a significant association between functional independence measure gain and potential prescribing omissions (crude: β = 0.167, P = 0.014; adjusted model: β = 0.180, P = 0.016). Participants without potential prescribing omissions (in other words, participants who were prescribed anti-osteoporosis drugs) had a greater functional independence measure gain than participants with potential prescribing omissions (in other words, those that were not prescribed anti-osteoporosis drugs). CONCLUSION To the best of our knowledge, this study is the first to report that participants without potential prescribing omissions had significantly improved rehabilitation outcomes. Geriatr Gerontol Int 2021; 21: 386-391.
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Affiliation(s)
- Koji Shibasaki
- Department of Rehabilitation Medicine, Asahi Neurology and Rehabilitation Hospital, Matsudo City, Japan.,Department of Geriatric Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Toshiomi Asahi
- Department of Rehabilitation Medicine, Asahi Neurology and Rehabilitation Hospital, Matsudo City, Japan
| | - Mari Kuribayashi
- Department of Rehabilitation Medicine, Asahi Neurology and Rehabilitation Hospital, Matsudo City, Japan
| | - Yuriko Tajima
- Department of Rehabilitation Medicine, Asahi Neurology and Rehabilitation Hospital, Matsudo City, Japan
| | - Miki Marubayashi
- Department of Rehabilitation Medicine, Asahi Neurology and Rehabilitation Hospital, Matsudo City, Japan
| | - Risa Iwama
- Department of Rehabilitation Medicine, Asahi Neurology and Rehabilitation Hospital, Matsudo City, Japan
| | - Masahiro Akishita
- Department of Geriatric Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Sumito Ogawa
- Department of Geriatric Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
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Coraci D, Loreti C, Fusco A, Giovannini S, Padua L. Peripheral Neuropathies Seen by Ultrasound: A Literature Analysis through Lexical Evaluation, Geographical Assessment and Graph Theory. Brain Sci 2021; 11:113. [PMID: 33467095 PMCID: PMC7829799 DOI: 10.3390/brainsci11010113] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 01/08/2021] [Accepted: 01/13/2021] [Indexed: 01/12/2023] Open
Abstract
(1) Background: Ultrasound is a well-known tool used for the diagnosis and management of many diseases, including peripheral neuropathies. The main aim of this study was the lexical analysis of the literature on this topic considering the most cited words and the relationship between the words and the papers. Furthermore, a geographical analysis was performed to evaluate the worldwide prevalence. (2) Methods: We performed a literature search on PubMed, and we calculated the occurrence of the words indicating nerves and the body parts. Furthermore, we calculated the number of papers for each country, considering the affiliation of the first author. Finally, to describe the relationships between the words and the papers, we used the 30 most cited words, and we built a matrix describing in which papers a word was cited. This matrix was used to create a network based on the graph theory using Gephi 0.9.2 software. (3) Results: The most cited nerves were median and ulnar ones, and the most cited body parts were hand, wrist and elbow. The United States of America was the most productive country, with 80 papers. The graph of the network showed the importance of ultrasound as support for therapy. (4) Conclusions: The study represents a lexical analysis of the literature and shows information about subjects, authors and relationships of the papers. This may be helpful for better understanding and evaluation of the situation of the current literature.
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Affiliation(s)
- Daniele Coraci
- UOC Neuroriabilitazione ad Alta Intensità, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (D.C.); (C.L.); (A.F.)
- Department of Neurosciences, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Claudia Loreti
- UOC Neuroriabilitazione ad Alta Intensità, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (D.C.); (C.L.); (A.F.)
| | - Augusto Fusco
- UOC Neuroriabilitazione ad Alta Intensità, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (D.C.); (C.L.); (A.F.)
| | - Silvia Giovannini
- UOC Riabilitazione e Medicina Fisica, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy;
| | - Luca Padua
- UOC Neuroriabilitazione ad Alta Intensità, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (D.C.); (C.L.); (A.F.)
- Department of Orthopaedics and Geriatrics, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
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Moser AD, Hembecker PK, Nakato AM. Relationship between functional capacity, nutritional status and sociodemographic variables of institutionalized older adults. REVISTA BRASILEIRA DE GERIATRIA E GERONTOLOGIA 2021. [DOI: 10.1590/1981-22562021024.210211.en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Abstract Objective To analyze the relationship between functional capacity, nutritional status, and sociodemographic variables of older adults living in long-term care facilities. Method This is a cross-sectional study conducted with 82 institutionalized older adults. For data collection, we used the Barthel Index to assess the degree of independence in the performance of basic activities of daily living and the Mini Nutritional Assessment (MNA) to assess the nutritional status of older adults. Data were collected in five geriatric long-term care facilities located in southern Brazil. Ordinal regression analyses were performed to identify associations between contextual social factors, and nutritional status with the functional capacity of institutionalized older adults. Results Most participants showed complete independence in performing activities of daily living (39.0%) and poor nutritional status (59.8%). The multivariate ordinal regression analysis showed that older adults with higher scores in the nutritional assessment are associated with better indicators of functional capacity (OR=1.33; 95% CI=1.15 to 1.54; p<0.001). We did not find an association between educational level, pressure injuries, body mass index, and functionality. Conclusion Nutritional status is a significant predictor for dependency in institutionalized older adults.
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Moser AD, Hembecker PK, Nakato AM. Relação entre capacidade funcional, estado nutricional e variáveis sociodemográficas de idosos institucionalizados. REVISTA BRASILEIRA DE GERIATRIA E GERONTOLOGIA 2021. [DOI: 10.1590/1981-22562021024.210211.pt] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Resumo Objetivo Analisar a relação entre a capacidade funcional, o estado nutricional e as variáveis sociodemográficas de idosos residentes em instituições de longa permanência. Método Trata-se de um estudo transversal conduzido com 82 idosos institucionalizados. Para a coleta de dados foram aplicados o Índice de Barthel para avaliação do grau de independência no desempenho das atividades básicas de vida diária e a Mini Avaliação Nutricional (MNA) para a avaliação do estado nutricional dos idosos. Os dados foram coletados em cinco instituições de longa permanência situadas na região Sul do Brasil. Análises de regressão logística ordinal foram realizadas para verificar as associações dos fatores contextuais com a capacidade funcional dos idosos institucionalizados Resultados A maioria dos participantes apresentou independência total no desempenho das atividades de vida diária (39,0%) e estado nutricional deficiente (59,8%). A análise de regressão ordinal multivariada demonstrou que idosos institucionalizados com maiores escores na avaliação nutricional estão associados com melhores indicadores de capacidade funcional (RC=1,33; IC 95%=1,15 a 1,54; p<0,001). Não se encontrou associação entre escolaridade, lesões por pressão, índice de massa corpórea e a capacidade funcional. Conclusão O estado nutricional é um importante preditor para a dependência de idosos institucionalizados.
