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Özaydın FN. Frequency of Single or Combined Anticholinergic Medication Usage as Potentially Inappropriate Medications among the Oldest-Old Age Subgroup. PSYCHIAT CLIN PSYCH 2024; 34:43-49. [PMID: 38883881 PMCID: PMC11177634 DOI: 10.5152/pcp.2024.23664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Accepted: 01/01/2024] [Indexed: 06/18/2024] Open
Abstract
Background The use of medications with anticholinergic effects can have negative effects on older patients, such as cognitive dysfunction and falls. The aim of this study was to determine the frequency of use of anticholinergic medication among the oldest-old age group and to analyze the factors associated with its use. Methods This is a descriptive study. The data were collected by visiting the oldest-olds at their homes, where the oldest-olds lived alone or with his or her family. The sample size was calculated as 354 using EpiInfo. The generic name of the medication used, the age, sex, and city of residence of the patient were recorded. The medications were analyzed using guidelines showing the anticholinergic effect, classified as 1 (low), 2 (moderate), and ≥3 (strong), and the frequency of usage by the oldest-olds was determined. Results A total of 549 oldest-olds participated in the research. Of the oldest-olds, 57.92% (n = 318) were using one or more anticholinergic medications. The median number of anticholinergic medications used by the oldest-olds was 1 (range: 0.00-6.00). Medications with strong anticholinergic effects (≥3) were used by 14.94% (n = 82) of the oldest-olds. The most commonly used were medications with low anticholinergic effects. However, the concomitant use of anticholinergic medications increased the total anticholinergic effect. Conclusion The oldest-old age group used medications with anticholinergic effects. A strong anticholinergic effect was obtained when medications with low or moderate anticholinergic effects were combined. Medications with anticholinergic effects should also be reviewed in the safety analysis of medications used by the oldest-old.
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Affiliation(s)
- Fuat Nihat Özaydın
- Department of Pharmacology, Istanbul Atlas University, School of Medicine, Istanbul, Turkey
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Zhang YX, Zhang Y, Bian Y, Liu YJ, Ren A, Zhou Y, Shi D, Feng XS. Benzodiazepines in complex biological matrices: Recent updates on pretreatment and detection methods. J Pharm Anal 2023; 13:442-462. [PMID: 37305786 PMCID: PMC10257149 DOI: 10.1016/j.jpha.2023.03.007] [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: 12/25/2022] [Revised: 03/10/2023] [Accepted: 03/25/2023] [Indexed: 04/04/2023] Open
Abstract
Benzodiazepines (BDZs) are used in clinics for anxiolysis, anticonvulsants, sedative hypnosis, and muscle relaxation. They have high consumptions worldwide because of their easy availability and potential addiction. They are often used for suicide or criminal practices such as abduction and drug-facilitated sexual assault. The pharmacological effects of using small doses of BDZs and their detections from complex biological matrices are challenging. Efficient pretreatment methods followed by accurate and sensitive detections are necessary. Herein, pretreatment methods for the extraction, enrichment, and preconcentration of BDZs as well as the strategies for their screening, identification, and quantitation developed in the past five years have been reviewed. Moreover, recent advances in various methods are summarized. Characteristics and advantages of each method are encompassed. Future directions of the pretreatment and detection methods for BDZs are also reviewed.
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Affiliation(s)
- Yi-Xin Zhang
- School of Pharmacy, China Medical University, Shenyang, 110122, China
| | - Yuan Zhang
- School of Pharmacy, China Medical University, Shenyang, 110122, China
| | - Yu Bian
- School of Pharmacy, China Medical University, Shenyang, 110122, China
| | - Ya-Jie Liu
- School of Pharmacy, China Medical University, Shenyang, 110122, China
| | - Ai Ren
- School of Pharmacy, China Medical University, Shenyang, 110122, China
| | - Yu Zhou
- Department of Pharmacy, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Du Shi
- Department of Urology, The First Hospital of China Medical University, Shenyang, 110001, China
| | - Xue-Song Feng
- School of Pharmacy, China Medical University, Shenyang, 110122, China
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Çolak ST, Vızdıklar C, Kaşkal M, Aydın V, Ataç Ö, Akıcı A. Comparison of primary care prescriptions for old and very old hypertensive patients. Turk J Med Sci 2023; 53:572-585. [PMID: 37476867 PMCID: PMC10388073 DOI: 10.55730/1300-0144.5618] [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: 09/03/2022] [Accepted: 02/02/2023] [Indexed: 07/22/2023] Open
Abstract
BACKGROUND Elderly and very elderly individuals might be subject to different approaches for the treatment of hypertension. We aimed to compare drug utilization in hypertensive old patients and very old patients in primary care, along with the evaluation of potentially inappropriate drug prescribing. METHODS In this cross-sectional study, we compared prescriptions of 65-79-year-old (old patient prescriptions [OPP], n = 433,988) vs. ≥80-year-old (very old patient prescriptions [VOPP], n = 134,079) with "essential hypertension" diagnosis, issued by 3:1 systematically-sampled primary care physicians (n = 1431) in İstanbul throughout 2016. Drug utilization patterns and distribution of antihypertensives based on drug class and combination status were evaluated. Frequency of potentially inappropriate drugs per Beers Criteria were identified and compared. RESULTS Antihypertensive monotherapy practice was less common in OPP than VOPP (43.3% vs. 45.3%; p < 0.001). In both groups,the most commonly prescribed drugs were beta-blockers for monotherapy (37.4% vs. 33.1%, p < 0.001) and thiazide diuretics for combined therapy (69.8% vs. 67.4%, p < 0.001). Metoprolol was the most commonly prescribed antihypertensive both in OPP and VOPP (15.3% vs. 14.8%). Furosemide was ranked 10th in OPP and 3rd in VOPP (2.7% vs. 5.5%). Cardiovascular system drugs were the most commonly encountered potentially inappropriate medications in both groups (263.9 vs. 283.4 per 10,000 prescriptions, p = 0.004). Regarding antihypertensive drugs, 2.2% of those in OPP and 2.4% of those in VOPP were identified as potentially inappropriate (p = 0.002). DISCUSSION Prescribing preferences to old and very old patients mostly showed slight differences. Almost half of prescriptions comprising antihypertensive monotherapy might imply hesitancy to prescribe combinations. Overuse of risky drugs such as furosemide in both groups, especially in the very elderly, requires more attention.
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Affiliation(s)
- Selcan Tülü Çolak
- Department of Medical Pharmacology, School of Medicine, Marmara University, İstanbul, Turkey
| | - Caner Vızdıklar
- Department of Medical Pharmacology, School of Medicine, Marmara University, İstanbul, Turkey
| | - Mert Kaşkal
- Department of Medical Pharmacology, School of Medicine, Marmara University, İstanbul, Turkey
| | - Volkan Aydın
- Department of Medical Pharmacology, International School of Medicine, İstanbul Medipol University, İstanbul, Turkey ; Marmara University Hypertension and Atherosclerosis Research Center (HİPAM), İstanbul, Turkey
| | - Ömer Ataç
- Department of Public Health, International School of Medicine, İstanbul Medipol University, İstanbul, Turkey ; Department of Health Management and Policy, College of Public Health, University of Kentucky, Lexington, United States
| | - Ahmet Akıcı
- Department of Medical Pharmacology, School of Medicine, Marmara University, İstanbul, Turkey ; Marmara University Hypertension and Atherosclerosis Research Center (HİPAM), İstanbul, Turkey
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Albarqouni L, Palagama S, Chai J, Sivananthajothy P, Pathirana T, Bakhit M, Arab-Zozani M, Ranakusuma R, Cardona M, Scott A, Clark J, Smith CF, Effa E, Ochodo E, Moynihan R. Overuse of medications in low- and middle-income countries: a scoping review. Bull World Health Organ 2023; 101:36-61D. [PMID: 36593777 PMCID: PMC9795388 DOI: 10.2471/blt.22.288293] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 08/09/2022] [Accepted: 08/10/2022] [Indexed: 01/04/2023] Open
Abstract
Objective To identify and summarize the evidence about the extent of overuse of medications in low- and middle-income countries, its drivers, consequences and potential solutions. Methods We conducted a scoping review by searching the databases PubMed®, Embase®, APA PsycINFO® and Global Index Medicus using a combination of MeSH terms and free text words around overuse of medications and overtreatment. We included studies in any language published before 25 October 2021 that reported on the extent of overuse, its drivers, consequences and solutions. Findings We screened 3489 unique records and included 367 studies reporting on over 5.1 million prescriptions across 80 low- and middle-income countries - with studies from 58.6% (17/29) of all low-, 62.0% (31/50) of all lower-middle- and 60.0% (33/55) of all upper-middle-income countries. Of the included studies, 307 (83.7%) reported on the extent of overuse of medications, with estimates ranging from 7.3% to 98.2% (interquartile range: 30.2-64.5). Commonly overused classes included antimicrobials, psychotropic drugs, proton pump inhibitors and antihypertensive drugs. Drivers included limited knowledge of harms of overuse, polypharmacy, poor regulation and financial influences. Consequences were patient harm and cost. Only 11.4% (42/367) of studies evaluated solutions, which included regulatory reforms, educational, deprescribing and audit-feedback initiatives. Conclusion Growing evidence suggests overuse of medications is widespread within low- and middle-income countries, across multiple drug classes, with few data of solutions from randomized trials. Opportunities exist to build collaborations to rigorously develop and evaluate potential solutions to reduce overuse of medications.
