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Lüthold RV, Cateau D, Jenkinson SP, Streit S, Jungo KT. Pharmacists' attitudes towards interprofessional collaboration to optimise medication use in older patients in Switzerland: a survey study. BMC Health Serv Res 2024; 24:849. [PMID: 39061037 PMCID: PMC11282592 DOI: 10.1186/s12913-024-11339-8] [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: 04/05/2024] [Accepted: 07/22/2024] [Indexed: 07/28/2024] Open
Abstract
BACKGROUND Collaboration between physicians and pharmacists facilitates the conduct of medication optimisation efforts. In the context of deprescribing, pharmacists' roles are often described as making deprescribing recommendations to physicians. Little is known about factors associated with pharmacists' willingness to make deprescribing recommendations and their interprofessional collaboration with physicians in Swiss primary care settings. OBJECTIVE To explore pharmacists' perspectives on medication optimisation and deprescribing in older adults, and their preferences for interprofessional collaboration in Swiss primary care settings. METHODS In this cross-sectional study, a random sample of 1000 pharmacist members of the Swiss Pharmacists Association pharmaSuisse was invited to participate in a survey on medication optimisation, deprescribing, and interprofessional collaboration. The survey contained three case vignettes of multimorbid patients with polypharmacy aged ≥ 80 years old, with different levels of dependency in activities in daily living (ADL) and cardiovascular disease (CVD). For each case vignette, pharmacists were asked if and which medications they would deprescribe. We calculated proportions of pharmacists' willingness to deprescribe by case vignette and performed a multilevel logistic regression to assess associations between CVD, ADL, and willingness to deprescribe. RESULTS One hundred thirty-eight (14%) pharmacists responded to the survey: 113 (82%) were female, their mean age was 44 years (SD = 11), and 66% (n = 77) reported having never received any specific training on how to conduct structured medication reviews. Eighty-three (72%) pharmacists reported to be confident in identifying deprescribing opportunities. All pharmacists were willing to deprescribe ≥ 1 medication in all vignettes. Patients with CVD were at lower odds of having medications deprescribed (OR = 0.27, 95%CI 0.21 to 0.36). Willingness to deprescribe was lower with higher dependency in ADL (medium versus low dependency: OR = 0.68, 95%CI 0.54 to 0.87, high versus low dependency: OR = 0.72, 95%CI 0.56 to 0.91). However, the effect of dependency in ADL on willingness to deprescribe was significantly modified by the history of CVD. One hundred five pharmacists (97%) reported to interact with physicians to clarify questions regarding prescriptions at least once a week and 88 (81%) wished to be more involved in deprescribing and medication review. CONCLUSION Pharmacists were willing to make deprescribing suggestions for older patients with polypharmacy, but two-thirds reported having received no formal training on how to perform structured medication reviews. Pharmacists would like to be more involved in the process of medication review and deprescribing, which should be leveraged in the context of Swiss primary care settings.
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Affiliation(s)
- Renata Vidonscky Lüthold
- Institute of Primary Health Care (BIHAM), University of Bern, 3012, Bern, Switzerland
- Graduate School for Health Sciences, University of Bern, 3012, Bern, Switzerland
| | - Damien Cateau
- Centre for Primary Care and Public Health (Unisanté), University of Lausanne, 1015, Lausanne, Switzerland
| | - Stephen Philip Jenkinson
- Institute of Primary Health Care (BIHAM), University of Bern, 3012, Bern, Switzerland
- Centre for Primary Care and Public Health (Unisanté), University of Lausanne, 1015, Lausanne, Switzerland
| | - Sven Streit
- Institute of Primary Health Care (BIHAM), University of Bern, 3012, Bern, Switzerland
| | - Katharina Tabea Jungo
- Institute of Primary Health Care (BIHAM), University of Bern, 3012, Bern, Switzerland.
- Division of Pharmacoepidemiology and Pharmacoeconomics and Center for Healthcare Delivery Sciences (C4HDS), Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, 02115, MA, Boston, USA.
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Bamps J, Lelubre S, Cauchies AS, Devillez A, Almpanis C, Patris S. Identification of seniors at risk (ISAR) score and potentially inappropriate prescribing: a retrospective cohort study. Int J Clin Pharm 2024:10.1007/s11096-024-01766-2. [PMID: 38954078 DOI: 10.1007/s11096-024-01766-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Accepted: 05/30/2024] [Indexed: 07/04/2024]
Abstract
BACKGROUND Potentially inappropriate prescribing (PIP) is usually associated with a higher risk of adverse health outcomes. It is therefore important to identify PIP in older adults. However, there are no clear prioritisation strategies to select patients requiring prescription reviews. AIM The aim of this study was to assess the association between the identification of seniors at risk (ISAR) score and the number of PIPs. METHOD A 12-month retrospective hospital-based study was conducted. PIPs, including potentially inappropriate medications (PIMs) and potential prescribing omissions (PPOs), were detected using the STOPP/START tool. Multivariate linear regressions were conducted to identify factors associated with the number of PIPs. Sensitivity, specificity, Youden index, and ROC curve were calculated to determine the predictive power of ISAR score. RESULTS This study included 266 records. The analysis led to the detection of 420 PIMs and 210 PPOs, with a prevalence of 80.1% and 54.9%, respectively. Multivariate linear regression revealed that the ISAR score (p = 0.041), and the number of medications (p < 0.001) were determinants of PIP. The number of medications remained the sole determinant of the number of PIMs (p < 0.001), while living in a nursing home was the only determinant of the number of PPOs (p = 0.036). CONCLUSION The study showed that the ISAR score and the number of medications were independently associated with the number of PIPs. Considering the use of the ISAR score and the number of medications may be useful strategies to prioritise patients for whom prescribing appropriateness should be assessed using explicit criteria.
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Affiliation(s)
- Julien Bamps
- Clinical Pharmacy Unit, Faculty of Medicine and Pharmacy, University of Mons (UMONS), Chemin du Champ de Mars, 25, Bât. 6, 7000, Mons, Belgium.
| | - Sophie Lelubre
- Clinical Pharmacy Unit, Faculty of Medicine and Pharmacy, University of Mons (UMONS), Chemin du Champ de Mars, 25, Bât. 6, 7000, Mons, Belgium
| | | | | | | | - Stéphanie Patris
- Clinical Pharmacy Unit, Faculty of Medicine and Pharmacy, University of Mons (UMONS), Chemin du Champ de Mars, 25, Bât. 6, 7000, Mons, Belgium
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Appukkuttan S, Ko G, Fu C, Bannister B, Kong SX, Jhaveri J, Freedland SJ. Drug-drug interaction potential among patients with nonmetastatic castration-resistant prostate cancer (nmCRPC) treated with novel androgen receptor inhibitors. Expert Rev Anticancer Ther 2024; 24:325-333. [PMID: 38469875 DOI: 10.1080/14737140.2024.2328778] [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: 01/04/2024] [Accepted: 02/21/2024] [Indexed: 03/13/2024]
Abstract
BACKGROUND Nonmetastatic castration-resistant prostate cancer (nmCRPC) patients are often older and use concurrent medications that increase the potential for drug-drug interactions (pDDIs). This study assessed pDDI prevalence in real-world nmCRPC patients treated with apalutamide, darolutamide, or enzalutamide. RESEARCH DESIGN AND METHODS Castrated prostate cancer patients without metastases prior to androgen receptor inhibitor initiation were identified retrospectively via Optum Clinformatics Data Mart claims data (8/2019-3/2021). The top 100 concomitant medications were assessed for pDDIs. RESULTS Among 1,515 patients (mean age: 77 ± 8 years; mean Charlson Comorbidity Index: 3 ± 3), 340 initiated apalutamide, 112 darolutamide, and 1,063 enzalutamide. Common concomitant medication classes were cardiovascular (80%) and central nervous system (52%). Two-thirds of the patients received ≥5 concomitant medications; 30 (30/100 medications) pDDIs were identified for apalutamide and enzalutamide each and 2 (2/100 medications) for darolutamide. Most pDDIs had risk ratings of C or D, but four for apalutamide were rated X. Approximately 58% of the patients on apalutamide, 5% on darolutamide, and 54% on enzalutamide had ≥1 identified pDDI. CONCLUSIONS Results showed a higher frequency of pDDIs in patients receiving apalutamide and enzalutamide vs darolutamide. The impact of these could not be determined retrospectively. DDI risk should be carefully evaluated when discussing optimal therapy for patients with nmCRPC.
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Affiliation(s)
| | - Gilbert Ko
- Data Generation and Observational Studies, Bayer Healthcare, Whippany, NJ, USA
| | - Chunmay Fu
- Data Generation and Observational Studies, Bayer Healthcare, Whippany, NJ, USA
| | | | - Sheldon X Kong
- Data Generation and Observational Studies, Bayer Healthcare, Whippany, NJ, USA
| | - Jay Jhaveri
- Data Generation and Observational Studies, Bayer Healthcare, Whippany, NJ, USA
| | - Stephen J Freedland
- Center for Integrated Research in Cancer and Lifestyle, Cedars-Sinai Medical Center, Los Angeles, CA, USA
- Section of Urology, Durham VA Medical Center, Durham, NC, USA
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Alanazi SA, Al Amri A, Almuqbil M, Alroumi A, Gamal Mohamed Alahmadi M, Obaid Ayesh Alotaibi J, Mohammed Sulaiman Alenazi M, Hassan Mossad Alahmadi W, Hassan Saleh Al Bannay A, Khaled Ahmad Marai S, AlKhatham SM, Al-kanhal S, Asdaq SMB. Use of potentially inappropriate medication for elderly patients in tertiary care hospital of Riyadh, Saudi Arabia. Saudi Pharm J 2024; 32:102015. [PMID: 38497086 PMCID: PMC10940805 DOI: 10.1016/j.jsps.2024.102015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Accepted: 02/24/2024] [Indexed: 03/19/2024] Open
Abstract
Background and objectives The elderly population is affected by chronic diseases and lifelong medication. The American Geriatrics Society (AGS) Beers Criteria is a comprehensive approach to medication usage in the older population to reduce potentially inappropriate medication (PIM) use. The purpose of this study was to assess the usage of PIMs in elderly patients upon discharge from tertiary care hospital settings in Riyadh, Saudi Arabia, using the AGS Beers Criteria 2019. Methods The data was obtained from the medical records of 1237 patients (>65 years) who were discharged from medical or surgical wards at two hospitals affiliated with King Abdulaziz Medical City. The data was analyzed to determine the prevalence of PIM prescription, and the proportional odds of the independent factors influencing outcomes were estimated using ordinal regression analysis for criteria 1 and 2, while Binary regression analysis was conducted for criterion 3. Results There were approximately equal numbers of male and female participants in our study (male: 50.8 % vs. female: 49.2 %). One-third of the patients were above the age of 80 years, with 41 % being between the ages of 70 and 80 years. Moreover, almost 70 % of the samples had chronic illnesses. The overall prevalence of PIMs was 29.2 %, with 11 % of PIMs to be avoided in elderly patients and 17 % to be used with caution in the elderly, while disease-specific PIMs were identified in 1.2 % of the patients. The most common PIM class was proton pump inhibitors (44.41 %), and patients discharged from the surgical unit were more likely to be prescribed PIMs. Proton pump inhibitors (44.41 %) were the most inappropriately prescribed drug class, and patients discharged from the surgical unit were more likely to be prescribed PIMs. Conclusion The study noticed that male gender, the presence of multiple diseases, and obesity are associated with more than one PIM prescription. There is a need to streamline the surgical department's prescription procedure to eliminate prescription disparities. Prescription monitoring is recommended to avoid medication errors, particularly in patients who are taking multiple medications.
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Affiliation(s)
- Saleh A. Alanazi
- Pharmaceutical Care Services, King Abdulaziz Medical City, Riyadh, Saudi Arabia
- King Saud bin Abdulaziz University for Health Science College of Pharmacy, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Abdulrahman Al Amri
- Pharmaceutical Care Services, King Abdulaziz Medical City, Riyadh, Saudi Arabia
- King Saud bin Abdulaziz University for Health Science College of Pharmacy, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Mansour Almuqbil
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh 11451, Saudi Arabia
| | - Abdullah Alroumi
- Pharmaceutical Care Services, King Abdulaziz Medical City, Riyadh, Saudi Arabia
- King Saud bin Abdulaziz University for Health Science College of Pharmacy, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | | | - Joud Obaid Ayesh Alotaibi
- Department of Pharmacy Practice, College of Pharmacy, AlMaarefa University, Dariyah, 13713 Riyadh, Saudi Arabia
| | | | | | | | - Shorooq Khaled Ahmad Marai
- Department of Pharmacy Practice, College of Pharmacy, AlMaarefa University, Dariyah, 13713 Riyadh, Saudi Arabia
| | | | - Sarah Al-kanhal
- Department of Pharmacy Practice, College of Pharmacy, AlMaarefa University, Dariyah, 13713 Riyadh, Saudi Arabia
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Tang JY, Teng PHJ, Chen CY, Tan KT, Ang W, Lau S, Ang AGC, Kyaw KK, Tay XY, Lim WMS, Espeleta WDV, Lin H, Ding YY, Lun P. Appropriate Prescribing for older adults with Multimorbidity (Pro-M): protocol for a feasibility study. Arch Public Health 2024; 82:37. [PMID: 38500190 PMCID: PMC10949664 DOI: 10.1186/s13690-024-01264-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Accepted: 03/05/2024] [Indexed: 03/20/2024] Open
Abstract
BACKGROUND Potentially inappropriate prescribing is common among older adults with multimorbidity due to various reasons, from concurrent application of multiple single-disease clinical guidelines to fragmentation of care. Interventions such as medication review have been implemented worldwide to reduce inappropriate prescribing for older adults. However, the implementability of such interventions are underexplored in the outpatient clinics in Singapore's public hospitals. Hence, the Pro-M study aims to assess the feasibility of implementing a physician-pharmacist collaborative care intervention in geriatric medicine outpatient clinics to facilitate appropriate prescribing for older adults in Singapore. METHODS This is a single-arm, non-randomised feasibility study using a pre-post evaluation design. This study consists of two parts: (1) implementation phase of the intervention (6 months) and an (2) evaluation phase (3 months). Eligible patients will be recruited from geriatric medicine outpatient clinics at two public hospitals in Singapore through convenience sampling. The main components of the Pro-M intervention are: (1) pharmacist-facilitated medication reviews with feedback on any medication issues and potential recommendations to physicians, and (2) physicians communicating changes to other relevant prescribers. The evaluation phase will involve surveying and interviewing physicians and pharmacists involved in the implementation of the intervention. A mixed-method approach will be employed for data collection and analysis. The quantitative and qualitative findings will be triangulated and reported using Proctor's implementation outcomes: appropriateness, penetration, acceptability, fidelity, feasibility, and sustainability. A basic cost analysis will be conducted alongside the study. DISCUSSION This is a phase 2 study to test the feasibility of implementing an intervention that was co-created with stakeholders during phase 1 development of an intervention to optimise prescribing for older adults with multimorbidity. The implementation will be assessed using Proctor's implementation outcomes to provide insights on the process and the feasibility of implementing medication reviews for older adults with multimorbidity as a routine practice in outpatient clinics. Data collected from this study will inform a subsequent scale-up study. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT05756478. Registered on 06 March 2023.
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Affiliation(s)
- Jia Ying Tang
- Geriatric Education & Research Institute, 2 Yishun Central 2, Singapore, 768024, Singapore.
| | - Poh Hoon June Teng
- Geriatric Education & Research Institute, 2 Yishun Central 2, Singapore, 768024, Singapore
| | | | - Keng Teng Tan
- Pharmacy, Tan Tock Seng Hospital, Singapore, Singapore
| | - Wendy Ang
- Pharmacy, Changi General Hospital, Singapore, Singapore
| | - Sabrina Lau
- Department of Geriatric Medicine, Tan Tock Seng Hospital, Singapore, Singapore
| | | | - Kay Khine Kyaw
- Department of Geriatric Medicine, Tan Tock Seng Hospital, Singapore, Singapore
| | - Xin Yong Tay
- Pharmacy, Changi General Hospital, Singapore, Singapore
| | | | | | - Huimin Lin
- Pharmacy, Changi General Hospital, Singapore, Singapore
| | - Yew Yoong Ding
- Geriatric Education & Research Institute, 2 Yishun Central 2, Singapore, 768024, Singapore
- Department of Geriatric Medicine, Tan Tock Seng Hospital, Singapore, Singapore
| | - Penny Lun
- Geriatric Education & Research Institute, 2 Yishun Central 2, Singapore, 768024, Singapore
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Alawainati M, Habib F, Ateya E, Dakheel E, Al-Buainain M. Prevalence, Characteristics and Determinants of Polypharmacy Among Elderly Patients Attending Primary Healthcare Centres in Bahrain: A cross-sectional study. Sultan Qaboos Univ Med J 2024; 24:63-69. [PMID: 38434473 PMCID: PMC10906769 DOI: 10.18295/squmj.9.2023.052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Revised: 08/12/2023] [Accepted: 09/12/2023] [Indexed: 03/05/2024] Open
Abstract
Objectives This study aimed to determine the prevalence, characteristics and determinants of polypharmacy among elderly patients in Bahrain. Methods This cross-sectional study was conducted between March and April 2022 in all primary healthcare centres in Bahrain. A simple random sample was obtained. An elderly patient was defined as one aged ≥60 years and polypharmacy was defined as the concomitant use of 5 or more medications, with excessive polypharmacy defined as the concomitant use of 10 or more medications. Results A total of 977 patients were included, with more than half of them being females (n = 533, 54.55%) and the mean age of the participants at 67.90 ± 6.87 years. Essential hypertension, hyperlipidaemia and diabetes mellitus were the most common comorbidities among the participants (61.51%, 57.63% and 53.22%, respectively). Among the cohort, 443 (45.34%) were on 5 or more medications and of those 66 (6.76%) were on at least 10 medications. A multivariate analysis revealed that patients with diabetes (odds ratio [OR] = 5.836, 95% confidence interval [CI]: 4.061-8.385; P <0.001), hypertension (OR = 6.231, 95% CI: 4.235-9.168; P <0.001), hyperlipidaemia (OR = 3.999, 95% CI: 2.756-5.802; P <0.001), cardiovascular diseases (OR = 3.589, 95% CI: 1.787-7.205; P <0.001) and asthma (OR = 3.148, 95% CI: 1.646-6.019; P <0.001) were significantly more likely to suffer from polypharmacy. Conclusion Polypharmacy is prevalent among elderly patients in Bahrain, particularly among those with non-communicable diseases. Polypharmacy should be considered while delivering healthcare services to the elderly, especially those with non-communicable diseases.
