scholarly journals Pharmacovigilance in Older Adults

2021 ◽  
Author(s):  
Daniel Gomes ◽  
Eva Rebelo Gomes ◽  
Inês Ribeiro-Vaz ◽  
Maria Teresa Herdeiro ◽  
Fátima Roque
Keyword(s):  
Older Adults ◽  
Healthcare Costs ◽  
Older Patients ◽  
Aging Process ◽  
Hospital Admissions ◽  
Inappropriate Medication ◽  
Drug Effects ◽  
The Elderly ◽  
Adverse Drug Effects ◽  
Age Range

Polypharmacy and physiological changes inherent to the aging process can cause significant modifications in the pharmacokinetic and dynamic regimens of drugs, making the elderly more susceptible to adverse drug effects. Adverse drug reactions (ADR) in older adults have a significant impact on hospital admissions, increasing hospital stay and healthcare costs. Most common ADR in this population are dose-related and predictable. However, they can be difficult to diagnose as they often have nonspecific symptoms. This could be minimized by decreasing the use and prescription of potentially inappropriate medication and being aware of possible drug interactions. Besides, being older patients underrepresented in clinical trials and due to their physiological modifications, serious or atypical ADR are more common in this age range. To minimize harm in older adults, effective pharmacovigilance must be encouraged.

Inappropriate Medication Use as a Risk Factor for Self-Reported Adverse Drug Effects in Older Adults

2009 ◽  
Vol 57 (6) ◽  
pp. 1000-1006 ◽  
Author(s):  
Elizabeth A. Chrischilles ◽  
Rachel VanGilder ◽  
Kara Wright ◽  
Michael Kelly ◽  
Robert B. Wallace
Keyword(s):  
Older Adults ◽  
Risk Factor ◽  
Inappropriate Medication ◽  
Medication Use ◽  
Drug Effects ◽  
Adverse Drug Effects ◽  
Inappropriate Medication Use

scholarly journals Comparison of adaptive versions of the Hong Kong-specific criteria and 2015 Beers criteria for assessing potentially inappropriate medication use in Hong Kong older patients

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Huanyu ZHANG ◽  
Eliza L. Y. WONG ◽  
Samuel Y. S. WONG ◽  
Patsy Y. K. CHAU ◽  
Benjamin H. K. YIP ◽  
...  
Keyword(s):  
Older Adults ◽  
Hong Kong ◽  
Older Patients ◽  
Inappropriate Medication ◽  
Female Gender ◽  
Potentially Inappropriate Medication ◽  
Multivariable Logistic Regression Analysis ◽  
Beers Criteria ◽  
Medical Conditions ◽  
Cross Sectional

Abstract Background The Hong Kong-specific criteria have been established in 2019 to assess potentially inappropriate medication (PIM) use in older adults and improve the local prescribing quality. The aim of this study was to compare the adaptive versions of the Hong Kong-specific criteria and 2015 Beers criteria for assessing the prevalence and correlates of PIM use in Hong Kong older patients. Methods A cross-sectional study was performed from January 1, 2014 to December 31, 2014 using the Hospital Authority (HA) database. A total of 489,301 older patients aged 65 years and older visiting general outpatient clinics (GOPCs) during the study period were included in the study. Two categories of PIM use included in the Hong Kong-specific criteria and 2015 Beers criteria, i.e. PIMs independent of diagnoses and PIMs considering specific medical conditions, were adapted to assess the prevalence of PIM use among the study sample. Characteristics of PIM users and the most frequently prescribed PIMs were investigated for each set of the criteria. Factors associated with PIM use were identified using the stepwise multivariable logistic regression analysis. Results The adaptive Hong Kong-specific criteria could detect a higher prevalence of patients exposed to at least one PIM than that assessed by the adaptive Beers criteria (49.5% vs 47.5%). Meanwhile, the adaptive Hong Kong-specific criteria could identify a higher rate of patients exposed to PIMs independent of diagnoses (48.1% vs 46.8%) and PIMs considering specific medical conditions (7.3% vs 4.9%) compared with that of the adaptive Beers criteria. The most frequently prescribed PIMs detected by the adaptive Beers criteria were all included in the adaptive Hong Kong-specific criteria. The strongest factor associated with PIM use was number of different medications prescribed. Patients with female gender, aged 65 ~ 74 years, a larger number of GOPC visits, and more than six diagnoses were associated with greater risk of PIM use, whereas advancing age was associated with lower risk of PIM use. Conclusions The adaptive Hong Kong-specific criteria could detect a higher prevalence of PIM use than the adaptive Beers criteria in older adults visiting GOPCs in Hong Kong. It is necessary to update the prevalence and correlates of PIM use regularly in older adults to monitor the burden of PIM use and identify vulnerable patients who need further interventions.