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Deprescribing in older adults during COVID-19 pandemic; Opportunity or risk? Res Social Adm Pharm 2020; 17:1024-1025. [PMID: 33288419 PMCID: PMC7704332 DOI: 10.1016/j.sapharm.2020.11.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 11/25/2020] [Indexed: 11/22/2022]
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Innes KE, Sambamoorthi U. The Potential Contribution of Chronic Pain and Common Chronic Pain Conditions to Subsequent Cognitive Decline, New Onset Cognitive Impairment, and Incident Dementia: A Systematic Review and Conceptual Model for Future Research. J Alzheimers Dis 2020; 78:1177-1195. [PMID: 33252087 DOI: 10.3233/jad-200960] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Growing evidence suggests that chronic pain and certain chronic pain conditions may increase risk for cognitive decline and dementia. OBJECTIVE In this systematic review, we critically evaluate available evidence regarding the association of chronic pain and specific common chronic pain conditions to subsequent decline in cognitive function, new onset cognitive impairment (CI), and incident Alzheimer's disease and related dementias (ADRD); outline major gaps in the literature; and provide a preliminary conceptual model illustrating potential pathways linking pain to cognitive change. METHODS To identify qualifying studies, we searched seven scientific databases and scanned bibliographies of identified articles and relevant review papers. Sixteen studies met our inclusion criteria (2 matched case-control, 10 retrospective cohort, 2 prospective cohort), including 11 regarding the association of osteoarthritis (N = 4), fibromyalgia (N = 1), or headache/migraine (N = 6) to incident ADRD (N = 10) and/or its subtypes (N = 6), and 5 investigating the relation of chronic pain symptoms to subsequent cognitive decline (N = 2), CI (N = 1), and/or ADRD (N = 3). RESULTS Studies yielded consistent evidence for a positive association of osteoarthritis and migraines/headaches to incident ADRD; however, findings regarding dementia subtypes were mixed. Emerging evidence also suggests chronic pain symptoms may accelerate cognitive decline and increase risk for memory impairment and ADRD, although findings and measures varied considerably across studies. CONCLUSION While existing studies support a link between chronic pain and ADRD risk, conclusions are limited by substantial study heterogeneity, limited investigation of certain pain conditions, and methodological and other concerns characterizing most investigations to date. Additional rigorous, long-term prospective studies are needed to elucidate the effects of chronic pain and specific chronic pain conditions on cognitive decline and conversion to ADRD, and to clarify the influence of potential confounding and mediating factors.
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Affiliation(s)
- Kim E Innes
- Department of Epidemiology, West Virginia University School of Public Health, Morgantown, WV, USA
| | - Usha Sambamoorthi
- Department of Pharmaceutical Systems and Policy, West Virginia University School of Pharmacy, Morgantown, WV, USA
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Eyigor S, Kutsal YG, Toraman F, Durmus B, Gokkaya KO, Aydeniz A, Paker N, Borman P. Polypharmacy, Physical and Nutritional Status, and Depression in the Elderly: Do Polypharmacy Deserve Some Credits in These Problems? Exp Aging Res 2020; 47:79-91. [PMID: 33183169 DOI: 10.1080/0361073x.2020.1846949] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Background: To investigate the association of polypharmacy with physical function, nutritional status, and depression in the elderly. Method: The study included 675 people aged over 65 years from 8 centers in various geographical regions. The polypharmacy status was categorized as non-polypharmacy (0-4 drugs), polypharmacy (≥5 drugs). The subjects' physical function was assessed based on their "physical activity levels, Holden ambulation scores, gait speeds, and hand grip strengths"; their nutritional status based on the "Mini Nutritional Assessment (MNA)"; and their psychological status based on the "Center for Epidemiologic Studies Depression Scale -CES-D". Results: The presence of polypharmacy in this population was found to be 30% (n = 203). A statistically significant difference was found between the groups on the level of physical activity, Holden ambulation score, and nutrition status (p < .05). There was a statistically significant difference between the groups also on hand grip strength, MNA score, Charlson score (p < .05). Conclusion: Polypharmacy was observed to have a significant association with physical function, nutrition, and depression in the elderly aged ≥ 65 years.