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Affiliation(s)
- Loai Albarqouni
- Institute for Evidence-Based Healthcare, Faculty of Health Sciences and Medicine, Bond University, 14 University Dr, Robina, QLD, 4229, Australia
| | - Sujeewa Palagama
- Institute for Evidence-Based Healthcare, Faculty of Health Sciences and Medicine, Bond University, 14 University Dr, Robina, QLD, 4229, Australia
| | - Julia Chai
- Cumming School of Medicine, University of Calgary, Alberta, Canada
| | | | - Thanya Pathirana
- School of Medicine and Dentistry, Griffith University, Sunshine Coast, Australia
| | - Mina Bakhit
- Institute for Evidence-Based Healthcare, Faculty of Health Sciences and Medicine, Bond University, 14 University Dr, Robina, QLD, 4229, Australia
| | - Morteza Arab-Zozani
- Social Determinants of Health Research Center, Birjand University of Medical Sciences, Birjand, Iran
| | - Respati Ranakusuma
- Clinical Epidemiology and Evidence-Based Medicine Unit, Dr Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Magnolia Cardona
- Institute for Evidence-Based Healthcare, Faculty of Health Sciences and Medicine, Bond University, 14 University Dr, Robina, QLD, 4229, Australia
| | - Anna Scott
- Institute for Evidence-Based Healthcare, Faculty of Health Sciences and Medicine, Bond University, 14 University Dr, Robina, QLD, 4229, Australia
| | - Justin Clark
- Institute for Evidence-Based Healthcare, Faculty of Health Sciences and Medicine, Bond University, 14 University Dr, Robina, QLD, 4229, Australia
| | | | - Emmanuel Effa
- Department of Internal Medicine, University of Calabar, Calabar, Nigeria
| | - Eleanor Ochodo
- Centre for Global Health Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Ray Moynihan
- Institute for Evidence-Based Healthcare, Faculty of Health Sciences and Medicine, Bond University, 14 University Dr, Robina, QLD, 4229, Australia
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Yuan J, Yin G, Gu M, Lu KZ, Jiang B, Li M. Physicians’ Knowledge, Altitudes, and Perceived Barriers of Inappropriate Prescribing for Older Patients in Shanghai, China. Front Pharmacol 2022; 13:821847. [PMID: 36071836 PMCID: PMC9441490 DOI: 10.3389/fphar.2022.821847] [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: 11/24/2021] [Accepted: 05/16/2022] [Indexed: 11/24/2022] Open
Abstract
Background: Inappropriate medication use is common around the world, particularly among older patients, and, despite potentially being preventable, often leads to adverse clinical and economic outcomes. However, there is a dearth of information regarding this prominent issue in China. Objectives: To evaluate the extent to which the physician can correctly identify potentially inappropriate medication (PIM) in older patients and to understand physicians’ attitudes towards improving PIM knowledge. Methods: An online, cross-sectional survey was conducted anonymously among practicing physicians in China from November through December 2020. Knowledge of PIM was accessed using seven clinical vignettes covering a wide variety of therapeutic areas. Source of information and perceived barriers regarding PIM were also evaluated. We performed the ordinary least square regression analysis to understand the potential factors related to physicians’ knowledge of PIM. Results: A total of 597 study participants were included in the analysis. More than half of them had never heard of any screening tool for PIMs (n = 328, 54.9%) and the most frequently acknowledged tool was the China PIM Criteria (n = 259, 43.4%). For the seven clinical vignettes testing physicians’ knowledge on the medications that should be generally avoided in older patients, the mean score was 2.91 points out of 7 (SD: 1.32), with the median score of three points (IQR: 2–4). Only one-third of the respondents were feeling confident when prescribing for older patients (n = 255, 35.08%). Package inserts have been used as the major source of PIM information (always, n = 177, 29.65%; frequently, n = 286, 47.91%). Perceived barriers to appropriate prescribing include polypharmacy (n = 460, 77.05%), lack of formal education on prescribing for the older patients (n = 428, 71.69%). Conclusion: In this online survey evaluating physicians’ ability to detect PIM for older patients, approximately 40% of PIM were recognized, suggesting an insufficient level of knowledge about appropriate prescribing.
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Affiliation(s)
- Jing Yuan
- Minhang Hospital and Department of Clinical Pharmacy at School of Pharmacy, Fudan University, Shanghai, China
| | - Guizhi Yin
- Department of Cardiology, Minhang Hospital, Fudan University, Shanghai, China
| | - Meng Gu
- Minhang Hospital and Department of Clinical Pharmacy at School of Pharmacy, Fudan University, Shanghai, China
| | - Kevin Z. Lu
- University of South Carolina College of Pharmacy, Columbia, SC, United States
- *Correspondence: Kevin Z. Lu, ; Bin Jiang, ; Minghui Li,
| | - Bin Jiang
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University, Beijing, China
- *Correspondence: Kevin Z. Lu, ; Bin Jiang, ; Minghui Li,
| | - Minghui Li
- Department of Clinical Pharmacy and Translational Science, University of Tennessee Health Science Center, Memphis, TN, United States
- *Correspondence: Kevin Z. Lu, ; Bin Jiang, ; Minghui Li,
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Meng Z, Cheng L, Hu X, Chen Q. Risk factors for in-hospital death in elderly patients over 65 years of age with dementia: A retrospective cross-sectional study. Medicine (Baltimore) 2022; 101:e29737. [PMID: 35777004 PMCID: PMC9239669 DOI: 10.1097/md.0000000000029737] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
As the population continues to age, dementia is becoming a huge social, economic, and healthcare burden. However, the risk factors for in-hospital death in elderly patients over 65 years of age with dementia are not well understood. Identifying factors that affect their prognosis could help clinicians with scientific decision-making. To examine the risk factors for in-hospital death in elderly patients over 65 years of age with dementia in the Geriatric Department of West China Hospital. In this retrospective, cross-sectional study, we analyzed inpatients aged ≥65 years with dementia between 2010 and 2016 using electronic medical records from the Information Center of West China Hospital. The risk factors for death were assessed using multivariable logistic regression. Out of a total of 2986 inpatients with dementia, 3.4% died. Patient deaths were related to digestive diseases, respiratory diseases, circulatory diseases, urinary diseases, and chronic obstructive pulmonary disease, whereas patient survival was associated with osteoporosis and Parkinson disease. Patients with a mean length of hospital stay of ≥60 days had an increased risk of death (all P <.05). In the multiple logistic regression analysis, age ≥80 years, digestive diseases, respiratory diseases, urinary diseases, diabetes, chronic obstructive pulmonary disease, and ≥7 comorbidities were risk factors for death. Mortality in hospitalized older patients with dementia is low, but some risk factors may be easily ignored. These findings could raise awareness among clinicians and caregivers about risk factors in hospitalized older patients, particularly hospitalized elderly patients with multiple comorbidities. Therefore, to reduce mortality, early prevention and management of potential risks are necessary.
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Affiliation(s)
- Zhangmin Meng
- Department of Geriatrics, West China Hospital, West China School of Nursing, Sichuan University, Chengdu, Sichuan, China
| | - Linan Cheng
- West China School of Nursing, Sichuan University/Innovation Center of Nursing Research, Nursing Key Laboratory of Sichuan Province, West China Hospital, Sichuan University, China
| | - Xiuying Hu
- Innovation Center of Nursing Research, Nursing Key Laboratory of Sichuan Province, West China Hospital, Sichuan University, Chengdu, China
| | - Qian Chen
- Department of Geriatrics, West China Hospital, West China School of Nursing, Sichuan University, Chengdu, Sichuan, China
- *Correspondence: Qian Chen, Department of Geriatrics, West China Hospital/West China School of Nursing, Sichuan University, No. 37, Guoxue Alley, Chengdu, Sichuan 610041, China (e-mail: )
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Zhao M, Chen Z, Tian F, Xu T. Potentially Inappropriate Medication Among People With Dementia in China: A Nationwide Cross-Sectional Study. Front Pharmacol 2022; 13:929584. [PMID: 35770092 PMCID: PMC9234126 DOI: 10.3389/fphar.2022.929584] [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: 04/27/2022] [Accepted: 05/24/2022] [Indexed: 11/13/2022] Open
Abstract
Objectives: The purpose of this study was to explore the prevalence of potentially inappropriate medication (PIM) among older outpatients (age ≥ 65 years old) with dementia in eight cities in China using the AGS Beers criteria of 2019 and to identify the potential factor increasing the number of PIMs.Methods: A cross-sectional study about PIM in older outpatients with dementia from January 2020 to December 2020 was carried out in eight cities in China, Chengdu, Beijing, Guangzhou, Shanghai, Shenyang, Tianjin, Zhengzhou, and Hangzhou, distributing five major geographical regions in China (east, west, north, south, central). The diagnosis of dementia was based on the International Classification of Diseases (ICD-10) to identify. Based on the 2019 AGS Beers criteria, the PIM prescriptions were evaluated. The identification of potential factors was completed using a binary logistic regression model.Results: Of 18,624 older outpatients with dementia, 3.52% were detected with 1 PIM, and 35.91% received at least two PIMs. The antipsychotic drugs quetiapine and olanzapine were most frequently prescribed in patients with PIM, accounting for 8.01 and 7.36%, respectively. Logistic regression analyses showed that female patients with dementia aged >80 years who took more medications were exposed easily to PIM use.Conclusion: PIM use among older outpatients with dementia in China is highly prevalent, and the associated risk factors were increasing age, female sex, and number of medications. The most frequently prescribed drugs by clinicians were anpsychotropic drugs, which were much more frequent than other drugs.