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Affiliation(s)
- Mahmood Alawainati
- Family Medicine, Primary Healthcare Centers, Manama, Bahrain
- Family Medicine, Royal College of Surgeons in Ireland - Medical University of Bahrain, Muharraq, Bahrain
| | - Fatima Habib
- Family Medicine, Primary Healthcare Centers, Manama, Bahrain
| | - Eman Ateya
- Family Medicine, Primary Healthcare Centers, Manama, Bahrain
| | - Eman Dakheel
- Family Medicine, Primary Healthcare Centers, Manama, Bahrain
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Xu Y, Zhang L, Dou X, Dong Y, Guo X. Physiologically based pharmacokinetic modeling of apixaban to predict exposure in populations with hepatic and renal impairment and elderly populations. Eur J Clin Pharmacol 2024; 80:261-271. [PMID: 38099940 PMCID: PMC10847219 DOI: 10.1007/s00228-023-03602-4] [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: 09/25/2023] [Accepted: 12/02/2023] [Indexed: 02/07/2024]
Abstract
BACKGROUND Apixaban is a factor Xa inhibitor with a limited therapeutic index that belongs to the family of oral direct anticoagulants. The pharmacokinetic (PK) behavior of apixaban may be altered in elderly populations and populations with renal or hepatic impairment, necessitating dosage adjustments. METHODS This study was conducted to examine how the physiologically based pharmacokinetic (PBPK) model describes the PKs of apixaban in adult and elderly populations and to determine the PKs of apixaban in elderly populations with renal and hepatic impairment. After PBPK models were constructed using the reported physicochemical properties of apixaban and clinical data, they were validated using data from clinical studies involving various dose ranges. Comparing predicted and observed blood concentration data and PK parameters was utilized to evaluate the model's fit performance. RESULTS Doses should be reduced to approximately 70% of the healthy adult population for the healthy elderly population to achieve the same PK exposure; approximately 88%, 71%, and 89% of that for the elderly populations with mild, moderate, and severe renal impairment, respectively; and approximately 96%, 81%, and 58% of that for the Child Pugh-A, Child Pugh-B, and Child Pugh-C hepatic impairment elderly populations, respectively to achieve the same PK exposure. CONCLUSION The findings indicate that the renal and hepatic function might be considered for apixaban therapy in Chinese elderly patients and the PBPK model can be used to optimize dosage regimens for specific populations.
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Affiliation(s)
- Yichao Xu
- Center of Clinical Pharmacology, the Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, Zhejiang, China
| | - Lei Zhang
- Department of Pharmacy, the Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, Zhejiang, China
| | - Xiaofan Dou
- Center for Plastic & Reconstructive Surgery, Department of Orthopedics, Zhejiang Provincial People's Hospital (Affiliated People's Hospital), Hangzhou Medical College, Hangzhou, Zhejiang, China
| | - Yongze Dong
- Center for Plastic & Reconstructive Surgery, Department of Orthopedics, Zhejiang Provincial People's Hospital (Affiliated People's Hospital), Hangzhou Medical College, Hangzhou, Zhejiang, China
| | - Xiangchai Guo
- Center for Plastic & Reconstructive Surgery, Department of Orthopedics, Zhejiang Provincial People's Hospital (Affiliated People's Hospital), Hangzhou Medical College, Hangzhou, Zhejiang, China.
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Neu S, Matta R, Locke JA, Troke N, Tadrous M, Saskin R, Rebullar K, Nam R, Herschorn S. The Use of Metformin in Overactive Bladder: A Retrospective Nested Case-control, Population-based Analysis. Urology 2024; 183:70-77. [PMID: 37805050 DOI: 10.1016/j.urology.2023.09.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 09/22/2023] [Accepted: 09/27/2023] [Indexed: 10/09/2023]
Abstract
OBJECTIVE To determine if metformin use is associated with a lower rate of overactive bladder (OAB) medication use. Metformin facilitates the proliferation and migration of stem cells, which have been shown to improve bladder overactivity in animal models. METHODS We conducted a retrospective nested case-control cohort study using population-based health-care administrative databases. Our cohort included patients with diabetes mellitus type 2 (DM2) ≥69years. Cases received a prescription for an OAB medication, matched with up to 4 controls based on age, sex, and DM2 diagnosis date. Exposure was a new prescription for metformin prior to receiving an OAB medication. Adjusted odds ratios were estimated using conditional logistic regression. Sensitivity analysis was done to assess the relationship between cumulative days' supply of metformin and use of OAB medications. RESULTS Within our cohort of 2,233,084 patients with DM2, there were 16,549 case subjects who received a prescription for an OAB medication, and 64,171 matched controls. We found a positive association between OAB medication use and metformin use (adjusted odds ratios=1.07, 95% CI=1.03-1.12). Summed days' supply of metformin was also associated with OAB medication use, except when summed metformin days was >2220. CONCLUSION Older patients with DM2 exposed to metformin had a slightly higher rate of OAB medication use, until 2220+ days' metformin supply, whereafter no association was found. This suggests no protective role for metformin in the prevention of OAB in this patient population.
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Affiliation(s)
- Sarah Neu
- Division of Urology, Department of Surgery, University of Toronto, Toronto, Ontario, Canada.
| | - Rano Matta
- Division of Urology, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Jennifer A Locke
- Division of Urology, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | | | - Mina Tadrous
- ICES, Toronto, Ontario, Canada; Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada; Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada
| | | | - Karla Rebullar
- Division of Urology, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Robert Nam
- Division of Urology, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Sender Herschorn
- Division of Urology, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
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Guo L, Zhu X, Zhang L, Xu Y. Physiologically based pharmacokinetic modeling of candesartan to predict the exposure in hepatic and renal impairment and elderly populations. Ther Adv Drug Saf 2023; 14:20420986231220222. [PMID: 38157240 PMCID: PMC10752084 DOI: 10.1177/20420986231220222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 11/27/2023] [Indexed: 01/03/2024] Open
Abstract
Background Candesartan cilexetil is a widely used angiotensin II receptor blocker with minimal adverse effects and high tolerability for the treatment of hypertension. Candesartan is administered orally as the prodrug candesartan cilexetil, which is wholly and swiftly converted to the active metabolite candesartan by carboxylesterase during absorption in the intestinal tract. In populations with renal or hepatic impairment, candesartan's pharmacokinetic (PK) behavior may be altered, necessitating dosage adjustments. Objectives This study was conducted to examine how the physiologically based PK (PBPK) model characterizes the PKs of candesartan in adult and geriatric populations and to predict the PKs of candesartan in elderly populations with renal and hepatic impairment. Design After developing PBPK models using the reported physicochemical properties of candesartan and clinical data, these models were validated using data from clinical investigations involving various dose ranges. Methods Comparing predicted and observed blood concentration data and PK parameters was used to assess the fit performance of the models. Results Doses should be reduced to approximately 94% of Chinese healthy adults for the Chinese healthy elderly population; approximately 92%, 68%, and 64% of that of the Chinese healthy adult dose in elderly populations with mild, moderate, and severe renal impairment, respectively; and approximately 72%, 71%, and 52% of that of the Chinese healthy adult dose in elderly populations with Child-Pugh-A, Child-Pugh-B, and Child-Pugh-C hepatic impairment, respectively. Conclusion The results suggest that the PBPK model of candesartan can be utilized to optimize dosage regimens for special populations.
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Affiliation(s)
- Lingfeng Guo
- The First Affiliated Hospital of Zhejiang University Shengzhou Branch, School of Medicine, Shengzhou, Zhejiang, China
| | - Xinyu Zhu
- The First Affiliated Hospital of Zhejiang University Shengzhou Branch, School of Medicine, Shengzhou, Zhejiang, China
| | - Lei Zhang
- Department of Pharmacy, The Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, Zhejiang, China
| | - Yichao Xu
- Center of Clinical Pharmacology, The Second Affiliated Hospital of Zhejiang University, School of Medicine, 88 Jiefang Road, Hangzhou, Zhejiang 310009, China
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Nishida S, Kato T, Hayashi Y, Yamada S, Fujii H, Yamada M, Asai N, Shimizu S, Niwa T, Iihara H, Kubota S, Sakai M, Takahashi Y, Takao K, Mizuno M, Hirota T, Kobayashi R, Horikawa Y, Yabe D, Suzuki A. Effectiveness of countermeasure for polypharmacy by multidisciplinary team review in patients with diabetes mellitus. J Diabetes Investig 2023; 14:1202-1208. [PMID: 37357565 PMCID: PMC10512905 DOI: 10.1111/jdi.14046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 05/22/2023] [Accepted: 06/14/2023] [Indexed: 06/27/2023] Open
Abstract
AIMS/INTRODUCTION Polypharmacy in diabetes patients is related to worse clinical outcomes. The aim of this study was to evaluate the usefulness of our countermeasure for polypharmacy, which combines a pharmacist check followed by a multidisciplinary team review in diabetic patients with polypharmacy. METHODS A single-center, retrospective observational study was conducted at Gifu University Hospital. Study participants included diabetic patients taking six or more drugs on admission to the diabetes ward between July 2021 and June 2022. Drugs which were discontinued by the present countermeasure were examined, and the number of drugs being taken by each patient was compared between admission and discharge. RESULTS 102 of 308 patients were taking six or more drugs on admission. The drugs being taken by these patients were evaluated by pharmacists using a checklist for polypharmacy. Eighty-four drugs which were evaluated as inappropriate or potentially inappropriate medications by pharmacists were discontinued following the multidisciplinary team review. The median and mean number of drugs taken by the 102 patients significantly decreased from 9.0 (IQR: 8-12) and 9.26 ± 2.64 on admission to 9.0 (IQR: 6-10) and 8.42 ± 2.95 on discharge (P = 0.0002). We followed up with these patients after discontinuation of the drugs and confirmed that their clinical status had not deteriorated. CONCLUSION The present countermeasure for polypharmacy, which combines a pharmacist check based on a checklist for evaluating polypharmacy followed by a multidisciplinary team review, was useful for reducing the number of inappropriate or potentially inappropriate medications taken by diabetes patients with polypharmacy.
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Affiliation(s)
| | - Takehiro Kato
- Department of Diabetes, Endocrinology and MetabolismGifu University Graduate School of MedicineGifuJapan
- Department of Rheumatology and Clinical ImmunologyGifu University Graduate School of MedicineGifuJapan
| | - Yuichi Hayashi
- Faculty of Nursing ScienceTsuruga Nursing UniversityTsurugaJapan
| | - Shoya Yamada
- Department of PharmacyGifu University HospitalGifuJapan
| | | | - Michi Yamada
- Department of PharmacyGifu University HospitalGifuJapan
| | - Nao Asai
- Department of PharmacyGifu University HospitalGifuJapan
| | | | - Takashi Niwa
- Department of PharmacyGifu University HospitalGifuJapan
| | - Hirotoshi Iihara
- Department of PharmacyGifu University HospitalGifuJapan
- Patient Safety DivisionGifu University HospitalGifuJapan
| | - Sodai Kubota
- Department of Diabetes, Endocrinology and MetabolismGifu University Graduate School of MedicineGifuJapan
- Department of Rheumatology and Clinical ImmunologyGifu University Graduate School of MedicineGifuJapan
| | - Mayu Sakai
- Department of Diabetes, Endocrinology and MetabolismGifu University Graduate School of MedicineGifuJapan
- Department of Rheumatology and Clinical ImmunologyGifu University Graduate School of MedicineGifuJapan
| | - Yoshihiro Takahashi
- Department of Diabetes, Endocrinology and MetabolismGifu University Graduate School of MedicineGifuJapan
- Department of Rheumatology and Clinical ImmunologyGifu University Graduate School of MedicineGifuJapan
| | - Ken Takao
- Department of Diabetes, Endocrinology and MetabolismGifu University Graduate School of MedicineGifuJapan
- Department of Rheumatology and Clinical ImmunologyGifu University Graduate School of MedicineGifuJapan
| | - Masami Mizuno
- Department of Diabetes, Endocrinology and MetabolismGifu University Graduate School of MedicineGifuJapan
- Department of Rheumatology and Clinical ImmunologyGifu University Graduate School of MedicineGifuJapan
| | - Takuo Hirota
- Department of Diabetes, Endocrinology and MetabolismGifu University Graduate School of MedicineGifuJapan
- Department of Rheumatology and Clinical ImmunologyGifu University Graduate School of MedicineGifuJapan
| | - Ryo Kobayashi
- Department of PharmacyGifu University HospitalGifuJapan
- Laboratory of Advanced Medical PharmacyGifu Pharmaceutical UniversityGifuJapan
| | - Yukio Horikawa
- Department of Diabetes, Endocrinology and MetabolismGifu University Graduate School of MedicineGifuJapan
- Department of Rheumatology and Clinical ImmunologyGifu University Graduate School of MedicineGifuJapan
- Center for Patient Flow ManagementGifu University HospitalGifuJapan
| | - Daisuke Yabe
- Department of Diabetes, Endocrinology and MetabolismGifu University Graduate School of MedicineGifuJapan
- Department of Rheumatology and Clinical ImmunologyGifu University Graduate School of MedicineGifuJapan
- Center for One Medicine Innovative Translational ResearchGifu University Institute for Advanced StudyGifuJapan
- Preemptive Food Research CenterGifu University Institute for Advanced StudyGifuJapan
- Center for Research, Education and Lifestyle DesignGifu UniversityGifuJapan
| | - Akio Suzuki
- Department of PharmacyGifu University HospitalGifuJapan
- Laboratory of Advanced Medical PharmacyGifu Pharmaceutical UniversityGifuJapan
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11
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Perales-Puchalt J, Burkhardt C, Baker J, Cernik C, Townley R, Niedens M, Burns JM, Mudaranthakam DP. Patient Polypharmacy use Following a Multi-Disciplinary Dementia Care Program in a Memory Clinic: A Retrospective Cohort Study. Kans J Med 2023; 16:237-241. [PMID: 37791031 PMCID: PMC10544887 DOI: 10.17161/kjm.vol16.20976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 08/29/2023] [Indexed: 10/05/2023] Open
Abstract
Introduction Dementia increases the risk of polypharmacy. Timely detection and optimal care can stabilize or delay the progression of dementia symptoms, which may in turn reduce polypharmacy. We aimed to evaluate the change in polypharmacy use among memory clinic patients living with dementia who participated in a dementia care program compared to those who did not. We hypothesized that patients in the dementia care program would reduce their use of polypharmacy compared to those who were not in standard care. Methods We retrospectively analyzed data extracted from electronic medical records from a university memory clinic. Data from a total of 381 patients were included in the study: 107 in the program and 274 matched patients in standard care. We used adjusted odds ratios to assess the association between enrollment in the program and polypharmacy use at follow-up (five or more concurrent medications), controlling for baseline polypharmacy use and stratified polypharmacy use by prescription and over-the-counter (OTC). Results The two groups did not differ in the use of five or more overall and prescription medications at follow-up, controlling for the use of five or more of the respective medications at baseline and covariates. Being in the program was associated with a three-fold lower odds of using five or more OTC medications at follow-up (adjusted odds ratio = 0.30; p <0.001; 95% Confidence interval = 0.15-0.58) after controlling for using five or more OTC medications at baseline and covariates. Conclusions Dementia care may reduce polypharmacy of OTC medications, potentially reducing risky drug-drug interactions. More research is needed to infer causality and understand how to reduce prescription medication polypharmacy.
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Affiliation(s)
| | | | - Jordan Baker
- University of Kansas Medical Center, Kansas City, KS
| | - Colin Cernik
- University of Kansas Medical Center, Kansas City, KS
| | - Ryan Townley
- University of Kansas Medical Center, Kansas City, KS
- University of Kansas Health System, Kansas City, KS
| | - Michelle Niedens
- University of Kansas Medical Center, Kansas City, KS
- University of Kansas Health System, Kansas City, KS
| | - Jeffrey M Burns
- University of Kansas Medical Center, Kansas City, KS
- University of Kansas Health System, Kansas City, KS
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12
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Salave S, Patel P, Desai N, Rana D, Benival D, Khunt D, Thanawuth K, Prajapati BG, Sriamornsak P. Recent advances in dosage form design for the elderly: a review. Expert Opin Drug Deliv 2023; 20:1553-1571. [PMID: 37978899 DOI: 10.1080/17425247.2023.2286368] [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: 09/17/2023] [Accepted: 11/17/2023] [Indexed: 11/19/2023]
Abstract
INTRODUCTION With the increase in the elderly population and the prevalence of multiple medical conditions, medication adherence, and efficacy have become crucial for the effective management of their health. The aging population faces unique challenges that need to be addressed through advancements in drug delivery systems and formulation technologies. AREAS COVERED The current review highlights the recent advances in dosage form design for older individuals, with consideration of their specific physiological and cognitive changes. Various dosage forms, such as modified-release tablets/capsules, chewable tablets, and transdermal patches, can be tailored to meet the specific needs of elderly patients. Advancements in drug delivery systems, such as nanotherapeutics, additive manufacturing (three-dimensional printing), and drug-food combinations, improve drug delivery and efficacy and overcome challenges, such as dysphagia and medication adherence. EXPERT OPINION Regulatory guidelines and considerations are crucial in ensuring the safe utilization of medications among older adults. Important factors to consider include geriatric-specific guidelines, safety considerations, labeling requirements, clinical trial considerations, and adherence and accessibility considerations.
