1
|
Ludlow K, Logan B, Arora J, Martin S, Miller E, Hubbard RE, Warren N, Gallagher O, Saunders R. Consumers' Perspectives on the Design of a New Digital Frailty Education Course, 'Focus on Frailty': A Qualitative Co-Design Study. Health Expect 2025; 28:e70287. [PMID: 40432255 PMCID: PMC12117197 DOI: 10.1111/hex.70287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2024] [Revised: 03/31/2025] [Accepted: 04/21/2025] [Indexed: 05/29/2025] Open
Abstract
INTRODUCTION Frailty-focused care in hospitals is hindered by systemic barriers, ageism and stereotypes about older adults and frailty. There is a need for frailty education to increase healthcare professionals' and students' understanding of frailty. OBJECTIVE As part of a larger study to co-design a new digital frailty education course, 'Focus on Frailty', this study aimed to explore consumers' and caregivers' perspectives on (i) how frailty and older adults should be represented in frailty education and (ii) what healthcare professionals should be taught about caring for older adults and people who are frail in hospitals. DESIGN This was a qualitative co-design study. SETTING AND PARTICIPANTS Participants (n = 25) were older Australians, people living with frailty and family caregivers (collectively, 'consumers') who had interacted with the hospital system. This study was conducted in Australia via Zoom and telephone. METHODS Participants engaged in focus groups or individual interviews and completed a demographic questionnaire and a Research Engagement Feedback Survey. Qualitative data were inductively analysed using template analysis (codebook thematic analysis). Quantitative demographic data were analysed using descriptive statistics. RESULTS Seven themes were identified: (1) Consumers' understanding of frailty as loss, deterioration and vulnerability; (2) Utilise a holistic approach to frailty care; (3) Dispel stereotypes; (4) Value consumers' lived experience expertise; (5) Include diverse representation and educate for diversity; (6) Promote meaningful interactions; and (7) Practice care coordination. DISCUSSION Participants acknowledged the multifaceted nature of frailty, advocating for holistic frailty education that considers physical, social, emotional, cognitive, financial and spiritual aspects. They described the importance of representing real-world scenarios and stories, images and videos of real people that reflected the diversity of lived experience. Participants wanted 'Focus on Frailty' to include education on individualised care; looking beyond the acute situation; multidisciplinary care coordination that involved informal caregivers; overcoming stereotypes and ageism; and meaningfully interacting with older adults and people who are frail. CONCLUSIONS Consumers wanted to be represented in frailty education in a way that elevates lived experience and celebrates diversity. They expressed that healthcare professionals should be taught to avoid stereotypes, coordinate multidisciplinary care and engage in meaningful interactions with patients. Consumer-focused recommendations for designing frailty education were generated. PATIENT OR PUBLIC CONTRIBUTION E.M., a consumer partner, contributed to the study design, focus group/interview guide, ethics application and participant information and consent forms. E.M. attended some of the focus groups and contributed to the interpretation of study findings. She also contributed to manuscript revisions. Twenty-five consumers (family caregivers, older adults and people with lived experience of frailty) participated in focus groups and interviews. Participants shared their perspectives on frailty and contributed to the co-design of a new digital frailty education course for healthcare professionals and students.
Collapse
Affiliation(s)
- Kristiana Ludlow
- Centre for Health Services ResearchThe University of QueenslandBrisbaneAustralia
- Australian Frailty NetworkBrisbaneAustralia
| | - Benignus Logan
- Centre for Health Services ResearchThe University of QueenslandBrisbaneAustralia
- Australian Frailty NetworkBrisbaneAustralia
| | - Jhalak Arora
- School of PsychologyThe University of QueenslandBrisbaneAustralia
| | - Sarah Martin
- Centre for Health Services ResearchThe University of QueenslandBrisbaneAustralia
- Australian Frailty NetworkBrisbaneAustralia
| | - Elizabeth Miller
- Centre for Health Services ResearchThe University of QueenslandBrisbaneAustralia
- Australian Frailty NetworkBrisbaneAustralia
- Princess Alexandra HospitalBrisbaneAustralia
| | - Ruth E. Hubbard
- Centre for Health Services ResearchThe University of QueenslandBrisbaneAustralia
- Australian Frailty NetworkBrisbaneAustralia
- Princess Alexandra HospitalBrisbaneAustralia
| | - Nicola Warren
- Australian Frailty NetworkBrisbaneAustralia
- Medical SchoolThe University of QueenslandBrisbaneAustralia
- Metro South Addiction and Mental Health ServicesBrisbaneAustralia
| | - Olivia Gallagher
- Australian Frailty NetworkBrisbaneAustralia
- Nursing & Midwifery Research Unit, South Metropolitan Health ServiceFiona Stanley HospitalPerthAustralia
- The School of Allied HealthUniversity of Western AustraliaPerthAustralia
| | - Rosemary Saunders
- Australian Frailty NetworkBrisbaneAustralia
- Centre for Research in Aged Care, School of Nursing and MidwiferyEdith Cowan UniversityPerthAustralia
| |
Collapse
|
2
|
Tulinayo FP, Ortega-Gil A, González N, Erreguerena I, Perea BL, Saralegui I, Zubeltzu B, Fullaondo A, Verdoy D, de Manuel Keenoy E. Understanding Complexities in Collaborative Management of Knowledge on Advance Care Planning for Multi-morbid Patients Within Personalized Integrated Care. JOURNAL OF HEALTHCARE INFORMATICS RESEARCH 2025; 9:220-245. [PMID: 40309132 PMCID: PMC12037948 DOI: 10.1007/s41666-025-00185-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2024] [Revised: 11/11/2024] [Accepted: 01/01/2025] [Indexed: 05/02/2025]
Abstract
Healthcare has shifted from paternalistic model of care to patient-centered care where shared decision making is key. The need to share and manage contributions and expertise of different healthcare professionals underlines the relevance of collaborative knowledge management (CKM). However, CKM in healthcare requires one to understand the complexities in integrating multiple aspects of care and the challenges associated with interdisciplinary collaboration and knowledge sharing among healthcare providers. In this study, we use a system modeling approach to understand the complexities in collaborative management of knowledge on advance care planning for multi-morbid patients, within personalized integrated care. To achieve this, focus group discussions (FGD) with 11 participants from Basque Public Health System (Osakidetza) in Spain were involved in identifying the key challenges and developing a systemic thinking model. As a result, three key challenges were identified, i.e., (1) culture, where citizens are not willing to talk about death; (2) healthcare professionals, whose attitude and perspectives need to change; and (3) the current system, that has to change its care model towards a holistic and a shared care model. From the developed causal loop diagrams (CLDs), it is noted that perpetuation of fragmented and paternalistic care is likely to get worse without recognition of the advance care plan (ACP) as a social need and as a crucial part of the clinical practice change. Supplementary Information The online version contains supplementary material available at 10.1007/s41666-025-00185-w.
Collapse
Affiliation(s)
- Fiona P. Tulinayo
- Information Technology Department, College of Computing & Information Sciences, Makerere University, Kampala, Uganda
| | - Ana Ortega-Gil
- Biosistemak Institute for Health Systems Research, Basque Country, Barakaldo, Spain
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Cuenca, Spain
| | - Nerea González
- Biosistemak Institute for Health Systems Research, Basque Country, Barakaldo, Spain
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Cuenca, Spain
| | - Irati Erreguerena
- Biosistemak Institute for Health Systems Research, Basque Country, Barakaldo, Spain
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Cuenca, Spain
| | - Bárbara López Perea
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Cuenca, Spain
| | - Iñaki Saralegui
- Osakidetza Basque Health Service, OSI Araba, Basque Country, Bilbao, Spain
| | - Beñat Zubeltzu
- Osakidetza Basque Health Service, OSI Araba, Basque Country, Bilbao, Spain
| | - Ane Fullaondo
- Biosistemak Institute for Health Systems Research, Basque Country, Barakaldo, Spain
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Cuenca, Spain
| | - Dolores Verdoy
- Biosistemak Institute for Health Systems Research, Basque Country, Barakaldo, Spain
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Cuenca, Spain
| | - Esteban de Manuel Keenoy
- Biosistemak Institute for Health Systems Research, Basque Country, Barakaldo, Spain
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Cuenca, Spain
| |
Collapse
|
3
|
Yue X, Yuan Q, Wang M. Enhancing comprehensive geriatric nursing competence: Insights into training status, demands, and willingness among clinical nurses-A multi-center study in China. Geriatr Nurs 2025:103368. [PMID: 40393812 DOI: 10.1016/j.gerinurse.2025.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2024] [Revised: 02/02/2025] [Accepted: 05/05/2025] [Indexed: 05/22/2025]
Abstract
This study aims to evaluate geriatric nursing competence (GNC), training status, demands and willingness of clinical nurses, and to identify the key factors that influence GNC. A cross-sectional multi-centre study was conducted, including 1024 clinical nurses. Results indicated an overall lower-to-moderate level of GNC, coupled with a low training rate (43.53 %) and a high demand for further training (87.44 %), 67.5 % of nurses expressed willingness to participate in geriatric nursing training, and 35.6 % were willing to engage in geriatric nursing practice. Multiple linear regression analysis identified several independent factors influencing GNC, including training status, willingness to participate in geriatric nursing training and engage in geriatric nursing practice, years of experience in geriatric nursing practice, nursing job satisfaction, and department (i.e., Geriatrics, Internal Medicine, and Surgery). The study underscores the complex interplay of factors shaping GNC among clinical nurses, highlighting significant areas for targeted improvements in geriatric care training.
Collapse
Affiliation(s)
- Xiao Yue
- Department of Geriatric Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
| | - Quan Yuan
- School of Nursing, Tongji Medical College, Huazhong University of Science and Technology, WuHan, China
| | - Mei Wang
- Department of Geriatric Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
| |
Collapse
|
4
|
Kumar A, Singh B. Modeling the spectrum and determinants of multimorbidity risk among older adults in India. PLoS One 2025; 20:e0323744. [PMID: 40378177 DOI: 10.1371/journal.pone.0323744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2024] [Accepted: 04/09/2025] [Indexed: 05/18/2025] Open
Abstract
BACKGROUND India is passing through a parallel phase of demographic and epidemiological transition coupled with the shifting burden of multimorbidity. Unhealthy ageing and escalating morbidity burden have been identified as key drivers of this shifting multimorbidity risk among older adults in India. This study aims to assess the distribution of morbidities and multimorbidity, provide new estimates of multimorbidity risk by socio-economic and demographic factors and further evaluate the multimorbidity count risk conditioned on leading factors. METHODS This study used the nationally representative Longitudinal Ageing Study in India (LASI), Wave - 1, 2017-18, data of individuals aged 45 years and above. First, we assessed the relative proportional share of morbidities and compositions of multimorbidity counts over age. Second, we applied the Random Forest (RF) model to estimate the age-specific risk of multimorbidity susceptibility associated with socio-economic and demographic factors over age. Finally, conditional plots were constructed to assess the distributional composition of the leading factors affecting multimorbidity counts. RESULTS The prevalence of multimorbidity was 43.20%. Eye disorders, followed by cardiovascular disease (CVDs), had the highest proportional share over age. Endocrine diseases, Gastrointestinal Conditions, and Infectious diseases showed a concordant decreasing proportional share in later age. The relative share of five or more multimorbidity counts increased significantly with age. The median expected risk of multimorbidity was significantly higher in females (66 years) than in males (71 years). The study also provides empirical evidence that individuals with higher levels of education, obesity, currently working, and poor childhood health were more prone to higher risk of multimorbidity at an early age. Furthermore, obesity was significantly associated with early multimorbidity onset and led to a pronounced escalation of complex multimorbidity progression, particularly in females. CONCLUSIONS Collective public health interventions are crucial to address early multimorbidity onset and burden disparities, to promote healthier ageing, and to address etiological factors.
Collapse
Affiliation(s)
- Ajay Kumar
- Department of Biostatistics and Epidemiology, International Institute for Population Sciences (IIPS), Mumbai, Maharashtra, India
| | - Bharti Singh
- Department of Survey Research and Data Analytics, International Institute for Population Sciences (IIPS), Mumbai, Maharashtra, India
| |
Collapse
|
5
|
Kuo HL, Chou YC, Chang WN, Chang KV, Chan DCD. Effectiveness of comprehensive geriatric assessment in frail older inpatients. J Formos Med Assoc 2025:S0929-6646(25)00211-6. [PMID: 40335426 DOI: 10.1016/j.jfma.2025.04.040] [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: 01/01/2025] [Revised: 04/06/2025] [Accepted: 04/30/2025] [Indexed: 05/09/2025] Open
Abstract
BACKGROUND Evidence regarding the effects of comprehensive geriatric assessment (CGA) on frail older inpatients is inconclusive. Moreover, various prior studies lacked proper patient selection using frailty assessment tools. Our review aimed to assess whether objectively identifying frail patients in clinical settings using a frailty tool and intervening with CGA provides clinical benefits in frail older inpatients. METHODS A systematic review and meta-analysis were conducted by searching PubMed, Embase, and Web of Science (January 1998-October 2022). Keywords included frailty, hospitalization, and CGA. Eligible studies were randomized controlled trials involving patients aged ≥65 years, with frailty defined by specific tools. The primary outcome was mortality; secondary outcomes included activities of daily living, quality of life, pain, patient satisfaction, polypharmacy, antidepressant use, post-discharge disposition, rehospitalization, and cost-effectiveness. RESULTS Of 2587 articles, 18 met inclusion criteria (2724 participants). Meta-analysis of five studies showed no significant differences in overall mortality for frail inpatients receiving CGA. However, CGA reduced mortality during follow-ups of ≤6 months. CGA also improved health-related quality of life, patient satisfaction, and activities of daily living, while reducing polypharmacy and modifying antidepressant use. CONCLUSIONS CGA did not significantly reduce overall mortality in frail older inpatients compared to usual care but lowered mortality rates at the 6-month follow-up. CGA also improved quality of life, daily functioning, and medication management, underscoring its value for managing frail older inpatients.
Collapse
Affiliation(s)
- Hui-Ling Kuo
- Department of Geriatrics and Gerontology, Cathay General Hospital, No. 280, Sec. 4, Ren Ai Rd., Da An Dist., Taipei City, 106438, Taiwan; Department of Geriatrics and Gerontology, National Taiwan University Hospital, No.7, Chung Shan South Road, Taipei, 100, Taiwan
| | - Yi-Chun Chou
- Department of Geriatrics and Gerontology, National Taiwan University Hospital, No.7, Chung Shan South Road, Taipei, 100, Taiwan; Department of Family Medicine, College of Medicine, National Taiwan University, No.1, Jen Ai Road Section 1, Taipei, 100, Taiwan
| | - Wan-Nin Chang
- Department of Medical Education, National Taiwan University Hospital, No.7, Chung Shan South Road, Taipei, 100, Taiwan
| | - Ke-Vin Chang
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, College of Medicine, National Taiwan University, No.7, Chung Shan South Road, Taipei, 100, Taiwan; Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Bei-Hu Branch, No. 87, Neijiang St., Wanhua Dist., Taipei City, 108206, Taiwan; Center for Regional Anesthesia and Pain Medicine, Wang-Fang Hospital, Taipei Medical University, No. 111, Sec. 3, Xinglong Rd., Wenshan Dist., Taipei City, 106077, Taiwan.
| | - Ding-Cheng Derrick Chan
- Department of Geriatrics and Gerontology, National Taiwan University Hospital, No.7, Chung Shan South Road, Taipei, 100, Taiwan; Department of Internal Medicine, National Taiwan University Hospital, No.7, Chung Shan South Road, Taipei, 100, Taiwan; Superintendent Office, National Taiwan University Hospital, Bei-Hu Branch, Taiwan.
| |
Collapse
|
6
|
Deussom PM, Ewonkem MB, Enang B, Kamdem MHK, Mbock MA, Fotsing MCD, Ndinteh DT, Njayou FN, Toze FA. Synthesis and biological evaluation of esterified anti-inflammatory drugs with ethylene glycol linkers: cytotoxicity, anti-inflammatory and antioxidant properties. ROYAL SOCIETY OPEN SCIENCE 2025; 12:241413. [PMID: 40370604 PMCID: PMC12074795 DOI: 10.1098/rsos.241413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/18/2024] [Revised: 10/30/2024] [Accepted: 04/08/2025] [Indexed: 05/16/2025]
Abstract
The development of multifunctional drugs from anti-inflammatory agents is a promising strategy for people with several inflammation-related comorbidities since such medicines could reduce complications, improve health outcomes and lower healthcare costs. In this study, esters of ibuprofen, cinnamic and salicylic acids were synthesized and characterized by spectroscopic methods, with six new compounds identified. Cytotoxicity and anti-inflammatory properties were assessed using the 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium assay in mouse-derived peritoneal macrophages, which were obtained following an intraperitoneal injection of 0.5 ml of a 2% starch solution. All the tested compounds were safe up to 50% concentrations (2.41 × 10⁻⁴ to 2.41 mM), and monoethylene glycol di-ibuprofen (2) displayed the highest toxicity (IC50 = 4.90 mM). Most compounds were non-toxic below 2.41 mM, and all inhibited nitric oxide (NO) production in a concentration-dependent manner at 0.24 mM. Ibuprofen and cinnamic acid derivatives (2, 3, 5a and 14) exhibited enhanced anti-inflammatory effects, with IC50 = 0.002 mM for monoethylene glycol mono-ibuprofen (3), while fatty-acid ester salicylates (DEW4) demonstrated weaker NO inhibition. Antioxidant tests (2,2-diphenyl-1-picrylhydrazyl, ferric reducing ability of plasma and 2,2'-azino-bis(3-ethylbenzothiazoline-6-sulfonate) (ABTS)) showed limited activities, with few compounds reducing the ABTS+ radical (0.1 ˂ SC50 ˂ 0.2 mM). Compounds 3, 5a, 7, 12 and 14 are potential new anti-inflammatory drugs, while 2 may have anti-cancer properties.
Collapse
Affiliation(s)
| | | | - Brice Enang
- Department of Biochemistry, University of Yaounde I Faculty of Sciences, Yaounde, Cameroon
| | - Michael H. K. Kamdem
- Department of Chemical Sciences, University of Johannesburg – Doornfontein Campus, Doornfontein, South Africa
| | - Michel A. Mbock
- Department of Chemistry, University of Yaounde I Faculty of Sciences, Yaounde, Cameroon
- Department of Biochemistry, University of Douala Faculty of Sciences, Douala, Cameroon
| | - Marthe C. D. Fotsing
- Department of Chemical Sciences, University of Johannesburg – Doornfontein Campus, Doornfontein, South Africa
| | - Derek T. Ndinteh
- Department of Chemical Sciences, University of Johannesburg – Doornfontein Campus, Doornfontein, South Africa
| | - Frederic N. Njayou
- Department of Biochemistry, University of Yaounde I Faculty of Sciences, Yaounde, Cameroon
| | - Flavien A. Toze
- Department of Chemistry, University of Douala, Douala, Cameroon
| |
Collapse
|
7
|
Umegaki H. Frailty, multimorbidity, and polypharmacy: Proposal of the new concept of the geriatric triangle. Geriatr Gerontol Int 2025; 25:657-662. [PMID: 40229144 PMCID: PMC12055515 DOI: 10.1111/ggi.70046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2024] [Revised: 02/27/2025] [Accepted: 04/02/2025] [Indexed: 04/16/2025]
Abstract
As people age, the prevalence of frailty, multimorbidity, and polypharmacy increases, presenting significant challenges in geriatric medicine. These three elements are interrelated in a bidirectional manner, forming what can be termed the "geriatric triangle." The complexity of their interconnections means that addressing each issue in isolation is insufficient for achieving an effective resolution. Thus, a comprehensive understanding of this geriatric triangle is essential for appropriate geriatric management. This review aims to illuminate the relationships within the geriatric triangle and to offer insights into potential strategies for managing these interconnected challenges. Geriatr Gerontol Int 2025; 25: 657-662.
