scholarly journals Medication Appropriateness in Vulnerable Older Adults: Healthy Skepticism of Appropriate Polypharmacy

2019 ◽  
Vol 67 (6) ◽  
pp. 1123-1127 ◽  
Author(s):  
Terri R. Fried ◽  
Marcia C. Mecca
Keyword(s):  
Older Adults ◽  
Medication Appropriateness

scholarly journals Medication-Related Factors and Hospital Readmission in Older Adults with Chronic Kidney Disease

2019 ◽  
Vol 8 (3) ◽  
pp. 395 ◽  
Author(s):  
Wubshet H. Tesfaye ◽  
Gregory M. Peterson ◽  
Ronald L. Castelino ◽  
Charlotte McKercher ◽  
Matthew Jose ◽  
...  
Keyword(s):  
Older Adults ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Hospital Readmission ◽  
Hospital Readmissions ◽  
Medication Regimen ◽  
Related Factors ◽  
Medication Regimen Complexity ◽  
Regimen Complexity ◽  
Medication Appropriateness

This study aimed to examine the association between medication-related factors and risk of hospital readmission in older patients with chronic kidney disease (CKD). A retrospective analysis was conducted targeting older CKD (n = 204) patients admitted to an Australian hospital. Medication appropriateness (Medication Appropriateness Index; MAI), medication regimen complexity (number of medications and Medication Regimen Complexity Index; MRCI) and use of selected medication classes were exposure variables. Outcomes were occurrence of readmission within 30 and 90 days, and time to readmission within 90 days. Logistic and Cox hazards regression were used to identify factors associated with readmission. Overall, 50 patients (24%) were readmitted within 30 days, while 81 (40%) were readmitted within 90 days. Mean time to readmission within 90 days was 66 (SD 34) days. Medication appropriateness and regimen complexity were not independently associated with 30- or 90-day hospital readmissions in older adults with CKD, whereas use of renin‒angiotensin blockers was associated with reduced occurrence of 30-day (adjusted OR 0.39; 95% CI 0.19–0.79) and 90-day readmissions (adjusted OR 0.45; 95% CI 0.24–0.84) and longer time to readmission within 90 days (adjusted HR 0.52; 95% CI 0.33–0.83). This finding highlights the importance of considering the potential benefits of individual medications during medication review in older CKD patients.

scholarly journals A systematic overview of systematic reviews evaluating interventions addressing polypharmacy

2019 ◽  
Vol 76 (21) ◽  
pp. 1777-1787 ◽  
Author(s):  
Laura J Anderson ◽  
Jeffrey L Schnipper ◽  
Teryl K Nuckols ◽  
Rita Shane ◽  
Catherine Sarkisian ◽  
...  
Keyword(s):  
Older Adults ◽  
Systematic Reviews ◽  
Patient Centered ◽  
Assessment Development ◽  
Cochrane Database ◽  
Evidence Quality ◽  
Overview Of Systematic Reviews ◽  
Grade Methodology ◽  
The Impact ◽  
Medication Appropriateness

Abstract Purpose To systematically evaluate and summarize evidence across multiple systematic reviews (SRs) examining interventions addressing polypharmacy. Summary MEDLINE, the Cochrane Database of Systematic Reviews, and the Database of Abstracts of Reviews of Effects (DARE) were searched for SRs evaluating interventions addressing polypharmacy in adults published from January 2004 to February 2017. Two authors independently screened, appraised, and extracted information. SRs with Assessment of Multiple Systematic Reviews (AMSTAR) scores below 8 were excluded. After extraction of relevant conclusions from each SR, evidence was summarized and conclusions compared. Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology was used to assess evidence quality. Six SRs met the inclusion criteria, 4 of which used meta-analytic pooling. Five SRs focused on older adults. Four were not restricted to any specific disease type, whereas 1 focused on proton pump inhibitors and another focused on patients with severe dementia. Care settings and measured outcomes varied widely. SRs examining the impact on patient-centered outcomes, including morbidity, mortality, patient satisfaction, and utilization, found inconsistent evidence regarding the benefit of polypharmacy interventions, but most concluded that interventions had either null or uncertain impact. Two SRs assessing medication appropriateness found very low-quality evidence of modest improvements with polypharmacy interventions. Conclusion An overview of SRs of interventions to address polypharmacy found 6 recent and high-quality SRs, mostly focused on older adults, in which both process and outcome measures were used to evaluate interventions. Despite the low quality of evidence in the underlying primary studies, both SRs that assessed medication appropriateness found evidence that polypharmacy interventions improved it. However, there was no consistent evidence of any impact on downstream patient-centered outcomes such as healthcare utilization, morbidity, or mortality.

scholarly journals Effect of pharmacist‐led medication review on medication appropriateness in older adults with chronic kidney disease

2019 ◽  
Vol 49 (5) ◽  
pp. 471-476 ◽  
Author(s):  
Wubshet H. Tesfaye ◽  
Barbara C. Wimmer ◽  
Gregory M. Peterson ◽  
Ronald L. Castelino ◽  
Matthew Jose ◽  
...  
Keyword(s):  
Older Adults ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Medication Review ◽  
Medication Appropriateness

scholarly journals The challenge to define a relevant change in medication appropriateness index score in older adults – An approach

2020 ◽  
Vol 86 (2) ◽  
pp. 398-399
Author(s):  
Laura Krisch ◽  
Angelika Mahlknecht ◽  
Ulrike Bauer ◽  
Nadja Nestler ◽  
Georg Hempel ◽  
...  
Keyword(s):  
Older Adults ◽  
Index Score ◽  
Medication Appropriateness Index ◽  
Relevant Change ◽  
Medication Appropriateness

scholarly journals End of life care for frail older people; do we have a consensus guideline on deprescribing?

