scholarly journals The Safety of Benzodiazepines and Opioids in the Geriatric Population: An Analysis of Patient Safety Events Reported by Hospitals and Ambulatory Surgical Facilities

2021 ◽  
pp. 42-49
Author(s):  
Elizabeth Kukielka
Keyword(s):  
Older Adults ◽  
Patient Safety ◽  
Motor Vehicle ◽  
Reversal Agent ◽  
Geriatric Population ◽  
Inappropriate Use ◽  
Safety Reporting ◽  
Pain Medications ◽  
Increased Risk ◽  
Potential Risks

Benzodiazepines may increase the risk of cognitive impairment, delirium, falls, fractures, and motor vehicle crashes in patients 65 years and older. The concomitant use of benzodiazepines and opioids may also be inappropriate for older adults due to the increased risk of overdose. We searched the Pennsylvania Patient Safety Reporting System (PA-PSRS) for reports of patient safety events related to the concomitant use of benzodiazepines and opioids in older adults in order to gain a better understanding of the potential risks of using these medications in combination. We identified 80 reports in which a patient may have experienced an adverse drug reaction (ADR) to the combined use of a benzodiazepine and an opioid pain medication. Reports were reviewed to determine the ADR(s) experienced by the patient. Changes in mental status were most common, occurring in more than two-thirds of reports (68.8%; 55 of 80), followed by respiratory reactions (51.3%; 41 of 80) and cardiovascular reactions (25.0%; 20 of 80). In over two-thirds of reports (70.0%; 56 of 80), the patient received a reversal agent, either flumazenil (10.7%; 6 of 56) or naloxone (35.7%; 20 of 56), or both (53.6%; 30 of 56). The inappropriate use of benzodiazepines and opioid pain medications in combination among patients 65 years and older is a growing problem, and an increased awareness may be the first step for providers to begin addressing it.

scholarly journals Inappropriate Medication Use In Older Adults According To Beers Criteria In A Tertiary Referral Hospital, In Bolu, Turkey

2021 ◽  
Vol 10 (2) ◽  
Author(s):  
Burcin M. Atak ◽  
Gulali Aktas ◽  
Tuba T. Duman ◽  
Ozge Kurtkulagi ◽  
Satilmis Bilgin ◽  
...  
Keyword(s):  
Older Adults ◽  
Inappropriate Medication ◽  
Bleeding Risk ◽  
Beers Criteria ◽  
Potentially Inappropriate Medications ◽  
Tertiary Referral Hospital ◽  
Inappropriate Use ◽  
Increased Risk ◽  
Risk Of Falls ◽  
Inappropriate Medications

Aims — We aimed to study the medications used by older adults for any potentially inappropriate medications. Material and Methods — A hundred and four consecutive subjects over 65 years of age who visited our clinic were enrolled in the study. Possible inappropriate medications were defined according to Beers Criteria. Results — A total of 57 women and 49 men were enrolled in the study. Mean ages of the women and men were 78.6±6.1 years and 77.4±5.4 years, respectively (p=0.30). While 18 subjects (17%) had no increased risk due to inappropriate use of medications, 30 were on inappropriate medications that increased renal failure risk, 5 were on inappropriate medication that amplified neurological side effects, 12 were on inappropriate medications that augmented bleeding risk, 20 were on inappropriate medication that lack safety and efficacy data, and 30 were on inappropriate medication that amplified the risk of falls. The number of increased risks according to Beers Criteria was significantly and positively correlated with number of medications used (r=0.366, p<0.001) and the number of comorbidities (r=0.312, p=0.001). Conclusion — The number of increased risks due to inappropriate use of medicines in older adults is positively correlated with the number of medicines used and the number of accompanied diseases. Therefore we suggest that the medicines used by older people should be reviewed in all settings, and unnecessary drugs should be avoided to be prescribed.

