Decision Making for Older Adults With Multiple Chronic Conditions: Executive Summary for the American Geriatrics Society Guiding Principles on the Care of Older Adults With Multimorbidity

Boyd, Cynthia M.; Smith, Cynthia D.; Masoudi, Frederick A.; Blaum, Caroline S.; Dodson, John A.; Green, Ariel R.; Kelley, Amy S.; Matlock, Daniel D.; Ouellet, Jennifer A.; Rich, Michael W.; Schoenborn, Nancy L.; Tinetti, Mary E.

doi:10.1111/jgs.15809

Cited by 183 publications

(152 citation statements)

References 77 publications

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“…The guiding principle also provides suggested tools, tips and example scripts to assist with carrying out these actions …”

Section: Tools To Aid the Overall Process Of Deprescribingmentioning

confidence: 99%

“…The American Geriatrics Society has published Guiding Principles on the Care of Older Adults With Multimorbidity. 17,18 These action steps were designed to assist clinicians to make patient-centred treatment decisions when faced with uncertainty, which is often the case when caring for older adults with multimorbidity. While not deprescribing-specific, their principles may be useful for guiding deprescribing decisions.…”

Section: Generic Deprescribing Frameworkmentioning

confidence: 99%

“…Step deprescribing framework (also known as the CEASE deprescribing framework) 11,14,20,72 Patient-centred deprescribing process 15,19 The Deprescribing Rainbow 16 (focus is more on the patient context than the process, may be used in conjunction with another framework) Decision Making for Older Adults With Multiple Chronic Conditions 17,18 (not strictly for deprescribing, however provides steps to assist clinicians when faced with uncertainty in older adults with multimorbidity) See recent systematic review of tools and criteria to identify inappropriate medications 46 Explicit tools (criteria-based, lists of PIMs): e.g. Beers criteria, 43 Screening Tool for Older Peoples Prescriptions (STOPP) 44 Implicit tools (guidance which requires clinical judgement): e.g.…”

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confidence: 99%

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Deprescribing tools: a review of the types of tools available to aid deprescribing in clinical practice

Reeve

2020

Pharmacy Practice and Res

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The importance of deprescribing, which is the process of withdrawing an inappropriate medication, supervised by a healthcare professional with the goal of managing polypharmacy and improving outcomes, is increasingly recognised as part of good clinical care. With this, a number of tools have been developed with the purpose of aiding health professionals to deprescribe in regular practice. The types of tools vary significantly in their form and include tools to aid in the overall process of deprescribing (such as generic frameworks and drug‐specific deprescribing guidelines) as well as tools that may assist in a specific part of the process (such as identifying inappropriate medications or engaging the patient). While many tools are available, most provide little (if any) information on how they were developed, and limited implementation research has been conducted. This paper provides an overview of the types of available tools and how they might be used in clinical practice.

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“…The guiding principle also provides suggested tools, tips and example scripts to assist with carrying out these actions …”

Section: Tools To Aid the Overall Process Of Deprescribingmentioning

confidence: 99%

Section: Generic Deprescribing Frameworkmentioning

confidence: 99%

mentioning

confidence: 99%

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Deprescribing tools: a review of the types of tools available to aid deprescribing in clinical practice

Reeve

2020

Pharmacy Practice and Res

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Section: Introductionmentioning

confidence: 99%

“…The American Geriatric Society (AGS) and the National Institute on Aging (NIA) developed tools to identify medications that are potentially inappropriate for older adults, delineate priorities and guiding principles for safe medication use, while promoting research on deprescribing practices in older populations. [10][11][12] The recently updated AGS Beers Criteria compiles a comprehensive list of medications potentially inappropriate in older patients. 10 Other tools are found in the literature: The STOPFrail criteria applies more specifically to the most vulnerable and frail patients; the STOPP/START criteria describes the use of software to aid in detecting inappropriate medications.…”

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confidence: 99%

Towards appropriate polypharmacy in older cardiovascular patients: How many medications do I have to take?

