Medication Use Among Nursing Home Residents With Severe Dementia: Identifying Categories of Appropriateness and Elements of a Successful Intervention

Kröger, Edeltraut; Wilchesky, Machelle; Marcotte, M.; Voyer, Philippe; Morin, Michèle; Champoux, Nathalie; Monette, Johanne; Aubin, Michèle; Durand, Pierre; Verreault, René; Arcand, Marcel

doi:10.1016/j.jamda.2015.04.002

Cited by 36 publications

(120 citation statements)

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“…The internal validity is enhanced as a quality assessment of inclusive studies were rated moderate to strong (Kroger et al, 2015). These studies have a strong method of data collection, and represent primarily level two and three evidence per Mazurek & Fineout-Overhold (2011), and quantitative data.…”

Section: Methods Of Data Collection Sample and Settingmentioning

confidence: 99%

“…Inclusive studies focused on the causes of problematic polypharmacy, including inappropriate medications, specific studies pertaining to inappropriate antipsychotic use, and three studies that generally addressed polypharmacy (Kroger et al, 2015). Studies also focused on outcomes of problematic polypharmacy, such as drug-related problems.…”

Section: Methods Of Data Collection Sample and Settingmentioning

confidence: 99%

“…Studies also focused on outcomes of problematic polypharmacy, such as drug-related problems. This review is a good representation of the literature, as the 35 studies included represent worldwide research, nonEnglish studies, and those published from 1987 to December 2013 (Kroger et al, 2015).…”

Section: Methods Of Data Collection Sample and Settingmentioning

confidence: 99%

“…A 15-member Delphi panel was formulated to evaluate the applicability of the findings of this review to nursing homes in Quebec, Canada (Kroger et al, 2015). To assure no limitations, the Delphi panel was inclusive of a multidisciplinary team, including geriatricians, physicians, nurses, pharmacists, social workers, and an ethicist (Kroger et al, 2015).…”

Section: Methods Of Data Collection Sample and Settingmentioning

confidence: 99%

“…Secondly, they aimed to identify interventions likely to succeed in improving medication use among residents that considered reducing the causes and outcomes of problematic polypharmacy. Lastly, researchers aimed to adapt findings to the context of Quebec, Canada (Kroger et al, 2015).…”

Section: Study Aimmentioning

confidence: 99%

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The role of the nurse practitioner in promoting a reduction in the causes and outcomes of problematic polypharmacy among nursing home residents in British Columbia

Jassar¹

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Problematic polypharmacy is an ongoing issue for older adults throughout Canada, and specifically among nursing home residents (Maher, Hanion, & Hajjar, 2013). Despite interventions that are currently in place in British Columbia (BC) to reduce the causes and outcomes of this issue, problematic polypharmacy continues to pose a risk for residents among BC nursing homes. This integrative review asks how nurse practitioners (NPs) can best promote a reduction in the causes and outcomes of problematic polypharmacy among residents in BC nursing homes.The background information of this project outlines the concept of problematic polypharmacy and the prevalence of contributing factors and outcomes. Nursing home demographics are also highlighted to demonstrate the risk this population faces to the causes and outcomes of problematic polypharmacy, and the subsequent effect this issue has on the health care system. Furthermore, the background provides an overview of the concept role overlap which exists between health care professionals in order to demonstrate how multiple health care professionals may share roles or parts of roles in reducing the causes and outcomes of problematic polypharmacy. Barriers faced by staff are also examined.Through a comprehensive review of the literature and critical appraisal, nine articles are found to address the research question. Key interventions that specifically demonstrate effectiveness in reducing causes and outcomes of problematic polypharmacy in the context of nursing homes emerged. These interventions are put forth as recommendations for NP practice and include: medication reviews while screening for inappropriate medications by using the Beers Criteria, computerized clinical decision support systems (CCDSS), and the Cockcroft Gault Score; assessing functional status for changes to assure instances of problematic 3 polypharmacy are not missed by using the Minimum Data Set -Activity of Daily Living (MDS-ADL) scale; education targeted for all staff members to detect, prevent, and manage problematic polypharmacy; multidisciplinary team meetings to facilitate a collaborative approach in reducing problematic polypharmacy and case conferences to provide resident-centered care.An important finding is that most interventions require participation from two or more health professionals, highlighting the concept of role overlap and the necessity of a multidisciplinary approach. In light of NP practice, this provides insight surrounding how NPs can influence and encourage other staff members to sustain their roles and overcome barriers for an ultimate reduction in the causes and outcomes of problematic polypharmacy with implications for practice, policy, education, and research.

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Section: Methods Of Data Collection Sample and Settingmentioning

confidence: 99%

Section: Methods Of Data Collection Sample and Settingmentioning

confidence: 99%

Section: Methods Of Data Collection Sample and Settingmentioning

confidence: 99%

Section: Methods Of Data Collection Sample and Settingmentioning

confidence: 99%

Section: Study Aimmentioning

confidence: 99%

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The role of the nurse practitioner in promoting a reduction in the causes and outcomes of problematic polypharmacy among nursing home residents in British Columbia

Jassar¹

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Cumulative Update of a Systematic Overview Evaluating Interventions Addressing Polypharmacy

Keller,

Qureshi,

Mays

et al. 2024

JAMA Netw Open

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

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Medication use problems among older adults at a primary care: A narrative of literature review

Christopher

Shrestha

et al. 2022

Aging Medicine

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The growing aging population is prominent globally. It is projected that by 2050, the proportion of the world's population over 60 years will be 22%. 1 This demographic transition to aging populations increases the health care burden because of multimorbidity and older adults' complex health care needs. Older adults often take several medications for chronic illnesses; however, the support ecosystem to optimize medication use in older adults is either lacking or not appropriately optimized, especially in the Organisation for Economic Co-operation and Development (OECD) regions. This region is compromised of 38 developed countries globally that aims to shape the policy constituting social, economic, and environmental challenges. 2 The aging process involves psychosocial and physiological changes that alter the body's pharmacokinetics and pharmacodynamics. 3 That leads to drug response variation and increases the

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Medication Use Among Nursing Home Residents With Severe Dementia: Identifying Categories of Appropriateness and Elements of a Successful Intervention

Cited by 36 publications

References 101 publications

The role of the nurse practitioner in promoting a reduction in the causes and outcomes of problematic polypharmacy among nursing home residents in British Columbia

The role of the nurse practitioner in promoting a reduction in the causes and outcomes of problematic polypharmacy among nursing home residents in British Columbia

Cumulative Update of a Systematic Overview Evaluating Interventions Addressing Polypharmacy

Medication use problems among older adults at a primary care: A narrative of literature review

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