Search Results (30)

Central nervous system (CNS)-active medications pose serious health risks for older adults with dementia but are nonetheless commonly used. Few deprescribing interventions have focused on people with dementia. We conducted a one-arm pilot study in six primary care practices of an integrated healthcare system between February and August 2023. The deprescribing intervention consisted of patient/care partner education and self-management materials and provider decision support. Participants were aged 60+ with diagnosed dementia and prescribed at least one CNS-active medication for three or more months of the six-month period prior to study start. We assessed feasibility and acceptability of the intervention and feasibility of ascertaining medication discontinuation and medically treated falls. The intervention was delivered to all (N = 114) eligible participants; their mean age was 80 ± 9 years; 72% were female and 13% non-White. Intervention acceptability, assessed by Weiner’s Acceptability of Intervention measure, was rated 3.5/5 (range 1–5; higher scores indicate higher acceptability). Among baseline antipsychotic users (N = 89), 39 (43.8%) had discontinued at follow-up. Among baseline tricyclic antidepressant users (N = 11), 6 (54.5%) had discontinued at follow-up. Among baseline skeletal muscle relaxant users (N = 3), 2 (66.7%) had discontinued at follow-up. Among baseline benzodiazepine users (N = 3), 1 (33.3%) had discontinued at follow-up. Among baseline opioid users (N = 13), 1 (7.7%) had discontinued at follow-up. Medically treated falls occurred among 22% at baseline vs. 21% at follow-up. The intervention is feasible and acceptable and may achieve meaningful reduction in CNS-active medication prescriptions. Findings support a controlled trial with sufficient power to assess effects on relevant clinical outcomes. Full article

Background and objectives: Life expectancies have increased globally, including in Romania, leading to an aging population and thus increasing the burden of chronic diseases. Over 80% of individuals over 65 have more than three chronic conditions, with many exceeding ten and often requiring multiple medications and supplements. This widespread polypharmacy raises concerns about drug interactions, side effects, and inappropriate prescribing. This review examines the impact of polypharmacy in older adult patients, focusing on the physiological changes affecting drug metabolism and the potential risks associated with excessive medication use. Special attention is given to proton pump inhibitors (PPIs), a commonly prescribed drug class with significant benefits but also risks when misused. The aging process alters drug absorption and metabolism, necessitating careful prescription evaluation. Methods: We conducted literature research on polypharmacy and PPIs usage in the older adult population and the risk associated with this practice, synthesizing 217 articles within this narrative review. Results: The overuse of medications, including PPIs, may lead to adverse effects and increased health risks. Clinical tools such as the Beers criteria, the STOPP/START Criteria, and the FORTA list offer structured guidance for optimizing pharmacological treatments while minimizing harm. Despite PPIs’ well-documented safety and efficacy, inappropriate long-term use has raised concerns in the medical community. Efforts are being made internationally to regulate their consumption and reduce the associated risks. Conclusions: Physicians across all specialties must assess the risk–benefit balance when prescribing medications to older adult patients. A personalized treatment approach, supported by evidence-based prescribing tools, is essential to ensure safe and effective pharmacotherapy. Addressing inappropriate PPI use is a priority to prevent potential health complications. Full article

Background: Medication-related problems (MRPs) are common among home-care patients urgently needing improvement. Due to limited resources, patients with the greatest risk of MRPs should be prioritised for interventions. Objectives: We sought to develop a collaborative assessment tool for nurses and pharmacists to identify home-care patients at high risk of developing MRPs. Methods: Using Pubmed^® for a first scoping literature review, we sought existing tools identifying patients at risk of MRPs or prioritising patients for clinical pharmacy services. Extracted items were prioritised in a first interprofessional Delphi round. Results from the first Delphi round were complemented by individual risk factors identified in a second scoping literature review and again submitted to the expert panel in a second Delphi round. Each item was rated for its relevance to identify home-care patients at risk of MRPs. The highest scoring factors were combined into an interprofessional assessment tool. Results: Literature review one yielded 19 risk tools and six lists containing potentially inappropriate medications. The 78 resulting risk factors were submitted to experts (five pharmacists, five physicians, five nurses) in Delphi round one. Since the identified tools did not fit the scope (interprofessional assessment in home care) entirely, the results of Delphi round one were complemented with individual risk factors identified in a second literature review, leading to 82 potential risk factors for Delphi round two. Experts decided on a 15-item tool for future pilot testing—the doMESTIC RISK tool. It incorporated diverse factors potentially influencing medication safety: demographic information, social context, diagnosis, specific medication and health care resources use. Conclusions: With expert feedback from a Delphi process, we developed a 15-item tool to help nurses and pharmacists jointly identify home-care patients at a high risk of MRPs. Validation of the doMESTIC RISK tool will be imperative to verify its value in clinical practice. Full article

