scholarly journals Managing Polypharmacy and Deprescribing in Elderly

2021 ◽  
Author(s):  
Çiğdem Apaydın Kaya
Keyword(s):  
Elderly Patients ◽  
Drug Effects ◽  
Clinical Decision ◽  
The Elderly ◽  
Negative Consequences ◽  
Medication Appropriateness Index ◽  
Inappropriate Drugs ◽  
Individualized Care ◽  
Risk Of Falls ◽  
Evidence Based Guidelines

The increase in the number of medications used may result many negative consequences for patients and health system. Elderly patients are more likely to encounter these health problems associated with polypharmacy. Deprescribing, the process of tapering, withdrawing, discontinuing, or stopping medications, is important in reducing polypharmacy, adverse drug effects, inappropriate or ineffective medication use, and costs. Deprescribing in elderly patients in accordance with the evidence based guidelines has many positive outcomes in older people such as decrease in the risk of falls, improvement in cognition, and improvement in patients’ global health status. Therefore, each visit of an elderly patient should be considered as an opportunity to evaluate the unnecessary use or harms of the prescribed or nonprescribed medications. Clinicians should decide to deprescription process by individualized care goals in line with current guidelines. Beers Criteria, STOPP/START and The Medication Appropriateness Index-MAI can be used to assit clinicians to identify unnecessary or potentially inappropriate drugs and reduce the number of medications in older patients. But, a balance is required between over and under prescribing. In conclusion, prevention of polypharmacy and withdrawing unneccesary and inappropriate medications may be the best clinical decision for family physicians who follow the elderly in primary care.

HYPERTENSION IN ELDERLY:OUR CURRENT TRENDS

2021 ◽  
pp. 56-57
Author(s):  
Rohit Arora ◽  
D.K Sharma
Keyword(s):  
Blood Pressure ◽  
Elderly Patients ◽  
The Elderly ◽  
Common Disease ◽  
Old Patients ◽  
Current Trends ◽  
Increased Risk ◽  
Individualized Approach ◽  
Risk Of Falls ◽  
Optimal Target

Hypertension is a common disease in the elderly associated with signicant morbidity and mortality. Due to the complexity of this population, the optimal target of blood pressure (BP) control is still controversial. In this article, we conduct a literature review of trials published in English in the last 10 years which were specically designed to study the efcacy and safety of various BP targets in patients who are 70 years or older. Using these criteria, we found that the benets in the positive studies were demonstrated even with a minimal BPcontrol (systolic BP[SBP] <150 mmHg) and continued to be reported for a SBP<120 mmHg. On the other hand, keeping SBP<140 mmHg seemed to be safely achieved in elderly patients. Although the safety of lowering SBP to <120 mmHg is debated, Systolic Blood Pressure Intervention Trial study has shown no increased risk of falls, fractures, or kidney failure in elderly patients with SBP lower than this threshold. While the recent guidelines recommended to keep BP <130/80 mmHg in the elderly, more individualized approach should be considered to achieve this goal in order to avoid undesirable complications. Furthermore, further studies are required to evaluate BPtarget in very old patients or those with multiple comorbidities.

The Elderly Psychiatric Patient with Positive Syphilis Serology: The Problem of Neurosyphilis

1998 ◽  
Vol 28 (3) ◽  
pp. 333-339 ◽  
Author(s):  
Ishwer L. Bharwani ◽  
Charles O. Hershey
Keyword(s):  
Elderly Patients ◽  
Clinical Decision Making ◽  
Relevant Literature ◽  
Clinical Decision ◽  
The Elderly ◽  
Illustrative Case ◽  
Positive Serology ◽  
Important Indicator ◽  
Syphilis Serology ◽  
Latent Syphilis

Objective: Older patients have a high prevalence of neurological and psychiatric disorders. They also have a baseline prevalence of late latent syphilis or positive syphilis serology. Thus the clinical question arises as to whether a neuropsychiatric disorder in a geriatric patient is neurosyphilis or if the positive serology is incidental. Method: An illustrative case example is used to illustrate this dilemma. The relevant literature is reviewed. Results: The cerebrospinal fluid (CSF) protein is an important indicator of inflammatory activity in the central nervous system and is used as a clinical guide in the diagnosis. Elderly patients have higher values of normal CSF protein than younger patients. Conclusions: Given the importance of CSF protein in the diagnosis of neurosyphilis, physicians must include this knowledge, that elderly patients have higher CSF protein values, in their clinical decision making in the differentiation between neurosyphilis and late latent syphilis in the elderly patient.

scholarly journals Correction to: COVID-19 and the elderly patients: insights into pathogenesis and clinical decision-making

2020 ◽  
Vol 32 (9) ◽  
pp. 1909-1909
Author(s):  
Fabio Perrotta ◽  
Graziamaria Corbi ◽  
Grazia Mazzeo ◽  
Matilde Boccia ◽  
Luigi Aronne ◽  
...  
Keyword(s):  
Decision Making ◽  
Elderly Patients ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
The Elderly

scholarly journals The Oral Anticoagulants Administration in Elderly Patients with Geriatric Syndromes: What's New?

