International Group for Reducing Inappropriate Medication Use & Polypharmacy (IGRIMUP): Position Statement and 10 Recommendations for Action

Drugs & Aging, Год журнала: 2018, Номер 35(7), С. 575 - 587

Опубликована: Июль 1, 2018

Globally, the number of drug prescriptions is increasing causing more adverse events, which now a significant cause mortality, morbidity, and disability that has reached epidemic proportions. The risk events correlated to very old age, multiple co-morbidities, dementia, frailty, limited life expectancy, with major contributor being polypharmacy. Each characteristic alters risk-benefit balance medications, typically reducing anticipated benefits amplifying risk. Current clinical guidelines are based on evidence proven in younger/healthier adult populations using single disease model their application older adults multimorbidity, whom testing not been conducted, yields different prospect makes inappropriate medication use polypharmacy inevitable. Applying practice antithetical good healthcare, likely increase health inequity, associated substantial negative clinical, economic, social implications for systems. casualties scale war or epidemic, yet usually invisible measures healthcare quality formal recommendations. Radical rapid action required achieve better remain true principles medical professionalism evidence-based medicine place patients' interests autonomy at fore. This first International Group Reducing Inappropriate Medication Use & Polypharmacy position statement briefly details causes, consequences, extent article outlines current strategies reduce use, provides effect, then proposes recommendations moving forward 10 12 research. We conclude an urgent integrated effort should be leading global target highest priority. cornerstone this from understanding without definite relevant benefit, when it comes prescribing, many patients 'less more'. approach differs most other guidance care, as focus what, when, how stop, rather than start medications/interventions. Disrupting framework indiscriminately applies standard requires new serves multimorbidity. transition shift education, research, diagnostic frameworks, re-examination used indicators. In achieving objective, we promote return some original concepts medicine: considers scientific data (where exists), judgment, patient/family preference, context. A needed: focuses conditions one simultaneously patient priorities. reframes clinician's role professional providing technician.

Язык: Английский

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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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Multi-Morbidity and Polypharmacy in Older People: Challenges and Opportunities for Clinical Practice

Geriatrics, Год журнала: 2020, Номер 5(4), С. 85 - 85

Опубликована: Окт. 28, 2020

Multi-morbidity and polypharmacy are common in older people pose a challenge for health social care systems, especially the context of global population ageing. They complex interrelated concepts that require early detection patient-centred shared decision making underpinned by multi-disciplinary team-led comprehensive geriatric assessment (CGA) across all settings. Personalised plans need to remain responsive adaptable needs wishes patient, enabling individual maintain their independence. In this review, we aim give an up-to-date account recognition management multi-morbidity person.

Язык: Английский

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Older Adults in the Cardiac Intensive Care Unit: Factoring Geriatric Syndromes in the Management, Prognosis, and Process of Care: A Scientific Statement From the American Heart Association

Circulation, Год журнала: 2019, Номер 141(2)

Опубликована: Дек. 9, 2019

Longevity is increasing, and more adults are living to the stage of life when age-related biological factors determine a higher likelihood cardiovascular disease in distinctive context concurrent geriatric conditions. Older with frequently admitted cardiac intensive care units (CICUs), where commensurate high risks but associated conditions (including multimorbidity, polypharmacy, cognitive decline delirium, frailty) may be inadvertently exacerbated destabilized. The CICU environment procedures, new medications, sensory overload, sleep deprivation, prolonged bed rest, malnourishment, usually inherently disruptive older patients regardless excellence care. Given these fundamental broad challenges patient aging, management priorities decision-making particularly complex need enhancements. In this American Heart Association statement, we examine describe some dynamics pertinent emerging opportunities enhance Relevant assessment tools discussed, as well for additional clinical research best advance already dominating still expanding population adults.

Язык: Английский

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Deprescribing in older people approaching end-of-life: development and validation of STOPPFrail version 2

Age and Ageing, Год журнала: 2020, Номер 50(2), С. 465 - 471

Опубликована: Июль 10, 2020

Abstract Background Screening Tool of Older Persons Prescriptions in Frail adults with limited life expectancy (STOPPFrail) criteria were developed 2017 to assist physicians deprescribing decisions older people approaching end-of-life. Updating was required make the tool more practical, patient-centred and complete. Methods a thorough literature review conducted to, first, devise practical method for identifying who are likely be end-of-life, second, reassess update existing criteria. An eight-member panel wide-ranging experience geriatric pharmacotherapy reviewed new draft STOPPFrail invited propose version 2 then validated using Delphi consensus methodology. Results emphasises importance shared decision-making process. A end-of-life is included along 25 Guidance relating antihypertensive therapies, anti-anginal medications vitamin D preparations comprises Conclusions have been updated efforts reduce drug-related morbidity burden their frailest patients. Version based on an up-to-date validation by experts.

