Mirko Petrovic

Ghent University, Gand, Flanders, Belgium

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Publications (90)181.21 Total impact

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    ABSTRACT: Guidelines discourage chronic benzodiazepines and related Z drugs (BZD/Zs) for sleep problems. However, prevalence among nursing home residents remains high. Discontinuing these drugs is widely recommended but seems difficult to implement. The aim of our study was to evaluate the overall feasibility in the nursing home, in terms of willingness towards discontinuation and success rate at 8 months, together with the impact on withdrawal symptoms, change in sleep quality, quality of life and medication use.
    European Journal of Clinical Pharmacology 08/2014; · 2.74 Impact Factor
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    ABSTRACT: Incidence rates of haematological malignancies increase with age. In these older cancer patients, important information may be missed without a Comprehensive Geriatric Assessment (CGA). A validated screening instrument is needed to identify those patients for whom a CGA would be beneficial. The G8 has recently been validated as a screening tool for older cancer patients in need of a CGA.
    European journal of oncology nursing: the official journal of European Oncology Nursing Society 06/2014; · 1.13 Impact Factor
  • A Somers, M Petrovic
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    ABSTRACT: Drug related problems represent an important problem in geriatric patients, and contribute to hospitalization in 15 to 30% of the admissions. In most cases this concerns adverse drug reactions (normal dose and overdose) but also drug therapy failures (e.g. undertreatment) are common. The main pharmacological classes involved are cardiovascular drugs and drugs for the central nervous system. Drug related problems can be prevented by regular medication review to decide if all drugs have to be continued, and to check for adverse drug reactions. Clinical pharmacists in hospitals can detect drug related problems (over-, under- and misuse using a systematic approach) and recommend changes to improve pharmacotherapy. The community pharmacist can help by elaborating drug schemes, by screening for medication interactions, and by resolving practical problems.
    Journal de pharmacie de Belgique 06/2014;
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    ABSTRACT: Background Malnutrition is common both after the age of 70 and in many types of cancer, being responsible for poor quality of life, poor treatment response and a shorter survival time. Patients with haematological malignancies face specific challenges regarding nutrition because of intensive treatments they endure. Early detection of nutritional problems is important to allow interventions. Objectives To assess the nutritional status of a group of older patients with aggressive haematological malignancies before the onset of systemic therapy using the MNA-SF. Setting The haematology department of a university hospital. Participants Patients ≥ 70 years, with newly diagnosed aggressive haematological malignancies. Methods Observational single centre study. Patients were screened for malnutrition before and two months after start of therapy using the Mini Nutritional Assessment Short Form (MNA-SF). Results Seventy patients were included. Mean age was 77.4 ± 4.7 years (range 70.0–91.0). At baseline, 20% (CI95 = 11–31%) were malnourished and 61% (CI95 = 49–73%) were at risk for malnutrition. Recent weight loss and declined food intake were the most recorded MNA-SF parameters. Mean Body Mass Index (BMI) was 26.3 ± 4.1 (range 19.8–41.1) and 41% (n = 29) of patients had a BMI < 25. Conclusions Using the MNA-SF, most of the older patients with an aggressive haematological malignancy are at risk for malnutrition. Therefore, nutritional assessment with individualised dietary advice and follow-up during treatment should be recommended as an integrated part of the treatment plan.
    European geriatric medicine 01/2014; · 0.63 Impact Factor
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    ABSTRACT: Background Incidence rates of haematological malignancies increase with age. In these older cancer patients, important information may be missed without a Comprehensive Geriatric Assessment (CGA). A validated screening instrument is needed to identify those patients for whom a CGA would be beneficial. The G8 has recently been validated as a screening tool for older cancer patients in need of a CGA. Objectives To test the performance of the G8 screening tool in older patients with aggressive haematological malignancies to identify those who would benefit from a CGA. Methods Cross-sectional study of patients ≥70 years with a recently diagnosed haematological malignancy. G8, CGA (including six questionnaires) and Cumulative Illness Rating Scale for Geriatrics (CIRS-G) were completed in each patient. The CGA was considered abnormal when at least one questionnaire showed an impaired score. Results Fifty patients with median age of 76 years were included; 88% (N = 44) had an abnormal CGA. ROC curve analyses revealed a G8 score ≤14 obtained a sensitivity of 89% (95% CI 75–96) and a specificity of 100% (95% CI 54–100), suggesting an optimal cut-off point. AUC ± SE was 0.949 ± 0.030. Inclusion of comorbidity in the CGA did not change the performance of the G8 (0.943 ± 0.034; P = 0.895). Conclusion The G8 can be used as a valid screening tool in older patients with aggressive haematological malignancies to identify those patients who would benefit from a CGA. Comorbidity should be assessed routinely and independently of the G8.
