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Janani Thillainadesan, Danijela Gnjidic, Sarah Green, Sarah N Hilmer
BACKGROUND: Polypharmacy and potentially inappropriate medications (PIMs) are prevalent in older adults in hospital, and are associated with negative outcomes including adverse drug reactions, falls, confusion, hospitalisation and death. Deprescribing may reduce inappropriate polypharmacy and use of inappropriate medications. OBJECTIVE: The aim of this systematic review was to investigate the efficacy of deprescribing interventions in older inpatients to reduce PIMs and impact on clinical outcomes...
March 14, 2018: Drugs & Aging
Philippe Martin, Cara Tannenbaum
Context: Interprofessional communication is an effective mechanism for reducing inappropriate prescriptions among older adults. Physicians' views about which elements are essential for pharmacists to include in an evidence-based pharmaceutical opinion for deprescribing remain unknown. Objective: To develop a prototype for an evidence-based pharmaceutical opinion that promotes physician-pharmacist communication around deprescribing. Methods: A standardized template for an evidence-based pharmaceutical opinion was developed with input from a convenience sample of 32 primary care physicians and 61 primary care pharmacists, recruited from conferences and community settings in Montreal, Canada...
March 2018: Canadian Pharmacists Journal: CPJ, Revue des Pharmaciens du Canada: RPC
Brian F Mandell
No abstract text is available yet for this article.
March 2018: Cleveland Clinic Journal of Medicine
Yi-Jen Wang, Shu-Chiung Chiang, Pei-Chen Lee, Yu-Chun Chen, Li-Fang Chou, Yueh-Ching Chou, Tzeng-Ji Chen
Objectives: Target populations with persistent polypharmacy should be identified prior to implementing strategies against inappropriate medication use, yet limited information regarding such populations is available. The main objectives were to explore the trends of excessive polypharmacy, whether transient or persistent, at the individual level. The secondary objectives were to identify the factors associated with persistently excessive polypharmacy and to estimate the probabilities for repeatedly excessive polypharmacy...
2018: Frontiers in Pharmacology
Eline Tommelein
No abstract text is available yet for this article.
March 2, 2018: Evidence-based Nursing
Alberto Dolara
Nonadherence to medications is common in cardiovascular diseases because of their long duration, the patient age and the complexity of therapy. Its prevalence depends on the population, the types of drugs and the disease under study. Adherence decreases from the initial prescription and it is usually under 80%, a value defined as satisfactory. Adverse outcomes of nonadherence consist of an increase in ambulatory visits and hospitalization and death rates. The causes of nonadherence are multiple and depend on the patient, the type of medication, the healthcare professional, and the health system...
February 2018: Recenti Progressi in Medicina
Marnie Goodwin Wilson, Todd C Lee, Aaron Hass, Cara Tannenbaum, Emily G McDonald
OBJECTIVES: To distribute the EMPOWER patient education brochure and use hospitalization as an opportunity to reduce inappropriate sedatives. DESIGN: Participants were sequentially recruited until we achieved 30-day follow-up telephone and pharmacy records for 50 individuals. The proportion meeting the primary outcome was compared with that of a control cohort and with rates of cessation achieved in the community. SETTING: Fifty-two-bed medical clinical teaching unit in Montréal, Canada...
March 1, 2018: Journal of the American Geriatrics Society
Ovadyah Avraham, Michael Biglow
BACKGROUND: Deprescribing is a recommended intervention to reduce morbidity and mortality caused by polypharmacy in older residents. However, a lack of definite deprescription guidelines and evidence of clinically meaningful outcomes complicates or precludes the practicality of such an approach. OBJECTIVE: The objective of the present pilot study is to establish and implement a stepwise taper protocol that can potentially minimize overuse of proton pump inhibitors in a safe, effective, and feasible manner in the nursing home...
