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Hughes GA, Inacio MC, Rowett D, Lang C, Jorissen RN, Corlis M, Sluggett JK. National Trends in Antidepressant Use in Australian Residential Aged Care Facilities (2006-2019). J Am Med Dir Assoc 2024; 25:104957. [PMID: 38432647 DOI: 10.1016/j.jamda.2024.01.026] [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: 07/27/2023] [Revised: 01/25/2024] [Accepted: 01/31/2024] [Indexed: 03/05/2024]
Abstract
OBJECTIVES Antipsychotics have been the focus of reforms for improving the appropriateness of psychotropic medicine use in residential aged care facilities (RACFs). Comprehensive evaluation of antidepressant use in RACFs is required to inform policy and practice initiatives targeting psychotropic medicines. This study examined national trends in antidepressant use among older people living in RACFs from 2006 to 2019. DESIGN National repeated cross-sectional study. SETTING AND PARTICIPANTS Individuals aged 65 to 105 years who were permanent, long-term (≥100 days) residents of Australian RACFs between January 2006 and December 2019 were included. METHODS Annual age- and sex-adjusted antidepressant prevalence rates and defined daily doses (DDDs) supplied per 1000 resident-days from 2006 to 2019 were determined. Age- and sex-adjusted prevalence rate ratios (aRRs) and 95% confidence intervals (CIs) were estimated using Poisson and negative binomial regression models. RESULTS A total of 779,659 residents of 3371 RACFs were included (786,227,380 resident-days). Overall, antidepressant use increased from 46.1% (95% CI, 45.9-46.4) in 2006 to 58.5% (95% CI, 58.3-58.8) of residents in 2019 (aRR, 1.02; 95% CI, 1.02-1.02). Mirtazapine use increased from 8.4% (95% CI, 8.2-8.5) to 20.9% (95% CI, 20.7-21.1) from 2006 to 2019 (aRR, 1.07; 95% CI, 1.07-1.07). Antidepressant use increased from 350.3 (95% CI, 347.6-353.1) to 506.0 (95% CI, 502.8-509.3) DDDs/1000 resident-days (aRR, 1.03; 95% CI, 1.03-1.03), with mirtazapine utilization increasing by 6% annually (aRR, 1.06; 95% CI, 1.06-1.06). CONCLUSIONS AND IMPLICATIONS This nationwide study identified a substantial increase in antidepressant use among residents of Australian RACFs, largely driven by mirtazapine. With nearly 3 in every 5 residents treated with an antidepressant in 2019, findings highlight potential off-label use and suggest that interventions to optimize care are urgently needed.
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Affiliation(s)
- Georgina A Hughes
- University of South Australia, UniSA Clinical & Health Sciences, Adelaide, South Australia, Australia; Registry of Senior Australians, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia.
| | - Maria C Inacio
- Registry of Senior Australians, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia; University of South Australia, UniSA Allied Health and Human Performance, Adelaide, South Australia, Australia
| | - Debra Rowett
- University of South Australia, UniSA Clinical & Health Sciences, Adelaide, South Australia, Australia; Southern Adelaide Local Health Network, Drug and Therapeutics Information Service, Adelaide, South Australia, Australia
| | - Catherine Lang
- Registry of Senior Australians, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
| | - Robert N Jorissen
- Registry of Senior Australians, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia; University of South Australia, UniSA Allied Health and Human Performance, Adelaide, South Australia, Australia; Flinders University, College of Medicine and Public Health, Bedford Park, South Australia, Australia
| | - Megan Corlis
- Australian Nursing and Midwifery Federation SA Branch, Adelaide, South Australia, Australia
| | - Janet K Sluggett
- Registry of Senior Australians, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia; University of South Australia, UniSA Allied Health and Human Performance, Adelaide, South Australia, Australia
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Alam K, Hayat AH, Ullah A, Syed Sulaiman SA, Ahmad W, Ooi GS. The Prevalence and Impact of Clinical Pharmacists' Intervention on Drug-Related Problems in Patients With Chronic Kidney Disease. Cureus 2024; 16:e59402. [PMID: 38817515 PMCID: PMC11137644 DOI: 10.7759/cureus.59402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/30/2024] [Indexed: 06/01/2024] Open
Abstract
Chronic kidney disease (CKD) is a global health issue of growing concern. According to projections from the Worldwide Health Observatory, it is currently one of the rapidly increasing contributors to global mortality. The prevalence of CKD and end-stage renal disease (ESRD) is increasing globally. The objective was to evaluate the prevalence and impact of clinical pharmacist intervention in resolving drug-related problems (DRPs) among patients with CKD. A single-arm, pre- and post-intervention study design was used, which was assessed to be suitable in testing for the feasibility of the implementation of an intervention in clinical practice. With this study pre- and post-intervention variables of interest were measured before and after an intervention in the same patients to evaluate the impact of clinical pharmacists on ambulatory patients with CKD. The findings of this study indicate a high prevalence of DRPs, with every patient experiencing at least one DRP. The mean DRP per patient was found to be 2.903 with STD ± 1.148. The study assessed the considerable influence of clinical pharmacist intervention on DRPs. The predominant form of DRP was drug interaction 167 (45.1%) which was reduced to 76 (20.5%) after intervention carried out by clinical pharmacists statistically significant (p = 0.032). Another common DRP was found to be poor compliance issues in pre-interventions (n = 144 (38.9%)) and was reduced to 80 (21.6%) at post-intervention significantly (p = 0.042). Untreated indications were noticed in 137 cases (37.0%), after pharmacist intervention, this number was significantly reduced to 27 cases (7.3%), with a statistically significant difference (p = 0.004). However, it is noteworthy that medication compliance among patients in our study was unsatisfactory and fell below expectations. As a clinical pharmacist played an important role in reducing the prevalence of poor medication adherence to lower levels in these CKD outpatients. This research emphasizes the vital role of clinical pharmacists in mitigating DRPs among CKD patients, resulting in improved medication management and potentially better health outcomes.
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Affiliation(s)
- Khurshid Alam
- Clinical Pharmacy, Universiti Sains Malaysia, Gelugor, MYS
| | - Amer H Hayat
- Clinical Pharmacy, Universiti Sains Malaysia, Gelugor, MYS
| | - Amir Ullah
- Nephrology, District Head Quarter (DHQ) Hospital Medical Teaching Institution (MTI) Bannu, Bannu, PAK
| | | | - Waqas Ahmad
- Pharmaceutical Chemistry, Universiti Sains Malaysia, Gelugor, MYS
| | - Guat See Ooi
- Pharmacy, Universiti Sains Malaysia, Gelugor, MYS
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Ayre MJ, Lewis PJ, Keers RN. Understanding the medication safety challenges for patients with mental illness in primary care: a scoping review. BMC Psychiatry 2023; 23:417. [PMID: 37308835 DOI: 10.1186/s12888-023-04850-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 05/06/2023] [Indexed: 06/14/2023] Open
Abstract
BACKGROUND Mental illness and medication safety are key priorities for healthcare systems around the world. Despite most patients with mental illness being treated exclusively in primary care, our understanding of medication safety challenges in this setting is fragmented. METHOD Six electronic databases were searched between January 2000-January 2023. Google Scholar and reference lists of relevant/included studies were also screened for studies. Included studies reported data on epidemiology, aetiology, or interventions related to medication safety for patients with mental illness in primary care. Medication safety challenges were defined using the drug-related problems (DRPs) categorisation. RESULTS Seventy-nine studies were included with 77 (97.5%) reporting on epidemiology, 25 (31.6%) on aetiology, and 18 (22.8%) evaluated an intervention. Studies most commonly (33/79, 41.8%) originated from the United States of America (USA) with the most investigated DRP being non-adherence (62/79, 78.5%). General practice was the most common study setting (31/79, 39.2%) and patients with depression were a common focus (48/79, 60.8%). Aetiological data was presented as either causal (15/25, 60.0%) or as risk factors (10/25, 40.0%). Prescriber-related risk factors/causes were reported in 8/25 (32.0%) studies and patient-related risk factors/causes in 23/25 (92.0%) studies. Interventions to improve adherence rates (11/18, 61.1%) were the most evaluated. Specialist pharmacists provided the majority of interventions (10/18, 55.6%) with eight of these studies involving a medication review/monitoring service. All 18 interventions reported positive improvements on some medication safety outcomes but 6/18 reported little difference between groups for certain medication safety measures. CONCLUSION Patients with mental illness are at risk of a variety of DRPs in primary care. However, to date, available research exploring DRPs has focused attention on non-adherence and potential prescribing safety issues in older patients with dementia. Our findings highlight the need for further research on the causes of preventable medication incidents and targeted interventions to improve medication safety for patients with mental illness in primary care.
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Affiliation(s)
- Matthew J Ayre
- Division of Pharmacy and Optometry, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK.
| | - Penny J Lewis
- Division of Pharmacy and Optometry, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
- NIHR Greater Manchester Patient Safety Translational Research Centre, Academic Health Science Centre (MAHSC), The University of Manchester, Manchester, UK
- Manchester University NHS Foundation Trust, Manchester, UK
| | - Richard N Keers
- Division of Pharmacy and Optometry, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
- NIHR Greater Manchester Patient Safety Translational Research Centre, Academic Health Science Centre (MAHSC), The University of Manchester, Manchester, UK
- Suicide, Risk and Safety Research Unit, Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
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Nalls V, Galik E, Klinedinst NJ, Barr E, Brandt N, Lerner N, Resnick B. Racial Differences in Antidepressant Use in Nursing Facility Residents With Moderate to Severe Cognitive Impairment. Sr Care Pharm 2022; 37:448-457. [PMID: 36039002 DOI: 10.4140/tcp.n.2022.448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Objective To describe and compare the use of antidepressants between Black or African descent and White nursing facility residents with moderate to severe cognitive impairment. Design This was a secondary data analysis using baseline data from the Function and Behavior Focused Care for Nursing Facility Residents with Dementia randomized control trial. Setting Participants were recruited from 10 urban and two rural nursing facilities from Maryland. Methods Participants had to be 55 years of age or older, English-speaking, reside in long-term care at time of recruitment, and score a 15 or less on the Mini Mental-State Examination. A total of 336 residents participated at baseline. Data were collected by a research evaluator through observation, proxy report from staff caring for the resident the day of testing, and patient charts. Main Outcomes A significant difference of antidepressant use between Black or African descent and White nursing facility residents with moderate to severe cognitive impairment would be noted when controlling for depression, age, gender, functional status, agitation, and number of co-morbidities. Results In adjusted models, Black or African descent residents were less likely to be prescribed antidepressants compared with White residents. Conclusion Racial differences were noted regarding antidepressant use among nursing facility residents with moderate to severe cognitive impairment, but it is unknown if race could impact prescribing practices when indications for use are known. Further research is needed to ascertain if knowing the specific indications for use might contribute to racial disparities with antidepressant prescribing in nursing facility residents with moderate to severe cognitive impairment.
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Affiliation(s)
- Victoria Nalls
- 1 School of Nursing, University of Maryland, Baltimore, Maryland
| | - Elizabeth Galik
- 1 School of Nursing, University of Maryland, Baltimore, Maryland
| | | | - Erik Barr
- 1 School of Nursing, University of Maryland, Baltimore, Maryland
| | - Nicole Brandt
- 2 School of Pharmacy, University of Maryland, Baltimore, Maryland
| | - Nancy Lerner
- 1 School of Nursing, University of Maryland, Baltimore, Maryland
| | - Barbara Resnick
- 1 School of Nursing, University of Maryland, Baltimore, Maryland
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Prevalence, progress, and subgroup disparities in pharmacological antidepressant treatment of those who screen positive for depressive symptoms: A repetitive cross-sectional study in 19 European countries. Lancet Reg Health Eur 2022; 17:100368. [PMID: 35373171 PMCID: PMC8969158 DOI: 10.1016/j.lanepe.2022.100368] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Background The European Mental Health Action Plan (EMHAP) 2013–2020 promoted community-based mental health services. One potential success indicator is the provision of antidepressant medication to those needing it. Methods Public data from two surveys (Health Survey for England, UK; Survey of Health, Ageing and Retirement in Europe) covered 19 European countries across EMHAP phases one (2011–2015) and two (2015–2018). People screening positive for depressive symptoms by self-report were included. The primary outcome was antidepressant use: using country-specific weighted regression models, we estimated temporal trends and subgroup disparities in antidepressant receipt, with secondary analysis by country-level measures including healthcare expenditure. Findings Across 37,250 participants, after controlling for age, sex, wealth, and physical disability, antidepressant use (amongst those screening positive) increased significantly in 14/19 countries, with the smallest increase being in Slovenia (adjusted OR[AOR] for trend=1.68[1.20–2.36]) and the highest increase being in Germany (AOR for trend=10.07[7.54–13.46]) and Austria (AOR for trend=10.07[7.32–13.74]). The overall proportion using antidepressants was positively associated with national health expenditure (coefficient=5.43[1.62–9.25]), but not with gross national income per capita or the number of psychiatrists, general practitioners, or psychiatric hospital beds. In 15/19 countries, antidepressants were used less by ≥65-year-olds than 50–64-year-olds, with the smallest differential reported in Luxembourg (AOR=0.70[0.49, 0.98]) and the highest in Germany (AOR=0.28[0.21, 0.37]); this disparity widened in 12/15 countries. Men used antidepressants less than women in 8/19 countries, across phases. In 13/19 countries, people with physical disability were more likely to receive antidepressants, with the smallest gap in Italy (AOR=1.42[1.12–1.80]) and the largest in Israel (AOR=2.34[1.46–3.74]); this disparity narrowed in 5/13 countries. Disparity by wealth was found in 8/19 countries, but its temporal trend varied. Interpretation Usage of antidepressants by those with depressive symptoms has increased, with wide variation between countries and subgroups. Disparities across age, sex, and disability should prompt further research. Funding Medical Research Council (grants MC_PC_17213 and MR/W014386/1), UK National Institute for Health Research (NIHR) Applied Research Collaboration (ARC) East of England, NIHR Cambridge Biomedical Research Centre (BRC-1215-20014).
