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Ierodiakonou D, Theodorou E, Sifaki-Pistolla D, Bouloukaki I, Antonopoulou M, Poulorinakis I, Tsakountakis N, Voltiraki F, Chliveros K, Tsiligianni I. Clinical characteristics and outcomes of polypharmacy in chronic obstructive pulmonary disease patients: A cross-sectional study from Crete, Greece. THE CLINICAL RESPIRATORY JOURNAL 2021; 15:1310-1319. [PMID: 34425633 DOI: 10.1111/crj.13434] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 07/29/2021] [Accepted: 08/09/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVES Polypharmacy and multimorbidity in chronic obstructive pulmonary disease (COPD) are highly prevalent, with potential associations with worse COPD outcomes. The aim of this study was to identify the clinical characteristics and outcomes of polypharmacy, investigate the relationship of polypharmacy with health status and exacerbations and assess the prevalence of inappropriate medication (PIM), risk of adverse drug reactions (ADRs) and drug-to-drug interactions in COPD patients. METHODS A total of 245 COPD patients were enrolled from primary care in Crete, Greece. Patients completed a questionnaire and the COPD Assessment Test (CAT). Multimorbidity was defined as having two or more comorbidities and polypharmacy was defined as taking five or more drugs per day. RESULTS Most of COPD patients (77.0%) and the majority (83.6%) of elderly (≥65 years) had multimorbidity, while polypharmacy was evident in 55.2% of all patients and 62.4% in elderly. After adjustments for age, gender and pack-years, polypharmacy was associated with CAT ≥ 10, multimorbidity, several cardiometabolic diseases, cancer and depression-anxiety and prostate disorders (all p values > 0.05). PIMs were found in 9.6% of subjects aged ≥65 years and were mainly mental health medication. Due to coadministration of medications, 22.3% of the population were at cumulative risk for falls, 17% for constipation and 12.8% for cardiovascular events. Finally, 15 pairs of drug-to-drug interactions were identified in 11.5% of patients. CONCLUSION Our data suggest that polypharmacy is highly prevalent and associated with worse health status and prescription risks in COPD patients. These findings potentially introduce an additional challenge on effective management of these patients.
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Affiliation(s)
- Despo Ierodiakonou
- Health Planning Unit, Department of Social Medicine, Faculty of Medicine, University of Crete, Crete, Greece
| | - Erotokritos Theodorou
- Health Planning Unit, Department of Social Medicine, Faculty of Medicine, University of Crete, Crete, Greece
| | - Dimitra Sifaki-Pistolla
- Health Planning Unit, Department of Social Medicine, Faculty of Medicine, University of Crete, Crete, Greece
- Clinic of Social and Family Medicine, Faculty of Medicine, University of Crete, Crete, Greece
| | | | | | | | | | - Filothei Voltiraki
- Primary Care, 4th Public Primary Care Unit of Heraklion, Heraklion, Crete, Greece
| | | | - Ioanna Tsiligianni
- Health Planning Unit, Department of Social Medicine, Faculty of Medicine, University of Crete, Crete, Greece
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Thapaliya K, Harris ML, Byles JE. Polypharmacy trajectories among older women with and without dementia: A longitudinal cohort study. EXPLORATORY RESEARCH IN CLINICAL AND SOCIAL PHARMACY 2021; 3:100053. [PMID: 35480610 PMCID: PMC9031090 DOI: 10.1016/j.rcsop.2021.100053] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Revised: 07/02/2021] [Accepted: 08/03/2021] [Indexed: 11/29/2022] Open
Abstract
Background Objective Method Results Conclusion
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Affiliation(s)
- Kailash Thapaliya
- Research Centre for Generational Health and Ageing, University of Newcastle, Newcastle, NSW, Australia
- Hunter Medical Research Institute (HMRI), Newcastle, NSW, Australia
- Corresponding author at.: Research Centre for Generational Health and Ageing, HMRI, University of Newcastle, Newcastle, NSW, Australia.
| | - Melissa L. Harris
- Research Centre for Generational Health and Ageing, University of Newcastle, Newcastle, NSW, Australia
- Hunter Medical Research Institute (HMRI), Newcastle, NSW, Australia
| | - Julie E. Byles
- Research Centre for Generational Health and Ageing, University of Newcastle, Newcastle, NSW, Australia
- Hunter Medical Research Institute (HMRI), Newcastle, NSW, Australia
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Coskun Benlidayi I, Gokce Kutsal Y. Antirheumatic drugs in older adults and polypharmacy issues. Z Gerontol Geriatr 2021; 55:507-512. [PMID: 34114088 DOI: 10.1007/s00391-021-01907-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 04/22/2021] [Indexed: 12/22/2022]
Abstract
Older individuals experience various noninflammatory and autoimmune inflammatory rheumatic diseases. Given the increased incidence of rheumatic conditions in older adults, it is of great importance for healthcare providers to be aware of the potential benefits and risks of antirheumatic drugs. The present article aims to provide a comprehensive review regarding antirheumatic drug use in older patients, particularly by focusing on safety issues and polypharmacy. Antirheumatic medications include nonsteroidal anti-inflammatory drugs (NSAIDs), glucocorticoids and disease-modifying antirheumatic drugs (DMARDs), which comprise conventional synthetic DMARDs, targeted synthetic DMARDs and biological DMARDs. Due to the alteration in drug pharmacokinetics and pharmacodynamics in old people, antirheumatic drug efficiency and safety may be different than in the younger population. Polypharmacy and multimorbidity are other potential challenges to be faced during the treatment of older patients with rheumatic diseases. The current review also discusses the strategies to minimize adverse reactions due to antirheumatic drugs.
