Medication review for the older person

2007 ◽  
Vol 17 (1) ◽  
pp. 25-32 ◽  
Author(s):  
Maggi Banning
Keyword(s):  
Older People ◽  
Health Care Professionals ◽  
Drug Dose ◽  
Inappropriate Drug ◽  
Older Person ◽  
Duration Of Treatment ◽  
Chronic Morbidity ◽  
Effects Of Aging ◽  
The Impact ◽  
Repeat Prescriptions

People of 65 years and older accounted for 21% of the population of England and Wales in 2001, and their proportion is increasing. It is forecast that the number of people over the age 75 years will double within the next 50 years, and that of those over the age of 90 will increase fivefold. The older patient with declining health poses significant challenges for health care professionals, in particular those of managing chronic morbidity and the effects of aging. Many older people require pharmacological treatment for multiple, co-existing pathologies. Those of 65 years and over receive 56% of all prescriptions in England, of which 78% are repeat prescriptions, and people in residential care, on average, receive five different medicines concurrently. The impact of repeat prescriptions means that, due to inadequate monitoring, many older people continue to administer medicines they no longer require, and thereby risk receiving an inappropriate drug, dose or duration of treatment. In addition to this, there is the propensity for older people to mismanage medicines, increasing their risk of unplanned drug-related admission to hospital and drug-related morbidity.

Partnership between healthcare professionals and family members in caring for older people during hospitalization: a literature review

2020 ◽  
Vol 24 (2) ◽  
pp. 137-142
Author(s):  
Watchara Tabootwong ◽  
Frank Kiwanuka
Keyword(s):  
Health Care ◽  
Literature Review ◽  
Older People ◽  
Health Care Professionals ◽  
Healthcare Professionals ◽  
Family Members ◽  
Family Satisfaction ◽  
Older Person ◽  
Content Type ◽  
The Family

Purpose Partnership is both a goal and an approach to family-centered care (FCC). Family members play an important role alongside the health-care team when an older family member is admitted to the hospital. Family involvement in care for an older person forms a partnership approach where health professionals and the family engage collaboratively in care. This enhances the quality of care and family satisfaction with care. The purpose of this paper is to highlight the potential areas of partnerships of family members with health-care professionals while caring for older people based on the perspective of FCC. Design/methodology/approach A literature review was carried out. Findings The findings of this study focus on how healthcare professionals can listen to, respect the perspectives of family members, and share useful information with the family while caring for an older person. Family participation in providing care and collaboration between healthcare professionals and families is a seminal goal strategy in caring for older people during hospitalization. It is helpful to family members as a way of training and preparing them to assist their loved one after hospital discharge. Furthermore, it can establish a good relationship between healthcare professionals and families. Originality/value Partnership between health-care professionals and families helps and supports the older people and the family in managing the health condition the following discharge from the hospital.

Living with Frailty - What Healthcare Issues Matter to an Older Person? A Focus Group Study

2020 ◽  
Author(s):  
Kathryn Tipping(Former Corresponding Author) ◽  
Asangaedem Akpan New
Keyword(s):  
Focus Group ◽  
Older People ◽  
Health Care Professionals ◽  
Quantitative Research ◽  
Discharge Planning ◽  
Health Issues ◽  
Older Person ◽  
Focus Group Study ◽  
Clinical Frailty Scale ◽  
Small Project

Abstract Background The study set out to interview older people with frailty and find out what healthcare issues matter to them. Older people with frailty are an important population subgroup. In the United Kingdom, over 65s already outnumber under 16s, and this is expected to increase. Research into health issues has been undertaken by the International Consortium for Health Outcomes Measurement (ICHOM) and this study builds on that. Recent research has been undertaken in America into health issues. However, these studies were not specifically focused on older people. Methods A scoping review of the literature was undertaken to highlight any gaps in this area of research. Thereafter a focus group interview was carried out with six older people with frailty. Qualitative research often uses smaller samples than quantitative research 7 . Braun and Clarke recommend that for a small project, such as this one, 6-10 interviews should be held. Braun and Clarke state that smaller groups (three to eight participants) work best in terms of generating a rich discussion and have the added benefit of being easier to manage 7 . The six participants were aged 65 years and over and had mild to moderate frailty using the Rockwood Clinical Frailty Scale. 8 The interview was recorded and transcribed, analysed and themes identified. Results The eight themes identified were trust in medical professionals, vulnerability of being an older person in hospital, polypharmacy and wastage of medication, discharge planning and co-ordination of care at home, taking responsibility for your own health, nomenclature, autonomy and falls. Conclusion This study has identified themes to raise awareness among health care professionals about what health issues matter to older people with frailty. The study findings will provide an opportunity for meaningful discussions around what is needed to meet these preferred health issues.

