scholarly journals Drug therapy, potential interactions and iatrogenesis as factors related to frailty in the elderly

2018 ◽  
Vol 21 (5) ◽  
pp. 588-596 ◽  
Author(s):  
Andressa Rodrigues Pagno ◽  
Carolina Baldissera Gross ◽  
Daiana Meggiolaro Gewehr ◽  
Christiane de Fátima Colet ◽  
Evelise Moraes Berlezi
Keyword(s):  
Drug Therapy ◽  
Drug Interactions ◽  
Inappropriate Medication ◽  
The Elderly ◽  
Potentially Inappropriate Medication ◽  
Potentially Inappropriate Medications ◽  
Elderly Persons ◽  
Potential Drug ◽  
Increased Risk ◽  
Inappropriate Medications

Abstract Objective: to investigate the use of drugs, potential drug interactions and iatrogenesis, as factors associated with frailty. Method: an observational, cross-sectional, population-based study of elderly persons registered with the Family Health Strategies of the urban area of a municipal region in the south of Brazil was carried out. The sample was probabilistic and involved 554 elderly persons; and the proportional stratified sampling technique by FHS and gender was used. Data collection was performed in the home, with the gathering of information regarding sociodemographic characteristics and pharmacotherapeutic profile and the evaluation of frailty based on Fried et al. (2001). Results: medications were taken by 86.3% of the elderly and there was a prevalence of frailty of 63.0%. A total of 39.4% of the elderly were exposed to polypharmacy, 49.1% used potentially inappropriate medications and 52.2% were exposed to potential drug interactions, the most frequent being enalapril and metformin. An association between increased risk of frailty and the variables: polypharmacy; use of potentially inappropriate medications; potential drug interactions; more than two potential drug interactions with the presence or absence of potentially inappropriate medication was identified. Conclusion: an association was found between frailty and polypharmacy, the use of potentially inappropriate medication and the presence of drug interactions. The findings underscore the importance of the monitoring of drug therapy in this population group with a view to the early detection, prevention and resolution of iatrogenesis arising from the use of medicines.

scholarly journals Analysis of potential drug interactions and adverse reactions to nonsteroidal anti-inflammatory drugs among the elderly

2016 ◽  
Vol 19 (3) ◽  
pp. 533-544 ◽  
Author(s):  
Tiago Aparecido Maschio de Lima ◽  
Adriana Antônia da Cruz Furini ◽  
Tábata Salum Calille Atique ◽  
Patricia Di Done ◽  
Ricardo Luiz Dantas Machado ◽  
...  
Keyword(s):  
Drug Interactions ◽  
Prescription Drugs ◽  
Adverse Reactions ◽  
Drug Distribution ◽  
The Elderly ◽  
Elderly Persons ◽  
Potential Drug ◽  
Increased Risk ◽  
Chi Squared ◽  
Elderly Users

Abstract Objective: The aim of the present study was to analyze potential drug interactions and adverse reactions to NSAIDs in elderly users of a private drug distribution service. Method: A prospective, exploratory and descriptive study with a quantitative approach was performed. The elderly users of NSAIDs attended by the service were interviewed and their prescriptions analyzed between May and September, 2014. Analysis of drug interactions was performed through computerized databases. The post-sales analysis of adverse reactions was performed using the Adverse Drug Reaction Probability Scale. Statistical analysis was performed with the Chi-squared and Fisher's Exact tests. Results: The study evaluated 200 elderly persons, among whom women predominated (56.5%). The average age was 65 years ±10. The NSAIDs accounted for 38.7% of prescription drugs used, and included dipyrone (26.9%), nimesulide (22.8%) and ketoprofen (16.3%). A total of 8.5% of such drugs were considered inappropriate medications for the elderly. A total of 104 potential drug interactions were identified, of which 24% were considered highly clinically significant. The NSAIDs with the greatest risk of interactions were ketoprofen 46.2%, ketorolac 14.4%, nimesulide 12.5% and diclofenac 9.6%. In post-sales monitoring 30.5% of the elderly persons reported undesirable symptoms after the use of NSAIDs, with stomach discomfort the most prevalent (17%). Conclusion: The present study confirmed the importance of monitoring the use of NSAIDs among the elderly due to the increased risk of drug interactions and adverse reactions associated with age, concomitant diseases, multi- prescriptions and polypharmacy. The choice of appropriate drugs for the elderly, the reconciliation of all the medications taken by the patient, and effective pharmaceutical care are measures that can contribute to the rational and safe use of NSAIDs.

