scholarly journals Assessment of Prescriptions in Elderly Patients Hospitalized in Medicine Departments

2021 ◽  
Vol 10 (22) ◽  
pp. 5343
Author(s):  
Audrey GIROUX ◽  
Christelle Prudent ◽  
Pierre Jouanny ◽  
Géraldine Muller ◽  
Hervé Devilliers ◽  
...  
Keyword(s):  
Renal Function ◽  
Elderly Patients ◽  
Elderly Population ◽  
Clinical Audit ◽  
The Elderly ◽  
Potentially Inappropriate Medications ◽  
Geriatric Population ◽  
Before And After ◽  
Two Phases ◽  
Inappropriate Medications

Drug-related iatrogenesis is an important issue in the elderly population, and preventing iatrogenic accidents helps to reduce hospitalizations (6). Our study’s objective was to evaluate prescriptions in the geriatric population of our establishment. The study conducted is a targeted clinical audit. Ten criteria were tested on the hospital prescriptions of people over 75 years old in 11 medical departments, before and after improvement actions. The non-compliance threshold was set at 10% of prescriptions for each criterion. In each phase, 165 patients were included. Four criteria were non-compliant (NC) in the first phase: the presence of Potentially Inappropriate Medications for the Elderly (PIMs) (NC = 57.6%), the adaptation of the medication to renal clearance (NC = 24.9%), the presence of illogical combination (NC = 9.7%), and the total anti-cholinergic score of the prescription (NC = 12.1%). After the implementation of improvement actions, the number of non-compliant criteria decreased between the two phases, from four to two. We obtained a significant improvement for three of the four criteria found to be non-compliant in the first phase. The criterion adaptation to renal function is close to compliance (NC = 10.1%) and the PIMs criterion remained non-compliant after reassessment (NC = 32.1%). Vigilance must be ongoing in order to limit drug iatrogeny, particularly in frail elderly patients.

A Closer Look at the 2015 Beers Criteria

2016 ◽  
Vol 30 (4) ◽  
pp. 419-424 ◽  
Author(s):  
Rebecca L. Salbu ◽  
Judith Feuer
Keyword(s):  
Elderly Patients ◽  
Health Care Providers ◽  
Clinical Judgment ◽  
The Elderly ◽  
Specific Information ◽  
Beers Criteria ◽  
Potentially Inappropriate Medications ◽  
Care Providers ◽  
Inappropriate Medications ◽  
Made In

The Beers Criteria identifies potentially inappropriate medications for patients who are 65 years of age and older. Initially published in 1991, the criteria have been updated multiple times, most recently in 2015. The Beers Criteria is a tool designed to alert health-care providers to the potential harms of specific medications so they may better tailor therapeutic regimens for their elderly patients. The expert panel of the 2015 update made changes to a number of previous recommendations and provided 2 new tables on select drug interactions and select medications requiring renal dose adjustments. The purpose of this review is to provide additional details and rationale behind selected noteworthy changes within the 2015 criteria. Specific information is provided on the changes in recommendations for the use of nitrofurantoin, antiarrhythmics, nonbenzodiazepine receptor agonist hypnotics, antipsychotics, and proton pump inhibitors in the elderly. Additional comparisons are made between the 2012 recommendations and newer recommendations made in the 2015 update, along with rationale for the change. This review will allow practitioners to apply the 2015 Beers Criteria and integrate their clinical judgment when evaluating and selecting drug therapy for elderly patients.

scholarly journals Inappropriate prescribing in hospitalized elderly patients

2017 ◽  
Vol 6 (4) ◽  
pp. 701
Author(s):  
Lina K. Massoud ◽  
Hala Z. AlAgha ◽  
Mahmoud H. Taleb
Keyword(s):  
Elderly Patients ◽  
Elderly People ◽  
Inappropriate Prescribing ◽  
The Elderly ◽  
Potentially Inappropriate Medications ◽  
Hospitalized Elderly ◽  
Different Types ◽  
Elderly Inpatients ◽  
Hospitalized Elderly Patients ◽  
Inappropriate Medications

Inappropriate prescribing (IP) is a major healthcare problem in elderly patients. The risk of this problem increases during hospitalization. This is due to increase morbidity and thus increases the use of medications by the inpatients. This study will clarify the problem of IP for elderly people during hospitalization and will identify the different types of it. It also will highlight some tools that are used to assess the different types of IP and the prevalence of it in elderly patients during hospitalization. Finally, the study will address the consequences of IP in the elderly inpatients and the risks associated with the use of some potentially inappropriate medications (PIMs) in the elderly. 

