Drugs with anticholinergic properties identified by the ACB scale and ARS are associated with worse cognitive and functional performance in elderly patients. The ACB scale might permit a rapid identification of drugs potentially associated with cognitive impairment in a dose-response pattern, but the ARS is better at rating activities of daily living.

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Hospitalization was associated with an increase in potentially severe DDIs. A significant association was found for mortality at 3 months after discharge in patients with at least two potentially severe DDIs. Careful monitoring for potentially severe DDIs, especially those created at discharge or recently generated, is important to minimize the risk of harm.

AIMSThe aim of the study was to evaluate the effect of an e-learning educational program meant to foster the quality of drug prescription in hospitalized elderly patients. METHODSTwenty geriatric and internal medicine wards were randomized to intervention (e-learning educational program) or control (basic geriatric pharmacology notions). Logistic regression analysis was used in order to assess the effect of the intervention on the use of potentially inappropriate medication (PIM, primary outcome) at hospital discharge. Secondary outcomes were a reduced prevalence of at least one potential drug-drug interaction (DDI) and potentially severe DDI at discharge. Mortality rate and incidence of re-hospitalizations were other secondary outcomes assessed at the 12-month follow-up. RESULTSA total of 697 patients (347 in the intervention and 350 in the control arms) were enrolled. No difference in the prevalence of PIM at discharge was found between arms (OR 1.29 95%CI 0.87-1.91). We also found no decrease in the prevalence of DDI (OR 0.67 95%CI 0.34-1.28) and potentially severe DDI ) at discharge, nor in mortality rates and incidence of rehospitalization at 12-month follow-up. CONCLUSIONSThis e-learning educational program had no clear effect on the quality of drug prescription and clinical outcomes in hospitalized elderly patients. Given the high prevalence of PIMs and potential DDIs recorded in the frame of this study, other approaches should be developed in order to improve the quality of drug prescription in this population. British Journal of Clinical Pharmacology WHAT IS ALREADY KNOWN ABOUT THIS SUBJECT• Older people usually have multiple chronic diseases, so that they are often exposed to chronic polypharmacy and to a high risk of prescription of potentially inappropriate medications and drug-drug interactions.• E-learning is a educational technology with several advantages, never used before for improvement of drug prescription in hospitalized older people. WHAT THIS STUDY ADDS• This e-learning educational program failed to improve the quality of drug prescription in older patients acutely hospitalized in internal medicine and geriatrics wards.• But this randomized-controlled study confirms the high prevalence of PIM, DDI and severe DDI in hospitalized older people and confirms that drug-related problems and drug-drug interactions are often underestimated issues among clinicians. IntroductionIn Western countries, people aged 75 years or older are the fastest growing segment of the population, and will account for more than 20% of the total population by 2060 [1]. This group is characterized by the occurrence of multiple chronic diseases, almost always accompanied by the use of multiple drugs (polypharmacy) [1][2][3]. Polypharmacy has been associated with negative outcomes, including adverse drug reactions (ADRs) and increased risks of morbidity, mortality and multiple hospital admissions [2,4]. Older people are usually frail and more susceptible to ADRs owing to changes in pharmacokinetics and pharmacodynamics [5...

The combination of an educational intervention and the CPSS can achieve a significant reduction in potentially inappropriate psychotropic drug use, psychotropic duplicates, and potentially severe DDIs in nursing homes.

Background Shoulder pain is one of the most frequent musculoskeletal complaints, and its prevalence and consequences increase with age. However, little is known about the incidence of shoulder pain among aging adults. We conducted this review to estimate the incidence of shoulder pain in ageing adults and its associated factors. Databases and data treatment We conducted a systematic review of cohort studies in which the incidence of shoulder pain and associated factors were explored in adults aged 40 years and over. PubMed, Embase, and Web of Science databases were consulted. Results We retrieved 3332 studies and included six, of which five were prospective cohort studies and one was retrospective. For adults aged 45–64 years, the annual cumulative incidence was 2.4%. The incidence density was estimated at 17.3 per 1,000 person‐years for adults in the 45–64 years age group, at 12.8 per 1000 person‐years for those in the 65–74 years group and at 6.7 per 1000 person‐years among those aged 75 years and over. Occupational factors, notably physical demands of work, were associated with the incidence of shoulder pain. Non‐occupational factors were also linked to the occurrence of shoulder pain. Conclusion Few studies have estimated the incidence of shoulder pain and associated factors among ageing adults. From this systematic review, we conclude that studies on the incidence of shoulder pain are scarce, and that both occupational and non‐occupational factors could be associated with the onset of shoulder pain among adults 40 years and over. This very limited evidence calls for more studies on this topic. Significance Shoulder pain is one of the most frequent musculoskeletal complaints, and its prevalence and consequences increase with age. However, since the prevalence of a recurring condition is determined by its incidence and the number and duration of episodes, it is important to have valid incidence estimates and to conduct aetiological studies on incidence measures to untangle risk factors of the occurrence of shoulder pain from those affecting the duration and number of episodes . In this systematic review, we sought to estimate the incidence of shoulder pain in ageing adults along with its associated factors. This work could lead to better interventions to prevent shoulder pain in older individuals.

Background: Few studies evaluated the clinical outcomes of Community Acquired Pneumonia (CAP), Hospital-Acquired Pneumonia (HAP) and Health Care-Associated Pneumonia (HCAP) in relation to the adherence of antibiotic treatment to the guidelines of the Infectious Diseases Society of America (IDSA) and the American Thoracic Society (ATS) in hospitalized elderly people (65 years or older). Methods: Data were obtained from REPOSI, a prospective registry held in 87 Italian internal medicine and geriatric wards. Patients with a diagnosis of pneumonia (ICD-9 480-487) or prescribed with an antibiotic for pneumonia as indication were selected. The empirical antibiotic regimen was defined to be adherent to guidelines if concordant with the treatment regimens recommended by IDSA/ATS for CAP, HAP, and HCAP. Outcomes were assessed by logistic regression models. Results: A diagnosis of pneumonia was made in 317 patients. Only 38.8% of them received an empirical antibiotic regimen that was adherent to guidelines. However, no significant association was found between adherence to guidelines and outcomes. Having HAP, older age, and higher CIRS severity index were the main factors associated with in-hospital mortality. Conclusions: The adherence to antibiotic treatment guidelines was poor, particularly for HAP and HCAP, suggesting the need for more adherence to the optimal management of antibiotics in the elderly with pneumonia

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