Global prevalence of polypharmacy and potentially inappropriate medication in older patients with dementia: a systematic review and meta-analysis

Frontiers in Pharmacology, Journal Year: 2023, Volume and Issue: 14

Published: Aug. 24, 2023

Background: Older patients with dementia always need multiple drugs due to comorbidities and cognitive impairment, further complicating drug treatment increasing the risk of potentially inappropriate medication. The objective our study is estimate global prevalence polypharmacy medication (PIM) explore factors PIM for older dementia. Methods: We searched PubMed, Embase (Ovid), Web Science databases identify eligible studies from inception 16 June 2023. conducted a meta-analysis observational reporting in using random-effect model. associated were meta-analyzed. Results: Overall, 62 included, which 53 reported 28 polypharmacy. pooled was 43% (95% CI 38–48) 62% 52–71), respectively. Sixteen referred use, 15 pooled. Polypharmacy (2.83, 95% 1.80–4.44), diabetes (1.31, 1.04–1.65), heart failure (1.17, 1.00–1.37), depression (1.45, 1.14–1.88), history cancer (1.20, 1.09–1.32), hypertension (1.46, 1.05–2.03), ischemic disease (1.55, 0.77–3.12), any cardiovascular (1.11, 1.06–1.17), vascular (1.09, 1.03–1.16), chronic obstructive pulmonary (1.39, 1.13–1.72), psychosis (1.91, 1.04–3.53) are positively use. Conclusion: highly prevalent Among different regions, use varied widely. Increasing closely For other such as diabetes, prescribing should be cautioned.

Language: Английский

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Neuroepigenetics of ageing and neurodegeneration-associated dementia: An updated review

Ageing Research Reviews, Journal Year: 2023, Volume and Issue: 91, P. 102067 - 102067

Published: Sept. 9, 2023

Language: Английский

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Improving Medication-Related Safety for Residents in Nursing Homes: A Qualitative Study

Journal of Gerontological Nursing, Journal Year: 2025, Volume and Issue: unknown, P. 1 - 6

Published: Jan. 8, 2025

Purpose To gain a better understanding of the perceptions RNs on medication safety concerns and potential solutions for nursing home (NH) residents. Method This prospective, qualitative study used semi-structured phone interviews with description approach. We purposeful sampling to recruit 12 employed at two NHs in northeastern region United States. The Systems Engineering Initiative Patient Safety constructs informed interview guide, coding, theme identification. Results categorized non–user-friendly charting systems gained insights into more experience paper-based under technology component. For organization component, participants identified importance teamwork, communication, leadership. Participants also mentioned how education nationality training impact administration (MA) safety. Task-related revealed different care approaches, extreme workload variation, task prioritization during day are perceived as critical issues that need be addressed. Staff shortages were expressed an environment-related concern. Conclusion Findings highlight appropriate nurse-to-patient ratio, significance user-friendly systems, customizing interface MA system. [ Journal Gerontological Nursing, xx (xx), xx–xx.]

Language: Английский

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Dementia and Mild Cognitive Impairment

Advanced clinical pharmacy - research, development and practical applications/Advanced clinical pharmacy - research, development and practical applications, Journal Year: 2025, Volume and Issue: unknown, P. 231 - 254

Published: Jan. 1, 2025

Language: Английский

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Risk of falls or fall-related injuries associated with potentially inappropriate medication use among older adults with dementia

BMC Geriatrics, Journal Year: 2024, Volume and Issue: 24(1)

Published: Aug. 23, 2024

Potentially inappropriate medications (PIMs) are prevalent in older adults with dementia and subsequent falls or fall-related injuries. The present study determined the risk of injuries associated PIM use dementia. National Health Insurance Service-Elderly Cohort Database 2.0 (NHIS-ECDB 2.0) was used for this self-controlled case series (SCCS) study. This included 1430 participants who went through exposure non-exposure periods application among patients experienced outcome events between January 2016 December 2019. incidence during post-exposure compared that period. Beers Criteria were to define PIMs Negative binomial regression conducted. rate ratio (IRR) determine During which occurred, mean number 3.76 (SD = 2.99), most commonly first-generation antihistamines (n 283; 59.1%). Compared period, adjusted IRR period 1.57 (95% CI 1.39–1.76). increased when initiated (1–14 days: 2.76, 95% 2.31–3.28; 15–28 1.95, 1.48–2.56; ≥ 29 1.17, 1.01–1.35). Especially, an greater Among dementia, significantly increase Therefore, strategies should be developed manage prescriptions prevent falls.

