Although the incidence and prevalence of serious adverse drug reactions (ADRs) in the elderly cannot be accurately stated, published estimates appear to be unchanged since the earliest reports in the 1960s. Whereas heightened awareness of the problem may weigh in favour of a reduction in ADR frequency, the dramatic increase in the number and availability of therapeutic agents has undoubtedly contributed to the observed high proportion of drug-induced morbidity among acute geriatric hospital admissions. No single drug or drug class is of particular concern since none appears to cause serious morbidity out of proportion with its use. Although numerous studies have sought to identify risk factors for ADRs, the only truly independent predictor is the absolute number of concurrently used medications. However, other studies indicate that there is poor doctor-patient agreement regarding a patient's drug regimen, and interventions that aim to reduce the incidence of ADRs have failed to demonstrate a positive effect. Thus at present the most rational approach would appear to be to establish an accurate knowledge of the patients drug regimens: once this is known one can attempt to rationally minimise the number of medications without compromising therapeutic goals.
A pharmacist-led multidisciplinary process was successfully developed and implemented within the hospital setting to increase overall antithrombotic use. Having addressed some of the known barriers and limitations to warfarin use, these algorithms may allow allied health workers, patients, and clinicians to work collaboratively to achieve optimal and, importantly, appropriate (i.e., safe and effective) antithrombotic use in at-risk elderly patients.
This study measured the prevalence of difficulty experienced by elderly inpatients in opening and removing tablets from a range of common commercial medication packagings and in breaking a bar-scored tablet in half. One hundred and twenty elderly patients admitted to a teaching hospital acute geriatric service were tested for their ability to open the container and remove a tablet from it. They were rated as 'able' or 'unable' to do so. In all, 94 patients (78.3%) were unable to break a tablet or open one or more of the containers. Of the 111 patients taking medication at the time of their admission, 46 (41.4%) were unable to perform one or more tasks necessary to gain access to medications in their own treatment regimen. The factors that were significantly and independently associated with inability to open containers were poor vision, impaired general cognitive function, and female sex. Many of the drug packagings in common use significantly impede access by elderly patients to their medications.
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