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Hsu YH, Chou MY, Chang WC, Chen MT, Wang YC, Liao MC, Liang CK, Chen LK, Lin YT. Association between changes in potentially inappropriate medication use and adverse outcomes during hospitalization in older adults: A retrospective study. Arch Gerontol Geriatr 2024; 116:105139. [PMID: 37567097 DOI: 10.1016/j.archger.2023.105139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 07/12/2023] [Accepted: 07/28/2023] [Indexed: 08/13/2023]
Abstract
PURPOSE To evaluate the association between the change in the number of PIMs in older adults during hospitalization and adverse outcomes. METHODS This retrospective cohort study was conducted in the internal medicine wards of a tertiary teaching hospital between May and December 2017. 3,460 patients (77.5±8.4 years, 60.4% male) were enrolled, and 206 patients died during hospitalization. PIMs were defined using the Beers Criteria as suggested by the American Geriatrics Society. Adverse outcomes studied were functional decline (a loss in 1 or more activities of daily living from admission to discharge), prolonged length of stay (LOS) (≥14 days), and mortality. RESULTS 2258 patients (65.3%) had increasing PIMs during hospitalization. They tended to be younger (77.0±8.3 versus 78.5±8.5 years, p<0.001) and had lower numbers of PIMs at admission (0.4±0.8 versus 0.8±1.1, p<0.001). Increasing PIM use was strongly associated with greater functional decline (aOR 1.36, 95%CI 1.01-1.67, p=0.005), prolonged LOS (aOR 3.47, 95%CI 2.71-4.44, p<0.001) and higher mortality rate (aOR 2.68, 95%CI 1.75-4.12, p<0.001), even after adjusting for all covariates. We observed a strong association between adverse outcomes and increasing PIMs in older adults during hospitalization (p for trend <0.001). CONCLUSIONS Older adults with increasing PIMs during hospitalization were at greater risk for functional decline, prolonged LOS, and mortality, especially in those with three or more PIMs. Further studies are needed to better understand the complex interactions and to evaluate the effectiveness of intervention programs to lower PIM number and improve discharge outcomes for patients who had increasing PIM use during hospitalization.
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Affiliation(s)
- Ying-Hsin Hsu
- Center for Geriatrics and Gerontology, Kaohsiung Veterans General Hospital, Kaohsiung City, Taiwan; Division of Neurology, Department of Internal Medicine, Kaohsiung Veterans General Hospital, Kaohsiung City, Taiwan
| | - Ming-Yueh Chou
- Center for Geriatrics and Gerontology, Kaohsiung Veterans General Hospital, Kaohsiung City, Taiwan; Center for Healthy Longevity and Aging Sciences, National Yang Ming Chiao Tung University, Taipei, Taiwan; Department of Geriatric Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei City, Taiwan
| | - Wei-Cheng Chang
- Checheng Township Public Health Center, Pingtung County, Taiwan
| | - Miao-Ting Chen
- Department of Pharmacy, Kaohsiung Veterans General Hospital, Kaohsiung City, Taiwan
| | - Yu-Chun Wang
- Center for Geriatrics and Gerontology, Kaohsiung Veterans General Hospital, Kaohsiung City, Taiwan
| | - Mei-Chen Liao
- Center for Geriatrics and Gerontology, Kaohsiung Veterans General Hospital, Kaohsiung City, Taiwan
| | - Chih-Kuang Liang
- Center for Geriatrics and Gerontology, Kaohsiung Veterans General Hospital, Kaohsiung City, Taiwan; Division of Neurology, Department of Internal Medicine, Kaohsiung Veterans General Hospital, Kaohsiung City, Taiwan; Center for Healthy Longevity and Aging Sciences, National Yang Ming Chiao Tung University, Taipei, Taiwan; Department of Geriatric Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei City, Taiwan.
| | - Liang-Kung Chen
- Taipei Municipal Gan-Dau Hospital, Taipei City, Taiwan; Center for Geriatrics and Gerontology, Taipei Veterans General Hospital, Taipei City, Taiwan
| | - Yu-Te Lin
- Center for Geriatrics and Gerontology, Kaohsiung Veterans General Hospital, Kaohsiung City, Taiwan; Division of Neurology, Department of Internal Medicine, Kaohsiung Veterans General Hospital, Kaohsiung City, Taiwan
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Kosto A, Lev D, Reiss N, Meged-Book T, Press Y. Discontinuation of benzodiazepines and Z-drugs in hospitalised population at the age of 60 and above. An open-label randomized controlled trial. Int J Geriatr Psychiatry 2023; 38:e6012. [PMID: 37807766 DOI: 10.1002/gps.6012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Accepted: 09/25/2023] [Indexed: 10/10/2023]
Abstract
BACKGROUND Treating insomnia with hypnotic drugs in elderly patients has many adverse effects. This study aims to assess the effect of two discontinuation methods of hypnotic drugs during acute hospitalization. METHODS We conducted an open-label randomized controlled trial that included participants aged 60 and above taking benzodiazepines or Z-Drugs for at least 3 months as a treatment for insomnia and were admitted to the hospital. In the prospective arm, patients were randomly assigned into two intervention groups. In the Minimal Intervention (MI) group, patients received an explanation of the dangers of long-term treatment and a recommendation to stop the treatment. In the Tapering Down Intervention (TDI) group, in addition to the explanation, patients received a tapering down table. In the retrospective arm (control group), we examined the use of hypnotic drugs among hospitalized patients 3 months after hospitalization, similar to the patients in the prospective arm. RESULTS 46 patients were enrolled in the MI group, 55 patients in the TDI group, and 114 patients in the control group. The mean age in the three groups was 75.0 ± 8.2, 75.9 ± 9.0, and 75.0 ± 7.9 years respectively (p = 0.85). After 3 months, seven (15.2%) of the patients in the MI group, 15 (27.3%) in the TD group, and 2 (1.8%) in the control group (p = 0.00003) were weaned from the hypnotic drugs treatment, without a significant difference between the intervention groups (p = 0.221). CONCLUSIONS A short intervention during hospitalization results in a significant decrease in hypnotic drug use.
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Affiliation(s)
- Amit Kosto
- Department of Internal Medicine, Soroka Medical Center, Beer-Sheva, Israel
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Danielle Lev
- Department of Internal Medicine, Soroka Medical Center, Beer-Sheva, Israel
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Nadav Reiss
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
- Department of Psychiatry, Soroka Medical Center, Beer-Sheva, Israel
| | - Tehilah Meged-Book
- Department of Internal Medicine, Soroka Medical Center, Beer-Sheva, Israel
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Yan Press
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
- Department of Geriatrics, Soroka Medical Center, Beer-Sheva, Israel
- Siaal Research Center for Family Medicine and Primary Care, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer- Sheva, Israel
- Unit for Community Geriatrics, Division of Health in the Community, Ben-Gurion University of the Negev, Beer-Sheva, Israel
- Center for Multidisciplinary Research in Aging, Ben-Gurion University of the Negev, Beer-Sheva, Israel
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Liang CK, Chou MY, Hsu YH, Wang YC, Liao MC, Chen MT, Hsiao PY, Chen LK, Lin YT. The association of potentially inappropriate medications, polypharmacy and anticholinergic burden with readmission and emergency room revisit after discharge: A hospital-based retrospective cohort study. Br J Clin Pharmacol 2023; 89:187-200. [PMID: 35821614 DOI: 10.1111/bcp.15457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 06/05/2022] [Accepted: 06/30/2022] [Indexed: 11/30/2022] Open
Abstract
AIMS While certain drug-use indicators are known to be associated with clinical outcomes, the relationship is unclear for some highly prevalent conditions in in patients aged ≥65 years. We examine correlations between 3 drug-use indicators and postdischarge healthcare services use by older patients according to the presence of dementia, advanced age and frailty. METHODS This retrospective cohort study analysed data collected from hospital electronic health records between April and December 2017. Potentially inappropriate medications (PIMs) and anticholinergic burden were assessed using the 2015 Beers Criteria and anticholinergic cognitive burden scale (ACBS) score. Minor and major polypharmacy were defined as the use of 5-9 and ≥10 drugs, respectively. Outcomes were set as emergency room revisits and readmissions at 1, 3 and 6 months postdischarge. The correlation between drug-use indicators and outcomes was analysed by multivariable logistic regression. RESULTS The final cohort included 3061 patients for the analysis, and 2930, 2671 and 2560 patients were followed up to 1, 3 and 6 months after discharge. After controlling for confounders, all 3 drug-use indicators were significantly associated with readmission and emergency room revisits except for the relationship between PIMs and readmission within 6 months. These associations were significantly observed among patients without dementia, aged >80 years and with frailty. CONCLUSION PIMs, polypharmacy and anticholinergic burden are common at discharge and correlate with future use of healthcare services. In older patients, the absence of dementia, advanced age and frailty should be given extra consideration with regard to medication safety.
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Affiliation(s)
- Chih-Kuang Liang
- Center for Geriatrics and Gerontology, Kaohsiung Veterans General Hospital, Kaohsiung City, Taiwan.,Aging and Health Research Center, National Yang Ming Chiao Tung University, Taipei City, Taiwan.,Department of Geriatric Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei City, Taiwan.,Division of Neurology, Department of Internal Medicine, Kaohsiung Veterans General Hospital, Kaohsiung City, Taiwan
| | - Ming-Yueh Chou
- Center for Geriatrics and Gerontology, Kaohsiung Veterans General Hospital, Kaohsiung City, Taiwan.,Aging and Health Research Center, National Yang Ming Chiao Tung University, Taipei City, Taiwan.,Department of Geriatric Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei City, Taiwan
| | - Ying-Hsin Hsu
- Center for Geriatrics and Gerontology, Kaohsiung Veterans General Hospital, Kaohsiung City, Taiwan.,Division of Neurology, Department of Internal Medicine, Kaohsiung Veterans General Hospital, Kaohsiung City, Taiwan.,Chia Nan University, Tainan City, Taiwan
| | - Yu-Chun Wang
- Center for Geriatrics and Gerontology, Kaohsiung Veterans General Hospital, Kaohsiung City, Taiwan
| | - Mei-Chen Liao
- Center for Geriatrics and Gerontology, Kaohsiung Veterans General Hospital, Kaohsiung City, Taiwan
| | - Miao-Ting Chen
- Department of Pharmacy, Kaohsiung Veterans General Hospital, Kaohsiung City, Taiwan
| | - Pei-Yu Hsiao
- Department of Pharmacy, Kaohsiung Veterans General Hospital, Kaohsiung City, Taiwan
| | - Liang-Kung Chen
- Aging and Health Research Center, National Yang Ming Chiao Tung University, Taipei City, Taiwan.,Department of Geriatric Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei City, Taiwan.,Taipei Municipal Gan-Dau Hospital, Taipei, Taiwan.,Center for Geriatrics and Gerontology, Taipei Veterans General Hospital, Taipei City, Taiwan
| | - Yu-Te Lin
- Center for Geriatrics and Gerontology, Kaohsiung Veterans General Hospital, Kaohsiung City, Taiwan.,Division of Neurology, Department of Internal Medicine, Kaohsiung Veterans General Hospital, Kaohsiung City, Taiwan.,Department of Pharmacy, Tajen University, Yanpu Township, Pingtung County, Taiwan
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Suzuki Y, Shiraishi N, Komiya H, Sakakibara M, Akishita M, Kuzuya M. Potentially inappropriate medications increase while prevalence of polypharmacy / hyperpolypharmacy decreases in Japan: a comparison of nationwide prescribing data. Arch Gerontol Geriatr 2022; 102:104733. [DOI: 10.1016/j.archger.2022.104733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 05/02/2022] [Accepted: 05/10/2022] [Indexed: 11/02/2022]
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Varavithya V, Tirapat C, Rojpibulstit P, Poovichayasumlit P, Prasert V, Vatcharavongvan P. Potentially inappropriate medication use and the hospitalization rate among Thai elderly patients: a retrospective cohort study. Eur J Clin Pharmacol 2022; 78:847-855. [DOI: 10.1007/s00228-021-03269-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Accepted: 12/18/2021] [Indexed: 11/03/2022]
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Stojanovic G, Djuric D, Jakovljevic B, Turnic-nikolic T, Maricic M, Stojanovic S, Milovanovic O. Potentially inappropriate medication prescribing among elderly patients with cardiovascular diseases. VOJNOSANIT PREGL 2022; 79:373-82. [DOI: 10.2298/vsp200623118s] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Background/Aim. The growing number of older adults means higher medicine utilization. The aim of the study was to determine the frequency and identify risk factors of potentially inappropriate medication (PIM) in the elderly population with cardiovascular diseases. Methods. The retrospective, cross-sectional study was performed in 2018, and the relevant data were collected during the period from January 2016 to December 2017. The study sample included 1,500 patients over 65 years with cardiovascular disease who had medical records at the Institute for Gerontology and Palliative Care, Belgrade. Assessment of PIM was done by standard international criteria such as the American Geriatrics Society 2015 updated Beers Criteria for PIM use in older adults. Results. PIM frequency in the elderly population was 70.3%. In relation to gender, it was more frequent in female elders. The mean number of prescribed drugs was similar for 2016 and 2017, 7.2 and 7.3, respectively. The most common were: medium-acting benzodiazepines (70.9%), central ? blockers (23.98%), and antipsychotics (typical and atypical) (20.94%). The most common comorbidity was noted in a group labeled with the International Disease Classification I00-I99, which includes heart and blood vessel diseases [n = 2,658 (36.9%)]. The most common diagnoses belonged to the subgroups I10-I15 [hypertensive diseases, n = 1,298 (18%)], I20-I25 [ischemic heart diseases n = 542 (7.5%)], I30-I52 [other forms of heart disease, n = 705 (9.8%)], I60-I69 [cerebrovascular diseases, n = 94 (1.3%)], and I80- I89 [diseases of veins, lymph vessels, and lymph nodes n = 12 (0.17%)]. The risk factors for PIM were: polypharmacy, gender, nicotine use, cognitive status, nutrition state, and the number of diseases registered in the study sample. Conclusion. Cardiovascular diseases in the elderly population are associated with a high prevalence of PIM. Creating health recommendations for prescribing drugs to the elderly that would emphasize these factors could reduce the prevalence of PIM in this population.
