Pub Date : 2011-06-01DOI: 10.1016/j.amjopharm.2011.04.004
Monica Payne BA , Megan Gething BA , Alison A. Moore MD, MPH , M. Carrington Reid MD, PhD
Background
Compared with younger adults, older adults consume a disproportionate percentage of pain and sleep medications. Some studies have reported that psychoactive medication misuse and abuse in older populations is a significant problem.
Objectives
The aim of this study was to understand the perspective of primary care providers (PCPs) regarding the extent and clinical presentations of misuse and abuse of psychoactive medications in older patients and to explore PCPs' perceived barriers to identifying affected individuals.
Methods
Seventeen physicians and 5 nurse practitioners from 2 ambulatory care practices serving older adults in New York City participated in this study. Six focus group discussions were audiotaped and transcribed. Two raters coded transcripts to identify recurring themes. Qualitative analysis software was employed for data coding and sorting purposes.
Results
Although PCPs indicated that only a small percentage of older patients were actively misusing or abusing their psychoactive medications (average estimate given by providers, 8%), they felt that these patients placed significant time burdens on them. Perceived risk factors included psychiatric disorders, previous substance abuse history, and cognitive impairment, but many PCPs found it impossible to predict which patients were at increased risk. PCPs identified multiple barriers to identifying affected patients, including lack of communication (between provider and patient, provider and patients' caregivers, and between different providers), nonspecific symptoms, and the lack of a clear definition of misuse and abuse.
Conclusions
The lack of a clear definition, absence of well-defined risk factors, and ambiguous clinical manifestations of psychoactive medication misuse and abuse present substantial barriers to diagnosis. A standard, age-appropriate definition could help PCPs establish a diagnosis, clarify what constitutes appropriate psychoactive medication use, define the extent of the problem, and pave the way for the development of effective screening and diagnostic tools.
{"title":"Primary Care Providers' Perspectives on Psychoactive Medication Disorders in Older Adults","authors":"Monica Payne BA , Megan Gething BA , Alison A. Moore MD, MPH , M. Carrington Reid MD, PhD","doi":"10.1016/j.amjopharm.2011.04.004","DOIUrl":"10.1016/j.amjopharm.2011.04.004","url":null,"abstract":"<div><h3>Background</h3><p>Compared with younger adults, older adults consume a disproportionate percentage of pain and sleep medications. Some studies have reported that psychoactive medication misuse and abuse in older populations is a significant problem.</p></div><div><h3>Objectives</h3><p>The aim of this study was to understand the perspective of primary care providers (PCPs) regarding the extent and clinical presentations of misuse and abuse of psychoactive medications in older patients and to explore PCPs' perceived barriers to identifying affected individuals.</p></div><div><h3>Methods</h3><p>Seventeen physicians and 5 nurse practitioners from 2 ambulatory care practices serving older adults in New York City participated in this study. Six focus group discussions were audiotaped and transcribed. Two raters coded transcripts to identify recurring themes. Qualitative analysis software was employed for data coding and sorting purposes.</p></div><div><h3>Results</h3><p>Although PCPs indicated that only a small percentage of older patients were actively misusing or abusing their psychoactive medications (average estimate given by providers, 8%), they felt that these patients placed significant time burdens on them. Perceived risk factors included psychiatric disorders, previous substance abuse history, and cognitive impairment, but many PCPs found it impossible to predict which patients were at increased risk. PCPs identified multiple barriers to identifying affected patients, including lack of communication (between provider and patient, provider and patients' caregivers, and between different providers), nonspecific symptoms, and the lack of a clear definition of misuse and abuse.</p></div><div><h3>Conclusions</h3><p>The lack of a clear definition, absence of well-defined risk factors, and ambiguous clinical manifestations of psychoactive medication misuse and abuse present substantial barriers to diagnosis. A standard, age-appropriate definition could help PCPs establish a diagnosis, clarify what constitutes appropriate psychoactive medication use, define the extent of the problem, and pave the way for the development of effective screening and diagnostic tools.</p></div>","PeriodicalId":50811,"journal":{"name":"American Journal Geriatric Pharmacotherapy","volume":"9 3","pages":"Pages 164-172"},"PeriodicalIF":0.0,"publicationDate":"2011-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.amjopharm.2011.04.004","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"29865100","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2011-04-01DOI: 10.1016/j.amjopharm.2011.03.004
Sandhya Mehta MS, Hua Chen MD, PhD, Michael Johnson PhD, Rajender R. Aparasu MPharm, PhD
Background
Antipsychotic agents can lead to severe cardiovascular adverse events due to multiple mechanisms involving electrophysiologic and metabolic effects. Few epidemiologic studies have evaluated the risk of serious cardiovascular-related events in typical and atypical antipsychotic users.
