scholarly journals The effect of pharmacist-led interventions in optimising prescribing in older adults in primary care: A systematic review

2016 ◽  
Vol 4 ◽  
pp. 205031211665256 ◽  
Author(s):  
David O Riordan ◽  
Kieran A Walsh ◽  
Rose Galvin ◽  
Carol Sinnott ◽  
Patricia M Kearney ◽  
...  
Keyword(s):  
Older Adults ◽  
Primary Care ◽  
Inappropriate Prescribing ◽  
Community Dwelling ◽  
Controlled Trials ◽  
Potentially Inappropriate Medications ◽  
Potentially Inappropriate Prescribing ◽  
Randomised Controlled ◽  
Community Dwelling Older Adults

Objective: To evaluate studies of pharmacist-led interventions on potentially inappropriate prescribing among community-dwelling older adults receiving primary care to identify the components of a successful intervention. Data sources: An electronic search of the literature was conducted using the following databases from inception to December 2015: PubMed, Embase, Cumulative Index to Nursing and Allied Health Literature, MEDLINE (through Ovid), Trip, Centre for Reviews and Dissemination databases, Cochrane Database of Systematic Reviews, ISI Web of Science, ScienceDirect, ClinicalTrials.gov , metaRegister of Controlled Trials, ProQuest Dissertations & Theses Database (Theses in Great Britain, Ireland and North America). Review methods: Studies were included if they were randomised controlled trials or quasi-randomised studies involving a pharmacist-led intervention compared to usual/routine care which aimed to reduce potentially inappropriate prescribing in older adults in primary care. Methodological quality of the included studies was independently assessed. Results: A comprehensive literature search was conducted which identified 2193 studies following removal of duplicates. Five studies met the inclusion criteria. Four studies involved a pharmacist conducting a medication review and providing feedback to patients or their family physician. One randomised controlled trial evaluated the effect of a computerised tool that alerted pharmacists when elderly patients were newly prescribed potentially inappropriate medications. Four studies were associated with an improvement in prescribing appropriateness. Conclusion: Overall, this review demonstrates that pharmacist-led interventions may improve prescribing appropriateness in community-dwelling older adults. However, the quality of evidence is low. The role of a pharmacist working as part of a multidisciplinary primary care team requires further investigation to optimise prescribing in this group of patients.

Continue Or Not To Continue? Attitudes Towards Deprescribing Among Community- Dwelling Older Adults In China

2021 ◽  
Author(s):  
Jie Tan ◽  
MinHong Wang ◽  
XiaoRui Pei ◽  
Quan Sun ◽  
ChongJun Lu ◽  
...  
Keyword(s):  
Older Adults ◽  
Chronic Disease ◽  
Inappropriate Prescribing ◽  
Prescription Medication ◽  
Adverse Outcomes ◽  
Community Dwelling ◽  
Potentially Inappropriate Medications ◽  
Cross Sectional ◽  
Wide Range ◽  
Community Dwelling Older Adults

Abstract Background: Inappropriate prescribing of medications and polypharmacy among older adults are associated with a wide range of adverse outcomes. It is critical to understand the attitudes towards deprescribing—reducing the use of potentially inappropriate medications (PIMs)—among this vulnerable group. Such information is particularly lacking in low - and middle-income countries.Methods: The present study examined attitudes towards deprescribing and individual-based characteristics that might be associated with these attitudes among community-dwelling older adults in China. We conducted a cross-sectional study through in-person interviews using the Patients' Attitudes Towards Deprescribing (PATD) and the revised PATD (rPATD) (version for older adults) questionnaires in two communities through the community-based physical examination platform in China. Participants were 65 years and older and had at least one chronic disease and one regular prescription medication.Results: Of the 1,897 participants in this study, average age was 73.8 years (SD=6.2 years) and 1,023 (53.9%) were women. The majority had one chronic disease (n=1,364 [71.9%]) and took 1-2 medications (n=1,483 [78.2%]). A total of 947 (50.0%) older adults reported being willing to stop taking one or more of their medicines if their physician said it was possible, and 1,204 (63.5%) older adults wanted to stop a medicine been taking for a long time. We did not find Individual-level factors to be associated with attitudes towards deprescribing. Conclusions: The proportions of participants’ willingness to deprescribing were much lower than what prior investigations among western populations reported. It is important to identify the reasons for the low wiliness to deprescribe and develop a patient-centered and practical deprescribing guideline that is suitable for Chinese older adults.

scholarly journals What Works to Prevent Falls in Community-Dwelling Older Adults? Umbrella Review of Meta-analyses of Randomized Controlled Trials

2015 ◽  
Vol 95 (8) ◽  
pp. 1095-1110 ◽  
Author(s):  
Brendon Stubbs ◽  
Simone Brefka ◽  
Michael D. Denkinger
Keyword(s):  
Older Adults ◽  
Methodological Quality ◽  
Community Dwelling ◽  
Falls Prevention ◽  
Controlled Trials ◽  
Umbrella Review ◽  
Randomized Controlled ◽  
Meta Analyses ◽  
Community Dwelling Older Adults