scholarly journals Prevalence and determinants of potentially inappropriate medication use in Hong Kong older patients: a cross-sectional study

BMJ Open ◽  
2021 ◽  
Vol 11 (7) ◽  
pp. e051527
Author(s):  
Huanyu Zhang ◽  
Eliza LY Wong ◽  
Samuel YS Wong ◽  
Patsy YK Chau ◽  
Benjamin HK Yip ◽  
...  
Keyword(s):  
Older Adults ◽  
Regression Analysis ◽  
Hong Kong ◽  
Older Patients ◽  
Inappropriate Medication ◽  
Cross Sectional Study ◽  
Potentially Inappropriate Medication ◽  
Multivariable Logistic Regression Analysis ◽  
Sectional Study ◽  
Cross Sectional

ObjectivesTo assess the prevalence of potentially inappropriate medication (PIM) use in Hong Kong older patients visiting general outpatient clinics (GOPCs) between 2006 and 2014 and to identify factors associated with PIM use among older adults visiting GOPCs in 2014.DesignCross-sectional study.SettingGOPC.ParticipantsTwo study samples were constructed including a total of 844 910 patients aged 65 and above from 2006 to 2014 and a cohort of 489 301 older patients in 2014.MeasurementsTwo subsets of the 2015 American Geriatrics Society Beers criteria—PIMs independent of diagnosis and PIMs due to drug–disease interactions—were used to estimate the prevalence of PIM use over 12 months. PIMs that were not included in the Hospital Authority drug formulary or with any specific restriction or exception in terms of indication, dose or therapy duration were excluded. Characteristics of PIM users and non-PIM users visiting GOPCs in 2014 were compared. Independent associations between patient variables and PIM use were assessed by stepwise multivariable logistic regression analysis.ResultsThe 12-month period prevalence of PIM use decreased from 55.56% (95% CI 55.39% to 55.72%) in 2006 to 47.51% (95% CI 47.37% to 47.65%) in 2014. In the multivariable regression analysis, the strongest factor associated with PIM use was the number of different drugs prescribed (adjusted OR, AOR 23.01, 95% CI 22.36 to 23.67). Being female (AOR 0.89, 95% CI 0.85 to 0.87 for males vs females) and having a greater number of GOPC visits (AOR 1.83, 95% CI 1.78 to 1.88) as well as more than six diagnoses (AOR 1.43, 95% CI 1.36 to 1.52) were associated with PIM use.ConclusionsThe overall prevalence of PIM use in older adults visiting GOPCs decreased from 2006 to 2014 in Hong Kong although the prevalence of PIM use was still high in 2014. Patients with female gender, a larger number of medications prescribed, more frequent visits to GOPCs, and more than six diagnoses were at higher risk for PIM use.

scholarly journals Use of seroprevalence to guide dengue vaccination plans for older adults in a dengue non-endemic country

2021 ◽  
Vol 15 (4) ◽  
pp. e0009312
Author(s):  
Yi-Hua Pan ◽  
Mei-Ying Liao ◽  
Yu-Wen Chien ◽  
Tzong-Shiann Ho ◽  
Hui-Ying Ko ◽  
...  
Keyword(s):  
Older Adults ◽  
Adult Population ◽  
Age Groups ◽  
The Elderly ◽  
Denv Infection ◽  
Serum Samples ◽  
Increased Risk ◽  
Southern Taiwan ◽  
Older Populations ◽  
Age Range