Study on medication prescription in the elderly population: benzodiazepine use and potential drug interactions

2021 ◽  
Author(s):  
Mariana Macedo Alvim ◽  
Danielle Teles da Cruz ◽  
Glenda de Almeida Aquino ◽  
Isabel Cristina Gonçalves Leite
Keyword(s):  
Drug Interactions ◽  
Elderly People ◽  
Elderly Population ◽  
Inappropriate Medication ◽  
The Elderly ◽  
Community Dwelling ◽  
Elderly Persons ◽  
Potential Drug ◽  
Elderly Individuals ◽  
Benzodiazepine Use

Abstract Background Prescription of medications for elderly individuals is complex, potentially involving polypharmacy, drug interactions, and inappropriate medication. Notable among the medications are benzodiazepines, whose long-term use is common and growing among the elderly population. Objective This study aimed to evaluate the occurrence of potential drug interactions (PDI) in elderly community-dwelling patients who use benzodiazepines. Method Cross-sectional study, conducted via household survey, with 73 elderly persons in Juiz de Fora, MG, Brazil. The search and classification of PDIs was carried out using the Micromedex® system. Results The prevalence of benzodiazepine use in this population was 18.3% (95% CI, 15.2-21.6). The use of benzodiazepines was associated with polypharmacy (p<0.01; PR 3.03; 95% CI, 1.79-5.26). A total of 157 PDI occurrences were found in 69.9% of the elderly people assessed. Of these, 25 were related to benzodiazepines. In the elderly individuals who use benzodiazepines, polypharmacy was associated with PDI (p<0.01; PR = 16.13; 95% CI, 4.67-55.55). PDI occurrence was high in the elderly people who use benzodiazepines, including interactions of highly significant clinical value. Conclusion In general, PDI is associated with polypharmacy, which demonstrates the need to rationalize drug use in the elderly population through continuous monitoring, seeking the simplest and safest possible therapeutic regimen.

scholarly journals Potential drug interactions and inappropriate medications prescribed for primary health care users

2020 ◽  
Vol 11 (2) ◽  
pp. 0365
Author(s):  
Rafaela S. ROCHA ◽  
Luanna G. SILVA ◽  
Máyra R. FERNANDES ◽  
Roberta C. FIGUEIREDO ◽  
André O. BALDONI
Keyword(s):  
Primary Care ◽  
Drug Interactions ◽  
The Elderly ◽  
Inappropriate Drug ◽  
Potentially Inappropriate Medications ◽  
Potential Drug ◽  
Beers Criterion ◽  
Inappropriate Drugs ◽  
Pharmacological Interactions ◽  
Inappropriate Medications

Objectives: To analyze potential pharmacological interactions and drugs potentially inappropriate for the elderly in users of primary care of the Unified Health System. Methods: This is a cross-sectional study with individuals aged 18 years or over, who were approached at the health facilities of the city of Divinópolis, MG, at which time a home visit was scheduled. A structured questionnaire on drug use was applied and drug interactions were analyzed in Drugs.com® sources, Micromedex®, bulletin of the Brazilian Health Regulatory Agency (ANVISA). Only the frequencies of serious interactions were analyzed. Potentially inappropriate drugs for elderly people (MPI) were identified by the Beers Criterion (2015) and the Brazilian Consensus on Potentially Inappropriate Medications for the Elderly (2016). The Mann-Whitney test was performed to compare the medians of the analyzed variables. Results: Among the study participants, 55% were elderly. Comparing them with the adult population, it was observed that the number of medications and potential drug interactions were significantly higher (p <0.05) among patients 60 years of age or older. Considering only the elderly, 77.3% used at least one MPI, according to the Beers Criterion. Conclusion: It was found that the vast majority of primary care users use at least one inappropriate drug and, when compared to adults, are more exposed to polypharmacy and potential drug interactions.

scholarly journals Use of potentially inappropriate medications among ambulatory home-dwelling elderly patients with dementia: A review of the literature

2017 ◽  
Vol 150 (3) ◽  
pp. 169-183 ◽  
Author(s):  
Tejal Patel ◽  
Karen Slonim ◽  
Linda Lee
Keyword(s):  
Older Adults ◽  
Cognitive Impairment ◽  
Adverse Events ◽  
Inappropriate Medication ◽  
Medication Use ◽  
Adverse Outcomes ◽  
Potentially Inappropriate Medication ◽  
Potentially Inappropriate Medications ◽  
Inappropriate Medication Use ◽  
Inappropriate Medications