2021 ◽  
Author(s):  
Arjun Poudel ◽  
Shakti Shrestha ◽  
Anna Lukacisinova ◽  
Lisa Nissen
Keyword(s):  
Older Adults ◽  
Life Expectancy ◽  
Older People ◽  
End Of Life ◽  
End Of Life Care ◽  
Life Care ◽  
Frail Older People ◽  
Limited Life Expectancy ◽  
Limited Life ◽  
Medication Appropriateness

Background: Deprescribing interventions have shown to improve medication appropriateness in older people. However, the evidence on the actual benefits and risks of deprescribing in older adults at the end of life are limited. Due to the lack of evidence on the safety and efficacy of medication in these populations, the most appropriate deprescribing approach is unclear. We aimed to conduct a narrative review of research on existing deprescribing guidelines targeted to frail older people at the end of life. Methods: A literature search was conducted in PubMed, Embase, CINAHL and Google Scholar to identify studies from inception to January 2021 on deprescribing guidelines/tools for frail older adults near end-of-life or palliative situation or life-limiting illnesses or limited life expectancy were included. Results: A total of nine studies were included. The deprescribing guidelines used in these studies were helpful to some extent in optimising medications in patients with limited life expectancy and life-limiting illnesses. Some of them have been tested in prospective studies that showed their usefulness in minimising the number of potentially inapproapriate medications. These studies however were not randomised and involved small sample sizes and had little insight into the clinical outcomes of using these tools. Conclusions: The existing tools and guidelines on deprescribing do not represent the end of life care nor address the medication appropriateness among individuals with a specific condition. An explicit and rigorous consensus-based guideline needs to be developed and tested in a well-designed clinical trial to measure clinically significant outcomes

scholarly journals STOPP-START Medication Review: A Non-Randomized Trial in an Indonesian Tertiary Hospital to Improve Medication Appropriateness and to Reduce the Length of Stay of Older Adults

2020 ◽  
pp. 001857872094222
Author(s):  
Fauna Herawati ◽  
Ida Bagus Nyoman Maharjana ◽  
Tuty Kuswardhani ◽  
Astrid Pratidina Susilo
Keyword(s):  
Older Adults ◽  
Length Of Stay ◽  
Medication Review ◽  
Screening Tool ◽  
Inappropriate Prescribing ◽  
Intervention Group ◽  
Tertiary Hospital ◽  
Control Group ◽  
Medication Reviews ◽  
Medication Appropriateness

Background: Inappropriate prescribing may lead to medication errors among older adults. Pharmacists can curb the occurrences of these errors by conducting medication reviews. Screening Tool of Older Person’s Prescriptions (STOPP) or Screening Tool to Alert doctors to Right Treatments (START) may curb the incidence of adverse drug reactions and improve medication appropriateness by providing guides about when particular types of medications should be started or stopped. Objective: This study aimed to evaluate the use of STOPP/START to improve the Adapted Medication Appropriateness Index (MAI), to reduce the risk of ADRs (GerontoNet score), and length of stay (LOS). Setting: Geriatric Inpatient Ward, Sanglah General Hospital, Bali, Indonesia. Method: A non-randomized controlled trial was conducted in older adults (>60 years) who were selected consecutively from inpatient units in a tertiary hospital in Bali, Indonesia. The intervention group received medication reviews by pharmacists in collaboration with physicians to assess its appropriateness with STOPP/START criteria on admission and during their stay at the hospital. The control group obtained standard care. Main Outcome Measures: The outcomes were measured using the Adapted MAI, GerontoNet Score, and LOS. Results: Thirty patients in the intervention group and 33 patients in the control group were included in this study. The adapted MAI was 2.97 (2.25) and 9.94 (6.14) with P < .001. The GerontoNet score was 3.33 (2.28) and 5.18 (2.10) with P = .003, LOS was 7.63 (3.00) days and 14.18 (9.97) days with P = .011, respectively. Conclusion: The use of STOPP/START as a tool for medication review improved medication appropriateness and reduced ADR risk and LOS.

Screening for Medication Appropriateness in Older Adults

2018 ◽  
Vol 34 (1) ◽  
pp. 39-54 ◽  
Author(s):  
Andrew R. Zullo ◽  
Shelly L. Gray ◽  
Holly M. Holmes ◽  
Zachary A. Marcum
Keyword(s):  
Older Adults ◽  
Medication Appropriateness
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