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.

scholarly journals Important Design Features of Personal Health Records to Improve Medication Adherence for Patients with Long-Term Conditions: Protocol for a Systematic Literature Review (Preprint)

2018 ◽  
Author(s):  
Elisavet Andrikopoulou ◽  
Philip James Scott ◽  
Helena Herrera
Keyword(s):  
Medication Adherence ◽  
Literature Review ◽  
Systematic Literature Review ◽  
Personal Health Records ◽  
Personal Health ◽  
Improve Medication Adherence ◽  
Long Term Conditions ◽  
Health Records ◽  
Important Design

BACKGROUND The National Health Service (NHS) England spent £15.5 billion on medication in 2015. More than a third of patients affected by at least one long-term condition do not adhere to their drug regime. Many interventions have been trialed to improve medication adherence. One promising innovation is the electronic personal health record. OBJECTIVE This systematic literature review aims to identify the important design features of personal health records to improve medication adherence for patients with long-term conditions. METHODS This protocol follows the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocol (PRISMA-P 2015) statement. The following databases will be searched for relevant articles: PubMed, Science Direct, BioMed Central, Cumulative Index to Nursing and Allied Health Literature, Cochrane Database of Systematic Reviews, and the Cochrane Central Register of Controlled Trials. Studies published in the last fifteen years, in English, will be included if the participants are adults who were treated outside the hospital, have the ability to self-administer their medication, and have at least one long-term condition. The review will exclude commercial or political sources and papers without references. Papers that research pediatrics, pregnant, or terminally ill patients will also be excluded, since their medication management is typically more complex. RESULTS One reviewer will screen the included studies, extract the relevant data, and assess the quality of evidence utilizing the Grading of Recommendations Assessment, Development, and Evaluation system and the risk of bias using the Cochrane RevMan tool. The second reviewer will assess the quality of 25% of the included studies to assess interrater agreement. Any disagreement will be solved by a third reviewer. Only studies of high and moderate quality will be included for narrative synthesis. CONCLUSIONS NHS policy assumes that increasing usage of personal health records by citizens will reduce demand on health care services. There is limited evidence, however, that the use of health apps can improve patient outcomes, and, to our knowledge, this is the first systematic literature review aiming to identify important design features of the personal health record which may improve medication adherence in the adult population with long-term conditions. CLINICALTRIAL PROSPERO CRD42017060542; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=60542 (Archived by WebCite at http://www.webcitation.org/6zeuWXxVh) REGISTERED REPORT IDENTIFIER RR1-10.2196/9778

scholarly journals What are the important design features of personal health records to improve medication adherence for patients with long-term conditions? A systematic literature review

BMJ Open ◽  
2019 ◽  
Vol 9 (9) ◽  
pp. e028628 ◽  
Author(s):  
Elisavet Andrikopoulou ◽  
Philip Scott ◽  
Helena Herrera ◽  
Alice Good
Keyword(s):  
Medication Adherence ◽  
Risk Of Bias ◽  
Personal Health ◽  
Design Features ◽  
Improve Medication Adherence ◽  
Long Term Conditions ◽  
Quality Of Evidence ◽  
Important Design

ObjectivesThis systematic literature review aims to identify important design features of the electronic personal health record (PHR) that may improve medication adherence in the adult population with long-term conditions.Data sourcesPubMed (including MEDLINE), CINAHL, Science Direct (including EMBASE), BioMed Central, ACM digital, Emerald Insight, Google Scholar and Research Gate.MethodsStudies that were published between 1 January 2002 and 31 May 2018 in English were included if the participants were adults, with at least one long-term condition, were able to self-administer their medication and were treated in primary care settings. The quality of evidence was assessed with the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system and the risk of bias was appraised using the Cochrane risk of bias tool.ResultsFrom a total of 27 studies that matched the inclusion criteria, 12 were excluded due to low quality of evidence, 10 were rated moderate and 5 were rated high quality. All the included studies had low sample size and limited follow-up duration. Thirteen of the included studies found that the use of a PHR has increased medication adherence. The identified design features are reminders, education, personalisation and tailoring, feedback and alerts, gamification, medication management, medical appointment management, diary and self-monitoring, health condition management, set goals, patient’s blog and tethered. It was impossible to draw conclusions as to which feature is important to what group of patients and why. The most frequently identified conditions were HIV and diabetes. This review did not identify any papers with negative results. It was not possible to numerically aggregate the PHR effect due to high heterogeneity of the medication adherence measurement, study type, participants and PHRs used.ConclusionAlthough we found recurrent evidence that PHRs can improve medication adherence, there is little evidence to date to indicate which design features facilitate this process.PROSPERO registration numberCRD42017060542.

