Anticholinergic and sedative drug burden in community-dwelling older people: a national database study

BMJ Open, Год журнала: 2018, Номер 8(7), С. e022500 - e022500

Опубликована: Июль 1, 2018

The Drug Burden Index (DBI) tool quantifies individual exposure to anticholinergic and sedative medications. DBI has been internationally validated against adverse health outcomes in older people. not reported the Irish population. This study aimed to: (1) develop a list of drugs with clinically significant and/or effects (DBI medications) relevant Ireland; (2) examine, using formula, prevalence medications people (3) explore patient factors associated exposure.A cross-sectional national pharmacy claims database study.Community setting General Medical Services (GMS) scheme maintained by Health Service Executive Primary Care Reimbursement Services.Irish individuals (aged ≥65 years) enrolled GMS dispensed at least one prescription item 2016 (n=428 516).Prevalence exposure.282 874 (66%) population aged years were exposed medication 2016. Prevalence was significantly higher females than males (females 71.6% vs 58.7%, adjusted OR 1.65, 95% CI 1.63 1.68). increased progressively number chronic used, rising from 42.7% those prescribed 0-4 95.4% on ≥12 (adjusted 27.8, 26.7 29.0). most frequently used codeine/paracetamol combination products (20.1% patients), tramadol (11.5%), zopiclone (9.5%), zolpidem (8.5%), pregabalin (7.9%) alprazolam (7.8%).The majority Ireland are effects, particularly multiple comorbidities. high use low-dose products, Z-drugs benzodiazepines, suggests there opportunities for deprescribing.

Язык: Английский

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Nurse-Led Medicines' Monitoring for Patients with Dementia in Care Homes: A Pragmatic Cohort Stepped Wedge Cluster Randomised Trial

PLoS ONE, Год журнала: 2015, Номер 10(10), С. e0140203 - e0140203

Опубликована: Окт. 13, 2015

Background People with dementia are susceptible to adverse drug reactions (ADRs). However, they not always closely monitored for potential problems relating their medicines: structured nurse-led ADR Profiles have the address this care gap. We aimed assess number and nature of clinical identified addressed changes in prescribing following introduction medicines' monitoring. Design Pragmatic cohort stepped-wedge cluster Randomised Controlled Trial (RCT) monitoring versus usual care. Setting Five UK private sector homes Participants 41 service users, taking at least one antipsychotic, antidepressant or anti-epileptic medicine. Intervention Nurses completed West Wales (WWADR) Profile Mental Health Medicines each participant according trial step. Outcomes Problems medicines prescribed. Data Collection Analysis Information was collected from participants' notes before randomisation after five monthly steps. The impact on found, actions taken reduction mental health explored multivariate analyses, accounting data collection step site. Results 10 sites 43 49 users approached participated. administration increased a mean 6.02 [SD 2.92] 9.86 [4.48], effect size 3.84, 95% CI 2.57–4.11, P <0.001. For example, pain more likely be treated (adjusted Odds Ratio [aOR] 1.78–8.30), patients attended dentists opticians (aOR 52.76 [11.80–235.90] 5.12 [1.45–18.03] respectively). use associated 4.45, 1.15–17.22). Conclusion WWADR can improve quality safety care, warrants further investigation as strategy mitigate known effects prescribed medicines. Registration ISRCTN 48133332

Язык: Английский

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Associations between the Drug Burden Index, Potentially Inappropriate Medications and Quality of Life in Residential Aged Care

Drugs & Aging, Год журнала: 2018, Номер 35(1), С. 83 - 91

Опубликована: Янв. 1, 2018

Язык: Английский

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Potentially inappropriate medication use in older people with cancer: Prevalence and correlates

Journal of Geriatric Oncology, Год журнала: 2014, Номер 5(4), С. 439 - 446

Опубликована: Авг. 7, 2014

Язык: Английский

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Potentially Inappropriate Medications and Anticholinergic Burden in Older People Attending Memory Clinics in Australia

Drugs & Aging, Год журнала: 2015, Номер 33(1), С. 37 - 44

Опубликована: Дек. 8, 2015

Язык: Английский

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Potentially inappropriate prescribing in dementia: a state-of-the-art review since 2007

BMJ Open, Год журнала: 2020, Номер 10(1), С. e029172 - e029172

Опубликована: Янв. 1, 2020

Objectives Dementia frequently occurs alongside comorbidities. Coexisting conditions are often managed with multiple medications, leading to increased risk of potentially inappropriate medication and adverse drug reactions. We aimed estimate prevalence of, identify factors reported be associated with, prescribing (PIP) for older individuals diagnosed dementia. Design used a state-of-the-art review approach, selecting papers written in English published from 2007 January 2018. Publications were retrieved Scopus Web Science databases. Inclusion criteria included formal diagnosis dementia, classification PIP as an outcome. Random effects models provide pooled PIP. The Appraisal tool Cross-Sectional Studies (AXIS tool) was assess bias the studies. Results bibliographic search yielded 221 citations, 12 studies meeting inclusion criteria. estimates people living dementia ranged 14% 64%. Prevalence 31% (95% CI 9 52) community, 42% 30 55) nursing/care homes. likely related (eg, hypnotics sedative cholinesterase inhibitors) treatment comorbidities cardiovascular drugs non-steroidal anti-inflammatory medication). Higher levels comorbidity PIP; however, only one study investigated associations specific Conclusion remains significant issue healthcare management PIP, but driving this increase remain unknown. Further work is necessary investigate presence common patients