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Affiliation(s)
- Mengnan Zhao
- Department of Pharmacy, West China Hospital, Sichuan University, Chengdu, China
- West China School of Medicine, Sichuan University, Chengdu, China
| | - Zhaoyan Chen
- Department of Pharmacy, West China Hospital, Sichuan University, Chengdu, China
| | - Fangyuan Tian
- Department of Pharmacy, West China Hospital, Sichuan University, Chengdu, China
| | - Ting Xu
- Department of Pharmacy, West China Hospital, Sichuan University, Chengdu, China
- West China School of Medicine, Sichuan University, Chengdu, China
- *Correspondence: Ting Xu,
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Tao L, Qu X, Gao H, Zhai J, Zhang Y, Song Y. Polypharmacy and potentially inappropriate medications among elderly patients in the geriatric department at a single-center in China: A retrospective cross-sectional study. Medicine (Baltimore) 2021; 100:e27494. [PMID: 34678882 PMCID: PMC8542109 DOI: 10.1097/md.0000000000027494] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 10/15/2020] [Accepted: 09/22/2021] [Indexed: 01/05/2023] Open
Abstract
ABSTRACT The aging of the population has become a worldwide concern, especially in China. Polypharmacy and potentially inappropriate medications (PIMs) are prominent issues in elderly patients. Therefore, the aim of this study was to investigate the prevalence of polypharmacy and PIMs in older inpatients and further to explore the factors associated with PIM use.A retrospective, single-center, cross-sectional study was conducted. A total of 1200 inpatients aged 65 years or older admitted from January 2015 to December 2015 were included. The prevalence of polypharmacy (5-9 medications) and hyperpolypharmacy (10 or more medications) was calculated. The 2019 American Geriatric Society Beers criteria were applied to assess PIMs use. Multivariate logistic regression was used to determine the independent factors of PIM use, while zero-inflated negative binomial regression was performed to evaluate the relationship between polypharmacy and PIM use.The median age of the study population was 76 years (interquartile range = 71-81). The median number of medications was 9 (interquartile range = 7-12). 91.58% of the patients took 5 or more medications simultaneously, and 30.08% of the patients were subjected to one or more PIMs. Spironolactone, furosemide, and zopiclone were the top 3 most frequently encountered PIMs. Hyperpolypharmacy and older age were identified as independent factors associated with PIM use. The risk of PIMs rises with the number of medications prescribed.Polypharmacy and PIM use were common in our study, and the risk of PIM use correlated with an increase in the number of medications already prescribed.
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Hammouda N, Vargas-Torres C, Doucette J, Hwang U. Geriatric emergency department revisits after discharge with Potentially Inappropriate Medications: A retrospective cohort study. Am J Emerg Med 2021; 44:148-156. [PMID: 33621716 DOI: 10.1016/j.ajem.2021.02.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2020] [Revised: 01/28/2021] [Accepted: 02/01/2021] [Indexed: 01/05/2023] Open
Abstract
OBJECTIVE To determine whether Potentially Inappropriate Medications (PIMs) prescribed in an academic emergency department (ED) are associated with increased ED revisits in older adults. METHODS A retrospective chart review of Medicare beneficiaries 65 years and older, discharged from an academic ED (January 2012 - November 2015) with any PIMs versus no PIMs. PIMs were defined using Category 1 of the 2015 Updated Beers criteria. Primary outcomes, obtained from a Medicare database linked to hospital ED subjects, were ED revisits 3 and 30 days from index ED discharge. Adjusted multiple logistic regression was used with entropy balance weighted covariates: Age in years, Gender, Race, Number of discharge medications, Charlson Comorbidity Index (CCI) score, Emergency Severity Index scores (ESI), Chief Complaint, Medicaid status, and prior 90 Day ED visits. RESULTS Over the study period, there were a total of 7,591 Medicare beneficiaries 65+ discharged from the ED with a prescription; 1,383 (18%) received one or more PIMs. ED revisits in 30 days were fewer for the PIMs cohort (12% PIMs vs 16% no PIMs, OR 0.79, 95% CI 0.65 - 0.95, P value <0.005). Hospital admissions in 30 days were fewer for the PIMs cohort (4 PIMs vs 7% no PIMs, OR 0.75, 95% CI 0.56 - 1.00, P value <0.005). In addition to PIMs, covariate risk factors associated with ED revisits in 30 days included comorbidity severity, history of prior ED revisits, chief complaint, and Medicaid status. Risk factors associated with hospitalization in 30 days included those plus age and emergency severity index, but not race nor ethnicity. CONCLUSIONS Patients discharged from the ED receiving potentially inappropriate medications as defined by Category 1 of the 2015 updated Beers criteria had lower odds of revisiting the ED within 30 days of index visit. Sociodemographic factors such as gender and race did not predict ED revisits or hospital admissions. Clinical characteristics predicted ED revisits and hospital admissions, the strongest risk being increasing Charlson Comorbidity Index score followed by triage acuity and chief complaint. Future studies are needed to delineate the implications of our findings.
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Affiliation(s)
- Nada Hammouda
- Department of Emergency Medicine, Mount Sinai School of Medicine, New York City, USA.
| | - Carmen Vargas-Torres
- Department of Emergency Medicine, Mount Sinai School of Medicine, New York City, USA
| | - John Doucette
- Department of Environmental Medicine and Public Health, Mount Sinai School of Medicine, New York City, USA
| | - Ula Hwang
- Department of Emergency Medicine, Yale School of Medicine, New Haven, CT, USA; Geriatric Research, Education and Clinical Center, James J. Peters VAMC, Bronx, NY, USA
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Delaš Aždajić M, Likić R, Gućanac M, Franceschi N, Tolušić Levak M, Štajduhar A, Šitum M, Štimac Grbić D. Prescription pattern and prevalence of benzodiazepine use among elderly patients. Asian J Psychiatr 2021; 55:102514. [PMID: 33360703 DOI: 10.1016/j.ajp.2020.102514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 10/22/2020] [Accepted: 12/08/2020] [Indexed: 10/22/2022]
Affiliation(s)
- Marija Delaš Aždajić
- Sestre milosrdnice University Hospital Center, Vinogradska cesta 29, Zagreb, Croatia.
| | - Robert Likić
- School of Medicine, University of Zagreb, Šalata 3, Zagreb, Croatia; University Hospital Centre Zagreb, Kišpatićeva 12, Zagreb, Croatia
| | | | - Nika Franceschi
- Sestre milosrdnice University Hospital Center, Vinogradska cesta 29, Zagreb, Croatia
| | - Maja Tolušić Levak
- Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Josipa Huttlera 4, Osijek, Croatia
| | | | - Mirna Šitum
- Sestre milosrdnice University Hospital Center, Vinogradska cesta 29, Zagreb, Croatia; School of Dental Medicine, University of Zagreb, Ivana Gundulića 5, Zagreb, Croatia
| | - Danijela Štimac Grbić
- School of Medicine, University of Zagreb, Šalata 3, Zagreb, Croatia; Croatian Institute of Public Health, Rockefellerova ulica 12, Zagreb, Croatia
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Potentially inappropriate medication in acute hospitalized elderly patients with polypharmacy: an observational study comparing PRISCUS, STOPP, and Beers criteria. Eur J Clin Pharmacol 2020; 77:757-766. [PMID: 33205281 DOI: 10.1007/s00228-020-03022-8] [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: 05/29/2020] [Accepted: 10/14/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE To compare the prevalence of potentially inappropriate medication (PIM) in the elderly according to the PRISCUS list, STOPP criteria, and Beers criteria. Secondary, to describe the differences using the three criteria focused on the inappropriate prescription of psychotropic drugs in the elderly. METHODS A retrospective study was performed at Severo Ochoa University Hospital. The study included 365 patients, aged 80 years and older, living in Madrid, Spain. RESULTS 93.42% of patients received at least one PIM during hospitalization. Using the PRISCUS list, this changed from 32.6 to 2.7% at discharge. Applying STOPP criteria lowered the percentage from 65.20 to 10.95%, and with Beers criteria from 80.27 to 10.13. Lower Barthel index at admission was associated with an increased relative risk for receiving at least one PIM (OR 1.79, 95% CI 1.15-2.80, p = 0.024) using PRISCUS list as a tool in conjunction with STOPP criteria (OR 1.44, 95% CI 0.89-2.33, p = 0.037). Polypharmacy at admission predicted the presence of PIMs with STOPP criteria (OR 1.74, 95% CI 1.07-2.84, p = 0.001). Regarding psychotropic medicines, 208 patients (56.98%) received at least one psychotropic medicine during hospitalization. A total of 26.30% of patients were treated with psychotropic medicines, detected by the PRISCUS list, and 53.97% and 29.85% with STOPP and Beers, respectively. CONCLUSIONS Explicit criteria are a useful tool for identifying during hospitalization of the elderly patients. As indicated by the results, new research is needed to carry out an adaptation in our country that includes an evaluation of the strengths of the three tools to decrease PIMs and improve prescription in the elderly.
