BMC Geriatrics, Journal Year: 2024, Volume and Issue: 24(1)
Published: June 27, 2024
General practitioners (GPs) have a central role to play on reduction of polypharmacy and deprescribing. This study aimed assess beliefs attitudes towards deprescribing in patients, aged 65 years or older primary care, identify factors associated with their willingness stop medication.
Language: Английский
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
Citations
21
Aging Clinical and Experimental Research, Journal Year: 2024, Volume and Issue: 36(1)
Published: March 8, 2024
Abstract Recent medical advancements have increased life expectancy, leading to a surge in patients affected by multiple chronic diseases and consequent polypharmacy, especially among older adults. This scenario increases the risk of drug interactions adverse reactions, highlighting need for medication review deprescribing reduce inappropriate medications optimize therapeutic regimens, with ultimate goal improving patients’ health quality life. position statement from Italian Scientific Consortium on aims describe key elements, strategies, tools, timing, healthcare professionals be involved, implementation different settings (i.e., primary care, hospital, long-term care facilities, palliative care). Challenges potential solutions are also discussed.
Language: Английский
Citations
6
Age and Ageing, Journal Year: 2023, Volume and Issue: 52(9)
Published: Sept. 1, 2023
Abstract Introduction Anticholinergic medications block the neurotransmitter acetylcholine in brain and peripheral nervous system. Many have anticholinergic properties, cumulative effect of these is termed burden. Increased burden can short-term side effects such as dry mouth, blurred vision urinary retention well long-term including dementia, worsening physical function falls. Methods We carried out a systematic review (SR) with meta-analysis (MA) looking at randomised controlled trials addressing interventions to reduce older adults. Results identified seven papers suitable for inclusion our SR MA. Interventions included multi-disciplinary involvement medication reviews deprescribing AC medications. Pooled data revealed no significant difference outcomes between control intervention group falls (OR = 0.76, 95% CI: 0.52–1.11, n 647), cognition (mean 1.54, −0.04 3.13, 405), 0.04, −0.11 0.18, 710) or quality life 0.12, 461). Discussion Overall, there was As we did not see change scores following interventions, it likely other would change. Short follow-up time lack training support surrounding successful may contributed.
Language: Английский
Citations
14
JAMA Network Open, Journal Year: 2023, Volume and Issue: 6(10), P. e2337281 - e2337281
Published: Oct. 11, 2023
Little is known about why older adults decline deprescribing recommendations, primarily because interventional studies rarely capture the reasons.To examine factors important to who disagree with a recommendation given by primary care physician hypothetical patient experiencing polypharmacy.This online, vignette-based survey study was conducted from December 1, 2020, March 31, 2021, participants 65 years or in United Kingdom, US, Australia, and Netherlands. The outcome of main disagreement recommendation. A content analysis subsequently free-text reasons provided strongly disagreed deprescribing. Data were analyzed August 22, 2022, February 12, 2023.Attitudes, beliefs, fears, recommended actions response recommendations.Of 899 included analysis, mean (SD) age 71.5 (4.9) years; 456 (50.7%) men. Attitudes, fears reported doubts (361 [40.2%]), valuing medications (139 [15.5%]), preference avoid change (132 [14.7%]). Valuing more commonly among compared those (48 205 [23.4%] vs 91 694 [13.1%], respectively; P < .001) had personal experience same medication class as vignette no (93 517 [18.0%] 46 318 [12.1%], = .02). Participants shared that improved communication (225 [25.0%]), alternative strategies (138 [15.4%]), consideration preferences (137 [15.2%]) may increase their agreement interested additional (196 [28.2%] 29 [14.2%], .001), (117 [16.9%] 21 [10.2%], .02), (122 [17.6%] 15 [7.3%], .001).In this study, communication, strategies, disagreed. These findings suggest identifying degree could be used tailor patient-centered adults.
Language: Английский
Citations
11
BMC Geriatrics, Journal Year: 2022, Volume and Issue: 22(1)
Published: Sept. 6, 2022
Language: Английский
Citations
18
Healthcare, Journal Year: 2024, Volume and Issue: 12(6), P. 678 - 678
Published: March 18, 2024
Introduction: Self-managed exercise and nutrition interventions can alleviate pre-frailty frailty but understanding of adherence to them is lacking. This study aimed explore the experiences of, barriers enablers to, a hospital-to-home self-managed combined program for hospitalised older adults living with frailty. Methods: A hybrid approach data- theory-driven descriptive thematic analysis identified experiences, barriers, participation in 3-month, self-managed, exercise–nutrition, frailty-support program. Pre-frail frail adult patients ≥ 65 years admitted acute medical unit at South Australian tertiary hospital were recruited. Individual semi-structured interviews audio-recorded, transcribed verbatim, analysed descriptively, using Theoretical Domains Framework. Results: The component found 11 common 18 enablers. included 14 24 Intentions, Social influences, Environmental context/resource Emotions served as primary towards both components. Common components Knowledge, identity, context/resource, Emotions. Conclusions: research revealed important factors affecting exercise–nutrition pre-frail within environment, resources, emotion domains that should be considered when designing other intervention programs this population group.