    European Journal of Oncology Nursing. 01/2014;
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    ABSTRACT: Changes in physical performance during hospital stay have rarely been evaluated. In this study, we examined functional changes during hospital stay by assessing both physical performance and activities of daily living. Additionally, we investigated characteristics of older patients associated with meaningful in-hospital improvement in physical performance. The CRiteria to assess appropriate Medication use among Elderly complex patients project recruited 1123 patients aged ≥65 years, consecutively admitted to geriatric or internal medicine acute care wards of seven Italian hospitals. We analyzed data from 639 participating participants with a Mini Mental State Examination score ≥18/30. Physical performance was assessed by walking speed and grip strength, and functional status by activities of daily living at hospital admission and at discharge. Meaningful improvement was defined as a measured change of at least 1 standard deviation. Multivariable logistic regression models predicting meaningful improvement, included age, gender, type of admission (through emergency room or elective), and physical performance at admission. Mean age of the study participants was 79 years (range 65-98), 52% were female. Overall, mean walking speed and grip strength performance improved during hospital stay (walking speed improvement: 0.04±0.20 m/s, p<0.001; grip strength improvement: 0.43±5.66 kg, p = 0.001), no significant change was observed in activities of daily living. Patients with poor physical performance at admission had higher odds for in-hospital improvement. Overall, physical performance measurements show an improvement during hospital stay. The margin for meaningful functional improvement is larger in patients with poor physical function at admission. Nevertheless, most of these patients continue to have poor performance at discharge.
    PLoS ONE 01/2014; 9(5):e96398. · 3.73 Impact Factor
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    ABSTRACT: Background: general opinion is growing that drug cessation in complex older patients is warranted in certain situations. From a clinical viewpoint, drug cessation seems most warranted in four situations, i.e., falls, delirium, cognitive impairment and end-of-life situations. To date, little information about the effects of drug cessation in these four situations is available.Objectives: to identify the effects and effectiveness of drug cessation on falls, delirium and cognitive impairment. For end-of-life situations, we reviewed cessation of inappropriate drug use.Methods: electronic databases were searched using MeSH terms and relevant keywords. Studies published in English were included if they evaluated the effects of drug cessation in older persons, aged ≥65 years, with falls, delirium or cognitive impairment; or cessation of inappropriate drug use in end-of-life situations.Results: we selected seven articles for falls, none for delirium, two for cognition and two for end-of-life situations. Withdrawal of psychotropics reduced fall rate; a prescribing modification programme for primary care physicians reduced fall risk. Withdrawal of psychotropics and a systematic reduction of polypharmacy resulted in an improvement of cognition. Very little rigorous research has been conducted on reducing inappropriate medications in patients approaching end of life.Conclusion: little research has focussed on drug cessation. Available studies showed a beneficial impact of cessation of psychotropic drugs on falls and cognitive status. More research in this field is needed. The issue of systematic drug withdrawal in end-of-life cases is controversial, but is increasingly relevant in the face of rising numbers of older people of this clinical status.
