A systematic review of the evidence for deprescribing interventions among older people living with frailty

BMC Geriatrics, Год журнала: 2021, Номер 21(1)

Опубликована: Апрель 17, 2021

Abstract Background Older people living with frailty are often exposed to polypharmacy and potential harm from medications. Targeted deprescribing in this population represents an important component of optimizing medication. This systematic review aims summarise the current evidence for among older frailty. Methods The literature was searched using Medline, Embase, CINAHL, PsycInfo, Web Science, Cochrane library up May 2020. Interventional studies any design or setting were included if they reported interventions aged 65+ who live identified reliable measures. primary outcome safety deprescribing; whereas secondary outcomes clinical outcomes, medication-related feasibility, acceptability cost-related outcomes. Narrative synthesis used findings study quality assessed Joanna Briggs Institute checklists. Results Two thousand three hundred twenty-two articles six (two randomised controlled trials) 657 participants total (mean age range 79–87 years). Studies heterogeneous their designs, settings Deprescribing pharmacist-led ( n = 3) multidisciplinary team-led 3). Frailty several measures implemented either explicit implicit tools both. Three showed no significant changes adverse events, hospitalisation mortality rates. positive impact on including depression, mental health status, function frailty; mixed falls cognition; life. All described a reduction potentially inappropriate medications number per-patient. Feasibility four which that 72–91% recommendations made implemented. evaluated further two cost saving. Conclusion There is paucity research about However, suggest could be safe, feasible, well tolerated can lead benefits. Research should now focus understanding status high risk populations. Trial registration registered international prospective register reviews (PROSPERO) ID number: CRD42019153367 .

Язык: Английский

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Polypharmacy, inappropriate prescribing, and deprescribing in older people: through a sex and gender lens

The Lancet Healthy Longevity, Год журнала: 2021, Номер 2(5), С. e290 - e300

Опубликована: Май 1, 2021

Язык: Английский

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Polypharmacy stewardship: a novel approach to tackle a major public health crisis

The Lancet Healthy Longevity, Год журнала: 2023, Номер 4(5), С. e228 - e235

Опубликована: Апрель 5, 2023

With growing global concern regarding medication-related harm, WHO launched a patient safety challenge, Medication Without Harm, in March, 2017. Multimorbidity, polypharmacy, and fragmented health care (ie, patients attending appointments with multiple physicians various health-care settings) are key drivers of which can result negative functional outcomes, high rates hospitalisation, excess morbidity mortality, particularly frailty older than 75 years. Some studies have examined the effect medication stewardship interventions cohorts, but focused on narrow spectrum potentially adverse practices, mixed results. In response to we propose novel concept broad-spectrum polypharmacy stewardship, coordinated intervention designed improve management multimorbidities, taking into account inappropriate medications, potential prescribing omissions, drug-drug drug-disease interactions, cascades, aligning treatment regimens condition, prognosis, preferences individual patient. Although efficacy need be tested well clinical trials, that this approach could minimise harm people multimorbidities exposed polypharmacy.

Язык: Английский

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How to handle polypharmacy in heart failure. A clinical consensus statement of the Heart Failure Association of the ESC

European Journal of Heart Failure, Год журнала: 2025, Номер unknown

Опубликована: Март 17, 2025

Abstract The multiplicity of coexisting comorbidities affecting patients with heart failure ( HF) , together the availability multiple treatments improving prognosis in HF reduced ejection fraction, has led to an increase number prescribed medications each patient. Polypharmacy is defined as regular use medications, and over last years become emerging aspect care, particularly older frailer who are more frequently on treatments, therefore likely exposed tolerability issues, drug–drug interactions practical difficulties management. negatively affects adherence treatment, associated a higher risk adverse drug reactions, impaired quality life, hospitalizations worse prognosis. It important adopt implement strategies for management polypharmacy from other medical disciplines, including medication reconciliation, therapeutic revision treatment prioritization. also essential develop new ‐specific strategies, primary goal avoiding redundant minimizing reactions interactions, finally adherence. This clinical consensus statement document Heart Failure Association European Society Cardiology proposes rationale, pragmatic multidisciplinary approach prescription current era multimorbidity ‘multi‐medication’ .

Язык: Английский

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Continued Use of Cholinesterase Inhibitors and Memantine in Hospice

JAMA Internal Medicine, Год журнала: 2025, Номер unknown

Опубликована: Март 24, 2025

This cohort study examines the use of cholinesterase inhibitors and memantine among older adults with dementia after admission into hospice care despite medications’ limited clinical benefit following enrollment hospice.