Background Preventing falls is an international priority. There is a need to synthesize the highest-quality falls prevention evidence in one place for clinicians. Purpose The aim of this study was to conduct an umbrella review of meta-analyses of randomized controlled trials (RCTs) of falls prevention interventions in community-dwelling older adults. Data Sources The MEDLINE, EMBASE, CINAHL, AMED, BNI, PsycINFO, Cochrane Library, PubMed, and PEDro databases were searched. Study Selection Meta-analyses with one pooled analysis containing ≥3 RCTs that investigated any intervention to prevent falls in community-dwelling older adults aged ≥60 years were eligible. Sixteen meta-analyses, representing 47 pooled analyses, were included. Data Extraction Two authors independently extracted data. Data Synthesis Data were narratively synthesized. The methodological quality of the meta-analyses was moderate. Three meta-analyses defined a fall, and 3 reported adverse events (although minor). There is consistent evidence that exercise reduces falls (including the rate, risk, and odds of falling), with 13/14 pooled analyses (93%) from 7 meta-analyses demonstrating a significant reduction. The methodological quality of meta-analyses investigating exercise were medium/high, and effect sizes ranged from 0.87 (relative risk 95% confidence interval=0.81, 0.94; number of studies=18; number of participants=3,568) to 0.39 (rate ratio 95% confidence interval=0.23, 0.66; number of meta-analyses=6). There is consistent evidence that multifactorial interventions reduce falls (5/6, 83% reported significant reduction). There is conflicting evidence regarding the influence of vitamin D supplementation (7/12, 58.3% reported significant reduction). Limitations Meta-analyses often used different methods of analysis, and reporting of key characteristics (eg, participants, heterogeneity, publication bias) was often lacking. There may be some overlap among included meta-analyses. Conclusions There is consistent evidence that exercise and individually tailored multifactorial interventions are effective in reducing falls in community-dwelling older adults.

scholarly journals Continue or not to continue? Attitudes towards deprescription among community-dwelling older adults in China

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 836-837
Author(s):  
Jie Tan ◽  
Chenkai Wu ◽  
Li Zhang ◽  
Ying Wang ◽  
Lihui Chen
Keyword(s):  
Older Adults ◽  
Chronic Disease ◽  
Inappropriate Prescribing ◽  
Prescription Medication ◽  
Cross Sectional Study ◽  
Community Dwelling ◽  
Potentially Inappropriate Medications ◽  
Cross Sectional ◽  
Individual Level ◽  
Community Dwelling Older Adults

Abstract Inappropriate prescribing of medications and polypharmacy among older adults could lead to avoidable harms. It is hence vital to stop potentially inappropriate medications in this vulnerable group. An approach coined ‘deprescribing’ has been used to describe a patient-centerd process of optimizing medication regimens. But patient resistance to discontinuing medication use is a significant barrier to deprescribing. The present study aims to describe attitudes towards deprescribing and to examine individual-based characteristics that might be associated with these attitudes among community-dwelling older adults in China. We conducted a cross-sectional study through in-person interviews using the validated Patients’ Attitudes Towards Deprescribing questionnaire in two communities through the community-based physical examination platform. Participants were 65 years and older and had at least one chronic disease and one regular prescription medication. Of the 1,897 participants in the study, the average age was 74 years and 1,023 (53.9%) were women. The majority had one chronic disease (n=1,364 [71.9%]) and took 1-2 medications (n=1,483 [78.2%]). A total of 947 (50.0%) older adults reported being willing to stop taking one or more of their medicines if their physician said it was possible, and 1204 (63.5%) older adults wanted to stop a medicine been taking for a long time. Chronological age, marital status, number of chronic diseases, and self-rated health status were associated with the attitudes towards deprescribing. This study showed that half of the participants were willing to cease a medication that their physician though was no longer required. Individual-level factors were associated with attitudes towards deprescribing.

scholarly journals Related Factors and Clinical Outcomes of Osteosarcopenia: A Narrative Review

Nutrients ◽  
2021 ◽  
Vol 13 (2) ◽  
pp. 291
Author(s):  
Tatsuro Inoue ◽  
Keisuke Maeda ◽  
Ayano Nagano ◽  
Akio Shimizu ◽  
Junko Ueshima ◽  
...  
Keyword(s):  
Older Adults ◽  
Longitudinal Studies ◽  
Clinical Outcomes ◽  
Daily Living ◽  
Community Dwelling ◽  
Related Factors ◽  
Cross Sectional ◽  
Meta Analyses ◽  
Community Dwelling Older Adults

Osteopenia/osteoporosis and sarcopenia are common geriatric diseases among older adults and harm activities of daily living (ADL) and quality of life (QOL). Osteosarcopenia is a unique syndrome that is a concomitant of both osteopenia/osteoporosis and sarcopenia. This review aimed to summarize the related factors and clinical outcomes of osteosarcopenia to facilitate understanding, evaluation, prevention, treatment, and further research on osteosarcopenia. We searched the literature to include meta-analyses, reviews, and clinical trials. The prevalence of osteosarcopenia among community-dwelling older adults is significantly higher in female (up to 64.3%) compared to male (8–11%). Osteosarcopenia is a risk factor for death, fractures, and falls based on longitudinal studies. However, the associations between osteosarcopenia and many other factors have been derived based on cross-sectional studies, so the causal relationship is not clear. Few studies of osteosarcopenia in hospitals have been conducted. Osteosarcopenia is a new concept and has not yet been fully researched its relationship to clinical outcomes. Longitudinal studies and high-quality interventional studies are warranted in the future.

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