Collapse
Affiliation(s)
- Hiroyuki Umegaki
- Department of Community Healthcare and GeriatricsNagoya University Graduate School of MedicineNagoyaJapan
| |
Collapse
|
8
|
See H, Gowling E, Boswell E, Aggarwal P, King K, Smith N, Lim S, Baxter M, Patel HP. Treatment Considerations for Severe Osteoporosis in Older Adults. Drugs Aging 2025; 42:395-412. [PMID: 40234371 PMCID: PMC12052748 DOI: 10.1007/s40266-025-01205-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/26/2025] [Indexed: 04/17/2025]
Abstract
Osteoporosis, a chronic metabolic bone disease, increases the predisposition to fragility fractures and is associated with considerable morbidity, high health care cost as well as mortality. An elevation in the rate of incident fragility fractures will be observed proportional with the increase in the number of older people worldwide. Severe osteoporosis is currently defined as having a bone density determined by dual-energy X-ray absorptiometry that is more than 2.5 standard deviations (SD) below the young adult mean with one or more past fractures due to osteoporosis. Nutrition, physical activity and adequate vitamin D are essential for optimal bone strength throughout life. Hormone (oestrogen/sex steroid) status is also a major determinant of bone health. This review explores mechanisms involved in bone homeostasis, followed by the assessment and management of severe osteoporosis, including an overview of several treatment options in older people that range from anti-resorptive to anabolic therapies.
Collapse
Affiliation(s)
- Heidi See
- Medicine for Older People, University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton, SO16 6YD, UK
| | - Emma Gowling
- Medicine for Older People, University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton, SO16 6YD, UK
| | - Evie Boswell
- Medicine for Older People, University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton, SO16 6YD, UK
| | - Pritti Aggarwal
- Living Well Partnership, Southampton, UK
- School of Primary Care, Population Sciences and Medical Education, University of Southampton, University Road, Highfield, Southampton, SO17 1BJ, UK
| | - Katherine King
- Medicine for Older People, University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton, SO16 6YD, UK
| | - Nicola Smith
- Medicine for Older People, University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton, SO16 6YD, UK
| | - Stephen Lim
- Medicine for Older People, University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton, SO16 6YD, UK
- Academic Geriatric Medicine, University of Southampton, Southampton General Hospital, Tremona Road, Mailpoint 63, G Level West Wing, Southampton, SO16 6YD, UK
- NIHR Applied Research Collaboration, University of Southampton, Southampton, UK
| | - Mark Baxter
- Medicine for Older People, University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton, SO16 6YD, UK
- Academic Geriatric Medicine, University of Southampton, Southampton General Hospital, Tremona Road, Mailpoint 63, G Level West Wing, Southampton, SO16 6YD, UK
| | - Harnish P Patel
- Medicine for Older People, University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton, SO16 6YD, UK.
- Academic Geriatric Medicine, University of Southampton, Southampton General Hospital, Tremona Road, Mailpoint 63, G Level West Wing, Southampton, SO16 6YD, UK.
- NIHR Biomedical Research Centre, University Hospital and University of Southampton, Tremona Road, Southampton, SO16 6YD, UK.
| |
Collapse
|
9
|
Contreras Macías E, Espina Lozano JM, Cantudo-Cuenca MD, Robustillo-Cortés MDLA, Gabella-Bazarot E, Morillo-Verdugo R. Comparative analysis of the prevalence 3-HIT concept in people living with HIV and seronegative patients with chronic conditions. Cross-3HIT Project. Eur J Hosp Pharm 2025; 32:236-240. [PMID: 38697803 DOI: 10.1136/ejhpharm-2023-004023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 04/16/2024] [Indexed: 05/05/2024] Open
Abstract
OBJECTIVES This study aimed to assess and compare the occurrence of 3-HIT in people living with HIV (PLWH) and seronegative patients. Additionally, the study investigated whether HIV infection could serve as a predictor of the presence of 3-HIT. METHODS A cross-sectional study was conducted between December 2022 and January 2023 to compare PLWH with a group of seronegative patients with chronic diseases attending an outpatient hospital pharmacy service. The 3-HIT concept encompasses the simultaneous presence of non-adherence to concomitant treatment (NAC), drug-drug interactions (DDIs), and high pharmacotherapeutic complexity in polymedicated patients. The assessment of 3-HIT compliance included NAC, evaluated using both the Morisky-Green questionnaire and electronic pharmacy dispensing records. DDIs were analysed using the Liverpool University and Micromedex databases. Pharmacotherapeutic complexity was measured using the Medication Regimen Complexity Index (MRCI) tool. Logistic regression analysis was performed to identify independent factors related to 3-HIT. Additionally, an explanatory logistic model was created to investigate whether HIV infection, along with other adjustment variables, could predict compliance with the 3-HIT concept. RESULTS The study included 145 patients: 75 PLWH and 70 seronegative patients. The median age was 40 versus 39 years, respectively (p=0.22). Seronegative patients exhibited a higher prevalence of NAC (p<0.01). HIV infection was identified as a protective factor in the context of DDIs (p<0.01). Male sex (p<0.01) and age (p=0.01) were identified as being associated with an MRCI ≥11.25 points. A higher prevalence of 3-HIT was observed in seronegative patients (18.7% vs 48.6%, p<0.01). However, the developed regression model identified HIV infection as a risk factor associated with an increased likelihood of 3-HIT (OR 4.00, 95% CI 1.88 to 8.52, p<0.01). CONCLUSIONS The 3-HIT concept exhibited a high prevalence among seronegative patients with chronic diseases, with HIV infection identified as a predicted risk factor for NAC and the development of 3-HIT.
Collapse
|
10
|
O'Donovan B, Kirke C, Pate M, McHugh S, Bennett K, Cahir C. A Quantitative Study Exploring and Comparing Key Factors in Medication Management in the Irish Healthcare Setting. Health Expect 2025; 28:e70256. [PMID: 40221845 PMCID: PMC11993810 DOI: 10.1111/hex.70256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2024] [Revised: 03/21/2025] [Accepted: 03/25/2025] [Indexed: 04/15/2025] Open
Abstract
BACKGROUND Shared decision-making in the context of medication management has been shown to be contingent on information-seeking behaviours such as patient knowledge, self-efficacy and engagement. OBJECTIVE The aim of this study was to: (i) compare differences in perceptions of patients' knowledge, capabilities and engagement across healthcare professionals (HCPs) and patients and family caregivers and (ii) investigate associations between these factors and patients' medication beliefs using a cross-sectional survey study of patients, family caregivers and community and hospital HCPs in Ireland. METHODS Two cross-sectional surveys measuring key factors in medication management were distributed to patients and family caregivers taking three or more medicines and HCPs involved in medicines management. χ2 tests were used to investigate differences between HCPs and patients and family caregivers. Multivariable linear regression with adjustment for the socio-demographic covariates was used to examine key factors in medication management and beliefs about medicine (BMQ-General) in patients and family caregivers. RESULTS Overall, 636 responses were received; patients and family caregivers (N = 134, 21%), community (N = 313, 49%) and hospital HCPs (N = 189, 30%). A higher proportion of patients and family caregivers self-reported as 'knowledgeable' about medications (N = 76; 56.7%) than community (N = 75, 24%) and hospital HCPs (N = 44, 23.3%) (p < 0.01). The majority of patients and family caregivers were 'fairly/very confident' they could maintain an accurate medication list without assistance (N = 78; 58.2%), compared to the majority of the community (N = 213, 68.1%) and hospital HCPs (N = 114, 60.3%) who were 'not at all/somewhat confident' (p < 0.01.) These patients and family caregivers also had significantly lower overall beliefs in medication harm (β = -1.23, 95% CI: -2.34, -0.13). Patient and family caregivers who asked HCPs about their medication frequently (> 7 times per year) had higher overall beliefs in medication overuse (β = 1.88, 95% CI: 0.06, 3.69) and medication harm (β = 2.65, 95% CI: 1.10, 4.20), compared to those who never asked. CONCLUSION There was divergence between HCPs and patients and family caregivers in their assessments of patients' medication knowledge and capabilities. Engagement between HCPs and patients around medication should be purposeful rather than frequent, to alleviate fears about overuse and harm. PATIENT OR PUBLIC CONTRIBUTION The patient and family caregiver survey was developed in partnership with members of the Patient and Public Involvement (PPI) group. Feedback was provided by the group to increase accessibility of survey and maximise distribution. In addition, the survey was piloted among members of the public involved in medication management.
Collapse
Affiliation(s)
- Bernadine O'Donovan
- Data Science Centre, School of Population HealthRCSI University of Medicine and Health SciencesDublinIreland
| | - Ciara Kirke
- Medication Safety, Quality Improvement DivisionHealth Service Executive (HSE)DublinIreland
| | - Muriel Pate
- Medication Safety, Quality Improvement DivisionHealth Service Executive (HSE)DublinIreland
| | - Sheena McHugh
- School of Public HealthUniversity College CorkCorkIreland
| | - Kathleen Bennett
- Data Science Centre, School of Population HealthRCSI University of Medicine and Health SciencesDublinIreland
| | - Caitríona Cahir
- Data Science Centre, School of Population HealthRCSI University of Medicine and Health SciencesDublinIreland
| |
Collapse
|
11
|
Al Bulushi S, McIntosh T, Talkhan H, Grant A, Stewart D, Al Famy M, Cunningham S. Barriers and facilitators to implementing polypharmacy management frameworks: a theory based qualitative exploration of key stakeholders. Int J Clin Pharm 2025; 47:412-422. [PMID: 39666181 PMCID: PMC11920292 DOI: 10.1007/s11096-024-01844-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2024] [Accepted: 11/23/2024] [Indexed: 12/13/2024]
Abstract
BACKGROUND Inappropriate polypharmacy arises through many factors including deficiencies in prescribing processes. Most research has focused on solutions at the clinician/patient levels with less at the organisational level. AIM To explore key stakeholder identified barriers and facilitators to implementation of an organisational level polypharmacy management framework. METHOD Qualitative data were collected within the Ministry of Health in Oman. Key stakeholders were purposively sampled encompassing senior representatives of pharmacy, medicine, and nursing directors; healthcare policymakers; patient safety leaders; and academic leaders. A semi-structured interview schedule was developed informed by a recent scoping review and underpinned by the Consolidated Framework for Implementation Research (CFIR). Interviews, which continued until data saturation, were audio-recorded, transcribed and analysed using the Framework Approach. RESULTS Thirteen key stakeholders were interviewed, with representation of each target group. Facilitators largely mapped to the CFIR domain of inner setting (i.e., aspects of stakeholder awareness, the electronic health system and national leadership), intervention characteristic (evidence gaps), characteristics of individuals (stakeholders and champions) and process (change strategy). Barriers also largely mapped to the inner setting (policy absence, communication and health professional practice) and outer setting (resource needs). CONCLUSION This study has illuminated the facilitators and barriers to the implementation of an organisational level polypharmacy management framework. Further work is required to translate these themes into an actionable plan to implement the framework. Particular attention is required for aspects of the CFIR domain of inner setting (i.e., the internal context within which implementation occurs) as most barriers mapped to this domain.
Collapse
Affiliation(s)
- S Al Bulushi
- Ministry of Health, Muscat, Oman
- School of Pharmacy and Life Sciences, Applied Sciences and Public Health, Robert Gordon University, Garthdee Road, Aberdeen, AB10 7GJ, UK
| | - T McIntosh
- School of Pharmacy and Life Sciences, Applied Sciences and Public Health, Robert Gordon University, Garthdee Road, Aberdeen, AB10 7GJ, UK
| | - H Talkhan
- Department of Clinical Pharmacy, College of Pharmacy, King Khalid University, Abha, Kingdom of Saudi Arabia
| | - A Grant
- School of Health, Robert Gordon University, Garthdee Road, Aberdeen, AB10 7GJ, UK
| | - D Stewart
- School of Pharmacy and Life Sciences, Applied Sciences and Public Health, Robert Gordon University, Garthdee Road, Aberdeen, AB10 7GJ, UK
- School of Pharmacy and Biomolecular Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
| | | | - S Cunningham
- School of Pharmacy and Life Sciences, Applied Sciences and Public Health, Robert Gordon University, Garthdee Road, Aberdeen, AB10 7GJ, UK.
| |
Collapse
|
12
|
Bischof T, al Jalali V, Zeitlinger M, Jorda A, Hana M, Singeorzan K, Riesenhuber N, Stemer G, Schoergenhofer C. Chat GPT vs. Clinical Decision Support Systems in the Analysis of Drug-Drug Interactions. Clin Pharmacol Ther 2025; 117:1142-1147. [PMID: 39935064 PMCID: PMC11924163 DOI: 10.1002/cpt.3585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2024] [Accepted: 01/21/2025] [Indexed: 02/13/2025]
Abstract
The current standard method for the analysis of potential drug-drug interactions (pDDIs) is time-consuming and includes the use of multiple clinical decision support systems (CDSSs) and the interpretation by healthcare professionals. With the emergence of large language models developed with artificial intelligence, an interesting alternative arose. This retrospective study included 30 patients with polypharmacy, who underwent a pDDI analysis between October 2022 and August 2023, and compared the performance of Chat GPT and established CDSSs (MediQ®, Lexicomp®, Micromedex®) in the analysis of pDDIs. A multidisciplinary team interpreted the obtained results and decided upon clinical relevance and assigned severity grades using three categories: (i) contraindicated, (ii) severe, (iii) moderate. The expert review identified a total of 280 clinically relevant pDDIs (3 contraindications, 13 severe, 264 moderate) using established CDSSs, compared with 80 pDDIs (2 contraindications, 5 severe, 73 moderate) using Chat GPT. Chat GPT almost entirely neglected pDDIs with the risk to QTc prolongation (85 vs. 8), which could also not be sufficiently improved by using a specific prompt. To assess the consistency of the results provided by Chat GPT, we repeated each query and found inconsistent results in 90% of the cases. In contrast, Chat GPT provided acceptable and comprehensible recommendations for specific questions on side effects. The use of Chat GPT for the identification of pDDIs cannot be recommended currently, because clinically relevant pDDIs were not detected, there were obvious errors and results were inconsistent. However, if these limitations are addressed accordingly, it is a promising platform for the future.
Collapse
Affiliation(s)
- Thorsten Bischof
- Department of Clinical PharmacologyMedical University of ViennaViennaAustria
| | - Valentin al Jalali
- Department of Clinical PharmacologyMedical University of ViennaViennaAustria
| | - Markus Zeitlinger
- Department of Clinical PharmacologyMedical University of ViennaViennaAustria
| | - Anselm Jorda
- Department of Clinical PharmacologyMedical University of ViennaViennaAustria
| | - Michelle Hana
- Department for Medicines Information and Clinical PharmacyPharmacy of the University Hospital ViennaViennaAustria
| | - Karla‐Nikita Singeorzan
- Department for Medicines Information and Clinical PharmacyPharmacy of the University Hospital ViennaViennaAustria
| | - Nikolaus Riesenhuber
- Department for Medicines Information and Clinical PharmacyPharmacy of the University Hospital ViennaViennaAustria
| | - Gunar Stemer
- Department for Medicines Information and Clinical PharmacyPharmacy of the University Hospital ViennaViennaAustria
| | | |
Collapse
|
13
|
Contreras Macías E, Robustillo Cortés MDLA, Morillo Verdugo R. Dual trajectories of polypharmacy and medication regimen complexity index in people living with human immunodeficiency virus in Spain. FARMACIA HOSPITALARIA 2025:S1130-6343(25)00010-8. [PMID: 40140307 DOI: 10.1016/j.farma.2025.02.003] [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: 03/12/2024] [Revised: 08/07/2024] [Accepted: 09/23/2024] [Indexed: 03/28/2025] Open
Abstract
INTRODUCTION Polypharmacy, using six or more medications, may increase the risk of high medication regimen complexity index (MRCI). We aimed to identify the interrelationship between trajectories of polypharmacy and MRCI. METHODS People living with HIV (PLWH) (aged ≥ 18) were included in from 2010 to 2021. Group-based trajectory modeling (GBTM) was used to identify polypharmacy trajectories and the complexity index of the medication regimen and the dual GBTM to identify their interrelationship. RESULTS In total, 789 participants who met the eligibility criteria were included in the study, with a median age of 47 years. GBTM analysis was used to reveal latent polypharmacy trajectories among PLWH. The findings disclosed four distinctive trajectories, with the majority (50.8%) of the PLWH falling into the "low increasing" trajectory. Furthermore, GBTM identified two trajectories characterized by high MRCI, and a substantial proportion (80.2%) was assigned to the 'slightly increasing low' trajectory group. The study revealed that younger age (less than 50 years) was a significant predictor of membership in the 'consistently low' trajectory, while male gender was associated with the groups of 'low increasing' and 'moderately decreasing' polypharmacy trajectory. CONCLUSIONS GBTM failed to discern a discernible interrelationship between polypharmacy and the high MRCI. It is imperative to undertake future studies within this research domain, considering potential effect modifiers, notably the specific type of concomitant drug. This approach is crucial due to the outcomes induced by both polypharmacy and the magnitude of the pharmacotherapeutic complexity in PLWH.
Collapse
|
14
|
Yang HW, Yu CH, Huang TY, Huang CH, Su YJ. Reducing polypharmacy through deprescribing in the emergency department. Medicine (Baltimore) 2025; 104:e41590. [PMID: 40068039 PMCID: PMC11902944 DOI: 10.1097/md.0000000000041590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2024] [Revised: 01/29/2025] [Accepted: 01/31/2025] [Indexed: 03/14/2025] Open
Abstract
Polypharmacy, the use of multiple medications, is a prevalent issue globally that contributes to increased healthcare costs and places additional burdens on patients' organs. This study aims to deprescribe and prevent polypharmacy in the emergency department. We conducted a retrospective review of randomly selected medical records from the Internal Medicine Department of Taipei MacKay Emergency Department, spanning from August 1, 2023, to October 31, 2023. For cases identified as involving polypharmacy, pharmacists provided medication education using the Team Resource Management Polypharmacy Interview Guide, while social workers contacted patients via phone to recommend follow-up visits for deprescribing. Patients experiencing polypharmacy were significantly older than those on appropriate medication regimens (79.8 vs 67.3 years, P = .002). After deprescribing interventions, the average number of medications for polypharmacy patients was 5.9 higher than for those receiving appropriate prescriptions (9.2 vs 3.3, P = .001). The most common conditions associated with polypharmacy were diabetes mellitus, hypertension, and arrhythmia. Polypharmacy poses a significant medication management challenge, with affected patients taking an average of 6.9 more medications than those on appropriate treatment regimens. The resource management module of our team successfully reduced the incidence of polypharmacy by 8.4% in the emergency department.
