Adverse Outcomes of Polypharmacy in Older People: Systematic Review of Reviews

Journal of the American Medical Directors Association, Journal Year: 2020, Volume and Issue: 21(2), P. 181 - 187

Published: Jan. 8, 2020

ObjectivePolypharmacy is widespread among older people, but the adverse outcomes associated with it are unclear. We aim to synthesize current evidence on health, social, medicines management, and health care utilization of polypharmacy in people.DesignA systematic review, reviews meta-analyses observational studies, was conducted. Eleven bibliographic databases were searched from 1990 February 2018. Quality assessed using AMSTAR (A Measurement Tool Assess Systematic Reviews).Setting participantsOlder people any setting, residential or country.ResultsTwenty-six reporting 230 unique studies included. Almost all operationalized as medication count, few examined classes disease states within this. Evidence for an association between many outcomes, including drug events disability, conflicting. The most consistent found hospitalization inappropriate prescribing. No research had explored very old (aged ≥85 years), potential social consequences use, such loneliness isolation.Conclusions implicationsThe literature examining complex, extensive, Until a more clinically relevant manner, will not be fully understood. Future should work toward this approach face rising multimorbidity population aging.

Language: Английский

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Deprescribing: A narrative review of the evidence and practical recommendations for recognizing opportunities and taking action

European Journal of Internal Medicine, Journal Year: 2017, Volume and Issue: 38, P. 3 - 11

Published: Jan. 5, 2017

Language: Английский

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Barriers and facilitators to deprescribing in primary care: a systematic review

BJGP Open, Journal Year: 2020, Volume and Issue: 4(3), P. bjgpopen20X101096 - bjgpopen20X101096

Published: July 28, 2020

Background Managing polypharmacy is a challenge for healthcare systems globally. It also health inequality concern as it can expose some of the most vulnerable in society to unnecessary medications and adverse drug-related events. Care patients with multimorbidity occurs primary care. Safe deprescribing interventions reduce exposure inappropriate polypharmacy. However, these are not fully accepted or routinely implemented. Aim To identify barriers facilitators safe adults Design & setting A systematic review studies published from 2000, examining Method search electronic databases: MEDLINE, Embase, Cumulative Index Nursing Allied Health Literature (CINHAL), Cochrane, Management Information Consortium (HMIC) inception 26 Feb 2019, using an agreed strategy. This was supplemented by handsearching relevant journals, screening reference lists citations included studies. Results In total, 40 14 countries were identified. Cultural organisational included: culture diagnosing prescribing; evidence-based guidance focused on single diseases; lack care older people multimorbidities; shared communication, decision-making systems, tools, resources. Interpersonal individual-level professional etiquette; fragmented care; prescribers’ patients’ uncertainties; gaps tailored support. Facilitators prudent greater availability acceptability non-pharmacological alternatives; resources; improved collaboration, knowledge, understanding; patient-centred decision-making. Conclusion whole approach required, involving key decision-makers, professionals, patients, carers.

Language: Английский

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Decision-Making Preferences and Deprescribing: Perspectives of Older Adults and Companions About Their Medicines

The Journals of Gerontology Series B, Journal Year: 2017, Volume and Issue: 73(7), P. e98 - e107

Published: Oct. 16, 2017

Polypharmacy in the older population is increasing-and can be harmful. It safe to reduce or carefully cease medicines (deprescribing) but a collaborative approach between patient and doctor required. This study explores decision-making about polypharmacy with adults their companions. Semi-structured interviews were conducted 30 people (aged 75+ years, taking multiple medicines) 15 Framework analysis was used identify qualitative themes. Participants varied considerably attitudes towards medicines, preferences for involvement decision-making, openness deprescribing. Three types identified. Type 1 held positive preferred leave decisions doctor. 2 voiced ambivalent proactive role, open 3 frail, perceived they lacked knowledge deferred most companion. provides novel typology describe differences who are happy take those To enable shared prescribers need adapt communication based on patients' decisions.