A shift in dengue cases toward the adult population, accompanied by an increased risk of severe cases of dengue in the elderly, has created an important emerging issue in the past decade. To understand the level of past DENV infection among older adults after a large dengue outbreak occurred in southern Taiwan in 2015, we screened 1498 and 2603 serum samples from healthy residents aged ≥ 40 years in Kaohsiung City and Tainan City, respectively, to assess the seroprevalence of anti-DENV IgG in 2016. Seropositive samples were verified to exclude cross-reaction from Japanese encephalitis virus (JEV), using DENV/JEV-NS1 indirect IgG ELISA. We further identified viral serotypes and secondary DENV infections among positive samples in the two cities. The overall age-standardized seroprevalence of DENV-IgG among participants was 25.77% in Kaohsiung and 11.40% in Tainan, and the seroprevalence was significantly higher in older age groups of both cities. Although the percentages of secondary DENV infection in Kaohsiung and Tainan were very similar (43.09% and 44.76%, respectively), DENV-1 and DENV-2 spanned a wider age range in Kaohsiung, whereas DENV-2 was dominant in Tainan. As very few studies have obtained the serostatus of DENV infection in older adults and the elderly, this study highlights the need for further investigation into antibody status, as well as the safety and efficacy of dengue vaccination in these older populations.

Aspirin Use for Primary Prevention of Cardiovascular Disease in Older Patients: A Review of Clinical Guidelines and Updated Evidence

2019 ◽  
Vol 34 (9) ◽  
pp. 580-594
Author(s):  
Jelena Lewis ◽  
Laressa Bethishou ◽  
Laura V. Tsu
Keyword(s):  
Older Adults ◽  
Primary Prevention ◽  
Older Patients ◽  
Data Extraction ◽  
The Elderly ◽  
Study Selection ◽  
Pubmed Search ◽  
Cv Disease ◽  
Meta Analyses

OBJECTIVE: To provide an up-to-date review of current guidelines, previous trials, and new trials regarding aspirin use in primary prevention of cardiovascular (CV) disease in the elderly population. DATA SOURCES: A PubMed search of articles published through April 2019 was performed using a combination of the following words: aspirin, bleeding, cardiovascular, elderly, hemorrhage, myocardial infarction, primary prevention, stroke. STUDY SELECTION/DATA EXTRACTION: Relevant randomized controlled trials, meta-analyses, and guidelines were assessed for the use of aspirin in primary prevention of CV disease in older patients. References from the above literature were also evaluated. Articles were selected for inclusion based on relevance to the topic, detailed methods, and complete results. DATA SYNTHESIS: The role of aspirin for primary prevention of CV disease in older adults is not well defined. As a result, the guideline recommendations for the use of aspirin in this setting are inconsistent. In 2018, the ARRIVE, ASCEND, and ASPREE studies were published. These studies tried to address some of the inconsistencies regarding the use of aspirin in primary prevention of CV disease. This article reviews the current recommendations along with previous and recent studies for aspirin use for primary prevention in older adults. CONCLUSION: The role of aspirin for primary prevention of CV disease in older adults should be individualized based on patient's risk factors, including risk of CV disease and likelihood of bleeding. Updated evidence provides more guidance regarding which patient populations will benefit from therapy.

scholarly journals Potentially inappropriate prescribing in older hospitalized Dutch patients according to the STOPP/START criteria v2: a longitudinal study

2020 ◽  
Author(s):  
Birgit A. Damoiseaux-Volman ◽  
Stephanie Medlock ◽  
Kimmy Raven ◽  
Danielle Sent ◽  
Johannes A. Romijn ◽  
...  
Keyword(s):  
Longitudinal Study ◽  
Older Patients ◽  
Hospital Admissions ◽  
Inappropriate Medication ◽  
Inappropriate Prescribing ◽  
Patient Characteristics ◽  
Start Criteria ◽  
High Prevalence ◽  
Inappropriate Prescriptions ◽  
Over Time

