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Lee EA, Steinberg SG, Cheng SC, Lieu WL, Yoshinaga MA, Powers DC, Kanter MH, Broder BI. Reduction of concurrent use of highly anticholinergic medications in an integrated healthcare system: 2018-2021. J Am Geriatr Soc 2023; 71:3921-3923. [PMID: 37737472 DOI: 10.1111/jgs.18604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 07/14/2023] [Indexed: 09/23/2023]
Affiliation(s)
- Eric A Lee
- Department of Internal Medicine, Southern California Permanente Medical Group, West Los Angeles, California, USA
- Department of Clinical Science, Kaiser Permanente - Bernard J Tyson School of Medicine, Pasadena, California, USA
| | - Steven G Steinberg
- Department of Family Medicine, Southern California Permanente Medical Group, Panorama City, California, USA
- Department of Health Systems Research, Kaiser Permanente - Bernard J Tyson School of Medicine, Pasadena, California, USA
| | - Stephen C Cheng
- Drug Use Management, Kaiser Permanente Southern California, Downey, California, USA
| | - William L Lieu
- Drug Use Management, Kaiser Permanente Southern California, Downey, California, USA
| | - Monica A Yoshinaga
- Drug Use Management, Kaiser Permanente Southern California, Downey, California, USA
| | - Daniel C Powers
- Drug Use Management, Kaiser Permanente Southern California, Downey, California, USA
| | - Michael H Kanter
- Department of Clinical Science, Kaiser Permanente - Bernard J Tyson School of Medicine, Pasadena, California, USA
- Department of Research and Evaluation, Southern California Permanente Medical Group, Pasadena, California, USA
| | - Benjamin I Broder
- Department of Health Systems Research, Kaiser Permanente - Bernard J Tyson School of Medicine, Pasadena, California, USA
- Department of Quality and Clinical Analysis, Southern California Permanente Medical Group, Pasadena, California, USA
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S AlHarkan K, Alsousi S, AlMishqab M, Alawami M, Almearaj J, Alhashim H, Alamrad H, M Alghamdi L, Almansour A, AlOmar RS. Associations between polypharmacy and potentially inappropriate medications with risk of falls among the elderly in Saudi Arabia. BMC Geriatr 2023; 23:222. [PMID: 37024805 PMCID: PMC10080807 DOI: 10.1186/s12877-023-03852-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 02/27/2023] [Indexed: 04/08/2023] Open
Abstract
BACKGROUND Falls are dangerous to the health of older adults and can impact their functional status leading to frailty. The use of potentially inappropriate medications (PIMs) among older adults may lead to adverse health outcomes and increase the risk of falls. Polypharmacy increases the incidence of falls. Beers criteria by the American Geriatric Society is one of the many criteria used to detect PIMs. It assesses the appropriateness of drug prescriptions (i.e., correct dose, duration, and indications) to ensure the safety of these drugs, reducing drug interactions and decreasing the hazards of side effects. This epidemiological study aims to explore the association between polypharmacy and Beers criteria with the risk of falls in the elderly. METHOD A total of 387 outpatients aged 60 or older were interviewed in person. The patients were recruited from the University Hospital and the Family and Community Medicine Center in Khobar city, Saudi Arabia, between the period of November 2021 to March 2022. All patients were able to walk independently. The survey began by collecting patients' demographics, gathering medication history, and asking three key questions to detect the risk of falls which was developed by the Center of Disease Control (CDC). Polypharmacy (defined as concurrent use of five or more medications) and PIMs (defined as use of one or more medications in the Beers list) were examined against risk of falls in the elderly. Multiple logistic regression analyses were used to estimate adjusted Odds Ratios (ORs). RESULT A total of 387 patients participated in the study; 62% were male, and most participants belonged to the 60 < 65 years age category (47.80%). Among all patients, 55% had a high risk of falling, and 21% of patients had fell during the past year. Polypharmacy applied to 50.90% of all patients, while Beers criteria positive group applied to 51.42%. Risk of falls and prior falls were associated with polypharmacy both before and after adjustment. CONCLUSION The results showed a significant association between risk of falls with polypharmacy and PIMs, and more than half of our study population had a high risk of falls. Of those at a higher risk, one out of five had indeed experienced a fall in the last 12 months. Higher rates of falls were associated with older aged patients, lower educational levels, female gender, and cardiovascular medications.
