scholarly journals Patient- and health care-related factors associated with initiation of potentially inappropriate medication in community-dwelling older persons

2018 ◽  
Vol 124 (1) ◽  
pp. 74-83 ◽  
Author(s):  
Virva Hyttinen ◽  
Johanna Jyrkkä ◽  
Leena K. Saastamoinen ◽  
Anna-Kaisa Vartiainen ◽  
Hannu Valtonen
Keyword(s):  
Health Care ◽  
Older Persons ◽  
Inappropriate Medication ◽  
Community Dwelling ◽  
Potentially Inappropriate Medication ◽  
Related Factors ◽  
Factors Associated

scholarly journals Development of a stepwise tool to aide primary health care professionals in the process of deprescribing in older persons

2020 ◽  
Vol 18 (4) ◽  
pp. 2033
Author(s):  
Roxana De las Salas ◽  
Javier Eslava-Schmalbach ◽  
Claudia Vaca-González ◽  
Dolores Rodríguez ◽  
Albert Figueras
Keyword(s):  
Health Care ◽  
Primary Health Care ◽  
Health Care Professionals ◽  
Older Persons ◽  
Clinical Decision Making ◽  
Inappropriate Medication ◽  
Clinical Decision ◽  
Potentially Inappropriate Medication ◽  
Kappa Statistics ◽  
Primary Health

Objective: The aim of this study was to develop and validate a stepwise tool to aid primary health care professionals in the process of deprescribing potentially inappropriate medication in older persons. Methods: We carried out a systematic review to identify previously published tools. A composite proposal of algorithm was made by following the steps from clinical experience to deprescribe medications. A 2-round electronic Delphi method was conducted to establish consensus. Eighteen experts from different countries (Colombia, Spain and Argentina) accepted to be part of the panel representing geriatricians, internists, endocrinologist, general practitioners, pharmacologists, clinical pharmacists, family physicians and nurses. Panel members were asked to mark a Likert Scale from 1 to 9 points (1= strongly disagree, 9= strongly agree). The content validity‏ ratio, item-level content validity, and Fleiss’ Kappa statistics was measured to establish reliability. The same voting method was used for round 2. Results: A 7-question algorithm was proposed. Each question was part of a domain and conduct into a decision. In round 1, a consensus was not reached but statements were grouped and organized. In round 2, the tool met consensus. The inter-rater reliability was between substantial and almost perfect for questions with Kappa=0.77 (95% CI 0.60-0.93), for domains with Kappa= 0.73 (95%CI 0.60-0.86) and for decisions with Kappa= 0.97 (95%CI 0.90-1.00). Conclusions: This is a novel tool that captures and supports healthcare professionals in clinical decision-making for deprescribing potentially inappropriate medication. This includes patient’s and caregiver’s preferences about medication. This tool will help to standardize care and provide guidance on the prescribing/deprescribing process of older persons’ medications. Also, it provides a holistic way to reduce polypharmacy and inappropriate medications in clinical practice.

scholarly journals Factors associated with going outdoors frequently: a cross-sectional study among Swiss community-dwelling older adults

BMJ Open ◽  
2020 ◽  
Vol 10 (8) ◽  
pp. e034248
Author(s):  
Julia Spaltenstein ◽  
Christophe Bula ◽  
Brigitte Santos-Eggimann ◽  
Helene Krief ◽  
Laurence Seematter-Bagnoud
Keyword(s):  
Depressive Symptoms ◽  
Older Persons ◽  
Fear Of Falling ◽  
Cross Sectional Study ◽  
Community Dwelling ◽  
Social Characteristics ◽  
Active Ageing ◽  
Cross Sectional ◽  
Factors Associated ◽  
Physical Limitations