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Affiliation(s)
- Sagar Salave
- Department of Pharmaceutics, National Institute of Pharmaceutical Education and Research (NIPER), Ahmedabad, India
| | - Pranav Patel
- Department of Pharmaceutics, National Institute of Pharmaceutical Education and Research (NIPER), Ahmedabad, India
| | - Nimeet Desai
- Department of Biomedical Engineering, Indian Institute of Technology Hyderabad, Kandi, India
| | - Dhwani Rana
- Department of Pharmaceutics, National Institute of Pharmaceutical Education and Research (NIPER), Ahmedabad, India
| | - Derajram Benival
- Department of Pharmaceutics, National Institute of Pharmaceutical Education and Research (NIPER), Ahmedabad, India
| | - Dignesh Khunt
- Graduate School of Pharmacy, Gujarat Technological University, Gandhinagar, Gujarat, India
| | | | - Bhupendra G Prajapati
- Shree S. K. Patel College of Pharmaceutical Education and Research, Ganpat University, Mehsana, India
| | - Pornsak Sriamornsak
- Faculty of Pharmacy, Silpakorn University, Nakhon Pathom, Thailand
- Academy of Science, The Royal Society of Thailand, Bangkok, Thailand
- Faculty of Pharmaceutical Sciences, Chulalongkorn University, Bangkok, Thailand
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13
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Shen C, Shao W, Wang W, Sun H, Wang X, Geng K, Wang X, Xie H. Physiologically based pharmacokinetic modeling of levetiracetam to predict the exposure in hepatic and renal impairment and elderly populations. CPT Pharmacometrics Syst Pharmacol 2023; 12:1001-1015. [PMID: 37170680 PMCID: PMC10349187 DOI: 10.1002/psp4.12971] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 04/06/2023] [Accepted: 04/10/2023] [Indexed: 05/13/2023] Open
Abstract
Levetiracetam (LEV) is an anti-epileptic drug approved for use in various populations. The pharmacokinetic (PK) behavior of LEV may be altered in the elderly and patients with renal and hepatic impairment. Thus, dosage adjustment is required. This study was conducted to investigate how the physiologically-based PK (PBPK) model describes the PKs of LEV in adult and elderly populations, as well as to predict the PKs of LEV in patients with renal and hepatic impairment in both populations. The whole-body PBPK models were developed using the reported physicochemical properties of LEV and clinical data. The models were validated using data from clinical studies with different dose ranges and different routes and intervals of administration. The fit performance of the models was assessed by comparing predicted and observed blood concentration data and PK parameters. It is recommended that the doses be reduced to ~70%, 60%, and 45% of the adult dose for the mild, moderate, and severe renal impairment populations and ~95%, 80%, and 57% of the adult dose for the Child Pugh-A (CP-A), Child Pugh-B (CP-B), and Child Pugh-C (CP-C) hepatic impairment populations, respectively. No dose adjustment is required for the healthy elderly population, but dose reduction is required for the elderly with organ dysfunction accordingly, on a scale similar to that of adults. A PBPK model of LEV was successfully developed to optimize dosing regimens for special populations.
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Affiliation(s)
- Chaozhuang Shen
- Anhui Provincial Center for Drug Clinical EvaluationYijishan Hospital of Wannan Medical CollegeWuhuAnhuiChina
| | - Wenxin Shao
- Anhui Provincial Center for Drug Clinical EvaluationYijishan Hospital of Wannan Medical CollegeWuhuAnhuiChina
| | - Wenhui Wang
- Anhui Provincial Center for Drug Clinical EvaluationYijishan Hospital of Wannan Medical CollegeWuhuAnhuiChina
| | - Hua Sun
- Anhui Provincial Center for Drug Clinical EvaluationYijishan Hospital of Wannan Medical CollegeWuhuAnhuiChina
| | - Xiaohu Wang
- Anhui Provincial Center for Drug Clinical EvaluationYijishan Hospital of Wannan Medical CollegeWuhuAnhuiChina
| | - Kuo Geng
- Anhui Provincial Center for Drug Clinical EvaluationYijishan Hospital of Wannan Medical CollegeWuhuAnhuiChina
| | - Xingwen Wang
- Anhui Provincial Center for Drug Clinical EvaluationYijishan Hospital of Wannan Medical CollegeWuhuAnhuiChina
| | - Haitang Xie
- Anhui Provincial Center for Drug Clinical EvaluationYijishan Hospital of Wannan Medical CollegeWuhuAnhuiChina
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14
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Omuya H, Nickel C, Wilson P, Chewning B. A systematic review of randomised-controlled trials on deprescribing outcomes in older adults with polypharmacy. INTERNATIONAL JOURNAL OF PHARMACY PRACTICE 2023:7156969. [PMID: 37155330 DOI: 10.1093/ijpp/riad025] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Accepted: 04/07/2023] [Indexed: 05/10/2023]
Abstract
BACKGROUND Mixed findings about deprescribing impact have emerged from varied study designs, interventions, outcome measures and targeting sub-categories of medications or morbidities. This systematic review controls for study design by reviewing randomised-controlled trials (RCTs) of deprescribing interventions using comprehensive medication profiles. The goal is to provide a synthesis of interventions and patient outcomes to inform healthcare providers and policy makers about deprescribing effectiveness. OBJECTIVES This systematic review aims to (1) review RCT deprescribing studies focusing on complete medication reviews of older adults with polypharmacy across all health settings, (2) map patients' clinical and economic outcomes against intervention and implementation strategies and (3) inform research agendas based on observed benefits and best practices. METHODS The PRISMA framework for systematic reviews was followed. Databases used were EBSCO Medline, PubMed, Cochrane Library, Scopus and Web of Science. Risk of bias was assessed using the Cochrane Risk of Bias tool for randomised trials. RESULTS Fourteen articles were included. Interventions varied in setting, preparation, use of interdisciplinary teams, validated guidelines and tools, patient-centredness and implementation strategy. Thirteen studies (92.9%) found deprescribing interventions reduced the number of drugs and/or doses taken. No studies found threats to patient safety in terms of primary outcomes including morbidity, hospitalisations, emergency room use and falls. Four of five studies identifying health quality of life as a primary outcome found significant effects associated with deprescribing. Both studies with cost as their primary outcome found significant effects as did two with cost as a secondary outcome. Studies did not systematically study how intervention components influenced deprescribing impact. To explore this gap, this review mapped studies' primary outcomes to deprescribing intervention components using the Consolidated Framework for Implementation Research. Five studies had significant, positive primary outcomes related to health-related quality of life (HRQOL), cost and/or hospitalisation, with four reporting patient-centred elements in their intervention. CONCLUSIONS RCT primary outcomes found deprescribing is safe and reduces drug number or dose. Five RCTs found a significant deprescribing impact on HRQOL, cost or hospitalisation. Important future research agendas include analysing (1) understudied outcomes like cost, and (2) intervention and implementation components that enhance effectiveness, such as patient-centred elements.
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Affiliation(s)
- Helen Omuya
- Health Services Research in Pharmacy, School of Pharmacy, University of Wisconsin Madison, Madison WI
| | - Clara Nickel
- School of Pharmacy, University of Wisconsin Madison, Madison WI
| | - Paije Wilson
- Ebling Library for the Health Sciences, University of Wisconsin Madison, Madison, WI, USA
| | - Betty Chewning
- Social and Administrative Sciences, School of Pharmacy, University of Wisconsin, Madison, WI, USA
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15
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Nishino M, Egami Y, Kawanami S, Sugae H, Ukita K, Kawamura A, Nakamura H, Yasumoto K, Tsuda M, Okamoto N, Matsunaga-Lee Y, Yano M, Tanouchi J, Yamada T, Yasumura Y, Seo M, Tamaki S, Hayashi T, Nakagawa A, Nakagawa Y, Sotomi Y, Nakatani D, Hikoso S, Sakata Y. Prognostic impact of cardiovascular polypharmacy on octogenarians with heart failure with preserved ejection fraction. Int J Cardiol 2023; 378:55-63. [PMID: 36796493 DOI: 10.1016/j.ijcard.2023.02.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 02/09/2023] [Accepted: 02/10/2023] [Indexed: 02/16/2023]
Abstract
BACKGROUNDS Drug treatments of heart failure with preserved ejection fraction (HFpEF) have a little clinical benefit, but cardiovascular polypharmacy (CP) trend is observed in elderly HFpEF. We investigated the impact of CP on octogenarian with HFpEF. METHODS We examined 783 consecutive octogenarians (≥80 years) enrolled in the PURSUIT-HFpEF registry. We defined medications for hypertension, dyslipidemia, heart failure (HF), coronary artery disease, stroke, peripheral artery disease, and atrial fibrillation as cardiovascular medications (CM). In this study, we defined CP as ≥5 CM. We investigated whether CP was correlated with the composite end point (CE) of all-cause mortality and HF rehospitalization. RESULTS The proportion with CP was 51.9% (n = 406). Background characteristics correlated with CP were frailty, history of coronary artery disease, atrial fibrillation and left atrial dimension. Multivariable Cox proportional hazards analysis showed CP was significantly and independently correlated with CE (hazard ratio (HR): 1.31; 95% confidence Interval (CI): 1.01-1.70) in addition to age, clinical frailty scale, history of HF admission and N-terminal pro brain natriuretic peptide. Kaplan-Meier curve analysis showed that, compared with the non-CP group, the CP group had significantly higher risk of CE and HF (HR: 1.27; 95%CI: 1.04-1.56; P = 0.02 and HR: 1.46; 95%CI: 1.13-1.88; P < 0.01, respectively), but not any-cause death. In addition, diuretics were correlated with CE (HR: 1.61; 95%CI: 1.17-2.22; P < 0.01), but antithrombotic drugs and HFpEF medications were not. CONCLUSIONS CP at discharge is a prognostic factor driven by HF rehospitalization in octogenarians with HFpEF. In these patients, diuretics may be correlated with the prognosis.
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Affiliation(s)
- Masami Nishino
- Division of Cardiology, Osaka Rosai Hospital, 3-1179 Nagasonecho, Kita-ku, Sakai, Osaka 591-8025, Japan.
| | - Yasuyuki Egami
- Division of Cardiology, Osaka Rosai Hospital, 3-1179 Nagasonecho, Kita-ku, Sakai, Osaka 591-8025, Japan
| | - Shodai Kawanami
- Division of Cardiology, Osaka Rosai Hospital, 3-1179 Nagasonecho, Kita-ku, Sakai, Osaka 591-8025, Japan
| | - Hiroki Sugae
- Division of Cardiology, Osaka Rosai Hospital, 3-1179 Nagasonecho, Kita-ku, Sakai, Osaka 591-8025, Japan
| | - Kohei Ukita
- Division of Cardiology, Osaka Rosai Hospital, 3-1179 Nagasonecho, Kita-ku, Sakai, Osaka 591-8025, Japan
| | - Akito Kawamura
- Division of Cardiology, Osaka Rosai Hospital, 3-1179 Nagasonecho, Kita-ku, Sakai, Osaka 591-8025, Japan
| | - Hitoshi Nakamura
- Division of Cardiology, Osaka Rosai Hospital, 3-1179 Nagasonecho, Kita-ku, Sakai, Osaka 591-8025, Japan
| | - Koji Yasumoto
- Division of Cardiology, Osaka Rosai Hospital, 3-1179 Nagasonecho, Kita-ku, Sakai, Osaka 591-8025, Japan
| | - Masaki Tsuda
- Division of Cardiology, Osaka Rosai Hospital, 3-1179 Nagasonecho, Kita-ku, Sakai, Osaka 591-8025, Japan
| | - Naotaka Okamoto
- Division of Cardiology, Osaka Rosai Hospital, 3-1179 Nagasonecho, Kita-ku, Sakai, Osaka 591-8025, Japan
| | - Yasuharu Matsunaga-Lee
- Division of Cardiology, Osaka Rosai Hospital, 3-1179 Nagasonecho, Kita-ku, Sakai, Osaka 591-8025, Japan
| | - Masamichi Yano
- Division of Cardiology, Osaka Rosai Hospital, 3-1179 Nagasonecho, Kita-ku, Sakai, Osaka 591-8025, Japan
| | - Jun Tanouchi
- Division of Cardiology, Osaka Rosai Hospital, 3-1179 Nagasonecho, Kita-ku, Sakai, Osaka 591-8025, Japan
| | - Takahisa Yamada
- Division of Cardiology, Osaka General Medical Center, 3-1-56 Mandaihigashi, Sumiyoshi-ku, Osaka 558-8558, Japan
| | - Yoshio Yasumura
- Division of Cardiology, Amagasaki Chuo Hospital, 1-12-1 Shioe, Amagasaki, Hyogo 661-0976, Japan
| | - Masahiro Seo
- Division of Cardiology, Osaka General Medical Center, 3-1-56 Mandaihigashi, Sumiyoshi-ku, Osaka 558-8558, Japan
| | - Shunsuke Tamaki
- Division of Cardiology, Rinku General Medical Center, 2-23 Rinkuoraikita, Izumisano, Osaka 598-0048, Japan
| | - Takaharu Hayashi
- Cardiovascular Division, Osaka Police Hospital, 10-31 Kitayamacho, Tennoji-ku, Osaka 543-0035, Japan
| | - Akito Nakagawa
- Division of Cardiology, Amagasaki Chuo Hospital, 1-12-1 Shioe, Amagasaki, Hyogo 661-0976, Japan; Department of Medical Informatics, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita 565-0871, Japan
| | - Yusuke Nakagawa
- Division of Cardiology, Kawanishi City Medical Center, 1-4-1 Hiuchi, Kawanishi, Hyogo 666-0017, Japan
| | - Yohei Sotomi
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita 565-0871, Japan
| | - Daisaku Nakatani
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita 565-0871, Japan
| | - Shungo Hikoso
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita 565-0871, Japan
| | - Yasushi Sakata
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita 565-0871, Japan
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16
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Shimomura T, Kawakami M, Yamada Y, Ito D, Miyazaki Y, Mori N, Tsujikawa M, Honaga K, Kondo K, Tsuji T. Impacts of increases and decreases of drugs on rehabilitation outcomes of subacute stroke patients. J Stroke Cerebrovasc Dis 2023; 32:107150. [PMID: 37119792 DOI: 10.1016/j.jstrokecerebrovasdis.2023.107150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 04/19/2023] [Accepted: 04/20/2023] [Indexed: 05/01/2023] Open
Abstract
OBJECTIVE To examine changes in drugs for subacute stroke patients and elucidate the impact of medications on rehabilitation outcomes. MATERIALS AND METHODS A total of 295 subacute stroke patients who were admitted to the convalescent rehabilitation ward between June 2018 and May 2019 were included. Polypharmacy was defined as five or more drugs at admission. The primary outcome was the Functional Independence Measure Total score (FIM-T) at discharge. Multiple regression analysis was performed to examine the relationships between the FIM-T at discharge and drug changes or other factors. This study was conducted in two stages. The first analysis included all stroke patients, and the second analysis included only stroke patients with polypharmacy. RESULTS On multiple regression analysis, the number of drugs at admission (β=-0.628) was associated with FIM-T at discharge of all stroke patients. Furthermore, the number of additional drugs during hospitalization (β=-1.964) was associated with FIM-T at discharge in the 176 stroke patients with polypharmacy. CONCLUSION This study suggested that the number of drugs at admission and the addition of drugs during hospitalization might have a negative impact on the rehabilitation outcomes of subacute stroke patients.
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Affiliation(s)
- Tadasuke Shimomura
- Department of Rehabilitation Medicine, Tokyo Bay Rehabilitation Hospital, Chiba, Japan; Department of Rehabilitation Medicine, Keio University School of Medicine, Tokyo, Japan.
| | - Michiyuki Kawakami
- Department of Rehabilitation Medicine, Keio University School of Medicine, Tokyo, Japan.
| | - Yuka Yamada
- Department of Rehabilitation Medicine, Keio University School of Medicine, Tokyo, Japan.
| | - Daisuke Ito
- Department of Rehabilitation Medicine, Keio University School of Medicine, Tokyo, Japan.
| | - Yuta Miyazaki
- Department of Rehabilitation Medicine, Tokyo Bay Rehabilitation Hospital, Chiba, Japan; Department of Rehabilitation Medicine, Keio University School of Medicine, Tokyo, Japan.
| | - Naoki Mori
- Department of Rehabilitation Medicine, Keio University School of Medicine, Tokyo, Japan.
| | - Masahiro Tsujikawa
- Department of Rehabilitation Medicine, Tokyo Bay Rehabilitation Hospital, Chiba, Japan; Department of Rehabilitation Medicine, Keio University School of Medicine, Tokyo, Japan.
| | - Kaoru Honaga
- Department of Rehabilitation Medicine, Tokyo Bay Rehabilitation Hospital, Chiba, Japan; Department of Rehabilitation Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan.
| | - Kunitsugu Kondo
- Department of Rehabilitation Medicine, Tokyo Bay Rehabilitation Hospital, Chiba, Japan.
| | - Tetsuya Tsuji
- Department of Rehabilitation Medicine, Keio University School of Medicine, Tokyo, Japan.