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Affiliation(s)
- Khalid S AlHarkan
- Department of Family and Community Medicine, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia.
| | - Safaa Alsousi
- Department of Family and Community Medicine, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Mujtaba AlMishqab
- College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Majd Alawami
- College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Jaffar Almearaj
- College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Hassan Alhashim
- College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Hassan Alamrad
- College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Layla M Alghamdi
- Department of Family and Community Medicine, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Abdulelah Almansour
- Department of Family and Community Medicine, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Reem S AlOmar
- Department of Family and Community Medicine, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
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Walker BS, Collier BR, Bower KL, Lollar DI, Faulks ER, Matos M, Nussbaum MS, Hamill ME. The Prevalence of Beers Criteria Medication Use and Associations with Falls in Geriatric Patients at a Level 1 Trauma Center. Am Surg 2020. [DOI: 10.1177/000313481908500842] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The Beers Criteria for Potentially Inappropriate Medication (PIM) use is a list of medications with multiple risks in older patients. Approximately 24 per cent use rate is reported in prior studies. Our objective was to determine the local PIM use and subsequent fall risk in geriatric trauma patients. We conducted a retrospective analysis of PIM use in all geriatric patients evaluated at our Level 1 trauma center between 2014 and 2017. Patients were identified from our trauma database. Pre-admission medication use was determined through medication reconciliation from our electronic medical record (EMR). Patients not undergoing medication reconciliation were excluded. After initial analysis, patients were stratified by age into three groups: 65 to 74, 75 to 84, and ≥85 years. Multivariate logistic regression analyses were used to calculate odds ratios of falls for specific PIMs. In all, 2181 patients met the inclusion criteria. Overall, 71.2 per cent of geriatric trauma patients were prescribed at least one PIM—73.1 per cent of falls compared with 68.6 per cent for other mechanisms. Specific PIM use varied by age group. PIMs associated with fall risk in all patients included antipsychotics, benzodiazepines, and diclofenac. For those aged 65 to 74 years, antihistamines, diclofenac, proton pump inhibitors, and promethazine were associated. In those aged 75 to 84 years, alprazolam, antipsychotics, benzodiazepines, cyclobenzaprine, diclofenac, and muscle relaxants were implicated. No significant associations were found for patients aged ≥85 years. PIM use at our trauma center seems to be rampant and well above the national average. Geriatric falls were associated with using ≥1 PIM and multiple specific PIMs implicated. We are designing a targeted educational program for local primary care physicians (PCPs) that will attempt to decrease geriatric PIM use.
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Affiliation(s)
- Benjamin S. Walker
- From the Department of Surgery, Virginia Tech Carilion School of Medicine, Roanoke, Virginia
| | - Bryan R. Collier
- From the Department of Surgery, Virginia Tech Carilion School of Medicine, Roanoke, Virginia
| | - Katie L. Bower
- From the Department of Surgery, Virginia Tech Carilion School of Medicine, Roanoke, Virginia
| | - Daniel I. Lollar
- From the Department of Surgery, Virginia Tech Carilion School of Medicine, Roanoke, Virginia
| | - Emily R. Faulks
- From the Department of Surgery, Virginia Tech Carilion School of Medicine, Roanoke, Virginia
| | - Miguel Matos
- From the Department of Surgery, Virginia Tech Carilion School of Medicine, Roanoke, Virginia
| | - Michael S. Nussbaum
- From the Department of Surgery, Virginia Tech Carilion School of Medicine, Roanoke, Virginia
| | - Mark E. Hamill
- From the Department of Surgery, Virginia Tech Carilion School of Medicine, Roanoke, Virginia
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Moosavi S, Woo M, Jacob DA, Pradhan S, Wilsack L, Buresi M, Gupta M, Al-Awadh Y, Li D, Andrews CN. Anticholinergic, anti-depressant and other medication use is associated with clinically relevant oesophageal manometric abnormalities. Aliment Pharmacol Ther 2020; 51:1130-1138. [PMID: 32383253 DOI: 10.1111/apt.15758] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Revised: 02/07/2020] [Accepted: 04/07/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND Medications can affect gastrointestinal tract motility. However, their effects on oesophageal motility in particular are often not as widely known or may be underestimated. AIM To review the effect of existing medication use on high-resolution oesophageal manometry (HRM) in a 'real-world' setting. METHODS Adult patients with upper gut symptoms and normal endoscopy or imaging who had HRM over a 22-month period were analysed. Achalasia and major disorders of peristalsis were excluded. All medications taken within 24 hours of the procedure were prospectively recorded and compared with HRM results, controlling for age, gender and proton pump inhibitor use. RESULTS A total of 502 patients (323 female, mean age 51) were recruited. Of these, 41.2% had normal oesophageal HRM, while 41.4% had ineffective oesophageal motility (IOM) and 7.6% had oesophagogastric junction outflow obstruction (OGJOO). Serotonin/norepinephrine reuptake inhibitors (SNRI) and opioids were associated with significantly higher resting lower oesophageal sphincter pressure. Benzodiazepines and opioids were associated with elevated integrated relaxation pressure. SNRI and inhaled beta-agonists were associated with increased distal contractile index, whereas calcium channel blockers were associated with a lower distal contractile index. Odds ratio of being on anticholinergics was higher in IOM patients vs normal (3.6, CI 1.2-10.8). Odds ratio for anticholinergics, inhaled beta-agonists, anticonvulsants, SNRIs and opioids (trend) were all > 3 for OGJOO patients vs normal. CONCLUSION Many medication classes are associated with abnormal HRM variables and diagnoses such as OGJOO and IOM; some of these associations are probably causal. These possible links should be taken into consideration during manometry interpretation.
