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Cheng C, Christensen M. Interventions Addressing Symptoms in Older Adults with Multimorbidity: An Umbrella Review. J Multidiscip Healthc 2024; 17:3181-3192. [PMID: 39006878 PMCID: PMC11246035 DOI: 10.2147/jmdh.s452426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Accepted: 02/07/2024] [Indexed: 07/16/2024] Open
Abstract
This umbrella review was to synthesize the summarized evidence-based research regarding interventions addressing symptoms in older populations with multimorbidity. Three databases including PsycINFO, MEDLINE, and CINAHL were searched systematically. The JBI Methodology for Umbrella Reviews and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statements were used to report this review. Six reviews published between 2016 and 2010 were included for analysis. Interventions were mixed and included components on health-related behaviors, body systems or functions, activities and participation domains, and the environment. Outcomes concerning physiological/clinical functioning were most reported. The evidence regarding the symptoms-related interventions was mixed, but all showed promising outcomes compared with usual care or not. To sum up, this umbrella review reveals the lack of strong empirical evidence for the effectiveness of intervention addressing symptoms in older adults with multimorbidity. It highlights the need to evaluate the established approach of interventions further to support this population.
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Affiliation(s)
- Cheng Cheng
- School of Nursing, Hong Kong Polytechnic University, Hong Kong, SAR, People’s Republic of China
- School of Nursing, Fudan University, Xuhui, Shanghai, People’s Republic of China
| | - Martin Christensen
- School of Nursing, Hong Kong Polytechnic University, Hong Kong, SAR, People’s Republic of China
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Kim JH, Thiruvengadam R. Hypertension in an ageing population: Diagnosis, mechanisms, collateral health risks, treatments, and clinical challenges. Ageing Res Rev 2024; 98:102344. [PMID: 38768716 DOI: 10.1016/j.arr.2024.102344] [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: 07/20/2023] [Revised: 05/07/2024] [Accepted: 05/15/2024] [Indexed: 05/22/2024]
Abstract
Ageing population is considerably increasing worldwide, which is considered to reflect an improved quality of life. However, longevity in the human lifespan has increased the burden of late-life illnesses including cancer, neurodegeneration, and cardiovascular dysfunction. Of these, hypertension is the most common condition with huge health risks, with an increased prevalence among the elderly. In this review, we outline the current guidelines for defining hypertension and examine the detailed mechanisms underlying the relationship between hypertension and ageing-related outcomes, including sodium sensitivity, arterial stiffness, endothelial dysfunction, isolated systolic hypertension, white coat effect, and orthostatic hypertension. As hypertension-related collateral health risk increases among the elderly, the available management strategies are necessary to overcome the clinical treatment challenges faced among elderly population. To improve longevity and reduce adverse health effects, potential approaches producing crucial information into new era of medicine should be considered in the prevention and treatment of hypertension among elderly population. This review provides an overview of mechanisms underlying hypertension and its related collateral health risk in elderly population, along with multiple approaches and management strategies to improve the clinical challenges among elderly population.
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Affiliation(s)
- Jin Hee Kim
- Department of Integrative Bioscience & Biotechnology, Sejong University, Seoul 05006, the Republic of Korea.
| | - Rekha Thiruvengadam
- Department of Integrative Bioscience & Biotechnology, Sejong University, Seoul 05006, the Republic of Korea
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Byun JY, Aiyeolemi A, Qdaisat A, Park C. Association between epidermal growth factor receptor-tyrosine kinase inhibitors and venous thromboembolism among older patients with advanced non-small cell lung cancer. Cancer 2024. [PMID: 38848305 DOI: 10.1002/cncr.35424] [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] [Received: 03/05/2024] [Revised: 04/27/2024] [Accepted: 05/20/2024] [Indexed: 06/09/2024]
Abstract
BACKGROUND Venous thromboembolism (VTE) risk is higher among patients with non-small cell lung cancer (NSCLC) and specific subgroups, including the elderly, but little is known about the VTE risk of different generations of epidermal growth factor receptor-tyrosine kinase inhibitors (EGFR-TKIs) and whether the risk differs by demographic characteristics. This study aims to compare the risk of VTE (deep venous thromboembolism [DVT]; pulmonary embolism [PE]) between a third-generation EGFR-TKI and first/second-generation EGFR-TKIs and stratify VTE risk by sex, age, and race/ethnicity in third-generation EGFR-TKI users. METHODS Via the 2006-2019 Surveillance, Epidemiology, and End Results-Medicare database, this retrospective cohort study included older patients (aged ≥65 years) with advanced NSCLC who initiated on a third-generation EGFR-TKI (n = 493) and first/second-generation EGFR-TKIs (n = 1036). We estimated the hazard ratio (HR) and its 95% confidence interval (95% CI) with the Cox proportional hazards model. RESULTS A third-generation EGFR-TKI had a significantly higher VTE risk than first/second-generation EGFR-TKIs (HR, 1.26 [95% CI, 1.01-1.57]; p = .037), with an elevated risk in males (HR, 2.16 [95% CI, 1.47-3.19]; p < .001), patients aged ≥75 years (HR, 1.38 [95% CI, 1.04-1.83]; p = .026), and non-Hispanic Whites (HR, 1.46 [95% CI, 1.10-1.95]; p = .010). Males consistently showed a significantly higher risk of DVT (HR, 2.49 [95% CI, 1.29-4.80]; p = .007) and PE (HR, 2.00 [95% CI, 1.29-3.11]; p = .002). A significantly higher risk of DVT (HR, 1.54 [95% CI, 1.00-2.37]; p = .050) and PE (HR, 1.47 [95% CI, 1.06-2.05]; p = .021) was shown in patients aged ≥75 years and non-Hispanic Whites, respectively. Among third-generation EGFR-TKI users, non-Hispanic Whites had a significantly higher risk of VTE (HR, 2.04 [95% CI, 1.03-4.02]; p = .041) and PE (HR, 2.88 [95% CI, 1.24-6.70]; p = .014) than non-Hispanic Asian/Pacific Islanders. CONCLUSIONS Close monitoring of VTE events in high-risk patients is essential to promote early diagnosis and treatment.
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Affiliation(s)
- Joo-Young Byun
- Health Outcomes Division, College of Pharmacy, The University of Texas at Austin, Austin, Texas, USA
- School of Pharmacy, Sungkyunkwan University, Suwon, South Korea
| | - Ayobami Aiyeolemi
- Health Outcomes Division, College of Pharmacy, The University of Texas at Austin, Austin, Texas, USA
| | - Aiham Qdaisat
- Division of Internal Medicine, Department of Emergency Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Chanhyun Park
- Health Outcomes Division, College of Pharmacy, The University of Texas at Austin, Austin, Texas, USA
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Đukić L, Soulis G, Janssens B, Müller F, Petrovic M, Kossioni A. Appropriate use of antibiotics for oral/dental conditions in older adults: a narrative review. Acta Clin Belg 2024:1-12. [PMID: 38795066 DOI: 10.1080/17843286.2024.2359182] [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: 03/23/2024] [Accepted: 05/20/2024] [Indexed: 05/27/2024]
Abstract
OBJECTIVES Considering the high rates in the use of antibiotics for oral/dental conditions in older patients and the rise in antimicrobial resistance, appropriate antibiotic prescription is important. This narrative review aimed to discuss the challenges and special considerations when prescribing antibiotics to older patients for oral/dental conditions. METHODS PubMed/MEDLINE, Scopus, Web of Science, and articles' reference lists were searched for antibiotics use for oral conditions by older patients. Moreover, scientific and professional organisations' official websites were searched for guidelines on antibiotic use in dentistry. RESULTS Despite several guidelines about the use of antibiotics in dentistry, specific information on their administration to older patients is missing. Relevant challenges include age-related changes in pharmacokinetics and pharmacodynamics, comorbidities and polypharmacy associated with low adherence, contraindications, adverse reactions, and drug-drug interactions. In unfit and frail older patients some antibiotics should be avoided, or doses should be adjusted, according to medical conditions or medications received. Amoxicillin, with doses adapted to renal function, is one of the safest options, while other antibiotics should be chosen with caution upon indications and individual patient characteristics. CONCLUSIONS Healthcare providers should prescribe antibiotics to unfit and frail older adults with caution, given the multitude of comorbidities and potential interactions with medications received. Further research is needed on the safe and effective use of antibiotics in older patients.
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Affiliation(s)
- Ljiljana Đukić
- Department of Pharmacology in Dentistry, School of Dental Medicine, University of Belgrade, Belgrade, Serbia
| | - George Soulis
- Outpatient Geriatric Assessment Unit, Henry Dunant Hospital Center, Athens, Greece
| | - Barbara Janssens
- Department of Oral Health Sciences, Gerodontology, ELOHA (Equal Lifelong Oral Health for All) research group, Ghent University, Ghent, Belgium
| | - Frauke Müller
- Division of Gerodontology and Removable Prosthodontics, University of Geneva, Geneva, Switzerland
| | - Mirko Petrovic
- Department of Internal Medicine and Paediatrics, Ghent University, Ghent, Belgium
| | - Anastassia Kossioni
- Department of Prosthodontics, School of Dentistry, National and Kapodistrian University of Athens, Athens, Greece
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Attrill L, Schofield P. Perspectives on approaching pain management in patients with dementia. Pain Manag 2024; 14:153-161. [PMID: 38525806 DOI: 10.2217/pmt-2023-0095] [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] [Indexed: 03/26/2024] Open
Abstract
This paper presents a review of the latest literature and guidance regarding the assessment and management of pain in older adults with dementia. The size and nature of the problem will be presented, in terms of the increasing aging population across the globe and potential for a significant increase in adults with dementia, along with the reduction in younger counterparts who will be available to provide care in the future. We will present the latest recommendations regarding how to assess pain and which tools are recommended for use underpinned by the strongest evidence. Finally, we will present the findings of the latest national (UK) guidelines for the management of pain. Recommendations will be made for future research and clinical practice.
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Affiliation(s)
- Lisa Attrill
- Lecturer in Adult Nursing (Education), School of Nursing & Midwifery (Faculty of Health) University of Plymouth, Kirkby Place Drake Circus, Plymouth, PL4 8AA, UK
| | - Pat Schofield
- Professor of Clinical Nursing, University of Plymouth, Kirkby Place Drake Circus, Plymouth, PL4 8AA, UK
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Ibrahim NA, Wong YY, Lean QY, Ramasamy K, Lim SM, Tan MP, Abdul Majeed AB. Medication self-management among older adults with cognitive frailty. Res Social Adm Pharm 2024; 20:172-181. [PMID: 37980238 DOI: 10.1016/j.sapharm.2023.11.001] [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: 06/09/2023] [Revised: 11/02/2023] [Accepted: 11/02/2023] [Indexed: 11/20/2023]
Abstract
BACKGROUND Independent and safe medication self-management is essential for successful aging. Nevertheless, how older adults with cognitive frailty (CF) self-manage medications at their own homes remain elusive. OBJECTIVE This study aimed at assessing the medication self-management capability of home-dwelling older adults with CF and exploring the ways, perceived challenges and barriers in medication self-management. METHODS A convergent mixed-method study design was used. The medication management capability of 16 CF individuals aged ≥ 60 years on ≥ 1 long-term prescription drugs were assessed using the Drug Regimen Unassisted Grading Scale (DRUGS). Virtual in-depth interviews were also performed between July-August 2022 using a semi-structured interview guide. All interviews were audio-recorded and transcribed verbatim. Qualitative data were analysed using a thematic analysis approach guided by Bailey and colleagues' model of medication self-management. RESULTS The mean DRUGS summary score was 96.86 [standard deviation (SD) 3.74] with highest performance scores observed in medication access (100 %) and lowest performance score in medication identification (91.46 %). Informants were able to independently take their medications and they tended to organise their medication intakes according to mealtime even though some admitted missing medication doses due to forgetfulness. Informants had difficulties with recalling drug names, with little awareness of self-monitoring their own health conditions and the effects of medications. Misconceptions towards medications, difficulties in accessing medications, reduced mobility and worsening health conditions could potentially deter informants from safe and independent medication self-management. In contrast, trust in doctors and a desire to achieve treatment goal could motivate medication self-management. CONCLUSION The findings revealed knowledge gaps among older adults with CF in identifying their medications and self-monitoring which warrant reinforcement by healthcare professionals to ensure chronic safe medication use. Future studies should evaluate strategies to enhance medication safety in terms of self-monitoring in individuals with CF.
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Affiliation(s)
- Nurul Alyaa Ibrahim
- Faculty of Pharmacy, Universiti Teknologi MARA Cawangan Selangor, Kampus Puncak Alam, 42300 Bandar Puncak Alam, Selangor Darul Ehsan, Malaysia; Faculty of Pharmacy, Universiti Teknologi MARA Cawangan Pulau Pinang, Bertam Campus, 13200 Kepala Batas, Pulau Pinang, Malaysia
| | - Yuet Yen Wong
- Faculty of Pharmacy, Universiti Teknologi MARA Cawangan Pulau Pinang, Bertam Campus, 13200 Kepala Batas, Pulau Pinang, Malaysia; Collaborative Drug Discovery Research (CDDR) Group, Faculty of Pharmacy, University Teknologi MARA (UiTM) Cawangan Selangor, Kampus Puncak Alam, 42300 Bandar Puncak Alam, Selangor Darul Ehsan, Malaysia.
| | - Qi Ying Lean
- Faculty of Pharmacy, Universiti Teknologi MARA Cawangan Pulau Pinang, Bertam Campus, 13200 Kepala Batas, Pulau Pinang, Malaysia
| | - Kalavathy Ramasamy
- Faculty of Pharmacy, Universiti Teknologi MARA Cawangan Selangor, Kampus Puncak Alam, 42300 Bandar Puncak Alam, Selangor Darul Ehsan, Malaysia; Collaborative Drug Discovery Research (CDDR) Group, Faculty of Pharmacy, University Teknologi MARA (UiTM) Cawangan Selangor, Kampus Puncak Alam, 42300 Bandar Puncak Alam, Selangor Darul Ehsan, Malaysia
| | - Siong Meng Lim
- Faculty of Pharmacy, Universiti Teknologi MARA Cawangan Selangor, Kampus Puncak Alam, 42300 Bandar Puncak Alam, Selangor Darul Ehsan, Malaysia; Collaborative Drug Discovery Research (CDDR) Group, Faculty of Pharmacy, University Teknologi MARA (UiTM) Cawangan Selangor, Kampus Puncak Alam, 42300 Bandar Puncak Alam, Selangor Darul Ehsan, Malaysia
| | - Maw Pin Tan
- Division of Geriatric Medicine, Department of Medicine, Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia
| | - Abu Bakar Abdul Majeed
- Faculty of Pharmacy, Universiti Teknologi MARA Cawangan Selangor, Kampus Puncak Alam, 42300 Bandar Puncak Alam, Selangor Darul Ehsan, Malaysia; Brain Degeneration and Therapeutics Group, Faculty of Pharmacy, University Teknologi MARA (UiTM) Cawangan Selangor, Kampus Puncak Alam, 42300 Bandar Puncak Alam, Selangor Darul Ehsan, Malaysia
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Espírito-Santo M, Santos S, Estêvão MD. Digital Solutions Available to Be Used by Informal Caregivers, Contributing to Medication Adherence: A Scoping Review. PHARMACY 2024; 12:20. [PMID: 38392927 PMCID: PMC10893508 DOI: 10.3390/pharmacy12010020] [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: 11/29/2023] [Revised: 01/17/2024] [Accepted: 01/20/2024] [Indexed: 02/25/2024] Open
Abstract
Medication adherence is essential for managing chronic diseases and achieving optimal health outcomes. However, this process is often challenging, particularly for patients with complex care needs. Informal caregivers play a pivotal role in supporting medication management, but they may face resource limitations and a lack of necessary support. Digital health tools offer a promising avenue to enhance medication adherence by providing reminders, education, and remote monitoring capabilities. This scoping review aimed to identify and evaluate digital solutions available to informal caregivers for improving medication adherence. A systematic search of PubMed and Web of Science was conducted using relevant keywords. Four studies were included in the review, examining a variety of digital tools including mobile apps, SMS messaging, and wearable devices. These tools demonstrated efficacy in improving medication adherence, managing disease symptoms, and enhancing quality of life for patients and caregivers. Digital health interventions hold the potential to revolutionize medication adherence among chronic disease patients. By empowering informal caregivers, these tools can bridge the gaps in medication management and contribute to better health outcomes. Further research is warranted to optimize the design, implementation, and evaluation of digital interventions for medication adherence.
