INTRODUCTION: Previous research has raised concerns about high prevalence of drug-related problems, polypharmacy and inappropriate benzodiazepine prescribing in nursing homes (NHs) and confirmed lack of studies from Central and South-Eastern Europe. The aim of our study was to determine the prevalence and characteristics of polypharmacy, hyperpolypharmacy and inappropriate benzodiazepine prescribing in NH residents in Croatia. METHODS: Data from 226 older NH residents from five Croatian NHs were collected using the InterRAI Long-Term Care Facilities assessment form. The prevalence and determinants of polypharmacy/hyperpolypharmacy and patterns of inappropriate benzodiazepine prescribing were documented. RESULTS: The prevalence of polypharmacy (49.6%) and hyperpolypharmacy (25.7%) among NH residents was high. In our study, 72.1% of NH residents were prescribed at least one psychotropic agent, 36.7% used 2-3 psychotropics and 6.6% used 4+ psychotropics. Among benzodiazepine users (55.8%), 28% of residents were prescribed benzodiazepines in higher than recommended geriatric doses, 75% used them for the long term and 48% were prescribed concomitant interacting medications. The odds of being prescribed polypharmacy/hyperpolypharmacy were significantly higher for older patients with polymorbidity (6+ disorders, proportional odds ratio (POR) = 19.8), type II diabetes (POR = 5.2), ischemic heart disease (POR = 4.6), higher frailty (Clinical Frailty Scale (CFS ≥5); POR = 4.3) and gastrointestinal problems (POR = 4.8). CONCLUSIONS: Our research underscores the persistent challenge of inappropriate medication use and drug-related harms among older NH residents, despite existing evidence and professional campaigns. Effective regulatory and policy interventions, including the implementation of geriatrician and clinical pharmacy services, are essential to address this critical issue and ensure optimal medication management for vulnerable NH populations.

• MeSH
• benzodiazepiny * terapeutické užití   škodlivé účinky   aplikace a dávkování   MeSH
• domovy pro seniory statistika a číselné údaje   MeSH
• lékařská praxe - způsoby provádění statistika a číselné údaje   normy   MeSH
• lidé MeSH
• nevhodné předepisování * statistika a číselné údaje   MeSH
• pečovatelské domovy * statistika a číselné údaje   MeSH
• polypharmacy * MeSH
• prevalence MeSH
• psychotropní léky terapeutické užití   škodlivé účinky   MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• Check Tag
• lidé MeSH
• mužské pohlaví MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• Geografické názvy
• Chorvatsko MeSH

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

• MeSH
• benzodiazepiny * škodlivé účinky   MeSH
• lidé MeSH
• prevalence MeSH
• průřezové studie MeSH
• senioři MeSH
• úzkostné poruchy * MeSH
• Check Tag
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• Geografické názvy
• Evropa MeSH

BACKGROUND: The prevalence rates of the use of Complementary and Alternative Medicine (CAM) in allergy patients range from 42% in the United States up to 50% in Europe. In the Czech Republic, no such data exists. Our aim was to examine patterns in CAM use in populations with self-reported allergies in the Czech Republic. METHODS: A cross-sectional survey was conducted. A sample of citizens aged 15 years and older, sex, age, and region-stratified, was randomly selected from the 2014 voter registration lists (n = 8,395,132). Respondents with self-reported allergies were further analyzed. RESULTS: Overall, 93% of the respondents with self-reported allergies reported the use of 1 or more CAM modalities during the past 30 days. Herbal teas, relaxation techniques, a detoxifying diet, dietary supplements (excluding vitamins and minerals), and reflexology were used in respondents with allergies. Females, under age 30, with higher education, higher income, and self-reported poor health, were significantly associated with the use of CAM among respondents with allergies. CONCLUSIONS: The prevalence of CAM use among people with self-reported allergies in the Czech Republic is higher compared to other countries, with determinants of CAM varying across specific CAM categories. More attention to existing use is needed to promote the healthy adoption of CAM by raising awareness of its safe and effective use, both for CAM users as well as for health care providers.