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Khowaja AR, Krause C, Kennedy C, Ridout B, Carriere S, Mitton C. Cost-effectiveness of a Province-wide Quality Improvement Initiative for Reducing Potentially Inappropriate Use of Antipsychotics in Long-Term Care in British Columbia, Canada. Pharmacoecon Open 2021; 5:491-504. [PMID: 33914292 PMCID: PMC8333184 DOI: 10.1007/s41669-021-00267-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 04/12/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND Potentially inappropriate use of antipsychotics (PIUA) raises serious concerns about safety, quality, and cost of care for residents in long-term care (LTC). OBJECTIVE This study aimed to estimate the cost-effectiveness of the Call for Less Antipsychotics in Long-Term Care (Clear) initiative compared with the status quo (pre-Clear, baseline). METHODS A model-based cost-utility analysis, from a public-payer perspective in British Columbia, was conducted using secondary data of residents in LTC homes from 2013 to 2019. Residents' health resource utilization and quality-adjusted life-year (QALY) measures were extracted from multiple administrative databases. Six Markov states were modelled for post-antipsychotic progression representing PIUA, appropriate use of antipsychotic, complete withdrawal, and death. The primary outcome was the incremental cost per QALY gained. RESULTS A cohort of 35,669 residents was included in the primary analysis. The Clear initiative, over 10 years, was estimated to have an incremental cost-effectiveness ratio (ICER) of CA$26,055 (2020 Canadian dollars) per QALY gained at an incremental cost of CA$5211 per resident and a QALY gain of 0.20. In the subgroup analyses, our findings were even more favourable for Clear wave 2 (ICER of CA$24,447 per QALY gained) and Clear wave 3 (ICER of CA$25,933 per QALY gained). At a willingness-to-pay of CA$50,000 per QALY gained, the probabilities of Clear waves 2 and 3 were 82% cost-effective. CONCLUSION This study demonstrated incremental costs and yielded favourable ICERs for Clear compared with the baseline. More research is needed to understand the level of support for individual care homes to sustain the Clear initiative in the long run.
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Affiliation(s)
- Asif Raza Khowaja
- Department of Health Sciences at Brock University, 1812 Sir Isaac Brock Way, St. Catharines, ON L2S 3A1 Canada
| | - Christina Krause
- BC Patient Safety & Quality Council and School of Population & Public Health, Faculty of Medicine at the University of British Columbia, Vancouver, Canada
| | - Colleen Kennedy
- Health System improvement, BC Patient Safety & Quality Council, Vancouver, Canada
| | - Ben Ridout
- Analytics and Strategic Initiatives, BC Patient Safety & Quality Council, Vancouver, Canada
| | - Sarah Carriere
- Health Systems Improvement, BC Patient Safety & Quality Council, Vancouver, Canada
| | - Craig Mitton
- School of Population and Public Health; and Senior Scientist at the Centre for Clinical Epidemiology and Evaluation, Vancouver, Canada
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Mekonnen AB, Redley B, de Courten B, Manias E. Potentially inappropriate prescribing and its associations with health-related and system-related outcomes in hospitalised older adults: A systematic review and meta-analysis. Br J Clin Pharmacol 2021; 87:4150-4172. [PMID: 34008195 PMCID: PMC8597090 DOI: 10.1111/bcp.14870] [Citation(s) in RCA: 52] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 03/17/2021] [Accepted: 04/14/2021] [Indexed: 12/21/2022] Open
Abstract
AIMS To synthesise associations of potentially inappropriate prescribing (PIP) with health-related and system-related outcomes in inpatient hospital settings. METHODS Six electronic databases were searched: Medline Complete, EMBASE, CINAHL, PyscInfo, IPA and Cochrane library. Studies published between 1 January 1991 and 31 January 2021 investigating associations between PIP and health-related and system-related outcomes of older adults in hospital settings, were included. A random effects model was employed using the generic inverse variance method to pool risk estimates. RESULTS Overall, 63 studies were included. Pooled risk estimates did not show a significant association with all-cause mortality (adjusted odds ratio [AOR] 1.10, 95% confidence interval [CI] 0.90-1.36; adjusted hazard ratio 1.02, 83% CI 0.90-1.16), and hospital readmission (AOR 1.11, 95% CI 0.76-1.63; adjusted hazard ratio 1.02, 95% CI 0.89-1.18). PIP was associated with 91%, 60% and 26% increased odds of adverse drug event-related hospital admissions (AOR 1.91, 95% CI 1.21-3.01), functional decline (AOR 1.60, 95% CI 1.28-2.01), and adverse drug reactions and adverse drug events (AOR 1.26, 95% CI 1.11-1.43), respectively. PIP was associated with falls (2/2 studies). The impact of PIP on emergency department visits, length of stay, and health-related quality of life was inconclusive. Economic cost of PIP reported in 3 studies, comprised various cost estimation methods. CONCLUSIONS PIP was significantly associated with a range of health-related and system-related outcomes. It is important to optimise older adults' prescriptions to facilitate improved outcomes of care.
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Affiliation(s)
- Alemayehu B Mekonnen
- Centre for Quality and Patient Safety Research, School of Nursing and Midwifery, Institute for Health Transformation, Deakin University, Burwood, VIC, 3125, Australia
| | - Bernice Redley
- Centre for Quality and Patient Safety Research, School of Nursing and Midwifery, Institute for Health Transformation, Deakin University, Burwood, VIC, 3125, Australia.,Centre for Quality and Patient Safety Research-Monash Health Partnership, School of Nursing and Midwifery, Institute for Health Transformation, Deakin University, Burwood, VIC, Australia
| | - Barbora de Courten
- Department of Medicine, School of Clinical Sciences, Monash University, Clayton, VIC, 3168, Australia
| | - Elizabeth Manias
- Centre for Quality and Patient Safety Research, School of Nursing and Midwifery, Institute for Health Transformation, Deakin University, Burwood, VIC, 3125, Australia
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Fusco D, Ferrini A, Pasqualetti G, Giannotti C, Cesari M, Laudisio A, Ballestrero A, Scabini S, Odetti PR, Colloca GF, Monzani F, Nencioni A, Antonelli Incalzi R, Monacelli F. Comprehensive geriatric assessment in older adults with cancer: Recommendations by the Italian Society of Geriatrics and Gerontology (SIGG). Eur J Clin Invest 2021; 51:e13347. [PMID: 32648990 DOI: 10.1111/eci.13347] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Revised: 05/19/2020] [Accepted: 06/14/2020] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Optimizing the approach to older adults with cancer is now a priority given the increasing frequency of new cancer diagnoses that are made in the older population. The comprehensive geriatric assessment (CGA) represents the gold-standard for (1) defining prognosis and ability to withstand cancer treatments, (2) exploring the multiple aspects that define the complexity of frail older persons, and (3) designing person-tailored interventions. MATERIALS AND METHODS In this document, based on a comprehensive revision of the literature, the Italian Society for Geriatrics and Gerontology proposes a CGA model (ONCOGER CGA) to be adopted by oncology centers for their routine approach to older patients with cancer. RESULTS AND DISCUSSION A widespread use of this standardized CGA format will facilitate comparisons across institutions, promote studies based on a multidimensional patient assessment, and foster the inclusion of geriatric endpoints in oncological clinical trials. Furthermore, we predict that the use of a standardized CGA approach will increase the integration of geriatricians into oncology care teams with the final result of improving therapeutic choices and clinical outcomes.
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Affiliation(s)
- Domenico Fusco
- Department of Geriatrics, Neurosciences and Orthopedics, Catholic University of the Sacred Heart School of Medicine, Teaching Hospital 'Agostino Gemelli', Rome, Italy
| | | | - Giuseppe Pasqualetti
- Geriatrics Unit, Department of Clinical and Experimental Medicine, University of Pisa4, Pisa PI, Italy
| | - Chiara Giannotti
- Department of Internal Medicine and Medical Specialties (DIMI), Section of Geriatrics, University of Genoa, Genoa, Italy.,IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Matteo Cesari
- Geriatric Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy.,Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Alice Laudisio
- Geriatric Unit, Campus Bio-Medico University, Rome, Italy
| | - Alberto Ballestrero
- Department of Internal Medicine and Medical Specialties (DIMI), Section of Geriatrics, University of Genoa, Genoa, Italy.,IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | | | - Patrizio R Odetti
- Department of Internal Medicine and Medical Specialties (DIMI), Section of Geriatrics, University of Genoa, Genoa, Italy.,IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Giuseppe F Colloca
- Department of Geriatrics, Neurosciences and Orthopedics, Catholic University of the Sacred Heart School of Medicine, Teaching Hospital 'Agostino Gemelli', Rome, Italy
| | - Fabio Monzani
- Geriatrics Unit, Department of Clinical and Experimental Medicine, University of Pisa4, Pisa PI, Italy
| | - Alessio Nencioni
- Department of Internal Medicine and Medical Specialties (DIMI), Section of Geriatrics, University of Genoa, Genoa, Italy.,IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | | | - Fiammetta Monacelli
- Department of Internal Medicine and Medical Specialties (DIMI), Section of Geriatrics, University of Genoa, Genoa, Italy.,IRCCS Ospedale Policlinico San Martino, Genoa, Italy
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De Vincentis A, Gallo P, Finamore P, Pedone C, Costanzo L, Pasina L, Cortesi L, Nobili A, Mannucci PM, Antonelli Incalzi R. Potentially Inappropriate Medications, Drug-Drug Interactions, and Anticholinergic Burden in Elderly Hospitalized Patients: Does an Association Exist with Post-Discharge Health Outcomes? Drugs Aging 2020; 37:585-93. [PMID: 32445121 DOI: 10.1007/s40266-020-00767-w] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Polypharmacy is very common in elderly patients and is associated with detrimental outcomes. OBJECTIVE Our objective was to evaluate the associations between a large panel of therapy quality indicators, including explicit lists of potentially inappropriate medications (PIMs; Beers criteria and Screening Tool of Older Persons' potentially inappropriate Prescriptions [STOPP] criteria), the Anticholinergic Cognitive Burden (ACB) score, and the number of drug-drug interactions (DDIs), with respect to mortality, rehospitalization, and physical function decline within 3 months from hospital discharge in a cohort of hospitalized elderly patients. METHODS We studied 2631 individuals aged ≥ 65 years (median age 79.6; males 48.6%) enrolled in the REPOSI registry. The relationships with mortality and rehospitalization were evaluated using Cox regressions, and relationships with functional status change (as percentage variation of Barthel Index [BI]) were evaluated using mixed linear models. RESULTS None of the studied indicators was associated with mortality and rehospitalization. Conversely, only ACB was associated with physical function decline, even after correction for confounders (adjusted mean BI variation of - 7.55%; 95% confidence interval [CI] - 12.37 to - 2.47). The number of medications at discharge, particularly polypharmacy (more than five drugs daily), were the only therapy-related factors associated with mortality (adjusted hazard ratio [aHR] 1.05 [95% CI 1.01-1.10] and 1.70 [95% CI 1.12-2.58], respectively) and rehospitalization (aHR 1.05 [95% CI 1.01-1.08] and 1.31 [95% CI 1.01-1.71], respectively). CONCLUSION Polypharmacy, a very simple measure, outperformed sophisticated PIM and DDI indicators of quality of therapy as a correlate of primary clinical outcomes, whereas ACB was associated with physical function decline. Thus, innovative approaches to the definition and research of PIMs and DDIs are eagerly awaited from the perspective of averaging the quantitative burden and qualitative interaction of drugs.
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Chivapricha W, Srinonprasert V, Suansanae T. Impact of Geriatric Pharmacy Specialist Interventions to Reduce Potentially Inappropriate Medication Among Hospitalized Elderly Patients at Medical Wards: A Prospective Quasi-Experimental Study. Drugs Real World Outcomes 2020; 8:39-47. [PMID: 33063296 PMCID: PMC7984164 DOI: 10.1007/s40801-020-00214-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/26/2020] [Indexed: 11/26/2022] Open
Abstract
Background Elderly patients are at greater risk of receiving potentially inappropriate medications (PIMs) and developing adverse drug events. Identification and correction of PIMs is essential to maximize medication safety. Objective To determine the prevalence of PIMs on admission in Thai elderly patients admitted to a medical ward and to compare changes of PIMs on discharge, following comprehensive care by a ward pharmacist with or without a geriatric pharmacy specialist. Patients and method A prospective, quasi-experimental study was performed at a tertiary university hospital in Bangkok, Thailand. Patients aged ≥ 60 years who were admitted to the medical ward were recruited and allocated to one of two groups: intervention (IG) and control (CG). The CG received pharmaceutical care from the ward pharmacist. The IG received pharmaceutical care from the geriatric pharmacy specialist along with the ward pharmacist. The 2012 Beers criteria were used to identify PIMs on admission, during hospitalization, and on discharge. Results Prevalence of PIMs on admission was 43.3% (N = 187). On discharge, prevalence of PIMs in the IG decreased significantly compared to that on admission (21.3% and 43.3%, p < 0.05) and was significantly lower than in the CG (21.3% and 40.9%, p = 0.036). Moreover, the percentage of patients without PIMs on discharge in the IG was significantly higher than in the CG (78.7% and 59.1%, p < 0.0001). Conclusion Use of PIMs was common among hospitalized elderly patients on admission. Pharmaceutical care provided by a geriatric pharmacy specialist in conjunction with a ward pharmacist significantly reduced the prevalence of PIMs on discharge compared with on admission.
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Affiliation(s)
| | - Varalak Srinonprasert
- Division of Geriatric Medicine, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Thanarat Suansanae
- Division of Clinical Pharmacy, Department of Pharmacy, Faculty of Pharmacy, Mahidol University, Bangkok, Thailand.
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12
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Tien SC, Chan HY, Hsu CC. The factors associated with inappropriate prescription patterns of benzodiazepines and related drugs among patients with dementia. Psychogeriatrics 2020; 20:447-457. [PMID: 32032470 DOI: 10.1111/psyg.12527] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2019] [Revised: 01/20/2020] [Accepted: 01/21/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND It has been emphasised that benzodiazepines and related drugs (BZDRs) should be used cautiously in people with dementia. The aim of this study was to identify factors associated with inappropriate prescription patterns of BZDRs including polypharmacy, long-term treatment and high doses among patients with dementia taking BZDRs. METHODS This was a retrospective chart review study of patients with dementia who were treated at the study hospital. The date that the patient was issued a catastrophic illness certificate from the National Health Insurance Administration was used as the index date. Medical records of the 2-year period after the index date were reviewed. RESULTS A total of 308 patients with dementia were included in this study. Among them, 151 (49.0%) received at least one prescription of BZDRs. After adjusting for covariates, psychiatric comorbidities (adjusted odds ratio (aOR) = 4.74, 95% CI = 1.75-12.81), history of past suicidal behaviour (aOR = 4.25, 95% CI = 1.40-12.88) and long-term treatment with BZDRs (aOR = 3.38, 95% CI = 1.11-10.27) were associated with polypharmacy of BZDRs. Age (aOR = 1.05, 95% CI = 1.0-1.11) and polypharmacy (aOR = 3.57, 95% CI = 1.23-10.32) were associated with long-term treatment. Living with family (aOR = 3.33, 95% CI = 1.32-9.79) and fewer psychiatric admissions to the study hospital (aOR = 0.56, 95% CI = 0.36-0.86) were associated with treatment with high doses of BZDRs. CONCLUSIONS Treatment with BZDRs is prevalent in patients with dementia. Inappropriate prescription patterns of BZDRs are not uncommon in these patients and may be interlinked.
