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Jónsdóttir F, Blöndal AB, Guðmundsson A, Bates I, Stevenson JM, Sigurðsson MI. Potentially inappropriate medication use before and after admission to internal medicine for older patients and polypharmacy. Am J Med 2024:S0002-9343(24)00475-3. [PMID: 39094842 DOI: 10.1016/j.amjmed.2024.07.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2024] [Revised: 07/09/2024] [Accepted: 07/15/2024] [Indexed: 08/04/2024]
Abstract
BACKGROUND With the aging of the population and the increase in chronic diseases, there is an inherent risk of polypharmacy and inappropriate medication use. The study aimed to determine the prevalence and incidence of potentially inappropriate medication use and its correlation with polypharmacy. METHODS A retrospective, population-based cohort study among patients ≥65 years hospitalized at The National University Hospital of Iceland from 2010-2020. Data on medication usage were retrieved from the National Prescription Medicine Registry. Based on the number of medications filled in in the year prior to admission and post-discharge, participants were categorized non-polypharmacy (<5), polypharmacy (5-9), and hyper-polypharmacy (≥10). The prevalence and incidence of potentially inappropriate medication use was assessed based on the 2019 Beers criteria. Regression models were used to correlate sociodemographic, clinical, and pharmacoepidemiologic variables and the odds of new potentially inappropriate medication use. RESULTS The cohort comprised 55,859 patients (48.5% male) with a median [IQR] age of 80 [73-86] years. The prevalence of inappropriate medication use in the year preceding admission was 34.0%, 77.7%, and 96.4% for patients with non-polypharmacy, polypharmacy, and hyper-polypharmacy. The incidence of new potentially inappropriate medication use was 46.7% (95% CI 45.6%-47.6%) among those with no potentially inappropriate medication use pre-admission. Factors associated with higher odds of new potentially inappropriate medication use after discharge were the use of multi-dose dispensing services, dementia, polypharmacy, and hyper-polypharmacy. CONCLUSIONS AND RELEVANCE An increased emphasis is needed to review and reevaluate the appropriateness of medication use among older population in internal medicine. CLINICAL TRIAL REGISTRATION https://clinicaltrials.gov/ct2/show/NCT05756400.
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Affiliation(s)
- Freyja Jónsdóttir
- Pharmaceutical Sciences, University of Iceland, Reykjavik, Iceland; Pharmacy Services, Landspitali - The National University Hospital of Iceland, Reykjavik, Iceland.
| | - Anna B Blöndal
- Pharmaceutical Sciences, University of Iceland, Reykjavik, Iceland; Development Centre for Primary Healthcare in Iceland, Reykjavik, Iceland
| | - Aðalsteinn Guðmundsson
- Division of Geriatrics, Landspitali - The National University Hospital of Iceland, Reykjavik, Iceland; Faculty of Medicine, University of Iceland, Reykjavik, Iceland
| | - Ian Bates
- School of Pharmacy, University College London, United Kingdom
| | - Jennifer M Stevenson
- Institute of Pharmaceutical Science, King's College, London, United Kingdom; Pharmacy Department, Guys and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Martin I Sigurðsson
- Division of Anaesthesia and Intensive Care Medicine, Landspitali -The National University Hospital of Iceland, Reykjavik, Iceland
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de Oliveira GD, Vicente LCC, Mourão AM, Dos Santos SHGP, de Lima Friche AA, Bicalho MAC. Dysphagia Screening in Brazilian Older Adults with Dementia: Content Development and Validation of a Questionnaire for Caregivers - RaDID-QC. J Cross Cult Gerontol 2024:10.1007/s10823-024-09510-z. [PMID: 39042243 DOI: 10.1007/s10823-024-09510-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/21/2024] [Indexed: 07/24/2024]
Abstract
This study aims to develop and validate the content and response processes of a questionnaire intended for caregivers to screen for dysphagia in Brazilian older adults with dementia due to Alzheimer's disease and/or vascular dementia. The instrument items were developed in Brazilian Portuguese language based on the theoretical framework. A committee of speech-language-hearing therapists analyzed the relevance, objectivity, clarity, and understandability of the items with the Delphi method. The content validity index cutoff agreement score for experts' answers to validate each item in the questionnaire was 0.78; in the intraclass correlation coefficient, it was 0.75 for all items. For response process validity evidence, the questionnaire was applied to 30 caregivers of older adults with dementia, who judged the clarity and understandability of the items. Each item was validated when understood by at least 95% of participants. The first version of the instrument had 29 items. After two expert assessments, the last version had 24 items. The intraclass correlation coefficient was 0.85. Only one item needed semantic adjustments in the pre-test. The dysphagia screening instrument applied to caregivers of older adults with dementia was developed with adequate content and response process validity evidence, enabling adjustments in its construct. Future studies will analyze the remaining evidence of validity and reliability.
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Affiliation(s)
- Grazielle Duarte de Oliveira
- Sciences Applied to Adult Health at the Federal University of Minas Gerais (UFMG), Avenida Professor Alfredo Balena, 190/246 - Santa Efigênia, Belo Horizonte, MG, Brazil.
| | - Laélia Cristina Caseiro Vicente
- Department of Speech-Language-hearing Sciences of the Medical School at UFMG, Avenida Professor Alfredo Balena, 190/251 - Santa Efigênia, Belo Horizonte, MG, Brazil
| | - Aline Mansueto Mourão
- Department of Speech-Language-hearing Sciences of the Medical School at UFMG, Avenida Professor Alfredo Balena, 190/251 - Santa Efigênia, Belo Horizonte, MG, Brazil
| | | | - Amélia Augusta de Lima Friche
- Department of Speech-Language-hearing Sciences of the Medical School at UFMG, Avenida Professor Alfredo Balena, 190/251 - Santa Efigênia, Belo Horizonte, MG, Brazil
| | - Maria Aparecida Camargos Bicalho
- Department of Medicine of the Medical School at UFMG, Geriatrician at the Jenny de Andrade Faria Institute for Older Adult Healthcare at the Clinics Hospital of the Federal University of Minas Gerais, UFMG - Avenida Professor Alfredo Balena, 190/246 - Santa Efigênia, Belo Horizonte, MG, Brazil
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De Guzman KR, Long D, Theodos A, Karlovic A, Falconer N. Assessment of a Geriatric Evaluation and Management in the Home (GEMITH) Service at a Quaternary Hospital: A Retrospective Observational Study. J Pharm Pract 2024:8971900241262376. [PMID: 38869964 DOI: 10.1177/08971900241262376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2024]
Abstract
Background: The increasing aging population in Australia has created a higher demand for specialist geriatric services within hospitals. A Geriatric Evaluation and Management in the Home (GEMITH) service was implemented at a quaternary Queensland hospital. The GEMITH service was unique as it incorporated a specialist pharmacist into the multidisciplinary team. Objective: To determine the medication safety and quality impact of the GEMITH service by evaluating the type and clinical significance of specialist pharmacist interventions. Methods: This was retrospective observational study of clinical interventions made by the GEMITH pharmacist for patients admitted to the service between October 2020 to April 2021. All pharmacist interventions were rated for their clinical significance using the Society of Hospital Pharmacists of Australia (SHPA) risk classification system. The ratings were undertaken by a panel of three pharmacists that independently assessed the interventions, coming together for final discussion. A narrative analysis of the interventions were derived through group consensus. Results: There was a total of 119 admissions to the GEMITH service, with 132 clinical interventions made by the specialist geriatric pharmacist. The majority (47%) of interventions were considered as low risk interventions, although high- (21%) and extreme-risk (2%) interventions still occurred. The most common type of intervention (32%) involved medication reconciliation. Other intervention types included monitoring recommendations, dosing interventions, and deprescribing suggestions. Conclusion: Multiple clinical interventions were made by the GEMITH pharmacist, which prevented possible and significant medication-related harm. This demonstrated the quality impact of the specialist pharmacist in improving medication safety for geriatric patients.