A Longitudinal Investigation of Falls and Motor Vehicle Crashes in Older Drivers

2020 ◽  
Vol 32 (9) ◽  
pp. 1258-1266
Author(s):  
Caitlin N. Pope ◽  
Pariya L. Fazeli ◽  
Tyler R. Bell ◽  
Meghana S. Gaini ◽  
Sylvie Mrug ◽  
...  
Keyword(s):  
Older Adults ◽  
Motor Vehicle ◽  
Motor Vehicle Crashes ◽  
Screening Methods ◽  
Vehicle Crashes ◽  
Longitudinal Investigation ◽  
Attention Tasks ◽  
Increased Risk ◽  
Driver's License ◽  
Longitudinal Association

Objective: To assess the longitudinal association between fall history reported at a driver’s license screening visit and the likelihood of subsequent vehicle crashes. Method: A total of 1,127 older adults were recruited from Maryland State Motor Vehicle Administration sites and interviewed annually over 15 years. Results: Individuals who reported a previous fall were more likely to be female, perform worse on physical functioning and divided attention tasks, and report more situational driving avoidance compared with non-fallers at baseline. Females who reported a fall at baseline had a 2.6× greater likelihood of subsequently reporting a crash over the 15 years than males. Among those who reported a fall at baseline, greater weekly driving exposure over the 15 years was associated with a 23% higher likelihood of a subsequent crash. Discussion: These findings support the utility of investigating nontraditional driver screening methods to identify drivers who may be at increased risk of future driving difficulties.

scholarly journals Non-conveyance of older adult patients and association with subsequent clinical and adverse events after initial assessment by ambulance clinicians: a cohort analysis

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Jakob Lederman ◽  
Veronica Lindström ◽  
Carina Elmqvist ◽  
Caroline Löfvenmark ◽  
Gunnar Ljunggren ◽  
...  
Keyword(s):  
Older Adults ◽  
Patient Safety ◽  
Adverse Events ◽  
Older Adult ◽  
Emergency Department Visits ◽  
Adult Patients ◽  
Ambulance Service ◽  
Oxygen Saturation Level ◽  
Presenting Symptoms ◽  
Increased Risk

Abstract Background Older adults (age ≥ 65 years) represent a significant proportion of all patients who are not transported to hospital after assessment by ambulance clinicians (non-conveyed patients). This study aimed to fill the knowledge gap in the understanding of the prevalence of older adult non-conveyed patients and investigate their characteristics and risk factors for subsequent and adverse events with those of younger non-conveyed patients comparatively. Methods This population-based retrospective cohort study included all adult non-conveyed patients who availed the ambulance service of Region Stockholm, Sweden in 2015; they were age-stratified into two groups: 18–64 and ≥ 65 years. Inter-group differences in short-term outcomes (i.e. emergency department visits, hospitalisations, and mortality within 7 days following non-conveyance) were assessed using multivariate regression analyses. Results Older adult patients comprised 48% of the 17,809 non-conveyed patients. Dispatch priority levels were generally lower among older non-conveyed patients than among younger patients. Non-conveyance among older patients occurred more often during daytime, and they were more frequently assessed by ambulance clinicians with nonspecific presenting symptoms. Approximately one in five older adults was hospitalised within 7 days following non-conveyance. Patients presenting with infectious symptoms had the highest mortality risk following non-conveyance. Oxygen saturation level < 95% or systolic blood pressure > 160 mmHg had significantly higher associations with hospitalisation within 7 days following non-conveyance in older adult patients. Conclusions Older adult patients have an increased risk for adverse events following non-conveyance. In combination with a complex and variating presentation of symptoms and vital signs proved difficult for dispatch operators and ambulance clinicians to identify and assess, the identified risks raise questions on the patient safety of older adult non-conveyed patients. The results indicate a system failure that need to be managed within the ambulance service organisation to achieve higher levels of patient safety for older non-conveyed patients.

scholarly journals Safety Events Impacting Hospitalized Patients Following Motor Vehicle Crashes: A Qualitative Study of Reports From Pennsylvania Hospitals

2021 ◽  
pp. 18-27
Author(s):  
Elizabeth Kukielka
Keyword(s):  
Patient Safety ◽  
Reporting System ◽  
Motor Vehicle ◽  
The United States ◽  
Motor Vehicle Crashes ◽  
Vehicle Crashes ◽  
Patient Harm ◽  
Contributing Factors ◽  
Safety Reporting ◽  
Communication Breakdowns