Collapse
Affiliation(s)
- Hsiu-Wu Yang
- Emergency Department, Toxicology Division, MacKay Memorial Hospital, Taipei, Taiwan
- Department of Emergency Medicine, Mackay Memorial Hospital, Taipei, Taiwan
- Department of Medicine, MacKay Medical College, New Taipei City, Taiwan
| | - Ching-Hsiang Yu
- Department of Emergency Medicine, Mackay Memorial Hospital, Taipei, Taiwan
| | - Teng-Yi Huang
- Social Service Department, MacKay Memorial Hospital, Taipei, Taiwan
| | - Chia-Hui Huang
- Department of Pharmacy, MacKay Memorial Hospital, Taipei, Taiwan
| | - Yu-Jang Su
- Emergency Department, Toxicology Division, MacKay Memorial Hospital, Taipei, Taiwan
- Department of Emergency Medicine, Mackay Memorial Hospital, Taipei, Taiwan
- Department of Medicine, MacKay Medical College, New Taipei City, Taiwan
- Department of Nursing, Yuanpei University of Medical Technology, Hsinchu, Taiwan
- MacKay Junior College of Medicine Nursing and Management, Taipei, Taiwan
| |
Collapse
|
15
|
Ward L, Tew GA, Wiley L, Rose F, Maturana Palacios CS, Bissell L, Howsam J, Rapley T. Perceptions and experiences of chair-based yoga by older adults with multimorbidity - a qualitative process evaluation of the Gentle Years Yoga randomised controlled trial. BMC Geriatr 2025; 25:152. [PMID: 40045209 PMCID: PMC11881412 DOI: 10.1186/s12877-025-05782-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2024] [Accepted: 02/11/2025] [Indexed: 03/09/2025] Open
Abstract
BACKGROUND Yoga is increasingly practised by older adults, with growing evidence for its safety and effectiveness across a range of health conditions common to the age group. This process evaluation, embedded within a randomised controlled trial of chair-based yoga for older adults with multimorbidity, qualitatively explored participants' perceptions and experiences of the chair-based yoga programme. METHODS One-to-one interviews and class observations were conducted with a subset of trial participants randomised to receive the 12-week chair-based yoga programme. Interview participants were selectively recruited to represent the demographic breadth of the main trial cohort; one yoga class was observed at each delivery site. Interviews were audio recorded, independently transcribed, and analysed according to longitudinal and thematic analysis. RESULTS Twenty-five yoga participants were interviewed once (N = 10) or twice (N = 15), providing a 40-interview data set. Participants were aged 66-91 years (mean age 74 years), 56% female (N = 14), predominantly White British (N = 22, 88%), with 2-8 long term health conditions (mean 4.5 conditions). Four interlinked and overarching themes predominated: perceptions of healthy ageing, delineating yoga and exercise, yoga as an adaptable multifaceted health tool, and patterns of ongoing yoga practice. Participants equated acute symptom presentation, not multimorbidity, with illness, and mostly viewed their health as good. They distinguished yoga from exercise based on its integration of the breath with physical movements, which provided a mental focus unfound in other physical activities. Impact of the yoga programme ranged from minimal to transformative, dependent on meaningful biopsychosocial improvements. Accordingly, continuation of yoga beyond the trial ranged from none to full integration as a multifaceted health management tool. CONCLUSIONS Participant experiences of the yoga programme interlinked views on health, ageing, exercise, and sustainable health management. Yoga presented as a safe, acceptable, and adaptable option for non-pharmacological health management in older adults. Impact on biopsychosocial health was variable, and directly linked to participants' longer term yoga engagement. Education of health professionals and activity providers regarding ageist stereotypes of health and ageing, together with the evidence base for the safety and effectiveness of yoga, could support and broaden yoga's reach and engagement among both older adult and multimorbid cohorts. TRIAL REGISTRATION ISRCTN ISRCTN13567538. Registered 18 March 2019.
Collapse
Affiliation(s)
- Lesley Ward
- Department of Social Work, Education and Community Wellbeing, Northumbria University, Newcastle uponTyne, UK.
| | - Garry A Tew
- Institute for Health and Care Improvement, York St John University, York, UK
| | - Laura Wiley
- York Trials Unit, Department of Health Sciences, University of York, York, UK
| | - Fiona Rose
- York Trials Unit, Department of Health Sciences, University of York, York, UK
| | | | | | - Jenny Howsam
- British Wheel of Yoga Qualifications, London, UK
| | - Tim Rapley
- Department of Social Work, Education and Community Wellbeing, Northumbria University, Newcastle uponTyne, UK
| |
Collapse
|
16
|
Engels L, van den Akker M, Denig P, Stoffers H, Gerger H, Bohnen J, Jansen J. Medication Management in Patients With Polypharmacy in Primary Care: A Scoping Review of Clinical Practice Guidelines. J Evid Based Med 2025; 18:e70015. [PMID: 40109028 PMCID: PMC11923579 DOI: 10.1111/jebm.70015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2024] [Revised: 02/27/2025] [Accepted: 03/10/2025] [Indexed: 03/22/2025]
Abstract
OBJECTIVE Inappropriate polypharmacy increases the risk of medication-related issues. Adequate management of polypharmacy is a challenge involving different healthcare professionals, complex decision-making and ideally including patient involvement. The objective of this scoping review was to provide an overview of national recommendations for medication management of patients with polypharmacy in primary care. METHODS A scoping review of clinical practice guidelines focusing on medication management in adults with polypharmacy, applicable to primary care was performed. Databases (G-I-N, Turning Research into Practice and PubMed), network, and a global report were screened for guidelines published after 2000 in English, Dutch, German, Spanish, French, or Russian. Raw data were extracted in duplicate using an extraction framework focusing on strategies, involvement of professionals, patient involvement, and implementation. Qualitative content analysis was used. Guideline quality was assessed using AGREE-II. The study was registered with the Open Science Framework. RESULTS Eight guidelines originating from eight countries were included. The most common recommended strategy was a medication review conducted by a general practitioner and/or a community pharmacist. Tasks and target population differed per guideline. Most guidelines recommended involving the patient in the process, mostly to elicit the patient's experiences and treatment goals. Few guidelines included advice on the implementation of recommendations. Three out of eight guidelines were of good quality (AGREE-II score >70% in 5/6 domains). CONCLUSIONS Most guidelines recommended a medication review, with patient involvement, as a strategy for medication management in polypharmacy in primary care. Guidance on task division and implementation of guidelines in practice was less clear. This review illustrates room for guideline improvements.
Collapse
Affiliation(s)
- Loes Engels
- Department of Family MedicineCare and Public Health Research InstituteMaastricht UniversityMaastrichtthe Netherlands
| | - Marjan van den Akker
- Department of Family MedicineCare and Public Health Research InstituteMaastricht UniversityMaastrichtthe Netherlands
- Institute of General PracticeGoethe University FrankfurtFrankfurt am MainGermany
- Academic Centre of General PracticeDepartment of Public Health and Primary CareKatholieke Universiteit LeuvenLeuvenBelgium
| | - Petra Denig
- Department of Clinical Pharmacy and PharmacologyUniversity Medical Center GroningenUniversity of GroningenGroningenthe Netherlands
| | - Henri Stoffers
- Department of Family MedicineCare and Public Health Research InstituteMaastricht UniversityMaastrichtthe Netherlands
| | - Heike Gerger
- Department of Family MedicineCare and Public Health Research InstituteMaastricht UniversityMaastrichtthe Netherlands
- Department of Clinical PsychologyFaculty of PsychologyOpen University of the NetherlandsHeerlenthe Netherlands
| | - Jolijn Bohnen
- Department of Family MedicineCare and Public Health Research InstituteMaastricht UniversityMaastrichtthe Netherlands
| | - Jesse Jansen
- Department of Family MedicineCare and Public Health Research InstituteMaastricht UniversityMaastrichtthe Netherlands
| |
Collapse
|
17
|
Boccardi V, Bahat G, Balci C, Bourdel-Marchasson I, Christiaens A, Donini LM, Cavdar S, Maggi S, Özkök S, Pavic T, Perkisas S, Volpato S, Zaidi MS, Zeyfang A, Sinclair AJ. Challenges, current innovations, and opportunities for managing type 2 diabetes in frail older adults: a position paper of the European Geriatric Medicine Society (EuGMS)-Special Interest Group in Diabetes. Eur Geriatr Med 2025:10.1007/s41999-025-01168-1. [PMID: 40014274 DOI: 10.1007/s41999-025-01168-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2024] [Accepted: 02/04/2025] [Indexed: 02/28/2025]
Abstract
PURPOSE This position paper aims to address the challenges of managing type 2 diabetes mellitus (T2DM) in frail older adults, a diverse and growing demographic with significant variability in health status. The primary research questions are: How can frailty assessment be effectively integrated into diabetes care? What strategies can optimize glycaemic control and outcomes for frail older adults? How can innovative tools and technologies, including artificial intelligence (AI), improve the management of this population? METHODS The paper uses the 5 I's framework (Identification, Innovation, Individualization, Integration, Intelligence) to integrate frailty into diabetes care, proposing strategies such as frailty tools, novel therapies, digital technologies, and AI systems. It also examines metabolic heterogeneity, highlighting anorexic-malnourished and sarcopenic-obese phenotypes. RESULTS The proposed framework highlights the importance of tailoring glycaemic targets to frailty levels, prioritizing quality of life, and minimizing treatment burden. Strategies such as leveraging AI tools are emphasized for their potential to enhance personalized care. The distinct management needs of the two metabolic phenotypes are outlined, with specific recommendations for each group. CONCLUSION This paper calls for a holistic, patient-centered approach to diabetes care for frail older adults, ensuring equity in access to innovations and prioritizing quality of life. It highlights the need for research to fill evidence gaps, refine therapies, and improve healthcare integration for better outcomes in this vulnerable group.
Collapse
Affiliation(s)
- Virginia Boccardi
- Division of Gerontology and Geriatrics, Department of Medicine and Surgery, University of Perugia, Piazzale Gambuli 1, 06132, Perugia, Italy.
| | - Gülistan Bahat
- Division of Geriatrics, Department of Internal Medicine, Istanbul Medical Faculty, Istanbul University, Çapa, 34093, Istanbul, Turkey
| | - Cafer Balci
- Division of Geriatric Medicine, Department of Internal Medicine, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Isabelle Bourdel-Marchasson
- CNRS, CRMSB, UMR 5536, University of Bordeaux, Bordeaux, France
- University Hospital of Bordeaux, Bordeaux, France
| | - Antoine Christiaens
- Fund for Scientific Research-FNRS, 1000, Brussels, Belgium
- Clinical Pharmacy and Pharmacoepidemiology Research Group, Louvain Drug Research Institute (LDRI), Université Catholique de Louvain, 1200, Brussels, Belgium
| | | | - Sibel Cavdar
- Division of Geriatrics, Department of Internal Medicine, Izmir City Hospital, Bayraklı, 35540, Izmir, Turkey
| | - Stefania Maggi
- CNR Institute of Neuroscience, Aging Branch, Padua, Italy
| | - Serdar Özkök
- Division of Geriatrics, Department of Internal Medicine, Istanbul Medical Faculty, Istanbul University, Çapa, 34093, Istanbul, Turkey
| | - Tajana Pavic
- Department of Gastroenterology and Hepatology, University Hospital Center Sestre Milosrdnice, Zagreb, Croatia
| | - Stany Perkisas
- University Centre for Geriatrics ZNA (Ziekenhuis Netwerk Antwerpen), University of Antwerp, Antwerp, Belgium
| | - Stefano Volpato
- Dipartimento di Scienze Mediche, Università di Ferrara, Ferrara, Italy
| | - Muhammad Shoaib Zaidi
- Department of Internal Medicine, King Saud University Medical City, Riyadh, Saudi Arabia
| | - Andrej Zeyfang
- Department of Internal Medicine, Geriatric Medicine and Diabetology, Medius Klinik Ostfildern-Ruit, Ostfildern, Germany
- Institute of Epidemiology and Medical Biometry, ZIBMT, Ulm University, Ulm, Germany
| | | |
Collapse
|
18
|
Alkhaldi M, Lindsey L, Richardson C. Role of informal carers in medication management for people with long-term conditions: a systematic review. BMJ Open 2025; 15:e094443. [PMID: 40000079 PMCID: PMC12083308 DOI: 10.1136/bmjopen-2024-094443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2024] [Accepted: 02/07/2025] [Indexed: 02/27/2025] Open
Abstract
OBJECTIVES To explore the literature about the role of unpaid informal carers in medication management for people with long-term conditions. DESIGN Systematic review designed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. INFORMATION SOURCE MEDLINE (Ovid), Embase (Ovid), PsycINFO, Cumulated Index in Nursing and Allied Health Literature (EBSCO), Scopus and Web of Science were searched from inception until April 2024. Additional papers were identified by searching backwards and forwards the reference lists of included papers. ELIGIBILITY CRITERIA Primary research studies were included if they reported medication-related activities undertaken by carers for people with long-term conditions. Qualitative and mixed methods studies were considered without restriction on language or country. DATA EXTRACTION AND SYNTHESIS Relevant data were extracted and summarised in a table. The Mixed Method Appraisal Tool was used for quality assessment. Data were narratively synthesised. RESULTS From 12 473 identified records, 107 underwent full text screening and 20 studies were included. Family carers were the predominant type of carer. Spouses and adult children constituted the largest caregiving dyads. Based on the required skills, two groups of roles were identified: physical roles, such as prescription management, and cognitive roles, such as decision-making. Carers used different strategies and tools to undertake medication-related activities including compliance aids and alarms. However, carers reported challenges in their experiences of caregiving, flagging up their need for additional support and education to commence such activities. CONCLUSION Informal carers undertake a wide variety of medication-related activities. The studies emphasised the need to support families as partners in health outcomes. This systematic review identifies the importance of bridging the gap between carers and healthcare providers. More efforts are needed to empower carers towards better and safer caregiving. Future work could address how to optimise carer involvement and engagement and provide best practice recommendations for carers' support. PROSPERO REGISTRATION NUMBER CRD42024506694.
Collapse
Affiliation(s)
- Maha Alkhaldi
- School of Pharmacy, Newcastle University, Newcaslte Upon Tyne, UK
- College of Clinical Pharmacy, King Faisal University, Al Ahsa, Saudi Arabia
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Laura Lindsey
- School of Pharmacy, Newcastle University, Newcaslte Upon Tyne, UK
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Charlotte Richardson
- School of Pharmacy, Newcastle University, Newcaslte Upon Tyne, UK
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
- Newcastel Patient Safety Research Collaboration, Newcastle University, Newcastle upon Tyne, UK
| |
Collapse
|
19
|
Shukla SK, John P, Khemani S, Nair AS, Singh N, Sadanandan R. Assessing the financial burden of multimorbidity among patients aged 30 and above in India. BMC Health Serv Res 2025; 25:86. [PMID: 39815285 PMCID: PMC11737259 DOI: 10.1186/s12913-025-12206-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2024] [Accepted: 01/01/2025] [Indexed: 01/18/2025] Open
Abstract
BACKGROUND Multimorbidity is associated with significant out-of-pocket expenditures (OOPE) and catastrophic health expenditure (CHE), especially in low- and middle-income countries like India. Despite this, there is limited research on the financial burden of multimorbidity in outpatient and inpatient care, and cross-state comparisons of CHE are underexplored. METHODS We conducted a cross-sectional analysis using nationally representative data from the National Sample Survey 75th Round 'Social Consumption in India: Health (2017-18)', focusing on patients aged 30 and above in outpatient and inpatient care in India. We assessed multimorbidity prevalence, OOPE, CHE incidence, and CHE intensity. Statistical models, including linear, log-linear, and logistic regressions, were used to examine the financial risk, with a focus on non-communicable diseases (NCDs), healthcare facility choice, and socioeconomic status and Epidemiological Transition Levels (ETLs). RESULTS Multimorbidity prevalence in outpatient care (6.1%) was six times higher than in inpatient care (1.1%). It was most prevalent among older adults, higher MPCE quintiles, urban patients, and those with NCDs. Multimorbidity was associated with higher OOPE, particularly in the rich quintile, patients seeking care from private providers, low ETL states, and rural areas. CHE incidence was highest in low ETL states, private healthcare users, poorest quintile, males, and patients aged 70 + years. CHE intensity, measured by mean positive overshoot, was greatest among the poorest quintile, low ETL states, rural, and male patients. Log-linear and logistic regressions indicated that multimorbidity patients with NCDs, those seeking private care, and those in low ETL states had higher OOPE and CHE risk. The poorest rural multimorbidity patients had the greatest likelihood of experiencing CHE. Furthermore, CHE intensity was significantly elevated among multimorbidity patients with NCDs (95% CI: 19.29-45.79), patients seeking care in private, poorest, and from low ETL states (95% CI: 7.36-35.79). CONCLUSIONS The high financial burden of OOPE and CHE among multimorbidity patients, particularly those with NCDs, highlight the urgent need for comprehensive health policies that address financial risk at the primary care level. To alleviate the financial burden among multimorbidity patients, especially in low-resource settings, it is crucial to expand public healthcare coverage, incorporate outpatient care into financial protection schemes, advocate for integrated care models and preventive strategies, establish standardized treatment protocols for reducing unnecessary medications linked to polypharmacy, and leverage the support of digital health technologies.
Collapse
Affiliation(s)
- Sudheer Kumar Shukla
- Health Systems Transformation Platform (HSTP), AISF Building, First Floor, Kalka Devi Marg, Lajpat Nagar IV, New Delhi, 110024, India.
| | - Pratheeba John
- Health Systems Transformation Platform (HSTP), AISF Building, First Floor, Kalka Devi Marg, Lajpat Nagar IV, New Delhi, 110024, India
| | - Sakshi Khemani
- Health Systems Transformation Platform (HSTP), AISF Building, First Floor, Kalka Devi Marg, Lajpat Nagar IV, New Delhi, 110024, India
| | - Ankur Shaji Nair
- Health Systems Transformation Platform (HSTP), AISF Building, First Floor, Kalka Devi Marg, Lajpat Nagar IV, New Delhi, 110024, India
| | - Nishikant Singh
- Health Systems Transformation Platform (HSTP), AISF Building, First Floor, Kalka Devi Marg, Lajpat Nagar IV, New Delhi, 110024, India
| | - Rajeev Sadanandan
- Health Systems Transformation Platform (HSTP), AISF Building, First Floor, Kalka Devi Marg, Lajpat Nagar IV, New Delhi, 110024, India
| |
Collapse
|
20
|
Nicholson K, Salerno J, Borhan S, Cossette B, Guenter D, Vanstone M, Queenan J, Greiver M, Howard M, Terry AL, Williamson T, Griffith LE, Fortin M, Stranges S, Mangin D. The co-occurrence of multimorbidity and polypharmacy among middle-aged and older adults in Canada: A cross-sectional study using the Canadian Longitudinal Study on Aging (CLSA) and the Canadian Primary Care Sentinel Surveillance Network (CPCSSN). PLoS One 2025; 20:e0312873. [PMID: 39813217 PMCID: PMC11734935 DOI: 10.1371/journal.pone.0312873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2024] [Accepted: 10/14/2024] [Indexed: 01/18/2025] Open
Abstract
BACKGROUND There is an increasing prevalence of multiple conditions (multimorbidity) and multiple medications (polypharmacy) across many populations. Previous literature has focused on the prevalence and impact of these health states separately, but there is a need to better understand their co-occurrence. METHODS AND FINDINGS This study reported on multimorbidity and polypharmacy among middle-aged and older adults in two national datasets: the Canadian Longitudinal Study on Aging (CLSA) and the Canadian Primary Care Sentinel Surveillance Network (CPCSSN). Using consistent methodology, we conducted a cross-sectional analysis of CLSA participants and CPCSSN patients aged 45 to 85 years as of 2015. When multimorbidity was defined as two or more conditions, the prevalence was 66.7% and 52.0% in the CLSA and CPCSSN cohorts, respectively. The prevalence of polypharmacy was 14.9% in the CLSA cohort and 22.6% in the CPCSSN cohort when defined as five or more medications. Using the same cut-points, the co-occurrence of multimorbidity and polypharmacy was similar between the two cohorts (CLSA: 14.3%; CPCSSN: 13.5%). Approximately 20% of older adults (65 to 85 years) were living with both multimorbidity and polypharmacy (CLSA: 21.4%; CPCSSN: 18.3%), as compared to almost 10% of middle-aged adults (45 to 64 years) living with this co-occurrence (CLSA: 9.2%; CPCSSN: 9.9%). Across both cohorts and age groups, females had consistently higher estimates of multimorbidity, polypharmacy and the co-occurrence of multimorbidity and polypharmacy. CONCLUSIONS This study found that multimorbidity and polypharmacy are not interchangeable in understanding population health needs. Approximately one in five older adults in the CLSA and CPCSSN cohorts were living with both multimorbidity and polypharmacy, double the proportion in the younger cohorts. This has implications for future research, as well as health policy and clinical practice, that aim to reduce the occurrence and impact of multimorbidity and unnecessary polypharmacy to enhance the well-being of aging populations.
