Comparing the Prevalence of Polypharmacy and Potential Drug-Drug Interactions in Nursing Homes and in the Community Dwelling Elderly of Emilia Romagna Region

Burato, Sofia; Leonardi, Luca; Antonazzo, Ippazio Cosimo; Raschi, Emanuel; Ajolfi, Chiara; Baraghini, Manuela; Chiarello, Antonella; Delmonte, V.; Castri, L Di; Donati, Monia; Fadda, Antonella; Fedele, Daniela; Ferretti, Alessandra; Gabrielli, Laura; Gobbi, Silvia; Lughi, Sereno; Mazzari, Martina; Pieraccini, Fabio; Renzetti, Alessandro; Russi, Elsa; Scanelli, Chiara; Zanetti, Barbara; Poluzzi, Elisabetta

doi:10.3389/fphar.2020.624888

Cited by 17 publications

(22 citation statements)

References 28 publications

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“…In good agreement with the findings of the international literature [ 20 , 21 , 22 , 23 , 24 ], women showed higher STOPP alerts and lower START alerts.…”

Section: Discussionsupporting

confidence: 91%

Nutritional Status and Potentially Inappropriate Medications in Elderly

Loddo

Salis

Rundeddu

et al. 2022

JCM

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(1) Background: The association between polypharmacy and malnutrition has been investigated in several studies; however, few of these specifically deepened the relationship between potentially inappropriate medication and malnutrition. With a descriptive approach, the primary aim of our study was to evaluate the impact of the nutritional status, assessed with the Mini Nutritional Assessment (MNA), on potentially inappropriate medications (PIM), estimated 10-year survival, and the risk of adverse drug reactions in elderly patients; the secondary aim was to evaluate how the Screening Tool of Older People’s Prescriptions (STOPP), Screening Tool to Alert to Right Treatment (START), and BEERS 2019 criteria identify PIM compared to nutritional status. (2) Methods: In this study, 3091 subjects were enrolled, of whom 2748 (71.7%) were women; the median age was 80 years, with an interquartile range between 75 and 85 years of age. The subjects were assessed at the outpatient service for frail older people of the University Hospital of Cagliari. The study population was evaluated for their: MNA, Charlson Comorbidity Index, 10-year survival estimation, BEERS 2019, STOPP and START criteria, and ADR Risk scores. (3) Results: We divided the study population into three groups: MNA1 (MNA score ≥ 24), MNA2 (23.5–17), and MNA3 (<17): the severity of comorbidities, STOPP and START alerts, and BEERS 2019 criteria were significantly worse in both MNA2 and MNA3 compared to MNA1—with the exception of BEERS “non-anti-infective medications that should be avoided or have their dosage reduced with varying levels of kidney function in older adults”. Moreover, the estimated 10-year survival was significantly higher in MNA1 than in MNA2 and MNA3, and also in MNA2 compared to MNA3. Finally, the ADR risk scores were significantly lower in MNA1 than in MNA2 and MNA3. (4) Conclusions: Our study demonstrated the association between nutritional status and PIM checked with the BEERS 2019 criteria, and, for the first time, with the STOPP and START criteria.

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“…In good agreement with the findings of the international literature [ 20 , 21 , 22 , 23 , 24 ], women showed higher STOPP alerts and lower START alerts.…”

Section: Discussionsupporting

confidence: 91%

Nutritional Status and Potentially Inappropriate Medications in Elderly

Loddo

Salis

Rundeddu

et al. 2022

JCM

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“…6,7 The reasons for this higher burden in the elderly are multiple and involve higher exposure to polymedication, changes in pharmacokinetics and/ or pharmacodynamics, and a care trajectory involving a higher number of health professionals. 8,9 In this population, the prevalence of dispensing for drugs whose concomitant use is contraindicated was estimated to be 0.4%, and 2.3% for drugs whose concomitant use is discommended. 10 As not all concomitant use of drugs known to interact leads to situations of clinically meaningful DDIs and, potentially, to adverse reactions, prevalence/incidence studies of such at-risk coprescribing or codispensing cannot preclude the concrete clinical impact of DDIs.…”

Section: Introductionmentioning

confidence: 98%

“…DDIs are estimated to be responsible for about 1% of hospital admissions in the general population 4,5 and 2 to 5% of hospital admissions in elderly patients 6,7 . The reasons for this higher burden in the elderly are multiple and involve higher exposure to polymedication, changes in pharmacokinetics and/or pharmacodynamics, and a care trajectory involving a higher number of health professionals 8,9 . In this population, the prevalence of dispensing for drugs whose concomitant use is contraindicated was estimated to be 0.4%, and 2.3% for drugs whose concomitant use is discommended 10 …”