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Age-specific differences in non-cardiac comorbidities among elderly patients hospitalized with heart failure: a special focus on young-old, old-old, and oldest-old. Chin Med J (Engl) 2020; 132:2905-2913. [PMID: 31809320 PMCID: PMC6964950 DOI: 10.1097/cm9.0000000000000560] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Supplemental Digital Content is available in the text Background Despite the growing epidemic of heart failure (HF), there is limited data available to systematically compare non-cardiac comorbidities in the young-old, old-old, and oldest-old patients hospitalized for HF. The precise differences will add valuable information for better management of HF in elderly patients. Methods A total of 1053 patients aged 65 years or older hospitalized with HF were included in this study. Patients were compared among three age groups: (1) young-old: 65 to 74 years, (2) old-old: 75 to 84 years, and (3) oldest-old: ≥85 years. Clinical details of presentation, comorbidities, and prescribed medications were recorded. Results The mean age was 76.7 years and 12.7% were 85 years or older. Most elderly patients with HF (97.5%) had at least one of the non-cardiac comorbidities. The patterns of common non-cardiac comorbidities were different between the young-old and oldest-old group. The three most common non-cardiac comorbidities were anemia (53.6%), hyperlipidemia (45.9%), and diabetes (42.4%) in the young-old group, while anemia (73.1%), infection (58.2%), and chronic kidney disease (44.0%) in the oldest-old group. Polypharmacy was observed in 93.0% elderly patients with HF. Additionally, 29.2% patients were diagnosed with infection, and 67.0% patients were prescribed antibiotics. However, 60.4% patients were diagnosed with anemia with only 8.9% of them receiving iron repletion. Conclusions Non-cardiac comorbidities are nearly universal in three groups but obviously differ by age, and inappropriate medications are very common in elderly patients with HF. Further treatment strategies should be focused on providing optimal medications for age-specific non-cardiac conditions.
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Fu M, Wushouer H, Nie X, Shi L, Guan X, Ross-Degnan D. Potentially inappropriate medications among elderly patients in community healthcare institutions in Beijing, China. Pharmacoepidemiol Drug Saf 2020; 29:923-930. [PMID: 32515047 DOI: 10.1002/pds.5064] [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: 04/14/2020] [Revised: 05/09/2020] [Accepted: 05/12/2020] [Indexed: 11/06/2022]
Abstract
PURPOSE To evaluate potentially inappropriate medications (PIMs) prevalence and predictors in community healthcare institutions (CHIs) for the elderly. METHODS We conducted a retrospective observational study, deriving data of patients aged ≥60 from 66 CHIs in Beijing, 2014-2018. The system of Criteria of PIM for Older Adults in China was applied to identify PIMs. The primary outcome was the prevalence of visits with at least one PIM; secondary outcomes were the frequency and rate per thousand visits of specific PIMs. We used descriptive analysis and generalized linear models to analyzed PIMs and the predictors, and marginal effects methods were applied to estimate the mean adjusted PIMs prevalence. RESULTS Overall, 4 528 884 elderly patient visits from 2014 to 2018 were eligible for inclusion. A total of 719 757 PIMs were detected, with 14.1% of the visits contained at least one PIM. PIM prevalence was significantly correlated with age, number of prescribed medications and number of diagnoses. Overall, 6.0 per thousand elderly patients in CHIs were exposed to at least one high-risk PIM, while 117.5 per thousand were exposed to at least one low-risk PIM. In 2018, 20% of GPs were responsible for more than half of overall PIM visits. CONCLUSION Prescribing of PIMs for older adults is common in CHIs in China, especially for patients who are aged, having multiple medications and diagnostic diseases. Strategies should be developed to enhance prescribing quality for geriatric patients, with special targeting of doctors responsible for a high number of PIMs.
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Affiliation(s)
- Mengyuan Fu
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University, Beijing, China.,Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA
| | - Haishaerjiang Wushouer
- International Research Center for Medicinal Administration, Peking University, Beijing, China.,Center for Strategic Studies, Chinese Academy of Engineering, Beijing, China
| | - Xiaoyan Nie
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University, Beijing, China.,Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA.,International Research Center for Medicinal Administration, Peking University, Beijing, China
| | - Luwen Shi
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University, Beijing, China.,International Research Center for Medicinal Administration, Peking University, Beijing, China
| | - Xiaodong Guan
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University, Beijing, China.,International Research Center for Medicinal Administration, Peking University, Beijing, China
| | - Dennis Ross-Degnan
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA
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Kimura T, Kato D, Nishimura T, Van Schyndle J, Uno S, Yoshida M. The Effect of Patient Age on Anticholinergic Use in the Elderly Japanese Population —Differences between Four Anticholinergic Scales. YAKUGAKU ZASSHI 2020; 140:701-710. [DOI: 10.1248/yakushi.19-00229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- Tomomi Kimura
- Advanced Informatics and Analytics, Astellas Pharma Inc
| | | | | | | | | | - Masaki Yoshida
- Department of Urology, National Center for Geriatrics and Gerontology
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Potentially inappropriate medications in older patients based on Beers criteria: a cross-sectional study of a family medicine practice in Saudi Arabia. BJGP Open 2020; 4:bjgpopen20X101009. [PMID: 32019777 PMCID: PMC7330182 DOI: 10.3399/bjgpopen20x101009] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Accepted: 10/03/2019] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND The use of potentially inappropriate medications (PIMs) is an important issue in older patients who are at risk of adverse drug events. AIM To determine the prevalence of PIM use, according to Beers criteria, among an older population (aged ≥65 years) in a large family medicine setting, and to identify the associated risks. DESIGN & SETTING A prospective cross-sectional study of patients aged ≥65 years was conducted from June 2017 to June 2018 at the Family and Community Medicine (FCM) clinics of King Saud Medical City (KSMC) in Riyadh, Saudi Arabia. METHOD This cross-sectional study included patients aged ≥65 years who were seen at new appointments or followed-up at the FCM clinics of KSMC in Riyadh, Saudi Arabia. Data were collected by extensive face-to-face interviews and from the patients' medical records. RESULTS A total of 270 older patients aged 72.41 ±6.23 years (mean ±standard deviation [SD]) were included in the present study. The prevalence of PIMs was 60.7% (n = 164). Multivariate analyses identified three independent variables associated with PIMs: incremental age per 5 years (odds ratio [OR] 1.47, 95% confidence intervals [CI] = 1.15 to 1.88; P = 0.002), female sex (OR 1.95, 95% CI = 1.10 to 3.42; P = 0.021), and polypharmacy (OR 8.21, 95% CI = 4.58 to 14.7; P<0.001). The most common PIMs used were 39.4% related to proton pump inhibitors (PPI), 25.2% to diuretics (other than spironolactone), 10.6% to non-steroidal anti-inflammatory drugs (NSAIDs), and 8.7% to aspirin use. CONCLUSION This study showed high prevalence of PIMs. Increasing age, female sex, and polypharmacy were found to be significant risk factors for PIM use. The frequency of morbidities was not significantly different among patients with PIMs compared to those without PIMs, except for hypertension and osteoarthritis, which were more common in the PIMs group. The present study reinforces the importance of comprehensive medication management and reviews.
