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Postprandial Hypotension and Spinal Cord Injury. J Clin Med 2021; 10:jcm10071417. [PMID: 33915893 PMCID: PMC8037943 DOI: 10.3390/jcm10071417] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 03/25/2021] [Accepted: 03/27/2021] [Indexed: 11/17/2022] Open
Abstract
Postprandial hypotension (PPH) is defined as a fall of ≥20 mmHg in systolic blood pressure (SBP) or a SBP of <90 mmHg after having been >100 mmHg before the meal within two hours after a meal. The prevalence of PPH among persons with spinal cord injury (SCI) is unknown. Ambulatory blood pressure measurement was performed in 158 persons with SCI, 109 men, median age was 59.1 years (min.:13.2; max.: 86.2). In total, 78 persons (49.4%) had PPH after 114 out of 449 meals (25.4%). The median change in SBP during PPH was −28 mmHg (min.: −87; max.: −15 mmHg) and 96% of the PPH episodes were asymptomatic. The occurrence of PPH was correlated to older age (p = 0.001), level of injury (p = 0.023), and complete SCI (p = 0.000), but not, gender or time since injury. Further studies are needed to elucidate if PPH contributes to the increased cardiovascular mortality in the SCI population.
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Per BL, Taylor AW, Gill TK. Prescription medicines, over-the-counter medicines and complementary and alternative medicines use: a comparison between baby boomers and older South Australians. AIMS Public Health 2019; 6:380-395. [PMID: 31909061 PMCID: PMC6940579 DOI: 10.3934/publichealth.2019.4.380] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Accepted: 10/09/2019] [Indexed: 11/18/2022] Open
Abstract
Objective This study examines the difference in medication use between baby boomers (born between 1946–1965) and older people (born before 1946) to determine the proportion of people combining over-the-counter (OTC) medicines and complementary and alternative medicines (CAM) use with prescription medicine use. Design A clustered, multistage, systematic, random, self-weighting area sample was obtained and a face-to-face interview was conducted to examine the difference in use in prescription medicines, OTC, and CAM and factors associated with the use between baby boomers and older people. Setting South Australia. Participants Respondents aged 15 years and over participated in surveys conducted in autumn (March to May) of 2004 (n = 3015) and 2008 (n = 3,034) in which all respondents were asked to list their current medications. This study focuses on those participants whose age was in the range defined by baby boomers and older people. Main outcome measures Proportion in each age group taking prescription medicine, OTC medicine, and CAM were determined. Multivariable logistic regression analyses were performed to investigate the relationships between medication use and demographic variables. Results The results showed that older people were not only the higher users of prescriptions medicines but also OTC medicines and CAM. Gender and education were associated with the use of CAM. Conclusions Due to the high use of CAM and OTC, it is important for the prescriber to take a full history of medication use before prescribing to reduce potential problems associated with drug interactions.
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Affiliation(s)
- Bee Leng Per
- SA Pharmacy, Central Adelaide Local Health Network, Royal Adelaide Hospital, Adelaide, SA, Australia
| | - Anne W Taylor
- Adelaide Medical School, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, SA, Australia
| | - Tiffany K Gill
- Adelaide Medical School, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, SA, Australia
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Ward LM, Thomas J. Patient Perception of Physicians and Medication Adherence Among Older Adults With Hypertension. J Aging Health 2018; 32:95-105. [DOI: 10.1177/0898264318806390] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Objective: To assess association between patient perception of physicians and adherence to antihypertensive medication among Medicare beneficiaries. Method: Logistic regression was used to assess association between the Patient Perception of Physicians Scale score and adherence to antihypertensive medication. The 2007 Medicare Current Beneficiary Survey data were used to create a 12-item patient perception of physician scale and 2008 Medicare Part D claims to assess adherence. Results: There were 2,510 beneficiaries included in the sample. The mean age was 76.4 years ( SD = ±6.88 years). Sixty-five percent of the sample was adherent in filling their antihypertensive medication. Beneficiaries with more favorable perceptions of their physician (scores 37 or higher) were more likely to be adherent to antihypertensive medications than beneficiaries with scores less than 37 (odds ratio [OR] = 1.341, 95% confidence interval [CI] = [1.101, 1.632], p = .0035). Discussion: These findings provide some evidence that patient perceptions of their physician are associated with adherence, and that the physician–patient relationship is an important factor.
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Affiliation(s)
- Lori M. Ward
- University of Mississippi Medical Center, Jackson, MS, USA
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McLeod KJ, Stromhaug A. Reversal of cognitive impairment in a hypotensive elderly population using a passive exercise intervention. Clin Interv Aging 2017; 12:1859-1866. [PMID: 29158668 PMCID: PMC5683775 DOI: 10.2147/cia.s147959] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Background Cognitive decline in the elderly is strongly associated with cerebral hypoperfusion, a condition that can be reversed with exercise. Adhering to a traditional exercise regimen, however, is challenging for this population. Objective In a pilot clinical study, we evaluated the ability of a “passive” exercise regimen (noninvasive calf muscle pump stimulation) to normalize blood pressure in a chronically hypotensive elderly population and enhance cognitive function. Participants and methods Ten elderly (82.5±7.5 years) men and women volunteers, residing in a senior living facility in upstate New York, were divided into control (N=5) and intervention (N=5) groups based on initial diastolic blood pressure (DBP); participants with initial DBP <65 mmHg became intervention participants, and those with initial DBP >65 mmHg enrolled in the control group. Body mass, blood pressure, and executive function (using incongruent Stroop and Trailmaking B test) were evaluated weekly for 4 months. Results At initiation of the study, time to complete the executive function tests in the hypotensive group was almost twice that of the control group. Daily calf muscle pump stimulation (passive exercise) for 1 hour/day, or less, was found to be sufficient to normalize DBP and significantly improve performance on the executive function tests.
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Neoh CF, Long CM, Lim SM, Ramasamy K, Shahar S, Majeed ABA. Medication use and adherence among multi-ethnic community-dwelling older adults in Malaysia. Geriatr Gerontol Int 2016; 17:1214-1220. [PMID: 27489036 DOI: 10.1111/ggi.12849] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2016] [Revised: 05/06/2016] [Accepted: 05/22/2016] [Indexed: 11/29/2022]
Abstract
AIM The present study assessed adherence, barriers, belief and awareness towards the use of medications among multi-ethnic community-dwelling older adults in Malaysia. Medication accessibility, expenditure and perceptions towards medicine labeling among older adults were also evaluated. METHODS A cross-sectional study was carried out in the central region of Malaysia from January to August 2015. The older adults enrolled in an ongoing prospective community-based geriatric cohort study and prescribed with medicines were interviewed using a 50-item validated questionnaire. RESULTS Of the 79 older adults interviewed, 39.2% had ≥4 prescribed medications. Most obtained their medications free-of-charge from government hospitals (66, 83.5%). Nearly half (35, 44.3%) had trouble reading labels for medicines that they had received. Chinese older adults (P = 0.001) and those with lower monthly household income (P < 0.001) expressed difficulty in reading medication labels. Most (59, 75.0%) were unable to differentiate between generic and brand names of the medications, and 49.4% of the older adults did not know that all medicines had to be registered with the Ministry of Health, Malaysia. Most older adults had positive beliefs about the necessity of their medications, and 50.6% (n = 40) reported high medication adherence. The medication adherence score was negatively correlated with the concerns score (r = -0.5, P < 0.001). CONCLUSIONS The findings from the present study provide a unique insight into the diversity of medication use among multiethnic community-dwelling older adults. Although high adherence to medications and positive beliefs about the necessity of medications were reported by the older adults, their knowledge about medications remained insufficient and they had difficulty in reading medication labels. Geriatr Gerontol Int 2017; 17: 1214-1220.
