BACKGROUND: Various explicit screening tools, developed mostly in central Europe and the USA, assist clinicians in optimizing medication use for older adults. The Turkish Inappropriate Medication use in oldEr adults (TIME) criteria set, primarily based on the STOPP/START criteria set, is a current explicit tool originally developed for Eastern Europe and subsequently validated for broader use in Central European settings. Reviewed every three months to align with the latest scientific literature, it is one of the most up-to-date tools available. The tool is accessible via a free mobile app and website platforms, ensuring convenience for clinicians and timely integration of updates as needed. Healthcare providers often prefer to use their native language in medical practice, highlighting the need for prescribing tools to be translated and adapted into multiple languages to promote optimal medication practices. OBJECTIVE: To describe the protocol for cross-cultural and language validation of the TIME criteria in various commonly used languages and to outline its protocol for clinical validation across different healthcare settings. METHODS: The TIME International Study Group comprised 24 geriatric pharmacotherapy experts from 12 countries. In selecting the framework for the study, we reviewed the steps and outcomes from previous research on cross-cultural adaptations and clinical validations of explicit tools. Assessment tools were selected based on both their validity in accurately addressing the relevant issues and their feasibility for practical implementation. The drafted methodology paper was circulated among the study group members for feedback and revisions leading to a final consensus. RESULTS: The research methodology consists of two phases. Cross-cultural adaptation/language validation phase follows the 8-step approach recommended by World Health Organization. This phase allows regions or countries to make modifications to existing criteria or introduce new adjustments based on local prescribing practices and available medications, as long as these adjustments are supported by current scientific evidence. The second phase involves the clinical validation, where participants will be randomized into two groups. The control group will receive standard care, while the intervention group will have their treatment evaluated by clinicians who will review the TIME criteria and consider its recommendations. A variety of patient outcomes (i.e., number of hospital admissions, quality of life, number of regular medications [including over the counter medications], geriatric syndromes and mortality) in different healthcare settings will be investigated. CONCLUSION: The outputs of this methodological report are expected to promote broader adoption of the TIME criteria. Studies building on this work are anticipated to enhance the identification and management of inappropriate medication use and contribute to improved patient outcomes.
Rational prescribing in geriatrics represents an important ethical as well as socio-economic issue. The aim of this project was to analyze the drug-related problems (DRPs) among the Czech nursing home residents and increase public awareness of further possible employment of clinical pharmacists in social care. The project was designed as a multicenter observational study. A total of 16 nursing homes and 800 participants with an average age of 84.6 ± 7.3 years were included in the study. Of them, a DRP was noted in 93.3% of people. The total amount of DRPs identified was 2215, which means an average of 2.8 ± 1.6 DRPs per patient. The most common DRPs identified were 'overtreatment' (19.5%), 'undertreatment' (12.8%), inappropriate dose (10.6%), recommendations for laboratory monitoring (10.4%) and adverse effects (10.3%). Of different drug classes, BZDs (OR 16.6, 95% CI 1.0-270.2), PPIs (OR 2.5, 95% CI 1.1-5.6) and NSAIDs (OR 4.4, 95% CI 1.1-18.3) were identified to be most commonly associated with DRPs. The risk of DRP identification clearly increased with the number of drugs used, with seven drugs demonstrated as the best cut-off for predicting DRP identification (AUC 0.842, sensitivity 0.602; specificity 0.796). 'SENIOR' project has confirmed a high rate of excessive polypharmacy among nursing home residents in the Czech republic resulting in high risk of potential and manifested DRPs. The project emphasized the role of clinical pharmacists in optimizing safety and effectiveness of treatment among older nursing home residents.
