Medication Undertreatment in Assisted Living Settings

Sloane, Philip D.; Gruber‐Baldini, Ann L.; Zimmerman, Sheryl; Roth, Mary T.; Watson, Lea C.; Boustani, Malaz; Magaziner, Jay; Hebel, J. Richard

doi:10.1001/archinte.164.18.2031

Cited by 102 publications

(81 citation statements)

References 60 publications

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“…24 Third, seven ACOVE criteria relative to underuse were selected, because the MAI does not detect underuse and because high levels of underuse were identified in previous studies. 6,7,[25][26][27][28] The ACOVE criteria are process measures of quality of care for vulnerable older people. 29 Underuse indicators are expressed as follows; if there is a certain condition, then the patient should receive a certain drug, unless contraindicated.…”

Section: Primary Outcome Measurementioning

confidence: 99%

Effect of a Collaborative Approach on the Quality of Prescribing for Geriatric Inpatients: A Randomized, Controlled Trial

Spinewine

Swine

Dhillon

et al. 2007

J American Geriatrics Society

268

260

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OBJECTIVES: To evaluate the effect of pharmaceutical care provided in addition to acute Geriatric Evaluation and Management (GEM) care on the appropriateness of prescribing. DESIGN: Randomized, controlled trial, with the patient as unit of randomization. SETTING: Acute GEM unit. PARTICIPANTS: Two hundred three patients aged 70 and older. INTERVENTION: Pharmaceutical care provided from admission to discharge by a specialist clinical pharmacist who had direct contacts with the GEM team and patients. MEASUREMENTS: Appropriateness of prescribing on admission, at discharge, and 3 months after discharge, using the Medication Appropriateness Index (MAI), Beers criteria, and Assessing Care of Vulnerable Elders (ACOVE) underuse criteria and mortality, readmission, and emergency visits up to 12 months after discharge. RESULTS: Intervention patients were significantly more likely than control patients to have an improvement in the MAI and in the ACOVE underuse criteria from admission to discharge (odds ratio (OR)=9.1, 95% confidence interval (CI)=4.2–21.6 and OR=6.1, 95% CI=2.2–17.0, respectively). The control and intervention groups had comparable improvements in the Beers criteria. CONCLUSION: Pharmaceutical care provided in the context of acute GEM care improved the appropriate use of medicines during the hospital stay and after discharge. This is an important finding, because only limited data exist on the effect of various strategies to improve medication use in elderly inpatients. The present approach has the potential to minimize risk and improve patient outcomes.

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Section: Primary Outcome Measurementioning

confidence: 99%

Effect of a Collaborative Approach on the Quality of Prescribing for Geriatric Inpatients: A Randomized, Controlled Trial

Spinewine

Swine

Dhillon

et al. 2007

J American Geriatrics Society

268

260

View full text Add to dashboard Cite

show abstract

“…Studies have investigated undertreatment of various diseases, for instance in heart failure, myocardial infarction and osteoporosis. The findings are that many patients do not receive the medication they need (40,(55)(56)(57)(58)(59). For example, patients treated for chronic medical diseases are often undertreated when it comes to other unrelated disorders (59).…”

Section: Underuse Of Medicationmentioning

confidence: 99%

The Janus face of polypharmacy – overuse versus underuse of medication

Viktil¹,

Blix²,

Reikvam³

2009

Nor J Epidemiol

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As modern guidelines may recommend several drugs for a single medical condition, it follows that many patients, especially if co-morbidity is present, use a number of medications. Also, an aging population implies more morbidity and consequently will have the result that many patients use many drugs -a situation often referred to as polypharmacy. Polypharmacy has been linked to negative health outcomes such as adverse drug reactions, interaction problems, poor patient adherence, and hospitalisations. Such experiences have led to the attitude that efforts should be made to reduce polypharmacy. However, this approach might prevent patients from obtaining optimal treatment. There is no universal definition of polypharmacy and measuring of a reduction in polypharmacy becomes problematic. Because polypharmacy is an imprecise term it should be used with caution in research as well as in patient management. Moreover, studies have shown that undertreatment occurs frequently also among patients using many drugs. This is the Janus face of polypharmacy: too many drugs should be avoided, but the individual patient should receive the appropriate drugs that have the potential to reduce morbidity and improve quality of life. It is the individual drugs themselves, along with patient specific factors, and not a fixed number of drugs, that we should pay attention to.

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“…Epidemiological studies have demonstrated that many evidence-based medications for cardiovascular diseases are underused by elderly people living in a community [1][2][3][4][5] , in institutions [5,6] or in sheltered housing [7] . Studies on cardiovascular drug use in relation to cardiovascular morbidity have shown that cognitive impairment is an additional risk for older patients for not being treated: Aspirin or warfarin are prescribed more seldom for demented patients at discharge from hospital after ischaemic stroke compared to cognitively intact patients [8] , fewer demented patients with congestive heart failure (CHF) receive angiotensin-converting enzyme (ACE) inhibitors compared to non-demented ones [6] , fewer community-dwelling demented elderly persons are prescribed lipid-lowering agents [3] , ␤ -blockers [1] and ACE inhibitors [1] than non-demented ones, and patients with vascular dementia are less likely to use aspirin after stroke and more likely to be without pharmacological treatment for hypertension than patients with milder cognitive impairment [5] .…”

Section: Introductionmentioning

confidence: 99%

Dementia Associates with Undermedication of Cardiovascular Diseases in the Elderly

Löppönen¹,

Räihä

Isoaho

et al. 2006

Dement Geriatr Cogn Disord

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Objective: To compare medication use in patients suffering from cardiovascular disease with and without dementia. Subjects: All inhabitants aged 75 and older in Lieto, Finland (n = 462, participation rate 82%). Measurements: Direct standardised assessments of dementia and cardiovascular diseases. Quantification of drug use by self-report and by prescription and drug container checks. Results: In multivariate analyses, the odds ratio for demented cardiovascular patients receiving any cardiovascular medication (use vs. non-use) was 0.31 (95% confidence interval 0.12–0.82). Compared to the non-demented, demented stroke patients were treated less often with antithrombotic agents (p = 0.041) and demented hypertensive patients less often with β-blockers (p = 0.045). Conclusion: Demented cardiovascular patients, even mildly to moderately demented, were prescribed fewer evidence-based cardiovascular medications than non-demented patients.

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Medication Undertreatment in Assisted Living Settings

Abstract: Undertreatment appears to be prevalent in RC/AL facilities. Since preserving independence is often a primary goal of care in these settings, more attention may need to be paid to the use of treatments that have been shown to reduce long-term morbidity.

Cited by 102 publications

References 60 publications

Effect of a Collaborative Approach on the Quality of Prescribing for Geriatric Inpatients: A Randomized, Controlled Trial

Effect of a Collaborative Approach on the Quality of Prescribing for Geriatric Inpatients: A Randomized, Controlled Trial

The Janus face of polypharmacy – overuse versus underuse of medication

Dementia Associates with Undermedication of Cardiovascular Diseases in the Elderly

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