scholarly journals The challenge to define a relevant change in medication appropriateness index score in older adults – An approach

2020 ◽  
Vol 86 (2) ◽  
pp. 398-399
Author(s):  
Laura Krisch ◽  
Angelika Mahlknecht ◽  
Ulrike Bauer ◽  
Nadja Nestler ◽  
Georg Hempel ◽  
...  
Keyword(s):  
Older Adults ◽  
Index Score ◽  
Medication Appropriateness Index ◽  
Relevant Change ◽  
Medication Appropriateness

Reliability of a Modified Medication Appropriateness Index in Community Pharmacies

2003 ◽  
Vol 37 (1) ◽  
pp. 40-46
Author(s):  
Rosemin Kassam ◽  
Linda G Martin ◽  
Karen B Farris ◽  
Homero A Monsanto ◽  
Jean-Marie Kaiser
Keyword(s):  
Community Pharmacy ◽  
Interrater Reliability ◽  
Intraclass Correlation ◽  
Community Setting ◽  
Medication Appropriateness Index ◽  
Paired Samples ◽  
Psychometric Data ◽  
Ambulatory Patients ◽  
Pharmacy Setting ◽  
Medication Appropriateness

Background The medication appropriateness index (MAI) has demonstrated reliability in selected outpatient clinics where medical data were easily accessible from medical charts. However, its use in the community setting where patient data may be limited has not been examined. Objective To evaluate the usefulness of a modified MAI for use in the community pharmacy setting by testing interrater reliability using 3 different rating schemes. Methods Two raters evaluated 160 medications for 32 elderly ambulatory patients. Patient information was acquired using community pharmacist-collected medication histories. A summated MAI score, percent agreement, κ, positive agreement, negative agreement, and intraclass correlation coefficient were calculated for each criterion using 3 scoring schemes. A paired samples t-test (95% CI) was used to test interrater reliability. Results The κ statistics were >0.75 for indication and effectiveness, but good (0.41–0.66) for the remaining criteria using the Hanlon scoring scheme. The intraclass coefficients (0.82, 0.86, 0.87) and overall κ (0.65, 0.66, 0.61) were similar for the 3 schemes. Conclusions This study suggests that the modified MAI has the potential to detect medication appropriateness and inappropriateness in the community pharmacy setting; however, it is not without limitations. Because the MAI has the most clinimetric and psychometric data available, the instrument should be studied further to increase its reliability and generalizability.

Reliability of a modified medication appropriateness index in primary care

2005 ◽  
Vol 61 (10) ◽  
pp. 769-773 ◽  
Author(s):  
Lisbeth Bregnhøj ◽  
Steffen Thirstrup ◽  
Mogens Brandt Kristensen ◽  
Jesper Sonne
Keyword(s):  
Primary Care ◽  
Medication Appropriateness Index ◽  
Medication Appropriateness

scholarly journals Different Modulatory Effects of Cognitive Training and Aerobic Exercise on Resting State Functional Connectivity of Entorhinal Cortex in Community-Dwelling Older Adults

2021 ◽  
Vol 13 ◽  
Author(s):  
NanNan Gu ◽  
Hechun Li ◽  
Xinyi Cao ◽  
Ting Li ◽  
Lijuan Jiang ◽  
...  
Keyword(s):  
Older Adults ◽  
Aerobic Exercise ◽  
Cognitive Training ◽  
Training Group ◽  
Exercise Group ◽  
Community Dwelling ◽  
Index Score ◽  
Angular Gyrus ◽  
The Right ◽  
Left Angular Gyrus

The entorhinal cortex (EC) plays an essential role in age-related cognitive decline. However, the effect of functional connectivity (FC) changes between EC and other cerebral cortices on cognitive function remains unclear. The aim of this study was to explore the modulation of two interventions (cognitive training and aerobic exercise) on EC-FC in community-dwelling older adults. In total, 94 healthy older adults aged between 65 and 75 years were assigned to either the cognitive training or aerobic exercise group to receive 24 sessions over 12 weeks, or to a control group. Resting-state functional magnetic resonance imaging was performed at both baseline and 12-month follow-up. Compared to the cognitive training group, the aerobic exercise group showed greater EC-FC in the bilateral middle temporal gyrus, right supramarginal gyrus, left angular gyrus, and right postcentral gyrus. Compared to the control group, the cognitive training group had a decreased EC-FC in the right hippocampus, right middle temporal gyrus, left angular gyrus, and right postcentral gyrus and an increased EC-FC in the bilateral pallidum, while the aerobic exercise group showed increased EC-FC between the right medial prefrontal cortex(mPFC), bilateral pallidum, and right precuneus. Baseline EC-FC in the mPFC was positively correlated with the visuospatial/constructional index score of the Repeatable Battery for the Assessment of Neuropsychological Status. In the cognitive training group, EC-FC value changes in the right hippocampus were negatively correlated with changes in the RBANS delayed memory index score, while in the aerobic exercise group, EC-FC value changes in the left angular gyrus were positively correlated with changes in the RBANS attention index score. These findings support the hypothesis that both cognitive training and aerobic exercise can modulate EC-FC in aging populations but through different neural pathways.