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O’Sullivan JL, Schweighart R, Lech S, Kessler EM, Tegeler C, Teti A, Nordheim J, Gellert P. Concordance of self- and informant-rated depressive symptoms in nursing home residents with Dementia: cross-sectional findings. BMC Psychiatry 2022; 22:241. [PMID: 35382790 PMCID: PMC8981933 DOI: 10.1186/s12888-022-03876-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 03/22/2022] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Depression is highly prevalent in nursing home residents living with moderate to severe dementia. However, assessing depressive symptoms in residents with dementia can be challenging and may vary by rater perspective. We aimed to investigate the concordance of, and factors associated with self- and informant-rated depressive symptoms in nursing home residents with dementia. METHODS Cross-sectional data was collected from N = 162 nursing home residents with dementia (age: 53-100; 74% women). Self-ratings were assessed with the Geriatric Depression Scale, while the depression and anxiety items of the Neuropsychiatric Inventory were used for informant-ratings. Cohen's Kappa was calculated to determine the concordance of both measures and of each with antidepressant medication. Multivariate associations with sociodemographic variables, self- and informant-rated quality of life, dementia stage, neuropsychiatric symptoms, functional status and antidepressant medication were analysed with linear mixed models and generalized estimating equations. RESULTS Concordance between self- and single item informant-rated depressive symptoms was minimal (Cohen's Kappa = .22, p = .02). No concordance was found for self-reported depressive symptoms and the combined informant-rated depression-anxiety score. Self-reported depression was negatively associated with self-rated quality of life (β = -.32; 95%CI: -.45 to -.19, p < .001), informant-rated quality of life (β = -.25; 95%CI: -.43 to -.07, p = .005) and functional status (β = -.16; 95%CI: -.32 to -.01, p = .04), whilst single item informant-rated depression revealed negative associations with informant-rated quality of life (β = -.32; 95%CI: -.52 to -.13, p = .001) and dementia stage (β = -.31; 95%CI: -.52 to -.10, p = .004). The combined informant-rated depression-anxiety score showed negative associations with self-rated quality of life (β = -.12; 95%CI: -.22 to -.03, p = .01) and dementia stage (β = -.37; 95%CI: -.67 to -.07, p = .02) and a positive association with neuropsychiatric symptoms (β = .30; 95%CI: .10 to .51, p = .004). No concordance was found with antidepressant medication. CONCLUSIONS In line with our expectations, low agreement and unique association patterns were found for both measures. These findings indicate that both instruments address different aspects of depression und underline the need for comprehensive approaches when it comes to detecting signs of clinically relevant depressive symptoms in dementia. TRIAL REGISTRATION The trial was registered with the ISRCTN registry (Trial registration number: ISRCTN98947160 ).
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Affiliation(s)
- Julie L. O’Sullivan
- grid.6363.00000 0001 2218 4662Institute for Medical Sociology and Rehabilitation Science, Charité Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117 Berlin, Germany
| | - Roxana Schweighart
- grid.449789.f0000 0001 0742 8825Institute for Gerontology, University Vechta, Driverstraße 2, 49377 Vechta, Germany
| | - Sonia Lech
- grid.6363.00000 0001 2218 4662Institute for Medical Sociology and Rehabilitation Science, Charité Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117 Berlin, Germany ,grid.7468.d0000 0001 2248 7639Department of Psychiatry and Psychotherapy, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universitätzu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117 Berlin, Germany
| | - Eva-Marie Kessler
- grid.466457.20000 0004 1794 7698Department of Psychology, MSB Medical School Berlin, Rüdesheimer Str. 50, 14197 Berlin, Germany
| | - Christina Tegeler
- grid.466457.20000 0004 1794 7698Department of Psychology, MSB Medical School Berlin, Rüdesheimer Str. 50, 14197 Berlin, Germany
| | - Andrea Teti
- grid.449789.f0000 0001 0742 8825Institute for Gerontology, University Vechta, Driverstraße 2, 49377 Vechta, Germany
| | - Johanna Nordheim
- grid.6363.00000 0001 2218 4662Institute for Medical Sociology and Rehabilitation Science, Charité Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117 Berlin, Germany
| | - Paul Gellert
- grid.6363.00000 0001 2218 4662Institute for Medical Sociology and Rehabilitation Science, Charité Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117 Berlin, Germany
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Poon EL, Lim HJ, Hollingworth SA, van Driel ML, Pache DM, Moses GM, McGuire TM. Patient concerns regarding antidepressant drug–drug interactions: a retrospective analysis using data from a medicines call centre. J Prim Health Care 2022; 14:99-108. [DOI: 10.1071/hc21150] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2021] [Accepted: 03/04/2022] [Indexed: 11/23/2022] Open
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Anticholinergic Use Among the Elderly With Alzheimer Disease in South Korea: A Population-based Study. Alzheimer Dis Assoc Disord 2021; 34:238-243. [PMID: 31913963 DOI: 10.1097/wad.0000000000000370] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVES To investigate the characteristics of anticholinergic use in the elderly with Alzheimer disease (AD) compared with those in the non-AD elderly. METHODS Using the Korean National Health Insurance Service Elderly cohort database, 388,629 adults aged 70 years and older in 2012 were included. The use of strong anticholinergic agents (ACs) in 2012 was quantified by standardized prescribed doses. Univariate and multivariate logistic regression models were applied to examine the level of their heavy use (≥90 doses of the prescribed amount in 2012) in patients with AD and potential explanations of the heavy use. RESULTS Antihistamines and antidepressants were the most prescribed strong ACs among non-AD and AD elderly, respectively. The heavy use of strong ACs was more prevalent in patients with AD than in non-AD elderly [odds ratio (95% confidence interval)=1.48 (1.41-1.56)]. When the morbidities associated with AD were adjusted for, odds ratio were reduced [0.91 (0.85-0.96)]. CONCLUSIONS Heavy use of strong ACs was more prevalent in patients with AD than in non-AD elderly. Multiple ACs for treating multimorbidities in AD were mainly attributable to their heavy use. In patients with AD, the integrated management of medications for reducing the preventable heavy use of these drugs should be reinforced.
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Bories M, Bouzillé G, Cuggia M, Le Corre P. Drug-Drug Interactions in Elderly Patients with Potentially Inappropriate Medications in Primary Care, Nursing Home and Hospital Settings: A Systematic Review and a Preliminary Study. Pharmaceutics 2021; 13:pharmaceutics13020266. [PMID: 33669162 PMCID: PMC7919637 DOI: 10.3390/pharmaceutics13020266] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 02/08/2021] [Accepted: 02/11/2021] [Indexed: 01/18/2023] Open
Abstract
Drug–drug interactions (DDI) occurring with potentially inappropriate medications (PIM) are additional risk factors that may increase the inappropriate character of PIM. The aim of this study was (1) to describe the prevalence and severity of DDI in patients with PIM and (2) to evaluate the DDI specifically regarding PIM. This systematic review is based on a search carried out on PubMed and Web-of-Science from inception to June 30, 2020. We extracted data of original studies that assessed the prevalence of both DDI and PIM in elderly patients in primary care, nursing home and hospital settings. Four hundred and forty unique studies were identified: 91 were included in the qualitative analysis and 66 were included in the quantitative analysis. The prevalence of PIM in primary care, nursing home and hospital were 19.1% (95% confidence intervals (CI): 15.1–23.0%), 29.7% (95% CI: 27.8–31.6%) and 44.6% (95% CI: 28.3–60.9%), respectively. Clinically significant severe risk-rated DDI averaged 28.9% (95% CI: 17.2–40.6), in a hospital setting; and were approximately 7-to-9 lower in primary care and nursing home, respectively. Surprisingly, only four of these studies investigated DDI involving specifically PIM. Hence, given the high prevalence of severe DDI in patients with PIM, further investigations should be carried out on DDI involving specifically PIM which may increase their inappropriate character, and the risk of adverse drug reactions.
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Affiliation(s)
- Mathilde Bories
- Pôle Pharmacie, Service Hospitalo-Universitaire de Pharmacie, CHU de Rennes, 35033 Rennes, France;
- Univ Rennes, CHU Rennes, INSERM, LTSI-UMR 1099, F-35000 Rennes, France; (G.B.); (M.C.)
- Laboratoire de Biopharmacie et Pharmacie Clinique, Faculté de Pharmacie, Université de Rennes 1, 35043 Rennes, France
| | - Guillaume Bouzillé
- Univ Rennes, CHU Rennes, INSERM, LTSI-UMR 1099, F-35000 Rennes, France; (G.B.); (M.C.)
| | - Marc Cuggia
- Univ Rennes, CHU Rennes, INSERM, LTSI-UMR 1099, F-35000 Rennes, France; (G.B.); (M.C.)
| | - Pascal Le Corre
- Pôle Pharmacie, Service Hospitalo-Universitaire de Pharmacie, CHU de Rennes, 35033 Rennes, France;
- Laboratoire de Biopharmacie et Pharmacie Clinique, Faculté de Pharmacie, Université de Rennes 1, 35043 Rennes, France
- Univ Rennes, CHU Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail)-UMR_S 1085, F-35000 Rennes, France
- Correspondence:
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Levine AMP, Emonds EE, Smith MA, Rickles NM, Kuchel GA, Steffens DC, Ohlheiser A, Fortinsky RH. Pharmacist Identification of Medication Therapy Problems Involving Cognition Among Older Adults Followed by a Home-Based Care Team. Drugs Aging 2020; 38:157-168. [PMID: 33354755 DOI: 10.1007/s40266-020-00821-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/09/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND Dementia, depression, and delirium alone or in combination (3Ds) can threaten independence among older adults, and polypharmacy may further accelerate decline. Clinical pharmacists can play an important role on multidisciplinary home-based care teams by identifying medication therapy problems (MTPs) involving cognition. Within a larger ongoing clinical trial, this paper describes cognition-related MTPs and pharmacist recommendations among older adults with 3Ds followed by a home-based care team. METHODS We conducted a retrospective analysis of medication data among Medicare Advantage members aged ≥ 65 years living at home in Connecticut with International Statistical Classification of Diseases and Related Health Problems, 10th Revision codes related to 3Ds; analyses include the first 105 subjects randomized to the home-based care team from March 2017 to January 2019. Advanced practice registered nurses conducted in-home medication reconciliations along with medical and cognitive assessments. Clinical pharmacists then conducted medication reviews centered on agents treating or exacerbating 3Ds. After review by the study advanced practice registered nurse, geriatrician, and psychiatrist, salient recommendations were forwarded to primary care providers for consideration. Medication therapy problems related to cognition were retrospectively abstracted and classified as: (1) indication: underuse or overuse; (2) effectiveness: ineffective agent or low dose (mainly for antidepressants); and (3) safety: undesirable effect (e.g., impaired cognition, dementia treatment side effects), unsafe medication (e.g., potentially inappropriate medications that can harm cognition), drug interaction, or high dose. RESULTS Pharmacists identified 166 cognitive MTPs, with a mean (standard deviation) of 1.58 (1.35) [range 0-6] MTPs per subject. Indication MTPs represented 34% of total MTPs, of which 79% involved underuse and 21% overuse; effectiveness represented 13% of total MTPs; and safety represented over half (52%) of all MTPs, with benzodiazepines and anticholinergics frequently implicated. Recommendations commonly included medication reduction (discontinuation 23% and dose reduction 19%). We found MTPs involving cognition among most (79%) patients. CONCLUSIONS Our study findings support the role of pharmacists on multidisciplinary teams to identify cognitively harmful medications, dementia treatment side effects, and untreated cognitive conditions. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov NCT02945085.
