Consolidated Medication Review Algorithm to Improve Medications Use in Older Adults: Components, Scoring Scheme, and Implementation

Thiruchelvam, Kaeshaelya; Wong, Pei Se; Kairuz, Therése; Babar, Zaheer Ud-Din; Hasan, Syed Shahzad

doi:10.1016/j.jamda.2018.03.007

Cited by 6 publications

(13 citation statements)

References 7 publications

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“…It is important to consider deprescribing for frail older adults, particularly those aged 75 years and over, and it is important to consider benefits versus risk. Medication optimisation is a pillar of patient-centred care and algorithms have been developed to identify PIMs [38] exclusively for frail older adults [39]. Patients' preferences and considerations should be taken into account, given the dynamic nature of frailty and the adverse events associated with PIMs that may vary between individuals.…”

Section: Discussionmentioning

confidence: 99%

Frailty and potentially inappropriate medications using the 2019 Beers Criteria: findings from the Australian Longitudinal Study on Women’s Health (ALSWH)

et al. 2021

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Background:Frailty is an essential consideration with potentially inappropriate medications (PIMs), especially among older women.Aims: This study determined the use of potentially inappropriate medications according to frailty status using the Beers Criteria 2019, identified medications that should be flagged as potentially inappropriate and harmful depending on individual health factors, and determined the association between frailty and PIMs, adjusted for characteristics associated with PIMs.Methods: This prospective longitudinal study included 9355 participants aged 77 to 82 years at baseline (2003). Frailty was measured using the FRAIL (Fatigue, Resistance, Ambulation, Illness, & Loss of Weight) scale. Generalised estimating equations using log-binomial regressions determined the association between frailty and risk of using PIMs.Results: Among participants who were frail and non-frail at baseline, the majority used ≥3 PIMs (74.2% and 58.5%, respectively). At 2017, the proportion using ≥3 PIMs remained constant in the frail group (72.0%) but increased in the non-frail group (66.0%). Commonly prescribed medications that may be potentially inappropriate in both groups included benzodiazepines, proton-pump inhibitors and nonsteroidal anti-inflammatory drugs, and risperidone was an additional contributor in the non-frail group. When adjusted for other characteristics, frail women had a 2% higher risk of using PIMs (RR 1.02; 95% CI: 1.01, 1.03). Conclusion:Given that the majority of frail women were using medications that may have been potentially inappropriate, it is important to consider both frailty and PIMs as indicators of health outcomes, and to review the need for PIMs for women aged 77 to 96 years who are frail.

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Section: Discussionmentioning

confidence: 99%

Frailty and potentially inappropriate medications using the 2019 Beers Criteria: findings from the Australian Longitudinal Study on Women’s Health (ALSWH)

et al. 2021

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“…Furthermore, appropriate training under the continuous professional development scheme should be provided to pharmacists who will be providing the medication reviews to ensure optimal provision of care for the residents. It is recommended that the reviews be aided by tools such as medication review algorithms and medication appropriateness quantifying tools . Results from a pilot study would aid in further strengthening of this service.…”

Section: Discussionmentioning

confidence: 99%

“…It is recommended that the reviews be aided by tools such as medication review algorithms and medication appropriateness quantifying tools. 55,56 Results from a pilot study would aid in further strengthening of this service. Such initiatives by pharmacists may ultimately improve the QoL and reduce the incidence of frailty among older people.…”

Section: Potential Role Of Pharmacists In Aged Care Facilitiesmentioning

confidence: 99%

Drug burden index, polypharmacy and patient health outcomes in cognitively intact older residents of aged care facilities in Malaysia

Hasan

Chang

Thiruchelvam

et al. 2020

Pharmacy Practice and Res

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Background The complexity of drug regimens among older people tend to increase over time, as multiple medications are required to treat a single condition. Aim This study examined the association of the drug burden index (DBI) and polypharmacy with patient health outcomes among cognitively intact older residents in aged care facilities (ACFs). Methods A review of prescribed medications and related outcomes was conducted in a cross‐sectional sample of older adults (≥60 years), recruited from 11 ACFs in Peninsular Malaysia. Frailty and quality of life (QoL) were evaluated using the Groningen frailty indicator and ‘Older People's Quality of Life – 35’ questionnaire, respectively; patients’ exposure to anticholinergic and sedative medicines was quantified using the DBI; and the mental health of residents was evaluated using the Hospital Anxiety and Depression Scale. Results More than two‐thirds of a sampled population received at least one anticholinergic or sedative medication and more than one‐quarter was exposed to polypharmacy. Exposure to DBI‐associated medications was noted in three of every four frail participants and was significantly correlated with frailty (r = 0.184, p = 0.023). The frail population had significantly increased risk of polypharmacy (odds ratio 6.07; 95% confidence interval 1.71–21.56; p = 0.005), but exposure to DBI‐associated medications was not significantly associated with overall QoL and activity of daily living measures. Conclusion Polypharmacy and anticholinergic and sedative burden were noticed in a substantial number of older adults in residential aged care facilities and were associated with frailty. Investing in the recruitment of pharmacists may benefit recognition of residential ACF quality of care, because pharmacy services (including pharmacists) are virtually non‐existent in Malaysian residential ACFs.

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“…6 Secondly, while current medication review guidelines 6 , 7 provide lists of common medication-related issues, this approach could be augmented using a guided framework. For example, an algorithm or minimisation framework could expedite the process when pharmacists conduct medication reviews, with the answer to one question leading to the next option that has to be considered 28 , 29 ; this may aid the decision-making process during medication reviews.…”

Section: Adopting Technology In Medication Reviewsmentioning

confidence: 99%

“…Finally, coupled with knowledge gained from being trained to conduct medication reviews 6 , 15 , 16 and utilising a guided framework, technology has the potential to improve the efficiency and effectiveness of medication reviews and could, for example, be adapted to focus specifically on older people. 2 , 28 , 29 Technology in the form of a computerised decision support system (CDSS) can ensure that a comprehensive review is conducted in a timely and cost-efficient manner. Cresswell and colleagues (2012) define CDSS as a software application utilising patient data, a database of clinical knowledge, and ‘conditional’ logic, for instance ‘if-then’ and ‘do while’, to produce patient-specific recommendations related to healthcare.…”

Section: Adopting Technology In Medication Reviewsmentioning

confidence: 99%

Innovating medication reviews through a technology-enabled process

Thiruchelvam

Byles

Hasan

et al. 2022

Research in Social and Administrative Pharmacy

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Consolidated Medication Review Algorithm to Improve Medications Use in Older Adults: Components, Scoring Scheme, and Implementation

Cited by 6 publications

References 7 publications

Frailty and potentially inappropriate medications using the 2019 Beers Criteria: findings from the Australian Longitudinal Study on Women’s Health (ALSWH)

Frailty and potentially inappropriate medications using the 2019 Beers Criteria: findings from the Australian Longitudinal Study on Women’s Health (ALSWH)

Drug burden index, polypharmacy and patient health outcomes in cognitively intact older residents of aged care facilities in Malaysia

Innovating medication reviews through a technology-enabled process

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