An Evaluation of the Central Nervous System Medication Use and Frailty among Residents of Aged Care Homes in Malaysia

Hasan, Syed Shahzad; Kow, Chia Siang; Thiruchelvam, Kaeshaelya; Chong, David Weng Kwai; Ahmed, Syed Imran

doi:10.1159/000480433

Cited by 10 publications

(17 citation statements)

References 61 publications

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“…Subjects with a score of ≥4 are considered frail [21,22]. The GFI construct was found to be valid and had good internal consistency in assessing frailty among aged care home residents (Cronbach’s alpha = 0.77) [23].…”

Section: Methodsmentioning

confidence: 99%

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

et al. 2019

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

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Section: Methodsmentioning

confidence: 99%

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

et al. 2019

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“…Frailty was assessed using Groningen frailty indicator (GFI). The GFI, validated in institutional homes, comprises 15 dichotomous items with scores ranging from 0 (normal activity without restriction) to 15 (completely disabled) . The GFI instrument has been used and validated in Malaysia .…”

Section: Methodsmentioning

confidence: 99%

“…The GFI, validated in institutional homes, comprises 15 dichotomous items with scores ranging from 0 (normal activity without restriction) to 15 (completely disabled). 27,28 The GFI instrument has been used and validated in Malaysia. 28 Participants with a GFI score ≥4 were considered frail.…”

Section: Assessment Of Patient Health Outcomesmentioning

confidence: 99%

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Drug burden index, polypharmacy and patient health outcomes in cognitively intact older residents of aged care facilities in Malaysia

Hasan

Chang

Thiruchelvam

et al. 2020

Pharmacy Practice and Res

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Background The complexity of drug regimens among older people tend to increase over time, as multiple medications are required to treat a single condition. Aim This study examined the association of the drug burden index (DBI) and polypharmacy with patient health outcomes among cognitively intact older residents in aged care facilities (ACFs). Methods A review of prescribed medications and related outcomes was conducted in a cross‐sectional sample of older adults (≥60 years), recruited from 11 ACFs in Peninsular Malaysia. Frailty and quality of life (QoL) were evaluated using the Groningen frailty indicator and ‘Older People's Quality of Life – 35’ questionnaire, respectively; patients’ exposure to anticholinergic and sedative medicines was quantified using the DBI; and the mental health of residents was evaluated using the Hospital Anxiety and Depression Scale. Results More than two‐thirds of a sampled population received at least one anticholinergic or sedative medication and more than one‐quarter was exposed to polypharmacy. Exposure to DBI‐associated medications was noted in three of every four frail participants and was significantly correlated with frailty (r = 0.184, p = 0.023). The frail population had significantly increased risk of polypharmacy (odds ratio 6.07; 95% confidence interval 1.71–21.56; p = 0.005), but exposure to DBI‐associated medications was not significantly associated with overall QoL and activity of daily living measures. Conclusion Polypharmacy and anticholinergic and sedative burden were noticed in a substantial number of older adults in residential aged care facilities and were associated with frailty. Investing in the recruitment of pharmacists may benefit recognition of residential ACF quality of care, because pharmacy services (including pharmacists) are virtually non‐existent in Malaysian residential ACFs.

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“…The GFI consists of 15 dichotomous items, ranging from a total score of 0 (normal activity without restrictions) to 15 (completely disabled); participants with scores ≥ 4 were considered frail [21]. We have validated the GFI tool and reported our findings elsewhere [22]. OPQOL was used to assess QOL in 9 domains: overall life, health, social relationships, independence, control over life, freedom, home, and neighborhood, psychological and emotional wellbeing, finance, and religion/ culture [23].…”

Section: Patient-reported Health Outcomesmentioning

confidence: 99%

Associations between Drug Burden Index, medication appropriateness and patient-reported outcomes in the community pharmacy setting in Malaysia

Hasan

Liew

Chong

et al. 2018

Drugs Ther Perspect

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Introduction The increasing complexity of drug regimens over time and the use of multiple medications exposes older patients to a greater risk of receiving inappropriate medications. The study aims to investigate whether drug burden index (DBI) and potentially inappropriate medications (PIMs) were associated with patient-reported health outcomes (PROs) in community-dwelling older adults (aged ≥60 years) in Malaysia. Methods DBI used to quantify patients' exposure to anticholinergic and sedative medications in a cross-sectional sample of older individuals from the community pharmacy setting in Malaysia. PIMs (based on Beers criteria), potentially inappropriate prescribing (PIP; based on STOPP criteria) and polypharmacy (use of ≥ 5 concurrent medications) used to quantify exposure to in appropriate medications. PROs were investigated using the Groningen Frailty Indicator (GFI) for frailty, and Older People's Quality of Life-35 (OPQOL) for quality of life (QOL). The adjusted associations between DBI, medication inappropriateness and PROs were analyzed. Results More than half of the study participants received ≥ 1 anticholinergic or sedative medication (mean 0.47/participant; range 0.0-2.14). Prevalence of frailty was low; 8.90% of patients with a mean GFI score of 1.67 (range 1-8) and was significantly and positively correlated with DBI (r 0.253; p = 0.003). In multivariate logistic regression, frailty was found to be significantly associated with the odds of receiving DBI-associated medications (odds ratio 1.44; 95% CI 1.02-2.02, p = 0.039). Non-significant associations between DBI and QOL domains, except significant and positive correlation between independence domain of OPQOL and PIPs. Conclusion The study indicates a significant relationship between drug burden measured by DBI, and frailty measured by GFI. The prescribers managing various medical conditions of older people should consider frailty and other relevant physical health parameters as important health outcomes.

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An Evaluation of the Central Nervous System Medication Use and Frailty among Residents of Aged Care Homes in Malaysia

Cited by 10 publications

References 61 publications

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

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

Drug burden index, polypharmacy and patient health outcomes in cognitively intact older residents of aged care facilities in Malaysia

Associations between Drug Burden Index, medication appropriateness and patient-reported outcomes in the community pharmacy setting in Malaysia

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