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Affiliation(s)
- Shin-Chiao Tien
- Department of Psychiatry, Taoyuan Psychiatric Centre, Taoyuan, Taiwan
| | - Hung-Yu Chan
- Department of Psychiatry, Taoyuan Psychiatric Centre, Taoyuan, Taiwan.,Department of Psychiatry, National Taiwan University Hospital and School of Medicine, National Taiwan University, Taipei, Taiwan
| | - Chun-Chi Hsu
- Department of Psychiatry, Taoyuan Psychiatric Centre, Taoyuan, Taiwan
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13
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Thiem U, Wilm S, Greiner W, Rudolf H, Trampisch HJ, Müller C, Theile G, Thürmann PA. Reduction of potentially inappropriate medication in the elderly: design of a cluster-randomised controlled trial in German primary care practices (RIME). Ther Adv Drug Saf 2020; 12:2042098620918459. [PMID: 32435445 PMCID: PMC7225783 DOI: 10.1177/2042098620918459] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2019] [Accepted: 03/09/2020] [Indexed: 12/14/2022] Open
Abstract
Background: Potentially inappropriate medication (PIM) is considered to have potentially more harmful than beneficial health effects in elderly patients. A German example for a PIM list is the PRISCUS list that has been available since 2010. PIMs are associated with an increased risk of hospitalisation and adverse health outcomes. Furthermore, drug–drug interactions (DDI) may pose additional risks to patients. It is not yet clear how numbers of PIM and DDI can be reduced in community-dwelling seniors in primary care; nor is it clear whether patients would benefit from such deprescribing. Methods: The cluster-randomised controlled study on the “Reduction of potentially Inappropriate Medication in the Elderly” (RIME study) is designed to examine whether an intervention based on the PRISCUS list can lower the proportion of community-dwelling people of ⩾70 years taking at least one PIM and/or medication inducing at least one dangerous DDI. The intervention consists of professional education and training on the reduction of PIM and DDI, and will be offered to either general practitioners (GPs) alone or GPs and their office staff in the experimental study arm. The control group will be offered professional education and training on more general issues of prescribing in the elderly, not specifically addressing PIM or DDI. The primary endpoint is the difference in the proportion of patients with at least one PIM or DDI between the start of the study and study closure after 12 months as compared between intervention and control group. Secondary endpoints include overall mortality, number of hospitalisations during the course of the study, quality of life and costs. Secondary analyses will be explorative, with the cluster randomisation being factored in. Discussion: The RIME study will contribute to answering the question of whether an intervention based on the PRISCUS list can reduce the proportion of community-dwelling seniors aged ⩾70 years with at least one PIM and/or DDI, and whether this will result in positive health effects, for example, as regards hospitalisations. Trial registration The Study has been registered in the German Clinical Trials Register (DRKS) under the number DRKS00003610.
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Affiliation(s)
- Ulrich Thiem
- Department of Medical Informatics, Biometry and Epidemiology, University of Bochum, Bochum, Germany
| | - Stefan Wilm
- Institute of General Practice, University of Düsseldorf, Düsseldorf, Germany
| | - Wolfgang Greiner
- Department of Health Economics and Health Care Management, Bielefeld University, Bielefeld, Germany
| | - Henrik Rudolf
- Department of Medical Informatics, Biometry and Epidemiology, Ruhr University Bochum, Bochum, Universitaetsstrasse 150, Bochum, 44801, Germany
| | - Hans-Joachim Trampisch
- Department of Medical Informatics, Biometry and Epidemiology, University of Bochum, Bochum, Germany
| | - Christiane Müller
- Department of General Practice, University Medical Centre Goettingen, Germany
| | | | - Petra A Thürmann
- Department of Clinical Pharmacology, School of Medicine, Faculty of Health, Witten/Herdecke University, Witten, Germany
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14
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Abstract
The use of psychotropic drugs (antipsychotics, benzodiazepines and benzodiazepine-related drugs, and antidepressants) is common, with a prevalence estimates range of 19-29% among community dwelling older adults. These drugs are often prescribed for off-label use, including neuropsychiatric symptoms. The older adult population also has high rates of pneumonia and some of these cases may be associated with adverse drug events. In this narrative review, we summarize the findings from current observational studies on the association between psychotropic drug use and pneumonia in older adults. In addition to studies assessing the use of psychotropics, we included antiepileptic drugs, as they are also central nervous system-acting drugs, whose use is becoming more common in the aging population. The use of antipsychotics, benzodiazepine, and benzodiazepine-related drugs are associated with increased risk of pneumonia in older adults (≥ 65 years of age), and these findings are not limited to this age group. Minimal and conflicting evidence has been reported on the association between antidepressant drug use and pneumonia, but differences between study populations make it difficult to compare findings. Studies regarding antiepileptic drug use and risk of pneumonia in older persons are lacking, although an increased risk of pneumonia in antiepileptic drug users compared with non-users in persons with Alzheimer's disease has been reported. Tools such as the American Geriatric Society Beers Criteria and the STOPP/START criteria for potentially inappropriate medications aids prescribers to avoid these drugs in order to reduce the risk of adverse drug events. However, risk of pneumonia is not mentioned in the current criteria and more research on this topic is needed, especially in vulnerable populations, such as persons with dementia.
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Affiliation(s)
- Blair Rajamaki
- School of Pharmacy, Faculty of Health Sciences, Kuopio Campus, University of Eastern Finland, P.O. Box 1627, 70211, Kuopio, Finland
- Kuopio Research Centre of Geriatric Care, University of Eastern Finland, Kuopio, Finland
| | - Sirpa Hartikainen
- School of Pharmacy, Faculty of Health Sciences, Kuopio Campus, University of Eastern Finland, P.O. Box 1627, 70211, Kuopio, Finland
- Kuopio Research Centre of Geriatric Care, University of Eastern Finland, Kuopio, Finland
| | - Anna-Maija Tolppanen
- School of Pharmacy, Faculty of Health Sciences, Kuopio Campus, University of Eastern Finland, P.O. Box 1627, 70211, Kuopio, Finland.
- Kuopio Research Centre of Geriatric Care, University of Eastern Finland, Kuopio, Finland.
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Komagamine J, Yabuki T, Kobayashi M. Association between potentially inappropriate medications at discharge and unplanned readmissions among hospitalised elderly patients at a single centre in Japan: a prospective observational study. BMJ Open 2019; 9:e032574. [PMID: 31699748 PMCID: PMC6858212 DOI: 10.1136/bmjopen-2019-032574] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
OBJECTIVE To determine the prevalence of potentially inappropriate medication (PIM) use at admission and discharge among hospitalised elderly patients and evaluate the association between PIMs at discharge and unplanned readmission in Japan. DESIGN A prospective observational study conducted by using electronic medical records. PARTICIPANTS All consecutive patients aged 65 years or older who were admitted to the internal medicine ward were included. Patients who were electively admitted for diagnostic procedures were excluded. MAIN OUTCOME MEASURES The primary outcome was 30-day unplanned readmissions. The secondary outcome was the prevalence of any PIM use at admission and discharge. PIMs were defined based on the Beers Criteria. The association between any PIM use at discharge and the primary outcome was evaluated by using logistic regression. RESULTS Seven hundred thirty-nine eligible patients were included in this study. The median patient age was 82 years (IQR 74-88); 389 (52.6%) were women, and the median Charlson Comorbidity Index was 2 (IQR 0-3). The proportions of patients taking any PIMs at admission and discharge were 47.2% and 32.2%, respectively. Of all the patients, 39 (5.3%) were readmitted within 30 days after discharge for the index hospitalisation. The use of PIMs at discharge was not associated with an increased risk of 30-day readmission (OR 0.93; 95% CI 0.46 to 1.87). This result did not change after adjusting for patient age, sex, number of medications, duration of hospital stay and comorbidities (OR 0.78; 95% CI 0.36 to 1.66). CONCLUSION The prevalence of any PIM use at discharge was high among hospitalised elderly patients in a Japanese hospital. Although the use of PIMs at discharge was not associated with an increased risk of unplanned readmission, given a lack of power of this study due to a low event rate, further studies investigating this association are needed. TRIAL REGISTRATION NUMBER UMIN000027189.
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Affiliation(s)
- Junpei Komagamine
- Internal Medicine, National Hospital Organization Tochigi Medical Center, Utsunomiya, Japan
| | - Taku Yabuki
- Internal Medicine, National Hospital Organization Tochigi Medical Center, Utsunomiya, Japan
| | - Masaki Kobayashi
- Internal Medicine, National Hospital Organization Tochigi Medical Center, Utsunomiya, Japan
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16
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Brunetti E, Aurucci ML, Boietti E, Gibello M, Sappa M, Falcone Y, Cappa G, Bo M. Clinical Implications of Potentially Inappropriate Prescribing According to STOPP/START Version 2 Criteria in Older Polymorbid Patients Discharged From Geriatric and Internal Medicine Wards: A Prospective Observational Multicenter Study. J Am Med Dir Assoc 2019; 20:1476.e1-1476.e10. [DOI: 10.1016/j.jamda.2019.03.023] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Revised: 03/21/2019] [Accepted: 03/22/2019] [Indexed: 01/09/2023]
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17
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Magalhães MS, Santos FSD, Reis AMM. Factors associated with the use of potentially inappropriate medication by elderly patients prescribed at hospital discharge. Einstein (Sao Paulo) 2019; 18:eAO4877. [PMID: 31664332 PMCID: PMC6896600 DOI: 10.31744/einstein_journal/2020ao4877] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Accepted: 05/23/2019] [Indexed: 01/19/2023] Open
Abstract
Objective To analyze the frequency of use of potentially inappropriate medication prescribed to elderly at hospital discharge from a public hospital, considering the Brazilian Consensus on Potentially Inappropriate Medication for Elderly, and to identify the associated factors. Methods Patients aged ≥60 years, admitted in clinical and geriatric units of a public hospital were invited to participate in the study. The information about the use of medicines was collected from the patient’s electronic record and through telephone contact. The Brazilian Consensus on Potentially Inappropriate Medication for Elderly was used to classify the medication, regardless of the clinical condition. Results A total of 255 elders were included in this study. The frequency of use of potentially inappropriate medication by elderly was 58.4%. The potentially inappropriate medication use in elderly was positively associated with the presence of depression (odds ratio of 2.208) and polypharmacy (odds ratio of 2.495). The hospitalization in a geriatric unit showed an inverse association with the potentially inappropriate medication use in elderly (odds ratio of 0.513). Conclusion The frequency of potentially inappropriate medication prescription to elderly upon hospital discharge was high. The presence of depression and polypharmacy were directly associated with use of potentially inappropriate medication in the elderly. Admission to the geriatric clinic has become a protection factor for the use of potentially inappropriate medication in elderly. Strategies to improve the elderly pharmacotherapy should implemented aiming at healthcare quality and safety in the transition of care.
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18
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Parekh N, Ali K, Davies JG, Rajkumar C. Do the 2015 Beers Criteria predict medication-related harm in older adults? Analysis from a multicentre prospective study in the United Kingdom. Pharmacoepidemiol Drug Saf 2019; 28:1464-1469. [PMID: 31338909 DOI: 10.1002/pds.4849] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Revised: 05/30/2019] [Accepted: 06/06/2019] [Indexed: 01/22/2023]
Abstract
PURPOSE To investigate whether inappropriate prescribing, defined by the Beers Criteria, is associated with medication-related harm (MRH), hospital admission, and mortality in older adults in England. METHODS A multicentre, prospective cohort study recruited 1280 patients (median age 82 years) at hospital discharge. Patients were followed-up in the community by pharmacists for 8 weeks to identify MRH (harm from adverse drug reactions, non-adherence, and medication errors) and hospital admissions. One-year mortality was determined using hospital records. Potentially inappropriate medications (PIMs) were determined using the 2015 version of the Beers criteria. Logistic regression was used to investigate the relationship between patients prescribed PIMs and adverse outcomes. RESULTS Two hundred and seventy-six patients (22%) were prescribed one or more PIMs at hospital discharge. The main PIM classes prescribed at hospital discharge were benzodiazepines and related drugs (30%) and antidepressants (27%). 1116 out of 1280 patients completed follow-up and 413 (37%) experienced MRH. In 51 cases (12%), MRH was attributable to a PIM. There was no significant relationship between patients prescribed PIMs and overall MRH, hospital readmission or all-cause one-year mortality. Multiple PIMs at discharge was independently associated with an increased risk of ADR (OR 2.32, 95% CI 1.03-5.23). CONCLUSION The prescribing of PIMs is common at hospital discharge of older adults in England. The 2015 Beers criteria have a limited clinical value to predict adverse outcomes following hospital discharge in this setting.
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Affiliation(s)
- Nikesh Parekh
- Academic Department of Geriatric Medicine, Brighton and Sussex Medical School, Brighton, UK.,Department of Elderly Medicine, Brighton and Sussex University Hospitals NHS Trust, Brighton, UK
| | - Khalid Ali
- Academic Department of Geriatric Medicine, Brighton and Sussex Medical School, Brighton, UK.,Department of Elderly Medicine, Brighton and Sussex University Hospitals NHS Trust, Brighton, UK
| | - J Graham Davies
- Institute of Pharmaceutical Science, King's College London, London, UK
| | - Chakravarthi Rajkumar
- Academic Department of Geriatric Medicine, Brighton and Sussex Medical School, Brighton, UK.,Department of Elderly Medicine, Brighton and Sussex University Hospitals NHS Trust, Brighton, UK
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19
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Xing XX, Zhu C, Liang HY, Wang K, Chu YQ, Zhao LB, Jiang DC, Wang YQ, Yan SY. Associations Between Potentially Inappropriate Medications and Adverse Health Outcomes in the Elderly: A Systematic Review and Meta-analysis. Ann Pharmacother 2019; 53:1005-1019. [PMID: 31129978 DOI: 10.1177/1060028019853069] [Citation(s) in RCA: 78] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Background: Adverse drug outcomes in the elderly have led to the development of lists of potentially inappropriate medications (PIMs), such as the Beers criteria, and these PIMs have been studied widely; however, it is still unclear whether PIM use is predictive of adverse outcomes in older people. Objective: To qualitatively examine the associations between exposure to PIMs from the general Beers criteria and the Screening Tool of Older Persons' Prescriptions list and adverse outcomes, such as adverse drug reactions (ADRs)/adverse drug events (ADEs), hospitalization, and mortality. Methods: Specified databases were searched from inception to February 1, 2018. Two reviewers independently selected studies that met the inclusion criteria, assessed study quality, and extracted data. Data were pooled using Stata 12.0. The outcomes were ADRs/ADEs, hospitalization, and mortality. Results: A total of 33 studies met the inclusion criteria. The combined analysis revealed a statistically significant association between ADRs/hospitalizations and PIMs (odds ratio [OR] = 1.44, 95% CI = 1.33-1.56; OR = 1.27, 95% CI = 1.20-1.35), but no statistically significant association was found between mortality and PIMs (OR = 1.04; 95% CI = 0.75-1.45). It is interesting to note that the results changed when different continents/criteria were used for the analysis. Compared with the elderly individuals exposed to 1 PIM, the risk of adverse health outcomes was much higher for those who took ≥2 PIMs. Conclusion and Relevance: We recommend that clinicians avoid prescribing PIMs for older adults whenever feasible. In addition, the observed associations should be generalized to other countries with different PIM criteria with caution.