    Age and Ageing 11/2013; · 3.82 Impact Factor
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    ABSTRACT: Reduction in length of hospital stay (LOS) is considered as a potential strategy to optimize resource consumption and reduce health care costs. We analysed predictors of increased LOS among older patients admitted to acute care wards according to type of admission (through the Emergency Room [ER] or elective). We analysed data of 1123 older patients, aged 65years or older, consecutively admitted to seven acute care wards. LOS was defined as the number of days from admission to discharge (or death) and categorized according to its median value (10days). Mean age of participants was 81±7years and 56% were women. Patients admitted through ER had a shorter LOS compared with those elective (10.4±6.7 vs. 12.0±6.7days; p<0.0001). Factors associated with LOS >10days, for patients admitted through ER, were female gender (OR 0.58; 95% C.I. 0.37-0.90), erythrocyte sedimentation rate (OR 1.02; 95% C.I. 1.01-1.03), and excessive polypharmacy (use of ≥10 drugs during stay) (OR 3.60; 95% C.I. 1.40-9.25). Predictors for elective patients were chronic alcohol consumption (OR 0.54; 95% C.I. 0.32-0.93), walking speed ≥0.8m/s (OR 0.31; 95% C.I. 0.14-0.72), excessive polypharmacy (OR 4.78; 95% C.I. 1.92-11.90), pressure ulcers (OR 2.60; 95% C.I. 1.01-6.79), cerebrovascular disease (OR 0.49; 95% C.I. 0.24-0.99) and dementia (OR 0.18; 95% C.I. 0.08-0.39). LOS differed between patients admitted through emergency and through elective admission. Demographic and clinical parameters can affect LOS and polypharmacy was the strongest and the only common risk factor in both groups.
    European Journal of Internal Medicine 09/2013; · 2.05 Impact Factor
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    ABSTRACT: OBJECTIVES: We aim to describe subjective sleep quality among long-term users of benzodiazepines (BZDs) in Belgian nursing homes, to compare it to nonusers, and to investigate determinants of poor sleep quality. METHODS: All mentally competent residents from 10 nursing homes were screened and compiled in a group of long-term BZD users or in a group of nonusers based on the medication chart. We collected demographic, functional, and medication characteristics and global and specific sleep parameters using the Pittsburgh Sleep Quality Index (PSQI). Linear regression was used to investigate which parameters were associated with sleep quality. RESULTS: Of the 300 residents, 178 (59%) were long-term BZD users and 122 were nonusers. The 2 groups did not differ in demographic and functional characteristics (mean age, 85.5y; range, 57-100; 75% women). The users reported significantly more difficulties with falling asleep, had more midnight awakenings, felt less rested in the morning, and had a poorer self-perceived sleep quality compared to nonusers. Sleep duration and time to fall asleep did not differ. The self-perceived sleep quality was mainly determined by difficulties during initiation of sleep. After controlling for demographic, medication, and functional characteristics, BZD use remained strongly associated with poor sleep (r=0.173; P=.003), and a study centre effect (differences among nursing homes) was observed (r=0.229; P<.001). CONCLUSION: Our findings do not support long-term effectiveness of BZDs; long-term users slept more poorly than nonusers and were even more outspoken in users of long-acting BZDs. In future longitudinal comparative studies of sleep quality, unexplained variability needs further assessment with medical, psychologic, and institutional parameters.
    Sleep Medicine 05/2013; · 3.49 Impact Factor
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    ABSTRACT: OBJECTIVE: Increasing the quality of life (QoL) of patients with chronic fatigue is challenging because recovery is seldom achieved. Therefore, it is important to identify processes that improve QoL. This study examined the extent of improvement related to cognitive behavior group therapy (CBT), and whether improvement is affected by initial levels of acceptance and neuroticism. METHODS: Eighty CFS patients followed CBT, and self-reported (pre-post design) on mental and physical QoL (MQoL and PQoL), fatigue, acceptance, and neuroticism. The extent of improvement was analyzed using t-tests, effect sizes, and clinically significant change criteria. Whether acceptance and neuroticism at baseline predicted changes was analyzed by means of correlation and regression analyses. RESULTS: Significant improvement was found for all variables. The effect size for MQoL and PQoL was small; for acceptance and fatigue, effect size was moderate. About 20% (MQoL) to 40% (fatigue) of the participants clinically improved. Pre-treatment level of acceptance was negatively correlated with changes in MQoL, not with PQoL changes. Neuroticism pre-treatment was positively related with MQoL changes. Regression analysis showed an effect of acceptance on changes in MQoL beyond the effect of neuroticism. CONCLUSIONS: Although CBT is an evidence-based treatment, the sizes of the effects are often small regarding QoL. Our study also revealed small effect sizes. Our study showed that patient characteristics at baseline were significantly associated with MQoL outcome; indicating that CFS patients with high neuroticism or with a low acceptance show more improvement in MQoL. We propose to specifically target acceptance and neuroticism before treatment in order to maximize clinical relevance.
