POLYPHARMACY IN ELDERLY OUT PATIENTS

The aim of the work is to study the daily practice of prescribing drugs at the outpatient stage of medical care and to analyze the data obtained based Beers 2012 criteria and STOPP / START version 1. Materials and Methods. The authors analyzed drug prescriptions for 150 outpatients, who were over 65 years old. Results. Cardiovascular diseases, diseases of the osteo-articular system and type 2 diabetes mellitus prevailed in the morbidity structure of patients. Oncological diseases, thyroid diseases, bronchial asthma, cataracts, pancreatitis, anemia, peptic ulcer disease were diagnosed in some patients. All drug prescriptions during the year were taken into account. Simultaneous prescription of more than 4 drugs was considered polypharmacy. All the patients were monitored for a year since drug prescriptions had been made. Death was taken as the end point. The authors considered drug therapy to be irrational according to Beers and STOPP / START criteria. The therapeutic value of drug prescription audit based on restrictive lists was evaluated. Conclusions. Polypharmacy is observed in more than half of elderly outpatients. According to Beers 2012 criteria, irrational drug therapy was detected in 20 % of elderly patients, according to STOPP and START lists – in 43.3 % and 66.6 %, respectively. The lack of drug prescriptions in accordance with START criteria is associated with increased mortality of elderly patients. Keywords: polypharmacy, pharmacotherapy, drug therapy, geriatrics, restrictive lists, Beers criteria, STOPP / START criteria. Цель работы – изучение ежедневной практики назначения лекарственных препаратов на амбулаторном этапе медицинской помощи и анализ полученных данных на основе критериев ограничительных перечней Бирса 2012 г. и STOPP/START версии 1. Материалы и методы. Проанализированы лекарственные назначения 150 пациентам старше 65 лет, находившимся на амбулаторном лечении. Результаты. В структуре заболеваемости пациентов преобладали сердечно-сосудистые заболевания, а также болезни костно-суставной системы и сахарный диабет 2-го типа. Онкологические заболевания, заболевания щитовидной железы, бронхиальная астма, катаракта, панкреатит, анемия, язвенная болезнь диагностированы у единичных больных. Учитывались все лекарственные назначения в течение года. За полипрагмазию принималось одновременное назначение более 4 препаратов. В течение последующего года отслеживалось состояние пациентов, за конечную точку принята смерть. Выявлена нерациональная лекарственная терапия на основе критериев Бирса и STOPP/START. Оценена терапевтическая значимость аудита лекарственных назначений по ограничительным перечням. Выводы. Полипрагмазия наблюдается более чем у половины амбулаторных пациентов пожилого возраста. На основе критериев ограничительных перечней Бирса 2012 г. нерациональная лекарственная терапия выявлена у 20 % пациентов пожилого возраста, на основе критериев STOPP и START – у 43,3 и 66,6 % соответственно. Отсутствие назначений лекарств в соответствии с критериями START ассоциировано с увеличением смертности пациентов пожилого возраста. Ключевые слова: полипрагмазия, фармакотерапия, лекарственная терапия, гериатрия, ограничительные перечни, критерии Бирса, критерии STOPP/START.

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Repeat Prescribing in the Elderly. A Case for Audit?

Scottish Medical Journal ◽

10.1177/003693308402900106 ◽

1984 ◽

Vol 29 (1) ◽

pp. 21-24 ◽

Cited By ~ 1

Author(s):

Fiona Nicol ◽

H. Gebbie

Keyword(s):

Elderly Patients ◽

Drug Prescription ◽

The Elderly ◽

Drug Prescriptions ◽

Repeat Prescription ◽

Repeat Prescribing ◽

Susceptible Group ◽

Repeat Prescriptions

An audit of repeat drug prescriptions in 531 elderly patients in an urban practice was undertaken. Two thirds of the patients (64%) were receiving repeat prescriptions at time of review and had been doing so for up to 20 years (mean 5.3 years). Individual practitioners' rates of starting repeat prescriptions and monitoring them were reviewed. The data revealed that drug prescription in this highly susceptible group was not being adequately monitored and stimulated the introduction of repeat prescription cards.

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A General Model of Drug Prescription

Methods of Information in Medicine ◽

10.1055/s-0038-1634606 ◽

1995 ◽

Vol 34 (04) ◽

pp. 310-317 ◽

Cited By ~ 6

Author(s):

B. Séné ◽

I. de Zegher ◽

C. Milstein ◽

S. Errore ◽

F de Rosis ◽

...

