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polypharmacy and elderly

Ann E Vandenberg, Katharina V Echt, Lawanda Kemp, Gerald McGwin, Molly M Perkins, Anna K Mirk
Suboptimal prescribing persists as a driver of poor quality care of older veterans and is associated with risk of hospitalization and emergency department visits. We adapted a successful medication management model, Integrated Management and Polypharmacy Review of Vulnerable Elders (IMPROVE), from an urban geriatric specialty clinic to rural community-based clinics that deliver primary care. The goals were to promote prescribing quality and safety for older adults, including reduced prescribing of potentially inappropriate medications (PIMs)...
March 2018: Journal of the American Geriatrics Society
M Fernández, C Valbuena, C Natal
OBJECTIVES: To describe the risk factors and the effect of medication use on the risk of falls in a population of 65 years or older. MATERIAL AND METHODS: Descriptive study of falls in the elderly population. The risk factors and consequences of the fall were recorded. Hypnotic and sedative risk drugs, opioids, and the simultaneous consumption of six or more drugs were considered. Diuretics were also included. The cumulative incidence for each group and the corresponding relative risks of falls were analysed from the cases registered between June and November 2016...
March 9, 2018: Revista de Calidad Asistencial: Organo de la Sociedad Española de Calidad Asistencial
Manuel E Machado-Duque, Juan Pablo Castaño-Montoya, Diego A Medina-Morales, Alejandro Castro-Rodríguez, Alexandra González-Montoya, Jorge E Machado-Alba
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...
January 1, 2018: Journal of Geriatric Psychiatry and Neurology
Dagmar Schaffler-Schaden, Stefan Pitzer, Magdalena Schreier, Johanna Dellinger, Beate Brandauer-Stickler, Miriam Lainer, Maria Flamm, Jürgen Osterbrink
Polypharmacy in elderly people is an increasing challenge for health professionals. Drug-Drug interactions, dosing or administration errors can cause preventable incidents and hospitalizations. Due to chronic illness and multi-morbidity, older people are considered as a particularly vulnerable group of patients. Furthermore, it is well known that communication between health professionals is often insufficient. The aim of this study is to improve the appropriateness of medication of nursing home residents by establishing a long-term structured medication review process and to enhance the interprofessional communication between general practitioners (GPs), nurses and pharmacists...
March 9, 2018: Journal of Interprofessional Care
Manuel P Pereira, Sonja Ständer
The prevalence of chronic pruritus (CP) in the general population is high and increases with age. Owing to high rates of comorbidities and polypharmacy in patients aged 65 or older, the clinical management of these patients is challenging. Areas covered: In this review, the authors discuss the available therapy options for patients aged ≥ 65 with CP, including emollients for dry skin, topical therapies, phototherapy and systemic agents for CP of various origins. Expert opinion: For multimorbid patients, topical substances and phototherapy constitute the best initial options...
March 1, 2018: Expert Opinion on Pharmacotherapy
Antonis Goulas, Nikolaos Raikos, Diamantis Krokos, Orthodoxia Mastrogianni, Amvrosios Orphanidis, Konstantinos Zisopoulos, Androniki Tsepa
Serotonin-specific reuptake inhibitors (SSRIs) are generally considered safe drugs but fatal adverse effects do sometimes occur, often as a consequence of interactions with other serotonin active drugs. Polypharmacy is usually a problem that the elderly encounter, but it can also have dire consequences for young people, especially when an underlying heart condition is present. Thus, failure to diagnose heart disease and the use of contraindicated medications can be a lethal combination, irrespective of age...
February 27, 2018: Forensic Science, Medicine, and Pathology
Dirk Müller-Wieland
Diabetes in older adults has a high prevalence and is frequently associated with comorbidities of the cardiovascular system, dysfunction of cognition as well as depression and impaired mobility or increased frailty. Furthermore, impaired renal function, heart failure, risk for hypoglycemia and polypharmacy has to be considered in the decision about the diabetes treatment strategy. The goal of blood glucose management is driven by patient relevant issues and patient self-esteem, quality of life defined by the patient, preservation of physical and social mobility rather than potential long-term effects on reduction of cardio- and microvascular events in the future, which is limited by patient-inherent reduced life expectancy of the aged individual...