Objective
The purpose of this study was to compare the risk of serious cardiac events in older adults taking typical antipsychotics with those taking atypical antipsychotics.
Methods
Prescription and medical information were derived from the IMS LifeLink Health Plan Claims database. The study involved a retrospective cohort of older adults (≥50 years) taking atypical or typical antipsychotics from July 1, 2000, to December 31, 2007. The primary outcome measure was hospitalization or emergency room visit due to serious cardiac events, including thromboembolism, myocardial infarction, cardiac arrest, and ventricular arrhythmias within 1 year after the index date. The 2 groups were matched on a propensity score to minimize the baseline differences between the groups. Survival analysis was conducted on the matched cohort to assess the risk of serious cardiovascular events in typical versus atypical users.
Results
A total of 5580 patients were selected in each antipsychotic users group after propensity score matching. Serious cardiac events were found in 666 (11.9 %) atypical antipsychotic users and 698 (12.4%) typical antipsychotic users. Survival analysis revealed that typical antipsychotic users were at increased risk of serious cardiovascular events compared with atypical antipsychotic users (hazard ratio = 1.21; 95% CI, 1.04–1.40) after controlling for other factors.
Conclusions
Moderate increases in risk of serious cardiac events are associated with older adults using typical antipsychotic agents compared with atypical users. Health care professionals should carefully evaluate the benefit/risk ratio of antipsychotic agents before prescribing these agents to a vulnerable population.
{"title":"Risk of Serious Cardiac Events in Older Adults Using Antipsychotic Agents","authors":"Sandhya Mehta MS, Hua Chen MD, PhD, Michael Johnson PhD, Rajender R. Aparasu MPharm, PhD","doi":"10.1016/j.amjopharm.2011.03.004","DOIUrl":"10.1016/j.amjopharm.2011.03.004","url":null,"abstract":"<div><h3>Background</h3><p><span>Antipsychotic agents can lead to severe cardiovascular adverse events due to multiple mechanisms involving electrophysiologic and metabolic effects. Few </span>epidemiologic studies have evaluated the risk of serious cardiovascular-related events in typical and atypical antipsychotic users.</p></div><div><h3>Objective</h3><p>The purpose of this study was to compare the risk of serious cardiac events in older adults taking typical antipsychotics with those taking atypical antipsychotics.</p></div><div><h3>Methods</h3><p>Prescription and medical information were derived from the IMS LifeLink Health Plan Claims database. The study involved a retrospective cohort of older adults (≥50 years) taking atypical or typical antipsychotics from July 1, 2000, to December 31, 2007. The primary outcome measure was hospitalization or emergency room visit due to serious cardiac events, including thromboembolism<span>, myocardial infarction, cardiac arrest, and ventricular arrhythmias within 1 year after the index date. The 2 groups were matched on a propensity score to minimize the baseline differences between the groups. Survival analysis was conducted on the matched cohort to assess the risk of serious cardiovascular events in typical versus atypical users.</span></p></div><div><h3>Results</h3><p>A total of 5580 patients were selected in each antipsychotic users group after propensity score matching. Serious cardiac events were found in 666 (11.9 %) atypical antipsychotic users and 698 (12.4%) typical antipsychotic users. Survival analysis revealed that typical antipsychotic users were at increased risk of serious cardiovascular events compared with atypical antipsychotic users (hazard ratio = 1.21; 95% CI, 1.04–1.40) after controlling for other factors.</p></div><div><h3>Conclusions</h3><p>Moderate increases in risk of serious cardiac events are associated with older adults using typical antipsychotic agents compared with atypical users. Health care professionals should carefully evaluate the benefit/risk ratio of antipsychotic agents before prescribing these agents to a vulnerable population.</p></div>","PeriodicalId":50811,"journal":{"name":"American Journal Geriatric Pharmacotherapy","volume":"9 2","pages":"Pages 120-132"},"PeriodicalIF":0.0,"publicationDate":"2011-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.amjopharm.2011.03.004","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"29877656","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Postural instability is a concern in several neurologic conditions and also among the elderly. Dysfunction in serotonergic, noradrenergic, and dopaminergic pathways may be involved in the etiology of postural imbalance.