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Affiliation(s)
- Keshia R De Guzman
- Pharmacy Department, Princess Alexandra Hospital, Brisbane, QLD, Australia
- School of Pharmacy, The University of Queensland, Brisbane, QLD, Australia
| | - Duncan Long
- Pharmacy Department, Princess Alexandra Hospital, Brisbane, QLD, Australia
| | - Alexander Theodos
- Pharmacy Department, Princess Alexandra Hospital, Brisbane, QLD, Australia
| | - Alexandra Karlovic
- Pharmacy Department, Princess Alexandra Hospital, Brisbane, QLD, Australia
| | - Nazanin Falconer
- Pharmacy Department, Princess Alexandra Hospital, Brisbane, QLD, Australia
- School of Pharmacy, The University of Queensland, Brisbane, QLD, Australia
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Jonsdottir F, Blondal AB, Gudmundsson A, Bates I, Stevenson JM, Sigurdsson MI. The association of degree of polypharmacy before and after among hospitalised internal medicine patients and clinical outcomes: a retrospective, population-based cohort study. BMJ Open 2024; 14:e078890. [PMID: 38548367 PMCID: PMC10982714 DOI: 10.1136/bmjopen-2023-078890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 03/15/2024] [Indexed: 04/02/2024] Open
Abstract
OBJECTIVES To determine the prevalence and incidence of polypharmacy/hyperpolypharmacy and which medications are most prescribed to patients with varying burden of polypharmacy. DESIGN Retrospective, population-based cohort study. SETTING Iceland. PARTICIPANTS Including patients (≥18 years) admitted to internal medicine services at Landspitali - The National University Hospital of Iceland, between 1 January 2010 with a follow-up of clinical outcomes through 17 March 2022. MAIN OUTCOMES MEASURES Participants were categorised into medication use categories of non-polypharmacy (<5), polypharmacy (5-10) and hyperpolypharmacy (>10) based on the number of medications filled in the year predischarge and postdischarge. The primary outcome was prevalence and incidence of new polypharmacy. Secondary outcomes were mortality, length of hospital stay and re-admission. RESULTS Among 85 942 admissions (51% male), the median (IQR) age was 73 (60-83) years. The prevalence of preadmission non-polypharmacy was 15.1% (95% CI 14.9 to 15.3), polypharmacy was 22.9% (95% CI 22.6 to 23.2) and hyperpolypharmacy was 62.5% (95% CI 62.2 to 62.9). The incidence of new postdischarge polypharmacy was 33.4% (95% CI 32.9 to 33.9), and for hyperpolypharmacy was 28.9% (95% CI 28.3 to 29.5) for patients with preadmission polypharmacy. Patients with a higher level of medication use were more likely to use multidose drug dispensing and have a diagnosis of adverse drug reaction. Other comorbidities, including responsible subspeciality and estimates of comorbidity and frailty burden, were identical between groups of varying polypharmacy. There was no difference in length of stay, re-admission rate and mortality. CONCLUSIONS Preadmission polypharmacy/hyperpolypharmacy and postdischarge new polypharmacy/hyperpolypharmacy is common amongst patients admitted to internal medicine. A higher level of medication use category was not found to be associated with demographic, comorbidity and clinical outcomes. Medications that are frequently inappropriately prescribed were among the most prescribed medications in the group. An increased focus on optimising medication usage is needed after hospital admission. TRIAL REGISTRATION NUMBER NCT05756400.
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Affiliation(s)
- Freyja Jonsdottir
- Pharmaceutical Sciences, University of Iceland, Reykjavik, Iceland
- Landspitali - The National University Hospital of Iceland, Reykjavik, Iceland
| | - Anna B Blondal
- Pharmaceutical Sciences, University of Iceland, Reykjavik, Iceland
- Development Centre for Primary Healthcare in Iceland, Reykjavik, Iceland
| | - Adalsteinn Gudmundsson
- Landspitali - The National University Hospital of Iceland, Reykjavik, Iceland
- University of Iceland, Reykjavik, Iceland
| | - Ian Bates
- University College London, London, UK
| | - Jennifer Mary Stevenson
- Institute of Pharmaceutical Sciences, King's College London, London, UK
- Pharmacy, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Martin I Sigurdsson
- Landspitali - The National University Hospital of Iceland, Reykjavik, Iceland
- University of Iceland, Reykjavik, Iceland
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Veronese N, Gallo U, Boccardi V, Demurtas J, Michielon A, Taci X, Zanchetta G, Campbell Davis SE, Chiumente M, Venturini F, Pilotto A. Efficacy of deprescribing on health outcomes: An umbrella review of systematic reviews with meta-analysis of randomized controlled trials. Ageing Res Rev 2024; 95:102237. [PMID: 38367812 DOI: 10.1016/j.arr.2024.102237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Revised: 02/06/2024] [Accepted: 02/14/2024] [Indexed: 02/19/2024]
Abstract
BACKGROUND Deprescribing is an important intervention across different settings in medicine, but the literature supporting such a practice is still conflicting. Therefore, we aimed to capture the breadth of outcomes reported and assess the strength of evidence of the use of deprescribing for health outcomes. METHODS Umbrella review of systematic reviews of the use of deprescribing searching in Medline, Scopus, and Web of Science until 01 November 2023. The grading of evidence was carried out using the GRADE for intervention studies, whilst data regarding systematic reviews were reported as narrative findings. RESULTS Among 456 papers, 12 systematic reviews (six with meta-analysis) for a total of 231 RCTs and 44,193 patients were included. In any setting, deprescribing was able to significantly reduce the number of total and of potentially inappropriate medications (PIMs) in older patients (low certainty of evidence) and to reduce the proportion of participants potentially having several or PIMs (moderate certainty of evidence). In community, supported by a high certainty of evidence, deprescribing was not more effective than standard care in decreasing injurious falls, any falls or number of fallers. In nursing home, deprescribing was associated with a significantly lower PIMs than standard care (very low certainty of evidence). In end-of-life situations, deprescribing significantly reduced mortality rate of approximately 41% (high certainty of evidence). CONCLUSIONS Deprescribing is a promising intervention across different settings and situations, but a notable gap in the literature concerning its effects on substantial outcomes still exists.
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Affiliation(s)
- Nicola Veronese
- Geriatrics Section, Department of Internal Medicine, University of Palermo, Palermo, Italy.
| | - Umberto Gallo
- Pharmaceutical Department, Local Health Unit n. 6 Euganea, Padua, Italy
| | - Virginia Boccardi
- Department of Medicine and Surgery, Institute of Gerontology and Geriatrics, University of Perugia, Perugia, Italy
| | - Jacopo Demurtas
- Family Medicine Department, USL Sud Est Toscana, Grosseto, Italy
| | - Alberto Michielon
- School of Specialization in Hospital Pharmacy, University of Siena, Siena, Italy
| | - Xhoajda Taci
- School of Specialization in Hospital Pharmacy, Università degli Studi di Padova, Padua, Italy
| | - Giulia Zanchetta
- School of Specialization in Hospital Pharmacy, Università degli Studi di Padova, Padua, Italy
| | | | - Marco Chiumente
- Scientific Direction, SIFaCT - Società Italiana di Farmacia Clinica e Terapia, Turin, Italy
| | | | - Alberto Pilotto
- Geriatrics Unit, Department Geriatric Care, Orthogeriatrics and Rehabilitation, E.O. Galliera Hospital, Genoa, Italy; Department of Interdisciplinary Medicine, University of Bari "Aldo Moro", Bari, Italy
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van Poelgeest E, Seppala L, Bahat G, Ilhan B, Mair A, van Marum R, Onder G, Ryg J, Fernandes MA, Cherubini A, Denkinger M, Eidam A, Egberts A, Gudmundsson A, Koçak FÖK, Soulis G, Tournoy J, Masud T, Wehling M, van der Velde N. Optimizing pharmacotherapy and deprescribing strategies in older adults living with multimorbidity and polypharmacy: EuGMS SIG on pharmacology position paper. Eur Geriatr Med 2023; 14:1195-1209. [PMID: 37812379 PMCID: PMC10754739 DOI: 10.1007/s41999-023-00872-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Accepted: 09/19/2023] [Indexed: 10/10/2023]
Abstract
Inappropriate polypharmacy is highly prevalent among older adults and presents a significant healthcare concern. Conducting medication reviews and implementing deprescribing strategies in multimorbid older adults with polypharmacy are an inherently complex and challenging task. Recognizing this, the Special Interest Group on Pharmacology of the European Geriatric Medicine Society has compiled evidence on medication review and deprescribing in older adults and has formulated recommendations to enhance appropriate prescribing practices. The current evidence supports the need for a comprehensive and widespread transformation in education, guidelines, research, advocacy, and policy to improve the management of polypharmacy in older individuals. Furthermore, incorporating deprescribing as a routine aspect of care for the ageing population is crucial. We emphasize the importance of involving geriatricians and experts in geriatric pharmacology in driving, and actively participating in this transformative process. By doing so, we can work towards achieving optimal medication use and enhancing the well-being of older adults in the generations to come.
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Affiliation(s)
- Eveline van Poelgeest
- Section of Geriatric Medicine, Department of Internal Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.
