scholarly journals Clinical and Humanistic Outcomes of Community Pharmacy-Based Healthcare Interventions Regarding Medication Use in Older Adults: A Systematic Review and Meta-Analysis

Healthcare ◽  
2021 ◽  
Vol 9 (11) ◽  
pp. 1577
Author(s):  
Christina Malini Christopher ◽  
Bhuvan KC ◽  
Ali Blebil ◽  
Deepa Alex ◽  
Mohamed Izham Mohamed Ibrahim ◽  
...  
Keyword(s):  
Older Adults ◽  
Community Pharmacy ◽  
Risk Ratio ◽  
Adverse Drug Events ◽  
Meta Analysis ◽  
Medication Use ◽  
The Elderly ◽  
Humanistic Outcomes ◽  
Medication Reviews ◽  
The Impact

This review and meta-analysis aimed to determine the clinical and humanistic outcomes of community pharmacy-based interventions on medication-related problems of older adults at the primary care level. We identified randomized controlled trials (RCTs) examining the impact of various community pharmacy-based interventions from five electronic databases (namely, MEDLINE (Ovid), EMBASE (Ovid), CINAHL, APA PSYInfo, and Scopus) from January 2010 to December 2020. Consequently, we assessed these interventions’ clinical and humanistic outcomes on older adults and compared them with non-intervention. We included 13 RCTs in the current review and completed a meta-analysis with six of them. The included studies had a total of 6173 older adults. Quantitative analysis showed that patient education was significantly associated with an increase in the discontinuation of sedative–hypnotics use (risk ratio 1.28; 95% CI (1.20, 1.36) I2 = 0%, p < 0.00001). Moreover, the qualitative analysis showed that medication reviews and education with follow-ups could improve various clinical outcomes, including reducing adverse drug events, reducing uncontrolled health outcomes, and improving appropriate medication use among the elderly population. However, medication review could not significantly reduce the number of older adults who fall (risk ratio 1.25; 95% CI (0.78, 1.99) I2 = 0%, p = 0.36) and require hospitalization (risk ratio 0.72; 95% CI (0.47, 1.12) I2 = 45%, p = 0.15). This study showed that community pharmacy-based interventions could help discontinue inappropriate prescription medications among older adults and could improve several clinical and humanistic outcomes. However, more effective community pharmacy-based interventions should be implemented, and more research is needed to provide further evidence for clinical and humanistic outcomes of such interventions on older adults.

scholarly journals The Effect of Exercise on the Older Adult’s Blood Pressure Suffering Hypertension: Systematic Review and Meta-Analysis on Clinical Trial Studies

2020 ◽  
Vol 2020 ◽  
pp. 1-19
Author(s):  
Mohsen Kazeminia ◽  
Alireza Daneshkhah ◽  
Rostam Jalali ◽  
Aliakbar Vaisi-Raygani ◽  
Nader Salari ◽  
...  
Keyword(s):  
Systematic Review ◽  
Blood Pressure ◽  
Older Adults ◽  
Treatment Plan ◽  
Meta Analysis ◽  
Intervention Group ◽  
The Elderly ◽  
Before And After ◽  
Cochran Test ◽  
The Impact

Background. Senescence refers to spontaneous and progressive irreversible degenerative changes in which both the physical and psychological power diminish significantly. Hypertension is the most common cardiovascular disease in the elderly. Several studies have been conducted regarding the effect of exercise on reducing the blood pressure of the elderly, which have found contradictory results. One of the uses of meta-analysis study is responding to these assumptions and resolving the discrepancies. Accordingly, the aim of the present study is to determine the impact of exercise on the blood pressure of older adults. Method. In this research, in order to find electronic published papers from 1992 to 2019, the papers published in both domestic and foreign databases including SID, MagIran, IranMedex, IranDox, Gogole Scholar, Cohrane, Embase, Science Direct, Scopus, PubMed, and Web of Science (ISI) were used. Heterogeneity index between the studies was determined based on Cochran test Q(c) and I2. Considering existence of heterogeneity, random effects model was employed to estimate the standardized subtraction of the mean exercise test score for reduction of blood pressure in the older adults across the intervention group before and after the test. Results. In this meta-analysis and systematic review, eventually 69 papers met the inclusion criteria. The total number of participants was 2272 in the pre- and postintervention groups when examining the systolic changes and 2252 subjects in the pre- and postintervention groups when inspecting the diastolic changes. The standardized mean difference in examining the systolic changes before the intervention was 137.1 ± 8.09 and 132.98 ± 0.96 after the intervention; when exploring the diastolic changes, the pre- and postintervention values were 80.3 ± 0.85 and 76.0 ± 6.56, respectively, where these differences were statistically significant (P<0.01). Conclusion. The results of this study indicated that exercise leads to significant reduction in both systolic and diastolic blood pressure. Accordingly, regular exercise can be part of the treatment plan for hypertensive elderly.

