1
|
Lee S, Frediani G, Lund BC, Kennelty K, Jeffery MM, Carnahan RM. A Nationwide Emergency Department Data Analysis to Predict Beers List Medications Use Among Older Adults. J Emerg Med 2024; 66:e704-e713. [PMID: 38734547 DOI: 10.1016/j.jemermed.2024.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Revised: 02/24/2024] [Accepted: 03/06/2024] [Indexed: 05/13/2024]
Abstract
BACKGROUND The use of potentially inappropriate medications (PIMs) is considered an important quality indicator for older adults seen in the ambulatory care setting. STUDY OBJECTIVES To evaluate the pattern of potentially inappropriate medication (PIMs) use as specified in the Beers Criteria, for older adults during emergency department (ED) visits in the United States. METHODS Using data from the National Hospital Ambulatory Care Survey (NHAMCS) we identified older adults (age 65 or older) discharged home from an ED visit in 2019. We defined PIMs as those with an 'avoid' recommendation under the American Geriatrics Society (AGS) 2019 Beers Criteria in older adults. Logistic regression models were used to assess demographic, clinical, and hospital factors associated with the use of any PIMs upon ED discharge. RESULTS Overall, 5.9% of visits by older adults discharged from the ED included administration or prescriptions for PIMs. Among those who received any PIMs, 25.5% received benzodiazepines, 42.5 % received anticholinergics, 1.4% received nonbenzodiazepine hypnotics, and 0.5% received barbiturates. A multivariable model showed statistically significant associations for age 65 to 74 (OR 1.91, 95% CI 1.39-2.62 vs. age >=75), dementia (OR 0.45, 95% CI 0.21-0.95), lower immediacy (OR 2.45, 95% CI 1.56-3.84 vs. higher immediacy), and Northeastern rural region (OR 0.34, 95% CI 0.21-0.55 vs. Midwestern rural). CONCLUSION We found that younger age and lower immediacy were associated with increased prescriptions of PIMs for older adults seen, while dementia and Northeastern rural region was associated with reduced use of PIMs seen and discharged from EDs in United States.
Collapse
Affiliation(s)
- Sangil Lee
- Department of Emergency Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa.
| | - Gabrielle Frediani
- Department of Emergency Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa
| | - Brian C Lund
- Center for Access & Delivery Research and Evaluation and Department of Pharmacy Practice, Iowa City Veterans Affairs Health Care System, Iowa City, Iowa
| | - Korey Kennelty
- Division of Health Service Research, College of Pharmacy, Department of Family Medicine, Carver College of Medicine, University of Iowa, Iowa City, Iowa
| | - Molly Moore Jeffery
- Associate Professor of Emergency Medicine, Division of Health Care Delivery Research and Department of Emergency Medicine, Mayo Clinic, Rochester, Minnesota
| | - Ryan M Carnahan
- Department of Epidemiology, The University of Iowa College of Public Health, Iowa City, Iowa
| |
Collapse
|
2
|
Wang J, James S, Hilmer SN, Aitken SJ, Soo G, Naganathan V, Kearney L, Thillainadesan J. Optimising Medications in Older Vascular Surgery Patients Through Geriatric Co-management. Drugs Aging 2023; 40:335-342. [PMID: 36862371 PMCID: PMC9979113 DOI: 10.1007/s40266-023-01015-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/07/2023] [Indexed: 03/03/2023]
Abstract
BACKGROUND Prescribing of potentially inappropriate medications and under-prescribing of guideline-recommended medications for cardiovascular risk modification have both been associated with negative outcomes in older adults. Hospitalisation represents an important opportunity to optimise medication use and may be achieved through geriatrician-led interventions. OBJECTIVE We aimed to evaluate whether implementation of a novel model of care called Geriatric Comanagement of older Vascular (GeriCO-V) surgery patients is associated with improvements in medication prescribing. METHODS We used a prospective pre-post study design. The intervention was a geriatric co-management model, where a geriatrician delivered comprehensive geriatric assessment-based interventions including a routine medication review. We included consecutively admitted patients to the vascular surgery unit at a tertiary academic centre aged ≥ 65 years with an expected length of stay of ≥ 2 days and who were discharged from hospital. Outcomes of interest were the prevalence of at least one potentially inappropriate medication as defined by the Beers Criteria at admission and discharge, and rates of cessation of at least one potentially inappropriate medication present on admission. In the subgroup of patients with peripheral arterial disease, the prevalence of guideline-recommended medications on discharge was determined. RESULTS There were 137 patients in the pre-intervention group (median [interquartile range] age: 80.0 [74.0-85.0] years, 83 [60.6%] with peripheral arterial disease) and 132 patients in the post-intervention group (median [interquartile range] age: 79.0 (73.0-84.0) years, 75 [56.8%] with peripheral arterial disease). There was no change in the prevalence of potentially inappropriate medication use from admission to discharge in either group (pre-intervention: 74.5% on admission vs 75.2% on discharge; post-intervention: 72.0% vs 72.7%, p = 0.65). Forty-five percent of pre-intervention group patients had at least one potentially inappropriate medication present on admission ceased, compared with 36% of post-intervention group patients (p = 0.11). A higher number of patients with peripheral arterial disease in the post-intervention group were discharged on antiplatelet agent therapy (63 [84.0%] vs 53 [63.9%], p = 0.004) and lipid-lowering therapy (58 [77.3%] vs 55 [66.3%], p = 0.12). CONCLUSIONS Geriatric co-management was associated with an improvement in guideline-recommended antiplatelet agent prescribing aimed at cardiovascular risk modification for older vascular surgery patients. The prevalence of potentially inappropriate medications was high in this population, and was not reduced with geriatric co-management.
