Intervención en ancianos con multimorbilidad y polimedicados: resultados en la prescripción y en la calidad de vida

Naveiro-Rilo, J.C.; Diez-Juárez, D.; Flores-Zurutuza, M.L.; Molina-Mazo, R.; Alberte-Pérez, C.

doi:10.1016/j.cali.2014.06.002

Cited by 8 publications

(11 citation statements)

References 25 publications

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“…In the present study, we found patients polymedicated with multiple comorbidities, very similar to others studies. 19,31,36 The fact that we had more women than men in our sample leads us to hypothesize that women tend to live longer and be more prone to have physical or psychological complaints.…”

Section: Discussionmentioning

confidence: 99%

“…2,3 Importantly, by the application of these criteria, there has been a reduction in the number of PIMs associated adverse events, and costs in health care, as well as a decrease in the rate of iatrogenic-based hospitalization. [9][10][11][19][20][21] Therefore, these tools may be effective in improving prescribing quality, and clinical, humanistic, and economic outcomes as well. 22 There are also studies evidencing their reliability even when applied by pharmacists or other healthcare professionals, helping to improve the quality of care in geriatric patients.…”

Section: Introductionmentioning

confidence: 99%

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<p>Medication Evaluation in Portuguese Elderly Patients According to Beers, STOPP/START Criteria and EU(7)-PIM List – An Exploratory Study</p>

Monteiro¹,

Canário²,

Ribeiro³

et al. 2020

PPA

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Purpose: The increase in drug prescription for the elderly raises the risk of the occurrence of potentially inappropriate medications (PIMs), thus increasing the incidence of drug-related problems. Likewise, potential prescribing omissions (PPOs) are also highly prevalent in the elderly. This study aimed at assessing the prevalence of PIMs in the elderly by using the EU (7)-PIM list, STOPP criteria version 2 and the Beers criteria version 2015, as well as the prevalence of PPOs by applying the START criteria version 2 in elderly nursing home residents and outpatients of the Eastern Central Region of Portugal. Patients and Methods: A descriptive cross-sectional study was carried out in a sample of 90 Portuguese elderly people. Age, gender, diagnoses and medication history were collected from the patients' clinical records. The prevalence of PIMs and PPOs was measured according to each of the criteria applied. Results: The patients' ages ranged from 65 to 103 years, with an average age of 84.15 years. In addition, the average number of medications prescribed was 7.6. The STOPP criteria identified 250 PIMs affecting 77 patients (85.5%), the EU(7)-PIM list detected 94 PIMs in 58 patients (64.4%) and the Beers criteria identified 69 PIMs in 51 patients (56.6%). Therefore, the STOPP criteria version 2 identified substantially more PIMs than the other two tools. Furthermore, by applying the START criteria 68 PPOs were detected in 52 patients (57.7%). Conclusion: A high prevalence of PIMs and PPOs was observed, suggesting the need to implement actions aimed at reducing the phenomenon and thus help to improve the quality of care provided in nursing homes. The variations in prevalence with the different tools suggest the need to carefully choose the tool for medication review in the elderly.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

<p>Medication Evaluation in Portuguese Elderly Patients According to Beers, STOPP/START Criteria and EU(7)-PIM List – An Exploratory Study</p>

Monteiro¹,

Canário²,

Ribeiro³

et al. 2020

PPA

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“…All 40 studies had been published in the period 2011-19, and the majority (n = 31) had been published in the 5 years immediately prior to the conduct of the synthesis (Table 5). The studies had been conducted in Europe [mainly Spain (n = 13), 51,53,56,58,60,61,73,79,[84][85][86][87][88] Belgium (n = 5) 49,55,57,74,78 and Ireland (n = 3)],…”

Section: Descriptive Summary Of Included Studiesmentioning

confidence: 99%

“…The majority of studies had been conducted in hospitals, most frequently across multiple departments (n = 25). 49,52,[54][55][56][57][58]60,64,[66][67][68][69][70][71][72][73][74]77,78,80,82,83,85,87 Other studies were conducted in nursing homes (n = 9), 59,61,62,65,75,79,81,84,88 primary care (n = 5) 50,51,53,63,86 or a community pharmacy (n = 1) 76 . The majority of studies (n = 29) 49, 51-53,56-59,62,65,68-71,73-77,79,81-88 used both STOPP and START tools.…”

