Deprescribing: An Application to Medication Management in Older Adults

Bemben, Nina M.

doi:10.1002/phar.1776

Cited by 20 publications

(13 citation statements)

References 40 publications

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“…Instead, comprehensive deprescribing interventions should be applied to target patients (such as male patients and old patients) or physicians (such as internists) in high-risk groups for utilizing or prescribing problematic polypharmacy. Evidence has proved that approaches such as shared decision making between patients and healthcare providers; providing infrastructural support for the coordination and continuity of care ( Bemben, 2016 ), especially for multi-morbidity patients ( Duerden et al, 2013 ); and educational programs on deprescribing for physicians are effective in improving problematic polypharmacy.…”

Section: Discussionmentioning

confidence: 99%

Is Excessive Polypharmacy a Transient or Persistent Phenomenon? A Nationwide Cohort Study in Taiwan

et al. 2018

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Objectives: Target populations with persistent polypharmacy should be identified prior to implementing strategies against inappropriate medication use, yet limited information regarding such populations is available. The main objectives were to explore the trends of excessive polypharmacy, whether transient or persistent, at the individual level. The secondary objectives were to identify the factors associated with persistently excessive polypharmacy and to estimate the probabilities for repeatedly excessive polypharmacy.Methods: Retrospective cohort analyses of excessive polypharmacy, defined as prescription of ≥ 10 medicines at an ambulatory visit, from 2001 to 2013 were conducted using a nationally representative claims database in Taiwan. Survival analyses with log-rank test of adult patients with first-time excessive polypharmacy were conducted to predict the probabilities, stratified by age and sex, of having repeatedly excessive polypharmacy.Results: During the study period, excessive polypharmacy occurred in 5.4% of patients for the first time. Among them, 63.9% had repeatedly excessive polypharmacy and the probabilities were higher in men and old people. Men versus women, and old versus middle-aged and young people had shorter median excessive polypharmacy-free times (9.4 vs. 5.5 months, 5.3 vs. 10.1 and 35.0 months, both p < 0.001). Overall, the probabilities of having no repeatedly excessive polypharmacy within 3 months, 6 months, and 1 year were 59.9, 53.6, and 48.1%, respectively.Conclusion: Although male and old patients were more likely to have persistently excessive polypharmacy, most cases of excessive polypharmacy were transient or did not re-appear in the short run. Systemic deprescribing measures should be tailored to at-risk groups.

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Section: Discussionmentioning

confidence: 99%

Is Excessive Polypharmacy a Transient or Persistent Phenomenon? A Nationwide Cohort Study in Taiwan

et al. 2018

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“…These results are incongruent with current guidelines that suggest CHEIs should be discontinued in severe dementia or at the end of life. 15,[18][19][20][21] The majority of patients in this study who were on a CHEI at time of admission did have a diagnosis of moderate dementia (58.3%) (where a CHEI is still indicated), however since their prognosis was estimated to be less than 3 months, there was a limited benefit of continuing their CHEI since they were close to the active stages of dying with a median length of stay of 21 days. These results corroborate with previous studies that show CHEIs are continued through the late stages of dementia and are not discontinued until the more active stages of dying.…”

Section: Discussionmentioning

confidence: 85%

“…18 CHEIs can be considered an unnecessary burden in the advanced stages of disease and many other studies corroborate with the University of Sydney's guidelines in suggesting that patients with end stage dementia should be discontinued on their CHEIs. [18][19][20][21] Unfortunately, studies have shown that individuals admitted to hospices or nursing homes with advanced dementia remain on CHEIs (20% at time of admission) or are tapered off CHEIs very close to their time of death. 22,23 Potential harms of continuing CHEIs in individuals with end stage dementia include drug interactions, cost of medication, pill burden, dysphagia, and a misunderstanding of a patient's goals of care.…”

Section: Introductionmentioning

confidence: 99%

Cholinesterase Inhibitor Use in Patients With Dementia Admitted to a Palliative Care Unit