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Affiliation(s)
- Xiao Xuan Xing
- 1 Xuanwu Hospital of Capital Medical University, Beijing, P R China.,2 National Clinical Research Center for Geriatric Disorders, Beijing, P R China
| | - Chen Zhu
- 3 Zhejiang University, Hangzhou, P R China
| | - Hua Yu Liang
- 4 The Seventh Medical Center of PLA General Hospital, Beijing, P R China
| | - Ke Wang
- 1 Xuanwu Hospital of Capital Medical University, Beijing, P R China.,2 National Clinical Research Center for Geriatric Disorders, Beijing, P R China
| | - Yan Qi Chu
- 1 Xuanwu Hospital of Capital Medical University, Beijing, P R China.,2 National Clinical Research Center for Geriatric Disorders, Beijing, P R China
| | - Li Bo Zhao
- 5 Capital Medical University, Beijing, P R China
| | - De Chun Jiang
- 1 Xuanwu Hospital of Capital Medical University, Beijing, P R China.,2 National Clinical Research Center for Geriatric Disorders, Beijing, P R China
| | - Yu Qin Wang
- 1 Xuanwu Hospital of Capital Medical University, Beijing, P R China.,2 National Clinical Research Center for Geriatric Disorders, Beijing, P R China
| | - Su Ying Yan
- 1 Xuanwu Hospital of Capital Medical University, Beijing, P R China.,2 National Clinical Research Center for Geriatric Disorders, Beijing, P R China
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Kympers C, Tommelein E, Van Leeuwen E, Boussery K, Petrovic M, Somers A. Detection of potentially inappropriate prescribing in older patients with the GheOP³S-tool: completeness and clinical relevance. Acta Clin Belg 2019; 74:126-136. [PMID: 30698077 DOI: 10.1080/17843286.2019.1568353] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
OBJECTIVES The Ghent Older People's Prescriptions community Pharmacy Screening (GheOP3S-) tool was recently developed as an explicit screening method to detect Potentially Inappropriate Prescribing (PIP) in the community pharmacy. We aimed to validate the GheOP3S-tool as an effective screening method for PIP. METHODS All patients admitted to the acute geriatric ward of the Sint-Vincentius hospital (Belgium) were consecutively screened for inclusion (≥70 years,≥5 drugs chronically). PIP prevalence was evaluated by applying the GheOP3S-tool on the complete medication history. For each PIP-item, clinical relevance of the detected item, relevance of proposed alternative and subsequent acceptance by the treating geriatrician and a general practitioner were evaluated. Additionally, contribution to the current admission and preventability was assessed by the geriatrician. The completeness of a PIP-screening with the GheOP3S-tool was evaluated through comparison with the adapted Medication Appropriateness Index (aMAI). RESULTS We detected 250 GheOP3S-items in 57 of 60 included patients (95%) (median: four PIP-items per patient; IQR: 3-5). Both the geriatrician and the general practitioners scored the clinical relevance of the detected items 'serious' or 'significant' in over 70% of cases. Proposed alternative treatment plans were accepted for 79% of the PIP-items (n = 198). The aMAI detected 536 items, of which 145 were also detected by the GheOP3S-tool. A total of 119 PIP-items were additionally detected by the GheOP3S-tool. CONCLUSION The clinical relevance of the PIP-items detected with the GheOP3S-tool is high, likewise the acceptance rate of proposed alternatives.
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Affiliation(s)
- C. Kympers
- Department of Internal medicine, section of Geriatrics, Faculty of Medicine and Health Sciences, Ghent University, Gent, Belgium
| | - E. Tommelein
- Pharmaceutical Care Unit, Faculty of Pharmaceutical Sciences, Ghent University, Gent, Belgium
| | - Ellen Van Leeuwen
- Department of Family Medicine and Primary Health Care, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
- Heymans Institute of Pharmacology, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - K. Boussery
- Pharmaceutical Care Unit, Faculty of Pharmaceutical Sciences, Ghent University, Gent, Belgium
| | - M. Petrovic
- Department of Internal medicine, section of Geriatrics, Faculty of Medicine and Health Sciences, Ghent University, Gent, Belgium
| | - A. Somers
- Department of Pharmacy, Ghent University Hospital, Gent, Belgium
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21
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Lai FTT, Wong SYS, Yip BHK, Guthrie B, Mercer SW, Chung RY, Chung GKK, Chau PYK, Wong ELY, Woo J, Yeoh EK. Multimorbidity in middle age predicts more subsequent hospital admissions than in older age: A nine-year retrospective cohort study of 121,188 discharged in-patients. Eur J Intern Med 2019; 61:103-111. [PMID: 30581041 DOI: 10.1016/j.ejim.2018.12.001] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2018] [Revised: 11/24/2018] [Accepted: 12/11/2018] [Indexed: 02/06/2023]
Abstract
BACKGROUND Previous research has suggested a differential short-term effect of multimorbidity on hospitalization by age, with younger groups affected more. This study compares the nine-year hospitalization pattern by age and multimorbidity status in a retrospective cohort of discharged in-patients, who represent a high-need portion of the population. METHODS We examined routine clinical records of all patients aged 45+ years with chronic conditions discharged from public general hospitals in 2005 in Hong Kong. Patterns of annual frequencies of hospital admissions and number of hospitalized days over nine years (2005-2014) were compared by multimorbidity status (1, 2, 3+ conditions) and age group (45-64, 65-74, 75+). RESULTS Among 121,188 included patients, 33.9% had 2+ conditions and 12.3% had 3+. Hospitalization patterns varied by age and multimorbidity status. For those having only 1 condition, annual number of admissions was similar by age, but older patients had more hospitalized days (4.40 days per person-year for the 45-64 group versus 10.29 for the 75+ group in the 5th year). For those with 3+ conditions, younger patients had more admissions (4.39 admissions per person-year for the 45-64 group versus 1.87 for the 75+ group in the 5th year) but similar number of hospitalized days with older patients. Interaction analysis showed effect of multimorbidity on hospitalization was stronger in younger groups (P < 0.05). CONCLUSION Middle-aged discharged in-patients with multimorbidity are admitted more often than their older counterparts and have similar total hospitalized days per year. Further research is needed to investigate chronic care needs of younger people with multimorbidity.
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Affiliation(s)
- Francisco T T Lai
- The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Sha Tin, New Territories, Hong Kong.
| | - Samuel Y S Wong
- The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Sha Tin, New Territories, Hong Kong.
| | - Benjamin H K Yip
- The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Sha Tin, New Territories, Hong Kong.
| | - Bruce Guthrie
- The Centre for Population Health Sciences, The Usher Institute, The University of Edinburgh, Edinburgh, Scotland, United Kingdom.
| | - Stewart W Mercer
- The Centre for Population Health Sciences, The Usher Institute, The University of Edinburgh, Edinburgh, Scotland, United Kingdom.
| | - Roger Y Chung
- The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Sha Tin, New Territories, Hong Kong.
| | - Gary K K Chung
- The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Sha Tin, New Territories, Hong Kong.
| | - Patsy Y K Chau
- The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Sha Tin, New Territories, Hong Kong.
| | - Eliza L Y Wong
- The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Sha Tin, New Territories, Hong Kong.
| | - Jean Woo
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong.
| | - Eng-Kiong Yeoh
- The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Sha Tin, New Territories, Hong Kong.
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Curtin D, Gallagher PF, O'Mahony D. Explicit criteria as clinical tools to minimize inappropriate medication use and its consequences. Ther Adv Drug Saf 2019; 10:2042098619829431. [PMID: 30800270 PMCID: PMC6378636 DOI: 10.1177/2042098619829431] [Citation(s) in RCA: 52] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Accepted: 01/13/2018] [Indexed: 11/15/2022] Open
Abstract
Polypharmacy and prescribing of potentially inappropriate medications (PIMs) are the key elements of inappropriate medication use (IMU) in older multimorbid people. IMU is associated with a range of negative healthcare consequences including adverse drug events and unplanned hospitalizations. Furthermore, prescribing guidelines are commonly derived from randomized controlled clinical trials which have specifically excluded older adults with multimorbidity. Consequently, indiscriminate application of single disease pharmacotherapy guidelines to older multimorbid patients can lead to increased risk of drug-drug interactions, drug-disease interactions and poor drug adherence. Both polypharmacy and PIMs are highly prevalent in older people and strategies to improve the quality and safety of prescribing, largely through avoidance of IMU, are needed. In the last 30 years, numerous explicit PIM criteria-based tools have been developed to assist physicians with medication management in clinically complex multimorbid older people. Very few of these PIM criteria sets have been tested as an intervention compared with standard pharmaceutical care in well-designed clinical trials. In this review, we describe the most widely used sets of explicit PIM criteria to address inappropriate polypharmacy with particular focus on STOPP/START criteria and FORTA criteria which have been associated with positive patient-related outcomes when used as interventions in recent randomized controlled trials.
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Affiliation(s)
- Denis Curtin
- Department of Medicine, University College Cork & Department of Geriatric Medicine, Cork University Hospital, Cork, Ireland, T12 DC4a
| | - Paul F Gallagher
- Department of Medicine, University College Cork & Department of Geriatric Medicine, Cork University Hospital, Cork, Ireland, T12 DC4a
| | - Denis O'Mahony
- Department of Medicine, University College Cork & Department of Geriatric Medicine, Cork University Hospital, Cork, Ireland, T12 DC4A
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Wang-Hansen MS, Wyller TB, Hvidsten LT, Kersten H. Can screening tools for potentially inappropriate prescriptions in older adults prevent serious adverse drug events? Eur J Clin Pharmacol 2019; 75:627-37. [PMID: 30662995 DOI: 10.1007/s00228-019-02624-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2018] [Accepted: 01/02/2019] [Indexed: 01/06/2023]
Abstract
PURPOSE The purpose of the study is to identify and explore risk factors of serious adverse drug events (SADE) and SADE-related admissions in acutely hospitalized multimorbid older adults and assess whether these could have been prevented by adherence to the prescription tools Screening Tool of Older Persons' Prescriptions (STOPP) and The Norwegian General Practice (NORGEP) criteria. METHODS Cross-sectional study of acutely admitted patients to a medical department in a Norwegian regional hospital. Eligible patients were community-dwelling, receiving home care services, and aged 75+, with ≥ 3 chronic diseases. Medications and information regarding the admission were retrieved from the referral letter and medical records, while an expert panel identified SADE using the Common Terminology Criteria for Adverse Events and SADE-related admissions. RESULTS We included 232 patients. Mean (SD) age was 86 (5.7) years, 137 (59%) were female, 121 (52%) used 5-9 drugs whereas 65 (28%) used ≥ 10. We identified SADEs in 72 (31%) of the patients, and in 49 (68%) of these cases, the SADE was considered to cause the hospital admission. A low body mass index (BMI) and a high Cumulative Illness Rating Scale-Geriatrics (CIRS-G) score were independent risk factors for SADEs. Among the SADEs identified, 32 (44%) and 11 (15%) were preventable by adherence to STOPP and NORGEP, respectively. CONCLUSIONS We found a high prevalence of SADE leading to hospitalization. Risk factors for SADE were high CIRS-G and low BMI. STOPP identified more SADEs than NORGEP, but adherence to the prescription tools could only to a limited degree prevent SADEs in this patient group.
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Kable A, Fullerton A, Fraser S, Palazzi K, Hullick C, Oldmeadow C, Pond D, Searles A, Edmunds K, Attia J, On Behalf Of Sms Dementia Study Investigators OBOSDS. Comparison of Potentially Inappropriate Medications for People with Dementia at Admission and Discharge during An Unplanned Admission to Hospital: Results from the SMS Dementia Study. Healthcare (Basel) 2019; 7:E8. [PMID: 30634548 DOI: 10.3390/healthcare7010008] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Revised: 01/04/2019] [Accepted: 01/07/2019] [Indexed: 11/16/2022] Open
Abstract
People with dementia (PWD) and cognitive impairment are particularly vulnerable to medication problems, and unplanned admission to hospital presents an opportunity to address polypharmacy, potentially inappropriate medications (PIMs) and anticholinergic burden. This study aimed to compare PIMS and other medication data for PWD to determine whether these changed during hospitalization. Medications documented in patient’s records at admission and discharge were evaluated for PWD recruited to phase one of a prospective quasi-experimental pre/post-controlled trial that was conducted at two regional hospitals in NSW, Australia. The study sample included PWD or cognitive impairment having an unplanned admission to hospital. Data were collected using a purpose developed audit tool for medications and PIMs, and a Modified Anticholinergic Burden Scale. Total participants were 277, and results determined that the cognitive status of PWD is not always detected during an unplanned admission. This may make them more vulnerable to medication problems and poor outcomes. Polypharmacy and PIMS for PWD were high at admission and significantly reduced at discharge. However, PWD should be routinely identified as high risk at admission; and there is potential to further reduce polypharmacy and PIMs during admission to hospital, particularly psychotropic medications at discharge. Future studies should focus on evaluating targeted interventions designed to increase medication safety for PWD.
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Mannucci PM, Nobili A, Pasina L. Polypharmacy in older people: lessons from 10 years of experience with the REPOSI register. Intern Emerg Med 2018; 13:1191-1200. [PMID: 30171585 DOI: 10.1007/s11739-018-1941-8] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Accepted: 08/27/2018] [Indexed: 01/24/2023]
Abstract
As a consequence of population aging, we have witnessed in internal medicine hospital wards a progressive shift from a population of in-patients relatively young and mainly affected by a single ailment to one of ever older and more and more complex patients with multiple chronic diseases, followed as out-patients by many different specialists with poor integration and inevitably treated with multiple medications. Polypharmacy (defined as the chronic intake of five or more drugs) is associated with increased risks of drug-drug interactions and related adverse effects, prescription and intake errors, poor compliance, re-hospitalization and mortality. With this background, the Italian Society of Internal Medicine chose to start in 2008 a prospective register called REPOSI (REgistro POliterapie SIMI, Società Italiana di Medicina Interna) in internal medicine and geriatric hospital wards. The country wide register is an ongoing observatory on multimorbidity and polypharmacy in the oldest old, with the goal to improve prescription appropriateness and, thus to avoid potentially inappropriate medications. The main findings of the register, that has accrued so far, 7005 older patients throughout a 10 year period, are summarized herewith, with special emphasis on the main patterns of poor prescription appropriateness and related risks of adverse events.
