Clinical impact of medication review and deprescribing in older inpatients: A systematic review and meta‐analysis

Journal of the American Geriatrics Society, Journal Year: 2024, Volume and Issue: 72(10), P. 3219 - 3238

Published: June 1, 2024

Polypharmacy is a primary risk factor for the prescription of potentially inappropriate medications (PIMs), drug-drug interactions (DDIs), and ultimately, adverse drug reactions (ADRs). Medication review deprescribing represent effective strategies to simplify therapeutic regimens, minimize risks, reduce PIM prescriptions. This systematic meta-analysis experimental observational studies aimed evaluate impact different medication interventions in hospitalized older patients.

Language: Английский

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Blood pressure targets, medication considerations and special concerns in elderly hypertension III: Focus on stroke and neurodegenerative disorders

Journal of the Formosan Medical Association, Journal Year: 2025, Volume and Issue: unknown

Published: Jan. 1, 2025

Controlling hypertension has become an important issue in the elderly population whom neurological comorbidities are highly prevalent. Most of large-scale trials focusing on management older populations have excluded patients with comorbid disorders. However, this requires special considerations, as benefits antihypertensive agents mostly uncertain and there is a higher risk adverse events. In review article, we discuss current evidence regarding common disorders, including stroke neurodegenerative diseases. patient history stroke, blood pressure strategy generally similar to that for young patients, however prevention from control less significant. For disorders such cognitive dysfunction Parkinson's disease, achieving adequate may be beneficial reducing cardiovascular risks, although events treatment offset some these benefits. Special considerations factors orthostatic hypotension, falls, polypharmacy, significant drug-drug interactions required but frequently neglected clinical practice. More efforts warranted determine optimal

Language: Английский

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Deprescribing in cognitively vulnerable older people: development and validation of STOPPCog criteria

Age and Ageing, Journal Year: 2025, Volume and Issue: 54(2)

Published: Feb. 1, 2025

Abstract Objective To validate STOPPCog, a list of explicit criteria for potentially inappropriate medication use in cognitively vulnerable older adults. Design A Delphi consensus survey an expert panel comprising academic geriatricians, old age psychiatrists, general practitioners, and clinical pharmacists. Setting Ireland. Subjects Nine panellists. Methods STOPPCog were initially created by the authors based on experience literature appraisal. Criteria organised according to drug/drug class. Using methodology, panellists ranked their agreement with each criterion 5-point Likert scale provided written feedback. median value 1 or 2 (strongly agree/agree) 25th centile ≤2 included final list. Results All completed two validation rounds. Twenty-five proposed initially, twenty accepted. One was rejected (multi-vitamin supplements), four rephrased (two these combined one greater clarity). The comprised 23 that are arranged six subgroups i.e. (i) drugs anticholinergic properties taken daily; (ii) sedative (iii) may exacerbate psychotic symptoms patients alpha-synuclein pathology; (iv) used chronic pain; (v) without proven efficacy dementia (vi) no benefit advanced stage rating 3.0 where palliation be appropriate. Conclusion comprises relating medications assist physicians deprescribing this patient population.

Language: Английский

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Multicomponent intervention to tailor prescriptions to patients with dementia in an intermediate care hospital: pre-post quasi experimental study

BMC Geriatrics, Journal Year: 2025, Volume and Issue: 25(1)

Published: Feb. 27, 2025

In persons with dementia, polypharmacy may be discordant the goals of care. It is necessary to design interventions that align treatment regimens patient's situation, prognosis and preferences. The objectives this study conducted at an intermediate care were to: i) identify inappropriate prescribing per main goal; ii) compare pharmacotherapy data pre post a medication review based on degree cognitive impairment; iii) assess implementation proposed recommendations three months after discharge. Pre-post quasi-experimental study. Patients dementia discharged from hospital between November 2021 April 2022. Demographic, clinical evaluated admission. Medication reviews interviews caregivers pharmacologic therapies overall At discharge, information was shared primary team in discharge summary. Follow up evaluate during performed months. Of 97 patients included, 94.8% had least one inappropriately prescribed medication. mean number chronic medications taken patient decreased by 29.6%, 8.05(SD 3.5) 5.67(SD 2.7) (p < 0.001); anticholinergic burden 18.6%, 1.59(SD 1.0) 1.29(SD 0.9) therapeutic complexity 28.4%, 29.23(SD 13.8) 20.94(SD 11.3) 0.001). 3 90.0%. Admission provides ideal setting for multicomponent intervention, tailoring prescriptions preferences, improving parameters related side effects, ensuring are maintained over medium term.

Language: Английский

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Prevalence and Factors with Potentially Inappropriate Prescribing among Older Surgical Outpatients in China: A Nationwide Cross-sectional Study in 100 Hospitals

Journal of Epidemiology and Global Health, Journal Year: 2025, Volume and Issue: 15(1)

Published: March 12, 2025

Older outpatients face a heightened risk of potentially inappropriate prescribing (PIP). However, there is paucity evidence evaluating PIP in older attending surgical outpatient departments China using Chinese-specific criteria. This study aimed to assess the prevalence and identify associated factors within this population. A cross-sectional design was employed, utilizing prescription data from across 100 hospitals seven Chinese cities between January December 2021. assessed based on criteria, multivariate logistic regression analysis performed factors. Trends were analyzed average annual percent change (AAPC) via joinpoint regression. total 357,135 prescriptions for analyzed. The according criteria 13.06%. five most commonly identified medications (PIMs) doxazosin, clopidogrel, tolterodine, estazolam, concurrent use more than two NSAIDs, which together accounted 52.73% all PIMs. From December, exhibited slight decrease, 13.29 13.21% (AAPC: -0.278%). Logistic revealed that such as tertiary-level hospital status, polypharmacy, pain, sleep disorders, hypertension, benign prostatic hyperplasia, stone disease positively with outpatients. found while among relatively low, attention needed widespread certain Although numerous studies have explored (PIP) patients, contributing remain unclear. Additionally, specific group are not well defined. reveals top account Furthermore, being treated hospital, age ≥ 80, polypharmacy be