ObjectiveThis study examines potential risk and protective factors associated with going outdoors frequently among older persons, and whether these factors vary according to physical limitations.DesignCross-sectional analysis.Setting and participantsCommunity-dwelling participants of the Lausanne cohort Lc65+ in 2016, aged 68–82 years (n=3419).MethodsAssociations between going outdoors frequently and physical limitations, sociodemographic, health, psychological and social variables were examined using logistic regression models. Subgroup analyses were performed according to the severity of physical limitations.Main outcome measures‘Going outdoors frequently’ was defined as going out ≥5 days/week and not spending most of the time sitting or lying down.ResultsThree in four (73.9%) participants reported going outdoors frequently. Limitations in climbing stairs (adjusted OR (AdjOR) 0.61, 95% CI 0.47 to 0.80) and walking (AdjOR 0.24, 95% CI 0.18 to 0.31), as well as depressive symptoms (AdjOR 0.58, 95% CI 0.47 to 0.70), dyspnoea (AdjOR 0.60, 95% CI 0.48 to 0.75), age (AdjORolder age group 0.73, 95% CI 0.59 to 0.92) and fear of falling (AdjOR 0.75, 95% CI 0.62 to 0.91) reduced the odds of going outdoors frequently. In contrast, living alone (AdjOR 1.30, 95% CI 1.08 to 1.56), reporting a dense (AdjOR 1.57, 95% CI 1.26 to 1.96) and a high-quality (AdjOR 1.28, 95% CI 1.06 to 1.53) social network increased the odds of going outdoors frequently. Among participants with severe limitations, 44.6% still went outdoors frequently. Among this subgroup, a new emotional relationship (AdjOR 2.52, 95% CI 1.18 to 5.38) was associated with going outdoors, whereas cognitive complaints (AdjOR 0.66, 95% CI 0.47 to 0.93), urinary incontinence (AdjOR 0.67, 95% CI 0.46 to 0.97), dyspnea (AdjOR:0.67, 95%CI:0.48-0.93), and depressive symptoms (AdjOR 0.67, 95% CI 0.48 to 0.93) lowered the odds of going outdoors.ConclusionPhysical limitations are associated with decreased odds of going outdoors frequently. However, social characteristics appear to mitigate this association, even among older persons with severe limitations. Further studies are needed to determine causality and help guide interventions to promote going outdoors as an important component of active ageing.

The association between functional status and health care cost in community dwelling older persons

2013 ◽  
Vol 4 ◽  
pp. S86
Author(s):  
M. van Rijn ◽  
J.J. Suijker ◽  
E.P. Moll van Charante ◽  
S.E. de Rooij ◽  
B.M. Buurman
Keyword(s):  
Health Care ◽  
Functional Status ◽  
Older Persons ◽  
Health Care Cost ◽  
Community Dwelling

scholarly journals Polypharmacy among Underserved Older African American Adults

2017 ◽  
Vol 2017 ◽  
pp. 1-8 ◽  
Author(s):  
Mohsen Bazargan ◽  
James Smith ◽  
Masoud Movassaghi ◽  
David Martins ◽  
Hamed Yazdanshenas ◽  
...  
Keyword(s):  
African American ◽  
Inappropriate Medication ◽  
Medication Use ◽  
Community Dwelling ◽  
Potentially Inappropriate Medication ◽  
Inappropriate Drug ◽  
Potentially Inappropriate Medications ◽  
African American Adults ◽  
Inappropriate Medication Use ◽  
Inappropriate Medications

The purpose of the present study was to examine correlates of polypharmacy among underserved community-dwelling older African American adults. Methods. This study recruited 400 underserved older African Americans adults living in South Los Angeles. The structured face-to-face interviews collected data on participants’ characteristics and elicited data pertaining to the type, frequency, dosage, and indications of all medications used by participants. Results. Seventy-five and thirty percent of participants take at least five and ten medications per day, respectively. Thirty-eight percent of participants received prescription medications from at least three providers. Inappropriate drug use occurred among seventy percent of the participants. Multivariate analysis showed that number of providers was the strongest correlate of polypharmacy. Moreover, data show that gender, comorbidity, and potentially inappropriate medication use are other major correlates of polypharmacy. Conclusions. This study shows a high rate of polypharmacy and potentially inappropriate medication use among underserved older African American adults. We documented strong associations between polypharmacy and use of potentially inappropriate medications, comorbidities, and having multiple providers. Polypharmacy and potentially inappropriate medications may be attributed to poor coordination and management of medications among providers and pharmacists. There is an urgent need to develop innovative and effective strategies to reduce inappropriate polypharmacy and potentially inappropriate medication in underserved elderly minority populations.

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