Prescription Drug Abuse Amongst The Elderly

This thesis attempts to document and illuminate the growing issue of prescription drug abuse among the elderly population. The average elder in the U.S. takes at least one prescription drug per day, depending upon their health status. Likewise, elders that suffer from multiple chronic conditions are more likely to take multiple prescription drugs. As the lifespan of humankind grows well into their 90\u27s and older, even more elders will be placed on prescription drugs. As part of this study, a narrative literature review was conducted to summarize the topic of prescription drug abuse amongst the elderly. The findings suggest that elderly white women over the age of 80 years old are more likely to take prescription drugs that lead to a higher risk of bodily injuries and death. This study is critically important and essential since the current generation that meets the age requirement to be considered elderly is the Baby Boomer generation. The Baby Boomer generation, defined as individuals born between 1946 and 1964, is considered one of the largest generations recorded in modern times. This study will be useful for practitioners, residential care facilities, policymakers, and family members to have better oversight and communication with elders suffering from chronic conditions that take prescription drugs to cure their illnesses

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

Inappropriate medication use in long-term care facility residents with advanced Alzheimer’s disease and other dementias

Les personnes atteintes de démence sévère, résidant dans un centre d’hébergement et de soins de longue durée (CHSLD) et approchant la fin de leur vie, ne reçoivent pas systématiquement des soins palliatifs, malgré que ce niveau de soins soit le plus approprié. La plupart de ces personnes reçoivent également un grand nombre de médicaments dont les effets indésirables peuvent contribuer à des souffrances évitables. Une approche axée sur les soins palliatifs serait possiblement associée à une réduction de la charge médicamenteuse et, du même coup, à une prescription plus appropriée. Les objectifs de ce projet de recherche étaient de décrire l’usage des médicaments chez les résidents atteints de démence sévère en CHSLD, de comparer leur usage de médicaments à des critères de pertinence et d’évaluer si la mise en œuvre d'une approche axée sur les soins palliatifs était associée aux médicaments prescrits. Cette étude décrit l’usage des médicaments chez 215 sujets atteints de démence sévère et en fin de vie qui ont participé à une étude d’intervention quasi expérimentale menée dans quatre CHSLD du Québec sur la mise en œuvre d'une approche axée sur les soins palliatifs. L’utilisation des médicaments a été comparée à trois listes de critères pertinents publiés, soit ceux de Holmes, Rancourt et Kröger, en utilisant des statistiques descriptives. Les analyses sur l’usage de 412 médicaments différents chez 120 sujets du groupe expérimental et 95 sujets du groupe témoin ont montré que cette approche axée sur les soins palliatifs n’est pas associée à une prescription plus appropriée des médicaments chez ces personnes particulièrement vulnérables.Individuals with severe dementia in long-term care facilities (LTCFs) near the end of life do not systematically receive palliative care, although this would be the appropriate care level. Most of these people also receive large numbers of medications, and prescribing for them is often challenging. Implementing a palliative care approach may be an important step towards more appropriate medication use. The objectives of this research project were to describe medication use in LTCF residents with severe dementia, to compare this use to criteria of appropriateness, and to assess whether implementation of a palliative care approach was associated with medication prescribing. This study describes medication use in 215 LTCF residents with severe dementia near the end of life who participated in a quasi-experimental clinical trial on the implementation of a palliative care approach in four LTCFs in Quebec province. Using descriptive statistics, medication use has been compared to three sets of published criteria on appropriateness including those of Holmes, Rancourt and Kröger. Analysis on the use of 412 different medications on 120 subjects in the experimental LTCF and 95 subjects in the control LTCF showed that the palliative care approach was not associated with changes in medication prescribing for these particularly vulnerable individuals

Systems to identify potentially inappropriate prescribing in people with advanced dementia: A systematic review

