scholarly journals Risk of Adverse Drug Events Following the Virtual Addition of COVID-19 Repurposed Drugs to Drug Regimens of Frail Older Adults with Polypharmacy

2020 ◽  
Vol 9 (8) ◽  
pp. 2591
Author(s):  
Sweilem Al Rihani ◽  
Matt Smith ◽  
Ravil Bikmetov ◽  
Malavika Deodhar ◽  
Pamela Dow ◽  
...  
Keyword(s):  
Older Adults ◽  
Adverse Drug Events ◽  
The Elderly ◽  
Risk Scores ◽  
Drug Induced ◽  
Care For The Elderly ◽  
Simulation Based ◽  
Drug Regimens ◽  
Repurposed Drugs ◽  
Novel Coronavirus

Determination of the risk–benefit ratio associated with the use of novel coronavirus disease 2019 (COVID-19) repurposed drugs in older adults with polypharmacy is mandatory. Our objective was to develop and validate a strategy to assess risk for adverse drug events (ADE) associated with COVID-19 repurposed drugs using hydroxychloroquine (HCQ) and chloroquine (CQ), alone or in combination with azithromycin (AZ), and the combination lopinavir/ritonavir (LPV/r). These medications were virtually added, one at a time, to drug regimens of 12,383 participants of the Program of All-Inclusive Care for the Elderly. The MedWise Risk Score (MRSTM) was determined from 198,323 drug claims. Results demonstrated that the addition of each repurposed drug caused a rightward shift in the frequency distribution of MRSTM values (p < 0.05); the increase was due to an increase in the drug-induced Long QT Syndrome (LQTS) or CYP450 drug interaction burden risk scores. Increases in LQTS risk observed with HCQ + AZ and CQ + AZ were of the same magnitude as those estimated when terfenadine or terfenadine + AZ, used as positive controls for drug-induced LQTS, were added to drug regimens. The simulation-based strategy performed offers a way to assess risk of ADE for drugs to be used in people with underlying medical comorbidities and polypharmacy at risk of COVID-19 infection without exposing them to these drugs.

scholarly journals A Qualitative Exploration of Choral Singing in Community-dwelling Older Adults

2019 ◽  
Vol 42 (5) ◽  
pp. 340-347 ◽  
Author(s):  
Darina V. Petrovsky ◽  
Justine S. Sefcik ◽  
Pamela Z. Cacchione
Keyword(s):  
Older Adults ◽  
Low Socioeconomic Status ◽  
The Elderly ◽  
Community Dwelling ◽  
Main Theme ◽  
Choral Singing ◽  
Care For The Elderly ◽  
Qualitative Descriptive ◽  
Qualitative Exploration ◽  
Participatory Arts

Recent research has recognized the value of participatory arts, including choirs, as a strategy to engage older adults in the community. Less is known about the participation of minority older adults of low socioeconomic status (SES) in choirs. The purpose of this qualitative descriptive study was to explore the perceived benefits of choral singing among older adults from Program of All-Inclusive Care for the Elderly (PACE) day centers. We elicited perceptions from 19 choir participants from three focus groups, the majority of whom were Black or African American (N =17/19), each held at a different PACE center. One main theme emerged, “Something for us to do that we love,” with two subthemes, “Joyful time together” and “Uplifting experience performing for others.” These study findings have implications for promoting choir singing in older adults to serve as a place for engagement in social interactions in a lifelong activity they love.

scholarly journals Clinical and Humanistic Outcomes of Community Pharmacy-Based Healthcare Interventions Regarding Medication Use in Older Adults: A Systematic Review and Meta-Analysis

Healthcare ◽  
2021 ◽  
Vol 9 (11) ◽  
pp. 1577
Author(s):  
Christina Malini Christopher ◽  
Bhuvan KC ◽  
Ali Blebil ◽  
Deepa Alex ◽  
Mohamed Izham Mohamed Ibrahim ◽  
...  
Keyword(s):  
Older Adults ◽  
Community Pharmacy ◽  
Risk Ratio ◽  
Adverse Drug Events ◽  
Meta Analysis ◽  
Medication Use ◽  
The Elderly ◽  
Humanistic Outcomes ◽  
Medication Reviews ◽  
The Impact

