Drugs & Aging, Journal Year: 2022, Volume and Issue: 39(12), P. 935 - 947
Published: Nov. 21, 2022
Language: Английский
The Lancet Healthy Longevity, Journal Year: 2021, Volume and Issue: 2(5), P. e290 - e300
Published: May 1, 2021
Language: Английский
Citations
138
BMC Geriatrics, Journal Year: 2023, Volume and Issue: 23(1)
Published: Sept. 25, 2023
A third of older people take five or more regular medications (polypharmacy). Conducting medication reviews in primary care is key to identify and reduce/ stop inappropriate (deprescribing). Recent recommendations for effective deprescribing include shared-decision making a multidisciplinary approach. Our aim was understand when, why, how interventions review involving teams (MDTs) work (or do not work) people.
Language: Английский
Citations
32
International Journal of General Medicine, Journal Year: 2021, Volume and Issue: Volume 14, P. 3793 - 3807
Published: July 1, 2021
Abstract: Polypharmacy is a major challenge in healthcare for older people, and associated with increased risks of adverse outcomes, such as delirium, falls, frailty, cognitive impairment hospitalization. There significant public professional interest the role deprescribing reducing medication-related harms people. We aim to provide narrative review 1) safety efficacy interventions, 2) challenges solutions research implementation clinical practice, 3) benefits using Computerized Clinical Decision Support Systems (CCDSS) Quality Indicators (QIs) practice. Deprescribing an established management strategy minimize polypharmacy potentially inappropriate medications. limited evidence its on global geriatric outcomes. Various at patient, system levels may impact success interventions Management strategies that target all are required overcome these challenges. Future studies consider large multicenter prospective designs establish effects sustainability Keywords: deprescribing, polypharmacy, geriatric, computerized decision support, quality indicator
Language: Английский
Citations
55
Ageing Research Reviews, Journal Year: 2024, Volume and Issue: 95, P. 102237 - 102237
Published: Feb. 16, 2024
Deprescribing is an important intervention across different settings in medicine, but the literature supporting such a practice still conflicting. Therefore, we aimed to capture breadth of outcomes reported and assess strength evidence use deprescribing for health outcomes. Umbrella review systematic reviews searching Medline, Scopus, Web Science until 01 November 2023. The grading was carried out using GRADE studies, whilst data regarding were as narrative findings. Among 456 papers, 12 (six with meta-analysis) total 231 RCTs 44,193 patients included. In any setting, able significantly reduce number potentially inappropriate medications (PIMs) older (low certainty evidence) proportion participants having several or PIMs (moderate evidence). community, supported by high evidence, not more effective than standard care decreasing injurious falls, falls fallers. nursing home, associated lower (very low end-of-life situations, reduced mortality rate approximately 41% (high promising notable gap concerning its effects on substantial exists.
Language: Английский
Citations
6
British Journal of Clinical Pharmacology, Journal Year: 2023, Volume and Issue: 90(1), P. 12 - 106
Published: Sept. 12, 2023
Aims The aim of this umbrella review was to identify tools and guidelines aid the deprescribing process potentially inappropriate medications (PIMs), evaluate development validation methods, describe evidence levels for medication inclusion. Methods Searches were conducted on MEDLINE (Ovid), Embase.com , Cochrane CDSR, CINAHL (EBSCO), Web Science Core Collection guideline databases from date inception 7 July 2022. Following initial search, an additional search updated versions 17 2023. We analysed contents guidelines. Results From 23 systematic reviews guidelines, we identified 95 (72 explicit, 12 mixed 11 implicit) nine Most (83.2%) developed use older persons, including 14 those with limited life expectancy. Seven children <18 years (7.37%). explicit/mixed (78.57%) all validated. found 484 PIMs 202 different appropriateness independent disease persons normal expectancy, respectively. Only two eight reported level, a quarter had high‐quality evidence. Conclusions Tools are available diversity populations. There discrepancies, same being classified as in some appropriate others, possibly due low‐quality In particular, patients expectancy based very evidence, research generate is urgently needed. Our lists, along level could facilitate efforts strengthen
Language: Английский
Citations
14
British Journal of Clinical Pharmacology, Journal Year: 2023, Volume and Issue: 90(3), P. 662 - 674
Published: Nov. 11, 2023
Abstract Aims The aim of this study was to compare the clinical decision‐making for benzodiazepine deprescribing between a healthcare provider (HCP) and an artificial intelligence (AI) chatbot GPT4 (ChatGPT‐4). Methods We analysed real‐world data from Croatian cohort community‐dwelling patients ( n = 154) within EuroAgeism H2020 ESR 7 project. HCPs evaluated using pre‐established criteria assess discontinuation potential. research team devised tested AI prompts ensure consistency with HCP judgements. An independent researcher employed ChatGPT‐4 predetermined simulate decisions each patient case. Data derived human‐HCP were compared agreement rates Cohen's kappa. Results Both HPC ChatGPT identified (96.1% 89.6%, respectively), showing rate 95% κ .200, P .012). Agreement on four ranged 74.7% 91.3% (lack indication .352, < .001; prolonged use .088, .280; safety concerns .123, .006; incorrect dosage .264, .001). Important limitations GPT‐4 responses identified, including 22.1% ambiguous outputs, generic answers inaccuracies, posing inappropriate risks. Conclusions While AI‐HCP is substantial, sole reliance poses risk unsuitable decision‐making. This study's findings reveal both strengths areas enhancement in recommendations sample. Our underscores need additional functionality therapy decision‐making, further fostering advancement optimal performance.
Language: Английский
Citations
14
Journal of Geriatric Oncology, Journal Year: 2021, Volume and Issue: 12(6), P. 863 - 871
Published: Jan. 19, 2021
Language: Английский
Citations
32
Research in Social and Administrative Pharmacy, Journal Year: 2021, Volume and Issue: 18(3), P. 2547 - 2549
Published: April 19, 2021
Language: Английский
Citations
31
Research in Social and Administrative Pharmacy, Journal Year: 2021, Volume and Issue: 18(3), P. 2550 - 2555
Published: June 6, 2021
Language: Английский
Citations
31
Drugs & Aging, Journal Year: 2025, Volume and Issue: unknown
Published: March 11, 2025
Polypharmacy is common amongst older people with dementia or mild cognitive impairment (MCI), increasing the risk of medication-related harm. Medicine optimisation and deprescribing to reduce polypharmacy considered feasible, safe can lead improved health. However, for those living MCI, this be challenging. This systematic review aimed summarise evidence on outcomes medicine interventions MCI. Literature was searched using CINAHL, Embase, Medline, PsychINFO, Web Science Cochrane Library from database inception January 2024. Papers reporting data specific MCI interventional research studies any design in setting were included. A narrative synthesis conducted owing heterogeneity study designs outcomes. Quality assessed Mixed Methods Appraisal Tool. total 32 papers 28 included, samples ranging 29 17,933 patients a mean patient age 74 88 years. Of studies, 60% undertaken long-term care settings. Involvement and/or carers limited. grouped as either incorporating medication component (n = 13), education 5) both 14). Studies primarily focussed outcomes, generally showing positive effect decreasing number improving appropriateness medications. Fewer reported clinical (behavioural psychological symptoms dementia, falls, quality life cognition) mixed findings. reduction no change mortality hospital attendance demonstrated safety few these The mixed. reduced increased medications, although less frequently reported, seemed showed an absence worsening highlights need further research, particularly at home, more focus greater involvement informal carers. protocol published International Prospective Register Systematic Reviews (PROSPERO) [Ref: CRD42023398139].
Language: Английский
Citations
0