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Affiliation(s)
- Chin Fen Neoh
- Faculty of Pharmacy, Universiti Teknologi MARA, Puncak Alam, Selangor, Malaysia.,Collaborative Drug Discovery Research (CDDR) Group, Pharmaceutical and Life Sciences Community of Research, Universiti Teknologi MARA, Shah Alam, Selangor, Malaysia
| | - Chiau Ming Long
- Faculty of Pharmacy, Universiti Teknologi MARA, Puncak Alam, Selangor, Malaysia.,Brain Degeneration and Therapeutics Group, Pharmaceutical and Life Sciences Community of Research, Universiti Teknologi MARA, Shah Alam, Selangor, Malaysia
| | - Siong Meng Lim
- Faculty of Pharmacy, Universiti Teknologi MARA, Puncak Alam, Selangor, Malaysia.,Collaborative Drug Discovery Research (CDDR) Group, Pharmaceutical and Life Sciences Community of Research, Universiti Teknologi MARA, Shah Alam, Selangor, Malaysia
| | - Kalavathy Ramasamy
- Faculty of Pharmacy, Universiti Teknologi MARA, Puncak Alam, Selangor, Malaysia.,Collaborative Drug Discovery Research (CDDR) Group, Pharmaceutical and Life Sciences Community of Research, Universiti Teknologi MARA, Shah Alam, Selangor, Malaysia
| | - Suzana Shahar
- Dietetic Program, School of Healthcare Sciences, Faculty of Health Sciences, National University of Malaysia, Kuala Lumpur, Malaysia
| | - Abu Bakar Abdul Majeed
- Faculty of Pharmacy, Universiti Teknologi MARA, Puncak Alam, Selangor, Malaysia.,Brain Degeneration and Therapeutics Group, Pharmaceutical and Life Sciences Community of Research, Universiti Teknologi MARA, Shah Alam, Selangor, Malaysia
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Moonen JEF, Foster-Dingley JC, de Ruijter W, van der Grond J, de Craen AJM, van der Mast RC. Effect of discontinuation of antihypertensive medication on orthostatic hypotension in older persons with mild cognitive impairment: the DANTE Study Leiden. Age Ageing 2016; 45:249-55. [PMID: 26758532 DOI: 10.1093/ageing/afv199] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2015] [Accepted: 12/02/2015] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND the relationship between antihypertensive medication and orthostatic hypotension in older persons remains ambiguous, due to conflicting observational evidence and lack of data of clinical trials. OBJECTIVE to assess the effect of discontinuation of antihypertensive medication on orthostatic hypotension in older persons with mild cognitive impairment. METHODS a total of 162 participants with orthostatic hypotension were selected from the Discontinuation of Antihypertensive Treatment in Elderly people (DANTE) Study. This randomised clinical trial included community-dwelling participants aged ≥75 years, with mild cognitive impairment, using antihypertensive medication and without serious cardiovascular disease. Participants were randomised to discontinuation or continuation of antihypertensive treatment (ratio 1:1). Orthostatic hypotension was defined as a drop of at least 20 mmHg in systolic blood pressure and/or 10 mmHg in diastolic blood pressure on standing from a seated position. Outcome was the absence of orthostatic hypotension at 4-month follow-up. Relative risks (RR) were calculated by intention-to-treat and per-protocol analyses. RESULTS at follow-up, according to intention-to-treat analyses, of the 86 persons assigned to discontinuation of antihypertensive medication, 43 (50%) were free from orthostatic hypotension, compared with 29 (38%) of the 76 persons assigned to continuation of medication [RR 1.31 (95% confidence interval (CI) 0.92-1.87); P = 0.13]. Per-protocol analysis showed that recovery from orthostatic hypotension was significantly higher in persons who completely discontinued all antihypertensive medication (61%) compared with the continuation group (38%) [RR 1.60 (95% CI 1.10-2.31); P = 0.01]. CONCLUSION in older persons with mild cognitive impairment and orthostatic hypotension receiving antihypertensive medication, discontinuation of antihypertensive medication may increase the probability of recovery from orthostatic hypotension.
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Affiliation(s)
- Justine E F Moonen
- Department of Psychiatry, Leiden University Medical Center, Leiden, The Netherlands
| | | | - Wouter de Ruijter
- Department of Public Health and Primary Care, Leiden University Medical Centre, Leiden, The Netherlands
| | - Jeroen van der Grond
- Department of Radiology, Leiden University Medical Center, Leiden, Zuid-Holland, The Netherlands
| | - Anton J M de Craen
- Department of Gerontology and Geriatrics, Leiden University Medical Center, Leiden, The Netherlands
| | - Roos C van der Mast
- Department of Psychiatry, Leiden University Medical Center, Leiden, The Netherlands Department of Psychiatry, Collaborative Antwerp Psychiatric Research Institute (CAPRI), University of Antwerp, Antwerp, Belgium
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Jodaitis L, Vaillant F, Snacken M, Boland B, Spinewine A, Dalleur O, Gilles C, Petrovic M, Pepersack T. Orthostatic hypotension and associated conditions in geriatric inpatients. Acta Clin Belg 2015; 70:251-8. [PMID: 26135806 DOI: 10.1179/2295333715y.0000000006] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
Screening of orthostatic hypotension (OH) was performed in 285 patients aged 75 years. Current drugs, reasons for admission, geriatric syndromes, and confounding medical conditions were collected. Patients with OH (n = 116, 41%) as compared to those without OH (n = 169) more frequently (P < 0.01) presented falls in the last 6 months (62 vs. 40%, P < 0.001), a fall as the reason for the current admission (49 vs. 26%, P < 0.001), feeling of fainting (20 vs. 6%, P = 0.002), syncope (29 vs. 4%, P < 0.001) or functional decline (71 vs. 47%, P = 0.012). No difference was observed between the two groups in terms of age (85 ± 5 vs. 84 ± 4 years), gender (59 vs. 50% female), common geriatric conditions (e.g. malnutrition 46 vs. 58%, dementia 22 vs. 26%), comorbidity or confounding conditions (dehydration 28 vs. 30%, sepsis 2 vs. 6%). No difference was detected in the use of drugs with psychotropic cardiovascular or diuretic effect, or in their associations. Orthostatic hypotension is frequent upon hospital admission and should be screened, particularly in geriatric fallers. This absence of relation between OH and drugs use suggests that non-pharmacological interventions should be first attempted in older inpatients with OH before deciding to reduce or withdraw useful drugs.
