MedWorm.com provides a medical RSS filtering service. Over 6000 RSS medical sources are combined and output via different filters. This feed contains the latest items from the 'NeLM - Care of Older People' source. Wed, 08 Feb 2012 16:54:28 +0100 http://www.medworm.com/index.php?rid=5668056&cid=s_38896_18_f&fid=38896&url=http%3A%2F%2Fwww.nelm.nhs.uk%2Fen%2FNeLM-Area%2FEvidence%2FMedicines-Management%2FReferences%2F2012---February%2F08%2FRelationship-of-health-literacy-to-intentional-and-unintentional-non-adherence-of-hospital-discharge-medications%2F Source: Journal of General Internal Medicine Area: Evidence > Medicines Management > References Background: Inadequate health literacy is prevalent among seniors and is associated with poor health outcomes.  At hospital discharge, medications are frequently changed and patients are informed of these changes via their discharge instructions. Objectives: To explore the association between health literacy and medication discrepancies 48 hours after hospital discharge and determine the causes of discharge medication discrepancies. Design: Face-to-face surveys assessing health literacy at hospital discharge using the short form of the Test of Functional Health Literacy in Adults (sTOFHLA).  We obtained the medication lists from the written discharge instructions.  At... NeLM - Care of Older People news http://www.medworm.com/rss/comments.php?id=5668056 Wed, 08 Feb 2012 05:00:00 +0100 5668056 http://www.medworm.com/index.php?rid=5668057&cid=s_38896_18_f&fid=38896&url=http%3A%2F%2Fwww.nelm.nhs.uk%2Fen%2FNeLM-Area%2FEvidence%2FMedicines-Management%2FReferences%2F2012---February%2F07%2FDrug-burden-index-and-Beers-criteria-impact-on-functional-outcomes-in-older-people-living-in-self-care-retirement-villages%2F The objectives of this study were to determine whether Drug Burden Index (DBI), a measure of individuals' exposure to anticholinergic and sedative drugs, and Beers criteria, an explicit measure of potentially inappropriate drug use, are associated with function in older adults living in low-level care facilities; and to compare DBI with Beers criteria as a predictor of function in older people. The study population consisted of 115 residents living in low-level care facilities in Sydney, Australia.  Data on demographics, drugs, and comorbidities were collected.  Outcomes included objective measures of physical function Short Performance Physical Battery (SPPB) and grip strength. In total, 50 (44%) participants were exposed to DBI drugs, 51 (44%) participants received at least... NeLM - Care of Older People news http://www.medworm.com/rss/comments.php?id=5668057 Tue, 07 Feb 2012 05:00:00 +0100 5668057 http://www.medworm.com/index.php?rid=5660564&cid=s_38896_18_f&fid=38896&url=http%3A%2F%2Fwww.nelm.nhs.uk%2Fen%2FNeLM-Area%2FEvidence%2FMedicines-Management%2FReferences%2F2012---February%2F03%2FMedication-reconciliation-during-the-transition-to-and-from-long-term-care-settings-a-systematic-review%2F Source: Research in Social and Administrative Pharmacy Area: Evidence > Medicines Management > References Background: Medication reconciliation has been recognised as an important process in care transitions to prevent adverse health outcomes.  Because older adults have multiple comorbid conditions and use multiple medications, they are more likely to experience complicated transitions between acute and long-term care settings.  Hence, it is important to develop effective interventions to protect older adults at transition points of care. Objective: To systematically review the literature and evaluate studies performing medication reconciliation interventions in patients transferred to and from long-term care settings. Methods: The literature search focused on studie... NeLM - Care of Older People news http://www.medworm.com/rss/comments.php?id=5660564 Fri, 03 Feb 2012 05:00:00 +0100 5660564 http://www.medworm.com/index.php?rid=5649141&cid=s_38896_18_f&fid=38896&url=http%3A%2F%2Fwww.nelm.nhs.uk%2Fen%2FNeLM-Area%2FEvidence%2FMedicines-Management%2FReferences%2F2012---February%2F02%2FRational-opioid-dosing-in-the-elderly-dose-and-dosing-interval-when-initiating-opioid-therapy%2F Source: Clinical Pharmacology and Therapeutics Area: Evidence > Medicines Management > References Opioids are the mainstay of treatment for moderate to severe pain.  However, opioid therapy in the elderly is often associated with significant morbidity because of excessive ventilatory depression.  The large amount of interindividual variability in opioid dose-response relationships makes it difficult to individualise the dose and dosing interval to provide safe and effective analgesia.  By examining how aging affects the pharmacokinetics (PK) and pharmacodynamics (PD) of opioids, it is possible to provide a rational basis for age adjustment in opioid dosing. Authors conclude that 'simulations with PK-PD models confirm the clinical impression that elderly patients n... NeLM - Care of Older People news http://www.medworm.com/rss/comments.php?id=5649141 Thu, 02 Feb 2012 05:00:00 +0100 5649141 http://www.medworm.com/index.php?rid=5649140&cid=s_38896_18_f&fid=38896&url=http%3A%2F%2Fwww.nelm.nhs.uk%2Fen%2FNeLM-Area%2FEvidence%2FMedicines-Management%2FReferences%2F2012---February%2F02%2FThe-effect-of-medication-reconciliation-in-elderly-patients-at-hospital-discharge%2F Source: International Journal of Clinical Pharmacy Area: Evidence > Medicines Management > References Objective: To assess the impact of medication reconciliation interventions on medication error rates when elderly patients are discharged from hospital to community care or nursing homes. Setting: Elderly patients (older than 65 years) in Sweden, living in nursing homes or in their own homes with care provided by the community nursing system. Method: All medical records containing information on drug treatment were collected from hospital departments, the community care service and GPs.  We then identified whether there were any changes in the transfer of information i.e. if the drugs were not the same as before the transfer.  Two different persons independently... NeLM - Care of Older People news http://www.medworm.com/rss/comments.php?id=5649140 Thu, 02 Feb 2012 05:00:00 +0100 5649140 http://www.medworm.com/index.php?rid=5629836&cid=s_38896_18_f&fid=38896&url=http%3A%2F%2Fwww.nelm.nhs.uk%2Fen%2FNeLM-Area%2FEvidence%2FMedicines-Management%2FReferences%2F2012---January%2F24%2FImproving-accuracy-of-medication-identification-in-an-older-population-using-a-medication-bottle-color-symbol-label-system%2F This study was conducted in two phases, consisting of three focus groups of patients from a family medicine clinic in North Texas, USA, (n = 25) and a pre-post medication identification test in a second group of patient participants (n = 100).  Results of focus group discussions were used to refine the medication label ... (Source: NeLM - Care of Older People) NeLM - Care of Older People news http://www.medworm.com/rss/comments.php?id=5629836 Tue, 24 Jan 2012 05:00:00 +0100 5629836 http://www.medworm.com/index.php?rid=5609977&cid=s_38896_18_f&fid=38896&url=http%3A%2F%2Fwww.nelm.nhs.uk%2Fen%2FNeLM-Area%2FEvidence%2FMedicines-Management%2FReferences%2F2012---January%2F20%2FPrevalence-of-unplanned-hospitalizations%2F Source: Journal of the American Geriatrics Society Area: Evidence > Medicines Management > References Objectives: To describe the prevalence of unplanned hospitalisations caused by adverse drug reactions (ADRs) in older veterans and to examine the association between this outcome and polypharmacy after controlling for comorbidities and other patient characteristics. Design: Retrospective cohort. Setting: US Veterans Affairs Medical Centers. Participants: 678 randomly selected unplanned hospitalisations of older (aged 65 years or older) veterans between 1 Oct 2003 and 30 Sep 2006. Measurements: Naranjo ADR algorithm, ADR preventability and polypharmacy (0-4, 5-8 and 9 or more scheduled medications). Results: 70 ADRs involving 113 drugs were found in 68 (10%... NeLM - Care of Older People news http://www.medworm.com/rss/comments.php?id=5609977 Fri, 20 Jan 2012 05:00:00 +0100 5609977 http://www.medworm.com/index.php?rid=5609978&cid=s_38896_18_f&fid=38896&url=http%3A%2F%2Fwww.nelm.nhs.uk%2Fen%2FNeLM-Area%2FEvidence%2FMedicines-Management%2FReferences%2F2012---January%2F18%2FHIV-management-by-nurse-prescribers-compared-with-doctors-at-a-paediatric-centre-in-Gaborone-Botswana2%2F Conclusions: The authors conclude that their findings suggest that the tolerability of these drugs differs substantially. (Source: NeLM - Care of Older People) NeLM - Care of Older People news http://www.medworm.com/rss/comments.php?id=5609978 Wed, 18 Jan 2012 05:00:00 +0100 5609978 http://www.medworm.com/index.php?rid=5598774&cid=s_38896_18_f&fid=38896&url=http%3A%2F%2Fwww.nelm.nhs.uk%2Fen%2FNeLM-Area%2FEvidence%2FMedicines-Management%2FReferences%2F2012---January%2F17%2FAntimicrobial-prescribing-in-hospitalized-adults-stratified-by-age-data-from-the-ESAC-point-prevalence-surveys%2F Source: Drugs and Aging Area: Evidence > Medicines Management > References Background: Geriatric infectious diseases are a major health care issue.  Infections in the elderly occur more frequently than in younger adults, are often associated with higher morbidity and mortality, and may present atypically.  Elderly patients are also often taking multiple medications, which increases the likelihood of drug-drug interactions.  Dosing decisions should take into consideration the reduced lean body mass and declining renal function in this age group. Objective: Antimicrobial prescribing in three age groups (65-74, 75-84 and 85 years or older) was compared with a reference age group (18-64 years), with the aim of identifying quality of care indicators specific to th... NeLM - Care of Older People news http://www.medworm.com/rss/comments.php?id=5598774 Tue, 17 Jan 2012 05:00:00 +0100 5598774 http://www.medworm.com/index.php?rid=5598775&cid=s_38896_18_f&fid=38896&url=http%3A%2F%2Fwww.nelm.nhs.uk%2Fen%2FNeLM-Area%2FEvidence%2FMedicines-Management%2FReferences%2F2012---January%2F16%2FMedication-use-and-functional-status-decline-in-older-adults-a-narrative-review%2F Source: American Journal of Geriatric Pharmacotherapy Area: Evidence > Medicines Management > References Background: Functional status is the cornerstone of geriatric care and serves as an indicator of general well-being.  A decline in function can increase health care use, worsen quality of life, threaten independence, and increase the risk of mortality.  One of several risk factors for decline in functional status is medication use. Objective: Our aim was to critically review published articles that have examined the relationship between medication use and functional status decline in the elderly. Methods: The MEDLINE and EMBASE databases were searched for English-language articles published from Jan 1986 to Jun 2011.  Search terms included aged, humans, drug ... NeLM - Care of Older People news http://www.medworm.com/rss/comments.php?id=5598775 Mon, 16 Jan 2012 05:00:00 +0100 5598775 http://www.medworm.com/index.php?rid=5583314&cid=s_38896_18_f&fid=38896&url=http%3A%2F%2Fwww.nelm.nhs.uk%2Fen%2FNeLM-Area%2FEvidence%2FMedicines-Management%2FReferences%2F2012---January%2F11%2FNursing-home-antipsychotics%2F Source: Journal of the American Medical Association Area: Evidence > Medicines Management > References News report of a hearing before the US Senate's Special Committee on Aging on 30 Nov 2011, which focused attention on the improper use of antipsychotic drugs in nursing homes.  The inspector general of the US Department of Health and Human Services referred to two recent reports by his office that found 14% of nursing home residents (approximately 300,000 patients) had Medicare claims for atypical antipsychotic drugs.  Half of these drug claims should not have been paid by the government because the drugs were not used for medically accepted indications, and for 1 in 5 of these claims, nursing homes dispensed the drugs in a way that violated sta... NeLM - Care of Older People news http://www.medworm.com/rss/comments.php?id=5583314 Wed, 11 Jan 2012 05:00:00 +0100 5583314 http://www.medworm.com/index.php?rid=5583313&cid=s_38896_18_f&fid=38896&url=http%3A%2F%2Fwww.nelm.nhs.uk%2Fen%2FNeLM-Area%2FNews%2F2012---January%2F11%2FNHS-Evidence-expert-commentary-Medicines-reconciliation-in-care-transition%2F Source: NHS Evidence Area: News The January edition of 'Eyes on Evidence', the free monthly e-bulletin from NHS Evidence covering major new evidence as it emerges with an explanation about what it means for current practice, includes an expert commentary on new evidence from a population-based cohort study evaluating the rates of potentially unintentional discontinuation of medications following hospital or ICU admission.   The study included 396,380 people aged 66 or older who were prescribed at least one of five medical groups for long-term use (statins; antiplatelet/anticoagulant agents; levothyroxine; respiratory inhalers, and gastric acid suppressing drugs).   Patients who had a deliberate reason for stopping medication were excluded.     The study r... NeLM - Care of Older People news http://www.medworm.com/rss/comments.php?id=5583313 Wed, 11 Jan 2012 05:00:00 +0100 5583313 http://www.medworm.com/index.php?rid=5583315&cid=s_38896_18_f&fid=38896&url=http%3A%2F%2Fwww.nelm.nhs.uk%2Fen%2FNeLM-Area%2FEvidence%2FMedicines-Management%2FReferences%2F2012---January%2F10%2FGuided-medication-dosing-for-elderly-emergency-patients-using-real-time-computerized-decision-support%2F Source: Journal of the American Medical Informatics Association Area: Evidence > Medicines Management > References Objective: To evaluate the impact of a real-time computerised decision support tool in the emergency department that guides medication dosing for the elderly on physician ordering behaviour and on adverse drug events (ADEs). Design: A prospective controlled trial was conducted over 26 weeks at a US hospital.  The status of the decision support tool alternated OFF (7/17/06-8/29/06), ON (8/29/06-10/10/06), OFF (10/10/06-11/28/06) and ON (11/28/06-1/16/07) in consecutive blocks during the study period.  In patients aged 65 or older who were ordered certain benzodiazepines, opiates, non-steroidals or sedative-hypnotics, the computer application either adj... NeLM - Care of Older People news http://www.medworm.com/rss/comments.php?id=5583315 Tue, 10 Jan 2012 05:00:00 +0100 5583315 http://www.medworm.com/index.php?rid=5583316&cid=s_38896_18_f&fid=38896&url=http%3A%2F%2Fwww.nelm.nhs.uk%2Fen%2FNeLM-Area%2FEvidence%2FMedicines-Management%2FReferences%2F2012---January%2F09%2FPrescribed-medicines-for-elderly-frail-people-with-diabetes-resident-in-nursing-homes%2F Conclusions: Polypharmacy, defined as taking 4 or more drugs per day per resident, is highly prevalent within ... (Source: NeLM - Care of Older People) NeLM - Care of Older People news http://www.medworm.com/rss/comments.php?id=5583316 Mon, 09 Jan 2012 05:00:00 +0100 5583316 http://www.medworm.com/index.php?rid=5561156&cid=s_38896_18_f&fid=38896&url=http%3A%2F%2Fwww.nelm.nhs.uk%2Fen%2FNeLM-Area%2FNews%2F2012---January%2F05%2FImmediate-and-late-benefits-of-treating-very-elderly-people-with-hypertension-active-treatment-extension-to-HYVET-%2F Source: BMJ Area: News The Hypertension in the Very Elderly Trial (HYVET) provided evidence of the benefits of treating very elderly (> 80 years) people with hypertension. Despite the short follow-up (mean 2.1 years), total mortality was found to have been reduced by 21% (p=0.019) and cardiovascular events by 34% (p<0.001). The HYVET Steering Committee agreed that a one year open label extension to run seamlessly from the end of the main trial might provide additional information to that obtained during the main trial, including whether early benefits would be seen in such an elderly group. The main findings from the trial extension have been reported in the BMJ.   Subjects on double blind treatment at the end of the primary study were eligible to enter the extension and ... NeLM - Care of Older People news http://www.medworm.com/rss/comments.php?id=5561156 Thu, 05 Jan 2012 05:00:00 +0100 5561156 http://www.medworm.com/index.php?rid=5538640&cid=s_38896_18_f&fid=38896&url=http%3A%2F%2Fwww.nelm.nhs.uk%2Fen%2FNeLM-Area%2FEvidence%2FMedicines-Management%2FReferences%2F2011---December%2F23%2FMedication-errors-during-patient-transitions-into-nursing-homes%2F Source: American Journal of Geriatric Pharmacotherapy Area: Evidence > Medicines Management > References Background: Patients transitioning to a nursing home from their home or other facility are at high risk for medication errors. Objective: Our aim was to describe characteristics of medication errors occurring during transitions to nursing homes, to compare characteristics of transition errors with errors not involving a transition, and to evaluate the impact of these errors on patient harm. Methods: This was a cross-sectional analysis of individual medication error incidents reported by North Carolina (USA) nursing homes to the Medication Error Quality Initiative during fiscal years 2007 to 2009.  Bivariate associations between errors in transition with patient fa... NeLM - Care of Older People news http://www.medworm.com/rss/comments.php?id=5538640 Fri, 23 Dec 2011 05:00:00 +0100 5538640 http://www.medworm.com/index.php?rid=5538639&cid=s_38896_18_f&fid=38896&url=http%3A%2F%2Fwww.nelm.nhs.uk%2Fen%2FNeLM-Area%2FEvidence%2FMedicines-Management%2FReferences%2F2011---December%2F23%2FImpact-of-a-multidisciplinary-intervention-on-antibiotic-use-for-nursing-home-acquired-pneumonia%2F Source: American Journal of Geriatric Pharmacotherapy Area: Evidence > Medicines Management > References Background: Academic detailing in nursing homes (NHs) has been shown to improve drug use patterns and adherence to guidelines. Objective: The purpose of this study was to evaluate the impact of a multidisciplinary intervention that included academic detailing on adherence to national nursing home-acquired pneumonia (NHAP) guidelines related to use of antibiotics. Methods: This quasi-experimental study evaluated the effects of a 2-year multifaceted and multidisciplinary intervention targeting implementation of national evidence-based guidelines for NHAP.  Interventions took place in 8 NHs in Colorado; 8 NHs in Kansas and Missouri served as controls.  Interventions ... NeLM - Care of Older People news http://www.medworm.com/rss/comments.php?id=5538639 Fri, 23 Dec 2011 05:00:00 +0100 5538639 http://www.medworm.com/index.php?rid=5538638&cid=s_38896_18_f&fid=38896&url=http%3A%2F%2Fwww.nelm.nhs.uk%2Fen%2FNeLM-Area%2FEvidence%2FMedicines-Management%2FReferences%2F2011---December%2F23%2FDevelopment-and-testing-of-a-tool-for-assessing%2F Source: American Journal of Geriatric Pharmacotherapy Area: Evidence > Medicines Management > References Background: Medication is one of the most important interventions for improving the health of older adults, yet it has great potential for causing harm.  Clinical pharmacists are well positioned to engage in medication assessment and planning.  The Individualized Medication Assessment and Planning (iMAP) tool was developed to aid clinical pharmacists in documenting medication-related problems (MRPs) and associated recommendations. Objective: The purpose of our study was to assess the reliability and usability of the iMAP tool in classifying MRPs and associated recommendations in older adults in the ambulatory care setting. Methods: Three cases, representative of o... NeLM - Care of Older People news http://www.medworm.com/rss/comments.php?id=5538638 Fri, 23 Dec 2011 05:00:00 +0100 5538638 http://www.medworm.com/index.php?rid=5538637&cid=s_38896_18_f&fid=38896&url=http%3A%2F%2Fwww.nelm.nhs.uk%2Fen%2FNeLM-Area%2FEvidence%2FMedicines-Management%2FReferences%2F2011---December%2F23%2FDetection-and-prevention-of-drug-drug-interactions-in-the-hospitalized-elderly%2F Source: American Journal of Geriatric Pharmacotherapy Area: Evidence > Medicines Management > References Background: Polypharmacy increases the risk of cytochrome P450-based drug-drug interactions (CYP450-DDIs), leading to decreased therapeutic efficacy or increased drug toxicity. Objective: The aims of this study were to investigate the utility of a new CYP450-DDI software, InterMED-Rx (Montreal, Canada), in aiding pharmacists in detecting CYP450-DDIs in hospitalised elderly patients and to ascertain pharmacists' agreement on how to intervene for each CYP450-DDI. Methods: A consensus panel of geriatric pharmacists first established guidelines for managing clinically relevant pharmacokinetic CYP450-DDIs.  