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Liu X, Jing B, Graham LA, Liu CK, Lee SJ, Steinman MA, Dave CV, Manja V, Li Y, Fung K, Odden MC. Complex Patterns of Antihypertensive Treatment Changes in Long-Term Care Residents. J Am Med Dir Assoc 2024; 25:105119. [PMID: 38950584 DOI: 10.1016/j.jamda.2024.105119] [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: 10/09/2023] [Revised: 04/19/2024] [Accepted: 05/22/2024] [Indexed: 07/03/2024]
Abstract
OBJECTIVES Antihypertensive treatment changes are common in long-term care residents, yet data on the frequency and predictors of changes are lacking. We described the patterns of antihypertensive changes and examined the triggering factors. DESIGN Retrospective cohort study. SETTING AND PARTICIPANTS A total of 24,870 Department of Veterans Affairs (VA) nursing home residents aged ≥65 years with long-term stays (≥180 days) from 2006 to 2019. METHODS We obtained data from the VA Corporate Data Warehouse. Based on Bar Code Medication Administration medication data, we defined 2 types of change events in 180 days of admission: deprescribing (reduced number of antihypertensives or dose reduction of ≥30% compared with the previous week and maintained for at least 2 weeks) and intensification (opposite of deprescribing). Mortality was identified within 2 years after admission. RESULTS More than 85% of residents were prescribed antihypertensives and 68% of them experienced ≥1 change event during the first 6 months of the nursing home stay. We categorized residents into 10 distinct patterns: no change (27%), 1 deprescribing (11%), multiple deprescribing (5%), 1 intensification (10%), multiple intensification (7%), 1 deprescribing followed by 1 intensification (3%), 1 intensification followed by 1 deprescribing (4%), 3 changes with mixed events (7%), >3 changes with mixed events (10%), and no antihypertensive use (15%). Treatment changes were more frequent in residents with better physical function and/or cognitive function. Potentially triggering factors differed by the type of antihypertensive change: incident high blood pressure and cardiovascular events were associated with intensification, and low blood pressure, weight loss, and falls were associated with deprescribing. Death occurred in 7881 (32%) residents over 2 years. The highest mortality was for those without antihypertensive medication (incidence = 344/1000 person-years). CONCLUSIONS AND IMPLICATIONS Patterns of medication changes existing in long-term care residents are complex. Future studies should explore the benefits and harms of these antihypertensive treatment changes.
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Affiliation(s)
- Xiaojuan Liu
- Department of Epidemiology and Population Health, Stanford University, Stanford, CA, USA; Geriatric Research Education and Clinical Center, VA Palo Alto Health Care System, Palo Alto, CA, USA.
| | - Bocheng Jing
- Geriatrics, Palliative, and Extended Care Service Line, San Francisco VA Medical Center, San Francisco, CA, USA; Division of Geriatrics, Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Laura A Graham
- Health Economics Resource Center, VA Palo Alto Health Care System, Palo Alto, CA, USA; Stanford-Surgery Policy Improvement Research Education Center, Department of Surgery, Stanford University, Stanford, CA, USA
| | - Christine Kee Liu
- Geriatric Research Education and Clinical Center, VA Palo Alto Health Care System, Palo Alto, CA, USA; Section of Geriatrics, Division of Primary Care and Population Health, Stanford University, School of Medicine, Stanford, CA, USA
| | - Sei J Lee
- Geriatrics, Palliative, and Extended Care Service Line, San Francisco VA Medical Center, San Francisco, CA, USA; Division of Geriatrics, Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Michael A Steinman
- Geriatrics, Palliative, and Extended Care Service Line, San Francisco VA Medical Center, San Francisco, CA, USA; Division of Geriatrics, Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Chintan V Dave
- Department of Pharmacy Practice and Administration, Ernest Mario School of Pharmacy, Rutgers University, Piscataway, NJ, USA; Center for Pharmacoepidemiology and Treatment Science, Institute for Health, Health Care Policy and Aging Research, Rutgers University, New Brunswick, NJ, USA
| | - Veena Manja
- Center for Innovation to Implementation, VA Palo Alto Health Care System, Palo Alto, CA, USA; Department of Health Policy, Stanford University, Stanford, CA, USA
| | - Yongmei Li
- Department of Epidemiology and Population Health, Stanford University, Stanford, CA, USA
| | - Kathy Fung
- Geriatrics, Palliative, and Extended Care Service Line, San Francisco VA Medical Center, San Francisco, CA, USA; Division of Geriatrics, Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Michelle C Odden
- Department of Epidemiology and Population Health, Stanford University, Stanford, CA, USA; Geriatric Research Education and Clinical Center, VA Palo Alto Health Care System, Palo Alto, CA, USA