Language: Английский
Citations
3
Basic & Clinical Pharmacology & Toxicology, Journal Year: 2023, Volume and Issue: 133(6), P. 673 - 682
Published: March 10, 2023
The purpose of this study was to examine factors important older adults who agreed with a deprescribing recommendation given by general practitioner (GP) hypothetical patient experiencing polypharmacy. We conducted an online, vignette-based, experimental in the United Kingdom, States and Australia participants ≥65 years. primary outcome agreement (6-point Likert scale; 1 = strongly disagree 6 agree). performed content analysis free-text reasons provided (score 5 or 6). Among 2656 deprescribing, approximately 53.7% shared preference for following GP's considered GP expert. medication referred as reason 35.6% participants. Less common themes included personal experience medicine (4.3%) age (4.0%). Older vignette most frequently reported desire follow recommendations expertise. Future research should be help clinicians efficiently identify patients have strong doctor's related may allow tailored, brief conversation.
Language: Английский
Citations
7
Journal of Internal Medicine, Journal Year: 2022, Volume and Issue: 295(4), P. 436 - 507
Published: Dec. 16, 2022
Abstract Over half of older adults experience polypharmacy, including medications that may be inappropriate or unnecessary. Deprescribing, which is the process discontinuing reducing and/or unnecessary medications, an effective way to reduce polypharmacy. This review summarizes (1) deprescribing and conceptual models tools have been developed facilitate deprescribing, (2) barriers, enablers, factors associated with (3) characteristics interventions in completed trials, as well (4) implementation considerations for routine practice. In multilevel patient, clinician, health‐care system are all related efficacy deprescribing. Numerous clinicians yet most require substantial time and, thus, difficult implement during encounters. Multiple evaluated, mostly include one more following components: patient education, medication review, identification targets, provider communication about high‐risk medications. Yet, there has limited consideration prior interventions, especially regard personnel resources existing systems feasibility incorporating components into care processes clinicians. Future trials a balanced both effectiveness when designing interventions.
Language: Английский
Citations
10
Health Expectations, Journal Year: 2022, Volume and Issue: 26(1), P. 399 - 408
Published: Nov. 24, 2022
Abstract Background In older people living with frailty, polypharmacy can lead to preventable harm like adverse drug reactions and hospitalization. Deprescribing is a strategy reduce problematic polypharmacy. All stakeholders should be actively involved in developing person‐centred deprescribing process that involves shared decision‐making. Objective To co‐design an intervention, supported by logic model, increase the engagement of frailty deprescribing. Design Experience‐based approach service improvement, which uses users providers identify problems design solutions. This was used create intervention potential improve quality outcomes process. A ‘trigger film’ showing talking about their healthcare experiences created facilitated discussions current Problems were then prioritized appropriate solutions developed. The review located context processes procedures. An ideal care pathway complex deliver better Setting Participants Older informal carers professionals and/or working West Yorkshire, England, UK. considered primary care. Results differed from pathway. containing seven elements required move towards Three these prototyped four still need development. responded priorities (a) clarity for what happening at all stages (b) one‐to‐one consultations. Conclusions Priorities improving successfully identified. Solutions developed structured as intervention. Further work underway complete prototyping conduct feasibility testing. Patient or Public Contribution (and carers) have made central contribution, collaborators, ensure has greatest possible enhance experience medicines.
Language: Английский
Citations
9
Basic & Clinical Pharmacology & Toxicology, Journal Year: 2023, Volume and Issue: 133(6), P. 640 - 652
Published: May 12, 2023
Deprescribing can be beneficial to a wide variety of patients but is often not done due barriers including lack time and challenges starting conversations.This study aimed identify broadly categorize existing deprescribing communication tools for clinicians patients.Our scoping review protocol was based on the Arksey O'Malley methods incorporated Levac Joanna Briggs Institute recommendations. EMBASE, CINAHL, PsycINFO, MEDLINE, grey literature were searched, with two independent reviewers assessing eligibility. A backwards search texts chosen full text screen completed. Two independently completed data extraction using pre-specified collection form.Databases identified 1121 results, searching 49 1323 results. After screening, 32 resources included which contained 40 unique tools. Most Canadian targeted adults over 65 years old living in community. had been tested intended patient audience or evaluated effectiveness.Deprescribing have developed facilitate conversations by providing structure, education, decision-making approaches. More research needed test effectiveness
Language: Английский
Citations
5