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Schiavo G, Forgerini M, Varallo FR, Corrêa BC, Salvetti MCP, Mastroianni PDC. Performance of triggers in detecting hospitalizations related to drug-induced respiratory disorders in older adults: A pilot cross-sectional study. Clinics (Sao Paulo) 2024; 79:100449. [PMID: 39068723 DOI: 10.1016/j.clinsp.2024.100449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Revised: 06/04/2024] [Accepted: 06/30/2024] [Indexed: 07/30/2024] Open
Abstract
BACKGROUND There is no gold-standard trigger for detecting drug-induced respiratory disorders, a type of Adverse Drug Event (ADE) with high morbimortality, particularly in older people. OBJECTIVE To propose and evaluate the performance of triggers for detecting hospitalizations related to drug-induced respiratory disorders in older people. METHODS A pilot cross-sectional study was conducted with older people (age ≥ 60) admitted to a Brazilian hospital. Electronic chart documentation was screened using ICD-10 codes; Global Trigger Tool (GTT); and drugs potentially associated with respiratory disorders. A chart and medication review were conducted to perform the causality assessment using the instrument developed by the World Health Organization. The performance of triggers was evaluated by the Positive Predictive Value (PPV), with values ≥ 0.20 indicating good performance. RESULTS Among 221 older people, 72 were eligible. Potential drug-induced dyspnea and/or cough were detected in six older people (6/72), corresponding to a prevalence of 8.3 %. The overall PPV of the triggers was 0.14, with abrupt medication stop (PPV = 1.00), codeine (PPV = 1.00), captopril (PPV = 0.33), and carvedilol (PPV = 0.33) showing good performance. Two triggers were proposed for detecting therapeutic ineffectiveness associated with respiratory disorders: furosemide (PPV = 0.23) and prednisone (PPV = 0.20). CONCLUSION The triggers enabled the identification that one in 12 hospitalizations was related to drug-induced respiratory. Although good performance was observed in the application of triggers, additional investigations are needed to assess the feasibility of incorporating them into clinical practice for the screening, detection, management, and reporting of these ADEs, which are considered to be underreported and difficult to detect.
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Affiliation(s)
- Geovana Schiavo
- Department of Drugs and Medicines, Faculdade de Ciências Farmacêuticas da Universidade Estadual Paulista (UNESP), Araraquara, SP, Brazil
| | - Marcela Forgerini
- Department of Drugs and Medicines, Faculdade de Ciências Farmacêuticas da Universidade Estadual Paulista (UNESP), Araraquara, SP, Brazil
| | - Fabiana Rossi Varallo
- Universidade de São Paulo (USP), Faculdade de Ciências Farmacêuticas de Ribeirão Preto, Ribeirão Preto, SP, Brazil
| | - Bruna Carolina Corrêa
- Hospital Estadual Américo Brasiliense (HEAB), Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo (USP), Ribeirão Preto, SP, Brazil
| | - Maisa Cabete Pereira Salvetti
- Hospital Estadual Américo Brasiliense (HEAB), Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo (USP), Ribeirão Preto, SP, Brazil
| | - Patrícia de Carvalho Mastroianni
- Department of Drugs and Medicines, Faculdade de Ciências Farmacêuticas da Universidade Estadual Paulista (UNESP), Araraquara, SP, Brazil.
