scholarly journals A Qualitative Analysis to Understand Perception about Medication-Related Problems among Older Minority Adults in a Historically Black Community

Pharmacy ◽  
2022 ◽  
Vol 10 (1) ◽  
pp. 14
Author(s):  
Ivy O. Poon ◽  
Felicia Skelton ◽  
Lena R. Bean ◽  
Dominique Guinn ◽  
Terica Jemerson ◽  
...  
Keyword(s):  
Older Adults ◽  
Historically Black ◽  
Adverse Drug Events ◽  
Ecological Model ◽  
Group Discussion ◽  
Medication Management ◽  
Unmet Need ◽  
Community Setting ◽  
Patient Centered ◽  
Increased Risk

Older adults taking multiple chronic medications experience an increased risk of adverse drug events and other medication-related problems (MRP). Most current literature on medication management involves researcher-driven intervention, yet few studies investigate patients’ understanding of MRP in a diverse community setting. This report investigates patients’ perception of MRP and patient-centered strategies among a cohort of the older adult group in a historically Black urban community. The study design is qualitative using structured open-ended questions in a multidisciplinary patient-centered focus group. Patients (age 65 years or older) taking seven or more medications were recruited. The group comprises patients, caregivers, pharmacists, health educators, a physician, and a nurse. Recordings of the group discussion are transcribed verbatim and analyzed using thematic content analysis and categorized by codes developed from the social-ecological model. The group reports patient-provider relationships, previous experience, fear of side effects played important roles in medication adherence. There is an unmet need for medication management education and tools to organize complex medication lists from multiple providers. This study provides important insights into MRP experienced by minority older adults and provided researchers with potential strategies for future interventions.

The role of a geriatrician in a cancer center.

2016 ◽  
Vol 34 (3_suppl) ◽  
pp. 39-39 ◽  
Author(s):  
Beatriz Korc-Grodzicki ◽  
Sung W. Sun ◽  
Armin Shahrokni ◽  
Koshy Alexander ◽  
Soo Jung Kim ◽  
...  
Keyword(s):  
Older Adults ◽  
Risk Assessment ◽  
Nurse Practitioners ◽  
Transitional Care ◽  
Unmet Need ◽  
Cancer Center ◽  
Ongoing Research ◽  
Increased Risk

39 Background: Older adults are likely to have coexisting health conditions, polypharmacy and functional limitations. The geriatrician may have a pivotal role in risk assessment, prevention and treatment of comorbidities and addressing geriatric syndromes. The purpose of this study is to describe the growth and development of, and the role of a Geriatrics Service (GS) in a cancer center. Methods: A GS was founded in MSKCC in 2009. Since then it has grown to provide inpatient (IP) and outpatient (OP) care for older adults undergoing cancer diagnosis, surveillance or active treatment. It offers preoperative evaluations, geriatric assessment (GA) and follow-up shared- care. Recently, a Transitional Care Management (TCM) program was established for patients at increased risk of rehospitalization. The GS strives to develop an interprofessional educational geriatrics curriculum and to participate in quality and research projects focused on cancer and aging. Results: Between 2009 and 2014 a total of 6679 new patients were evaluated by the GS. 16% of the patients were 65-75, 70% were 76-85 and 14% were older than 85. 46% were male and 84% were white. 15% were IP and 85% were OP consultations. 13% of the OP consults were for GA, the rest were preoperative evaluations. All patients seen preoperatively who are admitted after surgery, are followed postoperatively by the IP geriatrics team. In total, 4 Geriatricians, 2 Geriatric Nurse Practitioners (GNP) and 3 RNs were recruited. The number of follow-up visits increased from 143 in 2009 to 733 in 2014. The new TCM program based on close communication between the IP and OP GNP has been successful in keeping frail patients from frequent rehospitalizations. Noon conferences on geriatrics for the house staff, a biannual course on “Advancing Nursing Expertise in the Care of Older Adults with Cancer” and a monthly interprofessional meeting for the discussion of Geriatric Clinical Complex Cases (GCCC) are ongoing. Research has focused on risk assessment and the use of telemedicine in geriatric patient care. Conclusions: The establishment of a GS in a cancer center was very well received and embraced by the oncologists showing an unmet need in the care of the older cancer patient. The potential reproducibility beyond the cancer center will be discussed.