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Elliott RA. Problems with Medication Use in the Elderly: An Australian Perspective. JOURNAL OF PHARMACY PRACTICE AND RESEARCH 2015. [DOI: 10.1002/j.2055-2335.2006.tb00889.x] [Citation(s) in RCA: 103] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Rohan A Elliott
- Austin Health, Heidelberg, and Department of Pharmacy Practice; Monash University; Parkville Victoria
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Fried TR, O'Leary J, Towle V, Goldstein MK, Trentalange M, Martin DK. Health outcomes associated with polypharmacy in community-dwelling older adults: a systematic review. J Am Geriatr Soc 2015; 62:2261-72. [PMID: 25516023 DOI: 10.1111/jgs.13153] [Citation(s) in RCA: 432] [Impact Index Per Article: 48.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVES To summarize evidence regarding the health outcomes associated with polypharmacy, defined as number of prescribed medications, in older community-dwelling persons. DESIGN Systematic review of MEDLINE (OvidSP 1946 to May, Week 3, 2014). SETTING Community. PARTICIPANTS Observational studies examining health outcomes according to number of prescription medications taken. MEASUREMENTS Association between number of medications and health outcomes. Because of the importance of comorbidity as a potential confounder of the relationship between polypharmacy and health outcomes, articles were assessed regarding the quality of their adjustment for confounding. RESULTS Of the 50 studies identified, the majority that were rated good in terms of their adjustment for comorbidity demonstrated relationships between polypharmacy and a range of outcomes, including falls, fall outcomes, fall risk factors, adverse drug events, hospitalization, mortality, and measures of function and cognition. However, a number of these studies failed to demonstrate associations, as did a substantial proportion of studies rated fair or poor. CONCLUSION Data are mixed regarding the relationship between polypharmacy, considered in terms of number of medications, and adverse outcomes in community-dwelling older persons. Because of the challenge of confounding, randomized controlled trials of medication discontinuation may provide more-definitive evidence regarding this relationship than observational studies can provide.
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Affiliation(s)
- Terri R Fried
- Clinical Epidemiology Research Center, Veterans Affairs Connecticut Healthcare System, West Haven, Connecticut; Department of Medicine, Yale University
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10
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Prevalence of Self-Medication and Associated Factors in an Elderly Population: A Systematic Review. Drugs Aging 2014; 31:883-96. [DOI: 10.1007/s40266-014-0217-x] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Wheeler KJ, Roberts ME, Neiheisel MB. Medication adherence part two: predictors of nonadherence and adherence. J Am Assoc Nurse Pract 2014; 26:225-232. [PMID: 24574102 DOI: 10.1002/2327-6924.12105] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
PURPOSE This is the second of a three-part series on medication adherence in which the authors describe the continuum of adherence to nonadherence of medication usage. DATA SOURCES Research articles through MEDLINE and PubMed. CONCLUSIONS Understanding the magnitude and scope of the problem of medication nonadherence is the first step in reaching better adherence rates (described in Part One of this series). The second step is to recognize the complexities of the reasons for medication adherence/nonadherence (described here). Reasons for nonadherence include beliefs related to the benefits of medication for physical and mental disorders, complexities of systems of health care and treatment plans, and lifestyle and demographic characteristics of patients. The final step is to evaluate each patient for medication adherence, tailoring the plan of care according to patient and system specific barriers (described in Part Three of this series). IMPLICATIONS FOR PRACTICE Nurse practitioners must recognize a critical element of thorough care is to assess medication adherence at each patient visit, countering patient and system barriers as indicated. Nurse practitioners also need to adjust assessment and prescribing practices according to the evidence for best practices to improve medication adherence.
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Affiliation(s)
- Kathy J Wheeler
- University of Kentucky College of Nursing, Lexington, Kentucky, Seton Hall University, South Orange, New Jersey, University of Louisiana at Lafayette, Lafayette, Louisiana
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Kusljic S, Manias E, Tran B, Williams A. Enablers and barriers affecting medication-taking behaviour in aging men with benign prostatic hyperplasia. Aging Male 2013; 16:112-7. [PMID: 23750816 DOI: 10.3109/13685538.2013.801951] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES To identify the enablers and barriers affecting medication-taking behaviour in aging men with benign prostatic hyperplasia. METHODS A total of 40 patients attending the urology outpatient clinic in Melbourne in 2012 were screened. Patients who successfully met the inclusion criteria were interviewed using a structured interview schedule. Information regarding the patient's medication, demographic data and presence of co-morbidities was collected. Content analysis was compared with patient demographic and medical data, contributing to the analysis. RESULTS Problems with medication-taking were reported in 58% of patients. All patients without co-morbidities reported issues regarding their medications, whereas only 27% of patients with co-morbidities reported concerns regarding their medications. Statistical analysis revealed that patients without co-morbidities were significantly more likely (p = 0.002) to have complaints with their medications compared to those with co-morbidities. Furthermore, patients with co-morbidities who required help of caregivers to assist with their medication-taking were significantly less likely (p = 0.05) to have complaints with their medications compared to patients who self-managed. CONCLUSIONS Older patients with caregivers who assisted managing their medication-taking had better adherence. Those receiving aid from their caregivers were significantly less likely to have complaints regarding their medications as opposed to those not requiring a caregiver. This highlights the importance of having support for medication-taking in patients with co-morbidities to assist with better adherence.
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Affiliation(s)
- Snezana Kusljic
- Department of Nursing, The University of Melbourne, Australia.
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Morgan TK, Williamson M, Pirotta M, Stewart K, Myers SP, Barnes J. A national census of medicines use: a 24-hour snapshot of Australians aged 50 years and older. Med J Aust 2012; 196:50-3. [PMID: 22256935 DOI: 10.5694/mja11.10698] [Citation(s) in RCA: 147] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To explore the current use of conventional and complementary medicines in Australians aged ≥ 50 years. DESIGN, SETTING AND PARTICIPANTS Cross-sectional postal survey sent to a random sample of 4500 Australians aged ≥ 50 years between June 2009 and February 2010. MAIN OUTCOME MEASURES Prevalence of medicines use, reasons for medicines use and sources of medicines. RESULTS Response rate was 37.3%. Medicines use was very common; 87.1% of participants took one or more medicines and 43.3% took five or more in the previous 24 hours. Complementary medicines were used by 46.3% of participants, 87.4% of whom used both conventional and complementary medicines. The most commonly used medicines were antihypertensive agents (43.2% of participants), natural marine and animal products including fish oil and glucosamine (32.4%) and lipid-lowering agents (30.4%). Doctors recommended 79.3% of all medicines and 93.0% of conventional medicines. Pharmacists commonly recommended occasional medicines (ie, as needed), while friends, family and media most often influenced use of complementary medicines. CONCLUSIONS The use of multiple medicines is common and higher than reported in the 1995 National Health Survey. Today, much medicines use is to prevent future disease by influencing risk factors. High levels of polypharmacy highlight the need to support the safe and effective use of medicines in the community. Although doctors recommend or prescribe most medicines, self-directed medication use is common. This highlights the need for consumer access to accurate information and strategies to improve health literacy about medicines.
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Park YH, Kim H, Jang SN, Koh CK. Predictors of adherence to medication in older Korean patients with hypertension. Eur J Cardiovasc Nurs 2012; 12:17-24. [PMID: 21704563 DOI: 10.1016/j.ejcnurse.2011.05.006] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND AND RESEARCH OBJECTIVES Adherence to a medication regimen is a major factor in achieving adequate blood pressure control for hypertensive patients. However, older adults often report having missed doses, which they attribute to forgetfulness. The purpose of this study was to identify significant factors, including socioeconomic variables, hypertension history, and cognitive functions, contributing to medication adherence among older Korean adults with hypertension. SUBJECTS AND METHOD This study involved 241 older patients with hypertension from a community senior center during the period from 2008 to 2009. Data were collected through face to face interviews. The association of medication adherence with socioeconomic characteristics, hypertension-related history, knowledge, antihypertensive lifestyle, and memory was assessed by computing odds ratios in logistic regressions. RESULTS AND CONCLUSIONS Of the 241 patients, 44% were aged 75 or older, and 60% were male. The rate of non-adherence with antihypertensive medication was 41%. Metamemory, adherence to an antihypertensive lifestyle, and employment status, were associated with participants' adherence to antihypertensive medication in both univariate and multivariate analyses. Results suggest that memory functions are a key factor to medication adherence among the Korean elderly population. In contrast to younger adults, unintentional non-adherence appears to be a major issue for older adults to keep medicating. Interventions focusing on memory ability, such as strategies for recalling and placing cues, are needed for implementation in the population of older Korean patients with hypertension. Unemployed older people who have hypertensive lifestyles should also be considered a high-risk group for non-adherence to medication.
