Managing Medications in Clinically Complex Elders "There's Got to Be a Happy Medium"

Division of Geriatrics, University of California, San Francisco, and the San Francisco VA Medical Center, San Francisco, California 94121, USA.
JAMA The Journal of the American Medical Association (Impact Factor: 35.29). 10/2010; 304(14):1592-601. DOI: 10.1001/jama.2010.1482
Source: PubMed

ABSTRACT Multiple medication use is common in older adults and may ameliorate symptoms, improve and extend quality of life, and occasionally cure disease. Unfortunately, multiple medication use is also a major risk factor for prescribing and adherence problems, adverse drug events, and other adverse health outcomes. Using the case of an older patient taking multiple medications, this article summarizes the evidence-based literature about improving medication use and withdrawing specific drugs and drug classes. It also describes a systematic approach for how health professionals can assess and improve medication regimens to benefit patients and their caregivers and families.

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    • "Clinicians should always remember the possibility of adverse reactions while treating an elderly patient. Any new symptom should be considered drug related until proven otherwise.[272829] The GerontoNet ADR risk score study reports that the risk of adverse reactions increases by fourfold with the number of medications ≥8. "
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    ABSTRACT: Aim: To evaluate the use of potentially inappropriate medicines in elderly inpatients in a tertiary care teaching hospital. Materials and Methods: Retrospective analysis was performed for cases of elderly patients admitted between January 2010 and December 2010. Data on age, gender, diagnosis, duration of hospital stay, treatment, and outcome were collected. Prescriptions were assessed for the use of potentially inappropriate medications in geriatric patients by using American Geriatric Society Beer's criteria (2012) and PRISCUS list (2010). Results: A total of 676 geriatric patients (52.12% females) were admitted in the medicine ward. The average age of geriatric patients was 72.69 years. According to Beer's criteria, at least one inappropriate medicine was prescribed in 590 (87.3%) patients. Metoclopramide (54.3%), alprazolam (9%), diazepam (8%), digoxin > 0.125 mg/day (5%), and diclofenac (3.7%) were the commonly used inappropriate medications. Use of nonsteroidal anti-inflammatory drugs (NSAIDs) in heart and renal failure patients was the commonly identified drug–disease interaction. According to PRISCUS list, at least one inappropriate medication was prescribed in 210 (31.06%) patients. Conclusion: Use of inappropriate medicines is highly prevalent in elderly patients.
    Perspectives in clinical research 03/2014; 5(4):184-189. DOI:10.4103/2229-3485.140562
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    • "In the “brown bag” review, patients are asked to bring all their medications to the office, including prescription medications, over-the-counter medications, vitamins, and herbal preparations. This method helps start a conversation and provides a clear picture of the patient’s most up-to-date medication use.124 "
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    ABSTRACT: The prevalence of human immunodeficiency virus (HIV) infection among people older than 50 years is increasing. Older HIV-infected patients are particularly at risk for polypharmacy because they often have multiple comorbidities that require pharmacotherapy. Overall, there is not much known with respect to both the impact of aging on medication use in HIV-infected individuals, and the potential for interactions with highly active antiretroviral therapy (HAART) and coadministered medications and its clinical consequences. In this review, we aim to provide an overview of polypharmacy with a focus on its impact on the HIV-infected older adult population and to also provide some clinical considerations in this high-risk population.
    Clinical Interventions in Aging 06/2013; 8:749-763. DOI:10.2147/CIA.S37738 · 2.08 Impact Factor
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    • "On the basis of these considerations, in older patients chronically taking diuretics, a close monitoring of their hydration status and electrolyte serum levels should be done. In addition, when there are difficulties in reaching a good balance between renal insufficiency and hemodynamic status, it could be reasonable to accept some degree of volume overload with slight worsening of renal function.[8],[88] "
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    ABSTRACT: Chronic heart failure (CHF) represents a major and growing health problem, due to its high incidence and prevalence, its poor prognosis and its impact on health-care costs. Although CHF patients are mainly elderly, few studies were aimed at testing the efficacy of diagnostic and therapeutic approaches in this population. The difficulty in CHF diagnosis among the elderly is related to different factors, such as: the frequent presence of co-morbidity conditions mimicking or masking heart failure signs and symptoms; the different diagnostic cut-offs of natriuretic peptides; and the need to correctly evaluate diastolic function in order to assess CHF with preserved ejection fraction. Furthermore, the therapy of elderly CHF patients has not been well defined, considering the few studies involving very aged patients and the absence of a therapeutic strategy demonstrated to improve prognosis of CHF patients with preserved ejection fraction. The aim of this review is to focus on the most recent issues concerning the diagnosis and therapy of elderly patients affected by CHF.
    Journal of Geriatric Cardiology 06/2013; 10(2):165-77. DOI:10.3969/j.issn.1671-5411.2013.02.010 · 1.40 Impact Factor
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