Objective
The objective of this case report was to quantify, using computerized posturography, substitution with venlafaxine, and later levodopa, in a suspected case of postural instability with paroxetine.
Case Summary
Presented is an 86-year-old woman with frequent falls and a Parkinson-like syndrome of the lower limbs secondary to microvascular dementia. Paroxetine was gradually discontinued and exchanged for venlafaxine, 37.5 mg twice daily. Before and after medication changes, static posturography was performed under eyes open and closed conditions. Following 3 months of venlafaxine, the patient showed significant improvement from baseline, however, venlafaxine was then reduced to 37.5 mg at bedtime. Six months later, levodopa was introduced and further improvement was observed. It is possible that venlafaxine, which maintains a more balanced affinity for serotonin and norepinephrine transporters, may have provided postural benefit. Decreased sedation secondary to venlafaxine reduction may have elicited further improvements in addition to the increased lower limb functionality observed with levodopa.
Conclusions
For patients on antidepressants, switching medications may be worthwhile in those with balance problems. The prudent addition of medications may also be an option.
{"title":"Balance Control Improves Following Replacement of Paroxetine with Venlafaxine and Levodopa in a Case of Microvascular Dementia","authors":"Jaime McDonald BScPharm , Philippe Corbeil PhD , Emmanuelle Pourcher MD, MSc","doi":"10.1016/j.amjopharm.2011.03.002","DOIUrl":"10.1016/j.amjopharm.2011.03.002","url":null,"abstract":"<div><h3>Background</h3><p>Postural instability is a concern in several neurologic conditions and also among the elderly. Dysfunction in serotonergic, noradrenergic, and dopaminergic pathways may be involved in the etiology of postural imbalance.</p></div><div><h3>Objective</h3><p>The objective of this case report was to quantify, using computerized posturography<span>, substitution with venlafaxine<span>, and later levodopa, in a suspected case of postural instability with paroxetine.</span></span></p></div><div><h3>Case Summary</h3><p>Presented is an 86-year-old woman with frequent falls and a Parkinson-like syndrome of the lower limbs secondary to microvascular dementia. Paroxetine was gradually discontinued and exchanged for venlafaxine, 37.5 mg twice daily. Before and after medication changes, static posturography was performed under eyes open and closed conditions. Following 3 months of venlafaxine, the patient showed significant improvement from baseline, however, venlafaxine was then reduced to 37.5 mg at bedtime. Six months later, levodopa was introduced and further improvement was observed. It is possible that venlafaxine, which maintains a more balanced affinity for serotonin and norepinephrine transporters, may have provided postural benefit. Decreased sedation secondary to venlafaxine reduction may have elicited further improvements in addition to the increased lower limb functionality observed with levodopa.</p></div><div><h3>Conclusions</h3><p>For patients on antidepressants, switching medications may be worthwhile in those with balance problems. The prudent addition of medications may also be an option.</p></div>","PeriodicalId":50811,"journal":{"name":"American Journal Geriatric Pharmacotherapy","volume":"9 2","pages":"Pages 133-137"},"PeriodicalIF":0.0,"publicationDate":"2011-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.amjopharm.2011.03.002","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"29827598","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2011-04-01DOI: 10.1016/j.amjopharm.2011.04.003
Dan Blazer MD, PhD
{"title":"Psychotropic Drug Use in Late Life: A Diverse Look at an Expanding Field","authors":"Dan Blazer MD, PhD","doi":"10.1016/j.amjopharm.2011.04.003","DOIUrl":"10.1016/j.amjopharm.2011.04.003","url":null,"abstract":"","PeriodicalId":50811,"journal":{"name":"American Journal Geriatric Pharmacotherapy","volume":"9 2","pages":"Pages 95-96"},"PeriodicalIF":0.0,"publicationDate":"2011-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.amjopharm.2011.04.003","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"29877653","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2011-04-01DOI: 10.1016/j.amjopharm.2011.04.001
David R. Thomas MD
Background
The loss of appetite, anorexia, is commonly observed in older persons and associated with adverse outcomes. It is becoming increasingly apparent that anorexia is the chief factor in producing weight loss in older adults. Although common and expected in acute illness, anorexia is also frequently associated with chronic diseases and leads to inadequate nutrient intake.