Keyword(s):

User Interface ◽

Life Events ◽

Drug Prescription ◽

Clinical Signs ◽

Object Oriented ◽

Drug Prescriptions ◽

Free Text ◽

Medical Procedures ◽

Dosage Regimens ◽

Structured Representation

Abstract:Currently, there is no widely accepted structured representation of drug prescription. Nevertheless, a structured representation is required for entering and storing drug prescriptions avoiding free text in computerized systems, and for drug prescription reviews. Derived from part of the work of the European OPADE project, we describe an object-oriented model of drug prescription which incorporates important concepts such as the phase and triggering event concepts. This model can be used to record all drug prescriptions, including infusions, in a structured way avoiding free text. The phase concept allows the storage of sequentially ordered dosage regimens for a drug within the same prescription. The prescription triggering event concept allows recording of the administration of a drug conditional to dates, symptoms and clinical signs, medical procedures, and everyday life events. This model has been implemented within the OPADE project; the corresponding aspects of the user interface are presented to show how this model can be used in practice. Even if other new attributes may be added to the described objects, the structure of this model is suitable for general use in software which requires the entry, storage and processing of drug prescriptions.

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Pharmacotherapy in the Elderly. Notice and Contrivance on Multiple Drug Prescription for Elderly Patients.

Nippon Ronen Igakkai Zasshi Japanese Journal of Geriatrics ◽

10.3143/geriatrics.36.176 ◽

1999 ◽

Vol 36 (3) ◽

pp. 176-180 ◽

Cited By ~ 1

Author(s):

Yasufumi Sawada

Keyword(s):

Elderly Patients ◽

Drug Prescription ◽

The Elderly ◽

Multiple Drug

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ORAL FRAILTY IS ASSOCIATED WITH MULTIFACETED FRAILTY IN ELDERLY OUTPATIENTS AT COMMUNITY DENTAL CLINICS

Innovation in Aging ◽

10.1093/geroni/igz038.530 ◽

2019 ◽

Vol 3 (Supplement_1) ◽

pp. S147-S147

Author(s):

Misa Nishimoto ◽

Tomoki Tanaka ◽

Yutaka Watanabe ◽

Hirohiko Hirano ◽

Takeshi Kikutani ◽

...

Keyword(s):

Elderly Patients ◽

Healthy Aging ◽

Confounding Factors ◽

Multiple Functions ◽

Oral Motor ◽

Dental Clinics ◽

Elderly Outpatients ◽

Chewing Ability ◽

Oral Frailty ◽

Age And Sex

Abstract Aim For achieving healthy aging, frailty prevention is essential. Because it is reported that accumulated declines in multiple oral functions (i.e. oral frailty) could lead to frailty progression, detailed countermeasures for oral frailty are currently required. However, dentists of community dental clinics don’t even know a prevalence of oral frailty among outpatients. Thus, we aimed to identify the prevalence of oral frailty and to examine the association with frailty in outpatients at community dental clinics. Methods The subjects were elderly outpatients at dental clinics in Kanagawa, Japan. Frailty was assessed using the Kihon checklists (KCL); those with ≥8 KCL score were classified as frailty. Furthermore, multiple functions (physical, nutrition, and oral) were assessed using subscale of the KCL. Oral frailty was defined as ≥3 deteriorations out of 5 oral status (remaining teeth, chewing ability, articulatory oral motor skill, subjective difficulties in eating and swallowing). Results Of 1,699 outpatients (mean age, 75 ± 6.3 years old; 40% men), 12% were frailty and 21% were oral frailty. When adjusted by confounding factors such as age and sex, those with oral frailty were associated with higher prevalence of frailty (OR, 3.25; 95%CI, 2.34-4.53), decreased physical and oral functions (OR, 1.53; 95%CI, 1.07-2.16: OR, 8.14; 95%CI, 6.05-10.95, respectively). Conclusions Oral frailty was associated with multi-faceted frailty in outpatients at community dental clinics. In addition to the importance of maintenance of whole oral functions including treating teeth, our findings suggest that it is also indispensable to consider the multi-faceted frailty for elderly patients.

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Future Opportunities for Drug Therapy in Peptic Ulcer Disease

Scandinavian Journal of Gastroenterology ◽

10.3109/00365528609093838 ◽

1986 ◽

Vol 21 (sup125) ◽

pp. 203-211 ◽

Cited By ~ 12

Author(s):

A. Garner

Keyword(s):

Peptic Ulcer ◽

Drug Therapy ◽

Peptic Ulcer Disease ◽

Ulcer Disease

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Elderly Patients' Understanding of Their Drug Therapy: The Effect of Cognitive Function

Age and Ageing ◽

10.1093/ageing/19.4.236 ◽

1990 ◽

Vol 19 (4) ◽

pp. 236-240 ◽

Cited By ~ 12

Author(s):

E. BURNS ◽

C. A. AUSTIN ◽

N. D. S. BAX

Keyword(s):

Drug Therapy ◽

Cognitive Function ◽

Elderly Patients

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Perioperative Multimodal Anesthesia Using Regional Techniques in the Aging Surgical Patient

