scholarly journals 467 - A narrative review of the deprescribing process in patients with dementia

2020 ◽  
Vol 32 (S1) ◽  
pp. 189-189
Author(s):  
Mariana Duarte Mangas ◽  
Gonçalo A. Santos ◽  
Catarina Pedro ◽  
Beatriz Jorge
Keyword(s):  
Medication Adherence ◽  
Narrative Review ◽  
Prescribing Practices ◽  
Barriers And Enablers ◽  
Medication Withdrawal ◽  
The Family ◽  
Drug Adverse Effects ◽  
Potential Benefits ◽  
Advance Care ◽  
Mental Decline

Deprescribing, an integral component of a continuum of good prescribing practices, is the process of medication withdrawal or dose reduction to correct or prevent medication-related complications, improve outcomes, and reduce costs. Deprescribing can be a challenge in patients with dementia. In this narrative review we evaluate topics related with deprescribing: what constitutes deprescribing, the importance to deprescribing for patients with dementia, the potential benefits, barriers and enablers of deprescribing and the deprescribing process.Patients with dementia often have multiple comorbidities and have complex medication regimens. Also, they face challenges with medication adherence because of the nature of the disease. Proper medication adherence is important to prevent progression of these comorbidities and decline in overall health. However, as dementia progresses, the risk of taking certain medications may outweigh the benefits. In addition, older people, especially those with physical and mental decline, tend to experience lower efficacy of these medications along with a higher risk of drug adverse effects. As with prescribing or continuing medications, deprescribing brings with it the potential for harm as well as benefit. Other barriers to deprescription include concerns from the patients or the family, worries and doubts from the physician and some issues related to each health system. Many challenges for its execution have been described.Recent studies report benefits and safety in the prescription of patients with dementia, reinforcing the importance of considering prescription in the reevaluation of the patient. Advance care planning is the cornerstone of palliative care, and prescription should be considered in this process.

scholarly journals New horizons in deprescribing for older people

2019 ◽  
Vol 48 (6) ◽  
pp. 768-775 ◽  
Author(s):  
Henry J Woodford ◽  
James Fisher
Keyword(s):  
Medication Adherence ◽  
Older People ◽  
Evidence Base ◽  
Ageing Population ◽  
Improve Medication Adherence ◽  
Long Term Conditions ◽  
Team Working ◽  
Drug Adverse Effects ◽  
Potential Benefits ◽  
Few Data

Abstract Deprescribing has gained interest recently, driven by an ageing population seeing an increasing number living with multiple long-term conditions. This, coupled with disease-specific guidelines derived from clinical trials in younger people, has led to an increase in exposure to polypharmacy and the associated therapeutic burden. Older people, especially those living with frailty, tend to experience lower efficacy of these medications along with a higher risk of drug adverse effects. Explanations for these differences include the physiological effects of frailty, drug–drug interactions, drug–disease interactions and reduced medication adherence. Adverse drug reactions often go unnoticed and can trigger further prescribing. Certain medications have been recognised as potentially inappropriate for people with frailty, yet their use remains common. Evidence suggests that many older people are open to the concept of reducing medications. Deprescribing should be based around a shared decision-making approach. Trials to date have suggested that it can often be achieved without harm. To date, there are few data to support improvements in hospitalisation or mortality rates. However, there is some evidence that it may reduce polypharmacy, improve medication adherence, reduce financial costs and improve quality of life. In the future, it will be necessary to grow the evidence base and improve public and clinician awareness of the potential benefits of deprescribing. It will require excellent team working and communication between all of those involved in the prescribing and administration of medications, also supported by improved healthcare informatics. Non-pharmacological approaches will need to be promoted. Fewer drugs is not less care.

PERAN KELUARGA DALAM MEMANTAU KEPATUHAN MINUM OBAT PENDERITA HIPERTENSI PADA MASYARAKAT

2017 ◽  
Vol 3 (1) ◽  
Author(s):  
Saiful Nurhidayat
Keyword(s):  
Blood Pressure ◽  
Medication Adherence ◽  
Rural Communities ◽  
Elementary Education ◽  
College Education ◽  
Cross Sectional ◽  
Hypertensive Patients ◽  
Purposive Sampling ◽  
The Family

