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Peral Bolaños C, Santaolalla García I, Gómez Valbuena I, Vega Ruíz L, Iglesias Carabias C, Martín Valero R, Martínez Martínez F. [Pharmacological intervention in the medication review of institutionalised elderly patients under polypharmacy]. Aten Primaria 2024; 56:102959. [PMID: 38763097 PMCID: PMC11126877 DOI: 10.1016/j.aprim.2024.102959] [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: 02/13/2024] [Revised: 04/09/2024] [Accepted: 04/12/2024] [Indexed: 05/21/2024] Open
Abstract
OBJECTIVE To describe the Drug-Related Problems (DRP) and their resolution after pharmacological review in institutionalised elderly patients under polypharmacy. DESIGN Descriptive, retrospective cohort study from January to October of 2022. LOCATION Twelve nursing homes at the Community of Madrid. PARTICIPANTS 295 patients aged 65 or older taking at least 5 chronic medications prescribed prior to the treatment review. INTERVENTIONS Medication reviews carried out by the pharmacist and agreed upon in face-to-face meetings between the primary care doctor, the nursing home doctor and the pharmacist. MAIN MEASUREMENTS Detected DRP, types and resolution. A age, sex, and number of medications before and after the intervention. Pharmacological subgroups according to anatomical therapeutic chemical classification system (ATC) and active pharmaceutical ingredients involved in the detected DRPs. RESULTS 1425 DRP were detected, with a mean of 4.85 (SD 3.33) DRPs/patient. The most frequent DRP was reconciliation error (32.52%), followed by pharmaceutical regimen and dosaje. Among the 1425 improvement proposals, 86.73% of them were accepted.Significant statistically differences were observed between the number of medications per patient prior to the pharmacotherapy review (12.29) and after it (10.20), obtaining an average difference of 2.09 (95%CI: 1.98-2.21; P<.001). CONCLUSIONS It is found that the intervention of multidisciplinary team in which the pharmacist performs a revision of the medication decreased the number of prescribed medications. Therefore, it reduces polymedication and its associated risks.
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Affiliation(s)
- Cristina Peral Bolaños
- Gerencia Asistencial de Atención Primaria de la Comunidad de Madrid, Dirección Asistencial Sureste, Madrid, España.
| | - Isabel Santaolalla García
- Gerencia Asistencial de Atención Primaria de la Comunidad de Madrid, Dirección Asistencial Sureste, Madrid, España
| | - Isabel Gómez Valbuena
- Gerencia Asistencial de Atención Primaria de la Comunidad de Madrid, Dirección Asistencial Sureste, Madrid, España
| | - Laura Vega Ruíz
- Gerencia Asistencial de Atención Primaria de la Comunidad de Madrid, Dirección Asistencial Sureste, Madrid, España
| | - Claudia Iglesias Carabias
- Unidad de Investigación, Gerencia Asistencial de Atención Primaria, Fundación para la Investigación e Innovación Biosanitaria en Atención Primaria, Madrid, España
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Higher FORTA (Fit fOR The Aged) scores are associated with poor functional outcomes, dementia, and mortality in older people. Eur J Clin Pharmacol 2022; 78:1851-1859. [PMID: 36167853 PMCID: PMC9546968 DOI: 10.1007/s00228-022-03389-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Accepted: 09/07/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE Higher Fit fOR The Aged (FORTA) scores have been shown to be negatively associated with adverse clinical outcomes in older hospitalized patients. This has not been evaluated in other health care settings. The aim of this study was to examine the association of the FORTA score with relevant outcomes in the prospective AgeCoDe-AgeQualiDe cohort of community-dwelling older people. In particular, the longitudinal relation between the FORTA score and mortality and the incidence of dementia was evaluated. METHODS Univariate and multivariate correlations between the FORTA score and activities of daily living (ADL) or instrumental activities of daily living (IADL) as well as comparisons between high vs. low FORTA scores were conducted. RESULTS The FORTA score was significantly correlated with ADL/IADL at baseline and at all follow-up visits (p < 0.0001). ADL/IADL results of participants with a low FORTA score were significantly better than in those with high FORTA scores (p < 0.0001). The FORTA score was also significantly (p < 0.0001) correlated with ADL/IADL in the multivariate analysis. Moreover, the mean FORTA scores of participants with dementia were significantly higher (p < 0.0001) than in those without dementia at follow-up visits 6 through 9. The mean FORTA scores of participants who died were significantly higher than those of survivors at follow-up visits 7 (p < 0.05), 8 (p < 0.001), and 9 (p < 0.001). CONCLUSION In this study, an association between higher FORTA scores and ADL as well as IADL was demonstrated in community-dwelling older adults. Besides, higher FORTA scores appear to be linked to a higher incidence of dementia and even mortality.
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Affiliation(s)
- Martin Wehling
- Clinical Pharmacology Mannheim, Centre for Gerontopharmacology, University of Heidelberg, Heidelberg, Germany.
| | - Mirko Petrovic
- Section of Geriatrics, Department of Internal Medicine and Paediatrics, Ghent University, Ghent, Belgium
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The FORTA (Fit fOR The Aged) List 2021: Fourth Version of a Validated Clinical Aid for Improved Pharmacotherapy in Older Adults. Drugs Aging 2022; 39:245-247. [PMID: 35194722 PMCID: PMC8934757 DOI: 10.1007/s40266-022-00922-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/17/2022] [Indexed: 11/16/2022]
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Geriatric Depression and Inappropriate Medication: Benefits of Interprofessional Team Cooperation in Nursing Homes. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182312438. [PMID: 34886164 PMCID: PMC8657238 DOI: 10.3390/ijerph182312438] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/24/2021] [Revised: 11/18/2021] [Accepted: 11/20/2021] [Indexed: 11/26/2022]
Abstract
An investigation of inappropriate medication use in treatment of depressivity in institutionalized older adults, based on a nurse-led evaluation of functional status and depressive symptoms in nursing home residents. Methods: A cross-sectional multicenter study was performed using records from 1087 residents cared for in fifteen nursing homes (NHs) in the Czech Republic. Inclusion criteria were being a permanent resident of one of the facilities, being 60 years of age or older, having a Geriatric Depression Scale score of 6 or more, and having a Mini Mental State examination score 10 or more. The final sample for analysis included 317 depressed NH residents. Results: 52 percent of NH residents with depressivity had no antidepressant treatment. Benzodiazepines were the only medication in 16 percent of depressed residents, and were added to antidepressant treatment in 18 percent of residents. Benzodiazepine users had significantly higher GDS scores compared to non-users (p = 0.007). Conclusion: More than half of depressed NH residents remained without antidepressant treatment. Residents inappropriately treated with benzodiazepines were more depressed than residents treated with antidepressants only, or even not treated at all. Cooperation of the interprofessional team in the screening of depressive symptoms has the potential to improve the quality of care.