• MeSH
• alergie epidemiologie   terapie   MeSH
• dospělí MeSH
• komplementární terapie statistika a číselné údaje   MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladiství MeSH
• mladý dospělý MeSH
• pacientův souhlas se zdravotní péčí statistika a číselné údaje   MeSH
• průřezové studie MeSH
• průzkumy a dotazníky MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladiství MeSH
• mladý dospělý MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• Geografické názvy
• Česká republika MeSH

BACKGROUND: Benzodiazepines (BZDs) and Z-drugs have high potential for developing frequent adverse drug events in older adults (e.g., psychomotor sedation, drug-related dementia, deliria, drug dependence, etc.). Knowledge of the prevalence and patterns of the use of BZDs/Z-drugs in vulnerable older patients is important in order to prevent and reduce the burden caused by their drug-related complications. Our study focused on international comparisons of the prevalence, country-specific prescribing patterns and risk factors of regular BZD/Z-drug use in nursing home (NH) residents. METHODS: This cross-sectional study retrospectively analysed data of 4156 NH residents, prospectively assessed in the Services and Health in the Elderly in Long TERm care (SHELTER) project conducted from 2009 to 2014. Residents aged 65+ in 57 NHs in 7 European countries and Israel were assessed by the InterRAI Long-Term Care Facilities instrument. Descriptive statistics and multiple logistic regression models were used to describe the country-specific prevalence, patterns and risk factors of BZD/Z-drug use. RESULTS: The mean age of the participants was 83.4 ± 9.4 years, 73% were female and 27.7% used BZDs/Z-drugs. The prevalence of BZD/Z-drug use differed significantly across countries, ranging from 44.1% in Israel to 14.5% in Germany. The most frequently prescribed were zopiclone (17.8%), lorazepam (17.1%) and oxazepam (16.3%). Lorazepam, oxazepam and diazepam were used in most of the countries. Brotizolam, temazepam and zolpidem showed highest prevalence in Israel (99.4% of all regular users of this medication in the sample), the Netherlands (72.6%) and France (50.0%), respectively. Residing in Israel was the most significant factor associated with the use of BZDs/Z-drugs or BZDs only (odds ratio [OR] 6.7; 95% confidence interval [CI] 4.8-9.2 and OR 9.7, 95%CI 6.5-14.5, respectively). The use of Z-drugs only was most significantly associated with residing in France (OR 21.0, 95%CI 9.0-48.9). CONCLUSIONS: Despite global recommendations and warnings, the preference for and extent of use of individual BZDs and Z-drugs in vulnerable NH residents differ significantly across countries. The strong association with country of residence compared to clinical and functional factors denotes that prescribing habits, social, cultural, behavioural, and regulatory factors still play an important role in the current diverse use of these medications.

• MeSH
• benzodiazepiny * MeSH
• léčivé přípravky * MeSH
• lidé MeSH
• pečovatelské domovy MeSH
• prevalence MeSH
• průřezové studie MeSH
• retrospektivní studie MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• Check Tag
• lidé MeSH
• mužské pohlaví MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH
• Geografické názvy
• Evropa MeSH
• Francie MeSH
• Izrael MeSH
• Německo MeSH
• Nizozemsko MeSH

Úvod: Předepisování negeriatrických dávek, nevhodných indikací ve stáří a interakcí lék–nemoc představuje specifické oblasti rizikové geriatrické preskripce, které mohou vést k častým polékovým komplikacím, zejména u polymorbidních seniorů s po‑lyfarmakoterapií a vyšším stupněm stařecké křehkosti. Evropský projekt SHELTER (z angl. „Services and Health in the Elderly in Long‑TERm care“, 7. rámcový program, 2009–2014) byl zaměřen na popis základních charakteristik (včetně preskripčních zvyklostí) u 4156 seniorů v zařízeních dlouhodobé ošetřovatelské péče v 7 evropských zemích (České republice, Itálii, Německu, Nizozemí, Finsku, Velké Británii, Francii) a Izraeli. Tato práce se zaměřuje na retrospektivní analýzu interakcí lék–nemoc ve stáří v českém souboru seniorů projektu SHELTER.Metodika práce: Semi‑implicitní metodou (tj. hodnocením komplexních protokolů geriatrických pacientů českého souboru evropského projektu SHELTER, červen–srpen 2019) byl retrospektivně zhodnocen výskyt interakcí lék–nemoc s využitím ex‑pertních explicitních kritérií. Jednalo se o Beersova kritéria z roku 2003 a 2012, IPET kritéria, Český expertní národní konsenzus potenciálně nevhodných lékových postupů z roku 2013, STOPP/START kritéria verze 1 a IPET kritéria. Senioři byli v projektu SHELTER vyšetřeni s pomocí komplexního geriatrického vyšetření (RAI‑LTCF verze II) v 10 regionálně odlišných zařízeních dlouhodobé ošetřovatelské péče (N = 490 seniorů, věk 65 let a více, zařazeni byli všichni senioři dlouhodobě umístění (3 a více měsíců) v účastnících se ošetřovatelských zařízeních. Ke statistickému zhodnocení byla použita popisná statistika s využitím chí ‑kvadrát (χ2) testu a Fisherova exaktního testu (p < 0,05).Výsledky: Nejvyšší prevalence užití potenciálně nevhodných interakcí lék–nemoc (64,3 %) byla popsána s pomocí Českého národního konsenzu potenciálně nevhodných léčiv z roku 2013 (z angl. CNC), dále s pomocí Beersových kritérií z roku 2012 (60,2 %), STOPP/START kritérií verze 1 (44,5 %/ 52,9 %) a IPET kritérií (30,2 %). Mezi nejčastěji užívané potenciálně nevhodné postupy identifikované s pomocí Českého národního konsenzu patřilo dlouhodobé užití benzodiazepinů (BZD) u seniorů s dia‑gnózou deprese (7,8 %), užití opioidních analgetik u pacientů s chronickou zácpou bez podání šetrných laxativ (6,3 %), užití BZD u pacientů se synkopami a pády (1 a více pádů za poslední 3 měsíce) (6,1 %) a současné dlouhodobé podávání ACE‑I a NSAID bez monitorování kalémie (6,1 %).Závěr: Užití Českého národního konsenzu (CNC) vedlo k dokumentaci nejvyšší prevalence interakcí lék–nemoc v českém souboru seniorů ve srovnání se zahraničními explicitními kritérii. S pomocí explicitních kritérií bylo v dlouhodobé ošetřovatelské péči v ČR identifikováno více než 60 % seniorů, kteří by byli prioritizováni ke komplexním intervencím klinických farmaceutů. S nově prosazeným výkonem klinických farmaceutů v ČR v ambulantní péči by se tito specialisté měli uplatnit i ve složitých lékových revizích u geriatric‑kých nemocných v primární péči, a to zejména v dlouhodobé ošetřovatelské péči, domácí péči, sociální péči a v paliativních hospicích.