Background: In intermediate care, older patients with polypharmacy are vulnerable to drug–drug interactions (DDI) and potentially inappropriate medication (PIM). Aims: To perform a consecutive intervention study to evaluate DDI/PIM. Methods: Clinically-relevant DDI/PIM were identified using AMeLI (electronic medication list) and PRISCUS 2.0 (PIM list). Consecutive patients (standard care group) were screened for DDI/PIM after admission (t0) and again before discharge (t1). In an interim period, physicians received general education about DDI/PIM. Then, consecutive patients (independent clinical pharmacy group) were screened for DDI/PIM after admission (t2). Physicians were then provided with patient-individualized recommendations by a clinical pharmacist to prevent DDI/PIM. The patients were then screened again for DDI/PIM before discharge (t3). Results: In each group, 100 patients were included with data available for evaluation from 97 (standard care group, median age: 78 years [Q25/Q75: 69/84]) and 89 (clinical pharmacy group, 76 years [67/84]). In the standard care group, DDI were identified in 55 (57%) patients after admission (t0) and 54 (56%) before discharge (t1, ARR[t0/t1] = 0.01, NNT[t0/t1] = 100, n.s.). In the clinical pharmacy group, DDI were identified in 32 (36%) after admission (t2; ARR[t0/t2] = 0.21/NNT[t0/t2] = 5, p < 0.01) and 26 (29%) before discharge (t3; ARR[t2/t3] = 0.07/NNT[t2/t3] = 15, n.s.; ARR[t1/t3] = 0.27/NNT[t1/t3] = 4, p < 0.001). PIM were identified in patients at t0: 34 (35%), t1: 35 (36%, ARR[t0/t1] = −0.01/NNH[t0/t1] = 100, n.s.), t2: 25 (26%, ARR[t0/t2] = 0.09/NNT[t0/t2] = 12, n.s.), t3: 23 (24%, ARR[t2/t3] = 0.11/NNT[t2/t3] = 10, n.s.; ARR[t1/t3] = 0.12/NNT[t1/t3] = 9, n.s.). Conclusions: In the standard care group, after admission, many DDI/PIM were identified in older intermediate care patients. Before discharge, their number was hardly influenced at all. General education for physicians led to DDI prevention after admission. In addition, the DDI frequency decreased by providing physicians with patient-individualized recommendations. Full article

Background/Objectives: This systematic review aimed to identify a comprehensive list of potential opioid-related indicators from the published literature to assess prescribing safety in any setting. Methods: Studies that reported prescribing indicators from 1990 to 2019 were retrieved from a previously published systematic review. A subsequent search was conducted from seven electronic databases to identify additional studies from 2019 to June 2024. Potential opioid safety prescribing indicators were extracted from studies that reported prescribing indicators of non-injectable opioids prescribed to adults with concerns about the potential risk of harm. The retrieved indicators were split by each opioid, and duplicates were removed. The identified indicators were categorized by the type of problem, medication, patient condition/disease, and the risk of the indicators. Results: A total of 99 unique opioid-specific prescribing indicators were identified from 53 included articles. Overall, 42 (42%) opioid prescribing indicators focused on a specific class of opioids. Pethidine, tramadol, and fentanyl were the most frequently reported drugs (n = 22, 22%). The indicators account for six types of problems: medication inappropriate for the population (n = 20), omission (n = 8), inappropriate duration (n = 10), inadequate monitoring (n = 2), drug–disease interaction (n = 26), and drug–drug interaction (n = 33). Of all the indicators, older age (over 65) is the most common risk factor (n = 38, 39%). Central nervous system-related adverse effects are the risk of concern for the 28 (29%) indicators associated with drug–drug interactions. Furthermore, five of the six ’omission’ indicators are related to ’without using laxatives’. Conclusions: This review identified a comprehensive set of indicators for flagging patients at high risk of opioid-related harm, thereby supporting informed decision-making in optimizing opioid utilization. However, further research is essential to validate these indicators and evaluate their feasibility across diverse healthcare settings. Full article