Section: Descriptive Summary Of Included Studiesmentioning

confidence: 99%

STOPP/START interventions to improve medicines management for people aged 65 years and over: a realist synthesis

Gangannagaripalli

Porter

Davey

et al. 2021

Health Serv Deliv Res

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Background Drug-related problems and potentially inappropriate prescribing impose a huge burden on patients and the health-care system. The most widely used tools for appropriate prescription in older adults in England and in other European countries are the Screening Tool of Older People’s Prescriptions (STOPP)/Screening Tool to Alert to the Right Treatment (START) tools. STOPP/START tools support medicines optimisation for older adults. Objectives To identify, test and refine the programme theories underlying how interventions based on the STOPP/START tools are intended to work, for whom, in what circumstances and why, as well as the resource use and cost requirements or impacts. Design A realist synthesis. Setting Primary care, hospital care and nursing homes. Patients Patients aged ≥ 65 years. Interventions Any intervention based on the use of the STOPP/START tools. Review methods Database and web-searching was carried out to retrieve relevant evidence to identify and test programme theories about how interventions based on the use of the STOPP/START tools work. A project reference group made up of health-care professionals, NHS decision-makers, older people, carers and members of the public was set up. In phase 1 we identified programme theories about STOPP/START interventions on how, for whom, in what contexts and why they are intended to work. We searched the peer-reviewed and grey literature to identify documents relevant to the research questions. We interviewed experts in the field in our reference group to gain input on our list of candidate context–mechanism–outcome configurations, to identify additional context–mechanism–outcome configurations and to identify additional literature and/or relevant concepts. In phase 2 we reviewed and synthesised relevant published and unpublished empirical evidence and tested the programme theories using evidence from a larger set of empirical studies. Results We developed a single logic model structured around three key mechanisms: (1) personalisation, (2) systematisation and (3) evidence implementation. Personalisation: STOPP/START-based interventions are based on shared decision-making, taking into account patient preferences, experiences and expectations (mechanisms), leading to increased patient awareness, adherence, satisfaction, empowerment and quality of life (outcomes). Systematisation: STOPP/START tools provide a standardised/systematic approach for medication reviews (mechanisms), leading to changes in professional and organisational culture and burden/costs (outcomes). Evidence implementation: delivery of STOPP/START-based interventions is based on the implementation of best evidence (mechanisms), reducing adverse outcomes through appropriate prescribing/deprescribing (outcomes). For theory testing, we identified 40 studies of the impact of STOPP/START-based interventions in hospital settings, nursing homes, primary care and community pharmacies. Most of the interventions used multiple mechanisms. We found support for the impact of the personalisation and evidence implementation mechanisms on selected outcome variables, but similar impact was achieved by interventions not relying on these mechanisms. We also observed that the impact of interventions was linked to the proximity of the selected outcomes to the intervention in the logic model, resulting in a clearer benefit for appropriateness of prescribing, adverse drug events and prescription costs. Limitations None of the available studies had been explicitly designed for evaluating underlying causal mechanisms, and qualitative information was sparse. Conclusions No particular configuration of the interventions is associated with a greater likelihood of improved outcomes in given settings. Study registration This study is registered as PROSPERO CRD42018110795. Funding This project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research; Vol. 9, No. 23. See the NIHR Journals Library website for further project information.

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“…12,16 Some factors interfere in the quality of life of the older adult, such as inadequate prescription of medications, that trigger adverse reactions (ADR) and cause consequences in the physiological performance of the elderly person, due to the appearance of undesirable side effects, making the process of prescription of complex drugs, since the quantity of medications, the frequency of doses, the guidelines for the management and the prescribed dosage forms must be considered. [17][18] Among the ADRs caused by the side effects of medications, the risk of falls is highlighted (the elderly who need the most drugs are the most vulnerable to falls because some drugs cause lethargy), the need to go to the toilet more often, reduction of reflexes, postural hypotension, and vertigo. All these symptoms favor the risk of falls and, as a result, the occurrence of fractures.…”

Section: The Polypharmacy and Quality Of Life Of The Elderly Personmentioning

confidence: 99%

O impacto da polifarmácia na qualidade de vida de idosos

Santana

Ramos

Campos

et al. 2019

Rev enferm UFPE on line.