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Affiliation(s)
- Margarida Espírito-Santo
- School of Health, University of Algarve, 8005-139 Faro, Portugal (M.D.E.)
- Centre for Health Studies and Development (CESUAlg), University of Algarve, 8005-139 Faro, Portugal
- Algarve Biomedical Center Research Institute (ABC-RI), 8005-139 Faro, Portugal
| | - Sancha Santos
- School of Health, University of Algarve, 8005-139 Faro, Portugal (M.D.E.)
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Rached L, Geraud A, Frelaut M, Ap Thomas Z, Goldschmidt V, Beraud-Chaulet G, Nagera-Lazarovici C, Danlos FX, Henon C, Parisi C, Gazzah A, Bahleda R, Postel Vinay S, Smolenschi C, Hollebecque A, Michot JM, Ribrag V, Loriot Y, Champiat S, Ouali K, Massard C, Ponce Aix S, Bringuier M, Baldini C. Antibody drug conjugates in older patients: State of the art. Crit Rev Oncol Hematol 2024; 193:104212. [PMID: 38007063 DOI: 10.1016/j.critrevonc.2023.104212] [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: 08/29/2023] [Accepted: 11/16/2023] [Indexed: 11/27/2023] Open
Abstract
More than half of cancer cases occur in patients aged 65 years or older. The efficacy and safety of antibody drug conjugates (ADCs) in older patients remains an unclear subject as available evidence is limited. Geriatric population is underrepresented in clinical trials. Consequently, most of our knowledge regarding innovative therapeutics was studied on a younger population. In this review of published literature, we report the available information on efficacy, safety and pharmacokinetics of FDA approved ADCs for hematologic malignancies and solid tumors in the geriatric population. We explore the results of clinical trials dedicated for older individuals as well as subgroup analyses of the geriatric population in major trials evaluating these drugs. Available data suggest a similar efficacy in older adults as compared to general population. However, older patients might be prone to a higher rate of adverse events in incidence with a potential impact on quality of life. We lack data to support primary dose reductions or schedule modifications in this category of patients. No pharmacokinetic differences were reported between age groups. It is crucial to encourage the development of clinical trials dedicated to older patients with geriatric parameters (G8 score, G-CODE…) so that results can be more representative of this population outside of clinical trials.
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Affiliation(s)
- Layal Rached
- Gustave Roussy, Department of Therapeutic Innovation and Early Phase Trials, 94805 Villejuif, France.
| | - Arthur Geraud
- Gustave Roussy, Department of Medical Oncology , 94805 Villejuif, France.
| | - Maxime Frelaut
- Gustave Roussy, Department of Medical Oncology , 94805 Villejuif, France.
| | - Zoe Ap Thomas
- Gustave Roussy, Department of Medical Oncology , 94805 Villejuif, France.
| | - Vincent Goldschmidt
- Gustave Roussy, Department of Therapeutic Innovation and Early Phase Trials, 94805 Villejuif, France.
| | | | | | - Francois-Xavier Danlos
- Gustave Roussy, Department of Therapeutic Innovation and Early Phase Trials, 94805 Villejuif, France.
| | - Clemence Henon
- Gustave Roussy, Department of Therapeutic Innovation and Early Phase Trials, 94805 Villejuif, France.
| | - Claudia Parisi
- Gustave Roussy, Department of Therapeutic Innovation and Early Phase Trials, 94805 Villejuif, France.
| | - Anas Gazzah
- Gustave Roussy, Department of Therapeutic Innovation and Early Phase Trials, 94805 Villejuif, France.
| | - Rastilav Bahleda
- Gustave Roussy, Department of Therapeutic Innovation and Early Phase Trials, 94805 Villejuif, France.
| | - Sophie Postel Vinay
- Gustave Roussy, Department of Therapeutic Innovation and Early Phase Trials, 94805 Villejuif, France.
| | - Cristina Smolenschi
- Gustave Roussy, Department of Therapeutic Innovation and Early Phase Trials, 94805 Villejuif, France.
| | - Antoine Hollebecque
- Gustave Roussy, Department of Therapeutic Innovation and Early Phase Trials, 94805 Villejuif, France.
| | - Jean-Marie Michot
- Gustave Roussy, Department of Therapeutic Innovation and Early Phase Trials, 94805 Villejuif, France.
| | - Vincent Ribrag
- Gustave Roussy, Department of Therapeutic Innovation and Early Phase Trials, 94805 Villejuif, France.
| | - Yohann Loriot
- Gustave Roussy, Department of Therapeutic Innovation and Early Phase Trials, 94805 Villejuif, France.
| | - Stephane Champiat
- Gustave Roussy, Department of Therapeutic Innovation and Early Phase Trials, 94805 Villejuif, France.
| | - Kaissa Ouali
- Gustave Roussy, Department of Therapeutic Innovation and Early Phase Trials, 94805 Villejuif, France.
| | - Christophe Massard
- Centre Eugène Marquis, Department of Medical Oncology, 35000 Rennes, France.
| | - Santiago Ponce Aix
- Gustave Roussy, Department of Therapeutic Innovation and Early Phase Trials, 94805 Villejuif, France.
| | - Michael Bringuier
- Institut Curie, PSL Research University, Department of Medical Oncology and Department of Supportive Care, UCOG Paris Ouest, F-92210 Saint-Cloud, France.
| | - Capucine Baldini
- Gustave Roussy, Department of Therapeutic Innovation and Early Phase Trials, 94805 Villejuif, France.
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Abudahab S, Slattum PW, Price ET, McClay JL. Epigenetic regulation of drug metabolism in aging: utilizing epigenetics to optimize geriatric pharmacotherapy. Pharmacogenomics 2024; 25:41-54. [PMID: 38126340 PMCID: PMC10794944 DOI: 10.2217/pgs-2023-0199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Accepted: 12/06/2023] [Indexed: 12/23/2023] Open
Abstract
We explore the relationship between epigenetic aging and drug metabolism. We review current evidence for changes in drug metabolism in normal aging, followed by a description of how epigenetic modifications associated with age can regulate the expression and functionality of genes. In particular, we focus on the role of epigenome-wide studies of human and mouse liver in understanding these age-related processes with respect to xenobiotic processing. We highlight genes encoding drug metabolizing enzymes and transporters revealed to be affected by epigenetic aging in these studies. We conclude that substantial evidence exists for epigenetic aging impacting drug metabolism and transport genes, but more work is needed. We further highlight the promise of pharmacoepigenetics applied to enhancing drug safety in older adults.
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Affiliation(s)
- Sara Abudahab
- Department of Pharmacotherapy & Outcomes Science, School of Pharmacy, Virginia Commonwealth University, Richmond, VA 23298, USA
| | - Patricia W Slattum
- Department of Pharmacotherapy & Outcomes Science, School of Pharmacy, Virginia Commonwealth University, Richmond, VA 23298, USA
- Virginia Center on Aging, Virginia Commonwealth University, Richmond, VA 23298, USA
| | - Elvin T Price
- Department of Pharmacotherapy & Outcomes Science, School of Pharmacy, Virginia Commonwealth University, Richmond, VA 23298, USA
| | - Joseph L McClay
- Department of Pharmacotherapy & Outcomes Science, School of Pharmacy, Virginia Commonwealth University, Richmond, VA 23298, USA
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Bardoczi JB, Brunner L, Spinewine A, Rodondi N, Aubert CE. Older Adult Attitudes toward Deprescribing Statins in Primary Cardiovascular Prevention Versus General Medications. Gerontol Geriatr Med 2024; 10:23337214241245918. [PMID: 38628165 PMCID: PMC11020750 DOI: 10.1177/23337214241245918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Revised: 03/14/2024] [Accepted: 03/19/2024] [Indexed: 04/19/2024] Open
Abstract
Background: There is little evidence for statins for primary cardiovascular prevention in older adults. Consequently, it is important to assess patient attitudes toward the use of statins, which might differ from attitudes toward other medications. We aimed to describe older patient attitudes toward deprescribing statins versus general medications. Methods: We conducted a survey using the revised Patients' Attitudes Toward Deprescribing questionnaire in its original version and adapted to statin use in adults ≥65 years taking a statin for primary prevention. Results: Among the 47 participants (mean age 74.6 years), 42 (89%) were satisfied with their current therapy, but still willing to stop ≥1 of their medications upon their doctor's advice. About 68% (N = 32) were satisfied with their statin therapy, while 83% (N = 39) would accept to consider deprescribing. Twenty-six (55%) participants were concerned about missing future benefits when stopping their general medications and 17 (36%) when stopping their statin. Eight (17%) participants believed they were experiencing side effects of statins and twice as many for general medication (38%, N = 18). Conclusion: Our study provides insight about differences and similarities in patient attitudes toward deprescribing general medications and statins in primary prevention. This information could support patient-centered conversations and shared-decision making about deprescribing.
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Affiliation(s)
| | | | - Anne Spinewine
- Louvain Drug Research Institute, Université catholique de Louvain, Brussels, Belgium
- Centre Hospitalier Universitaire (CHU) UCL Namur, Yvoir, Belgium
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Nigussie S, Demeke F. Potentially Inappropriate Medications Use and Associated Factors Among Older Patients on Follow-Up at the Chronic Care Clinic of Hiwot Fana Comprehensive Specialized Hospital in Eastern Ethiopia. CURRENT THERAPEUTIC RESEARCH 2023; 100:100730. [PMID: 38362229 PMCID: PMC10867584 DOI: 10.1016/j.curtheres.2023.100730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 11/17/2023] [Indexed: 02/17/2024]
Abstract
Background Potentially inappropriate medications (PIMs) use often cause to poor health outcomes in older patients. There is a dearth of information on PIMS use in this population of patients seeking treatment at Hiwot Fana Comprehensive Specialized Hospital. Objective To assess PIMs use and associated factors among older patients receiving follow-up treatment at the chronic care clinic of Hiwot Fana Comprehensive Specialized Hospital in eastern Ethiopia. Methods A retrospective cross-sectional study using medical records of 419 older patients was conducted. older patients, aged 65 years or older, treated in the ambulatory care clinic were included. Simple random sampling technique was used. PIMs use was identified by using the 2023 American Geriatrics Society Beers Criteria (AGS Beers Criteria) and Screening Tool of Older People's Potentially Inappropriate Prescriptions Criteria and Screening Tool to Alert Doctors to Right Treatment (STOPP/START) version 2 criteria. The multivariable logistic regression analysis was employed to identify factors associated with PIMs use. The strength of statistical association was measured by adjusted odds ratio (aOR) and 95% CI. P values < 0.05 were considered statistically significant. Results A total of 419 patients' medical records were reviewed. Of these, 411 patients' medical records fulfilled the inclusion criteria and were considered for final analysis. About 56.9% (n= 234) of the study population was women. The prevalence of PIMs use was 28.5% and 18.5%, according to 2023 AGS Beers Criteria and STOPP/START version 2 criteria, respectively. In accordance with 2023 AGS Beers Criteria, male sex (aOR = 1.78; 95% CI, 1.10-2.87), diabetes mellitus (aOR = 0.35; 95% CI, 0.19-0.62), and chronic kidney disease (aOR = 6.68; 95% CI, 2.55-9.32) were found to be the determining factors for PIMs use. According to STOPP/START version 2 criteria, deep vein thrombosis, diabetes mellitus, hypertension, and advanced age were the primary factors influencing PIMs use. Conclusions Compared with other study findings from across the world, the prevalence of PIMs use was low. Based on 2023 AGS Beers Criteria, male sex, diabetes mellitus, and chronic kidney disease were found to be the determinant factors for PIMs use. Deep vein thrombosis, diabetes mellitus, hypertension, and advanced age were significant factor of PIMs use according STOPP/START version 2 criteria.