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Affiliation(s)
- Ilke Coskun Benlidayi
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Cukurova University, Adana, Turkey.
| | - Yesim Gokce Kutsal
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Hacettepe University, Ankara, Turkey
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A multidimensional measure of polypharmacy for older adults using the Health and Retirement Study. Sci Rep 2021; 11:8783. [PMID: 33888728 PMCID: PMC8062687 DOI: 10.1038/s41598-021-86331-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Accepted: 01/07/2021] [Indexed: 02/05/2023] Open
Abstract
Polypharmacy is commonly defined based on the number of medications taken concurrently using standard cut-offs, but several studies have highlighted the need for a multidimensional assessment. We developed a multidimensional measure of polypharmacy and compared with standard cut-offs. Data were extracted for 2141 respondents of the 2007 Prescription Drug Survey, a sub-study of the Health Retirement Study. Latent classes were identified based on multiple indicators of polypharmacy, including quantity, temporality and risk profile. A four-class model was selected based on fit statistics and clinical interpretability: ‘High risk, long-term’ (Class 1), ‘Low risk, long-term’ (Class 2), ‘High risk, short-term’ (Class 3), and ‘High risk for drug interactions, medium-term, regular’ (Class 4). Classes differed regarding sex, cohabitation, disability and multimorbidity. Participants in the ‘low risk’ class tended to be male, cohabitating, and reported fewer health conditions, compared to ‘high risk’ classes. Polypharmacy classes were compared to standard cut-offs (5+ or 9+ medications) in terms of overlap and mortality risk. The three ‘high risk’ classes overlapped with the groups concurrently taking 5+ and 9+ medications per month. However, the multidimensional measure further differentiated individuals in terms of risk profile and temporality of medication taking, thus offering a richer assessment of polypharmacy.
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Mair A, Antoniadou E, Hendry A, Gabrovec B. Appropriate polypharmacy: a barometer for integrated care. JOURNAL OF INTEGRATED CARE 2020. [DOI: 10.1108/jica-04-2020-0019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
PurposePolypharmacy, the concurrent use of multiple medicines by one individual, is a common and growing challenge driven by an ageing population and the growing number of people living longer with chronic conditions. Up to 11% of unplanned hospital admissions in the UK are attributable to, mostly avoidable, harm from medicines. However, this topic is not yet central to integrated practice. This paper reviews the challenge that polypharmacy presents to the health and care system and offers lessons for integrated policy and practice.Design/methodology/approachTwo commonly encountered scenarios illustrate the relevance of addressing inappropriate polypharmacy to integrated practice. An overview of the literature on polypharmacy and frailty, including two recent large studies of policy and practice in Europe, identifies lessons for practitioners, managers, policy makers and commissioners.FindingsComprehensive change strategies should extend beyond pharmacist led deprescribing initiatives. An inter-professional and systems thinking approach is required, so all members of the integrated team can play their part in realising the value of holistic prescribing, appropriate polypharmacy and shared decision making.Practical implicationsAwareness and education about polypharmacy should be embedded in inter-professional training for all practitioners who care for people with multimorbidity or frailty.Originality/valueThis paper will help policy makers, commissioners, managers and practitioners understand the value of addressing polypharmacy within their integrated services. Best practice national guidance developed in Scotland illustrates how to target resources so those at greatest risk of harm from polypharmacy can benefit from effective pharmaceutical care as part of holistic integrated care.
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PAŞALI KİLİT T, ONBAŞI K, ÖZYİĞİT F. Treatment Adherence Levels and Factors Affecting Adherence in Patients Receiving Osteoporosis Treatment. CLINICAL AND EXPERIMENTAL HEALTH SCIENCES 2020. [DOI: 10.33808/clinexphealthsci.533942] [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]
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Pariseault CA. An Integrative Review of Methods of Measurement of Polypharmacy. J Nurs Meas 2019; 27:554-574. [PMID: 31871291 DOI: 10.1891/1061-3749.27.3.554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND AND PURPOSE The purpose of this integrative review is to synthesize research on the measurement of polypharmacy. METHODS A comprehensive search of the literature databases Cumulative Index to Nursing and Allied Health Literature (CINAHL) and PubMed was conducted using a combination of terms/keywords to search existing studies to explore measures used to address polypharmacy. RESULTS Several methods of measuring the existence of polypharmacy have been used in research. In addition to screening tools, the number of medications taken was used as an indicator of polypharmacy. CONCLUSIONS Multiple methods of the measurement of polypharmacy have been used throughout the literature. Most methods related to the intended study objectives and population. The most frequently reported measure of screening was the Beers Criteria.