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Molist-Brunet N, Sevilla-Sánchez D, Puigoriol-Juvanteny E, Espaulella-Ferrer M, Amblàs-Novellas J, Espaulella-Panicot J. Factors Associated with the Detection of Inappropriate Prescriptions in Older People: A Prospective Cohort. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:11310. [PMID: 34769827 PMCID: PMC8582657 DOI: 10.3390/ijerph182111310] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 10/11/2021] [Accepted: 10/22/2021] [Indexed: 11/24/2022]
Abstract
(1) Background: Ageing is associated with complex and dynamic changes leading to multimorbidity and, therefore, polypharmacy. The main objectives were to study an older community-dwelling cohort, to detect inappropriate prescriptions (IP) applying the Patient-Centred Prescription model, and to evaluate the most associated factors. (2) Methods: This was a prospective, descriptive, and observational study conducted from June 2019 to October 2020 on patients ≥ 65 years with multimorbidity who lived in the community. Demographic, clinical and pharmacological data were assessed. Variables assessed were: degree of frailty, using the Frail-VIG index; therapeutical complexity and anticholinergic and sedative burden; and the number of chronic drugs to determine polypharmacy or excessive polypharmacy. Finally, a medication review was carried out through the application of the Patient-Centred Prescription model. We used univariate and multivariate regression to identify the factors associated with IP. (3) Results: We recruited 428 patients (66.6% women; mean age 85.5, SD 7.67). A total of 50.9% of them lived in a nursing home; the mean Barthel Index was 49.93 (SD 32.14), and 73.8% of patients suffered some degree of cognitive impairment. The prevalence of frailty was 92.5%. Up to 90% of patients had at least one IP. An increase in IP prevalence was detected when the Frail-VIG index increased (p < 0.05). With the multivariate model, the relationship of polypharmacy with IP detection stands out above all. (4) Conclusions: 90% of patients presented one IP or more, and this situation can be detected through the PCP model. Factors with higher association with IP were frailty and polypharmacy.
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Affiliation(s)
- Núria Molist-Brunet
- Hospital Universitari de la Santa Creu de Vic, 08500 Vic, Spain; (M.E.-F.); (J.A.-N.); (J.E.-P.)
- Central Catalonia Chronicity Research Group (C3RG), Centre for Health and Social Care Research (CESS), Universitat de Vic. University of Vic-Central University of Catalonia (UVIC-UCC), 08500 Vic, Spain;
| | - Daniel Sevilla-Sánchez
- Central Catalonia Chronicity Research Group (C3RG), Centre for Health and Social Care Research (CESS), Universitat de Vic. University of Vic-Central University of Catalonia (UVIC-UCC), 08500 Vic, Spain;
- Pharmacy Department, Parc Sanitari Pere Virgili, 08023 Barcelona, Spain
| | - Emma Puigoriol-Juvanteny
- Epidemiology department. Hospital Universitari de Vic, 08500 Vic, Spain;
- Tissue Repair and Regeneration Laboratory (TR2Lab), University of Vic-Central University of Catalonia (UVIC-UCC), Fundació Hospital Universitari de la Santa Creu de Vic, and Hospital Universitari de Vic, 08500 Vic, Spain
| | - Mariona Espaulella-Ferrer
- Hospital Universitari de la Santa Creu de Vic, 08500 Vic, Spain; (M.E.-F.); (J.A.-N.); (J.E.-P.)
- Tissue Repair and Regeneration Laboratory (TR2Lab), University of Vic-Central University of Catalonia (UVIC-UCC), Fundació Hospital Universitari de la Santa Creu de Vic, and Hospital Universitari de Vic, 08500 Vic, Spain
| | - Jordi Amblàs-Novellas
- Hospital Universitari de la Santa Creu de Vic, 08500 Vic, Spain; (M.E.-F.); (J.A.-N.); (J.E.-P.)
- Central Catalonia Chronicity Research Group (C3RG), Centre for Health and Social Care Research (CESS), Universitat de Vic. University of Vic-Central University of Catalonia (UVIC-UCC), 08500 Vic, Spain;
- Chair of Palliative Care, University of Vic, 08500 Vic, Spain
| | - Joan Espaulella-Panicot
- Hospital Universitari de la Santa Creu de Vic, 08500 Vic, Spain; (M.E.-F.); (J.A.-N.); (J.E.-P.)
- Central Catalonia Chronicity Research Group (C3RG), Centre for Health and Social Care Research (CESS), Universitat de Vic. University of Vic-Central University of Catalonia (UVIC-UCC), 08500 Vic, Spain;
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Molist-Brunet N, Sevilla-Sánchez D, González-Bueno J, Garcia-Sánchez V, Segura-Martín LA, Codina-Jané C, Espaulella-Panicot J. Therapeutic optimization through goal-oriented prescription in nursing homes. Int J Clin Pharm 2021; 43:990-997. [PMID: 33247821 PMCID: PMC8352828 DOI: 10.1007/s11096-020-01206-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2020] [Accepted: 11/17/2020] [Indexed: 11/23/2022]
Abstract
Background People living in nursing homes are highly vulnerable and frail. Polypharmacy and inappropriate prescription (IP) are also common problems. Objectives The objectives of the study are (i) to study the baseline situation and calculate the frailty index (FI) of the residents, (ii) to assess the results of routine clinical practice to do a pharmacotherapy review (patient-centred prescription (PCP) model) (Molist Brunet et al., Eur Geriatr Med. 2015;6:565-9) and (iii) to study the relationship between IP and frailty, functional dependence, advanced dementia and end-of-life situation. Setting Two nursing homes in the same geographical area in Catalonia (Spain). Method This was a prospective, descriptive and observational study of elderly nursing home residents. Each patient's treatment was analysed by applying the PCP model, which centres therapeutic decisions on the patient's global assessment and individual therapeutic goal. Main outcome measure Prevalence of polypharmacy and IP. Results 103 patients were included. They were characterized by high multimorbidity and frailty. Up to 59.2% were totally dependent. At least one IP was identified in 92.2% of residents. Prior to the pharmacological review, the mean number of chronic medications prescribed per resident was 6.63 (SD 2.93) and after this review it was 4.97 (SD 2.88). Polypharmacy decreased from 72.55% to 52.94% and excessive polypharmacy fell from 18.62% to 5.88%.The highest prevalence of IP was detected in people with a higher FI, in those identified as end-of-life, and also in more highly dependent residents (p < 0.05). Conclusions People who live in nursing homes have an advanced frailty. Establishing individualized therapeutic objectives with the application of the PCP model enabled to detect 92.2% of IP. People who are frailer, are functionally more dependent and those who are end-of-life are prescribed with inappropriate medication more frequently.
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Affiliation(s)
- N Molist-Brunet
- Hospital Universitari de la Santa Creu de Vic, Vic, Barcelona, Spain.