scholarly journals Surgery in the older person: Training needs for the provision of multidisciplinary care

2016 ◽  
Vol 98 (6) ◽  
pp. 367-370 ◽  
Author(s):  
L Pearce ◽  
J Bunni ◽  
K McCarthy ◽  
J Hewitt
Keyword(s):  
Older People ◽  
Perioperative Care ◽  
Health Care Professionals ◽  
Geriatric Medicine ◽  
Multidisciplinary Care ◽  
Surgical Patients ◽  
Surgical Patient ◽  
Ageing Population ◽  
Older Person ◽  
Surgical Trainees

Introduction Many older surgical patients are exposed to high risks of morbidity and mortality when undergoing both elective and emergency surgery. Methods We provide an overview of perioperative care teams and the educational opportunities available to surgeons who undertake surgery in the older person. Findings The number of older people undergoing surgery is increasing at a rate faster than the proportion of older people in the overall population. Management of the older surgical patient throughout the surgical pathway forms part of the Specialty Training Curriculum for Geriatric Medicine. While ‘surgery in childhood’ continues to form part of the general surgical higher training syllabus, surgery in the later years of life does not. There are limited postgraduate courses and training opportunities currently available to surgeons in this field. There is clear societal need to address perioperative care for older surgical patients, which has proved successful in some centers. Moreover, surgical trainees support the inclusion of geriatric medicine issues into their training. Conclusions The ageing population requires a multidisciplinary perioperative approach, with dedicated and appropriately trained clinicians and allied health care professionals to improve outcomes.

The side effects of risperidone depot in patients with psychotic disorders

2017 ◽  
Vol 41 (S1) ◽  
pp. s816-s816
Author(s):  
T. Jupe ◽  
F. Elezi ◽  
B. Zenelaj ◽  
E. Myslimi
Keyword(s):  
Side Effects ◽  
Negative Symptoms ◽  
Psychotic Disorders ◽  
Statistical Processing ◽  
Drug Dose ◽  
Strong Positive Correlation ◽  
Duration Of Treatment ◽  
Positive Correlation ◽  
Long Acting ◽  
The Impact

Background and aimA long-acting form of risperidone is now broadly available for the treatment of schizophrenia and closely related psychiatric conditions. It combines the advantage of previously available depot formulations for first-generation drugs with the favorable characteristics of the modern “atypical” antipsychotics, namely higher efficacy in the treatment of the negative symptoms of schizophrenia and reduced motor disturbances [1].MethodsDuring this study, we observed side effects that appear in patients that are treated with risperidone depot. Patients were observed for a period of 3 months (October–December 2015) and the side effects were evaluated with Glasgow Antipsychotic Side-effect Scale (GASS). The data obtained were analyzed with SPSS, trying to prove the impact of variables such as: gender, age, diagnosis, dose and duration of treatment on the occurrence of side effects.ResultsThrough statistical processing, we reached the conclusion that there is a statistically significant correlation between duration of treatment and side effects (P value was 0.0001). Between two variables has a strong positive correlation (Kendall value was 0.766). Has a statistically significant correlation between the drug dose and side effects (P value was 0.026). Between two variables has a moderate positive correlation (Kendall value was 0.504). No statistically significant correlation between these variables: gender-side effects, diagnose-side effects and age-side effects.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Clinical pharmacist interventions in post stroke follow up patients in tertiary care hospital on coastal region

2020 ◽  
Vol 8 (2) ◽  
pp. 45-52
Author(s):  
Prakash A ◽  
Kalyan Rao B ◽  
Sujitha Sri K ◽  
Lakshman Naik R ◽  
Shaik Shahin Kouser ◽  
...  
Keyword(s):  
Health Care Professionals ◽  
Medical Condition ◽  
Tertiary Care ◽  
Inappropriate Drug ◽  
Care Hospital ◽  
Stroke Patients ◽  
Total Study Population ◽  
Patient Counselling ◽  
The Impact

