Deprescribing in older adults with polypharmacy

BMJ, Год журнала: 2024, Номер unknown, С. e074892 - e074892

Опубликована: Май 7, 2024

Abstract Polypharmacy is common in older adults and associated with adverse drug events, cognitive functional impairment, increased healthcare costs, risk of frailty, falls, hospitalizations, mortality. Many barriers exist to deprescribing, but efforts have been made develop implement deprescribing interventions that overcome them. This narrative review describes intervention components summarizes findings from published randomized controlled trials tested polypharmacy, as well reports on ongoing trials, guidelines, resources can be used facilitate deprescribing. Most were medication reviews primary care settings, many contained such shared decision making and/or a focus patient priorities, training for professionals, facing education materials, involvement family members, representing great heterogeneity addressing polypharmacy adults. Just over half study found perform better than usual at least one their outcomes, most assessed 12 months or less.

Язык: Английский

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What makes a multidisciplinary medication review and deprescribing intervention for older people work well in primary care? A realist review and synthesis

BMC Geriatrics, Год журнала: 2023, Номер 23(1)

Опубликована: Сен. 25, 2023

A third of older people take five or more regular medications (polypharmacy). Conducting medication reviews in primary care is key to identify and reduce/ stop inappropriate (deprescribing). Recent recommendations for effective deprescribing include shared-decision making a multidisciplinary approach. Our aim was understand when, why, how interventions review involving teams (MDTs) work (or do not work) people.

Язык: Английский

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Cumulative Update of a Systematic Overview Evaluating Interventions Addressing Polypharmacy

JAMA Network Open, Год журнала: 2024, Номер 7(1), С. e2350963 - e2350963

Опубликована: Янв. 10, 2024

Importance Polypharmacy is associated with mortality, falls, hospitalizations, and functional cognitive decline. The study of polypharmacy-related interventions has increased substantially, prompting the need for an updated, more focused systematic overview. Objective To systematically evaluate summarize evidence across multiple reviews (SRs) examining addressing polypharmacy. Evidence Review A search was conducted MEDLINE, Cochrane Database Systematic Reviews, Abstracts Reviews Effects articles published from January 2017-October 2022, as well those identified in a previous overview (January 2004-February 2017). were included regardless design, setting, or outcome. summarized by 4 categories: (1) medication-related process outcomes (eg, potentially inappropriate medication [PIM] potential prescribing omission reductions), (2) clinical outcomes, (3) health care use economic (4) acceptability intervention. Findings Fourteen SRs (3 overview), 7 which meta-analyses, representing 179 unique studies. Nine examined (low to very low quality). using pooled analyses found significant reductions number PIMs, omissions, total medications, improvements appropriateness. Twelve (very moderate Five mortality; all mortality meta-analyses null, but studies longer follow-up periods greater mortality. falls incidence; results predominantly null save meta-analysis PIMs discontinued. Of 8 quality life, most (7) effects. Ten hospitalizations readmissions quality) emergency department visits One SR among higher-intensity face-to-face patient components. Another effect. without readmissions, had results. Two visits. quality), finding wide variation adoption interventions. Conclusions Relevance This updated noted little association between reduced important outcomes. More needed regarding are useful populations would benefit most.

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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Multimorbidity patterns and influencing factors in older Chinese adults: a national population-based cross-sectional survey

Journal of Global Health, Год журнала: 2025, Номер 15

Опубликована: Фев. 21, 2025

This study aims to develop specific multimorbidity relationships among the elderly and explore association of multidimensional factors with these relationships, thereby facilitating formulation personalised strategies for management. Cluster analysis identified chronic conditions that tend cluster together, then rule mining was used investigate within clusters more closely. Stepwise logistic regression conducted relationship between influencing different health statuses in older adults. The results this were presented by network graph visualisation. A total 15 045 individuals included study. average age 73.0 ± 6.8 years. number patients 7426 (49.4%). most common binary disease combination hypertension depression. four major tumour-digestive cluster, metabolic-circulatory metal-psychological age-related degenerative cluster. sex region revealed similar numbers types each some variations. Gender medications had a consistent effect across all clusters, while aging, body mass index (BMI), waist-to-hip ratio (WHR), cognitive impairment, plant-based foods, animal-based highly processed foods marital status varying effects clusters. Multimorbidity is prevalent population. impact lifestyle varies multimorbidity, there need implement according rather than an integrated approach

Язык: Английский

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Quality of prescribing and health-related quality of life in older adults: a narrative review with a special focus on patients with atrial fibrillation and multimorbidity