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Affiliation(s)
- Pier Mannuccio Mannucci
- Scientific Direction, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Francesco Sforza, 35, Via Pace, 9, 20122, Milan, Italy.
| | - Alessandro Nobili
- Neuroscience Department, IRCCS Istituto di Ricerche Farmacologiche Mario Negri, Via Giuseppe La Masa, 19, 20156, Milan, Italy
| | - Luca Pasina
- Neuroscience Department, IRCCS Istituto di Ricerche Farmacologiche Mario Negri, Via Giuseppe La Masa, 19, 20156, Milan, Italy
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Khan MS, Roberts MS. Challenges and innovations of drug delivery in older age. Adv Drug Deliv Rev 2018; 135:3-38. [PMID: 30217519 DOI: 10.1016/j.addr.2018.09.003] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2018] [Revised: 08/31/2018] [Accepted: 09/07/2018] [Indexed: 12/12/2022]
Abstract
Both drug delivery performance and various age-related physical, mental and physiological changes can affect drug effectiveness and safety in elderly patients. The many drug delivery systems developed over the years include recent novel transdermal, nasal, pulmonary and orally disintegrating tablets that provide consistent, precise, timely and more targeted drug delivery. Certain drug delivery systems may be associated with suboptimal outcomes in the elderly because of the nature of drug present, a lack of appreciation of the impact of age-related changes in drug absorption, distribution and clearance, the limited availability of pharmacokinetic, safety and clinical data. Polypharmacy, patient morbidity and poor adherence can also contribute to sub-optimal drug delivery systems outcomes in the elderly. The development of drug delivery systems for the elderly is a poorly realised opportunity, with each system having specific advantages and limitations. A key challenge is to provide the innovation that best meets the specific physiological, psychological and multiple drug requirements of individual elderly patients.
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Jeon HL, Park J, Han E, Kim DS. Potentially inappropriate medication and hospitalization/emergency department visits among the elderly in Korea. Int J Qual Health Care 2018; 30:50-56. [PMID: 29438504 DOI: 10.1093/intqhc/mzx171] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2016] [Accepted: 01/11/2018] [Indexed: 12/31/2022] Open
Abstract
Objective To investigate the association between potentially inappropriate medicine (PIM) use, defined using the American Geriatric Society (AGS) 2012 Beers criteria, and the risk of hospitalization or emergency department (ED) visits in elderly patients, and to examine the most frequently used PIMs among patients with adverse outcomes. Design/Setting This was a retrospective study using National Health Insurance claims data from 2010 to 2012. Intervention(s) Elderly patients who took PIMs are compared to those who were not taking PIMs. Study participants Elderly patients (n = 79 552) who visited medical institutions in Jeju Island during 2011. Main outcome measure Hospitalization and ED visits were evaluated according to whether the patients took PIMs during the study period. The most frequent medications used by the PIM group were also investigated. Results The likelihood of hospitalization was higher in older patients who took at least one PIM than in those who were not taking PIMs during the study period (odds ratio 2.25, 95% confidence interval 2.09-2.44). Patients taking PIMs were more likely to visit EDs (odds ratio 1.59, 95% confidence interval 1.50-1.67). Among patients who were hospitalized or visited EDs, 45.5% had taken at least one PIM on that day. The most commonly used PIMs included chlorpheniramine maleate, diazepam, metoclopramide HCl and diclofenac sodium. Conclusion Our findings indicate that PIM use can lead to negative health consequences, providing further evidence of the inappropriateness of these medications. Thus, pharmaceutical policies regarding PIM use may need to be implemented for elderly adults in Korea.
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Affiliation(s)
- Ha-Lim Jeon
- Department of Research, Health Insurance Review & Assessment Service, Hyeoksin-ro 60, Wonju-si, Ganwon-do, Seoul 26465, South Korea
| | - Juhee Park
- Department of Research, Health Insurance Review & Assessment Service, Hyeoksin-ro 60, Wonju-si, Ganwon-do, Seoul 26465, South Korea
| | - Euna Han
- College of Pharmacy, Yonsei Institute of Pharmaceutical Science, Yonsei University, 162-1 Songdo-Dong, Yeonsu-Gu Incheon, South Korea
| | - Dong-Sook Kim
- Department of Research, Health Insurance Review & Assessment Service, Hyeoksin-ro 60, Wonju-si, Ganwon-do, Seoul 26465, South Korea
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Masnoon N, Shakib S, Kalisch-Ellett L, Caughey GE. Tools for Assessment of the Appropriateness of Prescribing and Association with Patient-Related Outcomes: A Systematic Review. Drugs Aging 2018; 35:43-60. [PMID: 29350335 DOI: 10.1007/s40266-018-0516-8] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
BACKGROUND There are tools and criteria in the literature aimed at distinguishing between appropriate and inappropriate medicines use. However, many have not been externally validated with regard to patient-related outcomes, potentially limiting their use in clinical practice. OBJECTIVES The aim of the study was to conduct a systematic review to summarise (1) available prescribing appropriateness assessment tools and criteria, and (2) their associations with patient-related outcomes (external validity). METHODS A systematic review was conducted using MEDLINE, EMBASE and Informit (Health Collection) databases to screen for articles in English that examined (1) tools to assess the appropriateness of prescribing and (2) associations of tools with patient-related outcomes, published between 2000 and 2016, without any limits placed on the study design, participant age or setting. RESULTS After screening 1710 articles, removing duplicates and shortlisting relevant articles, 42 prescribing assessment tools were identified. Out of the 42 tools, 78.6% (n = 33) provided guidance around stopping inappropriate medications, 28.6% (n = 12) around starting appropriate medications, 61.9% (n = 26) were explicit (criteria based) and 31.0% (n = 13) had been externally validated, with hospitalisation being the most commonly used patient-related outcome (n = 9, 21.4%). CONCLUSION The results of this systematic review highlight the need for evidence-based and externally validated tools, which combine the different aspects of medication management to optimise patient-related outcomes. PROSPERO registration number: CRD42017067233.
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Affiliation(s)
- Nashwa Masnoon
- Quality Use of Medicines and Pharmacy Research Centre, School of Pharmacy and Medical Sciences, University of South Australia, Frome Road, Adelaide, SA, Australia.
- Department of Pharmacy, Royal Adelaide Hospital, North Terrace, Adelaide, SA, Australia.
| | - Sepehr Shakib
- Department of Clinical Pharmacology, Royal Adelaide Hospital, North Terrace, Adelaide, SA, Australia
- Discipline of Pharmacology, School of Medicine, University of Adelaide, North Terrace, Adelaide, SA, Australia
| | - Lisa Kalisch-Ellett
- Quality Use of Medicines and Pharmacy Research Centre, School of Pharmacy and Medical Sciences, University of South Australia, Frome Road, Adelaide, SA, Australia
| | - Gillian E Caughey
- Quality Use of Medicines and Pharmacy Research Centre, School of Pharmacy and Medical Sciences, University of South Australia, Frome Road, Adelaide, SA, Australia
- Department of Clinical Pharmacology, Royal Adelaide Hospital, North Terrace, Adelaide, SA, Australia
- Discipline of Pharmacology, School of Medicine, University of Adelaide, North Terrace, Adelaide, SA, Australia
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Komagamine J. Prevalence of potentially inappropriate medications at admission and discharge among hospitalised elderly patients with acute medical illness at a single centre in Japan: a retrospective cross-sectional study. BMJ Open 2018; 8:e021152. [PMID: 30030316 PMCID: PMC6059264 DOI: 10.1136/bmjopen-2017-021152] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVE To determine the prevalence of potentially inappropriate medications (PIMs) at admission and discharge among hospitalised elderly patients with acute medical illness in Japan. DESIGN A retrospective single-centre cross-sectional study. PARTICIPANTS Hospitalised patients aged 65 years or older admitted for pneumonia, heart failure, ischaemic stroke, acute coronary syndrome, chronic obstructive pulmonary disease or asthma, gastrointestinal bleeding, urinary tract infection or epilepsy from September 2014 to June 2016 who were still alive at discharge. MAIN OUTCOME MEASURES The primary outcome was the proportion of patients taking at least one PIM at admission and discharge. PIMs were defined based on the 2015 American Geriatric Society Beers Criteria. Temporal changes in the proportion of patients taking at least one PIM from admission to discharge were also evaluated. RESULTS During the study period, 689 eligible patients were identified. The median patient age was 82.0 years (IQR 76.0-88.0), 348 (50.5%) were men and the median number of medications at admission was 5.0 (IQR 3.0-8.0). The proportions of patients taking any PIMs at admission and discharge were 47.9% (95% CI 44.2% to 51.6%) and 25.1% (95% CI 21.9% to 28.4%), respectively. The proportion of patients taking any PIMs was significantly lower at discharge than at admission (reduction rate 0.48, 95%, CI 0.41 to 0.53). CONCLUSIONS A substantial proportion of hospitalised elderly patients with acute medical illness took PIMs at admission and discharge. These findings should be confirmed at other hospitals in Japan.
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Affiliation(s)
- Junpei Komagamine
- Department of Internal Medicine, National Hospital Organisation Tochigi Medical Centre, Utsunomiya, Japan
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Fabbietti P, Ruggiero C, Sganga F, Fusco S, Mammarella F, Barbini N, Cassetta L, Onder G, Corsonello A, Lattanzio F, Di Rosa M. Effects of hyperpolypharmacy and potentially inappropriate medications (PIMs) on functional decline in older patients discharged from acute care hospitals. Arch Gerontol Geriatr 2018; 77:158-162. [DOI: 10.1016/j.archger.2018.05.007] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2017] [Revised: 04/19/2018] [Accepted: 05/09/2018] [Indexed: 10/16/2022]
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Almeida TA, Reis EA, Pinto IVL, Ceccato MDGB, Silveira MR, Lima MG, Reis AMM. Factors associated with the use of potentially inappropriate medications by older adults in primary health care: An analysis comparing AGS Beers, EU(7)-PIM List , and Brazilian Consensus PIM criteria. Res Social Adm Pharm 2018; 15:370-377. [PMID: 29934277 DOI: 10.1016/j.sapharm.2018.06.002] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Accepted: 06/11/2018] [Indexed: 11/24/2022]
Abstract
BACKGROUND Potentially inappropriate medications (PIM) for the older adults are those with an unfavorable risk-benefit ratio when more effective and safe therapeutic alternatives are available and is an important public health problem. PURPOSE To analyze the factors associated with the use of PIM by the older adults and to investigate the agreement of PIM use frequency using the 2015 American Geriatric Society Beers Criteria for Potentially Inappropriate Medication Use in Older Adults - 2015 AGS Beers Criteria, the Brazilian consensus on potentially inappropriate medication for older adults (BCPIM) and the European union list of potentially inappropriate medications - EU (7)-PIM List. METHODS This is a cross-sectional study conducted in two primary health care centers in southeastern Brazil. The 2015 AGS Beers Criteria, BCPIM, and EU (7)-PIM List were used for the classification of PIM. The association between PIM use and independent variables was assessed by multiple logistic regression. The level of agreement of PIM use among the three criteria was measured with the Cohen's kappa coefficient. RESULTS A total of 227 patients ≥60 years of age were included in the study. The frequency of PIM use was 53.7% for 2015 AGS Beers, 55.9% for BCPIM and 63.4% for the EU (7)-PIM List. The agreement between 2015 AGS Beers and BCPIM and between this and the EU (7)-PIM List was high, and moderate between the 2015 AGS Beers and the EU (7)-PIM List. Logistic regression showed association of PIM use with polypharmacy, self-reported neuropsychiatric and musculoskeletal diseases, age ≤70 years, preserved cognition and positive self-perception of health. CONCLUSION The frequency of PIM use by the older adults of health centers investigated is high. Strategies for improving the pharmacotherapy of the older adults in primary health care should be implemented.
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Affiliation(s)
- Thiago Augusto Almeida
- Faculdade de Farmácia da Universidade Federal de Minas Gerais, 6627 Presidente Antônio Carlos Ave., Pampulha, Belo Horizonte, Minas Gerais, 31270901, Brazil
| | - Edna Afonso Reis
- Instituto de Ciências Exatas da Universidade Federal de Minas Gerais, 6627 Presidente Antônio Carlos Ave., Pampulha, Belo Horizonte, Minas Gerais, 31270901, Brazil
| | - Isabela Vaz Leite Pinto
- Prefeitura Municipal de Belo Horizonte, Farmácia Distrital Leste, Rua Joaquim Felício 141 Sagrada Família, Belo Horizonte, Minas Gerais, 31030-200, Brazil
| | - Maria das Graças Braga Ceccato
- Faculdade de Farmácia da Universidade Federal de Minas Gerais, 6627 Presidente Antônio Carlos Ave., Pampulha, Belo Horizonte, Minas Gerais, 31270901, Brazil
| | - Micheline Rosa Silveira
- Faculdade de Farmácia da Universidade Federal de Minas Gerais, 6627 Presidente Antônio Carlos Ave., Pampulha, Belo Horizonte, Minas Gerais, 31270901, Brazil
| | - Marina Guimarães Lima
- Faculdade de Farmácia da Universidade Federal de Minas Gerais, 6627 Presidente Antônio Carlos Ave., Pampulha, Belo Horizonte, Minas Gerais, 31270901, Brazil
| | - Adriano Max Moreira Reis
- Faculdade de Farmácia da Universidade Federal de Minas Gerais, 6627 Presidente Antônio Carlos Ave., Pampulha, Belo Horizonte, Minas Gerais, 31270901, Brazil.
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Colombo F, Nunnari P, Ceccarelli G, Romano AV, Barbieri P, Scaglione F. Measures of Drug Prescribing at Care Transitions in an Internal Medicine Unit. J Clin Pharmacol 2018; 58:1171-1183. [PMID: 29723431 DOI: 10.1002/jcph.1123] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2018] [Accepted: 02/23/2018] [Indexed: 11/09/2022]
Abstract
Care transitions represent a common source of drug errors and confusions. The purpose of our prospective observational study was to assess the prevalence of medication discrepancies at care transitions, along with potentially inappropriate medications and potential drug-drug interactions, in an internal medicine unit of an Italian hospital. Adverse drug reactions that occurred in the 30-day period after the discharge from the hospital were included. A related-samples McNemar test was performed for evaluating the effects of hospitalization on the above-mentioned measures of drug prescribing. Medication discrepancies were frequent both on admission (93.4% [95%CI 0.8749, 0.9713]) and at discharge (78.7% [95%CI 0.7035, 0.8558]), with a significant difference between transition times (-14.7% [95%CI -21.82%, -7.69%]; P < .001)]. A high potentially inappropriate medication use prevalence was revealed without differences between care transitions. Potential drug-drug interactions were more frequent at admission to the hospital, with a significant difference of 8.2% in the distribution of patients with potential drug-drug interactions between care transitions. None of the adverse drug reactions recorded on follow-up was related to unintentional discrepancies, and the prevalence rate of patients with potentially inappropriate medication-related adverse drug reactions ranged between 4.9% and 6.9%, and the prevalence rate of patients with drug-drug interaction-related adverse drug reactions was 4.1% of patients. This study is important to raise awareness of the potential dangers medication discrepancies, potentially inappropriate medications, and potential drug-drug interactions could have on older adults. Clinicians and clinical pharmacologists must collaborate to improve patient care and minimize drug-related clinical outcomes.