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Ersoy S, Engin VS. Risk factors for polypharmacy in older adults in a primary care setting: a cross-sectional study. Clin Interv Aging 2018; 13:2003-2011. [PMID: 30410317 PMCID: PMC6197244 DOI: 10.2147/cia.s176329] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Purpose Polypharmacy (PP) is a clinical challenge in older adults. Therefore, assessment of daily drug consumption (DDC) and its relationships is important. First-line health services have a crucial role in monitoring and preventing PP. In this study, we aimed to assess DDC and investigate the risk factors for higher DDC among older adults in a primary care setting. Patients and methods A total of 1,000 patients aged ≥65 years who visited Melek Hatun Family Practice Center between December 1, 2014, and August 1, 2017, were enrolled in the study. All patients were seen either at the center or in their homes, and informed consent was obtained. Comprehensive geriatric assessment was performed for each subject. Data were analyzed using SPSS software (version 17). The daily number of medicines that each patient used (DDC) regardless of whether they were prescribed was the dependent variable. Relationships between DDC and other continuous variables were examined using Pearson's correlation. For between-group comparisons of DDC, Student's t-tests were performed. Results Univariate tests showed relationships between DDC and various demographic and clinical parameters. The variables that remained significant at the last step of a stepwise linear regression analysis were metabolic syndrome, chronic pain, incontinence, increased serum creatinine level, increased Geriatric Depression Scale scores, reported gastric disturbances, and neutrophil/lymphocyte ratio. Conclusion Along with certain chronic conditions, depressive symptoms and an inflammatory marker (neutrophil/lymphocyte ratio) were significantly and independently related to higher DDC. Longitudinal and larger studies are needed to further explore the multifaceted relationships of PP.
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Affiliation(s)
- Suleyman Ersoy
- Department of Family Medicine, Faculty of Medicine, Karabuk University, Karabuk, Turkey,
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Korukcu O, Kukulu K, Tufan I. Working and supporting people with dementia when you are a student: a qualitative research. Psychogeriatrics 2018; 18:299-306. [PMID: 30133937 DOI: 10.1111/psyg.12330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2017] [Revised: 12/22/2017] [Accepted: 02/02/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND Participation of young people in the care of older people will provide important contributions to improving older people's health. METHODS This qualitative case study was conducted to clarify the possible difficulties and experiences of student interns at the Blue House Alzheimer's Center for Alzheimer's Patients and Families. Data were collected by focus group interview. RESULTS It was seen that all students who practice at the Blue House Alzheimer's Patient and Patient Relatives Center willingly choose the gerontology profession. Gerontology is a new field in Turkey and the increasing number of older people leads students to gravitate towards this profession. Students who participated in the present study stated that internship at the nursing home is different to internship at the Alzheimer's care center, and it is much more difficult to empower individuals with dementia. Students stated that they had difficulty constantly meeting patients suffering from dementia, teaching an activity over and over again, caring for patients who constantly talk about their memories of past professional life, the theoretical and practical differences in caring for Alzheimer's disease patients, and the fear of one day suffering from dementia themselves. CONCLUSION In the most energetic years of their life, incorporating students into the care of Alzheimer's disease patients increased their knowledge and care skills.
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Affiliation(s)
- Oznur Korukcu
- Department of Obstetrics and Gynecology Nursing, Akdeniz University, Faculty of Nursing, Antalya, Turkey
| | - Kamile Kukulu
- Department of Obstetrics and Gynecology Nursing, Akdeniz University, Faculty of Nursing, Antalya, Turkey
| | - Ismail Tufan
- Department of Gerontology, Akdeniz University, Faculty of Literature, Antalya, Turkey
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Rouck JE, Malmstrom TK, Morley JE. Initial Validation of the Toulouse St. Louis University Mini Falls Assessment in Older Adults. J Nutr Health Aging 2018; 22:880-884. [PMID: 30272087 DOI: 10.1007/s12603-018-1073-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
BACKGROUND/OBJECTIVES Falls are one of the most prevalent health issues facing older adults. This study examines the validity of the Toulouse-St. Louis University Mini Falls Assessment (TSLUMFA). Objectives were to validate the TSLUMFA by testing if it differentiates between prior non fallers (n=80) and fallers (n=23), and predicts future falls as well as or better than the gold standard Tinetti Gait and Balance Instrument (TGBI). Examine if the subset of FRAIL Scale items on the TSLUMFA distinguishes between previous non fallers (n=75) and fallers (n=20), and predicts future falls as well as or better than the TGBI. Identify TSLUMFA cut offs scores for fall risk. DESIGN Prospective validation study. SETTING Participants were ambulatory patients presenting to the SLU Geriatrics Clinic. PARTICIPANTS 103 ambulatory older adults. MEASUREMENTS Fall risk was assessed using the three assessments. Outcome measures were previous falls and follow up falls. RESULTS TSLUMFA, FRAIL, and TGBI differentiated between previous fallers and non fallers. A TSLUMFA score <23 stratified patients as moderate risk (Sensitivity=0.806 Specificity=0.776) and a score <21 stratified patients as high risk (Sensitivity=0.929 Specificity=0.897). 78% of patients (n=80) participated in follow up and 20% (n=16) of these patients fell during follow up. TSLUMFA and TGBI absolute scores were lower among patients who fell during the follow up period versus non fallers but the observed differences were not statistically significant (TSLUMFA P=0.123 and TGBI P=0.074). CONCLUSION This study validated the TSLUMFA and FRAIL. No test predicted falls with statistical significance (most likely due to the low follow up participation) but a positive trend was seen. Clinical recommendations from this study are to use the FRAIL as an initial fall screen and patients scoring > 3 should be analyzed by TSLUMFA. The TSLUMFA's advantage is that it pinpoints areas that will directly benefit from therapy to reduce falls.
