Depression, antidepressants and fall risk: therapeutic dilemmas—a clinical review

European Geriatric Medicine, Год журнала: 2021, Номер 12(3), С. 585 - 596

Опубликована: Март 15, 2021

The aim of this clinical review was to summarize the existing knowledge on fall risk associated with antidepressant use in older adults, describe underlying mechanisms, and assist clinicians decision-making regard (de-) prescribing antidepressants persons.

Язык: Английский

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Deprescribing Education vs Usual Care for Patients With Cognitive Impairment and Primary Care Clinicians

JAMA Internal Medicine, Год журнала: 2022, Номер 182(5), С. 534 - 534

Опубликована: Март 28, 2022

Individuals with dementia or mild cognitive impairment frequently have multiple chronic conditions (defined as ≥2 medical conditions) and take medications, increasing their risk for adverse outcomes. Deprescribing (reducing stopping medications which potential harms outweigh benefits) may decrease of

Язык: Английский

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Young‐onset dementia diagnosis, management and care: a narrative review

The Medical Journal of Australia, Год журнала: 2023, Номер 218(4), С. 182 - 189

Опубликована: Фев. 19, 2023

Young-onset dementia comprises a heterogeneous range of dementias, with onset at less than 65 years age. These include primary dementias such as Alzheimer disease, frontotemporal and vascular dementias; genetic/familial metabolic disorders; secondary those that result from alcohol use disorder, traumatic brain injury, infections. The presentation young-onset is varied may cognitive, psychiatric neurological symptoms. Diagnostic delay common, frequent diagnostic conundrum being, "Is this or psychiatric?". For assessment accurate diagnosis, thorough screen recommended, collateral history investigations neuroimaging, lumbar puncture, neuropsychology, genetic testing. management needs to be age-appropriate multidisciplinary, timely access services consideration the family (including children).

Язык: Английский

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Optimizing pharmacotherapy and deprescribing strategies in older adults living with multimorbidity and polypharmacy: EuGMS SIG on pharmacology position paper

European Geriatric Medicine, Год журнала: 2023, Номер 14(6), С. 1195 - 1209

Опубликована: Окт. 9, 2023

Abstract Inappropriate polypharmacy is highly prevalent among older adults and presents a significant healthcare concern. Conducting medication reviews implementing deprescribing strategies in multimorbid with are an inherently complex challenging task. Recognizing this, the Special Interest Group on Pharmacology of European Geriatric Medicine Society has compiled evidence review formulated recommendations to enhance appropriate prescribing practices. The current supports need for comprehensive widespread transformation education, guidelines, research, advocacy, policy improve management individuals. Furthermore, incorporating as routine aspect care ageing population crucial. We emphasize importance involving geriatricians experts geriatric pharmacology driving, actively participating this transformative process. By doing so, we can work towards achieving optimal use enhancing well-being generations come.

Язык: Английский

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Less Is More: The Impact of Deprescribing Psychotropic Drugs on Behavioral and Psychological Symptoms and Daily Functioning in Nursing Home Patients. Results From the Cluster-Randomized Controlled COSMOS Trial

American Journal of Geriatric Psychiatry, Год журнала: 2020, Номер 29(3), С. 304 - 315

Опубликована: Июль 12, 2020

To investigate the impact of medication reviews using collegial mentoring and systematic clinical evaluation on psychotropic prescriptions, behavioral psychological symptoms dementia (BPSD), activities daily living (ADL).Four-month multicenter, multicomponent, cluster-randomized, single-blinded controlled trial.Thirty-three Norwegian nursing homes including 67 home wards (clusters).A total 723 enrolled patients, which 428 participated in study; 217 were randomized to intervention 211 care as usual (control).The COSMOS consisted Communication, Systematic pain management, Medication reviews, Organization activities, Safety. During review, physician evaluated treatment with colleagues systematically results from validated assessments.Mean changes baseline month 4 number prescribed drugs (antipsychotics, anxiolytics, hypnotics or sedatives, antidepressants, antidementia drugs); Neuropsychiatric Inventory Nursing Home Version (NPI-NH) Cornell Scale Depression Dementia (CSDD); Lawton Brody's Physical Self Maintenance (PSMS).Compared control, mean change was reduced both regular number, while NPI-NH CSDD scores did not differ between groups. Mean PSMS showed improvement group, deterioration control group.Medication led safe deprescribing, reductions drug use negatively affect BPSD, ADL improved.