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17
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Hwang J, Lyu B, Ballew S, Coresh J, Grams ME, Couper D, Lutsey P, Shin JI. The association between socioeconomic status and use of potentially inappropriate medications in older adults. J Am Geriatr Soc 2023; 71:1156-1166. [PMID: 36511705 PMCID: PMC10089965 DOI: 10.1111/jgs.18165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 11/06/2022] [Accepted: 11/17/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND Potentially inappropriate medication (PIM) use is an important public health problem, particularly among older adults who may need multiple pharmacologic therapies for various chronic conditions. As socioeconomic status (SES) affects the quality of healthcare that individuals receive, SES may be associated with the use of PIM in older adults. This study aimed to determine whether low SES is associated with increased use of PIM. METHODS We studied 4927 participants (aged 66-90 years) who were on at least one medication at visit five (2011-2013) of the Atherosclerosis Risk in Communities Study. We created a cumulative SES score categorized as high (7-9), middle (3-6), and low (0-2) based on education, income, and area deprivation index. We use multivariable logistic regression to examine the associations between SES and use of two or more PIM for older adults, defined by the 2019 Beers Criteria. RESULTS A total of 31.0% and 6.9% of the participants used one or more PIM and two or more PIM, respectively. After adjusting for demographic characteristics and insurance type, low cumulative SES score was associated with significantly greater use of two or more PIM (odds ratio [OR] = 1.83 [95% confidence interval (CI) 1.18-2.86]), as was middle cumulative SES score (OR = 1.40 [95% CI 1.06-1.83]), compared to high cumulative SES score. The results remained significant after further adjusting for comorbidities and medication burden for low cumulative SES score (OR = 1.66 [95%CI 1.02-2.71]). CONCLUSIONS We found that lower SES was associated with greater use of PIM among older adults independent of their medication burden and comorbidities, suggesting socioeconomic disparities in quality of medication management. Focused efforts targeting older adults with low SES to reduce PIM use may be needed to prevent adverse drug events.
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Affiliation(s)
- Jimin Hwang
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Beini Lyu
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Shoshana Ballew
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University, Baltimore, Maryland
| | - Josef Coresh
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University, Baltimore, Maryland
| | - Morgan E. Grams
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University, Baltimore, Maryland
- Division of Nephrology, Department of Internal Medicine, Johns Hopkins University, Baltimore, Maryland
| | - David Couper
- Department of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Pamela Lutsey
- Division of Epidemiology & Community Health, University of Minnesota, Minneapolis, Minnesota
| | - Jung-Im Shin
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University, Baltimore, Maryland
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Hanai T, Nishimura K, Miwa T, Maeda T, Imai K, Suetsugu A, Takai K, Shimizu M. Prevalence, association, and prognostic significance of polypharmacy and sarcopenia in patients with liver cirrhosis. JGH OPEN 2023; 7:208-214. [PMID: 36968562 PMCID: PMC10037035 DOI: 10.1002/jgh3.12877] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 01/23/2023] [Accepted: 02/01/2023] [Indexed: 02/15/2023]
Abstract
Background and Aim Polypharmacy and sarcopenia are increasing public health problems worldwide. However, data on the prevalence, association, and prognostic significance of polypharmacy and sarcopenia in patients with liver cirrhosis are limited. Methods Polypharmacy and sarcopenia were assessed in 239 patients with liver cirrhosis. Polypharmacy was defined as the daily use of six or more medications, and sarcopenia was diagnosed based on muscle strength and mass evaluated on computed tomography. The association between polypharmacy and sarcopenia and their effects on mortality were analyzed using logistic regression and Cox proportional hazards models. Results Among the 239 patients, 52% were men, the median age was 68 years, and the number of medications used per patient was 6. Further, 53% and 29% patients had polypharmacy and sarcopenia, respectively. The number of medications used and the prevalence of sarcopenia increased with age. Patients with polypharmacy and sarcopenia had similar characteristics, such as older age, increased medication use, advanced liver disease, and decreased muscle strength and mass. After adjusting for confounders, polypharmacy was significantly associated with sarcopenia (odds ratio, 2.11; 95% confidence interval [CI], 1.07-4.17). During the median follow-up of 2.2 years, 62 (26%) patients died. Polypharmacy (hazard ratio [HR], 1.83; 95% CI, 1.01-3.37) and sarcopenia (HR, 2.00; 95% CI, 1.12-3.50) independently predicted mortality. The prognostic significance of polypharmacy was more prominent in older adults than in younger adults (HR, 2.31; 95% CI, 1.01-5.67). Conclusion Polypharmacy and sarcopenia are interrelated and associated with poor prognosis in patients with cirrhosis. Further large, prospective, population-based studies are required to validate these findings.
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Affiliation(s)
- Tatsunori Hanai
- Department of Gastroenterology/Internal Medicine Gifu University Graduate School of Medicine Gifu Japan
| | - Kayoko Nishimura
- Center for Nutrition Support and Infection Control Gifu University Hospital Gifu Japan
| | - Takao Miwa
- Department of Gastroenterology/Internal Medicine Gifu University Graduate School of Medicine Gifu Japan
| | - Toshihide Maeda
- Department of Gastroenterology/Internal Medicine Gifu University Graduate School of Medicine Gifu Japan
| | - Kenji Imai
- Department of Gastroenterology/Internal Medicine Gifu University Graduate School of Medicine Gifu Japan
| | - Atsushi Suetsugu
- Department of Gastroenterology/Internal Medicine Gifu University Graduate School of Medicine Gifu Japan
| | - Koji Takai
- Department of Gastroenterology/Internal Medicine Gifu University Graduate School of Medicine Gifu Japan
| | - Masahito Shimizu
- Department of Gastroenterology/Internal Medicine Gifu University Graduate School of Medicine Gifu Japan
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Hashmi AZ, Christy J, Saxena S, Factora R. An age-friendly population health dashboard geolocating by clinical and social determinant needs. Health Serv Res 2023; 58 Suppl 1:44-50. [PMID: 36116085 PMCID: PMC9843082 DOI: 10.1111/1475-6773.14070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Affiliation(s)
- Ardeshir Z. Hashmi
- Cleveland Clinic Community CareCleveland Clinic Center for Geriatric MedicineEuclidOhioUSA
| | - James Christy
- Strategic Workforce PlannerWorkforce Strategies Administration Caregiver Office – Cleveland ClinicBeachwoodOhioUSA
| | - Saket Saxena
- Cleveland Clinic Community CareCleveland Clinic Center for Geriatric MedicineEuclidOhioUSA
| | - Ronan Factora
- Cleveland Clinic Community CareCleveland Clinic Center for Geriatric MedicineEuclidOhioUSA
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20
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Farrell A, Castro T, Nalubola S, Lakhi N. Trauma-related falls in an urban geriatric population: predictive risk factors for poorer clinical outcomes. Inj Epidemiol 2023; 10:7. [PMID: 36717881 PMCID: PMC9887835 DOI: 10.1186/s40621-023-00418-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Accepted: 01/19/2023] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND The aim of this study was to elucidate associations between polypharmacy, types of medications, and geriatric comorbidities to identify predictive risk factors for poorer clinical outcomes following trauma-related falls in the geriatric population. Nearly 80% of trauma-related hospital admissions in the older adult population are secondary to falls, accounting for 3 million emergency department visits annually. Numerous studies have demonstrated associations between falls, polypharmacy, and other geriatric comorbidities, but studies outlining predictive risk factors for poor clinical outcomes are lacking. METHODS A retrospective cohort study of 1087 patients ≥ 65 years old who presented to Level 1 Trauma Center after a trauma-related fall. Comorbidities, current medication, demographic information, and clinical outcomes were identified to ascertain predictive risk factors for poorer clinical outcomes. Variables were assessed for statistical significance on unadjusted analysis. Variables found to be significant were entered into a multivariable logistic regression model to test for adjusted associations, with p < 0.05 as statistically significant, and presented as adjusted odds ratios with 95% confidence intervals. RESULTS Polypharmacy ≥ 4 medications (aOR 2.38 (1.10-5.15), p < .028) was an independent predictor of hospital readmission within 30 days. Chronic kidney disease, male gender, and Asian race had an increased association with ICU admission. History of malignancy (aOR 3.65 (1.62-8.19), p < .002) and chronic kidney disease (aOR 2.56 (1.11-5.96), p < .027) were independent predictors of 30-day mortality. CONCLUSIONS Polypharmacy, chronic renal disease, malignancy history, male gender, and Asian race had an increased association of adverse clinical outcomes after falls in the geriatric population. Critical evaluation of patients with these risk factors may be needed to mitigate risk in this population.
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Affiliation(s)
- Alexander Farrell
- grid.430773.40000 0000 8530 6973Touro University College of Osteopathic Medicine, Middletown, NY USA
| | - Taylor Castro
- grid.260914.80000 0001 2322 1832College of Osteopathic Medicine, New York Institute of Technology, Old Westbury, NY USA
| | - Shreya Nalubola
- grid.260917.b0000 0001 0728 151XSchool of Medicine, New York Medical College, Valhalla, NY USA
| | - Nisha Lakhi
- grid.260917.b0000 0001 0728 151XSchool of Medicine, New York Medical College, Valhalla, NY USA ,grid.416977.a0000 0004 0622 3555Department of Trauma Surgery, Richmond University Medical Center, Staten Island, NY USA
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21
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Ming Y, Zecevic AA, Booth RG, Hunter SW, Tirona RG, Johnson AM. Medication Prescribed Within One Year Preceding Fall-Related Injuries in Ontario Older Adults. Can Geriatr J 2022; 25:347-367. [PMID: 36505916 PMCID: PMC9684022 DOI: 10.5770/cgj.25.569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
Background Serious injuries secondary to falls are becoming more prevalent due to the worldwide ageing of societies. Several medication classes have been associated with falls and fall-related injuries. The purpose of this study was to describe medication classes and the number of medication classes prescribed to older adults prior to the fall-related injury. Methods This population-based descriptive study used secondary administrative health-care data in Ontario, Canada for 2010-2014. Descriptive statistics were reported for Anatomic Therapeutic Chemical 4th level medication classes. Frequency of medications prescribed to older adults was calculated on different sex, age groups, types of medications, and injures. Results Over five years (2010-2014), 288,251 older adults (63.2% females) were admitted to an emergency department for a fall-related injury (40.0% fractures, 12.1% brain injury). In the year before the injury, 48.5% were prescribed statins, 27.2% antidepressants, 25.0% opioids, and 16.6% anxiolytics. Females were prescribed more diuretics, antidepressants, and anxiolytics than males; and people aged 85 years and older had a higher percentage of diuretics, antidepressants, and antipsychotics. There were 36.4% of older adults prescribed 5-9 different medication classes and 41.2% were prescribed 10 or more medication classes. Discussion Older adults experiencing fall-related injuries were prescribed more opioids, benzodiazepines, and antidepressants than previously reported for the general population of older adults in Ontario. Higher percentage of females and more 85+ older adults were prescribed with psychotropic drugs, and they were also found to be at higher risk of fall-related injuries. Further associations between medications and fall-related injuries need to be explored in well-defined cohort studies.
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Affiliation(s)
- Yu Ming
- School of Health Studies, Western University, London, ON
| | | | - Richard G. Booth
- Arthur Labatt Family School of Nursing, Western University, London, ON
| | | | - Rommel G. Tirona
- School of Physiology and Pharmacology, Western University, London, ON
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22
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A review of the safety of buprenorphine in special populations. Am J Med Sci 2022; 364:675-684. [PMID: 35843298 DOI: 10.1016/j.amjms.2022.06.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 04/17/2022] [Accepted: 06/29/2022] [Indexed: 01/25/2023]
Abstract
Rates of opioid misuse and opioid use disorder have been increasing in recent years. Buprenorphine has emerged as an appealing medication for its use not only as treatment for opioid use disorder, but also as an opioid for chronic pain that has a ceiling effect on risks associated with opioid therapy. As other opioid prescribing decreases, buprenorphine prescribing continues to increase. As a result, it is imperative to understand the safety and efficacy of its use in special populations. This review article will explore the safety and efficacy of buprenorphine when used in subjects with hepatic and renal impairment, the elderly, and pregnant women. While manufacturer labeling for buprenorphine products may caution against their use in these populations, further examination of available data indicates that buprenorphine can be used safely and effectively for both chronic pain and/or opioid use disorder in all four of these populations.
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Lüthold RV, Jungo KT, Weir KR, Geier AK, Scholtes B, Kurpas D, Wild DMG, Petrazzuoli F, Thulesius H, Lingner H, Assenova R, Poortvliet RKE, Lazic V, Rozsnyai Z, Streit S. Understanding older patients' willingness to have medications deprescribed in primary care: a protocol for a cross-sectional survey study in nine European countries. BMC Geriatr 2022; 22:920. [PMID: 36451180 PMCID: PMC9709365 DOI: 10.1186/s12877-022-03562-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Accepted: 10/25/2022] [Indexed: 12/05/2022] Open
Abstract
INTRODUCTION To reduce inappropriate polypharmacy, deprescribing should be part of patients' regular care. Yet deprescribing is difficult to implement, as shown in several studies. Understanding patients' attitudes towards deprescribing at the individual and country level may reveal effective ways to involve older adults in decisions about medications and help to implement deprescribing in primary care settings. In this study we aim to investigate older adults' perceptions and views on deprescribing in different European countries. Specific objectives are to investigate the patients' willingness to have medications deprescribed by medication type and to have herbal or dietary supplements reduced or stopped, the role of the Patient Typology (on medication perspectives), and the impact of the patient-GP relationship in these decisions. METHODS AND ANALYSIS This cross-sectional survey study has two parts: Part A and Part B. Data collection for Part A will take place in nine countries, in which per country 10 GPs will recruit 10 older patients (≥65 years old) each (n = 900). Part B will be conducted in Switzerland only, in which an additional 35 GPs will recruit five patients each and respond to a questionnaire themselves, with questions about the patients' medications, their willingness to deprescribe those, and their patient-provider relationship. For both Part A and part B, a questionnaire will be used to assess the willingness of older patients with polypharmacy to have medications deprescribed and other relevant information. For Part B, this same questionnaire will have additional questions on the use of herbal and dietary supplements. DISCUSSION The international study design will allow comparisons of patient perspectives on deprescribing from different countries. We will collect information about willingness to have medications deprescribed by medication type and regarding herbal and dietary supplements, which adds important information to the literature on patients' preferences. In addition, GPs in Switzerland will also be surveyed, allowing us to compare GPs' and patients' views and preferences on stopping or reducing specific medications. Our findings will help to understand patients' attitudes towards deprescribing, contributing to improvements in the design and implementation of deprescribing interventions that are better tailored to patients' preferences.
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Affiliation(s)
- Renata Vidonscky Lüthold
- grid.5734.50000 0001 0726 5157Institute of Primary Health Care (BIHAM), University of Bern, Mittelstrasse 43, 3012 Bern, Switzerland ,grid.5734.50000 0001 0726 5157Graduate School for Health Sciences, University of Bern, Bern, Switzerland
| | - Katharina Tabea Jungo
- grid.5734.50000 0001 0726 5157Institute of Primary Health Care (BIHAM), University of Bern, Mittelstrasse 43, 3012 Bern, Switzerland
| | - Kristie Rebecca Weir
- grid.5734.50000 0001 0726 5157Institute of Primary Health Care (BIHAM), University of Bern, Mittelstrasse 43, 3012 Bern, Switzerland ,grid.1013.30000 0004 1936 834XSydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Anne-Kathrin Geier
- grid.9647.c0000 0004 7669 9786Department of General Practice, Faculty of Medicine, Leipzig University, Leipzig, Germany
| | - Beatrice Scholtes
- grid.4861.b0000 0001 0805 7253Research Unit of Primary Care and Health, Department of General Medicine, Faculty of Medicine, University of Liège, Liège, Belgium
| | - Donata Kurpas
- grid.4495.c0000 0001 1090 049XFamily Medicine Department, Wrocław Medical University, Wrocław, Poland
| | - Dorothea M. G. Wild
- grid.10388.320000 0001 2240 3300Institute of Family Medicine and General Practice, University Hospital Bonn, Bonn University, Bonn, Germany
| | - Ferdinando Petrazzuoli
- Sezione SNaMID Caserta, Caserta, Italy ,grid.4514.40000 0001 0930 2361Center for Primary Health Care Research, Department of Clinical Sciences, Lund University, Malmö, Sweden
| | - Hans Thulesius
- grid.8148.50000 0001 2174 3522Department of Medicine and Optometry, Faculty of Health and Life Sciences, Linnaeus University, Kalmar, Sweden ,grid.4514.40000 0001 0930 2361Department of Clinical Sciences, Lund University, Malmö, Sweden
| | - Heidrun Lingner
- grid.10423.340000 0000 9529 9877Hannover Medical School, Center for Public Health and Healthcare, Hannover, Germany
| | - Radost Assenova
- grid.35371.330000 0001 0726 0380Department of Urology and General Practice, Faculty of Medicine, Medical University of Plovdiv, Plovdiv, Bulgaria
| | - Rosalinde K. E. Poortvliet
- grid.10419.3d0000000089452978University Network for the Care sector Zuid-Holland, Leiden University Medical Center, Leiden, The Netherlands ,grid.10419.3d0000000089452978Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
| | - Vanja Lazic
- Health center Zagreb – Centar, Zagreb, Croatia
| | - Zsofia Rozsnyai
- grid.5734.50000 0001 0726 5157Institute of Primary Health Care (BIHAM), University of Bern, Mittelstrasse 43, 3012 Bern, Switzerland
| | - Sven Streit
- grid.5734.50000 0001 0726 5157Institute of Primary Health Care (BIHAM), University of Bern, Mittelstrasse 43, 3012 Bern, Switzerland
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Vaishnav LM, Joshi SH, Joshi AU, Mehendale AM. The National Programme for Health Care of the Elderly: A Review of its Achievements and Challenges in India. Ann Geriatr Med Res 2022; 26:183-195. [PMID: 36039665 PMCID: PMC9535372 DOI: 10.4235/agmr.22.0062] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Accepted: 08/22/2022] [Indexed: 11/18/2022] Open
Abstract
Aging care is critical. Projections for 2020 indicate that India’s older population will comprise 6.57% of the overall population. The best-known newly developed technologies must be provided to the older population. Non-governmental organizations and private institutions are increasingly providing more door-to-door guidance and help. This study evaluated the impact of the National Programme for Health Care of the Elderly (NPHCE) in India and analyzed its achievements and challenges. The program’s key strategies include providing preventive and promotional care and sickness management, empowering geriatric services, and guaranteeing optimal rehabilitation. The NPHCE is an excellent project for caring for a rapidly aging population. This study described the existing programs and schemes related to older people in India, with a focus on the NPHCE and an analysis of the program’s achievements and challenges.