scholarly journals The Impact of Age Difference on the Efficacy and Safety of COVID-19 Vaccines: A Systematic Review and Meta-Analysis

2021 ◽  
Vol 12 ◽  
Author(s):  
Jiting Wang ◽  
Yue Tong ◽  
Duo Li ◽  
Jun Li ◽  
Yaling Li
Keyword(s):  
Older Adults ◽  
Young Adults ◽  
Young People ◽  
Publication Bias ◽  
Meta Analysis ◽  
Geometric Mean ◽  
The Elderly ◽  
Age Difference ◽  
Efficacy And Safety ◽  
The Impact

ObjectiveThis meta-analysis compared the efficacy and safety of five kinds of COVID-19 vaccines in different age groups (young adults and older adults), aiming to analyze the difference of adverse events (AEs) rate and virus geometric mean titer (GMT) values between young and older people, in order to find a specific trend, and explore the causes of this trend through meta-analysis.MethodMeta-analysis was used to analyze the five eligible articles. The modified Jadad scoring scale was used to evaluate the quality of eligible literature with a scoring system of 1 to 7. The primary endpoint of the effectiveness index was GMT. The primary endpoints of the safety index were the incidence of local AEs and systemic AEs. Stata 12.0 software was used for meta-analysis. Revman 5.0 software was used to map the risk of publication bias, and Egger’s test was used to analyze publication bias.ResultsThe GMT values of young adults were higher than older adults (SMD = 1.40, 95% CI (0.79, 2.02), P&lt;0.01). There was a higher incidence of local and systemic AEs in young people than in the elderly (OR = 1.10, 95% CI (1.08, 1.12), P&lt;0.01; OR = 1.18, 95% CI (1.14, 1.22), P&lt;0.01).ConclusionThe immune effect of young people after being vaccinated with COVID-19 vaccines was better than that of the elderly, but the safety was worse than that of old people, the most common AEs were fever, rash, and local muscle pain, which were tolerable for young people. As the AEs of the elderly were lower, they can also be vaccinated safely; the reason for the low level of GMT in the elderly was related to Immunosenescence. The vaccine tolerance of people of different ages needs to be studied continuously.

scholarly journals Interventions to Improve Hydration in Older Adults: A Systematic Review and Meta-Analysis

Nutrients ◽  
2021 ◽  
Vol 13 (10) ◽  
pp. 3640
Author(s):  
Chevonne Bruno ◽  
Annaleise Collier ◽  
Margaret Holyday ◽  
Kelly Lambert
Keyword(s):  
Older Adults ◽  
Meta Analysis ◽  
The Elderly ◽  
Limited Evidence ◽  
Behavioural Interventions ◽  
Nutritional Interventions ◽  
Effective Interventions ◽  
Care Groups ◽  
Tract Infections ◽  
The Impact

Dehydration is common in the elderly, especially when hospitalised. This study investigated the impact of interventions to improve hydration in acutely unwell or institutionalised older adults for hydration and hydration linked events (constipation, falls, urinary tract infections) as well as patient satisfaction. Four databases were searched from inception to 13 May 2020 for studies of interventions to improve hydration. Nineteen studies (978 participants) were included and two studies (165 participants) were meta-analysed. Behavioural interventions were associated with a significant improvement in hydration. Environmental, multifaceted and nutritional interventions had mixed success. Meta-analysis indicated that groups receiving interventions to improve hydration consumed 300.93 mL more fluid per day than those in the usual care groups (95% CI: 289.27 mL, 312.59 mL; I2 = 0%, p < 0.00001). Overall, there is limited evidence describing interventions to improve hydration in acutely unwell or institutionalised older adults. Behavioural interventions appear promising. High-quality studies using validated rather than subjective methods of assessing hydration are needed to determine effective interventions.