This review and meta-analysis aimed to determine the clinical and humanistic outcomes of community pharmacy-based interventions on medication-related problems of older adults at the primary care level. We identified randomized controlled trials (RCTs) examining the impact of various community pharmacy-based interventions from five electronic databases (namely, MEDLINE (Ovid), EMBASE (Ovid), CINAHL, APA PSYInfo, and Scopus) from January 2010 to December 2020. Consequently, we assessed these interventions’ clinical and humanistic outcomes on older adults and compared them with non-intervention. We included 13 RCTs in the current review and completed a meta-analysis with six of them. The included studies had a total of 6173 older adults. Quantitative analysis showed that patient education was significantly associated with an increase in the discontinuation of sedative–hypnotics use (risk ratio 1.28; 95% CI (1.20, 1.36) I2 = 0%, p < 0.00001). Moreover, the qualitative analysis showed that medication reviews and education with follow-ups could improve various clinical outcomes, including reducing adverse drug events, reducing uncontrolled health outcomes, and improving appropriate medication use among the elderly population. However, medication review could not significantly reduce the number of older adults who fall (risk ratio 1.25; 95% CI (0.78, 1.99) I2 = 0%, p = 0.36) and require hospitalization (risk ratio 0.72; 95% CI (0.47, 1.12) I2 = 45%, p = 0.15). This study showed that community pharmacy-based interventions could help discontinue inappropriate prescription medications among older adults and could improve several clinical and humanistic outcomes. However, more effective community pharmacy-based interventions should be implemented, and more research is needed to provide further evidence for clinical and humanistic outcomes of such interventions on older adults.

scholarly journals Home Care for the Elderly under the Epidemic of Novel Coronavirus Pneumonia

2020 ◽  
Vol 9 (3) ◽  
pp. 145
Author(s):  
Jieling Chen ◽  
Lin Wang ◽  
Ruiying Huang ◽  
Jiali Chen
Keyword(s):  
Home Care ◽  
The Elderly ◽  
Care For The Elderly ◽  
Novel Coronavirus

scholarly journals Evaluation of the Direct Costs of Managing Adverse Drug Events in all Ages and of Avoidable Adverse Drug Events in Older Adults in Japan

2021 ◽  
Vol 12 ◽  
Author(s):  
Hayato Katsuno ◽  
Tomoya Tachi ◽  
Takuya Matsuyama ◽  
Mayuko Sugioka ◽  
Satoshi Aoyama ◽  
...  
Keyword(s):  
Older Adults ◽  
Direct Cost ◽  
Adverse Drug Events ◽  
Japanese Version ◽  
The Elderly ◽  
Medical Costs ◽  
Direct Costs ◽  
Municipal Hospital ◽  
Retrospective Survey ◽  
National Medical

In Japan, medical costs are increasing annually, and the increase in national medical costs, particularly in the direct cost of managing adverse drug events, is high. An in-depth understanding of these costs is important for their reduction. This study aimed to calculate the direct cost of managing adverse drug events in all ages, including older adults, and that of avoidable adverse drug events in older adults. We conducted a retrospective survey on patients aged 1 year or older who visited Gifu Municipal Hospital in Japan. We investigated and calculated the direct cost of managing adverse drug events and that of avoidable adverse drug events based on the Beers Criteria Japanese version (BCJ) and “Guidelines for medical treatment and its safety in the elderly 2015” (GMTSE-2015) in inpatients and outpatients. Among 6,504 patients, 11.1% visited the hospital or were hospitalized due to adverse drug events. The direct costs per patient with adverse drug events were 21,281 and 22,590 yen (166 and 176 euros as on September 13, 2021) for outpatients, and 853,175 and 874,582 yen (6,648 and 6,815 euros) for inpatients of all ages and older adults, respectively. The direct costs of avoidable adverse drug events per patient using drugs listed in the BCJ and GMTSE-2015 for older adults were 3,212 and 3,341 yen (25 and 26 euros) for outpatients, and 55,548 and 80,246 yen (433 and 625 euros) for inpatients, respectively. In sum, considering both inpatients and outpatients in the whole country, the direct costs of managing adverse drug events were 804.53 billion and 597.19 billion yen (6,269 million and 4,653 million euros) per year for all ages and older ages, respectively. The direct cost of avoidable adverse drug events in older adults was 83.43–258.44 billion yen (650–2,013 million euros) per year. We found that, in Japan, high medical costs are often caused by managing adverse drug events, and that the costs of avoidable adverse drug events in older adults based on the BCJ and GMTSE-2015 account for a substantial proportion of the medical cost. Therefore, by using the BCJ and GMTSE-2015, avoiding adverse drug events and reducing medical costs may be possible.

scholarly journals Safer Prescribing and Care for the Elderly (SPACE): Protocol of a Cluster Randomized Controlled Trial in Primary Care (Preprint)

2018 ◽  
Author(s):  
Katharine Ann Wallis ◽  
Carolyn Raina Elley ◽  
Arier Lee ◽  
Simon Moyes ◽  
Ngaire Kerse
Keyword(s):  
Primary Care ◽  
Randomized Controlled Trial ◽  
High Risk ◽  
Adverse Drug Events ◽  
Controlled Trial ◽  
The Elderly ◽  
Drug Event ◽  
Randomized Controlled ◽  
Care For The Elderly ◽  
Cluster Randomized

