Drug-related problems in the elderly

2012 ◽  
Vol 153 (49) ◽  
pp. 1926-1936 ◽  
Author(s):  
Andrea Bor ◽  
Mária Matuz ◽  
Péter Doró ◽  
Réka Viola ◽  
Gyöngyvér Soós
Keyword(s):  
Elderly Patients ◽  
Financial Burden ◽  
The Elderly ◽  
Developed Countries ◽  
Evidence Based ◽  
Beers Criteria ◽  
Drug Related Problems ◽  
Drug Reactions ◽  
Inappropriate Drugs

The aging population in developed countries is a growing problem nowadays. The burden on healthcare is particularly high, since the prevalence of the diseases, especially chronic diseases increases with age. Prevalence of polypharmacy is common among elderly patients. While comorbidities require usage of several active agents with evidence based indication, polypharmacy increases the likelihood of interactions and adverse drug reactions, reduces patient compliance, affects quality of life and puts a significant financial burden on the patient and society. In order to reduce drug-related problems among the elderly, different lists of potentially inappropriate drugs and doses were created. One of the earliest known lists is the “Beers criteria”. The use of listed drugs is risky and not recommended for elderly patients. Following foreign examples, a list was compiled and adapted to the Hungarian drug spectrum based on the main concerns and alternative therapeutic suggestions. Orv. Hetil., 2012, 153, 1926–1936.

scholarly journals Effectiveness of Family Function in Quality of Life in Elderly Patients: An Evidence Based Case Report

2021 ◽  
Vol 1 (2) ◽  
pp. 52
Author(s):  
Muhammad Sobri Maulana
Keyword(s):  
Quality Of Life ◽  
Elderly Patients ◽  
Chronically Ill ◽  
The Elderly ◽  
Evidence Based ◽  
Literature Searching ◽  
Family Function ◽  
Based Medicine

Background: Geriatric care is an important part in healthcare and are sometimes neglected.  Family caregivers figures assume a key role in postponing and potentially forestalling standardization of chronically ill elderly patients. The role of family function in depression has been demonstrated from earlier studies, however, the part of family function in quality of life the elderly has not concentrated widely. Objective: To evaluate the connection between family function and quality of life. Methods: Literature searching was conducted through PubMed, Science Direct and Embase. Critical appraisal using appraisal sheet for prognosis from Oxford Center for Evidence Based Medicine in 2011. Results: One article was found with good validity showed that direct relationship between family function and quality of life is not associated. However, if depression is present it plays as a strong mediator between family function and quality of life. Conclusion: Family function mediated with depression plays an important role in quality of life in elderly patients.

scholarly journals Older people’s challenges and expectations of healthcare in Ghana: A qualitative study

PLoS ONE ◽  
2021 ◽  
Vol 16 (1) ◽  
pp. e0245451
Author(s):  
Confidence Alorse Atakro ◽  
Abigail Atakro ◽  
Janet Sintim Aboagye ◽  
Alice Aluwah Blay ◽  
Stella Boatemaa Addo ◽  
...  
Keyword(s):  
Developing Countries ◽  
Health Workers ◽  
Financial Burden ◽  
Elderly Care ◽  
The Elderly ◽  
Developed Countries ◽  
Elderly Persons ◽  
Structured Interviews ◽  
Inadequate Information

Background The increase in the number of elderly persons in developing countries has not had a corresponding increase in social and health care support systems for the elderly. There is a substantial difference in the quality of healthcare received by older people in developing and developed countries. Elderly persons in developing countries including Ghana are increasingly becoming marginalised and isolated. There is, however, limited evidence of healthcare challenges and expectations by elderly persons in Ghana. This study explored healthcare challenges and expectations of elderly persons to inform policy that could lead to improved quality of life for elderly persons in Ghana. Materials and methods Qualitative exploratory descriptive study design was used in conducting this study. Semi-structured interviews were used in collecting data from 30 participants from three regions in Ghana (10 from each region). Data analysis was carried out through content analysis. Results Four themes were extracted from data. These themes were: 1. Inadequate information from health workers regarding care of the older person. 2. Queuing frustrations. 3. Financial burden. 4. Focused elderly care demand. Conclusion The elderly in Ghana experience challenges of healthcare which include inadequate information, queuing frustrations and financial burdens. Elderly persons also have expectations of healthcare which include having dedicated professionals and units that will attend to them during their hospital visits. Academic and clinical gerontology experts could collaborate and help improve gerontology knowledge of health workers through workshops and conferences. Improving knowledge of health workers in gerontology may be a positive step towards meeting healthcare expectations of older Ghanaians.

