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Jerjes W, Harding D. Confronting polypharmacy and social isolation in elderly care: a general practitioner's perspective on holistic primary care. FRONTIERS IN AGING 2024; 5:1384835. [PMID: 38881825 PMCID: PMC11176503 DOI: 10.3389/fragi.2024.1384835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/10/2024] [Accepted: 04/26/2024] [Indexed: 06/18/2024]
Affiliation(s)
- Waseem Jerjes
- Research and Development Unit, Hammersmith and Fulham Primary Care Network, London, United Kingdom
- Faculty or Medicine, Imperial College London, London, United Kingdom
| | - Daniel Harding
- Research and Development Unit, Hammersmith and Fulham Primary Care Network, London, United Kingdom
- Faculty or Medicine, Imperial College London, London, United Kingdom
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Delgado-Parada E, Alonso-Sánchez M, Ayuso-Mateos JL, Robles-Camacho M, Izquierdo A. Liaison psychiatry before and after the COVID-19 pandemic. Psychiatry Res 2022; 314:114651. [PMID: 35640325 PMCID: PMC9124364 DOI: 10.1016/j.psychres.2022.114651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 05/20/2022] [Accepted: 05/21/2022] [Indexed: 01/13/2023]
Abstract
INTRODUCTION the COVID-19 pandemic had an impact on hospital admissions. The clinical profiles of patients referred to liaison psychiatry teams (LPT) remained stable over the last few decades. We postulate changes in patient profiles due to the COVID-19 pandemic. MATERIALS AND METHODS a total of 384 patients admitted to a tertiary care University Hospital in Madrid (Spain) and referred to LPTs were recruited. Patients referred 5 months before and after the first admission for COVID-19 were included. Clinical and sociodemographic characteristics were collected, and non-parametric hypothesis contrast tests were used to study possible differences between both periods. RESULTS patients referred during the pandemic were significantly older (U = 2.006; p = .045), most of them were admitted to medical hospitalization units (χ2 (2) = 5.962; p = 015), and with a different reason for admission. There was an increase in the rate of adjustment disorders (χ2 (1) =7.893; p = 005) and delirium (χ2 (1) =9.413; p = 002), as well as psychiatric comorbidity (χ2 (2) = 9.930; p = .007), and a reduction in the proportion of patients treated for substance misuse (χ2 (5) = 19.152; p = .002). The number of deaths increased significantly (χ2 (1) = 6.611; p = .010). In persons over 65 years inappropriate prescription was significantly lower (χ2 (1) = 8.200; p = .004). CONCLUSIONS the pandemic had an impact on the activity of the LPTs due to the change in the clinical profile and evolution of referred patients, maintaining standards of care that are reflected through prescription.
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Affiliation(s)
- E Delgado-Parada
- Department of Psychiatry, Hospital Universitario de La Princesa, c/ Diego de León, 62, (28006) Madrid, Spain; Instituto de Investigación Sanitaria Hospital Universitario de la Princesa (IIS-Princesa), c/ Diego de León, 62, (28006) Madrid, Spain
| | - M Alonso-Sánchez
- Department of Psychiatry, Hospital Universitario de La Princesa, c/ Diego de León, 62, (28006) Madrid, Spain.