Background: Multimorbidity, polypharmacy, and inappropriate prescribing are significant challenges in the geriatric population. Tools such as the Beers List, FORTA, and STOPP/START criteria have been developed to identify potentially inappropriate prescribing (PIP). STOPP/START criteria detect both potentially inappropriate medications (PIMs) and potential prescribing omissions (PPOs). The latest, third version of STOPP/START criteria expands the tool, based on the growing literature. The study aimed to evaluate the prevalence of PIP and the number of PIP per person identified by STOPP/START version 3 and to compare it to the previous version. Methods: This retrospective, cross-sectional study enrolled one hundred geriatric patients with polypharmacy from two day-care centers for partially dependent people in Poland. Collected data included demographic and medical data. STOPP/START version 3 was used to identify potentially inappropriate prescribing, whereas the previous version served as a reference. Results: STOPP version 3 detected at least one PIM in 73% of the study group, a significantly higher result than that for version 2 (56%). STOPP version 3 identified more PIMs per person than the previous version. Similarly, START version 3 had a significantly higher prevalence of PPOs (74% vs. 57%) and a higher number of PPOs per person than the previous version. The newly formed STOPP criteria with high prevalence were those regarding NSAIDs, including aspirin in cardiovascular indications. Frequent PPOs regarding newly formed START criteria were the lack of osmotic laxatives for chronic constipation, the lack of mineralocorticoid receptor antagonists, and SGLT-2 inhibitors in heart failure. Conclusions: This study showed the high effectiveness of the STOPP/START version 3 criteria in identifying potentially inappropriate prescribing, with a higher detection rate than version 2. Full article

Background: Frailty and polymedication are closely interrelated. Addressing these concurrent conditions in primary care settings relies on the utilization of potentially inappropriate medication (PIM) lists and medication reviews (MRs), particularly in rural areas, where healthcare professionals serve as the sole point of access to the medical system. The aim of this study was to examine the relationship between medication appropriateness and variables related to frailty in a rural municipality in order to propose potential strategies for therapy optimization. Methods: This cross-sectional study included all adult community dwellers aged 50 and above officially registered in the municipality of Tiriez (Albacete, Spain) in 2023 (n = 241). The primary outcome variable was frailty (assessed using the fatigue, resistance, ambulation, illness, and loss of weight (FRAIL) scale). The independent variables were age, gender, medication regimen, history of falls, comorbidities, PIMs (evaluated using the screening tool of older persons’ prescriptions (STOPP) 2023 criteria), fall-risk-increasing drugs (FRID), and anticholinergic burden (ACB). Results: The prevalence of frailty was approximately 20%. FRID and ACB scores were statistically associated (p-value < 0.001) with frailty, 1.1 ± 1.3 vs. 2.5 ± 1.7, and 1.0 ± 1.3 vs. 2.8 ± 2.5, respectively. Regardless of age, frailty was observed to be more prevalent among females (odds ratio (OR) [95% confidence interval (CI)]: 3.5 [1.5, 9.0]). On average, 2.1 ± 1.6 STOPP criteria were fulfilled, with the prolonged use of anxiolytics and anti-peptic-ulcer agents being the most frequent. Priority interventions (PIs) included opioid dose reduction, benzodiazepine withdrawal, and the assessment of antidepressant and antiplatelet treatment plans. Conclusions: The optimization of medication in primary care is of paramount importance for frail patients. Interventional measures should focus on ensuring the correct dosage and combination of drugs for each therapeutic regimen. Full article

