Deprescribing in Older Adults: Attitudes, Awareness, Training, and Clinical Practice Among Portuguese Physicians

Acta Médica Portuguesa, Journal Year: 2024, Volume and Issue: 37(10), P. 684 - 696

Published: Oct. 1, 2024

The importance of deprescribing in clinical practice is growing, particularly aging populations with polypharmacy scenarios, making it a crucial matter Portugal, one Europe's most aged nations. aim this study was to investigate awareness, training, attitudes, and practices among Portuguese physicians inform future healthcare strategies.

Language: Английский

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Older Adult Perspectives on Statin Continuation and Discontinuation in Primary Cardiovascular Disease Prevention: A Mixed-Methods Study

Patient Preference and Adherence, Journal Year: 2024, Volume and Issue: Volume 18, P. 15 - 27

Published: Jan. 1, 2024

Background and Purpose: Evidence for statin use primary cardiovascular disease prevention in older adults is limited. When evidence on risk-benefit profile of a medication uncertain, using it or not becomes preference-sensitive decision. We aimed to assess explore patient perspectives continuation discontinuation statins used adults. Patients Methods: convergent mixed-methods design, conducting parallel survey among 47 patients three focus groups (FGs) with 14 total. recruited aged ≥ 65 years taking prevention. The FGs experiences use, views discontinuation, including decision-making. Quantitative qualitative data were first analyzed separately – descriptive statistics quantitative thematic analysis then integrated create metainferences, joint displays. Results: Forty-one percent (N=19) reluctant discontinue the statin, whereas 22% (N=10) willing try discontinuing it. A reason continue was its perceived necessity, while self-estimated low risk wish reduce burden given as reasons Lack expertise assumed by decide about uncertainty indication, fear having event after made many uncertain deciding statin. In this context, 70% (N=33) would rather have their physician choose them, 94% (N=44) long told them do so. Conclusion: This study highlights factors that influence willingness statins, important role physicians play decision-making process. Keywords: barriers, facilitators, care providers,

Language: Английский

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Cardiovascular risk management in the elderly with type 2 diabetes prior to death: A Danish nationwide register study of discontinuation patterns

medRxiv (Cold Spring Harbor Laboratory), Journal Year: 2024, Volume and Issue: unknown

Published: Feb. 27, 2024

ABSTRACT Background Cardioprotective medication usage among elderly individuals with type 2 diabetes (T2D) is prevalent, however, the degree and timing of discontinuation unknown. This study aims to describe extent, timing, secular changes cardioprotective in T2D. Methods In this register-based cohort all T2D, deceased between 2006-2018 at an age 80 years or older, were identified through Danish nation-wide registers. We followed population backward time, from death last intake antihypertensive, lipid-lowering, antithrombotic medication. Poisson regression models used model rates prior while binomial estimate proportion on time death. Results 52,523 (55% women) a mean (SD) T2D diagnosis 77.3 (7.8) median (Q1-Q3) 86.5 [83.3-90.3] years. The any antihypertensive was high (approximately 78% [95% CI 77-78] 48% 47-49%] death, respectively) increased slightly increasing calendar year Discontinuations occurred predominantly life but initiated earlier for who died recent However, angiotensin-converting enzyme, thiazides, acetylsalicylic acid we found more continuous decade statins markedly peaking 34% 33-35%] 2016 subsequent decrease 29% 28-30%] 2018. Discontinuation patterns shifted occurring continues before Conclusion Our results suggest intensification pronounced during life. may be result focus individualized-treatment-regimens.

Language: Английский

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Highlighting the latest research: March 2024

British Journal of Cardiac Nursing, Journal Year: 2024, Volume and Issue: 19(3), P. 1 - 6

Published: March 2, 2024

Sarah Jane Palmer presents a selection of recently published articles interest to nurses working in cardiovascular nursing, while Helen Cowan explores their application practice. The aim this roundup is provide brief overview the research papers selected and highlight relevance cardiac nursing A full reference provided for those who wish look at further detail.