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Affiliation(s)
- Sarvee Moosavi
- Department of Gastroenterology and Hepatology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Division of Gastroenterology, Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Matthew Woo
- Department of Gastroenterology and Hepatology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Deepti A Jacob
- Department of Gastroenterology and Hepatology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Department of Gastroenterology and Hepatology, Mayo Clinic Health Systems, Eau Claire, WI, USA
| | - Sarah Pradhan
- Department of Gastroenterology and Hepatology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Lynn Wilsack
- Department of Gastroenterology and Hepatology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Michelle Buresi
- Department of Gastroenterology and Hepatology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Milli Gupta
- Department of Gastroenterology and Hepatology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Yacoub Al-Awadh
- Department of Gastroenterology and Hepatology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Haya Al-Habeeb Gastroenterology Center, Mubarak Al-Kabeer Hospital, Jabriya, Kuwait
| | - Dorothy Li
- Department of Gastroenterology and Hepatology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Christopher N Andrews
- Department of Gastroenterology and Hepatology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
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Lee EA, Brettler JW, Kanter MH, Steinberg SG, Khang P, Distasio CC, Martin J, Dreskin M, Thompson NH, Cotter TM, Thai K, Yasumura L, Gibbs NE. Refining the Definition of Polypharmacy and Its Link to Disability in Older Adults: Conceptualizing Necessary Polypharmacy, Unnecessary Polypharmacy, and Polypharmacy of Unclear Benefit. Perm J 2019; 24:18.212. [PMID: 31905333 DOI: 10.7812/tpp/18.212] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
The term polypharmacy in older adults is generally used in a pejorative context in the medical literature. Because of its link to geriatric syndromes and disability, the avoidance of polypharmacy is usually recommended in older adults as a strategy to optimize functional status. However, there are many polypharmacy regimens based on high-quality trials that clearly reduce the risk of disability in older adults. Other guidelines for older adults recommend the use of additional medications that may or may not be evidence based and that may or may not reduce disability. Therefore, we propose that, in the geriatric literature, polypharmacy now be categorized as "necessary polypharmacy," "unnecessary polypharmacy," or "polypharmacy of unclear benefit." In this article, we discuss the 3 categories of polypharmacy and give examples on each polypharmacy regimen and its potential relationship to disability in older adults.
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Affiliation(s)
- Eric A Lee
- Department of Internal Medicine, West Los Angeles Medical Center, CA
| | | | - Michael H Kanter
- Department of Clinical Science, Kaiser Permanente School of Medicine, Pasadena, CA
| | | | - Peter Khang
- Department of Geriatrics, Palliative Medicine, and Continuing Care, Los Angeles Medical Center, CA
| | | | - John Martin
- Department of Internal Medicine, Los Angeles Medical Center, CA
| | - Mark Dreskin
- Department of Integrated Behavioral Health, Los Angeles Medical Center, CA.,Urgent Care Division, Los Angeles Medical Center, CA
| | | | | | - Kim Thai
- Department of Physical Medicine and Rehabilitation, Baldwin Park Medical Center, CA
| | - Lyn Yasumura
- Department of Obstetrics and Gynecology, Baldwin Park Medical Center, CA
| | - Nancy E Gibbs
- Department of Geriatrics, Kaiser Permanente Southern California, Pasadena, CA
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Nissan R, Brill S, Hershkovitz A. Association between anticholinergic drug prescription changes and rehabilitation outcome in post-acute hip fractured patients. Disabil Rehabil 2019; 42:2917-2922. [PMID: 30978127 DOI: 10.1080/09638288.2019.1576782] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Purpose: To follow changes in anticholinergic drug prescriptions throughout hip fractured patients' rehabilitation; to assess whether a change in anticholinergic burden affects rehabilitation outcome.Methods: Retrospective study of 869 hip fractured patients admitted between January 2011 to October 2015, performed in a post-acute geriatric rehabilitation center. The Anticholinergic Cognitive Burden Scale quantified the anticholinergic burden. Main outcome measures: Functional Independence Measure, motor Functional Independence Measure, Montebello Rehabilitation Factor Score on motor Functional Independence Measure and length of stay. Multiple linear regression analysis tested for independent association between admission anticholinergic burden and anticholinergic burden