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Affiliation(s)
- Lokesh Mukut Vaishnav
- Department of Community Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Sciences (Deemed to be University), Sawangi (Meghe), India
| | - Shiv Hiren Joshi
- Department of Community Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Sciences (Deemed to be University), Sawangi (Meghe), India
| | - Abhishek Upendra Joshi
- Department of Community Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Sciences (Deemed to be University), Sawangi (Meghe), India
- Corresponding Author: Shiv Hiren Joshi, MD Department of Community Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Sciences (Deemed to be University), Sawangi (Meghe), 442001, India E-mail:
| | - Ashok Madhukar Mehendale
- Department of Community Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Sciences (Deemed to be University), Sawangi (Meghe), India
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25
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Jung-Poppe L, Nicolaus HF, Roggenhofer A, Altenbuchner A, Dormann H, Pfistermeister B, Maas R. Systematic Review of Risk Factors Assessed in Predictive Scoring Tools for Drug-Related Problems in Inpatients. J Clin Med 2022; 11:jcm11175185. [PMID: 36079114 PMCID: PMC9457151 DOI: 10.3390/jcm11175185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 08/15/2022] [Accepted: 08/18/2022] [Indexed: 11/16/2022] Open
Abstract
Drug-related problems (DRP, defined as adverse drug events/reactions and medication errors) are a common threat for patient safety. With the aim to aid improved allocation of specialist resources and to improve detection and prevention of DRP, numerous predictive scoring tools have been proposed. The external validation and evidence for the transferability of these tools still faces limitations. However, the proposed scoring tools include partly overlapping sets of similar factors, which may allow a new approach to estimate the external usability and validity of individual risk factors. Therefore, we conducted this systematic review and analysis. We identified 14 key studies that assessed 844 candidate risk factors for inclusion into predictive scoring tools. After consolidation to account for overlapping terminology and variable definitions, we assessed each risk factor in the number of studies it was assessed, and, if it was found to be a significant predictor of DRP, whether it was included in a final scoring tool. The latter included intake of ≥ 8 drugs, drugs of the Anatomical Therapeutic Chemical (ATC) class N, ≥1 comorbidity, an estimated glomerular filtration rate (eGFR) <30 mL/min and age ≥60 years. The methodological approach and the individual risk factors presented in this review may provide a new starting point for improved risk assessment.
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Affiliation(s)
- Lea Jung-Poppe
- Institute of Experimental and Clinical Pharmacology and Toxicology, Friedrich-Alexander-Universität Erlangen-Nürnberg, 91054 Erlangen, Germany
- Correspondence: (L.J.-P.); (R.M.)
| | - Hagen Fabian Nicolaus
- Institute of Experimental and Clinical Pharmacology and Toxicology, Friedrich-Alexander-Universität Erlangen-Nürnberg, 91054 Erlangen, Germany
- University Hospital Erlangen, 91054 Erlangen, Germany
| | - Anna Roggenhofer
- Institute of Experimental and Clinical Pharmacology and Toxicology, Friedrich-Alexander-Universität Erlangen-Nürnberg, 91054 Erlangen, Germany
| | - Anna Altenbuchner
- Institute of Experimental and Clinical Pharmacology and Toxicology, Friedrich-Alexander-Universität Erlangen-Nürnberg, 91054 Erlangen, Germany
| | - Harald Dormann
- Central Emergency Department, Fürth Hospital, 90766 Fürth, Germany
| | | | - Renke Maas
- Institute of Experimental and Clinical Pharmacology and Toxicology, Friedrich-Alexander-Universität Erlangen-Nürnberg, 91054 Erlangen, Germany
- Correspondence: (L.J.-P.); (R.M.)
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26
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Hosoi T, Yamana H, Tamiya H, Matsui H, Fushimi K, Akishita M, Yasunaga H, Ogawa S. Association between comprehensive geriatric assessment and polypharmacy at discharge in patients with ischaemic stroke: A nationwide, retrospective, cohort study. EClinicalMedicine 2022; 50:101528. [PMID: 35784439 PMCID: PMC9241103 DOI: 10.1016/j.eclinm.2022.101528] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 06/01/2022] [Accepted: 06/06/2022] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND Polypharmacy and its adverse drug events are a major healthcare challenge related to falls, hospitalisations and mortality. Comprehensive geriatric assessment (CGA) may contribute to polypharmacy improvement, however, there is no clear evidence so far. METHODS Using a national inpatient database in Japan from April 1, 2014 to March 31, 2018, we investigated the association between CGA and polypharmacy. We identified patients aged ≥65 years admitted for ischaemic stroke who could receive oral medications. Propensity score matching was conducted for patients with and without CGA during hospitalisation. The outcomes were polypharmacy (defined as use of five or more types of oral medications) at discharge, the number of medication types prescribed at discharge, and the difference between the numbers of medication types prescribed on admission and at discharge. FINDINGS A total of 162,443 patients were analysed, of whom 39,356 (24·2%) received CGA, and propensity score matching identified 39,349 pairs. Compared with non-CGA group, the CGA group had a significantly lower proportion of polypharmacy at discharge (34·3% vs. 32·9%, p < 0·001) and a smaller number of medication types prescribed at discharge (3·84 vs. 3·76, p < 0·001). INTERPRETATION This study shows the clear evidence that there is a positive relationship between CGA and a reduction in the number of medications in older inpatients with ischaemic stroke. FUNDING The Ministry of Health, Labour and Welfare, Japan and the Ministry of Education, Culture, Sports, Science and Technology, Japan.
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Affiliation(s)
- Tatsuya Hosoi
- Department of Geriatric Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, Japan
| | - Hayato Yamana
- Department of Health Services Research, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, Japan
| | - Hiroyuki Tamiya
- Department of Geriatric Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, Japan
| | - Hiroki Matsui
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, Japan
| | - Kiyohide Fushimi
- Department of Health Policy and Informatics, Tokyo Medical and Dental University Graduate School of Medicine, 1-5-45 Yushima, Bunkyo-ku, Tokyo, Japan
| | - Masahiro Akishita
- Department of Geriatric Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, Japan
| | - Hideo Yasunaga
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, Japan
| | - Sumito Ogawa
- Department of Geriatric Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, Japan
- Corresponding author at: Department of Geriatric Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan.
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27
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Hatano M, Mizuno T, Arakawa Y, Inagaki R, Kato A, Matsuzaki H, Mizokami F, Koseki T, Yamada S. Efficacy of a Pharmacist Team Clinical Medication Review in Older Adults: A Prospective and Retrospective Observational Study. Biol Pharm Bull 2022; 45:1166-1171. [DOI: 10.1248/bpb.b22-00245] [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)
- Masakazu Hatano
- Department of Clinical Pharmacy, Fujita Health University School of Medicine
| | - Tomohiro Mizuno
- Department of Clinical Pharmacy, Fujita Health University School of Medicine
| | - Yuki Arakawa
- Department of Clinical Pharmacy, Fujita Health University School of Medicine
| | - Risa Inagaki
- Department of Clinical Pharmacy, Fujita Health University School of Medicine
| | - Arisa Kato
- Department of Clinical Pharmacy, Fujita Health University School of Medicine
| | - Haruna Matsuzaki
- Department of Clinical Pharmacy, Fujita Health University School of Medicine
| | - Fumihiro Mizokami
- Department of Pharmacy, National Center for Geriatrics and Gerontology
| | - Takenao Koseki
- Department of Clinical Pharmacy, Fujita Health University School of Medicine
| | - Shigeki Yamada
- Department of Clinical Pharmacy, Fujita Health University School of Medicine
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Potentially Inappropriate Medication and Polypharmacy in Nursing Home Residents: A Cross-Sectional Study. J Clin Med 2022; 11:jcm11133808. [PMID: 35807092 PMCID: PMC9267842 DOI: 10.3390/jcm11133808] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 06/28/2022] [Accepted: 06/29/2022] [Indexed: 02/07/2023] Open
Abstract
Inappropriate prescribing in the elderly is a risk factor for higher adverse drugs reactions, hospitalisation, and mortality rates. Therefore, it is necessary to identify irrational prescriptions and implement interventions to improve geriatric clinical practices in nursing homes. This study aimed to examine and compare the prevalence of potentially inappropriate medications in nursing home residents using three different updated criteria: 2019 Beers criteria, PRISCUS list, and v2 STOPP criteria, and to determine the prevalence of potential prescribing omissions according to v2 START criteria. A descriptive, observational, and cross-sectional study design was used. A total of 218 residents were involved in this study. Data on drug use were collected from medical charts. Information was screened with the software CheckTheMeds. Potentially inappropriate medications were present in 96.3%, 90.8%, and 35.3% of residents, according to the STOPP, Beers, and PRISCUS criteria or list, respectively. Inappropriate medication was found to be significantly associated with polypharmacy and severe or moderate drug–drug interactions with the three tools and with pathologies and unnecessary drugs only for STOPP criteria. The most frequent inappropriate medications were benzodiazepines and proton pump inhibitors. A regular use of software to review medications in nursing home residents would help to reduce the risk of these drug-related problems.
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Toxicity of the polymeric excipients in geriatric polypharmacy. Int J Pharm 2022; 622:121901. [PMID: 35688286 DOI: 10.1016/j.ijpharm.2022.121901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 06/01/2022] [Accepted: 06/05/2022] [Indexed: 11/24/2022]
Abstract
Geriatric polypharmacy is already a complicated issue in pharmacotherapy as multiple biological and pharmaceutical factors are involved. Given the fact that the geriatric population, in general, takes more than five medications for multiple diseases and most likely takes several supplements, there is a hidden issue with the types and amounts of the pharmaceutical inactive ingredients (polymers in particular) as they, as well as their impurities, may build up in an ill-performing body beyond their safety levels. In this commentary, we impart on biological factors, the importance of polymers, and the types and amounts of the impurities within each polymeric excipient that can potentially lead to severe pharmacological and biological impacts. Given the complex safety and toxicity issues in polypharmacy, we may need to revisit the safety standards and regulations on the inactive materials that are widely used in geriatric medications.
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Windolf H, Chamberlain R, Breitkreutz J, Quodbach J. 3D Printed Mini-Floating-Polypill for Parkinson's Disease: Combination of Levodopa, Benserazide, and Pramipexole in Various Dosing for Personalized Therapy. Pharmaceutics 2022; 14:931. [PMID: 35631518 PMCID: PMC9145509 DOI: 10.3390/pharmaceutics14050931] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 04/19/2022] [Accepted: 04/22/2022] [Indexed: 01/27/2023] Open
Abstract
Therapy for Parkinson’s disease is quite challenging. Numerous drugs are available for symptomatic treatment, and levodopa (LD), in combination with a dopa decarboxylase inhibitor (e.g., benserazide (BZ)), has been the drug of choice for years. As the disease progresses, therapy must be supplemented with a dopamine agonist (e.g., pramipexole (PDM)). Side effects increase, as do the required dose and dosing intervals. For these specific requirements of drug therapy, the 3D printing method fused deposition modelling (FDM) was applied in this study for personalized therapy. Hot melt extrusion was utilized to produce two different compositions into filaments: PDM and polyvinyl alcohol for rapid drug release and a fixed combination of LD/BZ (4:1) in an ethylene-vinyl acetate copolymer matrix for prolonged drug release. Since LD is absorbed in the upper gastrointestinal tract, a formulation that floats in gastric fluid was desired to prolong API absorption. Using the FDM 3D printing process, different polypill geometries were printed from both filaments, with variable dosages. Dosage forms with 15−180 mg LD could be printed, showing similar release rates (f2 > 50). In addition, a mini drug delivery dosage form was printed that released 75% LD/BZ within 750 min and could be used as a gastric retentive drug delivery system due to the floating properties of the composition. The floating mini-polypill was designed to accommodate patients’ swallowing difficulties and to allow for individualized dosing with an API release over a longer period of time.
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Affiliation(s)
- Hellen Windolf
- Institute of Pharmaceutics and Biopharmaceutics, Heinrich Heine University, Universitätsstr. 1, 40225 Düsseldorf, Germany; (H.W.); (R.C.); (J.B.)
| | - Rebecca Chamberlain
- Institute of Pharmaceutics and Biopharmaceutics, Heinrich Heine University, Universitätsstr. 1, 40225 Düsseldorf, Germany; (H.W.); (R.C.); (J.B.)
| | - Jörg Breitkreutz
- Institute of Pharmaceutics and Biopharmaceutics, Heinrich Heine University, Universitätsstr. 1, 40225 Düsseldorf, Germany; (H.W.); (R.C.); (J.B.)
| | - Julian Quodbach
- Institute of Pharmaceutics and Biopharmaceutics, Heinrich Heine University, Universitätsstr. 1, 40225 Düsseldorf, Germany; (H.W.); (R.C.); (J.B.)
- Department of Pharmaceutics, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Universiteitsweg 99, 3584 CG Utrecht, The Netherlands
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31
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Díez R, Cadenas R, Susperregui J, Sahagún AM, Fernández N, García JJ, Sierra M, López C. Drug-Related Problems and Polypharmacy in Nursing Home Residents: A Cross-Sectional Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:4313. [PMID: 35409994 PMCID: PMC8998432 DOI: 10.3390/ijerph19074313] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 03/30/2022] [Accepted: 04/02/2022] [Indexed: 02/05/2023]
Abstract
At present, 19.2% of the Spanish population is aged 65 or older. Polypharmacy is a frequent condition among the elderly, especially in those living in nursing homes, which is associated with adverse outcomes, such as adverse drug events or drug-drug interactions. This study aimed to assess the pattern of polypharmacy in a nursing home in Leon, one of Spain's most ageing regions, and its relationship with different drug-related problems. A descriptive, observational, and cross-sectional study design was used; 222 residents were involved in this study. Data on drug use were collected from medical charts. Information was screened with the software CheckTheMeds, BOT PLUS and Drug-Reax. Residents were on a median of 7 medicines. Polypharmacy and inappropriate medications were present in 78.8% and 96.8% of residents, respectively. Drug-related problems were present in almost all the populations evaluated. Drug-drug interactions were very common in participants (81.1%), being severe/moderate in 24.7%. A high prevalence of polypharmacy and drug-related problems in the nursing home population assessed has been observed. A significantly higher risk of suffering drug-drug interactions was revealed for increasing polypharmacy and anticholinergic risk. A regular evaluation of drug prescribing in nursing home residents is necessary to minimize drug-related problems risk.
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Affiliation(s)
- Raquel Díez
- Pharmacology, Department of Biomedical Sciences, Faculty of Health Sciences, Institute of Biomedicine (IBIOMED), University of León, 24071 León, Spain; (R.D.); (R.C.); (N.F.); (J.J.G.); (M.S.); (C.L.)
| | - Raquel Cadenas
- Pharmacology, Department of Biomedical Sciences, Faculty of Health Sciences, Institute of Biomedicine (IBIOMED), University of León, 24071 León, Spain; (R.D.); (R.C.); (N.F.); (J.J.G.); (M.S.); (C.L.)
| | - Julen Susperregui
- Applied Mathematics, Department of Mathematics, University of León, 24071 León, Spain;
| | - Ana M. Sahagún
- Pharmacology, Department of Biomedical Sciences, Faculty of Health Sciences, Institute of Biomedicine (IBIOMED), University of León, 24071 León, Spain; (R.D.); (R.C.); (N.F.); (J.J.G.); (M.S.); (C.L.)
| | - Nélida Fernández
- Pharmacology, Department of Biomedical Sciences, Faculty of Health Sciences, Institute of Biomedicine (IBIOMED), University of León, 24071 León, Spain; (R.D.); (R.C.); (N.F.); (J.J.G.); (M.S.); (C.L.)
| | - Juan J. García
- Pharmacology, Department of Biomedical Sciences, Faculty of Health Sciences, Institute of Biomedicine (IBIOMED), University of León, 24071 León, Spain; (R.D.); (R.C.); (N.F.); (J.J.G.); (M.S.); (C.L.)
| | - Matilde Sierra
- Pharmacology, Department of Biomedical Sciences, Faculty of Health Sciences, Institute of Biomedicine (IBIOMED), University of León, 24071 León, Spain; (R.D.); (R.C.); (N.F.); (J.J.G.); (M.S.); (C.L.)
| | - Cristina López
- Pharmacology, Department of Biomedical Sciences, Faculty of Health Sciences, Institute of Biomedicine (IBIOMED), University of León, 24071 León, Spain; (R.D.); (R.C.); (N.F.); (J.J.G.); (M.S.); (C.L.)
