Elderly Patients and Management in Intensive Care Units (ICU): Clinical Challenges

Clinical Interventions in Aging, Journal Year: 2023, Volume and Issue: Volume 18, P. 93 - 112

Published: Jan. 1, 2023

Abstract: There is a growing population of older adults requiring admission to the intensive care unit (ICU). This outpaces ability clinicians with geriatric training assist in their management. Specific and education for intensivists patients valuable help understand inform clinical care, as physiologic changes aging affect each organ system. review highlights some these processes discusses implications vulnerable population. Other considerations when caring ICU include functional outcomes morbidity, opposed merely focus on mortality. An overall holistic approach incorporating physiology aging, applying current evidence, including patient family should be used ICU. Keywords: syndrome, critical illness, dysfunction, shock, respiratory failure

Language: Английский

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A systems approach to identifying the challenges of implementing deprescribing in older adults across different health-care settings and countries: a narrative review

Expert Review of Clinical Pharmacology, Journal Year: 2020, Volume and Issue: 13(3), P. 233 - 245

Published: Feb. 14, 2020

Introduction: There is increasing recognition of the need for deprescribing inappropriate medications in older adults. However, efforts to encourage implementation clinical practice have resulted mixed results across settings and countries.Area covered: Searches were conducted PubMed, Embase, Google Scholar June 2019. Reference lists, citation checking, personal reference libraries also utilized. Studies capturing main challenges of, opportunities for, implementing into selected health-care internationally, international deprescribing-orientated policies included summarized this narrative review.Expert opinion: Deprescribing intervention studies are inherently heterogeneous because complexity interventions employed often do not reflect real-world. Further research investigating enhanced required. Process evaluations needed determine contextual factors that important translation may be individually tailored target unique barriers different settings. Introduction national beneficial, but evaluated if there any unintended consequences.

Language: Английский

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Process, impact and outcomes of medication review in Australian residential aged care facilities: A systematic review

Australasian Journal on Ageing, Journal Year: 2019, Volume and Issue: 38(S2), P. 9 - 25

Published: Sept. 1, 2019

Abstract Objective To systematically review literature reporting processes, impact and outcomes of medication reconciliation in Australian residential aged care facilities ( RACF s). Methods PubMed/ MEDLINE , EMBASE CINAHL Informit Health grey were searched from 1995 to July 2018. Studies a stand‐alone or interventions s included. Results Thirteen studies investigated review, eight which studied Residential Medication Management Reviews RMMR Five reported that reviews identified an average 2.7‐3.9 medication‐related problems MRP s) per resident. One study had no on quality life, hospitalisation mortality, but was not powered assess these. Three general practitioners’ acceptance pharmacists’ recommendations resolve s, ranging between 45 84%. Conclusions may be useful strategy identify prompt resolution s. However, the clinical resident‐centred remains unclear.

Language: Английский

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A Systematic Review of Studies of the STOPP/START 2015 and American Geriatric Society Beers 2015 Criteria in Patients ≥ 65 Years

Current Aging Science, Journal Year: 2019, Volume and Issue: 12(2), P. 121 - 154

Published: May 17, 2019

Polypharmacy remains problematic for individuals ≥65.To summarise the percentages of patients meeting 2015 STOPP criteria Potentially Inappropriate Prescriptions (PIPs), Beers Medications (PIMs), and START Potential Prescribing Omissions (PPOs).Searches conducted on 2 January 2019 in Medline, Embase, PubMed identified 562 studies 62 were retained review. Data abstracted independently.62 (n=1,854,698) included two RCTs 60 non-randomised studies. For thirty STOPP/START (n=1,245,974) average ≥1 PIP weighted by study size 42.8% 1,242,010 community 51.8% 3,964 hospitalised patients. nineteen (n = 595,811) PIM 58% 593,389 55.5% 2,422 thirteen (n=12,913) assessing both 33.9% PIMs 46.8% 8,238 patients, ≥ 1 42.4% 60.5% 4,675 Only ten assessed changes over time eight found positive changes.PIP/PIM/PPO rates are high many countries. needed interventions to: reduce new/existing PIPs/PIMs/PPO prescriptions, prescriptions causing adverse effects, enable regulatory authorities to monitor inappropriate real time. Substantial differences between assessments need be investigated whether they due criteria, differential medication availability countries, or data assess criteria.

