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      Prevalence and impact of potentially inappropriate medication on community-dwelling older adults Translated title: Prevalencia e impacto de la medicación potencialmente inapropiada en ancianos que viven en comunidad

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          Abstract

          Introduction

          Potentially inappropriate medication is associated with adverse health and functional outcomes, as well as increased health care costs.

          Objective

          To estimate the prevalence and types of potentially inappropriate medication according to the Beers criteria in community-dwelling older persons and to identify the major clinical and functional consequences of potentially inappropriate medication during two years of following.

          Materials and methods

          We conducted a longitudinal, descriptive, and observational study that included 400 65-year or older community-dwelling people (48% women) selected by simple random sampling in 2012. In 2014, 372 people were re-evaluated and classified into two groups based on the presence or absence of potentially inappropriate medication through the follow-up period.

          Results

          In total, 31% had polypharmacy (5-9 medications) and 1,8% had excessive polypharmacy (10 or more medications). The mean of the number of medications was higher in the potentially inappropriate medication group (3 vs. 5.78; p<0.001) and 21.9% still had the potentially inappropriate medication status during the follow-up; of them, 75% had one potentially inappropriate medication and 23% two. The presence of potentially inappropriate medication was more frequent among frail and depressed male individuals with a bad health self-assessment and comorbidities, especially diabetes mellitus and chronic obstructive pulmonary disease. In the group with sustained potentially inappropriate medication, we found a worsening health self-assessment, increased frailty, a higher incidence of recurrent falls and prevalence of depression, as well as a higher hospital admission rate, ambulatory medical consultation, and more prescribed medications. We did not find an impact on functional capacity.

          Conclusions

          We validated the negative effects of potentially inappropriate medication in the long run for the health of older people and, therefore, potentially inappropriate medications should be monitored in primary care services to avoid greater risks.

          Translated abstract

          Introducción

          La medicación potencialmente inapropiada se asocia con consecuencias clínicas, geriátricas, funcionales y farmacoeconómicas negativas.

          Objetivo

          Estimar la prevalencia y los tipos de medicación potencialmente inapropiada según los criterios de Beers en ancianos que viven en comunidad y determinar las principales consecuencias clínicas y funcionales a lo largo de dos años de seguimiento.

          Materiales y métodos

          Se hizo un estudio descriptivo, observacional y longitudinal que incluyó 400 mayores de 65 años (48% mujeres) residentes en la comunidad seleccionados mediante muestreo aleatorio simple en el 2012. En el seguimiento del 2014 se reevaluaron 372 de ellos y se clasificaron en dos grupos: quienes a lo largo de los dos años siguieron tomando medicación potencialmente inapropiada y quienes no.

          Resultados

          El 31% de los ancianos estaban polimedicados, (5 a 9 medicamentos) y 1,8% polimedicados de forma excesiva (10 o más medicamentos). El promedio de consumo de medicamentos era mayor en el grupo de medicación potencialmente inapropiada (3 Vs. 5,78; p<0,001), y el 21,9% siguieron recibiendo medicación poitencialmente inapropiada durante el seguimiento; de ellos, el 75% recibía un medicamento de este tipo y el 23%, dos. El uso de dicha medicación fue más frecuente en hombres frágiles con una mala percepción de la propia salud, depresión y un mayor número de comorbilidades, especialmente diabetes mellitus y enfermedad-pulmonar-obstructiva-crónica. En el grupo que siguió recibiendo medicación potencialmente inapropiada la percepción de la propia salud empeoró, con un incremento de la fragilidad, las caídas recurrentes y la depresión, así como en los ingresos hospitalarios y las consultas médicas y mayor cantidad de medicamentos formulados. No se evidenció un impacto en la capacidad funcional.

          Conclusiones

          Se corroboran los efectos negativos a largo plazo de la medicación potencialmente inapropiada en la salud de los ancianos, por lo cual se la debe monitorizar en la atención primaria para evitar mayores riesgos.