Background: Older adults with dementia are at high risk for drug-related adverse outcomes. While much is known about potentially inappropriate medication use in older adults, its prevalence and characteristics among those with dementia are not as well elucidated. We conducted a literature review to examine the prevalence of potentially inappropriate medication use among home-dwelling older adults with dementia. Our secondary aim was to determine the most frequently implicated medications and factors associated with potentially inappropriate medication use. Methods: MEDLINE, EMBASE, CINAHL, and International Pharmaceutical Abstracts were searched between 1946 and 2014 for articles that referenced potentially inappropriate medication use and types of dementia. One reviewer screened all titles and abstracts from the initial search and full-text articles after the initial screen for eligibility, then 2 reviewers independently abstracted data from included studies. Results: Searches yielded 81 articles, of which 7 met inclusion criteria. Prevalence of potentially inappropriate medication use varied from 15% to 46.8%. No single drug or drug class was reported consistently across all studies as the most frequent potentially inappropriate medication, but anticholinergics and benzodiazepines, drugs that affect cognition, were among the most common medications or pharmacological classes listed. Discussion: Older adults with dementia may be particularly vulnerable to potentially inappropriate medications because of cognitive impairment from their condition and the greater likelihood of experiencing adverse events from medications. Given this population’s greater susceptibility to adverse events, more intense medication and patient monitoring may be warranted, especially among those taking anticholinergics and benzodiazepines, as these drugs can contribute to cognitive impairment.

scholarly journals Inappropriate Medication Use In Older Adults According To Beers Criteria In A Tertiary Referral Hospital, In Bolu, Turkey

2021 ◽  
Vol 10 (2) ◽  
Author(s):  
Burcin M. Atak ◽  
Gulali Aktas ◽  
Tuba T. Duman ◽  
Ozge Kurtkulagi ◽  
Satilmis Bilgin ◽  
...  
Keyword(s):  
Older Adults ◽  
Inappropriate Medication ◽  
Bleeding Risk ◽  
Beers Criteria ◽  
Potentially Inappropriate Medications ◽  
Tertiary Referral Hospital ◽  
Inappropriate Use ◽  
Increased Risk ◽  
Risk Of Falls ◽  
Inappropriate Medications

Aims — We aimed to study the medications used by older adults for any potentially inappropriate medications. Material and Methods — A hundred and four consecutive subjects over 65 years of age who visited our clinic were enrolled in the study. Possible inappropriate medications were defined according to Beers Criteria. Results — A total of 57 women and 49 men were enrolled in the study. Mean ages of the women and men were 78.6±6.1 years and 77.4±5.4 years, respectively (p=0.30). While 18 subjects (17%) had no increased risk due to inappropriate use of medications, 30 were on inappropriate medications that increased renal failure risk, 5 were on inappropriate medication that amplified neurological side effects, 12 were on inappropriate medications that augmented bleeding risk, 20 were on inappropriate medication that lack safety and efficacy data, and 30 were on inappropriate medication that amplified the risk of falls. The number of increased risks according to Beers Criteria was significantly and positively correlated with number of medications used (r=0.366, p<0.001) and the number of comorbidities (r=0.312, p=0.001). Conclusion — The number of increased risks due to inappropriate use of medicines in older adults is positively correlated with the number of medicines used and the number of accompanied diseases. Therefore we suggest that the medicines used by older people should be reviewed in all settings, and unnecessary drugs should be avoided to be prescribed.

scholarly journals Polypharmacy among Underserved Older African American Adults

2017 ◽  
Vol 2017 ◽  
pp. 1-8 ◽  
Author(s):  
Mohsen Bazargan ◽  
James Smith ◽  
Masoud Movassaghi ◽  
David Martins ◽  
Hamed Yazdanshenas ◽  
...  
Keyword(s):  
African American ◽  
Inappropriate Medication ◽  
Medication Use ◽  
Community Dwelling ◽  
Potentially Inappropriate Medication ◽  
Inappropriate Drug ◽  
Potentially Inappropriate Medications ◽  
African American Adults ◽  
Inappropriate Medication Use ◽  
Inappropriate Medications

The purpose of the present study was to examine correlates of polypharmacy among underserved community-dwelling older African American adults. Methods. This study recruited 400 underserved older African Americans adults living in South Los Angeles. The structured face-to-face interviews collected data on participants’ characteristics and elicited data pertaining to the type, frequency, dosage, and indications of all medications used by participants. Results. Seventy-five and thirty percent of participants take at least five and ten medications per day, respectively. Thirty-eight percent of participants received prescription medications from at least three providers. Inappropriate drug use occurred among seventy percent of the participants. Multivariate analysis showed that number of providers was the strongest correlate of polypharmacy. Moreover, data show that gender, comorbidity, and potentially inappropriate medication use are other major correlates of polypharmacy. Conclusions. This study shows a high rate of polypharmacy and potentially inappropriate medication use among underserved older African American adults. We documented strong associations between polypharmacy and use of potentially inappropriate medications, comorbidities, and having multiple providers. Polypharmacy and potentially inappropriate medications may be attributed to poor coordination and management of medications among providers and pharmacists. There is an urgent need to develop innovative and effective strategies to reduce inappropriate polypharmacy and potentially inappropriate medication in underserved elderly minority populations.