Язык: Английский

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Improving individualized prescription in patients with multimorbidity through medication review

BMC Geriatrics, Год журнала: 2022, Номер 22(1)

Опубликована: Май 12, 2022

Abstract Background Older patients tend to have multimorbidity, represented by multiple chronic diseases or geriatric conditions, which leads a growing number of prescribed medications. As result, pharmacological prescription has become major concern because the increased difficulties ensure appropriate in older adults. The study’s main objectives were characterize cohort adults with carry out medication review and compare data before after globally according frailty index. Methods This was quasi-experimental (uncontrolled pre-post) study ≥ 65 years old multimorbidity. Data collected from June 2019 October 2020. Variables assessed included demographic, clinical, data, degree (Frail-VIG index), regimen complexity index, anticholinergic sedative burden monthly drug expenditure. Finally, carried an interdisciplinary team (primary care consultant geriatrician clinical pharmacist) applying Patient-Centered Prescription model align treatment goals. Results Four hundred twenty-eight recruited [66.6% women; mean age 85.5 (SD 7.67)]. frail index 0.39 0.13), corresponding moderate frailty. Up 90% presented at least one inappropriate prescription, prescriptions per patient 3.14 2.27). At three-month follow-up [mortality 17.7% ( n = 76)], medications decreased 17.96%, varying 8.13 3.87) 6.67 3.72) p < 0.001). 19.03%, 31.0 16.2) 25.1 15.1), 8.40%, 1.19 0.82) 1.09 A decrease polypharmacy, more frequent among patients, especially those severe Conclusions An individualized model, decreases parameters related adverse effects, such as therapeutical complexity, and, burden. benefits are for

Язык: Английский

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Perspectives on deprescribing in palliative care

Expert Review of Clinical Pharmacology, Год журнала: 2023, Номер 16(5), С. 411 - 421

Опубликована: Март 30, 2023

Pharmacotherapy plays a critical role in the delivery of high-quality palliative care, but intersection care and deprescribing has received little attention.

Язык: Английский

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Tools and guidelines to assess the appropriateness of medication and aid deprescribing: An umbrella review

British Journal of Clinical Pharmacology, Год журнала: 2023, Номер 90(1), С. 12 - 106

Опубликована: Сен. 12, 2023

Aims The aim of this umbrella review was to identify tools and guidelines aid the deprescribing process potentially inappropriate medications (PIMs), evaluate development validation methods, describe evidence levels for medication inclusion. Methods Searches were conducted on MEDLINE (Ovid), Embase.com , Cochrane CDSR, CINAHL (EBSCO), Web Science Core Collection guideline databases from date inception 7 July 2022. Following initial search, an additional search updated versions 17 2023. We analysed contents guidelines. Results From 23 systematic reviews guidelines, we identified 95 (72 explicit, 12 mixed 11 implicit) nine Most (83.2%) developed use older persons, including 14 those with limited life expectancy. Seven children <18 years (7.37%). explicit/mixed (78.57%) all validated. found 484 PIMs 202 different appropriateness independent disease persons normal expectancy, respectively. Only two eight reported level, a quarter had high‐quality evidence. Conclusions Tools are available diversity populations. There discrepancies, same being classified as in some appropriate others, possibly due low‐quality In particular, patients expectancy based very evidence, research generate is urgently needed. Our lists, along level could facilitate efforts strengthen

Язык: Английский

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Disentangling concepts of inappropriate polypharmacy in old age: a scoping review

BMC Public Health, Год журнала: 2023, Номер 23(1)

Опубликована: Фев. 4, 2023

Abstract Introduction Polypharmacy is a common concern, especially in the older population. In some countries more that 50% of all individuals over 60 receive five or drugs, most often due to multimorbidity and increased longevity. However, polypharmacy associated with multiple adverse events, medication may not always be answer. The terms “appropriate” “inappropriate” are used distinguish between “much” “too much” medications relation research practice, but no explicit definition exists describe what these encompass. aim this review unfold different understandings perspectives on (in)appropriate suggest framework for further practice. Method A scoping was conducted using Arksey O’Malley Levac et al. Pubmed, Embase, PsycINFO, CINAHL, Cochrane database, Scopus Web Science were searched references English, Danish, Norwegian Swedish search string “Polypharmacy” AND “Appropriate” OR “Inappropriate”. Data extracted author information, aims objectives, methodology, study population setting, country origin, main findings implications, text including words “appropriate,” “inappropriate,” “polypharmacy.” Qualitative meaning condensation analysis data charted descriptive thematic analysis. Results Of 3982 references, total 92 included review. Most from 2016-2021, fields related medicine pharmacy, occurred within primary secondary healthcare settings. Based qualitative analysis, assembled consisting Context , three domains (S tandardization, Practices Values & Concerns ) Patient Perspective . Conclusion Inappropriate concept loaded by its heterogeneity usefulness single doubtful. Instead, suggested article representing dimensions inappropriate serve as an initial strategy focusing practice old age.

Язык: Английский

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Deprescribing Opportunities for Frail Residents of Nursing Homes: A Multicenter Study in Australia, China, Japan, and Spain

Journal of the American Medical Directors Association, Год журнала: 2024, Номер 25(5), С. 876 - 883

Опубликована: Фев. 26, 2024

Язык: Английский

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