- Aging and Later Life, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands.
| | - Lotta Seppala
- Section of Geriatric Medicine, Department of Internal Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
- Aging and Later Life, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Gülistan Bahat
- Division of Geriatrics, Department of Internal Medicine, Istanbul Medical School, Istanbul University, Capa, Istanbul, Turkey
| | - Birkan Ilhan
- Division of Geriatrics, Department of Internal Medicine, Liv Hospital Vadistanbul, Istanbul, Turkey
| | - Alpana Mair
- Effective Prescribing and Therapeutics, Health and Social Care Directorate, Scottish Government, Edinburgh, Scotland, UK
- Edinburgh Napier University, Edinburgh, UK
| | - Rob van Marum
- Aging and Later Life, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
- Department of Elderly Care Medicine, Amsterdam University Medical Centers, Location Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, The Netherlands
| | - Graziano Onder
- Fondazione Policlinico Gemelli IRCCS, Rome, Italy
- Università Cattolica del Sacro Cuore, Rome, Italy
| | - Jesper Ryg
- Department of Geriatric Medicine, Odense University Hospital, Odense, Denmark
- Geriatric Research Unit, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Marília Andreia Fernandes
- Department of Internal Medicine, Hospital Curry Cabral, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal
| | - Antonio Cherubini
- Geriatria Accettazione geriatrica e Centro di Ricerca per l'invecchiamento IRCCS INRCA, Ancona, Italy
| | - Michael Denkinger
- Agaplesion Bethesda Clinic Ulm, Institute for Geriatric Research, Ulm University, Geriatric Center Ulm, Ulm, Germany
| | - Annette Eidam
- Center for Geriatric Medicine, Heidelberg University Hospital, AGAPLESION Bethanien Hospital Heidelberg, Heidelberg, Germany
| | - Angelique Egberts
- Department of Hospital Pharmacy, Franciscus Gasthuis & Vlietland, Rotterdam, Schiedam, The Netherlands
| | - Aðalsteinn Gudmundsson
- Faculty of Medicine, Landspitali University Hospital, University of Iceland, Reykjavik, Iceland
| | - Fatma Özge Kayhan Koçak
- Division of Geriatrics, Department of Internal Medicine, Faculty of Medicine, Ege University, Izmir, Turkey
| | - George Soulis
- Outpatient Geriatric Assessment Unit, Henry Dunant Hospital Center, Athens, Greece
- Hellenic Open University, Patras, Greece
| | - Jos Tournoy
- Department of Geriatric Medicine, KU Leuven University Hospitals Leuven Gasthuisberg Campus, Leuven, Belgium
- Department of Public Health and Primary Care, KU Leuven Biomedical Sciences Group, Leuven, Belgium
| | - Tahir Masud
- Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Martin Wehling
- Clinical Pharmacology Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Nathalie van der Velde
- Section of Geriatric Medicine, Department of Internal Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
- Aging and Later Life, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
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Bellanca CM, Augello E, Cantone AF, Di Mauro R, Attaguile GA, Di Giovanni V, Condorelli GA, Di Benedetto G, Cantarella G, Bernardini R. Insight into Risk Factors, Pharmacogenetics/Genomics, and Management of Adverse Drug Reactions in Elderly: A Narrative Review. Pharmaceuticals (Basel) 2023; 16:1542. [PMID: 38004408 PMCID: PMC10674329 DOI: 10.3390/ph16111542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 10/23/2023] [Accepted: 10/25/2023] [Indexed: 11/26/2023] Open
Abstract
The European Medicine Agency (EMA) has defined Adverse Drug Reactions (ADRs) as "a noxious and unintended response to a medicine", not including poisoning, accidental, or intentional overdoses. The ADR occurrence differs based on the approach adopted for defining and detecting them, the characteristics of the population under study, and the research setting. ADRs have a significant impact on morbidity and mortality, particularly among older adults, and represent a financial burden for health services. Between 30% and 60% of ADRs might be predictable and preventable, emerging as a result of inappropriate prescription, drug chemistry inherent toxicity, cell-specific drug toxicity, age- and sex-related anomalies in drug absorption, distribution, metabolism, and elimination (ADME), and drug-drug interactions (DDIs) in combination therapies or when a patient is treated with different drugs for concomitant disorders. This is particularly important in chronic diseases which require long-term treatments. Rapid developments in pharmacogenetics/genomics have improved the understanding of ADRs accompanied by more accurate prescriptions and reduction in unnecessary costs. To alleviate the burden of ADRs, especially in the elderly, interventions focused on pharmaceutical principles, such as medication review and reconciliation, should be integrated into a broader assessment of patients' characteristics, needs, and health priorities. Digital health interventions could offer valuable solutions to assist healthcare professionals in identifying inappropriate prescriptions and promoting patient adherence to pharmacotherapies.
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Affiliation(s)
- Carlo Maria Bellanca
- Department of Biomedical and Biotechnological Sciences, Section of Pharmacology, University of Catania, 95123 Catania, Italy; (C.M.B.); (E.A.); (A.F.C.); (G.A.A.); (G.A.C.); (G.C.); (R.B.)
- Clinical Toxicology Unit, University Hospital of Catania, 95123 Catania, Italy
| | - Egle Augello
- Department of Biomedical and Biotechnological Sciences, Section of Pharmacology, University of Catania, 95123 Catania, Italy; (C.M.B.); (E.A.); (A.F.C.); (G.A.A.); (G.A.C.); (G.C.); (R.B.)
- Clinical Toxicology Unit, University Hospital of Catania, 95123 Catania, Italy
| | - Anna Flavia Cantone
- Department of Biomedical and Biotechnological Sciences, Section of Pharmacology, University of Catania, 95123 Catania, Italy; (C.M.B.); (E.A.); (A.F.C.); (G.A.A.); (G.A.C.); (G.C.); (R.B.)
| | - Rosaria Di Mauro
- Dipartimento del Farmaco, ASP Trapani, 91100 Trapani, Italy; (R.D.M.); (V.D.G.)
| | - Giuseppe Antonino Attaguile
- Department of Biomedical and Biotechnological Sciences, Section of Pharmacology, University of Catania, 95123 Catania, Italy; (C.M.B.); (E.A.); (A.F.C.); (G.A.A.); (G.A.C.); (G.C.); (R.B.)
| | | | - Guido Attilio Condorelli
- Department of Biomedical and Biotechnological Sciences, Section of Pharmacology, University of Catania, 95123 Catania, Italy; (C.M.B.); (E.A.); (A.F.C.); (G.A.A.); (G.A.C.); (G.C.); (R.B.)
| | - Giulia Di Benedetto
- Department of Biomedical and Biotechnological Sciences, Section of Pharmacology, University of Catania, 95123 Catania, Italy; (C.M.B.); (E.A.); (A.F.C.); (G.A.A.); (G.A.C.); (G.C.); (R.B.)
- Clinical Toxicology Unit, University Hospital of Catania, 95123 Catania, Italy
| | - Giuseppina Cantarella
- Department of Biomedical and Biotechnological Sciences, Section of Pharmacology, University of Catania, 95123 Catania, Italy; (C.M.B.); (E.A.); (A.F.C.); (G.A.A.); (G.A.C.); (G.C.); (R.B.)
| | - Renato Bernardini
- Department of Biomedical and Biotechnological Sciences, Section of Pharmacology, University of Catania, 95123 Catania, Italy; (C.M.B.); (E.A.); (A.F.C.); (G.A.A.); (G.A.C.); (G.C.); (R.B.)