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Affiliation(s)
- Sibel Eyigor
- Dept of Physical Medicine and Rehabilitation, Ege University Faculty of Medicine , Izmir, Turkey
| | - Yeşim Gökçe Kutsal
- Dept. of Physical Medicine and Rehabilitation, Hacettepe University Faculty of Medicine , Ankara, Turkey
| | - Fusun Toraman
- Dept of Physical Medicine and Rehabilitation, University of Health Sciences Antalya Education and Research Hospital , Antalya, Turkey
| | - Bekir Durmus
- Dept of Physical Therapy and Rehabilitation, Erenköy Education and Research Hospital Physical Therapy and Rehabilitation Clinic , Istanbul, Turkey
| | - Kutay Ordu Gokkaya
- Dept of Physical Therapy and Rehabilitation, Gaziler Physical Therapy and Rehabilitation Training and Research Hospital , Ankara, Turkey
| | - Ali Aydeniz
- Dept of Physical Medicine and Rehabilitation, Gaziantep University Faculty of Medicine , Gaziantep, Turkey
| | - Nurdan Paker
- Dept of Physical Therapy and Rehabilitation, Istanbul Physical Therapy and Rehabilitation Training and Research Hospital , İstanbul, Turkey
| | - Pinar Borman
- Dept. of Physical Medicine and Rehabilitation, Hacettepe University Faculty of Medicine , Ankara, Turkey
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Giovannini S, Onder G, van der Roest HG, Topinkova E, Gindin J, Cipriani MC, Denkinger MD, Bernabei R, Liperoti R. Use of antidepressant medications among older adults in European long-term care facilities: a cross-sectional analysis from the SHELTER study. BMC Geriatr 2020; 20:310. [PMID: 32854659 PMCID: PMC7457305 DOI: 10.1186/s12877-020-01730-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Accepted: 08/23/2020] [Indexed: 11/12/2022] Open
Abstract
Background Late-life depression is common among older adults living in nursing homes (NHs). Over the last 30 years there has been an increase in the rates of prescription of antidepressant medications across all ages, with the largest rise reported in older adults. This study aimed to describe the pattern of antidepressant medication use among NH residents from 7 European countries and Israel and to examine patient and facilities characteristics that may account for it. Methods We conducted a cross-sectional analysis of data from the SHELTER study, an observational longitudinal cohort study that collected comprehensive resident data using the interRAI Long-Term Care Facility instrument in 7 European Countries and Israel. Descriptive statistics were used to examine sample characteristics. Potential correlates of antidepressant medication use were identified using multiple logistic regression modeling. Results Among 4023 residents entering the study, 32% had depressive symptoms and nearly half of these individuals used antidepressants. Antidepressant medication use varied by country, with a prevalence in the overall sample of 35.6% (n = 1431). Among antidepressant users, 59.9% were receiving selective serotonin reuptake inhibitors (SSRI). The strongest correlates of antidepressant use included reported diagnosis of anxiety, depression, bipolar disorder, pain, falls and high level of social engagement. Age over 85 years, living in facilities located in rural areas and a diagnosis of schizophrenia reduced the likelihood of being prescribed with an antidepressant. Conclusions A large proportion of residents in European long-term care facilities receive antidepressant medications. The decision to prescribe antidepressants to NH residents seems to be influenced by both patient and facility characteristics. Future longitudinal studies should evaluate the efficacy and safety of antidepressant use in NHs thus providing evidence for recommendations for clinical practice.
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Affiliation(s)
- Silvia Giovannini
- Department of Aging, Neurological, Orthopaedic and Head-Neck Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy.
| | | | - Henriëtte G van der Roest
- Department of General Practice and Elderly Care Medicine, Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, The Netherlands
| | - Eva Topinkova
- Department of Geriatrics, First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Jacob Gindin
- The Centre for Standards in Health and Disability, Research Authority, University of Haifa, Haifa, Israel
| | - Maria Camilla Cipriani
- Department of Aging, Neurological, Orthopaedic and Head-Neck Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Michael D Denkinger
- AGAPLESION Bethesda Clinic, Competence Centre of Geriatrics, University of Ulm, Ulm, Germany
| | - Roberto Bernabei
- Fondazione Policlinico Universitario A. Gemelli IRCCS - Università Cattolica del Sacro Cuore, Rome, Italy
| | - Rosa Liperoti
- Fondazione Policlinico Universitario A. Gemelli IRCCS - Università Cattolica del Sacro Cuore, Rome, Italy
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Kose E, Wakabayashi H. Rehabilitation pharmacotherapy: A scoping review. Geriatr Gerontol Int 2020; 20:655-663. [PMID: 32691925 DOI: 10.1111/ggi.13975] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2020] [Revised: 05/15/2020] [Accepted: 06/01/2020] [Indexed: 12/15/2022]
Abstract
Many patients in rehabilitation facilities are affected by polypharmacy. Polypharmacy is associated with rehabilitation outcomes and functional recovery. Consequently, a combination of rehabilitation and pharmacotherapy may improve the outcomes of older people undergoing rehabilitation. A recent report described the concept of rehabilitation pharmacotherapy. The concept envisages helping frail older people and people with disabilities to achieve the highest possible body function, activity level and quality of life. There are two key tenets of rehabilitation pharmacotherapy: "pharmacotherapy in consideration of rehabilitation" and "rehabilitation in consideration of pharmacotherapy." "Pharmacotherapy in consideration of rehabilitation" includes use of drugs to treat impairment, activity limitation and participation restriction based on the International Classification of Functioning, Disability, and Health. "Rehabilitation in consideration of pharmacotherapy" refers to tailoring of rehabilitation considering the content of pharmacotherapy. With respect to drugs and motor dysfunction, anticholinergic drugs are associated with dysphagia and fractures. Increased use of potentially inappropriate medications may adversely affect the nutritional status. With respect to activities of daily living, polypharmacy and use of potentially inappropriate medications negatively affect the improvement in motor function during rehabilitation. Potent anticholinergic drugs are more likely to impede the improvement in cognitive function. In this review, we address the concept of rehabilitation pharmacotherapy and discuss its importance from the perspective of polypharmacy, the effect of drugs on disability and disease, nutritional status and activities of daily living. Geriatr Gerontol Int 2020; 20: -.
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Affiliation(s)
- Eiji Kose
- Department of Pharmacy, Teikyo University School of Medicine University Hospital, Tokyo, Japan
| | - Hidetaka Wakabayashi
- Department of Rehabilitation Medicine, Tokyo Women's Medical University Hospital, Tokyo, Japan
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A nurse practitioner led protocol to address polypharmacy in long-term care. Geriatr Nurs 2020; 41:956-961. [PMID: 32718755 PMCID: PMC7380258 DOI: 10.1016/j.gerinurse.2020.07.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 07/06/2020] [Accepted: 07/08/2020] [Indexed: 12/01/2022]
Abstract
Polypharmacy is common in long term care facilities and frequently associated with poor outcomes. A focus on decreasing polypharmacy as part of 60-day periodic review process in long term care facilities has the potential to improve resident outcomes and assist health care providers in improved medication management. To achieve success in decreasing polypharmacy, an interdisciplinary team with shared goals and communication is needed.