Perri

Wilson

Gardner

et al. 2021

Am J Hosp Palliat Care

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Objectives: Current guidelines suggest that patients with severe dementia on cholinesterase inhibitors (CHEIs) should discontinue their CHEIs by taper. This study aims to define the prevalence of patients admitted to a palliative care unit (PCU) with dementia on a CHEI and to determine whether these patients were tapered off their CHEIs according to current deprescribing guidelines. Design: This is a descriptive retrospective chart review that examined patients admitted to a PCU with dementia on a CHEI from January 2015 to June 2019. Methods: Individuals admitted to the PCU with a primary or comorbid diagnosis of dementia were identified. Their corresponding CHEI dose, frequency and discontinuation pattern were identified. Data were analyzed using descriptive statistics. Results: A total of 36 patients were admitted to the PCU with dementia on a CHEI (prevalence of 2.3%). The median length of stay was 21 days. For 31 of these patients, their CHEI was discontinued, only 9 of which had a taper. Of the 24 patients who discontinued their CHEI suddenly, 10 patients had an order to discontinue their CHEI in the last 2 days before their date of death. Conclusion: This study suggests that although patients admitted to a PCU with dementia have their CHEI discontinued, the discontinuation was done without a taper. In many cases the CHEIs were continued through the active stage of dying. Future work should explore reasons why PCU physicians are mostly late to taper CHEIs for patients admitted with dementia.

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“…20 The chances of polypharmacy greatly increase when several sets of guidance are being implemented in patients with multimorbidity 21 and healthcare professionals recognise that fulfilling multiple guidelines might compromise patient-centred care. 22 There is evidence this simultaneous medication administration can lead to an increased risk of patient hospitalisation 23 24 and work has begun to reduce this risk, 25 focusing on reducing inappropriate prescribing of non-steroidal anti-inflammatory drugs, proton pump inhibitors and duplicate therapy. 26 However progress is inconsistent and large interpractice variation in levels of polypharmacy remains.…”

Section: Introductionmentioning

confidence: 99%

Assessing the extent of drug interactions among patients with multimorbidity in primary and secondary care in the West Midlands (UK): a study protocol for the Mixed Methods Multimorbidity Study (MiMMS)

Backman

Weber

Turner³

et al. 2017

BMJ Open

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IntroductionThe numbers of patients with three or more chronic conditions (multimorbidity) are increasing, and will rise to 2.9 million by 2018 in the UK alone. Currently in the UK, conditions are mainly managed using over 250 sets of single-condition guidance, which has the potential to generate conflicting recommendations for lifestyle and concurrent medication for individual patients with more than one condition. To address some of these issues, we are developing a new computer-based tool to help manage these patients more effectively. For this tool to be applicable and relevant to current practice, we must first better understand how existing patients with multimorbidity are being managed, particularly relating to concerns over prescribing and potential polypharmacy.Methods and analysisUp to four secondary care centres, two community pharmacies and between four and eight primary care centres in the West Midlands will be recruited. Interviewees will be purposively sampled from these sites, up to a maximum of 30. In this mixed methods study, we will perform a dual framework analysis on the qualitative data; the first analysis will use the Theoretical Domains Framework to assess barriers and enablers for healthcare professionals around the management of multimorbid patients; the second analysis will use Normalisation Process Theory to understand how interventions are currently being successfully implemented in both settings. We will also extract quantitative anonymised patient data from primary care to determine the extent of polypharmacy currently present for patients with multimorbidity in the West Midlands.DiscussionWe aim to combine these data so that we can build a useful, fully implementable tool which addresses the barriers most amenable to change within both primary and secondary care contexts.Ethics and disseminationFavourable ethical approval has been granted by The University of Birmingham Research Ethics Committee (ERN_16–0074) on 17 May 2016. Our work will be disseminated through peer-reviewed literature, trade journals and conferences. We will also use the dedicated web page hosted by the University to serve as a central point of contact and as a repository of our findings. We aim to produce a minimum of three articles from this work to contribute to the international scientific literature.Protocol registration numberNIHR Clinical Research Network Portfolio Registration CPMS ID 30613.

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Deprescribing: An Application to Medication Management in Older Adults

Cited by 20 publications

References 40 publications

Is Excessive Polypharmacy a Transient or Persistent Phenomenon? A Nationwide Cohort Study in Taiwan

Is Excessive Polypharmacy a Transient or Persistent Phenomenon? A Nationwide Cohort Study in Taiwan

Cholinesterase Inhibitor Use in Patients With Dementia Admitted to a Palliative Care Unit

Assessing the extent of drug interactions among patients with multimorbidity in primary and secondary care in the West Midlands (UK): a study protocol for the Mixed Methods Multimorbidity Study (MiMMS)

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