Prescribing for frail older people

Hilmer, Sarah N.; Gnjidic, Danijela

doi:10.18773/austprescr.2017.055

Cited by 66 publications

(77 citation statements)

References 32 publications

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“…This could also contribute to a higher risk of adverse drug reactions and toxicity in frail older people. Older people seem to have an increased sensitivity to certain drugs, but the evidence of the possible influence of frailty on pharmacodynamics and efficacy is scarce , although plausible due to physiological changes . Moreover, as a predictor of clinical outcomes and limited life expectancy, frailty may modify the goals of health care and its priorities, and influence decision‐making regarding the use of medicines .…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

The relationship between frailty and polypharmacy in older people: A systematic review

Gutiérrez-Valencia

Izquierdo

Cesari

et al. 2018

Brit J Clinical Pharma

314

219

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Section: Discussionmentioning

confidence: 99%

“…Moreover, as a predictor of clinical outcomes and limited life expectancy, frailty may modify the goals of health care and its priorities, and influence decision‐making regarding the use of medicines . These issues have been addressed more in depth in other publications .…”

Section: Discussionmentioning

confidence: 99%

The relationship between frailty and polypharmacy in older people: A systematic review

Gutiérrez-Valencia

Izquierdo

Cesari

et al. 2018

Brit J Clinical Pharma

314

219

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“…Since the underlying causes of tubal feeding were serious diseases, such as cerebrovascular diseases, pneumonia and sarcopenia, most of the subjects likely had a high degree of frailty. Frail elderly individuals are reported to have reduced pharmacokinetics, especially concerning drug metabolic and excretion capabilities [41]. Another study showed a close relationship between polypharmacy and the occurrence of adverse drug events, and the relationship was more pronounced in patients with frailty than in those without frailty [20].…”

Section: Discussionmentioning

confidence: 99%

The associations of the number of medications and the use of anticholinergics with recovery from tubal feeding: a longitudinal hospital-based study

et al. 2020

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Background Several medications, such as anticholinergics, are considered to affect the swallowing function adversely; however, whether or not anticholinergics or polypharmacy should be avoided to prevent eating dysfunction in elderly populations remains unclear. We therefore examined whether or not the number of medications or the use of anticholinergics was associated with recovery from tubal feeding in elderly inpatients. Methods We conducted a retrospective 1-year observation study in 95 Japanese hospitalized patients (83.3 ± 9.7 years old) receiving nutrition through a feeding tube. The anticholinergic cognitive burden scale (ACBs) was used as an index for quantifying the anticholinergic action. Results Thirty-six (37.9%) subjects recovered from tubal to oral feeding during the observation period. The logistic regression models showed that an increased number of prescribed medications and an increase in ACBs decreased the incidence of recovery from tubal feeding (odds ratio [95% confidence interval]: 0.66 [0.50–0.87], P = 0.003 and 0.52 [0.29–0.92], P = 0.024, respectively). Furthermore, the cumulative incidence of recovery from tubal feeding was significantly lower in the subjects who were given an additional ≥3 medications during the observation period than in those who were not (hazard ratio [95% confidence interval]: 0.08 [0.01–0.59], P = 0.014). Conclusions The findings of this study suggest that an increased exposure to medications, especially anticholinergics, may be an important factor interfering with recovery from tubal feeding in hospitalized elderly patients.

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“…La deprescripción es un proceso continuo e individualizado, que debe realizarse fármaco a fármaco. Se debe identificar el problema de salud que hay que tratar, especificar unos objetivos terapéuticos, verificar si el tratamiento es adecuado, dar instrucciones adecuadas a los pacientes y monitorizar la efectividad del tratamiento 13 . En un estudio de cohortes en ancianos de la comunidad, la reducción de 3 fármacos mejoró la calidad de vida y no aumentó la mortalidad 14 .…”

Section: Medicación En Las Personas Mayoresunclassified