Polypharmacy is common in long term care facilities and frequently associated with poor outcomes. This study sought to determine if a medication management protocol completed at four month intervals by nurse practitioners (NP) could impact polypharmacy and administration times for long term care residents. The data was collected as part of a Centers for Medicare and Medicaid Services (CMS) “Initiative to Reduce Avoidable Hospitalization among Nursing Facility Residents” grant. Residents were recruited from participating long-term care facilities. NP completed a medication management protocol on admission to the program and at subsequent 4-month intervals or with an acute change in condition. A total of 2442 non-duplicated individuals were seen for at least 1 visit. Although the protocol did not result in a reduction of regularly scheduled medications, the number of scheduled medication administration times did significantly decrease. NP polypharmacy assessments and recommendations are important but were insufficient to decrease the medication burden.
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Shafiee Hanjani L, Hubbard RE, Freeman CR, Gray LC, Scott IA, Peel NM. Medication use and cognitive impairment among residents of aged care facilities. Intern Med J 2020; 51:520-532. [PMID: 32092243 DOI: 10.1111/imj.14804] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Revised: 02/19/2020] [Accepted: 02/20/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND Potentially inappropriate polypharmacy is common in residential aged care facilities (RACF). This is of particular concern among people with cognitive impairment who, compared with cognitively intact residents, are potentially more sensitive to the adverse effects of medications. AIM To compare the patterns of medication prescribing of RACF residents based on cognitive status. METHODS De-identified data collected during telehealth-mediated geriatric consultations with 720 permanent RACF residents were analysed. Residents were categorised into cognitively intact, mild to moderate impairment and severe impairment groups using the interRAI Cognitive Performance Scale. The number of all regular and when-required medications used in the past 3 days, the level of exposure to anti-cholinergic/sedative medications and potentially inappropriate medications and the use of preventive and symptom control medications were compared across the groups. RESULTS The median number of medications was 10 (interquartile range (IQR) 8-14). Cognitively intact residents were receiving significantly more medications (median (IQR) 13 (10-16)) than those with mild to moderate (10 (7-13)) or severe (9 (7-12)) cognitive impairment (P < 0.001). Overall, 82% of residents received at least one anti-cholinergic/sedative medication and 26.9% were exposed to one or more potentially inappropriate medications, although the proportions of those receiving such medications were not significantly different across the groups. Of 7658 medications residents were taking daily, 21.3% and 11.7% were classified as symptom control and preventive medications respectively with no significant difference among the groups in their use. CONCLUSION Our findings highlight the need for optimising prescribing in RACF residents, with particular attention to medications with anti-cholinergic effects.
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Affiliation(s)
- Leila Shafiee Hanjani
- Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Ruth E Hubbard
- Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia.,PA-Southside Clinical Unit, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Christopher R Freeman
- Centre for Optimising Pharmacy Practice-based Excellence in Research, School of Pharmacy, The University of Queensland, Brisbane, Queensland, Australia
| | - Leonard C Gray
- Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Ian A Scott
- PA-Southside Clinical Unit, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia.,Internal Medicine and Clinical Epidemiology, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Nancye M Peel
- Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
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Loggia G, Attoh-Mensah E, Pothier K, Morello R, Lescure P, Bocca ML, Marcelli C, Chavoix C. Psychotropic Polypharmacy in Adults 55 Years or Older: A Risk for Impaired Global Cognition, Executive Function, and Mobility. Front Pharmacol 2020; 10:1659. [PMID: 32082159 PMCID: PMC7002919 DOI: 10.3389/fphar.2019.01659] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Accepted: 12/17/2019] [Indexed: 01/05/2023] Open
Abstract
Objectives With their broad spectrum of action, psychotropic drugs are among the most common medications prescribed to the elderly. Consequently, the number of older adults taking multiple psychotropic drugs has more than doubled over the last decade. To improve knowledge about the deleterious effects of psychotropic polypharmacy, we investigated whether there is a threshold number of psychotropic molecules that could lead to impairment of global cognition, executive function, or mobility. Furthermore, relationships between the number of psychotropic molecules and cognitive and mobility impairment were examined. Design Cross-sectional study Setting University Hospital of Caen (France) and advertisements in medical offices Participants Community-dwelling older adults 55 years and older (n = 177; 69.8 ± 9.3 years; 81% women) Measurements Number of psychotropic molecules taken daily, global cognition assessed with the Mini Mental State Examination (MMSE) and the Montreal Cognitive Assessment (MoCA), processing speed with the Trail Making Test (TMT) A, executive function with the TMT B and TMT B-A, and mobility with the Time Up and Go (TUG). The threshold numbers of psychotropic molecules were determined by ROC curves analysis. Based on these threshold values, multinomial logistic regression adjusting for covariates was then performed. Results Logistic regressions showed that the threshold of two daily psychotropic molecules, identified by the ROC curves analysis, increases the risk of impaired executive function (p = .05 and.005 for the TMT B and TMT B-A, respectively), global cognition (p = .006 and.001 for the MMSE and MoCA, respectively), and mobility (p = .005 for the TUG), independent of confounding factors, including comorbidities. Furthermore, psychotropic polypharmacy would affect mobility through executive functions. Conclusion Impairment of global cognition, executive function, and mobility when as few as two psychotropic molecules are consumed in relatively healthy young older adults should alert physicians when prescribing combinations of psychotropic medications.