- MeSH
- Homes for the Aged * statistics & numerical data MeSH
- Pharmacists MeSH
- Pharmaceutical Services * organization & administration MeSH
- Humans MeSH
- Inappropriate Prescribing * statistics & numerical data prevention & control MeSH
- Drug-Related Side Effects and Adverse Reactions * epidemiology diagnosis prevention & control MeSH
- Nursing Homes * statistics & numerical data MeSH
- Polypharmacy MeSH
- Aged, 80 and over MeSH
- Aged MeSH
- Check Tag
- Humans MeSH
- Male MeSH
- Aged, 80 and over MeSH
- Aged MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
- Multicenter Study MeSH
- Observational Study MeSH
- Geographicals
- Czech Republic MeSH
OBJECTIVE: The aim of this study was to determine the prevalence of potentially inappropriate medications (PIMs) in nursing home residents across eight countries and investigate differences between residents with and without cognitive impairment, as well as those with and without life expectancy of six months or less. METHODS AND DEIGN: The study utilized the second edition of the STOPP-Frail criteria to operationalize PIMs in the baseline assessment of nursing home residents participating in the Services and Health for Elderly in Long TERm care (SHELTER) project. The data were collected between 2009 and 2012. The project was conducted in eight countries: Czech Republic, England, Finland, France, Germany, Italy, the Netherlands, and Israel. Cognitive impairment was measured by the cognitive performance scale (CPS). The presence of end-stage disease with a life expectancy of six months or less was recorded. The study included residents aged 60 years or older who underwent a valid medication assessment. RESULTS: Among the 3,832 eligible residents, 87.9% had at least one PIM. Specifically, 24.3%, 23.5%, 18.8%, and 19.3% of residents had one, two, three, and four or more PIMs, respectively. On average, each person was prescribed 2.16 PIMs. Cognitively impaired residents (n = 1999) had an average of 1.96 PIMs (SD 1.49) per person, while residents with a low CPS score (n = 1783) had an average of 2.40 PIMs (SD 1.57) per person, showing a statistically significant difference (P < 0.001). Similarly, NH residents with life expectancy of six months or less had an average of 1.66 PIMs (SD 1.30), whereas those without had an average of 2.17 PIMs (SD 1.55) (p < 0.001). The average number of PIMs varied across countries, ranging from 3.23 in Finland to 2.15 in the UK (P < 0.001). Anti-platelets and aspirin were the most prescribed PIMs, accounting for over 38.0% of prescriptions. CONCLUSIONS: This study highlights the high prevalence of PIMs among nursing home residents. However, PIMs were somewhat lower in residents with cognitive impairment and life expectancy of six months or less. Efforts must continue to improve the rationale behind prescribing practices in nursing homes.
- MeSH
- Homes for the Aged MeSH
- Frail Elderly MeSH
- Middle Aged MeSH
- Humans MeSH
- Inappropriate Prescribing statistics & numerical data MeSH
- Nursing Homes * MeSH
- Prevalence MeSH
- Aged, 80 and over MeSH
- Aged MeSH
- Potentially Inappropriate Medication List * MeSH
- Check Tag
- Middle Aged MeSH
- Humans MeSH
- Male MeSH
- Aged, 80 and over MeSH
- Aged MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
- Multicenter Study MeSH
- Geographicals
- Germany MeSH
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
- Benzodiazepines * therapeutic use adverse effects administration & dosage MeSH
- Homes for the Aged statistics & numerical data MeSH
- Practice Patterns, Physicians' statistics & numerical data standards MeSH
- Humans MeSH
- Inappropriate Prescribing * statistics & numerical data MeSH
- Nursing Homes * statistics & numerical data MeSH
- Polypharmacy * MeSH
- Prevalence MeSH
- Psychotropic Drugs therapeutic use adverse effects MeSH
- Aged, 80 and over MeSH
- Aged MeSH
- Check Tag
- Humans MeSH
- Male MeSH
- Aged, 80 and over MeSH
- Aged MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
- Geographicals
- Croatia MeSH
This study aimed to analyze the effect of fall risk-increasing drugs (FRIDs) and drug-related factors relative to falls through clinical pharmacy service in hospitalized patients, focusing on the relevance of clinical pharmacist evaluation in the context of physician assessment. A prospective study of inpatient falls was conducted in 2017 retrieving data from 4 hospitals in South Bohemia, Czech Republic. An online database was developed to collect patient and fall-related data, and fall evaluation records. Healthcare professionals classified the overall effect of drugs on falls using Likert scale. Univariate and multivariate correlations were performed with a significance level of p < 0.05. Out of the total 280 falls (mean age of patients 77.0 years), a mean of 2.8 diagnoses with fall-related risk, 8.8 drugs, and 4.1 FRIDs per fall were identified. Incidence of falls decreased quarterly (p < 0.001). Use of FRIDs were positively associated with increasing age (p = 0.007). Clinical pharmacists were more likely to identify pharmacotherapy as the relevant fall-related risk, compared to physicians evaluation (p < 0.001). An increasing total number of prescribed drugs as well as higher number of FRIDs increased the suspicion in both professionals in the context of drug-related causes of falls.
