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Pascal Menecier, Laure Menecier-Ossia
Psychotropic medicines represent, after alcohol, the second class of substances most susceptible to abuse by elderly people. It can be particularly difficult for caregivers to understand such behaviour as these are prescription-only medicines. This misuse is partly a result of older people tending to trivialise and overrate pharmaceutical drugs, ignoring the potential of non-medicinal methods and psychotherapeutic treatments. The boundaries between prescribed use, overuse, self-medication, excessive use, dependency or addiction to prescription drugs are blurred in older people...
January 2017: Soins. Gérontologie
N Gómez Aguirre, A Caudevilla Martínez, L Bellostas Muñoz, M Crespo Avellana, J Velilla Marco, J Díez-Manglano
Polypathological patients are usually elderly and take numerous drugs. Polypharmacy affects 85% of these individuals and is not associated with greater survival. On the contrary, polypharmacy exposes these individuals to more adverse effects, such as weight loss, falls, functional and cognitive impairment and hospitalisations. The complexity of a drug regimen covers more aspects than the simple number of drugs consumed. The galenic form, the dosage and the method for preparing the drug can impede the understanding of and compliance with prescriptions...
February 16, 2017: Revista Clínica Española
Gurusamy Sivagnanam
Deprescribing is a structured approach to drug discontinuation. An alternative suggested term is "prescription metabolism." The major aim of deprescription is to purge the drug(s) considered unwanted in a given patient, especially in the elderly patients with multiple comorbidities or in those suffering from chronic disease. Like drug metabolism, prescription metabolism is a way of eliminating unwanted, troublesome, or cost-ineffective medications. The removal of such drugs has been found to decrease the incidence of adverse drug reactions and improves the rate of medication adherence, thereby reducing the economic burden on the patient as well as on the health care providers...
July 2016: Journal of Pharmacology & Pharmacotherapeutics
Meritxell Pujal Herranz
OBJECTIVE: The aim of this study is to evaluate the prevalence of proton pump inhibitors (PPIs) prescription, and the level of adequacy of the indication of these drugs in oncohematologic patients under ambulatory oncoespecific treatment. METHOD: An observational descriptive study in oncohematologic patients under ambulatory oncoespecific treatment. A protocol for the rational use of PPI targeted to oncohematologic patients based on the PPI protocol of our hospital was designed...
September 1, 2016: Farmacia Hospitalaria
Arritxu Etxeberria, Josune Iribar, Javier Hernando, Ignacia Idarreta, Itziar Vergara, Carmela Mozo, Kalliopi Vrotsou, Joaquín Belzunegui, Arantxa Lekuona
OBJECTIVE: To evaluate the impact of a multifactorial intervention to promote bisphosphonate deprescription after over 5 years of use (BF5y) in a health care organisation (HCO) in Gipuzkoa (Spain) and to compare it with the standard intervention in other HCOs in the Basque Health Service-Osakidetza. METHODS: An 8-month follow-up study (results from before and after) to assess the impact of two interventions. All patients from Osakidetza receiving BF5y treatment (electronic prescription) in July 2013 were included...
January 2017: Gaceta Sanitaria
Liliana Oliveira, Marta Oliveira Ferreira, Alexandre Rola, Miguel Magalhães, José Ferraz Gonçalves
In palliative care, drugs are considered futile if they do not have a short-term benefit in symptom control or quality of life. The authors examined pharmacotherapy prescribed for patients referred to palliative care to identify futile drugs. This was a retrospective analysis of patients referred over 6 months, focusing on the prescription of gastric protectants, antidiabetic agents, bisphosphonates, anticoagulants, antidementia drugs, statins, and antihypertensive agents. The sample consisted of 448 patients...
September 2016: Journal of Pain & Palliative Care Pharmacotherapy
Thomas E MacMillan, Reza Kamali, Rodrigo B Cavalcanti
BACKGROUND: Hospital admissions provide an opportunity to deprescribe ineffective medications and reduce pill burden. Docusate sodium is a stool softener that is frequently prescribed to treat constipation despite poor evidence for efficacy, thus providing a good target for deprescription. The aims of this study were to characterize rates of use and discontinuation of docusate among internal medicine inpatients, as well as use of other laxatives. METHODS: We conducted a retrospective observational study over 1 year on all patients admitted to internal medicine at 2 urban academic hospitals to determine rates of docusate use...
September 2016: American Journal of Medicine
Nele J Van Den Noortgate, Rebecca Verhofstede, Joachim Cohen, Ruth D Piers, Luc Deliens, Tinne Smets
CONTEXT: Palliative care for the older person is often limited, resulting in poor quality of dying. Pharmacological management can be one of the components to achieve better symptom control. OBJECTIVES: To describe the anticipatory prescription of medication for symptomatic treatment and the deprescription of potentially inappropriate medication during the last days of life. METHODS: This was a cross-sectional descriptive study between October 1, 2012 and September 30, 2013 in 23 acute geriatric wards in Flanders, Belgium...
June 2016: Journal of Pain and Symptom Management
Joaquín Hortal Carmona, Iván Aguilar Cruz, Francisco Parrilla Ruiz
The therapeutic structure of health systems relies heavily on medical prescription, which generates a marked tendency to add drugs to a patient's medical history. There is an absence of incentives for professionals to reassess prescriptions and withdraw those with a negative or neutral risk/benefit. This can create a deviation of medical resources to the maintenance of useless or even harmful treatments. Deprescribing, a process of thoughtful medication withdrawal that complements moderate prescribing, is aimed to stop this unfair deviation of resources towards non-beneficial, if not maleficent, prescription...
April 20, 2015: Medicina Clínica
Patrice Queneau, Jean Doucet, François Paille
Elderly people are frequently prescribed unnecessary and/or dangerous medications. The resulting polymedication carries four types of risk : an increased risk of adverse drug events (ADEs), decreased benefits of appropriate drugs, decreased compliance with appropriate treatments, and increased cost. Physicians should thus, when possible, deprescribe, reduce, replace or withdraw inappropriate medications. This article examines the following questions: Which medications can be stopped? What are the risks? How best to withdraw undesirable drugs? What are the potential health benefits for elderly people? When should drugs not be deprescribed? How to promote controlled trials aimed at optimizing the duration of treatments, especially in elderly people? and How to educate prescribers, pharmacists and patients in deprescription?...
February 2007: Bulletin de L'Académie Nationale de Médecine
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