Underuse in Elderly Adults: An Underestimated Suboptimal Prescribing

Andro, Marion; Coutard, Anne; Gentric, A.

doi:10.1111/j.1532-5415.2012.04071.x

Cited by 2 publications

(3 citation statements)

References 8 publications

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“…A high prevalence of vitamin D deficiency in patients aged 85 years and over [ 25 ], and the association between hypovitaminosis D and various health problems in the elderly have been described [ 26 ]. Moreover, omission of calcium and vitamin D supplements in the elderly with osteoporosis has been the leading cause of PPO in different studies [ 21 , 27 ]. This is relevant, taking into account the benefit of calcium and vitamin D supplements in preventing bone loss and fractures in elderly people with osteoporosis [ 28 , 29 ], although once again, these studies were not performed on the very elderly.…”

Section: Discussionmentioning

confidence: 99%

Inappropriate prescribing to the oldest old patients admitted to hospital: prevalence, most frequently used medicines, and associated factors

et al. 2015

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BackgroundScientific evidence on treatments of chronic diseases in patients 85 years old or older is very limited, as is available information on inappropriate prescription (IP) and its associated factors. The study aimed to describe medicine prescription, potentially inappropriate medicines (PIM) and potentially prescribing omissions (PPO) and their associated factors on this population.MethodsIn the context of an observational, prospective and multicentric study carried out in elderly patients admitted to seven Spanish hospitals for a year, a sub-analysis of those aged 85 years and over was performed. To assess PIMs, the Beers and STOPP criteria were used, and to assess PPOs, the START and the ACOVE-3 criteria were used. To assess factors associated with IP, a multivariate logistic regression analysis was performed. Patients were selected randomly every week on consecutive days from the hospitalization lists.ResultsA total of 336 patients were included in the sub-analysis with a median (Q1-Q3) age of 88 (86–90) years. The median medicines taken during the month prior to admission was 10 (7–13). Forty-seven point two per cent of patients had at least one Beers-listed PIM, 63.3% at least one STOPP-listed PIM, 53.6% at least one START-listed PPO, and 59.4% at least one ACOVE-3-listed PPO. Use of benzodiazepines in patients who are prone to falls (18.3%) and omission of calcium and vitamin D supplements in patients with osteoporosis (13.3%) were the most common PIM and PPO, respectively. The main factor associated with the Beers-listed and the STOPP-listed PIM was consumption of 10 or more medicines (OR = 5.7, 95% CI 1.8-17.9 and OR = 13.4, 95% CI 4.0-44.0, respectively). The main factors associated with the START-listed PPO was a non-community dwelling origin (OR 2.3, 95% CI 1.0-5.0), and multimorbidity (OR1.8, 95% CI 1.0-3.1).ConclusionsPrescribed medicines and PIM and PPO prevalence were high among patients 85 years and over. Benzodiazepine use in those who are prone to falls and omission of calcium and vitamin D in those with osteoporosis were the most frequent PIM and PPO, respectively. Factors associated with PIM and PPO differed with polypharmacy being the most important factor associated with PIM.Electronic supplementary materialThe online version of this article (doi:10.1186/s12877-015-0038-8) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 99%

Inappropriate prescribing to the oldest old patients admitted to hospital: prevalence, most frequently used medicines, and associated factors

et al. 2015

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“…This benefit is recognized as greater than the risk of bleeding [30]. Underuse of PAI for documented atherosclerosis is one of the most common instances of underuse in geriatrics [8]. One study showed that 40% of patients received neither PAI nor anticoagulants after stroke and a hospital stay in geriatrics [10].…”

Section: Pai In Older Patients: From Underuse To Overusementioning

confidence: 99%

“…Prescribing drugs is particularly complex in the elderly, and vigilance is required with regard to both excess (overuse) and insufficient treatment (underuse) [7]. PAI is one of the most commonly underused drugs for secondary prevention in geriatrics [8], despite strong evidence that its use is beneficial [9]. However, there is to date little evidence of benefit of preventive strategies in frail older subjects with multiple comorbidities and polypharmacy.…”

Section: Introductionmentioning

confidence: 99%

Impact of Age, Multimorbidity and Frailty on the Prescription of Preventive Antiplatelet Therapy in Older Population

Laborde

Barben

Mihai

et al. 2020

IJERPH

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Platelet aggregation inhibitors (PAI) have widely proven their efficiency for the prevention of ischemic cardiovascular events. We aimed to describe PAI prescription in an elderly multimorbid population and to determine the factors that influence their prescription, including the impact of age, comorbidities and frailty, evaluated through a comprehensive geriatric assessment. This cross-sectional study included all patients admitted to the acute geriatric department of a university hospital from November 2016 to January 2017. We included 304 consecutive hospitalized patients aged 88.7 ± 5.5 years. One third of the population was treated with PAI. A total of 133 (43.8%) patients had a history of cardiovascular disease, 77 of whom were on PAI. For 16 patients, no indication was identified. The prescription or the absence of PAI were consistent with medical history in 61.8% of patients. In the multivariate analysis, among the 187 patients with an indication for PAI, neither age (odds ratio (OR) = 1.00; 95% confidence interval (CI): [0.91–1.08], per year of age), nor comorbidities (OR = 0.97; 95% CI: [0.75–1.26], per point of Charlson comorbidity index), nor cognitive disorders (OR = 0.98; 95% CI [0.91–1.06] per point of Mini Mental State Examination), nor malnutrition (OR = 1.07; 95% CI [0.96–1.18], per g/L of albumin) were significantly associated with the therapeutic decision. PAI were less prescribed in primary prevention situations, in patients taking anticoagulants and in patients with a history of bleeding. In conclusion, a third of our older comorbid population of inpatients was taking PAI. PAI prescription was consistent with medical history for 61.8% of patients. Age, multimorbidity and frailty do not appear to have a significant influence on therapeutic decision-making. Further research is needed to confirm such a persistence of cardiovascular preventive strategies in frail older patients from other settings and to assess whether these strategies are associated with a clinical benefit in this specific population.

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Underuse in Elderly Adults: An Underestimated Suboptimal Prescribing

Cited by 2 publications

References 8 publications

Inappropriate prescribing to the oldest old patients admitted to hospital: prevalence, most frequently used medicines, and associated factors

Inappropriate prescribing to the oldest old patients admitted to hospital: prevalence, most frequently used medicines, and associated factors

Impact of Age, Multimorbidity and Frailty on the Prescription of Preventive Antiplatelet Therapy in Older Population

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