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Bennie M, Santa-Ana-Tellez Y, Galistiani GF, Trehony J, Despres J, Jouaville LS, Poluzzi E, Morin L, Schubert I, MacBride-Stewart S, Elseviers M, Nasuti P, Taxis K. The prevalence of polypharmacy in older Europeans: A multi-national database study of general practitioner prescribing. Br J Clin Pharmacol 2024. [PMID: 38812250 DOI: 10.1111/bcp.16113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 03/08/2024] [Accepted: 05/09/2024] [Indexed: 05/31/2024] Open
Abstract
AIMS The aims of this study were to measure the prevalence of polypharmacy and describe the prescribing of selected medications known for overuse in older people with polypharmacy in primary care. METHODS This was a multinational retrospective cohort study across six countries: Belgium, France, Germany, Italy, Spain and the UK. We used anonymized longitudinal patient-level information from general practice databases hosted by IQVIA. Patients ≥65 years were included. Polypharmacy was defined as having 5-9 and ≥10 distinct drug classes (ATC Level 3) prescribed during a 6-month period. Selected medications were: opioids, antipsychotics, proton pump inhibitors (PPI), benzodiazepines (ATC Level 5). We included country experts on the healthcare context to interpret findings. RESULTS Age and gender distribution was similar across the six countries (mean age 75-76 years; 54-56% female). The prevalence of polypharmacy of 5-9 drugs was 22.8% (UK) to 58.3% (Germany); ≥10 drugs from 11.3% (UK) to 28.5% (Germany). In the polypharmacy population prescribed ≥5 drugs, opioid prescribing ranged from 11.5% (France) to 27.5% (Spain). Prescribing of PPI was highest with almost half of patients receiving a PPI, 42.3% (Germany) to 65.5% (Spain). Benzodiazepine prescribing showed a marked variation between countries, 2.7% (UK) to 34.9% (Spain). The healthcare context information explained possible underreporting for selected medications. CONCLUSIONS We have found a high prevalence of polypharmacy with more than half of the older population being prescribed ≥5 drugs in four of the six countries. Whilst polypharmacy may be appropriate in many patients, worryingly high usage of PPIs and benzodiazepines supports current efforts to improve polypharmacy management across Europe.
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Affiliation(s)
- Marion Bennie
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, United Kingdom, Public Health Scotland, Edinburgh, UK
| | - Yared Santa-Ana-Tellez
- Utrecht Centre for Pharmaceutical Policy & Regulation, Utrecht Institute for Pharmaceutical Sciences (UIPS), Utrecht University, Utrecht, The Netherlands
| | | | | | | | | | - Elisabetta Poluzzi
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Lucas Morin
- Inserm U1018, High-Dimensional Biostatistics for Drug Safety and Genomics, CESP, Paris, France
| | - Ingrid Schubert
- PMV Research Group, Faculty of Medicine and University Hospital of Cologne, Cologne, Germany
| | | | - Monique Elseviers
- Department of Clinical Pharmacology, University of Ghent, Ghent and Centre for Research and Innovation in Care (CRIC), University of Antwerp, Antwerp, Belgium
| | | | - Katja Taxis
- PharmacoTherapy, Epidemiology and Economics, University of Groningen, Groningen, Netherlands
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Dormosh N, Abu-Hanna A, Calixto I, Schut MC, Heymans MW, van der Velde N. Topic evolution before fall incidents in new fallers through natural language processing of general practitioners' clinical notes. Age Ageing 2024; 53:afae016. [PMID: 38364820 PMCID: PMC10939375 DOI: 10.1093/ageing/afae016] [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: 07/20/2023] [Indexed: 02/18/2024] Open
Abstract
BACKGROUND Falls involve dynamic risk factors that change over time, but most studies on fall-risk factors are cross-sectional and do not capture this temporal aspect. The longitudinal clinical notes within electronic health records (EHR) provide an opportunity to analyse fall risk factor trajectories through Natural Language Processing techniques, specifically dynamic topic modelling (DTM). This study aims to uncover fall-related topics for new fallers and track their evolving trends leading up to falls. METHODS This case-cohort study utilised primary care EHR data covering information on older adults between 2016 and 2019. Cases were individuals who fell in 2019 but had no falls in the preceding three years (2016-18). The control group was randomly sampled individuals, with similar size to the cases group, who did not endure falls during the whole study follow-up period. We applied DTM on the clinical notes collected between 2016 and 2018. We compared the trend lines of the case and control groups using the slopes, which indicate direction and steepness of the change over time. RESULTS A total of 2,384 fallers (cases) and an equal number of controls were included. We identified 25 topics that showed significant differences in trends between the case and control groups. Topics such as medications, renal care, family caregivers, hospital admission/discharge and referral/streamlining diagnostic pathways exhibited a consistent increase in steepness over time within the cases group before the occurrence of falls. CONCLUSIONS Early recognition of health conditions demanding care is crucial for applying proactive and comprehensive multifactorial assessments that address underlying causes, ultimately reducing falls and fall-related injuries.