| | - J L Ayuso-Mateos
- Department of Psychiatry, Hospital Universitario de La Princesa, c/ Diego de León, 62, (28006) Madrid, Spain; Instituto de Investigación Sanitaria Hospital Universitario de la Princesa (IIS-Princesa), c/ Diego de León, 62, (28006) Madrid, Spain; Centro de Investigación Biomédica en Red en Salud Mental (CIBERSAM), Av/ Monforte de Lemos, 3-5. Pabellón 11. Planta 0 (28029) Madrid, Spain; Departament of Psychiatry, Universidad Autónoma de Madrid, c/ Arzobispo Morcillo, 4, (28029) Madrid, Spain
| | - M Robles-Camacho
- Department of Psychiatry, Hospital Universitario de La Princesa, c/ Diego de León, 62, (28006) Madrid, Spain
| | - A Izquierdo
- Department of Psychiatry, Hospital Universitario de La Princesa, c/ Diego de León, 62, (28006) Madrid, Spain; Instituto de Investigación Sanitaria Hospital Universitario de la Princesa (IIS-Princesa), c/ Diego de León, 62, (28006) Madrid, Spain; Centro de Investigación Biomédica en Red en Salud Mental (CIBERSAM), Av/ Monforte de Lemos, 3-5. Pabellón 11. Planta 0 (28029) Madrid, Spain; Departament of Psychiatry, Universidad Autónoma de Madrid, c/ Arzobispo Morcillo, 4, (28029) Madrid, Spain
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Baik D, Yu YM, Jung SY, Kang HY. Prevalence and patterns of the concurrent use of anticholinergics for the motor symptoms of Parkinson's disease and acetylcholinesterase inhibitors in Parkinson's disease patients with dementia: a cross-sectional study using Korea National Health Insurance claims data. BMC Geriatr 2022; 22:609. [PMID: 35864474 PMCID: PMC9306150 DOI: 10.1186/s12877-022-03296-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Accepted: 07/13/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The concurrent use of anticholinergics and acetylcholinesterase inhibitors (ACHEIs) in Parkinson's disease (PD) patients with dementia should be avoided because the opposing pharmacological actions of both drugs reduce the treatment efficacy. We aimed to investigate the prevalence of the concurrent use of these two types of drugs in Korean patients. METHODS In the 2017 Health Insurance Review and Assessment Service-National Aged Patient Sample data, comprising insurance claims records for a 10% random sample of patients aged ≥ 65 years in Korea, "concurrent use" was defined as the overlapping of anticholinergic and ACHEI doses for at least 2 months. RESULTS Among 8,845 PD patients with dementia, 847 (9.58%) were co-administered anticholinergics, used to treat the motor symptoms of PD, and ACHEIs for a mean duration of 7.7 months. A total of 286 (33.77% of all co-administered) patients used both drug types concurrently all year. About 80% of concurrent users were prescribed each drug by the same prescriber, indicating that coadministration may not be due to a lack of information sharing between providers. Logistic regression analysis showed that patients mainly treated at clinics (odds ratio (OR), 1.541; 95% confidence interval (CI), 1.158-2.059), hospitals (OR, 2.135; 95% CI, 1.586-2.883), and general hospitals (OR, 1.568; 95% CI, 1.221-2.028) were more likely to be co-prescribed anticholinergics and ACHEIs than those mainly treated at tertiary-care hospitals. PD patients with dementia treated at healthcare organizations located in areas other than the capital city had an approximately 22% higher risk of concurrent use (OR: 1.227, 95% CI: 1.046-1.441). CONCLUSIONS The concurrent use of anticholinergics for the motor symptoms of PD and ACHEIs in elderly Korean PD patients with dementia cannot be ignored, and strategies that mitigate potentially inappropriate concurrent drug use are required.
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Affiliation(s)
- Deborah Baik
- College of Pharmacy, Yonsei Institute of Pharmaceutical Sciences, Yonsei University, 85 Songdogwahak-ro, Incheon, 21983, South Korea
| | - Yun Mi Yu
- College of Pharmacy, Yonsei Institute of Pharmaceutical Sciences, Yonsei University, 85 Songdogwahak-ro, Incheon, 21983, South Korea
| | - Sun-Young Jung
- College of Pharmacy, Chung-Ang University, Seoul, South Korea
| | - Hye-Young Kang
- College of Pharmacy, Yonsei Institute of Pharmaceutical Sciences, Yonsei University, 85 Songdogwahak-ro, Incheon, 21983, South Korea.
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Jin T, Jin Y, Lee SM. Medication Use and Risk of Delirium in Mechanically Ventilated Patients. Clin Nurs Res 2019; 30:474-481. [PMID: 31466469 DOI: 10.1177/1054773819868652] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
One of the principal complications in patients in the intensive care unit, particularly in those receiving mechanical ventilation, is medication-induced delirium. The present study aimed to intensively analyze pharmaceutical factors affecting the development of delirium in mechanically ventilated patients using the electronic health records. The present study was designed as a retrospective case-control study. The delirium group included 500 mechanically ventilated patients. The non-delirium group included 2,000 patients who were hospitalized during the same period as the delirium group and received mechanical ventilation. A total of seven types of medications (narcotic analgesics, non-narcotic analgesics, psychopharmaceuticals, sleep aid medications, anticholinergics, steroids, and diuretics), conventionally used to manage mechanical ventilation, were found to be major risk factors associated with the occurrence of delirium. Since these medications are an integral part of managing mechanically ventilated patients, prudent protocol-based medication approaches are essential to decrease the risk of delirium.