Use of Benzodiazepines and Z-Drugs in the Geriatric Population

2020 ◽  
pp. 41-67
Author(s):  
Jan M. Kitzen
Keyword(s):  
Elderly Patients ◽  
Behavioral Therapy ◽  
Adult Population ◽  
Large Body ◽  
The Elderly ◽  
Hepatic Function ◽  
Potentially Inappropriate Medications ◽  
Geriatric Population ◽  
Nervous System Function ◽  
Balance Functions

The benzodiazepine (BZD) class of drugs has proven to be a useful addition to therapeutic management of anxiety and sleep disorders in the adult population. However, after many years of experience with BZDs in elderly patients (≥65 years), a large body of evidence indicates that BZDs are no longer recommended for use in this segment of the population, except under special conditions. Several aging-related changes in physiology such as decreases in renal and hepatic function, altered central nervous system function and changes in body composition can lead to impaired excretion of drug, higher plasma levels and accumulation of these drugs in the body. Side effects such as sedation, dizziness, cognitive impairment, and diminished control of gait and balance functions place the elderly at greater risk of various adverse events, especially falls and fractures, compared to younger adults. Another class of drugs, known as Z-drugs is structurally dissimilar from the BZDs but able to bind to GABAA, receptors making them useful for management of insomnia. These drugs have also been found to pose significant hazards to the elderly and are also not recommended for use in elderly patients. Both of these classes of drugs are currently included in the AGS Beers Criteria® of potentially inappropriate medications for use in the elderly. Alternative pharmacologic approaches to managing these conditions include use of either serotonin-norepinephrine reuptake inhibitors or buspirone for anxiety and the use of either low doses of doxepin, melatonin, or the melatonin agonist ramelteon for management of insomnia. Cognitive behavioral therapy and other relaxation techniques offer non-pharmacologic approaches to managing these conditions, thereby decreasing the need for prescribing BZDs or Z-drugs in the elderly.

scholarly journals Evaluating Potentially Inappropriate Medications in the Elderly Population at KAUH, Jeddah, KSA.

2017 ◽  
Vol 5 (11) ◽  
pp. 540-545 ◽  
Author(s):  
SamiM Bahlas ◽  
◽  
Neda’aW Anshasi ◽  
SaadH Alqurashi ◽  
AbdullahA Elhosiny ◽  
...  
Keyword(s):  
Elderly Population ◽  
The Elderly ◽  
Potentially Inappropriate Medications ◽  
Inappropriate Medications

Highlights From the 2019 AGS Beers Criteria® Updates

2020 ◽  
Vol 35 (2) ◽  
pp. 68-74
Author(s):  
Creaque V. Charles ◽  
Angie Eaton
Keyword(s):  
Older Adults ◽  
Older Adult ◽  
Data Extraction ◽  
Inappropriate Medication ◽  
The Elderly ◽  
The United States ◽  
Beers Criteria ◽  
Potentially Inappropriate Medications ◽  
Geriatric Population ◽  
Inappropriate Medications

OBJECTIVE: To compare the 2015 and 2019 AGS Beers Criteria® of potentially inappropriate medications in the elderly.<br/> DATA SOURCES: American Geriatrics Society 2015 and 2019 Updated AGS Beers Criteria® for Potentially Inappropriate Medication (PIM) Use in Older Adults published literature.<br/> STUDY SELECTION/DATA EXTRACTION: The literature was reviewed, compared, and summarized to identify pertinent changes and updates to the AGS Beers Criteria of PIMs in the elderly.<br/> DATA SYNTHESIS: The AGS Beers Criteria® contains a list of potentially inappropriate medications that should be used with caution, avoided, notable drug-drug interactions, and drugs that should be dose-adjusted based on kidney function in the older adult. The updated AGS Beers Criteria® also includes removal of medications that are no longer sold in the United States, have a low usage rate, provide low evidence of harm, and/or the potential harm is not unique to the older adult.<br/> CONCLUSION: The AGS Beers Criteria® is intended to improve and optimize the care of the geriatric population. It serves as a guide to minimize older adults' exposure to PIMs whenever possible. As with previously published updates to the AGS Beers Criteria®, the 2019 update outlines the following: recommendations, rationale, and quality of the recommendations, as well as the strength of the recommendations.

scholarly journals The role of the State Drug Formulary of Ukraine in providing rational pharmacotherapy for elderly patients

Pharmacia ◽  
2020 ◽  
Vol 67 (4) ◽  
pp. 261-268
Author(s):  
Yuliya Nastyukha ◽  
Kateryna Kostyana ◽  
Maria Maksymovych ◽  
Olga Boretska
Keyword(s):  
Elderly Patients ◽  
Pharmaceutical Care ◽  
The Elderly ◽  
The State ◽  
Potentially Inappropriate Medications ◽  
Drug Formulary ◽  
Rational Pharmacotherapy ◽  
Role Of The State ◽  
Inappropriate Medications

Applying the Classification for Drug-Related Problems (DRPs) of the Pharmaceutical Care Network Europe (V 9.00, 2019) allowed to systematize the information on the use of drugs in elderly patients given in the Annex of the State Drug Formulary of Ukraine. As a result of this work, special warnings and recommendations of the State Drug Formulary were presented together with the possible causes for potential DRPs, which they allow to prevent. The lists of potentially inappropriate medications (PIMs) for the elderly (n = 98), drugs the dosage of which in patients of this age group should be adjusted (n = 127), and drugs that need monitoring (n = 108) were formed. The obtained results can serve as a basis for the development of a specialized geriatric tool to ensure rational pharmacotherapy, in particular in the provision of pharmaceutical care.

