Practical advice for prescribing in old age

Caslake, Robert; Soiza, Roy L.; Mangoni, Arduino A.

doi:10.1016/j.mpmed.2012.10.006

Cited by 5 publications

(4 citation statements)

References 20 publications

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“…When identifying a medication as ‘potentially inappropriate’, it must be remembered that this does not mean that it is possible to withdraw it at the time it is identified, if at all. In the absence of strong clinical evidence on the risks and benefits of medications, which is often the case in older people, it may be almost impossible to identify undoubtedly inappropriate medications . It is more likely that ‘potentially’ or ‘probably’ inappropriate medications will be identified, and it is through the later steps of the deprescribing process (particularly monitoring and follow‐up) that the benefit (and perhaps to a lesser extent the risks) and therefore appropriateness of the medication in the individual can be established.…”

Section: The Patient‐centred Deprescribing Processmentioning

confidence: 99%

Review of deprescribing processes and development of an evidence‐based, patient‐centred deprescribing process

Reeve

Shakib

Hendrix

et al. 2014

Brit J Clinical Pharma

286

305

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Inappropriate use of medication is widespread, especially in older people, and is associated with risks, including adverse drug reactions, hospitalization and increased mortality. Optimization of appropriate medication use to minimize these harms is an ongoing challenge in healthcare. The term ‘deprescribing’ has been used to describe the complex process that is required for safe and effective cessation of medication. Patients play an important role in their own health and, while they may complain about the number of medications they have to take, they may also be reluctant to cease a medication when given the opportunity to do so. A review of previously proposed deprescribing processes and relevant literature was used to develop the patient‐centred deprescribing process, which is a five‐step cycle that encompasses gaining a comprehensive medication history, identifying potentially inappropriate medications, determining whether the potentially inappropriate medication can be ceased, planning the withdrawal regimen (e.g. tapering where necessary) and provision of monitoring, support and documentation. This is the first deprescribing process developed using knowledge of the patients' views of medication cessation; it focuses on engaging patients throughout the process, with the aim of improving long‐term health outcomes. Despite a comprehensive review of the literature, there is still a lack in the evidence base on which to conduct deprescribing. The next step in broadening the evidence to support deprescribing will be to test the developed process to determine feasibility in the clinical setting.

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Section: The Patient‐centred Deprescribing Processmentioning

confidence: 99%

Review of deprescribing processes and development of an evidence‐based, patient‐centred deprescribing process

Reeve

Shakib

Hendrix

et al. 2014

Brit J Clinical Pharma

286

305

View full text Add to dashboard Cite

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“…Judicious use of medications and optimal drug prescribing is one of the cornerstones of comprehensive geriatric assessment [ 38 ]. Almost three-quarters of elderly patients with hyponatremia after fragility fracture were prescribed at least one medication known to cause hyponatremia [ 33 ].…”

Section: Treatment Of Hyponatremia In Older Peoplementioning

confidence: 99%

Hyponatremia: Special Considerations in Older Patients

Soiza

Cumming

Clarke

et al. 2014

JCM

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Hyponatremia is especially common in older people. Recent evidence highlights that even mild, chronic hyponatremia can lead to cognitive impairment, falls and fractures, the latter being in part due to bone demineralization and reduced bone quality. Hyponatremia is therefore of special significance in frail older people. Management of hyponatremia in elderly individuals is particularly challenging. The underlying cause is often multi-factorial, a clear history may be difficult to obtain and clinical examination is unreliable. Established treatment modalities are often ineffective and carry considerable risks, especially if the diagnosis of underlying causes is incorrect. Nevertheless, there is some evidence that correction of hyponatremia can improve cognitive performance and postural balance, potentially minimizing the risk of falls and fractures. Oral vasopressin receptor antagonists (vaptans) are a promising innovation, but evidence of their safety and effect on important clinical outcomes in frail elderly individuals is limited.

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“…This is particularly pertinent for those especially susceptible to indiscriminate use of guidelines or policies to intensively control BP, such as frail older people and those nearing the end of life. 10…”

Section: Opinionmentioning

confidence: 99%