- Clinical Toxicology Unit, University Hospital of Catania, 95123 Catania, Italy
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8
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Gui X, Zhao J, Ding L, Chai J, Lai H, Cai Y, Luo S, Zeng Y, Wu W, Chen H, Yao H, Wang Y. Assessing real-world safety concerns of Sacituzumab govitecan: a disproportionality analysis using spontaneous reports in the FDA adverse event reporting system. Front Oncol 2023; 13:1276976. [PMID: 37869095 PMCID: PMC10587566 DOI: 10.3389/fonc.2023.1276976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Accepted: 09/20/2023] [Indexed: 10/24/2023] Open
Abstract
Aim The aim of this study was to identify potential safety concerns associated with Sacituzumab Govitecan (SG), an antibody-drug conjugate targeting trophoblastic cell-surface antigen-2, by analyzing real-world safety data from the largest publicly available worldwide pharmacovigilance database. Methods All data obtained from the FDA Adverse Event Reporting System (FAERS) database from the second quarter of 2020 to the fourth quarter of 2022 underwent disproportionality analysis and Bayesian analysis to detect and assess the adverse event signals of SG, considering statistical significance when the lower limit of the 95% CI >1, based on at least 3 reports. Results Total of 1072 cases were included. The main safety signals were blood and lymphatic system disorders [ROR(95CI)=7.23 (6.43-8.14)], gastrointestinal disorders [ROR(95CI)=2.01 (1.81-2.22)], and relative infection adverse events, such as neutropenic sepsis [ROR(95CI)=46.02 (27.15-77.99)] and neutropenic colitis [ROR(95CI)=188.02 (120.09-294.37)]. We also noted unexpected serious safety signals, including large intestine perforation [ROR(95CI)=10.77 (3.47-33.45)] and hepatic failure [ROR(95CI)=3.87 (1.45-10.31)], as well as a high signal for pneumonitis [ROR(95CI)=9.93 (5.75-17.12)]. Additionally, age sub-group analysis revealed that geriatric patients (>65 years old) were at an increased risk of neutropenic colitis [ROR(95CI)=282.05 (116.36-683.66)], neutropenic sepsis [ROR(95CI)=101.11 (41.83-244.43)], acute kidney injury [ROR(95CI)=3.29 (1.36-7.94)], and atrial fibrillation [ROR(95CI)=6.91 (2.86-16.69)]. Conclusion This study provides crucial real-world safety data on SG, complementing existing clinical trial information. Practitioners should identify contributing factors, employ monitoring and intervention strategies, and focus on adverse events like neutropenic sepsis, large intestine perforation, and hepatic failure. Further prospective studies are needed to address these safety concerns for a comprehensive understanding and effective management of associated risks.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Herui Yao
- Breast Tumor Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Ying Wang
- Breast Tumor Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China
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9
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Uematsu T, Kawakami Y, Nojiri S, Saito T, Irie Y, Kasai T, Hiratsuka Y, Ishijima M, Kuroki M, Daida H, Nishizaki Y. Association between number of medications and hip fractures in Japanese elderly using conditional logistic LASSO regression. Sci Rep 2023; 13:16831. [PMID: 37803071 PMCID: PMC10558461 DOI: 10.1038/s41598-023-43876-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 09/29/2023] [Indexed: 10/08/2023] Open
Abstract
To examine the association between hip fracture and associated factors, including polypharmacy, and develop an optimal predictive model, we conducted a population-based matched case-control study using the health insurance claims data on hip fracture among Japanese patients. We included 34,717 hospitalized Japanese patients aged ≥ 65 years with hip fracture and 34,717 age- and sex- matched controls who were matched 1:1. This study included 69,434 participants. Overall, 16 variable comorbidities and 60 variable concomitant medications were used as explanatory variables. The participants were added to early elderly and late elderly categories for further analysis. The odds ratio of hip fracture increased with the number of medications only in the early elderly. AUC was highest for early elderly (AUC, 0.74, 95% CI 0.72-0.76). Use of anti-Parkinson's drugs had the largest coefficient and was the most influential variable in many categories. This study confirmed the association between risk factors, including polypharmacy and hip fracture. The risk of hip fracture increased with an increase in medication number taken by the early elderly and showed good predictive accuracy, whereas there was no such association in the late elderly. Therefore, the early elderly in Japan should be an active target population for hip fracture prevention.
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Affiliation(s)
- Takuya Uematsu
- Clinical Translational Science, Juntendo University School of Medicine Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
- Department of Hospital Pharmacy, Juntendo University Hospital, Tokyo, Japan
| | - Yuta Kawakami
- Clinical Research and Trial Center, Juntendo University, Tokyo, Japan
- Graduate School of Engineering Science, Yokohama National University, Kanagawa, Japan
| | - Shuko Nojiri
- Clinical Translational Science, Juntendo University School of Medicine Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan.
- Medical Technology Innovation Center, Juntendo University, Tokyo, Japan.
| | - Tomoyuki Saito
- Medical Technology Innovation Center, Juntendo University, Tokyo, Japan
| | - Yoshiki Irie
- Clinical Research and Trial Center, Juntendo University, Tokyo, Japan
- Graduate School of Engineering Science, Tokyo University of Science, Tokyo, Japan
| | - Takatoshi Kasai
- Department of Cardiology, Juntendo University School of Medicine Graduate School of Medicine, Tokyo, Japan
| | - Yoshimune Hiratsuka
- Department of Ophthalmology, Juntendo University School of Medicine Graduate School of Medicine, Tokyo, Japan
| | - Muneaki Ishijima
- Department of Medicine for Orthopedics and Motor Organ, Juntendo University School of Medicine Graduate School of Medicine, Tokyo, Japan
| | - Manabu Kuroki
- Graduate School of Engineering Science, Yokohama National University, Kanagawa, Japan
| | - Hiroyuki Daida
- Department of Cardiology, Juntendo University School of Medicine Graduate School of Medicine, Tokyo, Japan
| | - Yuji Nishizaki
- Clinical Translational Science, Juntendo University School of Medicine Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
- Medical Technology Innovation Center, Juntendo University, Tokyo, Japan
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10
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Bassotti G, Battaglia E. Considerations for laxatives in terms of their interactions with other drugs. Expert Opin Drug Metab Toxicol 2023; 19:121-123. [PMID: 36930791 DOI: 10.1080/17425255.2023.2193326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/19/2023]
Affiliation(s)
- Gabrio Bassotti
- Gastroenterology & Hepatology Section, Department of Medicine and Surgery, University of Perugia and Gastroenterology Unit, Perugia General Hospital, Perugia, Italy
- Gastroenterology Unit, ASL TO4 (Cirié-Chivasso-Cuorgné-Ivrea), Perugia, Italy
| | - Edda Battaglia
- Gastroenterology Unit, ASL TO4 (Cirié-Chivasso-Cuorgné-Ivrea), Perugia, Italy
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11
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Abstract
Late-life depression is common but underrecognized and undertreated leading to significant morbidity and mortality, including from suicide. The presence of comorbidities necessitates screening followed by a careful history in order to make the diagnosis of depression. Because older adults tend to take longer to respond to treatment and have higher relapse rates than younger patients, they benefit most from persistent, attentive therapy. Although both pharmacotherapy and psychosocial treatments, or a combination of the two, are considered as the first-line therapy for late-life depression, most data support a combined, biopsychosocial treatment approach provided by an interdisciplinary team.
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Affiliation(s)
- Elizabeth Gundersen
- University of Colorado School of Medicine, Mail Stop B178 Academic Office One, 12631 E. 17th Avenue, Aurora, CO 80045, USA.
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12
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Schmid O, Bereznicki B, Peterson GM, Stankovich J, Bereznicki L. Persistence of Adverse Drug Reaction-Related Hospitalization Risk Following Discharge. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19095585. [PMID: 35564982 PMCID: PMC9101512 DOI: 10.3390/ijerph19095585] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 04/25/2022] [Accepted: 04/29/2022] [Indexed: 12/28/2022]
Abstract
This retrospective cohort study analyzed the administrative hospital records of 91,500 patients with the aim of assessing adverse drug reaction (ADR)-related hospital admission risk after discharge from ADR and non-ADR-related admission. Patients aged ≥18 years with an acute admission to public hospitals in Tasmania, Australia between 2011 and 2015 were followed until May 2017. The index admissions (n = 91,550) were stratified based on whether they were ADR-related (n = 2843, 3.1%) or non-ADR-related (n = 88,707, 96.9%). Survival analysis assessed the post-index ADR-related admission risk using (1) the full dataset, and (2) a matched subset of patients using a propensity score analysis. Logistic regression was used to identify the risk factors for ADR-related admissions within 90 days of post-index discharge. The patients with an ADR-related index admission were almost five times more likely to experience another ADR-related admission within 90 days (p < 0.001). An increased risk persisted for at least 5 years (p < 0.001), which was substantially longer than previously reported. From the matched subset of patients, the risk of ADR-related admission within 90 and 365 days more than doubled in the patients with an ADR-related index admission (p < 0.0001). These admissions were often attributed to the same drug class as the patients’ index ADR-related admission. Cancer was a major risk factor for ADR-related re-hospitalization within 90 days; other factors included heart failure and increasing age.
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Affiliation(s)
- Olive Schmid
- School of Pharmacy and Pharmacology, University of Tasmania, Hobart, TAS 7001, Australia; (G.M.P.); (J.S.); (L.B.)
- Correspondence:
| | - Bonnie Bereznicki
- Tasmanian School of Medicine, University of Tasmania, Hobart, TAS 7000, Australia;
| | - Gregory Mark Peterson
- School of Pharmacy and Pharmacology, University of Tasmania, Hobart, TAS 7001, Australia; (G.M.P.); (J.S.); (L.B.)
| | - Jim Stankovich
- School of Pharmacy and Pharmacology, University of Tasmania, Hobart, TAS 7001, Australia; (G.M.P.); (J.S.); (L.B.)
| | - Luke Bereznicki
- School of Pharmacy and Pharmacology, University of Tasmania, Hobart, TAS 7001, Australia; (G.M.P.); (J.S.); (L.B.)
