Efficacy of deprescribing on health outcomes: An umbrella review of systematic reviews with meta-analysis of randomized controlled trials
Ageing Research Reviews,
Год журнала:
2024,
Номер
95, С. 102237 - 102237
Опубликована: Фев. 16, 2024
Deprescribing
is
an
important
intervention
across
different
settings
in
medicine,
but
the
literature
supporting
such
a
practice
still
conflicting.
Therefore,
we
aimed
to
capture
breadth
of
outcomes
reported
and
assess
strength
evidence
use
deprescribing
for
health
outcomes.
Umbrella
review
systematic
reviews
searching
Medline,
Scopus,
Web
Science
until
01
November
2023.
The
grading
was
carried
out
using
GRADE
studies,
whilst
data
regarding
were
as
narrative
findings.
Among
456
papers,
12
(six
with
meta-analysis)
total
231
RCTs
44,193
patients
included.
In
any
setting,
able
significantly
reduce
number
potentially
inappropriate
medications
(PIMs)
older
(low
certainty
evidence)
proportion
participants
having
several
or
PIMs
(moderate
evidence).
community,
supported
by
high
evidence,
not
more
effective
than
standard
care
decreasing
injurious
falls,
falls
fallers.
nursing
home,
associated
lower
(very
low
end-of-life
situations,
reduced
mortality
rate
approximately
41%
(high
promising
notable
gap
concerning
its
effects
on
substantial
exists.
Язык: Английский
Complex Patterns of Antihypertensive Treatment Changes in Long-Term Care Residents
Journal of the American Medical Directors Association,
Год журнала:
2024,
Номер
25(9), С. 105119 - 105119
Опубликована: Июнь 28, 2024
Язык: Английский
Exploring Early, Middle, and Late Loss in Basic Activities of Daily Living among Nursing Home Residents: A Multicenter Observational Study
Healthcare,
Год журнала:
2024,
Номер
12(8), С. 810 - 810
Опубликована: Апрель 9, 2024
Nursing
home
(NH)
residents
commonly
face
limitations
in
basic
activities
of
daily
living
(BADLs),
following
a
hierarchical
decline.
Understanding
this
hierarchy
is
crucial
for
personalized
care.
This
study
explores
factors
associated
with
early,
middle,
and
late
loss
BADLs
among
NH
residents.
A
multicenter
cross-sectional
was
conducted
30
NHs
Catalonia,
Spain.
Dependent
variables
were
related
to
BADLs:
early
(self-care-related
personal
hygiene,
dressing,
or
bathing),
middle
(mobility-related
walking
wheelchair
handling,
toileting,
transferring),
(eating).
Independent
based
on
comprehensive
geriatric
assessment
institutional
factors.
Logistic
regression
used
the
multivariate
analyses.
The
included
671
older
adults.
Early
significantly
urinary
incontinence,
cognitive
impairment,
falls.
Middle
linked
fecal
ulcers,
impairment.
Late
not
owning
kitchen,
neurological
disease,
dysphagia,
polypharmacy,
weight
loss.
These
findings
highlight
need
address
syndromes,
especially
impairment
bladder/bowel
incontinence.
Monitoring
these
syndromes
could
effectively
anticipate
care
dependency.
presence
kitchens
may
help
eating,
allowing
potential
meal
adaptation.
Язык: Английский
Feasibility of a theory-based intervention towards benzodiazepine deprescribing in Belgian nursing homes: protocol of the END-IT NH cluster-randomised controlled trial
BMJ Open,
Год журнала:
2024,
Номер
14(10), С. e085435 - e085435
Опубликована: Окт. 1, 2024
Introduction
Despite
several
calls
to
deprescribe
benzodiazepine
receptor
agonists
(BZRA)
in
older
adults,
their
use
among
nursing
home
residents
(NHRs)
remains
high.
Therefore,
we
developed
an
intervention
targeting
general
practitioners’
and
healthcare
professionals’
behaviours
regarding
BZRA
deprescribing
homes
(NHs):
The
END-IT
NH
(bENzodiazepines
Deprescribing
InTerventions
Nursing
homes)
6-component
intervention.