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Affiliation(s)
- J E Rouck
- John E. Rouck, BS. Division of Geriatric Medicine, 1402 South Grand Blvd., Room M238 St. Louis, MO 63110-0250, Personal Phone: 314-477-8462,
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Castioni J, Marques-Vidal P, Abolhassani N, Vollenweider P, Waeber G. Prevalence and determinants of polypharmacy in Switzerland: data from the CoLaus study. BMC Health Serv Res 2017; 17:840. [PMID: 29268737 PMCID: PMC5740765 DOI: 10.1186/s12913-017-2793-z] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2017] [Accepted: 12/13/2017] [Indexed: 11/10/2022] Open
Abstract
Background Polypharmacy is a frequent condition, but its prevalence and determinants in the Swiss mid-aged population are unknown. We aimed to evaluate the prevalence and determinants of polypharmacy in a large Swiss mid-aged population-based sample. Methods Data from 4938 participants of the CoLaus study (53% women, age range 40–81 years) were collected between 2009 and 2012. Polypharmacy was defined by the regular use of five or more drugs. Results Polypharmacy was reported by 580 participants [11.8%, 95% confidence interval (10.9; 12.6)]. Participants on polypharmacy were significantly older (mean ± standard deviation: 66.0 ± 9.1 vs. 56.6 ± 10.1 years), more frequently obese (35.9% vs. 14.7%), of lower education (66.6% vs. 50.7%) and former smokers (46.7% vs. 36.4%) than participants not on polypharmacy. These findings were confirmed by multivariate analysis: odds ratio and (95% confidence interval) for age groups 50–64 and 65–81 relative to 40–49 years: 2.90 (2.04; 4.12) and 10.3 (7.26; 14.5), respectively, p for trend < 0.001; for low relative to high education: 1.56 (1.17; 2.07); for overweight and obese relative to normal weight participants: 2.09 (1.65; 2.66) and 4.38 (3.39; 5.66), respectively, p for trend < 0.001; for former and current relative to never smokers: 1.42 (1.14, 1.75) and 1.63 (1.25, 2.12), respectively, p for trend < 0.001. Conclusion One out of nine participants of our sample is on polypharmacy. Increasing age, body mass index, smoking and lower education independently increase the likelihood of being on polypharmacy. Electronic supplementary material The online version of this article (10.1186/s12913-017-2793-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Julien Castioni
- Department of Medicine, Internal Medicine, Lausanne university hospital, Rue du Bugnon 46, 1011, Lausanne, Switzerland.
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Abrahamson K, Nazir A, Pressler K. A novel approach to deprescribing in long-term care settings: The SMART campaign. Res Social Adm Pharm 2017; 13:1202-1203. [DOI: 10.1016/j.sapharm.2016.11.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2016] [Accepted: 11/27/2016] [Indexed: 11/16/2022]
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Almeida NAD, Reiners AAO, Azevedo RCDS, Silva AMCD, Cardoso JDC, Souza LCD. Prevalence of and factors associated with polypharmacy among elderly persons resident in the community. REVISTA BRASILEIRA DE GERIATRIA E GERONTOLOGIA 2017. [DOI: 10.1590/1981-22562017020.160086] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Abstract Objective: to verify the prevalence of and factors associated with polypharmacy among elderly residents of the city of Cuiabá, in the state of Mato Grosso. Method: a cross-sectional study of 573 people aged 60 and over was performed. Polypharmacy was defined as the use of five or more medications. To investigate the association between polypharmacy and sociodemographic variables, health and access to medication, the Mantel Haenszel chi square test was used in bivariate analysis and Poisson regression was used in multivariate analysis. The significance level adopted was 5%. Result: the prevalence of polypharmacy was 10.30%. Statistically significant associations were found between polypharmacy and living with others, describing suffering from circulatory, endocrine, nutritional and digestive tract diseases, and referring to financial difficulties for the purchase of medicines. Conclusion: some social and health condition factors play an important role in the use of multiple medications among the elderly.
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Yuruyen M, Yavuzer H, Demirdag F, Kara Z, Cengiz M, Yavuzer S, Doventas A, Erdincler DS, Beger T. Is Depression a Predictive Factor for Polypharmacy in Elderly? ACTA ACUST UNITED AC 2017. [DOI: 10.5455/bcp.20160224101558] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- Mehmet Yuruyen
- Istanbul University, Cerrahpasa School of Medicine, Department of Internal Medicine, Division of Geriatrics, Istanbul - Turkey
| | - Hakan Yavuzer
- Istanbul University, Cerrahpasa School of Medicine, Department of Internal Medicine, Division of Geriatrics, Istanbul - Turkey
| | - Filiz Demirdag
- Istanbul University, Cerrahpasa School of Medicine, Department of Internal Medicine, Division of Geriatrics, Istanbul - Turkey
| | - Zehra Kara
- Istanbul University, Cerrahpasa School of Medicine, Department of Internal Medicine, Division of Geriatrics, Istanbul - Turkey
| | - Mahir Cengiz
- Istanbul University, Cerrahpasa School of Medicine, Department of Internal Medicine, Division of General Medicine, Istanbul - Turkey