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13
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Stevenson JM, Parekh N, Chua KC, Davies JG, Schiff R, Rajkumar C, Ali K. A multi-centre cohort study on healthcare use due to medication-related harm: the role of frailty and polypharmacy. Age Ageing 2022; 51:6555655. [PMID: 35353136 PMCID: PMC8966695 DOI: 10.1093/ageing/afac054] [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: 07/28/2021] [Indexed: 01/11/2023] Open
Abstract
Objectives To determine the association between frailty and medication-related harm requiring healthcare utilisation. Design Prospective observational cohort study. Setting Six primary and five secondary care sites across South East England, September 2013–November 2015. Participants One thousand and two hundred and eighty participants, ≥65 years old, who were due for discharge from general medicine and older persons’ wards following an acute episode of care. Exclusion criteria were limited life expectancy, transfer to another hospital and consent not gained. Main outcome measures Medication-related harm requiring healthcare utilisation (including primary, secondary or tertiary care consultations related to MRH), including adverse drug reactions, non-adherence and medication error determined via the review of data from three sources: patient/carer reports gathered through a structured telephone interview; primary care medical record review; and prospective consultant-led review of readmission to recruiting hospital. Frailty was measured using a Frailty Index, developed using a standardised approach. Marginal estimates were obtained from logistic regression models to examine how probabilities of healthcare service use due to medication-related harm were associated with increasing number of medicines and frailty. Results Healthcare utilisation due to medication-related harm was significantly associated with frailty (OR = 10.06, 95% CI 2.06–49.26, P = 0.004), independent of age, gender, and number of medicines. With increasing frailty, the need for healthcare use as a result of MRH increases from a probability of around 0.2–0.4. This is also the case for the number of medicines. Conclusions Frailty is associated with MRH, independent of polypharmacy. Reducing the burden of frailty through an integrated health and social care approach, alongside strategies to reduce inappropriate polypharmacy, may reduce MRH related healthcare utilisation.
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Affiliation(s)
- Jennifer M Stevenson
- Medicines Use Research Group, Institute of Pharmaceutical Science, King’s College London, London, UK
- Pharmacy Department, Guy’s and St. Thomas’ NHS Foundation Trust, London, UK
| | - Nikesh Parekh
- Seaford Medical Practice, Seaford, UK
- Public Health and Wellbeing, Royal Borough of Greenwich, London, UK
| | - Kia-Chong Chua
- Centre for Implementation Science, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | - J Graham Davies
- Medicines Use Research Group, Institute of Pharmaceutical Science, King’s College London, London, UK
- School of Pharmacy and Biomolecular Sciences, University of Brighton, Brighton, UK
| | - Rebekah Schiff
- Department of Ageing and Health, Guy’s and St. Thomas’ NHS Foundation Trust, London, UK
| | - Chakravarthi Rajkumar
- Academic Department of Geriatrics, Brighton and Sussex Medical School, Brighton, UK
- Department of Geriatrics, University Hospitals Sussex NHS Foundation Trust, Sussex, UK
| | - Khalid Ali
- Academic Department of Geriatrics, Brighton and Sussex Medical School, Brighton, UK
- Department of Geriatrics, University Hospitals Sussex NHS Foundation Trust, Sussex, UK
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14
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Takechi H, Tsuzuki A, Matsumoto K, Fukui A, Kawakita H, Yoshino H, Kanada Y. Differences in the frequency of subjective geriatric complaints along with aging and their associations with physical function, multimorbidity, and mood: A cross-sectional study. PLoS One 2022; 17:e0263889. [PMID: 35148335 PMCID: PMC8836324 DOI: 10.1371/journal.pone.0263889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Accepted: 01/28/2022] [Indexed: 11/18/2022] Open
Abstract
Background In this study, we investigated subjective geriatric complaints (SGCs) as conditions regarding health concerns in community-dwelling older people and analyzed their frequencies with aging and relationships with other factors. Methods This cross-sectional study enrolled 10,434 older people living in a community with a representative aging population in Japan. A questionnaire was sent by mail to those who had not applied for formal care needs certification. The presence of and concern for symptoms common in old age were asked as SGCs, as were physical function levels, multimorbidity, and depression. Categorical principal component analysis (CATPCA) of the symptoms was performed, and the association between the obtained components and other factors was analyzed. Results The mean age of the participants was 73.7 ± 6.1 years, and 52.5% were women. On average, they had 1.72 ± 1.57 SGCs, which showed a gradual increase with age. The results of the CATPCA revealed four components: SGC1, excretory/circulatory/swallowing complaints; SGC2, audiovisual complaints; SGC3, neurological complaints; and SGC4, musculoskeletal complaints. All SGC components were independently associated with physical function, multimorbidity, and depression. Conclusions Each SGC showed various frequencies and differences along with aging, and SGCs were classified into four components that were thought to share a common background. These findings could contribute to the planning of better health management strategies for older people.
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Affiliation(s)
- Hajime Takechi
- Department of Geriatrics and Cognitive Disorders, School of Medicine, Fujita Health University, Toyoake, Aichi, Japan
- * E-mail:
| | - Akira Tsuzuki
- Faculty of Rehabilitation, School of Health Science, Fujita Health University, Toyoake, Aichi, Japan
| | - Komaki Matsumoto
- Department of Community Care, Toyoake City Municipal Office, Toyoake, Aichi, Japan
| | - Akane Fukui
- Department of Community Care, Toyoake City Municipal Office, Toyoake, Aichi, Japan
| | - Hitomi Kawakita
- Faculty of Human Health Science, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Hiroshi Yoshino
- Department of Geriatrics and Cognitive Disorders, School of Medicine, Fujita Health University, Toyoake, Aichi, Japan
| | - Yoshikiyo Kanada
- Department of Community Care, Toyoake City Municipal Office, Toyoake, Aichi, Japan
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15
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Sloane PD, Warshaw G. Should Slowing Be Considered a Distinct Geriatric Syndrome? J Am Med Dir Assoc 2021; 23:20-22. [PMID: 34953590 DOI: 10.1016/j.jamda.2021.11.028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Revised: 11/22/2021] [Accepted: 11/29/2021] [Indexed: 01/29/2023]
Affiliation(s)
- Philip D Sloane
- Departments of Family Medicine and Internal Medicine, School of Medicine, and the Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
| | - Gregg Warshaw
- Departments of Internal Medicine and Family Medicine, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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16
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Taushanov Z, Verloo H, Wernli B, Di Giovanni S, von Gunten A, Pereira F. Transforming a Patient Registry Into a Customized Data Set for the Advanced Statistical Analysis of Health Risk Factors and for Medication-Related Hospitalization Research: Retrospective Hospital Patient Registry Study. JMIR Med Inform 2021; 9:e24205. [PMID: 33973865 PMCID: PMC8150425 DOI: 10.2196/24205] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Revised: 02/11/2021] [Accepted: 04/04/2021] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Hospital patient registries provide substantial longitudinal data sets describing the clinical and medical health statuses of inpatients and their pharmacological prescriptions. Despite the multiple advantages of routinely collecting multidimensional longitudinal data, those data sets are rarely suitable for advanced statistical analysis and they require customization and synthesis. OBJECTIVE The aim of this study was to describe the methods used to transform and synthesize a raw, multidimensional, hospital patient registry data set into an exploitable database for the further investigation of risk profiles and predictive and survival health outcomes among polymorbid, polymedicated, older inpatients in relation to their medicine prescriptions at hospital discharge. METHODS A raw, multidimensional data set from a public hospital was extracted from the hospital registry in a CSV (.csv) file and imported into the R statistical package for cleaning, customization, and synthesis. Patients fulfilling the criteria for inclusion were home-dwelling, polymedicated, older adults with multiple chronic conditions aged ≥65 who became hospitalized. The patient data set covered 140 variables from 20,422 hospitalizations of polymedicated, home-dwelling older adults from 2015 to 2018. Each variable, according to type, was explored and computed to describe distributions, missing values, and associations. Different clustering methods, expert opinion, recoding, and missing-value techniques were used to customize and synthesize these multidimensional data sets. RESULTS Sociodemographic data showed no missing values. Average age, hospital length of stay, and frequency of hospitalization were computed. Discharge details were recoded and summarized. Clinical data were cleaned up and best practices for managing missing values were applied. Seven clusters of medical diagnoses, surgical interventions, somatic, cognitive, and medicines data were extracted using empirical and statistical best practices, with each presenting the health status of the patients included in it as accurately as possible. Medical, comorbidity, and drug data were recoded and summarized. CONCLUSIONS A cleaner, better-structured data set was obtained, combining empirical and best-practice statistical approaches. The overall strategy delivered an exploitable, population-based database suitable for an advanced analysis of the descriptive, predictive, and survival statistics relating to polymedicated, home-dwelling older adults admitted as inpatients. More research is needed to develop best practices for customizing and synthesizing large, multidimensional, population-based registries. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR2-10.1136/bmjopen-2019-030030.
