Optimizing pharmacotherapy and deprescribing strategies in older adults living with multimorbidity and polypharmacy: EuGMS SIG on pharmacology position paper

van Poelgeest, Eveline; Seppala, Lotta; Bahat, Gülistan; Ilhan, Birkan; Mair, Alpana; van Marum, Rob; Onder, Graziano; Ryg, Jesper; Fernandes, Marília Andreia; Cherubini, Antonio; Denkinger, Michael; Eidam, Annette; Egberts, Angelique; Gudmundsson, Aðalsteinn; Koçak, Fatma Özge Kayhan; Soulis, George; Tournoy, Jos; Masud, Tahir; Wehling, Martin; van der Velde, Nathalie; ,

doi:10.1007/s41999-023-00872-0

Cited by 7 publications

(4 citation statements)

References 113 publications

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“…This could be reached through detailed information on medication optimisation in hospital discharge letters. Higher sustainability can also be reached by shifting the focus towards the needs of older patients and routinely incorporate deprescribing, as recommended by the position paper of the European Geriatric Medicine Society [ 66 ].…”

Section: Discussionmentioning

confidence: 99%

Effects of medication management in geriatric patients who have fallen: results of the EMMA mixed-methods study

Clemens,

Iglseder,

Alzner

et al. 2024

Age and Ageing

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Background comprehensive medication management (CMM) can reduce medication-related risks of falling. However, knowledge about inter-individual treatment effects and patient-related barriers remains scarce. Objective to gain in-depth insights into how geriatric patients who have fallen view their medication-related risks of falling and to identify effects and barriers of a CMM in preventing falls. Design complementary mixed-methods pre–post study, based on an embedded quasi-experimental model. Setting geriatric fracture centre. Methods qualitative, semi-structured interviews framed the CMM intervention, including a follow-up period of 12 weeks. Interviews explored themes of falling, medication-related risks, post-discharge acceptability and sustainability of interventions using qualitative content analysis. Optimisation of pharmacotherapy was assessed via changes in the weighted and summated Medication Appropriateness Index (MAI) score, number of fall-risk-increasing drugs (FRID) and potentially inappropriate medications (PIM) according to the Fit fOR The Aged and PRISCUS lists using parametric testing. Results thirty community-dwelling patients aged ≥65 years, taking ≥5 drugs and admitted after an injurious fall were recruited. The MAI was significantly reduced, but number of FRID and PIM remained largely unchanged. Many patients were open to medication reduction/discontinuation, but expressed fear when it came to their personal medication. Psychosocial issues and pain increased the number of indications. Safe alternatives for FRID were frequently not available. Psychosocial burden of living alone, fear, lack of supportive care and insomnia increased after discharge. Conclusion as patients’ individual attitudes towards trauma and medication were not predictable, an individual and longitudinal CMM is required. A standardised approach is not helpful in this population.

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Section: Discussionmentioning

confidence: 99%

Effects of medication management in geriatric patients who have fallen: results of the EMMA mixed-methods study

Clemens,

Iglseder,

Alzner

et al. 2024

Age and Ageing

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“…Explicit criteria might also be regrouped as either drug-oriented listing approaches (DOLAs) or patient-in-focus listing approaches (PILAs), for which a knowledge of some patient characteristics is required [ 63 ]. This taxonomy could be relevant because of the existence of differences in efficacy between DOLAs and PILAs when applied to deprescribing in older people [ 68 ].…”

Section: Deprescribing Tools In Older Patients With Multimorbiditymentioning

confidence: 99%

“…Regarding person-centered frameworks, they represent an advanced type of medication review where patients’ values and preferences are taken into consideration, as well as their medication history and clinical data [ 68 ]. Either national or regional initiatives aiming to improve safety in patients with polypharmacy through person-centered framework have been developed [ 69 ].…”

Section: Deprescribing Tools In Older Patients With Multimorbiditymentioning

confidence: 99%

“…Furthermore, the frequency of medication reviews during which deprescribing is considered in older patients with multimorbidity is not uniformly recommended, but these reviews should ideally be performed on a regular basis, especially when it comes to patients with frailty or cognitively impaired older adults [ 68 ].…”

Section: Deprescribing Tools In Older Patients With Multimorbiditymentioning

confidence: 99%

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Drug-Related Problems in Elderly Patients Attended to by Emergency Services

Ruiz-Ramos,

Plaza-Diaz,

Roure-i-Nuez

et al. 2023

JCM

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The progressive aging and comorbidities of the population have led to an increase in the number of patients with polypharmacy attended to in the emergency department. Drug-related problems (DRPs) have become a major cause of admission to these units, as well as a high rate of short-term readmissions. Anticoagulants, antibiotics, antidiabetics, and opioids have been shown to be the most common drugs involved in this issue. Inappropriate polypharmacy has been pointed out as one of the major causes of these emergency visits. Different ways of conducting chronic medication reviews at discharge, primary care coordination, and phone contact with patients at discharge have been shown to reduce new hospitalizations and new emergency room visits due to DRPs, and they are key elements for improving the quality of care provided by emergency services.

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Effects of proactive healthcare on pain, physical and activities of daily living functioning in vulnerable older adults with chronic pain: a pragmatic clinical trial with one- and two-year follow-up

Dong,

Peolsson,

Johansson

2024

Eur Geriatr Med

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Purpose To investigate the changes in pain, physical and activities of daily living (ADL) functioning in vulnerable older adults with chronic pain after proactive primary care intervention. Methods This study was embedded in a prospective, pragmatic, matched-control multicenter trial at 19 primary care practices in Sweden, with proactive medical and social care (Intervention Group, IG, n = 134) in comparison with usual care (Control Group, CG, n = 121). Patients with chronic pain, defined as pain experienced longer than 3 months, were included in this subgroup analysis. Data on pain aspects, physical and ADL functioning were collected in the questionnaires at baseline, one- and two-year follow-up (FU-1 and FU-2). Data on prescribed pain medications was collected by local health authorities. Results Mean age was 83.0 ± 4.7 years with almost equal representation of both genders. From baseline until FU-2, there were no significant within-group or between-group changes in pain intensity. Small adjustments of pain medication prescriptions were made in both groups. Compared to FU-1, the functional changes were more measurable at FU-2 as fewer participants had impaired physical functioning in IG (48.4%) in comparison to CG (62.6%, p = 0.027, Effect Size φ = 0.14). Higher scores of ADL-staircase (more dependent) were found in both groups (p < 0.01, Effect Size r = 0.24 in CG and r = 0.16 in IG). Conclusion Vulnerable older adults with chronic pain seemed to remain physical and ADL functioning after proactive primary care intervention, but they may need tailored strategies of pain management to improve therapeutic effects. Trial registration: ClinicalTrials.gov 170608, ID: NCT03180606.

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Optimizing pharmacotherapy and deprescribing strategies in older adults living with multimorbidity and polypharmacy: EuGMS SIG on pharmacology position paper

Cited by 7 publications

References 113 publications

Effects of medication management in geriatric patients who have fallen: results of the EMMA mixed-methods study

Effects of medication management in geriatric patients who have fallen: results of the EMMA mixed-methods study

Drug-Related Problems in Elderly Patients Attended to by Emergency Services

Effects of proactive healthcare on pain, physical and activities of daily living functioning in vulnerable older adults with chronic pain: a pragmatic clinical trial with one- and two-year follow-up

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