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Affiliation(s)
- Allison M P Levine
- Center on Aging, UConn Health, 263 Farmington Avenue, Farmington, CT, 06030, USA.
| | - Erin E Emonds
- PGY1 Pharmacy Practice Residency Program, UConn Health, Farmington, CT, USA
| | - Marie A Smith
- Center on Aging, UConn Health, 263 Farmington Avenue, Farmington, CT, 06030, USA.,Department of Pharmacy Practice, School of Pharmacy, University of Connecticut, Storrs, CT, USA
| | - Nathaniel M Rickles
- Department of Pharmacy Practice, School of Pharmacy, University of Connecticut, Storrs, CT, USA
| | - George A Kuchel
- Center on Aging, UConn Health, 263 Farmington Avenue, Farmington, CT, 06030, USA
| | - David C Steffens
- Department of Psychiatry, University of Connecticut School of Medicine, Farmington, CT, USA
| | - Alis Ohlheiser
- Center on Aging, UConn Health, 263 Farmington Avenue, Farmington, CT, 06030, USA
| | - Richard H Fortinsky
- Center on Aging, UConn Health, 263 Farmington Avenue, Farmington, CT, 06030, USA
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Antidepressants and the Risk of Cardiovascular Events in Elderly Affected by Cardiovascular Disease: A Real-Life Investigation From Italy. J Clin Psychopharmacol 2020; 40:112-121. [PMID: 32134848 DOI: 10.1097/jcp.0000000000001189] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
PURPOSE The purpose of this study was to assess the possible relation between use of antidepressant (AD) drugs, that is, tricyclic ADs, selective serotonin reuptake inhibitors (SSRIs), and atypical ADs (AAs), and the risk of hospitalization for cardiovascular (CV) events among older patients with previous CV diseases. METHODS A nested case-control study was carried out among patients aged 65 years and older from 5 Italian health care territorial units who were discharged for CV disease during 2008 to 2010. The cohort was composed by 344,747 individuals, and of these, 97,739 (28%) experienced hospital admission for CV events (myocardial infarction, arrhythmia, stroke, heart failure) during follow-up (until 2014) and were included as cases. Up to 5 controls were randomly selected and matched to each. A conditional logistic regression was fitted to estimate the risk of CV events associated with ADs past or current use. A within-patient comparison was performed by the case-crossover design to account the effect of depression. FINDINGS Current users of SSRIs and AAs were at increased risk of CV events with odds ratios of 1.25 (95% confidence interval, 1.21-1.29) and 1.31 (1.25-1.37), respectively. An increased risk of arrhythmia and stroke was associated with current use of SSRIs and AAs, whereas an increased risk of heart failure was detected with current use of any ADs. The results were confirmed by the case-crossover approach. IMPLICATIONS Evidence that AD use is associated with an increased risk of CV events in accordance with specific mechanisms of action among older people with CV disease was added by this study.
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Shah T, Deolanker J, Luu T, Sadeghi-Nejad H. Pretreatment screening and counseling on prolonged erections for patients prescribed trazodone. Investig Clin Urol 2020; 62:85-89. [PMID: 33314808 PMCID: PMC7801163 DOI: 10.4111/icu.20200195] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 06/22/2020] [Accepted: 09/02/2020] [Indexed: 11/18/2022] Open
Abstract
Purpose We examined whether patients are appropriately screened for previous prolonged erections or priapism and counseled about trazodone complications, specifically prolonged erections and priapism, prior to trazodone treatment. Materials and Methods We identified patients under the age of 50 on trazodone as of February 27, 2019 at the VA New Jersey Health Care System. Patients were asked about information provided to them prior to medication initiation, occurrence of prolonged erections/priapism, and reporting rate of side effects. Results Two hundred and twenty nine out of five hundred and twenty four male patients agreed to participate in the study. Forty three out of two hundred and twenty nine of patients were informed about the side effects of prolonged erections and 37/229 of patients were informed of risk of priapism prior to treatment. Only 17/229 of patients were asked if they had had any episodes of prolonged erection or priapism in the past. Eighteen patients developed prolonged erection while taking trazodone. Only 5/18 patients who had developed prolonged erections informed their physicians. Conclusions Only a fraction of patients were properly screened for previous prolonged erections or priapism and properly informed about the side effects of trazodone. Urologist should better educate trazodone prescribers, such as family medicine and psychiatric colleagues, regarding the side effects of trazodone. It is imperative that prescribing physicians appropriately screen and educate patients prior to trazodone initiation and instruct patients to report any treatment side effects to avoid potential long-term adverse outcomes.
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Affiliation(s)
- Tejash Shah
- Department of Urology, Rutgers New Jersey Medical School, NJ, USA.
| | - Juhi Deolanker
- Department of Urology, Rutgers New Jersey Medical School, NJ, USA
| | - Thaiphi Luu
- Department of Urology, Rutgers New Jersey Medical School, NJ, USA
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Gallant NL, Peckham A, Marchildon G, Hadjistavropoulos T, Roblin B, Stopyn RJN. Provincial legislative and regulatory standards for pain assessment and management in long-term care homes: a scoping review and in-depth case analysis. BMC Geriatr 2020; 20:458. [PMID: 33167897 PMCID: PMC7650170 DOI: 10.1186/s12877-020-01758-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Accepted: 09/08/2020] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Among Canadian residents living in long-term care (LTC) facilities, and especially among those with limited ability to communicate due to dementia, pain remains underassessed and undermanaged. Although evidence-based clinical guidelines for the assessment and management of pain exist, these clinical guidelines are not widely implemented in LTC facilities. A relatively unexplored avenue for change is the influence that statutes and regulations could exert on pain practices within LTC. This review is therefore aimed at identifying the current landscape of policy levers used across Canada to assess and manage pain among LTC residents and to evaluate the extent to which they are concordant with evidence-based clinical guidelines proposed by an international consensus group consisting of both geriatric pain and public policy experts. METHODS Using scoping review methodology, a search for peer-reviewed journal articles and government documents pertaining to pain in Canadian LTC facilities was carried out. This scoping review was complemented by an in-depth case analysis of Alberta, Saskatchewan, and Ontario statutes and regulations. RESULTS Across provinces, pain was highly prevalent and was associated with adverse consequences among LTC residents. The considerable benefits of using a standardized pain assessment protocol, along with the barriers in implementing such a protocol, were identified. For most provinces, pain assessment and management in LTC residents was not specifically addressed in their statutes or regulations. In Alberta, Saskatchewan, and Ontario, regulations mandate the use of the interRAI suite of assessment tools for the assessment and reporting of pain. CONCLUSION The prevalence of pain and the benefits of implementing standardized pain assessment protocols has been reported in the research literature. Despite occasional references to pain, however, existing regulations do not recommend assessments of pain at the frequency specified by experts. Insufficient direction on the use of specialized pain assessment tools (especially in the case of those with limited ability to communicate) that minimize reliance on subjective judgements was also identified in current regulations. Existing policies therefore fail to adequately address the underassessment and undermanagement of pain in older adults residing in LTC facilities in ways that are aligned with expert consensus.
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Affiliation(s)
- Natasha L. Gallant
- Department of Psychology and Center on Aging and Health, University of Regina, 3737 Wascana Parkway, Regina, Saskatchewan S4S 0A2 Canada
| | - Allie Peckham
- Edson College of Nursing and Health Innovation, Arizona State University, 550 N 3rd Street, Phoenix, AZ 85004 USA
- Institute of Health Policy, Management and Evaluation, University of Toronto, 425–155 College Street, Toronto, Ontario M5T 3M6 Canada
| | - Gregory Marchildon
- Institute of Health Policy, Management and Evaluation, University of Toronto, 425–155 College Street, Toronto, Ontario M5T 3M6 Canada
| | - Thomas Hadjistavropoulos
- Department of Psychology and Center on Aging and Health, University of Regina, 3737 Wascana Parkway, Regina, Saskatchewan S4S 0A2 Canada
| | - Blair Roblin
- Institute of Health Policy, Management and Evaluation, University of Toronto, 425–155 College Street, Toronto, Ontario M5T 3M6 Canada
| | - Rhonda J. N. Stopyn
- Department of Psychology and Center on Aging and Health, University of Regina, 3737 Wascana Parkway, Regina, Saskatchewan S4S 0A2 Canada
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Schäfer W, Reinders T, Riedel O, Haug U. How often are antidepressants prescribed off-label among older adults in Germany? A claims data analysis. Br J Clin Pharmacol 2020; 87:1778-1789. [PMID: 32986874 DOI: 10.1111/bcp.14564] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 09/01/2020] [Accepted: 09/13/2020] [Indexed: 11/29/2022] Open
Abstract
AIM To estimate the extent of off-label prescribing of antidepressants in older adults and to characterize patients with off-label vs on-label prescriptions of antidepressants using a large German health claims database. METHODS Using data from the German Pharmacoepidemiological Research Database (GePaRD), we conducted a cross-sectional study in adults aged 65 years or older with a dispensation of an antidepressant between 1 January 2009 and 31 December 2015 after a period of 365 days without such a dispensation. We assessed the overall and annual proportion of off-label prescriptions of antidepressants by class and individual substance. RESULTS Among 263 276 incident users of antidepressants, the proportion of off-label prescribing was 43.6% (95% CI 43.4-43.8%) with little variation between 2009 and 2015 (42.2-44.4%). The proportion of off-label use was higher in men (49%) than women (41%). While the proportion of off-label prescriptions was highest for tri- and tetracyclic antidepressants with 56.2% (amitriptyline 54.6%, maximum 65.9% for trimipramine), it amounted to 41.8% for selective serotonin reuptake inhibitors (citalopram 41.6%, maximum 46.0% for escitalopram) and was 51.2% for mirtazapine. Indicators of overall morbidity were similar in both groups, eg, pain was coded in 72% of off-label users vs 77% of on-label users (insomnia 20% vs 24%). CONCLUSION Our study suggests a high prevalence of off-label antidepressant use among older adults in Germany, which was not restricted to certain classes of antidepressants or individual antidepressants. Given the unclear risk-benefit ratio, studies investigating the safety of off-label use among older adults for individual antidepressants are urgently needed.
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Affiliation(s)
- Wiebke Schäfer
- Leibniz Institute for Prevention Research and Epidemiology - BIPS, Achterstraße 30, Bremen, 28359, Germany
| | - Tammo Reinders
- Leibniz Institute for Prevention Research and Epidemiology - BIPS, Achterstraße 30, Bremen, 28359, Germany
| | - Oliver Riedel
- Leibniz Institute for Prevention Research and Epidemiology - BIPS, Achterstraße 30, Bremen, 28359, Germany
| | - Ulrike Haug
- Leibniz Institute for Prevention Research and Epidemiology - BIPS, Achterstraße 30, Bremen, 28359, Germany.,Faculty of Human and Health Sciences, University of Bremen, Bremen, 28359, Germany
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Kimura T, Kato D, Nishimura T, Van Schyndle J, Uno S, Yoshida M. The Effect of Patient Age on Anticholinergic Use in the Elderly Japanese Population —Differences between Four Anticholinergic Scales. YAKUGAKU ZASSHI 2020; 140:701-710. [DOI: 10.1248/yakushi.19-00229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- Tomomi Kimura
- Advanced Informatics and Analytics, Astellas Pharma Inc
| | | | | | | | | | - Masaki Yoshida
- Department of Urology, National Center for Geriatrics and Gerontology
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Baruth JM, Gentry MT, Rummans TA, Miller DM, Burton MC. Polypharmacy in older adults: the role of the multidisciplinary team. Hosp Pract (1995) 2020; 48:56-62. [PMID: 31900000 DOI: 10.1080/21548331.2019.1706995] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Patients over the age 65 are a quickly expanding segment of the US population and represent a large percentage of patients requiring inpatient care. Older adults are more likely to experience polypharmacy and adverse drug effects. This review explains the risks of polypharmacy and potentially inappropriate medications in the elderly. Specific classes of medications frequently used in older adults in acute care settings are examined, including anticholinergic, sedative hypnotics, and antipsychotic medications. We discuss strategies aimed at addressing polypharmacy in this population including a drug regimen review (which is distinct from medication reconciliation), screening tools, pharmacist-led interventions, and computer-based strategies in the context of current literature and research findings. We provide a summary of general guidelines that may be helpful for geriatricians and hospitalists in improving patient care and clinical outcomes.