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Affiliation(s)
- Yeon-Hwan Park
- Research Institute of Nursing Science, College of Nursing, Seoul National University, Seoul, South Korea
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Tsai KT, Chen JH, Wen CJ, Kuo HK, Lu IS, Chiu LS, Wu SC, Chan DC. Medication adherence among geriatric outpatients prescribed multiple medications. ACTA ACUST UNITED AC 2012; 10:61-8. [PMID: 22264853 DOI: 10.1016/j.amjopharm.2011.11.005] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2011] [Revised: 11/26/2011] [Accepted: 11/30/2011] [Indexed: 11/18/2022]
Abstract
BACKGROUND Poor medication adherence (PMA) is associated with higher risks of morbidity, hospitalization, and mortality. Polypharmacy is not only a determinant of PMA but is also associated with many adverse health outcomes. OBJECTIVE We aimed to determine the prevalence and correlates of PMA in an older population with polypharmacy. METHODS Baseline data from 193 older adults from the Medication Safety Review Clinic Taiwan Study were analyzed. Patients were either prescribed ≥8 long-term medications or visited ≥3 different physicians between August and October 2007. PMA was defined as taking either <80% or >120% of prescribed amounts of a medication. Patients were classified as no (0%), low level (>0 but <25%), and high level (≥25%) PMA depending on what percentage of entire medication regimen taken reached PMA. RESULTS Mean (SD) age was 76 (6) years, and mean number of medications was 9 (3), with a mean medication class number of 4 (1). Of the 1713 medications reviewed, 19% had PMA. However, at patient level, 34%, 32%, and 34% of patients were classified as no, low level, and high level PMA, respectively. Correlates varied by levels of PMA. Compared with patients without PMA, higher medication class number and use of alimentary tract, psychotropic, and hematologic agents were associated with both low and high level PMA. History of dizziness was associated with low level PMA, and higher Mini Mental Status Examination score was associated with high level PMA. CONCLUSIONS To enhance medication adherence in older adults prescribed multiple medications, medication class numbers and certain high-risk medication classes should be taken into account. Physicians should also routinely assess systemic (eg, cognition) or drug-specific characteristics (eg, side effects).
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Affiliation(s)
- Kang-Ting Tsai
- Department of Geriatrics and Gerontology, National Taiwan University Hospital, Taipei, Taiwan
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17
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Abstract
SummaryInsomnia and other sleep disturbances are common in older people, with up to 40% reporting some difficulty sleeping. Insomnia is a syndrome with multiple causes including medications, other illnesses and environmental factors. An accurate diagnosis is needed for effective management. Sleep disturbances are associated with functional and cognitive impairment and excess mortality. Management should initially be non-pharmacological including sleep hygiene education and behavioural therapy. Medications, including benzodiazepines (BZDs), are second-line with little evidence to support long-term usage. BZD usage in older people is associated with a range of disorders including falls, accidents and cognitive impairment. The management of insomnia in specific situations such as residential care, those with dementia and depressed older people can be challenging. Additional research is needed, particularly on the risks/benefit of long-term pharmacotherapy and to determine whether therapy reduces the consequences of sleep disturbances.
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Epstein NU, Saykin AJ, Risacher SL, Gao S, Farlow MR. Differences in medication use in the Alzheimer's disease neuroimaging initiative: analysis of baseline characteristics. Drugs Aging 2010; 27:677-86. [PMID: 20658795 DOI: 10.2165/11538260-000000000-00000] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
INTRODUCTION The ADNI (Alzheimer's Disease Neuroimaging Initiative) is a large longitudinal study of patients with probable Alzheimer's disease (AD), patients with mild cognitive impairment (MCI) and healthy elderly controls followed for at least 2-3 years. Many participants in the ADNI are being treated with medications, and these may have beneficial or deleterious effects. OBJECTIVE The goal of the study was to characterize baseline medication use in the ADNI. METHODS Diagnosis, demographics, medication status, psychometric data and MRI measures of hippocampal volume and entorhinal cortex thickness were obtained for 818 participants from the ADNI cohort. Total number of medications, Beers list (potentially dangerous) medications and AD treatments were also tabulated. ANOVA and logistic regression were used to assess associations between baseline pharmacotherapy and diagnosis, demographics, and selected clinical and MRI variables. RESULTS Of the 818 enrolled ADNI participants, 809 were available for analysis in the present study, including 184 patients with AD, 399 patients with MCI and 226 healthy elderly controls. Significant gender differences in recruitment were observed in the MCI group. The average number of medications per participant was 8 (SD 4) and 22% reported treatment with one or more Beers list medications. For symptomatic treatment of MCI or AD, donepezil and memantine were the most commonly reported drugs. As expected, MCI and AD patients with more severe impairment were more likely to be treated. Men received treatment more frequently than women. Older subjects and those with less education were less likely to receive treatment. CONCLUSIONS AD and MCI participants from the ADNI cohort were being treated with polypharmacy and many were also taking one or more medications with the potential for adverse effects. Off-label use of cholinesterase inhibitors and/or memantine for MCI was common, with more severely affected patients most likely to receive treatment. Differences in the frequency of symptomatic treatment were also observed as a function of age, years of education, gender and disease severity.
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Affiliation(s)
- Noam U Epstein
- Indiana University School of Medicine, Indianapolis, 46202, USA
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Abstract
The definition of "polypharmacy" ranges from the use of a large number of medications; the use of potentially inappropriate medications, which can increase the risk for adverse drug events; medication underuse despite instructions to the contrary; and medication duplication. Older adults are particularly at risk because they often present with several medical conditions requiring pharmacotherapy. Cancer-related therapy adds to this risk in older adults, but few studies have been conducted in this patient population. In this review, we outline the adverse outcomes associated with polypharmacy and present polypharmacy definitions offered by the geriatrics literature. We also examine the strengths and weaknesses of these definitions and explore the relationships among these definitions and what is known about the prevalence and impact of polypharmacy.
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Affiliation(s)
- Ronald J Maggiore
- Yale Comprehensive Cancer Center and Yale University School of Medicine, New Haven, Connecticut, USA
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Abstract
Hypertension is an important risk factor for cardiovascular morbidity and mortality, particularly in the elderly. Blood pressure elevation in the elderly is due to structural and functional changes that occur with aging. Treatment of hypertension reduces the risk of stroke, heart failure, myocardial infarction, all-cause mortality, cognitive impairment, and dementia in elderly patients with hypertension. A healthy lifestyle helps hypertension management, with benefits extending beyond lowering of blood pressure. Several classes of antihypertensive drugs are effective in preventing cardiovascular events. Treatment decisions should be guided by the presence of compelling indications such as diabetes or heart failure and by the tolerability of individual drugs or drug combinations in individual patients. The concomitant intake of certain medications that counter the effects of antihypertensive drugs and the frequent occurrence of orthostatic hypotension complicate treatment in older patients and drive down blood pressure control rates.
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Affiliation(s)
- Maria Czarina Acelajado
- Vascular Biology and Hypertension Program of Division of Cardiovascular Disease, Department of Medicine, School of Medicine, University of Alabama at Birmingham, USA.