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Bojuwoye AO, Suleman F, Perumal-Pillay VA. Polypharmacy and the occurrence of potential drug-drug interactions among geriatric patients at the outpatient pharmacy department of a regional hospital in Durban, South Africa. J Pharm Policy Pract 2022; 15:1. [PMID: 34983680 PMCID: PMC8729144 DOI: 10.1186/s40545-021-00401-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 12/22/2021] [Indexed: 11/12/2022] Open
Abstract
Background Polypharmacy is the administration of an excessive number of medicines and a significant irrational medicine use practice. Little is known about this practice in South Africa. This study aimed to determine the level of polypharmacy and potential drug–drug interactions amongst the geriatric patient population in a facility in South Africa. Method A cross-sectional retrospective prescription chart review for 250 geriatric patients was conducted at the outpatient pharmacy department of a regional hospital. Variables extracted included demographic information, diagnosis, type of prescriber contact, and polypharmacy. Potential drug–drug interactions were determined with web-based multi-drug interaction checkers. Results The average (SD) number of diagnosed clinical problems was 3.54 ± 1.26, with hypertension, diabetes mellitus, and heart disease occurring most frequently. The level of polypharmacy was high with patients receiving an average (SD) of 12.13 ± 4.25 prescribed medicines from 3032 prescribed medicines. The level of polypharmacy was highest within the age categories, 60–64, and 70–74 years of age, respectively. The level of potential drug–drug interactions was also high with an average (SD) of 10.30 ± 7.48 from 2570 potential drug interactions. The majority of these interactions were moderate (72.5%) and pharmacodynamic (73.2%) by nature of the clinical severity of action and mechanism of action, respectively. Polypharmacy and type of prescriber contact were statistically significant contributors to the occurrence of potential drug–drug interactions, (F (2, 249) = 68.057, p < 0.05). However, in a multivariate analysis of variables to determine the strength of the association, polypharmacy was determined to be the strongest contributor to the occurrence of potential drug–drug interactions (p < 0.05) when compared with the type of prescriber contact (p value = 0.467). Therefore, irrespective of the type of prescriber contact, polypharmacy increases the potential for drug interactions among the sampled patient population. Conclusion A comprehensive consideration of disease management guidelines, patient factors, and rational medicine review could be measurable strategies towards improving medicine use. This would also limit the occurrence of significant drug interactions among the geriatric patient population. A national study is required to determine if differences occur across hospitals and regions.
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Affiliation(s)
- Adetola Olaniyi Bojuwoye
- Discipline of Pharmaceutical Sciences, University of KwaZulu-Natal, Private Bag X54001, Durban, 4000, South Africa
| | - Fatima Suleman
- Discipline of Pharmaceutical Sciences, University of KwaZulu-Natal, Private Bag X54001, Durban, 4000, South Africa
| | - Velisha Ann Perumal-Pillay
- Discipline of Pharmaceutical Sciences, University of KwaZulu-Natal, Private Bag X54001, Durban, 4000, South Africa.
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Rizza S, Piciucchi G, Mavilio M, Longo S, Montagna M, Tatonetti R, Nucera A, Federici M. Effect of deprescribing in elderly patients with type 2 diabetes: iDegLira might improve quality of life. Biomed Pharmacother 2021; 144:112341. [PMID: 34678725 DOI: 10.1016/j.biopha.2021.112341] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Revised: 10/11/2021] [Accepted: 10/13/2021] [Indexed: 12/21/2022] Open
Abstract
Older people with type 2 diabetes (T2D) often have several comorbidities and take multiple drugs. This study tested a deprescribing strategy in older T2D patients, replacing a hypoglycemic therapeutic scheme with a single drug combination (iDegLira). In this 6-month, real-world, single-arm, open interventional study, we enrolled patients ≥ 75 years with T2D taking ≥ 2 medications for diabetes. Patients on a basal-bolus insulin regimen (n = 13), on a basal-insulin regimen plus oral glucose-lowering drugs (n = 9), and those on oral glucose-lowering drugs (n = 18) were switched to daily iDegLira. The primary clinical endpoint of the study was an improvement in CASP-19 and/or DTSQ score after 6 months. We also evaluated changes in glucose metabolism, depression, cognitive function, level of independence, and markers of inflammation. Thirty-five patients (12 women, mean age=81.4 y) completed the protocol. Results shown here are given as estimated mean difference (95%CI). DTSQ score improved [11.08 (7.13/15.02); p = 0.0001], whereas CASP-19 did not after 6 months of iDegLira treatment. We observed reductions in BMI [- 0.81 (- 1.27/0.35); p < 0.001], fasting glucose [- 52.07 (- 77.26/26.88); p < 0.001], HbA1c [- 0.58 (- 1.08/0.08); p < 0.05], and TNF-α [- 1.83 (- 3.12/- 0.54); p = 0.007]. Activities of daily living and cognitive function score increased [p = 0.006 and p = 0.02], whereas depression score significantly decreased [p = 0.02]. Notably, no patient reported episodes of severe hypoglycemia after initiation of iDegLira treatment. Among older patients with T2D, deprescribing using a single dose of iDegLira resulted in a greater likelihood of improving health and quality of life. Although our data indicate the effectiveness and safety of this approach, it must be confirmed in larger studies.
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Affiliation(s)
- Stefano Rizza
- Department of System Medicine, University of Rome Tor Vergata, Italy.
| | - Giacomo Piciucchi
- Department of System Medicine, University of Rome Tor Vergata, Italy
| | - Maria Mavilio
- Department of System Medicine, University of Rome Tor Vergata, Italy
| | - Susanna Longo
- Department of System Medicine, University of Rome Tor Vergata, Italy
| | - Martina Montagna
- Department of System Medicine, University of Rome Tor Vergata, Italy
| | | | - Alessandro Nucera
- Department of System Medicine, University of Rome Tor Vergata, Italy
| | - Massimo Federici
- Department of System Medicine, University of Rome Tor Vergata, Italy
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Wang CY, Chang KC, Chuang CJ, Chen YP, Hsieh CY, Huang YC, Chen LY, Yang YH, Jeng Y, Chen HH, Liao LC, Liou HH. A proactive remote pharmaceutical care for rural elderly population: The Houston-Apollo polypharmacy project. Int J Clin Pract 2021; 75:e14505. [PMID: 34196443 DOI: 10.1111/ijcp.14505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 06/09/2021] [Indexed: 11/28/2022] Open
Abstract
AIMS To evaluate polypharmacy-related problems in the elderly people who live in rural through a proactive pharmaceutical care project under a novel remote medical service infrastructure (the Houston-Apollo polypharmacy project). METHODS It is a prospectively cross-sectional study. The elderly aged 65 years old lived in communities executed the congregate meal service and joined the Houston-Apollo project were included. During March and July on 2020, the pharmaceutical care team of Houston-Apollo polypharmacy project interviewed old people and collected their medications by remote video. Polypharmacy situation and drug-related problems, including potentially inappropriate medications (PIMs), anticholinergic burden (ACB) and risk of sarcopaenia, were evaluated by clinical pharmacists. In addition, we analysed the categories of the prescription types between polypharmacy and non-polypharmacy users, polypharmacy users with and without PIMs or ACB. A patient-specific integrated pharmacist's note for medication education and a dear doctor letter (as needed) were generated and delivered within 2-weeks postinterviewed. Age- and sex-adjusted logistic regression model was used to evaluate the association between polypharmacy and these potential medication problems. RESULTS There were 87 older people (mean age = 75.9) and 536 long-term medications were collected. Among them, 52% were defined as polypharmacy users. Polypharmacy was significantly associated with higher risk of PIMs and ACB. The adjusted odd ratio was 5.31 (95% CI: 2.02-13.9) and 10.1 (95% CI: 3.4-29.7), respectively. Among polypharmacy users, there were nearly double the prescriptions for the nervous system and musculoskeletal system among patients with PIMs compared with those without PIMs. Besides, polypharmacy users with ACB showed higher rate of prescriptions for the nervous system and the alimentary tract and metabolism system compared with those without ACB. CONCLUSION Polypharmacy was significantly associated with negative impact of medication safety among the elderly people in rural area. A persistent remote pharmaceutical care intervention was crucial for improving this problem.
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Affiliation(s)
- Chen-Yu Wang
- School of Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan
- Graduate Institute of Clinical Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan
- Department of Pharmacy, National Taiwan University Hospital Yun-Lin Branch, Douliu, Taiwan
| | - Kai-Chieh Chang
- Department of Neurology, National Taiwan University Hospital Yun-Lin Branch, Douliu, Taiwan
| | - Chin-Ju Chuang
- Department of Pharmacy, National Taiwan University Hospital Yun-Lin Branch, Douliu, Taiwan
| | - Yi-Pin Chen
- Department of Pharmacy, National Taiwan University Hospital Yun-Lin Branch, Douliu, Taiwan
| | - Cheng-Ying Hsieh
- Department of Pharmacy, National Taiwan University Hospital Yun-Lin Branch, Douliu, Taiwan
| | - Yung-Cheng Huang
- Department of Pharmacy, National Taiwan University Hospital Yun-Lin Branch, Douliu, Taiwan
| | - Li-Yu Chen
- Department of Pharmacy, National Taiwan University Hospital Yun-Lin Branch, Douliu, Taiwan
| | - Yi-Hsuan Yang
- Department of Pharmacy, National Taiwan University Hospital Yun-Lin Branch, Douliu, Taiwan
| | - Yachung Jeng
- Institute of Epidemiology and Prevention Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Hsiu-Hsi Chen
- Institute of Epidemiology and Prevention Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Ling-Chiao Liao
- Department of Pharmacy, National Taiwan University Hospital Yun-Lin Branch, Douliu, Taiwan
| | - Horng-Huei Liou
- Department of Neurology, National Taiwan University Hospital Yun-Lin Branch, Douliu, Taiwan
- Department of Neurology and Pharmacology, College of Medicine, National Taiwan University, Taipei, Taiwan
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Ng SK, Martin SA, Adams RJ, O'Loughlin P, Wittert GA. The Effect of Multimorbidity Patterns and the Impact of Comorbid Anxiety and Depression on Primary Health Service Use: The Men Androgen Inflammation Lifestyle Environment and Stress (MAILES) Study. Am J Mens Health 2021; 14:1557988320959993. [PMID: 33063608 PMCID: PMC7873770 DOI: 10.1177/1557988320959993] [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] [Indexed: 11/28/2022] Open
Abstract
This study sought to determine patterns of multimorbidity and quantify their impact on use of primary health services in the presence and absence of anxiety and depression among a cohort of urban community-dwelling men in Australia. The analytic sample consisted of men (n = 2039; age 38–85) from the follow-up wave of a prospective cohort study of all participants of the Florey Adelaide Male Ageing Study (FAMAS; Stage 2 [2007–2010]) and age-matched men from the North-West Adelaide Health Study (NWAHS; Stage 3 [2008–2010]). Self-reported data and linkage with a national universal health coverage scheme (Medicare) provided information on the prevalence of eight chronic conditions and health service utilization information (including annual GP visits). Obesity and cardiovascular disease (CVD) were associated with the highest number of comorbid conditions. Two nonrandom multimorbidity “clusters” emerged: “CVD, Obesity, Diabetes” and “CVD, Obesity, Osteoarthritis.” Participants with conditions comorbid with CVD were more likely to have 10 or more annual GP visits, compared to multimorbidity involving other conditions. In comparison to participants without CVD, the presence of CVD increased the chance of having 10 or more annual GP visits (adjusted risk ratio: 3.7; 95% CI [2.8, 4.8]). When CVD was comorbid with anxiety and depression, having 10 or more annual GP visits was more common (adjusted risk ratio: 1.8; 95% CI [1.2, 2.5]). Multimorbidity patterns involving CVD, especially for multimorbidity that includes CVD with comorbid anxiety and depression, should be considered in developing clinical trials to better inform medical decision-making and care for patients with CVD and comorbid conditions.
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Affiliation(s)
- Shu-Kay Ng
- School of Medicine and Menzies Health Institute Queensland, Griffith University, Nathan, Queensland, Australia
| | - Sean A Martin
- Freemasons Centre for Male Health and Wellbeing, University of Adelaide, Adelaide, SA, Australia
| | - Robert J Adams
- Adelaide Institute for Sleep Health, College of Medicine and Public Health, Flinders University, Bedford Park, SA, Australia.,The Health Observatory, Discipline of Medicine, University of Adelaide, The Queen Elizabeth Hospital Campus, Woodville, SA, Australia
| | - Peter O'Loughlin
- Freemasons Centre for Male Health and Wellbeing, University of Adelaide, Adelaide, SA, Australia.,Chemical Pathology, SA Pathology, Adelaide, SA, Australia
| | - Gary A Wittert
- Freemasons Centre for Male Health and Wellbeing, University of Adelaide, Adelaide, SA, Australia
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Bengaard AK, Iversen E, Kallemose T, Juul-Larsen HG, Rasmussen LJH, Dalhoff KP, Andersen O, Eugen-Olsen J, Houlind MB. Using soluble urokinase plasminogen activator receptor to stratify patients for medication review in the emergency department. Br J Clin Pharmacol 2021; 88:1679-1690. [PMID: 34242432 DOI: 10.1111/bcp.14982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 06/25/2021] [Accepted: 06/27/2021] [Indexed: 11/30/2022] Open
Abstract
AIMS To investigate whether the association between levels of medication use (including polypharmacy and potentially inappropriate medications [PIMs]) and health outcomes such as readmission and mortality is dependent on baseline soluble urokinase plasminogen activator receptor (suPAR). METHODS This registry-based cohort study included medical patients admitted to the emergency department at Copenhagen University Hospital Hvidovre, Denmark. Patients were grouped according to their admission suPAR levels: low (0-3 ng/mL), intermediate (3-6 ng/mL), or high (>6 ng/mL). Hyper-polypharmacy was defined as ≥10 prescribed medications. PIMs were identified based on the EU(7)-PIM list, and data on admissions and mortality were obtained from national registries. Risk of 90-day readmission and mortality was assessed by Cox regression analysis adjusted for sex, age and Charlson comorbidity index. Results were reported as hazard ratios within 90 days of index discharge. RESULTS In total, 26 291 patients (median age 57.3 y; 52.7% female) were included. Risk of 90-day readmission and mortality increased significantly for patients with higher suPAR or higher number of medications. Among patients with low suPAR, patients with ≥10 prescribed medications had a hazard ratio of 2.41 (95% confidence interval = 2.09-2.78) for 90-day readmission and 8.46 (95% confidence interval = 2.53-28.28) for 90-day mortality compared to patients with 0 medications. Patients with high suPAR generally had high risk of readmission and mortality, and the impact of medication use was less pronounced in this group. Similar, but weaker, association patterns were observed between suPAR and PIMs. CONCLUSION The association between levels of medication use and health outcomes is dependent on baseline suPAR.
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Affiliation(s)
- Anne Kathrine Bengaard
- Department of Clinical Research, Copenhagen University Hospital - Amager and Hvidovre, Copenhagen, Denmark.,The Capital Region Pharmacy, Herlev, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Esben Iversen
- Department of Clinical Research, Copenhagen University Hospital - Amager and Hvidovre, Copenhagen, Denmark.,Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Thomas Kallemose
- Department of Clinical Research, Copenhagen University Hospital - Amager and Hvidovre, Copenhagen, Denmark
| | - Helle Gybel Juul-Larsen
- Department of Clinical Research, Copenhagen University Hospital - Amager and Hvidovre, Copenhagen, Denmark
| | - Line Jee Hartmann Rasmussen
- Department of Clinical Research, Copenhagen University Hospital - Amager and Hvidovre, Copenhagen, Denmark.,Department of Psychology and Neuroscience, Duke University, Durham, North Carolina, USA
| | - Kim Peder Dalhoff
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.,Department of Clinical Pharmacology, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Ove Andersen
- Department of Clinical Research, Copenhagen University Hospital - Amager and Hvidovre, Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.,Emergency Department, Copenhagen University Hospital - Amager and Hvidovre, Copenhagen, Denmark
| | - Jesper Eugen-Olsen
- Department of Clinical Research, Copenhagen University Hospital - Amager and Hvidovre, Copenhagen, Denmark
| | - Morten Baltzer Houlind
- Department of Clinical Research, Copenhagen University Hospital - Amager and Hvidovre, Copenhagen, Denmark.,The Capital Region Pharmacy, Herlev, Denmark.,Department of Drug Design and Pharmacology, University of Copenhagen, Copenhagen, Denmark
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Liu Y, Wang R, Huang R, Cao Y, Wang J, Feng D. Influencing factors and their relationships of risk perception and decision-making behaviour of polypharmacy in patients with chronic diseases: a qualitative descriptive study. BMJ Open 2021; 11:e043557. [PMID: 33906839 PMCID: PMC8088251 DOI: 10.1136/bmjopen-2020-043557] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 03/16/2021] [Accepted: 03/19/2021] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVES In order to understand the influencing factors of the medication-taking behaviour in patients with chronic diseases, reveal the deep-seated causes underlying the phenomenon of polypharmacy, explore the formation rules of the risk perception of polypharmacy and how risk perception affect the medication decision-making behaviour of patients with chronic diseases. DESIGN A qualitative descriptive design was used. Study data were collected through semi-structured interviews with patients and physicians. We used the grounded theory approach to refine influencing factors, followed by interpretative structural modelling that analysed the interaction between these factors. SETTING Patients from two hospitals, two nursing homes and two communities. Physicians from two community hospitals in Wuhan, China. PARTICIPANTS Patients with chronic diseases with high willingness to cooperate and good communication ability. Physicians with rich experience in the treatment of chronic diseases. RESULTS Twenty-nine interviews were conducted (20 patients and 9 physicians). A total of 35 influencing factors of the medication-taking behaviours in patients with chronic diseases were extracted from the interview data, further integrated into 10 integrated influencing factors and ultimately clustered into three aspects: 'medication benefit', 'medication risk' and 'medication strategy'. Medication risk can be divided into four specific dimensions: economic risk, physical risk, psychosocial risk and time risk. 10 integrated influencing factors constituted the interpretative structural model of the medication decision-making behaviours in patients with chronic diseases. CONCLUSIONS The causes underlying the medication decision-making behaviour of patients with chronic diseases are complex, involving a series of influencing factors such as their risk perception of the medication-taking behaviour. In order to alleviate the adverse effects of polypharmacy on patients' health and medical costs, further safety measures should be proposed to improve the medication-taking behaviour in patients with chronic diseases based on the relationship and internal mechanism of the influencing factors of the medication decision-making behaviour.