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Affiliation(s)
- Joshua M Baruth
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA
| | - Melanie T Gentry
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA
| | - Teresa A Rummans
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA.,Department of Psychiatry and Psychology, Mayo Clinic, Jacksonville, FL, USA
| | - Donna M Miller
- Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
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Abdeljalil AB, Arbus C, Montastruc F, de Souto Barreto P, André L, Vellas B, Rolland Y. Antidepressants in nursing homes for dependent older patients: the cross-sectional associations of institutional factors with prescription conformance. Eur Geriatr Med 2019; 10:421-430. [DOI: 10.1007/s41999-019-00189-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Accepted: 04/02/2019] [Indexed: 11/25/2022]
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Verhaak PFM, de Beurs D, Spreeuwenberg P. What proportion of initially prescribed antidepressants is still being prescribed chronically after 5 years in general practice? A longitudinal cohort analysis. BMJ Open 2019; 9:e024051. [PMID: 30813115 PMCID: PMC6377556 DOI: 10.1136/bmjopen-2018-024051] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVES Antidepressant prescribing almost doubled in the Netherlands between 1996 and 2012, which could be accounted for by longer continuation after the first prescription. This might be problematic given a growing concern of large-scale antidepressant dependence. We aimed to assess the extent and determinants of chronic antidepressant prescribing among patient aged 18 years and older. We hypothesise a relatively large prevalence of chronic (>2 years) prescription. DESIGN A longitudinal observational study based on routinely registered prescription data from general practice. SETTING 189 general practices in the Netherlands. PARTICIPANTS 326 025 patients with valid prescription data for all 5 years of the study. OUTCOME MEASURES Primary outcome measure: the number of patients (N) receiving at least four antidepressant prescriptions in 2011, as well as during each of the four subsequent years. Secondary outcome measure: the above, but specified for selective serotonin reuptake inhibitors and for tricyclic antidepressants. RESULTS Antidepressants were prescribed to almost 7% of our 326 025 participants each year. They were prescribed for depression (38%), anxiety (17%), other psychological disorders (20%) and non-psychological indications (25%). Antidepressants were prescribed in all 5 years to the 42% of the population who had at least four prescriptions dispensed in 2011. Chronic prescribing was higher among women than men, for those aged 45-64 years than for those aged >65 years and for those treated for depression or anxiety than for non-psychological indications (eg, neuropathic pain). Chronic prescribing also varied markedly among general practices. CONCLUSION Chronic antidepressant use is common for depression and for anxiety and non-psychological diagnoses. Once antidepressants have been prescribed, general practitioners and other prescribers should be aware of the risks associated with long-term use and should provide annual monitoring of the continued need for therapy.
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Affiliation(s)
- Peter F M Verhaak
- Netherlands Institute of Health Services Research (NIVEL), Utrecht, The Netherlands
- Department of General Practice, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Derek de Beurs
- Netherlands Institute of Health Services Research (NIVEL), Utrecht, The Netherlands
| | - Peter Spreeuwenberg
- Netherlands Institute of Health Services Research (NIVEL), Utrecht, The Netherlands
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Bobo WV, Grossardt BR, Lapid MI, Leung JG, Stoppel C, Takahashi PY, Hoel RW, Chang Z, Lachner C, Chauhan M, Flowers L, Brue SM, Frye MA, St. Sauver J, Rocca WA, Sutor B. Frequency and predictors of the potential overprescribing of antidepressants in elderly residents of a geographically defined U.S. population. Pharmacol Res Perspect 2019; 7:e00461. [PMID: 30693088 PMCID: PMC6344796 DOI: 10.1002/prp2.461] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Revised: 12/07/2018] [Accepted: 12/18/2018] [Indexed: 12/20/2022] Open
Abstract
The purpose of this study was to estimate the extent of potential antidepressant overprescribing in a geographically defined U.S. population, and to determine the indications and factors that account for it. We conducted a cohort study of new antidepressant prescriptions for elderly residents of Olmsted County, Minnesota, 2005-2012, using the Rochester Epidemiology Project medical records-linkage system. Indications for antidepressants were abstracted from health records for all cohort members. Potential antidepressant overprescribing was defined based on regulatory approval, the level of evidence identified from a standardized drug information database, and multidisciplinary expert review. Predictors of potential antidepressant overprescribing were investigated using logistic regression models, stratified by general antidepressant indication (general medical indication, specific psychiatric diagnosis, and non-specific psychiatric symptoms). Potential antidepressant overprescribing occurred in 24% of 3199 incident antidepressant prescriptions during the study period, and involved primarily newer antidepressants that were prescribed for non-specific psychiatric symptoms and subthreshold diagnoses. Potential antidepressant overprescribing was associated with nursing home residence, having a higher number of comorbid medical conditions and outpatient prescribers, taking more concomitant medications, having greater use of urgent or acute care services in the year preceding the index antidepressant prescription, and being prescribed antidepressants via telephone, e-mail, or patient portal. In conclusion, potential antidepressant overprescribing occurred in elderly persons and involved mainly newer antidepressants used for non-specific psychiatric symptoms and subthreshold diagnoses, and was associated with indicators of higher clinical complexity or severity and with prescribing without face-to-face patient contact.
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Affiliation(s)
- William V. Bobo
- Department of Psychiatry & PsychologyMayo ClinicJacksonvilleFlorida
| | - Brandon R. Grossardt
- Division of Biomedical Statistics and InformaticsDepartment of Health Sciences ResearchMayo ClinicRochesterMinnesota
| | - Maria I. Lapid
- Department of Psychiatry & PsychologyMayo ClinicRochesterMinnesota
| | | | - Cynthia Stoppel
- Department of Psychiatry & PsychologyMayo ClinicRochesterMinnesota
| | - Paul Y. Takahashi
- Department of Primary Care Internal MedicineMayo ClinicRochesterMinnesota
| | - Robert W. Hoel
- Department of Pharmacy ServicesMayo ClinicRochesterMinnesota
| | - Zheng Chang
- Department of Medical Epidemiology and BiostatisticsKarolinska InstitutetStockholmSweden
| | | | - Mohit Chauhan
- Department of Psychiatry & PsychologyMayo ClinicJacksonvilleFlorida
| | - Lee Flowers
- Department of Psychiatry & PsychologyMayo ClinicRochesterMinnesota
| | - Scott M. Brue
- Biomedical Informatics Support SystemMayo ClinicRochesterMinnesota
| | - Mark A. Frye
- Department of Psychiatry & PsychologyMayo ClinicRochesterMinnesota
| | - Jennifer St. Sauver
- Division of EpidemiologyDepartment of Health Sciences ResearchMayo ClinicRochesterMinnesota
| | - Walter A. Rocca
- Division of EpidemiologyDepartment of Health Sciences ResearchMayo ClinicRochesterMinnesota
- Department of NeurologyMayo ClinicRochesterMinnesota
| | - Bruce Sutor
- Department of Psychiatry & PsychologyMayo ClinicRochesterMinnesota
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Chang DD, Eyre HA, Abbott R, Coudreaut M, Baune BT, Shaman JA, Lavretsky H, Lenze EJ, Merrill DA, Singh AB, Mulsant BH, Reynolds CF, Müller DJ, Bousman C. Pharmacogenetic guidelines and decision support tools for depression treatment: application to late-life. Pharmacogenomics 2018; 19:1269-1284. [DOI: 10.2217/pgs-2018-0099] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Late-life depression (LLD) is a major depressive disorder that affects someone after the age of 60 years. LLD is frequently associated with inadequate response and remission from antidepressants, in addition to polypharmacy. Pharmacogenetics offers a promising approach to improve clinical outcomes in LLD via new discoveries determining the genetic basis of response rates and side effects, as well as the development of tailored pharmacogenetic-based decision support tools. This invited review evaluates the LLD pharmacogenetic evidence base and the extent to which this was incorporated into existing commercial decision support tools and clinical pharmacogenetic guidelines.
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Affiliation(s)
- Donald D Chang
- School of Medicine, University of Queensland-Ochsner Clinical School, Brisbane, Queensland, 4072, Australia
| | - Harris A Eyre
- Innovation Institute, Texas Medical Center, Houston, TX 77006, USA
- IMPACT SRC, School of Medicine, Deakin University, Geelong, Victoria, 3220, Australia
- Department of Psychiatry, University of Melbourne, Melbourne, Victoria, 3003, Australia
- Discipline of Psychiatry, University of Adelaide, Adelaide, South Australia, 5055, Australia
| | - Ryan Abbott
- University of Surrey, Surrey, GU2 7XH, UK
- David Geffen School of Medicine, University of California Los Angeles (UCLA), Los Angeles, CA 90095, USA
| | - Michael Coudreaut
- Department of Psychiatry, Intermountain Healthcare, Salt Lake City, UT 84102, USA
| | - Bernhard T Baune
- Discipline of Psychiatry, University of Adelaide, Adelaide, South Australia, 5055, Australia
| | | | - Helen Lavretsky
- David Geffen School of Medicine, University of California Los Angeles (UCLA), Los Angeles, CA 90095, USA
| | - Eric J Lenze
- Department of Psychiatry, Washington University, St Louis, MO 63130, USA
| | - David A Merrill
- David Geffen School of Medicine, University of California Los Angeles (UCLA), Los Angeles, CA 90095, USA
| | - Ajeet B Singh
- IMPACT SRC, School of Medicine, Deakin University, Geelong, Victoria, 3220, Australia
| | - Benoit H Mulsant
- Department of Psychiatry, University of Toronto, Toronto, ON, M5S 3H7, Canada
- Campbell Family Mental Health Research Institute, Centre for Addiction & Mental Health, Toronto, ON, M5S 3H7, Canada
| | - Charles F Reynolds
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA 15260, USA
| | - Daniel J Müller
- Department of Psychiatry, University of Toronto, Toronto, ON, M5S 3H7, Canada
- Campbell Family Mental Health Research Institute, Centre for Addiction & Mental Health, Toronto, ON, M5S 3H7, Canada
| | - Chad Bousman
- Departments of Medical Genetics, Psychiatry, & Physiology & Pharmacology, University of Calgary, Calgary, AB, AN T2N 1N4, Canada
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Agathokleous E, Kitao M, Calabrese EJ. Human and veterinary antibiotics induce hormesis in plants: Scientific and regulatory issues and an environmental perspective. ENVIRONMENT INTERNATIONAL 2018; 120:489-495. [PMID: 30149340 DOI: 10.1016/j.envint.2018.08.035] [Citation(s) in RCA: 62] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Revised: 08/13/2018] [Accepted: 08/14/2018] [Indexed: 06/08/2023]
Abstract
UNLABELLED Veterinary and human pharmaceuticals have been widely used in the developed world, thus increasing their accumulation in the environment and thereby posing ecological risks. Earlier studies report that active pharmaceutical ingredients induce hormesis in plants, i.e. at low doses may enhance plant health whereas at high doses may suppress plant vigor. There is hitherto no study critically reviewing the effects of antibiotics on plants within a hormetic context despite effects of low doses on plants can have implications to animals, including humans, and to ecological processes. This study critically reviews for first time antibiotic-induced hormesis in plants, both quantitatively and qualitatively. Hormesis was induced by several antibiotics in a variety of species and endpoints. The maximum stimulatory response (MAX) was commonly <1.5-fold the control response and the distance from MAX to no-observed-adverse-effect level (NOAEL) was commonly up to 10-fold. Further quantitative and qualitative evaluations are provided and discussed in relation to scientific and regulatory aspects. Low doses of antibiotics are equally important as high doses as they can negatively affect plants, depending on plant tissues and the time tissues are subject to exposure. Antibiotic-induced hormesis in plants provides a significant environmental perspective and should be incorporated into the hazard and risk assessment process. CAPSULE Common antibiotics released in the environment induce hormesis in plants, urging for re-examination of the risk assessment practices by worldwide regulatory agencies.