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Villavicencio-Chávez C, Miralles Basseda R, González Marín P, Cervera AM. [Orthostatic and postprandial hypotension in elderly patients with chronic diseases and disability: prevalence and related factors]. Rev Esp Geriatr Gerontol 2009; 44:12-18. [PMID: 19237029 DOI: 10.1016/j.regg.2008.07.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2008] [Revised: 07/14/2008] [Accepted: 07/15/2008] [Indexed: 05/27/2023]
Abstract
INTRODUCTION To assess the prevalence of orthostatic hypotension (OH) and postprandial hypotension (PPH) in patients admitted to an intermediate care unit, as well as to analyze the characteristics of these patients. PATIENTS AND METHODS Sixty patients were analyzed according to the following criteria: age >65 years, able to take food orally, stand up and/or sit down, and clinically stable. A comprehensive geriatric assessment was carried out and the main diagnosis and the presence of autonomic neuropathy symptoms (ANS) were registered. Blood pressure (BP) was registered in the morning in supine position during the first 3min of postural change (standing or sitting). OH was defined as a decrease in systolic blood pressure (SBP) of 20mm Hg or a decrease in diastolic blood pressure (DBP) of 10mmHg. BP was registered after 15min of sitting and 60min after breakfast. PPH was defined as a decrease in SBP of 20mmHg. RESULTS The mean age was 79.1+/-7.8 years. Nine patients (15%) had OH and 29 (48.3%) had PPH. The mean Lawton index (LI) score in patients with OH was 3.1+/-2.1 and was 5.2+/-2.6 in the remaining patients (P<.02). The mean body mass index (BMI) was 23.3+/-3.1 vs. 26.2+/-5.1 (P<.04). ANS was present in all nine patients (100%) with OH but in only 30 (58.8%) of the remaining 51 patients (chi-square=5.71; P<.03). CONCLUSIONS PPH was more frequent than OH. Patients with OH had a significantly lower LI score and BMI. The presence of ANS was significantly more frequent in patients with OH. There was no significant relationship between HO and PPH or among the remaining variables studied.
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Bertoldi AD, Barros AJD, Wagner A, Ross-Degnan D, Hallal PC. A descriptive review of the methodologies used in household surveys on medicine utilization. BMC Health Serv Res 2008; 8:222. [PMID: 18976465 PMCID: PMC2584639 DOI: 10.1186/1472-6963-8-222] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2008] [Accepted: 10/31/2008] [Indexed: 12/04/2022] Open
Abstract
Background Studies carried out in the community enable researchers to understand access to medicines, affordability, and barriers to use from the consumer's point of view, and may stimulate the development of adequate medicines policies. The aim of the present article was to describe methodological and analytical aspects of quantitative studies on medicine utilization carried out at the household level. Methods Systematic review of original papers with data collected in studies in which the household was a sampling unit, published between 1995 and 2008. The electronic review was carried out in Medline/Pubmed, Scielo and Lilacs. The reference lists of the papers identified were examined, as well as other publications by their authors. Studies on the utilization of specific pharmacological groups, or those including only respondents with a given disease were excluded. Results Out of 4852 papers initially identified in the literature search, 61 fulfilled our inclusion criteria. Most studies were carried out in Europe and North America and used a cross-sectional approach. More than 80% used face-to-face interviews for data collection, and the most frequently used recall period for assessing medicine utilization was 14–15 days. In 59% of the studies, interviewers were trained to request the packaging of the medicines reported by the subjects; medical prescriptions were requested less frequently (15% of the studies). Conclusion These data will be useful for updating researchers on what methods their peers are currently using. Such information may help overcome challenges in the planning and analyses of future studies. Moreover, this publication may contribute to the improvement of the quality of medicine use data obtained in household surveys.
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Affiliation(s)
- Andréa D Bertoldi
- Programa de pós-graduação em Saúde Coletiva, Universidade do Vale do Rio dos Sinos, Brazil.
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Salazar JA, Poon I, Nair M. Clinical consequences of polypharmacy in elderly: expect the unexpected, think the unthinkable. Expert Opin Drug Saf 2007; 6:695-704. [PMID: 17967158 DOI: 10.1517/14740338.6.6.695] [Citation(s) in RCA: 95] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Multiple medication use has been coined 'polypharmacy'. Polypharmacy is highly prevalent in older patients secondary to the increased number of co-morbid disease states with ageing. Existing practice guidelines recommend multiple drug use for certain chronic diseases (i.e., HIV, tuberculosis, hypertension, etc.). A polypharmacologic approach for certain diseases has been shown to improve therapeutic response, decrease morbidity and mortality. On the contrary, polypharmacy may induce iatrogenic complications that are often unseen prior to the initiation of medicinal regimens. This paper will review the potential clinical consequences of polypharmacy in the elderly and common medication administration errors that may occur. Consequences of polypharmacy include adverse drug effects, drug-drug interactions, disease-drug interactions, food-drug interactions, nutraceutical-drug interactions and medication cascade effect. Medication administration errors, such as phonetic confusion, flip-flopping dosing errors and pill visual-cue errors, are also reviewed. Prescribing for the elderly, whose medications are vast in number, is often uncharted physiologic territory. The clinician must expect the unexpected and think of the unthinkable in the geriatric patient, when dealing with polypharmacy and the potential consequences.
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Affiliation(s)
- Joel A Salazar
- Transitional Care Center, Michael E DeBakey VA Medical Center, Baylor College of Medicine, 2002 Holcombe Blvd, Houston, TX 77030, USA.
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Small G, Dubois B. A review of compliance to treatment in Alzheimer's disease: potential benefits of a transdermal patch. Curr Med Res Opin 2007; 23:2705-13. [PMID: 17892635 DOI: 10.1185/030079907x233403] [Citation(s) in RCA: 96] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Following prescribed medication regimens is essential for the effective treatment of any medical condition. Unfortunately, patients often fail to follow recommendations, and treatment non-compliance represents a widespread, often underestimated problem, placing tremendous burden on the healthcare system. Compliance in Alzheimer's disease (AD), a chronic neurodegenerative disease typically afflicting older adults, is especially challenging. SCOPE To review factors contributing to poor treatment compliance in AD, considering the prominent role care givers often play in treatment management; and acknowledging strategic approaches, particularly modern transdermal patches, to improve compliance in this particularly susceptible population. Articles were identified by searching MEDLINE in November 2006 (search limits: 1987-2007) using the terms: compliance; Alzheimer's; treatment; and transdermal. Additional resources included bibliographies of identified articles. FINDINGS Strategic approaches to improving treatment compliance include: simplifying treatment regimens, using reminder packaging, and developing more patient- or caregiver-friendly modes of administration. To date, AD therapies have been administered orally. However, recent developments in alternative modes of drug delivery, such as transdermal patches, may offer effective, well-tolerated treatment options with the potential to enhance compliance. A patch containing rivastigmine (Exelon), an established cholinesterase inhibitor, has been developed and demonstrated to have good efficacy and tolerability in patients with AD. In addition, initial caregiver experience suggests preference for the patch over oral administration. CONCLUSION Transdermal patches may be an effective way to optimize treatment compliance for AD, as well as an increasing number of other chronic conditions that typically afflict the older population, offering the possibility of more sustained clinical benefits.
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Affiliation(s)
- Gary Small
- UCLA Semel Institute for Neuroscience and Human Behavior, Los Angeles, CA 90024-1759, USA.