Language: Английский

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Deprescribing in older adults in a French community: a questionnaire study on patients’ beliefs and attitudes

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

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Deprescribing Cardiovascular Medications in Older Adults Living with Frailty

CJC Open, Journal Year: 2024, Volume and Issue: 6(12), P. 1503 - 1512

Published: Sept. 25, 2024

Certain medications have shown significant effectiveness in reducing the incidence of cardiovascular events and mortality, leading them to be among those that are prescribed most commonly for Canadian seniors. However, polypharmacy, which disproportionately affects older adults, is particularly concerning frail individuals who at higher risk adverse medication-related events. The deprescribing process discontinuation, either immediate or gradual, inappropriate medications, address polypharmacy improve outcomes. Nonetheless, incorporation principles into clinical practice present challenges, including limited amount data available on benefits deprescription, a lack consensus how deprescribe. current narrative review explores frailty as basis deciding deprescribe medication. evidence regarding use common conditions (including acetylsalicylic acid, statins, antihypertensives) adults with reviewed. also examines issue should initiate process, associated psychological implications. Although no one-size-fits-all approach deprescription available, patient goals prioritized. For frailty, healthcare professionals must consider carefully whether medication outweighs potential harms. Ideally, involve shared decision-making physicians, other health professionals, patients and/or their substitute decision-makers, goal improving

Language: Английский

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Screening for Hypoglycaemia Risk and Medication Changes in Diabetes Patients Using Pharmacy Dispensing Data

Journal of Clinical Medicine, Journal Year: 2024, Volume and Issue: 13(19), P. 5855 - 5855

Published: Sept. 30, 2024

Background: To improve hypoglycaemia management in primary care, more insight is needed into the opportunities to screen for risk and subsequent treatment modification using routinely available data. Our aim was assess number of diabetes patients with an estimated high describe changes these pharmacy dispensing Additionally, our investigate patient characteristics associated such changes. Methods: A drug utilisation cohort study a 1-year follow-up IADB.nl database conducted. Patients aged 35 years or older who received at least two glucose-lowering medication dispensings 2019 were included. Hypoglycaemia determined validated algorithm based on demographics The score ranged between 0 1. anniversary method used evaluate after 1 year. Factors assessed by multinomial logistic regression. Results: Around one-quarter (26.9%) 36,628 included had 0.6 more. After follow-up, majority (88.9%) experienced no De-intensification observed 8.8% intensification 2.3%. Having high-risk score, being female, younger age de-intensification. Conclusions: substantial care medications appear hypoglycaemia, whereas few them undergo Pharmacy data can be helpful screening whom review indicated.

Language: Английский

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Pharmacist-led deprescribing of cardiovascular and diabetes medication within a clinical medication review: the LeMON study (Less Medicines in Older Patients in the Netherlands), a cluster randomized controlled trial

Research Square (Research Square), Journal Year: 2024, Volume and Issue: unknown

Published: Oct. 22, 2024

Background Deprescribing of inappropriate cardiovascular and diabetes medication has shown to be adequate, feasible safe. Healthcare providers often experience the deprescribing as a challenge therefore it is still not widely implemented in daily practice.Aim The aim was assess whether training on performance more deprescribing-focused clinical review results greater reduction use medication.Method A cluster randomized controlled trial involving 20 community pharmacists, who conducted 10 patients. intervention group received deprescribing. Patients 70 years or older; polypharmacy antihypertensive having systolic blood pressure below 140 mmHg, and/or HbA1c level 54 mmol/mol were included. Follow-up took place within four weeks (T1) after three months (T2).Results 71 69 patients included control group, respectively. At T2 32% 26% had one discontinued. With regard any these percentages 51% 36%, respectively.Conclusion Increased awareness ability pharmacists deprescribe general practitioners data, led successfully conduct practice. Further research need for additional optimize required.

Language: Английский

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