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.

• Klíčová slova
• Nursing home residents, geriatric deprescribing, inappropriate benzodiazepine prescribing, polypharmacy/hyperpolypharmacy, psychiatric polypharmacy/hyperpolypharmacy,
• 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 epidemiologie   MeSH
• Názvy látek
• benzodiazepiny * MeSH
• psychotropní léky MeSH

We aimed to systematically review the prevalence of potentially inappropriate prescribing (PIP) in older adults in Central and Eastern Europe (CEE) in all care settings. We searched Embase and MEDLINE (up to June 2019) and checked the reference lists of the included studies and relevant reviews. Eligible studies used validated explicit or implicit tools to assess the PIP prevalence in older adults in CEE. All study designs were considered, except case‒control studies and case series. We assessed the risk of bias using the Joanna Briggs Institute Prevalence Critical Appraisal Tool and the certainty of evidence using the GRADE approach. Meta-analysis was inappropriate due to heterogeneity in the outcome measurements. Therefore, we used the synthesis without meta-analysis approach-summarizing effect estimates method. This review included twenty-seven studies with 139,693 participants. Most studies were cross-sectional and conducted in high-income countries. The data synthesis across 26 studies revealed the PIP prevalence: the median was 34.6%, the interquartile range was 25.9-63.2%, and the range was 6.5-95.8%. The certainty of this evidence was very low due to the risk of bias, imprecision, and inconsistency. These findings show that PIP is a prevalent issue in the CEE region. Further well-designed studies conducted across countries are needed to strengthen the existing evidence and increase the generalizability of findings.

• MeSH
• lidé MeSH
• nevhodné předepisování * MeSH
• prevalence MeSH
• senioři MeSH
• studie případů a kontrol MeSH
• Check Tag
• lidé MeSH
• senioři MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH
• systematický přehled MeSH
• Geografické názvy
• Evropa epidemiologie   MeSH
• východní Evropa epidemiologie   MeSH

Background: Drug-related problems (DRPs) which arise from potentially inappropriate medications (PIMs) are a common problem in older people with multi-morbidity and polypharmacy. Aim: To develop an integrated PIM clinical decision support tool for identification of DRPs in geriatric multi-morbid polypharmacy patients, using the EU(7)-PIM and EURO-FORTA lists, with a focus on high-risk medications. Methods: The integrated PIM tool used the information on PIMs in both databases-the EU(7)-PIM and EURO-FORTA. PIMs were classified into four color groups based on risk profile: high-risk PIMs (should be avoided in older patients) as red, moderate-risk PIMs (require dose and/or treatment duration adjustment) as yellow, low-risk PIMs (low DRP risk) as green, and questionable PIMs (incomplete/missing information) as grey. Results: The summarized list of the high-risk (red and some grey) PIMs contained 81 active substances and medication classes. According to the ATC classification, most of the high-risk PIMs (n = 60, 74.1%) belong to the A, C, and N medication groups and 50.6% (n = 41) of the high-risk PIMs have currently marketing authorization in Estonia. The preliminary list of the moderate- and low-risk (yellow, green, and other grey) PIMs contained 240 active substances and medication classes, but sub-classification of this category into one or another group depends mainly on an individual patient´s clinical characteristics in a concrete analyzed study sample and needs further research. Conclusion: The integrated clinical decision support tool based on the EU(7)-PIM and EURO-FORTA criteria addresses the need for more efficient identification of DRPs. It can be applied to identify PIMs and geriatric prescribing problems in different health care settings, and also in a context of little clinical information available.

• Klíčová slova
• Estonia, clinical decision support tool, drug related problems, multi-morbidity, older adults, polypharmacy, potentially inappropriate medications,
• Publikační typ
• časopisecké články MeSH

BACKGROUND: The European Union (EU)(7)-PIM (potentially inappropriate medication) list presents the most comprehensive and up-to-date tool for evaluation of PIM prescribing in Europe; however, several country-specific studies have documented lower specificity of this list on pharmaceutical markets of some countries. The aim of our study was to describe approval rates and marketing of PIMs stated by EU(7)-PIM criteria in six EU countries [in comparison with the American Geriatric Society (AGS) Beers 2015 criteria]. METHODS: Research teams of six EU countries (Czech Republic, Spain, Portugal, Serbia, Hungary and Turkey) participated in this study conducted by WG1b EU COST Action IS1402 group in the period October 2015-November 2018. Data on approval rates of PIMs and their availability on pharmaceutical markets have been obtained from databases of national drug-regulatory institutes and up-to-date drug compendia. The EU(7)-PIM list and AGS Beers 2015 Criteria (Section 1) were applied. RESULTS: PIMs from EU(7)-PIM list were approved for clinical use more often than those from the AGS Beers 2015 criteria (Section 1). Approval rates for EU(7)-PIMs ranged from 42.8% in Serbia to 71.4% in Spain (for AGS criteria only from 36.4% to 65.1%, respectively). Higher percentages of approved PIMs were documented in Spain (71.4%), Portugal (67.1%) and Turkey (67.5%), lower in Hungary (55.5%), Czech Republic (50.2%) and Serbia (42.8%). The majority of approved PIMs were also currently marketed in all countries except in Turkey (19.8-21.7% not marketed PIMs) and less than 20% of PIMs were available as over-the-counter medications (except in Turkey, 46.4-48.1%). CONCLUSIONS: The EU(7)-PIM list was created for utilization in European studies; however, applicability of this list is still limited in some countries, particularly in Eastern and Central Europe. The EU project EUROAGEISM H2020 (2017-2021) that focuses on PIM prescribing and regulatory measures in Central and Eastern European countries must consider these limits.