- MeSH
- Medical Errors statistics & numerical data MeSH
- Inpatients MeSH
- Humans MeSH
- Inappropriate Prescribing prevention & control statistics & numerical data MeSH
- Risk Factors MeSH
- Accidental Falls * statistics & numerical data MeSH
- Check Tag
- Humans MeSH
- Publication type
- Research Support, Non-U.S. Gov't MeSH
INTRODUCTION: The importance of rational drug therapy is increasing with the aging of the population. Since one of the main reasons for inappropriate drug prescribing is also the "age-blind" approach, which results in ageist practices, this narrative literature review focuses on the description of the main barriers related to insufficient individualization of drug regimens associated with such age-blind approaches. METHODOLOGY: A narrative literature review using the PubMed, WoS, Embase, and Scopus databases was conducted by the EU COST Action IS1402. Experts in different scientific fields from six countries (the Czech Republic, Spain, Portugal, Hungary, Serbia, and Turkey) worked in four specific areas: (1) underrepresentation of older adults in clinical trials and clinical and ethical consequences; (2) insufficient consideration of age-related changes and geriatric frailty in the evaluation of the therapeutic value of drugs; (3) frequent prescribing of potentially inappropriate medications (PIMs); and (4) frequent underuse of highly beneficial nonpharmacological strategies (e.g., exercise). RESULTS: Older patients are underrepresented in clinical trials. Therefore, rigorous observational geriatric research is needed in order to obtain evidence on the real efficacy and safety of frequently used drugs, and e.g. developed geriatric scales and frailty indexes for claims databases should help to stimulate such research. The use of PIMs, unfortunately, is still highly prevalent in Europe: 22.6% in community-dwelling older patients and 49.0% in institutionalized older adults. Specific tests to detect the majority of age-related pharmacological changes are usually not available in everyday clinical practice, which limits the estimation of drug risks and possibilities to individualize drug therapy in geriatric patients before drug prescription. Moreover, the role of some nonpharmacological strategies is highly underestimated in older adults in contrast to frequent use of polypharmacy. Among nonpharmacological strategies, particularly physical exercise was highly effective in reducing functional decline, frailty, and the risk of falls in the majority of clinical studies. CONCLUSION: Several regulatory and clinical barriers contribute to insufficient knowledge on the therapeutic value of drugs in older patients, age-blind approach, and inappropriate prescribing. New clinical and observational research is needed, including data on comprehensive geriatric assessment and frailty, to document the real efficacy and safety of frequently used medications.
- MeSH
- Geriatric Assessment MeSH
- Drug Prescriptions standards statistics & numerical data MeSH
- Humans MeSH
- Inappropriate Prescribing statistics & numerical data MeSH
- Polypharmacy * MeSH
- Prevalence MeSH
- Randomized Controlled Trials as Topic statistics & numerical data MeSH
- Risk Factors MeSH
- Aged, 80 and over MeSH
- Aged MeSH
- Potentially Inappropriate Medication List statistics & numerical data MeSH
- Age Factors MeSH
- Check Tag
- Humans MeSH
- Male MeSH
- Aged, 80 and over MeSH
- Aged MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
- Review MeSH
- Geographicals
- Europe MeSH
- Turkey MeSH
- MeSH
- Homes for the Aged MeSH
- Drug Utilization Review * statistics & numerical data MeSH
- Drug Interactions MeSH
- Drug Prescriptions classification statistics & numerical data MeSH
- Medication Errors statistics & numerical data MeSH
- Inappropriate Prescribing statistics & numerical data MeSH
- Publication type
- Newspaper Article MeSH
Lékové interakce patří k hlavním rizikům farmakoterapie ve všech vyspělých zemích. Pacienti užívající větší počet léků mají někdy obavy, zda jimi užívané kombinace léků jsou bezpečné. Webová poradna provozovaná AIFP podává pacientům základní informace, zda příslušné kombinace léků jsou v zásadě bezpečné, nebo zda přináší určité riziko. Seznamy užívaných léků, které pacienti do poradny zaslali, byly zhodnoceny experty za pomoci elektronické Databáze lékových interakcí DrugAgency, a. s. Pacientům byly zaslány odpovědi a nalezené lékové interakce a duplicity léků byly uloženy do anonymní databáze dotazů. Z celkem 29 263 dotazů v 10 223 případech byla identifikována alespoň jedna klinicky významná léková interakce. Nejčastějšími interagujícími léky byly antiagregancia a antikoagulancia, léky ovlivňující renin-angiotenzinový systém, NSA, kardiovaskulární léky a antidepresiva. Celkem bylo identifikováno 2 850 lékových duplicit. Informace z tohoto průzkumu mohou lékařům pomoci identifikovat nejčastější lékové interakce, aby si osvěžili znalosti, jak příslušné situace v každodenní praxi zvládat správným způsobem.