scholarly journals Identifikasi Potentially Inappropriate Medications (PIMs) Berdasarkan Kriteria STOPP START pada Pasien Geriatri Rawat Inap di RS Advent Bandar Lampung

2018 ◽  
Vol 7 (1) ◽  
pp. 657 ◽  
Author(s):  
Siti Juliha
Keyword(s):  
Vascular Disease ◽  
Inappropriate Medication ◽  
Potentially Inappropriate Medication ◽  
Potentially Inappropriate Medications ◽  
Chi Square ◽  
Cerebral Vascular Disease ◽  
Inappropriate Medications ◽  
Cerebral Vascular

<p>Identifikasi peresepan obat pada populasi geriatri sangat penting untuk terus dilakukan karena peresepan yang membahayakan pada populasi ini akan berasosiasi dengan peningkatan morbiditas, terjadinya kejadian yang tidak diinginkan terkait obat, dan mortalitas. Tujuan penelitian ini adalah untuk mengidentifikasi PIM (<em>Potentially Inappropriate Medication</em>) pada pasien geriatri rawat inap di RS Advent Bandar Lampung pada tahun 2016 berdasarkan Kriteria<strong> ST</strong>OPP START. Jenis penelitian ini adalah deskriptif. Populasi dalam penelitian ini adalah seluruh rekam medik pasien geriatric yang berobat rawat inap di RS Advent Bandar Lampung tahun 2016 dengan jumlah sampel sebanyak 72 rekam medik. Uji statistic yang digunakan adalah  uji <em>Chi square</em>. Identifikasi penggunaan PIM disesuaikan dengan criteria STOPP START. Hasil analisis univariat menunjukkan tiga jenis PIM terbanyak pada pengobatan pasien geritari di RS Advent Bandar Lampung adalah tidak digunakannya statin pada pasien yang memiliki riwayat penyakit jantung koroner dan <em>cerebral vascular disease </em>(51,28%), adanya duplikasi kelas obat (17,95%), dan penggunaan benzodiazepine pada pasien yang berisiko jatuh (11,43%).  Analisis bivariat menunjukkan tidak ada hubungan secara bermakna antara kejadian PIM dengan jenis kelamin, usia, jumlah obat yang diberikan, komorbid, dan lama rawat.</p>

scholarly journals Use of potentially inappropriate medication and polypharmacy in older adults: a repeated cross-sectional study

2020 ◽  
Author(s):  
Kristine Thorell ◽  
Patrik Midlöv ◽  
Johan Fastbom ◽  
Anders Halling
Keyword(s):  
Chronic Conditions ◽  
Adverse Drug Events ◽  
Inappropriate Medication ◽  
Cross Sectional Study ◽  
P Value ◽  
Potentially Inappropriate Medications ◽  
Sectional Study ◽  
Cross Sectional ◽  
Increased Risk ◽  
Inappropriate Medications

Abstract Background: With age, the number of chronic conditions increases along with the use of medications. For several years, polypharmacy has been found to be on the increase in western societies. Polypharmacy is associated with an increased risk of adverse drug events (ADE). Medications called potentially inappropriate medications (PIM) have also been found to increase the risk of ADEs in an older population. In this study, which we conducted during a national information campaign to reduce PIM, we analysed the prevalence of PIM in an older adult population and in different strata of the variables age, gender, number of chronic conditions and polypharmacy and how that prevalence changed over time. Methods: This is a registry-based repeated cross-sectional study including two cohorts. Individuals aged 75 or older listed at a primary care centre in Blekinge on the 31st March 2011 (cohort 1, 15 361 individuals) or on the 31st December 2013 (cohort 2, 15 945 individuals) were included in the respective cohorts. Using a chi2 test, the two cohorts were compared on the variables age, gender, number of chronic conditions and polypharmacy. Use of five or more medications at the same time was the definition for polypharmacy. Results: Use of PIM decreased from 10.60% to 7.04% (p-value <0.001) between 2011 and 2013, while prevalence of five to seven chronic conditions increased from 20.55% to 23.66% (p-value <0.001). Use of PIM decreased in all strata of the variables age, gender number of chronic conditions and polypharmacy. Except for age 80-84 and males, where it increased, prevalence of polypharmacy was stable in all strata of the variables. Conclusions: Use of potentially inappropriate medications had decreased in all variables between 2011 and 2013; this shows the possibility to reduce PIM with a focused effort. Polypharmacy does not increase significantly compared to the rest of the population.

