scholarly journals The prescription paradox: a guide to appropriate prescribing in the elderly

2019 ◽  
Vol 5 (2) ◽  
Author(s):  
Ryan B. Thomas ◽  
Se Ryeong Jang ◽  
Marco Lombardi ◽  
Vittorio Maio
Keyword(s):  
Clinical Guidelines ◽  
Older Patients ◽  
Adverse Drug Events ◽  
Continuous Process ◽  
The Elderly ◽  
Clinical Treatment ◽  
Patient Choice ◽  
Economic Outcomes ◽  
Physiological Changes ◽  
Appropriate Prescribing

Appropriate prescribing in the elderly can be challenging. While most of the older patients suffer from multiple comorbidities and undergo physiological changes with aging, no clinical guidelines account for these unique characteristics of the elderly adequately. Our commentary proposes a continuous process of prescribing and deprescribing as a necessary step for providers to prevent adverse drug events associated with unnecessary polypharmacy, a result of clinical guidelines working in silos. In addressing this issue, we employed Dr. Nick Barber’s four tenants of appropriate prescribing – maximize effectiveness, minimize risk, minimize cost, and respect patient choice – as a framework to guide providers through actionable insights on how to optimize the intended effects of their clinical treatment while also achieving desirable humanistic and economic outcomes.

scholarly journals Drug Prescribing to the Elderly Patients

2018 ◽  
Vol 1 (2) ◽  
pp. 65
Author(s):  
Misha’l Aly A
Keyword(s):  
Elderly Patients ◽  
Drug Interactions ◽  
Adverse Drug Event ◽  
Older Patients ◽  
Adverse Drug Events ◽  
The Elderly ◽  
Health Sciences ◽  
Drug Event ◽  
Drug Prescribing ◽  
Age Related

Age-related physiologic and anatomic changes in various body systems are accompanied by significant pharmacokinetic and pharmacodynamic alterations that make it mandatory for treating physicians to adjust types and dosages of medications for their older patients. Moreover, physicians should be always alert for adverse drug events, and consider any new symptoms as drug-related until proven otherwise. Other issues addressed include prescribing cascades, polypharmacy, drug-drug interactions, and the need to review all medications used by the elderly patients, with special attention to non-prescription and herbetic drugs. This review aims at maximizing safe medicine prescribing, and minimizing adverse drug event in caring for older subjects.International Journal of Human and Health Sciences Vol. 01 No. 02 July’17. Page : 65-69

Clinical Treatment of the Elderly: Never Too Late

1987 ◽  
Vol 32 (12) ◽  
pp. 1036-1036
Author(s):  
Susan Krauss Whitbourne
Keyword(s):  
The Elderly ◽  
Clinical Treatment

ACUTE KIDNEY INJURY IN ELDERLY PATIENTS

2019 ◽  
Vol 72 (8) ◽  
pp. 1466-1472
Author(s):  
Grażyna Kobus ◽  
Jolanta Małyszko ◽  
Hanna Bachórzewska-Gajewska
Keyword(s):  
Acute Kidney Injury ◽  
Renal Failure ◽  
Acute Renal Failure ◽  
Elderly Patients ◽  
Older Patients ◽  
Age Groups ◽  
Kidney Injury ◽  
The Elderly ◽  
Younger Patients ◽  
Common Cause

Introduction: In the elderly, impairment of kidney function occurs. Renal diseases overlap with anatomic and functional changes related to age-related involutionary processes. Mortality among patients with acute renal injury is approximately 50%, despite advances in treatment and diagnosis of AKI. The aim: To assess the incidence of acute kidney injury in elderly patients and to analyze the causes of acute renal failure depending on age. Materials and methods: A retrospective analysis included medical documentation of patients hospitalized in the Nephrology Clinic during the 6-month period. During this period 452 patients were hospitalized in the clinic. A group of 77 patients with acute renal failure as a reason for hospitalization was included in the study. Results: The prerenal form was the most common cause of AKI in both age groups. In both age groups, the most common cause was dehydration; in the group of patients up to 65 years of age, dehydration was 29.17%; in the group of people over 65 years - 43.39%. Renal replacement therapy in patients with AKI was used in 14.29% of patients. In the group of patients up to 65 years of age hemodialysis was 16.67% and above 65 years of age. -13.21% of patients. The average creatinine level in the group of younger patients at admission was 5.16 ± 3.71 mg / dl, in the group of older patients 3.14 ± 1.63 mg / dl. The size of glomerular filtration GFR in the group of younger patients at admission was 21.14 ± 19.54 ml / min, in the group of older patients 23.34 ± 13.33 ml / min. Conclusions: The main cause of acute kidney injury regardless of the age group was dehydration. Due to the high percentage of AKI in the elderly, this group requires more preventive action, not only in the hospital but also at home.