scholarly journals The Geriatric Medication Game to Raise Community Pharmacists’ Awareness on Older Adults’ Day-to-Day Challenges

2021 ◽  
pp. 1-6
Author(s):  
Aisha F. Badr
Keyword(s):  
Older Adults ◽  
Saudi Arabia ◽  
Learning Process ◽  
Community Pharmacists ◽  
The Elderly ◽  
Learning Activity ◽  
Simulation Games ◽  
Self Reflection ◽  
Satisfaction Rate ◽  
The Impact

<b><i>Introduction:</i></b> In Saudi Arabia; it is estimated that the elderly (aged 60 and above) would reach up to (22.9%) by 2050, compared to (5.6%) in 2017. Simulation games have proven to be a useful and effective method of education in pharmacy schools, as it actively involves participants in the learning process. The objective of this study was to examine the impact of the modified geriatric medication game on community pharmacists’ awareness and attitudes toward older adults with common disabilities. <b><i>Methods:</i></b> A modified geriatric medication game was adopted to stimulate both physical and sensory disabilities in older adults. A total of 9 community pharmacists were gathered in 1 room and were asked to play 2 scenarios each. Self-reflection was assessed and ground theories were analyzed. <b><i>Results:</i></b> All pharmacists felt frustration and anger playing the game (100%), followed by becoming more aware of the extra time and guidance needed with older adults and realized how disabling chronic diseases could be, and felt they needed to improve common perceived attitude towards the elderly (88.89%). Pharmacists also felt empathy, sympathy, and compassion towards this population, needed improvement of common perceived attitude towards older adults, and felt the need to double check with older adults if they have any disabilities before counseling (77.78%). Finally, over half pharmacists (55.5%) wished they had more training on geriatrics during pharmacy school and the need for further review of Beer’s criteria. All pharmacists were satisfied with the game and recommended it to all community pharmacists. <b><i>Conclusion:</i></b> Simulation games are a great way to strengthen awareness and change practice accordingly. Pharmacists improved their awareness and attitude towards the elderly and reported a positive perceived value of this learning activity; with a 100% satisfaction rate. Adding a geriatric course with simulation component is recommended for better geriatric care.

scholarly journals Pharmacist-Led Collaborative Medication Management for the Elderly with Chronic Kidney Disease and Polypharmacy

2021 ◽  
Vol 18 (8) ◽  
pp. 4370
Author(s):  
A Kim ◽  
Hayeon Lee ◽  
Eun-Jeong Shin ◽  
Eun-Jung Cho ◽  
Yoon-Sook Cho ◽  
...  
Keyword(s):  
Older Adults ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Medication Management ◽  
Medication Use ◽  
Potentially Inappropriate Medications ◽  
Management Service ◽  
Ckd Stage ◽  
The Impact

Inappropriate polypharmacy is likely in older adults with chronic kidney disease (CKD) owing to the considerable burden of comorbidities. We aimed to describe the impact of pharmacist-led geriatric medication management service (MMS) on the quality of medication use. This retrospective descriptive study included 95 patients who received geriatric MMS in an ambulatory care clinic in a single tertiary-care teaching hospital from May 2019 to December 2019. The average age of the patients was 74.9 ± 7.3 years; 40% of them had CKD Stage 4 or 5. Medication use quality was assessed in 87 patients. After providing MMS, the total number of medications and potentially inappropriate medications (PIMs) decreased from 13.5 ± 4.3 to 10.9 ± 3.8 and 1.6 ± 1.4 to 1.0 ± 1.2 (both p < 0.001), respectively. Furthermore, the number of patients who received three or more central nervous system-active drugs and strong anticholinergic drugs decreased. Among the 354 drug-related problems identified, “missing patient documentation” was the most common, followed by “adverse effect” and “drug not indicated.” The most frequent intervention was “therapy stopped”. In conclusion, polypharmacy and PIMs were prevalent in older adults with CKD; pharmacist-led geriatric MMS improved the quality of medication use in this population.