| | - Serap Yavuzer
- Istanbul University, Cerrahpasa School of Medicine, Department of Internal Medicine, Division of General Medicine, Istanbul - Turkey
| | - Alper Doventas
- Istanbul University, Cerrahpasa School of Medicine, Department of Internal Medicine, Division of Geriatrics, Istanbul - Turkey
| | - Deniz Suna Erdincler
- Istanbul University, Cerrahpasa School of Medicine, Department of Internal Medicine, Division of Geriatrics, Istanbul - Turkey
| | - Tanju Beger
- Istanbul University, Cerrahpasa School of Medicine, Department of Internal Medicine, Division of Geriatrics, Istanbul - Turkey
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Turkmenoglu FP, Kutsal YG, Dolgun AB, Diker Y, Baydar T. Evaluation of herbal product use and possible herb–drug interactions in Turkish elderly. Complement Ther Clin Pract 2016; 23:46-51. [DOI: 10.1016/j.ctcp.2016.03.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2016] [Accepted: 03/16/2016] [Indexed: 12/13/2022]
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Nishtala PS, Salahudeen MS. Temporal Trends in Polypharmacy and Hyperpolypharmacy in Older New Zealanders over a 9-Year Period: 2005–2013. Gerontology 2016; 61:195-202. [PMID: 25428287 DOI: 10.1159/000368191] [Citation(s) in RCA: 70] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2014] [Accepted: 09/08/2014] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Polypharmacy and hyperpolypharmacy are proxy indicators for inappropriate medicine use. Inappropriate medicine use in older people leads to adverse clinical outcomes. OBJECTIVE The objectives of this study were to investigate the prevalence and trends of polypharmacy and hyperpolypharmacy in older people in New Zealand from 2005 to 2013, analyzing the pharmaceutical collections maintained by the Ministry of Health. METHODS A repeated cross-sectional analysis of population-level dispensing data was conducted from January 1, 2005 to December 31, 2013. Polypharmacy and hyperpolypharmacy in individuals were defined as the use of 5-9 medicines and ≥10 medicines, respectively, dispensed concurrently for a period of ≥90 days. Differences in polypharmacy and hyperpolypharmacy between 2005 and 2013 were examined. A multinomial regression model was used to predict sociodemographic characteristics associated with polypharmacy and hyperpolypharmacy. RESULTS Polypharmacy and hyperpolypharmacy were found to be higher in 2013 compared to 2005 (polypharmacy: 29.5 vs. 23.4%, p<0.001; hyperpolypharmacy: 2.1 vs. 1.3%, p<0.001). The risk of polypharmacy and hyperpolypharmacy was higher in females, in those aged 80-84 years, in the Māori population (for polypharmacy) and the Middle Eastern, Latin American, or African population (for hyperpolypharmacy), in people living in the Southern-district health board, and in individuals with increasing deprivation. CONCLUSION The population of New Zealand is aging and the number of older people with multiple chronic conditions is increasing. The proportion of older people exposed to polypharmacy and hyperpolypharmacy has increased in 2013 compared to 2005. Our study provides important information to alert health policy makers, researchers, and clinicians about the dire need to reduce the medication burden in older New Zealanders.
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Affiliation(s)
- Y Rolland
- John E. Morley, MB, BCh, Division of Geriatric Medicine, Saint Louis University School of Medicine, 1402 S. Grand Blvd., M238, St. Louis, MO 63104,
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Wysokiński A, Sobów T, Kłoszewska I, Kostka T. Mechanisms of the anorexia of aging-a review. AGE (DORDRECHT, NETHERLANDS) 2015; 37:9821. [PMID: 26232135 PMCID: PMC5005824 DOI: 10.1007/s11357-015-9821-x] [Citation(s) in RCA: 125] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/20/2015] [Accepted: 07/22/2015] [Indexed: 05/05/2023]
Abstract
Many, even healthy, older people fail to adequately regulate food intake and experience loss of weight. Aging-associated changes in the regulation of appetite and the lack of hunger have been termed as the anorexia of aging. The etiology of the anorexia of aging is multi-factorial and includes a combination of physiological changes associated with aging (decline in smell and taste, reduced central and peripheral drive to eat, delayed gastric emptying), pathological conditions (depression, dementia, somatic diseases, medications and iatrogenic interventions, oral-health status), and social factors (poverty, loneliness). However, exact mechanisms of the anorexia of aging remain to be elucidated. Many neurobiological mechanisms may be secondary to age-related changes in body composition and not associated with anorexia per se. Therefore, further studies on pathophysiological mechanisms of the anorexia of aging should employ accurate measurement of body fat and lean mass. The anorexia of aging is associated with protein-energy malnutrition, sarcopenia, frailty, functional deterioration, morbidity, and mortality. Since this symptom can lead to dramatic consequences, early identification and effective interventions are needed. One of the most important goals in the geriatric care is to optimize nutritional status of the elderly.
