Deprescribing in older adults with polypharmacy

BMJ, Год журнала: 2024, Номер unknown, С. e074892 - e074892

Опубликована: Май 7, 2024

Abstract Polypharmacy is common in older adults and associated with adverse drug events, cognitive functional impairment, increased healthcare costs, risk of frailty, falls, hospitalizations, mortality. Many barriers exist to deprescribing, but efforts have been made develop implement deprescribing interventions that overcome them. This narrative review describes intervention components summarizes findings from published randomized controlled trials tested polypharmacy, as well reports on ongoing trials, guidelines, resources can be used facilitate deprescribing. Most were medication reviews primary care settings, many contained such shared decision making and/or a focus patient priorities, training for professionals, facing education materials, involvement family members, representing great heterogeneity addressing polypharmacy adults. Just over half study found perform better than usual at least one their outcomes, most assessed 12 months or less.

Язык: Английский

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Older Adults’ Attitudes Toward Deprescribing in 14 Countries

JAMA Network Open, Год журнала: 2025, Номер 8(2), С. e2457498 - e2457498

Опубликована: Фев. 10, 2025

Importance Better understanding of patients’ attitudes toward deprescribing specific medications will inform future interventions. Objective To investigate older adults’ by investigating which they would like to have deprescribed, the reasons why, and patient factors associated with interest in deprescribing. Design, Setting, Participants This survey study was conducted from May 2022 December 2023 primary care settings 14 countries. Patients aged 65 years or taking 5 more were consecutively recruited their general practitioner (GP) completed questionnaire. Exposures Patient characteristics, including gender, number medications, GP education level, financial status, confidence completing medical forms, self-rated health, satisfaction trust GP, country. Main Outcomes Measures The outcomes as measured responses question, “Thinking about your current medication list, are there any that you stop reduce dose of?” Multilevel multivariable logistic regression analysis used, adjusted for clustering effect at country association between characteristics Results Of 1340 patients (mean [SD], 96 [47] per country), 736 (55%) women, 580 (44%) had secondary school highest level education, 1089 (82%) satisfied 589 expressed deprescribe 1 medications. varying levels, 79% (86 109 patients) Poland 23% (21 Bulgaria. 3 most reported deprescribed diuretics (111 1002 [11%]), lipid-modifying agents (109 acting on renin-angiotensin system (83 [8%]). odds naming least lower higher (odds ratio, 0.31; 95% CI, 0.21-0.47) 0.960; 0.930-0.998). Conclusions Relevance In this older, varied across countries, demonstrating interventions could be impactful when adapted contexts. These findings highlight importance patient-practitioner communication ensuring appropriate use.

Язык: Английский

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It's time to take a sustainable approach to health care in the face of the challenges of the 21st century

One Health, Год журнала: 2023, Номер 16, С. 100510 - 100510

Опубликована: Фев. 20, 2023

Health challenges in the 21st century have become increasingly complex and global. The recent COVID-19 pandemic has only exacerbated many problems faced by health care systems around world sadly, exposed various flaws. With ageing populations, particularly Canada, as well unavoidable factors such globalization accelerating climate change, it is becoming imperative to implement a new approach based on intersectorality interdisciplinarity. Furthermore, links must be forged between all stakeholders, i.e. researchers, system its specialists, communities individuals themselves. It this perspective, where everyone concerned equally involved attaining better quality of life, that concepts One sustainable deployed.

Язык: Английский

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Deprescribing Interventions for Older Patients: A Systematic Review and Meta-Analysis

Journal of the American Medical Directors Association, Год журнала: 2023, Номер 24(11), С. 1718 - 1725

Опубликована: Авг. 12, 2023

Язык: Английский

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Association of Healthy Lifestyle and Incident Polypharmacy

The American Journal of Medicine, Год журнала: 2024, Номер 137(5), С. 433 - 441.e2

Опубликована: Янв. 3, 2024

BackgroundPolypharmacy, commonly defined as taking ≥5 medications, is an undesirable state associated with lower quality of life. Strategies to prevent polypharmacy may be important priority for patients. We sought examine the association healthy lifestyle, a modifiable risk factor, incident polypharmacy.MethodsWe performed secondary analysis REasons Geographic and Racial Differences in Stroke (REGARDS) cohort study, including 15,478 adults aged ≥45 years without at baseline. The primary exposure was lifestyle baseline measured by Healthy Behavior Score (HBS), cumulative assessment diet, exercise frequency, tobacco smoking, sedentary time. HBS ranges from 0-8, whereby 0-2 indicates low HBS, 3-5 moderate 6-8 high HBS. used multinomial logistic regression between polypharmacy, survival death.ResultsHigher (i.e., healthier lifestyle) inversely after adjusting sociodemographic health variables. Compared participants those had odds (odds ratio [OR] 0.85; 95% confidence interval [CI], 0.73-0.98) dying (OR 0.74; CI, 0.65-0.83). Participants even both 0.75; 0.64-0.88) death 0.62; 0.54-0.70). There interaction age, where most pronounced ≤65 years.ConclusionsHealthier polypharmacy.