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Affiliation(s)
- Noman Dormosh
- Department of Medical Informatics, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands
- Aging and Later Life & Methodology, Amsterdam Public Health, Amsterdam, The Netherlands
| | - Ameen Abu-Hanna
- Department of Medical Informatics, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands
- Aging and Later Life & Methodology, Amsterdam Public Health, Amsterdam, The Netherlands
| | - Iacer Calixto
- Department of Medical Informatics, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands
- Methodology & Mental Health, Amsterdam Public Health, Amsterdam, The Netherlands
| | - Martijn C Schut
- Department of Medical Informatics, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands
- Department of Laboratory Medicine, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Methodology & Quality of Care, Amsterdam Public Health, Amsterdam, The Netherlands
| | - Martijn W Heymans
- Department of Epidemiology and Data Science, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Methodology & Personalized Medicine, Amsterdam Public Health, Amsterdam, The Netherlands
| | - Nathalie van der Velde
- Department of Internal Medicine, Section of Geriatric Medicine, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands
- Aging and Later Life, Amsterdam Public Health, Amsterdam, The Netherlands
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Mekonnen AB, Reijnierse EM, Soh CH, Lim WK, Maier AB, Manias E. Associations between potentially inappropriate prescribing and increased number of medications with postdischarge health outcomes among geriatric rehabilitation inpatients: RESORT study. Br J Clin Pharmacol 2023; 89:3375-3388. [PMID: 37376923 DOI: 10.1111/bcp.15838] [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: 03/12/2023] [Revised: 06/02/2023] [Accepted: 06/18/2023] [Indexed: 06/29/2023] Open
Abstract
AIMS Older adults are vulnerable to medication-related harm mainly due to high use of medications and inappropriate prescribing. This study aimed to investigate the associations between inappropriate prescribing and number of medications identified at discharge from geriatric rehabilitation with subsequent postdischarge health outcomes. METHOD RESORT (REStORing health of acutely unwell adulTs) is an observational, longitudinal cohort study of geriatric rehabilitation inpatients. Potentially inappropriate medications (PIMs) and potential prescribing omissions (PPOs) were measured at acute admission, and at admission and discharge from geriatric rehabilitation, using Version 2 of the STOPP/START criteria. RESULTS In total, 1890 (mean age 82.6 ± 8.1 years, 56.3% female) were included. The use of at least 1 PIM or PPO at geriatric rehabilitation discharge was not associated with 30-day and 90-day readmission and 3-month and 12-month mortality. Central nervous system/psychotropics and fall risk PIMs were significantly associated with 30-day hospital readmission (adjusted odds ratio [AOR] 1.53; 95% confidence interval [CI] 1.09-2.15), and cardiovascular PPOs with 12-month mortality (AOR 1.34; 95% CI 1.00-1.78). Increased number of discharge medications was significantly associated with 30-day (AOR 1.03; 95% CI 1.00-1.07) and 90-day (AOR 1.06; 95% CI 1.03-1.09) hospital readmissions. The use and number of PPOs (including vaccine omissions) were associated with reduced independence in instrumental activities of daily living scores at 90-days after geriatric rehabilitation discharge. CONCLUSION The number of discharge medications, central nervous system/psychotropics and fall risk PIMs were significantly associated with readmission, and cardiovascular PPOs with mortality. Interventions are needed to improve appropriate prescribing in geriatric rehabilitation patients to prevent hospital readmission and mortality.