Objective
The aim of this paper was to review clinical studies on the use of orexigenic drugs to stimulate appetite.
Methods
Clinical trials were identified related to improving appetite and/or weight gain in older persons. Articles were identified by Ovid search using terms nutrition, anorexia, cachexia, weight loss, orexigenic drugs, and by searching references from retrieved papers.
Results
Environmental and nutritional interventions to improve intake should be the first intervention. When these fail to produce adequate intake, orexigenic drugs should be considered. No drug has received approval from the US Food and Drug Administration for geriatric anorexia.
Conclusions
In the presence of adequate food, weight loss most often is due to cytokine-associated cachexia and anorexia. Assessment of changes in appetite is essential to evaluating older persons with weight loss. When anorexia is identified, a search for reversible causes should be instituted. Intervention should first be aimed at the provision of adequate calories and protein, often in the form of high-density nutritional supplements. Failure to respond to adequate nutrition or supplements should trigger a concern for cachexia. Orexigenic drugs have been reported to improve appetite and produce weight gain. The mechanism is unknown, but it may relate to suppression of proinflammatory cytokines.
{"title":"Use of Orexigenic Medications in Geriatric Patients","authors":"David R. Thomas MD","doi":"10.1016/j.amjopharm.2011.04.001","DOIUrl":"10.1016/j.amjopharm.2011.04.001","url":null,"abstract":"<div><h3>Background</h3><p><span>The loss of appetite, anorexia, is commonly observed in older persons and associated with </span>adverse outcomes. It is becoming increasingly apparent that anorexia is the chief factor in producing weight loss in older adults. Although common and expected in acute illness, anorexia is also frequently associated with chronic diseases and leads to inadequate nutrient intake.</p></div><div><h3>Objective</h3><p>The aim of this paper was to review clinical studies on the use of orexigenic drugs to stimulate appetite.</p></div><div><h3>Methods</h3><p>Clinical trials<span> were identified related to improving appetite and/or weight gain in older persons. Articles were identified by Ovid search using terms nutrition, anorexia, cachexia, weight loss, orexigenic drugs, and by searching references from retrieved papers.</span></p></div><div><h3>Results</h3><p>Environmental and nutritional interventions to improve intake should be the first intervention. When these fail to produce adequate intake, orexigenic drugs should be considered. No drug has received approval from the US Food and Drug Administration for geriatric anorexia.</p></div><div><h3>Conclusions</h3><p>In the presence of adequate food, weight loss most often is due to cytokine-associated cachexia and anorexia. Assessment of changes in appetite is essential to evaluating older persons with weight loss. When anorexia is identified, a search for reversible causes should be instituted. Intervention should first be aimed at the provision of adequate calories and protein, often in the form of high-density nutritional supplements. Failure to respond to adequate nutrition or supplements should trigger a concern for cachexia. Orexigenic drugs have been reported to improve appetite and produce weight gain. The mechanism is unknown, but it may relate to suppression of proinflammatory cytokines.</p></div>","PeriodicalId":50811,"journal":{"name":"American Journal Geriatric Pharmacotherapy","volume":"9 2","pages":"Pages 97-108"},"PeriodicalIF":0.0,"publicationDate":"2011-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.amjopharm.2011.04.001","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"29877654","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Late-life depression is a common psychiatric disorder associated with increased morbidity and mortality. Depression is often under-detected and undertreated in elderly nursing home residents.