scholarly journals Multicenter phase III randomized trial comparing laparoscopy and laparotomy for colon cancer surgery in patients older than 75 years: the CELL study, a Fédération de Recherche en Chirurgie (FRENCH) trial

BMC Cancer ◽  
2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Gilles Manceau ◽  
Antoine Brouquet ◽  
Pascal Chaibi ◽  
Guillaume Passot ◽  
Olivier Bouché ◽  
...  
Keyword(s):  
Colon Cancer ◽  
Elderly Patients ◽  
Randomized Trial ◽  
Postoperative Morbidity ◽  
The Elderly ◽  
Cancer Surgery ◽  
Phase Iii ◽  
Randomized Controlled ◽  
Colon Cancer Surgery

Abstract Background Several multicenter randomized controlled trials comparing laparoscopy and conventional open surgery for colon cancer have demonstrated that laparoscopic approach achieved the same oncological results while improving significantly early postoperative outcomes. These trials included few elderly patients, with a median age not exceeding 71 years. However, colon cancer is a disease of the elderly. More than 65% of patients operated on for colon cancer belong to this age group, and this proportion may become more pronounced in the coming years. In current practice, laparoscopy is underused in this population. Methods The CELL (Colectomy for cancer in the Elderly by Laparoscopy or Laparotomy) trial is a multicenter, open-label randomized, 2-arm phase III superiority trial. Patients aged 75 years or older with uncomplicated colonic adenocarcinoma or endoscopically unresectable colonic polyp will be randomized to either colectomy by laparoscopy or laparotomy. The primary endpoint of the study is overall postoperative morbidity, defined as any complication classification occurring up to 30 days after surgery. The secondary endpoints are: 30-day and 90-day postoperative mortality, 30-day readmission rate, quality of surgical resection, health-related quality of life and evolution of geriatric assessment. A 35 to 20% overall postoperative morbidity rate reduction is expected for patients operated on by laparoscopy compared with those who underwent surgery by laparotomy. With a two-sided α risk of 5% and a power of 80% (β = 0.20), 276 patients will be required in total. Discussion To date, no dedicated randomized controlled trial has been conducted to evaluate morbidity after colon cancer surgery by laparoscopy or laparotomy in the elderly and the benefits of laparoscopy is still debated in this context. Thus, a prospective multicenter randomized trial evaluating postoperative outcomes specifically in elderly patients operated on for colon cancer by laparoscopy or laparotomy with curative intent is warranted. If significant, such a study might change the current surgical practices and allow a significant improvement in the surgical management of this population, which will be the vast majority of patients treated for colon cancer in the coming years. Trial registration ClinicalTrials.gov NCT03033719 (January 27, 2017).

scholarly journals Tapentadol Prolonged Release for Severe Chronic Osteoarthritis Pain in the Elderly—A Subgroup Analysis of Routine Clinical Practice Data

2020 ◽  
Vol 2020 ◽  
pp. 1-10 ◽  
Author(s):  
Andreas Schwittay ◽  
Melanie Sohns ◽  
Birgit Heckes ◽  
Christian Elling
Keyword(s):  
Quality Of Life ◽  
Clinical Practice ◽  
Elderly Patients ◽  
Subgroup Analysis ◽  
The Elderly ◽  
Routine Clinical Practice ◽  
Prolonged Release ◽  
Younger Patients ◽  
Quality Of Life Measures