scholarly journals Establishing an evidence base for adapting social housing for an ageing population

2016 ◽  
Vol 21 (2) ◽  
pp. 137-159 ◽  
Author(s):  
Frank Boyle ◽  
Craig Thomson
Keyword(s):  
Older People ◽  
Social Housing ◽  
Local Authority ◽  
Housing Stock ◽  
Evidence Base ◽  
Lead Author ◽  
Ageing Population ◽  
Theory Approach ◽  
Content Type ◽  
Information Gap

Purpose Prolonged life expectancy coupled with the retirement of the “post war baby boomers” has resulted in an exponential rise in the 50+ population, peaking in the UK in 2035. Recognising that longevity is often not accompanied by health, mobility or quality of life, the “shifting the balance of care” agenda promotes an integrated care model based around the resident’s home. This study aims to explore the adaptability of the existing social housing stock and how it relates to the requirements and preferences of the ageing population. Design/methodology/approach This research focuses at the local authority level, with the lead author embedded within North Ayrshire Council to establish the evidence base for their housing strategy for older people. Following a constructivist grounded theory approach, key themes emerge through consultation with a working group, wider stakeholder groups and an iterative review of policy and literature. These themes were explored through an evidence base of available health and housing datasets, and a questionnaire survey of 1,500+ people aged 50+ exploring housing preferences and needs for older people; six focus groups split between residents and social housing providers and stakeholder interviews. Findings The scale and acute nature of the problem facing social housing providers is highlighted and reveals an alarming information gap within housing data sets, exposing an in-balance between the supply and demand and realising the cost implications for adapting the housing stock. Practical implications It is important to resolve this information gap to develop the social housing stock to respond to preferences and establish solutions appropriate for its residents. Originality/value This work strengthens calls for a cohesive and integrated housing, health and social care system and exposes the challenge of delivering this at a local authority level.

scholarly journals Introduction: Themed Section on the Costs of Long-Term Care for Older People

2007 ◽  
Vol 6 (3) ◽  
pp. 349-351
Author(s):  
Alison Bowes
Keyword(s):  
Older People ◽  
Evidence Base ◽  
Royal Commission ◽  
Ageing Population ◽  
Term Care ◽  
Alternative Funding ◽  
Care Services ◽  
Care And Support ◽  
History Of ◽  
The Impact

Cost has long been a preoccupation in policy documents concerned with the care and support of older people (Means and Smith, 1998; Royal Commission, 1999). A history of moral panic about the ageing population coupled with a stereotype of older people as a dependent and ‘unproductive’ sector of society have combined to produce negatively focused debate, lacking in evidential support. Most recently, Wanless (2006) has highlighted the limitations of the evidence base and the narrowness of debate concerning the provision of social care services, arguing both for more informed debate and for consideration of the impact of developments in services and alternative funding models.

Advance care planning for an ageing population

2018 ◽  
Author(s):  
Martin J. Vernon
Keyword(s):  
Older People ◽  
Advance Care Planning ◽  
Later Life ◽  
Ageing Population ◽  
Care Planning ◽  
Long Term Conditions ◽  
Health Decline ◽  
People With Dementia ◽  
Increased Risk ◽  
Advance Care

Population ageing is driven by declining fertility and improved life expectancy. As people survive to later life with multiple long-term conditions, advance care planning ACP) is of increasing importance to those wishing to retain control over their end-of-life care. Understanding disability trajectories for people can assist with advance care planning, mindful that older people living with frailty have increased risk of acute and unexpected health decline. Routine frailty identification by severity in older people can prompt care planning in anticipation of health decline and imminent lost capacity to make important decisions. Recognizing potential professional and organizational barriers to advance carer planning for older people could also improve its uptake. Guided serious illness conversations could assist this process over time for older people and those important to them. In care homes and among people with dementia ACP is also likely to be beneficial.

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.

Sign in / Sign up

Export Citation Format

Share Document