Immune checkpoint inhibitor toxicity and associated outcomes in a geriatric population.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. e24014-e24014
Author(s):  
Peter James Polewski ◽  
Yacki Hayashi-Tanner ◽  
Mamatha Gaddam ◽  
Nancy R Fisher ◽  
Attila J Kovacs ◽  
...  
Keyword(s):  
Elderly Patients ◽  
Immune Checkpoint ◽  
Elderly Population ◽  
Immune Checkpoint Inhibitor ◽  
Checkpoint Inhibitor ◽  
The Elderly ◽  
Practice Setting ◽  
Geriatric Population ◽  
Community Oncology ◽  
Oncology Practice

e24014 Background: Increased use of immune checkpoint inhibitor (ICI) therapy over various cancer types has resulted in a parallel rise in immune-related adverse events (irAEs). There is limited data with regards to understanding irAEs in the elderly population despite its widespread use. We aimed to investigate irAEs in elderly patients receiving checkpoint inhibitor immunotherapy in a community oncology practice setting. Methods: Our retrospective study included patients ≥65 years old treated at a community oncology practice setting from January 1, 2011 through September 30, 2019 who received at least one treatment of a PD-1 or PDL-1 inhibitor (PDI) and/or CTLA-4 checkpoint inhibitor. We evaluated the prevalence of irAEs, determined if age, class of ICI, or oncologic response (clinical and radiographic) was associated with higher grades of irAE. The impact of irAEs on progression-free survival (PFS) and overall survival (OS) was also analyzed. Results: A total of 210 patients were identified, of which 76 developed irAEs. The overall mean age was 75.0 ± 7.2 years. Males accounted for 58% and the overall majority were Caucasian. The most common cancers were lung (56.7%), melanoma (20.0%) and genitourinary (14.8%). The prevalence of irAEs was 36.2% with a distribution of grades 1-2-3-4-5 being 31.6% - 43.4% - 17.1% - 6.6% and 1.3%, respectively. Hazard ratio adjusted for number of cycles for OS was 1.47 (95% CI, 0.98 to 2.19; p = 0.058) and PFS was 1.11 (95% CI, 0.72 to 1.71). Conclusions: To our knowledge, this is one of the few studies that has explored irAEs in the geriatric population. There was no association between ICI-associated higher-grade toxicities and oncologic response in our elderly population. Although there was a trend in OS, we found no statistical differences between elderly patients with irAEs and those without for OS and PFS. Further study is needed to explore the occurrence irAEs in the elderly to improve management of these patients.

scholarly journals How to Treat Hepatocellular Carcinoma in Elderly Patients

2021 ◽  
Vol 14 (3) ◽  
pp. 233
Author(s):  
Piera Federico ◽  
Emilio Francesco Giunta ◽  
Annalisa Pappalardo ◽  
Andrea Tufo ◽  
Gianpaolo Marte ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Elderly Patients ◽  
Elderly Population ◽  
Primary Tumour ◽  
The Elderly ◽  
Chronic Liver Diseases ◽  
Old Patients ◽  
Choice Of Treatment ◽  
Definition Of ◽  
Optimal Treatment Strategy

Hepatocellular carcinoma (HCC) is the primary tumour of the liver with the greatest incidence, particularly in the elderly. Additionally, improvements in the treatments for chronic liver diseases have increased the number of elderly patients who might be affected by HCC. Little evidence exists regarding HCC in old patients, and the elderly are still underrepresented and undertreated in clinical trials. In fact, this population represents a complex subgroup of patients who are hard to manage, especially due to the presence of multiple comorbidities. Therefore, the choice of treatment is mainly decided by the physician in the clinical practice, who often tend not to treat elderly patients in order to avoid the possibility of adverse events, which may alter their unstable equilibrium. In this context, the clarification of the optimal treatment strategy for elderly patients affected by HCC has become an urgent necessity. The aim of this review is to provide an overview of the available data regarding the treatment of HCC in elderly patients, starting from the definition of “elderly” and the geriatric assessment and scales. We explain the possible treatment choices according to the Barcelona Clinic Liver Cancer (BCLC) scale and their feasibility in the elderly population.

Sign in / Sign up

Export Citation Format

Share Document