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Buda V, Prelipcean A, Andor M, Dehelean L, Dalleur O, Buda S, Spatar L, Mabda MC, Suciu M, Danciu C, Tudor A, Petrescu L, Cristescu C. Potentially Inappropriate Prescriptions in Ambulatory Elderly Patients Living in Rural Areas of Romania Using STOPP/START (Version 2) Criteria. Clin Interv Aging 2020; 15:407-417. [PMID: 32256055 PMCID: PMC7090181 DOI: 10.2147/cia.s233270] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Accepted: 01/29/2020] [Indexed: 01/17/2023] Open
Abstract
Background Rational use of medications and monitoring of prescriptions in elderly patients is important to decrease the number and duration of hospitalizations, emergency medical consultations, mortality, as well as medical costs. Purpose To identify potentially inappropriate medications (PIMs) and potential prescription omissions (PPOs), and determine their prevalence based on the Screening Tool of Older Persons' potentially inappropriate Prescriptions (STOPP) v2 criteria and Screening Tool to Alert doctors to Right Treatment (START) v2 criteria for patients aged >65 years. Methods This cross-sectional study was conducted in two rural counties in Romania based on electronic prescriptions for chronic conditions (EPCCs) issued from 30 days to 90 days by a specialist or general practitioner. Collected EPCCs were evaluated by an interdisciplinary team of specialists based on 26 STOPP v2 criteria and 10 START v2 criteria. Results PIM prevalence was 25.80% and PPO prevalence was 41.72% for 646 EPCCs. The mean age of patients was 75 years and the mean number of drugs per EPCC was four. The most frequently identified PIMs were treatment duration (6.65%), theophylline administration (5.72%), drug indication (4.64%), cyclo-oxygenase-2 non-steroidal anti-inflammatory drugs (1.39%), and zopiclone prescription (0.77%). Statins (24.76%), beta-blockers (8.04%), and beta-2 agonist/antimuscarinic bronchodilators (5.88%) were the most frequently identified PPOs. Conclusion PPOs were more prevalent than PIMs for elderly populations living in the two rural counties in Romania we studied. Health practitioners (family physicians, specialists, and pharmacists) should focus on prophylactic and curative considerations when prescribing agents to decrease the morbidity and mortality of elderly rural Romanian patients.
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Affiliation(s)
- Valentina Buda
- Department of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy, "Victor Babeş" University of Medicine and Pharmacy, Timisoara, Romania
| | | | - Minodora Andor
- Department of Medical Semiotics, Faculty of Medicine, "Victor Babeş" University of Medicine and Pharmacy, Timisoara, Romania
| | - Liana Dehelean
- Discipline of Psychiatry, Department of Neurosciences, Faculty of Medicine, "Victor Babeş" University of Medicine and Pharmacy, Timisoara, Romania
| | - Olivia Dalleur
- Clinical Pharmacy Research Group, Louvain Drug Research Institute, Université catholique de Louvain UCLouvain, Bruxelles, Belgium
| | - Simona Buda
- "Victor Babeş" University of Medicine and Pharmacy, Timisoara, Romania
| | - Lavinia Spatar
- "Victor Babeş" University of Medicine and Pharmacy, Timisoara, Romania
| | - Maria Cristiana Mabda
- Department of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy, "Victor Babeş" University of Medicine and Pharmacy, Timisoara, Romania
| | - Maria Suciu
- Department of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy, "Victor Babeş" University of Medicine and Pharmacy, Timisoara, Romania
| | - Corina Danciu
- Department of Pharmacognosy, Faculty of Pharmacy, "Victor Babeş" University of Medicine and Pharmacy, Timisoara, Romania
| | - Anca Tudor
- Department of Statistics and Biomedical Informatics, Faculty of Pharmacy, "Victor Babeş" University of Medicine and Pharmacy, Timisoara, Romania
| | - Lucian Petrescu
- Department of Cardiology VI, Faculty of Medicine, "Victor Babeş" University of Medicine and Pharmacy, Timisoara, Romania.,Cardiovascular Diseases Institute, Timisoara, Romania
| | - Carmen Cristescu
- Department of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy, "Victor Babeş" University of Medicine and Pharmacy, Timisoara, Romania
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Identification of potentially inappropriate cardiovascular prescriptions in the elderly using Beers’ criteria. REVISTA COLOMBIANA DE CARDIOLOGÍA 2020. [DOI: 10.1016/j.rccar.2019.02.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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18
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Fernandes DDS, Gonçalves LHT, Ferreira AMR, Santos MIPDO. Functional capacity assessment of long-lived older adults from Amazonas. Rev Bras Enferm 2019; 72:49-55. [PMID: 31826191 DOI: 10.1590/0034-7167-2017-0798] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2017] [Accepted: 06/16/2018] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To evaluate the functional capacity of long-lived older adults from Amazonas. METHOD A cross-sectional epidemiological study was carried out with 116 older adults aged 80 years or older, registered in a primary health care unit in Belém, in the state of Pará, Brazil. The Functional Independence Measure (FIM) was used for functional capacity assessment and the Mini-Mental State Examination (MMSE) for cognitive screening. Univariate and bivariate analyses were carried out, in addition to the Pearson's chi-square test. RESULTS The older adults presented modified independence in the self-care, sphincter control and locomotion dimensions, and needed supervision for mobility/transfers. In mobility, men presented complete independence. Modified independence was found in the 80-89 age group. It was observed that, the lower the education level, the worse the cognitive performance. CONCLUSION In spite of their advanced age, long-lived older adults still present functional capacity for activities of daily living, even though they required supervision for high energy expenditure tasks, such as mobility and transfers.
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Affiliation(s)
- Daiane de Souza Fernandes
- Universidade do Estado do Pará, Belém, Pará, Brazil.,Universidade Federal do Pará. Belém, Pará, Brazil
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19
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Anticholinergic and sedative medications exposure in older patients: a cross-sectional study. Int J Clin Pharm 2019; 41:1152-1158. [DOI: 10.1007/s11096-019-00885-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Accepted: 07/27/2019] [Indexed: 10/26/2022]
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20
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Kim JY, Song HC, Jee HG. Refractory healing after surgical therapy of osteonecrosis of the jaw: associated risk factors in aged patients. Clin Interv Aging 2019; 14:797-804. [PMID: 31123397 PMCID: PMC6510385 DOI: 10.2147/cia.s200455] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Accepted: 03/08/2019] [Indexed: 11/30/2022] Open
Abstract
Purpose: Osteonecrosis of the jaw (ONJ), both medication-related and non medication-related, mainly occurs in aged patients. It needs surgical intervention. Refractory healing after an operation of ONJ can significantly lower the quality of life of elderly patients. The purpose of this study was to determine risk factors associated with refractory healing in aged patients. Patients and methods: We performed a retrospective study of ONJ in aged patients who underwent surgical treatments in a single institute during a 12-year period. Multiple logistic regression analysis was used to determine independent risk factors associated with refractory healing. Results: A total of 122 patients were included. Of them, 25 patients were identified as the refractory group and 97 patients as the control group. Diabetes mellitus (DM) (AOR=5.03, 95% CI: 1.74–14.52) and glucocorticoid administration (AOR=7.97, 95% CI: 2.52–25.23) were found to be significant risk factors for refractory healing of ONJ. Conclusion: DM and medication of glucocorticoid might be risk factors for refractory healing of ONJ.
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Affiliation(s)
- Ji-Youn Kim
- Division of Oral & Maxillofacial Surgery, Department of Dentistry, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Hyun Chul Song
- Division of Oral & Maxillofacial Surgery, Department of Dentistry, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Hyeon-Gun Jee
- Healthcare Innovation Park, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
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21
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Yoshida M, Kato D, Nishimura T, Van Schyndle J, Uno S, Kimura T. Anticholinergic burden in the Japanese elderly population: Use of antimuscarinic medications for overactive bladder patients. Int J Urol 2018; 25:855-862. [DOI: 10.1111/iju.13758] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Accepted: 05/08/2018] [Indexed: 11/30/2022]
Affiliation(s)
- Masaki Yoshida
- Department of Urology; National Center for Geriatrics and Gerontology; Obu Japan
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22
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Hyttinen V, Jyrkkä J, Saastamoinen LK, Vartiainen AK, Valtonen H. Patient- and health care-related factors associated with initiation of potentially inappropriate medication in community-dwelling older persons. Basic Clin Pharmacol Toxicol 2018; 124:74-83. [PMID: 30003664 DOI: 10.1111/bcpt.13096] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Accepted: 07/08/2018] [Indexed: 11/28/2022]
Abstract
Potentially inappropriate medications (PIMs) in older persons are defined as medications of which the potential harms outweigh their benefits. The purpose of this study was to determine how initiation of PIMs accumulate in community-dwelling persons aged 65-74 and ≥75 years, and which patient- and health care-related factors are associated with PIM initiation over time. Data of this study were gathered from population-based registers by a 10% random sample of persons (n = 28 497) aged ≥65 years with no prior PIMs within a 2-year period preceding the index date (1 January 2002), and the study individuals were followed until 2013. The Finnish Prescription Register was linked using a personal identity code to register on inpatient care and causes of deaths and socio-economic data. In this study, 10 698 (37.5%) persons initiated PIMs during the study period. Female gender was associated with PIM initiation in 65-74-year-olds, but not in ≥75-year-olds. In 65-74-year-olds, the risk of PIM initiation increased with the higher income, whereas in ≥75-year-olds, the association between PIM initiation and the high income was not significant. The prescribing physician explained 9%-16% of the variation in the probability of PIM initiation. In conclusion, there were age-related differences in the factors associated with PIM initiation in relation to gender and socio-economic status. Overall, patient-related factors explained a large proportion of variation of PIM initiation, but there were also differences in PIM prescribing among physicians. However, physician-related variance of PIM initiations decreased during the 12-year follow-up.
