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Polypharmacy and deprescribing

Takuya Aoki, Yosuke Yamamoto, Tatsuyoshi Ikenoue, Shunichi Fukuhara
Background Deprescribing is a patient-centered intervention with inherent uncertainties and requires shared decision making and patient involvement. Objective In the present study, we aimed to investigate factors associated with patient preferences toward deprescribing in a representative sample in Japan. Methods We conducted a nationwide cross-sectional survey and used a quota sampling method to select representative samples of the Japanese general population. We collected data on participant demographic and clinical factors including the number of chronic health conditions and the number of regular prescription medications...
February 5, 2019: International Journal of Clinical Pharmacy
Yael Schenker, Seo Young Park, Kwonho Jeong, Jennifer Pruskowski, Dio Kavalieratos, Judith Resick, Amy Abernethy, Jean S Kutner
BACKGROUND: Polypharmacy may be particularly burdensome near the end of life, as patients "accumulate" medications to treat and prevent multiple diseases. OBJECTIVE: To evaluate associations between polypharmacy, symptom burden, and quality of life (QOL) in patients with advanced, life-limiting illness (clinician-estimated, 1 month-1 year). DESIGN: Secondary analysis of baseline data from a trial of statin discontinuation. PARTICIPANTS: Adults with advanced, life-limiting illness...
February 4, 2019: Journal of General Internal Medicine
Natasha Parekh, Yael Schenker, Chester B Good, Lynn Neilson, William H Shrank
Polypharmacy has been linked to adverse outcomes including increased risk of hospitalization, falls, and death and contributes to unnecessary healthcare spending. Deprescribing efforts aim to reduce medication burden while improving or maintaining patients' quality of life. While the practice of deprescribing is gaining momentum, quality measurement and provider reimbursement are barriers that must be addressed for deprescribing to achieve widespread adoption. Because many quality measures are focused on medication use and adherence, deprescribing efforts may negatively impact primary care provider and health plan quality ratings and value-based reimbursement...
February 4, 2019: Journal of General Internal Medicine
Sarah K Fineberg, Swapnil Gupta, Jacob Leavitt
Psychopharmacology in borderline personality disorder (BPD) is complicated by comorbid disorders, substance use, sensitivity to side effects, risk of self-harm through medication misuse, and intense but transient symptoms. Patients' relationships with medications may range from tenuous to highly enmeshed, and may profoundly influence the response to treatment. For these reasons, awareness of current evidence and flexible approaches are particularly relevant to prescribing in BPD. In this narrative review, we illustrate the current status of medication management in BPD by focusing on polypharmacy...
January 22, 2019: Harvard Review of Psychiatry
Nagham Ailabouni, Dee Mangin, Prasad S Nishtala
Background Prolonged use of anticholinergic and sedative medicines is correlated with worsening cognition and physical function decline. Deprescribing is a proposed intervention that can help to minimise polypharmacy whilst potentially improving several health outcomes in older people. Objective This study aimed to examine the feasibility of implementing a deprescribing intervention that utilises a patient-centred pharmacist-led intervention model; in order to address major deprescribing challenges such as general practitioner time constraints and lack of accessible deprescribing guidelines and processes...
January 18, 2019: International Journal of Clinical Pharmacy
Joanna Ulley, Deborah Harrop, Ali Ali, Sarah Alton, Sally Fowler Davis
BACKGROUND: Polypharmacy, and the associated adverse drug events such as non-adherence to prescriptions, is a common problem for elderly people living with multiple comorbidities. Deprescribing, i.e. the gradual withdrawal from medications with supervision by a healthcare professional, is regarded as a means of reducing adverse effects of multiple medications including non-adherence. This systematic review examines the evidence of deprescribing as an effective strategy for improving medication adherence amongst older, community dwelling adults...
January 18, 2019: BMC Geriatrics
Joshua Chou, Monica Tong, Nicole J Brandt
Polypharmacy, defined as the use of five or more medications, is becoming increasingly prevalent in older adults throughout the United States. Depre-scribing, along with the use of existing tools, such as the American Geriatrics Society Beers Criteria, can help guide health care providers in reducing the risks associated with polypharmacy such as side effects and drug interactions. The framework of deprescribing and the use of existing guidelines and resources are valuable in guiding health care providers in addressing polypharmacy...