February 1, 2018: Annals of Pharmacotherapy
Rachel Whitty, Sandra Porter, Kiran Battu, Pranjal Bhatt, Ellen Koo, Csilla Kalocsai, Peter Wu, Kendra Delicaet, Isaac I Bogoch, Robert Wu, James Downar
BACKGROUND: Many seriously ill and frail inpatients receive potentially inappropriate or harmful medications and do not receive medications for symptoms of advanced illness. We developed and piloted an interprofessional Medication Rationalization (MERA) approach to deprescribing inappropriate medications and prescribing appropriate comfort medications. METHODS: We conducted a single-centre pilot study of inpatients at risk of 6-month mortality from advanced age or morbidity...
February 16, 2018: CMAJ Open
Marian Z M Hurmuz, Sarah I M Janus, Jeannette G van Manen
Background The more (inappropriate) drugs a patient uses, the higher the risk of drug related problems. To reduce these risks, medication reviews can be performed. Objective To report changes in the prescribed number of (potentially inappropriate) drugs before and after performing a medication review in high-risk polypharmacy patients. A secondary objective was to study reasons for continuing potentially inappropriate drugs (PIDs). Setting Dutch community pharmacy and general medical practice. Methods A retrospective longitudinal intervention study with a pre-test/post-test design and follow-up of 1 week and 3 months was performed...
February 17, 2018: International Journal of Clinical Pharmacy
Barbara Bień, Katarzyna Bień-Barkowska
INTRODUCTION Multimorbidity in older adults leads to polypharmacy with all its hazardous outcomes and drug related problems. OBJECTIVES We assess the difference in the number of drugs between admission to and discharge from a geriatric ward and identify the patient-related factors associated with changes in the drug regimen. PATIENTS AND METHODS This retrospective cross-sectional study covered 301 geriatric patients who underwent drug optimization in line with the Beers and STOPP/START criteria. The numbers of drugs per individual at hospital admission and discharge were compared using the Wilcoxon signed-rank test...
February 14, 2018: Polish Archives of Internal Medicine
Elizabeth Phung, Laura Triantafylidis, Haipeng Mark Zhang, Irene M Yeh
No abstract text is available yet for this article.
February 2018: Journal of Palliative Medicine
Luís Monteiro, Tiago Maricoto, Isabel S Solha, Matilde Monteiro-Soares, Carlos Martins
INTRODUCTION: Life expectancy continues to increase in developed countries. Elderly people are more likely to consume more medications and become vulnerable to age-related changes in drugs' pharmacokinetics and pharmacodynamics. Recent studies have identified opportunities and barriers for deprescribing potentially inappropriate medications. It has already been demonstrated that computerised decision support systems can reduce physician orders for unnecessary tests. We will systematically review the available literature to understand if computerised decision support is effective in reducing the use of potentially inappropriate medications, thus having an impact on health outcomes...
January 30, 2018: BMJ Open
Edwin C K Tan, Janet K Sluggett, Kristina Johnell, Graziano Onder, Monique Elseviers, Lucas Morin, Davide L Vetrano, Jonas W Wastesson, Johan Fastbom, Heidi Taipale, Antti Tanskanen, J Simon Bell
Medication management is becoming increasingly challenging for older people, and there is limited evidence to guide medication prescribing and administration for people with multimorbidity, frailty, or at the end of life. Currently, there is a lack of clear research priorities in the field of geriatric pharmacotherapy. To address this issue, international experts from 5 research groups in geriatric pharmacotherapy and pharmacoepidemiology research were invited to attend the inaugural Optimizing Geriatric Pharmacotherapy through Pharmacoepidemiology Network workshop...
January 17, 2018: Journal of the American Medical Directors Association
Lise M Bjerre, Barbara Farrell, Matthew Hogel, Lyla Graham, Geneviève Lemay, Lisa McCarthy, Lalitha Raman-Wilms, Carlos Rojas-Fernandez, Samir Sinha, Wade Thompson, Vivian Welch, Andrew Wiens
OBJECTIVE: To develop an evidence-based guideline to help clinicians make decisions about when and how to safely taper and stop antipsychotics; to focus on the highest level of evidence available and seek input from primary care professionals in the guideline development, review, and endorsement processes. METHODS: The overall team comprised 9 clinicians (1 family physician, 1 family physician specializing in long-term care, 1 geriatric psychiatrist, 2 geriatricians, 4 pharmacists) and a methodologist; members disclosed conflicts of interest...