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Affiliation(s)
- Adam Wysokiński
- Department of Old Age Psychiatry and Psychotic Disorders, Medical University of Lodz, Czechosłowacka 8/10, 92-216, Łódź, Poland,
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Morley JE. Exercise: The Ultimate Medicine. J Am Med Dir Assoc 2015; 16:351-3. [DOI: 10.1016/j.jamda.2015.02.011] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2015] [Accepted: 02/16/2015] [Indexed: 12/25/2022]
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Kaehr E, Visvanathan R, Malmstrom TK, Morley JE. Frailty in Nursing Homes: The FRAIL-NH Scale. J Am Med Dir Assoc 2015; 16:87-9. [DOI: 10.1016/j.jamda.2014.12.002] [Citation(s) in RCA: 75] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2014] [Accepted: 12/01/2014] [Indexed: 10/24/2022]
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Yang M, Lu J, Hao Q, Luo L, Dong B. Does residing in urban or rural areas affect the incidence of polypharmacy among older adults in western China? Arch Gerontol Geriatr 2014; 60:328-33. [PMID: 25440757 DOI: 10.1016/j.archger.2014.11.004] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2014] [Revised: 11/09/2014] [Accepted: 11/13/2014] [Indexed: 02/05/2023]
Abstract
The aim of this study is to explore the differences among older adults who are rural or urban residents with respects to their socioeconomic position, chronic health conditions and medication use. This cross-sectional study included 887 community-dwelling older adults (≥60 years) from western China. Trained interviewers collected data from all of the study subjects through face-to-face interviews. Polypharmacy was defined as the concomitant use of five or more medications. A total of 717 participants were included in the study analyses. Compared with their urban counterparts, the older adults in rural China were more likely to have more chronic health conditions, and a lower education level, annual income and insurance coverage rate. In addition, the rural inhabitants were less likely to use medications (58.7% vs. 75.7%, p<0.001). The intensity of medication use (the mean number of drugs) was 1.7 for rural residents and 2.3 for urban residents (p<0.001). The prevalence of polypharmacy was significantly lower in rural residents than urban residents (11.5% vs. 17.5%, p=0.021). Urban residence (odds ratios (OR) 1.89, 95% confidence intervals (CI) 1.03-3.48), number of chronic conditions (OR 1.95, 95% CI 1.16-3.30), diabetes (OR 4.14, 95% CI 2.33-7.37), and cardiovascular disease (CVD) (OR 2.09, 95% CI 1.25-3.51) were positively associated with polypharmacy, whereas good self-rated health (OR 0.32, 95% CI 0.16-0.65) was negatively associated with polypharmacy. In conclusion, urban residence is independently associated with polypharmacy in Chinese elders regardless of chronic health conditions and socioeconomic status.
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Affiliation(s)
- Ming Yang
- The Center of Gerontology and Geriatrics, West China Hospital, Sichuan University, No. 37 Guoxue Lane, Chengdu, Sichuan, China
| | - Jing Lu
- Department of Pharmacy, West China Hospital, Sichuan University, No. 37 Guoxue Lane, Chengdu, Sichuan, China
| | - Qiukui Hao
- The Center of Gerontology and Geriatrics, West China Hospital, Sichuan University, No. 37 Guoxue Lane, Chengdu, Sichuan, China
| | - Li Luo
- The Center of Gerontology and Geriatrics, West China Hospital, Sichuan University, No. 37 Guoxue Lane, Chengdu, Sichuan, China
| | - Birong Dong
- The Center of Gerontology and Geriatrics, West China Hospital, Sichuan University, No. 37 Guoxue Lane, Chengdu, Sichuan, China.
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Inappropriate Drug Prescribing and Polypharmacy Are Major Causes of Poor Outcomes in Long-Term Care. J Am Med Dir Assoc 2014; 15:780-2. [DOI: 10.1016/j.jamda.2014.09.003] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2014] [Accepted: 09/04/2014] [Indexed: 01/14/2023]
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Morley JE, Mahon G. Statins and the nursing home. J Am Med Dir Assoc 2014; 14:853-4. [PMID: 24286708 DOI: 10.1016/j.jamda.2013.09.016] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2013] [Accepted: 09/24/2013] [Indexed: 12/31/2022]
Affiliation(s)
- John E Morley
- Divisions of Geriatric Medicine and Endocrinology, Saint Louis University School of Medicine, St. Louis, MO.
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Salih SB, Yousuf M, Durihim H, Almodaimegh H, Tamim H. Prevalence and associated factors of polypharmacy among adult Saudi medical outpatients at a tertiary care center. J Family Community Med 2014; 20:162-7. [PMID: 24672273 PMCID: PMC3957169 DOI: 10.4103/2230-8229.121987] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Objective: The objective of this study was to assess the prevalence of polypharmacy (PP) and the associated factors in medical outpatients. Materials and Methods: A cross-sectional, observational, descriptive study was carried out in adult medical outpatients attending internal medicine clinics at King Abdulaziz Medical City, Riyadh, Saudi Arabia from 1 March 2009 to 31 December 2009. PP was defined as the concomitant use of ≥5 medications daily. The number of medications being currently taken by patient was recorded. Effect of patients’ age, gender, educational level, number of prescribers, disease load and disease type on PP was assessed by multivariate analysis using Statistical Package for Social Sciences Incorporated (SPSS Inc) Version 18. Results: Out of 766 patients included in the study, 683 (89%) had PP. The mean number of prescribed medications, oral pills and doses was 8.8, 9.6 and 12.1, respectively. Factors significantly associated with PP included age (≥61 years), disease load and the number of prescribers. Gender had no impact on PP while education beyond primary education significantly decreased PP. Hypertension, diabetes mellitus and dyslipidemia alone and as a cluster increased PP. Conclusion: We found an extremely high level of PP in medical outpatients at our tertiary care center. The impact of PP on medication compliance and control of underlying diseases in Saudi Arabia is unknown and needs to be studied at different levels of care.