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Affiliation(s)
- Taixian Jin
- The Catholic University of Korea, Seoul, Republic of Korea
| | | | - Sun-Mi Lee
- The Catholic University of Korea, Seoul, Republic of Korea
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Mino-León D, Sánchez-García S, Giraldo-Rodríguez L, Reyes-Morales H. Potentially inappropriate prescribing to older adults in ambulatory care: prevalence and associated patient conditions. Eur Geriatr Med 2019; 10:639-647. [PMID: 34652727 DOI: 10.1007/s41999-019-00181-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Accepted: 03/08/2019] [Indexed: 11/26/2022]
Abstract
PURPOSE To analyze potentially inappropriate prescribing (PIP), its prevalence and patient conditions associated with this phenomenon, in a cohort of older adults receiving outpatient care in Mexico. METHODS Data from 1252 adults ≥ 60 years of age, from primary care centers were analyzed. Information included sociodemographic data, medications, chronic diseases, polypharmacy (≥ 5 medications), functional dependence, cognitive impairment and frailty. Three logistic regression models were employed to identify associations between PIP (according to the Beers criteria) and different variable combinations. RESULTS A total of 41.8% of participants had at least one PIP. The most frequently identified PIPs involved nonsteroidal anti-inflammatory drugs (NSAIDs) and glibenclamide; clonazepam in patients with cognitive impairment; and interactions of warfarin with NSAIDs. In the multivariate analyses, Model 1 showed that frailty and polypharmacy were associated with PIP. In Model 2, only polypharmacy was associated with PIP. For Model 3, lower educational levels, taking hypoglycemics, nervous system disease drugs, antiasthmatics, gastrointestinal disease drugs and anti-inflammatories-antirheumatics and analgesics, were associated with PIP. CONCLUSION PIP is common in outpatient treatment of health care services in Mexico. Its association with medical and nonmedical factors highlights the need to improve drug treatment quality focused on implementation of effective strategies, such as educative interventions, electronic medication safety alerts, and inclusion of pharmacists in the health team.
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Affiliation(s)
- Dolores Mino-León
- Clinical Epidemiology Research Unit, Hospital de Especialidades, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Mexico City, Mexico
| | - Sergio Sánchez-García
- Epidemiology and Health Services Research Unit, Aging Area, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Mexico City, Mexico
| | - Liliana Giraldo-Rodríguez
- Research Division, Demographic Epidemiology and Social Determinants Department, Instituto Nacional de Geriatría, Secretaría de Salud, Mexico City, Mexico
| | - Hortensia Reyes-Morales
- Center for Health Systems Research, Instituto Nacional de Salud Pública, Avenida Universidad #655, Santa María Ahuacatitlán, 62100, Cuernavaca, Morelos, Mexico.
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Risk Factors for the Progression of Mild Cognitive Impairment in Different Types of Neurodegenerative Disorders. Behav Neurol 2018; 2018:6929732. [PMID: 29971138 PMCID: PMC6008817 DOI: 10.1155/2018/6929732] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Revised: 03/24/2018] [Accepted: 04/05/2018] [Indexed: 12/24/2022] Open
Abstract
Objective Mild cognitive impairment (MCI) is a transitional state between normal aging and early dementia. It has a heterogeneous etiology and clinical course. This study aimed to examine the factors associated with the progression of MCI in different types of dementia disorders. Method A retrospective, longitudinal, observational study of outpatients with MCI was conducted at a medical center in northern Taiwan. Patient medical records were reviewed, and risk factors were analyzed by multivariate analysis. Results Among 279 patients with MCI, 163 (58.4%), 68 (24.4%), and 48 (17.2%) were diagnosed with Alzheimer's disease, vascular cognitive impairment, and Lewy body diseases, respectively. During the observation period, 37.2% of patients progressed to dementia. Older age and a higher Clinical Dementia Rating Scale-Sum of Boxes were associated with the risk of progression. Hyperlipidemia was associated with a decreased risk. Converters were more likely to receive an antidementia prescription. Conclusion Our study suggests the importance of comprehensive clinical profiling, risk factor assessment, and detailed drug history evaluations in improving our understanding and management of dementia subtypes.