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Affiliation(s)
- Gilles Loggia
- Normandie Univ, UNICAEN, INSERM, COMETE, Caen, France.,Department of Geriatrics, Normandie Univ, UNICAEN, CHU de Caen Normandie, Caen, France
| | | | | | - Rémy Morello
- Department of Statistics and Clinical Research, Normandie Univ, UNICAEN, CHU de Caen Normandie, Caen, France
| | - Pascale Lescure
- Normandie Univ, UNICAEN, INSERM, COMETE, Caen, France.,Department of Geriatrics, Normandie Univ, UNICAEN, CHU de Caen Normandie, Caen, France
| | | | - Christian Marcelli
- Normandie Univ, UNICAEN, INSERM, COMETE, Caen, France.,Department of Rheumatology, Normandie Univ, UNICAEN, CHU de Caen Normandie, Caen, France
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31
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Assari S, Wisseh C, Saqib M, Bazargan M. Polypharmacy Is Associated with Lower Memory Function in African American Older Adults. Brain Sci 2020; 10:brainsci10010049. [PMID: 31963177 PMCID: PMC7017256 DOI: 10.3390/brainsci10010049] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2019] [Revised: 01/08/2020] [Accepted: 01/14/2020] [Indexed: 12/15/2022] Open
Abstract
Although previous research has linked polypharmacy to lower cognitive function in the general population, we know little about this association among economically challenged African American (AA) older adults. This study explored the link between polypharmacy and memory function among AA older adults. This community-based study recruited 399 AA older adults who were 65+ years old and living in economically disadvantaged areas of South Los Angeles. Polypharmacy (taking 5+ medications) was the independent variable, memory function was the outcome variable (continuous variable), and gender, age, living arrangement, socioeconomic status (educational attainment and financial strain), health behaviors (current smoking and any binge drinking), and multimorbidity (number of chronic diseases) were the covariates. Linear regression was used for data analyses. Polypharmacy was associated with lower scores on memory function, above and beyond covariates. Among AA older adults, polypharmacy may be linked to worse cognitive function. Future research should test the mechanisms by which polypharmacy is associated with lower levels of cognitive decline. There is a need for screening for memory problems in AA older adults who are exposed to polypharmacy.
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Affiliation(s)
- Shervin Assari
- Department of Family Medicine, Charles R Drew University of Medicine and Science, Los Angeles, CA 90095, USA;
- Correspondence: ; Tel.: +1-734-858-8333
| | - Cheryl Wisseh
- Department of Pharmacy Practice, West Coast University School of Pharmacy, Los Angeles, CA 91606, USA;
| | - Mohammed Saqib
- Health Behavior & Health Education, University of Michigan, Ann Arbor, MI 48109, USA;
| | - Mohsen Bazargan
- Department of Family Medicine, Charles R Drew University of Medicine and Science, Los Angeles, CA 90095, USA;
- Department of Family Medicine, University of California Los Angeles (UCLA), Los Angeles, CA 90095, USA
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Katsimpris A, Linseisen J, Meisinger C, Volaklis K. The Association Between Polypharmacy and Physical Function in Older Adults: a Systematic Review. J Gen Intern Med 2019; 34:1865-1873. [PMID: 31240604 PMCID: PMC6712133 DOI: 10.1007/s11606-019-05106-3] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Revised: 05/03/2019] [Accepted: 05/20/2019] [Indexed: 01/10/2023]
Abstract
BACKGROUND Reduced physical function and polypharmacy (PPha) are two highly prevalent negative effects of aging, which are expected to increase more, since demographic aging is expected to grow rapidly within the next decades. Previous research suggests that polypharmacy (PPha) is a predictor of poor physical function and vice versa in older adults and therefore we conducted a systematic review of the literature to summarize and critically analyze the relationship between physical function and PPha and vice versa in older adults, in order to provide recent scientific evidence. METHODS We searched MEDLINE and Embase from their inception to 19th October 2018 for English-language observational studies or trials assessing the effect of PPha on physical function and vice versa in older adults. Two investigators independently extracted study data and assessed the quality of the studies, after having screened the available studies from the literature search. Any disagreement was resolved by consensus. RESULTS Eighteen observational studies met the inclusion criteria. Eight studies assessed the impact of physical function on PPha and ten studies assessed the impact of PPha on physical function. Regarding the studies with PPha measurements as the outcome, all of them, except for one, found that better physical function is associated with lower risk of PPha. Likewise, all the studies with physical function measurements as the outcome, except for one, suggested that PPha is associated with lower physical function. DISCUSSION Evidence examining the effect of PPha on physical function and vice versa in older adults suggests a strong bidirectional association between these two factors and clinicians should be aware of this strong relationship. The limitations of our study include the high variability in PPha definitions and physical function measures, and the treatment of PPha and physical function as constant instead of time-varying variables in the studies' analyses.
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Affiliation(s)
- Andreas Katsimpris
- Ludwig-Maximilians-Universität München, UNIKA-T Augsburg, Augsburg, Germany.
| | - Jacob Linseisen
- Ludwig-Maximilians-Universität München, UNIKA-T Augsburg, Augsburg, Germany
- Helmholtz Zentrum München, Institute of Epidemiology, Neuherberg, Germany
| | - Christa Meisinger
- Ludwig-Maximilians-Universität München, UNIKA-T Augsburg, Augsburg, Germany
- Helmholtz Zentrum München, Institute of Epidemiology, Neuherberg, Germany
| | - Konstantinos Volaklis
- Ludwig-Maximilians-Universität München, UNIKA-T Augsburg, Augsburg, Germany
- Department of Prevention and Sports Medicine, Technische Universität München, Munich, Germany
- 7FIT, Cardiac Rehabilitation Center, Augsburg, Germany
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Sirois C, Simard M, Gosselin E, Gagnon ME, Roux B, Laroche ML. Mixed Bag “Polypharmacy”: Methodological Pitfalls and Challenges of This Exposure Definition. CURR EPIDEMIOL REP 2019. [DOI: 10.1007/s40471-019-00214-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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Ticinesi A, Nouvenne A, Prati B, Lauretani F, Morelli I, Tana C, Fabi M, Meschi T. Profiling the hospital-dependent patient in a large academic hospital: Observational study. Eur J Intern Med 2019; 64:41-47. [PMID: 30819605 DOI: 10.1016/j.ejim.2019.02.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Revised: 01/31/2019] [Accepted: 02/20/2019] [Indexed: 01/05/2023]
Abstract
BACKGROUND In older patients with acute illness, a condition of "hospital-dependence" may arise: patients get adapted to the hospital care and, once discharged, may experience health status decline, requiring repeated readmissions despite appropriate treatments. AIMS The objective of this case-series study was to describe the characteristics of 118 patients (72 F) aged ≥75 (mean 83.7 ± 4.9) who were urgently admitted to our institution at least 4 times in 2015. METHODS For each patient and admission, data on multimorbidity (Cumulative Illness Rating Scale Comorbidity Score and Severity Index), frailty (Rockwood Clinical Frailty Scale), functional dependence, functional status, polypharmacy, length of stay and interval between admissions were extrapolated from clinical records. Mortality during the years 2015 and 2016 was assessed on the institutional database. RESULTS At the first admission, patients had a high burden of polypharmacy (median number of drugs 8.5, IQR 6-11) and multimorbidity (Comorbidity Score 15.8 ± 4.1, Severity Index 2.9 ± 1.1). However, most (55.5%) were fit or pre-frail according to Clinical Frailty Scale (score 1-4). At multivariate models, Severity Index was significantly correlated with the length of stay (β ± SE 2.23 ± 0.89, p = .01) and readmission interval (β ± SE -22.49 ± 9.27, p = .02). Significantly increasing trends of multimorbidity and disability occurred across admissions. By the end of 2016, 66% of patients had died. Frailty (RR 2.005, 95%CI 1.054-3.814, p = .007) and cancer were the only predictors of mortality. CONCLUSIONS Hospital-dependent patients had severe multimorbidity, but exhibited an unexpectedly low prevalence of frailty/disability at baseline, though increasing across admissions. Trends of frailty and multimorbidity are paramount for profiling the hospital-dependence risk.