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Affiliation(s)
- Yuxin Liu
- Tongji Medical College, School of Pharmacy, Huazhong University of Science and Technology, Wuhan, China
| | - Ruoxi Wang
- Tongji Medical College, School of Medicine and Health Management, Huazhong University of Science and Technology, Wuhan, China
| | - Rui Huang
- Tongji Medical College, School of Pharmacy, Huazhong University of Science and Technology, Wuhan, China
| | - Yan Cao
- Tongji Medical College, School of Pharmacy, Huazhong University of Science and Technology, Wuhan, China
| | - Jia Wang
- Tongji Medical College, School of Pharmacy, Huazhong University of Science and Technology, Wuhan, China
| | - Da Feng
- Tongji Medical College, School of Pharmacy, Huazhong University of Science and Technology, Wuhan, China
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38
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Jing Y, Diao L, Han L. Adverse events associated with potential drugs for COVID-19: a case study from real-world data. Brief Bioinform 2021; 22:1232-1238. [PMID: 33003194 PMCID: PMC7543289 DOI: 10.1093/bib/bbaa234] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 08/03/2020] [Accepted: 08/26/2020] [Indexed: 01/08/2023] Open
Abstract
The coronavirus disease 2019 (COVID-19) has resulted as a global pandemic. The World Health Organization announced the most promising drugs in SOLIDARITY for the global trial, and several other drugs are under investigation through ongoing clinical trials to prove the effectiveness and safety of potential therapeutics. Here, we depicted the safety profile of these drugs and investigated their associated adverse events (AEs). We observed the associated AEs in different organs/systems, especially in skin and subcutaneous tissue, immune system and musculoskeletal and connective tissue. Furthermore, we observed strong bias of AEs in different groups of sex and age. Our study provides knowledge of the toxicity of potential COVID-19 drugs. While these drugs hold promise to fight the global pandemic, healthcare providers should pay attention to AEs to maximize the treatment benefit while minimizing toxicity.
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Affiliation(s)
- Ying Jing
- Department of Biochemistry and Molecular Biology, The University of Texas Health Science Center at Houston McGovern Medical School, USA
| | - Lixia Diao
- Department of Bioinformatics and Computational Biology, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - Leng Han
- Department of Biochemistry and Molecular Biology, The University of Texas Health Science Center at Houston McGovern Medical School, USA
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Rieckert A, Teichmann AL, Drewelow E, Kriechmayr C, Piccoliori G, Woodham A, Sönnichsen A. Reduction of inappropriate medication in older populations by electronic decision support (the PRIMA-eDS project): a survey of general practitioners' experiences. J Am Med Inform Assoc 2021; 26:1323-1332. [PMID: 31504572 PMCID: PMC6798559 DOI: 10.1093/jamia/ocz104] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Revised: 04/29/2019] [Accepted: 05/29/2019] [Indexed: 12/31/2022] Open
Abstract
Objective We sought to investigate the experiences of general practitioners (GPs) with an electronic decision support tool to reduce inappropriate polypharmacy in older patients (the PRIMA-eDS [Polypharmacy in chronic diseases: Reduction of Inappropriate Medication and Adverse drug events in older populations by electronic Decision Support] tool) in a multinational sample of GPs and to quantify the findings from a prior qualitative study on the PRIMA-eDS-tool. Materials and Methods Alongside the cluster randomized controlled PRIMA-eDS trial, a survey was conducted in all 5 participating study centers (Bolzano, Italy; Manchester, United Kingdom; Salzburg, Austria; Rostock, Germany; and Witten, Germany) between October 2016 and July 2017. Data were analyzed using descriptive statistics and chi-square tests. Results Ninety-one (n = 160) percent of the 176 questionnaires were returned. Thirty-two percent of the respondents reported that they did not cease drugs because of the medication check. The 68% who had discontinued drugs comprise 57% who had stopped on average 1 drug and 11% who had stopped 2 drugs or more per patient. The PRIMA-eDS tool was found to be useful (69%) and the recommendations were found to help to increase awareness (86%). The greatest barrier to implementing deprescribing recommendations was the perceived necessity of the medication (69%). The majority of respondents (65%) would use the electronic medication check in routine practice if it was part of the electronic health record. Conclusions GPs generally viewed the PRIMA-eDS medication check as useful and as informative. Recommendations were not always followed due to various reasons. Many GPs would use the medication check if integrated into the electronic health record.
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Affiliation(s)
- Anja Rieckert
- Department of Human Medicine, Institute of General Practice and Family Medicine, Faculty of Health, Witten/Herdecke University, Witten, Germany
| | - Anne-Lisa Teichmann
- Department of Human Medicine, Institute of General Practice and Family Medicine, Faculty of Health, Witten/Herdecke University, Witten, Germany
| | - Eva Drewelow
- Institute of General Practice, Rostock University Medical Center, Rostock, Germany
| | - Celine Kriechmayr
- Institute of General Practice, Family Medicine and Preventive Medicine, Paracelsus Medical University, Salzburg, Austria
| | | | - Adrine Woodham
- Division of Population Health, Health Services Research and Primary Care, School of Health Sciences, University of Manchester, Manchester, United Kingdom
| | - Andreas Sönnichsen
- Division of Population Health, Health Services Research and Primary Care, School of Health Sciences, University of Manchester, Manchester, United Kingdom.,Department of General Practice and Family Medicine, Center for Public Health, Medical University of Vienna, Vienna, Austria
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Variables associated with poor health-related quality of life among patients with dyslipidemia in Jordan. Qual Life Res 2021; 30:1417-1424. [PMID: 33385271 DOI: 10.1007/s11136-020-02726-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/28/2020] [Indexed: 02/07/2023]
Abstract
PURPOSE The study aim was to evaluate HRQOL and to explore the variables associated with poor HRQOL among patients with dyslipidemia in Jordan. METHODS The present study utilized the EQ-5D questionnaire which evaluates HRQOL in terms of mobility, self-care, usual activities, pain/discomfort, and anxiety/depression. Responses to the five dimensions were presented using the value set, which ranges from 1 for full health to - 0.594 for severe problems in all five dimensions. Multiple linear regression analysis was implemented to identify the variables that best predicted the total EQ-5D score and hence HRQOL in the study population. RESULTS The mean age of the 228 participants was 60.23 (SD = 10.64). The mean of the total EQ-5D score was 0.675 (SD = 0.14). Regression analysis identified necessity for dyslipidemia medication (B = 0.18, P < 0.01) and patients with controlled lipid profile (B = 0.28, P < 0.01) were positively associated with HRQOL, while having concerns about dyslipidemia medications (B = - 0.16, P < 0.01), number of medication (B = - 0.13, P = 0.02), duration of dyslipidemia (B = - 0.22, P < 0.01), receiving high-intensity statin (B = - 0.18, P < 0.01) or statin in combination with fibrate (B = - 0.15, P < 0.01) were associated with lower HRQOL. CONCLUSION HRQOL has considerable scope for improvement in patients with dyslipidemia in Jordan. Improving dyslipidemia medications' beliefs and simplifying medication regimen by prescribing less medications, particularly for patients with longer disease duration and those on statin therapy, should be considered in future management programs aim at improving HRQOL in patients with dyslipidemia.
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Antipsychotic Polypharmacy Is Associated With Adverse Drug Events in Psychiatric Inpatients: The Japan Adverse Drug Events Study. J Clin Psychopharmacol 2021; 41:397-402. [PMID: 34108429 PMCID: PMC8244930 DOI: 10.1097/jcp.0000000000001416] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND Antipsychotic (AP) polypharmacy (APP), the coprescription of more than 1 AP, is frequently practiced in psychiatric inpatients and is considered to be a risk factor for adverse drug events (ADEs). However, the association between APP and ADEs among psychiatric inpatients has not been well investigated. METHODS The Japan Adverse Drug Events (JADE) study was a series of cohort studies conducted in several clinical settings. In particular, the JADE study for psychiatric inpatients was a retrospective cohort study of 448 psychiatric inpatients with a cumulative 22,733 patient-days. We investigated the relationship between APP, defined as a concurrent prescription of 2 or more APs and ADEs. We also assessed the relationship between potential risk factors for ADEs due to APs. RESULTS Among the 448 patients included in this study, 106 patients (24%) had APP and the remaining 342 patients were prescribed 1 AP or none. Risperidone was the most frequent drug (25%, 109/442 AP prescriptions) used, and levomepromazine was most frequently prescribed as a concurrent medication with other APs (91%, 29/32). The median number of ADEs among the patients with APP was significantly higher than in those without APP (P = 0.001). Antipsychotic polypharmacy was a risk factor for the occurrence of first (adjusted hazard ratio, 1.54; 95% confidence interval, 1.15-2.04) and second (adjusted hazard ratio, 1.99; 95% confidence interval, 1.40-2.79) ADEs. CONCLUSIONS Antipsychotic polypharmacy was a risk factor for the occurrence of single and multiple ADEs. Antipsychotic polypharmacy should be conservatively and minimally practiced.
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Torres-Bondia F, Dakterzada F, Galván L, Buti M, Besanson G, Gill E, Buil R, de Batlle J, Piñol-Ripoll G. Proton pump inhibitors and the risk of Alzheimer's disease and non-Alzheimer's dementias. Sci Rep 2020; 10:21046. [PMID: 33273636 PMCID: PMC7713356 DOI: 10.1038/s41598-020-78199-0] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Accepted: 11/23/2020] [Indexed: 02/07/2023] Open
Abstract
Proton pump inhibitors (PPIs) are among the most prescribed medications. Previous epidemiological studies have presented contradictory results about PPIs and the risk of dementia. Our objective was to investigate the association between the use of PPIs and an increasing risk of incident AD or non-AD dementias. A community-based retrospective cohort study was conducted based on the data available from 1st January 2002 to 31st December 2015 in the Catalan health service (CatSalut) system. This cohort included all PPI users (N = 36,360) and non-users (N = 99,362). A lag window of 5 years was considered between the beginning of the PPI treatment and the diagnosis of dementia. PPI use was not associated with the risk of AD (adjusted odds ratio (OR) 1.06) (95% CI 0.93–1.21; p = 0.408). A weakly but significantly increased risk of non-AD dementias was observed among PPI users (adjusted OR 1.20, 95% CI 1.05–1.37; p = 0.007). A higher dose of PPIs was not associated with an increased risk of either AD or non-AD dementias (OR 1.20; 95% CI 0.91–1.61 and OR 0.95; 95% CI 0.74–1.22, respectively). Regarding the number of PPIs used, we observed an increased risk of AD (OR 1.47; 95% CI 1.18–1.83) and non-AD dementias (OR 1.38; 95% CI 1.12–1.70) in users of two types of PPIs compared with those who used only one type. We did not find a higher incidence of AD among PPI users, but a weak increase in the risk of non-AD dementias among PPI users was observed.
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Affiliation(s)
- Francisco Torres-Bondia
- Unitat Trastorns Cognitius (Cognitive Disorders Unit), Clinical Neuroscience Research Group, Santa Maria University Hospital, IRBLleida, Rovira Roure no. 44, 25198, Lleida, Spain
| | - Farida Dakterzada
- Unitat Trastorns Cognitius (Cognitive Disorders Unit), Clinical Neuroscience Research Group, Santa Maria University Hospital, IRBLleida, Rovira Roure no. 44, 25198, Lleida, Spain
| | - Leonardo Galván
- Pharmacy Department, Servei Català de La Salut (Catalan Health Services), Lleida, Spain
| | - Miquel Buti
- Unitat D'Avaluació Clínica (Clinical Evaluation Unit), Institut Català de La Salut (Catalan Institute of Health), Lleida, Spain
| | - Gaston Besanson
- Accenture Innovation Center, Barcelona, Spain.,Barcelona Graduate School of Economics (BGSE), Barcelona, Spain
| | - Eric Gill
- Accenture Innovation Center, Barcelona, Spain
| | - Roman Buil
- Accenture Innovation Center, Barcelona, Spain.,Universitat Oberta de Catalunya (UOC), Barcelona, Spain
| | - Jordi de Batlle
- Group of Translational Research in Respiratory Medicine, Arnau de Vilanova University Hospital and Santa Maria University Hospital, IRBLleida, Lleida, Spain.,Biomedical Research Networking Center in Respiratory Diseases (Centro de Investigación Biomédica en Red de Enfermedades Respiratorias, CIBERES), Madrid, Spain
| | - Gerard Piñol-Ripoll
- Unitat Trastorns Cognitius (Cognitive Disorders Unit), Clinical Neuroscience Research Group, Santa Maria University Hospital, IRBLleida, Rovira Roure no. 44, 25198, Lleida, Spain.
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Potentially inappropriate prescribing in older hospitalized Dutch patients according to the STOPP/START criteria v2: a longitudinal study. Eur J Clin Pharmacol 2020; 77:777-785. [PMID: 33269418 PMCID: PMC8032616 DOI: 10.1007/s00228-020-03052-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Accepted: 11/20/2020] [Indexed: 11/05/2022]
Abstract
Purpose To investigate prevalence, independent associations, and variation over time of potentially inappropriate prescriptions in a population of older hospitalized patients. Methods A longitudinal study using a large dataset of hospital admissions of older patients (≥ 70 years) based on an electronic health records cohort including data from 2015 to 2019. Potentially inappropriate medication (PIM) and potential prescribing omission (PPO) prevalence during hospital stay were identified based on the Dutch STOPP/START criteria v2. Univariate and multivariate logistic regression were used for analyzing associations and trends over time. Results The data included 16,687 admissions. Of all admissions, 56% had ≥ 1 PIM and 58% had ≥ 1 PPO. Gender, age, number of medications, number of diagnoses, Charlson score, and length of stay were independently associated with both PIMs and PPOs. Additionally, number of departments and number of prescribing specialties were independently associated with PIMs. Over the years, the PIM prevalence did not change (OR = 1.00, p = .95), whereas PPO prevalence increased (OR = 1.08, p < .001). However, when corrected for changes in patient characteristics such as number of diagnoses, the PIM (aOR = 0.91, p < .001) and PPO prevalence (aOR = 0.94, p < .001) decreased over the years. Conclusion We found potentially inappropriate prescriptions in the majority of admissions of older patients. Prescribing relatively improved over time when considering complexity of the admissions. Nevertheless, the high prevalence shows a clear need to better address this issue in clinical practice. Studies seeking effective (re)prescribing interventions are warranted. Supplementary Information The online version contains supplementary material available at 10.1007/s00228-020-03052-2.
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Richardson K, Loke YK, Fox C, Maidment I, Howard R, Steel N, Arthur A, Boyd PJ, Aldus C, Ballard C, Savva GM. Adverse effects of Z-drugs for sleep disturbance in people living with dementia: a population-based cohort study. BMC Med 2020; 18:351. [PMID: 33228664 PMCID: PMC7683259 DOI: 10.1186/s12916-020-01821-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Accepted: 10/20/2020] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND Sleep disturbance is common in dementia and often treated with Z-drugs (zopiclone, zaleplon, and zolpidem). While some observational studies suggest that Z-drugs are associated with adverse events such as falls and fracture risks in older people, this has not been studied in dementia. METHODS We used data from 27,090 patients diagnosed with dementia between January 2000 and March 2016 from the Clinical Practice Research Datalink linked to Hospital Episodes Statistics data in England. We compared adverse events for 3532 patients newly prescribed Z-drugs by time-varying dosage to (1) 1833 non-sedative-users with sleep disturbance; (2) 10,214 non-sedative-users with proximal GP consultation matched on age, sex, and antipsychotic use; and (3) 5172 patients newly prescribed benzodiazepines. We defined higher dose Z-drugs and benzodiazepines as prescriptions equivalent to ≥ 7.5 mg zopiclone or > 5 mg diazepam daily. Cox regression was used to estimate hazard ratios (HRs) for incident fracture, hip fracture, fall, mortality, acute bacterial infection, ischaemic stroke/transient ischaemic attack, and venous thromboembolism over a 2-year follow-up, adjusted for demographic- and health-related covariates. RESULTS The mean (SD) age of patients was 83 (7.7) years, and 16,802 (62%) were women. Of 3532 patients prescribed Z-drugs, 584 (17%) were initiated at higher doses. For patients prescribed higher dose Z-drugs relative to non-users with sleep disturbance, the HRs (95% confidence interval) for fractures, hip fractures, falls, and ischaemic stroke were 1.67 (1.13-2.46), 1.96 (1.16-3.31), 1.33 (1.06-1.66), and 1.88 (1.14-3.10), respectively. We observed similar associations when compared to non-sedative-users with proximal GP consultation. Minimal or inconsistent excess risks were observed at ≤ 3.75 mg zopiclone or equivalent daily, and for mortality, infection, and venous thromboembolism. We observed no differences in adverse events for Z-drugs compared to benzodiazepines, except lower mortality rates with Z-drugs (HR [95% confidence interval] of 0.73 [0.64-0.83]). CONCLUSIONS Higher dose Z-drug use in dementia is associated with increased fracture and stroke risks, similar or greater to that for higher dose benzodiazepines. Higher dose Z-drugs should be avoided, if possible, in people living with dementia, and non-pharmacological alternatives preferentially considered. Prescriptions for higher dose Z-drugs in dementia should be regularly reviewed. TRIAL REGISTRATION ENCePP e-register of studies, EUPAS18006.
