scholarly journals High Prevalence of Multimorbidity and Polypharmacy in Elderly Patients With Chronic Pain Receiving Home Care are Associated With Multiple Medication-Related Problems

2021 ◽  
Vol 12 ◽  
Author(s):  
Juliana Schneider ◽  
Engi Abd Elhady Algharably ◽  
Andrea Budnick ◽  
Arlett Wenzel ◽  
Dagmar Dräger ◽  
...  
Keyword(s):  
Chronic Pain ◽  
Elderly Patients ◽  
Home Care ◽  
Drug Interactions ◽  
Oral Anticoagulants ◽  
Median Number ◽  
Self Medication ◽  
High Prevalence ◽  
Severe Comorbidity ◽  
History Of

Aim: To measure the extent of polypharmacy, multimorbidity and potential medication-related problems in elderly patients with chronic pain receiving home care.Methods: Data of 355 patients aged ≥65 years affected by chronic pain in home care who were enrolled in the ACHE study in Berlin, Germany, were analyzed. History of chronic diseases, diagnoses, medications including self-medication were collected for all patients. Multimorbidity was defined as the presence of ≥2 chronic conditions and levels were classified by the Charlson-Comorbidity-Index. Polypharmacy was defined as the concomitant intake of ≥5 medications. Potentially clinically relevant drug interactions were identified and evaluated; underuse of potentially useful medications as well as overprescription were also assessed.Results: More than half of the patients (55.4%) had moderate to severe comorbidity levels. The median number of prescribed drugs was 9 (range 0–25) and polypharmacy was detected in 89.5% of the patients. Almost half of them (49.3%) were affected by excessive polypharmacy (≥10 prescribed drugs). Polypharmacy and excessive polypharmacy occurred at all levels of comorbidity. We detected 184 potentially relevant drug interactions in 120/353 (34.0%) patients and rated 57 (31.0%) of them as severe. Underprescription of oral anticoagulants was detected in 32.3% of patients with atrial fibrillation whereas potential overprescription of loop diuretics was observed in 15.5% of patients.Conclusion: Multimorbidity and polypharmacy are highly prevalent in elderly outpatients with chronic pain receiving home care. Medication-related problems that could impair safety of drug treatment in this population are resulting from potentially relevant drug interactions, overprescribing as well as underuse.

scholarly journals Two-year outcomes of more than 30 000 elderly patients with atrial fibrillation: results from the All Nippon AF In the Elderly (ANAFIE) Registry

2021 ◽  
Author(s):  
Takeshi Yamashita ◽  
Shinya Suzuki ◽  
Hiroshi Inoue ◽  
Masaharu Akao ◽  
Hirotsugu Atarashi ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Catheter Ablation ◽  
Elderly Patients ◽  
Major Bleeding ◽  
Oral Anticoagulants ◽  
Clinical Status ◽  
The Elderly ◽  
Very Elderly ◽  
History Of ◽  
Bleeding History

Abstract Aims To clarify the real-world clinical status and prognosis of elderly and very elderly non-valvular atrial fibrillation (NVAF) patients, more than 30 000 elderly patients with NVAF aged ≥75 years were enrolled in the ANAFIE Registry. Methods and Results This multicentre, prospective, observational study followed elderly NVAF patients in Japan for ∼2 years. Among 32 275 patients (mean age 81.5 years; men, 57.3%; mean CHA2DS2-VASc score 4.5), 2445 (7.6%) were not receiving oral anticoagulants (OACs) and 29 830 (92.4%) were given OACs. Of these, 21 585 (66.9%) were receiving direct OACs (DOACs) and 8233 (25.5%), warfarin (mean time in therapeutic range: ∼75%). In total, the 2-year incidence rate was 3.01% for stroke/systemic embolic events (SEE); 2.00%, major bleeding; and 6.95%, all-cause death. As compared with the warfarin group, the DOAC group had a lower hazard ratio (HR) for stroke/SEE, major bleeding, and all-cause death after adjusting for confounders. The group without OACs had a higher HR for stroke/SEE and all-cause death, with a lower HR for major bleeding. History of falls within 1 year at enrolment and of catheter ablation were positive and negative independent risk factors, respectively, for stroke/SEE, major bleeding and all-cause death. Conclusion In Japan, a large proportion of elderly and very elderly NVAF patients were receiving DOACs, which was significantly associated with lower rate of stroke/SEE, major bleeding, and all-cause death vs well-controlled warfarin. History of falls and of catheter ablation were independently associated with stroke/SEE, major bleeding, and all-cause death.