2020 ◽  
Vol 16 (6) ◽  
pp. 984-993
Author(s):  
N. M. Vorobyeva ◽  
O. N. Tkacheva
Keyword(s):  
Atrial Fibrillation ◽  
Elderly Patients ◽  
Oral Anticoagulants ◽  
Direct Oral Anticoagulants ◽  
The Elderly ◽  
Evidence Base ◽  
Geriatric Syndromes ◽  
Consensus Document ◽  
Venous Thromboembolic ◽  
Risk Of Falls

The administration of oral anticoagulants in elderly patients with geriatric syndromes such as senile asthenia syndrome, falls and high risk of falls, dementia, polymorbidity, polypharmacy are discussed in the article. The evidence base for the anticoagulants taking in patients with atrial fibrillation aged ≥75, ≥80, ≥85 and ≥90 years, in patients with atrial fibrillation and various geriatric syndromes, as well as in elderly patients with venous thromboembolic complications and frailty syndrome is presented. Most studies indicate significant advantages of direct oral anticoagulants (dabigatran, rivaroxaban, apixaban, and edoxaban) over the vitamin K antagonist warfarin in elderly patients with geriatric syndromes. An updated version of the FORTA consensus document, which aims to optimize the prescription of medicines for the elderly, is also presented. Apixaban has a FORTA-A safety class and is the safest oral anticoagulant in elderly patients.

scholarly journals Special considerations of breast cancer management in the elderly

2020 ◽  
pp. BMT46
Author(s):  
Lauren F Cornell ◽  
Sarah A Mclaughlin ◽  
Sandhya Pruthi ◽  
Dawn M Mussallem
Keyword(s):  
Breast Cancer ◽  
Clinical Trials ◽  
Elderly Patients ◽  
Management Strategies ◽  
The Elderly ◽  
Evidence Based ◽  
Limited Evidence ◽  
Cancer Management ◽  
Breast Cancer Management ◽  
Evidence Based Guidelines

There are increasing numbers of elderly patients diagnosed with breast cancer. These patients are under-represented in available clinical trials, and as such, there are limited evidence-based guidelines for treatment in this population. Elderly patients have unique needs and management strategies should be tailored accordingly. This article reviews available literature regarding breast cancer management and special considerations in elderly patients.

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 The Effect of Frankel’s Stabilization Exercises and Stabilometric Platform in the Balance in Elderly Patients: A Randomized Clinical Trial

Medicina ◽  
2019 ◽  
Vol 55 (9) ◽  
pp. 583
Author(s):  
Mańko ◽  
Pieniążek ◽  
Tim ◽  
Jekiełek
Keyword(s):  
Elderly Patients ◽  
The Elderly ◽  
Rehabilitation Program ◽  
Risk Of Falling ◽  
Risk Of Falls ◽  
Group 2 ◽  
And Gender ◽  
Specific Disorders ◽  
Experimental Group ◽  
And Training

Background and Objectives: Every year, older people are becoming a larger part of the population. In a couple of years medicine is going to struggle with specific disorders and their consequences, where one of them are falls. Fall prevention involves a use of strengthening exercises, equivalent exercises, stabilometric platforms, and special exercise programs. Almost the entire brain is involved in maintaining correct balance. Reduction of a volume of gray matter negatively affects balance. Single exercise sessions do not significantly improve balance. In order to achieve satisfactory results at least 10 training sessions are required. The aim of this study is to determine if there is a correlation between a risk of falls, gender, and a risk of falls and the age of the subjects. Another reason to conduct that research was to assess the effectiveness of Frankel’s exercises and training of using the stabilometric platform in rehabilitation, which aims to reduce the risk of falls among elderly people. Materials and Methods: The study involved 40 elderly patients referred for physiotherapy to a rehabilitation center. The patients were divided into two groups of 20 people. In experimental group 1 (C) Frankel’s stabilization exercises were used; in experimental group 2 (E) a stabilometric platform was used. The correlation between the risk of falls and age as well a risk of falling and the gender of the examined persons was taken into consideration. The effect of therapy that uses stabilization exercises and the stabilometric platform on the risk of falls in the examined persons was assessed using the Tinetti scale. Clinical control was performed using the Tinetti scale, before and after a two-week rehabilitation period. Results: The study showed no correlation between the degree of risk of falling and age, and between the risk of falling by the elderly and gender. There were also changes in the results obtained by patients after using the training, both with the use of Frankel’s stabilization exercises as well as with the use of the stabilometric platform. Patients using the dynamometric platform obtained higher results in the Tinetti test after treatment. Conclusions: In the examined sample, no correlation was found between the risk of falls and age as well as the risk of falls and gender. Both Frankel's exercises and training with the use of the stabilometric platform were effective in a rehabilitation program aimed at reducing the risk of falls among the elderly.