Before
moving
on
a
large-scale
effectiveness
cost-effectiveness
evaluation,
this
feasibility
study
aims
at:
(1)
assessing
the
of
implementation
NHs,
(2)
conducting
larger-scale
terms
recruitment
data
collection
(3)
exploratory
evaluation.
Methods
analysis
We
will
conduct
cluster-randomised
controlled
trial
sample
6
with
10–15
NHRs
included
per
NHs.
Four
NHs
be
randomised
into
group,
two
deliver
usual
care
(control
group).
Data
occur
at
baseline,
3,
months
(study
end).
collect
information
explore
fidelity,
mechanisms
impact
contextual
factors
patient-level,
NH-level
professional-level,
using
both
quantitative
qualitative
measures.
conduction
assessed
by
measuring
attrition
rates
completeness
collection.
An
evaluation
conducted
based
quality
life
cost
data.
Ethics
dissemination
This
protocol
received
approval
from
ethical
committee
CHU
UCL
Namur
20
June
2023.
All
are
confidential
anonymised
prior
analysis.
De-identified
shared
depository
2-year
embargo.
results
disseminated
through
scientific
paper
communicated
local
stakeholders
policymakers
symposium.
Trial
registration
number
NCT05929443
.
Язык: Английский
Potentially Inappropriate Medication: A Pilot Study in Institutionalized Older Adults
Healthcare,
Год журнала:
2024,
Номер
12(13), С. 1275 - 1275
Опубликована: Июнь 26, 2024
Institutionalized
older
adults
often
face
complex
medication
regimens,
increasing
their
risk
of
adverse
drug
events
due
to
polypharmacy,
overprescribing,
interactions,
or
the
use
Potentially
Inappropriate
Medications
(PIM).
However,
data
on
and
associated
risks
in
this
population
remain
scarce.
This
pilot
study
aimed
characterize
sociodemographic,
clinical
pharmacotherapeutic
profiles,
PIM
among
institutionalized
elders
residing
Residential
Structures
for
Elderly
People
(ERPI)
Faro
municipality,
located
Portuguese
region
Algarve.
We
conducted
a
cross-sectional
non-randomized
sample
96
participants
(mean
age:
86.6
±
7.86
years)
where
trained
researchers
reviewed
profiles
identified
potentially
inappropriate
medications
using
EU(7)-PIM
list.
Over
90%
exhibited
polypharmacy
(≥5
medications),
with
an
average
9.1
4.15
per
person.
About
92%
had
potential
including
major
moderate
interactions.
More
than
86%
used
at
least
one
medication,
most
commonly
central
nervous
system
drugs.
demonstrates
that
may
be
high
medication-related
problems.
Implementing
comprehensive
review
programs
promoting
adapted
prescribing
practices
are
crucial
optimize
improve
well-being
vulnerable
population.
Язык: Английский
Findings from an expert focus group on psychotropic medication deprescribing practices for children and youth with complex needs
Frontiers in Child and Adolescent Psychiatry,
Год журнала:
2024,
Номер
3
Опубликована: Ноя. 20, 2024
Introduction
Psychotropic
medication
can
be
effective
at
stabilizing
emotional
and
behavioural
disturbances
associated
with
physiological
processes
in
children
youth.
When
benefits,
indication
or
adverse
effects
are
queried,
deprescribing
should
considered.
Current
guidelines
for
mainly
adults/elderly
largely
theoretical,
not
practical,
especially
polypharmacy.
Methods
At
a
tertiary
center
youth
complex
needs,
physicians
on
staff
have
expertise
conducting
assessments
of
efficacy,
side
effect
burden,
safety
concerns.
Deprescribing
is
routinely
undertaken
the
context
inpatient
outpatient
services
partnership
children/youth
their
families.
A
qualitative
initiative
leveraged
specialized
eight
(six
psychiatrists
two
pediatricians).
Results
Emerging
themes
were
review,
timing,
stepwise
approach,
setting
conditions
(inpatient
outpatient),
recurring
subcategories
patient/family
engagement
as
well
underlying
importance
continuity
care
psychosocial/behavioural
supports.
Discussion
The
findings
from
this
expert
focus
group
serve
step
towards
supporting
prescribing
clinicians
mindful
when
medications
no
longer
best
interest
young
patients.
Язык: Английский