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Affiliation(s)
- Shambel Nigussie
- Department of Clinical Pharmacy, School of Pharmacy, College of Health and Medical Science, Haramaya University, Harar, Ethiopia
| | - Fekade Demeke
- Department of Epidemiology and Biostatistics, School of Public Health, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
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12
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Stielow M, Witczyńska A, Kubryń N, Fijałkowski Ł, Nowaczyk J, Nowaczyk A. The Bioavailability of Drugs-The Current State of Knowledge. Molecules 2023; 28:8038. [PMID: 38138529 PMCID: PMC10745386 DOI: 10.3390/molecules28248038] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Revised: 12/04/2023] [Accepted: 12/09/2023] [Indexed: 12/24/2023] Open
Abstract
Drug bioavailability is a crucial aspect of pharmacology, affecting the effectiveness of drug therapy. Understanding how drugs are absorbed, distributed, metabolized, and eliminated in patients' bodies is essential to ensure proper and safe treatment. This publication aims to highlight the relevance of drug bioavailability research and its importance in therapy. In addition to biochemical activity, bioavailability also plays a critical role in achieving the desired therapeutic effects. This may seem obvious, but it is worth noting that a drug can only produce the expected effect if the proper level of concentration can be achieved at the desired point in a patient's body. Given the differences between patients, drug dosages, and administration forms, understanding and controlling bioavailability has become a priority in pharmacology. This publication discusses the basic concepts of bioavailability and the factors affecting it. We also looked at various methods of assessing bioavailability, both in the laboratory and in the clinic. Notably, the introduction of new technologies and tools in this field is vital to achieve advances in drug bioavailability research. This publication also discusses cases of drugs with poorly described bioavailability, providing a deeper understanding of the complex challenges they pose to medical researchers and practitioners. Simultaneously, the article focuses on the perspectives and trends that may shape the future of research regarding bioavailability, which is crucial to the development of modern pharmacology and drug therapy. In this context, the publication offers an essential, meaningful contribution toward understanding and highlighting bioavailability's role in reliable patient treatment. The text also identifies areas that require further research and exploration.
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Affiliation(s)
| | - Adrianna Witczyńska
- Department of Organic Chemistry, Faculty of Pharmacy, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University, 2 Jurasza Street, 85-089 Bydgoszcz, Poland; (A.W.); (N.K.); (Ł.F.)
| | - Natalia Kubryń
- Department of Organic Chemistry, Faculty of Pharmacy, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University, 2 Jurasza Street, 85-089 Bydgoszcz, Poland; (A.W.); (N.K.); (Ł.F.)
| | - Łukasz Fijałkowski
- Department of Organic Chemistry, Faculty of Pharmacy, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University, 2 Jurasza Street, 85-089 Bydgoszcz, Poland; (A.W.); (N.K.); (Ł.F.)
| | - Jacek Nowaczyk
- Department of Physical Chemistry and Physicochemistry of Polymers, Faculty of Chemistry, Nicolaus Copernicus University, 7 Gagarina Street, 87-100 Toruń, Poland;
| | - Alicja Nowaczyk
- Department of Organic Chemistry, Faculty of Pharmacy, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University, 2 Jurasza Street, 85-089 Bydgoszcz, Poland; (A.W.); (N.K.); (Ł.F.)
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13
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Bužančić I, Ortner Hadžiabdić M. Deprescribing in a multimorbid older adult: A case vignette study among community pharmacists and primary care physicians. Basic Clin Pharmacol Toxicol 2023; 133:729-740. [PMID: 37177977 DOI: 10.1111/bcpt.13899] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 05/10/2023] [Accepted: 05/11/2023] [Indexed: 05/15/2023]
Abstract
Collaborative deprescribing can include pharmacists' medication review with identification and suggestion of potential deprescribing targets to physicians. Case vignettes can be a valuable method for researching variations in clinical decision making, especially in settings unaccustomed to newer clinical approaches such as deprescribing. This study aimed to explore if pharmacists can identify deprescribing targets and if physicians would accept pharmacist's deprescribing rationales. A cross-sectional study was performed using an online case vignette based on a real-life elderly patient. Pharmacists were asked to indicate which medicines they would recommend deprescribing, alongside a rationale. Physicians were asked to state their acceptance of the proposed pharmacist's deprescribing suggestion. Pharmacists gave 1275 deprescribing rationales, and most were given for deprescribing opioids, NSAID and diuretics. Physicians would accept rationales to deprescribe a median of 10 medicines, while pharmacist would recommend deprescribing a median of six medicines. Most difference lays in deprescribing of preventative medicines. Healthcare providers share agreement on deprescribing targets, but pharmacists show hesitancies in making recommendations that could hamper potential collaboration. Action is needed to improve pharmacists' skills in recognizing deprescribing targets and confidence in making suggestions, which could lead to opening of possibilities for joint patient care.
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Affiliation(s)
- Iva Bužančić
- City Pharmacies Zagreb, Zagreb, Croatia
- Faculty of Pharmacy and Biochemistry, University of Zagreb, Zagreb, Croatia
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14
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DiLeo DA, Gidener T, Aytaman A. Chronic Liver Disease in the Older Patient-Evaluation and Management. Curr Gastroenterol Rep 2023; 25:390-400. [PMID: 37991713 DOI: 10.1007/s11894-023-00908-2] [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: 11/01/2023] [Indexed: 11/23/2023]
Abstract
PURPOSE OF REVIEW As our population ages, the number of elderly patients with advanced chronic liver disease (ACLD) will increase. In this review we explore risk factors for liver injury, noninvasive assessment of liver disease, complications of cirrhosis, and management of frailty and sarcopenia in the older patient with ACLD. RECENT FINDINGS Multiple guidelines regarding ACLD have been updated over the past few years. New cutoffs for FIB-4 and NAFLD (MASLD - Metabolic Dysfunction Associated Steatotic Liver Disease) fibrosis scores for elderly patients are being validated. Older patients with MASLD benefit from caloric restriction, exercise programs, and GLP-1 agonists. Patients with ACLD need to be screened for alcohol use disorder with modified scoring systems, and if positive, benefit from referral to chemical dependency programs. Carvedilol and diuretics may safely be used in the elderly for portal hypertension and ascites, respectively, with careful monitoring. Malnutrition, frailty, sarcopenia, and bone mineral disease are common in older patients with ACLD, and early intervention may improve outcomes. Early identification of ACLD in elderly patients allows us to manage risk factors for liver injury, screen for complications, and implement lifestyle and pharmacological therapy to reduce decompensation and death. Future studies may clarify the role of noninvasive imaging in assessing liver fibrosis in the elderly and optimal interventions for nutrition, frailty, sarcopenia, bone health in addition to reevaluation of antibiotic prophylaxis for liver conditions with rising antibiotic resistance.
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Affiliation(s)
- Daniel Anthony DiLeo
- Department of Gastroenterology, Brooklyn Campus of the Veterans Affairs New York Harbor Healthcare System, 800 Poly Pl, Brooklyn, NY, 11209, USA.
| | - Tolga Gidener
- Department of Medicine, SUNY Downstate Health Sciences University, Brooklyn, NY, 11203, USA
| | - Ayse Aytaman
- Department of Gastroenterology, Brooklyn Campus of the Veterans Affairs New York Harbor Healthcare System, 800 Poly Pl, Brooklyn, NY, 11209, USA
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15
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Clark CM, Eimer MC, Intorre FM. Transitions of Care: Strategies for Medication Optimization and Deprescribing in Older Adults. J Gerontol Nurs 2023; 49:5-10. [PMID: 38015150 DOI: 10.3928/00989134-20231107-02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2023]
Abstract
Older adults have an increased risk of adverse drug events related to polypharmacy and potentially inappropriate medication (PIM) use. These patients are even more vulnerable as they transition through different health care settings. In 2023, the American Geriatrics Society published an updated version of the Beers Criteria®, providing updated guidance on identifying and managing PIMs. Nurses and nurse practitioners play important roles in medication management across the continuum of care. The current article aims to illustrate key concepts regarding medication safety and deprescribing for older adult patients during transitions of care. [Journal of Gerontological Nursing, 49(12), 5-10.].
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16
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Koehl JL. Adverse Drug Event Prevention and Detection in Older Emergency Department Patients. Clin Geriatr Med 2023; 39:635-645. [PMID: 37798069 DOI: 10.1016/j.cger.2023.04.008] [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] [Indexed: 10/07/2023]
Abstract
Older adults are given therapies to enhance the quality and longevity of life, but with the benefits of medication therapy also comes the potential for adverse drug events (ADEs). Avoiding ADEs has become a national health priority with substantial impact on health outcomes and health care costs. The presence of multimorbidity, changes in physiologic function, and polypharmacy make older adults more vulnerable to medication-related ADEs. Use of interactive support tools in the form of geriatric-friendly medication order sets and geriatric consultations along with pharmacist-led medication review and optimization are imperative to decrease the occurrence of ADEs and unnecessary prescribing cascades.
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Affiliation(s)
- Jennifer L Koehl
- Department of Pharmacy, Emergency Medicine, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA.
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van Kampen E, van Bussel MTJ, Oude Munnink TH, Touw DJ, Broekman KE. Representation of older patients in the safety analysis of protein kinase inhibitor registration studies. J Geriatr Oncol 2023; 14:101636. [PMID: 37806290 DOI: 10.1016/j.jgo.2023.101636] [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: 10/24/2022] [Revised: 07/13/2023] [Accepted: 09/19/2023] [Indexed: 10/10/2023]
Abstract
INTRODUCTION Older patients (≥65 years old) make up the majority of the cancer population. Older patients seem to experience more adverse events (AEs) from protein kinase inhibitors (PKIs) in clinical practice. Yet they are underrepresented in clinical trials. We aimed to evaluate whether age-related safety differences were described at authorization of PKIs. Representation of older patients in registration studies was also evaluated. MATERIALS AND METHODS European Public Assessment Reports (EPARs) of PKIs authorized between 2010 and 2015 were evaluated for the description of age-related safety- and pharmacokinetic differences. The International Council for Harmonization of Technical Requirement for Pharmaceuticals for Human Use (ICH) E7 guideline was applied to EPARs to assess the representation of older patients. Study results were presented descriptively. RESULTS Eighteen PKIs with 19 EPARs were analyzed. Age-related safety differences were described in 14 out of 19 EPARs, and age-related pharmacokinetic differences in 1 out of 19 EPARs. More than 100 older patients were included in half of the studies. Older patients were not excluded solely by age, although other inclusion and exclusion criteria negatively influenced enrollment of older patients. None of the PKIs met all criteria from the ICH E7 guideline. DISCUSSION Age-related safety differences are described for most PKIs. Older patients were underrepresented in PKI registration studies. Adequate representation of older patients in clinical trials for PKIs is vital, since they make up most of the cancer population.
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Affiliation(s)
- Emma van Kampen
- Department of Clinical Pharmacy and Pharmacology, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 GZ Groningen, the Netherlands
| | - Mark T J van Bussel
- College ter Beoordeling van Geneesmiddelen, Dutch Medicines Evaluation Board (CBG-MEB), Graadt van Roggenweg 500, 3531 AH Utrecht, the Netherlands
| | - Thijs H Oude Munnink
- Department of Clinical Pharmacy and Pharmacology, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 GZ Groningen, the Netherlands
| | - Daan J Touw
- Department of Clinical Pharmacy and Pharmacology, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 GZ Groningen, the Netherlands
| | - K Esther Broekman
- College ter Beoordeling van Geneesmiddelen, Dutch Medicines Evaluation Board (CBG-MEB), Graadt van Roggenweg 500, 3531 AH Utrecht, the Netherlands; Department of Medical Oncology, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ Groningen, the Netherlands.
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Lyne S. Benefits of deprescribing for older people with frailty and polypharmacy: part one. Nurs Older People 2023; 35:35-41. [PMID: 37670533 DOI: 10.7748/nop.2023.e1441] [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: 05/31/2023] [Indexed: 09/07/2023]
Abstract
The UK population is ageing rapidly, a trend that is likely to continue due to improvements in chronic disease management and increased life expectancy. Comorbidities, including frailty, become increasingly common with age and as a result it is likely that multiple medicines will be prescribed for older people, leading to polypharmacy. This is a concern because polypharmacy is associated with various adverse effects and an increased medicine burden in this population, as well as a financial burden for the healthcare system. This article, the first of two parts, explains the physiology of ageing and frailty, and considers the adverse effects of polypharmacy on older people with frailty, using a fictional case study to illustrate this. Part two will use the case study to explore the use of medication reviews and deprescribing benefits as part of medicines optimisation.
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Affiliation(s)
- Sue Lyne
- East Sussex Healthcare NHS Trust, East Sussex, England
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Pereira F, Meyer-Massetti C, Del Río Carral M, von Gunten A, Wernli B, Verloo H. Development of a patient-centred medication management model for polymedicated home-dwelling older adults after hospital discharge: results of a mixed methods study. BMJ Open 2023; 13:e072738. [PMID: 37730411 PMCID: PMC10514617 DOI: 10.1136/bmjopen-2023-072738] [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: 02/14/2023] [Accepted: 09/01/2023] [Indexed: 09/22/2023] Open
Abstract
OBJECTIVE This study aimed to investigate medication management among polymedicated, home-dwelling older adults after discharge from a hospital centre in French-speaking Switzerland and then develop a model to optimise medication management and prevent adverse health outcomes associated with medication-related problems (MRPs). DESIGN Explanatory, sequential, mixed methods study based on detailed quantitative and qualitative findings reported previously. SETTING Hospital and community healthcare in the French-speaking part of Switzerland. PARTICIPANTS The quantitative strand retrospectively examined 3 years of hospital electronic patient records (n=53 690 hospitalisations of inpatients aged 65 years or older) to identify the different profiles of those at risk of 30-day hospital readmission and unplanned nursing home admission. The qualitative strand explored the perspectives of older adults (n=28), their informal caregivers (n=17) and healthcare professionals (n=13) on medication management after hospital discharge. RESULTS Quantitative results from older adults' profiles, affected by similar patient-related, medication-related and environment-related factors, were enhanced and supported by qualitative findings. The combined findings enabled us to design an interprofessional, collaborative medication management model to prevent MRPs among home-dwelling older adults after hospital discharge. The model comprised four interactive fields of action: listening to polymedicated home-dwelling older adults and their informal caregivers; involving older adults and their informal caregivers in shared, medication-related decision-making; empowering older adults and their informal caregivers for safe medication self-management; optimising collaborative medication management practices. CONCLUSION By linking the retrospective and prospective findings from our explanatory sequential study involving multiple stakeholders' perspectives, we created a deeper comprehension of the complexities and challenges of safe medication management among polymedicated, home-dwelling older adults after their discharge from hospital. We subsequently designed an innovative, collaborative, patient-centred model for optimising medication management and preventing MRPs in this population.