- Central Catalonia Chronicity Research Group (C3RG), Centre for Health and Social Care Research (CESS), Universitat de Vic-University of Vic-Central University of Catalonia (UVIC-UCC), C. Miquel Martí i Pol, 1, 08500, Vic, Spain.
| | - D Sevilla-Sánchez
- Central Catalonia Chronicity Research Group (C3RG), Centre for Health and Social Care Research (CESS), Universitat de Vic-University of Vic-Central University of Catalonia (UVIC-UCC), C. Miquel Martí i Pol, 1, 08500, Vic, Spain
- Pharmacy Department, Hospital Universitari de Vic, Vic, Barcelona, Spain
| | - J González-Bueno
- Central Catalonia Chronicity Research Group (C3RG), Centre for Health and Social Care Research (CESS), Universitat de Vic-University of Vic-Central University of Catalonia (UVIC-UCC), C. Miquel Martí i Pol, 1, 08500, Vic, Spain
- Pharmacy Department, Hospital Universitari de Vic, Vic, Barcelona, Spain
| | | | | | - C Codina-Jané
- Central Catalonia Chronicity Research Group (C3RG), Centre for Health and Social Care Research (CESS), Universitat de Vic-University of Vic-Central University of Catalonia (UVIC-UCC), C. Miquel Martí i Pol, 1, 08500, Vic, Spain
- Pharmacy Department, Hospital Universitari de Vic, Vic, Barcelona, Spain
| | - J Espaulella-Panicot
- Hospital Universitari de la Santa Creu de Vic, Vic, Barcelona, Spain
- Central Catalonia Chronicity Research Group (C3RG), Centre for Health and Social Care Research (CESS), Universitat de Vic-University of Vic-Central University of Catalonia (UVIC-UCC), C. Miquel Martí i Pol, 1, 08500, Vic, Spain
- Geriatric and Palliative Care Department, Hospital Universitari de Vic, Vic, Barcelona, Spain
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Pazan F, Gercke Y, Weiss C, Wehling M. The JAPAN-FORTA (Fit fOR The Aged) list: Consensus validation of a clinical tool to improve drug therapy in older adults. Arch Gerontol Geriatr 2020; 91:104217. [PMID: 32791361 DOI: 10.1016/j.archger.2020.104217] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 07/28/2020] [Accepted: 07/29/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE Multimorbidity and subsequent polypharmacy are highly prevalent in older people. To improve inappropriate drug treatment, listing approaches such as the Beers or FORTA lists have been developed. Latter is the only clinically validated drug list issuing both positive (FORTA labels A, B) and negative (FORTA labels C, D) recommendations. Several country-specific FORTA lists have been developed to acknowledge national prescription habits, drug availabilities, and expert opinions. Here, this approach was applied to Japan. METHODS 13 Japanese experts in geriatric pharmacotherapy participated as raters in a 2-step Delphi consensus validation of the FORTA list. The proposal of FORTA labels was based on the EURO-FORTA List and raters were asked to add, delete or re-evaluate medications, add relevant diagnoses and comments. RESULTS The final JAPAN-FORTA list contains 210 items aligned to 24 main indication groups. 15 items were added to the proposal and the 71 items either not used/approved in Japan or not evaluated by any rater (oncological drugs) were removed. Excluding latter, the JAPAN-FORTA list differs from the EURO-FORTA list by 23 %. Removals mainly concerned psychotropic drugs. A maximum of one label was changed per indication. The majority (96.9 percent) of the proposed FORTA labels were confirmed, only 6 labels had to be changed. CONCLUSION The new JAPAN-FORTA list addresses the appropriateness of drug treatment in older people in Japan. This unique listing approach issuing both positive and negative medication recommendations has been shown to improve of drug therapy in older adults and its country-specific version is now available for Japan.
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Affiliation(s)
- Farhad Pazan
- Institute of Clinical Pharmacology, Medical Faculty Mannheim, Ruprecht-Karls-University Heidelberg, Germany
| | - Yana Gercke
- Institute of Clinical Pharmacology, Medical Faculty Mannheim, Ruprecht-Karls-University Heidelberg, Germany
| | - Christel Weiss
- Department of Medical Statistics, Biomathematics and Information Processing, Medical Faculty of the University of Heidelberg in Mannheim, Germany
| | - Martin Wehling
- Institute of Clinical Pharmacology, Medical Faculty Mannheim, Ruprecht-Karls-University Heidelberg, Germany.
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Moreira FSM, Jerez-Roig J, Ferreira LMDBM, Dantas APDQM, Lima KC, Ferreira MÂF. Use of potentially inappropriate medications in institutionalized elderly: prevalence and associated factors. CIENCIA & SAUDE COLETIVA 2020; 25:2073-2082. [PMID: 32520255 DOI: 10.1590/1413-81232020256.26752018] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Accepted: 10/26/2018] [Indexed: 12/21/2022] Open
Abstract
This study aimed to verify the prevalence of the use of Potentially Inappropriate Medications (PIM) for elderly living in Long-Term Care Institutions for the Elderly (LTCIE), as well as the types of medications and their associated factors. This is a cross-sectional study carried out in 10 LTCIEs in the city of Natal in the period October-December 2013. Potentially inappropriate medications were classified according to the 2015 American Geriatric Society Beers Criteria for Potentially Inappropriate Medication Use in Older Adults - 2015. Sociodemographic, LTCIE-related and health-related variables were considered. Univariate and multivariate analyses were performed between the primary variable (PIM use) and the independent variables using Poisson regression. The sample consisted of 321 older people, of whom 304 used medications. The prevalence of PIM use was 54.6% (95% CI: 48.9-60.2) and was associated with polypharmacy and dementia in the final model. The most common PIMs were antipsychotics and benzodiazepines. The study revealed a high prevalence of PIM use among the elderly of the LTCIEs, evidencing the need to adopt indicators on the use of these drugs and the implementation of strategies that make drug therapy safer and more adequate for older adults.