The clinical context of drug interactions detected by automated analysis systems is particularly important in older patients with multimorbidities. We aimed to provide unique, up-to-date data on the prevalence of potentially inappropriate medications (PIMs) and drug–drug interactions (DDIs) in the Polish geriatric population over 80 years old and determine the frequency and the most common PIMs involved in DDIs. We analyzed all non-prescription and prescription drugs in a representative national group of 178 home-dwelling adults over 80 years old with excessive polypharmacy (≥10 drugs). The FORTA List was used to assess PIMs, and the Lexicomp^® Drug Interactions database was used for DDIs. DDIs were detected in 66.9% of the study group, whereas PIMs were detected in 94.4%. Verification of clinical indications for the use of substances involved in DDIs resulted in a reduction in the total number of DDIs by more than 1.5 times, as well as in a nearly 3-fold decrease in the number of interactions requiring therapy modification and drug combinations that should be strictly avoided. The most common PIMs involved in DDIs were painkillers, and drugs used in psychiatry and neurology. Special attention should be paid to DDIs with PIMs since they could increase their inappropriate character. The use of automated interaction analysis systems, while maintaining appropriate clinical criticism, can increase both chances for a good therapeutic effect and the safety of the elderly during treatment processes. Full article

Institutionalized older adults often face complex medication regimens, increasing their risk of adverse drug events due to polypharmacy, overprescribing, medication interactions, or the use of Potentially Inappropriate Medications (PIM). However, data on medication use and associated risks in this population remain scarce. This pilot study aimed to characterize the sociodemographic, clinical and pharmacotherapeutic profiles, and the use of PIM among institutionalized elders residing in Residential Structures for Elderly People (ERPI) in the Faro municipality, located in the Portuguese region of the Algarve. We conducted a cross-sectional study in a non-randomized sample of 96 participants (mean age: 86.6 ± 7.86 years) where trained researchers reviewed medication profiles and identified potentially inappropriate medications using the EU(7)-PIM list. Over 90% of participants exhibited polypharmacy (≥5 medications), with an average of 9.1 ± 4.15 medications per person. About 92% had potential drug interactions, including major and moderate interactions. More than 86% used at least one potentially inappropriate medication, most commonly central nervous system drugs. This pilot study demonstrates that institutionalized older adults may be at high risk of potential medication-related problems. Implementing comprehensive medication review programs and promoting adapted prescribing practices are crucial to optimize medication use and improve the well-being of this vulnerable population. Full article

Introduction: To promote optimal healthcare delivery, safeguarding older adults from the risks associated with inappropriate medication use is paramount. Objective: This study aims to evaluate the effectiveness of implementing the Qatar Tool for Reducing Inappropriate Medication (QTRIM) in ambulatory older adults to enhance medication safety. Method: The QTRIM was developed by an expert consensus panel using the Beers Criteria and contained a list of potentially inappropriate medications (PIMs) based on the local formulary. Using quality improvement methodology, it was piloted and implemented in two outpatient pharmacy settings serving geriatric medicine and dermatology clinics at Rumailah Hospital, Qatar. Key performance indicators (KPIs) using implementation documentation as a process measure and the percentage reduction in PIM prescriptions as an outcome measure were assessed before and after QTRIM implementation. This study was conducted between July 2022 and September 2023. Results: In the outpatient department (OPD) geriatric pharmacy, the prescription rate of PIMs was reduced from an average of 1.2 ± 0.7 PIMs per 1000 orders in 2022 to an average of 0.8 ± 0.2 PIMs per 1000 orders in 2023. In the OPD geriatric pharmacy, the results showed a 66.6% reduction in tricyclic antidepressants (TCAs) (from 30 to 10), a reduction in first-generation antihistamines by 51.7% (29 to 14), and muscle relaxants by 33.3% (36 to 24). While in dermatology, the older adult prescription rate of PIMs was reduced from an average of 8 ± 3 PIMs per 1000 orders in 2022 to a rate of 5 ± 3 PIMs per 1000 orders in 2023; the most PIM reductions were (49.4%) in antihistamines (from 89 to 45), while muscle relaxants and TCAs showed a minimal reduction. Conclusions: Implementing QTRIM with pharmacy documentation monitoring markedly reduced the PIMs dispensed from two specialized outpatient pharmacies serving older adults. It may be a promising effective strategy to enhance medication safety in outpatient pharmacy settings. Full article

