Implications for policy and planning to foster solidarity between the generations and enhance healthy life among older adults.

This policy document is a compilation of the studies of the five Early Stage Researchers (ESRs) in Working Package 2 of the EuroAgeism project (WP2). WP2 explores ageism in access to goods and services: social and health services (formal, informal), and appropriate drug treatment. It examines the origins, manifestations, and consequences of ageism in social life, social and health care services, and medication treatment. The integration of the five programmes of individual study provides an opportunity to identify common threads of contextual influences on the manifestation of ageism and its negative outcomes, such as poor access to goods and services, including access for people living with dementia; social support; and health and social care, including timely and appropriate medications. Given its multidimensional nature, ageism has to be studied from a multi-disciplinary perspective to consider the individual (micro), social (meso) and structural (macro) levels together. As such, through the five ESRs programmes of study, WP2 will compare and contrast the intersections between individuals and society. This analysis involves ageist attitudes and behaviours perpetuated by the media and held by older adults, by others in their social environment and those of service providers. WP2 addresses ageism as a factor that impacts all aspects of life, including social relations, media, social care and health care. This policy document provides a synthesis of the five programmes of work to highlight the implications for, and to inform policy on, fostering solidarity between generations and enhancing healthy life among older adults. The EuroAgeism project has received funding from the European Union's Horizon 2020 research and innovation programme, under the Marie Skłodowska-Curie grant agreement number 764632

Polypharmacy Practice Inquiry Project

“The impending crisis, which has been foreseen for decades, is now upon us.The nation needs to act now to prepare the health care workforce to meet the care needs of older adults.” Institute of Medicine. Given the rising tide of people over the age of 65, taking multiple medications or polypharmacy is a becoming more prevalent in older adults. Unfortunately, there are many negative consequences associated with polypharmacy. Specifically, this burden has been associated with greater health care costs and an increased risk of adverse drug events, drug-interactions, medication non-adherence, reduced functional capacity and multiple geriatric syndromes including cognitive impairment. Cognitive impairment, seen with both delirium and dementia, has been associated with polypharmacy. Current medical practice guidelines often require multiple medications to treat each chronic disease state for optimal clinical benefit. Cognitive impairment can put a patient at risk for either under- or overtreatment due to their numerous chronic illnesses requiring treatment. In Primary Care, the burden of polypharmacy can be daunting, especially when patient visit times are short and there are other issues to be addressed. There is a lack of an evidence-based, step-by-step protocol to address polypharmacy in Primary Care that can take the healthcare provider and patient through the medication list together, efficiently. If there was such an instrument, polypharmacy could be focused on and adverse reactions such as hospitalizations, falls, and cognitive impairment could be avoided. The purpose of this DNP project is to investigate the impact of polypharmacy on older adults and what is available in the literature to address this problem in primary care. Then implement a streamlined Polypharmacy Protocol in this type of setting to investigate its positive and negative attributes for future use to apply to the problem of polypharmacy

Knowledge among Drug Dispensers and Antimalarial Drug Prescribing Practices in Public Health Facilities in Dar es Salaam.

Irrational prescribing and dispensing of antimalarials has been identified as a contributing factor in the emergence of malaria parasites resistant to existing antimalarial drugs. Factors that contribute to such irrational prescribing and dispensing should therefore be identified to address this problem. The aim of this study was to assess irrational antimalarial drug dispensing and prescribing practices in public health facilities. A descriptive-retrospective cross-sectional study was conducted between January and June 2011 in order to assess prescribing and dispensing practices for antimalarial drugs in three public hospitals and nine health centers in Dar es Salaam, Tanzania. Thirty-two drug dispensers were interviewed using a structured questionnaire. A total of 4,320 prescriptions for the period January to December 2010 were collected and assessed for antimalarial drug prescribing patterns. The majority (84.6%) of drug dispensers had poor knowledge regarding the basic information required from patients before dispensing artemether-lumefantrine. Seventeen of 32 drug dispensers did not know the basic information that should be given to patients in order to increase absorption of artemether-lumefantrine after oral intake. Most drug dispensers also showed limited knowledge about the dosage and contraindications for artemether-lumefantrine. Eighty-seven percent of all prescriptions contained artemether-lumefantrine as the only antimalarial drug, 77.1% contained at least one analgesic, and 26.9% contained at least one antibiotic, indicating unnecessary use of analgesics and antibiotics with antimalarial drugs. A substantial number of prescriptions contained antimalarial drugs that have already been declared ineffective for the treatment of malaria in Tanzania, providing additional evidence of inadequate knowledge among health care workers concerning treatment policy. Despite the government's efforts to increase public awareness regarding use of artemether-lumefantrine as first-line treatment for uncomplicated malaria, there is still irrational prescribing, dispensing, and use of this combination. Based on the results of this study, it is proposed that regular on-the-job training and continuing education be provided to drug dispensers and prescribers in public health facilities