Objectives
The aim of this study was to examine the prevalence of antidepressant drug use and to identify the factors associated with its use among elderly nursing home residents.
Methods
The study involved the analysis of a nationally representative sample of prescription and resident files from the 2004 National Nursing Home Survey (NNHS). The study sample included all elderly nursing home residents ≥65 years of age. The analysis focused on prescribing from any antidepressant class, including selective serotonin reuptake inhibitors (SSRIs), tricyclic antidepressants (TCAs), serotonin modulators, serotonin-norepinephrine reuptake inhibitors (SNRIs), monoamine oxidase inhibitors (MAOIs), and others. Descriptive weighted analysis was performed to examine antidepressant use prevalence patterns in elderly nursing home residents. Multiple logistic regression analysis within the conceptual framework of Anderson's behavioral model was used to examine the predisposing, enabling, and need characteristics associated with antidepressant use.
Results
According to the 2004 NNHS, overall prevalence of antidepressant use among elderly nursing home residents was 46.22% (95% CI, 45.16–47.27). Most antidepressant users were ≥85 years of age (49.7%), female (75.7%), non-Hispanic (96.4%), and white (91.1%). The most prescribed class of antidepressants was SSRIs (31.09%; 95% CI, 30.12–32.07), followed by serotonin modulators (4.65%; 95% CI, 4.22–5.09), SNRIs (2.78%; 95% CI, 2.45–3.12), TCAs (2.34%; 95% CI, 2.03–2.65), and MAOIs (0.01%; 95% CI, 0.00–0.03). Citalopram (12.92%; 95% CI, 12.21–13.63) was the most prescribed individual antidepressant, followed by mirtazapine (10.19%; 95% CI, 9.55–10.84). Among the predisposing characteristics, age, race, and marital status were significantly associated with antidepressant use. The odds of receiving an antidepressant were lower for those aged ≥85 years and those who were unmarried elderly residents, when compared with their counterparts; whites were more likely to receive an antidepressant than nonwhites. Enabling factors such as Medicaid and bed capacity significantly predicted antidepressant use. Having Medicaid was positively associated with antidepressant prescription, whereas an increase in the total number of beds decreased the probability of an antidepressant prescription. Among need characteristics, the likelihood of antidepressant prescription use decreased with increased dependence in decision-making ability and out-of-bed mobility. The presence of depressed mood indicators and a history of falls/fractures increased the likelihood of antidepressant prescription use. The odds of re
{"title":"Prevalence and Predictors of Antidepressant Prescribing in Nursing Home Residents in the United States","authors":"Swapna U. Karkare MS, Sandipan Bhattacharjee MS, Pravin Kamble MS, Rajender Aparasu MPharm, PhD","doi":"10.1016/j.amjopharm.2011.03.001","DOIUrl":"10.1016/j.amjopharm.2011.03.001","url":null,"abstract":"<div><h3>Background</h3><p>Late-life depression is a common psychiatric disorder associated with increased morbidity and mortality. Depression is often under-detected and undertreated in elderly nursing home residents.</p></div><div><h3>Objectives</h3><p>The aim of this study was to examine the prevalence of antidepressant drug use and to identify the factors associated with its use among elderly nursing home residents.</p></div><div><h3>Methods</h3><p><span><span>The study involved the analysis of a nationally representative sample of prescription and resident files from the 2004 National Nursing Home Survey (NNHS). The study sample included all elderly nursing home residents ≥65 years of age. The analysis focused on prescribing from any antidepressant class, including selective serotonin reuptake inhibitors (SSRIs), </span>tricyclic antidepressants<span> (TCAs), serotonin modulators, serotonin-norepinephrine reuptake inhibitors (SNRIs), monoamine oxidase inhibitors (MAOIs), and others. Descriptive weighted analysis was performed to examine antidepressant use prevalence patterns in elderly nursing home residents. Multiple </span></span>logistic regression analysis within the conceptual framework of Anderson's behavioral model was used to examine the predisposing, enabling, and need characteristics associated with antidepressant use.