Pain Research and Treatment ◽

10.1155/2014/902174 ◽

2014 ◽

Vol 2014 ◽

pp. 1-13 ◽

Cited By ~ 5

Author(s):

Diana Nordquist ◽

Thomas M. Halaszynski

Keyword(s):

Drug Therapy ◽

Adverse Effects ◽

Elderly Patients ◽

Regional Anesthesia ◽

Pain Control ◽

The Elderly ◽

Surgical Patient ◽

Cochrane Central Register ◽

Promising Alternative ◽

Age Related

Background. Elderly patients have unique age-related comorbidities that may lead to an increase in postoperative complications involving neurological, pulmonary, cardiac, and endocrine systems. There has been an increase in the number of elderly patients undergoing surgery as this portion of the population is increasing in numbers. Despite advances in perioperative anesthesia and analgesia along with improved delivery systems, monotherapy with opioids continues to be the mainstay for treatment of postop pain. Reliance on only opioids can oftentimes lead to inadequate pain control or increase in the incidence of adverse events. Multimodal analgesia incorporating regional anesthesia is a promising alternative that may reduce needs for high doses and dependence on opioids along with any potential associated adverse effects. Methods. The following databases were searched for relevant published trials: Cochrane Central Register of Controlled Trials and PubMed. Textbooks and meeting supplements were also utilized. The authors assessed trial quality and extracted data. Conclusions. Multimodal drug therapy and perioperative regional techniques can be very effective to perioperative pain management in the elderly. Regional anesthesia as part of multimodal perioperative treatment can often reduce postoperative neurological, pulmonary, cardiac, and endocrine complications. Regional anesthesia/analgesia has not been proven to improve long-term morbidity but does benefit immediate postoperative pain control. In addition, multimodal drug therapy utilizes a variety of nonopioid analgesic medications in order to minimize dosages and adverse effects from opioids while maximizing analgesic effect and benefit.

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Possibility of oxygen-ozone therapy in the geriatric patient

Ozone Therapy ◽

10.4081/ozone.2016.6471 ◽

2017 ◽

Vol 1 (3) ◽

pp. 53

Author(s):

Marianno Franzini ◽

Giulia Ionita

Keyword(s):

Drug Therapy ◽

Side Effects ◽

Minimally Invasive ◽

Elderly Patients ◽

Geriatric Patient ◽

Multidisciplinary Care ◽

Invasive Technique ◽

Ozone Therapy ◽

Muscular Pain ◽

Care Of Elderly

In the context of multidisciplinary care of elderly patients, this work will want to consider the presence of osteo-articular and muscular pain, mostly chronic, of these subjects. The treatment has made use of oxygen-ozone therapy, given the absence of side effects of this minimally invasive technique, and the possibility of its use simultaneously with an already established poly-drug therapy, as typically found in the geriatric patient.

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Optimizing Antiepileptic Drug Therapy in the Elderly

Annals of Pharmacotherapy ◽

10.1345/aph.1e683 ◽

2005 ◽

Vol 39 (11) ◽

pp. 1852-1860 ◽

Cited By ~ 9

Author(s):

William R Garnett

Keyword(s):

Drug Therapy ◽

Elderly Patients ◽

Antiepileptic Drug ◽

Age Groups ◽

The Elderly ◽

Complex Partial Seizures ◽

Medline Search ◽

Age Related ◽

Epilepsy In The Elderly ◽

Clonic Seizures

OBJECTIVE To review and evaluate the medical literature concerning antiepileptic drug (AED) therapy in elderly patients. DATA SOURCES A MEDLINE search (1982–December 2004) was conducted. Bibliographies of the articles identified were also reviewed, and an Internet search engine was used to identify additional pertinent references. STUDY SELECTION AND DATA EXTRACTION Clinical studies and reviews were evaluated, and relevant information was included. DATA SYNTHESIS The elderly have the highest incidence of seizures among all age groups. Complex partial seizures are the most common, followed by primary generalized tonic–clonic seizures. An accurate diagnosis may prove difficult because of a low suspicion of epilepsy in the elderly and other diseases that may mimic seizures. Most AEDs are approved for treatment of elderly patients who have partial and tonic–clonic seizures. However, a number of age-related variables should be addressed when selecting an appropriate AED. Age-dependent differences in pharmacokinetics and pharmacodynamics of AEDs must be taken into account. Drug–drug interactions must be considered since elderly people often take multiple medications. The ultimate factor that often determines AED selection is tolerability. CONCLUSIONS Numerous factors must be considered in treating elderly patients for seizures, but maximizing the ability of patients to tolerate drug therapy is often the basis for AED selection. Special consideration should be made along several lines, including elderly patients’ cognitive functioning and their tendency to respond to lower AED concentrations.

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