Older adults often consume high amounts of medicines, some of which may not be suitable for their age. A cross-sectional descriptive study was carried out on elderly people (>60 years) diagnosed with chronic diseases and taking at least one medication. The consumption of potentially inappropriate medication (PIM) was analyzed using the EU(7)-PIM List. Of the 65 elderly included, the majority were women (83.1%), diagnosed with hypertension (60.0%), and took 4.09 ± 2.104 medicines. More than 58% consumed at least one PIM. Nervous system PIMs were the most prevalent (29.2%, n = 19). There is a high prevalence of PIM use among the elderly, necessitating regular evaluation for safer medication use. Full article

Background: Previous studies identified alarming increases in medication use, polypharmacy, and the use of potentially inappropriate medications (PIMs) among minority older adults with multimorbidity. However, PIM use among underserved older Latino adults is still largely unknown. The main objective of this study is to examine the prevalence of PIM use among underserved, community-dwelling older Latino adults. This study examines both the complexity of polypharmacy in this community and identifies associations between PIM and multimorbidity, polypharmacy, and access to medical care among this segment of our population. Methods: This community-based, cross-sectional study included 126 community-dwelling Latinos aged 65 years and older. The updated 2019 AGS Beers Criteria was used to identify participants using PIMs. We used multinomial logistic regression to examine the independent association of PIM with several independent variables including demographic characteristics, the number of chronic conditions, the number of prescription medications used, level of pain, and sleep difficulty. In addition, we present five cases in order to offer greater insight into PIM use among our sample. Results: One-third of participants had at least one use of PIM. Polypharmacy (≥5 medications) was observed in 55% of our sample. In addition, 46% took drugs to be used with caution (UWC). In total, 16% were taking between 9 and 24 medications, whereas 39% and 46% were taking 5 to 8 and 1 to 4 prescription medications, respectively. The multinomial logit regression analysis showed that (controlling for demographic variables) increased PIM use was associated with an increased number of prescription medications, number of chronic conditions, sleep difficulty, lack of access to primary care, financial strains, and poor self-rated health. Discussion: Both qualitative and quantitative analysis revealed recurrent themes in the missed identification of potential drug-related harm among underserved Latino older adults. Our data suggest that financial strain, lack of access to primary care, as well as an increased number of medications and co-morbidity are inter-connected. Lack of continuity of care often leads to fragmented care, putting vulnerable patients at risk of polypharmacy and drug–drug interactions as clinicians lack access to a current and complete list of medications patients are using at any given time. Therefore, improving access to health care and thereby continuity of care among older Latino adults with multimorbidity has the potential to reduce both polypharmacy and PIM use. Programs that increase access to regular care and continuity of care should be prioritized among multimorbid, undeserved, Latino older adults in an effort toward improved health equity. Full article

Aging is associated with an increase in the prevalence of chronic diseases and polypharmacy, and with the prescription of potentially inappropriate medications (PIMs). This study aimed to analyze the variation in PIMs from hospital admission to discharge. A retrospective cohort study was conducted on inpatients of an internal medicine service. According to the Beers criteria, 80.7% of the patients had been prescribed at least one PIM at admission and 87.2% at discharge; metoclopramide was the most-prescribed PIM from admission to discharge, and acetylsalicylic acid was the most-deprescribed one. According to the STOPP criteria, 49.4% of patients had been prescribed at least one PIM at admission and 62.2% at discharge; quetiapine was the most-prescribed PIM from admission to discharge, and captopril was the most-deprescribed one. According to the EU(7)-PIM list, 51.3% of patients had been prescribed at least one PIM at admission and 70.3% at discharge, and bisacodyl was the most-prescribed PIM from admission to discharge and propranolol the most-deprescribed one. It was found that the number of PIMs at discharge was higher than at admission, suggesting the need to develop a guide with adapted criteria to be applied in an internal medicine service. Full article

