Review of deprescribing processes and development of an evidence‐based, patient‐centred deprescribing process

British Journal of Clinical Pharmacology, Год журнала: 2014, Номер 78(4), С. 738 - 747

Опубликована: Март 25, 2014

Inappropriate use of medication is widespread, especially in older people, and associated with risks, including adverse drug reactions, hospitalization increased mortality. Optimization appropriate to minimize these harms an ongoing challenge healthcare. The term ‘deprescribing’ has been used describe the complex process that required for safe effective cessation medication. Patients play important role their own health and, while they may complain about number medications have take, also be reluctant cease a when given opportunity do so. A review previously proposed deprescribing processes relevant literature was develop patient‐centred process, which five‐step cycle encompasses gaining comprehensive history, identifying potentially inappropriate medications, determining whether can ceased, planning withdrawal regimen (e.g. tapering where necessary) provision monitoring, support documentation. This first developed using knowledge patients' views cessation; it focuses on engaging patients throughout aim improving long‐term outcomes. Despite literature, there still lack evidence base conduct deprescribing. next step broadening will test determine feasibility clinical setting.

Язык: Английский

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Pharmacokinetics and Pharmacodynamic Changes Associated with Aging and Implications for Drug Therapy

Clinics in Geriatric Medicine, Год журнала: 2012, Номер 28(2), С. 273 - 286

Опубликована: Апрель 13, 2012

Язык: Английский

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Medication quality and quality of life in the elderly, a cohort study

Health and Quality of Life Outcomes, Год журнала: 2011, Номер 9(1), С. 95 - 95

Опубликована: Янв. 1, 2011

Modern drugs have made large contributions to better health and quality of life. Increasing proportions negative side effects due extensive pharmacological treatment are however observed especially among elderly patients who multiple problems. The aim our study was see if there is an association between medication 150 discharged from hospital. Inclusion criteria were: living in ordinary homes, ≥ 75 years 5 drugs. Home visits were performed all, including prescription reviews calculation appropriateness index. divided into three groups depending on index score followed for 12 months. validated recognized EQ-5D EQ VAS instruments used assess A lower associated with a statistically significantly different (declining each group) the (p = 0.001 at start, p 6 months 0.013 months) as 0.026 0.003 0.007 months). This has shown validity basic principle prescribing: more appropriate Since drug related patients' life, immense reason continuously evaluate every treatment. evaluation possible deprescribing should be done process where both patient physician involved.

Язык: Английский

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Dietary approaches that delay age-related diseases

Clinical Interventions in Aging, Год журнала: 2006, Номер 1(1), С. 11 - 31

Опубликована: Янв. 1, 2006

Reducing food intake in lower animals such as the rat decreases body weight, retards many aging processes, delays onset of most diseases old age, and prolongs life.A number clinical trials restriction healthy adult human subjects running over 2-15 years show significant reductions blood cholesterol, glucose, pressure, which are risk factors for development cardiovascular disease diabetes.Lifestyle interventions that energy balance by reducing weight physical exercise can also delay diabetes disease.In general, suggesting diets high calories or fat along with overweight associated increased disease, type 2 diabetes, some cancers, dementia.There is a growing literature indicating specific dietary constituents able to influence age-related diseases, including certain fats (trans fatty acids, saturated, polyunsaturated fats) cholesterol glycemic index fiber fruits vegetables calcium vitamin D osteoporosis bone fracture.In addition, there compounds from different functional foods, herbs, neutraceuticals ginseng, nuts, grains, polyphenols may affect diseases.Long-term prospective will be needed confirm these diet-disease relationships.On basis current research, best diet one low saturated wholegrain cereals, legumes, vegetables, maintains lean weight.Such should become key component aging, delaying agerelated perhaps intervening process itself.Furthermore, studies nutrition childhood even fetus later lifespan.

Язык: Английский

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The administration ofl-thyroxine as soft gel capsule or liquid solution

Expert Opinion on Drug Delivery, Год журнала: 2014, Номер 11(7), С. 1103 - 1111

Опубликована: Июнь 4, 2014

Introduction: Levothyroxine (l-T4) is the mainstay of treating hypothyroidism. The tablet traditional formulation l-T4. Tablet l-T4 malabsorption results from either hindered gastric dissolution or binding by sequestrants in intestinal lumen.Areas covered: This review provides an overview pharmacokinetics formulations available market: tablet, soft gel capsule and oral solution. We literature on new anticipate areas future research.Expert opinion: Failure treatment to reach target serum thyroid-stimulating hormone levels generally prompts physicians increase daily dose. In vitro studies have shown that releases active ingredient more consistently at varying pH than tablet. addition, vivo confirmed data demonstrated both liquid are capable solve caused certain drugs, bariatric surgery coffee. These may be attractive also for patients who cannot/do not want change their (improper) habits ingestion. Finally, solution could suitable cannot swallow solid formulations.