Язык: Английский

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Polypharmacy and potentially inappropriate medications among hospitalized older adults with COVID-19 in Malaysian tertiary hospitals

Journal of Pharmaceutical Policy and Practice, Год журнала: 2023, Номер 16(1)

Опубликована: Янв. 12, 2023

Older adults are among the most vulnerable groups during COVID-19 epidemic, contributing to a large proportion of COVID-19-related death. Medication review and reconciliation by pharmacist can help reduce number potentially inappropriate medications but these services were halted COVID-19.To assess prevalence factors associated with medicine use older populations COVID-19.This was cross-sectional, retrospective analysis hospitalized COVID-19. Potentially medication categorized using Beer's STOPP criteria.Combining both criteria, 181 (32.7%) 553 patients identified have used at least one or more medication. A marginally higher documented Beers 2019 criteria (151 PIM in 124 patients) compared (133 PIMS 104 patients). The long-term proton pump inhibitors (n = 68; 12.3%) drugs which increases risk postural hypotension commonly reported 41; 7.4%). previous history hospital admission past 12 months (Odds ratio [OR]: 2.27; 95% CI 1.29-3.99) discharge medications.Nearly, three had been prescribed PIM, polypharmacy increased after discharge. This highlights importance having clinical conducting reviews identify PIMs ensure appropriateness.

Язык: Английский

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Attitudes towards deprescribing and patient-related factors associated with willingness to stop medication among older patients with type 2 diabetes (T2D) in Indonesia: a cross-sectional survey study

BMC Geriatrics, Год журнала: 2023, Номер 23(1)

Опубликована: Янв. 12, 2023

Deprescribing of preventive medication is recommended in older patients with polypharmacy, including people type 2 diabetes (T2D). It seems that many low-middle-income countries are not willing to have their medicines deprescribed. This study aims assess attitudes Indonesian T2D towards deprescribing general and regarding specific cardiometabolic medicines, factors influencing willingness stop medicines.Primary care ≥60 years Indonesia completed the revised Patients' Attitudes Towards (rPATD) questionnaire. for were reported descriptively. Proportions one or more when by different healthcare professionals compared Chi-square test. Multiple regression analysis was used analyse influence between patient-related medicines.The survey 196 participants (median age 69 years, 73% female). The percentages 69, 67, 41%, practitioner (GP), specialist, pharmacist initiates process (p-value < 0.001). Higher perceived burden = 0.03) less concerns about stopping 0.001) associated a higher if proposed GP. Patients using multiple glucose-regulating 0.02). Using complementary alternative stop. If pharmacist, without substantial education than educated patients.Only two-thirds GP specialist this, even this. Attention should be given especially among glucose-lowering who may eligible but accept deprescribing.

Язык: Английский

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Predictors of older patients' willingness to have medications deprescribed: A cross‐sectional study

Basic & Clinical Pharmacology & Toxicology, Год журнала: 2023, Номер 133(6), С. 703 - 717

Опубликована: Апрель 18, 2023

Deprescribing is a complex process requiring patient-centred approach. One frequently expressed deprescribing barrier patients' attitudes and beliefs towards deprescribing. This study aimed to identify the predictors of willingness have medications deprescribed.A cross-sectional was conducted with community-dwelling patients aged ≥65 who are taking at least one regular medication. Data collection included demographic clinical characteristics Portuguese revised Patients' Attitudes Towards (rPATD) questionnaire. Descriptive statistics were used present characteristics. Multiple binary logistic regression analysis performed deprescribed.One hundred ninety-two participants (median age 72 years; 65.6% female) included. Most (83.33%) willing deprescribed, (adjusted odds ratio [aOR] = 1.136; 95% CI 1.026, 1.258), female sex (aOR 3.036; 1.059, 8.708) rPATD concerns about stopping factor 0.391; 0.203, 0.754).Most their deprescribed if it recommended by doctors. Older increased deprescribe; higher decreased odds. These findings suggest that addressing medicines may contribute success.

Язык: Английский

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Challenges and barriers to physician decision-making for prescribing and deprescribing among patients with multimorbidity in eastern China’s primary care settings: a qualitative study

BMJ Open, Год журнала: 2025, Номер 15(2), С. e095063 - e095063

Опубликована: Фев. 1, 2025

Objectives Patients with multimorbidity have an increased risk of medication-related problems. Physicians face the dilemmas management multiple medications in primary care settings. We aimed to investigate experiences and perceptions physicians (PCPs) regarding their decision-making processes prescribing deprescribing for patients multimorbidity, identify challenges barriers they face. Design From 5 October 2023 27 January 2024, this qualitative study was conducted through semi-structured interviews that encouraged in-depth exploration participants’ perspectives. The were audio-recorded, transcribed verbatim, independently coded by two investigators. Themes developed using a conventional content analysis approach. Setting 12 community health centers 8 township across four regions eastern China included. Participants 26 PCPs from 20 institutions interviewed purposive sampling, representing mix urban rural healthcare Results Of participants study, 14 (53.8%) women, mean age 36.3 years old. When stopping often encounter complex challenges. These stemmed three key areas: (1) difficulties identifying drug-disease drug-drug interactions; (2) cognitive biases medication benefit-risk evaluation (3) heavy treatment burden. further compounded barriers, including clinical inertia among physicians, patient resistance changes, inadequate decision support training, time constraints consultation. Conclusions complexity decisions faced treating is influenced interconnected factors related patients, technology working environment. Future research could develop evaluate implementation strategies address specific allow make effective multimorbidity.

Язык: Английский

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Preventive medication deprescribing in advanced cancer patients approaching end of life

Internal Medicine Journal, Год журнала: 2025, Номер unknown

Опубликована: Март 8, 2025

Previous reports indicated many patients with advanced cancer and limited life expectancy have ongoing preventive medication prescription (PMP) of uncertain benefit increased risk. Our review palliative care oncology admissions found high rates PMP (69%) at time first admission, despite inpatient deprescription (88%) death a median 16 days (interquartile range 10-45) following admission. Rates PMPs did not vary by from last systemic treatment (P = 0.29) or prior involvement 0.82). Physicians the wider multidisciplinary team may be missing opportunities for terminally ill patients.

Язык: Английский

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