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Affiliation(s)
- Filipa Pereira
- Abel Salazar Institute of Biomedical Sciences, University of Porto, Porto, Portugal
- School of Health Sciences, HES-SO Valais/ Wallis, Sion, Switzerland
| | - Carla Meyer-Massetti
- Clinical Pharmacology and Toxicology, Clinical of General Internal Medicine, Inselspital, University Hospital of Bern, Bern, Switzerland
- Institute for Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
| | - María Del Río Carral
- Institute of Psychology, Research Center for the Psychology of Health, Aging and Sports Examination (PHASE), University of Lausanne, Lausanne, Switzerland
| | - Armin von Gunten
- Service of Old Age Psychiatry, Lausanne University Hospital, Lausanne, Switzerland
| | - Boris Wernli
- Swiss Centre of Expertise in the Social Sciences (FORS), University of Lausanne, Lausanne, Switzerland
| | - Henk Verloo
- School of Health Sciences, HES-SO Valais/ Wallis, Sion, Switzerland
- Service of Old Age Psychiatry, Lausanne University Hospital, Lausanne, Switzerland
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Selvakumar D, Sivanandy P, Ingle PV, Theivasigamani K. Relationship between Treatment Burden, Health Literacy, and Medication Adherence in Older Adults Coping with Multiple Chronic Conditions. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1401. [PMID: 37629691 PMCID: PMC10456640 DOI: 10.3390/medicina59081401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 06/27/2023] [Accepted: 06/29/2023] [Indexed: 08/27/2023]
Abstract
A prospective study was conducted to investigate the impact of treatment burden and health literacy on medication adherence among older adults with multiple chronic conditions (MCC) and to explore the potential moderating effects of demographic and clinical factors. Face-to-face structured interviews were conducted among older adults aged 60 and above using the Burden of Treatment Questionnaire (TBQ-15), Short Form Health Literacy Questionnaire (HLS-SF12), and Malaysia Medication Adherence Assessment Tool (MyMAAT). This study included 346 older adults aged 60 years and above with two or more chronic conditions (n = 346). Hypertension (30.2%), hyperlipidemia (24.0%), and diabetes (18.0%) were the most reported chronic conditions among participants. The mean score of treatment burden was 53.4 (SD = 28.2), indicating an acceptable burden of treatment. The mean score of health literacy was 16.4 (SD = 12.6), indicating a limited health literacy level among participants; meanwhile, the mean score of medication adherence was 32.6 (SD = 12.3), indicating medication non-adherence among participants. Medication adherence was significantly correlated with treatment burden (r = -0.22, p < 0.0001), health literacy (r = 0.36, p < 0.0001), number of chronic conditions (r = -0.23, p < 0.0001), and age (r = -0.11, p < 0.05). The study findings emphasize that multimorbid older adults with high treatment burdens and low health literacy are more likely to have poor medication adherence. This underscores the importance for clinicians to address these factors in order to improve medication adherence among older adults with multiple chronic conditions (MCC).
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Affiliation(s)
- Dharrshinee Selvakumar
- School of Postgraduate Studies, International Medical University, Kuala Lumpur 57000, Malaysia
| | - Palanisamy Sivanandy
- Department of Pharmacy Practice, School of Pharmacy, International Medical University, Kuala Lumpur 57000, Malaysia
| | - Pravinkumar Vishwanath Ingle
- Department of Pharmacy Practice, School of Pharmacy, International Medical University, Kuala Lumpur 57000, Malaysia
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Wolf U, Ghadir H, Drewas L, Neef R. Underdiagnosed CKD in Geriatric Trauma Patients and Potent Prevention of Renal Impairment from Polypharmacy Risks through Individual Pharmacotherapy Management (IPM-III). J Clin Med 2023; 12:4545. [PMID: 37445580 DOI: 10.3390/jcm12134545] [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: 05/06/2023] [Revised: 06/27/2023] [Accepted: 06/29/2023] [Indexed: 07/15/2023] Open
Abstract
The aging global patient population with multimorbidity and concomitant polypharmacy is at increased risk for acute and chronic kidney disease, particularly with severe additional disease states or invasive surgical procedures. Because from the expertise of more than 58,600 self-reviewed medications, adverse drug reactions, drug interactions, inadequate dosing, and contraindications all proved to cause or exacerbate the worsening of renal function, we analyzed the association of an electronic patient record- and Summaries of Product Characteristics (SmPCs)-based comprehensive individual pharmacotherapy management (IPM) in the setting of 14 daily interdisciplinary patient visits with the outcome: further renal impairment with reduction of eGFR ≥ 20 mL/min (redGFR) in hospitalized trauma patients ≥ 70 years of age. The retrospective clinical study of 404 trauma patients comparing the historical control group (CG) before IPM with the IPM intervention group (IG) revealed a group-match in terms of potential confounders such as age, sex, BMI, arterial hypertension, diabetes mellitus, and injury patterns. Preexisting chronic kidney disease (CKD) > stage 2 diagnosed as eGFR < 60 mL/min/1.73 m2 on hospital admission was 42% in the CG versus 50% in the IG, although in each group only less than 50% of this was coded as an ICD diagnosis in the patients' discharge letters (19% in CG and 21% in IG). IPM revealed an absolute risk reduction in redGFR of 5.5% (11 of 199 CG patients) to 0% in the IPM visit IG, a relative risk reduction of 100%, NNT 18, indicating high efficacy of IPM and benefit in improving outcomes. There even remained an additive superimposed significant association that included patients in the IPM group before/beyond the 14 daily IPM interventions, with a relative redGFR risk reduction of 0.55 (55%) to 2.5% (5 of 204 patients), OR 0.48 [95% CI 0.438-0.538] (p < 0.001). Bacteriuria, loop diuretics, allopurinol, eGFR ≥ 60 mL/min/1.73 m2, eGFR < 60 mL/min/1.73 m2, and CKD 3b were significantly associated with redGFR; of the latter, 10.5% developed redGFR. Further multivariable regression analysis adjusting for these and established risk factors revealed an additive, superimposed IPM effect on redGFR with an OR 0.238 [95% CI 0.06-0.91], relative risk reduction of 76.2%, regression coefficient -1.437 including patients not yet visited in the IPM period. As consequences of the IPM procedure, the IG differed from the CG by a significant reduction of NSAIDs (p < 0.001), HCT (p = 0.028) and Würzburger pain drip (p < 0.001), and significantly increased prescription rate of antibiotics (p = 0.004). In conclusion, (1) more than 50% of CKD in geriatric patients was not pre-recognized and underdiagnosed, and (2) the electronic patient records-based IPM interdisciplinary networking strategy was associated with effective prevention of further periinterventional renal impairment and requires obligatory implementation in all elderly patients to urgently improve patient and drug safety.
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Affiliation(s)
- Ursula Wolf
- Pharmacotherapy Management, University Hospital Halle (Saale), Martin Luther University Halle-Wittenberg, 06120 Halle (Saale), Germany
| | - Hassan Ghadir
- Medical Clinic II, University Hospital Schleswig-Holstein, Lübeck Campus, 23562 Lübeck, Germany
| | - Luise Drewas
- Internal Medicine Clinic II, Martha-Maria Hospital Halle-Dölau, 06120 Halle (Saale), Germany
| | - Rüdiger Neef
- Department of Orthopedics, Trauma and Reconstructive Surgery, Division of Geriatric Traumatology, University Hospital Halle (Saale), Martin Luther University Halle-Wittenberg, 06120 Halle (Saale), Germany
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22
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Butranova OI, Ushkalova EA, Zyryanov SK, Chenkurov MS, Baybulatova EA. Pharmacokinetics of Antibacterial Agents in the Elderly: The Body of Evidence. Biomedicines 2023; 11:1633. [PMID: 37371728 DOI: 10.3390/biomedicines11061633] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 05/31/2023] [Accepted: 06/01/2023] [Indexed: 06/29/2023] Open
Abstract
Infections are important factors contributing to the morbidity and mortality among elderly patients. High rates of consumption of antimicrobial agents by the elderly may result in increased risk of toxic reactions, deteriorating functions of various organs and systems and leading to the prolongation of hospital stay, admission to the intensive care unit, disability, and lethal outcome. Both safety and efficacy of antibiotics are determined by the values of their plasma concentrations, widely affected by physiologic and pathologic age-related changes specific for the elderly population. Drug absorption, distribution, metabolism, and excretion are altered in different extents depending on functional and morphological changes in the cardiovascular system, gastrointestinal tract, liver, and kidneys. Water and fat content, skeletal muscle mass, nutritional status, use of concomitant drugs are other determinants of pharmacokinetics changes observed in the elderly. The choice of a proper dosing regimen is essential to provide effective and safe antibiotic therapy in terms of attainment of certain pharmacodynamic targets. The objective of this review is to perform a structure of evidence on the age-related changes contributing to the alteration of pharmacokinetic parameters in the elderly.
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Affiliation(s)
- Olga I Butranova
- Department of General and Clinical Pharmacology, Peoples' Friendship University of Russia named after Patrice Lumumba (RUDN University), 6 Miklukho-Maklaya St., 117198 Moscow, Russia
| | - Elena A Ushkalova
- Department of General and Clinical Pharmacology, Peoples' Friendship University of Russia named after Patrice Lumumba (RUDN University), 6 Miklukho-Maklaya St., 117198 Moscow, Russia
| | - Sergey K Zyryanov
- Department of General and Clinical Pharmacology, Peoples' Friendship University of Russia named after Patrice Lumumba (RUDN University), 6 Miklukho-Maklaya St., 117198 Moscow, Russia
- State Budgetary Institution of Healthcare of the City of Moscow "City Clinical Hospital No. 24 of the Moscow City Health Department", Pistzovaya Srt. 10, 127015 Moscow, Russia
| | - Mikhail S Chenkurov
- Department of General and Clinical Pharmacology, Peoples' Friendship University of Russia named after Patrice Lumumba (RUDN University), 6 Miklukho-Maklaya St., 117198 Moscow, Russia
| | - Elena A Baybulatova
- Department of General and Clinical Pharmacology, Peoples' Friendship University of Russia named after Patrice Lumumba (RUDN University), 6 Miklukho-Maklaya St., 117198 Moscow, Russia
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Shimizu W, Yamashita T, Akao M, Atarashi H, Ikeda T, Koretsune Y, Okumura K, Suzuki S, Tsutsui H, Toyoda K, Hirayama A, Yasaka M, Yamaguchi T, Teramukai S, Kimura T, Morishima Y, Takita A, Inoue H. Renal Function and Clinical Outcomes Among Elderly Patients With Nonvalvular Atrial Fibrillation From ANAFIE. JACC. ASIA 2023; 3:475-487. [PMID: 37396416 PMCID: PMC10308099 DOI: 10.1016/j.jacasi.2023.02.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 01/24/2023] [Accepted: 01/30/2023] [Indexed: 07/04/2023]
Abstract
Background Advancing age, decreasing renal function, and atrial fibrillation are strongly associated. Real-world evidence of direct oral anticoagulant (DOAC) use among elderly patients ≥75 years of age with nonvalvular atrial fibrillation and renal dysfunction is limited. Objectives This study sought to assess 2-year outcomes and anticoagulant treatment, stratified by renal function. Methods Enrolled patients were divided into 4 subgroups by creatinine clearance (CrCl) to determine the impact of renal dysfunction on clinical outcomes. Results Of 32,275 patients, 26,202 with CrCl data were analyzed (median follow-up 2.00 [IQR: 1.92-2.00] years); 1.3% of patients had CrCl <15 mL/min, 10.7% had CrCl 15 to <30 mL/min, 33.4% had CrCl 30 to <50 mL/min, 35.8% had CrCl ≥50 mL/min, and 18.9% had unknown CrCl. Cumulative incidences of stroke/systemic embolic events, major bleeding, major plus clinically relevant nonmajor bleeding, cardiovascular death, all-cause death, and net clinical outcomes increased with decreasing CrCl. In multivariable Cox regression analysis, lower CrCl emerged as an independent risk factor for these clinical outcomes, except for major bleeding, compared with CrCl ≥50 mL/min. The effectiveness and safety of DOACs over warfarin were similar or better across 3 CrCl subgroups with CrCl 15 mL/min or more. DOAC use was associated with a lower risk of stroke/systemic embolic events, major bleeding, cardiovascular death, all-cause death, and net clinical outcome compared with warfarin in patients with CrCl 30 to <50 mL/min. Conclusions Incidences of major clinical outcomes increased with decreasing renal function in elderly nonvalvular atrial fibrillation patients. DOACs were effective and safe even in patients with renal dysfunction (CrCl 15-<50 mL/min). (Prospective Observational Study in Late-Stage Elderly Patients with Non-Valvular Atrial Fibrillation: All Nippon AF In Elderly Registry [ANAFIE Registry]; UMIN000024006).
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Affiliation(s)
- Wataru Shimizu
- Department of Cardiovascular Medicine, Nippon Medical School, Tokyo, Japan
| | | | - Masaharu Akao
- Department of Cardiology, National Hospital Organization Kyoto Medical Center, Kyoto, Japan
| | | | - Takanori Ikeda
- Department of Cardiovascular Medicine, Toho University Faculty of Medicine, Tokyo, Japan
| | | | - Ken Okumura
- Division of Cardiology, Saiseikai Kumamoto Hospital Cardiovascular Center, Kumamoto, Japan
| | | | - Hiroyuki Tsutsui
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Kazunori Toyoda
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan
| | | | - Masahiro Yasaka
- Department of Cerebrovascular Medicine and Neurology, Cerebrovascular Center, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan
| | - Takenori Yamaguchi
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Satoshi Teramukai
- Department of Biostatistics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Tetsuya Kimura
- Primary Medical Science Department, Daiichi Sankyo Co, Ltd, Tokyo, Japan
| | | | - Atsushi Takita
- Data Intelligence Department, Daiichi Sankyo Co, Ltd, Tokyo, Japan
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Marques L, Vale N. Prediction of CYP-Mediated Drug Interaction Using Physiologically Based Pharmacokinetic Modeling: A Case Study of Salbutamol and Fluvoxamine. Pharmaceutics 2023; 15:1586. [PMID: 37376035 DOI: 10.3390/pharmaceutics15061586] [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: 04/25/2023] [Revised: 05/15/2023] [Accepted: 05/22/2023] [Indexed: 06/29/2023] Open
Abstract
Drug-drug interactions (DDIs) represent a significant concern in healthcare, particularly for patients undergoing polytherapy. DDIs can lead to a range of outcomes, from decreased therapeutic effectiveness to adverse effects. Salbutamol, a bronchodilator recommended for the treatment of respiratory diseases, is metabolized by cytochrome P450 (CYP) enzymes, which can be inhibited or induced by co-administered drugs. Studying DDIs involving salbutamol is crucial for optimizing drug therapy and preventing adverse outcomes. Here, we aimed to investigate CYP-mediated DDIs between salbutamol and fluvoxamine through in silico approaches. The physiologically based pharmacokinetic (PBPK) model of salbutamol was developed and validated using available clinical PK data, whereas the PBPK model of fluvoxamine was previously verified by GastroPlus. Salbutamol-fluvoxamine interaction was simulated according to different regimens and patient's characteristics (age and physiological status). The results demonstrated that co-administering salbutamol with fluvoxamine enhanced salbutamol exposure in certain situations, especially when fluvoxamine dosage increased. To sum up, this study demonstrated the utility of PBPK modeling in predicting CYP-mediated DDIs, making it a pioneer in PK DDI research. Furthermore, this study provided insights into the relevance of regular monitoring of patients taking multiple medications, regardless of their characteristics, to prevent adverse outcomes and for the optimization of the therapeutic regimen, in cases where the therapeutic benefit is no longer experienced.