Язык: Английский

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Medicine Optimisation and Deprescribing Intervention Outcomes for Older People with Dementia or Mild Cognitive Impairment: A Systematic Review

Drugs & Aging, Год журнала: 2025, Номер unknown

Опубликована: Март 11, 2025

Polypharmacy is common amongst older people with dementia or mild cognitive impairment (MCI), increasing the risk of medication-related harm. Medicine optimisation and deprescribing to reduce polypharmacy considered feasible, safe can lead improved health. However, for those living MCI, this be challenging. This systematic review aimed summarise evidence on outcomes medicine interventions MCI. Literature was searched using CINAHL, Embase, Medline, PsychINFO, Web Science Cochrane Library from database inception January 2024. Papers reporting data specific MCI interventional research studies any design in setting were included. A narrative synthesis conducted owing heterogeneity study designs outcomes. Quality assessed Mixed Methods Appraisal Tool. total 32 papers 28 included, samples ranging 29 17,933 patients a mean patient age 74 88 years. Of studies, 60% undertaken long-term care settings. Involvement and/or carers limited. grouped as either incorporating medication component (n = 13), education 5) both 14). Studies primarily focussed outcomes, generally showing positive effect decreasing number improving appropriateness medications. Fewer reported clinical (behavioural psychological symptoms dementia, falls, quality life cognition) mixed findings. reduction no change mortality hospital attendance demonstrated safety few these The mixed. reduced increased medications, although less frequently reported, seemed showed an absence worsening highlights need further research, particularly at home, more focus greater involvement informal carers. protocol published International Prospective Register Systematic Reviews (PROSPERO) [Ref: CRD42023398139].

Язык: Английский

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Interventions to optimize medication use in nursing homes: a narrative review

European Geriatric Medicine, Год журнала: 2021, Номер 12(3), С. 551 - 567

Опубликована: Март 9, 2021

Abstract Purpose Polypharmacy, medication errors and adverse drug events are frequent among nursing home residents. Errors can occur at any step of the use process. We aimed to review interventions aiming optimization in homes. Methods narratively reviewed quantitative as well qualitative studies, observational experimental studies that described interventions, their effects barriers enablers implementation. prioritized recent with relevant findings for European setting. Results Many led improvements use. However, because outcome heterogeneity, comparison between was difficult. Prescribing most studied aspect At micro-level, review, multidisciplinary work, more recently, patient-centered care components dominated. macro-level, guidelines legislation, mainly specific classes (e.g., antipsychotics) were employed. Utilization technology also helped improve administration. Several reported, individual, organizational, system levels. Conclusion Overall, existing effective optimizing However there is a need further well-designed large-scale evaluations under-researched intervention health information technology, approaches), antithrombotic agents), targeting aspects other than prescribing monitoring). Further development uptake core sets required. Finally, on implementation would enable theory-driven design.

Язык: Английский

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Attitudes toward deprescribing among older adults with dementia in the United States

Journal of the American Geriatrics Society, Год журнала: 2022, Номер 70(6), С. 1764 - 1773