Motor vehicle crashes (MVCs) are a significant cause of morbidity and mortality in the United States and around the world. When a patient who has experienced trauma in an MVC presents to the emergency department, they may be unable to participate in their own care due to numerous factors, such as being unconscious, physically incapacitated, or suffering from confusion. To better characterize challenges with care of these patients, we analyzed reports of patient safety events submitted to the Pennsylvania Patient Safety Reporting System (PA-PSRS) related to MVCs, and we identified 282 reports for analysis that occurred from 2018–2020. Patients were more often male (58.9%; 166 of 282) than female (41.1%; 116 of 282), and they ranged in age from 1 to 93 years. A total of 13.1% (37 of 282) of reports were classified as serious events (i.e., events that resulted in patient harm), compared with 2.9% in the full acute care PA-PSRS database. Problems with monitoring or treatment were most common (43.3%; 122 of 282), followed by problems with evaluation (18.4%; 52 of 282), falls (11.7%; 33 of 282), problems with documentation (7.4%; 21 of 282), medication errors (7.4%; 21 of 282), and problems with transfers (6.4%; 18 of 282). Some potential contributing factors included communication breakdowns, lack of policies or protocols or unawareness about existing policies or protocols for treating certain patient populations, and prioritization of conditions related to an MVC over underlying health conditions.

scholarly journals Slow Down: New-Onset Atrial Fibrillation Challenges for Ambulatory Surgical Facilities

2021 ◽  
pp. 39-41
Author(s):  
Melanie Motts ◽  
Lea Anne Gardner
Keyword(s):  
Atrial Fibrillation ◽  
Patient Safety ◽  
Healthcare Facilities ◽  
Safety Reporting ◽  
Cardiac Monitor ◽  
Medical Issues ◽  
Increased Risk ◽  
Act One ◽  
Onset Atrial Fibrillation ◽  
New Onset

As patient safety liaisons (PSLs), we are continually educating and collaborating with our Pennsylvania healthcare facilities. We often are asked questions about reportable events under the Medical Care Availability and Reduction of Error (MCARE) Act. One of the most common examples we discuss is cancellations and transfers out of an ambulatory surgical facility (ASF). The top three reasons for cancellations include preop instructions not followed, missed medical issues identified during preop screening, and no shows. The top three reasons for transfers include cardiac arrhythmias, aspiration, and hypertension. Interestingly, between discussions with facilities and review of event reports, new-onset atrial fibrillation (AF) has come up often as a common reason for cancellations or transfers out of the ASF setting, especially in gastrointestinal (GI) procedures. In fact, as PSLs, when educating ASFs on reportable events we often give the example of placing a patient on the cardiac monitor in preop and the patient is found to be in AF. In 2009, it was estimated that 13.1% of AF cases were undiagnosed,3 which may explain why patients are presenting with new-onset AF. People with AF are at an increased risk of complications (e.g., stroke);3,4 therefore, a cancellation or transfer may be necessary depending on the patient’s condition. These events are considered reportable to the Pennsylvania Patient Safety Reporting System (PA-PSRS) under MCARE.

Patient Safety and Risk Reduction in Geriatric Psychiatry Patients

2017 ◽  
Author(s):  
Jacob C. Holzer ◽  
Paul Gluck
Keyword(s):  
Patient Safety ◽  
Elderly Population ◽  
The Elderly ◽  
Geriatric Psychiatry ◽  
Military Operations ◽  
Design Strategies ◽  
Geriatric Population ◽  
Team Coordination ◽  
Safe Management ◽  
Increased Risk

Awareness of patient safety, error reduction, and risk management is increasingly important in clinical geriatric psychiatry and in medical-legal applications as the baby-boomer population ages and as psychiatric therapeutics gain in complexity. The concept of maximizing patient safety and minimizing risk is based in part on improvement in communication and team coordination adopted from airline and military operations. The elderly population presents unique challenges to safe management, including the risks of medical comorbidity, polypharmacy, cognitive impairment, and reduced sensory input and physical functioning. Understanding the reasons for increased risk in the geriatric population will help clinicians design strategies to lower these risks and reduce the potential for harm.

scholarly journals Cancellations and Transfers Related to New-Onset Atrial Fibrillation: An Analysis of Survey and Patient Safety Reporting Data From Ambulatory Surgical Facilities

2021 ◽  
pp. 28-38
Author(s):  
Lea Anne Gardner ◽  
Rebecca Jones ◽  
Melanie Motts
Keyword(s):  
Atrial Fibrillation ◽  
Patient Safety ◽  
Safety Issue ◽  
Future Research ◽  
Safety Reporting ◽  
Increased Risk ◽  
Rapid Heart Rate ◽  
Patient Safety Issue ◽  
Reporting Data ◽  
New Onset