Language: Английский

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Association of the Drug Burden Index (DBI) exposure with outcomes: A systematic review

Journal of the American Geriatrics Society, Journal Year: 2023, Volume and Issue: 72(2), P. 589 - 603

Published: Nov. 25, 2023

Abstract Background The Drug Burden Index (DBI) measures an individual's total exposure to anticholinergic and sedative medications. This systematic review aimed investigate the association of DBI with clinical prescribing outcomes in observational pharmaco‐epidemiological studies, effect on functional pre‐clinical models. Methods A search nine electronic databases, citation indexes gray literature was performed (April 1, 2007–December 31, 2022). Studies that reported primary data or conducted any setting humans aged ≥18 years animals were included. Quality assessment using Joanna Briggs Institute critical appraisal tools Systematic Review Centre for Laboratory animal Experimentation risk bias tool. Results Of 2382 studies screened, 70 met inclusion criteria (65 humans, five animals). In included function ( n = 56), cognition 20), falls 14), frailty 7), mortality 9), quality life 8), hospitalization length stay 5), readmission 1), other 15) 2). higher significantly associated increased (11/14, 71%), poorer (31/56, 55%), (11/20, 55%) related outcomes. Narrative synthesis used due significant heterogeneity study population, setting, type, definition DBI, outcome measures. could not be pooled heterogeneity. animals, 18), 2), 1). a caused frailty. Conclusions may decreased cognition. Higher inconsistently mortality, stay, frailty, reduced life. Human findings respect are supported by preclinical interventional studies. as tool identify older adults at harm.

Language: Английский

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Assessing the psychometric performance of EQ-5D-5L in dementia: a systematic review

Health and Quality of Life Outcomes, Journal Year: 2022, Volume and Issue: 20(1)

Published: Sept. 28, 2022

EQ-5D is widely used for valuing changes in quality of life economic evaluation interventions people with dementia. There are concerns about EQ-5D-3L terms content validity, poor inter-rater agreement and reliability the presence cognitive impairment, but there also evidence to support its use this population. An gap remains regarding psychometric properties EQ-5D-5L.To report around EQ-5D-5L dementia.A systematic review identified primary studies reporting Searches were completed up November 2020. Study selection, data extraction assessment undertaken independently by at least 2 researchers.Evidence was extracted from 20 articles 14 unique covering a range dementia severity. Evidence known group validity 5 7 indicated that distinguishes severity disease measured depression, level dependence pain. Convergent (9 studies) showed statistically significant correlations weak moderate strengths, between scores on other key measures. Statistically change observed only one 6 papers allowed property be examined. All seven lack self proxy reports former higher than those provided proxies. Five ten found acceptable, assessed whether measure could PwD and/or amount missing data. As increased, feasibility self-completing decreased. Three reported ceiling effects, two some did not.EQ-5D-5L seems capture health basis known-group convergent inconclusive responsiveness EQ-5D-5L. progresses, ability self-complete diminished.

Language: Английский

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Understanding the medication safety challenges for patients with mental illness in primary care: a scoping review

BMC Psychiatry, Journal Year: 2023, Volume and Issue: 23(1)

Published: June 12, 2023

Abstract Background Mental illness and medication safety are key priorities for healthcare systems around the world. Despite most patients with mental being treated exclusively in primary care, our understanding of challenges this setting is fragmented. Method Six electronic databases were searched between January 2000-January 2023. Google Scholar reference lists relevant/included studies also screened studies. Included reported data on epidemiology, aetiology, or interventions related to care. Medication defined using drug-related problems (DRPs) categorisation. Results Seventy-nine included 77 (97.5%) reporting 25 (31.6%) 18 (22.8%) evaluated an intervention. Studies commonly (33/79, 41.8%) originated from United States America (USA) investigated DRP non-adherence (62/79, 78.5%). General practice was common study (31/79, 39.2%) depression a focus (48/79, 60.8%). Aetiological presented as either causal (15/25, 60.0%) risk factors (10/25, 40.0%). Prescriber-related factors/causes 8/25 (32.0%) patient-related 23/25 (92.0%) Interventions improve adherence rates (11/18, 61.1%) evaluated. Specialist pharmacists provided majority (10/18, 55.6%) eight these involving review/monitoring service. All positive improvements some outcomes but 6/18 little difference groups certain measures. Conclusion Patients at variety DRPs However, date, available research exploring has focused attention potential prescribing issues older dementia. Our findings highlight need further causes preventable incidents targeted

