Prescribing for older people

Milton, James C.; Hill‐Smith, Ian; Jackson, Stephen

doi:10.1136/bmj.39503.424653.80

Cited by 232 publications

(194 citation statements)

References 31 publications

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“…Among hospitalized elderly, the prevalence of polypharmacy ranged from 20% to 60%, reflecting different criteria used to select patients and collect medication data (6)(7)(8). Although polypharmacy has no generally accepted definition, most often it is defined by cut-offs, in terms of the number of medications taken, ranging from two to ten (9)(10)(11)(12). However, regardless of the definition, its prevalence has been reported to rise with age, and is associated with an increased risk of inappropriate drug prescription, under-use of effective treatment, medication errors, poor adherence to pharmacological therapies, drug/drug and drug/disease interactions, and adverse effects (3,(13)(14)(15)(16)(17)(18).…”

Section: Introductionmentioning

confidence: 99%

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Polypharmacy, length of hospital stay, and in-hospital mortality among elderly patients in internal medicine wards. The REPOSI study

Nobili¹,

Licata²,

Salerno³

et al. 2011

Eur J Clin Pharmacol

279

195

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Purposes: We evaluated the prevalence and factors associated with polypharmacy and investigated the role of polypharmacy as a predictor of length of hospital stay and in-hospital mortality. Methods: Thirty-eight internal medicine wards in Italy participated in the Registro Politerapie SIMI (REPOSI) study during 2008. One thousand three hundred and thirty-two in-patients aged ≥65 years were enrolled. Polypharmacy was defined as the concomitant use of five or more medications. Linear regression analyses were used to evaluate predictors of length of hospital stay and logistic regression models for predictors of in-hospital mortality. Age, sex, Charlson comorbidity index, polypharmacy, and number of in-hospital clinical adverse events (AEs) were used as possible confounders. Results: The prevalence of polypharmacy was 51.9% at hospital admission and 67.0% at discharge. Age, number of drugs at admission, hypertension, ischemic heart disease, heart failure, and chronic obstructive pulmonary disease were independently associated with polypharmacy at discharge. In multivariate analysis, the occurrence of at least one AE while in hospital was the only predictor of prolonged hospitalization (each new AE prolonged hospital stay by 3.57 days, p<0.0001). Age [odds ratio (OR) 1.04; 95% confidence interval (CI) 1.01-1.08; p=0.02), comorbidities (OR 1.18; 95% CI 1.12-1.24; p<0.0001), and AEs (OR 6.80; 95% CI 3.58-12.9; p<0.0001) were significantly associated with in-hospital mortality. Conclusions: Although most elderly in-patients receive polypharmacy, in this study, it was not associated with any hospital outcome. However, AEs were strongly correlated with a longer hospital stay and higher mortality risk. © 2011 Springer-Verlag

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Section: Introductionmentioning

confidence: 99%

“…The incidence of adverse drug reactions (ADRs) rises exponentially rather than linearly with the number of drugs taken, and advanced age and polypharmacy are associated with a substantial increase in the risk of ADRs (4,10,15,(19)(20)(21).…”

Section: Introductionmentioning

confidence: 99%

Polypharmacy, length of hospital stay, and in-hospital mortality among elderly patients in internal medicine wards. The REPOSI study

Nobili¹,

Licata²,

Salerno³

et al. 2011

Eur J Clin Pharmacol

279

195

View full text Add to dashboard Cite

show abstract

“…There are several reasons why older people may be more vulnerable to adverse drug reactions including age-related changes in pharmacokinetics and pharmacodynamics, impaired cardiac, renal and baroreceptor function, and cognitive impairment. [6][7][8] Several studies have confirmed the high incidence of ADRs in elderly patients taking antihypertensives, and these agents are a frequent cause of ADRs leading to hospital admission. 9,10 Polypharmacy is common in the elderly and can increase the risk of drug interactions and adverse events as a consequence.…”

Section: Discussionmentioning

confidence: 99%

“…Increasing age is also associated with changes in pharmacokinetics and pharmacodynamics, impaired cardiac, renal and baroreceptor function, and cognitive impairment, all of which can make prescribing in this age group challenging. [6][7][8] The aim of this study was to determine whether development of or the potential risk of adverse drug reactions (ADRs) to antihypertensive drugs limits the clinician's ability to follow guidelines and achieve blood pressure targets in the very elderly. Ambulatory blood pressure monitoring (ABPM) was used to assess blood pressure control at the time of referral to a hospital hypertension service.…”

Section: Introductionmentioning

confidence: 99%

Managing hypertension in the very elderly: effect of adverse drug reactions (ADRs) on achieving targets

et al. 2010

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“…El tratamiento farmacológico de los ancia nos presenta serias dificultades debido a los importantes cambios fisiopatológicos y modificaciones en la farmacocinética de los principios activos asociados a este grupo de edad. Además, la inclusión de personas mayores en ensayos clínicos es escasa 2 . En estas condiciones, la habitual fragilidad de los enfermos de este grupo de edad supone un reto para su atención 3 , el complicado tratamiento farmacológico se asocia a la polifarmacia 4 y a una alta preva lencia de prescripciones inadecuadas 5 .…”

Section: Introductionunclassified