Язык: Английский

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Association of the Drug Burden Index (DBI) exposure with outcomes: A systematic review

Journal of the American Geriatrics Society, Год журнала: 2023, Номер 72(2), С. 589 - 603

Опубликована: Ноя. 25, 2023

Abstract Background The Drug Burden Index (DBI) measures an individual's total exposure to anticholinergic and sedative medications. This systematic review aimed investigate the association of DBI with clinical prescribing outcomes in observational pharmaco‐epidemiological studies, effect on functional pre‐clinical models. Methods A search nine electronic databases, citation indexes gray literature was performed (April 1, 2007–December 31, 2022). Studies that reported primary data or conducted any setting humans aged ≥18 years animals were included. Quality assessment using Joanna Briggs Institute critical appraisal tools Systematic Review Centre for Laboratory animal Experimentation risk bias tool. Results Of 2382 studies screened, 70 met inclusion criteria (65 humans, five animals). In included function ( n = 56), cognition 20), falls 14), frailty 7), mortality 9), quality life 8), hospitalization length stay 5), readmission 1), other 15) 2). higher significantly associated increased (11/14, 71%), poorer (31/56, 55%), (11/20, 55%) related outcomes. Narrative synthesis used due significant heterogeneity study population, setting, type, definition DBI, outcome measures. could not be pooled heterogeneity. animals, 18), 2), 1). a caused frailty. Conclusions may decreased cognition. Higher inconsistently mortality, stay, frailty, reduced life. Human findings respect are supported by preclinical interventional studies. as tool identify older adults at harm.

Язык: Английский

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The relationship between sleep quality, inappropriate medication use and frailty among older adults in aged care homes in Malaysia

PLoS ONE, Год журнала: 2019, Номер 14(10), С. e0224122 - e0224122

Опубликована: Окт. 17, 2019

Poor sleep quality is prevalent among older adults and compounded by frailty polypharmacy. This descriptive, cross-sectional study examines the associations between quality, inappropriate medication use frailty. The was conducted 151 residents of 11 aged care homes in three states Malaysia; convenience sampling used. Subjective assessed using Pittsburgh Sleep Quality Index (PSQI), Groningen Frailty Indicator (GFI) used to assess Medication appropriateness Drug burden (DBI), Potentially Inappropriate Medications (PIMs) Prescriptions (PIPs). Most subjects (approximately 95%) reported poor as measured a cut-off global PSQI score ≥ 5. With second at 10, just over half (56%) moderately followed 39% who had very quality. (90%) denied taking improve their during previous month. There no statistically significant association inappropriateness (PIMs, PIPs, DBI) score. However, average number PIM associated significantly with efficiency (a measure actual 'sleep total time spent bed) (p = 0.037). PIP subjective 0.045) medications 0.001), inversely disturbance (0.049). Furthermore, correlated overall 0.032). Findings support need for review identify reduce PIMs optimise prescriptions hence, related health outcomes homes.

Язык: Английский

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Polypharmacy and medication regimen complexity as factors associated with staff informant rated quality of life in residents of aged care facilities: a cross-sectional study

European Journal of Clinical Pharmacology, Год журнала: 2016, Номер 72(9), С. 1117 - 1124

Опубликована: Июнь 2, 2016

Язык: Английский

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Impact of drug burden index on adverse health outcomes in Irish community-dwelling older people: a cohort study

BMC Geriatrics, Год журнала: 2019, Номер 19(1)

Опубликована: Апрель 29, 2019

The Drug Burden Index (DBI) quantifies exposure to medications with anticholinergic and/or sedative effects. A consensus list of DBI available in Ireland was recently developed for use as a tool. aim this study validate tool by examining the association score important health outcomes Irish community-dwelling older people.This cohort using data from Longitudinal Study on Ageing (TILDA) linked pharmacy claims data. Individuals aged ≥65 years participating TILDA and enrolled General Medical Services scheme were eligible inclusion. determined applying participants' medication dispensing year prior outcome assessment. recoded into categorical variable [none (0), low (> 0 < 1), high (≥1)]. Outcome measures included any Activities Daily Living (ADL) impairment, Instrumental (IADL) self-reported fall previous 12 months, frailty criterion met (Fried Phenotype measure), quality life (QoL) (CASP-19 [Control Autonomy Self-realisation Pleasure] healthcare utilisation (any hospital admission emergency department (ED) visit) months. Statistical analyses multivariate logistic linear regression models controlling potential confounders.61.3% (n = 1946) participants received at least one prescription before their High (DBI ≥ 1) vs none significantly associated impaired function (ADL impairment adjusted OR 1.89, 95% CI 1.25, 2.88; IADL 2.97, 1.91, 4.61), falls (adjusted 1.50, 95%CI 1.03, 2.18), 1.74, 1.14, 2.67), reduced QoL (β - 1.84, -3.14, 0.54). There no significant between utilisation.The findings predicting risk functional falls, people Ireland, may be extended other European countries. Integration routine practice an appropriate step forward improve people.

Язык: Английский

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