Journal of Intellectual Disability Research,
Journal Year:
2024,
Volume and Issue:
68(12), P. 1386 - 1395
Published: Aug. 26, 2024
Medications
with
sedative
or
anticholinergic
properties
should
be
prescribed
caution
in
those
cognitive
complaints.
This
is
particularly
relevant
people
ageing
an
intellectual
disability
(ID).
Higher
drug
burden
index
(DBI)
scores
are
associated
increased
frailty
and
falls
reduced
quality
of
life
older
risk
adverse
effects
(daytime
somnolence,
constipation)
ID.
While
previous
studies
have
shown
that
the
ID
population
has
higher
rates
a
propensity
to
antipsychotic
than
general
population,
degree
not
been
assessed
specifically
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.
European Geriatric Medicine,
Journal Year:
2025,
Volume and Issue:
unknown
Published: March 9, 2025
Abstract
Purpose
To
summarise
the
association
between
potentially
inappropriate
prescribing
(PIP)
and
health-related
quality
of
life
(HRQOL)
in
older
adults,
with
a
special
focus
on
those
atrial
fibrillation
(AF)
multimorbidity,
while
exploring
potential
interventions
to
improve
their
impact
HRQOL.
Methods
A
comprehensive
search
strategy
was
conducted
MEDLINE
using
PubMed
interface
August
16th,
2024,
focusing
key
terms
related
“potentially
prescribing”
“quality
life”.
Additionally,
reference
lists
included
studies
were
screened.
Only
utilising
validated
assessment
tools
for
HRQOL
or
measuring
global
self-perceived
health
status
considered.
Studies
involving
populations
an
average
age
≥
65
years
included.
Results
Of
1810
articles
screened,
35
The
findings
indicate
that
prescribing,
independent
polypharmacy,
may
negatively
influence
review
identified
range
aimed
at
improving
among
including
pharmacist-driven,
general
practitioner-driven,
multidisciplinary
approaches.
Interventions
assessed
distinct
population
groups
specifically
residential
care
homes.
While
some
demonstrated
improvements
quality,
overall
evidence
regarding
remains
limited.
Conclusion
relationship
underexplored
adults
AF
despite
high
prevalence
PIP.
Effective
pharmacotherapy
should
be
coupled
patients'
clinical
functional
parameters,
considering
Adopting
multidisciplinary,
integrated,
patient-centred
approach
is
essential
sustainable
appropriate
practices
enhance
Drugs & Aging,
Journal Year:
2021,
Volume and Issue:
38(11), P. 1025 - 1037
Published: Oct. 11, 2021
Older
patients
are
at
increased
risk
of
drug-drug
interactions
(DDIs)
due
to
polypharmacy.
Cardiovascular
and
central
nervous
system
(CNS)
drugs
commonly
implicated
in
serious
DDIs.
BMJ,
Journal Year:
2023,
Volume and Issue:
unknown, P. e071883 - e071883
Published: Feb. 14, 2023
Abstract
Objective
To
estimate
the
effectiveness,
cost
effectiveness
(to
be
reported
elsewhere),
and
safety
of
pharmacy
independent
prescribers
in
care
homes.
Design
Cluster
randomised
controlled
trial,
with
clusters
based
on
triads
a
pharmacist
prescriber,
general
practice,
one
to
three
associated
Setting
Care
homes
across
England,
Scotland,
Northern
Ireland,
their
practices,
prescribers,
formed
into
triads.
Participants
49
882
residents
were
randomised.
home
residents,
aged
≥65
years,
taking
at
least
prescribed
drug,
recruited
20
residents/triad.
Intervention
Each
prescriber
provided
pharmaceutical
approximately
homes,
weekly
visits
over
six
months.
Pharmacy
developed
plan
for
each
resident,
did
medicines
reviews/reconciliation,
trained
staff,
supported
related
procedures,
deprescribing,
authorisation
prescriptions.
control
group
received
usual
care.
Main
outcomes
measures
The
primary
outcome
was
fall
rate/person
months
analysed
by
intention
treat,
adjusted
prognostic
variables.
Secondary
included
quality
life
(EQ-5D
proxy),
Barthel
score,
Drug
Burden
Index,
hospital
admissions,
mortality.
Assuming
21%
reduction
falls,
880
needed,
allowing
20%
attrition.