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Pit SW, Byles JE, Henry DA, Holt L, Hansen V, Bowman DA. A Quality Use of Medicines program for general practitioners and older people: a cluster randomised controlled trial. Med J Aust 2007; 187:23-30. [PMID: 17605699 DOI: 10.5694/j.1326-5377.2007.tb01110.x] [Citation(s) in RCA: 107] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2006] [Accepted: 04/30/2007] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To investigate the effectiveness of an educational Quality Use of Medicines program, delivered at the level of general practice, on medicines use, falls and quality of life in people aged > or = 65 years. DESIGN Cluster randomised controlled trial conducted in 2002. SETTING General practices in the Hunter Region, New South Wales, Australia. PARTICIPANTS Twenty general practitioners recruited 849 patients to participate in the study. INTERVENTION Education (academic detailing, provision of prescribing information and feedback); medication risk assessment; facilitation of medication review; financial incentives. MAIN OUTCOME MEASURES PRIMARY MEASURES a composite score reflecting use of benzodiazepines, non-steroidal anti-inflammatory drugs (NSAIDs) and thiazide diuretics; secondary measures: use of medication reviews, occurrence of falls, quality of life (as assessed by SF-12 and EQ-5D survey scores. RESULTS Compared with the control group, participants in the intervention group had increased odds of having an improved medication use composite score (odds ratio [OR], 1.86; 95% CI, 1.21-2.85) at 4-month follow-up but not at 12 months. At 4-month follow-up, the intervention group had reduced odds of using NSAIDs (OR, 0.62; 95% CI, 0.39-0.99) and showed a non-significant reduction in use of benzodiazepines (OR, 0.51; 95% CI, 0.20-1.30) and thiazide diuretics (OR, 0.70; 95% CI, 0.48-1.01). Changes in drug use were not significant at 12-month follow-up. At 12 months, intervention-group participants had lower adjusted ORs (AORs) for having a fall (AOR, 0.61; 95% CI, 0.41-0.91), injury (AOR, 0.56; 95% CI, 0.32-0.96), and injury requiring medical attention (AOR, 0.46; 95% CI, 0.30-0.70). Quality-of-life scores were unaffected by the intervention. CONCLUSION Education and systems for medication review conducted by GPs can be used to improve use of medicines. These interventions are associated with a reduction in falls among older people, without adverse effects on quality of life.
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Affiliation(s)
- Sabrina W Pit
- School of Medical Practice and Public Health, Faculty of Health, University of Newcastle, Newcastle, New South Wales, Australia.
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Arve S, Savikko N, Lavonius S, Lehtonen A, Isoaho H. Physical functioning, health and survival: a ten-year follow-up study. Aging Clin Exp Res 2006; 18:367-73. [PMID: 17167300 DOI: 10.1007/bf03324832] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND AND AIMS Cutbacks in human resources are putting home care personnel under increasing pressure in their work. Home health care personnel need to know how they can prevent undesirable conditions and support older people towards successful aging. The aim of this ten-year follow-up study was to identify factors associated with increased mortality among 70-year-old subjects living in the community. METHODS Data were collected in 1991 by a postal questionnaire sent to all residents of Turku, Finland, born in 1920. A physical examination was also conducted. Ten years later, in 2001, the mortality rate of this population was determined. The data were examined statistically. RESULTS Many health-related factors, such as smoking, poor subjective health, and mobility, were related to an increased level of mortality. In addition, several diseases (e.g., diabetes, angina pectoris, cancer) at age 70 were associated with increased mortality over ten years. Difficulties in daily activities at age 70 also increased the risk of mortality. CONCLUSIONS The findings offer useful clues for planning health care services and preventive interventions provided by home health care personnel. Home health care personnel should give special attention to older people who feel ill or very ill.
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Affiliation(s)
- Seija Arve
- Turku City Hospital, Kunnallissairaalantie 20, FIN-20700 Turku, Finland.
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van Vliet MJ, Schuurmans MJ, Grypdonck MHF, Duijnstee MSH. Improper intake of medication by elders--insights on contributing factors: a review of the literature. Res Theory Nurs Pract 2006; 20:79-93. [PMID: 16544895 DOI: 10.1891/rtnp.20.1.79] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Elders represent 6.4% of the world's populations, and 60% of them take medication. In one of six hospital admissions of elders, failures in medication intake are involved. Most of these admissions (88%) could be prevented if elders at risk can be identified (Beijer & Blaey, 2002). This review was conducted to identify and gain insight into which factors influence medication intake in elders. The factors are grouped into six categories: physiological factors, cognitive factors, polypharmacy and medication frequency, patient consent to the treatment and motivation for taking the medication, demographic variables, and family caregivers and social support. In order to identify elders at risk in an early stage, it is recommended that a risk-assessment instrument be developed.
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Affiliation(s)
- Marjolein J van Vliet
- Faculty of Health Care, University of Professional Sciences, Utrecht, The Netherlands.
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Pinto E, Bulpitt C, Beckett N, Peters R, Staessen JA, Rajkumar C. Rationale and methodology of monitoring ambulatory blood pressure and arterial compliance in the Hypertension in the Very Elderly Trial. Blood Press Monit 2006; 11:3-8. [PMID: 16410734 DOI: 10.1097/01.mbp.0000184965.30220.10] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE This article describes the rationale and methodology for the monitoring of ambulatory blood pressure and arterial compliance in hypertensive patients aged 80 years and above. This is a side project of the Hypertension in the Very Elderly Trial. METHODS The hypertension in the Very Elderly Trial is a multicentre, double-blind, randomized, placebo-controlled trial aiming to investigate the effect of active treatment on cardiovascular and other outcomes in hypertensive patients aged 80 years or more. Patients are randomized to placebo or active treatment starting with the diuretic indapamide and adding the angiotensin-converting enzyme inhibitor perindopril if required. This study has completed a pilot trial and the main trial is now underway. Six hundred patients will have two ABPM recordings, the first at baseline and the second a year after randomization. Arterial compliance is measured using the Q wave (electrocardiogram) to Korotkoff diastole sound interval. RESULTS Baseline characteristics for the first 50 patients recruited are presented. CONCLUSION This side project will allow the investigation of 24-h ambulatory measures of blood pressure and arterial compliance as predictors of cerebrovascular and cardiovascular events in the very elderly. The project will also allow the investigation of the blood pressure and vascular compliance profiles in the very elderly and their changes with posture. The association between these measurements and mortality and morbidity in this age group will be addressed.
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Affiliation(s)
- Elisabete Pinto
- Faculty of Medicine, Imperial College London, Hammersmith Campus, UK
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Frazier SC. Health outcomes and polypharmacy in elderly individuals: an integrated literature review. J Gerontol Nurs 2005; 31:4-11. [PMID: 16190007 DOI: 10.3928/0098-9134-20050901-04] [Citation(s) in RCA: 177] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The purpose of this integrated literature review was to determine the extent of research available related to polypharmacy and its effect on the health outcomes of the elderly population. A search of the Cumulative Index of Nursing and Allied Health Literature and Medline was conducted for studies published between 1995 and 2003 that linked polypharmacy and outcomes in the elderly population. The 16 studies in this integrative literature review were conducted in the United States, Canada, Australia, and Europe. Polypharmacy was shown to be a statistically significant predictor of hospitalization, nursing home placement, death, hypoglycemia, fractures, impaired mobility, pneumonia, and malnutrition. The effect of polypharmacy on elderly individuals is significant as demonstrated by this literature review. Nurses are in a unique position to monitor and potentially eliminate adverse effects of a complex medication regimen. Nursing research on polypharmacy and its effects on nursing-sensitive outcomes will help define guidelines for prevention and intervention.