scholarly journals Drug interactions for elderly with respiratory disorders and times of COVID-19: a systematic scoping review

Revista Vitae ◽  
2020 ◽  
Vol 27 (3) ◽  
Author(s):  
Marcela Forgerini ◽  
Geovana Schiavo ◽  
Rosa Camila Lucchetta ◽  
Patricia Mastroianni
Keyword(s):  
Drug Interactions ◽  
Respiratory System ◽  
Scoping Review ◽  
Beta Blockers ◽  
Inappropriate Medication ◽  
The Elderly ◽  
Potentially Inappropriate Medication ◽  
Respiratory Disorders ◽  
Explicit Criteria ◽  
Worse Prognosis

Background: The elderly people have high morbimortality associated with respiratory disorders, in addition to the presence of other safety risk factors, such as the use of potentially inappropriate medication and the occurrence of drug interactions. Objective: Considering the current pandemic scenario, it was intended to identify explicit criteria-based tools that reported drug interactions between potentially inappropriate medication and respiratory system disorders and possibly worse prognosis of COVID-19 infection. Methods: A systematic scoping review was conducted until February 2020. Study characteristics of explicit criteria-based tools, and potentially inappropriate medication, drug interactions, and therapeutic management, were extracted. Results: Nineteen explicit criteria-based tools were included. Nineteen drug interactions and 17 potentially inappropriate medications with concerns for three respiratory disorders (asthma, chronic pulmonary obstructive disease, and respiratory failure) were identified. The most frequent pharmacological classes reported were benzodiazepines and beta-blockers. For clinical management, the tools recommend using cardioselective beta-blockers, calcium channel blockers, angiotensin-converting enzyme inhibitors, and angiotensin II type I receptor blockers, and benzodiazepines with a short or intermediate half-life. Conclusion: Considering the increased risk of COVID-19 infection in the elderly, drug interactions and the use of potentially inappropriate medication associated with the occurrence of adverse drug events in the respiratory system may also worsening COVID-19 infection in patients with uncontrolled respiratory disorders. Thus, it is essential to assess drug therapy in use, to identify safety risks, and monitor the elderly in general and those with a worse prognosis concerning COVID-19, promoting patient safety.

scholarly journals Use of potentially inappropriate medication and polypharmacy in older adults: a repeated cross-sectional study

2020 ◽  
Author(s):  
Kristine Thorell ◽  
Patrik Midlöv ◽  
Johan Fastbom ◽  
Anders Halling
Keyword(s):  
Chronic Conditions ◽  
Adverse Drug Events ◽  
Inappropriate Medication ◽  
Cross Sectional Study ◽  
P Value ◽  
Potentially Inappropriate Medications ◽  
Sectional Study ◽  
Cross Sectional ◽  
Increased Risk ◽  
Inappropriate Medications

Abstract Background: With age, the number of chronic conditions increases along with the use of medications. For several years, polypharmacy has been found to be on the increase in western societies. Polypharmacy is associated with an increased risk of adverse drug events (ADE). Medications called potentially inappropriate medications (PIM) have also been found to increase the risk of ADEs in an older population. In this study, which we conducted during a national information campaign to reduce PIM, we analysed the prevalence of PIM in an older adult population and in different strata of the variables age, gender, number of chronic conditions and polypharmacy and how that prevalence changed over time. Methods: This is a registry-based repeated cross-sectional study including two cohorts. Individuals aged 75 or older listed at a primary care centre in Blekinge on the 31st March 2011 (cohort 1, 15 361 individuals) or on the 31st December 2013 (cohort 2, 15 945 individuals) were included in the respective cohorts. Using a chi2 test, the two cohorts were compared on the variables age, gender, number of chronic conditions and polypharmacy. Use of five or more medications at the same time was the definition for polypharmacy. Results: Use of PIM decreased from 10.60% to 7.04% (p-value <0.001) between 2011 and 2013, while prevalence of five to seven chronic conditions increased from 20.55% to 23.66% (p-value <0.001). Use of PIM decreased in all strata of the variables age, gender number of chronic conditions and polypharmacy. Except for age 80-84 and males, where it increased, prevalence of polypharmacy was stable in all strata of the variables. Conclusions: Use of potentially inappropriate medications had decreased in all variables between 2011 and 2013; this shows the possibility to reduce PIM with a focused effort. Polypharmacy does not increase significantly compared to the rest of the population.

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