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Beheydt LL, Schrijvers D, Docx L, Bouckaert F, Hulstijn W, Sabbe B. Psychomotor retardation in elderly untreated depressed patients. Front Psychiatry 2014; 5:196. [PMID: 25674065 PMCID: PMC4306283 DOI: 10.3389/fpsyt.2014.00196] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2014] [Accepted: 12/19/2014] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND Psychomotor retardation (PR) is one of the core features in depression according to DSM V (1), but also aging in itself causes cognitive and psychomotor slowing. This is the first study investigating PR in relation to cognitive functioning and to the concomitant effect of depression and aging in a geriatric population ruling out contending effects of psychotropic medication. METHODS A group of 28 non-demented depressed elderly is compared to a matched control group of 20 healthy elderly. All participants underwent a test battery containing clinical depression measures, cognitive measures of processing speed, executive function and memory, clinical ratings of PR, and objective computerized fine motor skill-tests. Statistical analysis consisted of a General Linear Method multivariate analysis of variance to compare the clinical, cognitive, and psychomotor outcomes of the two groups. RESULTS Patients performed worse on all clinical, cognitive, and PR measures. Both groups showed an effect of cognitive load on fine motor function but the influence was significantly larger for patients than for healthy elderly except for the initiation time. LIMITATIONS Due to the restrictive inclusion criteria, only a relatively limited sample size could be obtained. CONCLUSION With a medication free sample, an additive effect of depression and aging on cognition and PR in geriatric patients was found. As this effect was independent of demand of effort (by varying the cognitive load), it was apparently not a motivational slowing effect of depression.
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Affiliation(s)
- Lieve Lia Beheydt
- Collaborative Antwerp Psychiatric Research Institute (CAPRI), Antwerp University , Antwerp , Belgium
| | - Didier Schrijvers
- Collaborative Antwerp Psychiatric Research Institute (CAPRI), Antwerp University , Antwerp , Belgium
| | - Lise Docx
- Collaborative Antwerp Psychiatric Research Institute (CAPRI), Antwerp University , Antwerp , Belgium
| | - Filip Bouckaert
- University Psychiatric Center KU Leuven , Kortenberg , Belgium
| | - Wouter Hulstijn
- Collaborative Antwerp Psychiatric Research Institute (CAPRI), Antwerp University , Antwerp , Belgium
| | - Bernard Sabbe
- Collaborative Antwerp Psychiatric Research Institute (CAPRI), Antwerp University , Antwerp , Belgium
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Abstract
As life expectancy lengthens, dementia is becoming a significant human condition in terms of its prevalence and cost to society worldwide. It is important in that context to understand the preventable and treatable causes of dementia. This article exposes the link between dementia and heart disease in all its forms, including coronary artery disease, myocardial infarction, atrial fibrillation, valvular disease, and heart failure. This article also explores the cardiovascular risk factors and emphasizes that several of them are preventable and treatable. In addition to medical therapies, the lifestyle changes that may be useful in retarding the onset of dementia are also summarized.
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Affiliation(s)
- B Ng Justin
- Departments of Neuroscience and Psychology, McGill University, Montreal, QC, Canada
| | - Michele Turek
- Division of Cardiology, The Ottawa Hospital, Ottawa, ON, Canada
- Department of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Antoine M Hakim
- Division of Neurology, The Ottawa Hospital, Ottawa, ON, Canada
- Brain and Mind Research Institute, University of Ottawa, Ottawa, ON, Canada
- Ottawa Hospital Research Institute, The Ottawa Hospital, Ottawa, ON, Canada
- Canadian Stroke Network, Ottawa, ON, Canada
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