Collapse
Affiliation(s)
- Kathryn Nicholson
- Department of Epidemiology & Biostatistics, Western University, London, Ontario, Canada
- Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Jennifer Salerno
- Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Sayem Borhan
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Benoit Cossette
- Faculté de médecine et des sciences de la santé, Université de Sherbrooke, Sherbrooke, Québec, Canada
| | - Dale Guenter
- Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Meredith Vanstone
- Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada
| | - John Queenan
- Department of Family Medicine, Queen’s University, Kingston, Ontario, Canada
| | - Michelle Greiver
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Michelle Howard
- Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Amanda L. Terry
- Department of Epidemiology & Biostatistics, Western University, London, Ontario, Canada
- Department of Family Medicine, Western University, London, Ontario, Canada
- Interfaculty Program in Public Health, Western University, London, Ontario, Canada
| | - Tyler Williamson
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Lauren E. Griffith
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Martin Fortin
- Department of Family Medicine and Emergency Medicine, Université de Sherbrooke, Sherbrooke, Québec, Canada
| | - Saverio Stranges
- Department of Epidemiology & Biostatistics, Western University, London, Ontario, Canada
- Department of Family Medicine, Western University, London, Ontario, Canada
- Department of Medicine, Western University, London, Ontario, Canada
- Department of Clinical Medicine and Surgery, University of Naples Federico II University, Naples, Italy
| | - Dee Mangin
- Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada
- Department of Primary Care and Clinical Simulation, University of Otago, Christchurch, New Zealand
| |
Collapse
|
21
|
Shareef J, Sridhar SB, Ahmad Ismail AN, Rao PG, Ain Ur R. Assessment of potential drug-drug interactions in hospitalized patients with infectious diseases: an experience from a secondary care hospital. F1000Res 2025; 13:164. [PMID: 39931321 PMCID: PMC11809622 DOI: 10.12688/f1000research.143186.3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/10/2024] [Indexed: 02/13/2025] Open
Abstract
Background Polypharmacy is common among hospitalized patients with infectious infections owing to comorbidities or concurrent illnesses. This raises the likelihood of drug-drug interactions and creates uncertainty for healthcare providers. This study aimed to assess the potential drug-drug interactions (pDDIs) among hospitalized patients with infectious diseases in a secondary care hospital. Methods A prospective observational study was conducted in the internal medicine ward for six months. Data were collected from patient case records, and prescriptions were screened for pDDIs and classified based on the severity from a portable electronic physician information database (PEPID) resource analyzed using SPSS, version 27.0. Results In total, 148 patient case records were analyzed, and 549 pDDIs were identified, with 66.8% having at least one or more DDIs. The mean number of drug interactions was 3.70 ± 4.58 per prescription. The most frequently encountered drug interactions were drug combinations such as bisoprolol with atorvastatin and aspirin with tazobactam/piperacillin. Based on the severity, most pDDIs belong to the 'moderate' category (40.07%). Bivariate analysis showed that age, comorbidities, length of hospital stay, and the number of drugs prescribed were risk factors associated with DDIs (p<0.05). In the multiple binary logistic regression analysis, DDIs were significantly associated with comorbidities and the number of prescribed medications (p<0.0001). Conclusions This study observed the prevalence of DDIs in hospitalized patients with infectious diseases of 'moderate' severity. Prescription screening using a drug information database assists in identifying and preventing DDIs early, enhancing drug safety and quality of patient-centered care.
Collapse
Affiliation(s)
- Javedh Shareef
- Department of Clinical Pharmacy & Pharmacology, RAK College of Pharmacy, RAK Medical & Health Sciences University, Ras Al Khaimah, 11172, United Arab Emirates
| | - Sathvik Belagodu Sridhar
- Department of Clinical Pharmacy & Pharmacology, RAK College of Pharmacy, RAK Medical & Health Sciences University, Ras Al Khaimah, 11172, United Arab Emirates
| | - Abu Nawa Ahmad Ismail
- Department of Clinical Pharmacy & Pharmacology, RAK College of Pharmacy, RAK Medical & Health Sciences University, Ras Al Khaimah, 11172, United Arab Emirates
| | - Padma G.M. Rao
- Department of Clinical Pharmacy & Pharmacology, RAK College of Pharmacy, RAK Medical & Health Sciences University, Ras Al Khaimah, 11172, United Arab Emirates
| | - Rashid Ain Ur
- Internal Medicine Specialist, Ibrahim Bin Hamad Obaidullah Hospital, Ras Al-Khaimah, Ras al Khaimah, 11172, United Arab Emirates
| |
Collapse
|
22
|
Frank HA, Karim ME. Physical comorbidity is associated with overnight hospitalization in U.S. adults with asthma: an assessment of the 2005-2018 National Health and Nutrition Examination Surveys. J Asthma 2025; 62:155-166. [PMID: 39155766 DOI: 10.1080/02770903.2024.2393677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Revised: 07/17/2024] [Accepted: 08/14/2024] [Indexed: 08/20/2024]
Abstract
OBJECTIVE Identifying the effects of comorbidity on healthcare utilization is critical for understanding the benefits of improved comorbidity management. Asthma is a common respiratory condition, associated with gastrointestinal, metabolic, psychiatric, and other respiratory conditions. Adults with asthma represent a key population in understanding comorbidity and its consequences. The objective was to explore the relationship between comorbidity and overnight hospitalizations in U.S. adults with asthma. STUDY DESIGN AND METHODS A cross-sectional sample of 3,887 subjects aged 20-79 was aggregated from seven cycles (2005-2018) of the National Health and Nutrition Examination Survey (NHANES). The survey design was created using the full seven cycles, then a subpopulation was used for the analysis. Design-based modified Poisson regression with robust standard errors compared the prevalence of overnight hospitalizations in subjects with and without comorbidities. Comorbidity was defined as the presence of one or more additional chronic conditions. RESULTS Over half (61.6%) of patients with asthma reported having comorbidities. The overnight hospitalization prevalence was higher in those with comorbidities (21.6%) than those without (7.4%). The adjusted prevalence ratio of overnight hospitalizations in those with comorbidities vs. those without was 2.02 (95% CI: 1.54-2.66). Conclusions from sensitivity analyses remained the same. CONCLUSIONS Comorbidity in U.S. adult asthma patients is associated with increased overnight hospitalizations. Study results concur with examinations of other healthcare utilization outcomes, revealing how comorbidity influences healthcare utilization patterns in patients with asthma. The reduction of overnight hospitalizations should be a targeted goal when developing and evaluating interventions to manage comorbidities in patients with asthma.
Collapse
Affiliation(s)
- Hanna A Frank
- School of Population and Public Health, The University of British Columbia, Vancouver, Canada
| | - Mohammad Ehsanul Karim
- School of Population and Public Health, The University of British Columbia, Vancouver, Canada
- Centre for Advancing Health Outcomes, University of British Columbia, Vancouver, Canada
| |
Collapse
|
23
|
Sukumaran L, Winston A, Anderson J, Boffito M, Post FA, Sachikonye M, Mallon PWG, Waters L, Vera J, Burns F, Sabin CA. Multimorbidity frameworks impact the composition of patterns and their associations with patient-reported outcomes among people with HIV. JOURNAL OF MULTIMORBIDITY AND COMORBIDITY 2025; 15:26335565251331732. [PMID: 40191070 PMCID: PMC11970071 DOI: 10.1177/26335565251331732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/20/2024] [Accepted: 03/14/2025] [Indexed: 04/09/2025]
Abstract
Objectives: There is no consensus definition for multimorbidity. We explored how different frameworks affect multimorbidity patterns and their associations with patient-reported outcomes using the prospective, observational Pharmacokinetic and clinical Observations in PeoPle over fiftY (POPPY) Study. Methods: Sixty-four conditions were classified into three frameworks: Framework-D (diseases), Framework-DCI (diseases and clinical indicators) and Framework-DCIS (diseases, clinical indicators and symptoms). Principal component analysis (PCA) identified five comparable patterns: Cardiovascular disease (CVD), Sexually transmitted diseases, Metabolic/AIDS-related, Mental health/Other, and Cancer. A sixth pattern was identified using Framework-D (Infections/Skin) and Framework-DCI/DCIS (Cardiometabolic). Using PCA loadings, burden z-scores were calculated for each individual/pattern, and their associations with functional impairment (Lawton Instrumental Activities of Daily Living <8), hospitalisation and SF-36 physical and mental health scores were assessed using logistic or linear regression. Results: The analyses included 1073 people with HIV (median [interquartile range; IQR] age 52 [47 - 59] years; 85% male; 97% on ART). Clinical indicators and symptoms were correlated with the CVD, Cardiometabolic and Mental health/Other patterns. While differences were marginal, Framework-DCI showed slightly stronger relationships between CVD and functional impairment, hospitalisation and physical health compared to Framework-D. Similarly, Framework-DCIS demonstrated somewhat stronger associations between Metabolic/AIDS-related and Mental health/Other patterns with certain outcomes. Conclusions: The inclusion of clinical indicators and symptoms were associated with some changes in the strength of associations between certain multimorbidity patterns and outcomes. Our findings suggest that their inclusion in multimorbidity frameworks should be guided by the specific research context and question, rather than solely by effect size on patient-important outcomes.
Collapse
Affiliation(s)
- Luxsena Sukumaran
- Institute for Global Health, University College London, London, UK
- National Institute for Health and Care Research (NIHR) Health Protection Research Unit (HPRU) in Blood-borne and Sexually Transmitted Infections at University College London, London, UK
| | - Alan Winston
- Department of Infectious Disease, Imperial College London, London, UK
| | | | - Marta Boffito
- Chelsea and Westminster Healthcare NHS Foundation Trust, London, UK
| | - Frank A. Post
- King’s College Hospital NHS Foundation Trust, London, UK
| | | | | | - Laura Waters
- Institute for Global Health, University College London, London, UK
- Mortimer Market Centre, Central and North West London NHS Foundation Trust, London, UK
| | - Jaime Vera
- Brighton and Sussex Medical School, Brighton, UK
| | - Fiona Burns
- Institute for Global Health, University College London, London, UK
| | - Caroline A. Sabin
- Institute for Global Health, University College London, London, UK
- National Institute for Health and Care Research (NIHR) Health Protection Research Unit (HPRU) in Blood-borne and Sexually Transmitted Infections at University College London, London, UK
| |
Collapse
|
24
|
Mortelmans L, Gentizon J, Dilles T. Medication Literacy and Medication Self-Management: A Cross-Sectional Study in Hospitalised Patients (65+) With Polypharmacy. J Nurs Manag 2024; 2024:5430265. [PMID: 40224806 PMCID: PMC11922036 DOI: 10.1155/jonm/5430265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Revised: 03/28/2024] [Accepted: 12/18/2024] [Indexed: 04/15/2025]
Abstract
This study aimed to examine the relationship between medication literacy and the degree to which patients are considered capable of medication self-management, the factors influencing the strength of this relationship and the factors influencing a patient's capability for medication self-management. Between January and April 2022, a cross-sectional survey was conducted on hospitalised patients (65+) with polypharmacy. Medication literacy was evaluated using the MEDication Literacy Assessment of Geriatric patients and informal caregivers (MED-fLAG). The SelfMED assessment determined a patient's capability for medication self-management. The relationship between MED-fLAG and SelfMED was explored with Pearson's r. Moderation analysis was used to explore the factors influencing the strength of the relationship between both. Linear regression explored the factors influencing SelfMED scores. In total, 169 patients participated in the study. Patients considered themselves more capable of in-hospital medication self-management (8/10 rating) compared to nurses' and physicians' opinions (6/10 rating). Interactive medication literacy scored higher (mean = 3.0) than functional (mean = 2.9) and critical medication literacy (mean = 2.8). The more medication literacy skills, the more patients were considered able for medication self-management by healthcare providers (r = 0.630, p < 0.001). Moderation analysis could not reveal any factors that significantly affected the strength of the relationship between both. Age, managing medication independently at home, the number of chronic conditions and medication literacy were significant predictors of a patient's capability for in-hospital medication self-management. This study demonstrated a rather strong correlation between the results of the MED-fLAG and the SelfMED assessment. Hence, SelfMED can be used as a stand-alone first screening instrument to determine a patient's capability for in-hospital medication self-management, without first assessing medication literacy. MED-fLAG can provide valuable insights into the medication literacy of patients considered less capable of managing their medication, allowing medication information and interventions to be tailored to the patient.
Collapse
Affiliation(s)
- Laura Mortelmans
- Department of Nursing Science and Midwifery, Centre for Research and Innovation in Care (CRIC), Nurse and Pharmaceutical Care (NuPhaC), Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
- Research Foundation Flanders (FWO), Brussels, Belgium
| | - Jenny Gentizon
- Institute of Higher Education and Research in Healthcare-IUFRS, University of Lausanne (UNIL), Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Tinne Dilles
- Department of Nursing Science and Midwifery, Centre for Research and Innovation in Care (CRIC), Nurse and Pharmaceutical Care (NuPhaC), Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| |
Collapse
|
25
|
Tantipinichwong N, Keller MS. Operation Polypharmacy: a pharmacist-led ambulatory care clinic design and evaluation for older patients. Sci Rep 2024; 14:31719. [PMID: 39738189 PMCID: PMC11685990 DOI: 10.1038/s41598-024-82285-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2024] [Accepted: 12/04/2024] [Indexed: 01/01/2025] Open
Abstract
The unintended consequences of polypharmacy pose significant risks to older adults. The complexities of managing numerous medications from multiple prescribers demand a comprehensive approach to mitigate harms. Pharmacist-led clinics have been shown to improve outcomes in patients with diabetes and hypertension. Pharmacist-led clinics focused on broader issues of polypharmacy have the potential to lead to better outcomes for older patients. We describe the design and the pre-post evaluation of a polypharmacy clinic. We conducted a retrospective standardized chart review of polypharmacy visits during October and November 2022. Systematic data collection was completed by March 2023. Our review included 84 polypharmacy visits; the average patient age was 80. Patients were on 17.3 (range: 7-33) medications at-visit and 15.9 (range: 4-30) medications post-visit, with an average of 1.4 medications deprescribed per visit. In patients with many medications (range: 17-33 medications) at the polypharmacy consult visit, 2.6 medications were deprescribed post-visit. In patients with a moderate number of medications (range: 7-16 medications) at-visit, 0.9 medications were deprescribed post-visit. Medication list accuracy increased to 72% at follow-up visits compared to initial visits (66%). 44% of patients were on 1 or more Potentially Inappropriate Medications (PIMs) and 24% were on 1 or more Drugs with Strong Anticholinergic Properties (DSAPs) at initial visits. At follow-up visit, the proportion of patients with PIMs decreased by 28%, and the proportion of patients with DSAPs decreased by 54%. Our evaluation demonstrates the value of a polypharmacy clinic in improving medication list accuracy and deprescribing PIMs and DSAPs.
Collapse
Affiliation(s)
| | - Michelle S Keller
- Leonard Davis School of Gerontology, University of Southern California, Los Angeles, CA, USA
| |
Collapse
|
26
|
Contreras Macías E, Robustillo Cortés MDLA, Morillo Verdugo R. Dual trajectories of polypharmacy and medication regimen complexity index in people living with HIV in Spain. FARMACIA HOSPITALARIA 2024:S1130-6343(24)00158-2. [PMID: 39645427 DOI: 10.1016/j.farma.2024.09.009] [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: 03/12/2024] [Revised: 08/07/2024] [Accepted: 09/23/2024] [Indexed: 12/09/2024] Open
Abstract
BACKGROUND Polypharmacy, using 6 or more medications, may increase the risk of high medication regimen complexity index (MRCI). We aimed to identify the interrelationship between trajectories of polypharmacy and MRCI. METHODS People living with HIV (PLWH) (aged ≥18) were included in from 2010 to 2021. Group-based trajectory modeling (GBTM) was used to identify polypharmacy trajectories and the complexity index of the medication regimen and the dual GBTM to identify their interrelationship. RESULTS In total, 789 participants who met the eligibility criteria were included in the study, with a median age of 47 years. GBTM analysis was used to reveal latent polypharmacy trajectories among PLWH. The findings disclosed four distinctive trajectories, with the majority (50.8%) of the PLWH falling into the 'low increasing' trajectory. Furthermore, GBTM identified 2 trajectories characterized by high MRCI, and a substantial proportion (80.2%) was assigned to the 'slightly increasing low' trajectory group. The study revealed that younger age (<50 years) was a significant predictor of membership in the 'consistently low' trajectory, while male gender was associated with the groups of 'low increasing' and 'moderately decreasing' polypharmacy trajectory. CONCLUSIONS GBTM failed to discern a discernible interrelationship between polypharmacy and the high MRCI. It is imperative to undertake future studies within this research domain, considering potential effect modifiers, notably the specific type of concomitant drug. This approach is crucial due to the outcomes induced by both polypharmacy and the magnitude of the pharmacotherapeutic complexity in PLWH.
Collapse
|
27
|
Stenmanns C, Moellmann HS, Wehling M, Frohnhofen H. Evaluation of drug prescriptions on hospital admission in older trauma patients using the Fit fOR The Aged (FORTA) rules. Z Gerontol Geriatr 2024; 57:609-615. [PMID: 39327276 DOI: 10.1007/s00391-024-02359-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2024] [Accepted: 08/14/2024] [Indexed: 09/28/2024]
Abstract
BACKGROUND Orthogeriatric comanagement of older patients with hip fractures has been proven to provide significant benefits concerning functional status, readmissions, nursing home placement, in-hospital complications and mortality. Medication management in older individuals is a cornerstone in orthogeriatric comanagement. The aim of the study was to analyze the extent of overprescription and undertreatment in older trauma patients. METHODS Personal and medical data of consecutively admitted older trauma patients were analyzed. Evaluation of medication was conducted according to the Fit fOR The Aged (FORTA) criteria. Data were retrieved from an ongoing observational study on the incidence of delirium in surgical patients. RESULTS A total of 492 patients were enrolled. There were 374 cases of overprescription and 575 cases of undertreatment. Only 78 (16%) patients had neither overprescription nor undertreatment on admission. Overprescription and undertreatment were most prevalent in cardiovascular disease. Undertreatment was most prevalent concerning osteoporosis. The number of prescribed drugs correlated with the Charlson Comorbidity Index (r = 0.478, p < 0.001), age (r = 0.122; p < 0.01), anticholinergic burden (r = 0.528, p < 0.001), FORTA score (r = 0.352, p < 0.001), and overtreatment (r = 0.492, p < 0.001), but not with undertreatment. Undertreatment also correlated with age (r = 0.172, p < 0.001) and overtreatment (r = 0.364, p < 0.01). The FORTA score correlated significantly with age (r = 0.159, p < 0.001), anticholinergic burden (ACB) score (r = 0.496, p < 0.001), Katz index (r = -0.119, p < 0.01), IADL score (r = -0.243, p < 0.001), and clinical frailty scale (CFS, r = 0.23, p < 0.001). CONCLUSION The high numbers of overprescription and undertreatment in older trauma patients underlines the need for orthogeriatric comanagement. Besides the evaluation of multimorbidity and geriatric problems, drug management is a core topic. Future studies should investigate the impact of medication management on outcome parameters such as quality of life, functional status, and mortality. A benefit can be expected.