Stroke is basically a medical condition where there is low blood flow to the brain and thus results in cell death. It remains the second most common cause of death. Stroke patients also have different comorbidities on an average where they are prescribed with 6-10 medicines. This increase the chances for drug-related problems (DRPs) and adverse drug events (ADEs) or adverse drug reactions (ADRs) and the interventions found during the follow up of stroke patients. Several studies finding of interventions in stroke patients and reconciliation are ways to reduce ADRs and improve medication use safety. Interventions and medical reconciliation (MR) address a wide array of potential medication-related issues, which is carefully planned that may be done by pharmacist or doctor or professional (or) physician. Here the aim was to access the impact of interventions which includes medications reconciliation and counselling of stroke patients and also identification and categorization of DRPs. Polypharmacy causing DRPs was statistically significant in all the regions inappropriate drug selection (2.85%), and dose selection (2.85%) was the primary cause of DRPs 85% partially solved. Epidemiologically of all the three regions (GNT, VIJ, RJY) in the total study population. Males are more affected than females. Majority of comorbidities like HTN(70.05%), and DM(47.01%)were in leading role causing stroke absorbed during interventions. Leaflet & patient counselling had prominent role in conducting medical reconciliation. Other health care professionals systematically find, differentiate & report interventions like (DRPs, ADRs, and causes).

scholarly journals Contrasts in older persons’ experiences and significant others’ perceptions of existential loneliness

2018 ◽  
Vol 26 (6) ◽  
pp. 1623-1637 ◽  
Author(s):  
Helena Larsson ◽  
Anna-Karin Edberg ◽  
Ingrid Bolmsjö ◽  
Margareta Rämgård
Keyword(s):  
Health Care ◽  
Older People ◽  
Health Care Professionals ◽  
Older Persons ◽  
Significant Others ◽  
Care Staff ◽  
Health Care Staff ◽  
Older Person ◽  
Existential Loneliness ◽  
Frail Older Persons

Background: As frail older people might have difficulties in expressing themselves, their needs are often interpreted by others, for example, by significant others, whose information health care staff often have to rely on. This, in turn, can put health care staff in ethically difficult situations, where they have to choose between alternative courses of action. One aspect that might be especially difficult to express is that of existential loneliness. We have only sparse knowledge about whether, and in what way, the views of frail older persons and their significant others concerning existential loneliness are in concordance. Objective: To contrast frail older (>75) persons’ experiences with their significant others’ perceptions of existential loneliness. Methods: A case study design was chosen for this study. Individual interviews with frail older persons (n = 15) and interviews with their significant others (n = 19), as well as field notes, served as a basis for the study. A thematic analysis was used to interpret data. Ethical considerations: This study was conducted in accordance with the principles of research ethics. Findings: The findings showed three themes: (1) Meaningless waiting in contrast to lack of activities, (2) Longing for a deeper connectedness in contrast to not participating in a social environment and (3) Restricted freedom in contrast to given up on life. Discussion: Knowledge about the tensions between older persons’ and their significant others’ views of existential loneliness could be of use as a basis for ethical reflections on the care of older people and in the encounter with their significant others. Conclusion: It is of importance that health care professionals listen to both the frail older person and their significant other(s) and be aware of whose voice that the care given is based on, in order to provide care that is beneficial and not to the detriment of the older person.

scholarly journals The emergence and utilisation of frailty in the United Kingdom: a contemporary biopolitical practice

2018 ◽  
Vol 40 (4) ◽  
pp. 695-712 ◽  
Author(s):  
Louise Tomkow
Keyword(s):  
Health Care ◽  
United Kingdom ◽  
Older People ◽  
Health Care Professionals ◽  
Geriatric Medicine ◽  
Adverse Outcomes ◽  
Ageing Population ◽  
Political Climate ◽  
The United Kingdom ◽  
The Impact

AbstractFrailty has recently emerged as a dominant concept against a backdrop of media and governmental narratives that frame the growing ageing population as an economic threat to the current configuration of health care in the United Kingdom (UK). Despite frailty's popularity amongst geriatricians and policy makers, the concept faces resistance from other health-care professionals and older people themselves. This paper draws on the Foucauldian idea of biopower; by suggesting that the contemporary emergence and utilisation of frailty represents a biopolitical practice a number or critical observations are made. First, despite biomedical experts acknowledging ambiguities in the definition of frailty, the concept is presented as a truth discourse. This is driven by the ability of frailty measurements to predict risk of costly adverse outcomes; the capability of frailty scores to enumerate complex needs; and the scientific legitimacy frailty affords to geriatric medicine. Consequently, frailty has become pervasive, knowable and measurable. Second, the routine delineation between frail and robust objectifies older people, and can be said to benefit those making the diagnosis over those being labelled frail, with the latter becoming disempowered. Last, studies show that frailty is associated with increasing wealth inequalities in the UK; however, experts’ suggested management of frailty shifts the focus of responsibility away from ideologically driven structural inequalities towards the frail older person, attempting to encourage individuals to modify lifestyle choices. This neglects the association between lifestyle opportunities and socio-economic deprivation, and the impact of long-term poverty on health. These observations, set against the contemporary political climate of economic austerity, cuts to public services and rationalisation of health resources, bring the urgency of a critical consideration of frailty to the fore.

