Geriatric Pharmacotherapy and Polypharmacy

Hanlon, Joseph T.; Handler, Steven M.; Maher, Robert L.; Schmader, Kenneth E.

doi:10.1016/b978-1-4160-6231-8.10104-7

Cited by 19 publications

(22 citation statements)

References 59 publications

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Section: Methodsmentioning

confidence: 99%

“…2 In addition search terms to describe medication adverse events (i.e., adverse drug events [ADE], adverse drug reactions [ADR], adverse drug withdrawal events [ADWE], and therapeutic failures [TF]) were included in these searches. 2 A similar search was conducted using the Google Scholar Internet search engine. In addition, a manual search for relevant articles from specific journals (i.e., New England Journal of Medicine, Annals of Internal Medicine, JAMA, Journal of the American Geriatrics Society, Journal of Gerontology: Medical Sciences, Clinical Pharmacology and Therapeutics, Pharmacoepidemiology and Drug Safety, Archives of Internal Medicine, Annals of Pharmacotherapy, Pharmacotherapy, American Journal of Health-Systems Pharmacy and Consultant Pharmacist) was conducted.…”

Section: Methodsmentioning

confidence: 99%

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Reconsideration of Key Articles Regarding Medication-Related Problems in Older Adults from 2011

Thorpe

Lassila

O’Neil

et al. 2012

The American Journal of Geriatric Pharmacotherapy

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Reconsideration of Key Articles Regarding Medication-Related Problems in Older Adults from 2011

Thorpe

Lassila

O’Neil

et al. 2012

The American Journal of Geriatric Pharmacotherapy

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“…anatomical and functional changes in the gastrointestinal tract of geriatric patients include disorders of the absorption, distribution, metabolism and excretion of drugs [7][8][9][10][11][12][13][14].…”

Section: Introductionmentioning

confidence: 99%

“…what is more, a phenomenon observed in geriatric pharmacotherapy is an exacerbation of the disease due to drugs administered for other conditions. The occurring drug-related adverse effects are misinterpreted as a new disease entity, and treated with other medicines, thus creating a sort of a vicious circle in pharmacotherapy, and potentially contributing to the iatrogenic geriatric syndrome [9][10][11][12][13][14]. Most previous studies conducted in Poland on patients over 60 years of age staying in nursing homes or psychogeriatric wards, focused on the influence of hypotensive drugs on the incidence of falls [15][16][17].…”

Section: Introductionmentioning

confidence: 99%

The incidence of falls among geriatric outpatients in relation to the number and types of drugs taken

Kamińska¹,

Brodowski²,

Karakiewicz³

2016

fmpcr

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Background. Causes of falls among people over 65 are complex because of age-related involutional changes, comorbidity and polypragmasy that exert negative influence on physical mobility. Objectives. The purpose of this study is to assess the incidence of falls in geriatric outpatients in relation to the number and type of drugs taken. Material and methods. The study involved 304 subjects aged 65-100 years, using ambulatory care services. The mean age of the respondents was 78.6 ± 7.4. women constituted 77.3% of those analyzed, men -22.7%. This survey-based study was performed using the geriatric environmental inquiry. Results. a higher number of drugs corresponded with more frequent falls (χ 2 test; p < 0.05). gender was not proved to influence the number of falls (χ 2 test; p > 0.05). gender was proved to influence the number of drugs (χ 2 test; p < 0.05). There was a statistically significant relationship between the number of falls and taking hypotensive, anxiolytic and oral antidiabetic drugs (χ 2 ; p < 0.05). Conclusions. 1. The use of a higher number of drugs, irrespective of their pharmacological group, contributes to a higher number of falls, which may be associated with an interaction between particular drugs or be a consequence of a multitude of diseases predisposing to falls. 2. Polypharmacotherapy is a fall risk factor, however it is difficult to say which pharmacology group, discussed in the study, contributes most to the incidence of falls. 3. it is suggested that geriatric pharmacotherapy should be individualized to minimize the incidence of the iatrogenic geriatric syndrome, which predisposes to falls. Key words: elderly, falls, geriatric pharmacotherapy.Wstęp. Przyczyny upadków osób po 65. roku życia są złożone ze względu na charakterystyczne dla wieku podeszłego występowanie inwolucyjnych zmian starczych, wielochorobowość i polipragmazję, które sprzyjają upośledzeniu mobilności. Cel pracy. Ocena występowania upadków wśród pacjentów podstawowej opieki zdrowotnej w wieku podeszłym w zależno-ści od liczby i rodzaju zażywanych leków. Materiał i metody. Badaniami objęto 304 osoby w wieku 65-100 lat, korzystające ze świadczeń zdrowotnych w warunkach ambulatoryjnych. Odsetek badanych kobiet wyniósł 77,3%, mężczyzn -22,7%. Średnia wieku badanych osób wyniosła 78,6 ± 7,4. Zastosowano metodę sondażu diagnostycznego z wykorzystaniem geriatrycznego Kwestionariusza wywiadu Środo-wiskowego. Wyniki. Stwierdzono, iż większa liczba przyjmowanych leków przyczynia się do większej liczby upadków (test χ 2 ; p < 0,05). nie wykazano, aby płeć determinowała liczbę upadków (test χ 2 ; p > 0,05). wykazano jednak zależność pomiędzy płcią a liczbą przyjmowanych leków (test χ 2 ; p < 0,05). Odnotowano istotną statystycznie zależność między przyjmowaniem leków hipotensyjnych, leków anksjolitycznych oraz doustnych leków przeciwcukrzycowych a liczbą upadków (test χ 2 ; p < 0,05). Wnioski. 1. Stosowanie większej liczby leków, niezależnie od grupy farmakologicznej, przyczynia się do większej liczby upadków, co może wiązać się ...