Language: Английский

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Prevalence of Reported Dietary Supplement Use in 2019 Older Adult (≥ 55 Years) National Alzheimer's Coordinating Center Participants With Normal Cognition, Mild Cognitive Impairment or Dementia

Journal of Human Nutrition and Dietetics, Journal Year: 2025, Volume and Issue: 38(2)

Published: April 1, 2025

In those with mild cognitive impairment (MCI) and dementia, nutritional intake decreases, increasing deficiency risk. Dietary supplements (DSs) may be an important source of nutrition, but recent insight into their use in normal cognition (NC), MCI or dementia is lacking. A cross-sectional study design determined prevalence for reported 12 DS categories 19 individual DSs based on co-participant report 9517 older adult (≥ 55 years) National Alzheimer's Coordinating Center (NACC) participants diagnosed NC (n = 5361), 1800) 2347) 2019. Multivariable binary logistic regression compared between NC, adjusting demographics. Reported any was highly prevalent (NC: 76.6%, MCI: 73.9% dementia: 69.6%). For all many DSs, significantly lower to NC. Prevalence progressively declined from 8/12 categories, including vitamin 71.2%, 68% 62.4%) mineral 34.8% 28.2% 23.5%). This trend also observed 4/19 D 49.2%, 41.2% 36.7%). B12 15.5%, 18.2% 18.5%) melatonin 6.0%, 7.3% 7.9%), increased dementia. NACC adults

Language: Английский

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One-Year Changes in Depressive Symptoms and Cognitive Function Among Brazilian Older Adults Attending Primary Care

Healthcare, Journal Year: 2025, Volume and Issue: 13(7), P. 807 - 807

Published: April 3, 2025

Background: Aging is a global phenomenon closely associated with changes in cognitive function and mental health. These conditions substantially burden public health systems adversely affect the quality of life older adults. This study aimed to examine depressive symptoms over 12-month follow-up period cohort Brazilian adults attending primary care. Methods: observational longitudinal included randomized sample individuals aged ≥60 years residing São Paulo, Brazil, registered at Primary Healthcare Unit (PHU). Data collection involved administering sociodemographic questionnaire along two validated instruments: Geriatric Depression Scale-15 (GDS-15) Mini-Mental State Examination (MMSE). Linear regression models were used for analyses. Results: A total 368 included, 63% being men mean age 74.65 years. After one year, showed notable increase, GDS-15 score rising from 5.97 7.48 (Cohen-d = 0.542). Likewise, there was decrease MMSE ranging 19.11 18.88 0.216). Adjusted analyses revealed that baseline (B 0.696; p 0.048; R2 0.19) 0.444; < 0.001; 0.26) predictive their respective deteriorations period. Conclusions: Depressive decline place significant on aging societies. findings underscore importance continuous monitoring early intervention strategies mitigate impact enhance

Language: Английский

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Correlation of nighttime fasting duration with cognitive decline in older adults: a cross-sectional study based on NHANES 2011-2014

Published: March 30, 2025

Background: Cognitive dysfunction is a significant health challenge in the global elderly population, and its prevalence associated with multiple factors, including modifiable lifestyle factors. The relationship between nighttime fasting duration, potential factor, cognitive function has yet to be thoroughly investigated. Objective: To investigate association duration function. Methods: This cross-sectional study was based on data from National Health Nutrition Examination Survey (NHANES) 2011 2014. Weighted linear regression utilized examine function, additional curve fitting inflection point analysis conducted further elucidate this Results: There negative (Learn: β = -1.2, 95% CI: -1.98, -0.43, P 0.006; Recall: -1.1, -2.11, -0.09, 0.036; Animal Fluency: -4.49, -7.26, -1.72, 0.004; Digit Symbol Substitution Test: -12.66, -19.30, -6.01, 0.002). Subgroup analyses showed that correlation prevalent most subgroups. Curve revealed scores, but did not identify point. Conclusions: Longer times may decline, either as continuous or categorical variable.

Language: Английский

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Deprescribing in Older Poly-Treated Patients Affected with Dementia

Geriatrics, Journal Year: 2024, Volume and Issue: 9(2), P. 28 - 28

Published: Feb. 26, 2024

Polypharmacy is an important issue in older patients affected by dementia because they are very vulnerable to the side effects of drugs'. Between October 2021 and September 2022, we randomly assessed 205 old-aged outpatients. The study was carried out a Center for Dementia collaboration with university center. primary outcomes were: (1) deprescribing inappropriate drugs through Beers STOPP&START criteria; (2) assessing duplicate risk iatrogenic damage due drug-drug drug-disease interactions. Overall, 69 men 136 women (mean age 82.7 ± 7.4 years) were assessed. Of these, 91 home care 114 outpatient. average number used sample 9.4 per patient; after first visit consequent process, dropped 8.7 patient (

Language: Английский

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Polypharmacy and associated factors in South Korean elderly patients with dementia: An analysis using National Health Insurance claims data

PLoS ONE, Journal Year: 2024, Volume and Issue: 19(4), P. e0302300 - e0302300

Published: April 25, 2024

Dementia is accompanied by several symptoms, including cognitive function decline, as well behavioral and psychological symptoms. Elderly patients with dementia often experience polypharmacy, the concurrent use of multiple medications, due to chronic comorbidities. However, research on polypharmacy in limited. This study aimed characterize associated factors among elderly South Korea, compare characteristics without patients.

Language: Английский

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