scholarly journals A Review on Deprescribing in Elderly

2021 ◽  
Vol 11 (4) ◽  
pp. 136-137
Author(s):  
Christy Babu ◽  
Lincy George ◽  
K. Krishnakumar
Keyword(s):  
Quality Of Life ◽  
Older Adults ◽  
High Risk ◽  
Older Patients ◽  
Adverse Drug Events ◽  
Patient Centered ◽  
Inappropriate Medications ◽  
Related Harm ◽  
Improve Health

Deprescribing can be defined as the process of stopping a medication or reducing its dose to reduce adverse effects and improve health outcomes. Elderly people with co morbidities usually have a risk of adverse drug events and these events can only be treated by medicines. Despite the benefits offered by these medicines, older patients are at a high risk of harm caused by these medications. The use of multiple medications for treating the comorbidities may also leads to severe health problems. Deprescribing help to reduce the risk related to inappropriate medicines. Deprescribing is usually a patient centered process which helps to withdraw drugs which are harmful to be prescribed to older patients. Several explicit and implicit tools have been developed internationally to identify these inappropriate medications. Deprescribing of inappropriate medicines would help to reduces drug-related harm and improves the quality of life of older adults. Keywords: Deprescribing, polypharmacy, older adults

Risk Factors for Adverse Drug Events in Older Adults with Mobility Limitations in the Community Setting

2007 ◽  
Vol 55 (1) ◽  
pp. 29-34 ◽  
Author(s):  
Elizabeth Chrischilles ◽  
Linda Rubenstein ◽  
Rachel Van Gilder ◽  
Margaret Voelker ◽  
Kara Wright ◽  
...  
Keyword(s):  
Risk Factors ◽  
Older Adults ◽  
Adverse Drug Events ◽  
Community Setting ◽  
Mobility Limitations

scholarly journals Utilization of potentially inappropriate medication and risk of adverse drug events among older adults with chronic renal insufficiency: a population-wide cohort study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Safoura Sheikh Rezaei ◽  
Hana Šinkovec ◽  
Alexander Schöberl ◽  
Christoph Rinner ◽  
Georg Heinze ◽  
...  
Keyword(s):  
Older Adults ◽  
Cohort Study ◽  
Adverse Drug Events ◽  
Inappropriate Medication ◽  
Threshold Level ◽  
Target Population ◽  
Potentially Inappropriate Medication ◽  
Control Group ◽  
Short Term Exposure ◽  
Increased Risk

Abstract Background The use of potentially inappropriate medication (PIM) in population of older adults may result in adverse drug events (ADE) already after short term exposure, especially when it is prescribed to patients with chronic kidney disease (CKD). In order to limit ADE in the treatment of older adults PIM lists have been constructed as a source of information for healthcare professionals. The aim of this study was to estimate the utilization of PIM and incidence of ADE in older adults (≥70 years) with CKD. Methods We conducted a retrospective population-wide cohort study including patients from Lower Austria who were 70 years or older and diagnosed with CKD in the period from 2008 to 2011. Utilization of PIM was estimated from prescriptions filled by target population. We estimated risks of hospitalization due to ADE within 30 days after incident PIM prescription and compared them to a PIM-free control group by using marginal structural models (MSM). Results We identified 11,547 patients (women: 50.6%, median age in 2008: 78 years) who fulfilled the inclusion criteria. In total 24.7 and 8.1% of all prescriptions from that period contained a medication with a substance listed in the EU (7)-PIM and AT-PIM list, respectively. Proton pump inhibitors and Ginkgo biloba were the most often prescribed PIMs in this population. 94.6 and 79.3% patients filled at least one EU(7)-PIM and AT-PIM prescription, respectively. Despite the relatively high utilization of PIM there was only a low incidence of clinically relevant ADE. No event type exceeded the threshold level of 1% in the analysis of risks of ADE after filling a prescription for PIM. Nevertheless, MSM analysis showed an increased risk for 11 drugs and reduced risk for 4 drugs. Conclusions PIM prescription was common among older adults with CKD, however, only a small number of these drugs eventually led to hospitalization due to ADE within 30 days after incident PIM was filled. In the absence of a clinically important PIM-related increase in risk, an assessment of potential ADE severity to a PIM list by using a warning score system seems prudent.

scholarly journals Acceptance of Pharmaceutical Services by Home-Dwelling Older Patients: A Case Study in a Portuguese Community Pharmacy