Atrial fibrillation and stroke in the older person

2020 ◽  
pp. 99-120
Author(s):  
David Mangion
Keyword(s):  
Risk Factors ◽  
Atrial Fibrillation ◽  
Decision Making ◽  
Older People ◽  
Antithrombotic Therapy ◽  
Significant Proportion ◽  
Screening Methods ◽  
Shared Decision ◽  
Older Person ◽  
The Impact

‘Atrial fibrillation and stroke in the older person’ (AF) examines this devastating condition that mainly affects older people. Despite the recent introduction of effective and safer anticoagulants, a significant proportion of older people do not receive appropriate stroke prophylaxis. It describes the incidence, epidemiology, risk factors of AF in older people, mechanisms of stroke in AF, antithrombotic therapy in AF, antithrombotic therapy in older people, risk stratification, screening methods, non-pharmacological and pharmacological treatments, barriers to anticoagulation, the impact of falls, disability, frailty, and cognitive issues on decision-making, and the importance of shared decision-making. Without improvements in stroke prevention, the problem of AF-related stroke will only increase.

scholarly journals Impact of an Integrated Community-based Model of Care for Older People with Complex Conditions on Hospital Emergency Presentations and Separations: A Step-wedged Randomized Trial

2021 ◽  
Author(s):  
Mann Jennifer ◽  
Fintan Thompson ◽  
Robyn McDermott ◽  
Adrian Esterman ◽  
Edward Strivens
Keyword(s):  
Older People ◽  
Controlled Trial ◽  
Community Dwelling ◽  
Ageing Population ◽  
Significant Finding ◽  
Older Person ◽  
Complex Needs ◽  
Significant Difference ◽  
The Impact ◽  
Open Arch

Abstract BackgroundAn ageing population and rise in multi-morbidity increase hospital utilisation and acuity of presentation, particularly amongst the older person with complex needs. Health systems must reorient towards preventative and co-ordinated care to reduce hospital demand and achieve positive and fiscally responsible client outcomes. Integrated care models can improve outcomes for the older person by aligning primary practice with the specialist health care and social services required to manage complex needs. This paper describes the impact of a community facing program that integrates care at the primary-secondary interface on the rate of Emergency Department (ED) presentation and hospital separations amongst older people with complex needs.MethodsThe OPEN ARCH study is a multicentre randomised controlled trial with a stepped wedge cluster design. General practitioners (GPs; n=14) are considered ‘clusters’ each comprising a mixed number of participants. 80 community dwelling persons over 70 years of age if non-Indigenous and over 50 years of age if Indigenous were included in the study. Clusters were randomly assigned to the time at which they would commence the OPEN ARCH intervention, with intervention periods of 3, 6 and 9 months duration. Each participant was its own control. ED presentations and hospital separations were collected from Queensland Health Casemix data and analysed with multilevel mixed-effects Poisson regression modelling to determine the effectiveness of the OPEN ARCH intervention. Data were analysed at the cluster and participant levels.ResultsThe OPEN ARCH intervention was found to not make a statistically significant difference to ED presentations or hospitalisations. However, a stabilising of ED presentations and trend toward lower hospitalisation rates over time was observed. ConclusionsWhile this study detected no statistically significant different change in ED presentations or hospital separations, a plateauing of ED presentation and hospitalisation ratesis a clinically significant finding for older persons with complex needs. Multi-sectoral integrated programs of care require an adequate preparation period and sufficient duration of intervention for effectiveness to be measured. Trial registrationThe OPEN ARCH study received ethical approval from the Far North Queensland Human Research Ethic Committee, HREC/17/QCH/104 – 1174 and is registered on the Australian and New Zealand Trials Registry, ACTRN12617000198325p.

Designing for older people: But who is an older person?

2016 ◽  
Author(s):  
Raghavendra Reddy Gudur ◽  
◽  
Alethea Blackler ◽  
Vesna Popovic ◽  
Doug Mahar
Keyword(s):  
Older People ◽  
Older Person
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