January 2018: Canadian Family Physician Médecin de Famille Canadien
Rachel Lumish, Joshana K Goga, Nicole J Brandt
The use of opioid drug therapy in older adults has increased over the past decade. Although use of opioid drugs may be clinically warranted, ongoing use needs to be monitored closely to evaluate risks and benefits, especially with the potential for adverse events and misuse. An opioid drug deprescribing protocol would provide clinicians with a method to assess an individual's need for opioid agents, as well as a systematic process to taper opioid drug therapy when deemed appropriate. Although more than 60 studies have reported methods for deprescribing, there is currently no established guideline for discontinuing opioid medications...
January 1, 2018: Journal of Gerontological Nursing
Ivana Ivanova, Maarten Wauters, Robert Vander Stichele, Thierry Christiaens, Jonas De Wolf, Tine Dilles, Monique Elseviers
BACKGROUND: Medication use is high among nursing home (NH) residents, but there is a lack of longitudinal studies, determining medication use at admission and its evolution over time. AIM: Describing the evolution of the medication use two years after entering a NH, compared to the baseline observations and exploring the relation to the physical and mental health. METHODS: Data from the observational prospective Ageing@NH study, based on an inception cohort of newly admitted residents at NHs (65+) was used, selecting those consenting and with medication chart available...
January 17, 2018: Archives of Gerontology and Geriatrics
Clare H Luymes, Rosalinde K E Poortvliet, Nan van Geloven, Margot W M de Waal, Yvonne M Drewes, Jeanet W Blom, Nynke Smidt, Willem J J Assendelft, Wilbert B van den Hout, Wouter de Ruijter, Mattijs E Numans
BACKGROUND: The use of cardiovascular medication for the primary prevention of cardiovascular disease (CVD) is potentially inappropriate when potential risks outweigh the potential benefits. It is unknown whether deprescribing preventive cardiovascular medication in patients without a strict indication for such medication is safe and cost-effective in general practice. METHODS: In this pragmatic cluster randomised controlled non-inferiority trial, we recruited 46 general practices in the Netherlands...
January 11, 2018: BMC Medicine
A H Abdelhafiz, A J Sinclair
IMPORTANCE: Intensive treatment of older people with diabetes is common placing them at increased risk of adverse events such as hypoglycaemia and hospitalisation for drug errors. Little is known about when, how or for whom to deintensify hypoglycaemic medications. OBJECTIVE: To explore the characteristics of patients for whom deintensification is appropriate and to determine the outcome of deintensification. EVIDENCE REVIEW: Medline, Google scholar and EmBase search from 1997 to present was performed using keywords relating to diabetes mellitus, polypharmacy, hypoglycaemia, hospitalisation, deintensification, deprescribing and reduction, simplification or withdrawal of hypoglycaemic medications...
November 29, 2017: Journal of Diabetes and its Complications
Kristel Paque, Monique Elseviers, Robert Vander Stichele, Koen Pardon, Marianne J Hjermstad, Stein Kaasa, Tinne Dilles, Martine De Laat, Simon Van Belle, Thierry Christiaens, Luc Deliens
BACKGROUND: Information on medication use in the last months of life is limited. AIM: To describe which medications are prescribed and deprescribed in advanced cancer patients receiving palliative care in relation to time before death and to explore associations with demographic variables. DESIGN: Prospective study, using case report forms for monthly data collection. Medication included cancer treatment and 19 therapeutic groups, grouped into four categories for: (1) cancer therapy, (2) specific cancer-related symptom relief, (3) other symptom relief and (4) long-term prevention...
December 1, 2017: Palliative Medicine
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