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Affiliation(s)
- Alemayehu B Mekonnen
- Centre for Quality and Patient Safety Research, School of Nursing and Midwifery, Institute for Health Transformation, Deakin University, Burwood, Victoria, Australia
- Department of Medicine and Aged Care, @AgeMelbourne, The Royal Melbourne Hospital, The University of Melbourne, Parkville, Victoria, Australia
| | - Esmee M Reijnierse
- Department of Medicine and Aged Care, @AgeMelbourne, The Royal Melbourne Hospital, The University of Melbourne, Parkville, Victoria, Australia
| | - Cheng Hwee Soh
- Department of Medicine and Aged Care, @AgeMelbourne, The Royal Melbourne Hospital, The University of Melbourne, Parkville, Victoria, Australia
| | - Wen Kwang Lim
- Department of Medicine and Aged Care, @AgeMelbourne, The Royal Melbourne Hospital, The University of Melbourne, Parkville, Victoria, Australia
| | - Andrea B Maier
- Department of Medicine and Aged Care, @AgeMelbourne, The Royal Melbourne Hospital, The University of Melbourne, Parkville, Victoria, Australia
- Department of Human Movement Sciences, @AgeAmsterdam, Amsterdam Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Healthy Longevity Translational Research Program, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Centre for Healthy Longevity, @AgeSingapore, National University Health System, Singapore, Singapore
| | - Elizabeth Manias
- Centre for Quality and Patient Safety Research, School of Nursing and Midwifery, Institute for Health Transformation, Deakin University, Burwood, Victoria, Australia
- Department of Medicine and Aged Care, @AgeMelbourne, The Royal Melbourne Hospital, The University of Melbourne, Parkville, Victoria, Australia
- School of Nursing and Midwifery, Monash University, Clayton, Victoria, Australia
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Abler V, Brain C, Ballard C, Berrio A, Coate B, Espay AJ. Motor- and cognition-related safety of pimavanserin in patients with Parkinson's disease psychosis. Front Neurol 2022; 13:919778. [PMID: 36277907 PMCID: PMC9580496 DOI: 10.3389/fneur.2022.919778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 09/07/2022] [Indexed: 12/01/2022] Open
Abstract
Background Pimavanserin, a selective 5-HT2A inverse agonist/antagonist, is the only treatment approved by the US Food and Drug Administration for hallucinations and delusions associated with Parkinson's disease (PD) psychosis. Aim We aimed to evaluate motor- and cognition-related safety in pimavanserin-treated patients with PD psychosis. Methods This analysis included patients with PD psychosis treated with pimavanserin 34 mg from a pooled analysis of 3 randomized, double-blind, placebo-controlled, 6-week studies [NCT00477672 (study ACP-103-012), NCT00658567 (study ACP-103-014), and NCT01174004 (study ACP-103-020)] and a subgroup of patients with PD dementia with psychosis from HARMONY (NCT03325556), a randomized discontinuation study that included a 12-week open-label period followed by a randomized double-blind period of up to 26 weeks. Motor- and cognition-related safety were examined. Results The pooled analysis included 433 randomized patients (pimavanserin, 202; placebo, 231). Least squares mean (standard error [SE]) change from baseline to week 6 Unified Parkinson's Disease Rating Scale (UPDRS) II + III score was similar for pimavanserin [−2.4 (0.69)] and placebo [−2.3 (0.60)] (95% Confidence Interval [CI]:−1.9, 1.6). The change from baseline to week 6 for UPDRS II and UPDRS III scores was similar between groups. In the HARMONY open-label period, 49 patients with PD dementia with psychosis were treated with pimavanserin 34 mg, 36 of whom were randomized in the double-blind period (pimavanserin, 16; placebo, 20). In the open-label period, the mean (SE) change from baseline to week 12 (n = 39) Extra-Pyramidal Symptom Rating Scale (ESRS-A) score was −1.7 (0.74); in the double-blind period, the results were generally comparable between the pimavanserin and placebo arms. The change from baseline in Mini-Mental State Examination (MMSE) score was also comparable between pimavanserin- and placebo-treated patients in HARMONY [open-label (n = 37): mean (SE) change from baseline to week 12, 0.3 (0.66)]. Rates of motor- and cognition-related adverse events were similar between pimavanserin and placebo in both analyses. Conclusions Pimavanserin 34 mg was well tolerated and did not yield a negative impact on motor- or cognition-related function in patients with PD psychosis.
