Clinical impact of potentially inappropriate medications during hospitalization of acutely ill older patients with multimorbidity

Kersten, Hege; Hvidsten, Lara T; Gløersen, Gløer; Wyller, Torgeir Bruun; Wang-Hansen, Marte Sofie

doi:10.3109/02813432.2015.1084766

Cited by 33 publications

(73 citation statements)

References 29 publications

(33 reference statements)

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“…Transitions of care, especially hospitalizations, common in the course of dementia play a key role in medication management. They offer an opportunity for medication review and deprescription but may also lead to an increased use of medications . During hospitalization, medications may be added to treat health problems that led to admission or conditions that occurred or worsened during hospitalization (such as agitation, pain, delirium, or infections) and may be maintained after discharge.…”

Section: Introductionmentioning

confidence: 99%

Anticholinergic burden before and after hospitalization in older adults with dementia: Increase due to antipsychotic medications

Reinold

Palese

Romanese

et al. 2019

Int J Geriat Psychiatry

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Objectives: To evaluate changes in the use of antipsychotics and medications with anticholinergic activity (MACs) during hospitalization in older adults with dementia and factors associated with antipsychotic prescriptions and increased anticholinergic burden (ACB). Methods and design:This retrospective cohort study included all patients aged 65 years or older with a discharge diagnosis of dementia hospitalized at the university hospital of Udine, Italy, from 2012 to 2014. Medications dispensed within 3 months before and after hospitalization were identified in community-pharmacy dispensations while those prescribed at discharge were collected from Hospital Electronic Medical Records (EMR). ACB was assessed using the Anticholinergic Cognitive Burden score.Results: Among 1908 patients included, at discharge, 37.0% used one or more antipsychotic (9.4% before and 12.6% after hospitalization), 68.6% used one or more MAC (49.1% and 45.7%, respectively), and ACB of 38.4% of patients increased at discharge mainly because of a higher use of antipsychotics with anticholinergic activity (33% at discharge vs 12% before hospitalization). Prescription of antipsychotics at discharge was associated with prior treatment with antipsychotics (adjusted odds ratio [aOR] 4.85; 95%CI, 3.37-6.97), psychiatric conditions, (4.39; 3.47-5.54) and discharge from surgical department (2.17; 1.32-3.55). An increased ACB was associated with psychiatric conditions (1.91; 1.52-2.39), discharge from surgical (1.75; 1.09-2.80) or medical department (1.50; 1.04-2.17), and with cardiac insufficiency (1.41; 1.00-1.99).Conclusions: ACB was higher at discharge, and antipsychotics were the main drivers of this increase. Clinicians treating older adults with dementia should be aware of the risks associated with antipsychotics and that some of these medications may increase the risk of anticholinergic effects.

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Section: Introductionmentioning

confidence: 99%

Anticholinergic burden before and after hospitalization in older adults with dementia: Increase due to antipsychotic medications

Reinold

Palese

Romanese

et al. 2019

Int J Geriat Psychiatry

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“…Certain changes in drug prescription profiles were found before and after hospitalization, such as an increase in the proportion of patients using antithrombotic agents and lipid modifying agents due to the high prevalence of cardiovascular diseases. A reduction in the number of patients who were prescribed psycholeptics, mainly diazepam, was highlighted, as reported by the Norwegian study (Kersten et al, 2015). A prospective cohort study with patients aged 70 years and over in Australian hospitals investigated the use of benzodiazepines in acute care settings and explored the association with falls before (during a 90-day period prior to admission) and during hospitalization.…”

Section: Discussionmentioning

confidence: 88%

“…The study used the Norwegian General Practice (NORGEP) criteria for PIM. The authors also found that the medication profile was more appropriate among elderly patients in the geriatric ward and a greater reduction of dosage and prescription of PIMs in comparison to other patients (Kersten et al, 2015). Certain changes in drug prescription profiles were found before and after hospitalization, such as an increase in the proportion of patients using antithrombotic agents and lipid modifying agents due to the high prevalence of cardiovascular diseases.…”

Section: Discussionmentioning

confidence: 94%

Does hospital admission provide an opportunity for improving pharmacotherapy among elderly inpatients?

Melo

Storpirtis

Ribeiro

2016

Braz. J. Pharm. Sci.

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The purpose of the work was to assess the incidence of potential drug interactions (pDDI), major pDDI, and the use of potentially inappropriate medication (PIM) at hospital admission, during hospitalization, and at discharge to evaluate whether hospital admission provides an opportunity for improving pharmacotherapy in elderly patients at a University hospital that has a clinical pharmacist. A prospective cohort study was carried out using data from the medical records of patients admitted to an internal medicine ward. All admissions and prescriptions were monitored between March and August 2006. Micromedex® DrugReax® and Beers Criteria 2015 were used to identify pDDI, major pDDI, and PIMs, respectively. A comparison of admission and discharge prescriptions showed the following: an increase in the proportion of patients using antithrombotic agents (76 versus 144; p<0.001), lipid modifying agents (58 versus 81; p=0.024), drugs for acid-related disorders (99 versus 152; p<0.001), and particularly omeprazole (61 versus 87; p=0.015); a decrease in the number of patients prescribed psycholeptics (73 versus 32; p<0.001) and diazepam (54 versus 13; p<0.001); and a decrease in the proportion of patients exposed to polypharmacy (16.1% versus 10.1%; p=0.025), at least one pDDI (44.5% versus 32.8%; p=0.002), major pDDI (19.9% versus 12.2%; p=0.010) or PIM (85.8% versus 51.9%; p<0.001). The conclusion is that admission to a hospital ward that has a clinical pharmacist was associated with a reduction in the number of patients exposed to polypharmacy, pDDI, major pDDI, and the use of PIMs among elderly inpatients.Uniterms:. Health Services/elderly patients. Internal Medicine/hospitals. Clinical Pharmacy. Drug interactions. Drug prescriptions.