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Affiliation(s)
- Fabrizio Colombo
- Internal Medicine Department, Azienda Socio Sanitaria Territoriale Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Pietro Nunnari
- Department of Oncology and Onco-Hematology, Postgraduate School of Clinical Pharmacology and Toxicology, University of Milan, Milan, Italy
| | - Giovanni Ceccarelli
- Quality and Clinical Risk Department, Azienda Socio Sanitaria Territoriale Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Angelo Valerio Romano
- Department of Oncology and Onco-Hematology, Postgraduate School of Clinical Pharmacology and Toxicology, University of Milan, Milan, Italy
| | - Pietro Barbieri
- Quality and Clinical Risk Department, Azienda Socio Sanitaria Territoriale Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Francesco Scaglione
- Department of Oncology and Onco-Hematology, Postgraduate School of Clinical Pharmacology and Toxicology, University of Milan, Milan, Italy.,Clinical Pharmacology Unit, Azienda Socio Sanitaria Territoriale Grande Ospedale Metropolitano Niguarda, Milan, Italy
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Suzuki Y, Sakakibara M, Shiraishi N, Hirose T, Akishita M, Kuzuya M. Prescription of potentially inappropriate medications to older adults. A nationwide survey at dispensing pharmacies in Japan. Arch Gerontol Geriatr 2018; 77:8-12. [PMID: 29587175 DOI: 10.1016/j.archger.2017.12.010] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2017] [Revised: 11/30/2017] [Accepted: 12/19/2017] [Indexed: 12/20/2022]
Abstract
OBJECTIVES Prescriptions to older adults were surveyed to elucidate factors associated with potentially inappropriate medications (PIMs) in Japan. METHODS Adults aged ≥65 years, who were prescribed medications at 585 dispensing pharmacies across Japan, participated (N = 180,673). Data were collected between October 1 and October 31, 2014. RESULTS Proportion of polypharmacy and that of PIMs increased with age (p < 0.001). Analgesic drugs were most commonly prescribed for the older adults aged 65-74 years, whereas benzodiazepines were prescribed most commonly for those aged over 75 years. A logistic regression analysis revealed that the increase of PIMs was explained by polypharmacy and mainly the use of central nervous systems (CNS) and psychotropic drugs. CONCLUSIONS The increased prevalence of polypharmacy with age and the common use of CNS and psychotropic medications account for the PIMs in old age in the current nationwide survey.
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Bo M, Quaranta V, Fonte G, Falcone Y, Carignano G, Cappa G. Prevalence, predictors and clinical impact of potentially inappropriate prescriptions in hospital-discharged older patients: A prospective study. Geriatr Gerontol Int 2017; 18:561-568. [DOI: 10.1111/ggi.13216] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 09/26/2017] [Accepted: 10/09/2017] [Indexed: 11/28/2022]
Affiliation(s)
- Mario Bo
- Unit of Geriatrics and Metabolic Bone Diseases; City of Health and Science- Molinette Hospital; Turin Italy
| | - Valeria Quaranta
- Unit of Geriatrics and Metabolic Bone Diseases; City of Health and Science- Molinette Hospital; Turin Italy
| | - Gianfranco Fonte
- Unit of Geriatrics and Metabolic Bone Diseases; City of Health and Science- Molinette Hospital; Turin Italy
| | - Yolanda Falcone
- Unit of Geriatrics and Metabolic Bone Diseases; City of Health and Science- Molinette Hospital; Turin Italy
| | - Giulia Carignano
- Unit of Geriatrics and Intermediate Care; Santa Croce and Carle Hospital; Cuneo Italy
| | - Giorgetta Cappa
- Unit of Geriatrics and Intermediate Care; Santa Croce and Carle Hospital; Cuneo Italy
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Pazan F, Burkhardt H, Frohnhofen H, Weiss C, Throm C, Kuhn-Thiel A, Wehling M. Changes in prescription patterns in older hospitalized patients: the impact of FORTA on disease-related over- and under-treatments. Eur J Clin Pharmacol 2017; 74:339-347. [PMID: 29196825 DOI: 10.1007/s00228-017-2383-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Accepted: 11/16/2017] [Indexed: 01/28/2023]
Abstract
PURPOSE Physicians often face difficulties in choosing appropriate medications for multimorbid older people. The FORTA (Fit for the Aged) classification (A: absolutely, B: beneficial, C: careful, D: don't) was proposed as a clinical tool for improving the quality of drug treatment in the aged. As an implicit tool, FORTA has been shown to aid medication optimization and improve clinical end points in the VALFORTA trial. In this prospective randomized controlled study, 207 older hospitalized patients received standard geriatric treatment and 202 patients received FORTA-guided treatment. METHODS Here, changes of drug prescriptions at the anatomical-therapeutic-chemical system (ATC) level were evaluated separately for important diagnoses in descriptive analyses; over- and under-treatment rates were compared between groups. RESULTS At the individual drug/drug class level related to all important diagnoses, the application of FORTA significantly improved under-treatments for 12 drugs/drug classes (e.g., ACE inhibitors to treat arterial hypertension) and over-treatments for 7 drugs/drug classes (e.g., proton pump inhibitors to treat gastroesophageal reflux disease). CONCLUSIONS FORTA representing the first combined positive/negative labeling approach at the individual drug level aids the optimization of drug treatment in older people as detected for drugs/drug classes at the ATC level in important indications. FORTA is effective in addressing over- and under-treatments even if analyzed for smaller subgroups of VALFORTA.
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Affiliation(s)
- Farhad Pazan
- Institute for Experimental and Clinical Pharmacology and Toxicology, Clinical Pharmacology, Medical Faculty Mannheim, Ruprecht-Karls-University Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Heinrich Burkhardt
- IV. Medical Department, Geriatrics, University Hospital Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Helmut Frohnhofen
- Faculty of Health, Department of Medicine, University Witten-Herdecke, Alfred-Herrhausen-Str. 50, 58448, Witten, Germany
| | - Christel Weiss
- Department of Medical Statistics, Biomathematics and Information Processing, Medical Faculty Mannheim, Heidelberg University, Ludolf-Krehl-Str. 13-16, 68167, Mannheim, Germany
| | - Christina Throm
- Department of Cardiology and Angiology, Agaplesion Markus Hospital, Wilhelm-Epstein-Str. 4, 60431, Frankfurt, Germany
| | | | - Martin Wehling
- Institute for Experimental and Clinical Pharmacology and Toxicology, Clinical Pharmacology, Medical Faculty Mannheim, Ruprecht-Karls-University Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany.
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Varga S, Alcusky M, Keith SW, Hegarty SE, Del Canale S, Lombardi M, Maio V. Hospitalization rates during potentially inappropriate medication use in a large population-based cohort of older adults. Br J Clin Pharmacol 2017; 83:2572-2580. [PMID: 28667818 DOI: 10.1111/bcp.13365] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Revised: 06/16/2017] [Accepted: 06/26/2017] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND AND AIMS The temporal relationship between potentially inappropriate medication (PIM) use and hospitalization remains uncertain. We examined whether current PIM use increases the rate of hospitalization and estimated the rate of hospitalization during exposure to individual PIMs. METHODS A retrospective population-based cohort study of 1 480 137 older adults was conducted using the 2003-2013 Italian Emilia-Romagna Regional administrative healthcare database (~4.5 million residents), which includes demographic, hospital and outpatient prescription information. Each day of follow-up was defined as exposed/unexposed to PIMs that 'should always be avoided', according to the Maio criteria, an Italian modified version of the Beers criteria. The study outcome was all-cause hospitalizations. Crude PIM-related hospitalization rates were calculated for individual PIMs. Repeated-events Cox proportional hazards models with time-dependent covariates estimated adjusted hazard ratios for hospitalization during PIM exposure, as defined by three versions of the Maio criteria (v2007, v2011, v2014). RESULTS During >10 million person-years of follow-up, 54.2% of individuals used ≥1 PIM and 10.9% of all person-time was exposed to v2014 PIMs. Among 1 604 901 hospitalizations, 15.6% occurred during v2014 PIM exposure. Crude hospitalization rates during v2014 PIM-exposed and unexposed person-time were 228.1 and 152.1 per 1000 person-years, respectively. The PIM with the highest rate of hospitalization was ketorolac, while nonsteroidal anti-inflammatory drugs had the most exposure time. The hazard of hospitalization was 16% greater (hazard ratio = 1.16; 95% confidence interval 1.14, 1.18) among patients exposed to v2014 PIMs. The v2007 and v2011 estimates were similar. CONCLUSIONS In this large population-based cohort of older adults, we found a 16% increased hospitalization risk associated with PIM exposure.
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Affiliation(s)
- Stefan Varga
- College of Population Health, Thomas Jefferson University, Philadelphia, PA, USA
| | - Matthew Alcusky
- University of Massachusetts Medical School, Worcester, MA, USA
| | - Scott W Keith
- Division of Biostatistics, Department of Pharmacology and Experimental Therapeutics, Thomas Jefferson University, Philadelphia, PA, USA
| | - Sarah E Hegarty
- Division of Biostatistics, Department of Pharmacology and Experimental Therapeutics, Thomas Jefferson University, Philadelphia, PA, USA
| | | | | | - Vittorio Maio
- College of Population Health, Thomas Jefferson University, Philadelphia, PA, USA
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Salvi F, Rossi L, Lattanzio F, Cherubini A. Is polypharmacy an independent risk factor for adverse outcomes after an emergency department visit? Intern Emerg Med 2017; 12:213-220. [PMID: 27075646 DOI: 10.1007/s11739-016-1451-5] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2015] [Accepted: 04/02/2016] [Indexed: 12/30/2022]
Abstract
This study aimed at verifying the role of polypharmacy as an independent risk factor for adverse health outcomes in older emergency department (ED) patients. This was a large (n = 2057) sample of older ED patients (≥65 years) participating in an observational cohort study. Polypharmacy and excessive polypharmacy were defined as having 6-9 drug prescriptions and 10 or more drug prescriptions in the last 3 months, respectively. The total number of medication prescriptions was also available. Outcome measures were in-hospital mortality; 30-day ED return; ED revisit, hospital admission, and mortality at 6 months. Logistic and Cox regression models as well as receiver operating characteristic curves using the Youden index and the area under the curve were calculated. Polypharmacy and excessive polypharmacy were present in 624 (30.3 %) and 367 (17.8 %) subjects, respectively. The mean number of prescriptions in the last 3 months was 5.7 (range 0-25) drugs. Polypharmacy and, particularly, excessive polypharmacy were constantly and independently associated with worse outcomes. A cut-off of 6 had the highest value of the Youden Index in predicting the majority of the adverse outcomes considered. Polypharmacy and excessive polypharmacy are independent risk factors for adverse health outcomes after an ED visit. Further studies are needed to clarify whether drug related issues (such as non-compliance, inappropriate or suboptimal prescribing, adverse drug reactions, and drug-drug or drug-disease interactions) or underlying multimorbidity and disease severity, as well as clinical complexity and frailty, are responsible for the negative outcomes associated with polypharmacy.
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Affiliation(s)
- Fabio Salvi
- Geriatrics and Emergency Care, IRCCS, Italian National Research Centres on Aging (INRCA), Via della Montagnola n. 81, 60127, Ancona, Italy.
| | - Lorena Rossi
- Scientific Direction, Italian National Research Centres on Aging (INRCA), Ancona, Italy
| | - Fabrizia Lattanzio
- Scientific Direction, Italian National Research Centres on Aging (INRCA), Ancona, Italy
| | - Antonio Cherubini
- Geriatrics and Emergency Care, IRCCS, Italian National Research Centres on Aging (INRCA), Via della Montagnola n. 81, 60127, Ancona, Italy
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Muhlack DC, Hoppe LK, Weberpals J, Brenner H, Schöttker B. The Association of Potentially Inappropriate Medication at Older Age With Cardiovascular Events and Overall Mortality: A Systematic Review and Meta-Analysis of Cohort Studies. J Am Med Dir Assoc 2017; 18:211-220. [PMID: 28131719 DOI: 10.1016/j.jamda.2016.11.025] [Citation(s) in RCA: 66] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2016] [Revised: 11/27/2016] [Accepted: 11/28/2016] [Indexed: 10/20/2022]
Abstract
OBJECTIVE The aim of this systematic review was to identify, evaluate, and meta-analyze cohort studies reporting the association of potentially inappropriate medication (PIM) intake with mortality and cardiovascular events. DESIGN A systematic review and meta-analysis of prospective and retrospective cohort studies were conducted. Study appraisal included a thorough risk of bias assessment. Data synthesis followed a random-effects model. DATA SOURCES The included studies were retrieved from the databases MEDLINE and ISI Web of Knowledge. Additionally, the authors checked the references of the included studies for further relevant literature. ELIGIBILITY CRITERIA FOR SELECTING STUDIES For inclusion in a study, the population needed to be older than 60 years of age and not restricted to having one specific disease. The outcome had to address all-cause mortality or cardiovascular events. Studies that examined polypharmacy or specific drugs were excluded. RESULTS At first, 13 studies were included in a meta-analysis. The association of PIM with overall mortality was not statistically significant (risk ratio; 95% confidence interval, 1.13; 0.95-1.35). However, the majority of studies showed a high risk of specific forms of bias. These biases can be excluded by applying a new user design. It ascertains that adverse events occurring early in therapy are recorded. After restricting the meta-analysis to three studies with a new user design, the association of PIM use and mortality was statistically significant (risk ratio; 95% confidence interval, 1.59; 1.45-1.75). Only one study focused on cardiovascular events and found no statistically significant association. However, the study was not conducted with a new user design. CONCLUSION In studies with adequate methods (new user design), PIM use, defined by Beers criteria or the HEDIS-DAE list, was associated with a 1.6-fold increased mortality in older adults. Physicians should therefore avoid prescribing PIM for older adults whenever feasible. Further new user design studies are required for cardiovascular outcomes and to compare the predictive value of different PIM criteria for mortality.