    Journal of psychosomatic research 05/2013; 74(5):367-372. · 2.91 Impact Factor
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    ABSTRACT: Older patients are particularly vulnerable to adverse drug reactions (ADRs) because age is associated with changes in pharmacokinetics and pharmacodynamics that may alter drug metabolism. In addition, other conditions, commonly observed in older adults, may increase the risk of ADRs in the older population (including polypharmacy, comorbidity, cognitive and functional limitations). ADRs in older adults are frequently preventable, suggesting that screening and prevention programmes aimed at reducing the rate of iatrogenic illness are necessary in this population. The present study reviews available approaches that may be used to screen and prevent the occurrence of ADRs in older adults, including medication review, avoiding the use of potentially inappropriate medications, computer-based prescribing systems and comprehensive geriatric assessment. Available evidence on these approaches is mixed and controversial, and none of them showed a clear beneficial effect on patients' health outcomes. Limitation of these interventions is the lack of standardisation, and these differences may give reason for the variability of the results documented in randomised clinical studies. Interestingly, most of the available research is focused on a single intervention targeting either clinical or pharmacological factors causing ADRs. When these approaches are combined, positive effects on patients health outcomes can be shown, suggesting that integration of skills from different health care professionals is needed to address medical complexity of the older adults. The challenge for future research is to integrate valuable information obtained by existing instruments and methodologies in a complete and global approach targeting all potential factors involved in the onset of ADRs.
    Age and Ageing 03/2013; · 3.82 Impact Factor
  • European geriatric medicine 02/2013; 4(1):50–58. · 0.63 Impact Factor
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    ABSTRACT: BACKGROUND: To assess and compare the predictive value of physical function measurements (PFMs) for all-cause mortality in older men and to evaluate the Timed Up and Go test (TUG) as a predictor in subjects with underlying comorbidity. DESIGN: Observational study of a population-based sample of 352 ambulatory older men aged 71-86 at study baseline. The Rapid disability rating scale-2, 36-Item short form health survey, Grip strength, Five times sit-to-stand test, Standing balance, and TUG were determined at baseline. Associations with all-cause mortality were assessed using Cox proportional hazard analyses. Age, Body mass index (BMI), smoking status, education, physical activity and cognitive status were included as confounders. Follow-up exceeded 15 years. Comorbidity status was categorized into cardiovascular disease, chronic obstructive pulmonary disease (COPD) and diabetes mellitus. RESULTS: All examined PFMs were associated with all-cause mortality. TUG was the best predictor (adjusted HR per SD increase = 1·58, 95% CI = 1·40-1·79, P < 0·001) for global mortality and continued to be predictive in subjects with cardiovascular disease (adjusted HR per SD increase = 1·80, 95% CI = 1·40-2·33, P < 0·001). CONCLUSIONS: The assessment of physical functioning is important in the evaluation of older persons. We encourage the use of the TUG as a reliable, quick and feasible screening tool in clinical settings.
    European Journal of Clinical Investigation 01/2013; · 3.37 Impact Factor
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    ABSTRACT: Background/Aim Prescription guidelines caution against chronic benzodiazepine (BZD) use. Nevertheless, chronic use among older adults, especially in nursing homes is widespread. We wanted to explore why it is difficult to implement discontinuation. We focused on individual residents that used BZDs and explored benefit and harm of chronic BZD use, willingness to try and barriers against the discontinuation of chronic BZD use. Methods In this cross-sectional study, we selected nursing home residents with at least 3 months of BZD use. A resident-specific questionnaire was addressed to the GP and to the responsible nurse and questioned effectiveness, side effects, initiation and willingness to stop. For every resident, the GP and nurse had to score 8 barrier statements on a 10-point Likert scale. Additionally, we collected 10 general attitudes scored by GPs and nurses. Results We received data for 109 chronic BZD users. GPs and nurses indicated that the BZD still had the desired effect in respectively 87% and 83% of the 109 residents and in 75% and 70% they observed no side-effect. Dependence was seen in respectively 41% and 28%. Overall, the GPs had higher barriers than the nurses but indicated a higher willingness to stop (33% vs. 21%). Both caregivers were willing to stop in 13% of the residents. Conclusion The perceived effectiveness, the absence of side-effects and the presence of dependence in most residents on chronic BZD use resulted in a low willingness to stop. Future discontinuation guidelines should consider all caregivers’ perceptions and promote a multidisciplinary approach.