Introduction: Prescribing of non-geriatric dosing, inappropriate indications and drug-disease interactions in older patients create specific areas of high-risk prescribing in geriatrics that often lead to drug-related complications, particularly in polymorbid older patients using polypharmacy and having higher degree of frailty. The European project SHELTER (Services and Health in the Elderly in Long-TERrm care, 7th FP, 2009-2014) aimed at describing comprehensive characteristics of 4 156 long-term care seniors (including drug prescribing habits) in 7 EU countries (Czech Republic, Italy, Germany, Netherlands, Finland, UK, France) and Israel. This study focuses on retrospective analyses of drug-disease interactions in the Czech sample of seniors of the SHELTER project. Methods: Semi-implicit method (evaluation of complex protocols of geriatric patients from the Czech sample of the European project SHELTER, June-August 2019) was used to retrospectively analyse the prevalence of drug-disease intereactions using expert explicit criteria. Mainly Beers criteria 2003 and 2012, Czech national consensus of potentially inappropriate medications 2013, STOPP/START criteria version I. and IPET criteria have been applied. In the SHELTER project, seniors were assessed using comprehensive geriatric assessment (RAI-LTCF vers.I) in 10 regionally different Czech (CZ) long-term care facilities (N = 490 seniors, age 65+, all patients residing for long-term (more than 3 months) in evaluated long-term care facilities). For statistical analyses, descriptive statistics has been used, namely chi-square (χ2) test and Fisher´s exact tests (p < 0,05). Results: The highest prevalence of potentially inappropriate drug-disease interactions (64.3 %) was identified using Czech national consensus of potentially inappropriate medications 2013 (CNC), then by Beers 2012 criteria (60.2 %), STOPP/START criteria version I. (44.5 %/52.9 %, respectively) and IPET criteria (30.2 %). The most prevalent prescribing problems were (according to CNC): long-term use of benzodiazepines (BZDs) in depressive patients (7.8 %), constipation caused by opioids without using laxatives-lactulose (7.3 %), long-term use of BZDs in patients suffering from syncopes and falls (1 and more falls in the past 3 months) (6.3 %) and long-term use of Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) and ACE-I without clinical monitoring of kalemia (6.1 %). Conclusion: Application of Czech national consensus (CNC) led to documentation of the highest prevalence of drug-disease interactions in the Czech sample of seniors in long-term care in comparison to foreign explicit criteria. With the help explicit criteria we identified in Czech long-term care facilities more than 60 % of seniors potentially prioritized for complex interventions of clinical pharmacists. In the light of newly approved payments in ambulatory care for interventions of clinical pharmacists in the Czech Republic, services of these specialists should be utilized for complex drug revisions of geriatric patients in primary care, particularly in long-term care, home care, social care and palliative hospices.