Опубликована: Март 10, 2022

Abstract Background People with dementia (PWD) take medications that may be unnecessary or harmful. This problem can addressed through deprescribing, but it is unclear if PWD would willing to engage in deprescribing their providers. Our goal was investigate attitudes toward among PWD. Methods a cross‐sectional study of 422 aged ≥65 years who completed the module National Health and Aging Trends Study (NHATS) 2016. Proxies provided responses when participant unable respond due health cognitive problems. Attitudinal outcomes comprised two statements from patients' questionnaire its revised version (representing belief about necessity one's willingness deprescribe); another elicited maximum number pills respondent comfortable taking. Results The weighted sample represented over 1.8 million PWD; 39% were 75 84 old 38% 85 older, 60% female, 55% reported six more regular medications. for 26% Overall, 22% believed they taking one medicines no longer needed, 87% stop medications, 50% uncomfortable five similar across sociodemographic clinical factors. ≥6 likely endorse at least medication necessary compared those <6 (adjusted probability 29% [95% confidence interval (CI), 22%–38%] vs. 13% CI, 8%–20%]; p = 0.004); same applied deprescribe (92% 87%–95%] 83% 76%–89%]; 0.04). Conclusions A majority are deprescribe, representing an opportunity improve quality life this vulnerable population.

Язык: Английский

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Why deprescribing antipsychotics in older people with dementia in long‐term care is not always successful: Insights from the HALT study

International Journal of Geriatric Psychiatry, Год журнала: 2019, Номер 34(11), С. 1572 - 1581

Опубликована: Июль 5, 2019

Introduction Antipsychotic medications are commonly used to manage behavioural and psychological symptoms of dementia despite their side effects harms. While the Halting Use in Long‐Term care (HALT) deprescribing trial was successful at reducing antipsychotic use, 19% participants had antipsychotics represcribed or never reached a dose zero. The aim this study investigate reasons for represcription medication factors associated with ongoing relating staff requests perceived changes. Materials methods Thirty‐nine 133 HALT ceased were regular pro re nata (PRN) after initial deprescribing. views nursing staff, general practitioner, family on circumstances leading up these outcomes collected via questionnaire‐based approach. This information triangulated observation detailed file audit (including progress notes, medical charts, incident reports, hospital discharge summaries). A consensus panel reconstructed represcribing context. Results Nurses most common drivers (63.2%), followed by members (39.5%), GPs (23.7%), specialists (13.2%), (10.5%). There multiple use 46.2% participants. Increased agitated aggressive behaviours reported even though changes not identified over time objective measures. Consent dosage practices remained poor education. Discussion Nursing key particularly response worsening agitation aggression among male residents. train‐the‐trainer model may have been insufficient its own improve competence confidence applying nonpharmacological approaches when responding behaviour change.

Язык: Английский

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What Makes Deprescription of Psychotropic Drugs in Nursing Home Residents with Dementia so Challenging? A Qualitative Systematic Review of Barriers and Facilitators

Drugs & Aging, Год журнала: 2021, Номер 38(8), С. 671 - 685

Опубликована: Июль 7, 2021

Behavioral and psychological symptoms of dementia are frequently experienced in the nursing home setting place a substantial burden on patients, relatives, staff. Despite guidelines recommending non-pharmacological treatments, psychotropic drugs often prescribed to address these symptoms. This is case despite their effects being limited, there risk side adverse events for patient. Several studies have aimed reduce use drugs, with varying results. The reasons behind variations not well understood. objective this systematic review was investigate which factors general practitioners staff experience as barriers or facilitators when attempting deprescribe residents. We searched PubMed, EMBASE, psycINFO, Web Science, CINAHL between April September 2020. An inductive method using thematic analysis qualitative findings applied derivation themes. Quantitative were included but described descriptively separately. Of 8204 unique records, 14 review. these, nine interview focus group five survey studies. Thematic resulted major themes identified either both: (1) 'Operationality routines'; (2) 'Lack resources qualifications'; (3) 'Patient-related outcomes', points strong belief negative patient-related outcomes discontinuation downplay medication; (4) 'Policies', including support buy-in from leadership; (5) 'Collaboration' physicians Themes 1 4 consist facilitators. Theme 2 consists barriers. 3 5 both Evaluation closed-ended questions surveys supported findings. Deprescribing used behavioral residents challenging. Resources need be deprescribing, positive doing so. Managerial support, routines, interprofessional collaboration some facilitating process, addition routines procedures allowing operationality common understanding. Addressing necessary ensure that deprescribing can understood meaningful pursued among healthcare professionals setting.

Язык: Английский

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