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Affiliation(s)
- Salih Bin Salih
- Department of Medicine, College of Medicine, King Abdulaziz Medical City and King Saud Bin Abulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia
| | - Muhammad Yousuf
- Department of Medicine, College of Medicine, King Abdulaziz Medical City and King Saud Bin Abulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia
| | - Huda Durihim
- Department of Medicine, College of Medicine, King Abdulaziz Medical City and King Saud Bin Abulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia
| | - Hind Almodaimegh
- Department of Clinical Pharmacy, College of Medicine, King Abdulaziz Medical City and King Saud Bin Abulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia
| | - Hani Tamim
- Department of Medical Education, College of Medicine, King Abdulaziz Medical City and King Saud Bin Abulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia
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Marco J, Barba R, Matía P, Plaza S, Méndez M, Canora J, Zapatero A. Low prevalence of hyponatremia codification in departments of internal medicine and its prognostic implications. Curr Med Res Opin 2013; 29:1757-62. [PMID: 23992405 DOI: 10.1185/03007995.2013.836079] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE Hyponatremia is the most frequent ionic disorder among ambulatory and hospitalized populations. The aim of the study is to describe the profile of patients admitted to internal medicine departments of Spanish hospitals with a diagnostic codification of hyponatremia in their discharge sheets. METHODS Data from the Minimum Basic Data Set (MBDS) of discharged patients from all departments of internal medicine (IM) of the Spanish National Health System (NHS) between 2007 and 2010 were analyzed to describe the profile of patients with diagnostic codification of hyponatremia. RESULTS A total of 2,134,363 admittances were analyzed, identifying 31,933 (1.5%) with a diagnostic code of hyponatremia (18.3% as principal diagnosis and 81.7% as secondary diagnosis). Mortality among patients with codified hyponatremia was markedly higher than in patients without this condition (13.1% vs 9.8% [OR 1.38; 95% CI 1.33-1.41]). Hyponatremia codification was independently associated with a higher risk of readmission (OR 1.33 CI 95% 1.29-1.38). Average length of stay for patients with hyponatremia was 11.67 days (SD 13.01), compared to 9.84 days (SD 11.61) among the general population admitted to IM (p < 0.001). Mean cost per admission in the presence of codified hyponatremia was €4023 (SD €2531), compared to €3537 (SD €2858.02); p < 0.001. Hyponatremia was more prevalent among patients with the following conditions: dementia, chronic and acute renal failure, hepatic cirrhosis, pressure ulcers, heart failure, and depression. CONCLUSIONS We found an extremely low prevalence of hyponatremia codification in our series (1.5%). Hyponatremia is underreported and undertreated although numerous studies have shown its devastating impact on hospital admittance. The first step in order to improve this situation is to raise awareness among physicians about a problem that despite its high prevalence is still overlooked.
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Affiliation(s)
- Javier Marco
- Internal Medicine Department, Hospital Clínico San Carlos , Madrid , Spain
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Morley JE, Vellas B, van Kan GA, Anker SD, Bauer JM, Bernabei R, Cesari M, Chumlea WC, Doehner W, Evans J, Fried LP, Guralnik JM, Katz PR, Malmstrom TK, McCarter RJ, Gutierrez Robledo LM, Rockwood K, von Haehling S, Vandewoude MF, Walston J. Frailty consensus: a call to action. J Am Med Dir Assoc 2013; 14:392-7. [PMID: 23764209 DOI: 10.1016/j.jamda.2013.03.022] [Citation(s) in RCA: 2405] [Impact Index Per Article: 218.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2013] [Accepted: 03/27/2013] [Indexed: 02/07/2023]
Abstract
Frailty is a clinical state in which there is an increase in an individual's vulnerability for developing increased dependency and/or mortality when exposed to a stressor. Frailty can occur as the result of a range of diseases and medical conditions. A consensus group consisting of delegates from 6 major international, European, and US societies created 4 major consensus points on a specific form of frailty: physical frailty. 1. Physical frailty is an important medical syndrome. The group defined physical frailty as "a medical syndrome with multiple causes and contributors that is characterized by diminished strength, endurance, and reduced physiologic function that increases an individual's vulnerability for developing increased dependency and/or death." 2. Physical frailty can potentially be prevented or treated with specific modalities, such as exercise, protein-calorie supplementation, vitamin D, and reduction of polypharmacy. 3. Simple, rapid screening tests have been developed and validated, such as the simple FRAIL scale, to allow physicians to objectively recognize frail persons. 4. For the purposes of optimally managing individuals with physical frailty, all persons older than 70 years and all individuals with significant weight loss (>5%) due to chronic disease should be screened for frailty.
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Affiliation(s)
- John E Morley
- Division of Geriatric Medicine, Saint Louis University School of Medicine, St. Louis, MO 63104, USA.
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Flaherty JH, Morley JE. Delirium in the Nursing Home. J Am Med Dir Assoc 2013; 14:632-4. [DOI: 10.1016/j.jamda.2013.06.009] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2013] [Accepted: 06/26/2013] [Indexed: 10/26/2022]
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Morley JE. Frailty, Falls, and Fractures. J Am Med Dir Assoc 2013; 14:149-51. [DOI: 10.1016/j.jamda.2012.12.009] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2012] [Accepted: 12/18/2012] [Indexed: 12/24/2022]
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Updated 2012 Beers Criteria: What’s Noteworthy and Cautionary? J Am Med Dir Assoc 2012; 13:768-9. [DOI: 10.1016/j.jamda.2012.08.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2012] [Accepted: 08/06/2012] [Indexed: 11/19/2022]
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Journal of the American Medical Directors Association: The State of the Journal. J Am Med Dir Assoc 2012; 13:571-3. [DOI: 10.1016/j.jamda.2012.07.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2012] [Accepted: 07/27/2012] [Indexed: 01/14/2023]
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Messinger-Rapport BJ, Cruz-Oliver DM, Thomas DR, Morley JE. Clinical Update on Nursing Home Medicine: 2012. J Am Med Dir Assoc 2012; 13:581-94. [DOI: 10.1016/j.jamda.2012.06.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2012] [Accepted: 06/08/2012] [Indexed: 01/24/2023]
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Affiliation(s)
- J E Morley
- Division of Geriatric Medicine, Saint Louis University School of Medicine, St. Louis, MO 63104, USA.