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Affiliation(s)
- Francisca Sueli Monte Moreira
- Departamento de Farmácia, Universidade Federal do Rio Grande do Norte (UFRN). R. General Gustavo Cordeiro de Farias s/n, Petrópolis. 59010-180, Natal, RN, Brasil.
| | - Javier Jerez-Roig
- Research Group on Methodology, Methods, Models and Outcomes of Health and Social Sciences (M3O), Faculty of Health Science and Welfare, Centre for Health and Social Care Research (CESS), University of Vic-Central University of Catalonia (UVIC-UCC)
| | | | | | - Kenio Costa Lima
- Programa de Pós-Graduação em Saúde Coletiva, UFRN. Natal, RN, Brasil
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Pazan F, Gercke Y, Weiss C, Wehling M, Marcum ZA, Gokula M, Nathan KT, Cheng HY, Tantipinichwong N, Gray SL, Sobeski LM, Sotelo M. The U.S.-FORTA (Fit fOR The Aged) List: Consensus Validation of a Clinical Tool to Improve Drug Therapy in Older Adults. J Am Med Dir Assoc 2020; 21:439.e9-439.e13. [DOI: 10.1016/j.jamda.2019.07.023] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Revised: 07/23/2019] [Accepted: 07/24/2019] [Indexed: 12/27/2022]
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Pazan F, Burkhardt H, Frohnhofen H, Weiss C, Throm C, Kuhn-Thiel A, Wehling M. Higher Fit-fOR-The-Aged (FORTA) Scores Comprising Medication Errors are Associated with Impaired Cognitive and Physical Function Tests in the VALFORTA Trial. Drugs Aging 2019; 36:269-277. [PMID: 30578459 DOI: 10.1007/s40266-018-0626-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND The Fit fOR The Aged (FORTA) list, a drug classification combining positive and negative labelling of drugs, has been clinically (VALFORTA-trial) validated to improve medication quality and clinical endpoints. OBJECTIVE The objective of this study was to determine the association of medication quality with functional abilities tested in cognitive and physical function tests. PATIENTS AND METHODS Data from the prospective, randomized controlled VALFORTA trial on 409 geriatric (mean age 81.53 years) in-hospital patients were tested for associations between the FORTA score (sum of over- and under-treatment errors) on admission and cognitive and physical function tests. Univariate and multivariate linear correlations corrected for age, sex, number of medications, number of chronic conditions, and body mass index as well as comparisons between high and low FORTA-score (cut-off 3) patients were performed. RESULTS The FORTA score was significantly correlated with Instrumental Activities of Daily Living (p < 0.0001), the Tinetti test (p < 0.002), Essen Questionnaire on Age and Sleepiness (p < 0.0001), Mini-Mental State Examination (p < 0.0001), and handgrip strength (p < 0.04) in the univariate analysis, and with Instrumental Activities of Daily Living (p < 0.003), the Tinetti test (p < 0.003), and the Essen Questionnaire on Age and Sleepiness (p < 0.0001) in the multivariate analysis. Effect size was weak for Instrumental Activities of Daily Living (R-squared = 0.12) and the Tinetti test (R-squared = 0.03) and medium for the Essen Questionnaire on Age and Sleepiness (R-squared = 0.22). Significant differences between patients with high and low FORTA scores were found for Instrumental Activities of Daily Living, the Tinetti test, mini-nutritional assessments, Mini-Mental State Examination, Essen Questionnaire on Age and Sleepiness, and the Geriatric Depression Scale. All significant tests revealed that higher FORTA scores (lower medication quality) were associated with less favorable test outcomes. CONCLUSIONS The FORTA score is associated with relevant aspects of comprehensive geriatric assessment, underlining the importance of medication quality for the functional and cognitive well-being of older patients. TRIAL REGISTRATION NUMBER DRKS00000531.
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Affiliation(s)
- Farhad Pazan
- Medical Faculty Mannheim, Institute for Clinical Pharmacology, Ruprecht-Karls-University Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Heinrich Burkhardt
- IV. Medical Department, Geriatrics, University Hospital Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Helmut Frohnhofen
- Department of Medicine, Faculty of Health, University Witten-Herdecke, Alfred-Herrhausen-Str. 50, 58448, Witten, Germany
| | - Christel Weiss
- Department of Medical Statistics, Biomathematics and Information Processing, Medical Faculty Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Christina Throm
- Department of Cardiology and Angiology, Agaplesion Markus Hospital, Wilhelm-Epstein-Str. 4, 60431, Frankfurt, Germany
| | | | - Martin Wehling
- Medical Faculty Mannheim, Institute for Clinical Pharmacology, Ruprecht-Karls-University Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany.
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The FORTA (Fit fOR The Aged) List 2018: Third Version of a Validated Clinical Tool for Improved Drug Treatment in Older People. Drugs Aging 2019; 36:481-484. [PMID: 30941728 DOI: 10.1007/s40266-019-00669-6] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Pazan F, Kather J, Wehling M. A systematic review and novel classification of listing tools to improve medication in older people. Eur J Clin Pharmacol 2019; 75:619-625. [PMID: 30683971 DOI: 10.1007/s00228-019-02634-z] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Accepted: 01/17/2019] [Indexed: 12/22/2022]
Abstract
PURPOSE Suboptimal drugs therapy is a threat to older people, and listing tools providing guidance are developed to address this problem. METHODS A systematic review was performed to identify and analyze such tools published until February 2018. A novel categorization was developed to separate patient-in-focus listing approaches (PILA) providing disease-related positive and negative guidance from drug-oriented, mostly negative listing approaches (DOLA, DOLA+: with disease specification). RESULTS In total, 76 tools were identified; only 9 were classified as PILA, 26 as DOLA, and 38 as DOLA+. Three DOLA(+) only address dementia. Most tools were developed in Europe or the USA and address community-dwellers. Thirty-two utilized a Delphi process, and only 10 provide a scoring system. Twenty tools utilize a questionnaire but no structured guidance or answers. Importantly, only 12 interventional clinical trials were identified reporting not only medication quality measures, but also clinical endpoints (e.g. falls, adverse drug reactions, hospitalization). For PILA, 4 trials showed positive, one negative clinical effects of a controlled intervention, for DOLA(+) 1 was positive, 7 negative (Fisher's exact test p < 0.05). DISCUSSION An abundance of listing tools has been created. DOLAs that may be applied without intricate patient knowledge prevail over PILAs by sevenfold; unfortunately their clinical validation seems to be far less successful than that of patient-initiated approaches. CONCLUSION Drug therapy in older people has to be tailored to their individual, very divergent needs; tools requiring detailed medical knowledge about the patient as the starting point for medication optimization provide the best support.
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Affiliation(s)
- Farhad Pazan
- Institute of Clinical Pharmacology, Medical Faculty Mannheim, Ruprecht-Karls-University Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Jonathan Kather
- Institute of Clinical Pharmacology, Medical Faculty Mannheim, Ruprecht-Karls-University Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Martin Wehling
- Institute of Clinical Pharmacology, Medical Faculty Mannheim, Ruprecht-Karls-University Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany.