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Affiliation(s)
- Kathryn Richardson
- Norwich Medical School, University of East Anglia, Norwich, NR4 7TJ, UK.
| | - Yoon K Loke
- Norwich Medical School, University of East Anglia, Norwich, NR4 7TJ, UK
| | - Chris Fox
- Norwich Medical School, University of East Anglia, Norwich, NR4 7TJ, UK
| | - Ian Maidment
- School of Life and Health Sciences, Aston University, Birmingham, B4 7ET, UK
| | - Robert Howard
- Division of Psychiatry, UCL Division of Psychiatry, University College London, Maple House, 149 Tottenham Court Road, London, W1T 7NF, UK
| | - Nicholas Steel
- Norwich Medical School, University of East Anglia, Norwich, NR4 7TJ, UK
| | - Antony Arthur
- School of Health Sciences, University of East Anglia, Norwich, NR4 7TJ, UK
| | - Penelope J Boyd
- Norwich Medical School, University of East Anglia, Norwich, NR4 7TJ, UK
| | - Clare Aldus
- School of Health Sciences, University of East Anglia, Norwich, NR4 7TJ, UK
| | - Clive Ballard
- Medical School, University of Exeter, Exeter, EX1 2LU, UK
| | - George M Savva
- School of Health Sciences, University of East Anglia, Norwich, NR4 7TJ, UK.,Quadram Institute Bioscience, Norwich Research Park, Norwich, NR4 7UQ, UK
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Kojima T, Mizokami F, Akishita M. Geriatric management of older patients with multimorbidity. Geriatr Gerontol Int 2020; 20:1105-1111. [PMID: 33084212 DOI: 10.1111/ggi.14065] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 09/17/2020] [Accepted: 09/27/2020] [Indexed: 01/08/2023]
Abstract
Older patients tend to have multimorbidity represented by multiple chronic diseases or geriatric conditions due to aging changes of organs, which require a variety of medical management. Currently, there are no sufficient disease treatment guidelines for older people with multimorbidity, therefore physicians have difficulty managing multimorbidity, such as which diseases should be treated intensively or to what extent the conditions should be improved. Furthermore, there are other points to be considered when initiating the treatment of diseases. For example, physicians must assess physical function. Some people have no difficulty with ambulation, but some are bedridden and have difficulty getting up on their own. As there are differences in disease severity, comorbid conditions and life expectancy, there should be differences in deciding treatment and prescribing drugs. It may be necessary to change the option for treatment depending on cognitive function, the living environment and the care environment, using comprehensive geriatric assessments. In addition, when treating multimorbidity, patients tend to have polypharmacy, which is a risk for adverse drug events. Because of this, it is necessary to consider dose reduction and drug discontinuation in patients with polypharmacy. Because of the global increase in older patients with multimorbidity, developing an essential method for managing multimorbidity is an urgent issue. More research and practices are necessary to achieve high-quality care in patients with multimorbidity. Geriatr Gerontol Int 2020; 20: 1105-1111.
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Affiliation(s)
- Taro Kojima
- Department of Geriatric Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Fumihiro Mizokami
- Department of Pharmacy, National Center for Geriatrics and Gerontology, Obu, Japan
| | - Masahiro Akishita
- Department of Geriatric Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
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Mannion C, Hughes J, Moriarty F, Bennett K, Cahir C. Agreement between self-reported morbidity and pharmacy claims data for prescribed medications in an older community based population. BMC Geriatr 2020; 20:283. [PMID: 32778067 PMCID: PMC7419222 DOI: 10.1186/s12877-020-01684-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Accepted: 07/29/2020] [Indexed: 11/21/2022] Open
Abstract
Background Studies have indicated variability around prevalence estimates of multimorbidity due to poor consensus regarding its definition and measurement. Medication-based measures of morbidity may be valuable resources in the primary-care setting where access to medical data can be limited. We compare the agreement between patient self-reported and medication-based morbidity; and examine potential patient-level predictors of discordance between these two measures of morbidity in an older (≥ 50 years) community-based population. Methods A retrospective cohort study was performed using national pharmacy claims data linked to The Irish LongituDinal study on Ageing (TILDA). Morbidity was measured by patient self-report (TILDA) and two medication-based measures, the Rx-Risk (< 65 years) and Rx-Risk-V (≥65 years), which classify drug claims into chronic disease classes. The kappa statistic measured agreement between self-reported and medication-based morbidity at the individual patient-level. Multivariate logistic regression was used to examine patient-level characteristics associated with discordance between measures of morbidity. Results Two thousand nine hundred twenty-five patients were included (< 65 years: N = 1095, 37.44%; and ≥ 65 years: N = 1830 62.56%). Hypertension and high cholesterol were the most prevalent self-reported morbidities in both age cohorts. Agreement was good or very good (κ = 0.61–0.81) for diabetes, osteoporosis and glaucoma; and moderate for high cholesterol, asthma, Parkinson’s and angina (κ = 0.44–0.56). All other conditions had fair or poor agreement. Age, gender, marital status, education, poor-delayed recall, depression and polypharmacy were significantly associated with discordance between morbidity measures. Conclusions Most conditions achieved only moderate or fair agreement between self-reported and medication-based morbidity. In order to improve the accuracy in prevalence estimates of multimorbidity, multiple measures of multimorbidity may be necessary. Future research should update the current Rx-Risk algorithms in-line with current treatment guidelines, and re-assess the feasibility of using these indices alone, or in combination with other methods, to yield more accurate estimates of multimorbidity.
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Affiliation(s)
- Clionadh Mannion
- Department of Pharmacology and Therapeutics, University of Dublin, Trinity College Dublin, Dublin, Ireland
| | - John Hughes
- Division of Population Health Sciences, Royal College of Surgeons in Ireland, Dublin 2, Ireland
| | - Frank Moriarty
- Health Research Board Centre for Primary Care Research, Royal College of Surgeons in Ireland, Dublin, Ireland.,The Irish Longitudinal Study on Ageing, Trinity College Dublin, Dublin, Ireland
| | - Kathleen Bennett
- Department of Pharmacology and Therapeutics, University of Dublin, Trinity College Dublin, Dublin, Ireland.,Division of Population Health Sciences, Royal College of Surgeons in Ireland, Dublin 2, Ireland
| | - Caitriona Cahir
- Division of Population Health Sciences, Royal College of Surgeons in Ireland, Dublin 2, Ireland.
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Kose E, Wakabayashi H. Rehabilitation pharmacotherapy: A scoping review. Geriatr Gerontol Int 2020; 20:655-663. [PMID: 32691925 DOI: 10.1111/ggi.13975] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2020] [Revised: 05/15/2020] [Accepted: 06/01/2020] [Indexed: 12/15/2022]
Abstract
Many patients in rehabilitation facilities are affected by polypharmacy. Polypharmacy is associated with rehabilitation outcomes and functional recovery. Consequently, a combination of rehabilitation and pharmacotherapy may improve the outcomes of older people undergoing rehabilitation. A recent report described the concept of rehabilitation pharmacotherapy. The concept envisages helping frail older people and people with disabilities to achieve the highest possible body function, activity level and quality of life. There are two key tenets of rehabilitation pharmacotherapy: "pharmacotherapy in consideration of rehabilitation" and "rehabilitation in consideration of pharmacotherapy." "Pharmacotherapy in consideration of rehabilitation" includes use of drugs to treat impairment, activity limitation and participation restriction based on the International Classification of Functioning, Disability, and Health. "Rehabilitation in consideration of pharmacotherapy" refers to tailoring of rehabilitation considering the content of pharmacotherapy. With respect to drugs and motor dysfunction, anticholinergic drugs are associated with dysphagia and fractures. Increased use of potentially inappropriate medications may adversely affect the nutritional status. With respect to activities of daily living, polypharmacy and use of potentially inappropriate medications negatively affect the improvement in motor function during rehabilitation. Potent anticholinergic drugs are more likely to impede the improvement in cognitive function. In this review, we address the concept of rehabilitation pharmacotherapy and discuss its importance from the perspective of polypharmacy, the effect of drugs on disability and disease, nutritional status and activities of daily living. Geriatr Gerontol Int 2020; 20: -.
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Affiliation(s)
- Eiji Kose
- Department of Pharmacy, Teikyo University School of Medicine University Hospital, Tokyo, Japan
| | - Hidetaka Wakabayashi
- Department of Rehabilitation Medicine, Tokyo Women's Medical University Hospital, Tokyo, Japan
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Atılgan D, Kölükçü E, Fırat F, Kölükçü V. Efficacy and Safety of Holmium Laser Lithotripsy Under Local Anesthesia in the Treatment of Urethral Stones in Elderly Male Patients. Healthcare (Basel) 2020; 8:healthcare8020150. [PMID: 32492932 PMCID: PMC7348794 DOI: 10.3390/healthcare8020150] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Revised: 05/21/2020] [Accepted: 05/30/2020] [Indexed: 11/29/2022] Open
Abstract
The elderly population has been increasing significantly in our century. In our study, it was aimed to analyze the treatment results of elderly male patients who underwent holmium laser lithotripsy (HLL) for urethral stones under local anesthesia. We evaluated a total of 31 male patients, aged ≥65 years, diagnosed with urethral stones and treated with HLL under local anesthesia. We noted the demographic data and visual pain scores (VAS) of the patients and the duration of the operation and hospital stay. Our analysis involved both the success rates of the surgical procedure and the complication rates according to the modified Clavien classification. In addition. we determined the patients’ preoperative clinical status using the Charlson comorbidity index (CCI). The mean age of the patients was 71.65 ± 8.19 years. Acute urinary retention was the most common complaint (45.2%). Their mean scores were 7.68 ± 2.53 according to CCI. The average operation time was 15.48 ± 5.22 min and the VAS was 2.03 ± 1.08. All patients were stone-free and there was a marked improvement in their symptoms None of them stayed in the hospital for more than one day. We did not observe any Grade 3 or higher complications. In light of the data obtained in our study, we concluded that HLL is an effective and reliable method to treat urethral stones under local anesthesia in elderly male patients.
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Affiliation(s)
- Dogan Atılgan
- Department of Urology, Faculty of Medicine, Gaziosmanpasa University, Tokat 60100, Turkey;
- Correspondence:
| | - Engin Kölükçü
- Department of Urology, Faculty of Medicine, Gaziosmanpasa University, Tokat 60100, Turkey;
| | - Fatih Fırat
- Department of Urology, Tokat State Hospital, Tokat 60100, Turkey;
| | - Vildan Kölükçü
- Department of Anesthesia and Reanimation, Zile State Hospital, Tokat 60400, Turkey;
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Salaffi F, Farah S, Di Carlo M. Frailty syndrome in rheumatoid arthritis and symptomatic osteoarthritis: an emerging concept in rheumatology. ACTA BIO-MEDICA : ATENEI PARMENSIS 2020; 91:274-296. [PMID: 32420963 PMCID: PMC7569610 DOI: 10.23750/abm.v91i2.9094] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Accepted: 02/11/2020] [Indexed: 12/17/2022]
Abstract
Musculoskeletal conditions such as rheumatoid arthritis (RA) and symptomatic osteoarthritis (OA) were the leading cause of disability in developed countries and disproportionately affects older adults. Frailty is an emerging concept in rheumatology, which represents an important construct to aid in the identification of in- dividuals who are vulnerable to adverse events and less favourable outcomes. The prevalence of frailty among the community-dwelling population increases with age: it ranges from 7% to 10% in those aged over 65 years and to 20-40% among octogenarians. Among patients with RA, the prevalence of frailty is comparable to, or even greater, that of older geriatric cohorts and pre-frailty, a condition including a major health vulnerability between robust and frail, is much more prevalent in RA than in geriatric cohorts. Clinical OA is also associated with frailty and pre-frailty in older adults in European countries. The overall prevalence of clinical OA at any site was 30.4%; frailty was present in 10.2% and pre-frailty in 51.0 %. The diagnosis of frailty is usually clinical and based on specific criteria, which are sometimes inconsistent. Therefore, there is an increasing need to identify and vali- date robust biomarkers for this condition. In the literature, different criteria have been validated to identify frail older subjects, which mainly refer to two conceptual models: the Physical Frailty (PF) phenotype proposed by Fried and the cumulative deficit approach proposed by Rockwood. The purpose of this review was to quantita- tively synthesize published literature on the prevalence of frailty in RA and OA and summarize current evidence on the validity and practicality of the most commonly used screening tools for frailty.
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Affiliation(s)
| | - Sonia Farah
- Clinica Reumatologica, Ospedale Carlo Urbani di Jesi, Università Politecnica delle Marche, (Ancona), Italy..
| | - Marco Di Carlo
- Clinica Reumatologica, Ospedale Carlo Urbani di Jesi, Università Politecnica delle Marche, (Ancona), Italy..
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Glass OM, Hermida AP, Hershenberg R, Schwartz AC. Considerations and Current Trends in the Management of the Geriatric Patient on a Consultation-Liaison Service. Curr Psychiatry Rep 2020; 22:21. [PMID: 32285305 DOI: 10.1007/s11920-020-01147-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
PURPOSE OF REVIEW To provide consultation-liaison psychiatrists with an updated resource that can assist in the treatment and management of geriatric patients. RECENT FINDINGS The current available literature has not shown any differences in efficacy between haloperidol and second-generation antipsychotics in patients with delirium. When considering relative advantages of forms of antipsychotic administration, there is no support for a superior safety profile of oral compared to intramuscular or intravenous administration. A recent meta-analysis of four randomized controlled trials concluded that when melatonin was administered to older age patients on medical wards, it significantly prevented the incidence of delirium when compared with the control group. While suvorexant administered nightly to elderly patients in acute care settings may lower the incidence of delirium, larger studies are needed to confirm this finding. Despite the black box warning of increased mortality risk in older patients with dementia, antipsychotics may be used with caution by the consultation-liaison (CL) psychiatrist to treat the neuropsychologic symptoms of dementia including hallucinations and psychosis in the hospital setting. While antidepressant studies have focused primarily on citalopram and escitalopram in the treatment of agitation in the setting of dementia, these two medications have not been adequately compared directly to other SSRIs for this condition. It is therefore not clear whether citalopram and escitalopram are more efficacious in treating agitation in the setting of dementia when compared to other SSRIs. While the evidence supporting trazodone's use is limited, it is generally well tolerated and is an option as a PRN for irritability and agitation in patients with Alzheimer's and mixed dementia. While there is some evidence to support the use of acetylcholinesterase inhibitors for treating cognitive impairments and hallucinations in Lewy body dementia, the usefulness of these agents in other forms of dementia is not well studied, and those studies did not show any benefit in the management of acute agitation. It is important to note that memantine can cause or exacerbate agitation and may be the cause of behavioral dysregulation. There is no evidence to support the routine use of benzodiazepines for behavioral improvement in patients with dementia. Escitalopram and citalopram do have a unique pharmacokinetic properties in the sense that they have been found to have 50-56% plasma protein binding, compared to sertraline, fluoxetine, and paroxetine (95% or more). Pooled analyses suggest that antidepressants are more effective than placebo in reducing the symptoms of post-stroke depression. SSRIs are considered first-line antidepressants in stroke patients, who are often elderly with underlying cardiovascular problems. Although treatment with SSRIs is recommended for post-stroke depression, there are no studies providing conclusive data on the superiority of a specific drug. Older age is associated with a better outcome from ECT, with remission rates of approximately 73% to 90% in patients over 65 years. ECT is the treatment of choice for patients with psychotic depression, and elderly patients with psychotic depression have been shown to have a higher remission rate and faster time to response than depressed patients without psychotic symptoms. With the average life expectancy increase, it is projected that 19 million people will reach the age of 85 or higher, an increase from 5.5 million in 2010. With an increasing older population, psychiatric consultation in the management of geriatric patients is becoming more necessary. Psychiatrists must be aware of the unique considerations in elderly patients. In this article, we provide evidence-based guidance to the CL psychiatrist on major issues relating to the older age patient, highlighting recent trends in treatment. First, we provide background on the evaluation of the medically hospitalized geriatric patient. As rates of medical and psychiatric illnesses increase with advancing age, elderly patients are more likely to be taking a higher number of medications as compared to younger patients, and physicians must pay special attention to polypharmacy, including side effects and drug interactions in this group. Next, we focus on the diagnosis, management, and unique needs of the geriatric patient presenting with common clinical syndromes of delirium, dementia, and depression. Delirium and dementia are among the most common causes of cognitive impairment in clinical settings yet are often either unrecognized or misdiagnosed as they may have similar signs and symptoms. In addition, depression is prevalent in older adults, especially in those with comorbid medical illness. Depression can be fatal as the rates of suicide are higher in later life than in any other age group. Consultation can improve the management of elderly patients and prevent unnecessary nursing home placement.
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Affiliation(s)
| | | | - Rachel Hershenberg
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
- Treatment Resistant Depression Program, Emory University, Atlanta, GA, USA
| | - Ann C Schwartz
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA.
- Psychiatry Consultation-Liaison Service, Grady Memorial Hospital, 80 Jesse Hill Jr. Dr., Atlanta, GA, USA.
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