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Increasing Awareness of the Factors Producing Falls: The Mini Falls Assessment. J Am Med Dir Assoc 2012; 13:87-90. [DOI: 10.1016/j.jamda.2011.11.002] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2011] [Accepted: 11/14/2011] [Indexed: 11/21/2022]
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Geriatric Principles: Evidence-Based Medicine at Its Best. J Am Med Dir Assoc 2012; 13:1-2.e1-2. [DOI: 10.1016/j.jamda.2011.10.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2011] [Accepted: 10/14/2011] [Indexed: 11/20/2022]
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Abstract
Polypharmacy is generally defined as the use of 5 or more prescription medications on a regular basis. The average number of prescribed and over-the-counter medications used by community-dwelling older adults per day in the United States is 6 medications, and the number used by institutionalized older persons is 9 medications. Almost all medications affect nutriture, either directly or indirectly, and nutriture affects drug disposition and effect. This review will highlight the issues surrounding polypharmacy, food-drug interactions, and the consequences of these interactions for the older adult.
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Affiliation(s)
- Roschelle Heuberger
- Department of Human Environmental Studies, Central Michigan University, Mt Pleasant, Michigan 48859, USA.
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Messinger-Rapport BJ, Morley JE, Thomas DR, Gammack JK. Clinical Update on Nursing Home Medicine: 2011. J Am Med Dir Assoc 2011; 12:615-626.e6. [DOI: 10.1016/j.jamda.2011.08.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2011] [Accepted: 08/17/2011] [Indexed: 12/30/2022]
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Morley JE. Dementia-Related Agitation. J Am Med Dir Assoc 2011; 12:611-612.e2. [DOI: 10.1016/j.jamda.2011.08.008] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2011] [Accepted: 08/23/2011] [Indexed: 01/05/2023]
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Anticholinergic Medications and Cognition. J Am Med Dir Assoc 2011; 12:543-543.e1. [DOI: 10.1016/j.jamda.2011.07.008] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2011] [Accepted: 07/14/2011] [Indexed: 01/17/2023]
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Franssen FME, Spruit MA, Wouters EFM. Determinants of polypharmacy and compliance with GOLD guidelines in patients with chronic obstructive pulmonary disease. Int J Chron Obstruct Pulmon Dis 2011; 6:493-501. [PMID: 22069360 PMCID: PMC3206765 DOI: 10.2147/copd.s24443] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Background Polypharmacy of respiratory medications is commonly observed in patients with chronic obstructive pulmonary disease (COPD). The aims of this study were to investigate determinants of polypharmacy and to study the consistency of actual respiratory drug use with current Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines in pulmonary rehabilitation candidates with COPD. Methods Data were extracted from the records of all patients with a diagnosis of COPD referred for pulmonary rehabilitation to CIRO+ between 2005 and 2009. Use of respiratory medications, self-reported COPD exacerbations, lung function, blood gases, exercise capacity, Medical Research Council (MRC) dyspnea grade, and St George’s Respiratory Questionnaire (SGRQ) were recorded as part of assessment of health status. Results In total, 1859 COPD patients of mean age (± standard deviation) 64.3 ± 9.7 years and with a forced expiratory volume in one second (FEV1) of 44.7% ± 18.2% were included. On average, patients used 3.5 ± 1.5 respiratory medications; this number increased with increasing GOLD stage, MRC score, and SGRQ scores. FEV1 (% predicted), SGRQ, and number of recent exacerbations were independent determinants of polypharmacy. Use of long-acting bronchodilators and inhaled corticosteroids was substantial and comparable in all GOLD stages. Use of corticosteroids was not restricted to patients with frequent exacerbations. Conclusion Polypharmacy of respiratory medications is common in COPD patients with persistent symptoms. In addition to severity of disease, health status is an independent predictor of polypharmacy. Actual drug use in COPD patients referred for pulmonary rehabilitation is partially inconsistent with current GOLD guidelines.
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Affiliation(s)
- Frits M E Franssen
- Program Development Center, CIRO+, Center of Expertise for Chronic Organ Failure, Horn, The Netherlands.
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AMDA—A Leader in Developing International Long-Term Care. J Am Med Dir Assoc 2011; 12:319-20. [DOI: 10.1016/j.jamda.2011.03.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2011] [Accepted: 03/31/2011] [Indexed: 11/23/2022]
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Abstract
With the advent of the graying of the baby boomers, there is an urgent need to enhance care in the nursing home. This article focuses on the areas where high-quality care can improve outcomes.
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Affiliation(s)
- Debbie Tolson
- Scottish Centre for Evidence Based Care of Older People, Glasgow Caledonian University, Cowcaddens Road, Glasgow G4 OBA, UK
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Morley JE. Undernutrition: a major problem in nursing homes. J Am Med Dir Assoc 2011; 12:243-6. [PMID: 21527163 DOI: 10.1016/j.jamda.2011.02.013] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2011] [Accepted: 02/24/2011] [Indexed: 11/16/2022]
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Philpot C, Tolson D, Morley JE. Advanced Practice Nurses and Attending Physicians: A Collaboration to Improve Quality of Care in the Nursing Home. J Am Med Dir Assoc 2011; 12:161-5. [DOI: 10.1016/j.jamda.2010.12.012] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2010] [Accepted: 12/13/2010] [Indexed: 12/19/2022]
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