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Affiliation(s)
- Lara Marques
- OncoPharma Research Group, Center for Health Technology and Services Research (CINTESIS), Rua Doutor Plácido da Costa, 4200-450 Porto, Portugal
- Faculty of Medicine, University of Coimbra, Azinhaga de Santa Comba, Celas, 3000-548 Coimbra, Portugal
- CINTESIS@RISE, Faculty of Medicine, University of Porto, Al. Prof. Hernâni Monteiro, 4200-319 Porto, Portugal
| | - Nuno Vale
- OncoPharma Research Group, Center for Health Technology and Services Research (CINTESIS), Rua Doutor Plácido da Costa, 4200-450 Porto, Portugal
- CINTESIS@RISE, Faculty of Medicine, University of Porto, Al. Prof. Hernâni Monteiro, 4200-319 Porto, Portugal
- Department of Community Medicine, Health Information and Decision (MEDCIDS), Faculty of Medicine, University of Porto, Rua Dr. Plácido da Costa, 4200-450 Porto, Portugal
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Kaczynski M, Benitez G, Mylona EK, Tran QL, Atalla E, Tsikala-Vafea M, Kalagara S, Shehadeh F, Mylonakis E. Factors Associated With Enrollment into Inpatient Coronavirus Disease 2019 Randomized Controlled Trials: A Cross-sectional Analysis. Open Forum Infect Dis 2023; 10:ofad197. [PMID: 37180601 PMCID: PMC10173548 DOI: 10.1093/ofid/ofad197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 04/11/2023] [Indexed: 05/16/2023] Open
Abstract
Background Clinical trials for coronavirus disease 2019 (COVID-19) have struggled to achieve diverse patient enrollment, despite underrepresented groups bearing the largest burden of the disease and, presumably, being most in need of the treatments under investigation. Methods To assess the willingness of patients to enroll into inpatient COVID-19 clinical trials when invited, we conducted a cross-sectional analysis of adults hospitalized with COVID-19 who were approached regarding enrollment. Associations between patient and temporal factors and enrollment were assessed by multivariable logistic regression analysis. Results A total of 926 patients were included in this analysis. Overall, Hispanic/Latinx ethnicity was associated with a nearly half-fold decrease in the likelihood to enroll (adjusted odds ratio [aOR], 0.60 [95% confidence interval {CI}, .41-.88]). Greater baseline disease severity (aOR, 1.09 [95% CI, 1.02-1.17]), age 40-64 years (aOR, 1.83 [95% CI, 1.03-3.25]), and age ≥65 years (aOR, 1.92 [95% CI, 1.08-3.42]) were each independently associated with higher likelihood to enroll. Over the course of the pandemic, patients were less likely to enroll during the summer 2021 wave in COVID-19-related hospitalizations (aOR, 0.14 [95% CI, .10-.19]) compared with patients from the first wave in winter 2020. Conclusions The decision to enroll into clinical trials is multifactorial. Amid a pandemic disproportionately affecting vulnerable groups, Hispanic/Latinx patients were less likely to participate when invited, whereas older adults were more likely. Future recruitment strategies must consider the nuanced perceptions and needs of diverse patient populations to ensure equitable trial participation that advances the quality of healthcare for all.
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Affiliation(s)
- Matthew Kaczynski
- Infectious Diseases Division, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Gregorio Benitez
- Infectious Diseases Division, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Evangelia K Mylona
- Infectious Diseases Division, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Quynh-Lam Tran
- Infectious Diseases Division, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
- Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire, USA
| | - Eleftheria Atalla
- Infectious Diseases Division, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
- Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Maria Tsikala-Vafea
- Infectious Diseases Division, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
- Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Saisanjana Kalagara
- Infectious Diseases Division, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Fadi Shehadeh
- Infectious Diseases Division, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
- School of Electrical and Computer Engineering, National Technical University of Athens, Athens, Greece
| | - Eleftherios Mylonakis
- Correspondence: Eleftherios Mylonakis, MD, PhD, Department of Medicine, Houston Methodist Hospital, FIDSA, 6550 Fannin, Smith Tower 1001, Houston, TX 77030 ()
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26
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Pronk AC, van Poelgeest EP, Seppala LJ, Ploegmakers KJ, Stricker BH, Swart KMA, van Dijk SC, Oliai Araghi S, de Groot LCPGM, van Schoor NM, Mathôt RAA, van der Velde N. Are higher antidepressant plasma concentrations associated with fall risk in older antidepressant users? Eur Geriatr Med 2023; 14:89-97. [PMID: 36656485 PMCID: PMC9902404 DOI: 10.1007/s41999-022-00742-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Accepted: 12/29/2022] [Indexed: 01/20/2023]
Abstract
PURPOSE Antidepressants are well-established fall-risk increasing drugs (FRIDs) and therefore falls should be considered an important adverse drug event (ADE) of antidepressants. However, not all antidepressant users experience fall incidents and factors associated with increased fall risk among antidepressant users are incompletely understood. Our objective was to explore whether antidepressant plasma concentrations are associated with falls in older antidepressant users. METHODS For this study, we included antidepressant users of the multicenter B-PROOF study. Fall incidents were recorded prospectively using fall calendars. Antidepressant plasma concentrations were analyzed by Liquid chromatography-mass spectrometry (LC-MS) at baseline and at 2 years follow-up. The associations between the observed antidepressant concentration and fall risk were assessed using Cox proportional hazard and logistic regression models and adjusted for potential confounders. RESULTS In total 93 selective serotonin reuptake inhibitor (SSRI) and 41 antidepressant (TCA) users were identified. There was a significant association between baseline TCA plasma concentration and fall risk within users (HR 2.50, 95% CI 1.07-5.87, crude model). In the adjusted model, there were no significant associations between concentrations of SSRIs and fall risk. CONCLUSION There might be an association between plasma concentrations of TCAs and the risk of falling in older users. However, these results needs to be interpreted with caution considering the small sample size and accompanying limitation of confinement to crude analyses. Therefore, these novel findings need to replicated in a larger cohort, preferably including adjustment for potential confounders and more frequent measures of plasma concentrations is needed.
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Affiliation(s)
- A C Pronk
- Internal Medicine, Section of Geriatric Medicine, Amsterdam UMC location University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands. .,Aging and Later Life, Amsterdam Public Health, Amsterdam, The Netherlands.
| | - E P van Poelgeest
- Internal Medicine, Section of Geriatric Medicine, Amsterdam UMC location University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands.,Aging and Later Life, Amsterdam Public Health, Amsterdam, The Netherlands
| | - L J Seppala
- Internal Medicine, Section of Geriatric Medicine, Amsterdam UMC location University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands.,Aging and Later Life, Amsterdam Public Health, Amsterdam, The Netherlands
| | - K J Ploegmakers
- Internal Medicine, Section of Geriatric Medicine, Amsterdam UMC location University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands.,Aging and Later Life, Amsterdam Public Health, Amsterdam, The Netherlands
| | - B H Stricker
- Department of Epidemiology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - K M A Swart
- General Practice, Amsterdam UMC location Vrije Universiteit Amsterdam, Boelelaan 1117, Amsterdam, The Netherlands
| | - S C van Dijk
- Department of Geriatrics, Franciscus Gasthuis & Vlietland, Rotterdam, The Netherlands
| | - S Oliai Araghi
- Department of Epidemiology, Erasmus University Medical Center, Rotterdam, The Netherlands.,Department of Internal Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - L C P G M de Groot
- Division of Human Nutrition and Health, Wageningen University, Wageningen, The Netherlands
| | - N M van Schoor
- Aging and Later Life, Amsterdam Public Health, Amsterdam, The Netherlands.,Epidemiology and Data Science, Amsterdam UMC location Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, Netherlands
| | - R A A Mathôt
- Hospital Pharmacy-Clinical Pharmacology, Amsterdam UMC location University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
| | - N van der Velde
- Internal Medicine, Section of Geriatric Medicine, Amsterdam UMC location University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands.,Aging and Later Life, Amsterdam Public Health, Amsterdam, The Netherlands
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Lukas S, Ramatillah D, Aldi Y, Wahyuni F, Khan K. Evaluation of increased antibody titer COVID-19 after astrazeneca vaccination based on the age at UTA'45 Jakarta Vaccine Center. ASIAN JOURNAL OF PHARMACEUTICAL RESEARCH AND HEALTH CARE 2023. [DOI: 10.4103/ajprhc.ajprhc_4_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023]
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28
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Vervalcke J, De Clercq A, De Paepe P, Petrovic M, Desmet T, De Cock PA. Pharmacokinetics and Target Attainment of ß-lactam Antibiotics in Older People: A Systematic Review of Current Literature. Clin Pharmacokinet 2023; 62:1-43. [PMID: 36633814 DOI: 10.1007/s40262-022-01196-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/07/2022] [Indexed: 01/13/2023]
Abstract
BACKGROUND AND OBJECTIVE (Patho)physiological changes in older people may influence the pharmacokinetics (PK), and consequently the target attainment, of ß-lactam antibiotics using standard dosing regimens. This systematic review compiles the current knowledge on the PK and target attainment of ß-lactam antibiotics in older people, with the aim to identify priorities for dose optimization in this patient population. METHODS A systematic literature search of the PubMed and EMBASE databases was conducted. Relevant articles published prior to 1 December 2021 were identified as eligible when they included data on the PK of ß-lactam antibiotics in adults ≥ 65 years of age. Extracted information included reported PK parameters (volume of distribution, clearance [CL], elimination rate constant, intercompartmental CL, elimination half-life, area under the concentration-time curve, maximum and trough concentration), covariates on PK parameters, target attainment rate, and dosing recommendations. RESULTS Ninety-one relevant articles were included in this review. Four main ß-lactam subclasses were represented: 59.3% on cephalosporins + cephamycins, 25.3% on penicillins, 15.4% on carbapenems, and 3.3% on monobactams; 65.9% of articles involved intravenous administration, 16.5% mixed administration routes, 12.1% oral administration, and 5.5% intramuscular administration. The majority of studies had a small sample size, often did not include detailed information on the study population and methods, and were fairly old. CL was, on average, decreased, while elimination half-life was prolonged in aged subjects compared with young subjects. Volume of distribution was generally similar between age groups. Most studies identified renal function as the most important contributor to altered drug CL. In only 30.8% of the articles, target attainment was studied, and in 35.7% of these articles, target attainment was found to be suboptimal. Dosing recommendations were incorporated in 87.9% of articles. CONCLUSION Studies frequently fail to provide an evidence-based dosing recommendation for this diverse patient population. Model-based PK studies that address both physiological and disease-related changes are urgently needed. This review identified gaps of knowledge to set priorities for further research.
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Affiliation(s)
- Jeroen Vervalcke
- Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Arnaud De Clercq
- Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Peter De Paepe
- Department of Basic and Applied Medical Sciences, Ghent University, Ghent, Belgium.,Department of Emergency Medicine, Ghent University Hospital, Ghent, Belgium
| | - Mirko Petrovic
- Section of Geriatrics, Department of Internal Medicine and Paediatrics, Ghent University, Ghent, Belgium
| | - Tania Desmet
- Department of Emergency Medicine, Ghent University Hospital, Ghent, Belgium
| | - Pieter A De Cock
- Department of Basic and Applied Medical Sciences, Ghent University, Ghent, Belgium. .,Department of Pharmacy, Ghent University Hospital, C. Heymanslaan 10, 9000, Ghent, Belgium.
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29
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Pereira F, Bieri M, del Rio Carral M, Martins MM, Verloo H. Collaborative medication management for older adults after hospital discharge: a qualitative descriptive study. BMC Nurs 2022; 21:284. [PMID: 36280875 PMCID: PMC9590396 DOI: 10.1186/s12912-022-01061-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 10/07/2022] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Safe medication management for older adults after hospital discharge requires a well-coordinated, interprofessional, patient-centered approach. This study aimed to describe the perceived needs for collaborative medication management for older adults taking several different medications at home after hospital discharge. METHODS A qualitative descriptive study was conducted using semi-structured interviews with older adults (n = 28), informal (n = 17), and professional caregivers (n = 13). RESULTS Findings revealed four main needs: older adults and informal caregivers' perceived needs for greater involvement in discharge planning; older adults' perceived needs to be informed, listened to, and to be actively involved in decision-making; informal caregivers' perceived needs for help in supporting and coordinating medication management; and older adults' and informal and professional caregivers' perceived needs for better communication and coordination between professional caregivers. CONCLUSION This study revealed two underutilized pathways towards improving collaborative medication management: medication follow-up involving a community healthcare professional taking an overarching responsibility and empowering older adults and their informal caregivers in medication management after hospital discharge.
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Affiliation(s)
- Filipa Pereira
- Institute of Biomedical Sciences Abel Salazar, University of Porto, Porto, Portugal
- School of Health Sciences, University of Applied Sciences and Arts Western Switzerland (HES- SO), CH-1950 Sion, Switzerland
| | - Marion Bieri
- School of Health Sciences, University of Applied Sciences and Arts Western Switzerland (HES- SO), CH-1950 Sion, Switzerland
| | - Maria del Rio Carral
- Institute of Psychology, Research Center for the Psychology of Health, Aging and Sports Examination, University of Lausanne, Lausanne, Switzerland
| | | | - Henk Verloo
- School of Health Sciences, University of Applied Sciences and Arts Western Switzerland (HES- SO), CH-1950 Sion, Switzerland
- Service of Old Age Psychiatry, Lausanne University Hospital, Lausanne, Switzerland
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30
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Considerations to comprehensive care for the older individual with myelofibrosis. Best Pract Res Clin Haematol 2022; 35:101371. [DOI: 10.1016/j.beha.2022.101371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Accepted: 07/30/2022] [Indexed: 11/17/2022]
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31
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Altered pharmacology and toxicology during ageing: implications for lung disease. Curr Opin Pulm Med 2022; 28:314-320. [PMID: 35749797 DOI: 10.1097/mcp.0000000000000878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE OF REVIEW Drug use in elderly people is high compared to younger people. Simultaneously, elderly are at greater risk when exposed to environmental substances. It is puzzling therefore, that ageing, as a variable in pharmacological and toxicological processes is not investigated in more depth. Moreover, recent data suggest that molecular manifestations of the ageing process also hallmark the pathogenesis of chronic lung diseases, which may impact pharmacology and toxicology. RECENT FINDINGS In particular, absorption, distribution, metabolism and excretion (ADME) processes of drugs and toxins alter because of ageing. Polypharmacy, which is quite usual with increasing age, increases the risk of drug-drug interactions. Individual differences in combination of drugs use in conjunction with individual variations in drug metabolizing enzymes can influence lung function. SUMMARY Exploring exposure throughout life (i.e. during ageing) to potential triggers, including polypharmacy, may avoid lung disease or unexplained cases of lung damage. Understanding of the ageing process further unravels critical features of chronic lung disease and helps to define new protective targets and therapies. Optimizing resilience can be key in pharmacology and toxicology and helps in maintaining healthy lungs for a longer period.