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Fougère B. RETRACTED ARTICLE: Management of Frailty: Screening and Interventions. J Nutr Health Aging 2018. [DOI: 10.1007/s12603-018-1009-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Anrys PM, Strauven GC, Foulon V, Degryse JM, Henrard S, Spinewine A. Potentially Inappropriate Prescribing in Belgian Nursing Homes: Prevalence and Associated Factors. J Am Med Dir Assoc 2018; 19:884-890. [DOI: 10.1016/j.jamda.2018.06.010] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2018] [Revised: 06/07/2018] [Accepted: 06/11/2018] [Indexed: 01/07/2023]
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Rieckert A, Trampisch US, Klaaßen-Mielke R, Drewelow E, Esmail A, Johansson T, Keller S, Kunnamo I, Löffler C, Mäkinen J, Piccoliori G, Vögele A, Sönnichsen A. Polypharmacy in older patients with chronic diseases: a cross-sectional analysis of factors associated with excessive polypharmacy. BMC FAMILY PRACTICE 2018; 19:113. [PMID: 30021528 PMCID: PMC6052592 DOI: 10.1186/s12875-018-0795-5] [Citation(s) in RCA: 57] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Accepted: 06/13/2018] [Indexed: 12/21/2022]
Abstract
BACKGROUND Polypharmacy is common in older people and associated with potential harms. The aim of this study was to analyse the characteristics of an older multimorbid population with polypharmacy and to identify factors contributing to excessive polypharmacy in these patients. METHODS This cross-sectional analysis is based on the PRIMA-eDS trial, a large randomised controlled multicentre study of polypharmacy in primary care. Patients' baseline data were used for analysis. A number of socioeconomic and medical data as well as SF-12-scores were entered into a generalized linear mixed model to identify variables associated with excessive polypharmacy (taking ≥10 substances daily). RESULTS Three thousand nine hundred four participants were recruited. Risk factors significantly associated with excessive polypharmacy were frailty (OR 1.45; 95% CI 1.22-1.71), > 8 diagnoses (OR 2.64; 95% CI 2.24-3.11), BMI ≥30 (OR 1.18; 95% CI 1.02-1.38), a lower SF-12 physical health composite score (OR 1.47; 95% CI 1.26-1.72), and a lower SF-12 mental health composite score (OR 1.33; 95% CI 1.17-1.59) than the median of the study population (≤36.6 and ≤ 48.7, respectively). Age ≥ 85 years (OR 0.83; 95% CI 0.70-0.99) led to a significantly lower risk for excessive polypharmacy. No association with excessive polypharmacy could be found for female sex, low educational level, and smoking. Regarding the study centres, being recruited in the UK led to a significantly higher risk for excessive polypharmacy compared to being recruited in Germany 1/Rostock (OR 1.71; 95% CI 1.27-2.30). Being recruited in Germany 2/Witten led to a slightly significant lower risk for excessive polypharmacy compared to Germany 1/Rostock (OR 0.74; 95% CI 0.56-0.97). CONCLUSIONS Frailty, multimorbidity, obesity, and decreased physical as well as mental health status are risk factors for excessive polypharmacy. Sex, educational level, and smoking apparently do not seem to be related to excessive polypharmacy. Physicians should especially pay attention to their frail, obese patients who have multiple diagnoses and a decreased health-related quality of life, to check carefully whether all the drugs prescribed are evidence-based, safe, and do not interact in an unfavourable way. TRIAL REGISTRATION This trial has been registered with Current Controlled Trials Ltd. on 31 July 2014 (ISRCTN10137559).
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Affiliation(s)
- Anja Rieckert
- Institute of General Practice and Family Medicine, Faculty of Health, Witten/Herdecke University, Alfred-Herrhausen-Str. 50, 58448 Witten, Germany
| | - Ulrike S. Trampisch
- Department of Medical Informatics, Biometry and Epidemiology, Ruhr University, Universitätsstr. 105, 44789 Bochum, Germany
| | - Renate Klaaßen-Mielke
- Department of Medical Informatics, Biometry and Epidemiology, Ruhr University, Universitätsstr. 105, 44789 Bochum, Germany
| | - Eva Drewelow
- Institute of General Practice, Rostock University Medical Center, Doberaner Str. 142, 18057 Rostock, Germany
| | - Aneez Esmail
- NIHR School of Primary Care Research, University of Manchester, Oxford Road 176, M13 9PL, Manchester, UK
| | - Tim Johansson
- Centre for Primary Care, NIHR School of Primary Care Research, University of Manchester, Oxford Road M13 9PL, Manchester, UK
| | - Sophie Keller
- Centre for Primary Care, NIHR School of Primary Care Research, University of Manchester, Oxford Road M13 9PL, Manchester, UK
| | - Ilkka Kunnamo
- Duodecim Medical Publications Ltd., Kaivokatu 10 A, 00100 Helsinki, Finland
| | - Christin Löffler
- Institute of General Practice, Rostock University Medical Center, Doberaner Str. 142, 18057 Rostock, Germany
| | - Joonas Mäkinen
- Duodecim Medical Publications Ltd., Kaivokatu 10 A, 00100 Helsinki, Finland
| | - Giuliano Piccoliori
- South Tyrolean Academy of General Practice, Wangergasse 18, 39100 Bolzano, Italy
| | - Anna Vögele
- South Tyrolean Academy of General Practice, Wangergasse 18, 39100 Bolzano, Italy
| | - Andreas Sönnichsen
- Institute of General Practice and Family Medicine, Faculty of Health, Witten/Herdecke University, Alfred-Herrhausen-Str. 50, 58448 Witten, Germany
- NIHR School of Primary Care Research, University of Manchester, Oxford Road 176, M13 9PL, Manchester, UK
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Cool C, Cestac P, McCambridge C, Rouch L, de Souto Barreto P, Rolland Y, Lapeyre‐Mestre M. Reducing potentially inappropriate drug prescribing in nursing home residents: effectiveness of a geriatric intervention. Br J Clin Pharmacol 2018; 84:1598-1610. [PMID: 29607568 PMCID: PMC6005629 DOI: 10.1111/bcp.13598] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Revised: 02/12/2018] [Accepted: 03/02/2018] [Indexed: 11/27/2022] Open
Abstract
AIMS Potentially inappropriate drug prescribing (PIDP) is frequent in nursing home (NH) residents. We aimed to investigate whether a geriatric intervention on quality of care reduced PIDP. METHODS We performed an ancillary study within a multicentric individually-tailored controlled trial (IQUARE trial). All NH received a baseline and 18-month audit regarding drug prescriptions and other quality of care indicators. After the initial audit, NHs of the intervention group benefited of an in-site intervention (geriatric education for NH staff) provided by a geriatrician from the closest hospital. The analysis included 629 residents of 159 NHs. The main outcome was PIDP, defined as the presence of at least one of the following criteria: (i) drug with an unfavourable benefit-to-risk ratio; (ii) with questionable efficacy; (iii) absolute contraindication; (iv) significant drug-drug interaction. Multivariable multilevel logistic regression models were performed including residents and NH factors as confounders. RESULTS PIDP was 65.2% (-3.6% from baseline) in the intervention group (n = 339) and 69.9% (-2.3%) in the control group (n = 290). The intervention significantly decreased PIDP [odds ratio (OR) = 0.63; 95% confidence interval 0.40-0.99], as a special care unit in NH (OR = 0.60; (0.42 to 0.85)), and a fall in the last 12 months (OR = 0.63; 0.44-0.90). Charlson Comorbidity Index [ORCCI = 1 vs. 0 = 1.38; 0.87-2.19, ORCCI ≥ 2 vs. 0 = 2.01; (1.31-3.08)] and psychiatric advice and/or hospitalization in a psychiatric unit (OR = 1.53; 1.07-2.18) increased the likelihood of PIDP. CONCLUSION This intervention based on a global geriatric education resulted in a significant reduction of PIDP at patient level.