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Affiliation(s)
- Dana Clarissa Muhlack
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Heidelberg, Germany; Network Aging Research, University of Heidelberg, Heidelberg, Germany
| | - Liesa Katharina Hoppe
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Heidelberg, Germany; Network Aging Research, University of Heidelberg, Heidelberg, Germany
| | - Janick Weberpals
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Heidelberg, Germany
| | - Hermann Brenner
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Heidelberg, Germany; Network Aging Research, University of Heidelberg, Heidelberg, Germany
| | - Ben Schöttker
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Heidelberg, Germany; Network Aging Research, University of Heidelberg, Heidelberg, Germany; Institute of Health Care and Social Sciences, FOM University, Essen, Germany.
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Galli TB, Reis WC, Andrzejevski VM. Potentially inappropriate prescribing andthe risk of adverse drug reactions in critically ill older adults. Pharm Pract (Granada) 2016; 14:818. [PMID: 28042352 PMCID: PMC5184374 DOI: 10.18549/pharmpract.2016.04.818] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2016] [Accepted: 11/29/2016] [Indexed: 11/22/2022] Open
Abstract
Background: Potentially inappropriate medication (PIM) use in the elderly is associated with increased risk of adverse drug reactions (ADRs), but there is limited information regarding PIM use in the intensive care unit (ICU) setting. Objective: The aim of the study is to describe the prevalence and factors associated with the use of PIM and the occurrence of PIM-related adverse reactions in the critically ill elderly. Methods: This study enrolled all critically ill older adults (60 years or more) admitted to medical or cardiovascular ICUs between January and December 2013, in a large tertiary teaching hospital. For all patients, clinical pharmacists listed the medications given during the ICU stay and data on drugs were analyzed using 2012 Beers Criteria, to identify the prevalence of PIM. For each identified PIM the medical records were analyzed to evaluate factors associated with its use. The frequency of ADRs and, the causal relationship between PIM and the ADRs identified were also evaluated through review of medical records. Results: According to 2012 Beers Criteria, 98.2% of elderly patients used at least one PIM (n=599), of which 24.8% were newly started in the ICUs. In 29.6% of PIMs, there was a clinical circumstance that justified their prescription. The number of PIMs was associated with ICU length of stay and total number of medications. There was at least one ADR identified in 17.8% of patients; more than 40% were attributed to PIM, but there was no statistical association. Conclusions: There is a high prevalence of PIM used in acutely ill older people, but they do not seem to be the major cause of adverse drug reactions in this population. Although many PIMs had a clinical circumstance that led to their prescription during the course of ICU hospitalization, many were still present upon hospital discharge. Therefore, prescription of PIMs should be minimized to improve the safety of elderly patients.
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Affiliation(s)
- Thamires B Galli
- Multiprofessional Residency Program of Cinics Hospital, Clinical Hospital of the Federal University of Paraná. Curitiba, PR ( Brazil ).
| | - Wálleri C Reis
- Laboratory of Clinical Services and Evidence Based Health (LASCES), Pharmacy Department, Federal University of Paraná , Curitiba, PR ( Brazil ). E-mail:
| | - Vânia M Andrzejevski
- Hospital Pharmacy Unit, Clinical Hospital of the Federal University of Paraná. Curitiba, PR ( Brazil ).
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Martins VDS, Mori ALPM, Dorea EL, Pinto GA, Hirata MH, Hirata FDC, Hirata RDC. Exposure to potentially inappropriate medications in Brazilian elderly outpatients with metabolic diseases. BRAZ J PHARM SCI 2016. [DOI: 10.1590/s1984-82502016000400014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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van der Stelt CAK, Vermeulen Windsant-van den Tweel AMA, Egberts ACG, van den Bemt PMLA, Leendertse AJ, Hermens WAJJ, van Marum RJ, Derijks HJ. The Association Between Potentially Inappropriate Prescribing and Medication-Related Hospital Admissions in Older Patients: A Nested Case Control Study. Drug Saf 2016; 39:79-87. [PMID: 26553305 DOI: 10.1007/s40264-015-0361-1] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Medication-related problems can cause serious adverse drug events (ADEs) that may lead to hospitalization of the patient. There are multiple screening methods to detect and reduce potentially inappropriate medications (PIMs) and potential prescribing omissions (PPOs). Whether this will result in less medication-related hospitalizations is unknown. The study objective was to assess the risk of preventable medication-related hospital admissions associated with potentially inappropriate prescribing, using the Beers 2012 and the Screening Tool of Older Person's Prescriptions and the Screening Tool to Alert doctors to Right Treatment (STOPP & START) 2008 criteria. DESIGN, SETTING AND PARTICIPANTS A nested case-control study was conducted with a subset of Dutch participants from the Hospital Admissions Related to Medication (HARM) study. Cases were defined as patients aged ≥65 years with a potentially preventable medication-related hospital admission. For each case, one control was selected, matched for age and sex. The primary determinant was the presence of one or more PIMs according to the Beers 2012 and STOPP 2008 criteria. The secondary determinant was the presence of one or more PIMs and PPOs according to the STOPP & START 2008 criteria. The strength of the association between inappropriate prescribing and medication-related hospital admission was evaluated with multivariate logistic regression and expressed as odds ratios (ORs) with 95 % confidence intervals (CIs). RESULTS The prevalence of Beers 2012 criteria PIMs in the total cohort was 44.4 %. The prevalence of STOPP & START 2008 criteria PIMs and PPOs were, respectively, 34.1 and 57.7 %. STOPP 2008 criteria PIMs were associated with preventable medication-related hospital admissions [OR adjusted for number of drugs and comorbidities (ORadj) 2.30, 95 % CI 1.30-4.07], whereas there was no association with Beers 2012 criteria PIMs (ORadj 1.49, 95 % CI 0.90-2.47). STOPP PIMs and START PPOs together were also associated with preventable medication-related hospital admissions (ORadj 3.47, 95 % CI 1.70-7.09). CONCLUSION Our study shows that patients with potentially inappropriate prescribing detected with the STOPP & START 2008 criteria are at risk of preventable medication-related hospital admissions. The STOPP & START 2008 criteria can be used to identify older people at risk of medication-related problems.
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Affiliation(s)
- C A K van der Stelt
- Department of Clinical Pharmacy, ZANOB, Jeroen Bosch Hospital, PO Box 3406, 5203 DK, 's-Hertogenbosch, The Netherlands.
| | | | - A C G Egberts
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands
- Department of Clinical Pharmacy, University Medical Center Utrecht, Utrecht, The Netherlands
| | - P M L A van den Bemt
- Department of Clinical Hospital Pharmacy, Erasmus Medical Center, Rotterdam, The Netherlands
| | - A J Leendertse
- Julius Center, University Medical Center Utrecht, Utrecht, The Netherlands
| | - W A J J Hermens
- Department of Clinical Pharmacy, ZANOB, Jeroen Bosch Hospital, PO Box 3406, 5203 DK, 's-Hertogenbosch, The Netherlands
| | - R J van Marum
- Geriatric Department, Jeroen Bosch Hospital, 's-Hertogenbosch, The Netherlands
- Department of General Practice and Elderly Care Medicine/EMGO Institute for Health and Care Research, VU University Medical Center Amsterdam, Amsterdam, The Netherlands
| | - H J Derijks
- Department of Clinical Pharmacy, ZANOB, Jeroen Bosch Hospital, PO Box 3406, 5203 DK, 's-Hertogenbosch, The Netherlands
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands
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Abstract
Benzodiazepine (BZD) inappropriate use (i.e., misuse and overuse) is a worldwide public health problem. Despite current knowledge about increased sensitivity to side effects in the elderly, that should lead to more caution, only a third of BZD prescriptions in this age group are considered appropriate. The most frequent inadequate situations are excessive duration and/or dosage of a medical prescription or self-medication, especially in a context where it would be contraindicated, e.g., long-acting BZD in the elderly. Polypharmacy and comorbidities are major risk factors. Consequences of BZD inappropriate use are falls, delirium and other cognitive dysfunction, acute respiratory failure, car accidents, dependence, and withdrawal symptoms. An emerging concern is a potentially increased risk of dementia. Contrary to most clinicians' belief, discontinuation of chronic BZD use in elderly patients is feasible, with adequate psychotherapeutic or pharmacological strategies, and can lead to long-term abstinence. Brief cognitive therapy mostly relies on psychoeducation and motivational enhancement and is particularly useful in this context. Further research is needed, notably in three areas: (1) assessing the impact of public health programs to prevent BZD inappropriate use in the elderly, (2) developing alternative strategies to treat anxiety and insomnia in elderly patients, and (3) exploring the association between chronic BZD use and dementia.
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Affiliation(s)
- Guillaume Airagnes
- AP-HP, Hôpitaux Universitaires Paris Ouest, Pôle Psychiatrie Addictions, Paris, France. .,Université Paris Descartes, Sorbonne Paris Cité, Faculté de Médecine, Paris, France. .,Centre Ambulatoire d'Addictologie, Hôpital Européen Georges Pompidou, 20 rue Leblanc, 75908, Paris, Cedex 15, France.
| | - Antoine Pelissolo
- AP-HP, Service de Psychiatrie, Hôpital Henri-Mondor, Université Paris-Est Créteil, INSERM U955, IMRB, Fondation FondaMental, Créteil, France
| | - Mélanie Lavallée
- Université Laval, Département de Psychiatrie et Neurosciences, Québec, Canada.,Centre Intégré Universitaire de Santé et de Services Sociaux de la Capitale-Nationale, Québec, Canada.,Institut Universitaire de Cardiologie et de Pneumologie de Québec, Québec, Canada
| | - Martine Flament
- University of Ottawa Institute of Mental Health Research, Royal Ottawa Mental Health Centre, Ottawa, Ontario, Canada
| | - Frédéric Limosin
- AP-HP, Hôpitaux Universitaires Paris Ouest, Pôle Psychiatrie Addictions, Paris, France.,Université Paris Descartes, Sorbonne Paris Cité, Faculté de Médecine, Paris, France.,Inserm, U894, Centre Psychiatrie et Neurosciences, Paris, France
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Franchi C, Tettamanti M, Djade CD, Pasina L, Mannucci PM, Onder G, Gussoni G, Manfellotto D, Bonassi S, Salerno F, Nobili A. E-learning in order to improve drug prescription for hospitalized older patients: a cluster-randomized controlled study. Br J Clin Pharmacol 2016; 82:53-63. [PMID: 26922904 PMCID: PMC4917810 DOI: 10.1111/bcp.12922] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2015] [Revised: 02/19/2016] [Accepted: 02/23/2016] [Indexed: 01/12/2023] Open
Abstract
AIMS The aim of the study was to evaluate the effect of an e-learning educational program meant to foster the quality of drug prescription in hospitalized elderly patients. METHODS Twenty geriatric and internal medicine wards were randomized to intervention (e-learning educational program) or control (basic geriatric pharmacology notions). Logistic regression analysis was used in order to assess the effect of the intervention on the use of potentially inappropriate medication (PIM, primary outcome) at hospital discharge. Secondary outcomes were a reduced prevalence of at least one potential drug-drug interaction (DDI) and potentially severe DDI at discharge. Mortality rate and incidence of re-hospitalizations were other secondary outcomes assessed at the 12-month follow-up. RESULTS A total of 697 patients (347 in the intervention and 350 in the control arms) were enrolled. No difference in the prevalence of PIM at discharge was found between arms (OR 1.29 95%CI 0.87-1.91). We also found no decrease in the prevalence of DDI (OR 0.67 95%CI 0.34-1.28) and potentially severe DDI (OR 0.86 95%CI 0.63-1.15) at discharge, nor in mortality rates and incidence of re-hospitalization at 12-month follow-up. CONCLUSIONS This e-learning educational program had no clear effect on the quality of drug prescription and clinical outcomes in hospitalized elderly patients. Given the high prevalence of PIMs and potential DDIs recorded in the frame of this study, other approaches should be developed in order to improve the quality of drug prescription in this population.
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Affiliation(s)
- Carlotta Franchi
- Laboratory for Quality Assessment of Geriatric Therapies and Services, Department of NeuroscienceIRCCS – Istituto di Ricerche Farmacologiche “Mario Negri”MilanItaly
| | - Mauro Tettamanti
- Laboratory for Quality Assessment of Geriatric Therapies and Services, Department of NeuroscienceIRCCS – Istituto di Ricerche Farmacologiche “Mario Negri”MilanItaly
| | - Codjo Dgnefa Djade
- Laboratory for Quality Assessment of Geriatric Therapies and Services, Department of NeuroscienceIRCCS – Istituto di Ricerche Farmacologiche “Mario Negri”MilanItaly
| | - Luca Pasina
- Laboratory for Quality Assessment of Geriatric Therapies and Services, Department of NeuroscienceIRCCS – Istituto di Ricerche Farmacologiche “Mario Negri”MilanItaly
| | - Pier Mannuccio Mannucci
- A. Bianchi Bonomi Hemophilia and Thrombosis CenterIRCCS – Maggiore Hospital FoundationMilanItaly
| | - Graziano Onder
- Department of Geriatrics, Policlinico A. GemelliCatholic University of the Sacred HeartRomeItaly
| | | | - Dario Manfellotto
- Department of Internal MedicineOspedale Fatebenefratelli‐AFaRRomeItaly
| | - Stefano Bonassi
- Area of Clinical and Molecular EpidemiologyIRCCS – San Raffaele PisanaRomeItaly
| | - Francesco Salerno
- Department of Medical and Surgery SciencesIRCCS Policlinico San Donato, University of MilanItaly
| | - Alessandro Nobili
- Laboratory for Quality Assessment of Geriatric Therapies and Services, Department of NeuroscienceIRCCS – Istituto di Ricerche Farmacologiche “Mario Negri”MilanItaly
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Suehs BT, Davis C, Franks B, Yuran TE, Ng D, Bradt J, Knispel J, Vassilakis M, Berner T. Effect of Potentially Inappropriate Use of Antimuscarinic Medications on Healthcare Use and Cost in Individuals with Overactive Bladder. J Am Geriatr Soc 2016; 64:779-87. [PMID: 27059714 DOI: 10.1111/jgs.14030] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVES To examine potentially inappropriate medication (PIM) use in older adults initiating an antimuscarinic medication for the treatment of overactive bladder (OAB). DESIGN Retrospective database analysis. SETTING Medical and pharmacy claims data. PARTICIPANTS Medicare Advantage Prescription Drug Plan members aged 65 and older newly initiated on an antimuscarinic OAB treatment were identified and assigned to PIM and non-PIM comparison groups based on 2012 American Geriatrics Society Beers Criteria and/or the presence of an anticholinergic medication interaction at the time of initiation of treatment (N = 66,275). MEASUREMENTS Healthcare costs and OAB medication use. RESULTS Of members initiated on an antimuscarinic OAB medication, 31.1% had a drug-drug or drug-disease or syndrome interaction. Dementia was the most common disease or syndrome interaction (11.3%), followed by constipation (8.6%) and delirium (2.9%). Paroxetine (2.6%), amitriptyline (2.2%), cyclobenzaprine (1.7%), and meclizine (1.6%) were the most common interacting medications. Subjects in the PIM group had greater healthcare costs over 12 months of follow-up ($12,001) than those in the non-PIM group ($9,373) after controlling for baseline characteristics (P < .001). There was no difference between the PIM and the non-PIM groups in odds of discontinuing OAB treatment at 12 months after controlling for baseline characteristics (odds ratio = 0.98, 95% confidence interval = 0.89-1.07, P = .63). CONCLUSION Potentially inappropriate medication use was highly prevalent and was associated with greater total healthcare costs. Providers should carefully consider medical history and concurrent medication use when initiating antimuscarinic medication for the treatment of OAB. Development of interventions to reduce potentially inappropriate use of antimuscarinics in individuals with OAB is warranted.