The Relationship between Knowledge and Use Behavior of Polypharmacy or Ya Chud in a Community in Srisaket Province

Objective: To determine level of knowledge and use behavior on polypharmacy (or Ya Chud) and the relationship between knowledge and the use behavior. Medthods: In this descriptive survey, study sample was 172 people residing in Ban Poe, Poe sub-district, Muang district, Srisaket province, Thailand recruited by simple random sampling method. We used questionnaires on knowledge and use behavior (20 items each). Results were presented by descriptive statistics including frequency with percentage and mean with standard deviation. Relationship between use behavior and demographic characteristics was examined by Chi-square test and that between knowledge and use behavior was test by Pearson’s product moment correlation. Results: Knowledge was found in a low level (41.66%) and use behavior a moderate level (mean = 2.6 of 5 points). No relationships between demographic characteristics and use behavior. Knowledge and use behavior was significantly positively correlated (r = 0.182, P-value < 0.05). Conclusion: People in Ban Poe, Poe sub-district, Srisaket province, had a low level of knowledge and a moderate level of use behavior. Even though there was a positive relationship between knowledge and use behavior, an awareness could be missed. Thus educational program or campaign to promote knowledge and proper use of Ya Chud should be developed. Keywords: knowledge, consumption behavior, polypharmacy, Ya Chudบทคัดย่อ วัตถุประสงค์: เพื่อประเมินระดับความรู้และพฤติกรรมการปฏิบัติใช้ยาชุด และทดสอบความสัมพันธ์ระหว่างความรู้กับพฤติกรรมดังกล่าว วิธีการศึกษา: การศึกษาสำรวจแบบพรรณา กลุ่มตัวอย่าง คือ ประชากรบ้านโพธิ์ ตำบลโพธิ์ อำเภอเมือง จังหวัดศรีสะเกษจำนวน 172 คน โดยวิธีสุ่มแบบง่าย ใช้แบบสอบถามประเมินความรู้และพฤติกรรมการใช้ยาชุด (อย่างละ 20 ข้อ) นำเสนอข้อมูลโดยใช้สถิติเชิงพรรณนา เช่น ความถี่พร้อมร้อยละ และค่าเฉลี่ยพร้อมส่วนเบี่ยงเบนมาตรฐาน ทดสอบความสัมพันธ์ระหว่างพฤติกรรมการใช้กับลักษณะทางประชากรศาสตร์ด้วย Chi-square test และระหว่างพฤติกรรมการใช้กับความรู้ด้วยสถิติสัมประสิทธิ์สหสัมพันธ์แบบเพียร์สัน ผลการศึกษา: กลุ่มตัวอย่างมีความรู้ในระดับต่ำ (ตอบถูกต้อง 41.66%) และมีพฤติกรรมในการใช้ยาชุดระดับปานกลาง (2.6 จากคะแนนเต็ม 10 คะแนน) พบว่าพฤติกรรมการใช้ยาชุดไม่สัมพันธ์กับลักษณะทางประชากรศาสตร์ของตัวอย่าง พบว่าความรู้และพฤติกรรมการใช้ยาชุดด้วยสัมพันธ์กันทางบวกอย่างมีนัยสำคัญ (ค่าสัมประสิทธิ์สหสัมพันธ์ของเพียร์สัน (r) เท่ากับ 0.182, P-value < 0.05) สรุป: ประชาชนบ้านโพธิ์ ต.โพธิ์ มีความรู้เรื่องการใช้ยาชุดที่ต่ำ และมีพฤติกรรมการใช้ยาชุดระดับปานกลาง แม้ความสัมพันธ์เชิงบวกจะชี้ว่าความรู้มากก็มีพฤติกรรมการใช้มาก แต่อาจเป็นเพราะยังขาดความตระหนัก ดังนั้น การให้ความรู้เพื่อส่งเสริมพฤติกรรมก็ยังจำเป็น คำสำคัญ: ความรู้, พฤติกรรมการบริโภค, ยาชุ