February 2018: Deutsche Medizinische Wochenschrift
Robert H G Schwinger
Elderly people show increased probability to develop atherosclerotic diseases; in consequence heart failure - most often following coronary heart disease - as well as atrial fibrillation is more common. Following guidelines may lead to polypharmacy, i. e. use of more than 5 drugs daily. Thus, drug interactions as well as side effects become more likely; especially in elderly patients reduced kidney function has to be taken into account. Only drugs which have shown to prolong life or to reduce symptoms in controlled clinical trials should be used...
February 2018: Deutsche Medizinische Wochenschrift
Jill Nawrot, Annelies Boonen, Ralph Peeters, Mirian Starmans, Marloes van Onna
OBJECTIVE: In this qualitative study we analyzed the (1) influence of age, comorbidity, and frailty on management goals in elderly patients with RA; (2) experiences of rheumatologists regarding the use of the Disease Activity Score at 28 joints (DAS28) to monitor disease activity; and (3) differences in management strategies in elderly patients with RA compared to their younger counterparts. METHODS: Rheumatologists were purposively sampled for a semistructured interview...
February 15, 2018: Journal of Rheumatology
Virtudes Pérez-Jover, José J Mira, Concepción Carratala-Munuera, Vicente F Gil-Guillen, Josep Basora, Adriana López-Pineda, Domingo Orozco-Beltrán
The growth of the aging population leads to the increase of chronic diseases, of the burden of multimorbility, and of the complexity polypharmacy. The prevalence of medication errors rises in patients with polypharmacy in primary care, and this is a major concern to healthcare systems. This study reviews the published literature on the inappropriate use of medicines in order to articulate recommendations on how to reduce it in chronic patients, particularly in those who are elderly, polymedicated, or multipathological...
February 10, 2018: International Journal of Environmental Research and Public Health
Luke D Kim, Kenneth Koncilja, Craig Nielsen
Managing medications is a major part of providing care to older adults. Polypharmacy is common in the elderly and is fraught with risks. A careful and systematic approach is needed for managing drug therapy in these patients, recognizing the patient's specific goals.
February 2018: Cleveland Clinic Journal of Medicine
Roberto Castelli, Riccardo Schiavon, Giorgio Lambertenghi Deliliers
Myelodysplastic syndromes (MDS) are heterogeneous clonal disorders ranging from indolent conditions with a near-normal life expectancy to forms approaching acute myeloid leukaemia. Comorbid conditions have rarely been systematically studied among patients with MDS. Older age per se has a negative impact on survival of MDS patients, in particular of those with lower risk. However, age indirectly affects also the survival of higher-risk patients by limiting their eligibility to intensive treatments. In addition, ageing is associated with an increasingly high risk of developing comorbidity, and a high prevalence of comorbid diseases has indeed been reported in MDS patients...
February 8, 2018: Medical Oncology
Kyung Suk Choi, Young Mi Jeong, Eunsook Lee, Kwang Ill Kim, Jeong Yee, Byung Koo Lee, Jee Eun Chung, Sandy Jeong Rhie, Hye Sun Gwak
BACKGROUND: Comprehensive geriatric assessment (CGA) has become a predictor for elderly cancer patients in post-surgical complications, including post-discharge institutionalization and mortality. AIMS: To determine whether pre-operative medication use is associated with post-operative morbidity and mortality in oncology patients receiving CGA. METHODS: Patients aged 65 years or older who were scheduled for cancer surgery and presented for CGA were included in the present study...
February 6, 2018: Aging Clinical and Experimental Research
Lidwien C Lemmens, Gepke O Delwel, Renske J Hoefman, Judith D de Jong, Marjolein Weda
Frail elderly with polypharmacy are at greater risk of preventable medication-related health damage. To improve medication safety, the healthcare field prepared, in consultation with the Dutch Health Care Inspectorate, a number of guidelines and standards containing conditions for safe prescribing. According to these standards the active involvement of patients by health care professionals is essential for good pharmacotherapeutic care. However, two studies with patients show that there is still room for improvement...