    European geriatric medicine 01/2013; · 0.63 Impact Factor
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    ABSTRACT: To evaluate the type, acceptance rate, and clinical relevance of clinical pharmacist recommendations at the geriatric ward of the Ghent university hospital. The clinical pharmacist evaluated drug use during a weekly 2-hour visit for a period of 4 months and, if needed, made recommendations to the prescribing physician. The recommendations were classified according to type, acceptance by the physician, prescribed medication, and underlying drug-related problem. Appropriateness of prescribing was assessed using the Medication Appropriateness Index (MAI) before and after the recommendations were made. Two clinical pharmacologists and two clinical pharmacists independently and retrospectively evaluated the clinical relevance of the recommendations and rated their own acceptance of them. The clinical pharmacist recommended 304 drug therapy changes for 100 patients taking a total of 1137 drugs. The most common underlying drug-related problems concerned incorrect dose, drug-drug interaction, and adverse drug reaction, which appeared most frequently for cardiovascular drugs, drugs for the central nervous system, and drugs for the gastrointestinal tract. The most common type of recommendation concerned adapting the dose, and stopping or changing a drug. In total, 59.7% of the recommendations were accepted by the treating physician. The acceptance rate by the evaluators ranged between 92.4% and 97.0%. The mean clinical relevance of the recommendations was assessed as possibly important (53.4%), possibly low relevance (38.1%), and possibly very important (4.2%). A low interrater agreement concerning clinical relevance between the evaluators was found: kappa values ranged between 0.15 and 0.25. Summated MAI scores significantly improved after the pharmacist recommendations, with mean values decreasing from 9.3 to 6.2 (P < 0.001). In this study, the clinical pharmacist identified a high number of potential drug-related problems in older patients; however, the acceptance of the pharmacotherapy recommendations by the treating physician was lower than by a panel of evaluators. This panel, however, rated most recommendations as possibly important and as possibly having low relevance, with low interrater reliability. As the appropriateness of prescribing seemed to improve with decreased MAI scores, clinical pharmacy services may contribute to the optimization of drug therapy in older inpatients.
    Clinical Interventions in Aging 01/2013; 8:703-709. · 2.65 Impact Factor
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    ABSTRACT: Objectives: Assessment of advanced activities of daily living (a-ADL) can be of interest in establishing the diagnosis of Alzheimer's disease (AD) in an earlier stage, since these activities demand high cognitive functioning and are more responsive to subtle changes. In this study we tested a new a-ADL tool, developed according to the International Classification of Functioning, Disability and Health (ICF). The a-ADL tool is based on the total number of activities performed (TNA) by a person and takes each subject as his own reference. It distinguishes a total Disability Index (a-ADL-DI), a Cognitive Disability Index (a-ADL-CDI), and a Physical Disability Index (a-ADL-PDI), with lower score representing more independency. We explored whether these indices allow distinction between cognitively healthy persons, patients with Mild Cognitive Impairment (MCI) and patients with mild AD. Methods: Participants were on average 80 years old (SD 4.6; 66-90), were community dwelling, and were diagnosed as (1) cognitively healthy subjects (n=26); (2) patients with MCI (n = 17), or (3) mild AD (n = 25), based upon extensive clinical evaluation and a set of global, cognitive, mood and functional assessments. The a-ADL-tool was not part of the clinical evaluation. Results: The a-ADL-CDI was significantly different between the three groups (p<.01). The a-ADL-DI was significantly different between MCI and AD (p<.001). The tool had good psychometrical properties (inter-rater reliability; agreement between patient and proxy; correlations with cognitive tests). Although the sample size was relatively small, ROC curves were computed for the a-ADL-DI and a-ADL-CDI with satisfactory and promising results. Conclusion: The a-ADL-CDI and a-ADL-DI might offer a useful contribution to the identification and follow up of patients with mild cognitive disorders in an older population.
