Polypharmacy in Nursing Home in Europe: Results From the SHELTER Study

Onder, Graziano; Liperoti, Rosa; Fialová, Daniela; Topinková, Eva; Tosato, Matteo; Danese, Paola; Gallo, Pietro; Carpenter, Iain; Finne-Soveri, Harriet; Gindin, Jacob; Bernabei, Roberto; Landi, Francesco

doi:10.1093/gerona/glr233

Cited by 265 publications

(238 citation statements)

References 25 publications

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“…Likewise, polypharmacy does not necessarily indicate frailty, although frailty has been linked to excessive polypharmacy in some community dwellers [41]. By comparison, patients with advanced dementia are often prescribed relatively fewer medications [42], but are at higher risk for important complications, including delirium [43], and failure to consider patients with dementia as frail and vulnerable compromises clinical care.…”

Section: Subjective Opinionmentioning

confidence: 99%

Patient frailty: the elephant in the operating room

2013

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SummaryFor most surgeons and many anaesthetists, patient frailty is currently the 'elephant in the (operating) room': it is easy to spot, but is often ignored. In this paper, we discuss different approaches to the measurement of frailty and review the evidence regarding the effect of frailty on peri-operative outcomes. We explore the limitations of 'eyeballing' patients to quantify frailty, and consider why the frail older patient, challenged by seemingly minor insults in the postoperative period, may suffer falls or delirium. Frailty represents a state of increased vulnerability to stressors, and older inpatients are exposed to multiple stressors in the peri-operative setting. Quantifying frailty is likely to increase the precision of peri-operative risk assessment. The Frailty Index derived from Comprehensive Geriatric Assessment is a simple and robust way to quantify frailty, but is yet to be systematically investigated in the preoperative setting. Furthermore, the optimal care for frail patients and the reversibility of frailty with prehabilitation are fertile areas for future research. (While I can't define it)…I know it when I see it.-Justice Potter Stewart, US Supreme Court Clinicians usually recognise a frail patient, who is often, but not always, elderly. However, at best, we usually quantify frailty in a largely subjective 'end-of-the-bed' or 'eyeball' way [1]. Furthermore, although studies have examined patient factors such as age and ASA physical status and their association with peri-operative complications and mortality [2-4], until very recently, few have examined frailty [5]. Frailty increases vulnerability to stressors, which, in the peri-operative setting, can include the procedure(s), complications and medical care administered.The aims of this paper are to review the emerging science around defining and quantifying frailty, and to examine its associated peri-operative risks. Current evidence suggests that quantifying frailty improves the precision of risk assessment [5]. However, we think that, for most surgeons and many anaesthetists, frailty and its associated risks represent an 'elephant in the (operating) room': it is easy to spot, but is often ignored.

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Section: Subjective Opinionmentioning

confidence: 99%

Patient frailty: the elephant in the operating room

2013

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“…Many seniors routinely use multiple drugs, polypharmacy, which leave some unpleasant sequels on their bodies [17,18]. In some emergency occasions, due to time limit, and/or because of incomplete assessments, due to lack of experience or training related to Geriatrics Emergency [19], seniors may receive some medications which might interact with their routine medications, or even some contraindications may happen [20].…”

Section: Seniors and Current Edsmentioning

confidence: 99%

Particular Emergency Department for Seniors

Amini¹

2012

Emergency Medicine

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“…Higher prevalence of multiple chronic disorders, symptoms and geriatric syndromes (sometimes as a consequence of inappropriate multiple drug therapy) as well as frailty, functional impairment, poor compliance and adverse drug events [7,9] are common in the older population. Adverse drug reactions and drug interactions occur four to seven times more frequently in the geriatric population when compared with middle-aged individuals.…”

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confidence: 99%

“…Adverse drug reactions and drug interactions occur four to seven times more frequently in the geriatric population when compared with middle-aged individuals. The prevalence of adverse drug reactions is documented to be 20-30 % in the 70-79 years age group compared with 3-6 % in the 20-29 years age group [7][8][9][10]. Frequent drugrelated complications result in a higher percentage of acute care admissions (in 6.6-41.3 % of older patients) [11], a higher number of physicianś visits and consequently a significantly greater proportion of total expenditure for drug treatment [11][12][13].…”

mentioning

confidence: 99%