Abstract : Hypertension or high blood pressure is an abnormal increase in blood pressure in the arteries continuously over a period. The dangers of hypertension can lead to damage to various organs including kidneys, brain, heart, eye, causing vascular resistance and stroke. Hypertension takes care of the old and continuously. One effective way to lower blood pressure is to obediently take medicine so that it takes the role of families in monitoring patients taking the medication. With the participation of the family are expected to hypertension sufferers can be controlled. This study aims to determine the family's role in monitoring the adherence of hypertensive patients. The study was conducted in rural communities Slahung Ponorogo, a representative sample of 53 respondents taken by purposive sampling. Quantitative design with cross sectional design of the study the family's role in monitoring the adherence of hypertensive patients. Instruments in this study using questionnaires and observation sheets. The results of 53 respondents obtained the majority of the 29 respondents (55%) has the role of both families and 24 respondents (45%) families have a bad role in monitoring medication adherence. Age and education contribute to determining the role family. Intermediate (41-60 years old) and college education contribute to determining the role well. Conversely > 61 years of elementary education and contribute in a bad role.Keywords : the role of the family, medication adherence, hypertension. Abstrak : Hipertensi atau tekanan darah tinggi adalah suatu peningkatan abnormal tekanan darah dalam pembuluh darah arteri secara terus-menerus lebih dari suatu periode. Bahaya hipertensi dapat memicu rusaknya berbagai organ tubuh diantaranya: ginjal, otak, jantung, mata, menyebabkan resistensi pembuluh darah dan stroke. Penyakit hipertensi membutuhkan perawatan yang lama dan terus menerus. Salah satu cara yang efektif untuk menurunkan tekanan darah adalah dengan patuh minum obat sehingga dibutuhkan peran keluarga dalam memantau minum obat penderita. Dengan adanya peran serta keluarga diharapkan penyakit hipertensi penderita dapat terkontrol. Penelitian ini bertujuan untuk mengetahui peran keluarga dalam memantau kepatuhan minum obat penderita hipertensi. Penelitian dilakukan pada masyarakat desa Slahung Ponorogo,sampel representatif sejumlah 53 responden diambil secara Purposive Sampling. Desain kuantitatif dengan rancangan Cross sectional yang mempelajari peran keluarga dalam memantau kepatuhan minum obat penderita hipertensi. Instrumen pada penelitian ini menggunakan kuesioner dan lembar observasi. Hasil penelitian dari 53 responden didapatkan sebagian besar 29 responden (55 %) keluarga mempunyai peran baik dan 24 responden (45 %) keluarga mempunyai peran buruk dalam memantau kepatuhan minum obat. Faktor usia dan pendidikan berkontribusi dalam menentukan peran keluarga. Usia madya (41-60 tahun) dan jenjang pendidikan perguruan tinggi berkontribusi dalam menentukan peran baik. Sebaliknya > 61 tahun dan jenjang pendidikan SD berkontribusi dalam peran buruk.Kata Kunci : peran keluarga, kepatuhan minum obat, penyakit hipertensi.

A Narrative review of Myths on Natal and Neonatal Teeth in Nigeria

2021 ◽  
Vol 1 (1) ◽  
pp. 3-11
Author(s):  
Mike Eghosa Ogbeide
Keyword(s):  
Public Health ◽  
Health Benefits ◽  
Narrative Review ◽  
Accurate Information ◽  
Natal Teeth ◽  
The People ◽  
The Family ◽  
High Esteem ◽  
Erroneous Beliefs

Abstract Myths associated with neonatal and natal teeth (NNT) differ across different countries and cultures, ranging from beliefs of a magnificent future at one end, to that of serious misfortune at the opposite end. In Nigeria, the beliefs reported on NNT have been mostly negative and erroneous, with consequential effects of varying degrees ranging from anxiety by the affected child‘s mother and other members of the family to infanticide contemplation. The beliefs surrounding NNT, oftentimes, are handed down from generation to generation, and they are held in high esteem in many families. These erroneous beliefs need to be dispelled and the accurate information regarding NNT need to be passed to the people for public health benefits.

Smartphone medication adherence apps: Potential benefits to patients and providers: Response to Aungst

2013 ◽  
Vol 53 (4) ◽  
pp. 345 ◽  
Author(s):  
Lindsey Dayer ◽  
Seth Heldenbrand ◽  
Paul Anderson ◽  
Paul O. Gubbins ◽  
Bradley C. Martin
Keyword(s):  
Medication Adherence ◽  
Potential Benefits

scholarly journals RF3-B Barriers and Enablers to Advance Care Planning with Patients in Primary Care: A Survey of Clinicians

2016 ◽  
Vol 52 (6) ◽  
pp. e47
Author(s):  
Michelle Howard ◽  
Carrie Bernard ◽  
Doug Klein ◽  
Amy Tan ◽  
Marissa Slaven ◽  
...  
Keyword(s):  
Primary Care ◽  
Advance Care Planning ◽  
Care Planning ◽  
Barriers And Enablers ◽  
Advance Care

HUBUNGAN DUKUNGAN KELUARGA DENGAN KEPATUHAN MINUM OBAT PASIEN HIPERTENSI LANSIA DI WILAYAH KERJA PUSKESMAS SUNGAI CUKA KABUPATEN TANAH LAUT

2017 ◽  
Vol 1 (1) ◽  
pp. 62
Author(s):  
Yugo Susanto
Keyword(s):  
Blood Pressure ◽  
Medication Adherence ◽  
Family Support ◽  
Cross Sectional ◽  
High Category ◽  
The Family ◽  
Adherence Scale ◽  
Hypertension Therapy ◽  
Elderly Hypertensive ◽  
Cross Sectional Design

One of communicable diseases become very serious health problem was hypertension. The purpose of hypertension therapy was to control blood pressure in range of normal blood pressure, it is needed the adherence for hypertension therapy. The family supportcould improved healthy status. Patient with family support  feel that people care, so it could directed patient to improve their healthy lifestyle.The purpose of this study was to determine elderly family support, medication adherence in elderly hypertensive patients, and analyzedthe correlation between the family support with the adherence ension in elderly hypertension patients in Puskesmas Sungai Cuka Tanah Laut.This study was conducted with the cross sectional design in December 2014 until January 2015. Population was280the elderly patient in the region of  primary public health Sungai Cuka and 164 of them were used for sample. Data was collected by completion questionnaires family support and Morisky Modification Adherence Scale (MMAS)questionnaires. Data analysis was performed by gamma test with 95% confidence level.Based on the results, that Elderly who have family support by category 23.8% lower category, middle category were 64%, high category were 11.6%, and 0.6% were very high category. The adherence degree of elderly hypertension patientwere 45,7% low adherence degree, moderate adherence degreewere 36%, and high adherence degree were 18.3%. There were a correlation between the family support andthe medication adherence in elderly hypertension patients at Puskesmas Sungai Cuka Tanah Laut. (γ =0.295).

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