Do Older Adults Have Social Lifestyles That Place Fewer Demands on Hearing?

2012 ◽  
Vol 23 (09) ◽  
pp. 697-711 ◽  
Author(s):  
Yu-Hsiang Wu ◽  
Ruth A. Bentler
Keyword(s):  
Older Adults ◽  
Social Network ◽  
Hearing Impairment ◽  
Age Groups ◽  
Sound Level ◽  
Index Score ◽  
Self Report ◽  
Daily Lives ◽  
Sound Levels ◽  
The Social

Background: Listening demand, or auditory lifestyle, is an important factor that needs to be considered when selecting a hearing aid and specific amplification features. Although elderly adults often report having fewer listening demands, auditory lifestyles of people in different age groups have not been objectively quantified and compared. Although it is assumed that the social lifestyles of older adults, e.g., retirement, place fewer demands on hearing, this assumption has not been examined empirically. Purpose: The purposes of the current study were to (1) objectively characterize and compare the auditory lifestyle of younger and older adults with hearing impairment and (2) examine the relationships between age, social lifestyle, and auditory lifestyle. Research Design: This is a nonexperimental study using a correlational design. Study Sample: Twenty-seven adults with bilateral hearing impairment aged 40–88 yr were recruited and served as subjects. Data Collection and Analysis: To objectively quantify auditory lifestyle, participants carried noise dosimeters to measure sound levels in their daily lives for 1 wk. To help interpret the dosimeter data, participants used paper-and-pencil journals to describe their listening activities and environments. The auditory lifestyle was also subjectively quantified by the Auditory Lifestyle and Demand Questionnaire (ALDQ). Three self-report inventories were used to characterize participants' social lifestyles: Social Network Index, Welin Activity Scale, and Social Convoy Questionnaire. Results: A total of 1,267 journal entries covering 2,032 hr of dosimeter recordings were obtained from participants for analyses. Although younger and older participants reported spending comparable time in a given category of listening event, the dosimeter-measured sound level was higher for younger listeners. For auditory lifestyle quantified by dosimeter, correlation analyses revealed that older age was associated with lower Social Network Index scores (smaller social networks) and fewer listening demands. Regression models further indicated that the Social Network Index score more accurately predicted listening demand than age. Finally, path analysis suggested that the effect of age on listening demand was mediated by the Social Network Index score. Self-report auditory lifestyle measured by the ALDQ was not associated with age and social lifestyle. Conclusions: The results indicate that older listeners tend to encounter quieter listening situations than younger listeners. The data are also consistent with the hypothesis that older adults have less active social lifestyles that place fewer demands on hearing. Therefore, the current study suggests the important role of social lifestyle in listening demand and the need to consider this factor in clinical management of hearing loss.

Weniger ist mehr – wie Polypharmazie vermeiden?

Praxis ◽  
2013 ◽  
Vol 102 (1) ◽  
pp. 21-27 ◽  
Author(s):  
Stefan Neuner-Jehle
Keyword(s):  
Decision Making ◽  
Shared Decision Making ◽  
Unerwünschte Arzneimittelwirkungen ◽  
Shared Decision ◽  
Medication Appropriateness Index ◽  
Medication Appropriateness

Wie schützen wir Gesunde vor dem Schaden durch medizinische Interventionen? Wie vermeiden wir bei polymorbiden, älteren Patienten Interaktionen und unerwünschte Arzneimittelwirkungen, bedingt durch eine Vielzahl gleichzeitig eingesetzter Medikamente? Handlungsbedarf ist gegeben, haben Patienten mit Polypharmazie doch ein erhöhtes Risiko für Morbidität, Hospitalisation, Pflegeheimeintritt und Tod. Wir stellen validierte Instrumente (Beers-Liste, PRISCUS-Liste) und Strategien (Medication Appropriateness Index, Good Palliative Geriatric Practice) vor, die diese Aufgabe erleichtern können. Die Reduktion von Medikamentenlisten ist anspruchsvoll, (noch) ungewohnt und muss gemeinsam mit dem Patienten («shared decision making») vorgenommen werden. Unter- und Fehlbehandlungen sind dabei zu beachten und zu vermeiden. Patientinnen und Patienten können in sehr erheblichem Ausmass von einer reduzierten Medikamentenliste profitieren: Weniger ist mehr!