    The Journal of Nutrition Health and Aging 01/2013; 17(1):64-71. · 2.39 Impact Factor
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    ABSTRACT: Antipsychotic agents are often used to treat neuropsychiatric symptoms (NPS) in dementia, although the literature is sceptical about their long-term use for this indication. Their effectiveness is limited and there is concern about adverse effects, including higher mortality with long-term use. When behavioural strategies have failed and drug therapy is instituted, regular attempts to withdraw these drugs are recommended. Physicians, nurses and families of older people with dementia are often reluctant to try to stop antipsychotics, fearing deterioration of NPS. Strategies to reduce antipsychotic use have been proposed, but a systematic review of interventions aimed at withdrawal of antipsychotic agents in older people with dementia has not yet been performed. To evaluate whether withdrawal of antipsychotic agents is successful in older people with dementia in community or nursing home settings, to list the different strategies for withdrawal of antipsychotic agents in older people with dementia and NPS, and to measure the effects of withdrawal of antipsychotic agents on behaviour. ALOIS, the Specialized Register of the Cochrane Dementia and Cognitive Improvement Group (CDCIG), The Cochrane Library, MEDLINE, EMBASE, PsycINFO, CINAHL, LILACS, clinical trials registries and grey literature sources were searched on 23 November 2012. The search included the following terms: antipsychotic* or neuroleptic* or phenothiazines or butyrophenones or risperidone or olanzapine or haloperidol or prothipendyl or methotrimeprazine or clopenthixol or flupenthixol or clothiapine or metylperon or droperidol or pipamperone or benperidol or bromperidol or fluspirilene or pimozide or penfluridol or sulpiride or veralipride or levosulpiride or sultopride or aripiprazole or clozapine or quetiapine or thioridazine combined wither terms such as discontinu* or withdraw* or cessat* or reduce* or reducing or reduct* or taper* or stop*.ALOIS contains records from all major healthcare databases (The Cochrane Library, MEDLINE, EMBASE, PsycINFO, CINAHL, LILACS), as well as from many clinical trials registries and grey literature sources. Randomised, placebo-controlled trials comparing an antipsychotic withdrawal strategy to continuation of antipsychotics in people with dementia. Review authors independently assessed trials for inclusion, rated their risk of bias and extracted data. We included nine trials with 606 randomised participants. Seven trials were conducted in nursing homes, one trial in an outpatient setting and one in both settings. In these trials, different types of antipsychotics prescribed at different doses were withdrawn. Both abrupt and gradual withdrawal schedules were used. The risk of bias of the included studies was generally low regarding blinding and outcome reporting and unclear for randomisation procedures and recruitment of participants.There was a wide variety of outcome measures. Our primary efficacy outcomes were success of withdrawal (i.e. remaining in study off antipsychotics) and NPS. Eight of nine trials reported no overall significant difference between groups on the primary outcomes, although in one pilot study of people with psychosis and agitation that had responded to haloperidol, time to relapse was significantly shorter in the discontinuation group (Chi(2) = 4.1, P value = 0.04). The ninth trial included people with psychosis or agitation who had responded well to risperidone therapy for four to eight months and reported that discontinuation led to an increased risk of relapse, that is, increase in the Neuropsychiatric Inventory (NPI)-core score of 30% or greater (P value = 0.004, hazard ratio (HR) 1.94, 95% confidence interval (CI) 1.09 to 3.45 at four months). The only outcome that could be pooled was the full NPI-score, used in two studies. For this outcome there was no significant difference between people withdrawn from and those continuing on antipsychotics at three months (mean difference (MD) -1.49, 95% CI -5.39 to 2.40). These two studies reported subgroup analyses according to baseline NPI-score (14 or less versus > 14). In one study, those with milder symptoms at baseline were significantly less agitated at three months in the discontinuation group (NPI-agitation, Mann-Whitney U test z = 2.4, P value = 0.018). In both studies, there was evidence of significant behavioural deterioration in people with more severe baseline NPS who were withdrawn from antipsychotics (Chi(2) = 6.8; P value = 0.009 for the marked symptom score in one study).Individual studies did not report significant differences between groups on any other outcome except one trial that found a significant difference in a measure of verbal fluency, favouring discontinuation. Most trials lacked power to detect clinically important differences between groups.Adverse events were not systematically assessed. In one trial there was a non-significant increase in mortality in people who continued antipsychotic treatment (5% to 8% greater than placebo, depending on the population analysed, measured at 12 months). This trend became significant three years after randomisation, but due to dropout and uncertainty about the use of antipsychotics in this follow-up period this result should be interpreted with caution. Our findings suggest that many older people with Alzheimer's dementia and NPS can be withdrawn from chronic antipsychotic medication without detrimental effects on their behaviour. It remains uncertain whether withdrawal is beneficial for cognition or psychomotor status, but the results of this review suggest that discontinuation programmes could be incorporated into routine practice. However, two studies of people whose agitation or psychosis had previously responded well to antipsychotic treatment found an increased risk of relapse or shorter time to relapse after discontinuation. Two other studies suggest that people with more severe NPS at baseline could benefit from continuing their antipsychotic medication. In these people, withdrawal might not be recommended.