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RESUMOObjetivo: objetivou-se analisar o impacto da polifarmácia na qualidade de vida dos idosos a partir das produções científicas. Método: trata-se de estudo bibliográfico, tipo revisão integrativa de literatura. Realizou-se a coleta de dados nas bases de dados Medline, LILACS e Biblioteca Scielo, entre o período de 2006 e 2016, nos idiomas inglês, espanhol e português, submetendo-se à Técnica de Análise de Conteúdo na Modalidade Análise de Conteúdo Temática. Resultados: evidenciou-se que a polimedicação pode levar ao desenvolvimento, no idoso, de uma série de complicações por conta dos efeitos adversos dos fármacos, afetando a qualidade de vida e a realização das suas atividades diárias. Defende-se que o cuidado com a interação medicamentosa, o aprazamento e a educação em saúde são de grande relevância no contexto do envelhecimento, comprometendo os aspectos fisiológicos do paciente. Conclusão: observa-se que a atuação do enfermeiro é indispensável pelo conhecimento teórico de Farmacologia e do processo de envelhecimento, pois contribui para a vigilância medicamentosa e dos efeitos colaterais em relação aos idosos que, muitas vezes, fazem uso de medicamentos sem prescrição médica. Descritores: Idoso; Preparações Farmacêuticas; Qualidade de Vida; Cuidados de Enfermagem; Saúde do Idoso; Enfermagem.ABSTRACTObjective: to analyze the impact of polypharmacy on the quality of life of the older adults from the scientific productions. Method: this is a bibliographical study, integrative literature review type. Data collection was carried out in the Medline, LILACS and Scielo databases between 2006 and 2016, in English, Spanish and Portuguese, submitted to the Content Analysis Technique in the Thematic Content Analysis Mode. Results: the polymedication can lead to the development of a series of complications for the older adult due to the adverse effects of the drugs, affecting the quality of life and the performance of their daily activities. Care with medication interaction, the time of taking the medication and education in health are of great relevance in the context of aging, compromising the physiological aspects of the patient. Conclusion: the nurses´ performance is indispensable by the theoretical knowledge of Pharmacology and the aging process since it contributes to drug surveillance and side effects for the elderly people, who often use medications without a medical prescription. Descriptors: Aged; Pharmaceutical Preparations; Quality of Life; Nursing Care; Health of the Elderly; Nursing.RESUMENObjetivo: analizar el impacto de la polifarmacia en la calidad de vida de los ancianos a partir de las producciones científicas. Método: se trata de un estudio bibliográfico, tipo revisión integradora de la literatura. Se realizó la recolección de datos en las bases de datos Medline, LILACS y Biblioteca Scielo, entre el período de 2006 a 2016, en los idiomas inglés, español y portugués, submetiéndose a la Técnica de Análisis de Contenido en la Modalidad Análisis de Contenido Temático. Resultados: se observó que la polimedicación puede llevar al desarrollo de una serie de complicaciones al anciano por cuenta de los efectos adversos de los fármacos, afectando la calidad de vida y la realización de sus actividades diarias. Se defiende que el cuidado con la interacción medicamentosa, el tempo de tomar la medicación y la educación en salud son de grande relevancia en el contexto del envejecimiento, comprometiendo los aspectos fisiológicos del paciente. Conclusión: se observa que la actuación del enfermero es indispensable por el conocimiento teórico de Farmacología y del proceso de envejecimiento, pues contribuye para la vigilancia medicamentosa y de los efectos colaterales en relación a los adultos mayores que muchas veces usan medicamentos sin prescripción médica. Descriptores: Anciano; Preparaciones Farmacéuticas; Calidad de Vida; Atención de Enfermería; Salud del Anciano; Enfermería.

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Intervención en ancianos con multimorbilidad y polimedicados: resultados en la prescripción y en la calidad de vida

Cited by 8 publications

References 25 publications

<p>Medication Evaluation in Portuguese Elderly Patients According to Beers, STOPP/START Criteria and EU(7)-PIM List – An Exploratory Study</p>

<p>Medication Evaluation in Portuguese Elderly Patients According to Beers, STOPP/START Criteria and EU(7)-PIM List – An Exploratory Study</p>

STOPP/START interventions to improve medicines management for people aged 65 years and over: a realist synthesis

O impacto da polifarmácia na qualidade de vida de idosos

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