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Andrade A, Nascimento T, Cabrita C, Leitão H, Pinto E. Potentially Inappropriate Medication: A Pilot Study in Institutionalized Older Adults. Healthcare (Basel) 2024; 12:1275. [PMID: 38998810 PMCID: PMC11241476 DOI: 10.3390/healthcare12131275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2024] [Revised: 06/09/2024] [Accepted: 06/24/2024] [Indexed: 07/14/2024] Open
Abstract
Institutionalized older adults often face complex medication regimens, increasing their risk of adverse drug events due to polypharmacy, overprescribing, medication interactions, or the use of Potentially Inappropriate Medications (PIM). However, data on medication use and associated risks in this population remain scarce. This pilot study aimed to characterize the sociodemographic, clinical and pharmacotherapeutic profiles, and the use of PIM among institutionalized elders residing in Residential Structures for Elderly People (ERPI) in the Faro municipality, located in the Portuguese region of the Algarve. We conducted a cross-sectional study in a non-randomized sample of 96 participants (mean age: 86.6 ± 7.86 years) where trained researchers reviewed medication profiles and identified potentially inappropriate medications using the EU(7)-PIM list. Over 90% of participants exhibited polypharmacy (≥5 medications), with an average of 9.1 ± 4.15 medications per person. About 92% had potential drug interactions, including major and moderate interactions. More than 86% used at least one potentially inappropriate medication, most commonly central nervous system drugs. This pilot study demonstrates that institutionalized older adults may be at high risk of potential medication-related problems. Implementing comprehensive medication review programs and promoting adapted prescribing practices are crucial to optimize medication use and improve the well-being of this vulnerable population.
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Affiliation(s)
- Amanda Andrade
- Escola Superior de Saúde, Universidade do Algarve (ESSUAlg), Campus de Gambelas, Edifício 1, 8005-139 Faro, Portugal; (A.A.); (T.N.); (C.C.)
| | - Tânia Nascimento
- Escola Superior de Saúde, Universidade do Algarve (ESSUAlg), Campus de Gambelas, Edifício 1, 8005-139 Faro, Portugal; (A.A.); (T.N.); (C.C.)
- Algarve Biomedical Center Research Institute (ABC-RI), Universidade do Algarve, Campus de Gambelas, Edifício 2, 8005-139 Faro, Portugal;
| | - Catarina Cabrita
- Escola Superior de Saúde, Universidade do Algarve (ESSUAlg), Campus de Gambelas, Edifício 1, 8005-139 Faro, Portugal; (A.A.); (T.N.); (C.C.)
| | - Helena Leitão
- Algarve Biomedical Center Research Institute (ABC-RI), Universidade do Algarve, Campus de Gambelas, Edifício 2, 8005-139 Faro, Portugal;
- Faculdade de Medicina e Ciências Biomédicas, Universidade do Algarve, Campus de Gambelas, Edifício 2, 8005-139 Faro, Portugal
| | - Ezequiel Pinto
- Escola Superior de Saúde, Universidade do Algarve (ESSUAlg), Campus de Gambelas, Edifício 1, 8005-139 Faro, Portugal; (A.A.); (T.N.); (C.C.)
- Algarve Biomedical Center Research Institute (ABC-RI), Universidade do Algarve, Campus de Gambelas, Edifício 2, 8005-139 Faro, Portugal;
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Moreno-Martin P, Minobes-Molina E, Carbó-Cardeña A, Masó-Aguado M, Solé-Casals M, Torrents-Solé M, Bort-Roig J, Amblàs-Novellas J, Gómez-Batiste X, Jerez-Roig J. Exploring Early, Middle, and Late Loss in Basic Activities of Daily Living among Nursing Home Residents: A Multicenter Observational Study. Healthcare (Basel) 2024; 12:810. [PMID: 38667572 PMCID: PMC11050254 DOI: 10.3390/healthcare12080810] [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: 02/13/2024] [Revised: 03/22/2024] [Accepted: 04/06/2024] [Indexed: 04/28/2024] Open
Abstract
Nursing home (NH) residents commonly face limitations in basic activities of daily living (BADLs), following a hierarchical decline. Understanding this hierarchy is crucial for personalized care. This study explores factors associated with early, middle, and late loss in BADLs among NH residents. A multicenter cross-sectional study was conducted in 30 NHs in Catalonia, Spain. Dependent variables were related to limitations in BADLs: early loss (self-care-related BADLs: personal hygiene, dressing, or bathing), middle loss (mobility-related BADLs: walking or wheelchair handling, toileting, and transferring), and late loss (eating). Independent variables were based on a comprehensive geriatric assessment and institutional factors. Logistic regression was used for the multivariate analyses. The study included 671 older adults. Early loss in BADLs was significantly associated with urinary incontinence, cognitive impairment, and falls. Middle loss in BADLs was linked to fecal incontinence, urinary incontinence, ulcers, and cognitive impairment. Late loss in BADLs was associated with fecal incontinence, the NH not owning a kitchen, neurological disease, cognitive impairment, dysphagia, polypharmacy, and weight loss. These findings highlight the need to address geriatric syndromes, especially cognitive impairment and bladder/bowel incontinence. Monitoring these syndromes could effectively anticipate care dependency. The presence of kitchens in NHs may help to address limitations to eating, allowing for potential personalized meal adaptation.