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Affiliation(s)
- Virva Hyttinen
- Department of Health and Social Management, University of Eastern Finland, Kuopio, Finland
| | - Johanna Jyrkkä
- Assessment of Pharmacotherapies, Finnish Medicines Agency, Kuopio, Finland
| | | | - Anna-Kaisa Vartiainen
- Department of Health and Social Management, University of Eastern Finland, Kuopio, Finland
| | - Hannu Valtonen
- Department of Health and Social Management, University of Eastern Finland, Kuopio, Finland
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Seeman MV, González-Rodríguez A. Use of psychotropic medication in women with psychotic disorders at menopause and beyond. Curr Opin Psychiatry 2018. [PMID: 29528895 DOI: 10.1097/yco.0000000000000410] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
PURPOSE OF REVIEW Drugs have been extensively prescribed for the treatment of psychotic symptoms in schizophrenia and related disorders, as well as for the management of psychotic features in delirium, dementia and affective disorders. The aim of this narrative review is to focus on the recent literature on drug treatment in women with psychosis at the transition to menopause and subsequently. RECENT FINDINGS The recent literature emphasizes the following points: the efficacy of antipsychotic medication in psychosis is largely confined to the alleviation of delusions and hallucinations; menopause and ageing alter the kinetics and dynamics of drug action; drugs other than antipsychotics are currently being tested to address the cognitive, affective and negative symptoms of psychotic illnesses; menopausal symptoms add to comorbidities and require simultaneous treatment, raising the probability of deleterious drug interactions; antipsychotic drugs have many side effects and contribute to high mortality rates in the older psychosis population. SUMMARY A major implication for research is that antipsychotic drugs with a wider range of action and with fewer side effects are urgently needed. The clinical implications of the pharmacotherapy of psychotic illness are: older women's needs must be assessed through a comprehensive history and review of systems and physical and mental examination. To avoid adverse effects, drug dosages are best kept low and polypharmacy avoided wherever possible. It is important to frequently reassess older patients, as their pharmacotherapy requirements change with age and with comorbidity.
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Affiliation(s)
- Mary V Seeman
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
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Redston MR, Hilmer SN, McLachlan AJ, Clough AJ, Gnjidic D. Prevalence of Potentially Inappropriate Medication Use in Older Inpatients with and without Cognitive Impairment: A Systematic Review. J Alzheimers Dis 2018; 61:1639-1652. [DOI: 10.3233/jad-170842] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Mitchell R. Redston
- Faculty of Pharmacy, The University of Sydney, Sydney, NSW, Australia
- Departments of Aged Care and Clinical Pharmacology, Kolling Institute of Medical Research, Royal North Shore Hospital, Sydney, NSW, Australia
| | - Sarah N. Hilmer
- Departments of Aged Care and Clinical Pharmacology, Kolling Institute of Medical Research, Royal North Shore Hospital, Sydney, NSW, Australia
- Sydney Medical School, The University of Sydney, Sydney, NSW, Australia
| | - Andrew J. McLachlan
- Faculty of Pharmacy, The University of Sydney, Sydney, NSW, Australia
- Centre for Education and Research on Ageing, Concord Repatriation General Hospital, Sydney, NSW, Australia
| | - Alexander J. Clough
- Faculty of Pharmacy, The University of Sydney, Sydney, NSW, Australia
- Departments of Aged Care and Clinical Pharmacology, Kolling Institute of Medical Research, Royal North Shore Hospital, Sydney, NSW, Australia
| | - Danijela Gnjidic
- Faculty of Pharmacy, The University of Sydney, Sydney, NSW, Australia
- Charles Perkins Centre, The University of Sydney, Sydney, NSW, Australia
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25
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Renom-Guiteras A, Thürmann PA, Miralles R, Klaaßen-Mielke R, Thiem U, Stephan A, Bleijlevens MHC, Jolley D, Leino-Kilpi H, Rahm Hallberg I, Saks K, Soto-Martin M, Zabalegui A, Meyer G. Potentially inappropriate medication among people with dementia in eight European countries. Age Ageing 2018; 47:68-74. [PMID: 28985257 DOI: 10.1093/ageing/afx147] [Citation(s) in RCA: 61] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2017] [Accepted: 08/02/2017] [Indexed: 11/14/2022] Open
Abstract
Objectives to evaluate the frequency of potentially inappropriate medication (PIM) prescription among older people with dementia (PwD) from eight countries participating in the European study 'RightTimePlaceCare', and to evaluate factors and adverse outcomes associated with PIM prescription. Methods survey of 2,004 PwD including a baseline assessment and follow-up after 3 months. Interviewers gathered data on age, sex, prescription of medication, cognitive status, functional status, comorbidity, setting and admission to hospital, fall-related injuries and mortality in the time between baseline and follow-up. The European Union(7)-PIM list was used to evaluate PIM prescription. Multivariate regression analysis was used to investigate factors and adverse outcomes associated with PIM prescription. Results overall, 60% of the participants had at least one PIM prescription and 26.4% at least two. The PIM therapeutic subgroups most frequently prescribed were psycholeptics (26% of all PIM prescriptions) and 'drugs for acid-related disorders' (21%). PwD who were 80 years and older, lived in institutional long-term care settings, had higher comorbidity and were more functionally impaired were at higher risk of being prescribed two PIM or more. The prescription of two or more PIM was associated with higher chance of suffering from at least one fall-related injury and at least one episode of hospitalisation in the time between baseline and follow-up. Conclusions PIM use among PwD is frequent and is associated with institutional long-term care, age, advanced morbidity and functional impairment. It also appears to be associated with adverse outcomes. Special attention should be paid to psycholeptics and drugs for acid-related disorders.
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Affiliation(s)
- Anna Renom-Guiteras
- School of Nursing Science, University of Witten/Herdecke, Witten, Germany
- Geriatrics Department, University Hospital Parc de Salut Mar, Barcelona, Spain
- Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Petra A Thürmann
- Chair of Clinical Pharmacology, University of Witten/Herdecke, Witten, Germany
- Philipp Klee-Institute of Clinical Pharmacology, HELIOS University Clinic Wuppertal, Wuppertal, Germany
| | - Ramón Miralles
- Geriatrics Department, University Hospital Parc de Salut Mar, Barcelona, Spain
- Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Renate Klaaßen-Mielke
- Department of Medical Informatics, Biometry and Epidemiology, Ruhr University, Bochum, Germany
| | - Ulrich Thiem
- Department of Medical Informatics, Biometry and Epidemiology, Ruhr University, Bochum, Germany
- Department of Geriatrics, Elisabeth Krankenhaus Essen, Essen, Germany
| | - Astrid Stephan
- School of Nursing Science, University of Witten/Herdecke, Witten, Germany
- Institute of Health and Nursing Science, Medical Faculty, Martin Luther UniversityHalle-Wittenberg, Halle (Saale), Germany
| | - Michel H C Bleijlevens
- Care and Public Health Research Institute (Caphri), Department of Health Services Research, Maastricht University, Maastricht, The Netherlands
| | - David Jolley
- Honorary Reader in Old Age Psychiatry, Personal Social Services Unit, University of Manchester, Manchester, UK
| | - Helena Leino-Kilpi
- Department of Nursing Science and Nurse Director, University of Turku, Turku University Hospital, Turku, Finland
| | | | - Kai Saks
- Department of Internal Medicine, University of Tartu, Tartu, Estonia
| | - Maria Soto-Martin
- Department of Geriatric Medicine, Gerontopole, Alzheimer Disease Research Center, Inserm UMR 1027, University Hospital of Toulouse, France
| | - Adelaida Zabalegui
- Hospital Clinic de Barcelona, Barcelona, Spain
- School of Medicine, Universitat de Barcelona, Barcelona, Spain
| | - Gabriele Meyer
- School of Nursing Science, University of Witten/Herdecke, Witten, Germany
- Institute of Health and Nursing Science, Medical Faculty, Martin Luther UniversityHalle-Wittenberg, Halle (Saale), Germany
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26
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Axmon A, Sandberg M, Ahlström G, Midlöv P. Prescription of potentially inappropriate medications among older people with intellectual disability: a register study. BMC Pharmacol Toxicol 2017; 18:68. [PMID: 29070067 PMCID: PMC5657112 DOI: 10.1186/s40360-017-0174-1] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Accepted: 10/15/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Older people have a greater disease burden and are more likely than younger to be prescribed medications. They are also more sensitive to adverse effects. With this in mind, a range of medications have been suggested inappropriate in this population. People with intellectual disability (ID) have a higher disease burden than the general population, putting them at even greater risk of prescription of such medications. The aim of this study was to describe prescription of potentially inappropriate medications among older people with ID in relation to prescriptions among their age peers in the general population. METHODS We established an administrative cohort of people with ID (ID cohort; n = 7936), using a Swedish national register. A referent cohort from the general population (gPop) was matched one-to-one by sex and year of birth. Data regarding prescription of potentially inappropriate medications were collected from the Swedish prescribed drug register for the years 2006-2012. RESULTS People with ID were more likely than the general population to be prescribed medications with anticholinergic effects, intermediate- or long-acting benzodiazepines, and antipsychotics at least once during the study period, and also had more number of years with prescription. Except for benzodiazepines, those in the ID cohort with at least one prescription had larger amounts prescribed than those in the gPop cohort. People in the ID cohort were less likely than the general population to be prescribed non-steroidal anti-inflammatory drugs (NSAIDs). Among those with at least one prescription of NSAIDs, those in the ID cohort had prescriptions during fewer years and in lower amounts than those in the gPop cohort. CONCLUSIONS Although prescription of potentially inappropriate medications overall is more common among people with ID than in the general population, the opposite pattern is found for medications for pain management. This may be a result of pain being under-recognized and under-treated in this population. Thus, there is a need for training as well as increased knowledge and awareness among care and health care professionals regarding signs of adverse effects and the need of continuous evaluation of treatment in this vulnerable group.