Collapse
Affiliation(s)
- Carla Stenmanns
- Department of Orthopedics and Trauma Surgery, Heinrich-Heine-University, Moorenstraße 5, 40225, Duesseldorf, Germany
| | - Henriette-Sophie Moellmann
- Department of Orthopedics and Trauma Surgery, Heinrich-Heine-University, Moorenstraße 5, 40225, Duesseldorf, Germany
| | - Martin Wehling
- Department of Orthopedics and Trauma Surgery, Heinrich-Heine-University, Moorenstraße 5, 40225, Duesseldorf, Germany
| | - Helmut Frohnhofen
- Department of Orthopedics and Trauma Surgery, Heinrich-Heine-University, Moorenstraße 5, 40225, Duesseldorf, Germany.
- Faculty of Health, Geriatrics, University Witten Herdecke, Witten, Germany.
| |
Collapse
|
28
|
Campbell C, Morris C, Sunderland B, McBain L, Czarniak P. Contribution of the community pharmacist workforce to primary care through the lens of medicines classification: comparison of Aotearoa New Zealand and Australia. J Prim Health Care 2024; 16:372-381. [PMID: 39704767 DOI: 10.1071/hc24050] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2024] [Accepted: 07/01/2024] [Indexed: 12/21/2024] Open
Abstract
Introduction Optimal use of the workforce in primary care is critical due to increasing complexity and demand resulting from multi-morbidity in ageing populations. Improving public access to medicines by making them available via a pharmacist without prescription can support self-care while ensuring oversight by a health professional. Aim The aim of this paper was to identify and explore key differences between New Zealand and Australia in medicines classified nationally for pharmacist-only non-prescription supply. Methods Medicines legally classified to allow sale by a pharmacist without a prescription were identified and compared between the two countries as of 1 February 2024. Based on consensus among the research team, notable differences were subjected to qualitative consideration about how medicines classification may be used to extend the role of pharmacists in primary care. Results Overall, New Zealand has a less restrictive approach to classification than Australia providing New Zealanders increased access to medicines via a pharmacist in two key therapeutic areas: sexual and reproductive health and infection. Oral contraceptives, sildenafil, antibiotics for urinary tract infection and two COVID-19 antivirals were classified for supply without prescription via pharmacists in New Zealand but not nationally in Australia, although some alternative legislative mechanisms are emerging at state level. Discussion Medicines classification has an ongoing role in enabling pharmacist contribution to primary care. Medicines classification needs to be considered alongside commissioning of services and other policy to facilitate integration of community pharmacy-provided care within the wider primary care environment. Digital tools supporting information sharing, collaboration and communication are key.
Collapse
Affiliation(s)
- Chloë Campbell
- Department of Primary Health Care and General Practice, University of Otago, Wellington 6242, New Zealand, Aotearoa
| | - Caroline Morris
- Department of Primary Health Care and General Practice, University of Otago, Wellington 6242, New Zealand, Aotearoa
| | - Bruce Sunderland
- Curtin Medical School, Faculty of Health Sciences, Curtin University, Perth, WA 6102, Australia
| | - Lynn McBain
- Department of Primary Health Care and General Practice, University of Otago, Wellington 6242, New Zealand, Aotearoa
| | - Petra Czarniak
- Curtin Medical School, Faculty of Health Sciences, Curtin University, Perth, WA 6102, Australia
| |
Collapse
|
29
|
Moellmann HL, Alhammadi E, Boulghoudan S, Kuhlmann J, Mevissen A, Olbrich P, Rahm L, Frohnhofen H. Risk of sarcopenia, frailty and malnutrition as predictors of postoperative delirium in surgery. BMC Geriatr 2024; 24:971. [PMID: 39604907 PMCID: PMC11600611 DOI: 10.1186/s12877-024-05566-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2024] [Accepted: 11/18/2024] [Indexed: 11/29/2024] Open
Abstract
BACKGROUND The risk factors for postoperative delirium are numerous and complex. One approach to identifying patients at risk is to evaluate their nutritional status. The aim of this prospective study is to better understand nutrition as a potential risk factor for postoperative delirium. METHODS A comprehensive preoperative assessment (Clinical Frailty Scale (CFS), the SARC-F questionnaire, Mini Nutritional Assessment-Short Form (MNA-SF)) were carried out as a prospective clinical study on 421 patients (70+) from 4 different surgical disciplines. Postoperatively, patients are examined daily for the presence of delirium using the 4AT screening tool (Arousal, Attention, Abbreviated Mental Test - 4, Acute change), the Nursing Delirium Screening Scale (NuDesc) and the Confusion Assessment Method (CAM) with its adaptation for the intensive care unit (CAM-ICU). RESULTS If there were indications of frailty or sarcopenia in the CFS or SARC-F, the association with delirium was increased 5.34-fold (OR of 5.34 [95% CI: 2.57;11.1]) and 5.56-fold (OR of 5.56 [95% CI: 2.97;10.4]) respectively. Delirium also occurred significantly more frequently with the risk of malnutrition or manifest malnutrition (MNA-SF) than with a normal nutritional status. CONCLUSIONS Patients' preoperative and nutritional status significantly impact the risk of developing postoperative delirium. Factors such as frailty, sarcopenia and possible malnutrition must be considered when implementing an effective and targeted preoperative assessment. TRAIL REGISTRATION German Clinical Trials Registry at https://www.drks.de/DRKS00028614 , Registered 25 March 2022.
Collapse
Affiliation(s)
- Henriette Louise Moellmann
- Cranio-and-Maxillo Facial Surgery, University Hospital Düsseldorf, Moorenstraße 5, 40225, Düsseldorf, Germany.
| | - Eman Alhammadi
- Cranio-and-Maxillo Facial Surgery, University Hospital Düsseldorf, Moorenstraße 5, 40225, Düsseldorf, Germany
| | - Soufian Boulghoudan
- Heinrich-Heine-Universität Düsseldorf, Universitätsstraße 1, 40225, Düsseldorf, Germany
| | - Julian Kuhlmann
- Heinrich-Heine-Universität Düsseldorf, Universitätsstraße 1, 40225, Düsseldorf, Germany
| | - Anica Mevissen
- Heinrich-Heine-Universität Düsseldorf, Universitätsstraße 1, 40225, Düsseldorf, Germany
| | - Philipp Olbrich
- Heinrich-Heine-Universität Düsseldorf, Universitätsstraße 1, 40225, Düsseldorf, Germany
| | - Louisa Rahm
- Heinrich-Heine-Universität Düsseldorf, Universitätsstraße 1, 40225, Düsseldorf, Germany
| | - Helmut Frohnhofen
- Orthopedics and Trauma Surgery, University Hospital Düsseldorf, Moorenstraße 5, 40225, Düsseldorf, Germany
| |
Collapse
|
30
|
Patel T, Laeer C, Darabi H, Lachance M, Anawati M, Chomienne MH. Usability of an automated medication dispensation device and adherence dashboard: A study protocol. PLoS One 2024; 19:e0296528. [PMID: 39561138 PMCID: PMC11575765 DOI: 10.1371/journal.pone.0296528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2024] [Accepted: 10/02/2024] [Indexed: 11/21/2024] Open
Abstract
Non-adherence to prescribed medication regimens can lead to suboptimal control of chronic health conditions and increased hospitalizations. Older adults may find it particularly challenging to self-manage medications due to physical and cognitive limitations, resulting in medication non-adherence. While automated medication dispensing technologies may offer a solution for medication self-management among older adults, these technologies must demonstrate usability before effectiveness can be investigated and products made available for widespread use. This study will aim to measure usability, workload, and unassisted task completion rates of an automated medication dispenser and medication adherence dashboard on the Medipense portal with older adults and their clinicians, respectively. This study is designed as a convergent parallel mixed-methods observational study with older adults and their clinicians. Usability will be examined with the use of the System Usability Scale (SUS) while NASA Load Index (NASA-TLX) will be utilized to assess the workload of both the device and the adherence monitoring platform. Cognitive walkthrough will be utilized prior to usability testing to identify series of steps required to use the automated dispenser and adherence dashboard. The study will assess the unassisted task completion rates to successfully operate the device. Semi-structured interviews with both types of participants will provide qualitative data with which to comprehensively gauge the automated dispenser user experience. The results of this study will allow us to examine usability of both the automated medication dispensing system and the adherence monitoring dashboard from older adult and health-care provider perspectives. The results of this study will highlight and address the challenges with usability that older adults and health-care providers may face with this device and dashboard. The results of this study will be used to optimize the usability of both the automated medication dispenser and the adherence dashboard. In clinical practice, usability of technology is important to establish prior to full-scale implementation. Products that are not user friendly, add to workload, impact workflow, or are difficult to navigate by both clinicians and population in general may not be adopted. Usability permits an evaluation of the products, to identify problems that must be addressed prior to implementation and to ensure products are useful in clinical practice.
Collapse
Affiliation(s)
- Tejal Patel
- School of Pharmacy, University of Waterloo, Kitchener, Ontario, Canada
- Centre for Family Medicine Family Health Team, Kitchener, Ontario, Canada
- Schlegel Research Institute of Aging, University of Waterloo, Waterloo, Ontario, Canada
| | - Christoph Laeer
- School of Pharmacy, University of Waterloo, Kitchener, Ontario, Canada
- Équipe de Santé Familiale Communautaire de l’Est d’Ottawa, Ottawa, Ontario, Canada
- Family First Family Health Team, c/o Family First Health Centre, Ottawa, Ontario, Canada
- Institut du Savoir Montfort, Ottawa, Ontario, Canada
- North West Telepharmacy Solutions, Winnipeg, Manitoba, Canada
| | - Hamed Darabi
- Leslie Dean Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada
| | | | - Michelle Anawati
- Équipe de Santé Familiale Communautaire de l’Est d’Ottawa, Ottawa, Ontario, Canada
- Institut du Savoir Montfort, Ottawa, Ontario, Canada
- Department of Family Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Marie-Hélène Chomienne
- Institut du Savoir Montfort, Ottawa, Ontario, Canada
- Department of Family Medicine, University of Ottawa, Ottawa, Ontario, Canada
| |
Collapse
|
31
|
Alhammadi E, Kuhlmann JM, Rana M, Frohnhofen H, Moellmann HL. Comprehensive geriatric assessment for predicting postoperative delirium in oral and maxillofacial surgery: a prospective cohort study. Sci Rep 2024; 14:27554. [PMID: 39528549 PMCID: PMC11554771 DOI: 10.1038/s41598-024-78940-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2024] [Accepted: 11/05/2024] [Indexed: 11/16/2024] Open
Abstract
Identifying high-risk patients for developing postoperative delirium (POD) is essential for optimizing the medical field's human and financial resources through specialty-relevant geriatric assessments that can aid in establishing prehabilitation strategies. This study aims to identify geriatric screening tools to predict preoperative delirium and explore the high-risk elderly patients undergoing oral maxillofacial surgery. A comprehensive geriatric assessment encompassing 23 instruments was used to evaluate inpatients undergoing surgery under general anaesthesia, preoperatively and postoperatively. Selective intraoperative and postoperative variables were also assessed for their relation to POD occurrence. This prospective study included 90 patients (mean age 79.0 years) from August 2022 to August 2023. The POD rate in this cohort was (8.9% n = 8). The Clock-Drawing Test (CDT) was significantly associated with POD occurrence (p = 0.005). Significant associations were found between POD occurrence and operation type (p = 0.018), duration (p = 0.026), length of stay ( p = 0.002), and postoperative hemoglobin levels (p = 0.027). This study highlights the importance of comprehensive geriatric assessments in predicting POD in elderly patients. Future research should build on these findings to enhance preoperative care strategies and improve outcomes.Trial registration: German Register of Clinical Studies, DRKSID DRKS00028614.
Collapse
Affiliation(s)
- Eman Alhammadi
- Cranio-and-Maxillo Facial Surgery, University Hospital Düsseldorf, Moorenstraße 5, 40225, Düsseldorf, Germany
- Dubai Health, Dubai, United Arab Emirates
| | - Julian Max Kuhlmann
- Heinrich-Heine-Universität Düsseldorf, Universitätsstrasse 1, 40225, Düsseldorf, Germany
| | - Majeed Rana
- Cranio-and-Maxillo Facial Surgery, University Hospital Düsseldorf, Moorenstraße 5, 40225, Düsseldorf, Germany
| | - Helmut Frohnhofen
- Orthopedics and Trauma Surgery, University Hospital Düsseldorf, Moorenstraße 5, 40225, Düsseldorf, Germany
| | - Henriette Louise Moellmann
- Cranio-and-Maxillo Facial Surgery, University Hospital Düsseldorf, Moorenstraße 5, 40225, Düsseldorf, Germany.
| |
Collapse
|
32
|
Stavrou F, Adams J, Patel HP, Vassilev I, Samuel D. Exploring Older People's Experiences and Factors Associated With 30-Day Hospital Readmission: A Qualitative Study Using Interpretive Phenomenological Analysis. Int J Older People Nurs 2024; 19:e12662. [PMID: 39487660 DOI: 10.1111/opn.12662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Revised: 08/26/2024] [Accepted: 10/14/2024] [Indexed: 11/04/2024]
Abstract
INTRODUCTION Hospital readmission has a negative impact on older people and the healthcare system. Current hospital readmission research predominantly reports on clinical outcomes based on cross-sectional data. Research exploring patients' experiences and priorities is limited. This study aimed to explore older people's experiences of hospital readmission in order to develop an understanding of what matters most to them. METHODS Semi-structured qualitative interviews were conducted to generate data that were analysed using principles of interpretative phenomenological analysis. RESULTS Ten participants over 65 years old, who had experienced unplanned hospital readmission within a period of 30 days, were recruited from a large single tertiary referral centre. Four themes emerged: 'All about me without me', 'Fragmented and ad hoc post-discharge support', 'My readmission experience and what led me back' and 'Segregated health and social services that are detached from people's needs'. CONCLUSION The study findings suggest that patients should be more involved in decisions about their care, and health professionals should endeavour to better understand the contexts, resources and access to formal and informal support of patients. Effective communication and stronger continuum of care could be a key to patients' recovery and avoidance of hospital readmission. This research highlights the importance of shared decision-making and patient-centred care to improve quality of care, maintain independence and preserve older adult's right to feel valued.
Collapse
Affiliation(s)
- Fanis Stavrou
- Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK
- Trauma and Orthopaedics, University Hospital Southampton NHSFT, Southampton, UK
| | - Jo Adams
- Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK
| | - Harnish P Patel
- Medicine for Older People, University Hospital Southampton NHSFT, Southampton, UK
- NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHSFT, Southampton, UK
| | - Ivaylo Vassilev
- Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK
| | - Dinesh Samuel
- Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK
| |
Collapse
|
33
|
Oliveira MG, Moreira PM, Amorim WW, Boockvar K. Deprescribing Hypertension Medication in Older Adults: Can It Lower Drug Burden Without Causing Harm? Clin Geriatr Med 2024; 40:659-668. [PMID: 39349038 PMCID: PMC11443064 DOI: 10.1016/j.cger.2024.04.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/02/2024]
Abstract
Due to the high prevalence of older individuals with multiple morbidities, polypharmacy, and exposed to unnecessary or inappropriate treatments that can cause potentially serious adverse effects, better medication management should be an objective of all health professionals. This is particularly important in older patients with hypertension. Antihypertensive deprescribing and non-pharmacological strategies have been disseminated as viable and safe alternatives for improving the quality of care for hypertension in the older population.
Collapse
Affiliation(s)
- Marcio Galvão Oliveira
- Multidisciplinary Institute in Health, Federal University of Bahia, Brazil; Postgraduate Program in Pharmaceutical Services and Policies, Federal University of Bahia, Brazil.
| | - Pablo Maciel Moreira
- Postgraduate Program in Pharmaceutical Services and Policies, Federal University of Bahia, Brazil; Municipal Health Department of Vitória da Conquista, Vitória da Conquista, Bahia, Brazil
| | - Welma Wildes Amorim
- State University of Southwest Bahia, Department of Health Sciences, Brazil. Estrada do Bem Querer, km 4. Bairro Universitário, CEP.: 45083 -900. Vitória da Conquista - BA, Brazil
| | - Kenneth Boockvar
- Division of Gerontology, Geriatrics, and Palliative Care, University of Alabama, 933 19th Street South, Birmingham, AL 35233, USA
| |
Collapse
|
34
|
Klisowska I, Felińczak A, Jankowska-Polańska B. Occurrence of Malnutrition among Seniors in Poland Depending on the Place of Residence: An Analysis of Socioeconomic and Health Risk Factors. Nutrients 2024; 16:3394. [PMID: 39408361 PMCID: PMC11478439 DOI: 10.3390/nu16193394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2024] [Revised: 09/24/2024] [Accepted: 09/29/2024] [Indexed: 10/20/2024] Open
Abstract
The aging population in Poland poses significant socioeconomic and health challenges, particularly regarding malnutrition among seniors. This study examines the impact of place of residence on the nutritional status and related health outcomes of older adults. Data were collected from 338 community-dwelling seniors and those in long-term care facilities. The results indicate that long-term care residents exhibited significantly higher frailty and depression levels and poorer nutritional status, functional fitness, gait, and balance compared to those in communities. Self-reported quality of life did not differ significantly between groups. Regardless of residence, having a family correlated with better nutritional status, quality of life, and functional fitness and lower frailty and depression levels. Malnutrition was significantly associated with reduced functional fitness across all residences, and well-nourished individuals in care facilities had lower functional fitness than those who were at home. Community-dwelling residents had significantly lower frailty levels, with frailty negatively correlating with nutritional status. Normal nutritional status was linked to higher balance and gait scores, indicating a lower fall risk, with the risk further reduced for those living in community settings. Additionally, normal nutritional status correlated with lower depression levels and higher quality of life, with malnourished individuals experiencing better quality of life in community-dwelling settings. These findings underscore the critical role of residence and family support in elderly nutrition and health outcomes.