European Geriatric Medicine, Год журнала: 2025, Номер unknown

Опубликована: Март 9, 2025

Abstract Purpose To summarise the association between potentially inappropriate prescribing (PIP) and health-related quality of life (HRQOL) in older adults, with a special focus on those atrial fibrillation (AF) multimorbidity, while exploring potential interventions to improve their impact HRQOL. Methods A comprehensive search strategy was conducted MEDLINE using PubMed interface August 16th, 2024, focusing key terms related “potentially prescribing” “quality life”. Additionally, reference lists included studies were screened. Only utilising validated assessment tools for HRQOL or measuring global self-perceived health status considered. Studies involving populations an average age ≥ 65 years included. Results Of 1810 articles screened, 35 The findings indicate that prescribing, independent polypharmacy, may negatively influence review identified range aimed at improving among including pharmacist-driven, general practitioner-driven, multidisciplinary approaches. Interventions assessed distinct population groups specifically residential care homes. While some demonstrated improvements quality, overall evidence regarding remains limited. Conclusion relationship underexplored adults AF despite high prevalence PIP. Effective pharmacotherapy should be coupled patients' clinical functional parameters, considering Adopting multidisciplinary, integrated, patient-centred approach is essential sustainable appropriate practices enhance

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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Colorectal cancer incidence after the first surveillance colonoscopy and the need for ongoing surveillance: a retrospective, cohort analysis

Gut, Год журнала: 2025, Номер unknown, С. gutjnl - 334242

Опубликована: Апрель 5, 2025

Background Recommendations for the first postpolypectomy surveillance colonoscopy (SC1), based on stratifying colorectal cancer (CRC) risk, are well established. Limited data inform recommendations beyond SC1. Objective We investigated which patient groups need Design Retrospective analysis of patients who underwent with polypectomy at 17 UK hospitals, mostly from 2000 to 2010, and had ≥1 colonoscopies. Cancer death were collected through 2017. examined in defined by risk baseline SC1, applying definitions 2020 guidelines: ‘low low risk’ (LR-LR), ‘high (HR-LR), high (LR-HR) (HR-HR). CRC incidence after censoring any second (SC2), SC2 end follow-up. compared general population using standardised ratios (SIRs). Results Analyses included 10 508 patients: LR-LR=6587 (63%), HR-LR=3272 (31%), LR-HR=248 (2%) HR-HR=401 (4%). Median follow-up SC1 was 8.0 years 151 CRCs diagnosed. Compared population, lower LR-LR group (SIR 0.48, 95% CI 0.34 0.67), non-significantly different HR-LR 1.17, 0.85 1.58) or LR-HR 2.51, 0.81 5.85) groups, but higher HR-HR 2.84, 1.30 5.39). After SC2, no longer than 1.86, 0.89 3.42). Conclusion Patients high-risk findings both needed an while those low-risk did not, regardless their findings.

Язык: Английский

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How can policies impact the relational process of deprescription? A realist review protocol with an initial theory

Frontiers in Public Health, Год журнала: 2025, Номер 13

Опубликована: Апрель 16, 2025

Introduction Reducing low-value care by deprescribing is a priority. However, current policies often fail due to healthcare provider resistance, lack of incentives, and poor patient engagement. We believe this insufficient focus on the relationships between key agents in process, making ‘one-size-fits-all’ interventions ineffective. Our goal understand ‘how, why, for whom, what contexts’ affect large-scale deprescribing. Methods To achieve our research aim, we propose an inductive abductive retroductive phases. The phase involved exploratory review literature, leading development initial theory presented article. includes three interconnected hypotheses: (a) success deprescription depends behaviours interactions specific within process. (b) These are influenced power trust dynamics, creating either vicious or virtuous causal loop. (c) impact policy chain its ability address diversity process given territory, considering dimensionality, ruggedness, context-specificity. will test theory’s applicability, while new mechanisms update it. This forms core realist literature review. After screening, selected articles assess how well explains impacts context. article analysis combine semantic latent content phase, analysis. Finally, compare updated with existing frameworks. Discussion ultimate purpose study guide policymakers providing framework informed decision-making before implementing policies. Its originality lies emphasizing relational nature examining implementation through lens complexity.

Язык: Английский

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Development of a complex multidisciplinary medication review and deprescribing intervention in primary care for older people living with frailty and polypharmacy

PLoS ONE, Год журнала: 2025, Номер 20(4), С. e0319615 - e0319615

Опубликована: Апрель 22, 2025

Introduction Reducing polypharmacy and overprescribing in older people living with frailty is challenging. Evidence suggests that this could be facilitated by structured medication review (SMR) deprescribing processes involving the multidisciplinary team (MDT). This study aimed to develop an MDT SMR intervention primary care for frailty. Methods Intervention development was informed Medical Research Council framework complex behaviour change implementation theories. planning included: 1) a realist of 28 papers identified 33 context-mechanism-outcome configurations successful care, 2) qualitative 26 healthcare professionals (HCPs), 13 their informal carers. The intervention’s guiding principles were developed functions proposed, discussed refined through iterative process four online co-design stakeholder workshops. Results final version consisted five components: Proactive identification patients targeted using routinely collected data; HCPs’ preparation evidence-based tool identify prioritise high-risk medications deprescribing; 3) Preparing carers leaflet sent prior explaining purpose reasons potentially stopping or changing medications; 4) Conducting person-centred face-to-face phone, tailored patient/carer needs, other members based on expertise; 5) Tailored follow-up plans allowing continuity highlighting signs symptoms monitor, arranging text, phone appointment. Conclusion A address multiple challenges deprescribing. use rigorous methods theories maximises feasibility, acceptability implementation.

Язык: Английский

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