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Affiliation(s)
- Pau Moreno-Martin
- Research Group on Methodology, Methods, Models and Outcomes of Health and Social Sciences (M3O), Faculty of Health Sciences and Welfare, Centre for Health and Social Care Research (CESS), University of Vic—Central University of Catalonia (UVic-UCC), 08500 Vic, Spain; (P.M.-M.); (A.C.-C.); (M.M.-A.); (J.J.-R.)
- Institute for Research and Innovation in Life and Health Sciences in Central Catalonia (IRIS-CC), 08500 Vic, Spain;
| | - Eduard Minobes-Molina
- Research Group on Methodology, Methods, Models and Outcomes of Health and Social Sciences (M3O), Faculty of Health Sciences and Welfare, Centre for Health and Social Care Research (CESS), University of Vic—Central University of Catalonia (UVic-UCC), 08500 Vic, Spain; (P.M.-M.); (A.C.-C.); (M.M.-A.); (J.J.-R.)
- Institute for Research and Innovation in Life and Health Sciences in Central Catalonia (IRIS-CC), 08500 Vic, Spain;
- Spanish Society of Geriatrics and Gerontology, C. Príncipe de Vergara, 57-59, 28006 Madrid, Spain
| | - Aina Carbó-Cardeña
- Research Group on Methodology, Methods, Models and Outcomes of Health and Social Sciences (M3O), Faculty of Health Sciences and Welfare, Centre for Health and Social Care Research (CESS), University of Vic—Central University of Catalonia (UVic-UCC), 08500 Vic, Spain; (P.M.-M.); (A.C.-C.); (M.M.-A.); (J.J.-R.)
- Institute for Research and Innovation in Life and Health Sciences in Central Catalonia (IRIS-CC), 08500 Vic, Spain;
| | - Montse Masó-Aguado
- Research Group on Methodology, Methods, Models and Outcomes of Health and Social Sciences (M3O), Faculty of Health Sciences and Welfare, Centre for Health and Social Care Research (CESS), University of Vic—Central University of Catalonia (UVic-UCC), 08500 Vic, Spain; (P.M.-M.); (A.C.-C.); (M.M.-A.); (J.J.-R.)
- Institute for Research and Innovation in Life and Health Sciences in Central Catalonia (IRIS-CC), 08500 Vic, Spain;
| | - Montserrat Solé-Casals
- Central Catalonia Chronicity Research Group (C3RG), Faculty of Health Sciences and Welfare, Centre for Health and Social Care Research (CESS), University of Vic—Central University of Catalonia (UVic-UCC), 08500 Vic, Spain; (M.S.-C.); (J.A.-N.); (X.G.-B.)
| | | | - Judit Bort-Roig
- Institute for Research and Innovation in Life and Health Sciences in Central Catalonia (IRIS-CC), 08500 Vic, Spain;
- Sport and Physical Activity Research Group, Faculty of Health Sciences and Welfare, University of Vic—Central University of Catalonia (UVic-UCC), 08500 Vic, Spain
| | - Jordi Amblàs-Novellas
- Central Catalonia Chronicity Research Group (C3RG), Faculty of Health Sciences and Welfare, Centre for Health and Social Care Research (CESS), University of Vic—Central University of Catalonia (UVic-UCC), 08500 Vic, Spain; (M.S.-C.); (J.A.-N.); (X.G.-B.)