Collapse
Affiliation(s)
- Iwona Klisowska
- Department of Pediatrics and Coordinated Child Care, Department of Nursing, Faculty of Nursing and Midwifery, Wrocław Medical University, 51-618 Wrocław, Poland; (I.K.); (A.F.)
| | - Anna Felińczak
- Department of Pediatrics and Coordinated Child Care, Department of Nursing, Faculty of Nursing and Midwifery, Wrocław Medical University, 51-618 Wrocław, Poland; (I.K.); (A.F.)
| | | |
Collapse
|
35
|
Lucà F, Andreotti F, Rao CM, Pelaggi G, Nucara M, Ammendolea C, Pezzi L, Ingianni N, Murrone A, Del Sindaco D, Lettino M, Geraci G, Riccio C, Bilato C, Colivicchi F, Grimaldi M, Oliva F, Gulizia MM, Parrini I. Acute Coronary Syndrome in Elderly Patients: How to Tackle Them? J Clin Med 2024; 13:5935. [PMID: 39407995 PMCID: PMC11478011 DOI: 10.3390/jcm13195935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2024] [Revised: 09/19/2024] [Accepted: 09/25/2024] [Indexed: 10/20/2024] Open
Abstract
Elderly patients diagnosed with acute coronary syndromes (ACS) represent a growing demographic population. These patients typically present more comorbidities and experience poorer outcomes compared to younger patients. Furthermore, they are less frequently subjected to revascularization procedures and are less likely to receive evidence-based medications in both the short and long-term periods. Assessing frailty is crucial in elderly patients with ACS because it can influence management decisions, as well as risk stratification and prognosis. Indeed, treatment decisions should consider geriatric syndromes, frailty, polypharmacy, sarcopenia, nutritional deficits, prevalence of comorbidities, thrombotic risk, and, at the same time, an increased risk of bleeding. Rigorous clinical assessments, clear revascularization criteria, and tailored approaches to antithrombotic therapy are essential for guiding personalized treatment decisions in these individuals. Assessing frailty helps healthcare providers identify patients who may benefit from targeted interventions to improve their outcomes and quality of life. Elderly individuals who experience ACS remain significantly underrepresented and understudied in randomized controlled trials. For this reason, the occurrence of ACS in the elderly continues to be a particularly complex issue in clinical practice, and one that clinicians increasingly have to address, given the general ageing of populations. This review aims to address the complex aspects of elderly patients with ACS to help clinicians make therapeutic decisions when faced with such situations.
Collapse
Affiliation(s)
- Fabiana Lucà
- Cardiology Department, Grande Ospedale Metropolitano di Reggio Calabria, 89100 Reggio Calabria, Italy; (F.L.); (G.P.); (M.N.)
| | - Felicita Andreotti
- Cardiology Department, A. Gemelli, University Hospital, IRCCS, 00100 Roma, Italy;
| | - Carmelo Massimiliano Rao
- Cardiology Department, Grande Ospedale Metropolitano di Reggio Calabria, 89100 Reggio Calabria, Italy; (F.L.); (G.P.); (M.N.)
| | - Giuseppe Pelaggi
- Cardiology Department, Grande Ospedale Metropolitano di Reggio Calabria, 89100 Reggio Calabria, Italy; (F.L.); (G.P.); (M.N.)
| | - Mariacarmela Nucara
- Cardiology Department, Grande Ospedale Metropolitano di Reggio Calabria, 89100 Reggio Calabria, Italy; (F.L.); (G.P.); (M.N.)
| | - Carlo Ammendolea
- Cardiology Department San Martino Hospital, 32100 Belluno, Italy;
| | - Laura Pezzi
- Cardiology Department, Ospedale Civile dello Spirito Santo, 65100 Pescara, Italy;
| | - Nadia Ingianni
- ASP Trapani Cardiologist Marsala Castelvetrano Districts, 91022 Castelvetrano, Italy;
| | - Adriano Murrone
- Cardiology Unit, Città di Castello Hospital, 06012 Città di Castello, Italy
| | | | - Maddalena Lettino
- Cardiology Unit, IRCCS San Gerardo dei Tintori Hospital, San Gerardo, 20900 Monza, Italy;
| | - Giovanna Geraci
- Cardiology Department, Sant’Antonio Abate Hospital, ASP Trapani, 91100 Erice, Italy;
| | - Carmine Riccio
- Cardiovascular Department, Sant’Anna e San Sebastiano Hospital, 95122 Caserta, Italy;
| | - Claudio Bilato
- Department of Cardiology, West Vicenza Hospitals, Arzignano, 36100 Vicenza, Italy;
| | - Furio Colivicchi
- Clinical and Rehabilitation Cardiology Department, San Filippo Neri Hospital, ASL Roma 1, 00100 Roma, Italy;
| | - Massimo Grimaldi
- Cardiology Department, F. Miulli Hospital, Acquaviva delle Fonti, 70021 Bari, Italy;
| | - Fabrizio Oliva
- Cardiology Unit, ASST Grande Ospedale Metropolitano Niguarda, 20100 Milano, Italy;
| | | | - Iris Parrini
- Cardiology Department, Mauriziano Hospital, 10128 Torino, Italy;
| |
Collapse
|
36
|
LaRowe LR, Miaskowski C, Miller A, Mayfield A, Keefe FJ, Smith AK, Cooper BA, Wei LJ, Ritchie CS. Prevalence and Sociodemographic Correlates of Chronic Pain Among a Nationally Representative Sample of Older Adults in the United States. THE JOURNAL OF PAIN 2024; 25:104614. [PMID: 38936750 PMCID: PMC11402580 DOI: 10.1016/j.jpain.2024.104614] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Revised: 06/14/2024] [Accepted: 06/19/2024] [Indexed: 06/29/2024]
Abstract
Subgroup analyses conducted among U.S. national survey data have estimated that 27 to 34% of adults aged ≥65 years have chronic pain. However, none of these studies focused specifically on older adults or examined disparities in chronic pain in those aged ≥65 years. To obtain current information on the prevalence and sociodemographic correlates of chronic pain in U.S. older adults, a cross-sectional analysis was conducted of data collected from 3,505 older adults recruited from the AmeriSpeak Panel. Chronic pain was defined as pain on most or every day in the last 3 months. Nationally representative chronic pain prevalence estimates were computed by incorporating study-specific survey design weights. Logistic regression analyses evaluated differences in chronic pain status as a function of sociodemographic characteristics (eg, gender, race/ethnicity, and socioeconomic status). The results indicated that 37.8% of older adults reported chronic pain. Compared with White older adults, Black (odds ratio [OR] = .6, 95% CI: .4-.8) and Asian (OR = .2, 95% CI: .1-.8) older adults were less likely to report chronic pain. The prevalence of chronic pain was also lower among those who reported the highest (vs lowest) household income (OR = .6, 95% CI: .4-.8). Those who were not working due to disability (vs working as a paid employee) were more likely to report chronic pain (OR = 3.2, 95% CI: 2.1-5.0). This study was the first to recruit a large, representative sample of older adults to estimate the prevalence of chronic pain and extends prior work by identifying subgroups of older adults that are disproportionately affected. PERSPECTIVE: This study was the first to estimate the prevalence and sociodemographic correlates of chronic pain among a large, representative sample of U.S. older adults. The findings underscore the high prevalence of chronic pain and highlight disparities in chronic pain prevalence rates among this historically understudied population.
Collapse
Affiliation(s)
- Lisa R LaRowe
- Mongan Institute Center for Aging and Serious Illness, Massachusetts General Hospital, Boston, Massachusetts; Department of Medicine, Harvard Medical School, Boston, Massachusetts.
| | - Christine Miaskowski
- School of Nursing, University of California, San Francisco, San Francisco, California
| | - Angela Miller
- Mongan Institute Center for Aging and Serious Illness, Massachusetts General Hospital, Boston, Massachusetts
| | | | - Francis J Keefe
- Department of Psychiatry & Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina
| | - Alexander K Smith
- Division of Geriatrics, University of California, San Francisco, San Francisco, California; Geriatrics, Palliative, and Extended Care Service Line, San Francisco VA Medical Center, San Francisco, California
| | - Bruce A Cooper
- School of Nursing, University of California, San Francisco, San Francisco, California
| | - Lee-Jen Wei
- Biostatistics, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Christine S Ritchie
- Mongan Institute Center for Aging and Serious Illness, Massachusetts General Hospital, Boston, Massachusetts; Department of Medicine, Harvard Medical School, Boston, Massachusetts
| |
Collapse
|
37
|
Babar ZUD. Building an effective medicines optimisation model: a health system approach. Int J Clin Pharm 2024; 46:1237-1242. [PMID: 38896393 DOI: 10.1007/s11096-024-01765-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2024] [Accepted: 05/28/2024] [Indexed: 06/21/2024]
Abstract
This commentary narrates on the building of an effective and innovative medicines optimisation model. It discusses the essential features, emphasizes the need, and considers the strong health and pharmacy system as a prerequisite before such a model could be built. The paper argues that it is important to strengthen the health system before the elements of pharmaceutical care and medicine optimisation can take shape. It discusses the discourse and interplay between medicine use and medicine access research. The other important elements to include are the "selection of medicines by health technology assessment", "economic evaluation of pharmacy services", "pharmacists' remuneration by the government", "Health system strengthening status", "quality use of generic medicines programmes", "rationale prescribing", "access to medicines and medicines pricing", "medicines advertising" and the "state of pharmacy practice and the development of the pharmacist's role". A set of different high-, middle- and low-income countries are used to provide examples of the status of the health system and the subsequent development of pharmacy practice and medicines optimisation. The countries include the UK, Australia, New Zealand, Pakistan, Türkiye, Malaysia, India, and Pakistan.
Collapse
|
38
|
Mortelmans L, Goossens E, De Cock AM, van den Bemt P, Dilles T. Nurses' responses to patients' medication self-management problems in hospital and the use of recommendations. Br J Clin Pharmacol 2024; 90:2684-2690. [PMID: 39086169 DOI: 10.1111/bcp.16204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Revised: 07/19/2024] [Accepted: 07/22/2024] [Indexed: 08/02/2024] Open
Abstract
This study aimed to describe the use of recommendations as a guide for healthcare providers to support patients experiencing medication self-management problems and to evaluate their feasibility, user-friendliness and usefulness. Between March and August 2023, 58 hospitalized patients completed a self-assessment on medication self-management problems. The problems addressed in this self-assessment were based on a list of frequently encountered medication self-management problems from previous research. Consequently, 18 nurses responded to the reported problems using the recommendations. Nurses evaluated the feasibility, user-friendliness and usefulness of these recommendations through a survey. A total of 217 medication self-management problems were reported by 58 patients. Nurses intervened in 52% of the problems using the recommendations. According to nurses, the recommendations were user-friendly and feasible but required a substantial time investment. Considering these pilot-based results, the recommendations have the potential to be a valuable resource for nurses in practice, though this potential requires further exploration.
Collapse
Affiliation(s)
- Laura Mortelmans
- Centre for Research and Innovation in Care (CRIC), Nurse and Pharmaceutical Care (NuPhaC), Department of Nursing Science and Midwifery, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
- Research Foundation Flanders (FWO), Brussels, Belgium
| | - Eva Goossens
- Centre for Research and Innovation in Care (CRIC), Nurse and Pharmaceutical Care (NuPhaC), Department of Nursing Science and Midwifery, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
- Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
- Department of Patient Care, Antwerp University Hospital (UZA), Antwerp, Belgium
| | - Anne-Marie De Cock
- Department of Geriatrics, ZNA, Antwerp, Belgium
- Department of Family Medicine and Population Health, University of Antwerp, Antwerp, Belgium
| | - Patricia van den Bemt
- Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen, Groningen, The Netherlands
| | - Tinne Dilles
- Centre for Research and Innovation in Care (CRIC), Nurse and Pharmaceutical Care (NuPhaC), Department of Nursing Science and Midwifery, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| |
Collapse
|
39
|
Zhang Y, Yuan X, Jiang Z, Hu R, Liang H, Mao Q, Xiong Y, Zhang J, Liu M. The relationship between multimorbidity and cognitive function in older Chinese adults: based on propensity score matching. Front Public Health 2024; 12:1422000. [PMID: 39328989 PMCID: PMC11425792 DOI: 10.3389/fpubh.2024.1422000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2024] [Accepted: 08/30/2024] [Indexed: 09/28/2024] Open
Abstract
Objective The goal of this study was to further validate the effect of multimorbidity on cognitive performance in older adults after controlling for confounders using propensity score matching (PSM). Methods A cross-sectional survey of older adult people aged 60 years or older selected by convenience sampling was conducted in seven medical institutions, three communities, and five nursing homes in Zunyi City, Guizhou Province. The data collected included general information, health-related information, and Mini-Mental State Examination (MMSE) scores. Variables were controlled for confounders by PSM to analyze differences in cognitive ability between multimorbidity and nonmultimorbidity older adults. Logistic regression and multivariate-adjusted restricted cubic spline (RCS) curves for matched samples were used to assess the relationship between multimorbidity and cognitive decline. Results A total of 14,175 respondents were enrolled, and the mean age of the participants included in this study was 71.26 ± 7.1 years, including 7,170 (50. 58%) of the participants were males, 7,005 (49.42%) were females, and 5,482 participants (38.67%) were screened for cognitive decline. After PSM, logistic regression analysis revealed that multimorbidity was a risk factor for cognitive decline (OR = 1.392, 95% CI = 1.271-1.525, p < 0.001). The RCS show that the risk of cognitive decline is always greater in older adults with multimorbidity than in older adults without multimorbidity at the same age. Age, sex, marital status, educational level, monthly income, drinking status, participation in social activities, and exercise were influential factors for cognitive decline in older adults (p < 0.05). The incidence of cognitive decline in older adults with multimorbidity was also greater than that in older adults with one chronic disease (p < 0.001). Conclusion The risk of cognitive decline in older adults with multimorbidity is greater than that in older adults without multimorbidity; therefore, the government should strengthen the prevention and treatment of multimorbidity in older adults to further protect their cognitive abilities.
Collapse
Affiliation(s)
- Yumeng Zhang
- Department of Nursing, Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou, China
- Faculty of Nursing, Zunyi Medical University, Zunyi, Guizhou, China
| | - Xiaoli Yuan
- Department of Nursing, Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou, China
| | - Zhixia Jiang
- College Office, Guizhou Nursing Vocational College, Guiyang, Guizhou, China
| | - Rujun Hu
- Department of Nursing, Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou, China
| | - Heting Liang
- Department of Nursing, Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou, China
| | - Qingyun Mao
- Faculty of Nursing, Zunyi Medical University, Zunyi, Guizhou, China
| | - Yan Xiong
- Faculty of Nursing, Zunyi Medical University, Zunyi, Guizhou, China
| | - Jiabi Zhang
- Kweichow Moutai Hospital, Renhuai, Guizhou, China
| | - Mi Liu
- Kweichow Moutai Hospital, Renhuai, Guizhou, China
| |
Collapse
|
40
|
Reji ES, Fredi F, Ismail RM, Bindu VM, Pereira P, Ramesh M, Syed J, Chalasani SH. Assessment of drug therapy satisfaction amongst the elderly: A patient reported outcomes measures approach. Geriatr Nurs 2024; 59:33-39. [PMID: 38981206 DOI: 10.1016/j.gerinurse.2024.06.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Revised: 06/20/2024] [Accepted: 06/27/2024] [Indexed: 07/11/2024]
Abstract
BACKGROUND Understanding elderly experiences enhance healthcare outcomes and patient satisfaction. Recognizing caregivers' role and implementing supportive measures enhance care. OBJECTIVES Quantify drug satisfaction using patient-reported outcomes measures approach. Assess caregiver burden using short version of Burden Scale for Family Caregivers. METHODS Six-month cross-sectional study in Department of Geriatrics. Elderly (≥60), minimum one comorbidity, admitted for >48 h, and consenting to participate were enrolled. Patient satisfaction assessed using Treatment Satisfaction with Medicines Questionnaire (SATMED-Q). SPSS version 27 used to calculate odds ratio. RESULTS 282 participants enrolled. SATMED-Q score 47.41 ± 10.34, indicating overall satisfaction. Treatment satisfaction range 47.07 % to 100 %. Age [OR 0.964, 95 % CI 0.932-0.996 (p = 0.029)] and education [OR 1.500, 95 % CI 1.129-1.992 (p = 0.005)] influenced satisfaction. 268 [95.03 %] had caregivers, 14 [4.96 %] did not. Caregiver burden score 9.25 ± 9.11. CONCLUSION Insights obtained from assessing satisfaction and caregiver burden enables physicians to improve welfare of elderly and caregivers.
Collapse
Affiliation(s)
- Eileen Susa Reji
- Department of Pharmacy Practice JSS College of Pharmacy JSS Academy of Higher Education & Research, Mysuru -15, Karnataka, India
| | - Feba Fredi
- Department of Pharmacy Practice JSS College of Pharmacy JSS Academy of Higher Education & Research, Mysuru -15, Karnataka, India
| | - R Muhammad Ismail
- Department of Pharmacy Practice JSS College of Pharmacy JSS Academy of Higher Education & Research, Mysuru -15, Karnataka, India
| | - V M Bindu
- Department of Pharmacy Practice JSS College of Pharmacy JSS Academy of Higher Education & Research, Mysuru -15, Karnataka, India
| | - Pratibha Pereira
- Department of Geriatrics, JSS Medical College & Hospital, JSS Academy of Higher Education & Research, Mysuru - 15 Karnataka, India
| | - M Ramesh
- Department of Pharmacy Practice JSS College of Pharmacy JSS Academy of Higher Education & Research, Mysuru -15, Karnataka, India
| | - Jehath Syed
- Department of Pharmacy Practice JSS College of Pharmacy JSS Academy of Higher Education & Research, Mysuru -15, Karnataka, India
| | - Sri Harsha Chalasani
- Department of Pharmacy Practice JSS College of Pharmacy JSS Academy of Higher Education & Research, Mysuru -15, Karnataka, India.
| |
Collapse
|
41
|
Inglis JM, Caughey G, Thynne T, Brotherton K, Liew D, Mangoni AA, Shakib S. Association of Drug-Disease Interactions with Mortality or Readmission in Hospitalised Middle-Aged and Older Adults: A Systematic Review and Meta-Analysis. Drugs Real World Outcomes 2024; 11:345-360. [PMID: 38852118 PMCID: PMC11365905 DOI: 10.1007/s40801-024-00432-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/16/2024] [Indexed: 06/10/2024] Open
Abstract
BACKGROUND AND OBJECTIVE Multimorbidity is common in hospitalised adults who are at increased risk of inappropriate prescribing including drug-disease interactions. These interactions occur when a medicine being used to treat one condition exacerbates a concurrent medical condition and may lead to adverse health outcomes. The aim of this review was to examine the association between drug-disease interactions and the risk of mortality and readmission in hospitalised middle-aged and older adults. METHODS A systematic review was conducted on drug-disease interactions in hospitalised middle-aged (45-64 years) and older adults (≥65 years). The study protocol was prospectively registered with PROSPERO (Registration Number: CRD42022341998). Drug-disease interactions were defined as a medicine being used to treat one condition with the potential to exacerbate a concurrent medical condition or that were inappropriate based on a comorbid medical condition. Both observational and interventional studies were included. The outcomes of interest were mortality and readmissions. The databases searched included MEDLINE, CINAHL, EMBASE, Web of Science, SCOPUS and the Cochrane Library from inception to 12 July, 2022. A meta-analysis was performed to pool risk estimates using the random-effects model. RESULTS A total of 563 studies were identified and four met the inclusion criteria. All were observational studies in older adults, with no studies identified in middle-aged adults. Most of the studies were at risk of bias because of an inadequate adjustment for covariates and a lack of clarity around individuals lost to follow-up. There were various definitions of drug-disease interactions within these four studies. Two studies assessed drugs that were contraindicated based on renal function, one assessed an individual drug-disease combination, and one was based on the clinical judgement of a pharmacist. There were two studies that showed an association between drug-disease interactions and the outcomes of interest. One reported that the use of diltiazem in patients with heart failure was associated with an increased risk of readmissions. The second reported that the use of medicines contraindicated according to renal function were associated with increased risk of all-cause mortality and a composite of mortality and readmission. Three of the studies (total study population = 5705) were amenable to a meta-analysis, which showed no significant association between drug-disease interactions and readmissions (odds ratio = 1.0, 95% confidence interval 0.80-1.38). CONCLUSIONS Few studies were identified examining the risk of drug-disease interactions and mortality and readmission in hospitalised adults. Most of the identified studies were at risk of bias. There is no universal accepted definition of drug-disease interactions in the literature. Further studies are needed to develop a standardised and accepted definition of these interactions to guide further research in this area.