Atrial fibrillation (AF) is a cardiac arrhythmia characterized by an irregular rhythm and often rapid heart rate. People with AF can be symptomatic or asymptomatic and are at increased risk for stroke. In this study, we used two data sources—a survey and Pennsylvania Patient Safety Reporting System (PA-PSRS) reports—to examine new-onset AF in Pennsylvania ambulatory surgical facilities (ASFs). The survey was developed and conducted to learn more about new-onset AF– related cancellations and transfers in Pennsylvania ASFs and to update the Patient Safety Authority ASF Cancellation and Transfer Tracking Tool. The survey response rate was 53.1%, with 50.9% of respondents indicating new-onset AF–related cancellations in the last year. A five-year review of PA-PSRS data revealed an increase in the number of new-onset AF–related cancellation and transfer events that occurred in the last two years. In 70.9% of the reports, patients were 65 years of age and older. A paucity of research on this patient safety issue led us to identify areas for future research.

Assessment of the Sensory Acceptability of Soy Milk Based Sandesh (Traditional Indian Sweet Dairy Dessert) For Elderly People (Aged > 60 Years) Living in Kolkata and its Efficacy on the Health Status of Geriatric Population

2020 ◽  
pp. 31-38
Author(s):  
Sweata Rani Rai ◽  
Sabia Nazmin
Keyword(s):  
Older Adults ◽  
Cerebrovascular Diseases ◽  
Buffalo Milk ◽  
Cow Milk ◽  
Eating Patterns ◽  
Soy Milk ◽  
Geriatric Population ◽  
Dietary Preference ◽  
Chemical Evaluation ◽  
Nutritional Needs

Background: Aging is often associated with the incidence of degenerative diseases such as cardiovascular, cerebrovascular diseases, diabetes, osteoporosis, and cancer, which affects dietary eating patterns in older adults. With advancing age, there is a decline in appetite and a reduced affinity to food. However, the eighty million citizens of West Bengal including the older adults have a craving for sweets. Therefore, the present study aims to evaluate the sensory and chemical evaluation of Sandesh prepared from soymilk and dates adhering to nutritional needs and dietary preference towards sweets for older adults. Method: Sandesh is prepared with the substitution of traditional milk chenna (fresh, unripened curd cheese made from cow milk/ buffalo milk)with soy milk and dates syrup.

Association between Vitamins and Minerals with Antioxidant Effects and Coronary Artery Calcification in Adults and Older Adults: A Systematic Review

2019 ◽  
Vol 25 (22) ◽  
pp. 2474-2479 ◽  
Author(s):  
Alisson Diego Machado ◽  
Gustavo Rosa Gentil Andrade ◽  
Jéssica Levy ◽  
Sara Silva Ferreira ◽  
Dirce Maria Marchioni
Keyword(s):  
Systematic Review ◽  
Older Adults ◽  
Coronary Artery ◽  
Coronary Artery Calcification ◽  
Serum Levels ◽  
Antioxidant Compounds ◽  
Increased Risk ◽  
Coronary Events ◽  
Antioxidant Effects

Background: Coronary Artery Calcification (CAC) is considered an important cardiovascular risk factor. There is evidence that CAC is associated with an increased risk of atherosclerosis, coronary events and cardiovascular mortality. Inflammation is one of the factors associated with CAC and despite the interest in antioxidant compounds that can prevent CAC, its association with antioxidants remains unclear. Objective: This study aimed to systematically review the association between vitamins and minerals with antioxidant effects and CAC in adults and older adults. Methods: We conducted a systematic review using PubMed for articles published until October 2018. We included studies conducted in subjects aged 18 years and older with no previous cardiovascular disease. Studies involving animal or in vitro experiments and the ones that did not use reference methods to assess the CAC, dietary intake or serum levels of vitamin or mineral were excluded. Results: The search yielded 390 articles. After removal of duplicates, articles not related to the review, review articles, editorials, hypothesis articles and application of the inclusion and exclusion criteria, 9 articles remained. The results of the studies included in this systematic review suggest that magnesium is inversely associated with CAC and results on the association between CAC and vitamin E have been conflicting. Conclusion: Additional prospective studies are needed to elucidate the role of these micronutrients on CAC.

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