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Affiliation(s)
- Andrea Ticinesi
- Geriatric-Rehabilitation Department, Azienda Ospedaliero-Universitaria di Parma, Via Antonio Gramsci 14, 43126 Parma, Italy; Department of Medicine and Surgery, University of Parma, Via Antonio Gramsci 14, 43126 Parma, Italy.
| | - Antonio Nouvenne
- Geriatric-Rehabilitation Department, Azienda Ospedaliero-Universitaria di Parma, Via Antonio Gramsci 14, 43126 Parma, Italy
| | - Beatrice Prati
- Geriatric-Rehabilitation Department, Azienda Ospedaliero-Universitaria di Parma, Via Antonio Gramsci 14, 43126 Parma, Italy
| | - Fulvio Lauretani
- Geriatric-Rehabilitation Department, Azienda Ospedaliero-Universitaria di Parma, Via Antonio Gramsci 14, 43126 Parma, Italy
| | - Ilaria Morelli
- Geriatric-Rehabilitation Department, Azienda Ospedaliero-Universitaria di Parma, Via Antonio Gramsci 14, 43126 Parma, Italy
| | - Claudio Tana
- Geriatric-Rehabilitation Department, Azienda Ospedaliero-Universitaria di Parma, Via Antonio Gramsci 14, 43126 Parma, Italy
| | - Massimo Fabi
- General Management, Azienda Ospedaliero-Universitaria di Parma, Via Antonio Gramsci 14, 43126 Parma, Italy
| | - Tiziana Meschi
- Geriatric-Rehabilitation Department, Azienda Ospedaliero-Universitaria di Parma, Via Antonio Gramsci 14, 43126 Parma, Italy; Department of Medicine and Surgery, University of Parma, Via Antonio Gramsci 14, 43126 Parma, Italy
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Soysal P, Perera G, Isik AT, Onder G, Petrovic M, Cherubini A, Maggi S, Shetty H, Molokhia M, Smith L, Stubbs B, Stewart R, Veronese N, Mueller C. The relationship between polypharmacy and trajectories of cognitive decline in people with dementia: A large representative cohort study. Exp Gerontol 2019; 120:62-67. [DOI: 10.1016/j.exger.2019.02.019] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Revised: 02/13/2019] [Accepted: 02/27/2019] [Indexed: 02/06/2023]
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Onder G, Vetrano DL, Villani ER, Carfì A, Lo Monaco MR, Cipriani MC, Manes Gravina E, Denkinger M, Pagano F, van der Roest HG, Bernabei R. Deprescribing in Nursing Home Residents on Polypharmacy: Incidence and Associated Factors. J Am Med Dir Assoc 2019; 20:1116-1120. [PMID: 30853425 DOI: 10.1016/j.jamda.2019.01.130] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Revised: 01/14/2019] [Accepted: 01/15/2019] [Indexed: 12/29/2022]
Abstract
OBJECTIVES To assess 1-year incidence and factors related to deprescribing in nursing home (NH) residents in Europe. DESIGN Longitudinal multicenter cohort study based on data from the Services and Health for Elderly in Long TERm care (SHELTER) study. SETTING NHs in Europe and Israel. PARTICIPANTS 1843 NH residents on polypharmacy. METHODS Polypharmacy was defined as the concurrent use of 5 or more medications. Deprescribing was defined as a reduction in the number of medications used over the study period. Residents were followed for 12 months. RESULTS Residents in the study sample were using a mean number of 8.6 (standard deviation 2.9) medications at the baseline assessment. Deprescribing was observed in 658 residents (35.7%). Cognitive impairment (mild/moderate impairment vs intact, odds ratio [OR] 1.41, 95% confidence interval [CI] 1.11-1.79; severe impairment vs intact, OR 1.60, 95% CI 1.23-2.09), presence of the geriatrician within the facility staff (OR 1.41, 95% CI 1.15-1.72), and number of medications used at baseline (OR 1.10, 95% CI 1.06-1.14) were associated with higher probabilities of deprescribing. In contrast, female gender (OR 0.76, 95% CI 0.61-0.96), heart failure (OR 0.69, 95% CI 0.53-0.89), and cancer (OR 0.64, 95% CI 0.45-0.90) were associated with a lower probability of deprescribing. CONCLUSIONS AND IMPLICATIONS Deprescribing is common in NH residents on polypharmacy, and it is associated with individual and organizational factors. More evidence is needed on deprescribing, and clear strategies on how to withdraw medications should be defined in the future.
