Interventions to optimize pharmacologic treatment in hospitalized older adults: A systematic review

Gutiérrez-Valencia, Marta; Velilla, Nicolás; Fabo, E Lacalle; Telleria, Idoia Beobide; Sola, B Larrayoz; Tosato, Matteo

doi:10.1016/j.rceng.2016.01.004

Cited by 8 publications

(3 citation statements)

References 68 publications

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“…However, the increase in life expectancy is not accompanied by health quality; indeed, only 9% of Portuguese older adults are considered healthy, which is a lower number when compared with Austria (58.0%), Germany (38.0%), and France (37%) [11]. This unhealthy state and aging-related loss of resilience and pharmacokinetic and pharmacodynamics alterations that occur in older adults [12] can be a major contribution to the high average number of hospitalized days [13] as well as to the fact that almost 10% of the participants had more than one hospitalization during 2019.…”

Section: Discussionmentioning

confidence: 99%

Profile of Prescription Medication in an Internal Medicine Ward

et al. 2021

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Aging-related loss of resilience associated with the lack of evidence regarding the therapeutic efficacy of medicines can prompt a lack of efficacy of treatments and multiple prescriptions. This work aims to characterize the medication profile of Portuguese older adult inpatients and explore the relationship between hospitalization days and the consumption of medicines. A retrospective data analysis study in older patients who were admitted to a medical internal medicine ward during 2019. The median age of the 616 patients included was 85 years. During the hospitalized period, patients took on average 18.08 medicines. The most prescribed drugs belong to the subgroup of (a) anti-thrombotic agents (6.7%), with enoxaparin being the most prescribed, (b) other analgesics and antipyretics (6.6%), paracetamol being the most frequent, and (c) the Angiotensin Conversion Enzyme Inhibitor (ACE) (6.5%), captopril being the most frequent. The high number of prescriptions in older adults during their hospitalization suggests the need of changing therapeutics to achieve a better efficacy of treatment, which corroborates the hypothesis that the lack of scientific evidence concerning the risk/benefits of many medical therapies in older adults can make it difficult to achieve good clinical outcomes and promote the wastage of health resources.

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Section: Discussionmentioning

confidence: 99%

Profile of Prescription Medication in an Internal Medicine Ward

et al. 2021

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“…This suggests that more specific interventions could enhance the outcomes of the CGA regarding medications . Interventions have been proposed elsewhere for medicine optimization in hospitalized older people, with different results . Van der Linden et al and Dalleur et al studied interventions in the context of inpatient geriatric consultation teams for older patients not admitted to acute geriatric care wards.…”

Section: Discussionmentioning

confidence: 99%

“…However, medication optimization strategies in older people when admitted to the hospital are not widely extended in clinical practice. Some interventions have been proposed, such as the identification of potentially inappropriate prescriptions or medication review strategies, although often they do not adequately meet the needs of complex patients and/or of more advanced age (including octogenarians and nonagenarians) . Interventions must be adapted to the settings and patients’ needs.…”

Section: Introductionmentioning

confidence: 99%

Medicine optimization strategy in an acute geriatric unit: The pharmacist in the geriatric team

Gutiérrez-Valencia

Izquierdo

Beobide-Telleria

et al. 2019

Geriatrics Gerontology Int

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Aim: Older patients admitted to acute geriatric units (AGU) frequently use many medications and are particularly vulnerable to adverse drug events, so specific interventions in this setting are required. In the present study, we describe a new medicine optimization strategy in an AGU, and explore its potential in reducing polypharmacy and improving medication appropriateness.Methods: The present prospective study included patients aged ≥75 years who were admitted to an AGU in a tertiary hospital. An intervention based on a pharmacist clinical interview, medication history and a structured medication review within a comprehensive geriatric assessment was proposed. The differences regarding polypharmacy as the primary outcome (≥5 chronic drugs), hyperpolypharmacy (≥10), number of drugs, drug-related problems and Screening Tool of Older Person's Prescription/Screening Tool to Alert Doctors to Right Treatment criteria between admission and discharge were evaluated.Results: From October 2016 to April 2017, 234 patients were enrolled, aged 87.6 years (SD 4.6 years); 143 (61.1%) were women. The intervention resulted in a statistically significant improvement in polypharmacy (−10.2%, 95% CI −15.3, −5.2), hyperpolypharmacy (−16.6%, 95% CI −22.3 −11.0), number of medications (−1.4, 95% CI −1.8, −1.0), Screening Tool of Older Person's Prescription criteria (−19.2%, 95% CI −24.9, −13.6), Screening Tool to Alert Doctors to Right Treatment criteria (−6.8%, 95% CI −10.1, −3.5) and drug-related problems (−2.7, 95% CI −2.9, −2.4; P ≤ 0.001 for all). Conclusions:A systematic pharmacist-led intervention at hospital admission to an AGU within a comprehensive geriatric assessment was associated to a decrease in polypharmacy, drug-related problems and potentially inappropriate prescribing.

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