Reducing Medication Use in Hospice Patients Residing in Long-Term Care

Polypharmacy has been identified as a significant issue in the elderly that leads to an increased risk of adverse drug events resulting in increased emergency room visits and falls, leading to rising costs to the healthcare system. Polypharmacy, although poorly defined, is too many medications or unnecessary medications, which can be considered a risk and potential burden to patients and caregivers. The purpose of this quality improvement project was to educate and empower long-term care (LTC) facility and hospice nurses to recognize polypharmacy and utilize the MedStopper® online tool for recommending medications for deprescribing. Education was provided to the nursing staff regarding the recognition of polypharmacy and how to use the MedStopper® online tool to facilitate medication conversations with the patient, the family, and the provider. The MedStopper® online tool was printed for each patient weekly and reviewed with nursing staff in preparation to recommend medications for deprescribing. Medication reviews were then conducted each week to evaluate the progression of the project. Project progress, written educational articles, and photos were posted at each LTC nursing station during weekly rounding by the primary project manager. At the end of the project, the data revealed a decrease in at least one of the seven targeted drug categories for each patient, vitamin/supplements, gastrointestinal reflux, statins, anticoagulants, cognitive enhancing, antihypertensives, and antihyperglycemics. Nurses are crucial to assisting the prescriber in making excellent medication decisions for all patients and especially those residing in long-term care facilities. Nurses must be educated and empowered to advocate for the medication management of their patients. Collaboration with team members and providers can and should be guided with evidence-based tools such as the MedStopper® online tool.D.N.P

Potentially Preventable Hospital Admissions Related to Medication:Stable, but shifting

The overall aim of this thesis was to assess the progress in risk management of (potentially preventable) hospital admissions related to medication ((PP)HARMs). Specifically, we aimed to determine the scope of the problem of HARMs, potential risk factors and their time dependence and the adherence to recommendations to reduce HARMs. The study on the number of (PP)HARMs between 2008 and 2013 showed that the prevalence did not change, but the type of PPHARMs did change compared to previous studies. As potential risk factors of PPHARMs we identified older age and female sex. These risk factors showed no time trend. This was confirmed by a systematic review on potential risk factors of (PP)HARMs comparing older studies with newer ones. In the last part of this thesis the adherence to guidelines to reduce the number of PPHARMs was described, showing there is still room for improvement in adherence by healthcare providers. In order to explore potential reasons for non-adherence, one specific recommendation was studied in depth, namely the co-prescription of laxatives with opioids by GPs. No clear reasons were identified but improvement is possible in communication with patients about these safety risks. This thesis shows the problem of (PP)HARMs is still present and there is still room for improvement in preventing these types of admissions

Deprescribing in the Hospice Population, Who is Eligible and Who is Agreeable: A Quality Improvement Project

Current evidence recommends and supports deprescribing medications to reduce polypharmacy in the hospice population. The project aim was to determine accurate percentages of deprescribing at three time periods: before hospice admission, at hospice enrollment, and four weeks post hospice enrollment. This project was a retrospective review of the medication administration record (MAR) of patients admitted into Sharp Hospice from a Sharp Healthcare facility. Sharp Hospice, in California, USA, admitted 164 patients during August 2020. Of those, 34 patients were eligible for inclusion in this retrospective quality improvement review. Prior to discharge from a Sharp facility, the percentage of target medications on the inpatient medication record equaled 80.5% for antihypertensives, 61.1% for statins, and 22.2% for oral diabetic medications for the sample. At hospice admission, 61.0 % of these patients were appropriately deprescribed, 13.8 % of patients were partially deprescribed, meaning some eligible medications were removed, and 25% of patients were not deprescribed. 64 % of patients were appropriately deprescribed target medications during the first four weeks of hospice enrollment. The results confirmed medication deprescribing is occurring but also identified missed opportunities for deprescribing in Sharp Hospice. These conclusions are beneficial and applicable to the next phase of project implementation to improve the organization\u27s deprescribing percentages

Complementary and alternative medicines usage in elderly patients in tertiary care teaching hospital of North India

Background: Complementary and alternative medicine (CAM) is defined as a group of diverse medical health care systems, practices and products that are not presently considered to be part of conventional medicine. Its use is highly prevalent in elderly population because of presence of chronic diseases. So, present study was planned to assess CAM usage in elderly patients.Methods: This observational, questionnaire-based study was conducted at department of pharmacology, in association with department of medicine and included all adult patients of more than 60 years of age who have taken any CAM therapy. Demographic data, name of CAM preparation, its characteristics and behavioral pattern for its usage were recorded.Results: Out of 200 patients of more than 60 years attending medicine outpatient department, 115 were found to be CAM users. CAM usage was more in females (59.1%); age group of 60-69 years (49.57%); rural residents (66.08%); low socioeconomic status (81.73%). Most common CAM preparations used were dietary supplements (61.7%) and vitamins and minerals (56.52%) for indications such as chronic pain and endocrine disorders because it was thought to be safe. 76.52 % of CAM users did not discuss CAM with their health care provider.Conclusions: CAM use is highly prevalent in elderly patients and more so in females of low socioeconomic status. Most common CAM therapy used was dietary supplements. Continuous educational efforts are needed to enhance the awareness of patients and healthcare providers regarding the CAM therapy