Collapse
Affiliation(s)
- Jeff Wang
- grid.414685.a0000 0004 0392 3935Centre for Education and Research on Ageing, Concord Hospital, Concord, Sydney, NSW Australia
| | - Sophie James
- grid.414685.a0000 0004 0392 3935Centre for Education and Research on Ageing, Concord Hospital, Concord, Sydney, NSW Australia
| | - Sarah N. Hilmer
- grid.1013.30000 0004 1936 834XFaculty of Medicine and Health, The University of Sydney, Concord, Sydney, NSW Australia ,grid.412703.30000 0004 0587 9093Kolling Institute of Medical Research, Sydney Medical School, University of Sydney and Royal North Shore Hospital, St Leonards, Sydney, NSW Australia
| | - Sarah J. Aitken
- grid.1013.30000 0004 1936 834XFaculty of Medicine and Health, The University of Sydney, Concord, Sydney, NSW Australia ,grid.414685.a0000 0004 0392 3935Department of Vascular Surgery, Concord Hospital, Concord, Sydney, NSW Australia
| | - Garry Soo
- grid.414685.a0000 0004 0392 3935Department of Pharmacy, Concord Hospital, Concord, Sydney, NSW Australia
| | - Vasi Naganathan
- grid.414685.a0000 0004 0392 3935Centre for Education and Research on Ageing, Concord Hospital, Concord, Sydney, NSW Australia ,grid.1013.30000 0004 1936 834XFaculty of Medicine and Health, The University of Sydney, Concord, Sydney, NSW Australia ,grid.414685.a0000 0004 0392 3935Department of Geriatric Medicine, Concord Hospital, Hospital Road, Building 12, Concord, Sydney, NSW 2139 Australia
| | - Leanne Kearney
- grid.414685.a0000 0004 0392 3935Centre for Education and Research on Ageing, Concord Hospital, Concord, Sydney, NSW Australia
| | - Janani Thillainadesan
- Centre for Education and Research on Ageing, Concord Hospital, Concord, Sydney, NSW, Australia. .,Faculty of Medicine and Health, The University of Sydney, Concord, Sydney, NSW, Australia. .,Department of Geriatric Medicine, Concord Hospital, Hospital Road, Building 12, Concord, Sydney, NSW, 2139, Australia.
| |
Collapse
|
3
|
Miller MG, Kneuss TG, Patel JN, Parala-Metz AG, Haggstrom DE. Identifying potentially inappropriate medication (PIM) use in geriatric oncology. J Geriatr Oncol 2020; 12:34-40. [PMID: 32571665 DOI: 10.1016/j.jgo.2020.06.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Revised: 06/05/2020] [Accepted: 06/06/2020] [Indexed: 10/24/2022]
Abstract
The median number of medications taken by adults aged 65 and older is four, but may be higher in older adults with cancer. A high number of prescribed medications increases risk for adverse drug reactions (ADRs), drug-drug interactions, drug-disease interactions, and overall healthcare utilization, emphasizing the need for frequent review of medications. There are many tools available to help the health care team assess medication appropriateness; however, none of the currently available tools have been validated in the geriatric oncology population. Older adults with cancer are at increased risk for ADRs and potentially inappropriate medications (PIMs) given the common need for multiple medications to manage cancer and cancer-related symptoms. Frequently used PIM identification tools, such as the American Geriatrics Society's (AGS) Beers criteria, often identify medications as "potentially inappropriate", although many of these medications are considered necessary to provide adequate supportive care in older patients with cancer. There are currently no specific guidelines to help direct application of available tools. This review summarizes literature available on the use of PIM identification tools in geriatric oncology and highlights a theoretical case and proposed medication management strategy, which combines the use of objective review with Beer's criteria and clinical judgement with the Medication Appropriateness Index (MAI). This two-pronged approach can serve to identify PIMs while recognizing factors unique to the geriatric oncology population.
Collapse
Affiliation(s)
- Mary Gwen Miller
- Levine Cancer Institute, Atrium Health, 1021 Morehead Medical Dr, Charlotte, NC 28204, USA.
| | - Tiffany G Kneuss
- Levine Cancer Institute, Atrium Health, 1021 Morehead Medical Dr, Charlotte, NC 28204, USA.
| | - Jai N Patel
- Levine Cancer Institute, Atrium Health, 1021 Morehead Medical Dr, Charlotte, NC 28204, USA.
| | - Armida G Parala-Metz
- Levine Cancer Institute, Atrium Health, 1021 Morehead Medical Dr, Charlotte, NC 28204, USA.
| | - Daniel E Haggstrom
- Levine Cancer Institute, Atrium Health, 1021 Morehead Medical Dr, Charlotte, NC 28204, USA.
| |
Collapse
|