Background. Tapentadol prolonged release (PR) has been shown effective and generally well tolerated in a broad range of chronic pain conditions. This subgroup analysis investigated its benefits for elderly patients with severe chronic osteoarthritis (OA) pain in routine clinical practice. Patients and Methods. Data of all patients with chronic OA pain were extracted from the database of a prospective, 3-month noninterventional tapentadol PR trial. The data of elderly OA patients (>65 years of age; n = 752) were compared with the data of younger OA patients (≤65 years; n = 282). Results. Almost all patients (elderly 98.7% and younger patients 99.3%) had received long-term analgesic medication prior to the start of tapentadol PR treatment but presented with severe pain accompanied by considerable impairments in sleep quality and quality of life measures. Tapentadol PR provided effective pain relief in both patient groups, with slightly better outcomes in younger patients. However, the mean baseline pain intensity of 7.1 (SD 1.5) was reduced by 3.8 points (p≤0.001), and sleep and quality of life measures had also markedly improved in the elderly: quality of sleep by 3 points, quality of life by 3.4 points, social activities by 3 points, and independence by 2.7 points (p≤0.001 for all measures; 11-point scale). At the end of observation, 68% of the elderly had clinically relevant pain reductions of at least 50% (vs baseline), and 87.9% attained either their intended pain reduction target and/or an additional individual treatment target (both predefined during baseline examination). Only 8.4% of the elderly experienced adverse drug reactions, most frequently nausea (2.7% of patients) and dizziness (1.5%). Conclusion. Tapentadol PR provided effective and well-tolerated treatment of severe chronic OA pain for elderly patients in routine clinical practice. The favorable tolerability profile in particular suggests tapentadol PR as a treatment option before classical strong opioids are considered.

scholarly journals Study of adverse drug reactions and clinical profile of elderly in relation to polypharmacy

2019 ◽  
Vol 10 (6) ◽  
pp. 80-84
Author(s):  
Nagaraja BS ◽  
Keerthana Sharma
Keyword(s):  
Older Adults ◽  
Adverse Drug Reactions ◽  
The Elderly ◽  
Control Group ◽  
Case Group ◽  
Drug Reactions ◽  
Age Related ◽  
Improve Compliance ◽  
Clinical Conditions

Background: Polypharmacy is a becoming more prevalent in older adults and adverse risk increases with age-related change. Adverse drug reactions (ADRs) are common in older adults and worrisome aspect of treatment in elderly. Aims and Objective: The study aimed to identify the common clinical conditions leading to polypharmacy and to compare the adverse drug profiles of the 2 groups. Materials and Methods: This case-control study was conducted in Hospitals attached to BMCRI, where 200 patients aged 65 or more were interviewed. 100 elderly patients using 5 or more drugs were identified as cases and assessed against a control group of 100 patients. Results: Our study found that ADRs were found to be three times higher in individuals on polypharmacy compared to the control group (OR 3.4675 95% CI 1.6241 to 7.4035). The most commonly occurring ADRs were dyspepsia (OR 1.9259), drowsiness (OR 3.5926) and fatigue (OR 1.5319) with increased incidence in the case group. The most common conditions associated with polypharmacy were found to be hypertension (53%), diabetes mellitus(46%), COPD(14%) and IHD(14%). 66% of the study group had two or more of the above diseases, whereas in the control group only 32% had multiple illnesses. The most commonly prescribed medications were antihypertensives (61%), hypolipidemics (44%), antiplatelets (41%) and antibiotics(40%). Conclusion: Polypharmacy in the elderly comes with a significant increase in adverse effects. The reduced pill burden will not only decrease ADRs and improve compliance, but will also result in greater patient satisfaction and mental health, thereby improving the quality of geriatric care.

The Role of Novel Bone Forming Agents in the Treatment of Osteoporosis

2020 ◽  
pp. 089719002096122
Author(s):  
Hansita B. Patel ◽  
Lynsie J. Lyerly ◽  
Cheryl K. Horlen
Keyword(s):  
Elderly Population ◽  
Cost Effective ◽  
The Elderly ◽  
Bisphosphonate Therapy ◽  
Evidence Based ◽  
First Line ◽  
Treatment Of Osteoporosis ◽  
Cost Effective Treatment

Osteoporosis is a growing epidemic that leads to significant morbidity and mortality among the elderly population due to associated fractures that lead to disabilities and reduced quality of life. Bisphosphonates are well-established as a first-line and cost-effective treatment for osteoporosis. Unfortunately, clinicians are often uncertain as to how to select treatments when bisphosphonates are ineffective as initial treatment or contraindicated. Romosozumab and abaloparatide are 2 alternative agents that have been recently FDA approved for the treatment of osteoporosis in postmenopausal women at high risk for fracture or patients who have failed or are intolerant to other osteoporosis therapies. Currently, the National Osteoporosis Foundation (NOF) has no formal recommendations in regard to these 2 novel agents. The purpose of this review is to help guide pharmacists on how to ensure appropriate utilization of these 2 novel bone-forming agents as potential alternatives to bisphosphonate therapy by providing evidence-based recommendations according to the current literature and key counseling points.