A prospective study was then conducted of patients newly admitted t... NeLM - Care of Older People news http://www.medworm.com/rss/comments.php?id=5538637 Fri, 23 Dec 2011 05:00:00 +0100 5538637 http://www.medworm.com/index.php?rid=5526194&cid=s_38896_18_f&fid=38896&url=http%3A%2F%2Fwww.nelm.nhs.uk%2Fen%2FNeLM-Area%2FEvidence%2FMedicines-Management%2FReferences%2F2011---December%2F19%2FMedication-administration-errors-for-older-people-in-long-term-residential-care%2F Source: BMC Geriatrics Area: Evidence > Medicines Management > References Background: Older people in long-term residential care are at increased risk of medication prescribing and administration errors.  The main aim of this study was to measure the incidence of medication administration errors in nursing and residential homes using a barcode medication administration (BCMA) system (Proactive Care System). Methods: A prospective study was conducted in 13 care homes (9 residential and 4 nursing) in England.  Data on all medication administrations for a cohort of 345 older residents were recorded in real-time using a disguised observation technique.  Every attempt by social care and nursing staff to administer medication over a 3-month observation period was analys... NeLM - Care of Older People news http://www.medworm.com/rss/comments.php?id=5526194 Mon, 19 Dec 2011 05:00:00 +0100 5526194 http://www.medworm.com/index.php?rid=5526195&cid=s_38896_18_f&fid=38896&url=http%3A%2F%2Fwww.nelm.nhs.uk%2Fen%2FNeLM-Area%2FEvidence%2FMedicines-Management%2FReferences%2F2011---December%2F19%2FVitamin-D-status-affects-strength-gains-in-older-adults-supplemented-with-a-combination%2F Source: Journal of Parenteral and Enteral Nutrition Area: Evidence > Medicines Management > References Older adults supplemented for 1 year with ?-hydroxy-?-methylbutyrate, arginine, and lysine (HMB/ARG/LYS) were previously shown to have significant gains in fat-free mass but not muscular strength.  Recently, increasing levels of serum vitamin D have been associated with an increase in muscle function, particularly in the elderly.  To determine if vitamin D status may have limited strength gain in participants supplemented with HMB/ARG/LYS, the authors performed post hoc analysis of strength based on the participants' vitamin D status.  The nutrient cocktail of HMB/ARG/LYS alone was effective in increasing muscle mass regardless of vitamin D status, but accompanying... NeLM - Care of Older People news http://www.medworm.com/rss/comments.php?id=5526195 Fri, 16 Dec 2011 05:00:00 +0100 5526195 http://www.medworm.com/index.php?rid=5506055&cid=s_38896_18_f&fid=38896&url=http%3A%2F%2Fwww.nelm.nhs.uk%2Fen%2FNeLM-Area%2FEvidence%2FMedicines-Management%2FReferences%2F2011---December%2F15%2FModels-of-Inter-Professional-Working-for-older-people-living-at-home%2F Source: BMC Health Services Research Area: Evidence > Medicines Management > References Background: Most services provided by health and social care organisations for older people living at home rely on interprofessional working (IPW).  Although there is research investigating what supports and inhibits how professionals work together, less is known about how different service models deliver care to older people and how effectiveness is measured.  The aim of this study was to describe how IPW for older people living at home is delivered, enacted and evaluated in England. Method: An online survey of health and social care managers across England directly involved in providing services to older people, and a review of local strategies for older people services produced b... NeLM - Care of Older People news http://www.medworm.com/rss/comments.php?id=5506055 Thu, 15 Dec 2011 05:00:00 +0100 5506055 http://www.medworm.com/index.php?rid=5506056&cid=s_38896_18_f&fid=38896&url=http%3A%2F%2Fwww.nelm.nhs.uk%2Fen%2FNeLM-Area%2FEvidence%2FMedicines-Management%2FReferences%2F2011---December%2F14%2FTreatment-decisions-on-antidepressants-in-nursing-homes-a-qualitative-study%2F Source: Scandinavian Journal of Primary Health Care Area: Evidence > Medicines Management > References Objective: To explore decision-making on treatment with antidepressants among doctors and nurses in nursing homes in Norway. Design and Subjects: A qualitative study based on interviews with three focus groups comprising 8 physicians engaged full time, 8 physicians engaged part-time and 8 registered nurses, respectively.  The interview guide comprised questions on initiating, evaluating and withdrawing treatment with antidepressants.  The interviews were audio-recorded, transcribed and analysed by systematic text condensation. Results: The first theme was the diagnostic process.  The informants expressed difficulty in differentiating between depr... NeLM - Care of Older People news http://www.medworm.com/rss/comments.php?id=5506056 Wed, 14 Dec 2011 05:00:00 +0100 5506056 http://www.medworm.com/index.php?rid=5487844&cid=s_38896_18_f&fid=38896&url=http%3A%2F%2Fwww.nelm.nhs.uk%2Fen%2FNeLM-Area%2FEvidence%2FMedicines-Management%2FReferences%2F2011---December%2F09%2FUse-of-potentially-inappropriate-medications-in-an-ambulatory-Medicare-population%2F Source: Consultant Pharmacist Area: Evidence > Medicines Management > References Objective: To determine the prevalence of potentially inappropriate medication (PIM) use by applying the Beers criteria in an ambulatory population of Medicare beneficiaries, and to identify the most common PIMs/PIM classes taken by this population. Design: Cross-sectional, observational study. Setting: Nine community outreach events throughout central and northern California, USA. Patients: 295 ambulatory Medicare beneficiaries (65 to 98 years of age). Interventions: Pharmacy students, under the supervision of licensed pharmacists, assisted beneficiaries with Medicare Part D plan enrollment and medication review, including identification of PIMs. Main Outcome Measures: Number of PIMs taken ... NeLM - Care of Older People news http://www.medworm.com/rss/comments.php?id=5487844 Fri, 09 Dec 2011 05:00:00 +0100 5487844 http://www.medworm.com/index.php?rid=5487845&cid=s_38896_18_f&fid=38896&url=http%3A%2F%2Fwww.nelm.nhs.uk%2Fen%2FNeLM-Area%2FNews%2F2011---December%2F08%2FEffect-of-warfarin-on-outcomes-in-septuagenarian-patients-with-atrial-fibrillation%2F Source: Am J Cardiology Area: News The safety and efficacy of warfarin remain unclear in patients aged ?70 years of age with atrial fibrillation (AF) and there are sparse data on the effect of long-term anticoagulation on mortality in these patients. A propensity-matched study of the association of warfarin and outcomes in older adults with AF was therefore conducted to examine this issue.   Of the 4060 patients (mean age 65 years, range 49 to 80) in the Atrial Fibrillation Follow-up Investigation of Rhythm Management (AFFIRM) trial, 2248 (55%) were aged 70 to 80 years, 1901 of whom were on warfarin. The propensity score for warfarin use, estimated for each of the 2248 patients, was used to match 227 of the 347 patients not on warfarin to 616 patients on warfarin who were balance... NeLM - Care of Older People news http://www.medworm.com/rss/comments.php?id=5487845 Thu, 08 Dec 2011 05:00:00 +0100 5487845 http://www.medworm.com/index.php?rid=5477355&cid=s_38896_18_f&fid=38896&url=http%3A%2F%2Fwww.nelm.nhs.uk%2Fen%2FNeLM-Area%2FEvidence%2FMedicines-Management%2FReferences%2F2011---December%2F05%2FInappropriate-medication-use-among-the-elderly%2F Source: BMC Geriatrics Area: Evidence > Medicines Management > References Background: Inappropriate medication use (IMU) by elderly people is a public health problem associated with adverse effects on health.  There are a number of methods for identifying IMU, some involving clinical judgment and others, consensually generated lists of drugs to be avoided.  This review aims to describe studies that used information from insurance company and social security administrative databases to assess IMU among community-dwelling elderly and to present the risk factors most often associated with IMU. Methods: The literature search was conducted in Medline and Embase, using descriptors combined with free terms in the title or abstract.  The limits applied were: publicat... NeLM - Care of Older People news http://www.medworm.com/rss/comments.php?id=5477355 Mon, 05 Dec 2011 05:00:00 +0100 5477355 http://www.medworm.com/index.php?rid=5469758&cid=s_38896_18_f&fid=38896&url=http%3A%2F%2Fwww.nelm.nhs.uk%2Fen%2FNeLM-Area%2FEvidence%2FMedicines-Management%2FReferences%2F2011---December%2F02%2FPotentially-inappropriate-drug-prescription-in-the-elderly-in-France%2F Source: European Journal of Clinical Pharmacology Area: Evidence > Medicines Management > References Background: Inappropriate prescribing is a known risk factor for adverse drug event occurrence in the elderly.  In various countries, several studies have used insurance healthcare databases to estimate the national prevalence of potentially inappropriate medications (PIM) in the elderly, as defined by explicit PIM lists.  Recently, a representative sample of the French National Insurance Healthcare database, known as the 'Echantillon Généraliste des Bénéficiaires' (EGB), was created, making it possible to assess the quality of drug prescribing in France.  Our objective was to evaluate the prevalence and the regional distribution of PIM prescription in the elderl... NeLM - Care of Older People news http://www.medworm.com/rss/comments.php?id=5469758 Fri, 02 Dec 2011 05:00:00 +0100 5469758 http://www.medworm.com/index.php?rid=5458826&cid=s_38896_18_f&fid=38896&url=http%3A%2F%2Fwww.nelm.nhs.uk%2Fen%2FNeLM-Area%2FEvidence%2FMedicines-Management%2FReferences%2F2011---November%2F29%2FValidity-of-the-Medication-Based-Disease-Burden-Index%2F Source: Drugs and Aging Area: Evidence > Medicines Management > References Background: Co-morbidity is common in older people.  A co-morbidity index reduces coexisting illnesses and their severity to a single numerical score, allowing comparison with scores from other patients.  Recently, the Medication-Based Disease Burden Index (MDBI) was developed. Objective: The aim of the study was to assess the MDBI's validity in hospitalised elderly patients. Methods: Clinical and demographic data and data on patients' medications on admission were obtained prospectively.  Retrospectively, we applied the MDBI to the patients' medication regimens, determining their co-morbidity using the Charlson Comorbidity Index and Cumulative Illness Rating Scale for Geriatrics (CIRS-G)... NeLM - Care of Older People news http://www.medworm.com/rss/comments.php?id=5458826 Tue, 29 Nov 2011 05:00:00 +0100 5458826 http://www.medworm.com/index.php?rid=5458825&cid=s_38896_18_f&fid=38896&url=http%3A%2F%2Fwww.nelm.nhs.uk%2Fen%2FNeLM-Area%2FEvidence%2FMedicines-Management%2FReferences%2F2011---November%2F30%2FUse-of-prescription-drug-samples-and-patient-assistance-programs-and-the-role-of-doctor-patient-communication%2F Source: Journal of General Internal Medicine Area: Evidence > Medicines Management > References Background: Cost-related underuse of medications is common among older adults, in the USA who seldom discuss medication costs with their physicians.  Some older adults may use free drug samples or industry-sponsored patient assistance programmes (PAP) in hopes of lowering out-of-pocket costs, although the long-term effect of these programmes on drug spending is unclear. Objectives: To examine older adults' use of industry-sponsored strategies to reduce out-of-pocket drug costs and the association between doctor-patient communication and use of these programmes. Design: Cross-sectional analysis of a 2006 nationally representative survey of US Medicare beneficiaries. Participan... NeLM - Care of Older People news http://www.medworm.com/rss/comments.php?id=5458825 Tue, 29 Nov 2011 05:00:00 +0100 5458825 http://www.medworm.com/index.php?rid=5458827&cid=s_38896_18_f&fid=38896&url=http%3A%2F%2Fwww.nelm.nhs.uk%2Fen%2FNeLM-Area%2FEvidence%2FMedicines-Management%2FReferences%2F2011---November%2F28%2FFrequency-and-determinants-of-potential-drug-drug-interactions%2F Source: Pharmacoepidemiology and Drug Safety Area: Evidence > Medicines Management > References Purpose: There is limited knowledge about prevalence and determinants of potential drug-drug-interactions (pDDI) in the ambulatory health care setting.  This study analysed the prevalence and determinants of pDDI in the AGnES home visit population (GP-supporting, community-based, e-health-assisted, systemic intervention in Germany). Methods: 779 Home-dwelling patients received an IT-supported home medication review (HMR).  The interaction monographs of the ABDA-database were used to identify pDDI.  A binary multivariate logistic regression model was used to analyse determinants for occurrence of moderate and serious pDDI, respectively. Results: Patients (mean age... NeLM - Care of Older People news http://www.medworm.com/rss/comments.php?id=5458827 Mon, 28 Nov 2011 05:00:00 +0100 5458827 http://www.medworm.com/index.php?rid=5442097&cid=s_38896_18_f&fid=38896&url=http%3A%2F%2Fwww.nelm.nhs.uk%2Fen%2FNeLM-Area%2FEvidence%2FMedicines-Management%2FReferences%2F2011---November%2F24%2FEmergency-hospitalizations-for-adverse-drug-events-in-older-Americans%2F Source: New England Journal of Medicine Area: Evidence > Medicines Management > References Background: Adverse drug events are important preventable causes of hospitalisation in older adults.  However, nationally representative data on adverse drug events that result in hospitalisation in this population in the USA have been limited. Methods: We used adverse-event data from the US National Electronic Injury Surveillance System - Cooperative Adverse Drug Event Surveillance project (2007 to 2009) to estimate the frequency and rates of hospitalisation after emergency department visits for adverse drug events in older adults and to assess the contribution of specific medications, including those identified as high-risk or potentially inappropriate by national quality measu... NeLM - Care of Older People news http://www.medworm.com/rss/comments.php?id=5442097 Thu, 24 Nov 2011 05:00:00 +0100 5442097 http://www.medworm.com/index.php?rid=5442098&cid=s_38896_18_f&fid=38896&url=http%3A%2F%2Fwww.nelm.nhs.uk%2Fen%2FNeLM-Area%2FEvidence%2FMedicines-Management%2FReferences%2F2011---November%2F23%2FInappropriate-medication-use-in-older-adults-undergoing-surgery-a-national-study%2F Source: Journal of the American Geriatrics Society Area: Evidence > Medicines Management > References Objectives: To determine the prevalence and factors associated with use of potentially inappropriate medications (PIMs) in older adults undergoing surgery. Design: Retrospective cohort study. Setting: 379 acute care hospitals in the USA participating in the nationally representative Perspective database (2006-08). Participants: Individuals aged 65 and older undergoing major inpatient gastrointestinal, gynecological, urological, and orthopedic surgery (N = 272,351). Measurements: Medications were classified as PIMs using previously published criteria defining 33 medications deemed potentially inappropriate in people aged 65 and older.  Information about parti... NeLM - Care of Older People news http://www.medworm.com/rss/comments.php?id=5442098 Wed, 23 Nov 2011 05:00:00 +0100 5442098 http://www.medworm.com/index.php?rid=5442099&cid=s_38896_18_f&fid=38896&url=http%3A%2F%2Fwww.nelm.nhs.uk%2Fen%2FNeLM-Area%2FEvidence%2FMedicines-Management%2FReferences%2F2011---November%2F23%2FHealth-literacy-and-decision-making-styles-for-complex-antithrombotic-therapy-among-older-multimorbid-adults%2F Source: Patient Education and Counseling Area: Evidence > Medicines Management > References Objectives: To evaluate the effect of functional health literacy (FHL) on preferences for decision-making; and among those initially preferring a passive decision-making role, to explore how preferences change if their physician actively encourages their involvement. Methods: Consecutive older adults with cardiovascular disease receiving complex antithrombotic therapy completed a comprehensive assessment including measures of FHL and preferences for shared decision making. Results: Half of all participants had inadequate or marginal FHL.  Those with inadequate FHL were more likely (P = 0.01) to prefer passive rather than active decision making styles even after controlling for age,... NeLM - Care of Older People news http://www.medworm.com/rss/comments.php?id=5442099 Tue, 22 Nov 2011 05:00:00 +0100 5442099 http://www.medworm.com/index.php?rid=5432428&cid=s_38896_18_f&fid=38896&url=http%3A%2F%2Fwww.nelm.nhs.uk%2Fen%2FNeLM-Area%2FEvidence%2FMedicines-Management%2FReferences%2F2011---November%2F21%2FDiabetes-medication-patient-safety-incident-reports-to-the-National-Reporting-and-Learning-Service%2F Source: Diabetic Medicine Area: Evidence > Medicines Management > References Aims: To analyse adverse drug events in older people with diabetes in the care home setting via incident reports obtained from the National Reporting and Learning Service. Methods: A Freedom of Information request was made to the National Reporting and Learning Service via the National Patient Safety Agency.  Within the National Reporting and Learning Service, reports on diabetes within the category of 'medication' using the location limiter of 'hospice or nursing home or residential home' were searched.  We requested information about the number and nature of adverse drug event reports that had been received in relation to diabetes.  The data were subdivided into reports (1) relating to ... NeLM - Care of Older People news http://www.medworm.com/rss/comments.php?id=5432428 Mon, 21 Nov 2011 05:00:00 +0100 5432428 http://www.medworm.com/index.php?rid=5423114&cid=s_38896_18_f&fid=38896&url=http%3A%2F%2Fwww.nelm.nhs.uk%2Fen%2FNeLM-Area%2FEvidence%2FMedicines-Management%2FReferences%2F2011---November%2F18%2FDiscontinuation-of-unnecessary-medications-in-older-adults%2F This article discusses a framework to evaluate the risks and benefits of medications.  A case-based approach will be employed to demonstrate the application of evidence-based medicine and the challenges that pharmacists face in attempting to discontinue medications in older adults. Data Sources: Medline and Micromedex were used as resources for primary literature as well as drug information. Study Selection: Studies were identified based on their relevance to the case to demonstrate the importance of applying emerging literature and evidence-based medicine. Data Extraction: Guidelines on managing osteoporosis as well as diabetes in older adults were used for this case. Data Synthesis: A structured framework was applied to demonstrate considerations when tackling challenging me... NeLM - Care of Older People news http://www.medworm.com/rss/comments.php?id=5423114 Fri, 18 Nov 2011 05:00:00 +0100 5423114 http://www.medworm.com/index.php?rid=5423113&cid=s_38896_18_f&fid=38896&url=http%3A%2F%2Fwww.nelm.nhs.uk%2Fen%2FNeLM-Area%2FEvidence%2FMedicines-Management%2FReferences%2F2011---November%2F18%2FDevelopment-of-an-antibiogram-in-a-long-term-care-facility%2F Source: Consultant Pharmacist Area: Evidence > Medicines Management > References Objective: To create an antibiogram - a profile of an organism's susceptibility/resistance to a panel of antibiotics - for a long-term care facility to assess the prevalence of resistance of bacteria present at the facility. Design: Retrospective analysis of culture and sensitivity data from 1 Jul 2009 to 30 Jun 2010. Setting: A long-term care facility in Huntsville, Alabama, USA. Patients and Participants: Residents of the long-term care facility that had one or more culture and sensitivity test performed. Main Outcome Measure: Susceptibility of bacteria to each antimicrobial tested. Results: Results were compiled and reported according to the Clinical and Laboratory Standards Institut... NeLM - Care of Older People news http://www.medworm.com/rss/comments.php?id=5423113 Fri, 18 Nov 2011 05:00:00 +0100 5423113 http://www.medworm.com/index.php?rid=5409559&cid=s_38896_18_f&fid=38896&url=http%3A%2F%2Fwww.nelm.nhs.uk%2Fen%2FNeLM-Area%2FEvidence%2FMedicines-Management%2FReferences%2F2011---November%2F16%2FAntibiotic-use-in-long-term-care-facilities%2F Source: Journal of Antimicrobial Chemotherapy Area: Evidence > Medicines Management > References Objectives: Evaluation and optimisation of antibiotic use (antibiotic stewardship) is being increasingly promoted as a means to reduce antibiotic resistance, adverse events, treatment complications and costs within institutions.  