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32
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Ornelas IM, Cini FA, Wießner I, Marcos E, de Araújo D, Goto-Silva L, Nascimento J, Silva SRB, Costa MN, Falchi M, Olivieri R, Palhano-Fontes F, Sequerra E, Martins-de-Souza D, Feilding A, Rennó-Costa C, Tófoli LF, Rehen SK, Ribeiro S. Nootropic effects of LSD: Behavioral, molecular and computational evidence. Exp Neurol 2022; 356:114148. [PMID: 35732217 DOI: 10.1016/j.expneurol.2022.114148] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 06/03/2022] [Accepted: 06/14/2022] [Indexed: 11/26/2022]
Abstract
The therapeutic use of classical psychedelic substances such as d-lysergic acid diethylamide (LSD) surged in recent years. Studies in rodents suggest that these effects are produced by increased neural plasticity, including stimulation of the mTOR pathway, a key regulator of metabolism, plasticity, and aging. Could psychedelic-induced neural plasticity be harnessed to enhance cognition? Here we show that LSD treatment enhanced performance in a novel object recognition task in rats, and in a visuo-spatial memory task in humans. A proteomic analysis of human brain organoids showed that LSD affected metabolic pathways associated with neural plasticity, including mTOR. To gain insight into the relation of neural plasticity, aging and LSD-induced cognitive gains, we emulated the experiments in rats and humans with a neural network model of a cortico-hippocampal circuit. Using the baseline strength of plasticity as a proxy for age and assuming an increase in plasticity strength related to LSD dose, the simulations provided a good fit for the experimental data. Altogether, the results suggest that LSD has nootropic effects.
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Affiliation(s)
- Isis M Ornelas
- D'Or Institute for Research and Education (IDOR), Rio de Janeiro, Brazil
| | - Felipe A Cini
- Brain Institute, Federal University of Rio Grande do Norte (UFRN), Natal, Brazil
| | - Isabel Wießner
- Brain Institute, Federal University of Rio Grande do Norte (UFRN), Natal, Brazil; Interdisciplinary Cooperation for Ayahuasca Research and Outreach (ICARO), School of Medical Sciences, University of Campinas (UNICAMP), Campinas, Brazil
| | - Encarni Marcos
- Instituto de Neurociencias de Alicante, Consejo Superior de Investigaciones Científicas-Universidad Miguel Hernández de Elche, San Juan de Alicante, Spain
| | - Dráulio de Araújo
- Brain Institute, Federal University of Rio Grande do Norte (UFRN), Natal, Brazil
| | - Livia Goto-Silva
- D'Or Institute for Research and Education (IDOR), Rio de Janeiro, Brazil
| | - Juliana Nascimento
- D'Or Institute for Research and Education (IDOR), Rio de Janeiro, Brazil; Institute of Biology, University of Campinas (UNICAMP), Campinas, Brazil
| | - Sergio R B Silva
- Brain Institute, Federal University of Rio Grande do Norte (UFRN), Natal, Brazil
| | - Marcelo N Costa
- D'Or Institute for Research and Education (IDOR), Rio de Janeiro, Brazil; Institute of Biology, Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil
| | - Marcelo Falchi
- Interdisciplinary Cooperation for Ayahuasca Research and Outreach (ICARO), School of Medical Sciences, University of Campinas (UNICAMP), Campinas, Brazil
| | - Rodolfo Olivieri
- Interdisciplinary Cooperation for Ayahuasca Research and Outreach (ICARO), School of Medical Sciences, University of Campinas (UNICAMP), Campinas, Brazil
| | | | - Eduardo Sequerra
- Brain Institute, Federal University of Rio Grande do Norte (UFRN), Natal, Brazil
| | - Daniel Martins-de-Souza
- D'Or Institute for Research and Education (IDOR), Rio de Janeiro, Brazil; Institute of Biology, University of Campinas (UNICAMP), Campinas, Brazil; Instituto Nacional de Biomarcadores em Neuropsiquiatria (INBION), Conselho Nacional de Desenvolvimento Científico e Tecnológico, São Paulo, Brazil; Experimental Medicine Research Cluster (EMRC), University of Campinas, Campinas, Brazil
| | | | - César Rennó-Costa
- Digital Metropolis Institute, Federal University of Rio Grande do Norte (UFRN), Natal, Brazil.
| | - Luis Fernando Tófoli
- Interdisciplinary Cooperation for Ayahuasca Research and Outreach (ICARO), School of Medical Sciences, University of Campinas (UNICAMP), Campinas, Brazil.
| | - Stevens K Rehen
- D'Or Institute for Research and Education (IDOR), Rio de Janeiro, Brazil; Institute of Biology, Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil.
| | - Sidarta Ribeiro
- Brain Institute, Federal University of Rio Grande do Norte (UFRN), Natal, Brazil.
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Klopotowska JE, Kuks PFM, Wierenga PC, Stuijt CCM, Arisz L, Dijkgraaf MGW, de Keizer N, Smorenburg SM, de Rooij SE. The effect of structured medication review followed by face-to-face feedback to prescribers on adverse drug events recognition and prevention in older inpatients - a multicenter interrupted time series study. BMC Geriatr 2022; 22:505. [PMID: 35715742 PMCID: PMC9206349 DOI: 10.1186/s12877-022-03118-z] [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: 12/22/2021] [Accepted: 04/27/2022] [Indexed: 11/10/2022] Open
Abstract
Background The effectiveness of interventions to improve medication safety in older inpatients is unclear, given a paucity of properly designed intervention studies applying clinically relevant endpoints such as hospital-acquired preventable Adverse Drug Events (pADEs) and unrecognized Adverse Drug Events (uADEs). Therefore, we conducted a quality improvement study and used hospital-acquired pADEs and uADEs as main outcomes to assess the effect of an intervention aimed to improve medication safety in older inpatients. Method The study followed an interrupted time series design and consisted of three equally spaced sampling points during baseline and during intervention measurements. Each sampling point included between 80 to 90 patients. A total of 500 inpatients ≥65 years and admitted to internal medicine wards of three Dutch hospitals were included. An expert team retrospectively identified and assessed ADEs via a structured patient chart review. The findings from baseline measurement and meetings with the internal medicine and hospital pharmacy staff were used to design the intervention. The intervention consisted of a structured medication review by hospital pharmacists, followed by face-to-face feedback to prescribers, on average 3 days per week. Results The rate of hospital-acquired pADEs per 100 hospitalizations was reduced by 50.6% (difference 16.8, 95% confidence interval (CI): 9.0 to 24.6, P < 0.001), serious hospital-acquired pADEs by 62.7% (difference 12.8, 95% CI: 6.4 to 19.2, P < 0.001), and uADEs by 51.8% (difference 11.2, 95% CI: 4.4 to 18.0, P < 0.001). Additional analyses confirmed the robustness of the intervention effect, but residual bias cannot be excluded. Conclusions The intervention significantly decreased the overall and serious hospital-acquired pADE occurrence in older inpatients, and significantly improved overall ADE recognition by prescribers. Trial registration International Standard Randomized Controlled Trial Number Register, trial registration number: ISRCTN64974377, registration date (date assigned): 07/02/2011. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-022-03118-z.
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Affiliation(s)
- Joanna E Klopotowska
- Amsterdam University Medical Centers location University of Amsterdam, Medical Informatics, Amsterdam, The Netherlands. .,Amsterdam Public Health, Quality of Care, Amsterdam, The Netherlands.
| | - Paul F M Kuks
- Amsterdam University Medical Centers location University of Amsterdam, Pharmacy and Clinical Pharmacology, Amsterdam, The Netherlands
| | - Peter C Wierenga
- Gelderse Vallei Hospital, Hospital Pharmacy, Ede, The Netherlands
| | - Clementine C M Stuijt
- Center of Excellence on Parkinson's disease (Punt voor Parkinson), Groningen, The Netherlands
| | - Lambertus Arisz
- Amsterdam University Medical Centers location University of Amsterdam, Internal Medicine, Amsterdam, The Netherlands
| | - Marcel G W Dijkgraaf
- Amsterdam University Medical Centers location University of Amsterdam, Epidemiology and Data Science, Amsterdam, The Netherlands.,Amsterdam Public Health, Methodology, Amsterdam, the Netherlands
| | - Nicolette de Keizer
- Amsterdam University Medical Centers location University of Amsterdam, Medical Informatics, Amsterdam, The Netherlands.,Amsterdam Public Health, Quality of Care, Amsterdam, The Netherlands
| | - Susanne M Smorenburg
- Amsterdam University Medical Centers location University of Amsterdam, Internal Medicine, Amsterdam, The Netherlands
| | - Sophia E de Rooij
- Amstelland Hospital, Board of Directors, Amstelveen, The Netherlands
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Tamargo J, Kjeldsen KP, Delpón E, Semb AG, Cerbai E, Dobrev D, Savarese G, Sulzgruber P, Rosano G, Borghi C, Wassman S, Torp-Pedersen CT, Agewall S, Drexel H, Baumgartner I, Lewis B, Ceconi C, Kaski JC, Niessner A. Facing the challenge of polypharmacy when prescribing for older people with cardiovascular disease. A review by the European Society of Cardiology Working Group on Cardiovascular Pharmacotherapy. EUROPEAN HEART JOURNAL. CARDIOVASCULAR PHARMACOTHERAPY 2022; 8:406-419. [PMID: 35092425 DOI: 10.1093/ehjcvp/pvac005] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 12/28/2021] [Accepted: 01/27/2022] [Indexed: 11/12/2022]
Abstract
Population ageing has resulted in an increasing number of older people living with chronic diseases (multimorbidity) requiring five or more medications daily (polypharmacy). Ageing produces important changes in the cardiovascular system and represents the most potent single cardiovascular risk factor. Cardiovascular diseases (CVDs) constitute the greatest burden for older people, their caregivers, and healthcare systems. Cardiovascular pharmacotherapy in older people is complex because age-related changes in body composition, organ function, homeostatic mechanisms, and comorbidities modify the pharmacokinetic and pharmacodynamic properties of many commonly used cardiovascular and non-cardiovascular drugs. Additionally, polypharmacy increases the risk of adverse drug reactions and drug interactions, which in turn can lead to increased morbi-mortality and healthcare costs. Unfortunately, evidence of drug efficacy and safety in older people with multimorbidity and polypharmacy is limited because these individuals are frequently underrepresented/excluded from clinical trials. Moreover, clinical guidelines are largely written with a single-disease focus and only occasionally address the issue of coordination of care, when and how to discontinue treatments, if required, or how to prioritize recommendations for patients with multimorbidity and polypharmacy. This review analyses the main challenges confronting healthcare professionals when prescribing in older people with CVD, multimorbidity, and polypharmacy. Our goal is to provide information that can contribute to improving drug prescribing, efficacy, and safety, as well as drug adherence and clinical outcomes.
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Affiliation(s)
- Juan Tamargo
- Department of Pharmacology and Toxicology, School of Medicine, Institute Gregorio Marañón, Universidad Complutense, Madrid, Spain
| | - Keld Per Kjeldsen
- Department of Cardiology, Copenhagen University Hospital (Amager-Hvidovre), Copenhagen, and Department of Health Science and Technology, The Faculty of Medicine, Aalborg University, Aalborg, Denmark
| | - Eva Delpón
- Department of Pharmacology and Toxicology, School of Medicine, Institute Gregorio Marañón, Universidad Complutense, Madrid,Spain
| | - Anne Grete Semb
- Department of Rheumatology, Preventive Cardio-Rheuma Clinic, Diakonhjemme Hospital, Oslo, Norway
| | - Elisabetta Cerbai
- Department of Neurosciences, Psychology, Drug Research and Child Health, University of Florence, Florence, Italy
| | - Dobromir Dobrev
- Institute of Pharmacology, West German Heart and Vascular Center, University Duisburg-Essen, Essen, Germany
| | - Gianluigi Savarese
- Division of Cardiology, Department of Medicine, Karolinska Institutet, and Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden
| | - Patrick Sulzgruber
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
| | - Giuseppe Rosano
- Department of Medical Sciences, IRCCS San Raffaele Hospital, Rome, Italy
| | - Claudio Borghi
- Medicine and Surgery Science Department, University of Bologna, Bologna, Italy
| | - Seven Wassman
- Cardiology Pasing, Munich, and Faculty of Medicine, University of the Saarland, Homburg/Saar, Germany
| | - Christian Tobias Torp-Pedersen
- Department of Cardiology, Nordsjaellands Hospital, and Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Stefan Agewall
- Department of Cardiology, Oslo University Hospital, Oslo, Norway
| | - Heinz Drexel
- Department of Internal Medicine and Cardiology, VIVIT Institute, Landeskrankenhaus Feldkirch, Feldkirch, Austria
| | - Iris Baumgartner
- Division of Angiology, Swiss Cardiovascular Center, Inselspital, Bern University Hospital, Bern, Switzerland
| | - Basil Lewis
- Department of Cardiovascular Clinical Research Institute, Lady Davis Carmel Medical Center, and the Ruth and Bruce Rappaport School of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Claudio Ceconi
- UO Cardiologia, Ospedale di Desenzano del Garda, Desenzano del Garda, Italy
| | - Juan Carlos Kaski
- Molecular and Clinical Sciences Research Institute, St George's, University of London, London, UK
| | - Alexander Niessner
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
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Pereira F, Bieri M, Martins MM, del Río Carral M, Verloo H. Safe Medication Management for Polymedicated Home-Dwelling Older Adults after Hospital Discharge: A Qualitative Study of Older Adults, Informal Caregivers and Healthcare Professionals’ Perspectives. NURSING REPORTS 2022; 12:403-423. [PMID: 35736616 PMCID: PMC9230543 DOI: 10.3390/nursrep12020039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 05/20/2022] [Accepted: 05/26/2022] [Indexed: 11/18/2022] Open
Abstract
Safe medication management is particularly challenging among polymedicated home-dwelling older adults after hospital discharge. This study aimed to identify and categorise the stressors experienced and reconstitution strategies adopted by older adults, their informal caregivers, and healthcare professionals as they manage older adults’ medications after hospital discharge. A primary study collected the perspectives of 28 older adults, 17 informal caregivers, and 13 healthcare professionals using a qualitative descriptive design. The Neuman Systems Model was used as the basis for a secondary deductive content analysis. Findings revealed that post-discharge medication management at home involved numerous stressors, often including dysfunctions in communication, collaboration, and coordination between the multiple stakeholders involved. Reconstitution strategies for safe medication management were not always successful or satisfactory and were sometimes identified as stressors themselves. Older adults, informal caregivers, and healthcare professionals’ perspectives highlighted several potential opportunities for improving safe medication management through nurse-led, interprofessional, patient-centred practices.