    Cochrane database of systematic reviews (Online) 01/2013; 3:CD007726. · 5.70 Impact Factor
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    ABSTRACT: Frailty tends to be considered as a major risk for adverse outcomes in older persons, but some important aspects remain matter of debate. Objectives: The purpose of this paper is to present expert's positions on the main aspects of the frailty syndrome in the older persons. Participants: Workshop organized by International Association of Gerontology and Geriatrics (IAGG), World Health Organization (WHO) and Société Française de Gériatrie et de Gérontologie (SFGG). Results: Frailty is widely recognized as an important risk factor for adverse health outcomes in older persons. This can be of particular value in evaluating non-disabled older persons with chronic diseases but today no operational definition has been established. Nutritional status, mobility, activity, strength, endurance, cognition, and mood have been proposed as markers of frailty. Another approach calculates a multidimensional score ranging from "very fit" to "severely frail", but it is difficult to apply into the medical practice. Frailty appears to be secondary to multiple conditions using multiple pathways leading to a vulnerability to a stressor. Biological (inflammation, loss of hormones), clinical (sarcopenia, osteoporosis etc.), as well as social factors (isolation, financial situation) are involved in the vulnerability process. In clinical practice, detection of frailty is of major interest in oncology because of the high prevalence of cancer in older persons and the bad tolerance of the drug therapies. Presence of frailty should also be taken into account in the definition of the cardiovascular risks in the older population. The experts of the workshop have listed the points reached an agreement and those must to be a priority for improving understanding and use of frailty syndrome in practice. Conclusion: Frailty in older adults is a syndrome corresponding to a vulnerability to a stressor. Diagnostic tools have been developed but none can integrate at the same time the large spectrum of factors and the simplicity asked by the clinical practice. An agreement with an international common definition is necessary to develop screening and to reduce the morbidity in older persons.
    The Journal of Nutrition Health and Aging 01/2013; 17(8):688-693. · 2.39 Impact Factor
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    ABSTRACT: Since antidepressants are prescribed for multiple indications, the use of an antidepressant cannot be equated with a diagnosis of depression. The objective of this study was to examine the quality of antidepressant prescribing in Belgian nursing homes, with a critical evaluation of indications and dosages, to see whether depression was appropriately treated in terms of drug choice, the indications for which antidepressants were being prescribed and whether there was underdosing. This analysis was based on data obtained in the Prescribing in Homes for the Elderly in Belgium (PHEBE) study, a cross-sectional, descriptive study of a representative, stratified, random sample of 1,730 residents from 76 Belgian nursing homes. The PHEBE study investigated overall drug utilization in Belgian nursing homes in 2006. Clinical and medication data for the present study were obtained from this study. A 28-item checklist of clinical conditions was designed ad hoc for the PHEBE study and sent to the residents' general practitioners (GPs) to collect clinical information. We copied the residents' medication charts, classified the drugs using the Anatomical Therapeutic Chemical (ATC) classification system codes and transferred the drug names and dosages into a database. Information on indications was retrospectively obtained from the GPs, so that we could link the indication to each medication. Minimum effective doses (MEDs) of antidepressants to treat major depression were obtained from the literature to assess underdosing. The overall use of antidepressants in nursing homes was 39.5 % (95 % CI 37.2, 41.8). The physicians classified 34.2 % (95 % CI 32.0, 36.4) of the residents as having