</p></div><div><h3>Results</h3><p>According to the 2004 NNHS, overall prevalence of antidepressant use among elderly nursing home residents was 46.22% (95% CI, 45.16–47.27). Most antidepressant users were ≥85 years of age (49.7%), female (75.7%), non-Hispanic (96.4%), and white (91.1%). The most prescribed class of antidepressants was SSRIs (31.09%; 95% CI, 30.12–32.07), followed by serotonin modulators (4.65%; 95% CI, 4.22–5.09), SNRIs (2.78%; 95% CI, 2.45–3.12), TCAs (2.34%; 95% CI, 2.03–2.65), and MAOIs (0.01%; 95% CI, 0.00–0.03). Citalopram<span> (12.92%; 95% CI, 12.21–13.63) was the most prescribed individual antidepressant, followed by mirtazapine (10.19%; 95% CI, 9.55–10.84). Among the predisposing characteristics, age, race, and marital status were significantly associated with antidepressant use. The odds of receiving an antidepressant were lower for those aged ≥85 years and those who were unmarried elderly residents, when compared with their counterparts; whites were more likely to receive an antidepressant than nonwhites. Enabling factors such as Medicaid and bed capacity significantly predicted antidepressant use. Having Medicaid was positively associated with antidepressant prescription, whereas an increase in the total number of beds decreased the probability of an antidepressant prescription. Among need characteristics, the likelihood of antidepressant prescription use decreased with increased dependence in decision-making ability and out-of-bed mobility. The presence of depressed mood indicators and a history of falls/fractures increased the likelihood of antidepressant prescription use. The odds of re","PeriodicalId":50811,"journal":{"name":"American Journal Geriatric Pharmacotherapy","volume":"9 2","pages":"Pages 109-119"},"PeriodicalIF":0.0,"publicationDate":"2011-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.amjopharm.2011.03.001","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"29877655","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2011-02-01DOI: 10.1016/j.amjopharm.2011.01.003
Emily P. Peron PharmD , Zachary A. Marcum PharmD , Richard Boyce PhD , Joseph T. Hanlon PharmD, MS , Steven M. Handler MD, PhD
Objective
This paper reviews articles from 2010 that examined medication mishaps (ie, medication errors and adverse drug events [ADEs]) in the elderly.
Methods
The MEDLINE and EMBASE databases were searched for English-language articles published in 2010 using a combination of search terms including medication errors, medication adherence, medication compliance, suboptimal prescribing, monitoring, adverse drug events, adverse drug withdrawal events, therapeutic failures, and aged. A manual search of the reference lists of the identified articles and the authors' article files, book chapters, and recent reviews was conducted to identify additional publications. Five studies of note were selected for annotation and critique. From the literature search, this paper also generated a selected bibliography of manuscripts published in 2010 (excluding those previously published in the American Journal of Geriatric Pharmacotherapy or by one of the authors) that address various types of medication errors and ADEs in the elderly.
Results
Three studies focused on types of medication errors. One study examined underuse (due to prescribing) as a type of medication error. This before-and-after study from the Netherlands reported that those who received comprehensive geriatric assessments had a reduction in the rate of undertreatment of chronic conditions by over one third (from 32.9% to 22.3%, P < 0.05). A second study focused on reducing medication errors due to the prescribing of potentially inappropriate medications. This quasi-experimental study found that a computerized provider order entry clinical decision support system decreased the number of potentially inappropriate medications ordered for patients ≥ 65 years of age who were hospitalized (11.56 before to 9.94 orders per day after, P < 0.001). The third medication error study was a cross-sectional phone survey of managed-care elders, which found that more blacks than whites had low antihypertensive medication adherence as per a self-reported measure (18.4% vs 12.3%, respectively; P < 0.001). Moreover, blacks used more complementary and alternative medicine (CAM) than whites for the treatment of hypertension (30.5% vs 24.7%, respectively; P = 0.005). In multivariable analyses stratified by race, blacks who used CAM were more likely than those who did not to have low antihypertensive medication adherence (prevalence rate ratio = 1.56; 95% CI, 1.14–2.15; P = 0.006).