Abstract Purpose To investigate prevalence, independent associations, and variation over time of potentially inappropriate prescriptions in a population of older hospitalized patients. Methods A longitudinal study using a large dataset of hospital admissions of older patients (≥ 70 years) based on an electronic health records cohort including data from 2015 to 2019. Potentially inappropriate medication (PIM) and potential prescribing omission (PPO) prevalence during hospital stay were identified based on the Dutch STOPP/START criteria v2. Univariate and multivariate logistic regression were used for analyzing associations and trends over time. Results The data included 16,687 admissions. Of all admissions, 56% had ≥ 1 PIM and 58% had ≥ 1 PPO. Gender, age, number of medications, number of diagnoses, Charlson score, and length of stay were independently associated with both PIMs and PPOs. Additionally, number of departments and number of prescribing specialties were independently associated with PIMs. Over the years, the PIM prevalence did not change (OR = 1.00, p = .95), whereas PPO prevalence increased (OR = 1.08, p < .001). However, when corrected for changes in patient characteristics such as number of diagnoses, the PIM (aOR = 0.91, p < .001) and PPO prevalence (aOR = 0.94, p < .001) decreased over the years. Conclusion We found potentially inappropriate prescriptions in the majority of admissions of older patients. Prescribing relatively improved over time when considering complexity of the admissions. Nevertheless, the high prevalence shows a clear need to better address this issue in clinical practice. Studies seeking effective (re)prescribing interventions are warranted.

scholarly journals Oropharyngeal Dysphagia in Older Patients

2021 ◽  
pp. 225-235
Author(s):  
Lina Spirgienė ◽  
Rebecca Lindhe ◽  
Gytė Damulevičienė
Keyword(s):  
Older Adults ◽  
Healthcare Costs ◽  
Older Patients ◽  
Oropharyngeal Dysphagia ◽  
Hydration Status ◽  
Speech Language Pathologist ◽  
Nutrition And Hydration ◽  
Adverse Influence ◽  
Management Of Dysphagia

AbstractDysphagia in older adults can have a profound adverse influence nutrition and hydration status, quality of life, morbidity, mortality and healthcare costs in adults. Identification and management of dysphagia in older adults are most effective when implemented by a team, including a nurse, physician, speech-language pathologist, dietitian and occupational therapist. However, each professional’s role may vary according to the standards, responsibilities and resources available in local settings.

scholarly journals The meaning of losing a child in older adults: a qualitative study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Azade Safa ◽  
Mohsen Adib-Hajbaghery ◽  
Mahboubeh Rezaei ◽  
Marzieh Araban
Keyword(s):  
Older Adults ◽  
Qualitative Study ◽  
Adult Child ◽  
The Elderly ◽  
Healthcare Team ◽  
Elderly Parents ◽  
Heart Of Darkness ◽  
Deceased Child ◽  
Positive Meaning ◽  
Age Range

Abstract Background After losing their child, elderly parents look for a meaning in this phenomenon. This meaning comes out from their experiences, and their responses to and actions in life are shaped based on this meaning. Therefore, this study was conducted with the aim of “understanding the meaning of losing a child in older adults.” Methods This qualitative study was conducted using conventional content analysis method. Using semi-structured face-to-face interviews, data were collected from 15 older adults who had experienced of losing their adult child. Data analysis was performed according to the steps proposed by Graneheim and Lundman, 2004. To prove the trustworthiness of the data, credibility, dependability, confirmability and transferability were used. Results The age range of participants was between 61 and 83 years and 73.3% of them were female. The two main categories of “tasting the bitter flavor of life” and “searching for a positive meaning in losing a child” together with the theme of “finding hope in the heart of darkness” were extracted from the participants’ experiences. Conclusions Despite the grief of losing a child, which had cast a dark shadow over the parents’ lives, the child’s liberation from worldly sufferings, his/her presence in a better world, and being hopeful about the grace of God had caused the elderly parents to find hope in the heart of darkness. After identifying the parents with a deceased child, they should be helped through psychological counseling and care of the healthcare team so that they can adapt to this situation by finding a positive meaning in losing their child.