Language: Английский

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Medication Overload: America's Other Drug Problem

Published: April 1, 2019

Every day, 750 older people living in the United States (age 65 and older) are hospitalized due to serious side effects from one or more medications. 1Over last decade, sought medical treatment visited emergency room than 35 million times for adverse drug events, there were 2 hospital admissions events (see Appendix A, p. 40). Older adults at a greater rate general population is opioids. 3In past prescribing multiple medications individual patients (called "polypharmacy" scientific literature) has reached epidemic proportions.More four ten take five prescription an increase of 300 percent over two decades. 4Nearly 20 drugs more.When over-thecounter supplements included, number taking rises 67 percent. 5Medications have improved lives individuals around world, many benefit drugs.Indeed, polypharmacy may be necessary who chronic disease.However, also greatly increases person's risk suffering serious, sometimes life-threatening effect.Over few decades, medication use U.S., especially people, gone far beyond polypharmacy, point where millions overloaded with too prescriptions experiencing significant harm as result.* An reaction defined negative prescribed.Adverse include reactions, but non-regular medication, such errors overdoses.

Language: Английский

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General practitioner strategies for managing patients with multimorbidity: a systematic review and thematic synthesis of qualitative research

BMC Family Practice, Journal Year: 2020, Volume and Issue: 21(1)

Published: July 1, 2020

General practitioners (GPs) increasingly manage patients with multimorbidity but report challenges in doing so. Patients describe poor experiences health care systems that treat each of their conditions separately, resulting fragmented, uncoordinated care. For GPs to provide the patient-centred, coordinated need and want, research agendas system structures policies will adapt address this epidemiologic transition. This systematic review seeks understand if how impacts on work GPs, strategies they employ challenges, what believe still needs addressing ensure quality patient care.Systematic thematic synthesis qualitative studies reporting GP managing multimorbidity. The search included nine major databases, grey literature sources, Google Scholar, a hand Journal Comorbidity, reference lists studies.Thirty-three from fourteen countries were included. Three identified: practising without supportive evidence; working within fragmented whose remain organised around single condition specialisation; clinical uncertainty associated complexity general practitioner perceptions decisional risk. revealed three approaches mitigating these challenges: prioritising patient-centredness relational continuity; relying knowledge preferences unique circumstances individualise care; structuring consultation create sense time minimise risk.GPs described an ongoing tension between applying guidelines as security against or penalty, potentially causing harm. Above all, chose prioritise long-term relationships for numerous gains brought such mutual trust, deeper insight into patient's circumstances, useable individual's capacity illness goals life. better management guidance. Perhaps more than this, require models practice remunerated space nurturing trustful therapeutic partnerships.

Language: Английский

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DEFEAT-polypharmacy: deprescribing anticholinergic and sedative medicines feasibility trial in residential aged care facilities

International Journal of Clinical Pharmacy, Journal Year: 2019, Volume and Issue: 41(1), P. 167 - 178

Published: Jan. 18, 2019

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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Consumer Attitudes Towards Deprescribing: A Systematic Review and Meta-Analysis

The Journals of Gerontology Series A, Journal Year: 2021, Volume and Issue: 77(5), P. 1020 - 1034

Published: Aug. 14, 2021

Abstract Background Harmful and/or unnecessary medication use in older adults is common. This indicates deprescribing (supervised withdrawal of inappropriate medicines) not happening as often it should. study aimed to synthesize the results Patients’ Attitudes Towards Deprescribing (PATD) questionnaire (and revised versions). Methods Databases were searched from January 2013 March 2020. Google Scholar was used for citation searching development and validation manuscripts identify original research using validated PATD, PATD (older adult caregiver versions), version people with cognitive impairment (rPATDcog). Two authors extracted data independently. A meta-analysis proportions (random-effects model) conducted subgroup meta-analyses setting population. The primary outcome question: “If my doctor said possible, I would be willing stop one or more medicines.” Secondary outcomes associations between participant characteristics other (r)PATD results. Results We included 46 articles describing 40 studies (n = 10,816 participants). found proportion participants who agreed strongly this statement 84% (95% CI 81%–88%) 80% 74%–86%) patients caregivers, respectively, significant heterogeneity (I2 95% 77%). Conclusion Consumers reported willingness have a deprescribed although should interpreted caution due heterogeneity. findings moves toward understanding attitudes deprescribing, which could increase discussion uptake recommendations clinical practice.

Language: Английский

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What makes a multidisciplinary medication review and deprescribing intervention for older people work well in primary care? A realist review and synthesis

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

Published: Sept. 25, 2023

A third of older people take five or more regular medications (polypharmacy). Conducting medication reviews in primary care is key to identify and reduce/ stop inappropriate (deprescribing). Recent recommendations for effective deprescribing include shared-decision making a multidisciplinary approach. Our aim was understand when, why, how interventions review involving teams (MDTs) work (or do not work) people.

Language: Английский

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