Minimizing Inappropriate Medications in Older Populations: A 10-step Conceptual Framework

Scott, Ian A; Gray, Leonard C.; Martin, Jennifer; Mitchell, Charles

doi:10.1016/j.amjmed.2011.09.021

Cited by 110 publications

(92 citation statements)

References 70 publications

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“…This unnecessary titration in dosage may predispose the patient to an increased risk of both hypoglycemic and hyperglycemic episodes, which, if not managed well, may be detrimental to the patient. 6 In the long run, the chronic diseases may not be well controlled and may even result in progression of the disease. 7 3.…”

Section: Why Is Adherence To Medications Important?mentioning

confidence: 99%

Medication adherence in the elderly

Yap

Thirumoorthy

Kwan

2016

Journal of Clinical Gerontology and Geriatrics

144

101

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a b s t r a c tMedication adherence is a crucial component in the treatment of chronic diseases. In the elderly, clinicians are faced with a unique set of problems associated with adherence that they may not have been adequately trained for. In this paper, we demonstrate the importance of medication adherence in the elderly through a case study. The different factors affecting medication adherence in the elderly are highlighted: patient, medication, health care providers, health care system, and socioeconomic factors. Lastly, we have proposed various ways to address these factors. In doing so, clinicians can better understand the problems that the elderly face, thus achieving better therapeutic outcomes.

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Section: Why Is Adherence To Medications Important?mentioning

confidence: 99%

Medication adherence in the elderly

Yap

Thirumoorthy

Kwan

2016

Journal of Clinical Gerontology and Geriatrics

144

101

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“…35 Deprescribing for patients with multimorbidity may constitute an essential step in minimizing drug-related iatrogenesis. 36,37 Some physicians admit discomfort in ceasing or reducing medications in patients with complex drug regimens. 38 Pharmacists can offer support to deprescribe, by helping with tapering protocols for discontinuing central nervous system and cardiovascular drugs that are known to be associated with the highest frequency of adverse events related to drug withdrawal.…”

Section: Evidence Reviewmentioning

confidence: 99%

The expanding scope of pharmacists’ practice: implications for physicians

Tannenbaum

Tsuyuki

2013

CMAJ

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“…A quality use of medicine framework was developed in Australia to minimize inappropriate medications in older people [58]. Incorporating 10 steps, this framework aims to decrease the number of medications to the appropriate number of essential drugs.…”

Section: -Step Quality Use Of Medicine Frameworkmentioning

confidence: 99%

“…One model for appropriate prescribing for patients late in life proposes focusing on four components: (a) remaining life expectancy, (b) time until treatment benefit, (c) goals of care and (d) treatment targets [63]. Another model proposed by Scott et al expands this to ten steps [adding (e) ascertainment of current medications; (f) identification of patients at high risk of or experiencing ADEs; (g) estimation of the magnitude of benefit vs. harm in relation to each medication; (h) assessing the relative utility of different drugs; (i) identification of drugs that may be discontinued; (j) ongoing evaluation of drug utility and patient adherence by a single nominated clinician] [58].…”

Section: Prescribing In Frail Patients At End-of-life Stagementioning

confidence: 99%

Prescribing appropriately in frail older people

2015

Healthy Aging Res

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Frailty is one of the most important aspects associated with the elderly. It is defined as a state of increased vulnerability to poor resolution of homeostasis after a stressor event, which increases the risk of adverse outcomes such as falls, institutionalization and death. Frail older adults are more likely to have several concurrent disorders, requiring multiple treatments and hence, considerable medication consumption. The functional reserve of multiple organs deteriorates with ageing and this often leads to changes in drug pharmacokinetics and metabolism. As a result, prescribing medications for frail older people is often complex and challenging. Furthermore, there is a paucity of evidence from clinical trials on the effects of multiple drug consumption in patients aged above 80 years since people from this age group tend to be excluded from such studies. Because of the changes in the pharmacokinetics and pharmacodynamics of drugs in older people, especially in those who are frail, there is an increased risk of adverse drug events for these patients, which can result in hospitalization, increased morbidity and mortality. In this review, appropriate prescribing for frail older people is explored. Consideration will be given to the impact of frailty on medication prescribing and how individualized prescribing could reduce the risk of adverse drug events in at-risk older patients. Tools used to enhance prescribing practice are examined, including those aimed at reducing polypharmacy, underprescribing and inappropriate prescribing. These tools use either explicit (criterion-based) or implicit (judgment-based) criteria. However, most of the current therapeutic guidelines are applicable mainly for the fit older population and cannot be directly applied where frail individuals are concerned. Approaches to improving appropriate prescribing among frail elderly patients, including those with limited life expectancy, are also reviewed.

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Minimizing Inappropriate Medications in Older Populations: A 10-step Conceptual Framework

Cited by 110 publications

References 70 publications

Medication adherence in the elderly

Medication adherence in the elderly

The expanding scope of pharmacists’ practice: implications for physicians

Prescribing appropriately in frail older people

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