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          Most cited references40

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          Frailty in Older Adults: Evidence for a Phenotype

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            The rising tide of polypharmacy and drug-drug interactions: population database analysis 1995–2010

            Background The escalating use of prescribed drugs has increasingly raised concerns about polypharmacy. This study aims to examine changes in rates of polypharmacy and potentially serious drug-drug interactions in a stable geographical population between 1995 and 2010. Methods This is a repeated cross-sectional analysis of community-dispensed prescribing data for all 310,000 adults resident in the Tayside region of Scotland in 1995 and 2010. The number of drug classes dispensed and the number of potentially serious drug-drug interactions (DDIs) in the previous 84 days were calculated, and age-sex standardised rates in 1995 and 2010 compared. Patient characteristics associated with receipt of ≥10 drugs and with the presence of one or more DDIs were examined using multilevel logistic regression to account for clustering of patients within primary care practices. Results Between 1995 and 2010, the proportion of adults dispensed ≥5 drugs doubled to 20.8%, and the proportion dispensed ≥10 tripled to 5.8%. Receipt of ≥10 drugs was strongly associated with increasing age (20–29 years, 0.3%; ≥80 years, 24.0%; adjusted OR, 118.3; 95% CI, 99.5–140.7) but was also independently more common in people living in more deprived areas (adjusted OR most vs. least deprived quintile, 2.36; 95% CI, 2.22–2.51), and in people resident in a care home (adjusted OR, 2.88; 95% CI, 2.65–3.13). The proportion with potentially serious drug-drug interactions more than doubled to 13% of adults in 2010, and the number of drugs dispensed was the characteristic most strongly associated with this (10.9% if dispensed 2–4 drugs vs. 80.8% if dispensed ≥15 drugs; adjusted OR, 26.8; 95% CI 24.5–29.3). Conclusions Drug regimens are increasingly complex and potentially harmful, and people with polypharmacy need regular review and prescribing optimisation. Research is needed to better understand the impact of multiple interacting drugs as used in real-world practice and to evaluate the effect of medicine optimisation interventions on quality of life and mortality. Electronic supplementary material The online version of this article (doi:10.1186/s12916-015-0322-7) contains supplementary material, which is available to authorized users.
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              The EU(7)-PIM list: a list of potentially inappropriate medications for older people consented by experts from seven European countries

              Purpose The aim of the study was to develop a European list of potentially inappropriate medications (PIM) for older people, which can be used for the analysis and comparison of prescribing patterns across European countries and for clinical practice. Methods A preliminary PIM list was developed, based on the German PRISCUS list of potentially inappropriate medications and other PIM lists from the USA, Canada and France. Thirty experts on geriatric prescribing from Estonia, Finland, France, the Netherlands, Spain and Sweden participated; eight experts performed a structured expansion of the list, suggesting further medications; twenty-seven experts participated in a two-round Delphi survey assessing the appropriateness of drugs and suggesting dose adjustments and therapeutic alternatives. Finally, twelve experts completed a brief final survey to decide upon issues requiring further consensus. Results Experts reached a consensus that 282 chemical substances or drug classes from 34 therapeutic groups are PIM for older people; some PIM are restricted to a certain dose or duration of use. The PIM list contains suggestions for dose adjustments and therapeutic alternatives. Conclusions The European Union (EU)(7)-PIM list is a screening tool, developed with participation of experts from seven European countries, that allows identification and comparison of PIM prescribing patterns for older people across European countries. It can also be used as a guide in clinical practice, although it does not substitute the decision-making process of individualised prescribing for older people. Further research is needed to investigate the feasibility and applicability and, finally, the clinical benefits of the newly developed list. Electronic supplementary material The online version of this article (doi:10.1007/s00228-015-1860-9) contains supplementary material, which is available to authorized users.
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                Author and article information

                Journal
                Biomedica
                Biomedica
                Biomédica
                Biomédica
                Biteca
                0120-4157
                2590-7379
                20 October 2020
                19 March 2021
                : 41
                : 1
                : 111-122
                Affiliations
                [1 ]deptFacultad de Ciencias para la Salud , Universidad de Caldas , Manizales, , Colombia
                [2 ]Departmento de Fisioterapia, Universidad Federal de Rio Grande do Norte , Natal, , Brasil
                Author notes
                Corresponding author: Alejandra Fernández, Facultad de Ciencias para la Salud, Universidad de Caldas, Edificio Miguel Arango Soto, Carrera 25 N° 48-57, Manizales, Colombia

                Author’s contribution:

                All authors participated in the organization and analysis of the data and in the preparation and edition of the article.

                Article
                5787
                10.7705/biomedica.5787
                8055584
                33761194
                82be7ee2-bba0-4a42-a63a-6a60d10fb7a7
                Copyright @ 2020

                This is an open-access article distributed under the terms of the Creative Commons Attribution (CC BY) 3.0 License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 27 August 2020
                : 14 October 2020
                Categories
                Article

                potentially inappropriate medication list,aged,comorbidity,frailty,lista de medicamentos potencialmente inapropiados,anciano,comorbilidad,fragilidad

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