Deprescribing in older adults with polypharmacy

BMJ, Journal Year: 2024, Volume and Issue: unknown, P. e074892 - e074892

Published: May 7, 2024

Abstract Polypharmacy is common in older adults and associated with adverse drug events, cognitive functional impairment, increased healthcare costs, risk of frailty, falls, hospitalizations, mortality. Many barriers exist to deprescribing, but efforts have been made develop implement deprescribing interventions that overcome them. This narrative review describes intervention components summarizes findings from published randomized controlled trials tested polypharmacy, as well reports on ongoing trials, guidelines, resources can be used facilitate deprescribing. Most were medication reviews primary care settings, many contained such shared decision making and/or a focus patient priorities, training for professionals, facing education materials, involvement family members, representing great heterogeneity addressing polypharmacy adults. Just over half study found perform better than usual at least one their outcomes, most assessed 12 months or less.

Language: Английский

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Older Adults’ Attitudes Toward Deprescribing in 14 Countries

JAMA Network Open, Journal Year: 2025, Volume and Issue: 8(2), P. e2457498 - e2457498

Published: Feb. 10, 2025

Importance Better understanding of patients’ attitudes toward deprescribing specific medications will inform future interventions. Objective To investigate older adults’ by investigating which they would like to have deprescribed, the reasons why, and patient factors associated with interest in deprescribing. Design, Setting, Participants This survey study was conducted from May 2022 December 2023 primary care settings 14 countries. Patients aged 65 years or taking 5 more were consecutively recruited their general practitioner (GP) completed questionnaire. Exposures Patient characteristics, including gender, number medications, GP education level, financial status, confidence completing medical forms, self-rated health, satisfaction trust GP, country. Main Outcomes Measures The outcomes as measured responses question, “Thinking about your current medication list, are there any that you stop reduce dose of?” Multilevel multivariable logistic regression analysis used, adjusted for clustering effect at country association between characteristics Results Of 1340 patients (mean [SD], 96 [47] per country), 736 (55%) women, 580 (44%) had secondary school highest level education, 1089 (82%) satisfied 589 expressed deprescribe 1 medications. varying levels, 79% (86 109 patients) Poland 23% (21 Bulgaria. 3 most reported deprescribed diuretics (111 1002 [11%]), lipid-modifying agents (109 acting on renin-angiotensin system (83 [8%]). odds naming least lower higher (odds ratio, 0.31; 95% CI, 0.21-0.47) 0.960; 0.930-0.998). Conclusions Relevance In this older, varied across countries, demonstrating interventions could be impactful when adapted contexts. These findings highlight importance patient-practitioner communication ensuring appropriate use.

Language: Английский

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Reducing potentially inappropriate polypharmacy at a national and international level: the impact of deprescribing networks

Expert Review of Clinical Pharmacology, Journal Year: 2024, Volume and Issue: 17(5-6), P. 433 - 440

Published: May 13, 2024

Over the past decade, polypharmacy has increased dramatically. Measurable harms include falls, fractures, cognitive impairment, and death. The associated costs are massive contribute substantially to low-value health care. Deprescribing is a promising solution, but there barriers. Establishing network address can help overcome barriers by connecting individuals with an interest expertise in deprescribing act as important source of motivation resources.

Language: Английский

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Advancing deprescribing: Learnings from the first international conference on deprescribing

Basic & Clinical Pharmacology & Toxicology, Journal Year: 2023, Volume and Issue: 134(1), P. 3 - 5

Published: Nov. 21, 2023

There are no conflicts to declare. Research data not shared.

Language: Английский

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Impact of comprehensive medication reviews on potentially inappropriate medication discontinuation in Medicare beneficiaries

Journal of the American Geriatrics Society, Journal Year: 2024, Volume and Issue: 72(8), P. 2347 - 2358

Published: June 3, 2024

Abstract Background The use of potentially inappropriate medications (PIMs) is associated with increased risk hospitalizations and emergency room visits varies by racial ethnic subgroups. Medicare's nationwide medication therapy management (MTM) program requires that Part D plans offer an annual comprehensive review (CMR) to all beneficiaries who qualify, provides a platform reduce PIM use. objective this study was assess the impact CMR on discontinuation in Medicare whether differed race or ethnicity. Methods Retrospective cohort community‐dwelling ≥66 years age were eligible for MTM from 2013 2019 based 5% fee‐for‐service claims data linked 100% file. Among those using PIM, MTM‐eligible recipients matched non‐recipients via sequential stratification. probability estimated regression models pooled yearly subcohorts accounting within‐beneficiary correlations. most common PIMs discontinued after reported. Results We 24,368 during observation period. Median 74–75, 35% males, White (86%–87%), median number 1. In adjusted analyses, receipt positively (adjusted relative [aRR]: 1.26, 95% CI: 1.20–1.32). There no evidence differential commonly glimepiride, zolpidem, digoxin, amitriptyline, nitrofurantoin. Conclusions are discontinuation, suggesting greater could facilitate reduction groups.

