In the specialties of geriatric medicine and long-term care, medication reduction
is a large focus of daily clinical work and research due to the significant morbidity
and mortality burden of polypharmacy on older adults.
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Many drug-specific tools and interventions to reduce polypharmacy have been developed
and tested across health care settings.
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Most of these interventions start with identifying the use of high-risk medications,
as well as those with a high utilization rate that could be a target for reduction
or optimization. In this issue, a group of researchers
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sought to describe medication utilization of older adults across Italy at a population
level. The study yielded interesting results, which are hypothesis driving and worth
discussing further.To read this article in full you will need to make a payment
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References
- The health care cost of drug-related morbidity and mortality in nursing facilities.Arch Intern Med. 1997; 157: 2089-2096
- Risk factors for adverse drug events among older adults in the ambulatory setting.J Am Geriatr Soc. 2004; 52: 1349-1354
- Strategies for reducing polypharmacy in older adults.J Gerontol Nurs. 2010; 36: 8-12
- Outcomes of a randomized controlled trial of a clinical pharmacy intervention in 52 nursing homes.Br J Clin Pharmacol. 2001; 51: 257-265
- Polypharmacy and mortality among nursing home residents with advanced cognitive impairment: Results from the Shelter study.J Am Med Dir Assoc. 2013; 14: 450.e7-450.e12
- Minimizing inappropriate medications in older populations: A 10-step conceptual framework.Am J Med. 2012; 125: 529-537.e4
- Reducing cost by reducing polypharmacy: The polypharmacy outcomes project.J Am Med Dir Assoc. 2012; 13: 818.e11-818.e15
- Reduction of polypharmacy by feedback to clinicians.J Gen Intern Med. 1991; 6: 133-136
- Promoting effective transitions of care at hospital discharge: A review of key issues for hospitalists.J Hosp Med. 2007; 2: 314-323
- ARMOR: A tool to evaluate polypharmacy in elderly persons.Ann Longterm Care. 2009; 17: 26-30
- Reducing polypharmacy: Evidence from a simple quality improvement initiative.J Am Med Dir Assoc. 2013; 14: 152-156
- Advanced age and medication prescription: More years, less medications? A nationwide report from the Italian Medicines Agency.J Am Med Dir Assoc. 2016; 17: 168-172
- Harmless herbs? Think again: Merits of a complete medication history.J Am Med Dir Assoc. 2006; 7: 446-447
- Understanding adverse drug reactions in older adults through drug-drug interactions.Eur J Intern Med. 2014; 25: 843-846
- Are the new guidelines for cholesterol and hypertension age friendly?.J Am Med Dir Assoc. 2014; 15: 373-375
- Improving the appropriate use of proton pump inhibitors: A skilled nursing facility based quality improvement project.J Am Med Dir Assoc. 2015; 16: B17-B18
- Risk of death associated with use of PPIs in three cohorts of institutionalized older people in Finland.J Am Med Dir Assoc. 2012; 13: 488.e9-488.e13
- Prevalence and potentially reversible factors associated with anorexia among older nursing home residents: Results from the ULISSE project.J Am Med Dir Assoc. 2013; 14: 119-124
- Risk factors for aspiration pneumonia in frail older people: A systematic literature review.J Am Med Dir Assoc. 2011; 12: 344-354
- Albumin, length of stay, and proton pump inhibitors: Key factors in Clostridium difficile-associated disease in nursing home patients.J Am Med Dir Assoc. 2005; 6: 105-108
- Gastric acid-inhibiting medications and vitamin B12 deficiency.JAMA. 2014; 311: 1444-1445
- Do acid-lowering agents affect vitamin B12 status in older adults?.J Am Med Dir Assoc. 2008; 9: 162-167
- Risk of stroke-associated pneumonia with acid-suppressive drugs: A population-based cohort study.Medicine. 2015; 94: e1227
- Continuous proton pump inhibitor therapy and the associated risk of recurrent Clostridium difficile infection.JAMA Intern Med. 2015; 175: 784-791
- Proton pump inhibitor treatment is associated with the severity of liver disease and increased mortality in patients with cirrhosis.Aliment Pharmacol Ther. 2015; 41: 459-466
- Population-based cohort study on the risk of pneumonia in patients with non-traumatic intracranial haemorrhage who use proton pump inhibitors.BMJ Open. 2014; 4: e006710
- Use of proton pump inhibitors and other acid suppressive medications in newly admitted nursing facility patients.J Am Med Dir Assoc. 2007; 8: 607-609
- Appropriate prescribing and important drug interactions in older adults.Med Clin North Am. 2015; 99: 295-310
- Use of proton pump inhibitors with lack of diagnostic indications in 22 Midwestern US skilled nursing facilities.J Am Med Dir Assoc. 2013; 14: 429-432
- Prevalence and associations of the use of proton-pump inhibitors in nursing homes: A cross-sectional study.J Am Med Dir Assoc. 2013; 14: 265-269
- Strategies for discontinuation of proton pump inhibitors: A systematic review.Fam Pract. 2014; 31: 625-630
- Statins and the nursing home.J Am Med Dir Assoc. 2013; 14: 853-854
- Cholesterol, statins, and longevity from age 70 to 90 years.J Am Med Dir Assoc. 2013; 14: 883-888
- AMDA-choosing wisely.J Am Med Dir Assoc. 2013; 14: 639-641
- Predictors of mortality, rehospitalization for syncope, and cardiac syncope in 352 consecutive elderly patients with syncope.J Am Med Dir Assoc. 2013; 14: 326-330
- Reverse epidemiology of traditional cardiovascular risk factors in the geriatric population.J Am Med Dir Assoc. 2015; 16: 933-939
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© 2016 AMDA – The Society for Post-Acute and Long-Term Care Medicine. Published by Elsevier Inc. All rights reserved.
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- Advanced Age and Medication Prescription: More Years, Less Medications? A Nationwide Report From the Italian Medicines AgencyJournal of the American Medical Directors AssociationVol. 17Issue 2