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Affiliation(s)
| | - Cralen Davis
- Comprehensive Health Insights, Inc., Louisville, Kentucky
| | - Billy Franks
- Astellas Pharma Global Development, Northbrook, Illinois
| | - Thomas E Yuran
- Astellas Pharma Global Development, Northbrook, Illinois
| | - Daniel Ng
- Astellas Pharma Global Development, Northbrook, Illinois
| | - Jason Bradt
- Astellas Pharma Global Development, Northbrook, Illinois
| | | | | | - Todd Berner
- Astellas Pharma Global Development, Northbrook, Illinois
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Juola AL, Pylkkanen S, Kautiainen H, Bell JS, Bjorkman MP, Finne-Soveri H, Soini H, Pitkälä KH. Burden of Potentially Harmful Medications and the Association With Quality of Life and Mortality Among Institutionalized Older People. J Am Med Dir Assoc 2016; 17:276.e9-14. [PMID: 26805751 DOI: 10.1016/j.jamda.2015.12.011] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2015] [Revised: 12/08/2015] [Accepted: 12/09/2015] [Indexed: 01/03/2023]
Abstract
OBJECTIVES This study investigated the overlap among 3 different definitions of potentially harmful medication (PHM) use and the corresponding associations with resident quality of life and mortality. DESIGN Cross-sectional study with 3-year follow-up for mortality. SETTING Assisted living facilities and nursing homes in Helsinki and Kouvola, Finland. PARTICIPANTS A total of 326 residents. MEASUREMENTS PHM use was defined as (1) use of medications with anticholinergic properties, (2) use of Beers Criteria medications, and (3) concomitant use 3 or more psychotropic medications. Health-related quality of life (HRQoL) was assessed using the 15D and psychological well-being (PWB) scale. Residents self-rated their own health using a 4-point scale. Mortality data were obtained from central registers. RESULTS There were 38.0%, 28.2%, and 12.6% of residents who used PHMs according to 1 (G1), 2 (G2), and 3 definitions (G3), respectively. Overall, 21.2% of residents did not use PHMs according to any of the 3 definitions (G0). There were no significant differences in comorbidity, cognition, or functioning among groups. In adjusted analyses, there was a stepwise association between use of multiple PHMs and poorer self-rated health, poorer PWB, and poorer HRQoL. There was no association in adjusted analyses between PHM use and 3-year mortality (47.8%-63.8%). CONCLUSION PHM use is highly prevalent in institutional settings, regardless of the definition of inappropriateness. Residents who used multiple categories of PHMs were at greatest risk of poor HRQoL, poor PWB, and poor self-rated health. However, there was no apparent association with increased mortality. Given the importance of quality of life as an outcome to older people, further efforts are needed to minimize PHM use in this setting.
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Tommelein E, Mehuys E, Petrovic M, Somers A, Colin P, Boussery K. Potentially inappropriate prescribing in community-dwelling older people across Europe: a systematic literature review. Eur J Clin Pharmacol 2015; 71:1415-27. [PMID: 26407687 DOI: 10.1007/s00228-015-1954-4] [Citation(s) in RCA: 206] [Impact Index Per Article: 22.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2015] [Accepted: 09/17/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND Potentially inappropriate prescribing (PIP) is one of the main risk factors for adverse drug events (ADEs) in older people. PURPOSE This systematic literature review aims to determine prevalence and type of PIP in community-dwelling older people across Europe, as well as identifying risk factors for PIP. METHODS The PubMed and Web of Science database were searched systematically for relevant manuscripts (January 1, 2000-December 31, 2014). Manuscripts were included if the study design was observational, the study participants were community-dwelling older patients in Europe, and if a published screening method for PIP was used. Studies that focused on specific pathologies or that focused on merely one inappropriate prescribing issue were excluded. Data analysis was performed using R statistics. RESULTS Fifty-two manuscripts were included, describing 82 different sample screenings with an estimated overall PIP prevalence of 22.6 % (CI 19.2-26.7 %; range 0.0-98.0 %). Ten of the sample screenings were based on the Beers 1997 criteria, 19 on the Beers 2003 criteria, 14 on STOPP criteria (2008 version), 8 on START-criteria (2008 version), and 7 on the PRISCUS list. The 24 remaining sample screenings were carried out using compilations of screening methods or used country-specific lists such as the Laroche criteria. It appears that only PIP prevalence calculated from insurance data significantly differs from the other data collection method categories. Furthermore, risk factors most often positively associated with PIP prevalence were polypharmacy, poor functional status, and depression. Drug groups most often involved in PIP were anxiolytics (ATC-code: N05B), antidepressants (N06A), and nonsteroidal anti-inflammatory and anti-rheumatic products (M01A). CONCLUSION PIP prevalence in European community-dwelling older adults is high and depends partially on the data collection method used. Polypharmacy, poor functional status, and depression were identified as the most common risk factors for PIP.
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Affiliation(s)
- Eline Tommelein
- Pharmaceutical Care Unit, Faculty of Pharmaceutical Sciences, Ghent University, Ottergemsesteenweg 460, 9000, Ghent, Belgium.
| | - Els Mehuys
- Pharmaceutical Care Unit, Faculty of Pharmaceutical Sciences, Ghent University, Ottergemsesteenweg 460, 9000, Ghent, Belgium
| | - Mirko Petrovic
- Department of Internal medicine, Faculty of Medicine and Health Sciences, Ghent University, De Pintelaan 185, 9000, Ghent, Belgium
| | - Annemie Somers
- Pharmaceutical Care Unit, Faculty of Pharmaceutical Sciences, Ghent University, Ottergemsesteenweg 460, 9000, Ghent, Belgium.,Department of Pharmacy, Ghent University Hospital, De Pintelaan 185, 9000, Ghent, Belgium
| | - Pieter Colin
- Laboratory of Medical Biochemistry and Clinical Analysis, Faculty of Pharmaceutical Sciences, Ghent University, Ghent, Belgium.,Department of Anesthesiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Koen Boussery
- Pharmaceutical Care Unit, Faculty of Pharmaceutical Sciences, Ghent University, Ottergemsesteenweg 460, 9000, Ghent, Belgium
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Kim SO, Jang S, Kim CM, Kim YR, Sohn HS. Consensus Validated List of Potentially Inappropriate Medication for the Elderly and Their Prevalence in South Korea. INT J GERONTOL 2015. [DOI: 10.1016/j.ijge.2015.05.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Santalucia P, Franchi C, Djade CD, Tettamanti M, Pasina L, Corrao S, Salerno F, Marengoni A, Marcucci M, Nobili A, Mannucci PM. Gender difference in drug use in hospitalized elderly patients. Eur J Intern Med 2015. [PMID: 26209883 DOI: 10.1016/j.ejim.2015.07.006] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
PURPOSE The aims of this study were to evaluate whether or not there are gender differences in drug use at hospital admission and prescription at discharge and to evaluate the effect of hospitalization on medication patterns in the elderly. METHOD In-patients aged >65years included in the REPOSI registry during a recruitment period of 3years (2008-2010-2012) were analyzed in order to evaluate drug use at hospital admission and prescription at discharge according to gender. RESULTS A total of 3473 patients, 52% women and 48% men, were considered. Polypharmacy (>5 drugs) is more frequent in men both at hospital admission and discharge. At hospital discharge, the number of prescriptions increased in both sexes at all age groups. Neuropsychiatric drugs were significantly more prescribed in women (p<0.0001). At admission men were more likely to be on antiplatelets (41.7% vs 36.7%; p=0.0029), ACE-inhibitors (28.7% vs 24.7%; p=0.0072) and statins (22.9% vs 18.3%; p=0.0008). At discharge, antiplatelets (43.7% vs 37.3%; p=0.0003) and statins (25,2% vs 19.6%; p<0.0001) continued to be prescribed more often in men, while women were given beta-blockers more often than men (21.8% vs 18.9%; p=0.0340). Proton pump inhibitors were the most prescribed drugs regardless of gender. At discharge, the medication pattern did not change according to gender. CONCLUSION Our study showed a gender difference in overall medications pattern in the hospitalized elderly. Hospitalization, while increasing the number of prescriptions, did not change drug distribution by sex.
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Affiliation(s)
- Paola Santalucia
- Scientific Direction, Foundation IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy; Department of Neuroscience, IRCCS, Istituto di Ricerche Farmacologiche "Mario Negri", Milan, Italy.
| | - Carlotta Franchi
- Department of Neuroscience, IRCCS, Istituto di Ricerche Farmacologiche "Mario Negri", Milan, Italy
| | - Codjo D Djade
- Department of Neuroscience, IRCCS, Istituto di Ricerche Farmacologiche "Mario Negri", Milan, Italy
| | - Mauro Tettamanti
- Department of Neuroscience, IRCCS, Istituto di Ricerche Farmacologiche "Mario Negri", Milan, Italy
| | - Luca Pasina
- Department of Neuroscience, IRCCS, Istituto di Ricerche Farmacologiche "Mario Negri", Milan, Italy
| | - Salvatore Corrao
- Dipartimento Biomedico di Medicina Interna e Specialistica, University of Palermo, Palermo, Italy
| | - Francesco Salerno
- Internal Medicine I, Policlinico IRCCS San Donato, University of Milan, Milan, Italy
| | - Alessandra Marengoni
- Geriatric Unit Spedali Civili, Department of Clinical and Experimental Sciences, University of Brescia, Brescia Italy
| | - Maura Marcucci
- Foundation IRCCS Cà Granda-Ospedale Maggiore Policlinico, Geriatrics, Milan, Italy; Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Alessandro Nobili
- Department of Neuroscience, IRCCS, Istituto di Ricerche Farmacologiche "Mario Negri", Milan, Italy
| | - Pier Mannuccio Mannucci
- Scientific Direction, Foundation IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
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Lavan AH, O’Grady J, Gallagher PF. Appropriate prescribing in the elderly: Current perspectives. World J Pharmacol 2015; 4:193-209. [DOI: 10.5497/wjp.v4.i2.193] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2014] [Revised: 03/20/2015] [Accepted: 05/11/2015] [Indexed: 02/06/2023] Open
Abstract
Advances in medical therapeutics have undoubtedly contributed to health gains and increases in life expectancy over the last century. However, there is growing evidence to suggest that therapeutic decisions in older patients are frequently suboptimal or potentially inappropriate and often result in negative outcomes such as adverse drug events, hospitalisation and increased healthcare resource utilisation. Several factors influence the appropriateness of medication selection in older patients including age-related changes in pharmacokinetics and pharmacodynamics, high numbers of concurrent medications, functional status and burden of co-morbid illness. With ever-increasing therapeutic options, escalating proportions of older patients worldwide, and varying degrees of prescriber education in geriatric pharmacotherapy, strategies to assist physicians in choosing appropriate pharmacotherapy for older patients may be helpful. In this paper, we describe important age-related pharmacological changes as well as the principal domains of prescribing appropriateness in older people. We highlight common examples of drug-drug and drug-disease interactions in older people. We present a clinical case in which the appropriateness of prescription medications is reviewed and corrective strategies suggested. We also discuss various approaches to optimising prescribing appropriateness in this population including the use of explicit and implicit prescribing appropriateness criteria, comprehensive geriatric assessment, clinical pharmacist review, prescriber education and computerized decision support tools.
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Alhmoud E, Khalifa S, Bahi AA. Prevalence and predictors of potentially inappropriate medications among home care elderly patients in Qatar. Int J Clin Pharm 2015; 37:815-21. [PMID: 25986290 DOI: 10.1007/s11096-015-0125-0] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2014] [Accepted: 04/15/2015] [Indexed: 11/28/2022]
Abstract
BACKGROUND Older patients receiving home health care are particularly at risk of receiving potentially inappropriate medications compared to community-dwelling population. Data on appropriateness of prescribing in these patients is limited. OBJECTIVE To investigate the prevalence, patterns and determinants of potentially inappropriate medications among elderly patients receiving Home Health Care Services in Qatar. SETTING Home Health Care Services department in Hamad Medical Corporation-Qatar. METHODS A cross-sectional study, conducted over a 3 months period. Patients 65 years and older, taking at least one medication and receiving home care services were included. Potentially inappropriate medications were identified and classified in accordance with the American Geriatrics Society 2012 Beers Criteria. MAIN OUTCOME MEASURE Prevalence of potentially inappropriate medications using updated Beers criteria. RESULTS A total of 191 patients (38.2%) had at least one potentially inappropriate medication. As per Beers criteria, 35% of medications were classified as medications to be avoided in older adults regardless of conditions and 9% as potentially inappropriate medications when used with certain diseases or syndromes. The majority of potentially inappropriate medications (56%) were classified as medications to be used with caution. The two leading classes of potentially inappropriate medications were antipsychotics (27.4%) and selective serotonin reuptake inhibitors (16%). Significant predictors of inappropriate prescribing were hypertension [adjusted OR 1.7; 95% CI (1.0, 2.8)], dementia [adjusted OR 2.0; 95% CI (1.2, 3.1)], depression [adjusted OR 21.6; 95% CI (2.8, 168.4)], and taking more than ten prescribed medications [adjusted OR 1.9; 95% CI (1.3, 2.8)]. CONCLUSION Prescribing potentially inappropriate medications is common among older adults receiving home health care services in Qatar, a finding that warrants further attention. Polypharmacy, hypertension, depression and dementia were significantly associated with potentially inappropriate prescribing.
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Affiliation(s)
- Eman Alhmoud
- Clinical Pharmacy Services-Pharmacy Department, Hamad General Hospital-Hamad Medical Corporation, Doha, Qatar.
| | - Sabah Khalifa
- Clinical Pharmacy Services-Pharmacy Department, Hamad General Hospital-Hamad Medical Corporation, Doha, Qatar
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