Collapse
Affiliation(s)
- Joshua M Inglis
- Department of Clinical Pharmacology, Flinders Medical Centre, Flinders University, Adelaide, SA, Australia.
- Adelaide Medical School, University of Adelaide, North Terrace, Adelaide, SA, 5000, Australia.
| | - Gillian Caughey
- Registry of Senior Australians, South Australian Health and Medical Research Institute, Adelaide, SA, Australia
| | - Tilenka Thynne
- Department of Clinical Pharmacology, Flinders Medical Centre, Flinders University, Adelaide, SA, Australia
| | - Kate Brotherton
- Department of Clinical Pharmacology, Flinders Medical Centre, Flinders University, Adelaide, SA, Australia
| | - Danny Liew
- Adelaide Medical School, University of Adelaide, North Terrace, Adelaide, SA, 5000, Australia
- Department of General Medicine, Royal Adelaide Hospital, Adelaide, SA, Australia
| | - Arduino A Mangoni
- Department of Clinical Pharmacology, Flinders Medical Centre, Flinders University, Adelaide, SA, Australia
| | - Sepehr Shakib
- Adelaide Medical School, University of Adelaide, North Terrace, Adelaide, SA, 5000, Australia
- Department of Clinical Pharmacology, Royal Adelaide Hospital, Adelaide, SA, Australia
| |
Collapse
|
42
|
Cavdar VC, Ballica B, Aric M, Karaca ZB, Altunoglu EG, Akbas F. Exploring depression, comorbidities and quality of life in geriatric patients: a study utilizing the geriatric depression scale and WHOQOL-OLD questionnaire. BMC Geriatr 2024; 24:687. [PMID: 39143531 PMCID: PMC11325729 DOI: 10.1186/s12877-024-05264-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2024] [Accepted: 07/30/2024] [Indexed: 08/16/2024] Open
Abstract
BACKGROUND The increasing prevalence of depression among older adults is a growing concern. Chronic health conditions, cognitive impairments, and hospitalizations amplify emotional distress and depression levels in this population. Assessing the quality of life is crucial for the well-being of older adults. AIMS Our study aimed to examine how comorbidities affect depression and quality of life in geriatric patients in both outpatient and hospital settings. METHODS 100 patients (50 from internal medicine outpatient clinic and 50 from internal medicine ward) were included in the study according to inclusion and exclusion criteria. Patients were classified into different age groups (65-74 years, 75-84 years and ≥ 85 years). Data on patients' location of application, age, sex, living alone or with family status, number of comorbid diseases, types of accompanying diseases were recorded and WHOQOL-OLD and Geriatric Depression Scale (GDS) questionnaires were administered. Results were evaluated using SPSS. RESULTS The WHOQOL-OLD questionnaire score was higher in the 65-74 age group compared to other groups, but there was no significant difference between outpatient group and hospitalized group. Patients with comorbid diseases had lower WHOQOL-OLD questionnaire scores compared to those without comorbid diseases. In the 75-84 and ≥ 85 age groups, the GDS scores were higher compared to the 65-74 age group. In hospitalized group, GDS scores were higher than outpatient clinic group. In patients with comorbid diseases, GDS scores were higher than the ones without comorbid diseases. DISCUSSION Our findings indicate that quality of life is higher among those aged 65-74, with lower incidence of depression compared to other age groups. Hospitalization correlates with higher depression rates but not quality of life. As number of comorbid diseases increases in older adults, the frequency of depression rises and the quality of life declines. CONCLUSIONS Early detection and intervention for depression are crucial for enhancing older adults' well-being.
Collapse
Affiliation(s)
- Vahit Can Cavdar
- University of Health Sciences, Department of Internal Medicine, Istanbul Training and Research Hospital, Abdurrahman Nafiz Gürman Cad. Etyemez, Samatya, Istanbul, 34098, Turkey
| | - Basak Ballica
- Faculty of Medicine, Bahcesehir University, Istanbul, Turkey
| | - Mert Aric
- University of Health Sciences, Department of Internal Medicine, Istanbul Training and Research Hospital, Abdurrahman Nafiz Gürman Cad. Etyemez, Samatya, Istanbul, 34098, Turkey
| | - Zekiye Busra Karaca
- Department of Internal Medicine, Beylikduzu State Hospital, Istanbul, Turkey
| | | | - Feray Akbas
- University of Health Sciences, Department of Internal Medicine, Istanbul Training and Research Hospital, Abdurrahman Nafiz Gürman Cad. Etyemez, Samatya, Istanbul, 34098, Turkey.
| |
Collapse
|
43
|
Rodrigues DA, Herdeiro MT, Mateos-Campos R, Figueiras A, Roque F. Potentially inappropriate anticholinergic drug use among older adults in primary healthcare: prevalence and determinants. Expert Opin Drug Saf 2024:1-7. [PMID: 39105534 DOI: 10.1080/14740338.2024.2385479] [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: 03/19/2024] [Accepted: 05/22/2024] [Indexed: 08/07/2024]
Abstract
BACKGROUND Considering the vulnerability of older adults to adverse drug reactions, medications with strong anticholinergic properties are considered potentially inappropriate for this population. This study aims to characterize older adults' profile of anticholinergics use and to identify the factors associated with their potentially inappropriate use. RESEARCH DESIGN AND METHODS A retrospective study was conducted on 1200 older adults in primary health care centers of Portugal between April 2021 and August 2022. Potentially inappropriate use was assessed according to the 2023 Beers criteria. Logistic regression analyses were performed to determine associations between independent variables and potentially inappropriate use. RESULTS A 8.9% (95% CI 0.074-0.107) of the older adults were exposed to one or more potentially inappropriate anticholinergics, and amitriptyline was the most used (2.0%). Multivariate analysis revealed that use was associated with a higher mean number of medications (OR 1.173, 95% CI 1.115-1.234), diagnoses of depression (OR 2.889, 95% CI 1.785-4.674) and psychiatric disorders (OR 1.654, 95% CI 1.003-2.729). CONCLUSIONS This study underscores the importance of vigilance in prescribing anticholinergic medications to older adults, particularly those with higher medication burdens and mental health diagnoses. By identifying factors associated with potentially inappropriate use, healthcare providers can better tailor medication regimens to mitigate risks and optimize the well-being of older adults.
Collapse
Affiliation(s)
- Daniela A Rodrigues
- Biotechnology Research, Innovation and Design for Health Products (BRIDGES) - Research Laboratory on Epidemiology and Population Health, Polytechnic of Guarda (IPG), Guarda, Portugal
- Health Sciences Research Centre, University of Beira Interior (CICS-UBI), Covilhã, Portugal
- PhD Student, University of Salamanca, Salamanca, Spain
| | - Maria Teresa Herdeiro
- Department of Medical Sciences, Institute of Biomedicine (iBiMED), University of Aveiro, Aveiro, Portugal
| | - Ramona Mateos-Campos
- Area of Preventive Medicine and Public Health, Department of Biomedical and Diagnostic Sciences, University of Salamanca, Salamanca, Spain
| | - Adolfo Figueiras
- Department of Preventive Medicine and Public Health, University of Santiago de Compostela, Santiago de Compostela, Spain
- Health Research Institute of Santiago de Compostela (Instituto de Investigación Sanitaria de Santiago de Compostela/IDIS), A Coruña, Spain
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBER en Epidemiología y Salud Pública/CIBERESP), Carlos III Institute of Health, Madrid, Spain
| | - Fátima Roque
- Biotechnology Research, Innovation and Design for Health Products (BRIDGES) - Research Laboratory on Epidemiology and Population Health, Polytechnic of Guarda (IPG), Guarda, Portugal
- Health Sciences Research Centre, University of Beira Interior (CICS-UBI), Covilhã, Portugal
| |
Collapse
|
44
|
Bergqvist M, Bastholm-Rahmner P, Modig K, Gustafsson LL, Schmidt-Mende K. Proud but Powerless: A Qualitative Study of Homecare Workers´ Work Experiences and Their Suggestions for How Care for Homebound Older Adults Can Be Improved. JOURNAL OF GERONTOLOGICAL SOCIAL WORK 2024; 67:841-860. [PMID: 38753563 DOI: 10.1080/01634372.2024.2355154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 05/10/2024] [Indexed: 05/18/2024]
Abstract
Many older adults with complex care needs live at home due to ageing-in-place policies. This study explored homecare workers' experiences and suggestions for improvements of care. Twelve semi-structured interviews were analyzed thematically, and revealed pride, capability, and satisfaction in their work, yet they feel undervalued and lack support. They advocate for integrated care models, recognition of their competence, flexible work approaches, and committed leadership. This would enhance patient care and address their own working conditions, addressing concerns from being relegated to the bottom of the hierarchy. They emphasize the need for comprehensive approaches, spanning from housekeeping to end-of-life palliative care.
Collapse
Affiliation(s)
- Monica Bergqvist
- Department of Neurobiology, Care Sciences and Society, Division of Nursing, Karolinska Institutet, Stockholm, Sweden
- Academic Primary Health Care Centre, Region Stockholm, Stockholm, Sweden
| | - Pia Bastholm-Rahmner
- Academic Primary Health Care Centre, Region Stockholm, Stockholm, Sweden
- Department of Laboratory Medicine, Karolinska Institutet, Division of Clinical Pharmacology, Karolinska Institutet, Stockholm, Sweden
| | - Karin Modig
- Institute of Environmental Medicine, Unit of Epidemiology, Karolinska Institutet, Stockholm, Sweden
| | - Lars L Gustafsson
- Department of Laboratory Medicine, Karolinska Institutet, Division of Clinical Pharmacology, Karolinska Institutet, Stockholm, Sweden
| | - Katharina Schmidt-Mende
- Academic Primary Health Care Centre, Region Stockholm, Stockholm, Sweden
- Department of Neurobiology and Care Sciences and Society, Division of Family Medicine and Primary Care, Karolinska Institutet, Stockholm, Sweden
| |
Collapse
|
45
|
Kim GJ, Lee JS, Jang S, Lee S, Jeon S, Lee S, Kim JH, Lee KH. Polypharmacy and Elevated Risk of Severe Adverse Events in Older Adults Based on the Korea Institute of Drug Safety and Risk Management-Korea Adverse Event Reporting System Database. J Korean Med Sci 2024; 39:e205. [PMID: 39048300 PMCID: PMC11263767 DOI: 10.3346/jkms.2024.39.e205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2024] [Accepted: 06/02/2024] [Indexed: 07/27/2024] Open
Abstract
BACKGROUND Older adults are at a higher risk of severe adverse drug events (ADEs) because of multimorbidity, polypharmacy, and lower physiological function. This study aimed to determine whether polypharmacy, defined as the use of ≥ 5 active drug ingredients, was associated with severe ADEs in this population. METHODS We used ADE reports from the Korea Institute of Drug Safety and Risk Management-Korea Adverse Event Reporting System Database, a national spontaneous ADE report system, from 2012 to 2021 to examine and compare the strength of association between polypharmacy and severe ADEs in older adults (≥ 65 years) and younger adults (20-64 years) using disproportionality analysis. RESULTS We found a significant association between severe ADEs of cardiac and renal/urinary Medical Dictionary for Regulatory Activities System Organ Classes (MedDRA SOC) with polypharmacy in older adults. Regarding individual-level ADEs included in these MedDRA SOCs, acute cardiac arrest and renal failure were more significantly associated with polypharmacy in older adults compared with younger adults. CONCLUSION The addition of new drugs to the regimens of older adults warrants close monitoring of renal and cardiac symptoms.
Collapse
Affiliation(s)
- Grace Juyun Kim
- Big Data Research Center, Asan Institute for Life Sciences, Asan Medical Center, Seoul, Korea
| | - Ji Sung Lee
- Clinical Research Center, Asan Institute for Life Sciences, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sujung Jang
- Department of Biomedical Engineering, Asan Medical Institute of Convergence Science and Technology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | | | - Seongwoo Jeon
- College of Medicine, Chungbuk National University, Cheongju, Korea
| | - Suehyun Lee
- Department of Computer Engineering, Gachon University, Seongnam, Korea
| | - Ju Han Kim
- Division of Biomedical Informatics, Seoul National University, Seoul, Korea
| | - Kye Hwa Lee
- Department of Information Medicine, Asan Medical Center, Seoul, Korea
- Department of Biomedical Informatics, Ulsan University College of Medicine, Ulsan, Korea.
| |
Collapse
|
46
|
Basu S, Maheshwari V, Malik M, Barzangi K, Hassan R. The burden and care cascade in young and middle-aged patients with diabetes hypertension comorbidity with abdominal obesity in India: A nationally representative cross-sectional survey. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0003413. [PMID: 39018298 PMCID: PMC11253957 DOI: 10.1371/journal.pgph.0003413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Accepted: 06/05/2024] [Indexed: 07/19/2024]
Abstract
We ascertained the burden, determinants, and care cascade in the young and middle-aged patients having co-existing hypertension (HTN), Diabetes Mellitus (DM), and abdominal obesity in India from a secondary data analysis of nationally representative data. The study examined cross-sectional data from the National Family Health Survey (NFHS-5) conducted in India from 2019 to 2021 in 788974 individuals aged 15-49 years including 695707 women and 93267 men. The weighted prevalence of DM-HTN comorbidity with high waist circumference in the sample was 0.75% (95% CI: 0.71 to 0.79) including 46.33% (95% CI: 44.06 to 48.62) newly diagnosed cases detected for HTN and high blood sugars. The weighted prevalence of Metabolic syndrome as per NCEP ATPIII criteria was found to be 1.13% (95% CI: 1.08 to 1.17). Only 46.16% existing cases were treated with both anti-diabetes and antihypertensive medication (full treatment), while 34.71% cases were untreated. On adjusted analysis, increasing age, females, higher wealth index, high fat diet, obesity and comorbidities were significantly associated with having DM-HTN comorbidity along with high-waist circumference. More than half of young and middle aged-population in India with DM-HTN-abdominal obesity triad are not initiated on treatment for DM and HTN comorbidities, while a majority of the previously diagnosed cases have uncontrolled blood pressure and poor glycemic control. The poor cascade of care for DM and HTN in these high-risk group of patients may substantially increase their risk for early progression and severity of microvascular and macrovascular complications especially cardiovascular disease.
Collapse
Affiliation(s)
- Saurav Basu
- Indian Institute of Public Health ‐ Delhi, Public Health Foundation of India, Haryana, India
| | - Vansh Maheshwari
- Indian Institute of Public Health ‐ Delhi, Public Health Foundation of India, Haryana, India
| | - Mansi Malik
- Indian Institute of Public Health ‐ Delhi, Public Health Foundation of India, Haryana, India
| | - Kara Barzangi
- University of Cambridge, Trinity Ln, Cambridge, United Kingdom
| | - Refaat Hassan
- University of Cambridge, Trinity Ln, Cambridge, United Kingdom
| |
Collapse
|
47
|
Keshvani C, Laylani N, Davila-Siliezar P, Kopel J, Lee AG. Neuro-ophthalmic challenges and multi-morbidity in vasculitis among the older adults. Expert Rev Clin Immunol 2024; 20:781-791. [PMID: 38572928 DOI: 10.1080/1744666x.2024.2339893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Accepted: 04/03/2024] [Indexed: 04/05/2024]
Abstract
INTRODUCTION Vasculitides are a heterogeneous group of disorders producing inflammation of blood vessels (e.g. arteries or veins). All major vasculitides potentially have ophthalmological symptoms and signs including visual loss. Co-morbidity, multimorbidity, polypharmacy, and geriatric syndromes all play important roles in patient outcomes for these rheumatic conditions in the elderly. This monograph reviews the NCBI PubMed database (Feb 2023) literature on the neuro-ophthalmic and geriatric considerations in vasculitis. AREAS COVERED Cogan Syndrome, Granulomatosis with Polyangiitis, Giant Cell Arteritis, Polyarteritis Nodosa, Takayasu Arteritis, Vasculitis epidemiology, and neuro-ophthalmological symptoms. EXPERT OPINION Geriatric patient care for vasculitis with neuro-ophthalmological manifestations can be complicated by the interplay of multiple co-morbidities, polypharmacy, and specific geriatric syndromes. The valuation and treatment of vasculitis and the complications associated with the disease can negatively impact patient care. Advances in noninvasive imaging and updates in diagnostic criteria have enabled increased identification of patients at earlier stages with less severe disease burden. Novel therapeutic agents can be glucocorticoid sparing and might reduce the adverse effects of chronic steroid use. Holistic care models like the 5 M geriatric care model (mind, mobility, medications, multicomplexity, and matters most) allow patients' needs to be in the forefront with biopsychosocial aspects of a patient being addressed.
Collapse
Affiliation(s)
- Caezaan Keshvani
- School of Medicine, Texas Tech University Health Sciences Center, Lubbock, TX, USA
| | - Noor Laylani
- Blanton Eye Institute, Houston Methodist Hospital, Houston, TX, USA
| | | | - Jonathan Kopel
- School of Medicine, Texas Tech University Health Sciences Center, Lubbock, TX, USA
| | - Andrew G Lee
- Blanton Eye Institute, Houston Methodist Hospital, Houston, TX, USA
- Department of Ophthalmology, Neurology, and Neurosurgery, Weill Cornell Medicine, New York, NY, USA
- Department of Ophthalmology, University of Texas Medical Branch, Galveston, TX, USA
- Department of Ophthalmology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
- Department of Ophthalmology, The University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| |
Collapse
|
48
|
Cantudo-Cuenca MD, Gutiérrez-Pizarraya A, García-Lloret P, Gabella-Bazarot E, Morillo-Verdugo R. Prevalence of compliance with PIMDINAC criteria among elderly people living with HIV and in non-infected outpatients with other chronic diseases. Eur J Hosp Pharm 2024; 31:339-343. [PMID: 36585218 PMCID: PMC11265553 DOI: 10.1136/ejhpharm-2022-003454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 12/19/2022] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND There is a high prevalence of multimorbidity and polypharmacy among older people, especially in people living with HIV (PLWH) with an increased life expectancy due to effective antiretroviral therapy (ART). Consequently, there is a higher risk of potentially inappropriate medications (PIM), potential drug-drug interactions (DI), and problems of non-adherence to treatment (NAC) in older PLWH. PIMDINAC criteria (potentially inappropriate medications (PIM), drug-drug interactions (DI), and non-adherence to treatment (NAC)) purport to jointly analyse these problems. The purpose of the study was to compare the prevalence of PIMDINAC criteria among elderly PLWH and non-infected patients with chronic diseases, and to determine whether HIV infection constitutes a predictor of the presence of PIMDINAC criteria, totally or partially. METHODS A cross sectional study was conducted between February and June 2020. HIV positive patients aged ≥65 years were compared with a group of patients with chronic conditions attending the outpatient hospital pharmacy service. RESULTS The study involved 140 patients: 47 HIV positive and 93 HIV negative, and mean age was 69 versus 73 years, respectively (p=0.062). The prevalence of total PIMDINAC criteria was similar between the groups (12.5 vs 10.8%, p=0.505). In relation to inappropriate medication, no differences were observed between groups (48.9 vs 55.9%, p=0434). Drug-drug interactions were higher in patients with chronic conditions (52.7 vs 25.5%, p=0.002) compared with non-adherence, which was higher in people with HIV (22.6 vs 65.6%, p<0.001). No differences in polypharmacy (≥6 and 11 drugs) rates were observed. CONCLUSIONS PIMDINAC criteria were highly prevalent in older PLWH, similar to non-infected patients. HIV infection in older people was associated with a lower risk of drug-drug interactions. However, non-adherence was a risk factor compared with age matched controls. Deprescribing strategies, including a capability-motivation-opportunity pharmaceutical care model based intervention should be implemented in clinical routines.