February 6, 2018: Tijdschrift Voor Gerontologie en Geriatrie
Silvia Giovannini, Henriëtte G van der Roest, Angelo Carfì, Harriet Finne-Soveri, Vjenka Garms-Homolová, Anja Declercq, Pálmi V Jónsson, Hein van Hout, Davide L Vetrano, Ester Manes Gravina, Roberto Bernabei, Graziano Onder
BACKGROUND: Home care (HC) patients are characterized by a high level of complexity, which is reflected by the prevalence of multimorbidity and the correlated high drug consumption. This study assesses prevalence and factors associated with polypharmacy in a sample of HC patients in Europe. METHODS: We conducted a cross-sectional analysis on 1873 HC patients from six European countries participating in the Identifying best practices for care-dependent elderly by Benchmarking Costs and outcomes of community care (IBenC) project...
February 6, 2018: Drugs & Aging
Izabella Uchmanowicz, Anna Chudiak, Beata Jankowska-Polańska, Robbert Gobbens
Hypertension is both a health problem and a financial one globally. It affects nearly 30 % of the general population. Elderly people, aged ≥65 years, are a special group of hypertensive patients. In this group, the overall prevalence of the disease reaches 60 %, rising to 70 % in those aged ≥80 years. In the elderly population, isolated systolic hypertension is quite common. High systolic blood pressure is associated with an increased risk of cardiovascular disease, cerebrovascular disease, peripheral artery disease, cognitive impairment and kidney disease...
November 2017: Cardiac failure review
Shoichi Masumoto, Mikiya Sato, Takami Maeno, Yumiko Ichinohe, Tetsuhiro Maeno
BACKGROUND: The use of dietary supplements and over-the-counter (OTC) drugs is increasing, and there is adequate concern about potential harmful effects. However, there are limited reports on the concurrent use of nonprescription medications with prescription medications in elderly patients. Therefore, this study was conducted to describe the use of dietary supplements and OTC drugs, and to identify predictors for their use in elderly patients using medications prescribed for chronic diseases...
January 24, 2018: BMC Family Practice
Masahiro Takahashi
The elderly population is heterogeneous. Chronological age alone does not reflect heterogeneity in the aging process. It is recommended that elderly cancer patients should be evaluated for some form of geriatric assessment(GA)to detect problems, to predict treatment-related toxicities, to predict functional decline, to predict prognosis, and to assist in cancer treatment decisions. It was reported that functional status, nutritional status, mental status, polypharmacy, and comorbidity were independent prognostic factors for survival in elderly cancer patients...
January 2018: Gan to Kagaku Ryoho. Cancer & Chemotherapy
Doron Garfinkel, Nataly Ilin, Alexander Waller, Ashley Torkan-Zilberstein, Netanel Zilberstein, Itai Gueta
BACKGROUND: Elderly patients are exposed to increased number of medications, often with no proof of a positive benefit/risk ratio. Unfortunately, this trend does not spare those with limited life expectancy, including end-stage cancer patients who require only palliative treatment. For many medications in this subpopulation, the risk of adverse drug events outweighs the possible benefits and yet, many are still poly-medicated during their last year of life. AIM: To describe the extent of polypharmacy among end-stage cancer patients, at the time of admission to homecare hospice...
January 23, 2018: International Journal of Clinical Practice
Štefan Alušík, Zoltán Paluch
In 2011/2012, the US Food and Drug Administration issued a warning about the effect of citalopram on the QT interval and decreased its dosing. Further studies addressing this issue have been published since then. The authors were interested to know whether or not the studies have furnished new information that could modify or further specify the FDA-issued recommendations. After analyzing the most relevant studies, the authors concluded that even papers published within the last 5 years confirmed that, of the SSRI class of drugs, citalopram prolongs the QT interval most significantly...
2018: Vnitr̆ní Lékar̆ství
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