The remaining two studies addressed some form of medication-related adverse patient events. A case-control study of Medicare Advantage patients revealed for the first time that the use of skeletal muscle relaxants was associated significantly with an increased fracture risk (adjusted odds ratio = 1.40; 95% CI, 1.15–1.72; P
{"title":"Year in Review: Medication Mishaps in the Elderly","authors":"Emily P. Peron PharmD , Zachary A. Marcum PharmD , Richard Boyce PhD , Joseph T. Hanlon PharmD, MS , Steven M. Handler MD, PhD","doi":"10.1016/j.amjopharm.2011.01.003","DOIUrl":"10.1016/j.amjopharm.2011.01.003","url":null,"abstract":"<div><h3>Objective</h3><p>This paper reviews articles from 2010 that examined medication mishaps (ie, medication errors and adverse drug events [ADEs]) in the elderly.</p></div><div><h3>Methods</h3><p>The MEDLINE and EMBASE databases were searched for English-language articles published in 2010 using a combination of search terms including <em>medication errors</em>, <em>medication adherence</em>, <em>medication compliance</em>, <em>suboptimal prescribing</em>, <em>monitoring</em>, <em>adverse drug events</em>, <em>adverse drug withdrawal events</em>, <em>therapeutic failures</em>, and <em>aged</em>. A manual search of the reference lists of the identified articles and the authors' article files, book chapters, and recent reviews was conducted to identify additional publications. Five studies of note were selected for annotation and critique. From the literature search, this paper also generated a selected bibliography of manuscripts published in 2010 (excluding those previously published in the <em>American Journal of Geriatric Pharmacotherapy</em> or by one of the authors) that address various types of medication errors and ADEs in the elderly.</p></div><div><h3>Results</h3><p>Three studies focused on types of medication errors. One study examined underuse (due to prescribing) as a type of medication error. This before-and-after study from the Netherlands reported that those who received comprehensive geriatric assessments had a reduction in the rate of undertreatment of chronic conditions by over one third (from 32.9% to 22.3%, <em>P</em> < 0.05). A second study focused on reducing medication errors due to the prescribing of potentially inappropriate medications. This quasi-experimental study found that a computerized provider order entry clinical decision support system decreased the number of potentially inappropriate medications ordered for patients ≥ 65 years of age who were hospitalized (11.56 before to 9.94 orders per day after, <em>P</em> < 0.001). The third medication error study was a cross-sectional phone survey of managed-care elders, which found that more blacks than whites had low antihypertensive medication adherence as per a self-reported measure (18.4% vs 12.3%, respectively; <em>P</em> < 0.001). Moreover, blacks used more complementary and alternative medicine (CAM) than whites for the treatment of hypertension (30.5% vs 24.7%, respectively; <em>P</em> = 0.005). In multivariable analyses stratified by race, blacks who used CAM were more likely than those who did not to have low antihypertensive medication adherence (prevalence rate ratio = 1.56; 95% CI, 1.14–2.15; <em>P</em> = 0.006).</p><p>The remaining two studies addressed some form of medication-related adverse patient events. A case-control study of Medicare Advantage patients revealed for the first time that the use of skeletal muscle relaxants was associated significantly with an increased fracture risk (adjusted odds ratio = 1.40; 95% CI, 1.15–1.72; <em>P</em>","PeriodicalId":50811,"journal":{"name":"American Journal Geriatric Pharmacotherapy","volume":"9 1","pages":"Pages 1-10"},"PeriodicalIF":0.0,"publicationDate":"2011-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.amjopharm.2011.01.003","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"29788339","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2011-02-01DOI: 10.1016/j.amjopharm.2011.02.007
Line Guénette PhD , Jocelyne Moisan PhD
Background
It is generally believed that elderly persons know little about the purpose of their medications. However, researchers have reported contradictory results. Moreover, little is known about which patient characteristics are associated with knowledge of a drug's purpose.