January 1, 2019: Journal of Gerontological Nursing
Thomas Grischott, Stefan Zechmann, Yael Rachamin, Stefan Markun, Corinne Chmiel, Oliver Senn, Thomas Rosemann, Nicolas Rodondi, Stefan Neuner-Jehle
BACKGROUND: Inappropriate medication and polypharmacy increase morbidity, hospitalisation rate, costs and mortality in multimorbid patients. At hospital discharge of elderly patients, polypharmacy is often even more pronounced than at admission. However, the optimal discharge strategy in view of sustained medication appropriateness remains unclear. In particular, unreflectingly switching back to the pre-hospitalisation medication must be avoided. Therefore, both the patients and the follow-up physicians should be involved in the discharge process...
December 27, 2018: Implementation Science: IS
Kannayiram Alagiakrishnan, Darren Mah, Raj Padwal
Prescribing medications safely and effectively in older adults is a complex process. This review discusses challenges with medication prescribing in older adults and outlines a holistic approach to medication management in older adults. Well-known challenges including the alterations in pharmacokinetics and pharmacodynamics that often occur with aging are discussed. Other classic concerns including polypharmacy, potentially inappropriate medication use, prescribing cascades, suboptimal prescribing, paradoxical harm and unintended consequences of medications, and drug interactions are reviewed...
October 2018: Discovery Medicine
Chong-Han Kua, Vivienne S L Mak, Shaun Wen Huey Lee
OBJECTIVES: Deprescribing is effective in addressing concerns relating to polypharmacy in residents of nursing homes. However, the clinical outcomes of deprescribing interventions among residents in nursing homes are not well understood. We evaluated the impact of deprescribing interventions by health care professionals on clinical outcomes among the older residents in nursing homes. DESIGN: Systematic review and meta-analysis of randomized controlled trials. CINAHL, International Pharmaceutical Abstracts, MEDLINE, EMBASE, and Cochrane Library were searched from inception until September 2017; manual searches of reference lists of systematic reviews identified in the electronic search; and online trial registries for unpublished, ongoing, or planned trials...
December 20, 2018: Journal of the American Medical Directors Association
Janice B Schwartz, Kenneth E Schmader, Joseph T Hanlon, Darrell R Abernethy, Shelly Gray, Jacqueline Dunbar-Jacob, Holly M Holmes, Michael D Murray, Robert Roberts, Michael Joyner, Josh Peterson, David Lindeman, Ming Tai-Seale, Laura Downey, Michael W Rich
OBJECTIVES: To identify the top priority areas for research to optimize pharmacotherapy in older adults with cardiovascular disease (CVD). DESIGN: Consensus meeting. SETTING: Multidisciplinary workshop supported by the National Institute on Aging, the American College of Cardiology, and the American Geriatrics Society, February 6-7, 2017. PARTICIPANTS: Leaders in the Cardiology and Geriatrics communities, (officers in professional societies, journal editors, clinical trialists, Division chiefs), representatives from the NIA; National Heart, Lung, and Blood Institute; Food and Drug Administration; Centers for Medicare and Medicaid Services, Alliance for Academic Internal Medicine, Patient-Centered Outcomes Research Institute, Agency for Healthcare Research and Quality, pharmaceutical industry, and trainees and early career faculty with interests in geriatric cardiology...
December 7, 2018: Journal of the American Geriatrics Society
Adam Todd, Jesse Jansen, Jim Colvin, Andrew J McLachlan
The area of "deprescribing" has rapidly expanded in recent years as a positive intervention to reduce inappropriate polypharmacy and improve health outcomes for (older) people with multimorbidity. While our understanding of deprescribing as a process has greatly improved and existing approaches all have patient-centered elements, there is still limited literature exploring the importance of the individual patient context in deprescribing decision-making. This is clearly an important consideration to ensure that any deprescribing approach is ethical, respectful, and successful...
November 29, 2018: BMC Geriatrics
Justin P Turner, Janet Currie, Johanna Trimble, Cara Tannenbaum
Many seniors remain unaware that certain medications may be harmful, despite high rates of polypharmacy and inappropriate medication use among community-dwelling older adults. Patient education is an effective method for reducing the use of inappropriate medications. Increasing public awareness and engagement is essential for promoting shared decision-making to deprescribe. The Canadian Deprescribing Network was created to address the lack of a systematic pan-Canadian initiative to implement deprescribing among older Canadians...
November 2018: Therapeutic Advances in Drug Safety
Rachel Edey, Nicholas Edwards, Jonah Von Sychowski, Ajay Bains, Jim Spence, Dan Martinusen
Background Successful deprescribing practices are required to address issues associated with polypharmacy but are hindered by minimal interprofessional collaboration, time constraints, concern for negative outcomes, and absence of a systematic and evidence-based approach. Objective Determine the impact of pharmacist-led deprescribing rounds within a clinical teaching unit (CTU) the number of home medications discontinued upon hospital discharge. Setting Canadian tertiary care hospital. Methods Prospective, dual-arm, interventional study conducted in a single centre, from November 23rd, 2015 to August 30th, 2016...