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Affiliation(s)
- Zhivko Taushanov
- Faculty of Social and Political Sciences, University of Lausanne, Lausanne, Switzerland.,Faculty of Psychology and Educational Sciences, University of Geneva, Geneva, Switzerland
| | - Henk Verloo
- School of Health Sciences, HES-SO Valais-Wallis, Sion, Switzerland.,Service of Old Age Psychiatry, Lausanne University Hospital, Lausanne, Switzerland
| | - Boris Wernli
- FORS, Swiss Centre of Expertise in the Social Sciences, University of Lausanne, Lausanne, Switzerland
| | - Saviana Di Giovanni
- School of Health Sciences, HES-SO Valais-Wallis, Sion, Switzerland.,Pharmacy Benu Tavil-Chatton, Morges, Switzerland
| | - Armin von Gunten
- Service of Old Age Psychiatry, Lausanne University Hospital, Lausanne, Switzerland
| | - Filipa Pereira
- School of Health Sciences, HES-SO Valais-Wallis, Sion, Switzerland.,Institute of Biomedical Sciences Abel Salazar, University of Porto, Porto, Portugal
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17
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Maxwell CJ, Mondor L, Pefoyo Koné AJ, Hogan DB, Wodchis WP. Sex differences in multimorbidity and polypharmacy trends: A repeated cross-sectional study of older adults in Ontario, Canada. PLoS One 2021; 16:e0250567. [PMID: 33901232 PMCID: PMC8075196 DOI: 10.1371/journal.pone.0250567] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Accepted: 04/09/2021] [Indexed: 11/25/2022] Open
Abstract
Background Multimorbidity is increasing among older adults, but the impact of these recent trends on the extent and complexity of polypharmacy and possible variation by sex remains unknown. We examined sex differences in multimorbidity, polypharmacy (5+ medications) and hyper-polypharmacy (10+ medications) in 2003 vs 2016, and the interactive associations between age, multimorbidity level, and time on polypharmacy measures. Methods and findings We employed a repeated cross-sectional study design with linked health administrative databases for all persons aged ≥66 years eligible for health insurance in Ontario, Canada at the two index dates. Descriptive analyses and multivariable logistic regression models were conducted; models included interaction terms between age, multimorbidity level, and time period to estimate polypharmacy and hyper-polypharmacy probabilities, risk differences and risk ratios for 2016 vs 2003. Multimorbidity, polypharmacy and hyper-polypharmacy increased significantly over the 13 years. At both index dates prevalence estimates for all three were higher in women, but a greater absolute increase in polypharmacy over time was observed in men (6.6% [from 55.7% to 62.3%] vs 0.9% [64.2%-65.1%] for women) though absolute increases in multimorbidity were similar for men and women (6.9% [72.5%-79.4%] vs 6.2% [75.9%-82.1%], respectively). Model findings showed that polypharmacy decreased over time among women aged < 90 years (especially for younger ages and those with fewer conditions), whereas it increased among men at all ages and multimorbidity levels (with larger absolute increases typically at older ages and among those with 4 or fewer conditions). Conclusions There are sex and age differences in the impact of increasing chronic disease burden on changes in measures of multiple medication use among older adults. Though the drivers and health consequences of these trends warrant further investigation, the findings support the heterogeneity and complexity in the evolving association between multimorbidity and polypharmacy measures in older populations.
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Affiliation(s)
- Colleen J. Maxwell
- Schools of Pharmacy and Public Health & Health Systems, University of Waterloo, Waterloo, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- Health System Performance Network (HSPN), Toronto, Ontario, Canada
- * E-mail:
| | - Luke Mondor
- ICES, Toronto, Ontario, Canada
- Health System Performance Network (HSPN), Toronto, Ontario, Canada
| | - Anna J. Pefoyo Koné
- Health System Performance Network (HSPN), Toronto, Ontario, Canada
- Department of Health Sciences, Lakehead University, Thunder Bay, Ontario, Canada
| | - David B. Hogan
- Division of Geriatric Medicine, Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Walter P. Wodchis
- ICES, Toronto, Ontario, Canada
- Health System Performance Network (HSPN), Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Institute for Better Health, Trillium Health Partners, Toronto, Ontario, Canada
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18
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Ibrahim K, Cox NJ, Stevenson JM, Lim S, Fraser SDS, Roberts HC. A systematic review of the evidence for deprescribing interventions among older people living with frailty. BMC Geriatr 2021; 21:258. [PMID: 33865310 PMCID: PMC8052791 DOI: 10.1186/s12877-021-02208-8] [Citation(s) in RCA: 94] [Impact Index Per Article: 31.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Accepted: 04/08/2021] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Older people living with frailty are often exposed to polypharmacy and potential harm from medications. Targeted deprescribing in this population represents an important component of optimizing medication. This systematic review aims to summarise the current evidence for deprescribing among older people living with frailty. METHODS The literature was searched using Medline, Embase, CINAHL, PsycInfo, Web of Science, and the Cochrane library up to May 2020. Interventional studies with any design or setting were included if they reported deprescribing interventions among people aged 65+ who live with frailty identified using reliable measures. The primary outcome was safety of deprescribing; whereas secondary outcomes included clinical outcomes, medication-related outcomes, feasibility, acceptability and cost-related outcomes. Narrative synthesis was used to summarise findings and study quality was assessed using Joanna Briggs Institute checklists. RESULTS Two thousand three hundred twenty-two articles were identified and six (two randomised controlled trials) were included with 657 participants in total (mean age range 79-87 years). Studies were heterogeneous in their designs, settings and outcomes. Deprescribing interventions were pharmacist-led (n = 3) or multidisciplinary team-led (n = 3). Frailty was identified using several measures and deprescribing was implemented using either explicit or implicit tools or both. Three studies reported safety outcomes and showed no significant changes in adverse events, hospitalisation or mortality rates. Three studies reported positive impact on clinical outcomes including depression, mental health status, function and frailty; with mixed findings on falls and cognition; and no significant impact on quality of life. All studies described medication-related outcomes and reported a reduction in potentially inappropriate medications and total number of medications per-patient. Feasibility of deprescribing was reported in four studies which showed that 72-91% of recommendations made were implemented. Two studies evaluated and reported the acceptability of their interventions and further two described cost saving. CONCLUSION There is a paucity of research about the impact of deprescribing in older people living with frailty. However, included studies suggest that deprescribing could be safe, feasible, well tolerated and can lead to important benefits. Research should now focus on understanding the impact of deprescribing on frailty status in high risk populations. TRIAL REGISTRATION The review was registered on the international prospective register of systematic reviews (PROSPERO) ID number: CRD42019153367 .
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Affiliation(s)
- Kinda Ibrahim
- Academic Geriatric Medicine, Faculty of Medicine, University of Southampton, Southampton, UK.
- NIHR Applied Research Collaboration Wessex, Southampton, UK.
| | - Natalie J Cox
- Academic Geriatric Medicine, Faculty of Medicine, University of Southampton, Southampton, UK
- Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS FT, Southampton, UK
| | - Jennifer M Stevenson
- Institute of Pharmaceutical Science, King's College London, London, UK
- Pharmacy Department, Guy's and St. Thomas' NHS FT, London, UK
| | - Stephen Lim
- Academic Geriatric Medicine, Faculty of Medicine, University of Southampton, Southampton, UK
- NIHR Applied Research Collaboration Wessex, Southampton, UK
| | - Simon D S Fraser
- NIHR Applied Research Collaboration Wessex, Southampton, UK
- Primary Care, Population Science and Medical Education, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Helen C Roberts
- Academic Geriatric Medicine, Faculty of Medicine, University of Southampton, Southampton, UK
- NIHR Applied Research Collaboration Wessex, Southampton, UK
- Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS FT, Southampton, UK
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19
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Hellemans L, Nuyts S, Hias J, van den Akker M, Van Pottelbergh G, Rygaert X, Spriet I, Vaes B, Tournoy J, Van der Linden L. Polypharmacy and excessive polypharmacy in community-dwelling middle aged and aged adults between 2011 and 2015. Int J Clin Pract 2021; 75:e13942. [PMID: 33340210 DOI: 10.1111/ijcp.13942] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Accepted: 12/14/2020] [Indexed: 01/03/2023] Open
Abstract
AIMS We aimed to assess the prevalence, components and evolution of polypharmacy and to evaluate risk factors associated with polypharmacy. METHODS A retrospective dynamic cohort study was performed, using a primary healthcare database comprising Flemish community-dwelling adults aged ≥40 years between 2011 and 2015. Polypharmacy and excessive polypharmacy were defined as the use of 5-9 or minimum 10 different medications during 1 year, respectively. Temporal changes were analysed using an autoregressive error model. Risk factors for polypharmacy were evaluated using logistic regression. RESULTS In total, 68 426 patients were included in the analysis. The prevalence of polypharmacy was 29.5% and 16.1% for excessive polypharmacy in 2015. The age-standardised prevalence rate of patients using minimum five medications increased with 1.3% per year (95% confidence interval (CI): 0.1968-2.4279). The mean number of unplanned hospital admissions was 0.07 (standard deviation (SD) 0.33) for polypharmacy patients and 0.19 (SD 0.53) for excessive polypharmacy patients. Four risk factors were found to be significantly correlated with polypharmacy: age (odds ratio (OR) 1.015; 95% CI: 1.013-1.017), female gender (OR 1.161; 95% CI: 1.108-1.216), number of chronic diseases (OR 1.126; 95% CI: 1.114-1.139) and number of general practitioner contacts (OR 1.283; 95% CI: 1.274-1.292). CONCLUSION The prevalence of polypharmacy increased between 2011 and 2015. Polypharmacy and excessive polypharmacy patients appeared to differ based on our observations of characteristics, drug therapy and outcomes. Age, female gender, number of chronic diseases and number of general practitioner contacts were associated with polypharmacy.