Therapeutic futility in cancer patients at the time of palliative care transition: An analysis with a modified version of the Medication Appropriateness Index

2015 ◽  
Vol 29 (7) ◽  
pp. 643-651 ◽  
Author(s):  
Duarte Domingues ◽  
Rui Carneiro ◽  
Isabel Costa ◽  
Carolina Monteiro ◽  
Yulyia Shvetz ◽  
...  
Keyword(s):  
Palliative Care ◽  
Cancer Patients ◽  
Care Transition ◽  
Medication Appropriateness Index ◽  
Medication Appropriateness

scholarly journals Medication-Related Factors and Hospital Readmission in Older Adults with Chronic Kidney Disease

2019 ◽  
Vol 8 (3) ◽  
pp. 395 ◽  
Author(s):  
Wubshet H. Tesfaye ◽  
Gregory M. Peterson ◽  
Ronald L. Castelino ◽  
Charlotte McKercher ◽  
Matthew Jose ◽  
...  
Keyword(s):  
Older Adults ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Hospital Readmission ◽  
Hospital Readmissions ◽  
Medication Regimen ◽  
Related Factors ◽  
Medication Regimen Complexity ◽  
Regimen Complexity ◽  
Medication Appropriateness

This study aimed to examine the association between medication-related factors and risk of hospital readmission in older patients with chronic kidney disease (CKD). A retrospective analysis was conducted targeting older CKD (n = 204) patients admitted to an Australian hospital. Medication appropriateness (Medication Appropriateness Index; MAI), medication regimen complexity (number of medications and Medication Regimen Complexity Index; MRCI) and use of selected medication classes were exposure variables. Outcomes were occurrence of readmission within 30 and 90 days, and time to readmission within 90 days. Logistic and Cox hazards regression were used to identify factors associated with readmission. Overall, 50 patients (24%) were readmitted within 30 days, while 81 (40%) were readmitted within 90 days. Mean time to readmission within 90 days was 66 (SD 34) days. Medication appropriateness and regimen complexity were not independently associated with 30- or 90-day hospital readmissions in older adults with CKD, whereas use of renin‒angiotensin blockers was associated with reduced occurrence of 30-day (adjusted OR 0.39; 95% CI 0.19–0.79) and 90-day readmissions (adjusted OR 0.45; 95% CI 0.24–0.84) and longer time to readmission within 90 days (adjusted HR 0.52; 95% CI 0.33–0.83). This finding highlights the importance of considering the potential benefits of individual medications during medication review in older CKD patients.

scholarly journals A systematic overview of systematic reviews evaluating interventions addressing polypharmacy

2019 ◽  
Vol 76 (21) ◽  
pp. 1777-1787 ◽  
Author(s):  
Laura J Anderson ◽  
Jeffrey L Schnipper ◽  
Teryl K Nuckols ◽  
Rita Shane ◽  
Catherine Sarkisian ◽  
...  
Keyword(s):  
Older Adults ◽  
Systematic Reviews ◽  
Patient Centered ◽  
Assessment Development ◽  
Cochrane Database ◽  
Evidence Quality ◽  
Overview Of Systematic Reviews ◽  
Grade Methodology ◽  
The Impact ◽  
Medication Appropriateness

Abstract Purpose To systematically evaluate and summarize evidence across multiple systematic reviews (SRs) examining interventions addressing polypharmacy. Summary MEDLINE, the Cochrane Database of Systematic Reviews, and the Database of Abstracts of Reviews of Effects (DARE) were searched for SRs evaluating interventions addressing polypharmacy in adults published from January 2004 to February 2017. Two authors independently screened, appraised, and extracted information. SRs with Assessment of Multiple Systematic Reviews (AMSTAR) scores below 8 were excluded. After extraction of relevant conclusions from each SR, evidence was summarized and conclusions compared. Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology was used to assess evidence quality. Six SRs met the inclusion criteria, 4 of which used meta-analytic pooling. Five SRs focused on older adults. Four were not restricted to any specific disease type, whereas 1 focused on proton pump inhibitors and another focused on patients with severe dementia. Care settings and measured outcomes varied widely. SRs examining the impact on patient-centered outcomes, including morbidity, mortality, patient satisfaction, and utilization, found inconsistent evidence regarding the benefit of polypharmacy interventions, but most concluded that interventions had either null or uncertain impact. Two SRs assessing medication appropriateness found very low-quality evidence of modest improvements with polypharmacy interventions. Conclusion An overview of SRs of interventions to address polypharmacy found 6 recent and high-quality SRs, mostly focused on older adults, in which both process and outcome measures were used to evaluate interventions. Despite the low quality of evidence in the underlying primary studies, both SRs that assessed medication appropriateness found evidence that polypharmacy interventions improved it. However, there was no consistent evidence of any impact on downstream patient-centered outcomes such as healthcare utilization, morbidity, or mortality.

scholarly journals Medication Appropriateness in Vulnerable Older Adults: Healthy Skepticism of Appropriate Polypharmacy

2019 ◽  
Vol 67 (6) ◽  
pp. 1123-1127 ◽  
Author(s):  
Terri R. Fried ◽  
Marcia C. Mecca
Keyword(s):  
Older Adults ◽  
Medication Appropriateness
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