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Affiliation(s)
- Charlène Cool
- UMR INSERM 1027University of Toulouse IIIToulouseFrance
- Pôle Pharmacie, Centre Hospitalo‐Universitaire (CHU) de Toulouse1 avenue Jean PoulhèsF 31059ToulouseFrance
| | - Philippe Cestac
- UMR INSERM 1027University of Toulouse IIIToulouseFrance
- Pôle Pharmacie, Centre Hospitalo‐Universitaire (CHU) de Toulouse1 avenue Jean PoulhèsF 31059ToulouseFrance
| | - Cécile McCambridge
- Pôle Pharmacie, Centre Hospitalo‐Universitaire (CHU) de Toulouse1 avenue Jean PoulhèsF 31059ToulouseFrance
| | - Laure Rouch
- UMR INSERM 1027University of Toulouse IIIToulouseFrance
- Pôle Pharmacie, Centre Hospitalo‐Universitaire (CHU) de Toulouse1 avenue Jean PoulhèsF 31059ToulouseFrance
| | - Philipe de Souto Barreto
- Gérontopôle de Toulouse, Institut du VieillissementCentre Hospitalo‐Universitaire de ToulouseToulouseFrance
- UMR 7268 Aix‐Marseille, Laboratoire d'Anthropologie bioculturelle, droit, éthique et santéFrance
| | - Yves Rolland
- UMR INSERM 1027University of Toulouse IIIToulouseFrance
- Gérontopôle de Toulouse, Institut du VieillissementCentre Hospitalo‐Universitaire de ToulouseToulouseFrance
| | - Maryse Lapeyre‐Mestre
- UMR INSERM 1027University of Toulouse IIIToulouseFrance
- Service de Pharmacologie Médicale et Clinique, CIC Inserm 1436CHU de Toulouse37 Allées Jules GuesdeF 31000ToulouseFrance
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Affiliation(s)
- B Vellas
- 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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Messinger-Rapport BJ, Little MO, Morley JE, Gammack JK. Clinical Update on Nursing Home Medicine: 2016. J Am Med Dir Assoc 2017; 17:978-993. [PMID: 27780573 DOI: 10.1016/j.jamda.2016.09.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2016] [Accepted: 09/07/2016] [Indexed: 12/31/2022]
Abstract
This is the tenth clinical update. It covers chronic kidney disease, dementia, hypotension, polypharmacy, rapid geriatric assessment, and transitional care.
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Affiliation(s)
| | - Milta O Little
- Division of Geriatric Medicine, Saint Louis University School of Medicine, St. Louis, MO
| | - John E Morley
- Division of Geriatric Medicine, Saint Louis University School of Medicine, St. Louis, MO.
| | - Julie K Gammack
- Division of Geriatric Medicine, Saint Louis University School of Medicine, St. Louis, MO
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Morley JE. JAMDA Maintains Excellent Impact Factor. J Am Med Dir Assoc 2017; 18:737-740. [PMID: 28859817 DOI: 10.1016/j.jamda.2017.06.033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Accepted: 06/30/2017] [Indexed: 01/06/2023]
Affiliation(s)
- John E Morley
- Division of Geriatric Medicine, Saint Louis University School of Medicine, St. Louis, Missouri.
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Morley JE. Rapid Geriatric Assessment: Secondary Prevention to Stop Age-Associated Disability. Clin Geriatr Med 2017; 33:431-440. [PMID: 28689573 DOI: 10.1016/j.cger.2017.03.006] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
The Rapid Geriatric Assessment (RGA) measures frailty, sarcopenia, anorexia, cognition, and advanced directives. The RGA is a screen for primary care physicians to be able to detect geriatric syndromes. Early intervention when geriatric syndromes are recognized can decrease disability, hospitalization, and mortality.
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Affiliation(s)
- John E Morley
- Division of Geriatric Medicine, Saint Louis University School of Medicine, 1402 South Grand Boulevard, M238, St Louis, MO 63104, USA; Division of Endocrinology, Saint Louis University School of Medicine, 1402 South Grand Boulevard, M238, St Louis, MO 63104, USA.
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Laffon de Mazières C, Morley JE, Levy C, Agenes F, Barbagallo M, Cesari M, De Souto Barreto P, Donini LM, Fitten J, Franco A, Izquierdo M, Kane RA, Martin FC, Onder G, Ouslander J, Pitkälä K, Saliba D, Sinclair A, Manas LR, Vellas B, Rolland Y. Prevention of Functional Decline by Reframing the Role of Nursing Homes? J Am Med Dir Assoc 2017; 18:105-110. [PMID: 28126135 DOI: 10.1016/j.jamda.2016.11.019] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2016] [Accepted: 11/28/2016] [Indexed: 01/08/2023]
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Morley JE, Little MO, Berg-Weger M. Rapid Geriatric Assessment: A Tool for Primary Care Physicians. J Am Med Dir Assoc 2017; 18:195-199. [PMID: 28108203 DOI: 10.1016/j.jamda.2016.11.017] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2016] [Accepted: 11/28/2016] [Indexed: 01/16/2023]
Affiliation(s)
- John E Morley
- Divisions of Geriatric Medicine and Endocrinology, Saint Louis University School of Medicine, St. Louis, MO.
| | - Milta O Little
- Division of Geriatric Medicine, Saint Louis University School of Medicine, St. Louis, MO
| | - Marla Berg-Weger
- Division of Geriatric Medicine, Saint Louis University School of Medicine, St. Louis, MO
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Polypharmacy and potentially inappropriate medications: a cross-sectional analysis among 451 nursing homes in France. Eur J Clin Pharmacol 2017; 73:601-608. [PMID: 28093640 DOI: 10.1007/s00228-016-2193-z] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2016] [Accepted: 12/29/2016] [Indexed: 10/20/2022]
Abstract
PURPOSE The quality of drug therapy is an important issue for nursing homes. This study aimed to assess the prevalence of polypharmacy and potentially inappropriate medications (PIMs) in a large sample of nursing home residents by using the data recorded during the preparation of pill dispensers. METHODS This is a cross-sectional study that included 451 nursing homes across France. Information about the medications received by the 30,702 residents (73.8% women) living in these nursing homes was extracted from the system that assists in the preparation of pill dispensers in pharmacies. The anonymized database included age, sex, and medications prescribed to residents, as well as nursing home characteristics (capacity, legal status). Factors associated with excessive polypharmacy (≥10 different drugs) and PIMs according to the Laroche list were studied using multilevel regression models. RESULTS The average number of drugs prescribed was 6.9 ± 3.3, and excessive polypharmacy concerned 21.1% of the residents (n = 6468). According to the Laroche list, 47.4% of residents (n = 14,547) received at least one PIM. Benzodiazepines (excessive doses, long-acting benzodiazepines, and combination of benzodiazepines) and anticholinergic medications (hydroxyzine, cyamemazine, alimemazine) accounted for a large part of PIMs. Individual characteristics (age, gender) influenced the risk of receiving PIMs whereas nursing home characteristics (capacity, legal status) influenced the risk of excessive polypharmacy. CONCLUSIONS This study shows that polypharmacy and PIMs remain highly prevalent among nursing home residents. Main PIMs concerned psychotropic and anticholinergic medications.