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Affiliation(s)
- Filipa Pereira
- Institute of Biomedical Sciences Abel Salazar, University of Porto, 4050-313 Porto, Portugal
- School of Health Sciences, HES-SO Valais/Wallis, 1950 Sion, Switzerland; (M.B.); (H.V.)
- Correspondence:
| | - Marion Bieri
- School of Health Sciences, HES-SO Valais/Wallis, 1950 Sion, Switzerland; (M.B.); (H.V.)
| | | | - María del Río Carral
- Research Center for Psychology of Health, Aging and Sport Examination, Institute of Psychology, University of Lausanne, 1015 Lausanne, Switzerland;
| | - Henk Verloo
- School of Health Sciences, HES-SO Valais/Wallis, 1950 Sion, Switzerland; (M.B.); (H.V.)
- Service of Old Age Psychiatry, Lausanne University Hospital, 1008 Prilly, Switzerland
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36
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Coulson J. Identifying and managing adverse drug reactions to promote medicines adherence and safety. Nurs Stand 2022; 37:e11829. [PMID: 35599604 DOI: 10.7748/ns.2022.e11829] [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: 02/15/2022] [Indexed: 06/14/2023]
Abstract
Unpleasant side effects or adverse drug reactions (ADRs) caused by medicines can have significant effects on people's quality of life and therapeutic outcomes. Knowledge of how ADRs occur enables nurses who prescribe and/or administer medicines to identify and manage them effectively, which can improve the patient experience and increase adherence. This article outlines the types of ADRs and explains how nurses can reduce medicines-related harm by following the principles of medicines optimisation, undertaking regular medication reviews and communicating openly with patients about their medicines.
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Affiliation(s)
- Jodie Coulson
- Department of Health Sciences, University of York, Heslington, England
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Windolf H, Chamberlain R, Breitkreutz J, Quodbach J. 3D Printed Mini-Floating-Polypill for Parkinson's Disease: Combination of Levodopa, Benserazide, and Pramipexole in Various Dosing for Personalized Therapy. Pharmaceutics 2022; 14:931. [PMID: 35631518 PMCID: PMC9145509 DOI: 10.3390/pharmaceutics14050931] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 04/19/2022] [Accepted: 04/22/2022] [Indexed: 01/27/2023] Open
Abstract
Therapy for Parkinson’s disease is quite challenging. Numerous drugs are available for symptomatic treatment, and levodopa (LD), in combination with a dopa decarboxylase inhibitor (e.g., benserazide (BZ)), has been the drug of choice for years. As the disease progresses, therapy must be supplemented with a dopamine agonist (e.g., pramipexole (PDM)). Side effects increase, as do the required dose and dosing intervals. For these specific requirements of drug therapy, the 3D printing method fused deposition modelling (FDM) was applied in this study for personalized therapy. Hot melt extrusion was utilized to produce two different compositions into filaments: PDM and polyvinyl alcohol for rapid drug release and a fixed combination of LD/BZ (4:1) in an ethylene-vinyl acetate copolymer matrix for prolonged drug release. Since LD is absorbed in the upper gastrointestinal tract, a formulation that floats in gastric fluid was desired to prolong API absorption. Using the FDM 3D printing process, different polypill geometries were printed from both filaments, with variable dosages. Dosage forms with 15−180 mg LD could be printed, showing similar release rates (f2 > 50). In addition, a mini drug delivery dosage form was printed that released 75% LD/BZ within 750 min and could be used as a gastric retentive drug delivery system due to the floating properties of the composition. The floating mini-polypill was designed to accommodate patients’ swallowing difficulties and to allow for individualized dosing with an API release over a longer period of time.
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Affiliation(s)
- Hellen Windolf
- Institute of Pharmaceutics and Biopharmaceutics, Heinrich Heine University, Universitätsstr. 1, 40225 Düsseldorf, Germany; (H.W.); (R.C.); (J.B.)
| | - Rebecca Chamberlain
- Institute of Pharmaceutics and Biopharmaceutics, Heinrich Heine University, Universitätsstr. 1, 40225 Düsseldorf, Germany; (H.W.); (R.C.); (J.B.)
| | - Jörg Breitkreutz
- Institute of Pharmaceutics and Biopharmaceutics, Heinrich Heine University, Universitätsstr. 1, 40225 Düsseldorf, Germany; (H.W.); (R.C.); (J.B.)
| | - Julian Quodbach
- Institute of Pharmaceutics and Biopharmaceutics, Heinrich Heine University, Universitätsstr. 1, 40225 Düsseldorf, Germany; (H.W.); (R.C.); (J.B.)
- Department of Pharmaceutics, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Universiteitsweg 99, 3584 CG Utrecht, The Netherlands
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Rekatsina M, Paladini A, Viswanath O, Urits I, Myrcik D, Pergolizzi J, Breve F, Varrassi G. Opioids in the Elderly Patients with Cognitive Impairment: A Narrative Review. Pain Ther 2022; 11:381-394. [PMID: 35380373 PMCID: PMC9098742 DOI: 10.1007/s40122-022-00376-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 03/10/2022] [Indexed: 11/30/2022] Open
Abstract
Introduction Assessment and management of pain in elderly people with cognitive impairment is particularly challenging. Physiological changes due to aging as well as comorbidities and polypharmacy are responsible for a complex clinical approach. Concomitantly, in cognitive impairment, including advanced dementia, changes in the central nervous system along with changes in the peripheral nervous system due to aging have a significant impact on pain perception. Sometimes clinicians decide to prescribe opioids to relieve pain, also without a clear indication. This review aims to investigate the effect of opioids in elderly patients with cognitive impairment. Methods A literature search of PubMed/Medline, Scopus, and Cochrane databases was conducted using keyword searches to generate lists of articles that were screened for relevance by title and abstract to give a final list of articles for full-text review. Further articles were identified by scanning the reference lists of the full-text articles. Discussion This review discusses the complex physiological and pharmacological changes in the elderly as well as the neurological changes that affect pain perception in this population. Additionally, it focuses on cognitive impairment and pain in Alzheimer’s disease and other dementias, the pain assessment in the elderly with cognitive impairment as well as the safety of opioid use in the elderly. Information regarding opioid prescription in nursing homes and recorded indications for opioid use, type and dosing of opioids, and compliance of treatment in advanced dementia are also provided. Conclusions Opioid prescription in the elderly population with cognitive impairment is particularly complex. All healthcare professionals involved in the care of such patients need to be aware of the challenges and strive to ensure analgesic use is guided by appropriate and accurate pain assessment.
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Affiliation(s)
- M Rekatsina
- Mid and South, Essex University Hospitals Group, Orsett Hospital, Grays, RM16 3EU, Essex, UK
| | - A Paladini
- Department MESVA, University of L'Aquila, 67100, L'Aquila, Italy
| | - O Viswanath
- Department of Anesthesiology, Creighton University School of Medicine, Omaha, NE, USA
- Department of Anesthesiology, Louisiana State University Health Shreveport, Shreveport, LA, USA
| | - I Urits
- Department of Anesthesiology, Louisiana State University Health Shreveport, Shreveport, LA, USA
- Southcoast Physician Group Pain Medicine, Southcoast Health, Wareham, MA, USA
| | - D Myrcik
- Department of Internal Medicine, Silesian University of Medicine, 42-600, Byton, Poland
| | | | - F Breve
- NEMA Research Group, Naples, FL, USA
| | - G Varrassi
- Paolo Procacci Foundation, 00193, Rome, Italy.
- NEMA Research Group (European Chapter), Naples, FL, USA.
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Soliman ME, Adewumi AT, Akawa OB, Subair TI, Okunlola FO, Akinsuku OE, Khan S. Simulation Models for Prediction of Bioavailability of Medicinal Drugs-the Interface Between Experiment and Computation. AAPS PharmSciTech 2022; 23:86. [PMID: 35292867 DOI: 10.1208/s12249-022-02229-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 02/03/2022] [Indexed: 12/17/2022] Open
Abstract
The oral drug bioavailability (BA) problems have remained inevitable over the years, impairing drug efficacy and indirectly leading to eventual human morbidity and mortality. However, some conventional lab-based methods improve drug absorption leading to enhanced BA, and the recent experimental techniques are up-and-coming. Nevertheless, some have inherent drawbacks in improving the efficacy of poorly insoluble and low impermeable drugs. Drug BA and strategies to overcome these challenges were briefly highlighted. This review has significantly unravelled the different computational models for studying and predicting drug bioavailability. Several computational approaches provide mechanistic insights into the oral drug delivery system simulation of descriptors like solubility, permeability, transport protein-ligand interactions, and molecular structures. The in silico techniques have long been known still are just being applied to unravel drug bioavailability issues. Many publications have reported novel applications of the computational models towards achieving improved drug BA, including predicting gastrointestinal tract (GIT) drug absorption properties and passive intestinal membrane permeability, thus maximizing time and resources. Also, the classical molecular simulation models for free solvation energies of soluble-related processes such as solubilization, dissolutions, supersaturation, and precipitation have been used in virtual screening studies. A few of the tools are GastroPlusTM that supports biowaiver for drugs, mainly BCS class III and predicts drug compounds' absorption and pharmacokinetic process; SimCyp® simulator for mechanistic modelling and simulation of drug formulation processes; pharmacodynamics analysis on non-linear mixed-effects modelling; and mathematical models, predicting absorption potential/maximum absorption dose. This review provides in silico-experiment annexation in the drug bioavailability enhancement, possible insights that lead to critical opinion on the applications and reliability of the various in silico models as a growing tool for drug development and discovery, thus accelerating drug development processes.
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40
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Coulson J. Understanding the pharmacology of the side effects of medicines for effective prevention of adverse drug reactions. Nurs Stand 2022; 37:37-43. [PMID: 34913303 DOI: 10.7748/ns.2021.e11820] [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: 10/04/2021] [Indexed: 11/09/2022]
Abstract
Most common adverse drug reactions (ADRs) are linked to pharmacology. No medicine has a single physiological effect, and many cause unwanted side effects in addition to their intended action, even when administered at the recommended dose. The higher the number of medicines people take, the higher their risk of ADRs. This article explores the role of pharmacokinetics and pharmacodynamics in ADRs and discusses how understanding the way in which the body processes medicines, and the factors that affect these mechanisms, can assist nurses in anticipating and avoiding ADRs. The article also explains how understanding the mode of action before administering medicines to patients can predict and prevent harmful interactions, exaggerated or unwanted side effects and responses at unintended sites.
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Affiliation(s)
- Jodie Coulson
- Department of Health Sciences, University of York, York, England
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41
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van Riet-Nales DA, van den Bemt B, van Bodegom D, Cerreta F, Dooley B, Eggenschwyler D, Hirschlérova B, Jansen PAF, Karapinar-Çarkit F, Moran A, Span J, Stegemann S, Sundberg K. Commentary on the EMA reflection paper on the pharmaceutical development of medicines for use in the older population. Br J Clin Pharmacol 2022; 88:1500-1514. [PMID: 35141926 DOI: 10.1111/bcp.15207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 12/09/2021] [Indexed: 11/28/2022] Open
Abstract
Older people are often affected by impaired organ and bodily functions resulting in multimorbidity and polypharmacy, turning them into the main user group of many medicines. Very often, medicines have not specifically been developed for older people, causing practical medication problems for them like limited availability of easy to swallow formulations, easy to open packaging and dosing instructions for enteral administration. In 2020, the European Medicines Agency (EMA) published a reflection paper 'Pharmaceutical development of medicines for use in the older population', which discusses how the emerging needs of an ageing European population can be addressed by medicines regulation. The paper intends to help industry to better consider the needs of older people during pharmaceutical/clinical medicines development by summarising data on the most relevant topics, providing early suggestions on how to move forward and prompting expert discussions and studies into knowledge gaps. Topics include patient acceptability, (dis)advantages of an administration route, formulation, dosage form, packaging, dosing device and user instruction. While the paper is directed at older people and the pharmaceutical industry, the reflections are also relevant to younger patients with similar disease-related needs and of value to other stakeholders parties, e.g., healthcare professionals, academics, patients and caregivers, as the paper makes clear what can be expected from industry and where collaborative work is needed. This commentary provides an overview of the different steps in the development of the reflection paper, discusses points considered most controversial and/or subject to (multidisciplinary) expert discussions and indicates their value for real world clinical practice.
