American Journal of Geriatric Pharmacotherapy 

About: American Journal of Geriatric Pharmacotherapy is an academic journal. The journal publishes majorly in the area(s): Population & Polypharmacy. It has an ISSN identifier of 1876-7761. Over the lifetime, 356 publications have been published receiving 16279 citations.

Polypharmacy in elderly patients

Abstract: Background: Polypharmacy (ie, the use of multiple medications and/or the administration of more medications than are clinically indicated, representing unnecessary drug use) is common among the elderly. Objective: The goal of this research was to provide a description of observational studies examining the epidemiology of polypharmacy and to review randomized controlled studies that have been published in the past 2 decades designed to reduce polypharmacy in older adults. Methods: Materials for this review were gathered from a search of the MEDLINE database (1986-June 2007) and International Pharmaceutical Abstracts (1986-June 2007) to identify articles in people aged >65 years. We used a combination of the following search terms: polypharmacy, multiple medications, polymedicine, elderly, geriatric , and aged . A manual search of the reference lists from identified articles and the authors' article files, book chapters, and recent reviews was conducted to identify additional articles. From these, the authors identified those studies that measured polypharmacy. Results: The literature review found that polypharmacy continues to increase and is a known risk factor for important morbidity and mortality. There are few rigorously designed intervention studies that have been shown to reduce unnecessary polypharmacy in older adults. The literature review identified 5 articles, which are included here. All studies showed an improvement in polypharmacy. Conclusions: Many studies have found that various numbers of medications are associated with negative health outcomes, but more research is needed to further delineate the consequences associated with unnecessary drug use in elderly patients. Health care professionals should be aware of the risks and fully evaluate all medications at each patient visit to prevent polypharmacy from occurring.

A Systematic Review of Barriers to Medication Adherence in the Elderly: Looking Beyond Cost and Regimen Complexity

Abstract: Background Medication nonadherence is a common problem among the elderly. Objective To conduct a systematic review of the published literature describing potential nonfinancial barriers to medication adherence among the elderly. Methods The PubMed and PsychINFO databases were searched for articles published in English between January 1998 and January 2010 that (1) described “predictors,” “facilitators,” or “determinants” of medication adherence or that (2) examined the “relationship” between a specific barrier and adherence for elderly patients (ie, ≥65 years of age) in the United States. A manual search of the reference lists of identified articles and the authors' files and recent review articles was conducted. The search included articles that (1) reviewed specific barriers to medication adherence and did not solely describe nonmodifiable predictors of adherence (eg, demographics, marital status), (2) were not interventions designed to address adherence, (3) defined adherence or compliance and specified its method of measurement, and (4) involved US participants only. Nonsystematic reviews were excluded, as were studies that focused specifically on people who were homeless or substance abusers, or patients with psychotic disorders, tuberculosis, or HIV infection, because of the unique circumstances that surround medication adherence for each of these populations. Results Nine studies met inclusion criteria for this review. Four studies used pharmacy records or claims data to assess adherence, 2 studies used pill count or electronic monitoring, and 3 studies used other methods to assess adherence. Substantial heterogeneity existed among the populations studied as well as among the measures of adherence, barriers addressed, and significant findings. Some potential barriers (ie, factors associated with nonadherence) were identified from the studies, including patient-related factors such as disease-related knowledge, health literacy, and cognitive function; drug-related factors such as adverse effects and polypharmacy; and other factors including the patient-provider relationship and various logistical barriers to obtaining medications. None of the reviewed studies examined primary nonadherence or nonpersistence. Conclusion Medication nonadherence in the elderly is not well described in the literature, despite being a major cause of morbidity, and thus it is difficult to draw a systematic conclusion on potential barriers based on the current literature. Future research should focus on standardizing medication adherence measurements among the elderly to gain a better understanding of this important issue.

Does the addition of a pharmacist transition coordinator improve evidence-based medication management and health outcomes in older adults moving from the hospital to a long-term care facility? Results of a randomized, controlled trial.