change during rehabilitation, and rehabilitation outcomes.Results: One hundred and sixty two (18.7%) patients were prescribed additional anticholinergic medications upon discharge; 76 (8.7%) were prescribed fewer. Patients with high admission anticholinergic burden presented with a significantly higher rate of higher education, less likely to reside at home, less independent pre-fracture, exhibited a significantly lower admission and discharge Functional Independence Measure score, a lower Functional Independence Measure score change and a lower Montebello Rehabilitation Factor Score. Admission anticholinergic burden, but not changes in anticholinergic burden during rehabilitation, was found to be independently associated with rehabilitation outcome (discharge FIM score).Conclusions: High admission anticholinergic burden is associated with lower functional ability in hip fractured patients. Changes in anticholinergic drug prescription during rehabilitation were not associated with rehabilitation outcomes.Implications for rehabilitationClinicians should make an effort to reduce AC drug use in hip fractured patients on admission to post-acute rehabilitation.AC burden should be carefully monitored throughout the rehabilitation period and reduced whenever possible.When functional ability does not improve as expected, AC burden should be considered as an intervening factor.
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Affiliation(s)
- Ran Nissan
- Beit Rivka Geriatric Rehabilitation Center, Petach Tikva, Israel
| | - Shai Brill
- Beit Rivka Geriatric Rehabilitation Center, Petach Tikva, Israel.,Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Avital Hershkovitz
- Beit Rivka Geriatric Rehabilitation Center, Petach Tikva, Israel.,Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
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The Beers criteria: Not just for geriatrics anymore? Analysis of Beers criteria medications in nongeriatric trauma patients and their association with falls. J Trauma Acute Care Surg 2019; 87:147-152. [DOI: 10.1097/ta.0000000000002280] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Chang C. Short-course therapy for diarrhea-predominant irritable bowel syndrome: understanding the mechanism, impact on gut microbiota, and safety and tolerability of rifaximin. Clin Exp Gastroenterol 2018; 11:335-345. [PMID: 30288076 PMCID: PMC6160288 DOI: 10.2147/ceg.s167031] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Irritable bowel syndrome (IBS) is a common gastrointestinal (GI) disorder characterized by abdominal pain that occurs with defecation or alterations in bowel habits. Further classification is based on the predominant bowel habit: constipation-predominant IBS, diarrhea-predominant IBS (IBS-D), or mixed IBS. The pathogenesis of IBS is unclear and is considered multifactorial in nature. GI dysbiosis, thought to play a role in IBS pathophysiology, has been observed in patients with IBS. Alterations in the gut microbiota are observed in patients with small intestinal bacterial overgrowth, and overgrowth may occur in a subset of patients with IBS. The management of IBS includes therapies targeting the putative factors involved in the pathogenesis of the condition. However, many of these interventions (eg, eluxadoline and alosetron) require long-term, daily administration and have important safety considerations. Agents thought to modulate the gut microbiota (eg, antibiotics and probiotics) have shown potential benefits in clinical studies. However, conventional antibiotics (eg, neomycin) are associated with several adverse events and/or the risk of bacterial antibiotic resistance, and probiotics lack uniformity in composition and consistency of response in patients. Rifaximin, a nonsystemic antibiotic administered as a 2-week course of therapy, has been shown to be safe and efficacious for the treatment of IBS-D. Rifaximin exhibits a favorable benefit-to-harm ratio when compared with daily therapies for IBS-D (eg, alosetron and tricyclic antidepressants), and rifaximin was not associated with the emergence of bacterial antibiotic resistance. Thus, short-course therapy with rifaximin is an appropriate treatment option for IBS-D.
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Affiliation(s)
- Christopher Chang
- New Mexico VA Health Care System, Division of Gastroenterology and Hepatology, Albuquerque, NM, USA,
- Department of Internal Medicine, University of New Mexico School of Medicine, Albuquerque, NM, USA,
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Lucchetti G, Lucchetti AL. Inappropriate prescribing in older persons: A systematic review of medications available in different criteria. Arch Gerontol Geriatr 2017; 68:55-61. [DOI: 10.1016/j.archger.2016.09.003] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2016] [Revised: 07/30/2016] [Accepted: 09/12/2016] [Indexed: 12/01/2022]
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