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Affiliation(s)
- Anna Axmon
- Occupational and Environmental Medicine, Department of Laboratory Medicine, Lund University, 221 00, Lund, SE, Sweden. .,Department of Health Sciences, Lund University, 221 00, Lund, SE, Sweden.
| | - Magnus Sandberg
- Department of Health Sciences, Lund University, 221 00, Lund, SE, Sweden
| | - Gerd Ahlström
- Department of Health Sciences, Lund University, 221 00, Lund, SE, Sweden
| | - Patrik Midlöv
- Center for Primary Health Care Research, Department of Clinical Sciences in Malmö, Lund University, 221 00, Lund, SE, Sweden
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Chan TT, Leung WCY, Li V, Wong KYW, Chu WM, Leung KC, Ng YZ, Kai YMG, Shea YF, Chang SKR, Chu LW. Association between high cumulative dose of benzodiazepine in Chinese patients and risk of dementia: a preliminary retrospective case-control study. Psychogeriatrics 2017; 17:310-316. [PMID: 28145025 DOI: 10.1111/psyg.12239] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Revised: 11/07/2016] [Accepted: 11/21/2016] [Indexed: 11/29/2022]
Abstract
BACKGROUND Evidence describing the association between high-dose benzodiazepine use and dementia has been conflicting. Most previous studies involved Caucasian populations, with only limited data on Chinese subjects. Possible differences exist between Chinese and Caucasian populations with regard to metabolism and prescription practice. This study aimed to assess the association between high-dose benzodiazepine use and dementia in a Chinese population. METHOD A retrospective case-control study was carried out in all public hospitals under the Hong Kong Hospital Authority Hong Kong West Cluster between 2000 and 2015. The study recruited 273 Chinese adults (91 cases, 182 controls) aged 75 and over, with at least 6 years of follow-up data. Each dementia case was matched with two controls according to sex, age group, and duration of follow-up. The number of patients with benzodiazepine ever-use and the exposure density based on the prescribed daily doses were assessed. Prescribed daily doses were categorized as either <1096 or ≥1096. Odds ratios and 95% confidence intervals were computed by multivariate analysis. RESULTS The difference in exposure density between the dementia and control groups was statistically significant between prescribed daily doses <1096 and ≥1096 (P = 0.02). There were two multivariate analyses models; one factored in depression (model 1), and the other (model 2) did not. Model 2 showed a statistically significant association (odds ratio = 1.71, 95% confidence intervals = 1.02-2.89, P = 0.04) between benzodiazepine exposure density and dementia. CONCLUSION High-dose benzodiazepine use may be associated with dementia in the Chinese population. Prospective studies are required.
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Affiliation(s)
- Tsz-Tai Chan
- Division of Geriatrics, Department of Medicine, Queen Mary Hospital, Hong Kong.,Division of Neurology, Department of Medicine, Queen Mary Hospital, Hong Kong
| | - William Chun-Yin Leung
- Division of Geriatrics, Department of Medicine, Queen Mary Hospital, Hong Kong.,Division of Neurology, Department of Medicine, Queen Mary Hospital, Hong Kong
| | - Victor Li
- Division of Geriatrics, Department of Medicine, Queen Mary Hospital, Hong Kong.,Division of Neurology, Department of Medicine, Queen Mary Hospital, Hong Kong
| | - Kin-Yiu Wesley Wong
- Division of Geriatrics, Department of Medicine, Queen Mary Hospital, Hong Kong.,Division of Neurology, Department of Medicine, Queen Mary Hospital, Hong Kong
| | - Wing-Ming Chu
- Division of Geriatrics, Department of Medicine, Queen Mary Hospital, Hong Kong.,Division of Neurology, Department of Medicine, Queen Mary Hospital, Hong Kong
| | - Ka-Chun Leung
- Division of Geriatrics, Department of Medicine, Queen Mary Hospital, Hong Kong.,Division of Neurology, Department of Medicine, Queen Mary Hospital, Hong Kong
| | - Yuey-Zhun Ng
- Division of Geriatrics, Department of Medicine, Queen Mary Hospital, Hong Kong.,Division of Neurology, Department of Medicine, Queen Mary Hospital, Hong Kong
| | - Yuen-Ming Gary Kai
- Division of Geriatrics, Department of Medicine, Queen Mary Hospital, Hong Kong.,Division of Neurology, Department of Medicine, Queen Mary Hospital, Hong Kong
| | - Yat-Fung Shea
- Division of Geriatrics, Department of Medicine, Queen Mary Hospital, Hong Kong
| | | | - Leung-Wing Chu
- Department of Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong.,Alzheimer's Disease Research Network, The University of Hong Kong, Hong Kong
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28
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Wu SW, Pan Q, Chen T, Wei LY, Xuan Y, Wang Q, Li C, Song JC. Research of Medical Expenditure among Inpatients with Unstable Angina Pectoris in a Single Center. Chin Med J (Engl) 2017. [PMID: 28639566 PMCID: PMC5494914 DOI: 10.4103/0366-6999.208242] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background: With the rising incidence as well as the medical expenditure among patients with unstable angina pectoris, the research aimed to investigate the inpatient medical expenditure through the combination of diagnosis-related groups (DRGs) among patients with unstable angina pectoris in a Grade A tertiary hospital to conduct the referential standards of medical costs for the diagnosis. Methods: Single-factor analysis and multiple linear stepwise regression method were used to investigate 3933 cases between 2014 and 2016 in Beijing Hospital (China) whose main diagnosis was defined as unstable angina pectoris to determine the main factors influencing the inpatient medical expenditure, and decision tree method was adopted to establish the model of DRGs grouping combinations. Results: The major influential factors of inpatient medical expenditure included age, operative method, therapeutic effects as well as comorbidity and complications (CCs) of the disease, and the 3933 cases were divided into ten DRGs by four factors: age, CCs, therapeutic effects, and the type of surgery with corresponding inpatient medical expenditure standards setup. Data of nonparametric test on medical costs among different groups were all significant (P < 0.001, by Kruskal-Wallis test), with R2 = 0.53 and coefficient of variation (CV) = 0.524. Conclusions: The classification of DRGs by adopting the type of surgery as the main branch node to develop cost control standards in inpatient treatment of unstable angina pectoris is conducive in standardizing the diagnosis and treatment behaviors of the hospital and reducing economic burdens among patients.