Drug interactions are one of the main risks of pharmacotherapy in all developed countries of the world. Patients using multiple medications are sometimes concerned with the safety of drug-drug combinations they use. Advisory web center „I know my medicaments“ was established by AIFP to give patients basic information, whether drug-drug combinations they use are fundamentally safe or whether some risk is present. The drug lists issued by patiens to advisory center was evaluated by experts with the aid of electronic DrugAgency a. s. database of drug-drug interactions. Answers were sent back to patiens, and the drug-drug interactions, as well as drug-drug duplicities, were put to anonymous query database. From 29 263 inquiries in 10 223 cases was at least one clinically relevant drug-drug interaction identified. The most common drugdrug interacting drugs were antiagregants and anticoagulants, agents acting on the renin-angiotensin system, NSAID, cardiovascular drugs and antidepressants. The number of duplicities was 2 825. Information from this survey may help physicians to identify common drug-drug interations in our population to refresh their knowledge information how to hadle these situations appropriately in everyday praxis.
- Keywords
- lékové duplicity,
- MeSH
- Amiodarone MeSH
- Anti-Inflammatory Agents, Non-Steroidal MeSH
- Antihypertensive Agents MeSH
- Anticoagulants MeSH
- Adrenergic beta-Antagonists MeSH
- Patient Safety MeSH
- Digoxin MeSH
- Diuretics MeSH
- Databases, Pharmaceutical MeSH
- Hypolipidemic Agents MeSH
- Platelet Aggregation Inhibitors MeSH
- Distance Counseling MeSH
- Contraindications, Drug MeSH
- Drug Interactions * MeSH
- Humans MeSH
- Inappropriate Prescribing * prevention & control statistics & numerical data MeSH
- Polypharmacy MeSH
- Propafenone MeSH
- Renin-Angiotensin System drug effects MeSH
- Selective Serotonin Reuptake Inhibitors MeSH
- Cytochrome P-450 Enzyme System drug effects MeSH
- Research MeSH
- Check Tag
- Humans MeSH
- MeSH
- Homes for the Aged MeSH
- Risk Assessment MeSH
- Contraindications, Drug MeSH
- Drug Interactions MeSH
- Humans MeSH
- Inappropriate Prescribing prevention & control statistics & numerical data adverse effects MeSH
- Drug-Related Side Effects and Adverse Reactions MeSH
- Polypharmacy MeSH
- Aged MeSH
- Check Tag
- Humans MeSH
- Aged MeSH
- Publication type
- Newspaper Article MeSH
AIM: Frail older people typically suffer several chronic diseases, receive multiple medications and are more likely to be institutionalized in residential aged care facilities. In such patients, optimizing prescribing and avoiding use of high-risk medications might prevent adverse events. The present study aimed to develop a pragmatic, easily applied algorithm for medication review to help clinicians identify and discontinue potentially inappropriate high-risk medications. METHODS: The literature was searched for robust evidence of the association of adverse effects related to potentially inappropriate medications in older patients to identify high-risk medications. Prior research into the cessation of potentially inappropriate medications in older patients in different settings was synthesized into a four-step algorithm for incorporation into clinical assessment protocols for patients, particularly those in residential aged care facilities. RESULTS: The algorithm comprises several steps leading to individualized prescribing recommendations: (i) identify a high-risk medication; (ii) ascertain the current indications for the medication and assess their validity; (iii) assess if the drug is providing ongoing symptomatic benefit; and (iv) consider withdrawing, altering or continuing medications. Decision support resources were developed to complement the algorithm in ensuring a systematic and patient-centered approach to medication discontinuation. These include a comprehensive list of high-risk medications and the reasons for inappropriateness, lists of alternative treatments, and suggested medication withdrawal protocols. CONCLUSIONS: The algorithm captures a range of different clinical scenarios in relation to potentially inappropriate medications, and offers an evidence-based approach to identifying and, if appropriate, discontinuing such medications. Studies are required to evaluate algorithm effects on prescribing decisions and patient outcomes. Geriatr Gerontol Int 2016; 16: 1002-1013.
- MeSH
- Algorithms * MeSH
- Patient Safety MeSH
- Chronic Disease drug therapy MeSH
- Risk Assessment MeSH
- Frail Elderly statistics & numerical data MeSH
- Humans MeSH
- Inappropriate Prescribing prevention & control statistics & numerical data MeSH
- Drug-Related Side Effects and Adverse Reactions epidemiology prevention & control MeSH
- Polypharmacy * MeSH
- Aged, 80 and over MeSH
- Aged MeSH
- Potentially Inappropriate Medication List statistics & numerical data MeSH
- Age Factors MeSH
- Check Tag
- Humans MeSH
- Male MeSH
- Aged, 80 and over MeSH
- Aged MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
- Review MeSH