2021 ◽  
Vol 18 (14) ◽  
pp. 7401
Author(s):  
Ana Rita Paiva ◽  
Ana Isabel Plácido ◽  
Isabel Curto ◽  
Manuel Morgado ◽  
Maria Teresa Herdeiro ◽  
...  
Keyword(s):  
Older Adults ◽  
Community Pharmacy ◽  
Medication Management ◽  
Management Service ◽  
Daily Lives ◽  
Medication Therapy ◽  
Medication Consumption ◽  
Increased Risk ◽  
Beneficial Impact

Background: Aging-related comorbidities predispose older adults to polypharmacy and consequently an increased risk of adverse drug reactions and poor compliance. Pharmacists’ interventions can have a beneficial impact on the improvement of clinical outcomes. Thus, this work aimed to assess the acceptance of Portuguese home-dwelling older adults regarding a pharmaceutical service paid by patients for medication management and pharmacotherapy follow-up. We also intended to analyze medication, characterize the medication consumption profile, and identify the main difficulties of our sample during their daily medication management. Methods: A questionnaire on adherence and medication therapy management was applied to polymedicated patients ≥65 years old, in a community pharmacy. Results: Of the 88 participants, 92.2% would be willing to pay for a pharmacotherapy management service, and 75.6% answered that they would be willing to pay for an individual medication preparation service. In addition, 45.7% of the participants were categorized as lower adherents to a medication therapeutic regimen. Our sample reported that during their daily lives, they felt difficulty: to remember to take their pills (17%), to manage so many medicines (15.9%), and to swallow the pills (9.1%). Conclusions: Polymedicated older adults are willing to pay for a service to improve the management of their medicines, suggesting that they recognize the role of pharmacists in medication management. This study provides useful information for the conceptualization of a pharmacotherapy management service that includes medication review and a pharmacotherapy follow-up.

scholarly journals UNDERSTANDING FACILITATORS AND BARRIERS TO PARTICIPATION IN EVIDENCE-BASED FALL-PREVENTION INTERVENTIONS

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S567-S567
Author(s):  
Janice Mark ◽  
Gwen Bergen ◽  
Briana Moreland
Keyword(s):  
Older Adults ◽  
Physical Therapy ◽  
Fall Prevention ◽  
Ecological Model ◽  
Medication Management ◽  
Evidence Based ◽  
Patient Attitudes ◽  
Cost Information ◽  
Prevention Interventions ◽  
Facilitators And Barriers

Abstract Prescribing evidence-based interventions based on older adults’ modifiable risk factors is recommended to prevent falls. Older adults need to adhere to the prescribed intervention to successfully reduce risk. This study reports on a structured systematic review to understand patient attitudes to adherence to fall prevention interventions. A systematic search for publications from 2008-2018 identified 72 articles on patient attitudes toward exercise, physical therapy, medication management, podiatry, and vision care for fall prevention. Three reviewers coded facilitators and barriers based on a socio-ecological model of interpersonal, intrapersonal, community, and policy factors. Perceived susceptibility to falling and perceived effectiveness of the intervention were important factors across all fall prevention interventions. Physician prescribing and discussion facilitated exercise, medication changes, and physical therapy. For attitudes related to community and policy, the most reported barriers were transportation and cost. Information from this review can be used to improve the implementation of fall prevention interventions.

scholarly journals How Can Providers Better Address Recovery Needs for Geriatric TBI Survivors?

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 91-91
Author(s):  
Mia Vogel ◽  
Wonkyung Jung ◽  
Hilaire Thompson
Keyword(s):  
Older Adults ◽  
Care Delivery ◽  
Health Service Delivery ◽  
Post Injury ◽  
Patient Centered ◽  
Study Approach ◽  
Taste Changes ◽  
Increased Risk ◽  
Common Balance