Collapse
|
49
|
Holdaway M, Hyde Z, Hughson JA, Malay R, Stafford A, Fulford K, Radford K, Flicker L, Smith K, Pond D, Russell S, Atkinson D, Blackberry I, LoGiudice D. Medications and cognitive risk in Aboriginal primary care: a cross-sectional study. Intern Med J 2024; 54:897-908. [PMID: 38158855 DOI: 10.1111/imj.16323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 12/12/2023] [Indexed: 01/03/2024]
Abstract
BACKGROUND Aboriginal and Torres Strait Islander people are ageing with high rates of comorbidity, yet little is known about suboptimal prescribing in this population. AIM The prevalence of potentially suboptimal prescribing and associated risk factors were investigated among older patients attending primary care through Aboriginal Community Controlled Health Services (ACCHSs). METHODS Medical records of 420 systematically selected patients aged ≥50 years attending urban, rural and remote health services were audited. Polypharmacy (≥ 5 prescribed medications), potentially inappropriate medications (PIMs) as per Beers Criteria and anticholinergic burden (ACB) were estimated and associated risk factors were explored with logistic regression. RESULTS The prevalence of polypharmacy, PIMs and ACB score ≥3 was 43%, 18% and 12% respectively. In multivariable logistic regression analyses, polypharmacy was less likely in rural (odds ratio (OR) = 0.43, 95% confidence interval (CI) = 0.24-0.77) compared to urban patients, and more likely in those with heart disease (OR = 2.62, 95% CI = 1.62-4.25), atrial fibrillation (OR = 4.25, 95% CI = 1.08-16.81), hypertension (OR = 2.14, 95% CI = 1.34-3.44), diabetes (OR = 2.72, 95% CI = 1.69-4.39) or depression (OR = 1.91, 95% CI = 1.19-3.06). PIMs were more frequent in females (OR = 1.88, 95% CI = 1.03-3.42) and less frequent in rural (OR = 0.41, 95% CI = 0.19-0.85) and remote (OR = 0.58, 95% CI = 0.29-1.18) patients. Factors associated with PIMs were kidney disease (OR = 2.60, 95% CI = 1.37-4.92), urinary incontinence (OR = 3.00, 95% CI = 1.02-8.83), depression (OR = 2.67, 95% CI = 1.50-4.77), heavy alcohol use (OR = 2.83, 95% CI = 1.39-5.75) and subjective cognitive concerns (OR = 2.69, 95% CI = 1.31-5.52). High ACB was less common in rural (OR = 0.10, 95% CI = 0.03-0.34) and remote (OR = 0.51, 95% CI = 0.25-1.04) patients and more common in those with kidney disease (OR = 3.07, 95% CI = 1.50-6.30) or depression (OR = 3.32, 95% CI = 1.70-6.47). CONCLUSION Associations between potentially suboptimal prescribing and depression or cognitive concerns highlight the importance of considering medication review and deprescribing for these patients.
Collapse
Affiliation(s)
- Marycarol Holdaway
- Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia
| | - Zoë Hyde
- Western Australian Centre for Health and Ageing, University of Western Australia, Perth, Western Australia, Australia
| | - Jo-Anne Hughson
- Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia
| | - Roslyn Malay
- Western Australian Centre for Health and Ageing, University of Western Australia, Perth, Western Australia, Australia
| | - Andrew Stafford
- Curtin Medical School, Faculty of Health Sciences, Curtin University, Perth, Western Australia, Australia
| | - Kate Fulford
- Western Australian Centre for Health and Ageing, University of Western Australia, Perth, Western Australia, Australia
| | - Kylie Radford
- Neuroscience Research Australia, Sydney, New South Wales, Australia
| | - Leon Flicker
- Western Australian Centre for Health and Ageing, University of Western Australia, Perth, Western Australia, Australia
| | - Kate Smith
- Centre for Aboriginal Medical and Dental Health, University of Western Australia, Perth, Western Australia, Australia
| | - Dimity Pond
- Department of General Practice, University of Newcastle, Newcastle, New South Wales, Australia
| | - Sarah Russell
- College of Medicine and Dentistry, James Cook University, Cairns, Queensland, Australia
| | - David Atkinson
- Rural Clinical School, University of Western Australia, Broome, Western Australia, Australia
| | - Irene Blackberry
- La Trobe University, John Richards Centre for Rural Ageing Research, Wodonga, Victoria, Australia
| | - Dina LoGiudice
- Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia
- Department Aged Care, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| |
Collapse
|
50
|
Zannetti EB, Cittadini N, Iovino P, De Maria M, D'Angelo D, Pennini A, Vellone E, Tarantino U, Alvaro R. Factors That Influence Quality of Life in Postmenopausal Osteoporotic Women With Nonvertebral Fractures: The Guardian Angel Multicenter Longitudinal Study. Orthop Nurs 2024; 43:151-157. [PMID: 38861745 DOI: 10.1097/nor.0000000000001028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/13/2024] Open
Abstract
The knowledge of variables associated with quality of life in women with nonvertebral fractures is poor. The aim of this study was to examine the independent associations between sociodemographic and clinical factors, self-care, and quality of life in this specific population. We undertook a 3-year multicenter longitudinal study on a cohort of Italian postmenopausal osteoporotic women with three follow-ups at 1, 3, and 6 months. Nurses asked women to complete questionnaires on quality of life and self-care. The sample (n = 532) had a mean age of 74.78 years. The results showed that women taking more than two medications per day (p = .026) and those with nine or more years of education (p = .036) were more likely to exhibit better quality of life levels (p < .001) than their counterparts. Both self-care and quality of life scores improved over time in all participants. This study shows positive independent associations between quality of life and polypharmacy, education, and self-care behaviors, which were improved by educational interventions to attain a better quality of life in our participants.
Collapse
Affiliation(s)
- Emanuela Basilici Zannetti
- Emanuela Basilici Zannetti, PhD, RN, Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy ( https://orcid.org/0000-0002-5330-9808 )
- Noemi Cittadini, PhD, RN, Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy ( https://orcid.org/0000-0001-8862-6857 )
- Paolo Iovino, PhD, RN, Department of Health Sciences, University of Florence ( https://orcid.org/0000-0001-5952-881X )
- Maddalena De Maria, RN, MSN, PhD, Associate Professor of Nursing Science, Department of Life Health Sciences and Health Professions, Campus University, Rome, Italy https://orcid.org/0000-0003-0507-0158
- Daniela D'Angelo, PhD, RN, Research Nurse. Azienda Sanitaria Locale Roma/6, Via Borgo Garibaldi,12 00041 Albano Laziale ( https://orcid.org/0000-0001-9451-0885 )
- Annalisa Pennini, PhD, RN, Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy ( https://orcid.org/0000-0003-3676-5956 )
- Ercole Vellone, PhD, RN, FAAN, FESC, Associate Professor of Nursing, Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy and Department of Nursing and Obstetrics, Wroclaw Medical University, Poland ( https://orcid.org/0000-0003-4673-7473 )
- Umberto Tarantino, PhD, MD, Department of Orthopaedics and Traumatology, Policlinic Tor Vergata Foundation, University of Rome Tor Vergata, Rome, Italy ( https://orcid.org/0000-0003-0330-2189 )
- Rosaria Alvaro, MSN, FESC, FAAN, Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy ( https://orcid.org/0000-0002-4659-1569 )
| | - Noemi Cittadini
- Emanuela Basilici Zannetti, PhD, RN, Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy ( https://orcid.org/0000-0002-5330-9808 )
- Noemi Cittadini, PhD, RN, Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy ( https://orcid.org/0000-0001-8862-6857 )
- Paolo Iovino, PhD, RN, Department of Health Sciences, University of Florence ( https://orcid.org/0000-0001-5952-881X )
- Maddalena De Maria, RN, MSN, PhD, Associate Professor of Nursing Science, Department of Life Health Sciences and Health Professions, Campus University, Rome, Italy https://orcid.org/0000-0003-0507-0158
- Daniela D'Angelo, PhD, RN, Research Nurse. Azienda Sanitaria Locale Roma/6, Via Borgo Garibaldi,12 00041 Albano Laziale ( https://orcid.org/0000-0001-9451-0885 )
- Annalisa Pennini, PhD, RN, Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy ( https://orcid.org/0000-0003-3676-5956 )
- Ercole Vellone, PhD, RN, FAAN, FESC, Associate Professor of Nursing, Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy and Department of Nursing and Obstetrics, Wroclaw Medical University, Poland ( https://orcid.org/0000-0003-4673-7473 )
- Umberto Tarantino, PhD, MD, Department of Orthopaedics and Traumatology, Policlinic Tor Vergata Foundation, University of Rome Tor Vergata, Rome, Italy ( https://orcid.org/0000-0003-0330-2189 )
- Rosaria Alvaro, MSN, FESC, FAAN, Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy ( https://orcid.org/0000-0002-4659-1569 )
| | - Paolo Iovino
- Emanuela Basilici Zannetti, PhD, RN, Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy ( https://orcid.org/0000-0002-5330-9808 )
- Noemi Cittadini, PhD, RN, Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy ( https://orcid.org/0000-0001-8862-6857 )
- Paolo Iovino, PhD, RN, Department of Health Sciences, University of Florence ( https://orcid.org/0000-0001-5952-881X )
- Maddalena De Maria, RN, MSN, PhD, Associate Professor of Nursing Science, Department of Life Health Sciences and Health Professions, Campus University, Rome, Italy https://orcid.org/0000-0003-0507-0158
- Daniela D'Angelo, PhD, RN, Research Nurse. Azienda Sanitaria Locale Roma/6, Via Borgo Garibaldi,12 00041 Albano Laziale ( https://orcid.org/0000-0001-9451-0885 )
- Annalisa Pennini, PhD, RN, Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy ( https://orcid.org/0000-0003-3676-5956 )
- Ercole Vellone, PhD, RN, FAAN, FESC, Associate Professor of Nursing, Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy and Department of Nursing and Obstetrics, Wroclaw Medical University, Poland ( https://orcid.org/0000-0003-4673-7473 )
- Umberto Tarantino, PhD, MD, Department of Orthopaedics and Traumatology, Policlinic Tor Vergata Foundation, University of Rome Tor Vergata, Rome, Italy ( https://orcid.org/0000-0003-0330-2189 )
- Rosaria Alvaro, MSN, FESC, FAAN, Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy ( https://orcid.org/0000-0002-4659-1569 )
| | - Maddalena De Maria
- Emanuela Basilici Zannetti, PhD, RN, Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy ( https://orcid.org/0000-0002-5330-9808 )
- Noemi Cittadini, PhD, RN, Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy ( https://orcid.org/0000-0001-8862-6857 )
- Paolo Iovino, PhD, RN, Department of Health Sciences, University of Florence ( https://orcid.org/0000-0001-5952-881X )
- Maddalena De Maria, RN, MSN, PhD, Associate Professor of Nursing Science, Department of Life Health Sciences and Health Professions, Campus University, Rome, Italy https://orcid.org/0000-0003-0507-0158
- Daniela D'Angelo, PhD, RN, Research Nurse. Azienda Sanitaria Locale Roma/6, Via Borgo Garibaldi,12 00041 Albano Laziale ( https://orcid.org/0000-0001-9451-0885 )
- Annalisa Pennini, PhD, RN, Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy ( https://orcid.org/0000-0003-3676-5956 )
- Ercole Vellone, PhD, RN, FAAN, FESC, Associate Professor of Nursing, Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy and Department of Nursing and Obstetrics, Wroclaw Medical University, Poland ( https://orcid.org/0000-0003-4673-7473 )
- Umberto Tarantino, PhD, MD, Department of Orthopaedics and Traumatology, Policlinic Tor Vergata Foundation, University of Rome Tor Vergata, Rome, Italy ( https://orcid.org/0000-0003-0330-2189 )
- Rosaria Alvaro, MSN, FESC, FAAN, Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy ( https://orcid.org/0000-0002-4659-1569 )
| | - Daniela D'Angelo
- Emanuela Basilici Zannetti, PhD, RN, Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy ( https://orcid.org/0000-0002-5330-9808 )
- Noemi Cittadini, PhD, RN, Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy ( https://orcid.org/0000-0001-8862-6857 )
- Paolo Iovino, PhD, RN, Department of Health Sciences, University of Florence ( https://orcid.org/0000-0001-5952-881X )
- Maddalena De Maria, RN, MSN, PhD, Associate Professor of Nursing Science, Department of Life Health Sciences and Health Professions, Campus University, Rome, Italy https://orcid.org/0000-0003-0507-0158
- Daniela D'Angelo, PhD, RN, Research Nurse. Azienda Sanitaria Locale Roma/6, Via Borgo Garibaldi,12 00041 Albano Laziale ( https://orcid.org/0000-0001-9451-0885 )
- Annalisa Pennini, PhD, RN, Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy ( https://orcid.org/0000-0003-3676-5956 )
- Ercole Vellone, PhD, RN, FAAN, FESC, Associate Professor of Nursing, Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy and Department of Nursing and Obstetrics, Wroclaw Medical University, Poland ( https://orcid.org/0000-0003-4673-7473 )
- Umberto Tarantino, PhD, MD, Department of Orthopaedics and Traumatology, Policlinic Tor Vergata Foundation, University of Rome Tor Vergata, Rome, Italy ( https://orcid.org/0000-0003-0330-2189 )
- Rosaria Alvaro, MSN, FESC, FAAN, Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy ( https://orcid.org/0000-0002-4659-1569 )
| | - Annalisa Pennini
- Emanuela Basilici Zannetti, PhD, RN, Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy ( https://orcid.org/0000-0002-5330-9808 )
- Noemi Cittadini, PhD, RN, Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy ( https://orcid.org/0000-0001-8862-6857 )
- Paolo Iovino, PhD, RN, Department of Health Sciences, University of Florence ( https://orcid.org/0000-0001-5952-881X )
- Maddalena De Maria, RN, MSN, PhD, Associate Professor of Nursing Science, Department of Life Health Sciences and Health Professions, Campus University, Rome, Italy https://orcid.org/0000-0003-0507-0158
- Daniela D'Angelo, PhD, RN, Research Nurse. Azienda Sanitaria Locale Roma/6, Via Borgo Garibaldi,12 00041 Albano Laziale ( https://orcid.org/0000-0001-9451-0885 )
- Annalisa Pennini, PhD, RN, Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy ( https://orcid.org/0000-0003-3676-5956 )
- Ercole Vellone, PhD, RN, FAAN, FESC, Associate Professor of Nursing, Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy and Department of Nursing and Obstetrics, Wroclaw Medical University, Poland ( https://orcid.org/0000-0003-4673-7473 )
- Umberto Tarantino, PhD, MD, Department of Orthopaedics and Traumatology, Policlinic Tor Vergata Foundation, University of Rome Tor Vergata, Rome, Italy ( https://orcid.org/0000-0003-0330-2189 )
- Rosaria Alvaro, MSN, FESC, FAAN, Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy ( https://orcid.org/0000-0002-4659-1569 )
| | - Ercole Vellone
- Emanuela Basilici Zannetti, PhD, RN, Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy ( https://orcid.org/0000-0002-5330-9808 )
- Noemi Cittadini, PhD, RN, Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy ( https://orcid.org/0000-0001-8862-6857 )
- Paolo Iovino, PhD, RN, Department of Health Sciences, University of Florence ( https://orcid.org/0000-0001-5952-881X )
- Maddalena De Maria, RN, MSN, PhD, Associate Professor of Nursing Science, Department of Life Health Sciences and Health Professions, Campus University, Rome, Italy https://orcid.org/0000-0003-0507-0158
- Daniela D'Angelo, PhD, RN, Research Nurse. Azienda Sanitaria Locale Roma/6, Via Borgo Garibaldi,12 00041 Albano Laziale ( https://orcid.org/0000-0001-9451-0885 )
- Annalisa Pennini, PhD, RN, Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy ( https://orcid.org/0000-0003-3676-5956 )
- Ercole Vellone, PhD, RN, FAAN, FESC, Associate Professor of Nursing, Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy and Department of Nursing and Obstetrics, Wroclaw Medical University, Poland ( https://orcid.org/0000-0003-4673-7473 )
- Umberto Tarantino, PhD, MD, Department of Orthopaedics and Traumatology, Policlinic Tor Vergata Foundation, University of Rome Tor Vergata, Rome, Italy ( https://orcid.org/0000-0003-0330-2189 )
- Rosaria Alvaro, MSN, FESC, FAAN, Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy ( https://orcid.org/0000-0002-4659-1569 )
| | - Umberto Tarantino
- Emanuela Basilici Zannetti, PhD, RN, Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy ( https://orcid.org/0000-0002-5330-9808 )
- Noemi Cittadini, PhD, RN, Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy ( https://orcid.org/0000-0001-8862-6857 )
- Paolo Iovino, PhD, RN, Department of Health Sciences, University of Florence ( https://orcid.org/0000-0001-5952-881X )
- Maddalena De Maria, RN, MSN, PhD, Associate Professor of Nursing Science, Department of Life Health Sciences and Health Professions, Campus University, Rome, Italy https://orcid.org/0000-0003-0507-0158
- Daniela D'Angelo, PhD, RN, Research Nurse. Azienda Sanitaria Locale Roma/6, Via Borgo Garibaldi,12 00041 Albano Laziale ( https://orcid.org/0000-0001-9451-0885 )
- Annalisa Pennini, PhD, RN, Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy ( https://orcid.org/0000-0003-3676-5956 )
- Ercole Vellone, PhD, RN, FAAN, FESC, Associate Professor of Nursing, Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy and Department of Nursing and Obstetrics, Wroclaw Medical University, Poland ( https://orcid.org/0000-0003-4673-7473 )
- Umberto Tarantino, PhD, MD, Department of Orthopaedics and Traumatology, Policlinic Tor Vergata Foundation, University of Rome Tor Vergata, Rome, Italy ( https://orcid.org/0000-0003-0330-2189 )
- Rosaria Alvaro, MSN, FESC, FAAN, Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy ( https://orcid.org/0000-0002-4659-1569 )
| | - Rosaria Alvaro
- Emanuela Basilici Zannetti, PhD, RN, Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy ( https://orcid.org/0000-0002-5330-9808 )
- Noemi Cittadini, PhD, RN, Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy ( https://orcid.org/0000-0001-8862-6857 )
- Paolo Iovino, PhD, RN, Department of Health Sciences, University of Florence ( https://orcid.org/0000-0001-5952-881X )
- Maddalena De Maria, RN, MSN, PhD, Associate Professor of Nursing Science, Department of Life Health Sciences and Health Professions, Campus University, Rome, Italy https://orcid.org/0000-0003-0507-0158
- Daniela D'Angelo, PhD, RN, Research Nurse. Azienda Sanitaria Locale Roma/6, Via Borgo Garibaldi,12 00041 Albano Laziale ( https://orcid.org/0000-0001-9451-0885 )
- Annalisa Pennini, PhD, RN, Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy ( https://orcid.org/0000-0003-3676-5956 )
- Ercole Vellone, PhD, RN, FAAN, FESC, Associate Professor of Nursing, Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy and Department of Nursing and Obstetrics, Wroclaw Medical University, Poland ( https://orcid.org/0000-0003-4673-7473 )
- Umberto Tarantino, PhD, MD, Department of Orthopaedics and Traumatology, Policlinic Tor Vergata Foundation, University of Rome Tor Vergata, Rome, Italy ( https://orcid.org/0000-0003-0330-2189 )
- Rosaria Alvaro, MSN, FESC, FAAN, Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy ( https://orcid.org/0000-0002-4659-1569 )
| |
Collapse
|