© 2016 The Author(s). Background: Systems for identifying potentially inappropriate medications in older adults are not immediately transferrable to advanced dementia, where the management goal is palliation. The aim of the systematic review was to identify and synthesise published systems and make recommendations for identifying potentially inappropriate prescribing in advanced dementia. Methods: Studies were included if published in a peer-reviewed English language journal and concerned with identifying the appropriateness or otherwise of medications in advanced dementia or dementia and palliative care. The quality of each study was rated using the STrengthening the Reporting of OBservational studies in Epidemiology (STROBE) checklist. Synthesis was narrative due to heterogeneity among designs and measures. Medline (OVID), CINAHL, the Cochrane Database of Systematic Reviews (2005 - August 2014) and AMED were searched in October 2014. Reference lists of relevant reviews and included articles were searched manually. Results: Eight studies were included, all of which were scored a high quality using the STROBE checklist. Five studies used the same system developed by the Palliative Excellence in Alzheimer Care Efforts (PEACE) Program. One study used number of medications as an index, and two studies surveyed health professionals' opinions on appropriateness of specific medications in different clinical scenarios. Conclusions: Future research is needed to develop and validate systems with clinical utility for improving safety and quality of prescribing in advanced dementia. Systems should account for individual clinical context and distinguish between deprescribing and initiation of medications

Mortality associated with the use of inappropiate drugs according Beers Criteria: a systematic review

The aims of this systematic review are to identify and analyse the scientist literature available evidence about the use of potentially inappropriate medications, according to the Beers Criteria, that is associated with mortality in the elderly people.It have been made a search of publications in most traditional electronic databases among the scientific community (Pubmed / Medline, EMBASE and Web of Science) and it have been selected publications that obey the criteria of 'observational study', 'elderly' and 'Beers Criteria' and that they had as a result the mortality of the study population .After publications selection it proceeded to dump data by two researchers independently to avoid selection bias. The methodological quality of the selected studies was assessed by the checklist Newcastle-Ottawa. The final sample of this systematic review has been made up of 17 studies published in Pubmed and Embase databases majority, 8 of which make up the meta-analysis. In descriptive synthesis has been observed that most of the studies have a level of evidence IV (94'1%) with cohortdelineation (94'1%) and non-probability sampling technique (70'6%).Data collection was prospective in 58'8% of cases, with a sample (n) greater than 1000 elderly (64'7%) and followed up for 6 to 12 months (52'9%).The meta-analysis involving 90.611 elders informed that users who take inappropriate drug according to the Beers Criteria had a higher relative risk for mortality outcome (RR = 1.11, 95% CI 1'01-1'22 P = 0'023), regardless of study stage, comorbidity presence, polypharmacy or type of inappropriate medication used

PRN Medicines Management for Older People with Long-Term Mental Health Disorders in Home Care

publishedVersio

The emergency department evaluation and outcomes of elderly fallers

BACKGROUND: Approximately one-third of community dwelling elderly people (age ≥65 years) falls each year contributing to over 2 million elderly emergency department (ED) visits for falls annually. The cost of care for fatal falls by elderly patients in the US was $179 million in 2000, and was$19 billion for non-fatal falls. The risk of falling increases with various risk factors including advancing age. Despite the frequency and costs associated with elderly falls, it is not clear what evaluation elderly fallers receive in the ED, after the ED, and the outcomes of the care provided. OBJECTIVES: We sought to examine the ED and post-ED workup of elderly fallers, and to compare this evaluation to that recommended by published ED fall evaluation and treatment guidelines. We also examined the disposition of these patients and the rate of adverse events which occurred within 1 year of discharge. METHODS: This study was a retrospective chart review of elderly ED fall patients from one urban teaching hospital with >90,000 visits per year. Patients aged ≥65 years who had an ED visit in 2012 with fall related ICD-9 codes E880-886, E888 and who had been seen by a primary care physician (PCP) within our hospital network during the past 3 years were included. We excluded patients who were transferred to our hospital and subsequent visits related to the original fall. We randomly selected 350 eligible patients for chart review. We adapted our data collection instrument from published fall evaluation recommendations including the American Geriatric Society. Categorical data were presented as percentages and continuous data were recorded as mean with standard deviation (SD) if normally distributed or medians with inter-quartile ranges (IQR) if non-normally distributed. RESULTS: A random sample of 450 charts were taken, 100 were subsequently excluded for erroneous identification. The average age was 80 (SD±9) years; 124 (35%) were male, with an average Charlson comorbidity index of 7.6 (SD 2.9). In terms of history, 251/350 (72%) took 5 or more medications, 144/350 (41%) had their visual acuity checked in the past 12 months, and 34/350 (10%) had fallen two or more times in the past 3 months. In the physical exam, only 43/350 (12%) had orthostatics done. 168/350 (48%) patients had their extremity strength recorded, of these 16/168 (10%) had decreased muscle strength. Only 128/350 (37%) patients had their gait recorded, of which 108/128 (84%) were noted to have an abnormal gait. Basic chemistry laboratory tests and hematology were sent on 199/350 (57%) of patients in the ED. X-rays were taken of 275/350 (79%) patients, and CTs were taken of 184/350 (53%) patients in the ED. 277/350 (79%) patients were discharged to their place of preadmission residence from the ED, ED observation unit, or hospital while 70/350 (20%) were discharged to a skilled rehab facility, all after being admitted to the hospital. 196/350 (56%) patients returned to the ED for any reason within 1 year of discharge, averaging 2.4 ± 1.9 visits. 161/350 (46%) patients were hospitalized within 1 year after discharge, averaging 2 ± 1.4 hospital admissions. 23 (7%) of patients died within 1 year after discharge. CONCLUSION: The comprehensive evaluation of falls for well-established risk factors and causes appears to be poor in this academic medical center ED. While results may not be generalizable to other EDs, the results suggest that standardized evaluation and treatment guidelines are needed

Factors Influencing Trends in Opioid Prescribing for Older People: A Scoping Review

Aim: The review aimed to identify factors influencing opioid prescribing as regular pain-management medication for older people. Background: Chronic pain occurs in 45–85% of older people but appears to be under-recognised and undertreated. However, strong opiate prescribing is more prevalent in older people, increasing at the fastest rate in this age group. Method: This review included all study types, published 1990-2017, which focused on opioid prescribing for pain-management among older adults. Arksey and O’Malley’s (2005) framework was used to scope the literature. PubMed, EBSCO Host, the UK Drug Database and Google Scholar were searched. Data extraction, carried out by two researchers, included factors explaining opioid prescribing patterns and prescribing trends. Findings: 613 papers were identified and 53 were included in the final review consisting of 35 research papers, 10 opinion pieces and 8 grey literature sources. Factors associated with prescribing patterns were categorised according to whether they were patient-related, prescriber-driven or system driven. Patient factors included age, gender, race and cognition; prescriber factors included attitudes towards opioids and judgements about ‘normal’ pain; and policy/system factors related to the changing policy landscape over the last three decades, particularly in the USA. Conclusion: A large number of context-dependent factors appeared to influence opioid prescribing for chronic pain-management in older adults but the findings were inconsistent. There is a gap in the literature relating to the UK healthcare system; the prescriber and the patient perspective; and within the context of multi-morbidity and treatment burden

ASSOCIATION BETWEEN POLYPHARMACY AND FUNCTIONAL STATUS IN COMMUNITY-DWELLING OLDER ADULTS

Background: Polypharmacy has no consensus definition in the literature. Previously used definitions include those based on the number of medications and those based on unnecessary or inappropriate medication use. Polypharmacy has been associated with increased risk of disability and functional limitations that impair a person\u27s ability to live independently. Older adults are a population of interest as they are at increased risk for both polypharmacy and functional impairments. Understanding the relationship between polypharmacy and functional impairment in older adults could help health care providers and policy makers to target an at-risk population for interventions. Objectives: To assess the relationship between the number of medications taken and functional status in community-dwelling older adults using a nationally representative dataset. To assess the change in the relationship between the number of medications taken and functional status over time (2 years and 4 years). To study confounders of the relationship between polypharmacy and functional status. Methods: Data came from the Health and Retirement Study (HRS), collected in the following years: 2004, 2006 and 2008. The primary outcome was functional limitation as measured using the following validated tools: activities of daily living and instrumental activities of daily living (ADL and IADL). The exposure under study was polypharmacy status (no polypharmacy: \u3c 5 prescribed medications, and polypharmacy: ≥5 prescribed medications). Both cross-sectional and longitudinal models were used to examine different aspects of the relationship between polypharmacy and functional status. Results: A total sample size of 1,545 was included in our study. The prevalence of polypharmacy was 35.9% at the beginning of the study. Polypharmacy status was significantly associated with functional decline in both the cross-sectional and longitudinal analyses after controlling for confounders. Self-reported health (SRH) and light exercise were associated with functional decline in all cross-sectional analyses. Age, arthritis, and SRH were also associated with functional decline in all longitudinal analyses. Other confounders were also associated with functional decline. Conclusion: Polypharmacy, defined as the use of more than five prescribed medications is a significant risk factor for functional decline in community-dwelling older adults