- Faculty of Medicine and Chair in Palliative Care, University of Vic—Central University of Catalonia (UVic-UCC), 08500 Vic, Spain
| | - Xavier Gómez-Batiste
- Central Catalonia Chronicity Research Group (C3RG), Faculty of Health Sciences and Welfare, Centre for Health and Social Care Research (CESS), University of Vic—Central University of Catalonia (UVic-UCC), 08500 Vic, Spain; (M.S.-C.); (J.A.-N.); (X.G.-B.)
- Faculty of Medicine and Chair in Palliative Care, University of Vic—Central University of Catalonia (UVic-UCC), 08500 Vic, Spain
| | - Javier Jerez-Roig
- Research Group on Methodology, Methods, Models and Outcomes of Health and Social Sciences (M3O), Faculty of Health Sciences and Welfare, Centre for Health and Social Care Research (CESS), University of Vic—Central University of Catalonia (UVic-UCC), 08500 Vic, Spain; (P.M.-M.); (A.C.-C.); (M.M.-A.); (J.J.-R.)
- Institute for Research and Innovation in Life and Health Sciences in Central Catalonia (IRIS-CC), 08500 Vic, Spain;
- Institute of Sport Science and Innovations, Lithuanian Sports University, 44221 Kaunas, Lithuania
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Veronese N, Gallo U, Boccardi V, Demurtas J, Michielon A, Taci X, Zanchetta G, Campbell Davis SE, Chiumente M, Venturini F, Pilotto A. Efficacy of deprescribing on health outcomes: An umbrella review of systematic reviews with meta-analysis of randomized controlled trials. Ageing Res Rev 2024; 95:102237. [PMID: 38367812 DOI: 10.1016/j.arr.2024.102237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Revised: 02/06/2024] [Accepted: 02/14/2024] [Indexed: 02/19/2024]
Abstract
BACKGROUND Deprescribing is an important intervention across different settings in medicine, but the literature supporting such a practice is still conflicting. Therefore, we aimed to capture the breadth of outcomes reported and assess the strength of evidence of the use of deprescribing for health outcomes. METHODS Umbrella review of systematic reviews of the use of deprescribing searching in Medline, Scopus, and Web of Science until 01 November 2023. The grading of evidence was carried out using the GRADE for intervention studies, whilst data regarding systematic reviews were reported as narrative findings. RESULTS Among 456 papers, 12 systematic reviews (six with meta-analysis) for a total of 231 RCTs and 44,193 patients were included. In any setting, deprescribing was able to significantly reduce the number of total and of potentially inappropriate medications (PIMs) in older patients (low certainty of evidence) and to reduce the proportion of participants potentially having several or PIMs (moderate certainty of evidence). In community, supported by a high certainty of evidence, deprescribing was not more effective than standard care in decreasing injurious falls, any falls or number of fallers. In nursing home, deprescribing was associated with a significantly lower PIMs than standard care (very low certainty of evidence). In end-of-life situations, deprescribing significantly reduced mortality rate of approximately 41% (high certainty of evidence). CONCLUSIONS Deprescribing is a promising intervention across different settings and situations, but a notable gap in the literature concerning its effects on substantial outcomes still exists.
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Affiliation(s)
- Nicola Veronese
- Geriatrics Section, Department of Internal Medicine, University of Palermo, Palermo, Italy.
| | - Umberto Gallo
- Pharmaceutical Department, Local Health Unit n. 6 Euganea, Padua, Italy
| | - Virginia Boccardi
- Department of Medicine and Surgery, Institute of Gerontology and Geriatrics, University of Perugia, Perugia, Italy
| | - Jacopo Demurtas
- Family Medicine Department, USL Sud Est Toscana, Grosseto, Italy
| | - Alberto Michielon
- School of Specialization in Hospital Pharmacy, University of Siena, Siena, Italy
| | - Xhoajda Taci
- School of Specialization in Hospital Pharmacy, Università degli Studi di Padova, Padua, Italy
| | - Giulia Zanchetta
- School of Specialization in Hospital Pharmacy, Università degli Studi di Padova, Padua, Italy
| | | | - Marco Chiumente
- Scientific Direction, SIFaCT - Società Italiana di Farmacia Clinica e Terapia, Turin, Italy
| | | | - Alberto Pilotto
- Geriatrics Unit, Department Geriatric Care, Orthogeriatrics and Rehabilitation, E.O. Galliera Hospital, Genoa, Italy; Department of Interdisciplinary Medicine, University of Bari "Aldo Moro", Bari, Italy
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