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Abstract
The Medicare programme already funds a large proportion of the medical care for older Americans. However, geriatricians are an underutilized resource for improving the quality of care delivered with Medicare funding, particularly to the most complex patients. Recent legislative changes will increase the involvement of the Medicare programme in the area of outpatient medications. This offers an important opportunity to bring geriatric consultation to bear on a broad range of geriatric prescribing issues, including polypharmacy, pharmacological undertreatment and inappropriate prescription choice.
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Affiliation(s)
- Neil J Nusbaum
- Department of Medicine, University of Illinois College of Medicine at Rockford, Rockford, Illinois 61107-1897, USA.
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Vloet LCM, Pel-Little RE, Jansen PAF, Jansen RWMM. High Prevalence of Postprandial and Orthostatic Hypotension Among Geriatric Patients Admitted to Dutch Hospitals. J Gerontol A Biol Sci Med Sci 2005; 60:1271-7. [PMID: 16282558 DOI: 10.1093/gerona/60.10.1271] [Citation(s) in RCA: 71] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Previous studies have indicated that postprandial hypotension (PPH) and orthostatic hypotension (OH) occur infrequently together. As data on geriatric patients in hospitals are scarce, we investigated the prevalence of PPH and OH and their combined occurrence. Our study sample included patients admitted to two geriatric departments in Dutch hospitals. METHODS During 9 months, hemodynamic changes were measured with Spacelab 90207 after standing and after meals in all eligible patients. PPH is defined as a meal-related decline in systolic blood pressure (SBP) > or =20 mmHg, OH after standing up. RESULTS Eighty-five patients (44 men), mean age 80 +/- 7 years (range 60-98 years), with 4 +/- 2 diseases and 6 +/- 3 prescriptions, were included. PPH was present in 57 patients (67%) with a significant postmeal SBP decrease of 34 +/- 4 mmHg. OH was present in 44 patients (52%) with a mean SBP decline of 44 +/- 4 mmHg after standing. Thirty-two patients (37%) had OH and PPH. Only 16 patients (19%) had neither OH nor PPH. Symptoms of PPH were present in 65% of patients, with syncope (in five patients) and sleepiness as the most common symptoms. OH was symptomatic in 61% of patients, with dizziness and risk for falls as the most common symptoms. CONCLUSIONS PPH and OH are more common in geriatric patients than was previously appreciated, with a high statistical probability that OH and PPH occur simultaneously. There is little overlap in symptoms of OH (dizziness, fall risk) versus PPH (sleepiness, syncope), which can play an important role in diagnosis. Because of the high prevalence of symptomatic PPH and OH, blood pressure measurements for diagnosing hypotensive syndromes should be part of a comprehensive geriatric assessment.
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Affiliation(s)
- Lilian C M Vloet
- Department of Geriatric Medicine, University Medical Center Nijmegen, The Netherlands
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Abstract
Estimates of adherence to long-term medication regimens range from 17% to 80%, and nonadherence (or nonpersistence) can lead to increased morbidity, mortality, and healthcare costs. Multifaceted interventions that target specific barriers to adherence are most effective, because they address the problems and reinforce positive behaviors. Providers must assess their patients' understanding of the illness and its treatment, communicate the benefits of the treatment, assess their patients' readiness to carry out the treatment plan, and discuss any barriers or obstacles to adherence that patients may have. A positive, supporting, and trusting relationship between patient and provider improves adherence. Individual patient factors also affect adherence. For example, conditions that impair cognition have a negative impact on adherence. Other factors--such as the lack of a support network, limited English proficiency, inability to obtain and pay for medications, or severe adverse effects or the fear of such effects--are all barriers to adherence. There are multiple reasons for nonadherence or nonpersistence; the solution needs to be tailored to the individual patient's needs. To have an impact on adherence, healthcare providers must understand the barriers to adherence and the methods or tools needed to overcome them. This report describes the barriers to medication adherence and persistence and interventions that have been used to address them; it also identifies interventions and compliance aids that practitioners and organizations can implement.
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Ellenbecker CH, Frazier SC, Verney S. Nurses' observations and experiences of problems and adverse effects of medication management in home care. Geriatr Nurs 2004; 25:164-70. [PMID: 15197376 DOI: 10.1016/j.gerinurse.2004.04.008] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
The purpose of this nonexperimental, descriptive study was to explore and describe the current state of medication management for patients receiving services from certified home health care agencies (CHHAs). Data were collected by self-report from a convenience sample of 101 home health care nurses from 12 agencies in six states. Nurses reported on a total of 1467 patients. Results of this study support the findings from previous research on medication management of older people living in the community. The majority of older home care patients were taking more than five prescription drugs. Many patients were taking medications in ways that deviated from the prescribed medication regimen. The results also suggest that patients are experiencing many adverse effects from medication errors. The reasons for these errors were reported to be a result of individual patient characteristics and, most frequently, communication problems in the system. Results of this study support recommendations for technology application, regulatory and policy changes, further research, and nursing practice.
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Vik SA, Maxwell CJ, Hogan DB. Measurement, Correlates, and Health Outcomes of Medication Adherence Among Seniors. Ann Pharmacother 2004; 38:303-12. [PMID: 14742770 DOI: 10.1345/aph.1d252] [Citation(s) in RCA: 268] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE To provide a comprehensive review of the literature on the measurement, correlates, and health outcomes of medication adherence among community-dwelling older adults. DATA SOURCES Searches of MEDLINE, PubMed, and International Pharmaceutical Abstracts databases for English-language literature (1966–December 2002) were conducted using one or more of the following terms: elderly, adherence/nonadherence, compliance/noncompliance, medication/drug, methodology/measurement, and hospitalization. STUDY SELECTION AND DATA EXTRACTION From the above search, studies of medication adherence in community-dwelling seniors were selected for review along with relevant publications from the reference lists of articles identified in the initial database search. DATA SYNTHESIS Although several methods are available for the assessment of adherence, accurate measurement continues to be difficult. The available evidence suggests that polypharmacy and poor patient–healthcare provider relationships (including the use of multiple providers) may be major determinants of nonadherence among older persons, with the impact of most sociodemographic factors being negligible. There is little consensus regarding other determinants of nonadherence. Relatively few high-quality investigations have examined the associations between nonadherence and subsequent health outcomes. Available data provide some support for increased health risks with nonadherence. However, interventions to improve adherence have seldom demonstrated positive effects on health outcomes. CONCLUSIONS There are few empirical data to support a simple systematic descriptor of the nonadherent patient. The inconsistencies across studies may be attributable, in part, to the inherent difficulties involved in the measurement of a behavioral risk factor such as nonadherence. Future research in this area would be strengthened by incorporation of detailed assessments of patient-reported reasons for nonadherence, the appropriateness of drug regimens, and the effect of nonadherence on health outcomes.