Language: Английский

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Clinical Pharmacist Intervention on Drug-Related Problems among Elderly Patients Admitted to Medical Wards of Northwest Ethiopia Comprehensive Specialized Hospitals: A Multicenter Prospective, Observational Study

BioMed Research International, Journal Year: 2022, Volume and Issue: 2022(1)

Published: Jan. 1, 2022

Background: Drug therapy in the elderly needs an emphasis on age‐related changes drug pharmacokinetics and pharmacodynamics profile. Hospitalized patients are at risk of more than one disease polypharmacy associated with these; they drug‐related problems. This study aimed to assess role clinical pharmacy identifying resolution problems among admitted medical ward Northwest Ethiopia comprehensive specialized hospitals. Methods : A multicenter prospective observational was conducted. systematic sampling technique used. The identified problem recorded classified using Cipolle, adverse reaction assessed Naranjo algorithm probability scale, Medscape used for drug‐drug interaction. Data were analyzed by STATA software version 14.1. Logistic regression used, results reported as odds ratios (ORs) 95% Confidence intervals P value < 0.05 statistically significant. Result total 389 participants included study. About 266 (68.4%) had least a single problem. 503 mean 1.32 (CI: 1.27‐1.36) per patient. three‐leading categories dose too high 108 (21.5%), nonadherence 105 (20.9%), 96 (19.1%). Alcohol use (AOR = 2.2, 95CI%: 1.23‐3.94), source 2.85, 1.63‐4.98), length hospitalization 2.32, 1.37‐3.95), number comorbidities 1.48, 1.09‐1.99), 3.06, 1.72‐5.46) important factors From intervention provided, 84.7% accepted prescribers. Among 67.4% totally solved. Conclusion revealed that DRPs Ethiopia. Comorbidity, hospitalization, ploy‐pharmacy, payer, alcohol drinker likely developed Treatment optimizations also done pharmacists interventions well

Language: Английский

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Polypharmacy in Chronic Neurological Diseases: Multiple Sclerosis, Dementia and Parkinson’s Disease

Current Pharmaceutical Design, Journal Year: 2021, Volume and Issue: 27(38), P. 4008 - 4016

Published: July 29, 2021

Polypharmacy is an important aspect of medication management and particularly affects elderly chronically ill people. Patients with dementia, Parkinson's disease (PD), or multiple sclerosis (MS) are at high risk multi due to their complex symptomatology. Our aim was provide overview different definitions polypharmacy present the current state research on in patients PD, MS. The most common definition literature concomitant use ≥5 medications (quantitative approach). rates up >50% have been reported for MS, although MS average significantly younger than those dementia PD. main predictor symptom profile these neurological disorders. Potentially inappropriate (PIM), drug-drug interactions, poor treatment adherence, severe course, cognitive impairment, hospitalisation, quality life, frailty, mortality associated For polypharmacy, either avoidance PIM (selective deprescribing) substitution more suitable drugs (appropriate polypharmacy) recommended achieve a effective therapeutic management.

Language: Английский

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Clinical significance of potential drug–drug interactions in older adults with psychiatric disorders: a retrospective study

BMC Psychiatry, Journal Year: 2022, Volume and Issue: 22(1)