BACKGROUND High-risk prescribing, adverse drug events, and avoidable adverse drug event hospitalizations are common. The single greatest risk factor for high-risk prescribing and adverse drug events is the number of medications a person is taking. More people are living longer and taking more medications for multiple long-term conditions. Most on-going prescribing occurs in primary care. The most effective, cost-effective, and practical approach to safer prescribing in primary care is not yet known. OBJECTIVE To test the effect of the Safer Prescribing And Care for the Elderly (SPACE) intervention on high-risk prescribing of nonsteroidal anti-inflammatory and antiplatelet medicines, and related adverse drug event hospitalizations. METHODS This is a protocol of a cluster randomized controlled trial. The clusters will be primary care practices. Data collection and analysis will be at the level of patient. RESULTS Recruitment started in 2018. Six-month data collection will be in 2018. CONCLUSIONS This study addresses an important translational gap, testing an intervention designed to prompt medicines review and support safer prescribing in routine primary care practice. CLINICALTRIAL Australian New Zealand Clinical Trials Registry: ACTRN12618000034235 http://www.ANZCTR.org.au/ACTRN12618000034235.aspx (Archived with Webcite at http://www.webcitation.org/6yj9RImDf)

Prevention of functional decline through gamified interventions in hospitalized older adults

2021 ◽  
Author(s):  
◽  
César Cuevas Lara
Keyword(s):  
Older Adults ◽  
Functional Capacity ◽  
Functional Decline ◽  
Bed Rest ◽  
The Elderly ◽  
Doctoral Thesis ◽  
Care For The Elderly ◽  
Reduced Physical Activity ◽  
Multidomain Intervention ◽  
Hospitalized Older Adults

This doctoral thesis focuses on the effects of gamified intervention programmes on the functional capacity of hospitalized older adults. Hospitalization is a process that leads to the development of disability in older adults. Hospitalization-associated disability is mainly induced by reduced physical activity and frequent episodes of bed rest during this process of health restoration. Gamified interventions can be a novel and effective strategy to prevent hospitalization-associated functional impairment in elderly patients. This doctoral thesis is based on three studies that have been published in international scientific journals. The first study (Chapter 1) aimed to evaluate the available evidence on the effectiveness of game-based interventions on health parameters (functional capacity, quality of life, etc.) of hospitalized older adults. In the second study (Chapter 2), the main objective was to detail the validation of a pilot multidomain intervention system (physical and cognitive training) based on gamification technologies to improve the functional capacity of hospitalized older adults. In the last study (Chapter 3), the main purpose was to analyse the effects of different modalities of gamified intervention programmes on functional capacity in hospitalized older adults in acute care for the elderly.

Multi-disciplinary Care for the Elderly in Disasters: An Integrative Review

2014 ◽  
Vol 30 (1) ◽  
pp. 72-79 ◽  
Author(s):  
Heather L. Johnson ◽  
Catherine G. Ling ◽  
Elexis C. McBee
Keyword(s):  
Older Adults ◽  
Health Care Providers ◽  
Disaster Planning ◽  
The Elderly ◽  
Integrative Review ◽  
Standards Of Care ◽  
Care Providers ◽  
Term Care ◽  
Care For The Elderly ◽  
Geological Processes

AbstractIntroductionOlder adults are disproportionately affected by disaster. Frail elders, individuals with chronic diseases, conditions, or disabilities, and those who live in long-term care facilities are especially vulnerable.PurposeThe purpose of this integrative review of the literature was to describe the system-wide knowledge and skills that multi-disciplinary health care providers need to provide appropriate care for the elderly during domestic-humanitarian and disaster-relief efforts.Data sourcesA systematic search protocol was developed in conjunction with a research librarian. Searches of PubMed, CINAHL, and PsycINFO were conducted using terms such as Disaster, Geological Processes, Aged, Disaster Planning, and Vulnerable Populations. Forty-six articles met criteria for inclusion in the review.ConclusionsPolicies and guidance regarding evacuating versus sheltering in place are lacking. Tenets of elderly-focused disaster planning/preparation and clarification of legal and ethical standards of care and liability issues are needed. Functional capacity, capabilities, or impairments, rather than age, should be considered in disaster preparation. Older adults should be included in disaster planning as population-specific experts.Implications for PracticeA multifaceted approach to population-specific disaster planning and curriculum development should include consideration of the biophysical and psychosocial aspects of care, ethical and legal issues, logistics, and resources.JohnsonHL, LingCG, McBeeEC. Multi-disciplinary care for the elderly in disasters: an integrative review. Prehosp Disaster Med. 2015;30(1):1-8.