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Affiliation(s)
- Evgenios Agathokleous
- Hokkaido Research Center, Forestry and Forest Products Research Institute (FFPRI), Forest Research and Management Organization, 7 Hitsujigaoka, Sapporo, Hokkaido 062-8516, Japan; Research Faculty of Agriculture, Hokkaido University, Kita 9 Nishi 9, Sapporo, Hokkaido 060-8589, Japan.
| | - Mitsutoshi Kitao
- Hokkaido Research Center, Forestry and Forest Products Research Institute (FFPRI), Forest Research and Management Organization, 7 Hitsujigaoka, Sapporo, Hokkaido 062-8516, Japan
| | - Edward J Calabrese
- Department of Environmental Health Sciences, Morrill I, N344, University of Massachusetts, Amherst, MA 01003, USA
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Jester DJ, Hyer K, Molinari V, Andel R, Rozek E. Age-dependent determinants of antipsychotic use among newly admitted residents of skilled nursing facilities: A population-based study. Int J Geriatr Psychiatry 2018; 33:1370-1382. [PMID: 29984493 DOI: 10.1002/gps.4934] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Accepted: 05/31/2018] [Indexed: 12/29/2022]
Abstract
OBJECTIVES To assess factors related to antipsychotic (AP) use in skilled nursing facilities for newly admitted residents aged 18 to 49, 50 to 64, 65 to 84, and 85 years or older. METHODS Retrospective, population-level, Minimum Data Set (MDS) 2.0 data from the United States during the year of 2009 were used. Over 1 million residents were included. Fourteen clinically relevant variables were identified through a literature search. Antipsychotic use was defined as APs dispensed daily for the prior 7 days. Logistic regression was used to identify clinically relevant variables, which were then ranked based on magnitude of their association with APs. RESULTS Bipolar disorder and schizophrenia were consistently related to AP use across age groups. For older age groups, off-label indications such as cognitive impairment, dementia, behavioral symptoms, and physical restraint use were more closely related to AP use, while delusions and hallucinations decreased in strength. Higher proportions of APs were found in all diseases and symptoms in nonelderly adults, with the exception of physical restraint use. Concurrent physical restraint and AP use was highest for older adults aged 65 to 84 at 36%. CONCLUSIONS Correlates of AP use varied by age, with stronger associations between on-label conditions and AP use among younger adults and off-label conditions among older adults. Several less conventional determinants, namely, Parkinson disease, traumatic brain injury, and the use of physical restraints were identified to increase the likelihood of AP use. This study highlights the importance of monitoring for adverse effects for residents of all ages.
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Affiliation(s)
- Dylan J Jester
- Florida Policy Exchange Center on Aging, School of Aging Studies, University of South Florida, Tampa, FL, USA
| | - Kathryn Hyer
- Florida Policy Exchange Center on Aging, School of Aging Studies, University of South Florida, Tampa, FL, USA
| | - Victor Molinari
- Florida Policy Exchange Center on Aging, School of Aging Studies, University of South Florida, Tampa, FL, USA
| | - Ross Andel
- Florida Policy Exchange Center on Aging, School of Aging Studies, University of South Florida, Tampa, FL, USA
| | - Ellen Rozek
- Department of Psychology, University of Wisconsin - La Crosse, La Crosse, WI, USA
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Potentially inappropriate prescription of antidepressants in old people: characteristics, associated factors, and impact on mortality. Int Psychogeriatr 2018; 30:715-726. [PMID: 29145919 DOI: 10.1017/s1041610217002290] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
UNLABELLED ABSTRACTBackground:The increasing use of antidepressants (ADs) has raised concerns about their inappropriate use in old people. OBJECTIVE To examine the prevalence of potentially inappropriate prescribing (PIP) of ADs, their associated factors, and their impact on mortality in a sample of old people in France. METHODS The analysis used data from the SIPAF study, a cross-sectional study consisting of 2,350 people aged ≥ 70 years. Trained nurses interviewed participants at home between 2008 and 2010. Information was collected concerning socio-demographic and health characteristics, including medication use. The study population consisted of the 318 AD users from the SIPAF study (13.5%). PIP of ADs was defined according to national and international criteria. Factors associated with PIP of ADs were assessed using a multivariate logistic regression model. The influence of PIP of ADs on mortality was assessed using a Cox model (median follow-up 2.8 years). RESULTS Among the SIPAF study, 71% of AD users were female and the mean age was 84 ± 7 years. Selective serotonin reuptake inhibitors (SSRIs) were the most prescribed ADs (19.8%). We found PIP of ADs in 36.8% of the study population, mainly the co-prescription of diuretics with SSRIs (17.6%) and the prescription of tricyclics (12.9%). PIP of ADs was associated with polypharmacy (aOR5-9 drugs 2. 61, 95% CI 1.11-6.16 and aOR≥10 drugs 2.69, 95% CI 1.06-6.87) and comorbidity (aOR3-4 chronic diseases 2.59, 95%CI 1.04-6.44 and aOR≥5 chronic diseases 2.33, 95%CI 0.94-5.79), and increased the risk of mortality during follow-up (aHR 2.30, 95%CI 1.28-4.12). CONCLUSIONS This study shows that more than one third of AD prescriptions may be inappropriate in old people. PIP of ADs was related to polypharmacy and comorbidity and increased mortality among AD users.
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Torrellas C, Carril JC, Cacabelos R. Optimization of Antidepressant use with Pharmacogenetic Strategies. Curr Genomics 2017. [PMID: 29081699 DOI: 10.2174/1389202918666170426164940.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND The response rate in the pharmacological treatment of depression has been estimated to be around 50%, achieving a remission in symptomatology in only one third of the patients. Suboptimal prescription of antidepressants has been proposed as a significant explanatory factor for this therapeutic inefficacy. The use of pharmacogenetic testing might favor the optimization of pharmacotherapy in emotional disorders. However, its implementation in the clinical routine requires studies which prove its efficacy. OBJECTIVE The aim is to explore the clinical effects obtained by means of the personalization of antidepressant treatment derived from the pharmacogenetic profile of the individual. METHOD A sample of 291 patients under antidepressant treatment was selected, and these patients were genotyped for the most common polymorphisms of the CYP2D6, CYP2C9, CYP2C19 and CYP3A4/5 genes using RT-PCR and TaqMan® technology. 30 of them were subjected to psycho-affective assessment using the HDRS scale before and after a process of individualization of their psychopharmacological treatment in accordance with the genotype obtained. RESULTS 70% of the individuals treated using the traditional criterion of trial-and-error were not taking the active ingredient most suited to their pharmacogenetic profile. The inclusion of this genetic information in the choice of drug and its dosage entailed a significant, progressive reduction in depressive symptomatology, with an efficacy ratio of 80% and a remission of the pathology in almost 30% of the cases. CONCLUSION These results suggest that the prescription of pharmacogenetic profile-based strategies has a positive effect on the therapeutic response to antidepressants.
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Affiliation(s)
- Clara Torrellas
- EuroEspes Biomedical Research Center, Institute of Medical Sciences and Genomic Medicine, 15165-Bergondo, Corunna, Spain.,Chair of Genomic Medicine, Camilo José Cela University, 28692- Madrid, Spain
| | - Juan Carlos Carril
- EuroEspes Biomedical Research Center, Institute of Medical Sciences and Genomic Medicine, 15165-Bergondo, Corunna, Spain.,Chair of Genomic Medicine, Camilo José Cela University, 28692- Madrid, Spain
| | - Ramón Cacabelos
- EuroEspes Biomedical Research Center, Institute of Medical Sciences and Genomic Medicine, 15165-Bergondo, Corunna, Spain.,Chair of Genomic Medicine, Camilo José Cela University, 28692- Madrid, Spain
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Torrellas C, Carril JC, Cacabelos R. Optimization of Antidepressant use with Pharmacogenetic Strategies. Curr Genomics 2017; 18:442-449. [PMID: 29081699 PMCID: PMC5635649 DOI: 10.2174/1389202918666170426164940] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2016] [Revised: 02/19/2016] [Accepted: 03/03/2016] [Indexed: 12/14/2022] Open
Abstract
Background: The response rate in the pharmacological treatment of depression has been estimated to be around 50%, achieving a remission in symptomatology in only one third of the patients. Suboptimal prescription of antidepressants has been proposed as a significant explanatory factor for this therapeutic inefficacy. The use of pharmacogenetic testing might favor the optimization of pharmacotherapy in emotional disorders. However, its implementation in the clinical routine requires studies which prove its efficacy. Objective: The aim is to explore the clinical effects obtained by means of the personalization of antidepressant treatment derived from the pharmacogenetic profile of the individual. Method: A sample of 291 patients under antidepressant treatment was selected, and these patients were genotyped for the most common polymorphisms of the CYP2D6, CYP2C9, CYP2C19 and CYP3A4/5 genes using RT-PCR and TaqMan® technology. 30 of them were subjected to psycho-affective assessment using the HDRS scale before and after a process of individualization of their psychopharmacological treatment in accordance with the genotype obtained. Results: 70% of the individuals treated using the traditional criterion of trial-and-error were not taking the active ingredient most suited to their pharmacogenetic profile. The inclusion of this genetic information in the choice of drug and its dosage entailed a significant, progressive reduction in depressive symptomatology, with an efficacy ratio of 80% and a remission of the pathology in almost 30% of the cases. Conclusion: These results suggest that the prescription of pharmacogenetic profile-based strategies has a positive effect on the therapeutic response to antidepressants.
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Affiliation(s)
- Clara Torrellas
- EuroEspes Biomedical Research Center, Institute of Medical Sciences and Genomic Medicine, 15165-Bergondo, Corunna, Spain.,Chair of Genomic Medicine, Camilo José Cela University, 28692- Madrid, Spain
| | - Juan Carlos Carril
- EuroEspes Biomedical Research Center, Institute of Medical Sciences and Genomic Medicine, 15165-Bergondo, Corunna, Spain.,Chair of Genomic Medicine, Camilo José Cela University, 28692- Madrid, Spain
| | - Ramón Cacabelos
- EuroEspes Biomedical Research Center, Institute of Medical Sciences and Genomic Medicine, 15165-Bergondo, Corunna, Spain.,Chair of Genomic Medicine, Camilo José Cela University, 28692- Madrid, Spain
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Breining A, Bonnet-Zamponi D, Zerah L, Micheneau C, Riolacci-Dhoyen N, Chan-Chee C, Deligne J, Harlin JM, Boddaert J, Verny M, Leperre-Desplanques A. Exposure to psychotropics in the French older population living with dementia: a nationwide population-based study. Int J Geriatr Psychiatry 2017; 32:750-760. [PMID: 27237864 DOI: 10.1002/gps.4517] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2015] [Revised: 02/24/2016] [Accepted: 05/05/2016] [Indexed: 11/08/2022]
Abstract
BACKGROUND Little is known about the level of psychotropic chronic exposure in all patients living with dementia. The aim of the study was to quantify chronic psychotropic exposure in older adults with dementia compared with the general population of the same age. METHODS This prospective cohort study was conducted in France between 2009 and 2011. Aged at least 65 years, 10,781,812 individuals (440,215 of them with dementia) either community based or nursing home residents were included. The numbers of single or combined prescriptions, per year for antipsychotics, antidepressants, anxiolytics, or hypnotics were measured. RESULTS Of patients with dementia, 15.5% are exposed to antipsychotics compared with 2.2% of the age-matched population (relative risk [RR] = 6.44, 95% confidence interval [CI] [6.39-6.48]), 39.5% to antidepressants compared with 12.6% (RR = 4.10, 95% CI [.4.07-4.12]), and 39.6% to anxiolytics or hypnotics compared with 26.9% (RR = 1.74, 95% CI [1.72-1.75]). Among older adults with dementia, 13.8% simultaneously consumed at least three psychotropics. All class age of older patients with dementia is more exposed to all psychotropics except for long-acting benzodiazepines. During the study period, chronic anxiolytic/hypnotic and antipsychotic exposure slightly decreased in population with dementia while chronic exposure to antidepressant drugs tended to increase. CONCLUSION This nationwide, population-based, drug-used study showed for the first time that older patients with dementia are chronically overexposed not only to antipsychotics but also to psychotropics.