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Affiliation(s)
- Victor Abler
- Acadia Pharmaceuticals Inc, San Diego, CA, United States
| | - Cecilia Brain
- Acadia Pharmaceuticals Inc, San Diego, CA, United States
| | - Clive Ballard
- University of Exeter Medical School, Exeter, United Kingdom
| | - Ana Berrio
- Acadia Pharmaceuticals Inc, San Diego, CA, United States
| | - Bruce Coate
- Acadia Pharmaceuticals Inc, San Diego, CA, United States
| | - Alberto J. Espay
- Gardner Family Center for Parkinson's Disease and Movement Disorders, Department of Neurology, University of Cincinnati, Cincinnati, OH, United States
- *Correspondence: Alberto J. Espay
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Higher FORTA (Fit fOR The Aged) scores are associated with poor functional outcomes, dementia, and mortality in older people. Eur J Clin Pharmacol 2022; 78:1851-1859. [PMID: 36167853 PMCID: PMC9546968 DOI: 10.1007/s00228-022-03389-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Accepted: 09/07/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE Higher Fit fOR The Aged (FORTA) scores have been shown to be negatively associated with adverse clinical outcomes in older hospitalized patients. This has not been evaluated in other health care settings. The aim of this study was to examine the association of the FORTA score with relevant outcomes in the prospective AgeCoDe-AgeQualiDe cohort of community-dwelling older people. In particular, the longitudinal relation between the FORTA score and mortality and the incidence of dementia was evaluated. METHODS Univariate and multivariate correlations between the FORTA score and activities of daily living (ADL) or instrumental activities of daily living (IADL) as well as comparisons between high vs. low FORTA scores were conducted. RESULTS The FORTA score was significantly correlated with ADL/IADL at baseline and at all follow-up visits (p < 0.0001). ADL/IADL results of participants with a low FORTA score were significantly better than in those with high FORTA scores (p < 0.0001). The FORTA score was also significantly (p < 0.0001) correlated with ADL/IADL in the multivariate analysis. Moreover, the mean FORTA scores of participants with dementia were significantly higher (p < 0.0001) than in those without dementia at follow-up visits 6 through 9. The mean FORTA scores of participants who died were significantly higher than those of survivors at follow-up visits 7 (p < 0.05), 8 (p < 0.001), and 9 (p < 0.001). CONCLUSION In this study, an association between higher FORTA scores and ADL as well as IADL was demonstrated in community-dwelling older adults. Besides, higher FORTA scores appear to be linked to a higher incidence of dementia and even mortality.