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Morley JE. The Future of Long-Term Care. J Am Med Dir Assoc 2017; 18:1-7. [DOI: 10.1016/j.jamda.2016.11.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Accepted: 11/01/2016] [Indexed: 02/07/2023]
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Onder G, Marengoni A, Russo P, Degli Esposti L, Fini M, Monaco A, Bonassi S, Palmer K, Marrocco W, Pozzi G, Sangiorgi D, Buda S, Marchionni N, Mammarella F, Bernabei R, Pani L, Pecorelli S. Advanced Age and Medication Prescription: More Years, Less Medications? A Nationwide Report From the Italian Medicines Agency. J Am Med Dir Assoc 2016; 17:168-72. [PMID: 26441359 DOI: 10.1016/j.jamda.2015.08.009] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2015] [Accepted: 08/10/2015] [Indexed: 01/23/2023]
Abstract
BACKGROUND In older adults co-occurrence of multiple diseases often leads to use of multiple medications (polypharmacy). The aim of the present study is to describe how prescription of medications varies across age groups, with specific focus on the oldest old. METHODS We performed a cross-sectional study using 2013 data from the OsMed Health-DB database (mean number of medicines and defined daily doses prescribed in 15,931,642 individuals). There were 3,378,725 individuals age 65 years or older (21.2% of the study sample). RESULTS The mean number of prescribed medications progressively rose from 1.9 in the age group <65 years to 7.4 in the age group 80-84 years and then declined, with a more marked reduction in the age group 95 years or older with a mean number of 2.8 medications. A similar pattern was observed for the mean number of defined daily doses. Among participants age ≥65 years, proton pump inhibitors were the most commonly prescribed medication (40.9% of individuals ≥65 years), followed by platelet aggregation inhibitors (32.8%) and hydroxy-methylglutaryl-coenzyme A reductase inhibitors (26.1%). A decline in prescription was observed among individuals age 90 years or older, but this reduction was less consistent for medications used to treat acute conditions (ie, antibiotics and glucocorticoids) rather than preventive medicines commonly used to treat chronic diseases (ie, antihypertensive medications and hydroxy-methylglutaryl-coenzyme A reductase inhibitors). CONCLUSIONS The burden of medication treatment progressively increases till age 85 and substantially declines after age of 90 years. Patterns of medication prescription widely vary across age groups.
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Affiliation(s)
- Graziano Onder
- Department of Geriatrics, Centro Medicina dell'Invecchiamento, Università Cattolica del Sacro Cuore, Rome, Italy.
| | - Alessandra Marengoni
- Department of Clinical and Experimental Sciences, Università degli Studi di Brescia, Brescia, Italy
| | | | | | - Massimo Fini
- Scientific Direction, IRCCS San Raffaele Pisana, Rome, Italy
| | | | - Stefano Bonassi
- Scientific Direction, IRCCS San Raffaele Pisana, Rome, Italy
| | - Katie Palmer
- Agenzia Italiana del Farmaco (AIFA), Rome, Italy
| | | | - Giuseppe Pozzi
- Court of Justice for the Right to Health, FederAnziani, Rome, Italy
| | - Diego Sangiorgi
- CliCon Srl Health, Economics and Outcomes Research, Ravenna, Italy
| | - Stefano Buda
- CliCon Srl Health, Economics and Outcomes Research, Ravenna, Italy
| | - Niccolò Marchionni
- Division of Geriatric Cardiology and Medicine, Department of Medicine and Geriatrics, University of Florence, Florence, Italy
| | - Federica Mammarella
- Department of Geriatrics, Centro Medicina dell'Invecchiamento, Università Cattolica del Sacro Cuore, Rome, Italy; Agenzia Italiana del Farmaco (AIFA), Rome, Italy
| | - Roberto Bernabei
- Department of Geriatrics, Centro Medicina dell'Invecchiamento, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Luca Pani
- Agenzia Italiana del Farmaco (AIFA), Rome, Italy
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Lalic S, Sluggett JK, Ilomäki J, Wimmer BC, Tan EC, Robson L, Emery T, Bell JS. Polypharmacy and Medication Regimen Complexity as Risk Factors for Hospitalization Among Residents of Long-Term Care Facilities: A Prospective Cohort Study. J Am Med Dir Assoc 2016; 17:1067.e1-1067.e6. [DOI: 10.1016/j.jamda.2016.08.019] [Citation(s) in RCA: 65] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2016] [Revised: 08/04/2016] [Accepted: 08/23/2016] [Indexed: 12/01/2022]
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Morley JE. Frailty and sarcopenia in elderly. Wien Klin Wochenschr 2016; 128:439-445. [PMID: 27670855 DOI: 10.1007/s00508-016-1087-5] [Citation(s) in RCA: 64] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Accepted: 08/23/2016] [Indexed: 12/18/2022]
Abstract
Frailty is a pre-disability syndrome where an older person can be identified as being at risk when exposed to stressors associated with high risk for disability or needing to be hospitalized. Two major frailty definitions exist. The physical phenotype of frailty and the multiple deficit model. A simple frailty screening tool-FRAIL-has been validated. Treatment of frailty involves resistance exercise, optimization of nutrition, and treatment of fatigue (sleep apnea, depression), treatable causes of weight loss and adjustment of polypharmacy. Sarcopenia (decline in function with low muscle mass) is a major cause of frailty. A simple sarcopenia screening tool-SARC-F-has been validated. The multiple causes of sarcopenia are reviewed. Optimal treatment is resistance exercise, leucine-enriched essential amino acids and vitamin D replacement.
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Affiliation(s)
- John E Morley
- Division of Geriatric Medicine, Saint Louis University School of Medicine, 1402 S. Grand Blvd., M238, 63104, St. Louis, MO, USA.