scholarly journals Drug interactions of oral anticoagulants

2020 ◽  
Vol 10 (1) ◽  
pp. 70
Author(s):  
Gayathri Anil ◽  
Pradhyumna Muraleedharan ◽  
Atiya Rehman Faruqui
Keyword(s):  
Drug Interactions ◽  
Vitamin K Antagonists ◽  
Oral Anticoagulants ◽  
Direct Oral Anticoagulants ◽  
Median Number ◽  
Potential Drug ◽  
Concomitant Medications ◽  
Potential Interactions ◽  
Major Drug

Background: Oral anticoagulants (OACs) are the drugs of choice where long-term anticoagulation is needed due to convenience of dosing. But their use has potential for several drug interactions. Monitoring for potential interactions with timely management will decrease the risk of complications of anticoagulation.Methods: We aimed to assess the presence of potential drug-drug interactions in patients on oral anticoagulants for various indications. Prescriptions of a cohort of patients on oral anticoagulants were analyzed. Potential drug interactions were identified using free software available at www.drugs.com and classified into major, moderate and minor types.Results: Of the 135 patients in the study, 83 were males and mean age was 52.9±17.3 years. Most commonly used OACs were vitamin K antagonists (VKAs) (80.0%) followed by direct oral anticoagulants (DOACs) (20.0%). Median number of concomitant medications per patient was 4 (IQR 3-6). A total of 307 potential interactions were identified in 121 patients with a median of 2 interactions per patient. Of the 56 patients who had potential for major drug interactions, 45 (41.6%) were on VKAs and 11 (40.7%) on DOACs had potential to develop major interactions. Using logistic regression model, significant predictors of major drug interactions were age>60 years (OR 2.50; 95% CI 1.05-5.95; p=0.04) and presence of venous thromboembolism VTE (OR 0.09; 95% CI 0.02-0.55; p=0.01).Conclusions: This hospital-based study showed potential drug interactions with OACs. Age more than 60 years and presence of VTE were significant predictors of major interactions. Awareness of potential interactions and monitoring doses of OACs help to prevent complications of therapy.

Clinical and anamnestic characteristics of patients with adenomyosis, accompanied by pelvic pain syndrome

GYNECOLOGY ◽  
2018 ◽  
Vol 20 (6) ◽  
pp. 77-80
Author(s):  
M R Orazov ◽  
V E Radzinsky ◽  
M B Khamoshina ◽  
A O Dukhin ◽  
L R Toktar ◽  
...  
Keyword(s):  
Pelvic Pain ◽  
Chronic Pelvic Pain Syndrome ◽  
Pain Syndrome ◽  
Reproductive Age ◽  
Pelvic Pain Syndrome ◽  
Common Disease ◽  
Contributing Factors ◽  
High Prevalence ◽  
Inflammatory Processes ◽  
History Of

Pelvic pain syndrome associated with adenomyosis is a common disease in women of reproductive age. Frequency of detection in the population varies from 10 to 53%. The aim - to study the clinical and anamnestic risk factors of pelvic pain, with adenomiose. Materials and methods. The study included 120 (n=120) patients with diffuse adenomyosis with pain and painless form of the disease who underwent examination and treatment in the gynecological Department of the Central clinical hospital №6 of Russian Railways in Moscow. Each patient was provided with an individual card, which was encrypted 171 sign. The studied parameters reflected the passport and anthropometric data, information about education, social status, presence of occupational hazards, complaints, illness. Results. Burdened gynecological and somatic histories, manifested a low health index, a more pronounced hereditary a family history of neoplastic diseases are contributing factors, and high prevalence of postponed surgeries, chronic, long-term ongoing inflammatory processes of the pelvic organs to create a favorable background for the further progression of chronic pelvic pain syndrome in adenomiose.