Language: Английский

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Psychotropic medications in older people in residential care facilities and associations with quality of life: a cross-sectional study

BMC Geriatrics, Journal Year: 2018, Volume and Issue: 18(1)

Published: Feb. 26, 2018

Psychotropic medications have been associated with many adverse outcomes in older people living residential care. Home-like models of care may be preferable to traditional and we hypothesized that this model impact on the prevalence psychotropic medications. The objectives were to: 1) examine associations between quality life adults facilities a high cognitive impairment dementia 2) determine if there was difference which provide small group home-like compared 'standard model' care.Participants included 541 residents from 17 aged Investigating Services Provided Residential Environment for Dementia (INSPIRED) study. Cross-sectional analyses completed above objectives. Quality measured questionnaire (DEMQOL) EQ-5D-5L by resident or proxy.Overall, 70.8% (n = 380) population had prescribed/dispensed at least one medication 100 days prior recruitment. An increased number lower according DEMQOL-Proxy-Utility scores (β (SE): - 0.012 (0.006), p 0.04) (- 0.024 (0.011), 0.03) after adjustment resident-level facility-level characteristics. Analysis individual classes showed antipsychotics 0.030 (0.014), benzodiazepines 0.059 (0.024), 0.01). Participants residing less likely prescribed (OR (95% CI): 0.24 (0.12, 0.46), < 0.001).An scores. These effects use these should re-examined when investigating approaches improve help reduce need medications, but further research is needed validate findings.

Language: Английский

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Deprescribing for older people living in residential aged care facilities: Pharmacist recommendations, doctor acceptance and implementation

Archives of Gerontology and Geriatrics, Journal Year: 2022, Volume and Issue: 107, P. 104910 - 104910

Published: Dec. 19, 2022

Language: Английский

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Dynamic changes in medication burden leading to fall and hospital readmissions in older adults: Toward a strategy for improving risk and managing costs

Journal of Managed Care & Specialty Pharmacy, Journal Year: 2025, Volume and Issue: 31(1), P. 96 - 100

Published: Jan. 1, 2025

The majority of a health plan's performance and designated Star Rating is related to medication-related behavior, eg, medication adherence, review, reconciliation, that are intricately adverse drug events (ADEs). Altered pharmacodynamics pharmacokinetics owing aging make older adults more vulnerable ADEs like falls, fractures, hospitalizations, mortality. Prevention avoidable risk factors such as burden can help maintain quality life. Studies multiple populations have established index (DBI), dose-dependent measure anticholinergic sedative burden, be strongly associated with worsening vertigo, dizziness, balance, which all predicate falls. mean difference in DBI greater than 0.1 provides predictive power for events, falls 30-day readmission rates. Inclusion delta metric especially on an electronic medical record has the potential reduce fall incidence outcomes hospitalizations death; this presents opportunity improve Centers Medicare & Medicaid Services Ratings by using meaningful tools foster engagement among informed active beneficiaries. We believe information extremely relevant real-world decision-making care professionals, specifically when changes dynamic happen very quickly. Moreover, managed organizations now dedicated eliciting deeper understanding mitigation social inequalities use consequences. Among proposed solutions includes tailoring prescription utilization management decrease incidences complications unintended costs. Understanding relationship between exposures causing costs third-party payments remains vital because United States, approximately one-third hospital admissions occur ADEs. This achieved emphasizing equitable therapy initiatives minimize racial disparities affect financial these patients. Importantly, approach becomes even critical systems increasingly emphasize star ratings, reflect delivered By prioritizing metrics we ensure not only clinically effective but also focused improving patients' overall well-being. Lastly, future directions, timely application advanced technologies artificial intelligence machine learning analyzing could enhance our ability predict value adjustments their correlation other These process vast amounts data quickly accurately, identifying patterns risks might otherwise go unnoticed.

Language: Английский

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