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Affiliation(s)
- Laura Hellemans
- Pharmacy Department, University Hospitals Leuven, Leuven, Belgium
| | - Shauni Nuyts
- Academic Centre of General Practice/Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
- L-BioStat, KU Leuven, Leuven, Belgium
| | - Julie Hias
- Pharmacy Department, University Hospitals Leuven, Leuven, Belgium
| | - Marjan van den Akker
- Academic Centre of General Practice/Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
- Institute of General Practice, Johann Wolfgang Goethe University, Frankfurt, Germany
- Department of Family Medicine, School CAPHRI, Maastricht University, Maastricht, The Netherlands
| | - Gijs Van Pottelbergh
- Academic Centre of General Practice/Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
| | | | - Isabel Spriet
- Pharmacy Department, University Hospitals Leuven, Leuven, Belgium
- Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium
| | - Bert Vaes
- Academic Centre of General Practice/Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
| | - Jos Tournoy
- Department of Geriatric Medicine, University Hospitals Leuven, Leuven, Belgium
- Department of Chronic Diseases, Metabolism and Ageing, KU Leuven, Leuven, Belgium
| | - Lorenz Van der Linden
- Pharmacy Department, University Hospitals Leuven, Leuven, Belgium
- Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium
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20
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Adverse drug reactions in older adults: a narrative review of the literature. Eur Geriatr Med 2021; 12:463-473. [PMID: 33738772 PMCID: PMC8149349 DOI: 10.1007/s41999-021-00481-9] [Citation(s) in RCA: 55] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Accepted: 02/26/2021] [Indexed: 12/21/2022]
Abstract
Aim To summarize the classification and occurrence of ADRs and identify risk factors and strategies to reduce and prevent ADRs in older adults. Findings In frail, multimorbid older adults, who are often treated with polypharmacy, ADRs are frequently associated with health burden and hospitalization. Multiple age-related risk factors, including changes in pharmacokinetics, multimorbidity, polypharmacy, and frailty can increase the risk of ADRs, and different strategies have been suggested to prevent the onset of ADRs. Message A multidimensional and holistic approach combining pharmaceutical interventions with a global evaluation of health needs and priorities can reduce the burden of ADRs in older adults. Purpose Adverse drug reactions (ADRs) represent a common and potentially preventable cause of unplanned hospitalization, increasing morbidity, mortality, and healthcare costs. We aimed to review the classification and occurrence of ADRs in the older population, discuss the role of age as a risk factor, and identify interventions to prevent ADRs. Methods We performed a narrative scoping review of the literature to assess classification, occurrence, factors affecting ADRs, and possible strategies to identify and prevent ADRs. Results Adverse drug reactions (ADRs) are often classified as Type A and Type B reactions, based on dose and effect of the drugs and fatality of the reaction. More recently, other approaches have been proposed (i.e. Dose, Time and Susceptibility (DoTS) and EIDOS classifications). The frequency of ADRs varies depending on definitions, characteristics of the studied population, and settings. Their occurrence is often ascribed to commonly used drugs, including anticoagulants, antiplatelet agents, digoxin, insulin, and non-steroidal anti-inflammatory drugs. Age-related factors—changes in pharmacokinetics, multimorbidity, polypharmacy, and frailty—have been related to ADRs. Different approaches (i.e. medication review, software identifying potentially inappropriate prescription and drug interactions) have been suggested to prevent ADRs and proven to improve the quality of prescribing. However, consistent evidence on their effectiveness is still lacking. Few studies suggest that a comprehensive geriatric assessment, aimed at identifying individual risk factors, patients’ needs, treatment priorities, and strategies for therapy optimization, is key for reducing ADRs. Conclusions Adverse drug reactions (ADRs) are a relevant health burden. The medical complexity that characterizes older patients requires a holistic approach to reduce the burden of ADRs in this population.
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21
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Thiem U, Heppner HJ, Sieber C. [Less can be more-Examples on medication in older and geriatric patients from current studies]. Internist (Berl) 2021; 62:363-372. [PMID: 33630097 DOI: 10.1007/s00108-021-00981-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/01/2021] [Indexed: 11/25/2022]
Abstract
Polypharmacy, i.e. the prescription of five or more different drugs for medicinal treatment, is a typical problem in older and geriatric patients. Polypharmacy predisposes to different negative health sequelae, such as undesired side effects, drug interactions, potentially inappropriate medication, reduced functional abilities, increased hospitalization and increased mortality. Various consensus groups and specialist societies have developed recommendations on how to handle polypharmacy in geriatric patients. Although concepts to reduce the number of drugs are considered necessary, in many areas there is a lack of evidence on how to limit polypharmacy in geriatric patients and to reduce and discontinue medication. This article presents examples of recent studies dealing with potentially inappropriate medication, vitamin D substitution and antipsychotic drugs, which show how to critically appraise a prescribed medication, to critically check the indications for drugs and to discontinue drug use.
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Affiliation(s)
- U Thiem
- Lehrstuhl für Geriatrie und Gerontologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland.
- Zentrum für Altersmedizin, Medizinisch-Geriatrische Klinik, Albertinen-Haus, Sellhopsweg 18-22, 22459, Hamburg, Deutschland.
| | - H J Heppner
- Lehrstuhl für Geriatrie, Fakultät für Gesundheit, Universität Witten/Herdecke, Witten, Deutschland
- Klinik für Geriatrie mit Tagesklinik, Helios Klinikum, Schwelm, Deutschland
- Lehrstuhl für Innere Medizin und Geriatrie, Friedrich-Alexander-Universität Erlangen-Nürnberg, Nürnberg, Deutschland
| | - C Sieber
- Lehrstuhl für Innere Medizin und Geriatrie, Friedrich-Alexander-Universität Erlangen-Nürnberg, Nürnberg, Deutschland
- Department für Innere Medizin, Kantonsspital Winterthur, Winterthur, Schweiz
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22
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Negishi A, Oshima S, Horii N, Mutoh M, Inoue N, Numajiri S, Ohshima S, Kobayashi D. Categorisation of Pharmaceutical Adverse Events Using the Japanese Adverse Drug Event Report Database: Characteristic Adverse Drug Events of the Elderly Treated with Polypharmacy. Drugs Real World Outcomes 2020; 8:49-61. [PMID: 33367976 PMCID: PMC7984209 DOI: 10.1007/s40801-020-00221-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/20/2020] [Indexed: 12/02/2022] Open
Abstract
Background Pharmacokinetics and pharmacodynamics of drugs in elderly individuals differ from those in younger adults; thus, adverse drug events (ADEs) are common in older patients with polypharmacy because co-existing comorbidities elevate the risk of ADEs occurring. However, ADEs have not yet been characterised based on the elderly patients of Japanese origin and polypharmacy. Objective The 100 most commonly reported ADEs were grouped into four classes (Class 1–Class 4) based on elderly patients with polypharmacy. Patients and Methods In this study, logistic regression analysis was performed using cases recorded in the Japanese Adverse Drug Event Report (JADER) database. Results ADEs in elderly patients treated with polypharmacy—in whom the risk of electrolyte abnormalities, renal and respiratory disorders, and coagulopathy was high—were categorised as ‘Class 1 [E(+), P(+)]’, while ADEs in elderly patients not treated with polypharmacy—in whom the risk of delirium and fall was high—were categorised as ‘Class 2 [E(+), P(−)]’. When there was no association with being elderly, ADEs associated with polypharmacy that carried a high risk of myelosuppression and infection were categorised as ‘Class 3 [E(−), P(+)]’, and allergic ADEs that were not affected by being elderly or polypharmacy, were categorised as ‘Class 4 [E(−), P(−)]’. Class 1 events as well as Class 3 ADEs occurred more frequently in females than in males, whereas Class 3 ADEs (deep vein thrombosis and pulmonary embolism) occurred more frequently in males. Conclusions Class 1 and Class 2 ADEs should be investigated in analyses that focus on individual drugs. Supplementary Information The online version contains supplementary material available at 10.1007/s40801-020-00221-8.