Results
average
age
participants
study
entry
85
years;
70%
female.
697
falls
(1.55
per
resident)
recorded
intervention
538
(1.26
rate
risk
ratio
compared
not
significant
(0.91,
95%
confidence
interval
0.66
1.26)
after
adjustment
all
model
covariates.
significantly
different
between
groups,
exception
which
favoured
intervention.
A
third
(185/566;
32.7%)
interventions
involved
falls.
No
adverse
events
or
concerns
identified.
Conclusions
Change
significant.
Limiting
follow-up
combined
small
proportion
predicted
affect
may
explain
this.
Index
realised
would
yield
future
clinical
benefits
patients.
This
large
trial
an
intensive
also
found
safe
well
received.
Trial
registration
ISRCTN
17847169.
The Journals of Gerontology Series A,
Journal Year:
2019,
Volume and Issue:
75(5), P. 1003 - 1009
Published: Nov. 22, 2019
Abstract
Background
It
is
well
established
that
individual
medications
affect
the
central
nervous
system
(CNS)
increase
falls
risk
in
older
adults.
However,
less
known
about
risks
associated
with
taking
multiple
CNS-active
medications.
Methods
Employing
a
new
user
design,
we
used
data
from
Adult
Changes
Thought
study,
prospective
cohort
of
community-dwelling
people
aged
65
and
without
dementia.
We
created
time-varying
composite
measure
medication
exposure
electronic
pharmacy
fill
categorized
into
mutually
exclusive
categories:
current
(within
prior
30
days),
recent
(31–90
past
(91–365
or
nonuse
(no
year).
calculated
standardized
daily
dose
identified
initiation.
Cox
proportional
hazards
models
examined
associations
between
exposures
outcome
fall-related
injury
health
plan
databases.
Results
Two
thousand
five
hundred
ninety-five
had
624
injuries
over
15,531
person-years
follow-up.
Relative
to
nonuse,
was
significantly
greater
for
use
(hazard
ratio
[HR]
=
1.95;
95%
CI
1.57–2.42),
but
not
use.
Among
users,
increased
noted
all
doses.
Risk
initiation
compared
no
(HR
2.81;
2.09–3.78).
Post
hoc
analyses
revealed
especially
elevated
opioids.
Conclusions
found
use,
initiation,
Increased
categories.
particularly
Journal of the American Geriatrics Society,
Journal Year:
2020,
Volume and Issue:
68(8), P. 1778 - 1786
Published: April 21, 2020
OBJECTIVES
To
evaluate
the
effects
of
a
community
pharmacy‐based
fall
prevention
intervention
(STEADI‐Rx)
on
risk
falling
and
use
medications
associated
with
an
increased
falling.
DESIGN
Randomized
controlled
trial.
SETTING
A
total
65
pharmacies
in
North
Carolina
(NC).
PARTICIPANTS
Adults
(age
≥65
years)
using
either
four
or
more
chronic
one
(n
=
10,565).
INTERVENTION
Pharmacy
staff
screened
patients
for
questions
from
Stopping
Elderly
Accidents,
Deaths,
Injuries
(STEADI)
algorithm.
Patients
who
positive
were
eligible
to
receive
pharmacist‐conducted
medication
review,
recommendations
sent
patients'
healthcare
providers
following
review.
MEASUREMENTS
At
pharmacies,
pharmacy
used
standardized
forms
record
participant
responses
screening
information
concerning
reviews.
For
participants
continuous
Medicare
Part
D/NC
Medicaid
coverage
3,212),
Drug
Burden
Index
(DBI)
was
assess
exposure
high‐risk
medications,
insurance
claims
records
emergency
department
visits
hospitalizations
falls.
RESULTS
Among
group
4,719),
73%
3,437)
risk.
those
1,901),
72%
1,373)
received
review;
27%
521)
had
at
least
medication‐related
recommendation
communicated
their
provider(s)
716
specific
made.
DBI
scores
decreased
pre‐
postintervention
period
both
control
group.
However,
amount
change
over
time
did
not
differ
between
these
two
groups
(
P
.66).
Risk
.58).
CONCLUSION
We
successfully
implemented
STEADI‐Rx
setting.
we
found
no
differences
groups.
J
Am
Geriatr
Soc
68:1778‐1786,
2020.