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“…Drug-use evaluations have been used to describe problems with ESA prescribing and monitoring in ambulatory care, hemodialysis clinics, and inpatient settings 22–24. However, little is known about the appropriateness of prescribing and monitoring of ESAs in the NH setting, where approximately 1.6 million Americans receive health care in more than 16,000 NHs annually 25. The specific objectives of this study were to conduct a drug-use evaluation in order to determine the prevalence and appropriateness of prescribing and monitoring of ESAs in the NH setting.…”

Section: Introductionmentioning

confidence: 99%

Assessing the Quality of Prescribing and Monitoring Erythropoiesis-Stimulating Agents in the Nursing Home Setting

Wong

Stephens

Aspinall

et al. 2009

Journal of the American Medical Directors Association

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Introduction As many as 50% of all nursing home (NH) residents meet the World Health Organization criteria for anemia. The objectives of this study were to determine the prevalence and appropriateness of prescribing and monitoring of erythropoiesis stimulating agents (ESAs) used to treat anemia in the NH setting. Methods Cross-sectional, one-month study of all NH residents in four community-based, university-affiliated NHs between January and February 2008. Residents were included in the analysis if they received at least one dose of an ESA during the study duration. Data collected through chart review included basic demographic information, ESA indication, ESA dosage, concurrent administration of iron supplements, hemoglobin (Hgb) monitoring, and blood pressure measurements. Results A total of 4.5% (22/485) of NH residents received at least one dose of an ESA. Residents who received ESAs had a mean age of 80.4 (± 14.5) years. Most residents who received ESAs were female (64% [14/22]), white (68% [15/22]), and had a mean weight of 72.0 (± 20.84) kg. Only 27% (6/22) of residents were prescribed an ESA for a FDA-approved indication. Darbepoetin alfa was the most commonly prescribed ESA (64% [14/22]) with a mean weekly dose of 70.8 (± 68.1) mcg, followed by epoetin alfa (37% [8/22]) with a mean weekly dose of 22,625 (± 21,232) units. More than one-quarter, (27% [6/22]) of those who received an ESA had a Hgb value ≥ 12 g/dL, the maximum recommended threshold for use of these medications. Of the 18 residents that had blood pressure measurements, 18% (2/18) were hypertensive. Conclusion Suboptimal prescribing and monitoring of ESAs were common in the NHs we studied. Future studies are needed to determine if the development and use of computerized decision support systems can improve prescribing and monitoring of ESAs in the NH setting.

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Geriatric Pharmacotherapy and Polypharmacy

Cited by 19 publications

References 59 publications

Reconsideration of Key Articles Regarding Medication-Related Problems in Older Adults from 2011

Reconsideration of Key Articles Regarding Medication-Related Problems in Older Adults from 2011

The incidence of falls among geriatric outpatients in relation to the number and types of drugs taken

Assessing the Quality of Prescribing and Monitoring Erythropoiesis-Stimulating Agents in the Nursing Home Setting

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