Digitalis Withdrawal in Elderly Nursing Home Patients

Wilkins, Charles E.; Khurana, Manbir S.

doi:10.1111/j.1532-5415.1985.tb05438.x

Cited by 16 publications

(15 citation statements)

References 9 publications

(9 reference statements)

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“…The mean age was over 80 years in 38 studies (4833 participants) . Thirty‐three studies included people living with dementia (6090 participants) , and another six studies were unclear whether they included participants living with dementia (429 participants) .…”

Section: Resultsmentioning

confidence: 99%

“…The mean age was over 80 years in 38 studies (4833 participants) [33-35, 37-40, 44-46, 50, 62, 74, 78-80, 84, 86, 94, 108-110, 112, 119, 120, 123]. Thirty-three studies included people living with dementia (6090 participants) [34, 36, 37, 40, 45, 50, 62, 63, 77-81, 94, 102, 107, 109, 110, 112, 120, 123, 131, 133], and another six studies were unclear whether they included participants living with dementia (429 participants) [38,55,74,145,150,160].…”

Section: Participantsmentioning

confidence: 99%

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The feasibility and effect of deprescribing in older adults on mortality and health: a systematic review and meta‐analysis

Page

Clifford

Potter

et al. 2016

Brit J Clinical Pharma

370

382

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AIMSDeprescribing is a suggested intervention to reverse the potential iatrogenic harms of inappropriate polypharmacy. The review aimed to determine whether or not deprescribing is a safe, effective and feasible intervention to modify mortality and health outcomes in older adults. METHODSSpecified databases were searched from inception to February 2015. Two researchers independently screened all retrieved articles for inclusion, assessed study quality and extracted data. Data were pooled using RevMan v5.3. Eligible studies included those where older adults had at least one medication deprescribed. The primary outcome was mortality. Secondary outcomes were adverse drug withdrawal events, psychological and physical health outcomes, quality of life, and medication usage (e.g. successful deprescribing, number of medications prescribed, potentially inappropriate medication use). RESULTSA total of 132 papers met the inclusion criteria, which included 34 143 participants aged 73.8 ± 5.4 years. In nonrandomized studies, deprescribing polypharmacy was shown to significantly decrease mortality (OR 0.32, 95% CI: 0.17-0.60). However, this was not statistically significant in the randomized studies (OR 0.82, 95% CI 0.61-1.11). Subgroup analysis revealed patientspecific interventions to deprescribe demonstrated a significant reduction in mortality (OR 0.62, 95% CI 0.43-0.88). However, generalized educational programmes did not change mortality (OR 1.21, 95% CI 0.86-1.69). CONCLUSIONSAlthough nonrandomized data suggested that deprescribing reduces mortality, deprescribing was not shown to alter mortality in randomized studies. Mortality was significantly reduced when applying patient-specific interventions to deprescribe in randomized studies. WHAT IS ALREADY KNOWN ABOUT THIS SUBJECT• Polypharmacy in older adults is correlated to poor health outcomes.• Deprescribing is one proposed intervention to reduce the harm associated with polypharmacy.• Limited evidence is available to support deprescribing as an intervention. British Journal of Clinical PharmacologyBr J Clin Pharmacol (2016) 82 583-623 583

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Section: Resultsmentioning

confidence: 99%

Section: Participantsmentioning

confidence: 99%

The feasibility and effect of deprescribing in older adults on mortality and health: a systematic review and meta‐analysis

Page

Clifford

Potter

et al. 2016

Brit J Clinical Pharma

370

382

View full text Add to dashboard Cite

show abstract

“…The median time to ADWE occurrence after drug withdrawal was 35 days (Figure). Twenty-six ADWEs (36%) were classified as major since they were associated with increased health services utilization; 19 resulted in hospitalization, 6 in emergency department or urgent care clinic evaluation without hospitalization, and 1 in prolonged hospital¬ ization.…”

Section: Resultsmentioning

confidence: 99%

“…A patient-level mul¬ tiple logistic regression model with age, number ofmedi¬ cations stopped, number of baseline chronic diagnoses, and number of regularly scheduled baseline medica¬ tions was significantly associated with a patient having an ADWE (x2, 19 …”

Section: Resultsmentioning

confidence: 99%

Adverse Events After Discontinuing Medications in Elderly Outpatients

Graves

Hanlon

Schmader³

et al. 1997

Arch Intern Med

116

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“…A patient may originally receive digoxin for an episode of heart failure induced by specific precipitants, but the digoxin is continued long past the therapeutic need. The literature has suggested for years that digoxin use in elderly patients is often unnecessary 21 , 22 and may be withdrawn without detriment 23–26 . Despite this evidence, long‐term digoxin use continues; digoxin is one of the most frequently prescribed drugs in elderly nursing home patients 27 .…”

Section: Discussionmentioning

confidence: 99%

Cimetidine Use in Nursing Homes: Prolonged Therapy and Excessive Doses

Sherman

Avorn

Campion

1987

J American Geriatrics Society

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Patterns of cimetidine use were identified in a survey of 3032 patients in 31 nursing homes. Of these, 60 (2%) were receiving cimetidine. For these patients, ages ranged from 63 to 102 years (mean, 81 years). The patients received a range of 1 to 11 regularly scheduled medications (mean, 5.6 medications). Duration of cimetidine treatment averaged 19.6 months for 48 patients (81%) receiving the drug for longer than an eight-week course of therapy. Prescribing indications appeared unjustified in 54 of 60 patients (90%). Doses were rarely appropriately reduced for patient age, despite established reasons to do so and the well-known potential for adverse effects of cimetidine in the elderly. The risks associated with prolonged drug-induced suppression of gastric acid are not known. This study suggests that use of cimetidine without justifiable indication and for extended periods of time is common in nursing home patients. Studies are needed concerning the safety of long-term cimetidine use in elderly patients.

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Digitalis Withdrawal in Elderly Nursing Home Patients

Cited by 16 publications

References 9 publications

The feasibility and effect of deprescribing in older adults on mortality and health: a systematic review and meta‐analysis

The feasibility and effect of deprescribing in older adults on mortality and health: a systematic review and meta‐analysis

Adverse Events After Discontinuing Medications in Elderly Outpatients

Cimetidine Use in Nursing Homes: Prolonged Therapy and Excessive Doses

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