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Affiliation(s)
- Alice Breining
- APHP, DHU FAST, Groupe Hospitalier Pitié Salpêtrière - Charles Foix, Centre de Gériatrie, Paris, France
| | - Dominique Bonnet-Zamponi
- OMEDIT Ile de France, Paris, France.,Université Paris Diderot, Sorbonne Paris Cité, UMR 1123 INSERM, Paris, France
| | - Lorène Zerah
- APHP, DHU FAST, Groupe Hospitalier Pitié Salpêtrière - Charles Foix, Centre de Gériatrie, Paris, France.,Sorbonne Universités, UPMC Univ Paris 06 and CNRS, UMR 8256 B2A, Paris, France
| | | | | | | | - Jean Deligne
- Régime Social des Indépendants, Saint Denis la Plaine, France
| | - Jean-Marc Harlin
- Caisse Centrale de la Mutualité Sociale Agricole, Bagnolet, France
| | - Jacques Boddaert
- APHP, DHU FAST, Groupe Hospitalier Pitié Salpêtrière - Charles Foix, Centre de Gériatrie, Paris, France.,Sorbonne Universités, UPMC Univ Paris 06 and CNRS, UMR 8256 B2A, Paris, France
| | - Marc Verny
- APHP, DHU FAST, Groupe Hospitalier Pitié Salpêtrière - Charles Foix, Centre de Gériatrie, Paris, France.,Sorbonne Universités, UPMC Univ Paris 06 and CNRS, UMR 8256 B2A, Paris, France
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Wei YJ, Simoni-Wastila L, Lucas JA, Brandt N. Fall and Fracture Risk in Nursing Home Residents With Moderate-to-Severe Behavioral Symptoms of Alzheimer's Disease and Related Dementias Initiating Antidepressants or Antipsychotics. J Gerontol A Biol Sci Med Sci 2017; 72:695-702. [PMID: 27247274 DOI: 10.1093/gerona/glw095] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2015] [Accepted: 05/10/2016] [Indexed: 11/14/2022] Open
Abstract
Background Both antidepressants and antipsychotics are used in older adults with behavioral symptoms of Alzheimer's disease and related dementias. Despite the prevalent use of these agents, little is known about their comparative risks for falls and fractures. Methods Using 2007-2009 Medicare claims data linked to Minimum Data Set 2.0, we identified new users of antidepressants and antipsychotics among nursing home residents with Alzheimer's disease and related dementias who had moderate-to-severe behavioral symptoms. Separate discrete-time survival models were used to estimate risks of falls, fractures, and a composite of both among antidepressant group versus antipsychotic group. Results Compared to antipsychotic users, antidepressant users experienced significantly higher risk for fractures (adjusted hazard ratio = 1.35, 95% confidence interval = 1.10-1.66). The overall risk of falls or fractures remained significant in the antidepressant versus antipsychotic group (adjusted hazard ratio = 1.16, 95% confidence interval = 1.02-1.32). Conclusions Antidepressants are associated with higher fall and fracture risk compared to antipsychotics in the management of older adults with Alzheimer's disease and related dementias who experience moderate-to-severe behavioral symptoms. Clinicians need to assess the ongoing risks/benefits of antidepressants for these symptoms especially in light of the increasingly prevalent use of these agents.
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Affiliation(s)
- Yu-Jung Wei
- Department of Pharmaceutical Health Services Research, University of Maryland School of Pharmacy, Baltimore.,Department of Pharmaceutical Outcomes and Policy, University of Florida College of Pharmacy, Gainesville
| | - Linda Simoni-Wastila
- Department of Pharmaceutical Health Services Research, University of Maryland School of Pharmacy, Baltimore
| | - Judith A Lucas
- Department of Behavioral and Community Health, Seton Hall University College of Nursing, South Orange, New Jersey
| | - Nicole Brandt
- Department of Pharmacy Practice and Science, University of Maryland School of Pharmacy, Baltimore
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Non-tricyclic and Non-selective Serotonin Reuptake Inhibitor Antidepressants and Recurrent Falls in Frail Older Women. Am J Geriatr Psychiatry 2016; 24:1221-1227. [PMID: 27743842 PMCID: PMC5136325 DOI: 10.1016/j.jagp.2016.08.008] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2016] [Revised: 07/05/2016] [Accepted: 08/08/2016] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To determine the risk of recurrent falls associated with antidepressants other than tricyclics (TCAs) and selective serotonin reuptake inhibitors (SSRIs) among frail older women. METHODS This is a secondary analysis of the Zoledronic acid in frail Elders to STrengthen bone, or ZEST, trial data treated as a longitudinal cohort in 181 frail, osteoporotic women aged ≥65 years in long-term care. The primary exposure was individual non-TCA/non-SSRI antidepressants (i.e., serotonin norepinephrine reuptake inhibitors, mirtazapine, trazodone, and bupropion) at baseline and 6 months. The main outcome was recurrent (at least two) falls within 6 months after antidepressant exposure. Adjusted odds ratios (AORs) and 95% confidence intervals (CIs) were derived using a generalized estimating equations model. RESULTS At least 15% of women experienced recurrent falls between 0-6 and 6-12 months. At baseline and 6 months, 18.2% and 6.9% had a non-TCA/non-SSRI antidepressant, respectively. Adjusting for demographics, health status, and other drugs that increase risk of falls, non-TCA/non-SSRI antidepressant exposure significantly increased the risk of recurrent falls (AOR: 2.14; 95% CI: 1.01-4.54). Fall risk further increased after removing bupropion from the non-TCA/non-SSRI antidepressant group in sensitivity analyses (AOR: 2.73; 95% CI: 1.24-6.01). CONCLUSIONS Other antidepressant classes may not be safer than TCAs/SSRIs with respect to recurrent falls in frail older women.
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Rodrigues MCS, Oliveira CD. Drug-drug interactions and adverse drug reactions in polypharmacy among older adults: an integrative review. Rev Lat Am Enfermagem 2016; 24:e2800. [PMID: 27598380 PMCID: PMC5016009 DOI: 10.1590/1518-8345.1316.2800] [Citation(s) in RCA: 67] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2015] [Accepted: 04/13/2016] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVE to identify and summarize studies examining both drug-drug interactions (DDI) and adverse drug reactions (ADR) in older adults polymedicated. METHODS an integrative review of studies published from January 2008 to December 2013, according to inclusion and exclusion criteria, in MEDLINE and EMBASE electronic databases were performed. RESULTS forty-seven full-text studies including 14,624,492 older adults (≥ 60 years) were analyzed: 24 (51.1%) concerning ADR, 14 (29.8%) DDI, and 9 studies (19.1%) investigating both DDI and ADR. We found a variety of methodological designs. The reviewed studies reinforced that polypharmacy is a multifactorial process, and predictors and inappropriate prescribing are associated with negative health outcomes, as increasing the frequency and types of ADRs and DDIs involving different drug classes, moreover, some studies show the most successful interventions to optimize prescribing. CONCLUSIONS DDI and ADR among older adults continue to be a significant issue in the worldwide. The findings from the studies included in this integrative review, added to the previous reviews, can contribute to the improvement of advanced practices in geriatric nursing, to promote the safety of older patients in polypharmacy. However, more research is needed to elucidate gaps. OBJETIVO identificar e sintetizar estudos que examinam as interações medicamentosas (IM) e reações adversas a medicamentos (RAM) em idosos polimedicados. MÉTODOS revisão integrativa de estudos publicados de janeiro de 2008 a dezembro de 2013, de acordo com critérios de inclusão e exclusão, nas bases de dados eletrônicas MEDLINE e EMBASE. RESULTADOS foram analisados 47 estudos de texto completo, incluindo 14,624,492 idosos (≥ 60 anos): 24 (51,1%) sobre RAM, 14 (29,8%) sobre IM e 9 estudos (19,1%) que investigaram tanto IM como RAM. Encontramos uma variedade de desenhos metodológicos. Os estudos revisados reforçaram que a polifarmácia é um processo multifatorial, e os preditores e a prescrição inadequada estão associados a resultados negativos de saúde, como aumento da frequência e tipos de RAM e IM envolvendo diferentes classes de drogas, além disso, alguns estudos mostram as intervenções mais bem-sucedidas para otimizar a prescrição. CONCLUSÕES IM e RAM entre idosos continuam a ser um problema significativo no mundo todo. Os resultados dos estudos incluídos nesta revisão integrativa, adicionado às revisões anteriores, podem contribuir para a melhoria das práticas avançadas de enfermagem geriátrica, para promover a segurança dos pacientes idosos em polifarmácia. No entanto, são necessárias mais pesquisas para elucidar lacunas. OBJETIVO identificar y resumir los estudios que analizan tanto las interacciones medicamentosas (IM) como las reacciones adversas a medicamentos (RAM) en los adultos mayores polimedicados. MÉTODOS revisión integradora de estudios publicados entre enero de 2008 a diciembre de 2013, siguiendo criterios de inclusión y exclusión, en las bases de datos electrónicas MEDLINE y EMBASE. RESULTADOS cuarenta y siete estudios de texto completo incluidos fueron analizados incluyendo 14,624,492 adultos mayores (≥ 60 años), de ellos 24 (51,1%) en relación con RAM, 14 (29,9%) con IM y 9 estudios (19,1%) que investigaron tanto IM como RAM. Encontramos una gran variedad de diseños metodológicos. Los estudios revisados reforzaron el concepto que la polifarmacia es un proceso multifactorial, y los predictores y la prescripción inadecuada se asocian con resultados negativos para la salud tales como el aumento de la frecuencia y tipos de RAM y IM implicando diferentes clases de fármacos, además que algunos estudios muestran cuales son las intervenciones más exitosas para optimizar la prescripción. CONCLUSIONES IM y RAM siguen siendo un problema importante en el mundo entero entre los adultos mayores. Los resultados de los estudios incluidos en esta revisión integradora, sumado a las revisiones previas, pueden contribuir a la mejora de las prácticas avanzadas de enfermería geriátrica, para promover la seguridad de los pacientes de mayor edad en la polifarmacia. Sin embargo, se necesita más investigación para esclarecer los vacíos de conocimiento.
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Affiliation(s)
- Maria Cristina Soares Rodrigues
- PhD, Associate Professor, Departamento de Enfermagem, Faculdade de Ciências da Saúde, Universidade de Brasília, Brasília, DF, Brazil. Scholarship holder from Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES), Brazil
| | - Cesar de Oliveira
- Researcher, Departament Epidemiology and Public Health, University College London, London, United Kingdom
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Abstract
When possible, chronic noncancer pain (CNCP) in older adults should be managed by nonpharmacologic modalities in conjunction with nonopioid analgesics. If moderate-to-severe pain persists despite these approaches, however, nonparenteral opioids may be considered as adjunctive therapy. This article reviews the epidemiology of opioid use and their effectiveness for CNCP in older adults and summarizes important age-related changes in opioid pharmacokinetics and pharmacodynamics that increase the risks of adverse effects in the elderly. Finally, to assist clinicians with selecting appropriate therapy, the article concludes with an evidence-based approach to optimize opioid prescribing in older adults with CNCP.
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Gentile G, Cipolla F, Capi M, Simmaco M, Lionetto L, Borro M. Precise medical decision making in geriatric anti-depressant therapy. EXPERT REVIEW OF PRECISION MEDICINE AND DRUG DEVELOPMENT 2016. [DOI: 10.1080/23808993.2016.1199951] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Affiliation(s)
- Giovanna Gentile
- Department of Neurosciences, Mental Health and Sensory Organs, Sapienza University of Rome, Rome, Italy
| | - Fabiola Cipolla
- Department of Neurosciences, Mental Health and Sensory Organs, Sapienza University of Rome, Rome, Italy
| | - Matilde Capi
- Department of Neurosciences, Mental Health and Sensory Organs, Sapienza University of Rome, Rome, Italy
| | - Maurizio Simmaco
- Department of Neurosciences, Mental Health and Sensory Organs, Sapienza University of Rome, Rome, Italy
| | - Luana Lionetto
- Advanced Molecular Diagnostics, IDI, Istituto Dermopatico dell’Immacolata-IRCCS, Rome, Italy
| | - Marina Borro
- Department of Neurosciences, Mental Health and Sensory Organs, Sapienza University of Rome, Rome, Italy
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Hiltunen H, Tan ECK, Ilomäki J, Hilmer SN, Visvanathan R, Emery T, Robson L, Jones MJ, Hartikainen S, Bell JS. Factors associated with antidepressant use in residents with and without dementia in Australian aged care facilities. Ther Adv Drug Saf 2016; 7:79-88. [PMID: 27298718 DOI: 10.1177/2042098616641355] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE Depressive symptoms are highly prevalent in residential aged care facilities (RACFs). The prevalence of antidepressant use is increasing but the effectiveness of antidepressants in people with dementia is uncertain. The objective of the study was to investigate factors associated with antidepressant use in residents with and without dementia. METHODS This was a prospective cross-sectional study of 383 residents in six Australian RACFs. Data on health status, medications and demographics were collected by trained study nurses from April to August 2014. Logistic regression was used to compute adjusted odds ratios (AORs) and 95% confidence intervals (CIs) for factors associated with antidepressant use. Analyses were stratified by dementia and depression. RESULTS Overall, 183 (47.8%) residents used antidepressants. The prevalence of antidepressant use was similar among residents with and without dementia. Clinician-observed pain was inversely associated with antidepressant use in the main analysis (AOR = 0.56, 95% CI = 0.32-0.99) and in subanalyses for residents with documented depression (AOR = 0.51, 95% CI = 0.27-0.96). In residents with dementia, moderate quality of life was associated with a lower odds of antidepressant use compared with poor quality of life (AOR = 0.35, 95% C I= 0.13-0.95). In residents without dementia, analgesic use was associated with antidepressant use (AOR = 2.34, 95% CI = 1.07-5.18). CONCLUSIONS The prevalence of antidepressant use was similar in residents with and without dementia. Clinician-observed pain was inversely associated with antidepressant use but there was no association between self-reported pain and antidepressant use.