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Affiliation(s)
- Graziano Onder
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; Università Cattolica Sacro Cuore, Rome, Italy.
| | - Davide L Vetrano
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Emanuele R Villani
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; Università Cattolica Sacro Cuore, Rome, Italy
| | - Angelo Carfì
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | | | | | | | - Michael Denkinger
- Geriatric Research Unit, Agaplesion Bethesda Clinic, Ulm University and Geriatric Center Ulm/Alb-Donau, Ulm, Germany
| | - Francesco Pagano
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Henriëtte G van der Roest
- Department of General Practice and Elderly Care Medicine, Amsterdam Public Health Research Institute, Amsterdam UMC, VU University medical center, Amsterdam, the Netherlands
| | - Roberto Bernabei
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; Università Cattolica Sacro Cuore, Rome, Italy
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Calderón-Larrañaga A, Vetrano DL, Ferrucci L, Mercer SW, Marengoni A, Onder G, Eriksdotter M, Fratiglioni L. Multimorbidity and functional impairment-bidirectional interplay, synergistic effects and common pathways. J Intern Med 2019; 285:255-271. [PMID: 30357990 PMCID: PMC6446236 DOI: 10.1111/joim.12843] [Citation(s) in RCA: 201] [Impact Index Per Article: 40.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
This review discusses the interplay between multimorbidity (i.e. co-occurrence of more than one chronic health condition in an individual) and functional impairment (i.e. limitations in mobility, strength or cognition that may eventually hamper a person's ability to perform everyday tasks). On the one hand, diseases belonging to common patterns of multimorbidity may interact, curtailing compensatory mechanisms and resulting in physical and cognitive decline. On the other hand, physical and cognitive impairment impact the severity and burden of multimorbidity, contributing to the establishment of a vicious circle. The circle may be further exacerbated by people's reduced ability to cope with treatment and care burden and physicians' fragmented view of health problems, which cause suboptimal use of health services and reduced quality of life and survival. Thus, the synergistic effects of medical diagnoses and functional status in adults, particularly older adults, emerge as central to assessing their health and care needs. Furthermore, common pathways seem to underlie multimorbidity, functional impairment and their interplay. For example, older age, obesity, involuntary weight loss and sedentarism can accelerate damage accumulation in organs and physiological systems by fostering inflammatory status. Inappropriate use or overuse of specific medications and drug-drug and drug-disease interactions also contribute to the bidirectional association between multimorbidity and functional impairment. Additionally, psychosocial factors such as low socioeconomic status and the direct or indirect effects of negative life events, weak social networks and an external locus of control may underlie the complex interactions between multimorbidity, functional decline and negative outcomes. Identifying modifiable risk factors and pathways common to multimorbidity and functional impairment could aid in the design of interventions to delay, prevent or alleviate age-related health deterioration; this review provides an overview of knowledge gaps and future directions.
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Affiliation(s)
- A Calderón-Larrañaga
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet-Stockholm University, Stockholm, Sweden
| | - D L Vetrano
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet-Stockholm University, Stockholm, Sweden.,Department of Geriatrics, Neurosciences and Orthopedics, Catholic University of the Sacred Heart, Rome, Italy.,Centro di Medicina dell'Invecchiamento, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy
| | - L Ferrucci
- National Institute on Aging, National Institutes of Health, Baltimore, MD, USA
| | - S W Mercer
- Institute of Health and Wellbeing, General Practice and Primary Care, University of Glasgow, Glasgow, UK
| | - A Marengoni
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - G Onder
- Department of Geriatrics, Neurosciences and Orthopedics, Catholic University of the Sacred Heart, Rome, Italy.,Centro di Medicina dell'Invecchiamento, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy
| | - M Eriksdotter
- Department of Neurobiology, Care Sciences and Society, Division of Clinical Geriatrics, Karolinska Institutet, Stockholm, Sweden
| | - L Fratiglioni
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet-Stockholm University, Stockholm, Sweden.,Stockholm Gerontology Research Center, Stockholm, Sweden
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Wastesson JW, Morin L, Tan ECK, Johnell K. An update on the clinical consequences of polypharmacy in older adults: a narrative review. Expert Opin Drug Saf 2018; 17:1185-1196. [PMID: 30540223 DOI: 10.1080/14740338.2018.1546841] [Citation(s) in RCA: 271] [Impact Index Per Article: 45.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
INTRODUCTION Polypharmacy, the use of multiple medications by one individual, is increasingly common among older adults. Caring for the growing number of older people with complex drug regimens and multimorbidity presents an important challenge in the coming years. AREAS COVERED This article reviews the international trends in the prevalence of polypharmacy, summarizes the results from previous reviews on polypharmacy and negative health outcomes, and updates a previous review on the clinical consequences of polypharmacy by focusing on studies published after 2013. This narrative review, which is based on a literature search in MEDLINE and EMBASE from January 1990 to June 2018, was undertaken to identify relevant articles. Search terms included variations of polypharmacy and multiple medications. EXPERT OPINION The prevalence of polypharmacy is increasing worldwide. More than half of the older population is exposed to polypharmacy in some settings. Polypharmacy is associated with a broad range of clinical consequences. However, methods to assess the dangers of polypharmacy should be refined. In our opinion, the issue of 'confounding by multimorbidity' has been underestimated and should be better accounted for in future studies. Moreover, researchers should develop more clinically relevant definitions of polypharmacy, including measures of inappropriate or problematic polypharmacy.