A new medical Internet system in healthcare: innovation of Telegeriatrics and healthcare demands of older patients of different age groups (Preprint)

2020 ◽  
Author(s):  
Yu Gong ◽  
Jianyuan Zhou
Keyword(s):  
Cardiovascular Diseases ◽  
General Practitioners ◽  
Older Patients ◽  
Metabolic Diseases ◽  
Treatment Plan ◽  
Age Groups ◽  
The Elderly ◽  
Diagnosis And Treatment ◽  
World Health ◽  
New Model

BACKGROUND Healthcare for older patients is a worldwide challenge for public health system. A new medical Internet system in healthcare which is a new model of telegeriatrics system has been established. The key innovation is the new telegeriatrics system was conducted jointly by general practitioners in the Community Health Service Center and specialists in university teaching hospital. Unlike the typical telemedicine that has been practiced in other countries, the new model provides a solution for the key issues in telemedicine where a doctor is unable to conduct a direct physical examination and the associated potential diagnostic error. OBJECTIVE This study is to introduce the operation mechanism of the new Telegeriatrics system and analyze healthcare demands of older patients in different age groups applying the new Telegeriatrics system. METHODS 472 older patients (aged≥60) were enrolled and divided into the young older group (aged 60 to 74), the old older group (aged 75 to 89) and the very old group (aged≥90) according to the age stratification of World Health Organization. Proportion of the top 10 diseases of older patients of different age groups was analyzed. RESULTS The process of older patients’ diagnosis and treatment made by specialist and general practitioners formed a closed loop. It ensures the timeliness and effectiveness of diagnosis and treatment of older patients. The treatment effect can be observed by general practitioners and specialist can adjust the treatment plan in time. In this study, it was found that older patients in different age groups have different healthcare demands. Coronary heart disease and type 2 diabetes mellitus were found to be the main diseases of the older patients and the young older patients as well as the old older patients applying Telegeriatrics. CONCLUSIONS The new telegeriatrics system can provide convenient and efficient healthcare services for older patients and overcome the disadvantage of currently used models of telegeriatrics. Older patients in different age groups have different medical care demands. Cardiovascular diseases and metabolic diseases have become the main diseases of the elderly applying the new Telegeriatrics system. Healthcare policy makers should invest more medical resources to the prevention of cardiovascular diseases and metabolic diseases in the elderly.

scholarly journals Corticobasal Degeneration Misdiagnosed As Musculoskeletal Disease: A Challenging Diagnosis of Higher-Level Gait Disease

2020 ◽  
Vol 11 (04) ◽  
pp. 640-642
Author(s):  
Halil Onder
Keyword(s):  
Corticobasal Degeneration ◽  
The Elderly ◽  
Gait Disorders ◽  
Physiological Changes ◽  
Gait Abnormality ◽  
Age Related ◽  
Musculoskeletal Problems ◽  
Neurological Exam ◽  
Long Time ◽  
High Level

AbstractGait disorders are common in the elderly as there are various causes of neurological and non-neurological conditions. On the other hand, most of the gait parameters do change with advancing age which is identified as age-related physiological changes in gait. At this point, the discrimination between age-related physiological changes and gait disorders may be strictly challenging. After identifying gait as an abnormal pattern, classification of it and making the responsible pathophysiology also require high-level expertise in this regard. Herein, we present a rare patient with corticobasal degeneration (CBD) who had admitted initially due to complaints of gait problems. Over a long time, the patient had received the misdiagnosis of gait abnormality due to musculoskeletal problems by multiple physicians. However, the detailed neurological exam showed a higher level gait disorder (HLGD). Further investigations at this point yielded the diagnosis of CBD.

Preventable and Non-Preventable Risk Factors for Adverse Drug Events Related to Hospital Admissions in the Elderly

2002 ◽  
Vol 22 (6) ◽  
pp. 385-392 ◽  
Author(s):  
J. Doucet ◽  
A. Jego ◽  
D. Noel ◽  
C.E. Geffroy ◽  
C. Capet ◽  
...  
Keyword(s):  
Risk Factors ◽  
Adverse Drug Events ◽  
Hospital Admissions ◽  
The Elderly

Older people's satisfaction with intermediate care: a systematic review

2007 ◽  
Vol 17 (3) ◽  
pp. 199-218 ◽  
Author(s):  
Andrew Wilson ◽  
Suzanne Richards ◽  
Janette Camosso-Stefinovic
Keyword(s):  
Systematic Review ◽  
Older People ◽  
Older Patients ◽  
Hospital Care ◽  
Patient Choice ◽  
Intermediate Care ◽  
Care Services ◽  
The Relationship