Risperidone in the treatment of psychoses in the elderly: a case report series

2002 ◽  
Vol 17 (2) ◽  
pp. 96-103 ◽  
Author(s):  
R. Bullock ◽  
S. Libretto
Keyword(s):  
Side Effects ◽  
Elderly Patients ◽  
Negative Symptoms ◽  
Case Reports ◽  
Antipsychotic Agents ◽  
The Elderly ◽  
The Body ◽  
Continuous Treatment ◽  
Atypical Antipsychotic Agents

SummaryRisperidone is one of the newer atypical antipsychotic agents, which combines potent serotonin and dopamine receptor antagonism. It shows efficacy against the positive and negative symptoms of schizophrenic psychoses and other psychotic conditions, and has a low propensity to cause extrapyramidal side effects. The aim of these case reports in elderly patients is to provide the benefit of personal experience with risperidone to the body of published literature and to demonstrate the types of patients that may benefit from treatment. These cases were compiled retrospectively from data collected on referral and during routine hospital appointments. This series covers four main areas of concern when treating the elderly: low-maintenance dosing minimising the likelihood of adverse events; successful treatment of patients previously uncontrolled and experiencing side effects with other antipsychotics; the possibility of intermittent rather than continuous treatment; and the benefits to patients, carers and the health services. At low doses, risperidone is an effective and well-tolerated treatment for psychoses in elderly patients that improves the quality of life for both patients and their caregivers.

scholarly journals PREDICTORS ASSOCIATED WITH ADVERSE DRUG REACTIONS AMONG GERIATRIC PATIENTS IN AN OUTPATIENT CLINIC

2019 ◽  
pp. 106-110
Author(s):  
GAYATRI SUJIVE ◽  
BENSAM T MATHEW ◽  
MAMATHA K ◽  
ANURADHA HV
Keyword(s):  
Adverse Drug Reactions ◽  
Outpatient Clinic ◽  
The Elderly ◽  
Drug Reactions ◽  
Organ Systems ◽  
Centered Care ◽  
Health Quality ◽  
Health Quality Of Life ◽  
Pedal Edema

Objective: The process of aging involves an individual’s structural and functional depravity of their organ systems often results in compromised pharmacological principles of the prescribed drugs. Multimorbidity and polypharmacy along with change in pharmacokinetic and pharmacodynamic responses of drugs predispose the elderly to adverse drug reactions (ADRs). The present study was aimed to identify and report the characteristics and incidence of ADRs among geriatrics in an outpatient clinic. Methods: This was a 6-month prospective hospital-based observational study among patients of either sex aged 60 years and above visiting an outpatient clinic at the study site. The suspected ADRs were categorized according to the Will’s and Brown classification system. Causality of these ADRs was verified by applying the WHO-UMC criteria and the Naranjo’s scale. Severity and preventability of the ADRs were classified using the modified Hartwig and Siegel scale and modified Schumock and Thornton scale, respectively. Multivariate logistic regression was used to determine the risk factors for developing ADRs. Results: Among the 365 patients monitored, 57 (15%) patients experienced 60 ADRs. Therapeutic classes of drugs frequently associated with ADRs were the drugs used in hypertension (27 [45%]). Patients presenting with amlodipine (9 [15%]) induced pedal edema were observed with the highest frequency of ADRs. Polypharmacy (OR: 1.619, 95% confidence interval: 0.957−2.741, p=0.021) was observed as the influential risk factor for ADRs. Conclusion: Pharmacist’s services and involvement in geriatric patient’s centered care can be associated with their improved health, quality of life and economic outcomes, a reduction in medicine-related adverse events, and limiting the morbidity and mortality in this age band.

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