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Affiliation(s)
- Shelly A Vik
- Department of Community Health Sciences, Faculty of Medicine, University of Calgary, Calgary, Alberta, Canada
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García Pérez A, Prados Torres D, Sánchez de la Cuesta F. Cumplimiento terapéutico en pacientes con hipertensión arterial y diabetes mellitus tipo 2. Semergen 2004. [DOI: 10.1016/s1138-3593(04)74275-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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Mathew RJ, Wilson WH, Davis R. Postural syncope after marijuana: a transcranial Doppler study of the hemodynamics. Pharmacol Biochem Behav 2003; 75:309-18. [PMID: 12873621 DOI: 10.1016/s0091-3057(03)00086-8] [Citation(s) in RCA: 60] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Twenty-nine volunteers participated in a randomized, double-blind, placebo-controlled study. Cerebral blood velocity (CBV), pulse rate, blood pressure (BP), skin perfusion (SP) on forehead and plasma delta9 tetrahydrocannabinol (THC) levels were quantified during reclining and standing for 10 min before and after THC infusions and marijuana smoking. Both THC and marijuana induced postural dizziness, with 28% reporting severe symptoms. Intoxication and dizziness peaked immediately after drug. The severe dizziness group showed the most marked postural drop in CBV and BP and showed a drop in pulse rate after an initial increase during standing. Postural dizziness was unrelated to plasma levels of THC and other indices.
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Affiliation(s)
- Roy J Mathew
- Texas Tech University Health Sciences Center, 800 West 4th Street, Odessa, TX 79763, USA.
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Wasserfallen JB, Bourgeois R, Büla C, Yersin B, Buclin T. Composition and cost of drugs stored at home by elderly patients. Ann Pharmacother 2003; 37:731-7. [PMID: 12708953 DOI: 10.1345/aph.1c310] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Elderly people often have multiple chronic diseases, are frequently treated by several physicians, and also use over-the-counter medications. Excessive prescribing, imperfect therapeutic adherence, treatment modifications after hospitalization, and oversized drug packages result in home storage of leftover drugs, resulting in a waste of healthcare resources. PATIENTS AND METHODS All patients aged >/=75 years hospitalized for >24 hours during a 6-month period in an urban teaching hospital in Switzerland were eligible for inclusion in a study collecting sociodemographics, medical, functional, and psychosocial characteristics. Six months later, a research nurse visited the patients at home and recorded the names, number of tablets, and expiration dates of all open or intact drug packages, and the doses actually taken. Acquisition costs of these drugs were computed. RESULTS One hundred ninety-five patients were included (127 women; mean age 82.2 +/- 4.8 y, range 75-96). They had a total of 2059 drugs (mean per patient 10.3 +/- 6.7, range per patient 1-42), corresponding to a total cost of (US) $62 826 (mean per patient 322 +/- 275, range per patient 10-1571). Self-reported drug intake was regular for 36% of the drugs (46.5% of total costs) and occasional for 11% (6.1%), whereas 35.7% (30.1%) had been stopped during the last month. Cardiovascular drugs amounted to 36.6% of the drugs and 55.5% of the costs. None of the patients' characteristics was significantly associated with a greater number of drugs and higher costs. CONCLUSIONS Drugs stored at home by elderly patients were worth about $320 per patient. Only about one-third of these drugs were regularly taken. In the context of resources shortage, innovative solutions should be found to reduce the waste linked with drugs stopped in previous months.
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Leemans L, Veroeveren L, Bulens J, Hendrickx C, Keyenberg W, Niesten F, Vandeberg J, Van Hoof J, Laekeman G. Frequency and trends of interventions of prescriptions in Flemish community pharmacies. PHARMACY WORLD & SCIENCE : PWS 2003; 25:65-9. [PMID: 12774566 DOI: 10.1023/a:1023253132487] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE To study the role of the community pharmacist in medication management. METHOD Participating Flemish pharmacists quantified their interventions during two weeks by use of validated diagrams. The clinical interventions were recorded in detail, while the technical interventions were only registered. RESULTS 124 pharmacists participated. Intervention was needed in 4.1% of the total number of prescriptions (n = 87.647). On average, 20.2 technical and 8.4 clinical interventions over a period of 2 weeks per pharmacy were needed. The main problem was missing or incorrect data on administering the drug (23%). Missing or incorrect advice (37.8%), dose-related problems (26.1%) and interactions or contra-indications (20.2%) were mentioned as important clinical discrepancies. The pharmacists utilized the patient medication records to solve most of the problems. In one out of five cases, the physician was contacted. CONCLUSION Interventions by community pharmacists in medication management have been recorded in this study. The results should be translated into a process of integrated pharmaceutical care.
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Affiliation(s)
- Lies Leemans
- Division of Drug and Patient Information, Faculty of Pharmaceutical Sciences, K.U. Leuven, Belgium.
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Keene JJ, Galasko GT, Land MF. Antidepressant use in psychiatry and medicine: importance for dental practice. J Am Dent Assoc 2003; 134:71-9. [PMID: 12555959 DOI: 10.14219/jada.archive.2003.0019] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Many dental patients receive antidepressant therapy. However, antidepressants taken with other drugs may increase the risk of complications that require special dental precautions and care. METHODS The authors conducted a retrospective study of 1,800 randomly selected patient records and evaluated the prevalence of using antidepressants and other medications concurrently. They analyzed antidepressant intake relative to drug classification and mechanism of action, age, sex and associated potential for clinical complications such as xerostomia, orthostatic hypotension and interaction with vasoconstrictors. The potential for additive adverse effects between antidepressants and other medications also was analyzed. RESULTS Three hundred eighty-one (21 percent) of the 1,800 patient records indicated that patients were being treated with 412 antidepressants. Female subjects out-numbered male subjects by an approximate 2.3:1 ratio. Selective serotonin reuptake inhibitors were most commonly prescribed, followed by tricyclic antidepressants, atypical and third-generation antidepressants, and monoamine oxidase inhibitors. Based on reported medication intake, almost 58 percent of subjects in the antidepressant group were receiving treatment with two or more medications that had the potential for producing xerostomia. Two hundred fifty-seven (67 percent) of the 381 records documented intake of an antidepressant or other medication with orthostatic hypotension potential. CONCLUSIONS Three hundred eighty-one patients reported that they were receiving antidepressant therapy for psychiatric and other medical reasons. Potential adverse effects and interactions with other medications have direct implications for dental treatment. CLINICAL IMPLICATIONS Patients receiving antidepressant therapy are at risk of developing xerostomia and orthostatic hypotension, as well as experiencing the adverse effects of interaction with vasoconstrictors. Dentists must take appropriate precautions in treating these patients.
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Affiliation(s)
- Joseph J Keene
- Department of Applied Dental Medicine, Southern Illinois University, School of Dental Medicine, Alton 62002, USA.
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Hanlon JT, Fillenbaum GG, Ruby CM, Gray S, Bohannon A. Epidemiology of over-the-counter drug use in community dwelling elderly: United States perspective. Drugs Aging 2001; 18:123-31. [PMID: 11346126 DOI: 10.2165/00002512-200118020-00005] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Among US community dwelling individuals aged > or = 65 years, about as many persons take nonprescription drugs as take prescription drugs. A review of US data from the last 2 decades indicates that the average number of over-the-counter (OTC) drugs taken daily is around 1.8, but varies with geographical area (highest in the Midwest) and race/ethnicity (lowest use among Hispanics, followed by African Americans. and highest use among Whites). Use has consistently been found to be higher in women than in men. While OTC use appears to be increasing over time, it also decreases with increase in age. The most common OTC classes used are analgesics, laxatives and nutritional supplements. Our ability to explain or to predict OTC use and change in use is poor, and further studies, particularly on use by elderly individuals of minority races, are needed.
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Affiliation(s)
- J T Hanlon
- College of Pharmacy, Institute for the Study of Geriatric Pharmacotherapy and Department of Experimental and Clinical Pharmacology, University of Minnesota, Minneapolis 55455, USA.
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