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Tolley APL, Reijnierse EM, Maier AB. Characteristics of geriatric rehabilitation inpatients based on their frailty severity and change in frailty severity during admission: RESORT. Mech Ageing Dev 2022; 207:111712. [PMID: 35905797 DOI: 10.1016/j.mad.2022.111712] [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: 01/29/2022] [Revised: 06/28/2022] [Accepted: 07/23/2022] [Indexed: 10/16/2022]
Abstract
BACKGROUND Frailty is prevalent amongst geriatric inpatients and worsens clinical outcomes. Determinants of admission frailty and changes in frailty severity are potential targets for intervention. OBJECTIVE To identify characteristics associated with frailty severity at admission and change in frailty severity during geriatric rehabilitation. METHODS The observational, prospective, longitudinal inception cohort REStORing health of acutely unwell adulTs (RESORT) includes geriatric rehabilitation inpatients. Demographic, medical, nutritional, functional, and psychological characteristics were analysed according to admission Clinical Frailty Scale. Linear and multinomial logistic regression prediction models identified admission characteristics predicting change in frailty severity during rehabilitation. RESULTS A total 1716 inpatients (median age [IQR] 83.4 [77.7-88.6] years, 56.4 % females) were included. Poorer admission medical, nutritional, functional, and psychological status was associated with more severe frailty. Cardiac admissions, higher Cumulative Illness Rating Scale, greater number of medications, and better Short Physical Performance Battery at admission predicted improved frailty severity. Admission cognitive impairment, delirium, higher Charlson Comorbidity Index, and Hospital Anxiety and Depression Scale anxiety predicted worsened frailty severity. Explained variation was low. CONCLUSIONS Frailer geriatric rehabilitation inpatients have more complicated disease and impaired nutritional, physical, and psychological markers. Admission cognitive impairment, delirium, comorbidity, and anxiety predict worsening frailty during rehabilitation, and require prompt management.
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Affiliation(s)
- Alec P L Tolley
- Department of Medicine and Aged Care, @AgeMelbourne, The Royal Melbourne Hospital, The University of Melbourne, Parkville, Victoria, Australia
| | - Esmee M Reijnierse
- Department of Medicine and Aged Care, @AgeMelbourne, The Royal Melbourne Hospital, The University of Melbourne, Parkville, Victoria, Australia; Department of Rehabilitation Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, the Netherlands
| | - Andrea B Maier
- Department of Medicine and Aged Care, @AgeMelbourne, The Royal Melbourne Hospital, The University of Melbourne, Parkville, Victoria, Australia; Department of Human Movement Sciences, @AgeAmsterdam, Faculty of Behavioural and Movement Sciences, Amsterdam Movement Sciences, Vrije Universiteit, Amsterdam, the Netherlands; Healthy Longevity Translational Research Program, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Centre for Healthy Longevity, @AgeSingapore, National University Health System, Singapore.
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Matsumoto A, Yoshimura Y, Nagano F, Bise T, Kido Y, Shimazu S, Shiraishi A. Polypharmacy and potentially inappropriate medications in stroke rehabilitation: prevalence and association with outcomes. Int J Clin Pharm 2022; 44:749-761. [PMID: 35578145 DOI: 10.1007/s11096-022-01416-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2021] [Accepted: 04/18/2022] [Indexed: 12/11/2022]
Abstract
Background Evidence is scarce regarding polypharmacy and potentially inappropriate medications (PIMs) in rehabilitation medicine. Aim To investigate the prevalence of polypharmacy and PIMs and their association with outcomes in stroke rehabilitation. Method A retrospective cohort study was conducted with 849 older inpatients post-stroke. Polypharmacy was defined as six or more medications, and PIMs were defined based on Beers criteria 2019. Study outcomes included functional independence measure (FIM)-motor, FIM-cognitive, energy intake, dysphagia, length of hospital stay, and the rate of home discharge. To consider the effect of pharmacotherapy during rehabilitation, multivariate analyses were used to determine whether the presence of polypharmacy or PIMs at discharge was associated with outcomes. Results After enrollment, 361 patients (mean age 78.3 ± 7.7 years; 49.3% male) were analyzed. Polypharmacy was observed in 43.8% and 62.9% of patients, and any PIMs were observed in 64.8% and 65.4% of patients at admission and discharge, respectively. The most frequently prescribed PIMs included antipsychotics, benzodiazepines, and proton pump inhibitors. Polypharmacy was negatively associated with FIM-motor score (β = - 0.062, P = 0.049), FIM-cognitive score (β = - 0.076, P = 0.014), energy intake (β = - 0.143, P = 0.005), and home discharge (OR: 0.458; 95% CI: 0.248, 0.847; P = 0.013). PIMs were negatively associated with home discharge (OR: 0.375; 95% CI: 0.195, 0.718; P = 0.003). Conclusion Polypharmacy and PIMs are commonly found among older patients undergoing stroke rehabilitation. Moreover, polypharmacy was negatively associated with activities of daily living (ADL) but not with PIMs and ADLs, and both were associated with home discharge.