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Affiliation(s)
- Henna Hiltunen
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, Australia
| | - Edwin C K Tan
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, Australia
| | - Jenni Ilomäki
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, Australia
| | - Sarah N Hilmer
- Kolling Institute of Medical Research, Sydney Medical School, Departments of Clinical Pharmacology and Aged Care, Royal North Shore Hospital, University of Sydney, Sydney, Australia
| | - Renuka Visvanathan
- Adelaide Geriatrics Training and Research with Aged Care (GTRAC) Centre, School of Medicine, University of Adelaide, Adelaide, Australia
| | - Tina Emery
- Resthaven Incorporated, Adelaide, Australia
| | | | - Mary J Jones
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, Australia
| | - Sirpa Hartikainen
- Kuopio Research Centre of Geriatric Care, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
| | - J Simon Bell
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University (Parkville Campus), 381 Royal Parade, Parkville, VIC 3052, Australia
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Meid AD, Quinzler R, Groll A, Wild B, Saum KU, Schöttker B, Heider D, König HH, Brenner H, Haefeli WE. Longitudinal evaluation of medication underuse in older outpatients and its association with quality of life. Eur J Clin Pharmacol 2016; 72:877-85. [DOI: 10.1007/s00228-016-2047-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2015] [Accepted: 03/15/2016] [Indexed: 11/29/2022]
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Elderly patients treated with psychotropic medicines admitted to hospital: associated characteristics and inappropriate use. Eur J Clin Pharmacol 2016; 72:755-64. [DOI: 10.1007/s00228-016-2032-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2015] [Accepted: 02/24/2016] [Indexed: 12/22/2022]
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Hoeft TJ, Hinton L, Liu J, Unützer J. Directions for Effectiveness Research to Improve Health Services for Late-Life Depression in the United States. Am J Geriatr Psychiatry 2016; 24:18-30. [PMID: 26525996 PMCID: PMC4706767 DOI: 10.1016/j.jagp.2015.07.003] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2014] [Revised: 06/20/2015] [Accepted: 07/07/2015] [Indexed: 11/23/2022]
Abstract
Considerable progress has been made in the treatment of late-life depression over the past 20 years, yet considerable gaps in care remain. Gaps in care are particularly pronounced for older men, certain racial and ethnic minority groups, and those with comorbid medical or mental disorders. We reviewed the peer-reviewed literature and conducted interviews with experts in late-life depression to identify promising directions for effectiveness research to address these gaps in care. We searched the PubMed, PsychInfo, and CINHAL databases between January 1, 1998, through August 31, 2013, using terms related to late-life depression and any of the following: epidemiology, services organization, economics of care, underserved groups including health disparities, impact on caregivers, and interventions. The results of this selective review supplemented by more current recommendations from national experts highlight three priority research areas to improve health services for late-life depression: focusing on the unique needs of the patient through patient-centered care and culturally sensitive care, involving caregivers outside the traditional clinical care team, and involving alternate settings of care. We build on these results to offer five recommendations for future effectiveness research that hold considerable potential to advance intervention and health services development for late-life depression.
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Affiliation(s)
- Theresa J Hoeft
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA.
| | - Ladson Hinton
- Department of Psychiatry and Behavioral Sciences, University of California, Davis, CA
| | - Jessica Liu
- Department of Psychiatry and Behavioral Sciences, University of California, Davis, CA
| | - Jürgen Unützer
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA
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Gogol M, Hartmann H, Wustmann S, Simm A. Influence of central nervous system-acting drugs on results of cognitive testing in geriatric inpatients. Z Gerontol Geriatr 2015; 47:279-84. [PMID: 25088385 DOI: 10.1007/s00391-014-0654-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
INTRODUCTION Growing evidence shows a high correlation between extensive use of central nervous system-acting drugs (CNSADs) in elderly patients and adverse drug reactions (ADRs) such as falls, fractures, and mortality. RESEARCH QUESTION Are results of cognitive testing with the Mini Mental Status Examination (MMSE) influenced by use of CNSADs? SETTING Geriatric inpatient service for acute, subacute, and rehabilitation care. METHODS Secondary combined analysis of two prospective, single-center study cohorts (PROPSYC, 2011 and AGE OUT, 2012) with identical procedure for the MMSE at a tertiary hospital. RESULTS Overall, 395 patients were included, 144 male (M) and 251 female (F). Mean age was 80.0 ± 8.4 years (M 76.7 ± 9.1, F 81.9 ± 7.3, p = 0.0000). Mean MMSE points were 22.9 ± 4.8 (M 23.2 ± 4.6, F 22.6 ± 5.0, p = 0.211). In total, 258 patients (65.3 %) used drugs with potential adverse cognitive properties. Analgesics with central activity were given to 117 of 395 patients (29.6 %). Low-potency opioids (tramadol hydrochloride, tilidine) were identified in 60 patients and high-potency opioids in 57 patients. Antidepressants were used in 66 patients, benzodiazepines in 26, and hypnotics in 11, while 38 patients received other CNSADs. We only found significant correlations with the results of cognitive testing for sedatives (diazepam and oxazepam, Pearson's r - 0.79, p = 0.05), but not for lorazepam. CONCLUSION Our analysis shows an influence of sedatives (diazepam and oxazepam, but not lorazepam) on cognitive testing with the MMSE in users of CNSADs.
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Affiliation(s)
- M Gogol
- Department of Geriatrics, Lindenbrunn Hospital, Lindenbrunn 1, 31863, Coppenbrügge, Germany,
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Singh S, Bajorek B. Pharmacotherapy in the ageing patient: The impact of age per se (A review). Ageing Res Rev 2015; 24:99-110. [PMID: 26226330 DOI: 10.1016/j.arr.2015.07.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2015] [Accepted: 07/17/2015] [Indexed: 12/23/2022]
Abstract
A literature search was carried out to review the influence of 'ageing' on pharmacotherapeutic decision-making, specifically how 'age' is defined and considered in the utilisation of medication. Embase, Medline, International Pharmaceutical Abstracts, and Google scholar were canvassed in a three-tiered search according to pre-established inclusion criteria. In tier 1, a total of 22 studies were identified highlighting the underutilisation of medication in elderly patients, with a particular focus on warfarin. Four studies highlighted an age-bias in medication-prescribing for elderly patients, specifically in relation to medicines for rheumatoid arthritis, angina, and hypertension. Tier 2 identified diverse definitions for 'elderly', including biological age, chronological age, physiological age, as well as various descriptions of 'elderly' in clinical trials and guidelines. Finally, medication optimisation tools were identified through the third tier, emphasising the use of chronological age to describe the 'elderly'. Old age influences pharmacotherapeutic decision-making at various levels, however, what complicates the situation is the absence of a comprehensive definition of 'elderly'. Clinical recommendations need to be based more on objective factors known to affect medication effectiveness and safety.
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Medication Underuse in Aging Outpatients with Cardiovascular Disease: Prevalence, Determinants, and Outcomes in a Prospective Cohort Study. PLoS One 2015; 10:e0136339. [PMID: 26288222 PMCID: PMC4544845 DOI: 10.1371/journal.pone.0136339] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2015] [Accepted: 08/01/2015] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Cardiovascular disease is a leading cause of death in older people, and the impact of being exposed or not exposed to preventive cardiovascular medicines is accordingly high. Underutilization of beneficial drugs is common, but prevalence estimates differ across settings, knowledge on predictors is limited, and clinical consequences are rarely investigated. METHODS Using data from a prospective population-based cohort study, we assessed the prevalence, determinants, and outcomes of medication underuse based on cardiovascular criteria from Screening Tool To Alert to Right Treatment (START). RESULTS Medication underuse was present in 69.1% of 1454 included participants (mean age 71.1 ± 6.1 years) and was significantly associated with frailty (odds ratio: 2.11 [95% confidence interval: 1.24-3.63]), body mass index (1.03 [1.01-1.07] per kg/m2), and inversely with the number of prescribed drugs (0.84 [0.79-0.88] per drug). Using this information for adjustment in a follow-up evaluation (mean follow-up time 2.24 years) on cardiovascular and competing outcomes, we found no association of medication underuse with cardiovascular events (fatal and non-fatal) (hazard ratio: 1.00 [0.65-1.56]), but observed a significant association of medication underuse with competing deaths from non-cardiovascular causes (2.52 [1.01-6.30]). CONCLUSION Medication underuse was associated with frailty and adverse non-cardiovascular clinical outcomes. This may suggest that cardiovascular drugs were withheld because of serious co-morbidity or that concurrent illness can preclude benefit from cardiovascular prevention. In the latter case, adapted prescribing criteria should be developed and evaluated in those patients.
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Evaluation of the heterogeneity of studies estimating the association between risk factors and the use of potentially inappropriate drug therapy for the elderly: a systematic review with meta-analysis. Eur J Clin Pharmacol 2015; 71:1037-50. [PMID: 26111636 DOI: 10.1007/s00228-015-1891-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2015] [Accepted: 06/15/2015] [Indexed: 01/13/2023]
Abstract
PURPOSE This study was conducted to evaluate the heterogeneity of studies estimating the association between risk factors (age, gender, and polypharmacy) and the use of potentially inappropriate drug therapy for the elderly (PIDT). METHODOLOGY This study is a systematic review with meta-analysis of observational studies. LILACS, PubMed, Scopus, and the Web of Science databases were reviewed. The following data were extracted from the included studies: country, type of study, characteristics of the sample, practice scenarios, instruments to evaluate potentially inappropriate drug therapy for the older adults, and patient-related variables. RESULTS Twenty-nine articles (17 cross-sectional and 12 cohort) were included. The majority of the studies were conducted in Europe. Regarding the study durations, 3 to 18 months was necessary to perform the research. As for the sample characteristics, all the studies analyzed involved the older adults and included anywhere from 96 patients to 33,830,599 outpatient consultations. Of the variables analyzed, only polypharmacy presented a positive association with the use of PIDT. All meta-analysis studies showed high heterogeneity, indicating the lack of a methodological standardization of the studies included, among other factors.
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Ana PALS, Daniel TS, Vanessa AC, Carina CS, Divaldo PDLJ, Angelo RA. An analysis of the quality of studies that evaluate potentially inappropriate drug therapy. ACTA ACUST UNITED AC 2015. [DOI: 10.5897/ajpp2014.4191] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Sultana J, Spina E, Trifirò G. Antidepressant use in the elderly: the role of pharmacodynamics and pharmacokinetics in drug safety. Expert Opin Drug Metab Toxicol 2015; 11:883-92. [DOI: 10.1517/17425255.2015.1021684] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Singh S, Bajorek B. Defining 'elderly' in clinical practice guidelines for pharmacotherapy. Pharm Pract (Granada) 2015; 12:489. [PMID: 25580172 PMCID: PMC4282767 DOI: 10.4321/s1886-36552014000400007] [Citation(s) in RCA: 115] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2014] [Accepted: 11/15/2014] [Indexed: 11/11/2022] Open
Abstract
OBJECTIVE To identify how 'elderly' patients are defined and considered within Australian clinical guidelines for the use of pharmacotherapy. METHOD Guidelines pertaining to the use of pharmacotherapy, focusing on conditions described in National Health Priority Areas, were identified using databases (Medline, Google Scholar) and organisation websites (Department of Health and Ageing, National Heart Foundation, National Health and Medical Research Council). Guidelines were reviewed and qualitatively analysed to identify any references or definitions of 'elderly' persons. RESULTS Among the 20 guidelines reviewed, 3 defined 'elderly' by chronological age (i.e., years since birth) while the remaining 17 guidelines did not define 'elderly' in any way. All 20 guidelines used the term 'elderly', whilst some guidelines provided age (chronological)-based dosage recommendations suggesting an ageist or generalist approach in their representation of 'elderly', for which rationale was seldom provided. Thematic analysis of the statements revealed five key themes regarding how 'elderly' was considered within the guidelines, broadly describing 'elderly' persons as being frail and with altered pharmacology. Some guidelines also highlighted the limited evidence base to direct clinical decision-making. A continuum of perceptions of ageing also emerged out of the identified themes. CONCLUSION Clinical practice guidelines currently do not adequately define 'elderly' persons and provide limited guidance on how to apply treatment recommendations to older persons. The representation of 'elderly' in guidelines needs to be less based on chronological age or generic definitions focusing more on establishing a direct link between an individual patient's characteristics and the pharmacology of their prescribed medication. Clinical guidelines that do not offer any practical descriptions of the features of ageing that are specifically related to the use of pharmacotherapy, or how to assess these in individual patients, render decision-making challenging.
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Affiliation(s)
- Shamsher Singh
- School of Pharmacy, Graduate School of Health, University of Technology Sydney . Sydney, NSW ( Australia ).
| | - Beata Bajorek
- GradCertEdStud GDipClinPharm PhD. Associate Professor. School of Pharmacy, Graduate School of Health, University of Technology Sydney . Sydney, NSW ( Australia ).