Influential Factors for Older Users’ Acceptance of eHealth Services: an Integrated Acceptance Framework (IAF) (Preprint)

2021 ◽  
Author(s):  
Jiyeon Yu ◽  
Angelica de Antonio ◽  
Elena Villalba-Mora
Keyword(s):  
Systematic Review ◽  
Older Adults ◽  
New Technologies ◽  
Meta Analysis ◽  
Health Condition ◽  
Influential Factors ◽  
Current Status ◽  
Five Dimensions ◽  
The Impact ◽  
Acceptance Factors

BACKGROUND eHealth and Telehealth play a crucial role in assisting older adults who visit hospitals frequently or who live in nursing homes and can benefit from staying at home while being cared for. Adapting to new technologies can be difficult for older people. Thus, to better apply these technologies to older adults’ lives, many studies have analyzed acceptance factors for this particular population. However, there is not yet a consensual framework to be used in further development and the search for solutions. OBJECTIVE This paper presents an Integrated Acceptance Framework (IAF) for the older user’s acceptance of eHealth, based on 43 studies selected through a systematic review. METHODS We conducted a four-step study. First, through a systematic review from 2010 to 2020 in the field of eHealth, the acceptance factors and basic data for analysis were extracted. Second, we carried out a thematic analysis to group the factors into themes to propose and integrated framework for acceptance. Third, we defined a metric to evaluate the impact of the factors addressed in the studies. Last, the differences amongst the important IAF factors were analyzed, according to the participants’ health conditions, verification time, and year. RESULTS Through the systematic review, 731 studies were founded in 5 major databases, resulting in 43 selected studies using the PRISMA methodology. First, the research methods and the acceptance factors for eHealth were compared and analyzed, extracting a total of 105 acceptance factors, which were grouped later, resulting in the Integrated Acceptance Framework. Five dimensions (i.e., personal, user-technology relational, technological, service-related, environmental) emerged with a total of 23 factors. Also, we assessed the quality of the evidence. And then, we conducted a stratification analysis to reveal the more appropriate factors depending on the health condition and the assessment time. Finally, we assess which are the factors and dimensions that are recently becoming more important. CONCLUSIONS The result of this investigation is a framework for conducting research on eHealth acceptance. To elaborately analyze the impact of the factors of the proposed framework, the criteria for evaluating the evidence from the studies that have extracted factors are presented. Through this process, the impact of each factor in the IAF has been presented, in addition to the framework proposal. Moreover, a meta-analysis of the current status of research is presented, highlighting the areas where specific measures are needed to facilitate e-Health acceptance.

scholarly journals Malnutrition in older adults: screening and determinants

2018 ◽  
Vol 78 (3) ◽  
pp. 372-379 ◽  
Author(s):  
Clare A. Corish ◽  
Laura A. Bardon
Keyword(s):  
Older Adults ◽  
Residential Care ◽  
Nutritional Assessment ◽  
Short Form ◽  
Meta Analysis ◽  
Protein Energy Malnutrition ◽  
Mini Nutritional Assessment ◽  
The Elderly ◽  
Screening Tools ◽  
Climbing Stairs

Older adults are at risk of protein-energy malnutrition (PEM). PEM detrimentally impacts on health, cognitive and physical functioning and quality of life. Given these negative health outcomes in the context of an ageing global population, the Healthy Diet for a Healthy Life Joint Programming Initiative Malnutrition in the Elderly (MaNuEL) sought to create a knowledge hub on malnutrition in older adults. This review summarises the findings related to the screening and determinants of malnutrition. Based on a scoring system that incorporated validity, parameters used and practicability, recommendations on setting-specific screening tools for use with older adults were made. These are: DETERMINE your health checklist for the community, Nutritional Form for the Elderly for rehabilitation, Short Nutritional Assessment Questionnaire-Residential Care for residential care and Malnutrition Screening Tool or Mini Nutritional Assessment-Short Form for hospitals. A meta-analysis was conducted on six longitudinal studies from MaNuEL partner countries to identify the determinants of malnutrition. Increasing age, unmarried/separated/divorced status (vs.married but not widowed), difficulties walking 100 m or climbing stairs and hospitalisation in the year prior to baseline or during follow-up predicted malnutrition. The sex-specific predictors of malnutrition were explored within The Irish Longitudinal Study of Ageing dataset. For females, cognitive impairment or receiving social support predicted malnutrition. The predictors for males were falling in the previous 2 years, hospitalisation in the past year and self-reported difficulties in climbing stairs. Incorporation of these findings into public health policy and clinical practice would support the early identification and management of malnutrition.