depression, and 80.9 % of these patients were treated with an antidepressant. Indications among the single antidepressant users (n = 551) were depression (66.2 %), insomnia (13.4 %), anxiety (6.2 %) and neuropathic pain (1.6 %). In the indication of depression, 74.8 % used a selective serotonin reuptake inhibitor (SSRI), predominantly citalopram, sertraline and escitalopram. Venlafaxine was used by 10.7 % of the residents. Dosages for these antidepressants were equal to or higher than the MED. But when trazodone, amitriptyline or mirtazapine were used to treat depression, respectively, 92.3, 55.5 and 44.5 % of prescribed dosages were below the MED. In the indication of insomnia, most of the time, trazodone (90.5 %) or mirtazapine (5.4 %) were used, and in lower dosages than those required for depression treatment (<MED). Tricyclic antidepressants were predominantly used for the treatment of neuropathic pain and were also used at lower dosages. Of all the residents receiving a medication for anxiety, only 13.9 % received an antidepressant (mostly an SSRI), and the remaining received a benzodiazepine. The number one indication for the use of an antidepressant was depression. Within this indication, mostly the recommended SSRIs were used, in dosages equal to or higher than the MED. Furthermore, we noticed that there was substantial use of sedative antidepressants for insomnia and that the physicians preferred to prescribe benzodiazepines over the recommended SSRIs to treat anxiety chronically.
    Drugs & Aging 09/2012; 29(9):759-69. · 2.50 Impact Factor
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    ABSTRACT: Background: Antipsychotic use for behavioural and psychological symptoms of dementia (BPSD) is controversial. Guidelines advise to reduce antipsychotics given the adverse effects and limited efficacy, to limit dose and treatment duration as well as to undertake discontinuation. Methods: A pilot study with 40 hospitalised geriatric cognitively impaired patients, in which the effects of abrupt antipsychotic discontinuation were investigated, using neuropsychiatric inventory (NPI) scores before and one month after discontinuation. Withdrawal symptoms were monitored thrice a day with a checklist during five consecutive days. Results: Participants (n = 40) had a mean age of 84 years (range 67-95) and 53% were male. The total mean baseline NPI score was 21 (SD 12) with predominantly behavioural rather than psychological disturbances. After abrupt discontinuation, mild withdrawal symptoms were observed in 72% of the patients, with frequencies of symptoms peaking on day 2 (53%) and day 3 (48%). After one month, 31 patients (85%) were still off antipsychotics and improved on the majority of NPI domains, with a total mean NPI score decreasing from 18 (SD 13) to 12 (SD 8, p = 0.003). In the relapse group, there was no deterioration associated with the abrupt discontinuation and subsequent resumption of therapy with a total mean NPI score decreasing from 31 (SD 12) at baseline to 27 (SD 8) at one-month follow-up (p = 0.345). Conclusion: Abrupt antipsychotic discontinuation appears to be feasible in older individuals with BPSD. Systematically performed discontinuation efforts in clinical practice are needed to differentiate between patients where antipsychotics have no added value and patients where the benefits outweigh the risks.
    Aging and Mental Health 08/2012; · 1.68 Impact Factor

Publication Stats

679 Citations
181.21 Total Impact Points

Institutions

  • 1999–2014
    • Ghent University
      • • Geriatrics
      • • Department of General Practice and Primary Health Care
      • • Faculty of Pharmaceutical Sciences
      • • Department of Internal Medicine
      Gand, Flanders, Belgium
  • 2013
    • Erasmus Universiteit Rotterdam
      Rotterdam, South Holland, Netherlands
  • 2012
    • Cork University Hospital
      • Department of Geriatric Medicine
      Corcaigh, Munster, Ireland
  • 1997–2012
    • Universitair Ziekenhuis Ghent
      • • Department of General Internal Medicine
      • • Department of Geriatrics
      Gand, Flanders, Belgium
  • 2010
    • University of Antwerp
      Antwerpen, Flanders, Belgium