Our goal was to examine the prevalence of antibiotic use among long-term care facility residents and the extent of variability across these institutions. Methods: We conducted a population-based, point-prevalence study of antibiotic use among elderly individuals (n = 37,371) residing in long-term care facilities (n = 363 institutions) in Ontario, Canada, between Apr and Jun 2009, using linked healthcare databases from Canada's largest province. &#1... NeLM - Care of Older People news http://www.medworm.com/rss/comments.php?id=5409559 Wed, 16 Nov 2011 05:00:00 +0100 5409559 http://www.medworm.com/index.php?rid=5409560&cid=s_38896_18_f&fid=38896&url=http%3A%2F%2Fwww.nelm.nhs.uk%2Fen%2FNeLM-Area%2FEvidence%2FMedicines-Management%2FReferences%2F2011---November%2F15%2FPotentially-inappropriate-drug-prescription-in-the-elderly-in-France%2F Source: European Journal of Clinical Pharmacology Area: Evidence > Medicines Management > References Background: Inappropriate prescribing is a known risk factor for adverse drug event occurrence in the elderly.  In various countries, several studies have used insurance healthcare databases to estimate the national prevalence of potentially inappropriate medications (PIM) in the elderly, as defined by explicit PIM lists.  Recently, a representative sample of the French National Insurance Healthcare database, known as the 'Echantillon Généraliste des Bénéficiaires' (EGB), was created, making it possible to assess the quality of drug prescribing in France.  Our objective was to evaluate the prevalence and the regional distribution of PIM prescription in the elderl... NeLM - Care of Older People news http://www.medworm.com/rss/comments.php?id=5409560 Tue, 15 Nov 2011 05:00:00 +0100 5409560 http://www.medworm.com/index.php?rid=5409561&cid=s_38896_18_f&fid=38896&url=http%3A%2F%2Fwww.nelm.nhs.uk%2Fen%2FNeLM-Area%2FEvidence%2FMedicines-Management%2FReferences%2F2011---November%2F14%2FIntentional-medication-nonadherence-in-a-geriatric-day-hospital%2F Source: Canadian Pharmacists Journal Area: Evidence > Medicines Management > References Estimates of nonadherence in patients over 65 years of age with chronic conditions vary from 40% to 75%.  A study looking at hospitalisations in patients over the age of 65 found that 11% of admissions were related to nonadherence to medications.   Interestingly, nonadherence in the elderly is often intentional.  In a study of nonadherence and adverse drug reactions in elderly patients admitted to the emergency department, 63% of all nonadherence was reported as intentional and only 37% as unintentional.  In this case report, two patients at a geriatric day hospital were found to be intentionally nonadherent to their medication regimens.  One had her medicatio... NeLM - Care of Older People news http://www.medworm.com/rss/comments.php?id=5409561 Mon, 14 Nov 2011 05:00:00 +0100 5409561 http://www.medworm.com/index.php?rid=5388680&cid=s_38896_18_f&fid=38896&url=http%3A%2F%2Fwww.nelm.nhs.uk%2Fen%2FNeLM-Area%2FEvidence%2FGuidelines%2FUpdated-PRODIGY-formerly-CKS-topic-on-dementia%2F Source: Prodigy Area: Evidence > Guidelines The PRODIGY (formerly CKS) topic on dementia has been updated to into include a summary of key recommendations from the World Alzheimer Report 2011 which emphasizes the benefits of early diagnosis and intervention.   This PRODIGY topic covers the management of dementia in primary care, and is based on the guideline on dementia published by the National Institute for Health and Clinical Excellence (NICE), and the NICE Technology Appraisals on donepezil, galantamine, rivastigmine, and memantine for the treatment of Alzheimer's disease   Please see link below for details. (Source: NeLM - Care of Older People) NeLM - Care of Older People news http://www.medworm.com/rss/comments.php?id=5388680 Wed, 09 Nov 2011 05:00:00 +0100 5388680 http://www.medworm.com/index.php?rid=5388683&cid=s_38896_18_f&fid=38896&url=http%3A%2F%2Fwww.nelm.nhs.uk%2Fen%2FNeLM-Area%2FEvidence%2FMedicines-Management%2FReferences%2F2011---November%2F08%2FPotentially-inappropriate-prescribing-in-elderly-assessing-doctor-knowledge-confidence-and-barriers%2F This study investigates doctors' knowledge about potentially inappropriate prescribing (PIP) in the elderly and their confidence in prescribing for the elderly, and explores perceived barriers. Methods: Family and Internal Medicine resident and attending doctors at three teaching hospitals in the USA were asked to complete a survey.  Six clinical vignettes based on the 2003 Beers criteria were used to evaluate doctors' knowledge about medications to avoid in the elderly.  Confidence in prescribing for the elderly and perceived barriers to appropriate prescribing in elderly were assessed using a 5-point Likert scale. Results: 89 doctors completed the survey, for a response rate of 45%.  44% of doctors surveyed estimated that over 25% of their prac... NeLM - Care of Older People news http://www.medworm.com/rss/comments.php?id=5388683 Tue, 08 Nov 2011 05:00:00 +0100 5388683 http://www.medworm.com/index.php?rid=5388682&cid=s_38896_18_f&fid=38896&url=http%3A%2F%2Fwww.nelm.nhs.uk%2Fen%2FNeLM-Area%2FEvidence%2FMedicines-Management%2FReferences%2F2011---November%2F08%2FInterventions-to-reduce-hospital-readmissions-in-the-elderly-in-hospital-or-home-care--A-systematic-review%2F The objective of this systematic review was to identify interventions that effectively reduce the risk of hospital readmissions in patients of 75 years and older, and to assess the role of home follow-up. Methods: We searched studies in MEDLINE, CINAHL, CENTRAL and seven other electronic databases up to Oct 2007, and we updated the MEDLINE search in Oct 2009.  Clinical trials (randomised or controlled) evaluating the effectiveness of an intervention aimed at reducing readmissions in elderly patients were selected.  Quality was assessed using the SIGN tool and the information extracted is presented in text and tables. Results: 32 clinical trials ... (Source: NeLM - Care of Older People) NeLM - Care of Older People news http://www.medworm.com/rss/comments.php?id=5388682 Tue, 08 Nov 2011 05:00:00 +0100 5388682 http://www.medworm.com/index.php?rid=5388681&cid=s_38896_18_f&fid=38896&url=http%3A%2F%2Fwww.nelm.nhs.uk%2Fen%2FNeLM-Area%2FEvidence%2FMedicines-Management%2FReferences%2F2011---November%2F08%2FMedication-discrepancies-identified-at-time-of-hospital-discharge-in-a-geriatric-population%2F Source: American Journal of Geriatric Pharmacotherapy Area: Evidence > Medicines Management > References Background: It has been reported that 14.1% of geriatric patients experience one or more medication discrepancies after hospitalisation. Objective: The goal of this study was to identify and characterise discharge medication list discrepancies among geriatric patients and to describe characteristics associated with discrepancies. Methods: An institutional review board-approved retrospective review was conducted of patients aged 65 years or older discharged from hospitalist and internal medicine services at a large tertiary care hospital in the USA from Aug 2008 to Dec 2009.  A random cohort of 200 patients was selected and categorised by age, gender, att... NeLM - Care of Older People news http://www.medworm.com/rss/comments.php?id=5388681 Tue, 08 Nov 2011 05:00:00 +0100 5388681 http://www.medworm.com/index.php?rid=5388684&cid=s_38896_18_f&fid=38896&url=http%3A%2F%2Fwww.nelm.nhs.uk%2Fen%2FNeLM-Area%2FEvidence%2FMedicines-Management%2FReferences%2F2011---November%2F08%2FRacial-disparities-in-quality-of-medication-use-in-older-adults-findings-from-a-longitudinal-study%2F This study was conducted to determine the prevalence, number, and types of medication-related problems in older adults, examining the impact of race on quality medication use. Methods: This was a prospective cohort study involving in-home interviews and medical record reviews of community-residing older adults in the USA, stratified by race, conducted 3 times over 1 year.  No intervention to address medication-related problems was performed.  The quality of medication use was ... (Source: NeLM - Care of Older People) NeLM - Care of Older People news http://www.medworm.com/rss/comments.php?id=5388684 Mon, 07 Nov 2011 05:00:00 +0100 5388684 http://www.medworm.com/index.php?rid=5362557&cid=s_38896_18_f&fid=38896&url=http%3A%2F%2Fwww.nelm.nhs.uk%2Fen%2FNeLM-Area%2FEvidence%2FMedicines-Management%2FReferences%2F2011---November%2F01%2FWhat-determines-influenza-vaccination-take-up-of-elderly-Europeans%2F Source: Health Economics Area: Evidence > Medicines Management > References We analyse the determinants of influenza vaccination take-up of Europeans above the age of 50 years using the first two waves of the Survey of Health, Ageing, and Retirement (SHARE).  Using quality-of-care indicators, special emphasis is put on the measurement and the impact of physician quality.  We find that age, health status, lifestyle, labour-force status and the family structure are important determinants of the decision to get a flu shot.  Physician quality, as measured by four indicators, also positively affects the probability of getting a flu shot. (Source: NeLM - Care of Older People) NeLM - Care of Older People news http://www.medworm.com/rss/comments.php?id=5362557 Tue, 01 Nov 2011 04:00:00 +0100 5362557 http://www.medworm.com/index.php?rid=5362558&cid=s_38896_18_f&fid=38896&url=http%3A%2F%2Fwww.nelm.nhs.uk%2Fen%2FNeLM-Area%2FEvidence%2FMedicines-Management%2FReferences%2F2011---October%2F31%2FBeers-criteria-as-a-proxy-for-inappropriate-prescribing-of-other-medications-among-older-adults%2F Source: Annals of Pharmacotherapy Area: Evidence > Medicines Management > References Background: The Beers criteria are a compilation of medications deemed potentially inappropriate for older adults, widely used as a prescribing quality indicator. Objective: To determine whether Beers criteria serve as a proxy measure for other forms of inappropriate prescribing, as measured by comprehensive implicit review. Methods: Data for patients aged 65 years and older were obtained from the US Veterans Affairs Enhanced Pharmacy Outpatient Clinic (EPOC) and the Iowa Medicaid Pharmaceutical Case Management (PCM) studies.  Comprehensive measurement of prescribing quality was conducted using expert clinician review of medical records according to the Medication Appropriateness Index (M... NeLM - Care of Older People news http://www.medworm.com/rss/comments.php?id=5362558 Mon, 31 Oct 2011 04:00:00 +0100 5362558 http://www.medworm.com/index.php?rid=5348973&cid=s_38896_18_f&fid=38896&url=http%3A%2F%2Fwww.nelm.nhs.uk%2Fen%2FNeLM-Area%2FNews%2F2011---October%2F26%2FMylan-launches-generic-rivastigmine-capsules-in-UK%2F Source: BioSpace.com Area: News According to a report by BioSpcae, Mylan Inc has announced the launch of generic rivastigmine capsules in the UK, for the treatment of dementia in patients with Alzheimers disease.   Further data on pricing is not available in this report. (Source: NeLM - Care of Older People) NeLM - Care of Older People news http://www.medworm.com/rss/comments.php?id=5348973 Wed, 26 Oct 2011 04:00:00 +0100 5348973 http://www.medworm.com/index.php?rid=5348975&cid=s_38896_18_f&fid=38896&url=http%3A%2F%2Fwww.nelm.nhs.uk%2Fen%2FNeLM-Area%2FEvidence%2FMedicines-Management%2FReferences%2F2011---October%2F24%2FComparison-of-different-approaches-to-confounding-adjustment%2F Source: American Journal of Epidemiology Area: Evidence > Medicines Management > References Selective prescribing of conventional antipsychotic medication (APM) to frailer patients is thought to have led to overestimation of the association with mortality in pharmacoepidemiologic studies relying on claims data.  The authors assessed the validity of different analytical techniques to address such confounding.  The cohort included 82,012 persons initiating APM use after admission to a nursing home in 45 US states with 2001-05 Medicaid/Medicare data, linked to clinical data (Minimum Data Set) and institutional characteristics.  The authors compared the association between APM class and 180-day mortality with multivariate outcome modelling, propensity score (PS) adjustm... NeLM - Care of Older People news http://www.medworm.com/rss/comments.php?id=5348975 Mon, 24 Oct 2011 04:00:00 +0100 5348975 http://www.medworm.com/index.php?rid=5348974&cid=s_38896_18_f&fid=38896&url=http%3A%2F%2Fwww.nelm.nhs.uk%2Fen%2FNeLM-Area%2FEvidence%2FMedicines-Management%2FReferences%2F2011---October%2F24%2FAttitudes-of-physicians-regarding-anticoagulation-for-atrial-fibrillation-a-systematic-review%2F Source: Age and Ageing Area: Evidence > Medicines Management > References Background: The efficacy of warfarin for prevention of stroke in patients with atrial fibrillation (AF) is well established, but many people with AF who would benefit from warfarin are not receiving it.  This systematic review aims to determine physicians' attitudes to the prescription of warfarin for AF, and identify reasons for its underuse. Methods: An electronic search of MEDLINE (1950 to present), EMBASE (1980 to present), CINAHL (1994 to present), PsycINFO (1987 to present) and Web of Knowledge (1970 to present) was performed in Nov 2010 to identify all studies which addressed, via survey, physicians' attitudes regarding anticoagulation for patients with AF. Results: A total of 1375 citat... NeLM - Care of Older People news http://www.medworm.com/rss/comments.php?id=5348974 Mon, 24 Oct 2011 04:00:00 +0100 5348974 http://www.medworm.com/index.php?rid=5337187&cid=s_38896_18_f&fid=38896&url=http%3A%2F%2Fwww.nelm.nhs.uk%2Fen%2FNeLM-Area%2FEvidence%2FMedicines-Management%2FReferences%2F2011---October%2F19%2FMedication-reconciliation-identifying-medication-discrepancies-in-acutely-ill-hospitalized-older-adults%2F This study was primarily qualitative, and descriptive (univariate) statistics are presented. ... (Source: NeLM - Care of Older People) NeLM - Care of Older People news http://www.medworm.com/rss/comments.php?id=5337187 Wed, 19 Oct 2011 04:00:00 +0100 5337187 http://www.medworm.com/index.php?rid=5337186&cid=s_38896_18_f&fid=38896&url=http%3A%2F%2Fwww.nelm.nhs.uk%2Fen%2FNeLM-Area%2FEvidence%2FMedicines-Management%2FReferences%2F2011---October%2F19%2FImplementation-of-a-community-pharmacy-based-falls-prevention-program%2F Source: American Journal of Geriatric Pharmacotherapy Area: Evidence > Medicines Management > References Background: Falls are the leading cause of fatal and nonfatal unintentional injury among older adults in the United States.  Multifaceted falls prevention programmes, which have been reported to reduce the risk for falls among older adults, usually include a medication review and modification component.  Based on a literature search, no randomised trials that have examined the effectiveness of this component have been published. Objective: The aim of this article was to report on a retrospective process evaluation of data from a randomised, controlled trial conducted to examine the effectiveness of a medication review intervention, delivered through community pharmacies, on... NeLM - Care of Older People news http://www.medworm.com/rss/comments.php?id=5337186 Wed, 19 Oct 2011 04:00:00 +0100 5337186 http://www.medworm.com/index.php?rid=5337185&cid=s_38896_18_f&fid=38896&url=http%3A%2F%2Fwww.nelm.nhs.uk%2Fen%2FNeLM-Area%2FEvidence%2FMedicines-Management%2FReferences%2F2011---October%2F19%2FImpact-of-telephone-medication-therapy-management%2F The objective of this study was to determine the impact of pharmacist-provided telephone MTM on: (1) medication and health-related problems (MHRPs); (2) medication adherence; and (3) Part D drug costs. Methods: This quasi-experimental study included Part D beneficiaries from a Texas health plan.  Andersen's Behavioral Model of Health Services Use served as the study framework.  MTM utilisation was the health behaviour.  Age, gender and race were predisposing factors, and number of medications, chronic diseases and medication regimen complexity were need factors.  Outcomes were pre-to-post changes in: (1) MHRPs; (2) medication adherence, using the medication possession ... (Source: NeLM - Care of Older People) NeLM - Care of Older People news http://www.medworm.com/rss/comments.php?id=5337185 Wed, 19 Oct 2011 04:00:00 +0100 5337185 http://www.medworm.com/index.php?rid=5337184&cid=s_38896_18_f&fid=38896&url=http%3A%2F%2Fwww.nelm.nhs.uk%2Fen%2FNeLM-Area%2FEvidence%2FMedicines-Management%2FReferences%2F2011---October%2F19%2FThe-Beers-criteria-as-an-outpatient-screening-tool-for-potentially-inappropriate-medications%2F Source: Consultant Pharmacist Area: Evidence > Medicines Management > References Objective: To determine the impact of using the Beers criteria (sometimes known as the Beers list) as an outpatient screening tool on the number or dosage of Beers criteria medications identified in patients' medication profiles immediately before an outpatient appointment. Design: Nonrandomised, prospective pre-/post pilot study. Setting: Six individual medicine and medicine-specialty clinics at a major academic medical centre in the USA. Participants: All subjects were 65 years of age or older. Interventions: Subjects 65 years of age or older had their medication profiles screened using the Beers criteria - medications potentially inappropriate for use in the elderly - prior to and directly after a ... NeLM - Care of Older People news http://www.medworm.com/rss/comments.php?id=5337184 Wed, 19 Oct 2011 04:00:00 +0100 5337184 http://www.medworm.com/index.php?rid=5316276&cid=s_38896_18_f&fid=38896&url=http%3A%2F%2Fwww.nelm.nhs.uk%2Fen%2FNeLM-Area%2FEvidence%2FMedicines-Management%2FReferences%2F2011---October%2F14%2FCan-a-multifaceted-educational-intervention-targeting%2F Source: Journal of Antimicrobial Chemotherapy Area: Evidence > Medicines Management > References Objectives: To assess the impact of a multifaceted educational intervention concerning treatment of infections in the nursing home setting. Methods: We used a cluster randomised controlled trial.  58 nursing homes in Sweden were randomly assigned either to educational intervention or control.  The intervention consisted of small educational group sessions with nurses and physicians, feedback on prescribing, presentation of guidelines and written materials.  The primary outcome was the proportion of quinolones prescribed for lower urinary tract infection (UTI) in women.  Secondary outcomes were for all infections: number of UTIs per resident, proportion of recorded in... NeLM - Care of Older People news http://www.medworm.com/rss/comments.php?id=5316276 Fri, 14 Oct 2011 04:00:00 +0100 5316276 http://www.medworm.com/index.php?rid=5316277&cid=s_38896_18_f&fid=38896&url=http%3A%2F%2Fwww.nelm.nhs.uk%2Fen%2FNeLM-Area%2FNews%2F2011---October%2F13%2FCQC-report-National-overview-of-dignity-and-nutrition-inspection-programme%2F Source: Care Quality Commission (CQC) Area: News The Care Quality Commission (CQC) has published a report into the standards of care that older people receive in hospital and calls for a system-wide response to combat the failings identified.   The report summarises the findings of 100 unannounced inspections of NHS acute hospitals which took place between March and June 2011, looking at whether the essential standards of dignity and nutrition were being met on wards caring for older people.   Of the 100 hospitals inspected:   . 45 hospitals met both standards . 35 met both standards but needed to improve in one or both . 