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Affiliation(s)
- Jonas W Wastesson
- a Aging Research Center, Department of Neurobiology , Care Sciences and Society, Karolinska Institutet & Stockholm University , Stockholm , Sweden
| | - Lucas Morin
- a Aging Research Center, Department of Neurobiology , Care Sciences and Society, Karolinska Institutet & Stockholm University , Stockholm , Sweden
| | - Edwin C K Tan
- a Aging Research Center, Department of Neurobiology , Care Sciences and Society, Karolinska Institutet & Stockholm University , Stockholm , Sweden.,b Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences , Monash University , Parkville , Australia
| | - Kristina Johnell
- a Aging Research Center, Department of Neurobiology , Care Sciences and Society, Karolinska Institutet & Stockholm University , Stockholm , Sweden
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Palmer K, Villani ER, Vetrano DL, Cherubini A, Cruz-Jentoft AJ, Curtin D, Denkinger M, Gutiérrez-Valencia M, Guðmundsson A, Knol W, Mak DV, O'Mahony D, Pazan F, Petrovic M, Rajkumar C, Topinkova E, Trevisan C, van der Cammen TJM, van Marum RJ, Wehling M, Ziere G, Bernabei R, Onder G. Association of polypharmacy and hyperpolypharmacy with frailty states: a systematic review and meta-analysis. Eur Geriatr Med 2018; 10:9-36. [PMID: 32720270 DOI: 10.1007/s41999-018-0124-5] [Citation(s) in RCA: 68] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Accepted: 10/24/2018] [Indexed: 01/19/2023]
Abstract
PURPOSE To investigate: (1) the cross-sectional association between polypharmacy, hyperpolypharmacy and presence of prefrailty or frailty; (2) the risk of incident prefrailty or frailty in persons with polypharmacy, and vice versa. METHODS A systematic review and meta-analysis was performed according to PRISMA guidelines. We searched PubMed, Web of Science, and Embase from 01/01/1998 to 5/2/2018. Pooled estimates were obtained through random effect models and Mantel-Haenszel weighting. Homogeneity was assessed with the I2 statistic and publication bias with Egger's and Begg's tests. RESULTS Thirty-seven studies were included. The pooled proportion of polypharmacy in persons with prefrailty and frailty was 47% (95% CI 33-61) and 59% (95% CI 42-76), respectively. Increased odds ratio of polypharmacy were seen for prefrail (pooled OR = 1.52; 95% CI 1.32-1.79) and frail persons (pooled OR = 2.62, 95% CI 1.81-3.79). Hyperpolypharmacy was also increased in prefrail (OR = 1.95; 95% CI 1.41-2.70) and frail (OR = 6.57; 95% CI 9.57-10.48) persons compared to robust persons. Only seven longitudinal studies reported data on the risk of either incident prefrailty or frailty in persons with baseline polypharmacy. A significant higher odds of developing prefrailty was found in robust persons with polypharmacy (pooled OR = 1.30; 95% CI 1.12-1.51). We found no papers investigating polypharmacy incidence in persons with prefrailty/frailty. CONCLUSIONS Polypharmacy is common in prefrail and frail persons, and these individuals are also more likely to be on extreme drug regimens, i.e. hyperpolypharmacy, than robust older persons. More research is needed to investigate the causal relationship between polypharmacy and frailty syndromes, thereby identifying ways to jointly reduce drug burden and prefrailty/frailty in these individuals. PROSPERO REGISTRATION NUMBER CRD42018104756.
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Affiliation(s)
- Katie Palmer
- Fondazione Ospedale San Camillo IRCCS, Via Alberoni 70, 30126, Venezia, Italia.
| | - Emanuele R Villani
- Department of Geriatrics, Centro Medicina dell'Invecchiamento, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Davide L Vetrano
- Department of Geriatrics, Centro Medicina dell'Invecchiamento, Università Cattolica del Sacro Cuore, Rome, Italy.,Aging Research Center, NVS, Karolinska Institutet, Stockholm, Sweden
| | - Antonio Cherubini
- Geriatria, Accettazione geriatrica e Centro di ricerca per l'invecchiamento, IRCCS INRCA, Ancona, Italy
| | | | - Denis Curtin
- Department of Medicine, Department of Geriatric Medicine, University College Cork, Cork University Hospital, Cork, Ireland
| | - Michael Denkinger
- Agaplesion Bethesda Clinic Ulm, Geriatric Center Ulm/Alb-Donau and Geriatric Research Unit, Ulm University, Ulm, Germany
| | - Marta Gutiérrez-Valencia
- Department of Pharmacy, Navarrabiomed, Universidad Pública de Navarra (UPNA), Complejo Hospitalario de Navarra (CHN), IdiSNA, Pamplona, Navarra, Spain
| | - Adalsteinn Guðmundsson
- Faculty of Medicine, University of Iceland, Reykjavík, Iceland.,Department of Geriatrics, Landspitali University Hospital, Reykjavík, Iceland
| | - Wilma Knol
- Department of Geriatric Medicine, Expertise Centre Pharmacotherapy in Old Persons, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Diane V Mak
- Department of Geriatric Medicine, Expertise Centre Pharmacotherapy in Old Persons, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Denis O'Mahony
- Department of Medicine, Department of Geriatric Medicine, University College Cork, Cork University Hospital, Cork, Ireland
| | - Farhad Pazan
- Institute for Clinical Pharmacology, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Mirko Petrovic
- Department of Internal Medicine, Section of Geriatrics, Ghent University, Ghent, Belgium
| | - Chakravarthi Rajkumar
- Department of Medicine, Brighton and Sussex Medical School, University of Sussex, Brighton, UK
| | - Eva Topinkova
- Department of Geriatrics, First Faculty of Medicine, Charles University, General Faculty Hospital, Prague, Czech Republic
| | - Catarina Trevisan
- Department of Medicine, Geriatrics Division, University of Padova, Padua, Italy
| | - Tischa J M van der Cammen
- Faculty of Industrial Design Engineering, Delft University of Technology, Delft, The Netherlands.,Department of Internal Medicine, Division of Geriatrics, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.,Academic Department of Geriatrics, Brighton and Sussex Medical School, Brighton, East Sussex, UK
| | - Rob J van Marum
- Department of General Practice and Old Age Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,Department of Geriatrics, Jeroen Bosch Hospital, 's-Hertogenbosch, The Netherlands
| | - Martin Wehling
- Medical Faculty Mannheim, Clinical Pharmacology, University of Heidelberg, Heidelberg, Germany
| | - Gijsbertus Ziere
- Department of Internal Medicine, Division of Geriatrics, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Roberto Bernabei
- Department of Geriatrics, Centro Medicina dell'Invecchiamento, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Graziano Onder
- Department of Geriatrics, Centro Medicina dell'Invecchiamento, Università Cattolica del Sacro Cuore, Rome, Italy
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40
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Deprescribing in Geriatric Medicine: Challenges and Opportunities. J Am Med Dir Assoc 2018; 19:919-922. [DOI: 10.1016/j.jamda.2018.09.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Accepted: 09/20/2018] [Indexed: 11/18/2022]
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