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Morin L, Laroche ML, Texier G, Johnell K. Prevalence of Potentially Inappropriate Medication Use in Older Adults Living in Nursing Homes: A Systematic Review. J Am Med Dir Assoc 2016; 17:862.e1-9. [PMID: 27473899 DOI: 10.1016/j.jamda.2016.06.011] [Citation(s) in RCA: 172] [Impact Index Per Article: 21.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2016] [Revised: 06/06/2016] [Accepted: 06/08/2016] [Indexed: 01/07/2023]
Abstract
IMPORTANCE As older adults living in nursing homes are at a high risk of adverse drug-related events, medications with a poor benefit/risk ratio or with a safer alternative should be avoided. OBJECTIVES To systematically evaluate the prevalence of potentially inappropriate medication use in nursing home residents. EVIDENCE REVIEW We searched in PubMed and EMBASE databases (1990-2015) for studies reporting the prevalence of potentially inappropriate medication use in people ≥60 years of age living in nursing homes. The risk of bias was assessed with an adapted version of the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) checklist. FINDINGS A total of 91 articles were assessed for eligibility, and 48 met our inclusion criteria. These articles reported the findings from 43 distinct studies, of which 26 presented point prevalence estimates of potentially inappropriate medication use (227,534 nursing home residents). The overall weighted point prevalence of potentially inappropriate medication use in nursing homes was 43.2% [95% confidence interval (CI) 37.3%-49.1%], increasing from 30.3% in studies conducted during 1990-1999 to 49.8% in studies conducted after 2005 (P < .001). Point prevalence estimates reported in European countries were found to be higher (49.0%, 95% CI 42.5-55.5) than those reported in North America (26.8%, 95% CI 16.5-37.1) or in other countries (29.8%, 95% CI 19.3-40.3). In addition, 18 studies accounting for 326,562 nursing home residents presented 20 distinct period prevalence estimates ranging from 2.3% to 50.3%. The total number of prescribed medications was consistently reported as the main driving factor for potentially inappropriate medications use. CONCLUSIONS AND RELEVANCE This systematic review shows that almost one-half of nursing home residents are exposed to potentially inappropriate medications and suggests an increase prevalence over time. Effective interventions to optimize drug prescribing in nursing home facilities are, therefore, needed.
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Affiliation(s)
- Lucas Morin
- Aging Research Center, Karolinska Institutet and Stockholm University, Stockholm, Sweden.
| | - Marie-Laure Laroche
- University Hospital of Limoges, Service de Pharmacologie, Toxicologie et Pharmacovigilance, Limoges, France; Université de Limoges, Faculté de Médecine, Limoges, France
| | - Géraldine Texier
- University Hospital of Rennes, Palliative Care Support Team, Rennes, France
| | - Kristina Johnell
- Aging Research Center, Karolinska Institutet and Stockholm University, Stockholm, Sweden
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Abele P, Morley JE. Advance Directives: The Key to a Good Death? J Am Med Dir Assoc 2016; 17:279-83. [PMID: 26952570 DOI: 10.1016/j.jamda.2016.01.020] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2016] [Accepted: 01/29/2016] [Indexed: 02/06/2023]
Affiliation(s)
- Patricia Abele
- Division of Geriatric Medicine, Saint Louis University School of Medicine, St Louis, MO
| | - John E Morley
- Division of Geriatric Medicine, Saint Louis University School of Medicine, St Louis, MO; Division of Endocrinology, Saint Louis University School of Medicine, St Louis, MO.
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Morley JE. Opening Pandora's Box: The Reasons Why Reducing Nursing Home Transfers to Hospital are so Difficult. J Am Med Dir Assoc 2016; 17:185-7. [DOI: 10.1016/j.jamda.2015.12.098] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2015] [Accepted: 12/31/2015] [Indexed: 11/25/2022]
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Morley JE, Cao L, Shum CK. Improving the Quality of End-of-Life Care. J Am Med Dir Assoc 2016; 17:93-5. [DOI: 10.1016/j.jamda.2015.12.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2015] [Accepted: 12/04/2015] [Indexed: 12/20/2022]
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Morley JE. Telemedicine: Coming to Nursing Homes in the Near Future. J Am Med Dir Assoc 2016; 17:1-3. [DOI: 10.1016/j.jamda.2015.10.012] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2015] [Accepted: 10/14/2015] [Indexed: 01/02/2023]
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Polypharmacy in Nursing Home Residents: What Is the Way Forward? J Am Med Dir Assoc 2016; 17:4-6. [DOI: 10.1016/j.jamda.2015.07.008] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2015] [Accepted: 07/08/2015] [Indexed: 12/27/2022]
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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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Luo H, Lum TY, Wong GH, Kwan JS, Tang JY, Chi I. Predicting Adverse Health Outcomes in Nursing Homes: A 9-Year Longitudinal Study and Development of the FRAIL-Minimum Data Set (MDS) Quick Screening Tool. J Am Med Dir Assoc 2015; 16:1042-7. [DOI: 10.1016/j.jamda.2015.09.006] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2015] [Revised: 09/10/2015] [Accepted: 09/11/2015] [Indexed: 12/16/2022]
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Singh S, Bajorek B. Pharmacotherapy in the ageing patient: The impact of age per se (A review). Ageing Res Rev 2015; 24:99-110. [PMID: 26226330 DOI: 10.1016/j.arr.2015.07.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2015] [Accepted: 07/17/2015] [Indexed: 12/23/2022]
Abstract
A literature search was carried out to review the influence of 'ageing' on pharmacotherapeutic decision-making, specifically how 'age' is defined and considered in the utilisation of medication. Embase, Medline, International Pharmaceutical Abstracts, and Google scholar were canvassed in a three-tiered search according to pre-established inclusion criteria. In tier 1, a total of 22 studies were identified highlighting the underutilisation of medication in elderly patients, with a particular focus on warfarin. Four studies highlighted an age-bias in medication-prescribing for elderly patients, specifically in relation to medicines for rheumatoid arthritis, angina, and hypertension. Tier 2 identified diverse definitions for 'elderly', including biological age, chronological age, physiological age, as well as various descriptions of 'elderly' in clinical trials and guidelines. Finally, medication optimisation tools were identified through the third tier, emphasising the use of chronological age to describe the 'elderly'. Old age influences pharmacotherapeutic decision-making at various levels, however, what complicates the situation is the absence of a comprehensive definition of 'elderly'. Clinical recommendations need to be based more on objective factors known to affect medication effectiveness and safety.
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Morley JE. Sleep and the Nursing Home. J Am Med Dir Assoc 2015; 16:539-43. [DOI: 10.1016/j.jamda.2015.05.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2015] [Accepted: 05/06/2015] [Indexed: 12/14/2022]
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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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Lima Ribeiro SM, Morley JE. Dehydration is Difficult to Detect and Prevent in Nursing Homes. J Am Med Dir Assoc 2015; 16:175-6. [DOI: 10.1016/j.jamda.2014.12.012] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2014] [Accepted: 12/15/2014] [Indexed: 12/19/2022]
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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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