20 hospitals did not meet one or both standards   The key themes observed in hospitals that were failing to meet ... NeLM - Care of Older People news http://www.medworm.com/rss/comments.php?id=5316277 Thu, 13 Oct 2011 04:00:00 +0100 5316277 http://www.medworm.com/index.php?rid=5316278&cid=s_38896_18_f&fid=38896&url=http%3A%2F%2Fwww.nelm.nhs.uk%2Fen%2FNeLM-Area%2FEvidence%2FMedicines-Management%2FReferences%2F2011---October%2F12%2FLiterature-review-using-pictographs-in-discharge-instructions-for-older-adults-with-low-literacy-skills%2F Source: Journal of Clinical Nursing Area: Evidence > Medicines Management > References Aims: To evaluate current visual aids used in health education; to explore evidence regarding the use of pictographs (simple line drawings showing explicit health care actions); and to provide suggestions for uses of pictographs in discharge instructions for older adults with low-literacy skills. Background: Discharge instructions consist of recommended homecare actions.  However, these healthcare actions are provided in text-based discharge instructions, which are often difficult for patients with low-literacy skills to follow precisely at home.  Various forms of visual aids are currently used to improve health education; however, the appropriateness of these visual aids for educating disch... NeLM - Care of Older People news http://www.medworm.com/rss/comments.php?id=5316278 Wed, 12 Oct 2011 04:00:00 +0100 5316278 http://www.medworm.com/index.php?rid=5305153&cid=s_38896_18_f&fid=38896&url=http%3A%2F%2Fwww.nelm.nhs.uk%2Fen%2FNeLM-Area%2FEvidence%2FMedicines-Management%2FReferences%2F2011---October%2F10%2FGender-and-use-of-hypnotics-or-sedatives-in-old-age-a-nationwide-register-based-study%2F Source: International Journal of Clinical Pharmacy Area: Evidence > Medicines Management > References Objective: To investigate whether gender is associated with use of hypnotics or sedatives and with different types of hypnotics or sedatives in older people after adjustment for age, socioeconomic status (i.e. education) and co-morbidity (i.e. number of other drugs). Setting: Sweden. Method: We conducted a register-based analysis of data on gender, age, dispensed drugs and education from people aged 75-89 years registered in the Swedish Prescribed Drug Register between Jul and Oct 2005 (n = 645,429). Main Outcome Measure: The hypnotic or sedative drug classes were benzodiazepines, benzodiazepine related drugs (i.e. Z-drugs) and other types of hypnotics or sedatives.  The indivi... NeLM - Care of Older People news http://www.medworm.com/rss/comments.php?id=5305153 Mon, 10 Oct 2011 04:00:00 +0100 5305153 http://www.medworm.com/index.php?rid=5297630&cid=s_38896_18_f&fid=38896&url=http%3A%2F%2Fwww.nelm.nhs.uk%2Fen%2FNeLM-Area%2FEvidence%2FMedicines-Management%2FReferences%2F2011---October%2F07%2FMulti-professional-clinical-medication-reviews-in-care-homes%2F Source: Trials Area: Evidence > Medicines Management > References Background: Evidence demonstrates that measures are needed to optimise therapy and improve administration of medicines in care homes for older people.  The aim of this study is to determine the clinical and cost effectiveness of a novel model of multi-professional medication review. Methods: A cluster randomised controlled trial design, involving 30 care homes in East Anglia.  In line with current practice in medication reviews, recruitment and consent will be sought from general practitioners and care homes, rather than individual residents.  Care homes will be segmented according to size and resident mix and allocated to the intervention arm (15 homes) or control arm (15 homes) sequentially using min... NeLM - Care of Older People news http://www.medworm.com/rss/comments.php?id=5297630 Fri, 07 Oct 2011 04:00:00 +0100 5297630 http://www.medworm.com/index.php?rid=5286593&cid=s_38896_18_f&fid=38896&url=http%3A%2F%2Fwww.nelm.nhs.uk%2Fen%2FNeLM-Area%2FEvidence%2FMedicines-Management%2FReferences%2F2011---October%2F06%2FAntimicrobial-prescribing-in-nursing-homes-in-Northern-Ireland-results-of-two-point-prevalence-surveys%2F Source: Drugs and Aging Area: Evidence > Medicines Management > References Background: In 2005, the European Commission recommended that all member states should establish or strengthen surveillance systems for monitoring the use of antimicrobial agents.  There is no evidence in the literature of any surveillance studies having been specifically conducted in nursing homes (NHs) in Northern Ireland (NI). Objective: The aim of this study was to determine the prevalence of antimicrobial prescribing and its relationship with certain factors (e.g. indwelling urinary catheterization, urinary incontinence, disorientation, etc.) in NH residents in NI. Methods: This project was carried out in NI as part of a wider European study under the protocols of the European Surveillance of Antimicr... NeLM - Care of Older People news http://www.medworm.com/rss/comments.php?id=5286593 Thu, 06 Oct 2011 04:00:00 +0100 5286593 http://www.medworm.com/index.php?rid=5286592&cid=s_38896_18_f&fid=38896&url=http%3A%2F%2Fwww.nelm.nhs.uk%2Fen%2FNeLM-Area%2FEvidence%2FMedicines-Management%2FReferences%2F2011---October%2F06%2FParenteral-versus-oral-administration-of-systemic-antimicrobials-in-European-nursing-homes%2F Source: Drugs and Aging Area: Evidence > Medicines Management > References Background: Residents in long-term care facilities are predisposed to healthcare-associated infections that are likely to be caused by antimicrobial-resistant micro-organisms.  Long-term care facilities are increasingly able to offer parenteral antimicrobial treatment but there are few data on the use and appropriateness of such treatment in this setting.  Information on the use of parenteral antimicrobials and associated factors in long-term care facilities is necessary to assess the risks and benefits of this treatment and to support the development of antimicrobial policies aimed at minimising the emergence and spread of antimicrobial resistance. Objective: The aim of this study was to describe the e... NeLM - Care of Older People news http://www.medworm.com/rss/comments.php?id=5286592 Thu, 06 Oct 2011 04:00:00 +0100 5286592 http://www.medworm.com/index.php?rid=5286594&cid=s_38896_18_f&fid=38896&url=http%3A%2F%2Fwww.nelm.nhs.uk%2Fen%2FNeLM-Area%2FEvidence%2FMedicines-Management%2FReferences%2F2011---October%2F05%2FConsumer-stories-about-labelling%2F Source: Australian Prescriber Area: Evidence > Medicines Management > References A consumer panel was established to contribute to two large research projects funded by the National Health and Medical Research Council, on medication safety and chronic illness in seniors (aged 65+ years) undertaken at the University of Western Australia. Two stories from members of the panel are quoted. A man had been taking two medicines and was not aware they were the same medicine (perindopril).  It was not until he sought advice from his pharmacist about his unexplained adverse effects that he was told his usual medicine had been substituted for a generic medicine.  The substitution had not been discussed or explained by either the doctor or the pharmacist.  The panel felt the confusio... NeLM - Care of Older People news http://www.medworm.com/rss/comments.php?id=5286594 Wed, 05 Oct 2011 04:00:00 +0100 5286594 http://www.medworm.com/index.php?rid=5286595&cid=s_38896_18_f&fid=38896&url=http%3A%2F%2Fwww.nelm.nhs.uk%2Fen%2FNeLM-Area%2FEvidence%2FMedicines-Management%2FReferences%2F2011---October%2F03%2FThe-unrecognized-psychosocial-factors-contributing-to-bleeding-risk-in-warfarin-therapy%2F Source: Stroke Area: Evidence > Medicines Management > References Background and Purpose: Warfarin is an effective drug for the prevention of thromboembolism in the elderly.  The major risk for patients taking warfarin is bleeding.  We aimed to assess the impact of psychosocial factors, including mood, cognition, social isolation and health literacy on warfarin instability among community-based elderly patients. Methods: A case-control study was conducted between Mar 2008 and Jun 2009 in a community-based setting in Australia.  Cases were patients previously stabilised on warfarin who recorded an international normalised ratio = 6.0 or higher.  Control subjects were patients whose INR measurement was maintained within the therapeutic range.  Patient intervi... NeLM - Care of Older People news http://www.medworm.com/rss/comments.php?id=5286595 Mon, 03 Oct 2011 04:00:00 +0100 5286595 http://www.medworm.com/index.php?rid=5274731&cid=s_38896_18_f&fid=38896&url=http%3A%2F%2Fwww.nelm.nhs.uk%2Fen%2FNeLM-Area%2FEvidence%2FMedicines-Management%2FReferences%2F2011---September%2F30%2FAge-and-receipt-of-guideline-recommended-medications-for-heart-failure-a-nationwide-study-of-veterans%2F Source: Journal of General Internal Medicine Area: Evidence > Medicines Management > References Background: Older patients often receive less guideline-concordant care for heart failure than younger patients. Objective: To determine whether age differences in heart failure care are explained by patient, provider and health system characteristics and/or by chart-documented reasons for non-adherence to guidelines. Design and Patients: Retrospective cohort study of 2772 ambulatory veterans with heart failure and left ventricular ejection fraction less than 40% from a 2004 US nationwide medical record review programme (the US Veterans Administration External Peer Review Program). Main Measures: Ambulatory use of ACE inhibitors, angiotensin receptor blockers (ARBs) and beta blockers... NeLM - Care of Older People news http://www.medworm.com/rss/comments.php?id=5274731 Fri, 30 Sep 2011 04:00:00 +0100 5274731 http://www.medworm.com/index.php?rid=5274732&cid=s_38896_18_f&fid=38896&url=http%3A%2F%2Fwww.nelm.nhs.uk%2Fen%2FNeLM-Area%2FNews%2F2011---September%2F29%2FLetter-Preparations-for-winter-planning-and-reporting-2011122%2F Source: Department of Health (DH) Area: News This letter from the Deputy Chief NHS Executive, and the Director General for Social Care, Local Government and Care Partnerships, sets out preparations for winter planning and reporting, which will run from 1 November 2011 to the end of February 2012. (Source: NeLM - Care of Older People) NeLM - Care of Older People news http://www.medworm.com/rss/comments.php?id=5274732 Thu, 29 Sep 2011 04:00:00 +0100 5274732 http://www.medworm.com/index.php?rid=5261741&cid=s_38896_18_f&fid=38896&url=http%3A%2F%2Fwww.nelm.nhs.uk%2Fen%2FNeLM-Area%2FEvidence%2FMedicines-Management%2FReferences%2F2011---September%2F27%2FElectronic-medical-record-reminders-and-panel-management-to-improve-primary-care-of-elderly-patients%2F Source: Archives of Internal Medicine Area: Evidence > Medicines Management > References Background: Most elderly patients do not receive recommended preventive care, acute care and care for chronic conditions. Methods: We conducted a controlled trial to assess the effectiveness of electronic medical record (EMR) reminders, with or without panel management, on health care proxy designation, osteoporosis screening, and influenza and pneumococcal vaccinations in patients older than 65 years.  Physicians were assigned to 1 of the following 3 arms: EMR reminder, EMR reminder plus panel manager, or control.  We assessed completion of recommended practices during a 1-year period. Results: Among patients who had not already received the recommended care, health care proxy was desig... NeLM - Care of Older People news http://www.medworm.com/rss/comments.php?id=5261741 Tue, 27 Sep 2011 04:00:00 +0100 5261741 http://www.medworm.com/index.php?rid=5261742&cid=s_38896_18_f&fid=38896&url=http%3A%2F%2Fwww.nelm.nhs.uk%2Fen%2FNeLM-Area%2FEvidence%2FMedicines-Management%2FReferences%2F2011---September%2F26%2FSeamless-care-Just-a-list-would-have-helped%2F Source: Health Expectations Area: Evidence > Medicines Management > References Background: Many older people use one or more prescribed medicines on a daily basis.  Effective medicines management at hospital discharge can support appropriate use of medicines following discharge and help avoid unnecessary hospital re-admission.  Many people, however, feel they receive insufficient information about medicines on discharge from hospital. Objectives: To explore older people and their family carers' experience of hospital discharge in relationship to the organisation and management of medicines. Design: Qualitative interviews with older people over 75 years old, taking 4 or more medicines, and their carers, following discharge from hospital in the United Kingdom (UK).  ... NeLM - Care of Older People news http://www.medworm.com/rss/comments.php?id=5261742 Mon, 26 Sep 2011 04:00:00 +0100 5261742 http://www.medworm.com/index.php?rid=5251480&cid=s_38896_18_f&fid=38896&url=http%3A%2F%2Fwww.nelm.nhs.uk%2Fen%2FNeLM-Area%2FEvidence%2FMedicines-Management%2FReferences%2F2011---September%2F23%2FElderly-persons-experiences-of-participation-in-hospital-discharge-process%2F Conclusions: The actual practice of involving old people in the discharge process is not well developed as experienced ... (Source: NeLM - Care of Older People) NeLM - Care of Older People news http://www.medworm.com/rss/comments.php?id=5251480 Fri, 23 Sep 2011 04:00:00 +0100 5251480 http://www.medworm.com/index.php?rid=5251479&cid=s_38896_18_f&fid=38896&url=http%3A%2F%2Fwww.nelm.nhs.uk%2Fen%2FNeLM-Area%2FEvidence%2FMedicines-Management%2FReferences%2F2011---September%2F23%2FAlternatives-to-potentially-inappropriate-medications-for-use-in-e-prescribing-software%2F Conclusions: Prospectively identifying older persons receiving ... (Source: NeLM - Care of Older People) NeLM - Care of Older People news http://www.medworm.com/rss/comments.php?id=5251479 Fri, 23 Sep 2011 04:00:00 +0100 5251479 http://www.medworm.com/index.php?rid=5238986&cid=s_38896_18_f&fid=38896&url=http%3A%2F%2Fwww.nelm.nhs.uk%2Fen%2FNeLM-Area%2FEvidence%2FMedicines-Management%2FReferences%2F2011---September%2F22%2FAntiepileptic-drug-use-in-community-dwelling-and-institutionalized-elderly-a-nationwide-study-of-over-1300000-older-people%2F Source: European Journal of Clinical Pharmacology Area: Evidence > Medicines Management > References Purpose: To investigate whether institutionalisation is associated with the use of antiepileptic drugs (AEDs) and to compare the association between use of AEDs and psychotropics in community-dwelling and institutionalised elderly, after adjustment for age, sex and co-morbidity (i.e. number of other drugs). Methods: We analysed data on age, sex and dispensed drugs for individuals aged 65 years or older registered in the Swedish Prescribed Drug Register from Jul to Sep 2008, record-linked to the Swedish Social Services Register (n = 1,345,273: 1,258,565 community-dwelling and 86,708 institutionalised elderly).  Multivariate logistic regression analysis was used to analyse w... NeLM - Care of Older People news http://www.medworm.com/rss/comments.php?id=5238986 Thu, 22 Sep 2011 04:00:00 +0100 5238986 http://www.medworm.com/index.php?rid=5238990&cid=s_38896_18_f&fid=38896&url=http%3A%2F%2Fwww.nelm.nhs.uk%2Fen%2FNeLM-Area%2FEvidence%2FMedicines-Management%2FReferences%2F2011---September%2F21%2FExposure-to-potentially-harmful-drug-disease-interactions%2F Source: Journal of the American Geriatrics Society Area: Evidence > Medicines Management > References Objectives: To identify prevalence and risk factors for exposure to drug-disease interactions included in the Healthcare Effectiveness Data and Information Set (HEDIS) Drug-Disease Interaction (Rx-DIS) measure. Design: Cross-sectional retrospective database analysis. Setting: Outpatient clinics within the US Department of Veterans Affairs (VA). Participants: Individuals aged 65 and older who received VA outpatient care between 1 Oct 2003 and 30 Sep 2006. Measurements: Rx-DIS exposure based on the HEDIS measure was identified in VA patients with dementia, falls and chronic renal failure using VA pharmacy and administrative databases.  Factors associated with Rx-DIS exposure we... NeLM - Care of Older People news http://www.medworm.com/rss/comments.php?id=5238990 Wed, 21 Sep 2011 04:00:00 +0100 5238990 http://www.medworm.com/index.php?rid=5238989&cid=s_38896_18_f&fid=38896&url=http%3A%2F%2Fwww.nelm.nhs.uk%2Fen%2FNeLM-Area%2FEvidence%2FMedicines-Management%2FReferences%2F2011---September%2F21%2FPsychoactive-medications-and-crash-involvement-requiring-hospitalization-for-older-drivers-a-population-based-study%2F Source: Journal of the American Geriatrics Society Area: Evidence > Medicines Management > References Objectives: To determine the association between psychoactive medications and crash risk in drivers aged 60 and older. Design: Retrospective population-based case-crossover study. Setting: A database study that linked the Western Australian Hospital Morbidity Data System and the Pharmaceutical Benefits Scheme. Participants: 616 individuals aged 60 and older who were hospitalised as the result of a motor vehicle crash between 2002 and 2008 in Western Australia. Measurements: Hospitalisation after a motor vehicle crash. Results: Greater risk for a hospitalisation crash was found for older drivers prescribed benzodiazepines (odds ratio (OR) = 5.3; 95% CI, 3.6 to 7.8; P less th... NeLM - Care of Older People news http://www.medworm.com/rss/comments.php?id=5238989 Wed, 21 Sep 2011 04:00:00 +0100 5238989 http://www.medworm.com/index.php?rid=5238988&cid=s_38896_18_f&fid=38896&url=http%3A%2F%2Fwww.nelm.nhs.uk%2Fen%2FNeLM-Area%2FEvidence%2FMedicines-Management%2FReferences%2F2011---September%2F21%2FProton-pump-inhibitor-discontinuation-in-long-term-care%2F Source: Journal of the American Geriatrics Society Area: Evidence > Medicines Management > References Objectives: To determine factors associated with proton pump inhibitor (PPI) discontinuation in long-term care. Design: Retrospective cohort analysis. Setting: US Veterans Affairs (VA) long-term care facilities. Participants: Veterans admitted for nonhospice care in 2005 with a length of stay of 7 days or more who were prescribed a PPI within 7 days of admission (N = 10,371). Measurements: Prescribed medications and comorbidities were determined from VA pharmacy and administrative databases and functional status from Minimum Data Set records.  Associations between participant characteristics and PPI discontinuation were determined using Cox proportional hazard ratios (HRs), c... NeLM - Care of Older People news http://www.medworm.com/rss/comments.php?id=5238988 Wed, 21 Sep 2011 04:00:00 +0100 5238988 http://www.medworm.com/index.php?rid=5238987&cid=s_38896_18_f&fid=38896&url=http%3A%2F%2Fwww.nelm.nhs.uk%2Fen%2FNeLM-Area%2FEvidence%2FMedicines-Management%2FReferences%2F2011---September%2F22%2FAntidepressants-utilization-among-elderly-in-Lombardy-from-2000-to-2007-dispensing-trends-and-appropriateness%2F Source: European Journal of Clinical Pharmacology Area: Evidence > Medicines Management > References Purpose: To investigate the prevalence and incidence of antidepressant (AD) use in the elderly during an 8-year period and to evaluate AD treatment appropriateness. Methods: A population-based dispensing study on the community-dwelling elderly of a large area in Lombardy, Italy, was performed.  Data were drawn from the regional administrative database and from a general practice registry.  For each year, prevalence of AD use (i.e. at least one recorded dispensing) and AD treatment (i.e. at least four recorded dispensings) was compared. Results: The prevalence of AD use and treatment doubled and tripled, respectively.  The greatest shift occurred between 2000 and 200... NeLM - Care of Older People news http://www.medworm.com/rss/comments.php?id=5238987 Wed, 21 Sep 2011 04:00:00 +0100 5238987 http://www.medworm.com/index.php?rid=5227120&cid=s_38896_18_f&fid=38896&url=http%3A%2F%2Fwww.nelm.nhs.uk%2Fen%2FNeLM-Area%2FEvidence%2FMedicines-Management%2FReferences%2F2011---September%2F16%2FPattern-of-use-of-beta-blockers-in-older-patients%2F Source: Drugs and Aging Area: Evidence > Medicines Management > References Background: Several drugs, including beta-blockers (beta-adrenoceptor antagonists), are generally under-utilised in older patients with cardiovascular disease. Objectives: The aims of this study were to evaluate whether older patients (aged ?65 years) with coronary artery disease (CAD) have a different pattern of use of ?-blockers than younger adult patients (aged <65 years) and whether gender differences or other clinical variables may influence the use of these drugs. Methods: Over 6 months, 2226 outpatients with stable CAD were enrolled in an observational, cross-sectional, multicentre survey in Italy.  