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“…Regueiro et al (17) , evaluaron el uso de medicamentos y la prescripción inadecuada en 215 adultos mayores de la comunidad en ciudad de La Plata, encontrando frecuencias de medicación potencialmente inapropiada en 25,5%, 31,9% y 30% según los criterios de Beers, lista PRISCUS y criterios STOPP. Kersten et al (18) también evaluaron a 232 adultos mayores de 75 años, procedentes de la comunidad y con comorbilidad, admitidos a emergencia, encontrando que la hospitalización no cambió la frecuencia de polifarmacia o el uso de medicación potencialmente inapropiada, hubo mejor manejo de medicación por equipos geriátricos multidisciplinario y no hubo impacto en las mediciones clínicas evaluadas (mental, funcional, fragilidad y velocidad de la marcha).…”

Section: La Prescripción Inadecuada De Medicamentos En El Adulto Mayorunclassified

Estrategias para optimizar el manejo farmacológico en el adulto mayor

Casas-Vásquez¹,

Ortiz-Saavedra²,

Penny-Montenegro³

2016

Rev Peru Med Exp Salud Publica

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RESUMENEl envejecimiento de la población tiene como consecuencia incrementos en la prevalencia de enfermedades crónicas y de multimorbilidad, en el consumo de múltiples fármacos y los problemas relacionados con los mismos. Se reporta que más del 50% de todos los medicamentos expendidos son consumidos por adultos mayores; más del 80% de las personas adultas mayores toman al menos una medicación diaria y 75% no informa a su médico que usa tratamientos no convencionales. Prescribir de forma apropiada en el adulto mayor es un trabajo difícil que requiere considerar un balance entre los riesgos y beneficios de las medicinas indicadas, las cuales suelen no tener una evidencia clara de su eficacia, dada la poca representatividad de la población adulta mayor en los ensayos clínicos randomizados sobre los cuales se basan las guías clínicas para el manejo de las enfermedades crónicas, condiciones altamente prevalentes en la población adulta mayor. Sin embargo, existen directrices y recomendaciones generales que deben de aplicarse de forma integral, apoyados por un equipo multidisciplinario, toda vez que se realice un manejo farmacológico en el adulto mayor. En este artículo, nos enfocamos en promover la prescripción adecuada sobre la base de recomendaciones basadas en evidencia para disminuir la medicación inapropiada, la polifarmacia y la automedicación.Palabras clave: adulto mayor, farmacoterapia, polifarmacia, automedicación (fuente: DeCS BIREME). STRATEGIES TO OPTIMIZE PHARMACOLOGICAL MANAGEMENT IN OLDER ADULTS ABSTRACTPopulation aging increases the prevalence of chronic and multiple morbid illnesses and increases the consumption of multiple medications and related problems accordingly. It is reported that >50% of dispensed medications are consumed by older adults; in fact, >80% of older adults take at least one medication daily and 75% do not inform their doctor that they are using unconventional treatments. Appropriate medication prescription to older adults is challenging and it requires the consideration of risks and benefits of the indicated medications, for which clear evidence of their efficacy is often lacking due to the limited inclusion of elderly populations in randomized clinical trials on which clinical guides are based for chronic disease management. However, general guidelines and recommendations must be comprehensively implemented and supported by a multidisciplinary team whenever pharmacological management is provided for older adults. Here we focus on promoting proper prescriptions according to evidence-based recommendations to reduce inappropriate prescriptions, polypharmacy, and self-medication words: elderly, pharmacotherapy, polypharmacy, self-medication (source: MESH NLM). Key INTRODUCCIÓNLa transición demográfica ya no es exclusiva de los países desarrollados, y este acelerado proceso de envejecimiento de la población trae consecuencias como incrementos en la prevalencia de enfermedades crónicas, de multimorbilidad, en el consumo de múltiples fármacos y, por ende, en los problemas relacionados ...

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Clinical impact of potentially inappropriate medications during hospitalization of acutely ill older patients with multimorbidity

Cited by 33 publications

References 29 publications

Anticholinergic burden before and after hospitalization in older adults with dementia: Increase due to antipsychotic medications

Anticholinergic burden before and after hospitalization in older adults with dementia: Increase due to antipsychotic medications

Does hospital admission provide an opportunity for improving pharmacotherapy among elderly inpatients?

Estrategias para optimizar el manejo farmacológico en el adulto mayor

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