Inappropriate prescribing (IP) increases the risk of adverse medication reactions and hospitalizations in elderly patients. Therefore, it is crucial to evaluate prescribing patterns among this population. This study was designed to assess the prevalence of potentially inappropriate medication (PIMs) use and potential prescribing omissions (PPOs) among geriatrics with cardiovascular diseases (CVDs). In addition, it determined the predictors for IP in this population. A multi-center study was performed retrospectively on 605 patients’ medical records collected randomly from seven governmental hospitals in Kuwait. Three of these hospitals have specialized cardiac centers (tertiary care). Inclusion criteria were age ≥ 65 years, diagnosed with at least one CVD, and attended the outpatient clinic during the last 6 months before data collection. A total of 383 patients (63.3%; 95% CI: 59.3–67.1%) were found using at least one PIM or having PPO or both, based on STOPP/START criteria. Three hundred and ninety-one patients (64.6%; 95% CI: 60.7–68.4%) were prescribed PIMs categorized as C and/or D medicines according to the Euro-FORTA list. Over one-quarter (28.8%; 95% CI: 25.2–32.6%) of the patients had drug–drug interactions class D that require therapy modification and/or X that should be avoided. Patients taking ≥ five medications had significantly higher PIMs based on STOPP and FORTA criteria, drug–drug interactions (p < 0.001), and significantly higher PPOs based on START criteria (p = 0.041). Patients with three or more chronic diseases had significantly higher PIMs based on STOPP and FORTA criteria and PPOs based on START criteria (p-values: 0.028, 0.035, and 0.005, respectively). Significantly higher PIMs based on STOPP criteria and PPOs based on START criteria were found in general hospitals compared to specialized cardiac centers (p= 0.002, p= 0.01, respectively). These findings highlight the need to develop and implement multifaceted interventions to prevent or minimize inappropriate prescribing among the geriatric population with CVDs in Kuwait. Full article

Introduction: Vaccines are the best tools to end the pandemic, and their public acceptance is crucial in achieving herd immunity. Despite global efforts to increase access to vaccination, the World Health Organization explicitly lists vaccination hesitancy (VH) as a significant threat. Despite robust safety reports from regulatory authorities and public health advisories, a substantial proportion of the community remains obsessed with the hazards of vaccination. This calls for identifying and eliminating possible causative elements, among which this study investigates the inappropriate dissemination of medical literature concerning COVID-19 and adverse events following immunization (AEFI), its influence on promoting VH, and proposals for overcoming this problem in the future. Methods: We searched PubMed, Embase, and Scopus databases, using the keywords “adverse events following immunization (AEFI)”, “COVID-19”, “vaccines” and “hesitancy” and related medical and subjective headings (MeSH) up to 31 March 2022, and extracted studies relevant to the COVID-19 AEFI and associated VH. Finally, 47 articles were chosen to generate a narrative synthesis. Results: The databases depicted a steep rise in publications on COVID-19 AEFI and COVID-19 VH from January 2021 onwards. The articles depicted multiple events of mild AEFIs without fatal events in recipients. While documenting AEFIs is praiseworthy, publishing such reports without prior expert surveillance can exaggerate public apprehension and inappropriately fuel VH. VH is a deep-rooted phenomenon, but it is difficult to zero in on the exact reason for it. Spreading rumors/misinformation on COVID-19 vaccines might be an important provocation for VH, which includes indiscriminately reporting AEFI on a massive scale. While a number of reported AEFIs fall within the acceptable limits in the course of extensive COVID-19 vaccinations, it is important to critically evaluate and moderate the reporting and dissemination of AEFI in order to allay panic. Conclusions: Vaccination programs are necessary to end any pandemic, and VH may be attributed to multiple reasons. VH may be assuaged by initiating educational programs on the importance of vaccination, raising public awareness and monitoring the inappropriate dissemination of misleading information. Government-initiated strategies can potentially restrict random AEFI reports from lay epidemiologists and healthcare practitioners. Full article