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Aspinall SL, Zhao X, Semla TP, Cunningham FE, Paquin AM, Pugh MJ, Schmader KE, Stone RA, Hanlon JT. Epidemiology of drug-disease interactions in older veteran nursing home residents. J Am Geriatr Soc 2014; 63:77-84. [PMID: 25537124 DOI: 10.1111/jgs.13197] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To describe the prevalence of and factors associated with drug-disease interactions (DDIs) in older nursing home residents according to the American Geriatrics Society 2012 Beers Criteria. DESIGN Cross-sectional. SETTING Fifteen Veterans Affairs Community Living Centers. PARTICIPANTS Individuals aged 65 and older with a diagnosis of dementia or cognitive impairment, a history of falls or hip fracture, heart failure (HF), a history of peptic ulcer disease (PUD), or Stage IV or V chronic kidney disease (CKD). MEASUREMENTS Medications that could exacerbate the above conditions (DDIs). RESULTS Three hundred sixty-one of 696 (51.9%) eligible residents had one or more DDIs. None involved residents with a history of PUD, one involved a resident with CKD, and four occurred in residents with HF. Of 540 residents with dementia or cognitive impairment, 50.7% took a drug that could exacerbate these conditions; the most commonly involved medications were antipsychotics (35.4%) and benzodiazepines (14.4%). Of 267 with a history of falls or hip fracture, 67.8% received an interacting medication, with selective serotonin reuptake inhibitors (33.1%), antipsychotics (30.7%), and anticonvulsants (25.1%) being most commonly involved. Using separate multivariable logistic regression models, factors associated with DDIs in dementia or cognitive impairment and falls or fractures included age 85 and older (adjusted odds ratio (aOR) = 0.38, 95% confidence interval (CI) = 0.24-0.60 and aOR = 0.48, 95% CI = 0.24-0.96, respectively), taking five to eight medications (aOR = 2.06, 95% CI = 1.02-4.16 and aOR = 4.76, 95% CI = 1.68-13.5, respectively), taking nine or more medications (aOR = 1.99, 95% CI = 1.03-3.85 and aOR = 3.68, 95% CI = 1.41-9.61, respectively), and being a long-stay resident (aOR = 1.80, 95% CI = 1.04-3.12 and aOR = 2.35, 95% CI = 1.12-4.91, respectively). CONCLUSION DDIs were common in older nursing home residents with dementia or cognitive impairment or a history of falls or fractures.
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Affiliation(s)
- Sherrie L Aspinall
- Veterans Affairs Pharmacy Benefits Management Services, Hines, Illinois; Center for Health Equity Research and Promotion, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, Pennsylvania; School of Pharmacy, University of Pittsburgh, Pittsburgh, Pennsylvania
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Hanlon JT, Aspinall SL, Handler SM, Gellad WF, Stone RA, Semla TP, Pugh MJV, Dysken MW. Potentially suboptimal prescribing for older veteran nursing home patients with dementia. Ann Pharmacother 2014; 49:20-8. [PMID: 25380592 DOI: 10.1177/1060028014558484] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Nursing home patients with dementia may be more likely to suffer adverse drug events from suboptimal prescribing. Previous studies have not used national samples, nor have they examined multiple types of suboptimal prescribing by dementia severity. OBJECTIVE To examine the prevalence of and factors associated with potentially suboptimal prescribing in older veteran nursing home patients with dementia. METHODS This is a retrospective descriptive study of 1303 veterans 65 years or older admitted between January 1, 2004, and June 30, 2005, with dementia for long stays (90+ days) to 133 Veterans Affairs Community Living Centers. Dementia severity was determined by the Cognitive Performance Scale and functional status dependences. RESULTS Overall, 70.2% with mild-moderate dementia (n = 1076) had underuse because they did not receive an acetylcholinesterase inhibitor (AChEI), and 27.2% had evidence of inappropriate use because of a drug-disease or drug-drug-disease interaction. Of the 227 with severe dementia, 36.1% had overuse by receiving an AChEI or lipid-lowering or other agents, and 25.1% had evidence of inappropriate use as a result of a drug-disease or drug-drug interaction. Multinomial logistic regression analyses among those with mild to moderate dementia identified that living in the South versus other regions was the single factor associated with all 3 types of suboptimal prescribing. In those with severe dementia, antipsychotic use was associated with all 3 suboptimal prescribing types. CONCLUSIONS Potentially suboptimal prescribing was common in older veteran nursing home patients with dementia. Clinicians should develop a heightened awareness of these problems. Future studies should examine associations between potentially suboptimal prescribing and health outcomes in patients with dementia.
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Affiliation(s)
- Joseph T Hanlon
- University of Pittsburgh(UPITT) and VA CHERP Pittsburgh, PA, USA
| | | | | | - Walid F Gellad
- University of Pittsburgh(UPITT) and VA CHERP Pittsburgh, PA, USA
| | - Roslyn A Stone
- University of Pittsburgh(UPITT) and VA CHERP Pittsburgh, PA, USA
| | - Todd P Semla
- VA, Hines, USA Northwestern University, Evanston, IL, USA
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Happy pills in nursing homes in Belgium: A cohort study to determine prescribing patterns and relation to fall risk. ACTA ACUST UNITED AC 2014. [DOI: 10.1016/j.jcgg.2013.12.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Simoni-Wastila L, Wei YJ, Luong M, Franey C, Huang TY, Rattinger GB, Zuckerman IH, Brandt N, Lucas JA. Quality of psychopharmacological medication use in nursing home residents. Res Social Adm Pharm 2014; 10:494-507. [DOI: 10.1016/j.sapharm.2013.10.003] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2013] [Revised: 10/14/2013] [Accepted: 10/14/2013] [Indexed: 10/26/2022]
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Andréoli L, Gaudoneix M, Beauverie P, de Beaurepaire R. [Off-label prescriptions in public psychiatric hospital practice]. Therapie 2013; 68:347-59. [PMID: 24246118 DOI: 10.2515/therapie/2013054] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2012] [Accepted: 07/24/2013] [Indexed: 11/20/2022]
Abstract
AIM Analyze prescriptions in public hospital psychiatric practice. METHODS Psychiatric and somatic prescriptions were analyzed a given day regarding their indication, dosage, treatment duration, and prescription scheme. Consultants were individually asked for the reasons of off-label prescriptions. RESULTS Five thousand eighty-six lines of prescription were recorded for 495 patients, showing a total of 34% off-label prescriptions, including 43.5% for psychiatric medications and 22.7% for somatic medications. Psychiatric medications: 22.3% were off-label for indication, 13.1% for dosage, 4.5% for treatment duration, and 6.2% for prescription scheme. (off-label prescriptions for indication: 12.1% without clonazepam - which delivery have been restricted by the end of 2011). Somatic medications: respectively 4.5%, 14.9%, 4.8% and 12.5%. CONCLUSIONS Percentage of off-label prescriptions for indication of psychiatric medications was clearly less than percentages published in the literature (other percentages are new). While most of off-label prescriptions were made in accordance with clinical reports in the literature, some others were not.
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Bourgeois J, Elseviers MM, Van Bortel L, Petrovic M, Vander Stichele RH. The use of antidepressants in Belgian nursing homes: focus on indications and dosages in the PHEBE study. Drugs Aging 2013; 29:759-69. [PMID: 23018612 DOI: 10.1007/s40266-012-0003-6] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
BACKGROUND Since antidepressants are prescribed for multiple indications, the use of an antidepressant cannot be equated with a diagnosis of depression. OBJECTIVE The objective of this study was to examine the quality of antidepressant prescribing in Belgian nursing homes, with a critical evaluation of indications and dosages, to see whether depression was appropriately treated in terms of drug choice, the indications for which antidepressants were being prescribed and whether there was underdosing. METHODS This analysis was based on data obtained in the Prescribing in Homes for the Elderly in Belgium (PHEBE) study, a cross-sectional, descriptive study of a representative, stratified, random sample of 1,730 residents from 76 Belgian nursing homes. The PHEBE study investigated overall drug utilization in Belgian nursing homes in 2006. Clinical and medication data for the present study were obtained from this study. A 28-item checklist of clinical conditions was designed ad hoc for the PHEBE study and sent to the residents' general practitioners (GPs) to collect clinical information. We copied the residents' medication charts, classified the drugs using the Anatomical Therapeutic Chemical (ATC) classification system codes and transferred the drug names and dosages into a database. Information on indications was retrospectively obtained from the GPs, so that we could link the indication to each medication. Minimum effective doses (MEDs) of antidepressants to treat major depression were obtained from the literature to assess underdosing. RESULTS The overall use of antidepressants in nursing homes was 39.5 % (95 % CI 37.2, 41.8). The physicians classified 34.2 % (95 % CI 32.0, 36.4) of the residents as having depression, and 80.9 % of these patients were treated with an antidepressant. Indications among the single antidepressant users (n = 551) were depression (66.2 %), insomnia (13.4 %), anxiety (6.2 %) and neuropathic pain (1.6 %). In the indication of depression, 74.8 % used a selective serotonin reuptake inhibitor (SSRI), predominantly citalopram, sertraline and escitalopram. Venlafaxine was used by 10.7 % of the residents. Dosages for these antidepressants were equal to or higher than the MED. But when trazodone, amitriptyline or mirtazapine were used to treat depression, respectively, 92.3, 55.5 and 44.5 % of prescribed dosages were below the MED. In the indication of insomnia, most of the time, trazodone (90.5 %) or mirtazapine (5.4 %) were used, and in lower dosages than those required for depression treatment (<MED). Tricyclic antidepressants were predominantly used for the treatment of neuropathic pain and were also used at lower dosages. Of all the residents receiving a medication for anxiety, only 13.9 % received an antidepressant (mostly an SSRI), and the remaining received a benzodiazepine. CONCLUSIONS The number one indication for the use of an antidepressant was depression. Within this indication, mostly the recommended SSRIs were used, in dosages equal to or higher than the MED. Furthermore, we noticed that there was substantial use of sedative antidepressants for insomnia and that the physicians preferred to prescribe benzodiazepines over the recommended SSRIs to treat anxiety chronically.
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Yoo JW, Choi JB, Kim SJ, Shin HP, Kim K, Ryu WS, Min TJ, Kim S, Nakagawa S. Factors Associated With Remaining in a Skilled Nursing Facility for Over 90 Days from Admission: Residents' Participation in Therapy and Desire to Return to the Community. J Am Med Dir Assoc 2013; 14:710.e1-4. [DOI: 10.1016/j.jamda.2013.05.022] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2013] [Revised: 05/28/2013] [Accepted: 05/29/2013] [Indexed: 10/26/2022]
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Carbone LD, Chin AS, Burns SP, Svircev JN, Hoenig H, Heggeness M, Weaver F. Morbidity following lower extremity fractures in men with spinal cord injury. Osteoporos Int 2013; 24:2261-7. [PMID: 23392311 DOI: 10.1007/s00198-013-2295-8] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2012] [Accepted: 01/03/2013] [Indexed: 11/29/2022]
Abstract
UNLABELLED The Veterans Affairs Spinal Cord Dysfunction Registry from 2002 to 2007 was reviewed to determine whether men with spinal cord injury (SCI) and lower extremity fractures had an increased risk of complications compared to those without fractures. We determined that fractures are associated with significant consequences, particularly during the first month postfracture. INTRODUCTION Despite increasing longevity, patients with SCI have a substantial number of illnesses and comorbid conditions. Lower extremity fractures are frequent events in these patients. However, whether these fractures are associated with any increased risk of complications in SCI is not certain. The purpose of this report was to determine the impact of lower extremity fractures on morbidities in men with SCI. METHODS A population-based, nested, case-control (1,027 cases and 1,027 propensity-matched controls) of men enrolled in the Veterans Affairs Spinal Cord Dysfunction Registry from fiscal years 2002 to 2007 was reviewed to determine whether lower extremity fractures were associated with an increased risk for complications. RESULTS In propensity score models matched for demographic (age, race) and SCI-related injury factors (level/completeness of SCI), Veterans Affairs-service connection status, and comorbidities, at 1 month following the fracture, there was an increased risk for respiratory infections, pressure ulcers, urinary tract infections, thromboembolic events, depression, and delirium (p ≤ 0.03 for all). Over 12 months, the only complication more common in fracture cases was pressure ulcers (p < 0.01), with an absolute difference of less than 2 % when compared to controls. There was no significant increased risk of cardiac arrhythmias at any time examined following fracture (≥0.12). CONCLUSIONS Lower extremity fractures are associated with significant consequences in men with SCI during the first month postfracture, but they do not persist for a long term, except for pressure ulcers. Targeted interventions to prevent complications should be considered following lower extremity fractures in SCI, particularly in the first month following fracture.
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Affiliation(s)
- L D Carbone
- Veterans Affairs Medical Center, Memphis, TN 38163, USA.
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