Abstract: Background: Poorly executed transfers of older patients from hospitals to long-term care facilities carry the risk of fragmentation of care, poor clinical outcomes, inappropriate use of emergency department services, and hospital readmission. Objective: This study was conducted to assess the impact of adding a pharmacist transition coordinator on evidence-based medication management and health outcomes in older adults undergoing first-time transfer from a hospital to a long-term care facility. Methods: This randomized, single-blind, controlled trial enrolled hospitalized older adults awaiting transfer to a long-term residential care facility for the first time. Patients were randomized either to receive the services of the pharmacist transition coordinator (intervention group) or to undergo the usual hospital discharge process (control group). The intervention included medication-management transfer summaries from hospitals, timely coordinated medication reviews by accredited community pharmacists, and case conferences with physicians and pharmacists. The primary outcome was the quality of prescribing, measured using the Medication Appropriateness Index (MAI). Secondary outcomes were emergency department visits, hospital readmissions, adverse drug events, falls, worsening mobility, worsening behaviors, increased confusion, and worsening pain. Results: One hundred ten older adults (67 women, 43 men; mean [SD] age, 82.7 [6.4] years) were recruited from 3 metropolitan hospitals and assigned to 85 metropolitan long-term care facilities. Fifty-six patients were randomized to the intervention group and 54 to the control group; 44 patients in each group were evaluable at 8-week follow-up. There were no significant differences in baseline characteristics between treatment groups, with the exception of the number of medications discontinued during hospitalization: a mean of 1.1 more drugs was discontinued in the control group compared with the intervention group (P = 0.011). The majority of patients (35 [62.5%] in the intervention group, 41 [76.0%] in the control group) changed physicians as part of the transition to a long-term care facility. At 8-week follow-up, there was no change in MAI from baseline in the intervention group, whereas it had worsened in the control group (mean [95% CI], 2.5 [1.4–3.7] vs 6.5 [3.9–9.1], respectively; P = 0.007). Patients who received the intervention and were alive at follow-up exhibited a significant protective effect of the intervention against worsening pain (relative risk ratio [95% CI], 0.55 [0.32–0.94]; P = 0.023) and hospital usage (ie, the combination of emergency department visits and hospital readmissions) (0.38 [0.15–0.99]; P = 0.035), but did not differ from control patients in terms of adverse drug events (1.05 [0.66–1.68]), falls (1.19 [0.71–1.99]), worsening mobility (0.39 [0.13–1.15]), worsening behaviors (0.52 [0.25–1.10]), or increased confusion (0.59 [0.28–1.22]). When data for patients who had died were included, the intervention had no effect on hospital usage in all patients (0.58 [0.28–1.21]). Conclusions: Older people transferring from hospital to a long-term care facility are vulnerable to fragmentation of care and adverse events. In this study, use of a pharmacist transition coordinator improved aspects of inappropriate use of medicines across health sectors.

Psychoactive drug abuse in older adults.

Abstract: Background: Misuse and abuse of legal and illegal drugs constitute a growing problem among older adults.

Polypharmacy as a risk factor for adverse drug reactions in geriatric nursing home residents.

Abstract: Objective: Polypharmacy is a well-known risk factor for adverse drug reactions (ADRs). The objective of this study was to determine the relationship between the use of ≥9 different scheduled medications and the occurrence of ADRs in geriatric nursing home residents. Methods: This was a retrospective cohort study conducted in a 1200-bed, county-owned and -operated, longterm care skilled nursing facility Participants were 335 subjects aged ≥65 years who were present at the facility during the index month of October 1998. Hospice, respite care, and rehabilitation patients were excluded. Use of ≥9 different scheduled medications was defined a priori as routinely administered medications, excluding as-needed agents, topical agents, 1-time administration, and vaccinations. ADRs were identified by voluntary reporting and by chart review during a 12-month period. ADRs were assessed individually by 2 clinical pharmacists applying the Naranjo ADR probability scale. Results: A total of 207 ADRs were identified. The cohort receiving ≥9 scheduled medications (n = 43) experienced 53 ADRs, compared with 154 ADRs in the control group receiving Conclusion: A positive correlation between the use of ≥9 different scheduled medications and ADRs was found among these geriatric nursing home residents.