Measures of polypharmacy and chemotherapy toxicity in older adults with cancer.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. 9545-9545 ◽  
Author(s):  
Ronald John Maggiore ◽  
Tao Feng ◽  
William Dale ◽  
Cary Philip Gross ◽  
William P. Tew ◽  
...  
Keyword(s):  
Older Adults ◽  
Adverse Drug Events ◽  
Inappropriate Medication ◽  
Geriatric Oncology ◽  
Stage Iv ◽  
The Elderly ◽  
Chi Square ◽  
Chemotherapy Toxicity ◽  
Chi Square Test ◽  
Grade 3

9545 Background: Polypharmacy is common and associated with adverse clinical outcomes in older adults. Potentially inappropriate medication (PIM) use serves as an adjunctive assessment of polypharmacy. The goals of this study in an outpatient population of older adults with cancer (CA) were: 1) to estimate the prevalence of polypharmacy using multiple measures; and 2) to determine the relationship between polypharmacy and chemotherapy (chemo) toxicity. Methods: Medication use was evaluated in 500 patients (pts) age ≥65 years with invasive CA who were starting a new chemo regimen. Polypharmacy was defined by number of daily medications (meds), including non-prescription meds. PIM use was defined by 4 indices: Beers (2003 and 2012 update), Zhan, and HEDIS Drugs to Avoid in the Elderly (DAE) criteria. Prevalence of polypharmacy, PIM, and their association with grade 3-5 chemo toxicity [NCI Common Toxicity Criteria (v. 3.0)] were analyzed using chi square test and unconditional logistic regression. Results: All 500 pts were evaluable [mean age, 73 years (range 65-91); 56% female; 61% stage IV]. The mean number of daily meds was 5 (range 0-23); 38% used ≤3 daily meds, 51% used 4-9 meds, and 11% using ≥10 meds. Using 0-3 daily meds as the referent group, no association was found between daily meds and chemo tox: 4-9 meds, OR 1.34 (95% CI: 0.92-1.97); ≥10, OR 0.82 (95% CI: 0.45-1.49). PIM use was identified in 87 (17%), 147 (29%), 54 (11%), and 69 (13%) patients utilizing the 2003 Beers, 2012 Beers, Zhan, and HEDIS DAE criteria, respectively. There was no association between each PIM use index and chemo toxicity (p>0.10 for all). Conclusions: Polypharmacy and PIM use were common in the geriatric oncology population. Although polypharmacy did not increase the risk of chemotherapy toxicity in this sample, further studies of polypharmacy’s impact on additional outcomes, including non-chemotherapy adverse drug events, in older persons with cancer are warranted.

scholarly journals Prescriber-Initiated Engagement of Pharmacists for Information and Intervention in Programs of All-Inclusive Care for the Elderly

Pharmacy ◽  
2020 ◽  
Vol 8 (1) ◽  
pp. 24 ◽  
Author(s):  
David L. Bankes ◽  
Richard O. Schamp ◽  
Calvin H. Knowlton ◽  
Kevin T. Bain
Keyword(s):  
Medication Safety ◽  
Information Needs ◽  
Adverse Drug Events ◽  
Drug Information ◽  
Medication Management ◽  
The Elderly ◽  
Routine Practice ◽  
Safety Concerns ◽  
Care For The Elderly ◽  
Alternative Medications

Little is known about the types of drug information inquiries (DIIs) prescribers caring for older adults ask pharmacists during routine practice. The objective of this research was to analyze the types of DIIs prescribing clinicians of Programs of All-Inclusive Care for the Elderly (PACE) made to clinical pharmacists during routine patient care. This was a retrospective analysis of documented pharmacists’ encounters with PACE prescribers between March through December, 2018. DIIs were classified using a developed taxonomy that describes prescribers’ motivations for consulting with pharmacists and their drug information needs. Prescribers made 414 DIIs during the study period. Medication safety concerns motivated the majority of prescribers’ inquiries (223, 53.9%). Inquiries received frequently involved modifying drug therapy (94, 22.7%), identifying or resolving adverse drug events (75, 18.1%), selecting or adjusting doses (61, 14.7%), selecting new drug therapies (57, 13.8%), and identifying or resolving drug interactions (52, 12.6%). Central nervous system medications (e.g., antidepressants and opioids), were involved in 38.6% (n = 160) of all DIIs. When answering DIIs, pharmacists made 389 recommendations. Start alternative medications (18.0%), start new medications (16.7%), and change doses (12.1%) were the most frequent recommendations rendered. Prescribers implemented at least 79.3% (n = 268) of recommendations based on pharmacy records (n = 338 verifiable recommendations). During clinical practice, PACE prescribers commonly ask pharmacists a variety of DIIs, largely related to medication safety concerns. In response to these DIIs, pharmacists provide medication management recommendations, which are largely implemented by prescribers.

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