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Affiliation(s)
- Akio Negishi
- Laboratory of Analytical Pharmaceutics and Informatics, Faculty of Pharmacy and Pharmaceutical Sciences, Josai University, 1-1 Keyakidai, Sakado, Saitama, 350-0295, Japan
| | - Shinji Oshima
- Laboratory of Analytical Pharmaceutics and Informatics, Faculty of Pharmacy and Pharmaceutical Sciences, Josai University, 1-1 Keyakidai, Sakado, Saitama, 350-0295, Japan.
| | - Norimitsu Horii
- Laboratory of Pharmacy Management, Faculty of Pharmacy and Pharmaceutical Sciences, Josai University, Saitama, Japan.,Josai University Pharmacy, Saitama, Japan
| | - Mizue Mutoh
- Laboratory of Pharmacy Management, Faculty of Pharmacy and Pharmaceutical Sciences, Josai University, Saitama, Japan
| | - Naoko Inoue
- Laboratory of Pharmacy Management, Faculty of Pharmacy and Pharmaceutical Sciences, Josai University, Saitama, Japan.,Josai University Pharmacy, Saitama, Japan
| | - Sachihiko Numajiri
- Student Learning Assistance Centre, Faculty of Pharmacy and Pharmaceutical Sciences, Josai University, Saitama, Japan
| | - Shigeru Ohshima
- Laboratory of Pharmacy Management, Faculty of Pharmacy and Pharmaceutical Sciences, Josai University, Saitama, Japan.,Josai University Pharmacy, Saitama, Japan
| | - Daisuke Kobayashi
- Laboratory of Analytical Pharmaceutics and Informatics, Faculty of Pharmacy and Pharmaceutical Sciences, Josai University, 1-1 Keyakidai, Sakado, Saitama, 350-0295, Japan.,Josai University Pharmacy, Saitama, Japan
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23
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Thillainadesan J, Mudge AM, Aitken SJ, Hilmer SN, Cullen JS, Yumol MF, Close JCT, Norris CM, Kerdic R, Naganathan V. The Prognostic Performance of Frailty for Delirium and Functional Decline in Vascular Surgery Patients. J Am Geriatr Soc 2020; 69:688-695. [PMID: 33151550 DOI: 10.1111/jgs.16907] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 09/10/2020] [Accepted: 10/07/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND Frailty in older vascular surgery patients is associated with increased mortality, hospital stay, and morbidity. The association of frailty with hospital-acquired geriatric syndromes such as delirium and functional decline has not been well studied. OBJECTIVES To investigate the association between frailty and hospital-acquired geriatric syndromes in older hospitalized vascular surgery patients, and to evaluate the prognostic performance of the frailty index (FI) and the Clinical Frailty Scale (CFS) for delirium and functional decline. DESIGN Prospective cohort study. SETTING Acute care academic hospital. PARTICIPANTS Patients aged 65 years or more admitted to a tertiary vascular surgery unit (N=150). MEASUREMENTS Frailty was assessed using the FI and CFS. The adjusted association of frailty status with delirium and functional decline was assessed using logistic regression analysis. The prognostic performance of FI and CFS was determined by assessing C-statistic and positive and negative predictive values (PPV and NPV). RESULTS Of 150 participants, FI identified 34 (23%) and CFS identified 45 (30%) as frail. Frailty was an independent predictor of delirium (FI adjusted odds ratio, odds ratio (OR) = 5.66, 95% confidence interval (CI) = 1.53-21.03; CFS adjusted OR = 4.07, 95% CI = 1.14-14.50), but not functional decline. FI and CFS showed acceptable prognostic performance for delirium (C-statistic 0.74), but not functional decline (C-statistic 0.63-0.64). For both outcomes, the FI and CFS had high NPV (86-96%), and low PPV (22-29%). CONCLUSION Frail older vascular surgery patients are more likely to develop hospital-acquired geriatric syndromes. The FI and CFS have acceptable prognostic performance for predicting delirium but not all individuals who are identified as frail develop delirium. Ongoing research is needed to identify interventions that improve outcomes in patients who screen positive for frailty.
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Affiliation(s)
- Janani Thillainadesan
- Department of Geriatric Medicine, Concord Hospital, Concord, Australia.,Concord Clinical School, Faculty of Medicine and Health, University of Sydney, Concord, Australia.,Centre for Education and Research on Ageing, and Ageing and Alzheimers Institute, Concord Hospital, Concord, Australia
| | - Alison M Mudge
- Internal Medicine Research Unit, Royal Brisbane and Women's Hospital, Herston, Australia.,School of Clinical Medicine, University of Queensland, Brisbane, Australia
| | - Sarah J Aitken
- Concord Clinical School, Faculty of Medicine and Health, University of Sydney, Concord, Australia.,Centre for Education and Research on Ageing, and Ageing and Alzheimers Institute, Concord Hospital, Concord, Australia.,Concord Institute of Academic Surgery, Vascular Surgery Department, Concord Hospital, Concord, Australia.,Department of Vascular Surgery, Concord Hospital, Concord, Australia
| | - Sarah N Hilmer
- Kolling Institute of Medical Research, Sydney Medical School, University of Sydney and Royal North Shore Hospital, St Leonards, Australia
| | - John S Cullen
- Department of Geriatric Medicine, Concord Hospital, Concord, Australia.,Concord Clinical School, Faculty of Medicine and Health, University of Sydney, Concord, Australia.,Centre for Education and Research on Ageing, and Ageing and Alzheimers Institute, Concord Hospital, Concord, Australia
| | - Minna F Yumol
- Department of Geriatric Medicine, Concord Hospital, Concord, Australia
| | - Jacqueline C T Close
- Falls, Balance and Injury Research Centre, Neuroscience Research Australia, Randwick, Australia.,Department of Aged Care, Prince of Wales Hospital, Randwick, Australia
| | - Christina M Norris
- Falls, Balance and Injury Research Centre, Neuroscience Research Australia, Randwick, Australia.,Department of Aged Care, Prince of Wales Hospital, Randwick, Australia
| | - Richard Kerdic
- Department of Vascular Surgery, Concord Hospital, Concord, Australia
| | - Vasi Naganathan
- Department of Geriatric Medicine, Concord Hospital, Concord, Australia.,Concord Clinical School, Faculty of Medicine and Health, University of Sydney, Concord, Australia.,Centre for Education and Research on Ageing, and Ageing and Alzheimers Institute, Concord Hospital, Concord, Australia
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24
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Takayama S, Tomita N, Arita R, Ono R, Kikuchi A, Ishii T. Kampo Medicine for Various Aging-Related Symptoms: A Review of Geriatric Syndrome. Front Nutr 2020; 7:86. [PMID: 32766269 PMCID: PMC7381143 DOI: 10.3389/fnut.2020.00086] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2020] [Accepted: 05/12/2020] [Indexed: 12/12/2022] Open
Abstract
With the continued growth of the aging population in Japan, geriatric syndrome (GS), which is associated with aging-related symptoms, has become a social problem. GS is caused by physiological and pathological aging and may manifest various symptoms. Physicians use multidisciplinary approaches to provide treatment for individual GS symptoms. Kampo medicine, a Japanese traditional medicine that uses multiple pharmacologically active substances, is useful for many syndromes, conditions, disorders, and diseases associated with GS. Evidence of the effectiveness of Kampo medicine for GS has accumulated in recent years. The effects of Kampo treatment for symptoms related to functional decline of the cardiovascular, respiratory, and digestive systems, cognitive impairment and related disorders, pain and other sensory issues, among others, support the use of Kampo medicine for the management of GS. The role of Kampo medicine for GS is summarized in this review.
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Affiliation(s)
- Shin Takayama
- Department of Kampo and Integrative Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan.,Department of Education and Support for Regional Medicine, Tohoku University Hospital, Sendai, Japan.,Department of Kampo Medicine, Tohoku University Hospital, Sendai, Japan
| | - Naoki Tomita
- Department of Geriatrics and Gerontology, Institue of Development, Aging and Cancer, Tohoku University, Sendai, Japan
| | - Ryutaro Arita
- Department of Education and Support for Regional Medicine, Tohoku University Hospital, Sendai, Japan.,Department of Kampo Medicine, Tohoku University Hospital, Sendai, Japan
| | - Rie Ono
- Department of Education and Support for Regional Medicine, Tohoku University Hospital, Sendai, Japan.,Department of Kampo Medicine, Tohoku University Hospital, Sendai, Japan
| | - Akiko Kikuchi
- Department of Kampo and Integrative Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan.,Department of Education and Support for Regional Medicine, Tohoku University Hospital, Sendai, Japan.,Department of Kampo Medicine, Tohoku University Hospital, Sendai, Japan
| | - Tadashi Ishii
- Department of Kampo and Integrative Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan.,Department of Education and Support for Regional Medicine, Tohoku University Hospital, Sendai, Japan.,Department of Kampo Medicine, Tohoku University Hospital, Sendai, Japan
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25
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Aprahamian I, Morley JE. Editorial: To Drug or Not to Drug: The Geriatrician Dilemma of Polypharmacy. J Nutr Health Aging 2020; 24:809-811. [PMID: 33009528 DOI: 10.1007/s12603-020-1451-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- I Aprahamian
- John E. Morley, MB, BCh, Division of Geriatric Medicine, Saint Louis University, SLUCare Academic Pavilion, Section 2500, 1008 S. Spring Ave., 2nd Floor, St. Louis, MO 63110, , Twitter: @drjohnmorley
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