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Affiliation(s)
- Ayaka Matsumoto
- Department of Pharmacy, Kumamoto Rehabilitation Hospital, Kumamoto, Japan
| | - Yoshihiro Yoshimura
- Center for Sarcopenia and Malnutrition Research, Kumamoto Rehabilitation Hospital, 760 Magate, Kikuyo-Town, Kikuchi-County, Kumamoto, 869-1106, Japan.
| | - Fumihiko Nagano
- Department of Rehabilitation, Kumamoto Rehabilitation Hospital, Kumamoto, Japan
| | - Takahiro Bise
- Department of Rehabilitation, Kumamoto Rehabilitation Hospital, Kumamoto, Japan
| | - Yoshifumi Kido
- Department of Rehabilitation, Kumamoto Rehabilitation Hospital, Kumamoto, Japan
| | - Sayuri Shimazu
- Department of Nutritional Management, Kumamoto Rehabilitation Hospital, Kumamoto, Japan
| | - Ai Shiraishi
- Department of Dental Office, Kumamoto Rehabilitation Hospital, Kumamoto, Japan
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Schmitt AK, Weiss C, Burkhardt H, Frohnhofen H, Wehling M, Pazan F. The Sex-Specific Impact of the FORTA (Fit-fOR-The-Aged) List on Medication Quality and Clinical Endpoints in Older Hospitalized Patients: Secondary Analysis of a Randomized Controlled Trial. Drugs Real World Outcomes 2022; 9:287-297. [PMID: 35297495 PMCID: PMC9114217 DOI: 10.1007/s40801-022-00292-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/19/2022] [Indexed: 11/27/2022] Open
Abstract
Background Little is known about the sex-specific impact of drug optimization tools such as the Fit fOR The Aged (FORTA) list on drug use and relevant clinical endpoints in older people. Objective We aimed to detect gender differences of interventional effects on medication quality and related clinical effects in the VALFORTA trial. Patients and methods A sex-specific analysis of data from 409 patients (147 men and 262 women, mean age 79.4 and 82.7 years, respectively) in acute geriatric care comparing the control and FORTA intervention groups was performed. Changes of the FORTA score (sum of over- and undertreatment errors per patient), the incidence of adverse drug events (ADEs) during hospitalization, and several clinically relevant endpoints [e.g., the Barthel index (BI)] were tested for equivalence at a 20% margin. “Success” or “failure” for the development of these clinical endpoints was defined and their frequencies compared by a risk reduction analysis. Results Sex differences were insignificant for the reduction of the FORTA score, the improvement of BI, or over- and undertreatment errors (p > 0.05). In women only, the FORTA intervention significantly increased the number of patients without an ADE (p = 0.010). Statistical sex equivalence was found for the improvement of the FORTA scores, BI, and the number of prevented events (e.g., falls, confusion, or renal failure) (p < 0.05), but not for the improvement of specific mistreatments or over- and undertreatment scores under altered inclusion criteria (p > 0.05). Conclusions Both sexes benefit equally from the FORTA intervention regarding the amelioration of the quality of drug treatment as well as several clinically relevant outcomes. In addition, the positive impact of the FORTA intervention on the number of adverse drug events appears to be greater in women. Trial Registration Number DRKS00000531. Supplementary Information The online version contains supplementary material available at 10.1007/s40801-022-00292-9.