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Affiliation(s)
- Diana A van Riet-Nales
- Department of Chemical Pharmaceutical Assessments, Medicines Evaluation Board (MEB), Utrecht, Netherlands
| | - Bart van den Bemt
- Department of Pharmacy, Sint Maartenskliniek, Ubbergen, Netherlands.,Department of Pharmacy, Radboud University Medical Center, Nijmegen, Netherlands
| | - David van Bodegom
- Public Health and Primary Care, Leyden Academy on Vitality and Ageing, Leiden, Netherlands.,Department Public Health and Primary Care, Leiden University Medical Centre, Leiden, Netherlands
| | - Francesca Cerreta
- Scientific Evidence Generation Department, Human Medicines Division, European Medicines Agency, Amsterdam, Netherlands
| | - Brian Dooley
- Quality and Safety of Medicines Department, Human Medicines Division, European Medicines Agency, Amsterdam, Netherlands
| | | | - Blanka Hirschlérova
- Department of Pharmaceutical Assessment of Chemical and Herbal Products, State Institute for Drug Control (SUKL), Prague, Czech Republic
| | - Paul A F Jansen
- Department of Chemical Pharmaceutical Assessments, Medicines Evaluation Board (MEB), Utrecht, Netherlands.,Geriatric Department, University Medical Center, Utrecht, Netherlands.,Expertise Centre Pharmacotherapy in Old Persons (EPHOR), Utrecht, Netherlands
| | | | - Abigail Moran
- Medicines and Healthcare Products Regulatory Agency, London, UK
| | - Jan Span
- Department of Chemical Pharmaceutical Assessments, Medicines Evaluation Board (MEB), Utrecht, Netherlands
| | - Sven Stegemann
- Institute of Process and Particle Engineering, Graz University of Technology, Graz, Austria
| | - Katarina Sundberg
- Department of Pharmaceutics and Biotechnology, Swedish Medical Products Agency (MPA), Uppsala, Sweden
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42
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Tackling older adults’ malnutrition through the development of tailored food products. Trends Food Sci Technol 2021. [DOI: 10.1016/j.tifs.2021.06.028] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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Barry HE, Hughes CM. An Update on Medication Use in Older Adults: a Narrative Review. CURR EPIDEMIOL REP 2021; 8:108-115. [PMID: 34306966 PMCID: PMC8294219 DOI: 10.1007/s40471-021-00274-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/04/2021] [Indexed: 12/17/2022]
Abstract
Purpose of Review The global phenomenon of population aging is impacting the health and care needs of society. The use of medications by older adults is acknowledged to be the most common form of medical intervention for many acute and chronic conditions and prescribing in this population continues to increase. In this narrative review, we summarise the age-related factors that should be considered when prescribing for older adults, address some of the perennial challenges related to medicine use in older people, and highlight important emerging research in this area. Recent Findings A range of age-related factors should be considered when prescribing for older adults. However, the evidence base still lacks data pertaining to older adults due to their continued under-representation in clinical trials. Multimorbidity, polypharmacy, and inappropriate prescribing continue to remain prevalent among older adults, although recent research has been focused on the development and evaluation of complex interventions to address these challenges. Summary Further high-quality studies of interventions to improve and support medication use in older adults are needed, ensuring that older adults are well represented in such trials and consideration is given to the measurement of patient- and provider-focused outcomes.
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Affiliation(s)
- Heather E Barry
- Primary Care Research Group, School of Pharmacy, Queen's University Belfast, Medical Biology Centre, 97 Lisburn Road, Belfast, BT9 7BL UK
| | - Carmel M Hughes
- Primary Care Research Group, School of Pharmacy, Queen's University Belfast, Medical Biology Centre, 97 Lisburn Road, Belfast, BT9 7BL UK
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Abstract
PURPOSE OF REVIEW The aim of this review was to summarize the recent literature on the clinical symptoms, functioning, outcomes and treatments for older adults with chronic schizophrenia. RECENT FINDINGS The number and proportion of older adults with schizophrenia is rapidly increasing. Schizophrenia is a heterogeneous disorder and older adults with schizophrenia display significant variability in symptom severity, quality of life and overall outcomes. Many achieve stable disease remission, some display persistent nonremission and others experience fluctuating symptoms. Depression is commonly reported, and although rates of suicide are higher when compared with age-matched peers, the excess mortality seen in this population is mainly attributed to natural causes of death. Cognitive decline and reduced illness awareness have important implications for functional status and quality of life. Antipsychotics remain essential in the treatment regimen, although elderly patients with chronic disease may be good candidates for gradual dose reduction. Interdisciplinary treatment approaches as well as nonpharmacologic psychosocial interventions play a critical adjunctive role in the treatment of older adults with schizophrenia. SUMMARY Research focusing on schizophrenia in late life is sparse. Too often, older patients are eliminated from research studies or averaged in with all age groups. Thus, there continues to be gaps in our understanding of modifiable predictors of remission and recovery, and the most efficacious and safest treatment approaches for this age group.
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Karapinar‐Çarkit F, van den Bemt PM, Sadik M, van Soest B, Knol W, van Hunsel F, van Riet‐Nales DA. Opportunities for changes in the drug product design to enhance medication safety in older people: Evaluation of a national public portal for medication incidents. Br J Clin Pharmacol 2020; 86:1946-1957. [PMID: 32473057 PMCID: PMC7495303 DOI: 10.1111/bcp.14392] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Revised: 04/23/2020] [Accepted: 04/30/2020] [Indexed: 12/12/2022] Open
Abstract
AIMS Medication safety requires urgent attention in hospital pharmacy. This study evaluated the medication-related problems/errors as reported to the Dutch medication incident registry and disseminated for information to pharmacists. Through analysis by an expert panel we aimed to better understand which problems could have been mitigated by the drug product design. Additionally, the (wider) implications of the problems for current hospital/clinical practice were discussed. METHODS Items were extracted from the public Portal for Patient Safety. Items were included if relevant for older people and connected with the drug product design and excluded if they should reasonably have been intercepted by compliance to routine controls or well-known professional standards in pharmaceutical care. To explore any underreporting of well-known incidents, it was investigated if different medication-related problems could be observed in a regional hospital practise over a 1-month period. For 6 included items (cases), the implications for hospital/clinical practise were discussed in an expert panel. RESULTS In total, 307 items were identified in the Portal for Patient Safety; all but 14 were excluded. Six cases were added from daily hospital practice. These 20 cases commonly related to confusing product characteristics, packaging issues such as the lack of a single unit package for an oncolytic product, or incorrect or incomplete user instructions. CONCLUSION Medication registries provide important opportunities to evaluate real-world medication-related problems. However, underreporting of well-known problems should be considered. The product design can be used as an (additional) risk mitigation measure to support medication safety in hospital practice.
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Affiliation(s)
| | | | - Mariam Sadik
- Department of Clinical PharmacyOLVG hospitalAmsterdamThe Netherlands
| | - Brigit van Soest
- Royal Pharmaceutical Society in the Netherlands (KNMP)The HagueThe Netherlands
| | - Wilma Knol
- Department of Geriatric Medicine and Expertise Centre Pharmacotherapy in Old Persons (EPHOR)University Medical Centre UtrechtThe Netherlands
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Drenth‐van Maanen AC, Wilting I, Jansen PAF. Prescribing medicines to older people-How to consider the impact of ageing on human organ and body functions. Br J Clin Pharmacol 2020; 86:1921-1930. [PMID: 31425638 PMCID: PMC7495267 DOI: 10.1111/bcp.14094] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2019] [Revised: 07/08/2019] [Accepted: 07/19/2019] [Indexed: 12/25/2022] Open
Abstract
Ageing is associated with several changes in human organs, which result in altered medication pharmacokinetics and pharmacodynamics. Ageing is also associated with changes in human body functions, such as impaired vision, hearing, swallowing, motor and cognitive functions, which can affect the adequate intake and administration of drugs. As a consequence, older people, and especially patients older than 75 years, are the main users of many drugs and they frequently use 5 drugs or more long-term (i.e. polypharmacy). All this increases the complexity of adequate drug intake, administration and adherence. However, there is a lack of evidence on the considerations that should be taken into account to ensure appropriate drug prescribing to older people. This review article summarizes the most clinically relevant changes in human organ and body functions and the consequential changes in pharmacokinetics and pharmacodynamics in older people, along with possible dosing consequences or alternatives for drugs frequently prescribed to this patient population. Recommendations are given on how ageing could be considered in clinical drug development, drug authorization and appropriate prescribing.
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Affiliation(s)
- A. Clara Drenth‐van Maanen
- Geriatric DepartmentUniversity Medical Center UtrechtThe Netherlands
- Expertise Centre Pharmacotherapy in Old Persons (Ephor), The Netherlands
| | - Ingeborg Wilting
- Department of Clinical PharmacyUniversity Medical Center Utrecht, The Netherlands
| | - Paul A. F. Jansen
- Geriatric DepartmentUniversity Medical Center UtrechtThe Netherlands
- Expertise Centre Pharmacotherapy in Old Persons (Ephor), The Netherlands
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47
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Stegemann S, van Riet-Nales D, de Boer A. Demographics in the 2020s-Longevity as a challenge for pharmaceutical drug development, prescribing, dispensing, patient care and quality of life. Br J Clin Pharmacol 2020; 86:1899-1903. [PMID: 32939841 PMCID: PMC7495272 DOI: 10.1111/bcp.14511] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 08/03/2020] [Accepted: 08/05/2020] [Indexed: 12/28/2022] Open
Affiliation(s)
- Sven Stegemann
- Institute of Process and Particle Engineering, Graz University of Technology, Graz, Austria
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van Marum RJ. Underrepresentation of the elderly in clinical trials, time for action. Br J Clin Pharmacol 2020; 86:2014-2016. [PMID: 32909294 PMCID: PMC7495271 DOI: 10.1111/bcp.14539] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2020] [Revised: 04/02/2020] [Accepted: 04/07/2020] [Indexed: 12/21/2022] Open
Affiliation(s)
- Rob J van Marum
- Department of General Practice and Elderly Care Medicine, Amsterdam Public Health Research Institute, Amsterdam UMC, location VUmc, Amsterdam, The Netherlands.,Departments of Clinical Pharmacology and Geriatrics, Jeroen Bosch Hospital, 's-Hertogenbosch, the Netherlands.,Medicines Evaluation Board, Utrecht, the Netherlands
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Powell JR, Cook J, Wang Y, Peck R, Weiner D. Drug Dosing Recommendations for All Patients: A Roadmap for Change. Clin Pharmacol Ther 2020; 109:65-72. [PMID: 32453862 PMCID: PMC7818440 DOI: 10.1002/cpt.1923] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Accepted: 05/15/2020] [Indexed: 12/16/2022]
Abstract
Most drug labels do not contain dosing recommendations for a significant portion of real‐world patients for whom the drug is prescribed. Current label recommendations predominately reflect the population studied in pivotal trials that typically exclude patients who are very young or old, emaciated or morbidly obese, pregnant, or have multiple characteristics likely to influence dosing. As a result, physicians may need to guess the correct dose and regimen for these patients. It is now feasible to provide dose and regimen recommendations for these patients by integrating available scientific knowledge and by utilizing or modifying current regulatory agency‐industry practices. The purpose of this commentary is to explore several factors that should be considered in creating a process that will provide more effective, safe, and timely drug dosing recommendations for most, if not all, patients. These factors include the availability of real‐world data, development of predictive models, experience with the US Food and Drug Administration (FDA)’s pediatric exclusivity program, development of clinical decision software, funding mechanisms like the Prescription Drug Users Fee Act (PDUFA), and harmonization of global regulatory policies. From an examination of these factors, we recommend a relatively simple, efficient expansion of current practices designed to predict, confirm, and continuously improve drug dosing for more patients. We believe implementing these recommendations will benefit patients, payers, industry, and regulatory agencies.
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Affiliation(s)
- J Robert Powell
- Clinical Pharmacology Consultant, Chapel Hill, North Carolina, USA
| | - Jack Cook
- Clinical Pharmacology, Pfizer Inc, Groton, Connecticut, USA
| | - Yaning Wang
- Office of Clinical Pharmacology, Office of Translational Sciences, US Food and Drug Administration, Silver Spring, Maryland, USA
| | - Richard Peck
- Roche Innovation Center Basel, Pharma Research & Early Development (pRED), Basel, Switzerland
| | - Dan Weiner
- Pharmacometrics Consultant, Chapel Hill, North Carolina, USA
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50
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Threapleton CJD, Kimpton JE, Carey IM, DeWilde S, Cook DG, Harris T, Baker EH. Development of a structured clinical pharmacology review for specialist support for management of complex polypharmacy in primary care. Br J Clin Pharmacol 2020; 86:1326-1335. [PMID: 32058606 DOI: 10.1111/bcp.14243] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Revised: 12/10/2019] [Accepted: 01/04/2020] [Indexed: 12/13/2022] Open
Abstract
AIMS Polypharmacy is widespread and associated with medication-related harms, including adverse drug reactions, medication errors and poor treatment adherence. General practitioners and pharmacists cite limited time and training to perform effective medication reviews for patients with complex polypharmacy, yet no specialist referral mechanism exists. To develop a structured framework for specialist review of primary care patients with complex polypharmacy. METHODS We developed the clinical pharmacology structured review (CPSR) and stopping by indication tool (SBIT). We tested these in an age-sex stratified sample of 100 people with polypharmacy aged 65-84 years from the Clinical Practice Research Datalink, an anonymised primary care database. Simulated medication reviews based on electronic records using the CPSR and SBIT were performed. We recommended medication changes or review to optimise treatment benefits, reduce risk of harm or reduce treatment burden. RESULTS Recommendations were made for all patients, for almost half (4.8 ± 2.4) of existing medicines (9.8 ± 3.1), most commonly stopping a drug (1.7 ± 1.3/patient) or reviewing with the patient (1.4 ± 1.2/patient). At least 1 new medicine (0.7 ± 0.9) was recommended for 51% patients. Recommendations predominantly aimed to reduce harm (44%). There was no relationship between number of recommendations made and time since last primary care medication review. We identified a core set of clinical information and investigations (polypharmacy workup) that could inform a standard screen prior to specialist review. CONCLUSION The CPSR, SBIT and polypharmacy workup could form the basis of a specialist review for patients with complex polypharmacy. Further research is needed to test this approach in patients in general practice.
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Affiliation(s)
- Christopher J D Threapleton
- Clinical Pharmacology, St George's University Hospitals NHS Foundation Trust, London, UK.,Clinical Pharmacology, Institute of Infection and Immunity, St George's, University of London, UK
| | - James E Kimpton
- Clinical Pharmacology, St George's University Hospitals NHS Foundation Trust, London, UK.,Clinical Pharmacology, Institute of Infection and Immunity, St George's, University of London, UK
| | - Iain M Carey
- Population Health Research Institute, St George's, University of London, UK
| | - Stephen DeWilde
- Population Health Research Institute, St George's, University of London, UK.,Lambton Road Medical Practice, London, UK
| | - Derek G Cook
- Population Health Research Institute, St George's, University of London, UK
| | - Tess Harris
- Population Health Research Institute, St George's, University of London, UK.,Sonning Common Health Centre, Oxfordshire, UK
| | - Emma H Baker
- Clinical Pharmacology, St George's University Hospitals NHS Foundation Trust, London, UK.,Clinical Pharmacology, Institute of Infection and Immunity, St George's, University of London, UK
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