Prevalence of Self-Medication and Its Factors among University Students in Bandar Abbas City

2018 ◽  
Vol 7 ◽  
Author(s):  
Atefeh Mohammadi
Keyword(s):  
Herbal Medicines ◽  
Target Population ◽  
Easy Access ◽  
Medical Sciences ◽  
Self Medication ◽  
Delay In Diagnosis ◽  
Consumption Culture ◽  
High Prevalence ◽  
The Mean ◽  
Bandar Abbas

Background: Self-medication can lead to the latency of the real severity of disease, delay in diagnosis, a complication of treatment, threatening side effects, and unexpected intoxication. The present research aimed to explore the prevalence of self-medication and its factors among students affiliated to Bandar Abbas universities in 2016. Materials and Methods: This Descriptive Analytic study was performed on 600 students affiliated to the universities in Bandar Abbas; Islamic Azad University, Payam-e-Noor University, and University of Medical Sciences. The sample was selected through a stratified sampling method, and the data were collected by a questionnaire comprised of two parts, demographic information (6 items), and risk factors of self-medication and self-medicated drugs (26 items). SPSS version 19 was used to analyze the data through the required tests. Result: The mean age of the students was 24.11±5.85 years. One hundred and ninety-one subjects (31.8%) were male, and 409 (68.2%) were female. The results revealed the prevalence of self-medication in the target population was 80.2%., the main reasons for self-medication were reported underestimating the disease 461(77.0%), previous experience of the disease 457(76.4%), repeated prescription 441(73.6%), and easy access to drug 423(70.6%). The most prevalent drugs self-medicated by students were acetaminophen, herbal medicines, antibiotics, other drugs, sedatives, and anti-acids, respectively. Conclusion: Considering the high prevalence of self-medication (80.2%) revealed in this research, there is a need for more attentive care for consistent education and drug consumption culture promotion. Specific approaches can help the provision of easy access to medical services in universities.

Clinically relevant drug interactions between newer antidepressants and oral anticoagulants

2019 ◽  
Vol 16 (1) ◽  
pp. 31-44 ◽  
Author(s):  
Edoardo Spina ◽  
Maria Antonietta Barbieri ◽  
Giuseppe Cicala ◽  
Antonio Bruno ◽  
Jose de Leon
Keyword(s):  
Drug Interactions ◽  
Oral Anticoagulants

scholarly journals Drug therapy problems identified among older adults placed in a nursing home: the Croatian experience

2020 ◽  
Vol 48 (6) ◽  
pp. 030006052092879
Author(s):  
Katarina Fehir Šola ◽  
Iva Mucalo ◽  
Andrea Brajković ◽  
Ivona Jukić ◽  
Donatella Verbanac ◽  
...  
Keyword(s):  
Nursing Home ◽  
Drug Therapy ◽  
Medication Management ◽  
Institutional Care ◽  
Nursing Home Residents ◽  
Median Number ◽  
Cross Sectional ◽  
High Prevalence ◽  
Care Facilities ◽  
Drug Therapy Problems

Objective The aim of this study was to determine the frequency and type of drug therapy problems (DTPs) in older institutionalized adults. Method We conducted a cross-sectional observational study from February to June 2016 at a 150-bed public nursing home in Croatia, where comprehensive medication management (CMM) services were provided. A rational decision-making process, referred to as the Pharmacotherapy Workup method, was used to classify DTPs. Results Data were prospectively collected from 73 residents, among which 71% were age 75 years or older. The median number of prescribed medications per patient was 7 (2–16) and polypharmacy (> 4) was recorded for 54 (74.0%) patients. A total 313 DTPs were identified, with an average of 4.3 ± 2 DTPs per patient. The most frequent DTP was needing additional drug therapy (n = 118; 37.7%), followed by adverse drug reaction (n = 55; 17.6%). Lactulose (14.4%), tramadol (6.7%), and potassium (6.4%) were the medications most frequently related to DTPs. Conclusion The high prevalence of DTPs identified among older institutionalized adults strongly suggests the need to incorporate new pharmacist-led CMM services within existing institutional care facilities, to improve the care provided to nursing home residents.

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