scholarly journals Use of Music Therapy as an Audiological Rehabilitation Tool in the Elderly Population: A Mini-Review

2021 ◽  
Vol 15 ◽  
Author(s):  
Anne Sophie Grenier ◽  
Louise Lafontaine ◽  
Andréanne Sharp
Keyword(s):  
Older Adults ◽  
Hearing Loss ◽  
Music Therapy ◽  
Cognitive Decline ◽  
Social Participation ◽  
Cognitive Abilities ◽  
Elderly Population ◽  
Vestibular Function ◽  
The Elderly ◽  
The Impact

It is well known and documented that sensory perception decreases with age. In the elderly population, hearing loss and reduced vestibular function are among the most prevalently affected senses. Two important side effects of sensory deprivation are cognitive decline and decrease in social participation. Hearing loss, vestibular function impairment, and cognitive decline all lead to a decrease in social participation. Altogether, these problems have a great impact on the quality of life of the elderly. This is why a rehabilitation program covering all of these aspects would therefore be useful for clinicians. It is well known that long-term music training can lead to cortical plasticity. Behavioral improvements have been measured for cognitive abilities and sensory modalities (auditory, motor, tactile, and visual) in healthy young adults. Based on these findings, it is possible to wonder if this kind of multisensory training would be an interesting therapy to not only improve communication but also help with posture and balance, cognitive abilities, and social participation. The aim of this review is to assess and validate the impact of music therapy in the context of hearing rehabilitation in older adults. Musical therapy seems to have a positive impact on auditory perception, posture and balance, social integration, and cognition. While the benefits seem obvious, the evidence in the literature is scarce. However, there is no reason not to recommend the use of music therapy as an adjunct to audiological rehabilitation in the elderly when possible. Further investigations are needed to conclude on the extent of the benefits that music therapy could bring to older adults. More data are needed to confirm which hearing abilities can be improved based on the many characteristics of hearing loss. There is also a need to provide a clear protocol for clinicians on how this therapy should be administered to offer the greatest possible benefits.

scholarly journals A TRIAL TO IMPROVE MEDICATION SAFETY IN OLDER ADULTS: RECRUITMENT CHALLENGES HAVE GENERALIZABILITY IMPLICATIONS

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S711-S711
Author(s):  
Kathryn Anzuoni ◽  
Terry Field ◽  
Kathleen Mazor ◽  
Yanhua Zhou ◽  
Timothy Konola ◽  
...  
Keyword(s):  
Older Adults ◽  
High Risk ◽  
Odds Ratio ◽  
Adverse Drug Events ◽  
Functional Decline ◽  
Post Discharge ◽  
Recruitment Challenges ◽  
Hospital To Home ◽  
The Impact ◽  
Visiting Nurse

Abstract For older adults, the transition from hospital to home is a high-risk period for adverse drug events, functional decline, and hospital readmission. Randomized trials of interventions to improve this transition must recruit potential subjects immediately after hospital discharge, when people are recovering and tired. Within a randomized trial assessing the impact of a pharmacist home visit to provide medication assistance immediately post-discharge, we determined whether individuals who enrolled were comparable to those who were invited but did not enroll, and described reasons for not enrolling. Individuals ≥50 years of age discharged from the hospital and prescribed a high-risk medication were eligible. We attempted to recruit individuals by phone within 3 days of discharge, and recorded reasons for not enrolling. Of 3,606 eligible individuals reached, 3,147 (87%) declined, 361 (10%) were enrolled, and 98 (3%) were initially recruited but did not complete a consent form. Individuals ≥80 years of age (odds ratio 0.45, CI 0.25, 0.78) and those with an assigned visiting nurse (odds ratio 0.64, CI 0.48, 0.85) were least likely to enroll. Among those who provided a reason for declining (2,473) the most common reason given was the belief they did not need medication assistance (22%). An additional 332 (13%) declined because they were receiving visiting nurse services. Recruiting older adults recently discharged from the hospital is difficult and may under-enroll the oldest individuals, limiting the ability to generalize findings across older patient populations. Researchers planning RCTs among newly discharged older adults may need creative approaches to overcome resistance.

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