Of these, 1416 patients aged 65 years or older were grouped into four subgroups according to ... NeLM - Care of Older People news http://www.medworm.com/rss/comments.php?id=5227120 Fri, 16 Sep 2011 04:00:00 +0100 5227120 http://www.medworm.com/index.php?rid=5227122&cid=s_38896_18_f&fid=38896&url=http%3A%2F%2Fwww.nelm.nhs.uk%2Fen%2FNeLM-Area%2FEvidence%2FMedicines-Management%2FReferences%2F2011---September%2F15%2FCharacteristics-of-older-people-and-theirconsequences-for-drug-therapy%2F Source: Journal de Pharmacie Clinique Area: Evidence > Medicines Management > References Pharmacokinetic, pharmacodynamic and physical changes in the elderly can have consequences for their drug therapy. When taking these into account in clinical practice, it seems necessary to be particularly careful with molecules with a narrow therapeutic window, in the presence of hypoalbuminaemia, and to estimate renal function systematically using creatinin clearance with whatever formula is used and to interpret it taking into account extremes of age and weight or possible dehydration.  From the pharmacodynamic point of view, geriatricians, pharmacologists and pharmacists have established lists of drugs considered inappropriate in ger... NeLM - Care of Older People news http://www.medworm.com/rss/comments.php?id=5227122 Thu, 15 Sep 2011 04:00:00 +0100 5227122 http://www.medworm.com/index.php?rid=5227121&cid=s_38896_18_f&fid=38896&url=http%3A%2F%2Fwww.nelm.nhs.uk%2Fen%2FNeLM-Area%2FEvidence%2FMedicines-Management%2FReferences%2F2011---September%2F15%2FClinical-pharmacy-activities-point-of-view-of-pharmacists-practising-in-a-geriatric-hospital%2F Source: Journal de Pharmacie Clinique Area: Evidence > Medicines Management > References Wards and institutions admitting older patients constitute ideal places to implement clinical pharmacy services.  Collaborative drug therapy management is possible there.  These services can be distributed in two categories according to whether they are provided for a specific patient (individualised objectives and benefits) or relate to a population (collective objectives and benefits).  The services offered to a specific patient can be divided into three sections according to whether they are arranged on admission, during the stay or in preparation for discharge from the hospital.  Pharmaceutical moni... NeLM - Care of Older People news http://www.medworm.com/rss/comments.php?id=5227121 Thu, 15 Sep 2011 04:00:00 +0100 5227121 http://www.medworm.com/index.php?rid=5210041&cid=s_38896_18_f&fid=38896&url=http%3A%2F%2Fwww.nelm.nhs.uk%2Fen%2FNeLM-Area%2FEvidence%2FMedicines-Management%2FReferences%2F2011---September%2F12%2FQuality-of-care-for-veterans-with-chronic-diseases%2F This study was conducted to assess and benchmark the quality of care, in terms of adherence to nationally recognised treatment guidelines, for veterans with common chronic diseases (i.e. asthma, chronic obstructive pulmonary disease (COPD), coronary artery disease (CAD), diabetes, heart failure, hyperlipidaemia (HL)) in a US Veterans Health Administration (VHA) system.  Patients with at least 1 of the target diagnoses in the period between Jan 2002 and mid-year 2006 were identified using electronic medical records of patients seen at the James A Haley Veterans' Hospital in Tampa, Florida, USA.  The most common diseases identified were HL (34%), CAD (21%) and diabetes (19%).  The percentage of patients filling a prescription for any guidelines-sanctioned pharmacotherapy ... NeLM - Care of Older People news http://www.medworm.com/rss/comments.php?id=5210041 Mon, 12 Sep 2011 04:00:00 +0100 5210041 http://www.medworm.com/index.php?rid=5210043&cid=s_38896_18_f&fid=38896&url=http%3A%2F%2Fwww.nelm.nhs.uk%2Fen%2FNeLM-Area%2FEvidence%2FMedicines-Management%2FReferences%2F2011---September%2F09%2FDrug-interactions-in-geriatrics%2F Source: Krankenhauspharmazie Area: Evidence > Medicines Management > References The incidence of adverse effects correlates with the amount of medication prescribed for older patients.  Furthermore, the risk of occurring adverse side effects is significantly increased by the reduction of renal function in geriatric patients.  The scope of this project was to investigate the clinical relevance of drug interactions in elderly patients attending the department of acute geriatric clinic and the geriatric day hospital at St Georg hospital, Leipzig, Germany.  Geriatric patients were treated with a mean of 7 drugs.  The interaction potential resulting from the 5324 drugs prescribed was classified according to the ABDA database classification system re... NeLM - Care of Older People news http://www.medworm.com/rss/comments.php?id=5210043 Fri, 09 Sep 2011 04:00:00 +0100 5210043 http://www.medworm.com/index.php?rid=5210042&cid=s_38896_18_f&fid=38896&url=http%3A%2F%2Fwww.nelm.nhs.uk%2Fen%2FNeLM-Area%2FNews%2F2011---September%2F09%2FClinical-Review-Cognitive-assessment-of-older-people%2F Source: BMJ Area: News This review article focuses on the cognitive assessment of older people (those aged over about 65 years) in the context of possible dementia, delirium, and depression. (Source: NeLM - Care of Older People) NeLM - Care of Older People news http://www.medworm.com/rss/comments.php?id=5210042 Fri, 09 Sep 2011 04:00:00 +0100 5210042 http://www.medworm.com/index.php?rid=5210044&cid=s_38896_18_f&fid=38896&url=http%3A%2F%2Fwww.nelm.nhs.uk%2Fen%2FNeLM-Area%2FEvidence%2FMedicines-Management%2FReferences%2F2011---September%2F08%2FInappropriate-drug-prescribing-and-adverse-drug-effects-in-elderly-patients%2F Source: Revista Clinica Espanola Area: Evidence > Medicines Management > References Aims: Inappropriate drug prescribing (IP) has been related to higher hospitalisation rates and development of adverse drug effects (ADE).  We studied inappropriate drug prescriptions given to elderly patients admitted to hospital and the frequency and severity of the adverse events associated with them. Patients and methods: A prospective study was conducted in a sample of 100 patients over 65 years admitted to the internal medicine department of a hospital in Spain, with at least one inappropriate drug prescription (Beers and STOPP (B-S) criteria (Screening Tool of Older Person's Prescriptions)) as outpatients or during the first 48 hours after admission.  The relationship of th... NeLM - Care of Older People news http://www.medworm.com/rss/comments.php?id=5210044 Thu, 08 Sep 2011 04:00:00 +0100 5210044 http://www.medworm.com/index.php?rid=5184878&cid=s_38896_18_f&fid=38896&url=http%3A%2F%2Fwww.nelm.nhs.uk%2Fen%2FNeLM-Area%2FNews%2F2011---September%2F01%2FCADTH-Rapid-Response-Report-Oral-nutritional-supplementation-for-the-prevention-of-fractures-due-to-falls-clinical-effectiveness-and-guidelines-%2F Source: Canadian Agency for Drugs and Technologies in Health (CADTH) Area: News This Rapid Response Report from the Canadian Agency for Drugs and Technologies in Health (CADTH) addresses the following questions and provides a summary of the abstracts identified from a limited literature search:   1. What is the clinical effectiveness of oral calcium administration as a mechanism for the prevention of fractures due to falls in adults over 65 years of age?   2. What is the clinical evidence regarding oral nutritional supplementation and the prevention of fractures due to falls in adults over 65 years of age?   3. What is the clinical evidence regarding the management of long-term malnutrition or low weight status, as a mechanism for the prevention of fractures due... NeLM - Care of Older People news http://www.medworm.com/rss/comments.php?id=5184878 Wed, 31 Aug 2011 23:00:00 +0100 5184878 http://www.medworm.com/index.php?rid=5176185&cid=s_38896_18_f&fid=38896&url=http%3A%2F%2Fwww.nelm.nhs.uk%2Fen%2FNeLM-Area%2FNews%2F2011---August%2F30%2FMeta-Analysis-Effect-of-vitamin-D-on-falls-%2F Source: The Journal of Clinical Endocrinology Area: News According to a meta-analysis published early online in the Journal of Clinical Endocrinology and Metabolism, vitamin D supplements can reduce the risk of falls in elderly people, particularly when they are deficient, and when vitamin D is taken with calcium.   Researchers conducted a meta-analysis of randomised controlled trials which investigated the effects of vitamin D on the incidence of falls.    A total of 26 studies (involving 45,782 patients) met inclusion criteria.  Odds ratios and associated 95% confidence intervals were estimated from each study and pooled.  The researchers reported that vitamin D was associated with statistically significant reduction in the risk of falls (odds ratio for... NeLM - Care of Older People news http://www.medworm.com/rss/comments.php?id=5176185 Mon, 29 Aug 2011 23:00:00 +0100 5176185 http://www.medworm.com/index.php?rid=5196993&cid=s_38896_18_f&fid=38896&url=http%3A%2F%2Fwww.nelm.nhs.uk%2Fen%2FNeLM-Area%2FEvidence%2FMedicines-Mngt%2FRef%2F2011---August%2F24%2FAgreement-between-equations-estimating-GFR-in-elderly-nursing-home-residents%2F Source: Age and Ageing Area: Evidence > Medicines Management > References Background: Detecting chronic kidney disease (CKD) may have important implications for the management of older and frail people.  We aimed at investigating whether clinical setting (nursing home: NH versus hospital: H) affects the agreement between glomerular filtration rate (GFR) values estimated by the Chronic Kidney Disease-Epidemiology Collaboration (CKD-EPI), Cockcroft-Gault (CG) and Modification of Diet in Renal Disease (MDRD) equations. Design: Observational study. Setting: Comparison between nursing home residents and hospital patients in Italy. Subjects: Data from 177 NH residents, and 439 H patients in Italy were used. Methods: The agreement between estimating equations and... NeLM - Care of Older People news http://www.medworm.com/rss/comments.php?id=5196993 Tue, 23 Aug 2011 23:00:00 +0100 5196993 http://www.medworm.com/index.php?rid=5196994&cid=s_38896_18_f&fid=38896&url=http%3A%2F%2Fwww.nelm.nhs.uk%2Fen%2FNeLM-Area%2FEvidence%2FMedicines-Mngt%2FRef%2F2011---August%2F23%2FPotentially-inappropriate-medications-in-geriatric-outpatients-with-polypharmacy%2F Source: British Journal of Clinical Pharmacology Area: Evidence > Medicines Management > References Aim: Our aim was to compare the practicability of six different potentially inappropriate medication (PIM) criteria in Taiwanese geriatric outpatients with polypharmacy. Methods: We analysed baseline data from the Medication Safety Review Clinic in Taiwanese Elders (MSRC-Taiwan) study.  The prevalence and correlates of PIMs were determined on the basis of criteria developed in the USA, Canada, France, Norway, Ireland and Thailand.  The percentage of PIMs considered as drug-related problems and the problem-solving rate are reported. Results: In the 193 participants, the prevalence of PIM varied from 24 to 73%.  Application of the criteria revealed that a high number of chr... NeLM - Care of Older People news http://www.medworm.com/rss/comments.php?id=5196994 Sun, 21 Aug 2011 23:00:00 +0100 5196994 http://www.medworm.com/index.php?rid=5196995&cid=s_38896_18_f&fid=38896&url=http%3A%2F%2Fwww.nelm.nhs.uk%2Fen%2FNeLM-Area%2FEvidence%2FMedicines-Mngt%2FRef%2F2011---August%2F22%2FMedication-errors-and-penalties-in-assisted-living-facilities%2F Source: Consultant Pharmacist Area: Evidence > Medicines Management > References Objective: To determine the percentage of medication-related proposed penalties for licensed assisted living facilities in North Carolina, USA. Design: This retrospective, cross-sectional study examined all proposed penalties and related case-file narratives stemming from annual surveys of licensed assisted living facilities conducted by the state between Jul 2007 and Dec 2008.  The percentage of medication-related deficiencies and proposed penalties were calculated.  Associations between the medication-related proposed penalties and facility size, location and penalty type were explored using chi-squared tests. Setting: Assisted living facilities in North Carolina. Main Outcome Measures: Perc... NeLM - Care of Older People news http://www.medworm.com/rss/comments.php?id=5196995 Thu, 18 Aug 2011 23:00:00 +0100 5196995 http://www.medworm.com/index.php?rid=5144797&cid=s_38896_18_f&fid=38896&url=http%3A%2F%2Fwww.nelm.nhs.uk%2Fen%2FNeLM-Area%2FEvidence%2FMedicines-Management%2FReferences%2F2011---August%2F19%2FExclusion-of-older-people-from-clinical-trials%2F Source: Drugs and Aging Area: Evidence > Medicines Management > References Background: There has been concern about under-representation of older people in clinical trials.  The PREDICT study reported that older people and those with co-morbidity continue to be excluded unjustifiably from clinical trials.  However, there is no information about differences of opinion on these issues between EU countries.  The results of a survey of health-related professionals from nine EU countries that participated in the PREDICT study are presented in this study. Objective: The aim of the study was to identify and examine any differences of opinion between EU countries on the inclusion of older patients in clinical trials. Methods: A questionnaire using a Likert scale and free text w... NeLM - Care of Older People news http://www.medworm.com/rss/comments.php?id=5144797 Thu, 18 Aug 2011 23:00:00 +0100 5144797 http://www.medworm.com/index.php?rid=5144799&cid=s_38896_18_f&fid=38896&url=http%3A%2F%2Fwww.nelm.nhs.uk%2Fen%2FNeLM-Area%2FEvidence%2FMedicines-Management%2FReferences%2F2011---August%2F17%2FPotential-underuse-overuse-and-inappropriate-use-of-antidepressants-in-older-veteran-nursing-home-residents%2F Source: Journal of the American Geriatrics Society Area: Evidence > Medicines Management > References Objectives: To examine prevalence and resident- and site-level factors associated with potential underuse, overuse and inappropriate use of antidepressants in older US Veterans Affairs (VA) Community Living Center (CLC) residents. Design: Longitudinal study. Setting: 133 VA CLCs in the United States. Participants: 3692 veterans aged 65 and older admitted between 1 Jan 2004 and 3 Jun 2005, with long stays (90 days or longer). Measurements: Prevalence of potential underuse, inappropriate use and overuse of antidepressants in residents with and without depression (as documented according to International Classification of Diseases, 9th Revision, Clinical Modification, codes... NeLM - Care of Older People news http://www.medworm.com/rss/comments.php?id=5144799 Tue, 16 Aug 2011 23:00:00 +0100 5144799 http://www.medworm.com/index.php?rid=5144798&cid=s_38896_18_f&fid=38896&url=http%3A%2F%2Fwww.nelm.nhs.uk%2Fen%2FNeLM-Area%2FNews%2F2011---August%2F17%2FNational-search-for-new-ideas-to-improve-the-lives-of-people-with-dementia-%2F Source: NHS Networks Area: News The Department of Health, in collaboration with the Design Council have launched a national challenge that will fund teams to develop new design-led ideas for products and services that make lives simpler, better and more enjoyable for those with dementia and their carers.   Living well with dementia will offer five teams a share of £360,000 alongside professional support to develop working prototypes and business models over the next five months. Please see link below for details. (Source: NeLM - Care of Older People) NeLM - Care of Older People news http://www.medworm.com/rss/comments.php?id=5144798 Tue, 16 Aug 2011 23:00:00 +0100 5144798 http://www.medworm.com/index.php?rid=5120407&cid=s_38896_18_f&fid=38896&url=http%3A%2F%2Fwww.nelm.nhs.uk%2Fen%2FNeLM-Area%2FNews%2F2011---August%2F11%2FNHS-Choices-assessment-of-press-reports-about-use-of-more-aggressive-chemotherapy-in-older-lung-cancer-patients%2F Source: NHS Choices Area: News NHS Choices has conducted an assessment of a report in The Daily Telegraph that "doctors' and patients' desire to be cautious can often result in patients being given single-drug therapy for advanced lung cancer, but new research has shown that using two drugs at a time could enable patients to live months longer."   The report is based on a RCT in patients aged 70 to 89 years with advanced lung cancer assigned to a combination therapy of carboplatin and paclitaxel or monotherapy with either vinorelbine or gemcitabine. The trial reported that average overall survival was 10.3 months with the combination therapy and 6.2 months for monotherapy patients. There were more toxic side effects with the combination therapy, but patients in both groups rated ... NeLM - Care of Older People news http://www.medworm.com/rss/comments.php?id=5120407 Wed, 10 Aug 2011 23:00:00 +0100 5120407 http://www.medworm.com/index.php?rid=5110541&cid=s_38896_18_f&fid=38896&url=http%3A%2F%2Fwww.nelm.nhs.uk%2Fen%2FNeLM-Area%2FNews%2F2011---August%2F09%2FCarboplatin-and-weekly-paclitaxel-doublet-chemotherapy-associated-with-survival-benefits-over-monotherapy-in-elderly-patients-with-advanced-NSCLC%2F Source: Lancet Area: News According to the results of a multicentre Phase III study published early online in the Lancet, platinum-based doublet chemotherapy is associated with survival benefits, despite increased toxicity compared to monotherapy, in elderly patients with advanced non-small cell lung cancer (NSCLC).   The authors note that there has been a rise in the incidence of lung cancer in elderly patients, with median ages of diagnosis in developed countries ranging from 63-70 years.  Elderly patients however may not receive the most appropriate treatment in clinical practice as they are under-represented in clinical trials; in addition there may be concerns about drug-related toxic effects in this age-group.  Guidelines from the American Society of Clinical Onco... NeLM - Care of Older People news http://www.medworm.com/rss/comments.php?id=5110541 Mon, 08 Aug 2011 23:00:00 +0100 5110541 http://www.medworm.com/index.php?rid=5098669&cid=s_38896_18_f&fid=38896&url=http%3A%2F%2Fwww.nelm.nhs.uk%2Fen%2FNeLM-Area%2FNews%2F2011---August%2F04%2FPredicting-chemotherapy-toxicity-in-older-adults-with-cancer-prospective-study%2F Source: JCO Area: News This prospective study was conducted to identify risk factors for chemotherapy toxicity in older adults and to develop a risk stratification schema for chemotherapy toxicity. The study was carried out at 7 institutions in the United States between November 2006 and November 2009 and recruited 500 patients with cancer from outpatient oncology practices. Patients (aged ?65) completed a pre-chemotherapy assessment that captured socio-demographics, tumour/treatment variables, laboratory test results, and geriatric assessment variables (function, co-morbidity, cognition, psychological state, social activity/support, and nutritional status). Patients were followed from beginning until the end of their chemotherapy course. Data relating to grade 3 to 5 chemotherapy related... NeLM - Care of Older People news http://www.medworm.com/rss/comments.php?id=5098669 Wed, 03 Aug 2011 23:00:00 +0100 5098669 http://www.medworm.com/index.php?rid=5089132&cid=s_38896_18_f&fid=38896&url=http%3A%2F%2Fwww.nelm.nhs.uk%2Fen%2FNeLM-Area%2FNews%2F2011---August%2F02%2FBleeding-risk-in-very-elderly-patients-on-anticoagulant-treatment%2F Source: Circulation Area: News This Italian multicentre prospective observational study evaluated the quality of anticoagulation and the incidence of bleeding in elderly patients ? 80 years of age.   The study enrolled 4093 patients (median age at beginning of follow-up 84 years [range, 80 to 102 years]) who were naïve to vitamin K antagonists (VKAs) for thromboprophylaxis of atrial fibrillation or after venous thromboembolism. The following findings were reported after 9603 patient-years of follow-up:    . There were 179 major bleeds (rate, 1.87 per 100 patient-years), 26 fatal (rate, 0.27 per 100 patient-years).   . The rate of bleeding was higher in men compared with women (relative risk, 1.4; 95% CI, 1.12 to 1.72; p = 0.002) and among patient... NeLM - Care of Older People news http://www.medworm.com/rss/comments.php?id=5089132 Mon, 01 Aug 2011 23:00:00 +0100 5089132 http://www.medworm.com/index.php?rid=5064281&cid=s_38896_18_f&fid=38896&url=http%3A%2F%2Fwww.nelm.nhs.uk%2Fen%2FNeLM-Area%2FEvidence%2FMedicines-Management%2FReferences%2F2011---July%2F25%2FMultidisciplinary-medication-review-in-long-term-care-a-review-of-the-clinical-evidence-and-guidelines%2F In conclusion, although there is some evidence to support the effectiveness of multidisciplinary medication review for LTC residents, data from further large and well-designed studies are needed to provide more compelling evidence for the use of multidisciplinary medication review for patients in long-term care. (Source: NeLM - Care of Older People) NeLM - Care of Older People news http://www.medworm.com/rss/comments.php?id=5064281 Sun, 24 Jul 2011 23:00:00 +0100 5064281 http://www.medworm.com/index.php?rid=5053637&cid=s_38896_18_f&fid=38896&url=http%3A%2F%2Fwww.nelm.nhs.uk%2Fen%2FNeLM-Area%2FEvidence%2FMedicines-Management%2FReferences%2F2011---July%2F22%2FAre-traditional-NSAIDs-prescribed-appropriately-among-French-elderly-with-osteoarthritis--Results-from-the-CADEUS-cohort%2F Source: European Journal of Clinical Pharmacology Area: Evidence > Medicines Management > References Aim: To describe the inappropriate use of traditional non-steroidal anti-inflammatory drugs (tNSAIDs) in elderly subjects in the CADEUS cohort using the Beers 2003 criteria modified by recommendations from the French Medicines Agency. Methods: Of the 23,217 subjects in the CADEUS cohort, 1851 were aged 65 years or older, had been diagnosed with osteoarthritis (OA), and had been dispensed a tNSAID at least once in the 6 months before the index date.  Data were obtained from the French national reimbursement database and from patient and prescriber questionnaires.  The Beers criteria for inappropriate use were modified to include all tNSAIDs, and long-term high-dose use was ... NeLM - Care of Older People news http://www.medworm.com/rss/comments.php?id=5053637 Thu, 21 Jul 2011 23:00:00 +0100 5053637 http://www.medworm.com/index.php?rid=5040791&cid=s_38896_18_f&fid=38896&url=http%3A%2F%2Fwww.nelm.nhs.uk%2Fen%2FNeLM-Area%2FNews%2F2011---July%2F18%2FEffective-pain-relief-can-reduce-behavioural-disturbance-in-patients-with-dementia%2F Source: BMJ Area: News A controlled trial found that effective pain treatment for patients with dementia and agitation significantly reduced behavioural disturbance over an eight-week period.   The authors of this study note that agitation and aggression are common in patients with dementia, and that antipsychotic drugs are often used to treat these symptoms despite their known disadvantages in such patients. Many patients with dementia are likely to have painful conditions and it has been suggested that pain in patients with impaired language and thinking may cause agitation. The authors of this study aimed to determine whether analgesic treatment according to a set protocol could reduce behavioural disturbance in patients with dementia and agitation. Participants were residents... NeLM - Care of Older People news http://www.medworm.com/rss/comments.php?id=5040791 Sun, 17 Jul 2011 23:00:00 +0100 5040791 http://www.medworm.com/index.php?rid=5031248&cid=s_38896_18_f&fid=38896&url=http%3A%2F%2Fwww.nelm.nhs.uk%2Fen%2FNeLM-Area%2FEvidence%2FMedicines-Management%2FReferences%2F2011---July%2F15%2FCo-Morbidity-and-Potential-Treatment-Conflicts-in-Elderly-Heart-Failure-Patients%2F Source: Drugs and Aging Area: Evidence > Medicines Management > References Background: Co-morbidity of both cardiac and non-cardiac conditions is common in the elderly with heart failure (HF) and can be associated with adverse clinical outcomes. Objectives: The aims of this study were to examine the prevalence of co-morbidity and potential treatment conflicts that may result in adverse clinical outcomes in a large cohort of elderly HF patients. Methods: We conducted a cross-sectional study using administrative claims data (1 Apr to 31 Jul 2007) from the Department of Veterans' Affairs, Australia, on all veterans aged 65 years or older with HF.  Co-morbidities were defined using the pharmaceutical based co-morbidity index Rx-Risk-V.  Potential treatment conflicts for pat... NeLM - Care of Older People news http://www.medworm.com/rss/comments.php?id=5031248 Thu, 14 Jul 2011 23:00:00 +0100 5031248 http://www.medworm.com/index.php?rid=5031247&cid=s_38896_18_f&fid=38896&url=http%3A%2F%2Fwww.nelm.nhs.uk%2Fen%2FNeLM-Area%2FEvidence%2FMedicines-Management%2FReferences%2F2011---July%2F15%2FPsychotropic-drug-use-in-community-dwelling-elderly-people---characteristics-of-persistent-and-incident-users%2F Source: European Journal of Clinical Pharmacology Area: Evidence > Medicines Management > References Purpose: The aim of this prospective cohort study was to analyse psychotropic drug use in community-dwelling elderly people in Finland over a 3-year period and characterise those individuals most susceptible to persistent and incident use. Methods: Data on demographics, health status, cognition, functional capacity and drug use were gathered by interviews at baseline (2004) and in three follow-ups (2005-07) in a population-based sample of 700 community-dwelling people aged?75 years or older.  Characteristics associated with persistent and incident use were identified using Cox proportional-hazards regression. Results: At baseline, 38% (n = 269) of the participants used psycho... NeLM - Care of Older People news http://www.medworm.com/rss/comments.php?id=5031247 Thu, 14 Jul 2011 23:00:00 +0100 5031247 http://www.medworm.com/index.php?rid=5031246&cid=s_38896_18_f&fid=38896&url=http%3A%2F%2Fwww.nelm.nhs.uk%2Fen%2FNeLM-Area%2FEvidence%2FMedicines-Management%2FReferences%2F2011---July%2F15%2FImpact-of-the-Lund-Integrated-Medicines-Management-LIMM-model%2F Source: European Journal of Clinical Pharmacology Area: Evidence > Medicines Management > References Purpose: To examine the impact of systematic medication reconciliations upon hospital admission and of a medication review while in hospital on the number of inappropriate medications and unscheduled drug-related hospital revisits in elderly patients. Methods: This was a prospective, controlled study in 210 patients, aged 65 years or older, who were admitted to one of three internal medicine wards at a University Hospital in Sweden.  Intervention patients received the complete Lund Integrated Medicines Management model (medication reconciliation upon admission and discharge, and medication review and monitoring) provided by a multi-professional team, including a clinical pharmacist.... NeLM - Care of Older People news http://www.medworm.com/rss/comments.php?id=5031246 Thu, 14 Jul 2011 23:00:00 +0100 5031246 http://www.medworm.com/index.php?rid=5031245&cid=s_38896_18_f&fid=38896&url=http%3A%2F%2Fwww.nelm.nhs.uk%2Fen%2FNeLM-Area%2FEvidence%2FMedicines-Management%2FReferences%2F2011---July%2F15%2FComparing-antidepressant-treatment-patterns-in-older-and-younger-adults-a-claims-database-analysis%2F Source: Journal of the American Geriatrics Society Area: Evidence > Medicines Management > References Objectives: To compare depressed older (65 years and older) and younger (25-64 years) adults with regard to antidepressant treatment patterns and to assess factors associated with 180-day nonpersistence. Design: Retrospective matched cohort study. Setting: US managed care population. Participants: Older and matched younger adults diagnosed with depression and treated with antidepressants. Measurements: Sociodemographic characteristics, comorbidities, polypharmacy and characteristics of antidepressant treatment at 180 days were compared between older and younger adults.  Analyses were conducted before and after the implementation in the USA of Medicare Part D on 1 Jan 200... NeLM - Care of Older People news http://www.medworm.com/rss/comments.php?id=5031245 Thu, 14 Jul 2011 23:00:00 +0100 5031245 http://www.medworm.com/index.php?rid=5031244&cid=s_38896_18_f&fid=38896&url=http%3A%2F%2Fwww.nelm.nhs.uk%2Fen%2FNeLM-Area%2FEvidence%2FMedicines-Management%2FReferences%2F2011---July%2F15%2FEffect-of-a-pharmacist-led-multicomponent-intervention%2F Source: Journal of the American Geriatrics Society Area: Evidence > Medicines Management > References Objectives: To determine the extent to which the use of a clinical informatics tool that implements prospective monitoring plans reduces the incidence of potential delirium, falls, hospitalisations potentially due to adverse drug events, and mortality. Design: Randomised cluster trial. Setting: 25 nursing homes in the USA serviced by two long-term care pharmacies. Participants: Residents living in nursing homes during 2003 (1711 in 12 intervention; 1491 in 13 usual care) and 2004 (1769 in 12 intervention; 1552 in 13 usual care). Intervention: The pharmacy automatically generated Geriatric Risk Assessment MedGuide (GRAM) reports and automated monitoring plans for falls an... NeLM - Care of Older People news http://www.medworm.com/rss/comments.php?id=5031244 Thu, 14 Jul 2011 23:00:00 +0100 5031244 http://www.medworm.com/index.php?rid=5021729&cid=s_38896_18_f&fid=38896&url=http%3A%2F%2Fwww.nelm.nhs.uk%2Fen%2FNeLM-Area%2FEvidence%2FMedicines-Management%2FReferences%2F2011---July%2F13%2FDoes-cost-sharing-really-reduce-inappropriate-prescriptions-among-the-elderly%2F Source: Health Policy Area: Evidence > Medicines Management > References Improving prescription drug quality is an essential health policy goal in modern health systems, though evidence on the available instruments to attain such a goal are scarce.  Cost sharing has an arguable role in improving the likelihood of an individual obtaining an appropriate prescription.  This paper empirically examines the effect of cost sharing for prescription drugs in some dimensions of medication-related quality, namely the probability of inappropriate prescription drug use.  Using data from United States seniors from 1996 to 2005, we explore various specifications of the probability of obtaining an inappropriate prescription that corrects for sample selection, endogeneity and unobserved het... NeLM - Care of Older People news http://www.medworm.com/rss/comments.php?id=5021729 Tue, 12 Jul 2011 23:00:00 +0100 5021729 http://www.medworm.com/index.php?rid=5021730&cid=s_38896_18_f&fid=38896&url=http%3A%2F%2Fwww.nelm.nhs.uk%2Fen%2FNeLM-Area%2FEvidence%2FMedicines-Management%2FReferences%2F2011---July%2F12%2FAppropriate-medication-prescribing-in-elderly-patients%2F Source: Journal of Clinical Pharmacy and Therapeutics Area: Evidence > Medicines Management > References What is known and Objectives: Increasing attention is being paid to inappropriate medication prescribing for the elderly.  A growing body of studies have detected a prevalence of inappropriate prescribing ranging from 12% to 40% worldwide, including Regione Emilia-Romagna, Italy.  To improve quality of prescribing, a multi-phase pilot project in the Local Health Unit (LHU) of Parma, Regione Emilia-Romagna, was established.  This phase aimed to assess primary care physicians' knowledge of appropriate prescribing in elderly patients. Methods: In total, 155 primary care physicians (51% of the total), convened by the LHU of Parma for an educational session, were asked to c... NeLM - Care of Older People news http://www.medworm.com/rss/comments.php?id=5021730 Mon, 11 Jul 2011 23:00:00 +0100 5021730 http://www.medworm.com/index.php?rid=5010553&cid=s_38896_18_f&fid=38896&url=http%3A%2F%2Fwww.nelm.nhs.uk%2Fen%2FNeLM-Area%2FEvidence%2FMedicines-Management%2FReferences%2F2011---July%2F08%2FHigh-concomitant-use-of-interacting-drugs-and-low-use%2F Source: Drugs and Aging Area: Evidence > Medicines Management > References Background: NSAIDs are commonly used in the elderly and carry significant risks of adverse events when used concomitantly with potentially interacting drugs. Objective: The aim of this study was to provide a valid estimate of concomitant use of potentially interacting drugs and gastroprotective agents among elderly NSAID users. Methods: This was a nationwide Swedish register-based study of drug prescriptions for 1,529,267 persons aged 65 years or older in 2008, using the Swedish Prescribed Drug Register.  The proportions of concomitant use of potentially interacting drugs and gastroprotective agents were analysed among NSAID users, categorised by age group, sex and NSAID use, defined as: non-users, pe... NeLM - Care of Older People news http://www.medworm.com/rss/comments.php?id=5010553 Thu, 07 Jul 2011 23:00:00 +0100 5010553 http://www.medworm.com/index.php?rid=5010555&cid=s_38896_18_f&fid=38896&url=http%3A%2F%2Fwww.nelm.nhs.uk%2Fen%2FNeLM-Area%2FEvidence%2FMedicines-Management%2FReferences%2F2011---July%2F07%2FDrug-utilization-and-polypharmacy-in-an-Italian-elderly-population-the-EPIFARM-elderly-project%2F Source: Pharmacoepidemiology and Drug Safety Area: Evidence > Medicines Management > References Objective: To investigate the prescribing patterns and the prevalence of polypharmacy in community-dwelling elderly people, and to analyse the association of chronic medications and number of drug prescriptions with age and sex. Methods: All prescriptions for people aged 65 years or older reimbursed by the Italian National Health Service (NHS) and dispensed by retail pharmacies of the 15 local health units (LHU) in the Lombardy Region during 2005 were analysed.  Logistic regression analysis was used to assess the association between drug prescription (overall, chronic drugs and polypharmacy) and age, sex and LHU of residence. Results: 88% of the 1,767,239 elderly people analysed r... NeLM - Care of Older People news http://www.medworm.com/rss/comments.php?id=5010555 Wed, 06 Jul 2011 23:00:00 +0100 5010555 http://www.medworm.com/index.php?rid=5010554&cid=s_38896_18_f&fid=38896&url=http%3A%2F%2Fwww.nelm.nhs.uk%2Fen%2FNeLM-Area%2FEvidence%2FMedicines-Management%2FReferences%2F2011---July%2F07%2FReview-Polypharmacy-in-elderly-patients-with-cancer%2F Source: Lancet Oncology Area: Evidence > Medicines Management > References In this review, the authors examine the clinical implications of polypharmacy for elderly patients with cancer under the following headings:   . Overview of polypharmacy   . Polypharmacy in patients with cancer   . Consequences of polypharmacy   . Management of polypharmacy   . Management of drug interactions in patients with cancer   . Polypharmacy-practical solutions (Source: NeLM - Care of Older People) NeLM - Care of Older People news http://www.medworm.com/rss/comments.php?id=5010554 Wed, 06 Jul 2011 23:00:00 +0100 5010554 http://www.medworm.com/index.php?rid=5000020&cid=s_38896_18_f&fid=38896&url=http%3A%2F%2Fwww.nelm.nhs.uk%2Fen%2FNeLM-Area%2FEvidence%2FMedicines-Management%2FReferences%2F2011---July%2F06%2FConjoint-analysis-of-patient-preferences-on-Medicare-medication-therapy-management%2F Source: Journal of the American Pharmacists Association Area: Evidence > Medicines Management > References Objectives: To identify attributes of medication therapy management (MTM) valued by US Medicare beneficiaries and to determine patient preferences and willingness to pay for MTM attributes. Design: Cross-sectional contingency valuation study. Setting: Six senior centres in Memphis, TN, USA, from Sep 2007 to Aug 2008. Participants: 355 Medicare beneficiaries. Intervention: A discrete choice experiment was used, in which each study participant was asked to choose from two different hypothetical MTM services defined by 7 attributes (service setting, provider type, number of drug therapy problems, provider experience in overall practice, provider experience in geriatrics, ti... NeLM - Care of Older People news http://www.medworm.com/rss/comments.php?id=5000020 Tue, 05 Jul 2011 23:00:00 +0100 5000020 http://www.medworm.com/index.php?rid=5000022&cid=s_38896_18_f&fid=38896&url=http%3A%2F%2Fwww.nelm.nhs.uk%2Fen%2FNeLM-Area%2FEvidence%2FMedicines-Management%2FReferences%2F2011---July%2F04%2FMedication-administration-errors-in-assisted-living-scope-characteristics-and-the-importance-of-staff-training%2F Source: Journal of the American Geriatrics Society Area: Evidence > Medicines Management > References Objectives: To compare rates of medication errors committed by assisted living staff with different training and to examine characteristics of errors. Design: Observation of medication preparation and passes, chart review, interviews, and questionnaires. Setting: Stratified random sample of 11 assisted living communities in the US states of South Carolina (which permits non-nurses to administer medications) and Tennessee (which does not). Participants: All staff who prepared or passed medications: nurses (one registered nurse and 6 licensed practical nurses (LPNs)); medication aides (n = 10); and others (n = 19), including those with more and less training. Measurements: Rates of ... NeLM - Care of Older People news http://www.medworm.com/rss/comments.php?id=5000022 Sun, 03 Jul 2011 23:00:00 +0100 5000022 http://www.medworm.com/index.php?rid=5000021&cid=s_38896_18_f&fid=38896&url=http%3A%2F%2Fwww.nelm.nhs.uk%2Fen%2FNeLM-Area%2FEvidence%2FMedicines-Management%2FReferences%2F2011---July%2F04%2FPatterns-of-antimicrobial-use-for-respiratory-tract-infections-in-older-residents-of-long-term-care-facilities%2F Source: Journal of the American Geriatrics Society Area: Evidence > Medicines Management > References Objectives: To describe patterns of antimicrobial use for respiratory tract infections (RTIs) in older residents of long-term care facilities (LTCFs). Design: Data from a prospective, randomised, controlled study of the effect of vitamin E supplementation on RTIs conducted from Apr 1998 to Aug 2001 were analysed. Setting: 33 LTCFs in the greater Boston area, USA. Participants: 617 subjects aged 65 and older residing in LTCFs. Measurements: RTIs, categorisd as acute bronchitis, pneumonia, common cold, influenza-like illness, pharyngitis and sinusitis, were studied for appropriateness of antimicrobial use, type of antibiotics used and factors associated with their use.&nbs... NeLM - Care of Older People news http://www.medworm.com/rss/comments.php?id=5000021 Sun, 03 Jul 2011 23:00:00 +0100 5000021 http://www.medworm.com/index.php?rid=4986915&cid=s_38896_18_f&fid=38896&url=http%3A%2F%2Fwww.nelm.nhs.uk%2Fen%2FNeLM-Area%2FEvidence%2FMedicines-Management%2FReferences%2F2011---June%2F30%2FMultidisciplinary-medication-review-evaluation-of-a-pharmaceutical-care-model-for-nursing-homes%2F The objective of this study was to assess implementation of a pharmaceutical care model for the multidisciplinary care of elderly patients in nursing homes. Setting: Prospective study, medication review, from Jan 2007 to Dec 2009 in 10 nursing homes affiliated to the Pharmacie interjurassienne (PIJ), Switzerland. Methods: Medication use data were collected and reviewed by a pharmacist, focusing on drug indication, dosing, side effects, renal/hepatic elimination and interactions.  Drug-related problems (DRPs) were discussed face-to-face with the responsible physician and a nurse.  The pharmaceutical care issues were formulated and medication interventions proposed during this meeting.  DRPs and interventions were documented using the Pharmaceutical Care Network Europ... NeLM - Care of Older People news http://www.medworm.com/rss/comments.php?id=4986915 Wed, 29 Jun 2011 23:00:00 +0100 4986915 http://www.medworm.com/index.php?rid=4986914&cid=s_38896_18_f&fid=38896&url=http%3A%2F%2Fwww.nelm.nhs.uk%2Fen%2FNeLM-Area%2FEvidence%2FMedicines-Management%2FReferences%2F2011---June%2F30%2FThe-impact-of-an-aged-care-pharmacist-in-a-department-of-emergency-medicine%2F Source: Journal of Evaluation in Clinical Practice Area: Evidence > Medicines Management > References Rationale, aims and objectives: Departments of emergency medicine (DEM) have experienced increased demand largely because of the aging population.  This project aimed to assess the impact of a specialist aged care pharmacist (ACP) on the efficiency and effectiveness of care of older patients seeking emergency treatment. Method: Eligible patients presenting to the DEM of Bundaberg Hospital (Australia), aged 65 years or older with a chronic condition, or 70 years or older without a chronic condition, and an Australian Triage Category score of 2 or more, were alternately allocated to either the ACP (for medication reconciliation and medication review roles, along with patien... NeLM - Care of Older People news http://www.medworm.com/rss/comments.php?id=4986914 Wed, 29 Jun 2011 23:00:00 +0100 4986914 http://www.medworm.com/index.php?rid=4978186&cid=s_38896_18_f&fid=38896&url=http%3A%2F%2Fwww.nelm.nhs.uk%2Fen%2FNeLM-Area%2FEvidence%2FMedicines-Management%2FReferences%2F2011---June%2F28%2FHow-Do-the-Attitudes-and-Beliefs-of-Older-People-and-Healthcare-Professionals%2F Source: Drugs and Aging Area: Evidence > Medicines Management > References Background: Low adherence of older people to multiple medicine regimens is of widespread concern, and multi-compartment compliance aids are frequently supplied to older people in an attempt to improve their ability to take all their medicines at home.  