February 2019: International Journal of Clinical Pharmacy
Robyn Gillespie, Judy Mullan, Lindsey Harrison
Polypharmacy is increasing among older Australians, raising their risk of experiencing medication-related harm. As part of the prescribing continuum, deprescribing is a strategy proposed to reduce inappropriate polypharmacy. This study explored factors that influence deprescribing among Australian GPs using a new 21-item survey to measure GP attitudes and practices. The 85 GP responses indicated that many factors are supportive of deprescribing. GPs suggest that they are willing to explore their older patients' deprescribing preferences; they believe that they have enough information about the potential harms and benefits of medication to inform their deprescribing decisions and are confident to communicate this information to their patients...
November 14, 2018: Australian Journal of Primary Health
Michaela L Schiøtz, Anne Frølich, Anette K Jensen, Lene Reuther, Hans Perrild, Tonny S Petersen, Jonatan Kornholt, Mikkel B Christensen
Polypharmacy is common among multimorbid adults and associated with increased morbidity and mortality. Excessive polypharmacy (ie, ≥10 medicine) is strongly associated with inappropriate medication use, but little is known about attitudes toward deprescribing in patients with excessive polypharmacy. We surveyed 100 Danish individuals aged 65 years and above with ≥10 prescribed medications, using the validated Patients' Attitudes Towards Deprescribing (PATD) instrument. Most participants (81, 81%) thought they took a large number of medications, and 79 (79%) believed that their medications were necessary...
December 2018: Pharmacology Research & Perspectives
Sophie Mantelli, Katharina Tabea Jungo, Zsofia Rozsnyai, Emily Reeve, Clare H Luymes, Rosalinde K E Poortvliet, Arnaud Chiolero, Nicolas Rodondi, Jacobijn Gussekloo, Sven Streit
BACKGROUND: Many oldest-old (> 80-years) with multimorbidity and polypharmacy are at high risk of inappropriate use of medication, but we know little about whether and how GPs would deprescribe, especially in the frail oldest-old. We aimed to determine whether, how, and why Swiss GPs deprescribe for this population. METHODS: GPs took an online survey that presented case-vignettes of a frail oldest-old patient with and without history of cardiovascular disease (CVD) and asked if they would deprescribe any of seven medications...
October 12, 2018: BMC Family Practice
James P Sheppard, Jenni Burt, Mark Lown, Eleanor Temple, John Benson, Gary A Ford, Carl Heneghan, F D Richard Hobbs, Sue Jowett, Paul Little, Jonathan Mant, Jill Mollison, Alecia Nickless, Emma Ogburn, Rupert Payne, Marney Williams, Ly-Mee Yu, Richard J McManus
INTRODUCTION: Recent evidence suggests that larger blood pressure reductions and multiple antihypertensive drugs may be harmful in older people, particularly frail individuals with polypharmacy and multimorbidity. However, there is a lack of evidence to support deprescribing of antihypertensives, which limits the practice of medication reduction in routine clinical care. The aim of this trial is to examine whether antihypertensive medication reduction is possible in older patients without significant changes in blood pressure control at follow-up...
October 4, 2018: BMJ Open
Laura K Triantafylidis, Chelsea E Hawley, Laura P Perry, Julie M Paik
Older adults with chronic kidney disease (CKD) often experience polypharmacy, a recognized predictor of prescribing problems including inappropriately dosed medications, drug-drug and drug-disease interactions, morbidity and mortality. Polypharmacy is also associated with nonadherence, which leads to recurrent hospitalizations and poorer hemodialysis outcomes in CKD patients. Further complicating medication management in this vulnerable population are the physiologic changes that occur with both age and CKD...
November 2018: Drugs & Aging
Óscar Esteban Jiménez, María Pilar Arroyo Aniés, Caterina Vicens Caldentey, Francisca González Rubio, Miguel Ángel Hernández Rodríguez, Mara Sempere Manuel
The increasing longevity of the population, the increase in morbidity and the consumption of medications have caused that polypharmacy is a priority health problem due to its consequences: increase of adverse effects, pharmacological interactions and favor the functional deterioration of the patient. The clinical situation of the patients changes over time and it is necessary to adjust the medication in each stage, assessing the fragility, the level of dependence and the functional deterioration. Deprescription is complex and requires an adequate clinical and pharmacological formation...
September 29, 2018: Atencion Primaria
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