14 Rational Prescribing in the Frail Elderly Population: A Quality Improvement Project to Reduce Inappropriate Prescribing Using STOPP-Frail Criteria

2020 ◽  
Vol 49 (Supplement_1) ◽  
pp. i1-i8
Author(s):  
J Brooke ◽  
R Darnell ◽  
M Boltova ◽  
N Hashemi
Keyword(s):  
Quality Improvement ◽  
Elderly Care ◽  
Inappropriate Prescribing ◽  
Drug Effects ◽  
The Elderly ◽  
Quality Improvement Project ◽  
University Hospital ◽  
Lipid Lowering ◽  
Adverse Drug Effects ◽  
Improvement Project

Abstract Introduction 2.5 million people in the UK are aged over 80 and up to 50% can be considered frail. Complex co-morbidities and polypharmacy are linked with adverse drug effects and negative outcomes. NICE recommends a medication review yearly, and a hospital admission provides an opportunity for this. STOPP-Frail is a screening tool designed to highlight medications that could be reduced/stopped with a view to improving quality of life. We conducted a quality improvement project to quantify levels of inappropriate prescribing at Croydon University Hospital (CUH), with a view to de-prescribing and reducing adverse drug effects. Methods A retrospective analysis was carried out on the Elderly Care wards at CUH. Data was collected from 60 consecutive patients discharged from 1st November 2018, utilising electronic Cerner records. Recorded medication on admission and discharge, noting any amendments in accordance with the STOPP-Frail criteria. Results Data collected from 60 patients; one exclusion for not meeting STOPP-Frail criteria (n=59). Median age 86 years (69 to 103 years). Mean number of medications on admission 7.42 (1 to 15). 93.2% patients had polypharmacy (defined as ≥ 4 medications). Mean number of medications on discharge 8.22; an increase of 0.8/patient. 19.4% admission medications met STOPP-Frail criteria for inappropriate prescriptions. Only 18.8% of these were reduced or stopped during admission. Gastrointestinal and cardiovascular medications were most commonly inappropriately prescribed (n=27 and 24 respectively). Most common medications not amended were lipid-lowering therapies (n=21) and proton-pump inhibitors (n= 20). Conclusions The opportunity to rationalise medication in the frailest patients admitted to CUH is missed in over 80% of cases. STOPP-Frail provides clear guidance to aid clinicians in reducing inappropriate prescribing. An educational programme is in place to highlight medication rationalisation and guide clinicians in the use of the STOPP-Frail tool. This includes doctors’ induction, departmental teaching, posters and computer flash cards.

scholarly journals Urban-Rural Differences in Geodetic Distance Between Home and the Nearest Pharmacy Among Older Pennsylvania Adults

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 200-200
Author(s):  
Shivani Khan ◽  
Debra Heller ◽  
Leroy Latty ◽  
Michelle LaSure ◽  
Theresa Brown
Keyword(s):  
Older Adults ◽  
Older Patients ◽  
The Elderly ◽  
Rural And Urban ◽  
Straight Line ◽  
Chi Squared ◽  
Straight Line Distance ◽  
Urban Rural ◽  
The Mean ◽  
Rural Older Adults

Abstract Aim: We examined differences in geodetic or straight line distance between home and the nearest community pharmacy among rural and urban older adults in Pennsylvania. Method: The addresses of 241,398 older adults (≥65 years) and 2,880 community pharmacies enrolled in Pennsylvania’s Pharmaceutical Assistance Contract for the Elderly (PACE) program in 2018 were geocoded. We identified pharmacies in the same or adjacent counties for each enrollee and measured the geodetic distance between home and those pharmacies. The pharmacy with the shortest distance from home was identified as the nearest pharmacy for each enrollee. Enrollees’ home addresses were categorized as urban or rural at the county level, based on the Center for Rural Pennsylvania’s definitions. T-tests and chi-squared tests were used for analyses. Results: Overall, 37% were rural older adults and the mean distance between home and the nearest pharmacy was 1.60 ± 2.21 miles. The mean distance between home and the nearest pharmacy was significantly greater in rural compared to urban older adults (2.78 ± 2.93 versus 0.91 ± 1.19; p&lt;.0001). A higher proportion of rural older adults resided &gt;5 miles away from the nearest pharmacy compared to urban older adults (19.19% versus 1.80%; p&lt;.0001). Moreover, 2.96% of rural older adults resided &gt;10 miles away from the nearest pharmacy compared to 0.08% of urban older adults (p&lt;.0001). Conclusion: Older patients in rural counties need to travel longer distances for pharmacy access than in urban counties. Efforts to provide convenient access to medications and pharmacy services for rural older patients are necessary.

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