However, the evidence base for the use of such aids is very limited, and there is some evidence that they are used inappropriately. Objective: We aimed to determine how the attitudes and beliefs of older people and healthcare professionals impacted on the use of multi-compartment compliance aids by older people living at home. Method: This was a qualitative study using grounded theory.  Semi-structured interviews were conducted with 15 older people (mea... NeLM - Care of Older People news http://www.medworm.com/rss/comments.php?id=4978186 Mon, 27 Jun 2011 23:00:00 +0100 4978186 http://www.medworm.com/index.php?rid=4978185&cid=s_38896_18_f&fid=38896&url=http%3A%2F%2Fwww.nelm.nhs.uk%2Fen%2FNeLM-Area%2FEvidence%2FMedicines-Management%2FReferences%2F2011---June%2F28%2FCriteria-for-drug-selection-in-frail-elderly-persons%2F In this study, we investigated which drug properties, such as effectiveness, safety, clinical experience and convenience, are relevant to the choice of medicine most appropriate for frail elderly patients. Objectives: The primary aim of this study was to develop a set of criteria to assist in the selection of the most appropriate drug within a drug class for the treatment of frail elderly patients.  A secondary goal was to test the usefulness of the set of criteria in the prescription of antipsychotics for delirium and behavioural and psychological symptoms of dementia (BPSD). Methods: 31 criteria potentially relevant to the choice of appropriate drugs for frail elderly patients were selected on ... (Source: NeLM - Care of Older People) NeLM - Care of Older People news http://www.medworm.com/rss/comments.php?id=4978185 Mon, 27 Jun 2011 23:00:00 +0100 4978185 http://www.medworm.com/index.php?rid=4978184&cid=s_38896_18_f&fid=38896&url=http%3A%2F%2Fwww.nelm.nhs.uk%2Fen%2FNeLM-Area%2FEvidence%2FMedicines-Management%2FReferences%2F2011---June%2F28%2FFewer-hospitalizations-result-when-primary-care-is-highly-integrated-into-a-continuing-care-retirement-community%2F Source: Health Affairs Area: Evidence > Medicines Management > References Meeting the medical and social needs of elderly people is likely to be costly, disruptive, and at odds with personal preferences if efforts to do so are not well coordinated.  We compared two different models of primary care in four different continuing care retirement communities in the USA.  In the first model, used in one community, the physicians and two part-time nurse practitioners delivered clinical care only at that site, covered all settings within it, and provided all after-hours coverage.  In the second model, used in three communities, on-site primary care physician hours were limited; the same physicians also had independent practices outside the retirement community; and after-hours cal... NeLM - Care of Older People news http://www.medworm.com/rss/comments.php?id=4978184 Mon, 27 Jun 2011 23:00:00 +0100 4978184 http://www.medworm.com/index.php?rid=4971151&cid=s_38896_18_f&fid=38896&url=http%3A%2F%2Fwww.nelm.nhs.uk%2Fen%2FNeLM-Area%2FNews%2F2011---June%2F24%2FAnticholinergic-side-effect-of-many-drugs-linked-with-increased-health-risks-for-over-65s%2F Source: Journal of the American Geriatrics Society, BBC Health News Area: News Research funded by the Medical Research Council (MRC) - the Cognitive Function and Ageing Studies (CFAS) project - has found that anticholinergic activity, an adverse effect of many commonly used medicines, appears to increase the risks of both cognitive brain impairment and death in older people. Groups of medicines with the greatest impact include: anti-depressants such as amitriptyline, imipramine and clomipramine; antipsychotics such as chlorpromazine and trifluoperazine; anti-muscarinic medication such as oxybutynin; and antihistamines such as chlorphenamine.   CFAS is a large, multi-centre initiative being led by the University of East Anglia (UEA). It was launched over 20 years ago to examine he... NeLM - Care of Older People news http://www.medworm.com/rss/comments.php?id=4971151 Thu, 23 Jun 2011 23:00:00 +0100 4971151 http://www.medworm.com/index.php?rid=4962047&cid=s_38896_18_f&fid=38896&url=http%3A%2F%2Fwww.nelm.nhs.uk%2Fen%2FNeLM-Area%2FEvidence%2FMedicines-Management%2FReferences%2F2011---June%2F23%2FOlder-adults-medication-use-6-months-before-and-after-hip-fracture-a-population-based-cohort-study%2F Source: Journal of the American Geriatrics Society Area: Evidence > Medicines Management > References Objective: To study changes in use of fall-risk increasing drugs (FRIDs) and bone density-related medication in participants with hip fracture before and after the fracture and to analyse differences between five healthcare districts in Sweden. Design: Population-based cohort study. Setting: Data retrieved from two national databases. Participants: All 2043 people with hip fracture aged 60 and older in a Swedish county in 2006. Measurements: Changes in FRIDs and bone-active medications prescribed within 6 months before and 6 months after hip fracture and differences between health care districts. Results: Before hip fracture, 1308 participants (67.7%) received any FRIDs or combi... NeLM - Care of Older People news http://www.medworm.com/rss/comments.php?id=4962047 Wed, 22 Jun 2011 23:00:00 +0100 4962047 http://www.medworm.com/index.php?rid=4962046&cid=s_38896_18_f&fid=38896&url=http%3A%2F%2Fwww.nelm.nhs.uk%2Fen%2FNeLM-Area%2FEvidence%2FMedicines-Management%2FReferences%2F2011---June%2F23%2FAssociations-Between-Drug-Burden-Index-and-Falls-in-Older-People-in-Residential-Aged-Care%2F Source: Journal of the American Geriatrics Society Area: Evidence > Medicines Management > References Objectives: To evaluate the association between the Drug Burden Index (DBI), a measure of a person's total exposure to anticholinergic and sedative medications that includes principles of dose-response and maximal effect and is associated with impaired physical function in community-dwelling older people, and falls in residents of residential aged care facilities (RACFs). Design: Data were drawn from participants in a randomised controlled trial that investigated falls and fractures. Setting: RACFs in Sydney, Australia. Participants: Study participants (N = 602; 70.9% female) were recruited from 51 RACFs.  Mean age was 85.7 +/- 6.4, and mean DBI was 0.60 +/- 0.66. M... NeLM - Care of Older People news http://www.medworm.com/rss/comments.php?id=4962046 Wed, 22 Jun 2011 23:00:00 +0100 4962046 http://www.medworm.com/index.php?rid=4955143&cid=s_38896_18_f&fid=38896&url=http%3A%2F%2Fwww.nelm.nhs.uk%2Fen%2FNeLM-Area%2FEvidence%2FMedicines-Management%2FReferences%2F2011---June%2F22%2FPrevention-of-potentially-inappropriate-prescribing-for-elderly-patients-a-randomized-controlled-trial-using-STOPPSTART-criteria%2F Source: Clinical Pharmacology and Therapeutics Area: Evidence > Medicines Management > References Inappropriate prescribing is particularly common in older patients and is associated with adverse drug events (ADEs), hospitalisation, and wasteful utilisation of resources.  We randomised 400 hospitalised patients in Ireland aged 65 years or older to receive either the usual pharmaceutical care (control) or screening with STOPP/START criteria followed up with recommendations to their attending physicians (intervention).  The Medication Appropriateness Index (MAI) and Assessment of Underutilization (AOU) index were used to assess prescribing appropriateness, both at the time of discharge and for 6 months after discharge.  Unnecessary polypharmacy, the use of drugs at ... NeLM - Care of Older People news http://www.medworm.com/rss/comments.php?id=4955143 Tue, 21 Jun 2011 23:00:00 +0100 4955143 http://www.medworm.com/index.php?rid=4955145&cid=s_38896_18_f&fid=38896&url=http%3A%2F%2Fwww.nelm.nhs.uk%2Fen%2FNeLM-Area%2FEvidence%2FMedicines-Management%2FReferences%2F2011---June%2F21%2FAntimicrobial-prescribing-in-European-nursing-homes%2F Source: Journal of Antimicrobial Chemotherapy Area: Evidence > Medicines Management > References Objectives: The aim of this study was to investigate antimicrobial prescribing in nursing homes in countries across Europe. Methods: Point prevalence studies were completed in Apr and Nov 2009 in 85 nursing homes in 15 European countries and two UK administrations. Results: A total of 10,388 and 9430 residents participated in Apr and Nov 2009, respectively.  The mean prevalence of antimicrobial prescribing in the nursing homes was 6.5% in April and 5.0% in November.  The most commonly prescribed antimicrobials were methenamine (17.5%), trimethoprim (11.4%) and co-amoxiclav (11.1%) in April and co-amoxiclav (12.2%), nitrofurantoin (12.2%) and methenamine (11.5%) in November. &nbsp... NeLM - Care of Older People news http://www.medworm.com/rss/comments.php?id=4955145 Mon, 20 Jun 2011 23:00:00 +0100 4955145 http://www.medworm.com/index.php?rid=4955144&cid=s_38896_18_f&fid=38896&url=http%3A%2F%2Fwww.nelm.nhs.uk%2Fen%2FNeLM-Area%2FEvidence%2FMedicines-Management%2FReferences%2F2011---June%2F21%2FReview-Inhaler-device-selection-in-the-elderly-population-with-COPD%2F Source: American Journal of Health-System Pharmacy Area: Evidence > Medicines Management > References The American Journal of Health-Systems Pharmacy has featured a review of special considerations required in the selection of medication inhaler devices for elderly patients with chronic obstructive pulmonary disease (COPD) in the ambulatory care setting.   The authors conclude that "In elderly patients with sufficient cognitive function, manual dexterity, and hand strength, the most important factors in inhaler device selection are cost reimbursement issues, device availability, device convenience, and patient preference. Pharmacist knowledge of appropriate inhaler technique, competent patient education and demonstration, and follow-up assessment are instrumental in optimising de... NeLM - Care of Older People news http://www.medworm.com/rss/comments.php?id=4955144 Mon, 20 Jun 2011 23:00:00 +0100 4955144 http://www.medworm.com/index.php?rid=4938746&cid=s_38896_18_f&fid=38896&url=http%3A%2F%2Fwww.nelm.nhs.uk%2Fen%2FNeLM-Area%2FNews%2F2011---June%2F14%2FSTOPP-criteria-better-than-Beers-for-identifying-inappropriate-medications-in-elderly-patients%2F In this report, the authors describe a prospective comparison between a newly-developed set of criteria, STOPP, and Beers criteria for detecting ADE in elderly people admitted to a university hospital. Participants were consecutive, unselected patients ... (Source: NeLM - Care of Older People) NeLM - Care of Older People news http://www.medworm.com/rss/comments.php?id=4938746 Mon, 13 Jun 2011 23:00:00 +0100 4938746 http://www.medworm.com/index.php?rid=4938745&cid=s_38896_18_f&fid=38896&url=http%3A%2F%2Fwww.nelm.nhs.uk%2Fen%2FNeLM-Area%2FNews%2F2011---June%2F14%2FEvaluating-inappropriate-medications-in-elderly-ITU-survivors%2F Source: Arch Internal Med Area: News A Research Letter describes an assessment of medication appropriateness in a cohort of ITU survivors, highlighting the number of potentially inappropriate medications (PIM) and actually inappropriate medications (AIM) found in this group.   The authors comment that there is no evidence on where in the hospitalisation process elderly patients are prescribed PIM or AIM, and if they are stopped during transitions within the hospital. They therefore assessed medications prescribed in a prospective cohort of patients aged 60 and over who were discharged alive from their academic hospital after receiving care in a medical, surgical, or cardiovascular ITU for shock or respiratory failure. Those discharged to hospice care were excluded. They obtained ... NeLM - Care of Older People news http://www.medworm.com/rss/comments.php?id=4938745 Mon, 13 Jun 2011 23:00:00 +0100 4938745 http://www.medworm.com/index.php?rid=4914626&cid=s_38896_18_f&fid=38896&url=http%3A%2F%2Fwww.nelm.nhs.uk%2Fen%2FNeLM-Area%2FNews%2F2011---June%2F08%2FUS-FDA-approves-generic-donepezil%2F Source: BioSpace.com Area: News The US Food and Drug Administration has approved generic donepezil 5mg and 10mg tablets for the treatment of dementia associated with Alzheimer's disease.   The UK patent expiry for donepezil (Aricept) is February 2012. (Source: NeLM - Care of Older People) NeLM - Care of Older People news http://www.medworm.com/rss/comments.php?id=4914626 Tue, 07 Jun 2011 23:00:00 +0100 4914626 http://www.medworm.com/index.php?rid=4914625&cid=s_38896_18_f&fid=38896&url=http%3A%2F%2Fwww.nelm.nhs.uk%2Fen%2FNeLM-Area%2FNews%2F2011---June%2F08%2FUnplanned-hospital-admissions-of-older-people-exploring-the-issues%2F Source: National Institutes of Health (NIH) Area: News The National Institute for Health Research (NIHR) has published the outcomes of a study which examined the impact of different governance models as local health and social care economies sought to reduce utilisation of unplanned inpatient bed days by older people.   Please see link below for details. (Source: NeLM - Care of Older People) NeLM - Care of Older People news http://www.medworm.com/rss/comments.php?id=4914625 Tue, 07 Jun 2011 23:00:00 +0100 4914625 http://www.medworm.com/index.php?rid=4865064&cid=s_38896_18_f&fid=38896&url=http%3A%2F%2Fwww.nelm.nhs.uk%2Fen%2FNeLM-Area%2FNews%2F2011---May%2F25%2FLow-calcium-intake-increases-fracture-risk-but-higher-intake-has-no-further-benefits%2F Source: British Medical Journal (BMJ) Area: News A long-term observational study found that low dietary calcium intake was associated with increased fracture risk, however increases beyond the minimum necessary did not further reduce the risk and may increase it.   Osteoporosis is a major health problem, leading to increased fracture risk: while maintaining adequate calcium intake is important, the evidence on the optimum intake is conflicting. The authors of this study used data from an existing long-running Swedish cohort study to examine the fracture risk associated with varying levels of dietary calcium intake in community-dwelling women. Data were obtained from the Swedish Mammography Cohort, which was established in 1987-1990 and included women from two Swedish counties who... NeLM - Care of Older People news http://www.medworm.com/rss/comments.php?id=4865064 Tue, 24 May 2011 23:00:00 +0100 4865064 http://www.medworm.com/index.php?rid=4854959&cid=s_38896_18_f&fid=38896&url=http%3A%2F%2Fwww.nelm.nhs.uk%2Fen%2FNeLM-Area%2FEvidence%2FMedicines-Management%2FReferences%2F2011---May%2F24%2FGeriatric-drug-evaluation-%2F Source: Archives of Internal Medicine Area: Evidence > Medicines Management > References The older population is currently the fastest growing age group in the United States, and this trend is expected to continue for several decades. Older individuals, in general, have a higher disease burden compared with younger adults and are the major users of medications; yet premarketing drug clinical trials have often excluded them even for the drugs that have high utility in this age group. Extrapolation of clinical results from younger to older individuals does not provide adequate benefit-risk estimation, and the frequent need for dose adjustment in older patients from initially approved doses exemplifies the current lack of adequate clinical data in the elderly.   In this article, the... NeLM - Care of Older People news http://www.medworm.com/rss/comments.php?id=4854959 Mon, 23 May 2011 23:00:00 +0100 4854959 http://www.medworm.com/index.php?rid=4776537&cid=s_38896_18_f&fid=38896&url=http%3A%2F%2Fwww.nelm.nhs.uk%2Fen%2FNeLM-Area%2FNews%2F2011---May%2F03%2FExcessive-levothyroxine-dose-in-older-people-associated-with-increased-fracture-risk%2F Source: BMJ Area: News An observational study that has received much media attention found an increased risk of fractures associated with levothyroxine treatment in older people, with a clear dose-response relationship.   The authors note that hypothyroidism is common in the elderly, and that thyroxine requirements diminish with age, however many people will have been on replacement therapy for decades and their doses may not be adjusted accordingly. They also note that hyperthyroidism is well known to increase the risk of osteoporosis and fractures, and that a number of studies suggest that even subclinical hyperthyroidism can increase fracture risk. Much previous research has been underpowered, however, so this retrospective population-based cohort study was intended to explore... NeLM - Care of Older People news http://www.medworm.com/rss/comments.php?id=4776537 Mon, 02 May 2011 23:00:00 +0100 4776537 http://www.medworm.com/index.php?rid=4759691&cid=s_38896_18_f&fid=38896&url=http%3A%2F%2Fwww.nelm.nhs.uk%2Fen%2FNeLM-Area%2FEvidence%2FMedicines-Management%2FReferences%2F2011---April%2F28%2FMedication-assessments-by-care-managers-reveal-potential-safety-issues-in-homebound-older-adults%2F Source: Annals of Pharmacotherapy Area: Evidence > Medicines Management > References Background: Over-the-counter (OTC) medications, benzodiazepines, and barbiturates are not covered under many US Medicare drug benefit plans; hence, their use by homebound older adults is largely unreported.  Furthermore, the tiered design of Medicare drug formularies may in fact promote the use of older but potentially inappropriate medications.  Little is known about the use of these medications in the homebound older adult population. Objective: To determine the prevalence of the use by homebound older adults of OTC drugs, dietary supplements (vitamins, minerals, and herbal products), Part D-excluded medications (benzodiazepines and barbiturates), and potentially inappropriate medications (a... NeLM - Care of Older People news http://www.medworm.com/rss/comments.php?id=4759691 Wed, 27 Apr 2011 23:00:00 +0100 4759691 http://www.medworm.com/index.php?rid=4759690&cid=s_38896_18_f&fid=38896&url=http%3A%2F%2Fwww.nelm.nhs.uk%2Fen%2FNeLM-Area%2FEvidence%2FMedicines-Management%2FReferences%2F2011---April%2F28%2FMedicines-related-admissions-you-can-identify-patients-to-stop-that-happening%2F Source: Pharmaceutical Journal Area: Evidence > Medicines Management > References The Harrow Integrated Medicines Management Service was established in 2008 as a collaboration between Harrow Primary Care Trust and North West London Hospitals Trust to reduce preventable medicines-related problems and readmissions.  As part of this service, the PREVENT tool was developed to identify patients at risk.  Pharmacists use the tool when visiting patients on admission to a ward, as part of the consultation around medicines reconciliation.  The PREVENT tool has helped to identify 147 patients considered to be at high risk of a medicines-related readmission. (Source: NeLM - Care of Older People) NeLM - Care of Older People news http://www.medworm.com/rss/comments.php?id=4759690 Wed, 27 Apr 2011 23:00:00 +0100 4759690 http://www.medworm.com/index.php?rid=4759692&cid=s_38896_18_f&fid=38896&url=http%3A%2F%2Fwww.nelm.nhs.uk%2Fen%2FNeLM-Area%2FEvidence%2FMedicines-Management%2FReferences%2F2011---April%2F26%2FThe-General-PractitionerPharmacist-Collaboration-GPPC-study-a-randomised-controlled-trial-of-clinical-medication-reviews-in-community-pharmacy%2F The objective of this study was to determine whether involvement of community pharmacists undertaking clinical medication reviews, working with general practitioners, improved medicine-related therapeutic outcomes for patients. A randomised controlled trial was carried out in New Zealand in people 65 years and older on five or more prescribed medicines.  Community pharmacists undertook a clinical medication review (Comprehensive Pharmaceutical Care) and met with the patient's general practitioner to discuss recommendations about possible medicine changes. The patients were followed-up 3-monthly.  The control group received usual care. The main outcome measures were Quality of Life (SF-36) and Medication Appropriateness Index.  