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Affiliation(s)
- Suo-Wei Wu
- Department of Medical Administration, Beijing Hospital, National Center of Gerontology, Beijing 100730, China
| | - Qi Pan
- Department of Medical Administration, Beijing Hospital, National Center of Gerontology, Beijing 100730, China
| | - Tong Chen
- Department of Medical Administration, Beijing Hospital, National Center of Gerontology, Beijing 100730, China
| | - Liang-Yu Wei
- Department of Medical Administration, Beijing Hospital, National Center of Gerontology, Beijing 100730, China
| | - Yong Xuan
- Department of Medical Administration, Beijing Hospital, National Center of Gerontology, Beijing 100730, China
| | - Qin Wang
- Department of Medical Administration, Beijing Hospital, National Center of Gerontology, Beijing 100730, China
| | - Chao Li
- Department of Medical Administration, Beijing Hospital, National Center of Gerontology, Beijing 100730, China
| | - Jing-Chen Song
- Department of Medical Administration, Beijing Hospital, National Center of Gerontology, Beijing 100730, China
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Li H, Pu S, Liu Q, Huang X, Kuang J, Chen L, Shen J, Cheng S, Wu T, Li R, Li Y, Mo L, Jiang W, Song Y, He J. Potentially inappropriate medications in Chinese older adults: The beers criteria compared with the screening tool of older persons' prescriptions criteria. Geriatr Gerontol Int 2017; 17:1951-1958. [PMID: 28224703 DOI: 10.1111/ggi.12999] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2016] [Revised: 11/25/2016] [Accepted: 12/07/2016] [Indexed: 02/05/2023]
Abstract
AIM The present study aimed to assess the prevalence of potentially inappropriate medications (PIM) use in West China Hospital residents aged ≥65 years, using two sets of criteria - the Beers and Screening Tool of Older Persons' Prescriptions (STOPP) criteria - and to compare the Beers and STOPP criteria, and to determine the better criteria for assessing PIM of older adults in China. METHODS This was a retrospective cross-sectional study, and all patients were aged ≥65 years and admitted through the Information Center of West China Hospital from October 2010 to April 2013. The Beers and STOPP criteria were used to identify PIM. A multivariate logistic regression study was used to identify the predictors of PIM use. RESULTS In the 6337 patients included, the mean age was 81.30 years (SD 6.75), 4795 (75.70%) were male and 5033 (79.42%) were prescribed at least one PIM by either criterion. The Beers criteria identified PIM use in 4593 (72.48%) of patients, and 3278 (51.73%) of patients used at least one PIM according to the STOPP criteria. The most prevalent PIM according to the Beers criteria were benzodiazepines (34.40%); according to the STOPP criteria, it was calcium channel blockers with chronic constipation (18.52%). Increasing age, sex (female), the number of diagnostic diseases and the number of prescribed medications predicted PIM use by both criteria. CONCLUSION The present study showed a high frequency of PIM in China. The Beers criteria had a higher detection rate and were more sensitive for assessing PIM of older adults in China. Geriatr Gerontol Int 2017; 17: 1951-1958.
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Affiliation(s)
- Hong Li
- Department of Pharmacy, West China Hospital of Sichuan University and Collaborative Innovation Center of Biotherapy, Chengdu, Sichuan, China.,Laboratory of Clinical Pharmacy and Adverse Drug Reaction, West China Hospital of Sichuan University and Collaborative Innovation Center of Biotherapy, Chengdu, Sichuan, China
| | - Shiyun Pu
- Department of Pharmacy, West China Hospital of Sichuan University and Collaborative Innovation Center of Biotherapy, Chengdu, Sichuan, China.,Laboratory of Clinical Pharmacy and Adverse Drug Reaction, West China Hospital of Sichuan University and Collaborative Innovation Center of Biotherapy, Chengdu, Sichuan, China
| | - Qinhui Liu
- Laboratory of Clinical Pharmacy and Adverse Drug Reaction, West China Hospital of Sichuan University and Collaborative Innovation Center of Biotherapy, Chengdu, Sichuan, China
| | - Xin Huang
- Department of Pharmacy, West China Hospital of Sichuan University and Collaborative Innovation Center of Biotherapy, Chengdu, Sichuan, China.,Laboratory of Clinical Pharmacy and Adverse Drug Reaction, West China Hospital of Sichuan University and Collaborative Innovation Center of Biotherapy, Chengdu, Sichuan, China
| | - Jiangying Kuang
- Department of Pharmacy, West China Hospital of Sichuan University and Collaborative Innovation Center of Biotherapy, Chengdu, Sichuan, China.,Laboratory of Clinical Pharmacy and Adverse Drug Reaction, West China Hospital of Sichuan University and Collaborative Innovation Center of Biotherapy, Chengdu, Sichuan, China
| | - Lei Chen
- Department of Pharmacy, West China Hospital of Sichuan University and Collaborative Innovation Center of Biotherapy, Chengdu, Sichuan, China.,Laboratory of Clinical Pharmacy and Adverse Drug Reaction, West China Hospital of Sichuan University and Collaborative Innovation Center of Biotherapy, Chengdu, Sichuan, China
| | - Jing Shen
- Department of Pharmacy, West China Hospital of Sichuan University and Collaborative Innovation Center of Biotherapy, Chengdu, Sichuan, China.,Laboratory of Clinical Pharmacy and Adverse Drug Reaction, West China Hospital of Sichuan University and Collaborative Innovation Center of Biotherapy, Chengdu, Sichuan, China
| | - Shihai Cheng
- Department of Pharmacy, West China Hospital of Sichuan University and Collaborative Innovation Center of Biotherapy, Chengdu, Sichuan, China.,Laboratory of Clinical Pharmacy and Adverse Drug Reaction, West China Hospital of Sichuan University and Collaborative Innovation Center of Biotherapy, Chengdu, Sichuan, China
| | - Tong Wu
- Department of Pharmacy, West China Hospital of Sichuan University and Collaborative Innovation Center of Biotherapy, Chengdu, Sichuan, China.,Laboratory of Clinical Pharmacy and Adverse Drug Reaction, West China Hospital of Sichuan University and Collaborative Innovation Center of Biotherapy, Chengdu, Sichuan, China
| | - Rui Li
- Department of Pharmacy, West China Hospital of Sichuan University and Collaborative Innovation Center of Biotherapy, Chengdu, Sichuan, China.,Laboratory of Clinical Pharmacy and Adverse Drug Reaction, West China Hospital of Sichuan University and Collaborative Innovation Center of Biotherapy, Chengdu, Sichuan, China
| | - Yanping Li
- Department of Pharmacy, West China Hospital of Sichuan University and Collaborative Innovation Center of Biotherapy, Chengdu, Sichuan, China.,Laboratory of Clinical Pharmacy and Adverse Drug Reaction, West China Hospital of Sichuan University and Collaborative Innovation Center of Biotherapy, Chengdu, Sichuan, China
| | - Li Mo
- The Center of Gerontology and Geriatrics, West China Hospital of Sichuan University and Collaborative Innovation Center of Biotherapy, Chengdu, Sichuan, China
| | - Wei Jiang
- Molecular Medicine Research Center, State Key Laboratory of Biotherapy and Cancer Center, West China Hospital of Sichuan University and Collaborative Innovation Center of Biotherapy, Chengdu, Sichuan, China
| | - Yi Song
- Department of Pharmacy, West China Hospital of Sichuan University and Collaborative Innovation Center of Biotherapy, Chengdu, Sichuan, China
| | - Jinhan He
- Department of Pharmacy, West China Hospital of Sichuan University and Collaborative Innovation Center of Biotherapy, Chengdu, Sichuan, China.,Laboratory of Clinical Pharmacy and Adverse Drug Reaction, West China Hospital of Sichuan University and Collaborative Innovation Center of Biotherapy, Chengdu, Sichuan, China
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30
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Wu SW, Pan Q, Wei LY, Li C, Wang Q, Song JC, Chen T. Research on 2041 Cases of High Inpatient Expenditure and Influence Factors during 3 Years in a Single Center. Chin Med J (Engl) 2016; 129:2325-30. [PMID: 27647192 PMCID: PMC5040019 DOI: 10.4103/0366-6999.190681] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background: The study was to explore the causes of high inpatient expenditure through analyzing the distribution characteristics as well as the influence factors of high inpatient expenditure cases during 3 years within a Grade-A tertiary hospital through various aspects and multiple angles, thus identifying the major influence factors for high medical expenditure to develop further research. Methods: We retrospectively studied 2041 inpatient cases which cost more than RMB 100,000 Yuan per case in a Grade-A tertiary hospital from 2013 to 2015. We analyzed the compositions of the medical cost to evaluate the major factors that cause the high inpatient expenditure. All the data and materials were collected from medical record system, and the statistical methods included t-test, variance of analysis, and multivariate linear regression. Results: The average cost of the 2,041 cases was RMB 152,173 Yuan for medicines and materials of medical costs, which respectively accounted for 33.03% and 32.32% of the total cost; and the average length of hospital stay was 28.39 days/person. Diseases of skeletal and muscular system, circulatory system, and tumor were the top three disease categories of high inpatient expenditure, which accounted for 39.00%, 33.46%, and 18.03%, respectively. Complications, criticality of the disease, gender of the patients, the occurrence of death, and the excessive length of hospital stay all had great impacts on average medical expenditure, while age, hospital infection, and surgery showed no significant impact on average medical cost. Conclusions: The main factors for high inpatient expenditure included the inadequate use of high-value medicines and materials, lacking cost control measures within the hospital, the excessive length of hospital stay for inpatients, and the unnecessary treatment for the patients.
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Affiliation(s)
- Suo-Wei Wu
- Department of Medical Administration, Beijing Hospital, Beijing 100730, China
| | - Qi Pan
- Department of Medical Administration, Beijing Hospital, Beijing 100730, China
| | - Liang-Yu Wei
- Department of Medical Administration, Beijing Hospital, Beijing 100730, China
| | - Chao Li
- Department of Medical Administration, Beijing Hospital, Beijing 100730, China
| | - Qin Wang
- Department of Medical Administration, Beijing Hospital, Beijing 100730, China
| | - Jing-Chen Song
- Department of Medical Administration, Beijing Hospital, Beijing 100730, China
| | - Tong Chen
- Department of Medical Administration, Beijing Hospital, Beijing 100730, China
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