Moulder

Hendricks

2019

Clinical Cardiology

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Background Polypharmacy in older adults leads to increased risks of side effects and drug‐drug interactions, affecting their health outcomes and quality of life. Deprescribing, the act of simplifying medication regimens, is challenging due to the lack of consensus guidelines. Hypothesis To offer some guidance on managing medication regimens for older cardiovascular patients. Methods We reviewed the most recent pertinent guidelines and literature. Results This review provides practical considerations for appropriate prescribing in the older population with cardiovascular disease in order to strike a balance between unnecessary or harmful medications and therapies with proven long‐term benefits. Conclusion On‐going dialogue between healthcare providers and patients allows close monitoring of medication effectiveness and prevention of side effects. Medication regimens require individualization, as patients' goals of care change with advancing age.

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Association of Patient Priorities–Aligned Decision-Making With Patient Outcomes and Ambulatory Health Care Burden Among Older Adults With Multiple Chronic Conditions

et al. 2019

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Health care may be burdensome and of uncertain benefit for older adults with multiple chronic conditions (MCCs). Aligning health care with an individual's health priorities may improve outcomes and reduce burden.OBJECTIVE To evaluate whether patient priorities care (PPC) is associated with a perception of more goal-directed and less burdensome care compared with usual care (UC).DESIGN, SETTING, AND PARTICIPANTS Nonrandomized clinical trial with propensity adjustment conducted at 1 PPC and 1 UC site of a Connecticut multisite primary care practice that provides care to almost 15% of the state's residents. Participants included 163 adults aged 65 years or older who had 3 or more chronic conditions cared for by 10 primary care practitioners (PCPs) trained in PPC and 203 similar patients who received UC from 7 PCPs not trained in PPC. Participant enrollment occurred between February 1, 2017, and March 31, 2018; follow-up extended for up to 9 months (ended September 30, 2018).INTERVENTIONS Patient priorities care, an approach to decision-making that includes patients' identifying their health priorities (ie, specific health outcome goals and health care preferences) and clinicians aligning their decision-making to achieve these health priorities. MAIN OUTCOMES AND MEASURES Primary outcomes included change in patients' OlderPatient Assessment of Chronic Illness Care (O-PACIC), CollaboRATE, and Treatment Burden Questionnaire (TBQ) scores; electronic health record documentation of decision-making based on patients' health priorities; medications and self-management tasks added or stopped; and diagnostic tests, referrals, and procedures ordered or avoided. RESULTSOf the 366 patients, 235 (64.2%) were female and 350 (95.6%) were white. Compared with the UC group, the PPC group was older (mean [SD] age, 74.7 [6.6] vs 77.6 [7.6] years) and had lower physical and mental health scores. At follow-up, PPC participants reported a 5-point greater decrease in TBQ score than those who received UC (ß [SE], -5.0 [2.04]; P = .01) using a weighted regression model with inverse probability of PCP assignment weights; no differences were seen in O-PACIC or CollaboRATE scores. Health priorities-based decisions were mentioned in clinical visit notes for 108 of 163 (66.3%) PPC vs 0 of 203 (0%) UC participants. Compared with UC patients, PPC patients were more likely to have medications stopped (weighted comparison, 52.0% vs 33.8%; adjusted odds ratio [AOR], 2.05; 95% CI, 1.43-2.95) and less likely to have self-management tasks (57.5% vs 62.1%; AOR, 0.59; 95% CI, 0.41-0.84) and diagnostic tests (80.8% vs 86.4%; AOR, 0.22; 95% CI, 0.12-0.40) ordered.CONCLUSIONS AND RELEVANCE This study's findings suggest that patient priorities care may be associated with reduced treatment burden and unwanted health care. Care aligned with patients' priorities may be feasible and effective for older adults with MCCs.TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT03600389

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Decision Making for Older Adults With Multiple Chronic Conditions: Executive Summary for the American Geriatrics Society Guiding Principles on the Care of Older Adults With Multimorbidity

Cited by 183 publications

References 77 publications

Deprescribing tools: a review of the types of tools available to aid deprescribing in clinical practice

Deprescribing tools: a review of the types of tools available to aid deprescribing in clinical practice

Towards appropriate polypharmacy in older cardiovascular patients: How many medications do I have to take?

Association of Patient Priorities–Aligned Decision-Making With Patient Outcomes and Ambulatory Health Care Burden Among Older Adults With Multiple Chronic Conditions

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