Although intermediate care takes a variety of different forms and has developed somewhat differently in different countries, we believe that intermediate-care schemes have enough in common to make it meaningful to examine the relationship between this method of care and the views of older patients receiving either it or its alternatives. This is particularly important as one of the underlying principles of intermediate care is to extend patient choice; furthermore, most intermediate-care services target older people. In this review we examine evidence about whether older people prefer intermediate or hospital care, and what they like and dislike about intermediate care.

scholarly journals Elderly and drugs: risks and necessity of rational use

2010 ◽  
Vol 46 (4) ◽  
pp. 617-632 ◽  
Author(s):  
André de Oliveira Baldoni ◽  
Farah Maria Drumond Chequer ◽  
Elisa Raquel Anastácio Ferraz ◽  
Danielle Palma de Oliveira ◽  
Leonardo Régis Leira Pereira ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Adverse Effects ◽  
Elderly Population ◽  
Adverse Drug Events ◽  
The Elderly ◽  
External Factors ◽  
Access To Information ◽  
Inappropriate Use ◽  
The World

In recent decades, the world has undergone a demographic transformation with a rapid growth of the elderly population, resulting in an increased demand for funds to maintain their health and drug consumption. Pharmacokinetic and pharmacodynamic changes occurring in the elderly can interfere directly in the adverse effects of drugs and increase the risk of intoxication. In addition, there are external factors interfering with the pharmacotherapy of the elderly, such as inappropriate use and the lack of access to information. Many therapeutic classes of drugs should be used with caution or avoided in the elderly population, such as anti-inflammatory and some anti-hypertensive drugs, diuretics and digitalis. If not managed carefully, these medicines can affect the safety and quality of life in the elderly. Thus, the aim of this review was to identify drugs that should be used with caution in elderly patients in order to avoid intoxication and/or adverse drug events.

A Clinical Conundrum: The Pharmacist's Role in Evaluating Comorbid Urinary incontinence and Heart Failure

2021 ◽  
Vol 36 (3) ◽  
pp. 142-146
Author(s):  
Robin Parker ◽  
Aaron Henslee ◽  
Zachary L. Cox
Keyword(s):  
Heart Failure ◽  
Urinary Incontinence ◽  
Older Patients ◽  
Complex Disease ◽  
Treatment Strategies ◽  
Shared Decision ◽  
Patient Centered ◽  
Appropriate Prescribing ◽  
Therapeutic Competition ◽  
Improve Patient

Heart failure (HF) is a complex disease to manage, and treatment strategies for older adults are complicated by the presence of comorbidities such as urinary incontinence (UI). There is a therapeutic competition that exists in the treatment of patients with both HF and UI, as many of the agents indicated for control of HF may directly exacerbate UI. A reported 80% of adults with HF are older than 65 years of age, and 50% of HF patients have UI. The prevalence of conflicting therapeutic objectives in older patients presents an opportunity for intervention by senior care pharmacists. Pharmacists are equipped to optimize medication outcomes through the provision of appropriate prescribing and deprescribing recommendations, when necessary. This provides an opportunity for shared decision making to improve patient-centered outcomes and goals of care within this population.

scholarly journals Safety assessment of essential medicines for elderly people: a bibliographic survey

2014 ◽  
Vol 50 (2) ◽  
pp. 269-284 ◽  
Author(s):  
Fabiana Rossi Varallo ◽  
Fernanda Mariana de Oliveira ◽  
Patrícia de Carvalho Mastroianni
Keyword(s):  
Elderly People ◽  
Safety Assessment ◽  
Search Strategy ◽  
Adverse Drug Events ◽  
The Elderly ◽  
Essential Medicines ◽  
Age Group ◽  
Over The Counter ◽  
Manual Search

Certain medicines are considered potentially inappropriate (PIM) for elderly people as they increase the risk of adverse drug events (ADE) and because safer alternative therapies are available on the market. In this context, in order to identify the instruments that assess the quality of medical prescriptions for elderly and to determine which drugs are considered PIM, a bibliographic survey was conducted in PUBMED, LILACS and PAHO databases, in February and March/2010. The search strategy included the use of health descriptors and a manual search in the references cited by selected papers. During the period of data collection, 15 instruments were identified. In 2012, with the publication of the update of Beers criteria, this instrument was included in the study. We identified 163 PIM of 25 therapeutic classes, of which 125 (76.7%) are marketed in Brazil. Of these, 31 (24.8%) are essential medicines (RENAME 2012), of which 13 have safer therapeutic equivalents and 19 (15.2%) are over-the-counter drugs. Data suggest the need for inclusion of safer alternatives for the elderly in the national list of essential medicines and the pharmaceutical care for early detection of ADE in this age group, in order to contribute to the safe use of medicines.

Sign in / Sign up

Export Citation Format

Share Document