Section: Introductionmentioning

confidence: 99%

Emergency department admissions induced by drug–drug interactions in the elderly: A cross‐sectional study

Létinier

Pujade

Duthoit

et al. 2022

Clinical Translational Sci

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The elderly people are increasingly exposed to polymedication and therefore to the risks of drug–drug interactions (DDIs). However, there are few data available on the clinical consequences of these drug combinations. We investigated the impact of the various DDIs classified as severe in terms of emergency admissions in the elderly. A cross‐sectional study was conducted using information from the emergency department admissions of Bordeaux University Hospital between September 2016 and August 2017. Events of interest were frequency of concomitant uses of interacting drugs that are contraindicated or warned against and frequency of emergency admissions due to contraindicated or warned against concomitant uses of interacting drugs. Five thousand, eight hundred sixty (5860) admissions to the emergency department were analyzed. A total of 375 (6.4%) contraindicated or warned against concomitant uses were identified, including 163 contraindicated (43.5%) and 212 warned against (56.5%). Reason for admission appeared likely related to the underlying DDI in 58 cases. Within these, 36 admissions were assessed as probably due to a DDI (0.6% of hospitalizations) and 22 as certainly (0.4% of hospitalizations). Of these, there were 24 (45%) admissions related to a long QT syndrome (LQTS), nine (16%) related to a drug overdose, and eight (14%) related to a hemorrhage. An antidepressant was involved in 22 of the 24 cases of LQTS. Seven of the eight cases of hemorrhage involved the antithrombotic agents / non‐steroidal anti‐inflammatory drugs combination. Elderly patients admitted to emergency departments are particularly exposed to high‐risk potential DDIs. These drug combinations lead mainly to LQTS and involve certain antidepressants.

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“…Approximately threequarters of residents used five or more prescription medicines regularly, and almost one-quarter used more than nine, according to a recent survey of NHs in eight European countries 5 . Many of these regimens include superfluous or redundant medicines, which are equally as likely as recommended pharmaceuticals to cause undesirable side effects and interact with one another 14 . This was recently discovered through extensive study in the United States' NHs.…”

Section: Introductionmentioning

confidence: 99%

Individualized Approaches to Diabetes Care in Nursing Homes

Majeed¹,

Sultana²,

Shakeel³

et al. 2022

PJMHS

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Although diabetes care has been widely established as a single entity, data in older, frail individuals with numerous comorbidities and have limited polymedication. This group accounts for a sizable number of nursing home residents (NHs). We came together as a group of experts with multidisciplinary (endocrinologists, geriatricians, Nurses staff, general practitioners and diabetologists) with real-world practice in this field, which is becoming more and more important globally, to compile practical, straightforward guidance on the managing of senior, fragile patients of diabetes. An Individual Care Plan (ICP), which is presented in layman's terms, is the cornerstone of a patient's diabetes treatment. This is due to the demands placed on personnel of NH (medical coordinator, manager, nurses, and caregiver working at the front lines, and the other caregiver worker which is under training). The actual purpose of this document, which is released when the patient is admitted, is to made prescriptions ensure that given at and followed after admission. It details the need for proper treatment, regular monitoring, and dates and times for essential examinations and testing. This entails keeping tabs on the patient's HbA1c, as well as their blood and urine glucose levels and any complications that may arise from the condition (hypoglycemia, cardiovascular disease, foot disorders, ocular problems, malnutrition, kidney failure and peripheral neuropathy). Consequentially, staff education on the unique challenges of care for an elderly person with diabetes, emergency procedures, and maintaining an up-to-date ICP for use by medical professionals is essential. Keywords: Diabetes care, nursing home, staff nurses

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Comparing the Prevalence of Polypharmacy and Potential Drug-Drug Interactions in Nursing Homes and in the Community Dwelling Elderly of Emilia Romagna Region

Cited by 17 publications

References 28 publications

Nutritional Status and Potentially Inappropriate Medications in Elderly

Nutritional Status and Potentially Inappropriate Medications in Elderly

Emergency department admissions induced by drug–drug interactions in the elderly: A cross‐sectional study

Individualized Approaches to Diabetes Care in Nursing Homes

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