Abstract Older adults are at increased risk for poorer recovery from traumatic brain injury (TBI), incidence of pre-injury frailty, and comorbidity compared to younger adults. In this study, a longitudinal multiple case study approach was taken to describe gaps in health service delivery identified by older adults following mild-moderate TBI. Participants were interviewed at 1 week, and 1, 3, 6, and 12 months post injury (5 times). In total, 57 interviews were conducted with 13 participants and transcribed verbatim. Codes were identified inductively to develop a codebook for guiding thematic analysis in NVIVO. Two independent investigators double coded 16 transcripts (28%) and reached consensus; remaining transcripts were allocated to the two investigators for independent coding and verified and reconciled with the other coder until consensus was reached. Many participants were happy with the care they received. However, ongoing health issues and TBI symptoms sometimes remained unaddressed. Follow-up and care planning would have been helpful for most patients as well as ways to address common balance and dizziness issues. Among some, the unwillingness to go to a provider for follow-up or adhere to medication and physical therapy exercises were issues. In some cases, providers were unable to help or understand the reason for patients’ symptoms (e.g., smell/taste changes, ear issues, etc.). Sometimes, providers did not address the issues that were of most concern to patients, or they would prescribe treatments that were not acceptable to patients. Empathetic, tailored, and patient-centered approaches are needed to improve care delivery and outcomes.

Polypharmacy, Medication Possession, and Deprescribing of Potentially Non-Beneficial Drugs in Hospice Patients

2020 ◽  
Vol 37 (12) ◽  
pp. 1076-1085
Author(s):  
Ian Duncan ◽  
Terri L. Maxwell ◽  
Nhan Huynh ◽  
Marisa Todd
Keyword(s):  
Prescription Drugs ◽  
Adverse Drug Events ◽  
Medication Management ◽  
Primary Diagnosis ◽  
Potentially Inappropriate Medications ◽  
Negative Consequences ◽  
Drug Classes ◽  
Increased Risk ◽  
Incidence Functions ◽  
Almost All

Patients frequently have comorbidities that when combined with their primary diagnosis qualifies the patient for hospice. Consequently, patients are at risk for polypharmacy due to the number of medications prescribed to treat both the underlying conditions and the related symptoms. Polypharmacy is associated with negative consequences, including increased risk for adverse drug events, drug–drug and drug–disease interactions, reduced functional status and falls, multiple geriatric syndromes, medication nonadherence, and increased mortality. Polypharmacy also increases the complexity of medication management for caregivers and contributes to the cost of prescription drugs for hospices and patients. Deprescribing or removing nonbeneficial or ineffective medications can reduce polypharmacy in hospice. We study medication possession ratios and rates of deprescribing of commonly prescribed but potentially nonbeneficial classes of medication using a large hospice pharmacy database. Prevalence of some classes of potentially inappropriate medications is high. We report possession ratios for 10 frequently prescribed classes, and, because death and prescription termination are competing events, we calculate prescription termination rates using Cumulative Incidence Functions. Median duration of antifungal and antiviral medications is brief (5 and 7 days, respectively), while statins and diabetes medications have slow discontinuance rates (median termination durations of 93 and 197 days). Almost all patients with a proton pump inhibitor prescription have the drug for their entire hospice stay. Data from this study identify those drug classes that are commonly deprescribed slowly, suggesting drug classes and diagnoses that hospices may wish to focus on more closely, as they act to limit polypharmacy and reduce prescription costs.

Interdisciplinary Therapy Assessments for the Older Adult

2012 ◽  
Vol 17 (1) ◽  
pp. 11-16
Author(s):  
Lynn Chatfield ◽  
Sandra Christos ◽  
Michael McGregor
Keyword(s):  
Older Adults ◽  
Health Care ◽  
Standardized Testing ◽  
Health Care Providers ◽  
Outcome Measurement ◽  
Care Providers ◽  
Patient Centered ◽  
Screening Process ◽  
Evidenced Based ◽  
Changing Economy

In a changing economy and a changing industry, health care providers need to complete thorough, comprehensive, and efficient assessments that provide both an accurate depiction of the patient's deficits and a blueprint to the path of treatment for older adults. Through standardized testing and observations as well as the goals and evidenced-based treatment plans we have devised, health care providers can maximize outcomes and the functional levels of patients. In this article, we review an interdisciplinary assessment that involves speech-language pathology, occupational therapy, physical therapy, and respiratory therapy to work with older adults in health care settings. Using the approach, we will examine the benefits of collaboration between disciplines, an interdisciplinary screening process, and the importance of sharing information from comprehensive discipline-specific evaluations. We also will discuss the importance of having an understanding of the varied scopes of practice, the utilization of outcome measurement tools, and a patient-centered assessment approach to care.

Sign in / Sign up

Export Citation Format

Share Document