A total of 498 patients were enrol... NeLM - Care of Older People news http://www.medworm.com/rss/comments.php?id=4759692 Tue, 26 Apr 2011 23:00:00 +0100 4759692 http://www.medworm.com/index.php?rid=4755336&cid=s_38896_18_f&fid=38896&url=http%3A%2F%2Fwww.nelm.nhs.uk%2Fen%2FNeLM-Area%2FNews%2F2011---April%2F26%2FUS-consensus-document-on-hypertension-in-the-elderly%2F Source: Circulation Area: News This expert consensus document on hypertension in the elderly has been developed by the American College of Cardiology Foundation (ACCF) and the American Heart Association (AHA), in collaboration with a number of expert groups.  The lengthy document discusses the epidemiology and pathophysiology of hypertension in the elderly, interactions between aging and other cardiovascular risk conditions associated with hypertension, and recommendations for management, including a discussion of each drug class.    The authors discuss the current uncertainty about appropriate blood pressure targets in the elderly, noting that several trials now underway may help to address this, including one in Japan which is comparing event rates in elderly patients... NeLM - Care of Older People news http://www.medworm.com/rss/comments.php?id=4755336 Mon, 25 Apr 2011 23:00:00 +0100 4755336 http://www.medworm.com/index.php?rid=4749265&cid=s_38896_18_f&fid=38896&url=http%3A%2F%2Fwww.nelm.nhs.uk%2Fen%2FNeLM-Area%2FEvidence%2FMedicines-Management%2FReferences%2F2011---April%2F26%2FSpecialist-medication-review-does-not-benefit-short-term-outcomes-and-net-costs-in-continuing-care-patients%2F Source: Age and Ageing Area: Evidence > Medicines Management > References Objectives: To evaluate specialist geriatric input and medication review in patients in high-dependency continuing care. Design: Prospective, randomised, controlled trial. Setting: Two residential continuing care hospitals in Ireland. Participants: 225 permanent patients. Intervention: Patients were randomised to either specialist geriatric input or regular input.  The specialist group had a medical assessment by a geriatrician and medication review by a multidisciplinary expert panel.  Regular input consisted of review as required by a medical officer attached to each ward.  Reassessment occurred after 6 months. Results: 110 patients were randomised to specialist input and 115 to ... NeLM - Care of Older People news http://www.medworm.com/rss/comments.php?id=4749265 Mon, 25 Apr 2011 23:00:00 +0100 4749265 http://www.medworm.com/index.php?rid=4749264&cid=s_38896_18_f&fid=38896&url=http%3A%2F%2Fwww.nelm.nhs.uk%2Fen%2FNeLM-Area%2FEvidence%2FMedicines-Management%2FReferences%2F2011---April%2F26%2FAssociated-factors-with-antipsychotic-use-in-assisted-living-facilities-a-cross-sectional-study-of-4367-residents%2F Source: Age and Ageing Area: Evidence > Medicines Management > References Background: Antipsychotics are widely used in assisted living (AL facilities).  Even more, the prescription of these drugs is gradually increasing since the availability of second-generation atypical antipsychotics.  More knowledge is needed on prescription reasons to understand this increasing prevalence. Methods: Cross-sectional analysis of 4367 residents in France.  Data were obtained from medical records assessed by geriatricians from the AL facility.  A multiple logistic regression model (backward stepwise) was used to assess the independent associated factors with antipsychotic use. Results: Antipsychotic prescription was found in 1203 (27.5%) of 4367 residents.  The independent as... NeLM - Care of Older People news http://www.medworm.com/rss/comments.php?id=4749264 Mon, 25 Apr 2011 23:00:00 +0100 4749264 http://www.medworm.com/index.php?rid=4749267&cid=s_38896_18_f&fid=38896&url=http%3A%2F%2Fwww.nelm.nhs.uk%2Fen%2FNeLM-Area%2FEvidence%2FMedicines-Management%2FReferences%2F2011---April%2F26%2FQuality-of-management-of-oral-anticoagulation-as-assessed-by-time-in-therapeutic-INR-range%2F Source: Age and Ageing Area: Evidence > Medicines Management > References Background: Sespite the overwhelming evidence of its effectiveness, oral anticoagulation continues to be underused in the elderly, presumably due to physicians' misconceptions when estimating bleeding risk and ability to comply with treatment. Objective: To investigate the quality of anticoagulation control among deprived elderly and younger patients. Design: Prospective observational study. Setting: A public anticoagulation clinic in a developing country (Brazil). Subjects: All adult patients on intended long-term (longer than 90 days) oral anticoagulation.  We studied 171 patients (79 elderly and 92 non-elderly) with a mean follow-up of 273 +/-  84.9 days. Methods: The main outcome me... NeLM - Care of Older People news http://www.medworm.com/rss/comments.php?id=4749267 Wed, 20 Apr 2011 23:00:00 +0100 4749267 http://www.medworm.com/index.php?rid=4749266&cid=s_38896_18_f&fid=38896&url=http%3A%2F%2Fwww.nelm.nhs.uk%2Fen%2FNeLM-Area%2FEvidence%2FMedicines-Management%2FReferences%2F2011---April%2F26%2FPotentially-inappropriate-medication-use-among-older-adults-in-the-USA-in-2007%2F Source: Age and Ageing Area: Evidence > Medicines Management > References Study to determine the most recent potentially inappropriate medication (PIM) use prevalence in the USA using 2007 Medical Expenditure Panel Survey (MEPS) for each medication and category, comparing the prevalence between 1996 and 2007 and identifying risk factors for PIM use. (Source: NeLM - Care of Older People) NeLM - Care of Older People news http://www.medworm.com/rss/comments.php?id=4749266 Wed, 20 Apr 2011 23:00:00 +0100 4749266 http://www.medworm.com/index.php?rid=4736780&cid=s_38896_18_f&fid=38896&url=http%3A%2F%2Fwww.nelm.nhs.uk%2Fen%2FNeLM-Area%2FHealth-In-Focus%2FNICE-Bites-April-2011-No-29-AChE-inhibitors-in-Alzheimers-CKD-Anaemia-management%2F Source: North West Medicines Information Centre Area: Health In Focus NICE Bites is a monthly bulletin which summarises key prescribing points from NICE guidance. This edition includes two topics; Donepezil, galantamine, rivastigmine and memantine for the treatment of Alzheimer's disease (review) & Anaemia management in people with CKD. (Source: NeLM - Care of Older People) NeLM - Care of Older People news http://www.medworm.com/rss/comments.php?id=4736780 Wed, 20 Apr 2011 23:00:00 +0100 4736780 http://www.medworm.com/index.php?rid=4726520&cid=s_38896_18_f&fid=38896&url=http%3A%2F%2Fwww.nelm.nhs.uk%2Fen%2FNeLM-Area%2FEvidence%2FMedicines-Management%2FReferences%2F2011---April%2F19%2FConcomitant-use-of-SSRIs-NSAIDsaspirin-and-gastroprotective-drugs-among-residents-of-long-term-care%2F The objectives of this study were to determine the prevalence and factors associated with concomitant SSRI/NSAID use among residents of long-term care facilities, and to investigate the use of gastroprotective drugs among concomitant SSRI/NSAID users. Methods: The study sample comprised 1087 out of 1444 residents of all 53 long-term care wards in Helsinki, Finland, in Sep 2003.  Data were extracted from residents' medication charts and medical records by trained nurses.  Medication, diagnostic and mortality data were available for 1004 residents. Results: Among the 1004 residents (mean +/- SD age 81.3 +/- 10.9 years), 28% used an SSRI, 38% used an NSAID and 24% used a gastroprotective drug.  ... (Source: NeLM - Care of Older People) NeLM - Care of Older People news http://www.medworm.com/rss/comments.php?id=4726520 Mon, 18 Apr 2011 23:00:00 +0100 4726520 http://www.medworm.com/index.php?rid=4726521&cid=s_38896_18_f&fid=38896&url=http%3A%2F%2Fwww.nelm.nhs.uk%2Fen%2FNeLM-Area%2FEvidence%2FMedicines-Management%2FReferences%2F2011---April%2F18%2FPolypharmacy-length-of-hospital-stay-and-in-hospital-mortality-among-elderly-patients-in-internal-medicine-wards--The-REPOSI-study%2F Source: European Journal of Clinical Pharmacology Area: Evidence > Medicines Management > References Aims: We evaluated the prevalence and factors associated with polypharmacy and investigated the role of polypharmacy as a predictor of length of hospital stay and in-hospital mortality. Methods; 38 internal medicine wards in Italy participated in the Registro Politerapie SIMI (REPOSI) study during 2008.  1332 in-patients aged 65 years or older were enrolled.  Polypharmacy was defined as the concomitant use of 5 or more medications.  Linear regression analyses were used to evaluate predictors of length of hospital stay and logistic regression models for predictors of in-hospital mortality.  Age, sex, Charlson comorbidity index, polypharmacy and numb... NeLM - Care of Older People news http://www.medworm.com/rss/comments.php?id=4726521 Sun, 17 Apr 2011 23:00:00 +0100 4726521 http://www.medworm.com/index.php?rid=4716032&cid=s_38896_18_f&fid=38896&url=http%3A%2F%2Fwww.nelm.nhs.uk%2Fen%2FNeLM-Area%2FEvidence%2FMedicines-Management%2FReferences%2F2011---April%2F15%2FGeriatric-conditions-medication-use-and-risk-of-adverse-drug-events-in-a-predominantly-male-older-veteran-population%2F Source: Journal of the American Geriatrics Society Area: Evidence > Medicines Management > References Objectives: To determine whether geriatric conditions and functional impairment are independent risk factors for adverse drug events (ADEs). Design: Prospective cohort study. Setting: US Veterans Affairs Medical Center. Participanta: 377 veterans aged 65 and older and taking 5 or more medications. Measurements: Geriatric conditions and functional status were assessed using participant interviews and structured assessments at study baseline.  ADEs were elicited during participant interviews 3 and 12 months after study enrollment using validated methods. Results: The strong majority (97%) of participants were male, with a mean age of 74 +/- 5; 123 (33%) had one or m... NeLM - Care of Older People news http://www.medworm.com/rss/comments.php?id=4716032 Thu, 14 Apr 2011 23:00:00 +0100 4716032 http://www.medworm.com/index.php?rid=4705745&cid=s_38896_18_f&fid=38896&url=http%3A%2F%2Fwww.nelm.nhs.uk%2Fen%2FNeLM-Area%2FEvidence%2FMedicines-Management%2FReferences%2F2011---April%2F13%2FPrevalence-and-risk-factors-for-inappropriate-drug-use-among-older-people-results-from-an-Indian-public-outpatient-setting%2F Source: Journal of Pharmaceutical Health Services Research Area: Evidence > Medicines Management > References Objectives: To determine the prevalence and risk factors associated with prescribing of inappropriate drugs using Modified Beers' criteria 2003, in older patients consulting medical specialists at a Geriatric Outpatient Clinic in India. Methods: This was a prospective interventional study with 1081 participants aged 60 years or over, of both sexes. Key Findings: The average number of medications was 6.32 +/- 0.08.  Only 117 patients were prescribed at least one inappropriate drug (10.8%).  Out of these, 112 received only one inappropriate drug while 5 patients received two.  Therefore, there were 122 cases of inappropriate drug use (IDU; 11.28%).  The ... NeLM - Care of Older People news http://www.medworm.com/rss/comments.php?id=4705745 Mon, 11 Apr 2011 23:00:00 +0100 4705745 http://www.medworm.com/index.php?rid=4687210&cid=s_38896_18_f&fid=38896&url=http%3A%2F%2Fwww.nelm.nhs.uk%2Fen%2FNeLM-Area%2FEvidence%2FMedicines-Management%2FReferences%2F2011---April%2F08%2FA-cluster-randomized-controlled-trial-of-an-adapted-US-model-of-pharmaceutical-care%2F Source: Journal of the American Geriatrics Society Area: Evidence > Medicines Management > References Objectives: To evaluate the cost-effectiveness of an adapted US model of pharmaceutical care to improve psychoactive prescribing for nursing home residents in Northern Ireland (Fleetwood NI Study). Design: Economic evaluation alongside a cluster randomised, controlled trial. Setting: Nursing homes in NI randomised to intervention (receipt of the adapted model of care; n = 11) or control (usual care continued; n = 11). Participants: Residents aged 65 and older who provided informed consent (N = 253; 128 intervention, 125 control) and who had full resource use data at 12 months. Intervention: Trained pharmacists reviewed intervention home residents' clinical and prescribing informat... NeLM - Care of Older People news http://www.medworm.com/rss/comments.php?id=4687210 Thu, 07 Apr 2011 23:00:00 +0100 4687210 http://www.medworm.com/index.php?rid=4687209&cid=s_38896_18_f&fid=38896&url=http%3A%2F%2Fwww.nelm.nhs.uk%2Fen%2FNeLM-Area%2FEvidence%2FMedicines-Management%2FReferences%2F2011---April%2F08%2FGeriatric-conditions-medication-use-and-risk-of-adverse-drug-events-in-a-predominantly-male-older-veteran-population%2F Source: Journal of the American Geriatrics Society Area: Evidence > Medicines Management > References First presented at the annual meeting of the American Geriatrics Society, Orlando, Florida, USA, May 2010. Objectives: To determine whether geriatric conditions and functional impairment are independent risk factors for adverse drug events (ADEs). Design: Prospective cohort study. Setting: US Veterans Affairs Medical Center. Participants: 377 veterans aged 65 and older and taking 5 or more medications. Measurements: Geriatric conditions and functional status were assessed using participant interviews and structured assessments at study baseline.  ADEs were elicited during participant interviews 3 and 12 months after study enrollment using validated methods. Resu... NeLM - Care of Older People news http://www.medworm.com/rss/comments.php?id=4687209 Thu, 07 Apr 2011 23:00:00 +0100 4687209 http://www.medworm.com/index.php?rid=4687211&cid=s_38896_18_f&fid=38896&url=http%3A%2F%2Fwww.nelm.nhs.uk%2Fen%2FNeLM-Area%2FEvidence%2FMedicines-Management%2FReferences%2F2011---April%2F07%2FAn-evaluation-of-the-inappropriate-prescribing-in-older-residents-in-long-term-care-facilities%2F Source: Centre for Ageing Research and Development in Ireland Area: Evidence > Medicines Management > References Background: Older individuals generally suffer from multiple co-morbidities and this makes this patient group particularly vulnerable to inappropriate prescribing (IP).  IP has been reported to be a substantial cause of morbidity and mortality and has been identified as a major contributing factor to increased healthcare utilisation.  One method of evaluating or identifying inappropriate or sub-optimal prescribing practice is to use validated evidence-based explicit criteria to define instances of potential IP.  Two sets of criteria have gained international recognition, i.e. Beers' criteria and the 'Screening Tool of Older Peoples Prescriptions (STOPP)'. Aim: ... NeLM - Care of Older People news http://www.medworm.com/rss/comments.php?id=4687211 Wed, 06 Apr 2011 23:00:00 +0100 4687211 http://www.medworm.com/index.php?rid=4687212&cid=s_38896_18_f&fid=38896&url=http%3A%2F%2Fwww.nelm.nhs.uk%2Fen%2FNeLM-Area%2FNews%2F2011---April%2F06%2FGoals-for-blood-glucose-control-in-frail-older-people-with-diabetes%2F Source: JAMA Area: News A Commentary in JAMA discusses appropriate goals for blood glucose control in frail older diabetics. The author notes that current guidelines are based on data from trials that have generally excluded older patients; they all have the aim of avoiding long-term adverse outcomes of hyperglycaemia such as stroke and retinopathy. Evidence suggests, however, that at least eight years tight control is needed to reduce the risk of these outcomes: frail elderly people are likely to have life expectancy of less than 8 years, however, and achieving tight control leads to a significant burden involving diet, lifestyle, medication, and the risks of hypoglycaemia.   Moderate control, however, may have significant benefits in the frail elderly, reducing the risks of sym... NeLM - Care of Older People news http://www.medworm.com/rss/comments.php?id=4687212 Tue, 05 Apr 2011 23:00:00 +0100 4687212 http://www.medworm.com/index.php?rid=4659703&cid=s_38896_18_f&fid=38896&url=http%3A%2F%2Fwww.nelm.nhs.uk%2Fen%2FNeLM-Area%2FEvidence%2FMedicines-Management%2FReferences%2F2011---March%2F31%2FEpidemiology-of-potentially-inappropriate-medication-use-in-elderly-patients-in-Japanese-acute-care-hospitals%2F Source: Pharmacoepidemiology and Drug Safety Area: Evidence > Medicines Management > References Purpose: The elderly receive many medications which may have adverse effects.  Little evidence is available about the epidemiology of potentially inappropriate medications being prescribed to the elderly in Japan as defined by the Beers criteria, or whether or not these medications result in harm when used in this population. Methods: We conducted a prospective cohort study of patients aged 65 years or older who were admitted to three acute care hospitals in Japan.  Trained research nurses followed up patients from randomly selected wards and collected data about their medications and all potential adverse drug events (ADEs).  Two independent reviewers evaluated all the da... NeLM - Care of Older People news http://www.medworm.com/rss/comments.php?id=4659703 Tue, 29 Mar 2011 23:00:00 +0100 4659703 http://www.medworm.com/index.php?rid=4654742&cid=s_38896_18_f&fid=38896&url=http%3A%2F%2Fwww.nelm.nhs.uk%2Fen%2FNeLM-Area%2FEvidence%2FMedicines-Management%2FReferences%2F2011---March%2F30%2FIncident-use-and-outcomes-associated-with-potentially-inappropriate-medication-use-in-older-adults%2F Source: American Journal of Geriatric Pharmacotherapy Area: Evidence > Medicines Management > References Background: Most studies of potentially inappropriate medication (PIM) use among older adults have focused on prevalence rather than incidence. Objectives: The goals of this study were to determine the 1-year incidence of PIM use among elderly Indiana Medicaid (USA) residents of nursing homes and to examine associations between incident PIM use and hospitalisation and mortality. Methods: A retrospective analysis was conducted using Indiana Medicaid enrollment and administrative claims files.  Individuals were included if they were Medicaid eligible and aged 65 years or older in Jan 2003 and received nursing home services in each month of 2003 or until death in 2003. ... NeLM - Care of Older People news http://www.medworm.com/rss/comments.php?id=4654742 Tue, 29 Mar 2011 23:00:00 +0100 4654742 http://www.medworm.com/index.php?rid=4654741&cid=s_38896_18_f&fid=38896&url=http%3A%2F%2Fwww.nelm.nhs.uk%2Fen%2FNeLM-Area%2FEvidence%2FMedicines-Management%2FReferences%2F2011---March%2F30%2FA-taxonomy-of-reasons-for-not-prescribing-guideline-recommended-medications-for-patients-with-heart-failure%2F This article develops a conceptual framework for understanding the proximate, patient-centred reasons why physicians do not prescribe ACE inhibitors or beta-blockers to patients with heart failure and reduced systolic function. Methods: This was a focus group study using a 2-stage design.  Academically affiliated clinicians of different specialties and levels of training were recruited by e-mailed invitations sent to clinicians within each target group.  To be included, candidates needed to be currently practising in an ambulatory care setting in which they encountered patients with heart failure.  In the first part of each group, participants were asked to describe reasons for not prescribing ACE inhibitors or beta-blockers for patients with heart failure.  Next, par... NeLM - Care of Older People news http://www.medworm.com/rss/comments.php?id=4654741 Tue, 29 Mar 2011 23:00:00 +0100 4654741 http://www.medworm.com/index.php?rid=4654740&cid=s_38896_18_f&fid=38896&url=http%3A%2F%2Fwww.nelm.nhs.uk%2Fen%2FNeLM-Area%2FNews%2F2011---March%2F30%2FReview-Investigation-and-management-of-unintentional-weight-loss-in-older-adults%2F Source: BMJ Area: News The British Medical Journal has featured a review on the investigation and management of unintentional weight loss in older adults.   The review features a discussion of the following questions and topics: . When is unintentional weight loss clinically important? . What can cause unintentional weight loss in older adults? . How is unintentional weight loss in older adults investigated? . Should a negative baseline reassure? . Managing unexplained weight loss in elderly people (Source: NeLM - Care of Older People) NeLM - Care of Older People news http://www.medworm.com/rss/comments.php?id=4654740 Tue, 29 Mar 2011 23:00:00 +0100 4654740