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Affiliation(s)
- Ann-Kathrin Schmitt
- Clinical Pharmacology Mannheim, Medical Faculty Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Christel Weiss
- Department of Medical Statistics, Biomathematics and Information Processing, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Heinrich Burkhardt
- IV. Medical Department, Medical Faculty Mannheim, University Medical Center, Heidelberg University, Mannheim, Germany
| | - Helmut Frohnhofen
- Fakultät für Gesundheit, Universität Witten Herdecke, Alfred-Herrhausen-Str. 50, 58455, Witten, Germany.,Heinrich Heine Universität Düsseldorf, UKD, Moorenstr. 5, 40225, Düsseldorf, Germany
| | - Martin Wehling
- Clinical Pharmacology Mannheim, Medical Faculty Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany.
| | - Farhad Pazan
- Clinical Pharmacology Mannheim, Medical Faculty Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
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Mekonnen A, Redley B, Crawford K, Jones S, de Courten B, Manias E. Associations between hyper-polypharmacy and potentially inappropriate prescribing with clinical and functional outcomes in older adults. Expert Opin Drug Saf 2022; 21:985-994. [PMID: 35180833 DOI: 10.1080/14740338.2022.2044786] [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] [Indexed: 11/04/2022]
Abstract
BACKGROUND : Hyper-polypharmacy and potentially inappropriate prescribing (PIP) are common among older inpatients. This study investigated associations between hyper-polypharmacy and PIP with clinical and functional outcomes in older adults at 3-months after hospital discharge. RESEARCH DESIGN AND METHOD : At discharge, prescribed medications were collected and PIPs, comprising potentially inappropriate medications (PIM) and potential prescribing omissions (PPO), were retrospectively identified using STOPP/START version 2. Clinical and functional outcomes were collected prospectively via telephone follow-up and audit. RESULTS : Data for 232 patients (mean age 80 years, 51.7 % female) were analysed. PIP prevalence at discharge was 73.7% (PIMs 62.5%, PPOs 36.6%). Exposure to at least 1 PIM was associated with an increased occurrence of unplanned hospital readmission (adjusted odds ratio (AOR) 5.09; 95% CI 2.38─10.85), emergency department presentation (AOR 4.69; 95% CI 1.55─14.21) and the composite outcome (AOR 6.83; 95% CI 3.20─14.57). The number rather than presence of PIMs was significantly associated with increased dependency in at least 1 activity of daily living (ADL) (AOR 2.31; 95% CI 1.08─4.20). Increased PIP use was associated with mortality (AOR 1.45; 95% CI 1.05─1.99). CONCLUSION : PIPs overall, and PIMs specifically, were frequent in older adults at hospital discharge, and were associated with increased re-hospitalizations and dependence in ADLs at 3-months post-discharge.
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Affiliation(s)
- Alemayehu Mekonnen
- School of Nursing and Midwifery, Centre for Quality and Patient Safety Research, Institute for Health Transformation, Deakin University, Burwood, Melbourne, VIC, Australia.,Centre for Quality and Patient Safety Research-Monash Health Partnership, School of Nursing and Midwifery, Deakin University, Melbourne, VIC, Australia.,Department of Medicine, School of Clinical Sciences, Monash University, Clayton, VIC, Australia
| | - Bernice Redley
- School of Nursing and Midwifery, Centre for Quality and Patient Safety Research, Institute for Health Transformation, Deakin University, Burwood, Melbourne, VIC, Australia.,Centre for Quality and Patient Safety Research-Monash Health Partnership, School of Nursing and Midwifery, Deakin University, Melbourne, VIC, Australia
| | - Kimberley Crawford
- Monash Nursing and Midwifery, Monash University, Clayton, VIC, Australia
| | - Stephanie Jones
- Department of General Medicine, Monash Health, Clayton, VIC, Australia
| | - Barbora de Courten
- Department of Medicine, School of Clinical Sciences, Monash University, Clayton, VIC, Australia.,Department of General Medicine, Monash Health, Clayton, VIC, Australia
| | - Elizabeth Manias
- School of Nursing and Midwifery, Centre for Quality and Patient Safety Research, Institute for Health Transformation, Deakin University, Burwood, Melbourne, VIC, Australia
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