Published: Aug. 22, 2022

Abstract Background Polypharmacy increases the risk of potential drug–drug interactions (pDDIs). This retrospective analysis was conducted to detect pDDIs and adverse drug reactions (ADRs) among older adults with psychiatric disorder, identify clinical significance. Methods A carried out based on medical records disorders. Data demographic characteristics, substance abuse, history, medications were extracted. The Lexi-Interact online database used pDDIs. minimal clinically important difference (MCID) set as change in Treatment Emergent Symptom Scale (TESS) score between admission discharge. median interquartile ranges for continuous variables, frequencies calculated dichotomous variables. Poisson regression implemented determine factors influencing number ADR types. each significance severity analysed using binary logistic regression. P < 0.05 considered statistically significant. Results total 308 enrolled, 171 (55.52%) whom had at least 1 pDDI. Thirty-six types that should be avoided found, most frequent pDDI coadministration lorazepam olanzapine (55.5%). 26 ADRs induced by identified, common constipation (26.05%). There a 9.4 10.3% increase extra diagnosis drug, respectively. 120% hospitalized 18–28 days compared those 3–17 days. an 11.1% decrease readmission. length hospitalization factor abnormal liver function ( 0.05). use large drugs gastric distress 0.05) dizziness fainting None four pDDIs, including coadministrations lorazepam, quetiapine potassium chloride, escitalopram, clonazepam, showed > Conclusions are prevalent adults, rate is increasing. However, many may have no terms severity. Further research assessing possible measures prevent serious DDIs needed reduce

Language: Английский

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Patients with dementia: prevalence and type of drug–drug interactions

Frontiers in Pharmacology, Journal Year: 2024, Volume and Issue: 15

Published: Oct. 28, 2024

Background Patients with Alzheimer’s disease (AD) and other dementias are more frequently exposed to polymedication, mainly due the presence of comorbidities, particularly vulnerable drug-related problems, present greater risk adverse effects drug–drug interactions (DDIs). Purpose To assess prevalence clinically relevant in dementia patients using a routine database, we describe most frequent factors associated them facilitate specific interventions programs prevent minimize them. Methods An observational, descriptive, cross-sectional study that included AD types (n = 100, 64% female) was conducted identify potential DDI their treatment Lexi-Interact/Lexicomp ® database. Results A total 769 drugs were prescribed, involving 190 different active ingredients; 83% treatments five or drugs. occurred 87% patients, which 63.2% female. 689 DDIs found, grouped 448 drug pairs, mean 6.9 ± 7.1 (range, 0–31) per patient, 680 considered relevant. It observed 89.8% had moderate level severity, 23.5% good relevance, pharmacodynamic-based accounted for 89.5%. The involved quetiapine (24.5%) acetylsalicylic acid (10%). 97 detected between acetylcholinesterase inhibitors (AChEIs), remaining administered concomitantly. One AChEIs beta-blocking agents 29, 4.3%). important showed strongest association use ( p 0.01) number 0.014) taken by patient. Conclusion increased DDIs. Among common psychotropic drugs, pharmacodynamic caused concomitant CNS-targeted results highlight difficulty evaluate clinical practice polymedication variety comorbidities. Therefore, it is review consider metabolism inhibition induction, potentially P450 substrate overlapping.

Language: Английский

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Potential drug-drug interactions in drug therapy for older adults with chronic coronary syndrome at hospital discharge: A real-world study

Frontiers in Pharmacology, Journal Year: 2022, Volume and Issue: 13

Published: Aug. 24, 2022

Introduction: Polypharmacy are commonly observed among older adults with cardiovascular disease. However, multiple medications lead to increased risk of drug-drug interactions (DDIs). Therefore, identification and prevention actions related harmful DDIs expected in adults. The study aimed describe the prevalence potential (pDDIs) discharge prescriptions chronic coronary syndrome (CCS). Methods: A single-center cross-sectional was performed a tertiary public hospital Beijing, China. CCS patients aged 65 years above who were admitted cardiology wards over 3-month period alive at included. Electronic medical records reviewed. pDDIs evaluated through Lexi-Interact online. Results: identified 72.9% 402 individuals (n = 293). total 864 obtained. 72.1% found C 290) 20.3% categorized D X 82). only DDI between cyclosporine atorvastatin. Under category D, glycemia alterations within antidiabetics chances bleeding antithrombotic most common. Concomitant use clopidogrel calcium channel blockers frequent situation C, followed by synergic blood pressure lowering agents rosuvastatin concentration induced clopidogrel. Conclusion: exposure common CCS. screening tools should be introduced alert adverse effects. Prescribers need rigorously review or modulate therapies prevent DDI-related outcomes. Clinical pharmacists more involved complex drug regimen management.

Language: Английский

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