Язык: Английский

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Environmental sustainability and the carbon emissions of pharmaceuticals

Journal of Medical Ethics, Год журнала: 2021, Номер unknown, С. medethics - 106842

Опубликована: Апрель 14, 2021

The US healthcare industry emits an estimated 479 million tonnes of carbon dioxide each year; nearly 8% the country's total emissions. When assessed by sector, hospital care, clinical services, medical structures, and pharmaceuticals are top emitters. For 15 years, research has been dedicated to structures equipment that contribute More recently, care services have examined. However, is understudied. This article will focus on emissions since they consistently calculated be among contributors assess factors pharmaceutical Specifically, overprescription, waste, antibiotic resistance, routine prescriptions, non-adherence, drug dependency, lifestyle drugs given due a lack preventive identified. Prescribing practices environmental ramifications. Carbon reduction, when focused pharmaceuticals, can lead cleaner, more sustainable healthcare.

Язык: Английский

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Frailty in patients on dialysis

Kidney International, Год журнала: 2024, Номер 106(1), С. 35 - 49

Опубликована: Май 3, 2024

Frailty is a condition that frequently observed among patients undergoing dialysis. characterized by decline in both physiological state and cognitive state, leading to combination of symptoms, such as weight loss, exhaustion, low physical activity level, weakness, slow walking speed. Frail not only experience poor quality life, but also are at higher risk hospitalization, infection, cardiovascular events, dialysis-associated complications, death. occurs result interaction various medical issues who on Unfortunately, frailty has no cure. To address frailty, multifaceted approach necessary, involving coordinated efforts from nephrologists, geriatricians, nurses, allied health practitioners, family members. Strategies optimizing nutrition chronic kidney disease-related reducing polypharmacy deprescription, personalizing dialysis prescription, considering home-based or assisted may help the function over time subjects with frailty. This review discusses underlying causes examines methods difficulties involved managing this group.

Язык: Английский

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Sleep Disturbance, Sleep Disorders and Co-Morbidities in the Care of the Older Person

Medical Sciences, Год журнала: 2021, Номер 9(2), С. 31 - 31

Опубликована: Май 21, 2021

Sleep complaints can be both common and complex in the older patient. Their consideration is an important aspect of holistic care, may have impact on quality life, mortality, falls disease risk. assessment should form part comprehensive geriatric assessment. If sleep disturbance brought to light, disorders, co-morbidity medication management a multifaceted approach. Appreciation bi-directional relationship interplay between patients element patient care. This article provides brief overview disorders patients, addition their association with specific co-morbidities including depression, heart failure, respiratory gastro-oesophageal reflux disease, nocturia, pain, Parkinson’s dementia, polypharmacy falls. A potential systematic multidomain approach outlined, emphasis non-pharmacological treatment where possible.

Язык: Английский

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Deprescribing interventions in primary health care mapped to the Behaviour Change Wheel: A scoping review

Research in Social and Administrative Pharmacy, Год журнала: 2020, Номер 17(7), С. 1229 - 1241

Опубликована: Сен. 22, 2020

Язык: Английский

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Principle of rational prescribing and deprescribing in older adults with multiple chronic conditions

Therapeutic Advances in Drug Safety, Год журнала: 2018, Номер 9(11), С. 639 - 652

Опубликована: Авг. 9, 2018

Although the majority of older adults in developed world live with multiple chronic conditions (MCCs), task selecting optimal treatment regimens is still fraught difficulty. Older MCCs may derive less benefit from prescribed medications than healthier patients as a result competing risk several possible outcomes including, but not limited to, death before can be accrued. In addition, these at increased medication-related harms form adverse effects and significant burdens treatment. At present, balance benefits often uncertain, given that are excluded clinical trials. this review, we propose framework to consider patients’ own priorities achieve regimens. To begin, practicing clinician needs information on patient’s goals, what patient willing able do an estimate trajectory, actually taking. We then describe how integrate understand matters most context array potential tradeoffs. Finally, conducting serial therapeutic trials prescribing deprescribing, success measured progress towards health outcome goals. The process described manuscript truly iterative process, which should repeated regularly account for changes status. With aim prescribing, is, maximize matter minimize harms.

Язык: Английский

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