• Klíčová slova
• PIMs, aged, geriatrics, potentially inappropriate medications, regulatory measures,
• Publikační typ
• časopisecké články 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.

• Klíčová slova
• Age-related changes, Ageism, Drug prescribing, Frailty, Observational studies, Older patients, Polypharmacy, Potentially inappropriate medications, Randomized controlled trials,
• MeSH
• geriatrické hodnocení MeSH
• lékové předpisy normy   statistika a číselné údaje   MeSH
• lidé MeSH
• nevhodné předepisování statistika a číselné údaje   MeSH
• polypharmacy * MeSH
• prevalence MeSH
• randomizované kontrolované studie jako téma statistika a číselné údaje   MeSH
• rizikové faktory MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• seznam potenciálně nevhodných léčiv statistika a číselné údaje   MeSH
• věkové faktory MeSH
• Check Tag
• lidé MeSH
• mužské pohlaví MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• přehledy MeSH
• Geografické názvy
• Evropa MeSH
• Turecko MeSH

• Publikační typ
• práce podpořená grantem MeSH
• úvodníky MeSH

Authors analyze actual situation in treatment of cardiovascular diseases in older patients. Different groups of recommended drugs are discussed separately; possible risks for elderly patients are stressed. Angiotensin converting enzyme inhibitors-this group is widely used in older patients because of their hypotensive effect, positive influence on cardiac failure, and positive modulation of endothelial dysfunction. The risk of hyperkalemia must be considered. Antiaggregants and anticoagulants are proved as potent prophylactic treatment, but the associated risk of gastrointestinal bleeding must be weighed very carefully. Bradycardia related to β-blockers, especially in combination with other medications lowering the heart rate must be taken into account. Otherwise, this group brings the highest profit in cardiovascular diseases as for morbidity and mortality. Attention is paid to calcium channel blockers, statins, diuretics, nitrates, and digoxin. A table listing the possible side effects and clinical symptoms of overdose by medications most frequently used in the elderly concludes the article.

• MeSH
• incidence MeSH
• kardiovaskulární látky terapeutické užití   MeSH
• kardiovaskulární nemoci farmakoterapie   epidemiologie   MeSH
• komorbidita MeSH
• lidé středního věku MeSH
• lidé MeSH
• medicína založená na důkazech MeSH
• nežádoucí účinky léčiv epidemiologie   MeSH
• rizikové faktory MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• přehledy MeSH
• Názvy látek
• kardiovaskulární látky MeSH

1. Older people have substantial interindividual variability in health, disability, age-related changes, polymorbidity, and associated polypharmacy, making generalization of prescribing recommendations difficult. 2. Medication use in older adults is often inappropriate and erroneous, partly because of the complexities of prescribing and partly because of many patient, provider, and health system factors that substantially influence the therapeutic value of medications in aged people. 3. A high prevalence of medication errors in older adults results on the one hand from accumulation of factors that contribute to medication errors in all age groups, such as polypharmacy, polymorbidity, enrollment in several disease-management programmes, and fragmentation of care. On the other hand, specific geriatric aspects play a role in these medication errors; these include age-related pharmacological changes, lack of specific evidence on the efficacy and safety of medications, underuse of comprehensive geriatric assessment, less availability of drug formulations offering geriatric doses, and inadequate harmonization of geriatric recommendations across Europe. 4. The dearth of geriatric clinical pharmacology and clinical pharmacy services compounds the difficulties. 5. There are gaps in research and clinical practice that lead to frequent medication errors in older adults, which must be solved by future studies and by regulatory measures in order to support errorless and appropriate use medications in these people.

• MeSH
• geriatrické hodnocení MeSH
• lékařská praxe - způsoby provádění organizace a řízení   normy   MeSH
• lékové předpisy normy   MeSH
• lidé MeSH
• medikační omyly prevence a kontrola   MeSH
• polypharmacy * MeSH
• rizikové faktory MeSH
• rozhodování MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• Check Tag
• lidé MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH