Hodnocení racionality a rizik farmakoterapie u geriatrických pacientů v léčebnách pro dlouhodobě nemocné

Záměr Hlavními cíli této disertační práce bylo zhodnotit dostupné informace týkající se farmakologických vlastností benzodiazepinů a jejich změn vlivem stárnutí organismu; zhodnotit prevalenci použití benzodiazepinů u geriatrických pacientů v léčebnách pro dlouhodobě nemocné; analyzovat vztah mezi užitím benzodiazepinů a pády v populaci akutně hospitalizovaných geriatrických pacientů a zmapovat vývoj preskripce benzodiazepinů v prostředí České republiky. Metodika Byla provedena nesystematická literární rešerše, která se stala zdrojem pro přehledový článek zaměřený na farmakokinetiku, farmakodynamiku, nežádoucí účinky a vliv užití benzodiazepinů na výskyt pádů u geriatrické populace. Hodnocení užití benzodiazepinů v léčebnách pro dlouhodobě nemocné v evropských zemích bylo provedeno v rámci retrospektivní průřezové analýzy dat z evropského projektu SHELTER (Service and Health in the Elderly in Long Term Care). Za účelem posouzení vlivu benzodiazepinů na výskyt pádů byla provedena analýza dopadů v prospektivní kohortové studii hospitalizovaných seniorů v Austrálii. Ke zmapování trendů ve spotřebách benzodiazepinů v České republice byla použita data ze Státního ústavu pro kontrolu léčiv a z databáze Všeobecné zdravotní pojišťovny. Tato disertační práce sestává z publikací všech výše uvedených studií a...Objectives Main objectives of this doctoral thesis were to review available information on pharmacological properties of benzodiazepines and their age-related changes; to evaluate the prevalence of benzodiazepine use in older patients residing in long term care facilities; to investigate the association between use of benzodiazepines and occurrence of falls in acutely hospitalized older patients; and to describe utilization of benzodiazepines in the Czech Republic. Methods A narrative review of literature focused on pharmacokinetics, pharmacodynamics, adverse effects and association of benzodiazepines with falls in older population was conducted. The evaluation of benzodiazepine use in long term care facilities was analysed in a retrospective cross-sectional study using data from the EC 7th Framework Program SHELTER project (Service and Health in the Elderly in Long Term Care). A prospective cohort study data of acutely hospitalized patients in Australia were used to evaluate association between benzodiazepines and falls. To describe utilization of benzodiazepines in the Czech Republic, data from the State Institute for Drug Control and from databases of General Health Insurance Fund were used. This dissertation thesis is a summary of published articles from above stated works and analyses. Results...Geriatrická klinika 1. LF UK a VFNDepartment of Geriatrics First Faculty of Medicine and General University HospitalFirst Faculty of Medicine1. lékařská fakult

Prevalence, country-specific prescribing patterns and determinants of benzodiazepine use in community-residing older adults in 7 European countries

Background: The use of benzodiazepines (BZDs) in older population is often accompanied by drug-related complications. Inappropriate BZD use significantly alters older adults’ clinical and functional status. This study compares the prevalence, prescribing patterns and factors associated with BZD use in community-dwelling older patients in 7 European countries. Methods: International, cross-sectional study was conducted in community-dwelling older adults (65 +) in the Czech Republic, Serbia, Estonia, Bulgaria, Croatia, Turkey, and Spain between Feb2019 and Mar2020. Structured and standardized questionnaire based on interRAI assessment scales was applied. Logistic regression was used to evaluate factors associated with BZD use. Results: Out of 2,865 older patients (mean age 73.2 years ± 6.8, 61.2% women) 14.9% were BZD users. The highest prevalence of BZD use was identified in Croatia (35.5%), Spain (33.5%) and Serbia (31.3%). The most frequently prescribed BZDs were diazepam (27.9% of 426 BZD users), alprazolam (23.7%), bromazepam (22.8%) and lorazepam (16.7%). Independent factors associated with BZD use were female gender (OR 1.58, 95%CI 1.19–2.10), hyperpolypharmacy (OR 1.97, 95%CI 1.22–3.16), anxiety (OR 4.26, 95%CI 2.86–6.38), sleeping problems (OR 4.47, 95%CI 3.38–5.92), depression (OR 1.95, 95%CI 1.29–2.95), repetitive anxious complaints (OR 1.77, 95%CI 1.29–2.42), problems with syncope (OR 1.78, 95%CI 1.03–3.06), and loss of appetite (OR 0.60, 95%CI 0.38–0.94). In comparison to Croatia, residing in other countries was associated with lower odds of BZD use (ORs varied from 0.49 (95%CI 0.32–0.75) in Spain to 0.01 (95%CI 0.00–0.03) in Turkey), excluding Serbia (OR 1.11, 95%CI 0.79–1.56). Conclusions: Despite well-known negative effects, BZDs are still frequently prescribed in older outpatient population in European countries. Principles of safer geriatric prescribing and effective deprescribing strategies should be individually applied in older BZD users

Evaluation of rationality and risks of pharmacotherapy in older patients in long-term care facilities

Objectives Main objectives of this doctoral thesis were to review available information on pharmacological properties of benzodiazepines and their age-related changes; to evaluate the prevalence of benzodiazepine use in older patients residing in long term care facilities; to investigate the association between use of benzodiazepines and occurrence of falls in acutely hospitalized older patients; and to describe utilization of benzodiazepines in the Czech Republic. Methods A narrative review of literature focused on pharmacokinetics, pharmacodynamics, adverse effects and association of benzodiazepines with falls in older population was conducted. The evaluation of benzodiazepine use in long term care facilities was analysed in a retrospective cross-sectional study using data from the EC 7th Framework Program SHELTER project (Service and Health in the Elderly in Long Term Care). A prospective cohort study data of acutely hospitalized patients in Australia were used to evaluate association between benzodiazepines and falls. To describe utilization of benzodiazepines in the Czech Republic, data from the State Institute for Drug Control and from databases of General Health Insurance Fund were used. This dissertation thesis is a summary of published articles from above stated works and analyses. Results..

Hodnocení racionality a rizik farmakoterapie u geriatrických pacientů v léčebnách pro dlouhodobě nemocné

Záměr Hlavními cíli této disertační práce bylo zhodnotit dostupné informace týkající se farmakologických vlastností benzodiazepinů a jejich změn vlivem stárnutí organismu; zhodnotit prevalenci použití benzodiazepinů u geriatrických pacientů v léčebnách pro dlouhodobě nemocné; analyzovat vztah mezi užitím benzodiazepinů a pády v populaci akutně hospitalizovaných geriatrických pacientů a zmapovat vývoj preskripce benzodiazepinů v prostředí České republiky. Metodika Byla provedena nesystematická literární rešerše, která se stala zdrojem pro přehledový článek zaměřený na farmakokinetiku, farmakodynamiku, nežádoucí účinky a vliv užití benzodiazepinů na výskyt pádů u geriatrické populace. Hodnocení užití benzodiazepinů v léčebnách pro dlouhodobě nemocné v evropských zemích bylo provedeno v rámci retrospektivní průřezové analýzy dat z evropského projektu SHELTER (Service and Health in the Elderly in Long Term Care). Za účelem posouzení vlivu benzodiazepinů na výskyt pádů byla provedena analýza dopadů v prospektivní kohortové studii hospitalizovaných seniorů v Austrálii. Ke zmapování trendů ve spotřebách benzodiazepinů v České republice byla použita data ze Státního ústavu pro kontrolu léčiv a z databáze Všeobecné zdravotní pojišťovny. Tato disertační práce sestává z publikací všech výše uvedených studií a...Objectives Main objectives of this doctoral thesis were to review available information on pharmacological properties of benzodiazepines and their age-related changes; to evaluate the prevalence of benzodiazepine use in older patients residing in long term care facilities; to investigate the association between use of benzodiazepines and occurrence of falls in acutely hospitalized older patients; and to describe utilization of benzodiazepines in the Czech Republic. Methods A narrative review of literature focused on pharmacokinetics, pharmacodynamics, adverse effects and association of benzodiazepines with falls in older population was conducted. The evaluation of benzodiazepine use in long term care facilities was analysed in a retrospective cross-sectional study using data from the EC 7th Framework Program SHELTER project (Service and Health in the Elderly in Long Term Care). A prospective cohort study data of acutely hospitalized patients in Australia were used to evaluate association between benzodiazepines and falls. To describe utilization of benzodiazepines in the Czech Republic, data from the State Institute for Drug Control and from databases of General Health Insurance Fund were used. This dissertation thesis is a summary of published articles from above stated works and analyses. Results...Katedra sociální a klinické farmacieDepartment of Social and Clinical PharmacyFaculty of Pharmacy in Hradec KrálovéFarmaceutická fakulta v Hradci Králov

Evaluation of rationality and risks of pharmacotherapyin older patients in long-term care facilities

Objectives Main objectives of this doctoral thesis were to review available information on pharmacological properties of benzodiazepines and their age-related changes; to evaluate the prevalence of benzodiazepine use in older patients residing in long term care facilities; to investigate the association between use of benzodiazepines and occurrence of falls in acutely hospitalized older patients; and to describe utilization of benzodiazepines in the Czech Republic. Methods A narrative review of literature focused on pharmacokinetics, pharmacodynamics, adverse effects and association of benzodiazepines with falls in older population was conducted. The evaluation of benzodiazepine use in long term care facilities was analysed in a retrospective cross-sectional study using data from the EC 7th Framework Program SHELTER project (Service and Health in the Elderly in Long Term Care). A prospective cohort study data of acutely hospitalized patients in Australia were used to evaluate association between benzodiazepines and falls. To describe utilization of benzodiazepines in the Czech Republic, data from the State Institute for Drug Control and from databases of General Health Insurance Fund were used. This dissertation thesis is a summary of published articles from above stated works and analyses. Results..

Optimising the care for older persons with complex chronic conditions in home care and nursing homes: design and protocol of I-CARE4OLD, an observational study using real-world data

Introduction In ageing societies, the number of older adults with complex chronic conditions (CCCs) is rapidly increasing. Care for older persons with CCCs is challenging, due to interactions between multiple conditions and their treatments. In home care and nursing homes, where most older persons with CCCs receive care, professionals often lack appropriate decision support suitable and sufficient to address the medical and functional complexity of persons with CCCs. This EU-funded project aims to develop decision support systems using high-quality, internationally standardised, routine care data to support better prognostication of health trajectories and treatment impact among older persons with CCCs.Methods and analysis Real-world data from older persons aged ≥60 years in home care and nursing homes, based on routinely performed comprehensive geriatric assessments using interRAI systems collected in the past 20 years, will be linked with administrative repositories on mortality and care use. These include potentially up to 51 million care recipients from eight countries: Italy, the Netherlands, Finland, Belgium, Canada, USA, Hong Kong and New Zealand. Prognostic algorithms will be developed and validated to better predict various health outcomes. In addition, the modifying impact of pharmacological and non-pharmacological interventions will be examined. A variety of analytical methods will be used, including techniques from the field of artificial intelligence such as machine learning. Based on the results, decision support tools will be developed and pilot tested among health professionals working in home care and nursing homes.Ethics and dissemination The study was approved by authorised medical ethical committees in each of the participating countries, and will comply with both local and EU legislation. Study findings will be shared with relevant stakeholders, including publications in peer-reviewed journals and presentations at national and international meetings