Objectives
To assess whether community-dwelling elderly persons could correctly identify the general purpose of their prescription and nonprescription drugs and to examine the link between participant and drug characteristics and this knowledge.
Methods
During an in-home interview, a random sample of pharmacy clients aged ≥65 years were asked to report all the drugs they had taken over the previous 30 days and to state the reasons for their use. Drugs were classified according to the anatomical therapeutic chemical (ATC) classification system. We looked for any information in the stated reasons that concerned the anatomical system, organs and diseases. We assumed that the person knew the general purpose of the drug if the reason stated referred to the anatomical system targeted by the drug. A multivariate logistic regression model was used to identify participant characteristics that were associated with knowledge.
Results
We interviewed 193 seniors who reported using 1645 drugs that could be classified according to the ATC classification system. Of those drugs, 1364 (82.9%) were self reported as physician prescribed. Among participants, 134 (69.4%) knew the general purpose of all drugs they reported. Characteristics associated with knowledge of the purpose were female gender (adjusted odds ratios [ORs], 3.3, 95% confidence intervals [CI] 1.5–7.1), normal cognition (adjusted OR, 5.0; 95% CI, 2.0–12.8), and average to superior socioeconomic status (adjusted OR, 2.7, 95% CI, 1.2–6.3). Knowledge was slightly better for nonprescribed drugs than for prescribed drugs (overall proportion of appropriate reasons: 96.1% vs 91.1%; P < 0.01).
Conclusions
Community-dwelling elderly persons have a good knowledge of the general purpose of their prescription and nonprescription drugs.
{"title":"Elderly People's Knowledge of the Purpose of Their Medicines","authors":"Line Guénette PhD , Jocelyne Moisan PhD","doi":"10.1016/j.amjopharm.2011.02.007","DOIUrl":"10.1016/j.amjopharm.2011.02.007","url":null,"abstract":"<div><h3>Background</h3><p>It is generally believed that elderly persons know little about the purpose of their medications. However, researchers have reported contradictory results. Moreover, little is known about which patient characteristics are associated with knowledge of a drug's purpose.</p></div><div><h3>Objectives</h3><p><span>To assess whether community-dwelling elderly persons could correctly identify the general purpose of their prescription and nonprescription drugs and to examine the link between participant and </span>drug characteristics and this knowledge.</p></div><div><h3>Methods</h3><p>During an in-home interview, a random sample of pharmacy clients aged ≥65 years were asked to report all the drugs they had taken over the previous 30 days and to state the reasons for their use. Drugs were classified according to the anatomical therapeutic chemical (ATC) classification system. We looked for any information in the stated reasons that concerned the anatomical system, organs and diseases. We assumed that the person knew the general purpose of the drug if the reason stated referred to the anatomical system targeted by the drug. A multivariate logistic regression model was used to identify participant characteristics that were associated with knowledge.</p></div><div><h3>Results</h3><p>We interviewed 193 seniors who reported using 1645 drugs that could be classified according to the ATC classification system. Of those drugs, 1364 (82.9%) were self reported as physician prescribed. Among participants, 134 (69.4%) knew the general purpose of all drugs they reported. Characteristics associated with knowledge of the purpose were female gender (adjusted odds ratios [ORs], 3.3, 95% confidence intervals [CI] 1.5–7.1), normal cognition (adjusted OR, 5.0; 95% CI, 2.0–12.8), and average to superior socioeconomic status (adjusted OR, 2.7, 95% CI, 1.2–6.3). Knowledge was slightly better for nonprescribed drugs than for prescribed drugs (overall proportion of appropriate reasons: 96.1% vs 91.1%; <em>P</em> < 0.01).</p></div><div><h3>Conclusions</h3><p>Community-dwelling elderly persons have a good knowledge of the general purpose of their prescription and nonprescription drugs.</p></div>","PeriodicalId":50811,"journal":{"name":"American Journal Geriatric Pharmacotherapy","volume":"9 1","pages":"Pages 49-57"},"PeriodicalIF":0.0,"publicationDate":"2011-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.amjopharm.2011.02.007","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"29788341","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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