Язык: Английский

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A pilot randomized controlled trial of deprescribing

Therapeutic Advances in Drug Safety, Год журнала: 2011, Номер 2(2), С. 37 - 43

Опубликована: Фев. 28, 2011

Objective: Polypharmacy and adverse drug reactions are frequent important among older people. Few clinical trials have evaluated systematic withdrawal of medications This small, open, study was conducted to determine the feasibility a randomized controlled deprescribing trial. Methods: Ten volunteers living in community (recruited by media advertising) 25 residential aged-care facilities (RCFs) were intervention or control groups. The gradual one target medication. primary outcome number participants whom medication could be achieved. Other outcomes measures quality life, adherence, sleep quality, cognitive impairment. Results: Participants aged 80 ± 11 years taking 9 2 medications. Fifteen commenced all ceased reduced dose their Two subjects withdrew; referred for review, participant declined further reductions. Conclusions: A trial acceptable participants. Recruitment RCFs is feasible. Definitive required.

Язык: Английский

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When thyroid hormone replacement is ineffective?

Current Opinion in Endocrinology Diabetes and Obesity, Год журнала: 2013, Номер 20(5), С. 467 - 477

Опубликована: Авг. 23, 2013

Purpose of review In this article, we will consider the failure thyroid hormone replacement therapy to normalize serum stimulating concentrations. We circumstances and causes for failures, discuss pertinent unpublished personal cases didactical value, provide practical suggestions providers encountering patients with similar presentations. Recent findings data are available on benefit novel formulations levothyroxine malabsorption. Summary Most frequently, reasons ineffectiveness noncompliance, inappropriate administration levothyroxine, gastrointestinal disorders, drug interactions. The diagnostic work-up should include careful history elucidate potential ineffective therapy.

Язык: Английский

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Use of Potentially Harmful Medications and Health-Related Quality of Life among People with Dementia Living in Residential Aged Care Facilities

Dementia and Geriatric Cognitive Disorders Extra, Год журнала: 2012, Номер 2(1), С. 361 - 371

Опубликована: Сен. 7, 2012

<b><i>Background:</i></b> Use of potentially harmful medications (PHMs) is common in people with dementia living Residential Aged Care Facilities (RACFs) and increases the risk adverse health outcomes. Debate persists as to how PHM use its association quality life should be measured. We designed this study determine exposure PHM, operationalized by three different measures, self-reported Health-Related Quality Life among residing RACFs. <b><i>Methods:</i></b> Cross-sectional 351 aged >65 years diagnosed RACFs MMSE ≤24. The primary outcome measure was self-rated – Alzheimer’s disease questionnaire (QoL-AD). collected data on patients’ medications, age, gender, total score, Neuropsychiatric Inventory comorbidities. Using regression analyses, we calculated crude adjusted mean differences between groups exposed not according inappropriate (PIMs; identified Modified Beers criteria), Drug Burden Index (DBI) >0 polypharmacy (i.e. ≥5 medications). <b><i>Results:</i></b> Of 226 participants able rate their QoL-AD, 56.41% were at least one PIM, 82.05% medication contributing DBI >0, 91.74% polypharmacy. Exposure PIMs associated QoL-AD ratings, while (also after adjustment); tripled odds lower ratings. <b><i>Conclusion:</i></b> medications), but (Modified inversely health-related for

Язык: Английский

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Optimization of Geriatric Pharmacotherapy: Role of Multifaceted Cooperation in the Hospital Setting

Drugs & Aging, Год журнала: 2016, Номер 33(3), С. 179 - 188

Опубликована: Фев. 16, 2016

Язык: Английский

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A Composite Screening Tool for Medication Reviews of Outpatients

Drugs & Aging, Год журнала: 2007, Номер 24(9), С. 733 - 760

Опубликована: Янв. 1, 2007

Язык: Английский

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