Language: Английский

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ATEMPTing to navigate between “lower is better” and “less is more”

The Lancet Healthy Longevity, Journal Year: 2024, Volume and Issue: 5(3), P. e164 - e165

Published: Feb. 9, 2024

Hypertension is a leading risk factor for dementia, cardiovascular disease, and death in older adults. Although intensive blood pressure control effectively reduces morbidity mortality, frail adults might be more susceptible to adverse effects such as hypotension, falls, electrolyte abnormalities. Most of the landmark hypertension trials that inform current clinical guidelines have excluded or those with significant multimorbidity, polypharmacy, disability, other factors can limit life expectancy ability strictly adhere burdensome study protocols.1Sheppard JP Lown M Burt J et al.Generalizability lowering patients: cross-sectional analysis.J Am Geriatr Soc. 2020; 68: 2508-2515Crossref PubMed Scopus (34) Google Scholar These exclusion criteria led substantial uncertainty management populations are simultaneously at highest disease medication-related effects, leaving clinicians struggling navigate between results Systolic Blood Pressure Intervention Trial (SPRINT) supporting notion "lower better" (ie, lower systolic target favourable these populations),2Williamson JD Supiano MA Applegate WB al.Intensive vs standard outcomes aged ≥75 years.JAMA. 2016; 3152673Crossref (918) versus "less more" approach The Optimising Treatment Mild Elderly (OPTiMISE) trial fewer pressure-lowering medications populations).3Sheppard al.Effect antihypertensive medication reduction usual care on short-term patients 80 years older: OPTIMISE randomized trial.JAMA. 323: 2039-2051Crossref (91) In Lancet Healthy Longevity, Jeannette Majert colleagues4Majert Nazarzadeh Ramakrishnan R al.Efficacy decentralised home-based treatment multimorbidity polypharmacy (ATEMPT): an open-label randomised controlled pilot trial.Lancet Health Longev. 2024; (published online Feb 8.)https://doi.org/10.1016/S2666-7568(23)00259-3Summary Full Text PDF (0) present study, Antihypertensive Evaluation Multimorbidity Polypharmacy (ATEMPT), specifically targeted 65 mild evidence both. ATEMPT was decentralised, randomly assigned participants stratified manner group targeting intensification another de-escalation therapy, aiming produce average difference two groups. Additionally, unlike most large-scale date, intervention delivered home environment, leveraging monitoring, participant portal, largely remote contact personnel medical personnel, delivery medications. At 13 months follow-up, therapy had mean decrease –10·7 mm Hg (95% CI –17·5 –4·0) relative intensity group. No differences were observed major events, cognitive function, frailty, quality life, although not powered outcomes. Consistent findings SPRINT, illustrates achieving improved vulnerable adults, slightly above 120 target, feasible typically entails addition 1 1·5 primary innovation this level through pragmatic strategy, which well received by participants. This could serve model future chronic community-dwelling However, one unanswered question what extent reductions managed would persist over multiple years, given typical time benefit from therapy5Chen T Shao F Chen K al.Time 60 hypertension.JAMA Intern Med. 2022; 182: 660Crossref (18) ease degrade time.6Jaeger BC Bress AP Bundy al.Longer-term all-cause mortality control: secondary analysis trial.JAMA Cardiol. 7: 1138-1146Crossref (22) it certainly premature assume safe population without larger longer duration, involving sensitive measures physical function. An important decision moving forward will how balance need full characterisation safety ascertainment geriatric constructs consistently assessed care,7Nicosia FM Spar MJ Steinman Lee SJ Brown RT Making function part conversation: clinician perspectives measuring functional status care.J 2019; 67: 493-502Crossref (13) desire use methodology eases burden participation. Another result fact deprescribing generally unsuccessful. reduced actually experienced increase 0·4 during follow-up. Despite growing interest throughout medicine,8Reeve E Thompson W Boyd C Lundby state research: did we get here?.Basic Clin Pharmacol Toxicol. 2023; 133: 657-660Crossref (1) reinforce view context easier said than done. Patients be, counterintuitively, amenable adding medications, rather removing they been taking if decades. As authors point out, observation consistent rate re-prescription OPTiMISE trial,3Sheppard has interventions less glycaemic type 2 diabetes frailty multimorbidity. Alternatively, nature allowed differential external influence prescribing, including overlapping indications (eg, alpha blockers benign prostatic hypertrophy) inconsistent reconciliation. provides window into feasibility enrolling retaining trials, safely short term. duration follow-up across needed ultimately draw conclusions, opens door improving often-neglected population. NMP investigator funding US National Institutes (R01 AG055606). does bear any responsibility commentary interpretations presented here. Efficacy trialRemotely substantially who often represented no serious events. focusing assessing safety, functioning, currently planning stages. also underscore efficiency designs, broader settings. Full-Text Open Access

Language: Английский

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Antihypertensive deprescribing in frail long-term care residents (OptimizeBP): protocol for a prospective, randomised, open-label pragmatic trial

BMJ Open, Journal Year: 2024, Volume and Issue: 14(8), P. e084619 - e084619

Published: Aug. 1, 2024

Although antihypertensive medication use is common among frail older adults, observational studies in this population suggest blood pressure (BP) lowering may convey limited benefit and perhaps even harm. This protocol describes an deprescribing trial adults powered for mortality morbidity outcomes.

Language: Английский

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Welcome to Basic & Clinical Pharmacology & Toxicology 2024

Basic & Clinical Pharmacology & Toxicology, Journal Year: 2023, Volume and Issue: 134(1), P. 126 - 128

Published: Dec. 12, 2023

Language: Английский

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