Drugs With Anticholinergic Potential and Risk of Falls With Hip Fracture in the Elderly Patients: A Case–Control Study

2018 ◽  
Vol 31 (2) ◽  
pp. 63-69 ◽  
Author(s):  
Manuel E. Machado-Duque ◽  
Juan Pablo Castaño-Montoya ◽  
Diego A. Medina-Morales ◽  
Alejandro Castro-Rodríguez ◽  
Alexandra González-Montoya ◽  
...  
Keyword(s):  
Hip Fracture ◽  
Elderly Patients ◽  
Case Control Study ◽  
The Elderly ◽  
Case Control ◽  
Anticholinergic Drugs ◽  
Female Predominance ◽  
Risk Of Falls ◽  
Probability Of Fracture ◽  
Control Study

Background/Objective: To determine the association between the use of anticholinergic drugs and the risk of falls with hip fracture in a population older than 60 years. Methods: A case–control study in patients older than 60 years with a diagnosis of hip fracture. All drugs dispensed during the previous 30 days were identified. Sociodemographic, clinical, pharmacological (drugs according to the Anticholinergic Risk Scale [ARS]), and polypharmacy variables were analyzed. Measurements: Falls with hip fracture and type of drug according to the ARS. Results: A total of 300 patients with hip fracture and 600 controls were included. The mean age was 81.6 ± 8.9 years, with female predominance (71.3%). The use of drugs with moderate (odds ratio [OR]: 1.97, 95% confidence interval [CI]: 1.19-3.27) or high ARS scores (OR: 1.83, 95% CI: 1.13-2.96) increased the probability of fracture. Conclusions: There was an association between the use of drugs with anticholinergic properties and the probability of hip fracture in elderly patients and it was possible to establish the level of risk.

Costs and Benefits of Pharmaceuticals: The Value Equation for Older Americans

2002 ◽  
Vol 3 (3) ◽  
pp. 135-143 ◽  
Author(s):  
Richard Levy
Keyword(s):  
Health Care ◽  
Elderly Patients ◽  
The Elderly ◽  
Individualized Therapy ◽  
Drug Benefit ◽  
Price Inflation ◽  
Older Americans ◽  
Ongoing Research ◽  
Individualized Care ◽  
Wide Range

Recent increases in drug expenditures are primarily due to the availability of more and better therapy rather than price inflation. Investment in new drugs generates savings throughout the health care system. Increased use of drugs, especially newer agents, has also resulted in increased longevity and reduced disability. Benefits from new pharmaceuticals far outweigh their costs for many key diseases of the elderly. Even incremental improvements in drug therapies contribute substantially to improved care. Chronic illness, disability, and an aging population will drive future health care spending. Pharmaceutical innovation will be an integral part of effective strategies to address this challenge. The availability of individualized therapy for the elderly will soon increase based on our rapidly growing understanding of the molecular and genetic basis of disease. This is expected to result in major advances in preventing, treating, and perhaps even curing many of the costly, life-threatening, and disabling diseases afflicting older Americans. The adequacy of drug benefit programs for elderly patients depends on the extent to which the range of drug therapies necessary for appropriate care are covered. Policies that foster the availability of unique pharmaceuticals can have important implications for treatment outcomes, quality of life, cost containment, and ongoing research investment in newer and more effective medicines. Such policies increase the diversity of agents within drug classes and thereby enable differentiated, individualized therapy. A wide range of choices is especially important for elderly patients, who have the greatest need for individualized care and are at greatest risk for compromised outcomes if choices are overly circumscribed.

106 Precipitating factors in the elderly patients admitted with the diagnosis of heart failure. Are easy to find?

2006 ◽  
Vol 5 (1) ◽  
pp. 25-26
Author(s):  
R VIDALPEREZ ◽  
E ABUASSI ◽  
M PARAMODEVEGA ◽  
P VELOSO ◽  
A VARELAROMAN ◽  
...  
Keyword(s):  
Heart Failure ◽  
Elderly Patients ◽  
The Elderly ◽  
Precipitating Factors
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