Optimising drug treatment for elderly people: the prescribing cascade
Paula A. Rochon,Jerry H. Gurwitz +1 more
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This article will focus on an under-recognised, and largely preventable drug related problem that is termed the “prescribing cascade”, which is an important area to target both to improve the quality of medical care for elderly people and to reduce the costs of health care for this population.Abstract:
The most frequent medical intervention performed by a doctor is the writing of a prescription. Because chronic illness increases with advancing age, older people are more likely to have conditions that require drug treatment. Advanced age, frailty, and increased use of drugs are all factors that contribute to a patient's risk of developing a drug related problem. As many as 28% of hospital admissions in the United States of older people are as a result of drug related problems,1 up to 70% of which are attributed to adverse reactions to drugs.1 Creating optimal drug regimens that meet the complex needs of elderly people requires thought and careful planning.
Inappropriate prescribing is expensive. In a recent study the costs of preventable adverse drug events—namely, injury resulting from a drug related medical intervention—occurring during a stay in hospital were estimated to be $2.8m (£1.75) annually in two large American teaching hospitals.2 The national cost of managing the consequences of inappropriate prescribing remains uncertain. One estimate has put the annual cost of drug related morbidity and mortality in outpatient clinics at $76.6bn.3 Drug related morbidity and mortality is an important area to target both to improve the quality of medical care for elderly people and to reduce the costs of health care for this population.
A prescriber can do little to modify age related physiological changes in trying to minimise the likelihood that an older person will develop an adverse drug reaction. However, when assessing a patient who is already taking drugs, a doctor should always consider the development of any new signs and symptoms as a possible consequence of the patient's drug treatment. This article will focus on an under-recognised, and largely preventable drug related problem that we have termed the “prescribing cascade.” 4 The prescribing cascade begins …read more
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ACCF/AHA Expert Consensus Document ACCF/AHA 2011 Expert Consensus Document on Hypertension in the Elderly A Report of the American College of Cardiology Foundation Task Force on Clinical Expert Consensus Documents
Wilbert S. Aronow,Jerome L. Fleg,Carl J. Pepine,Nancy T. Artinian,George Bakris,Alan S. Brown,Keith C. Ferdinand,Mary Ann Forciea,William H. Frishman,Cheryl Jaigobin,John B. Kostis,Giuseppi Mancia,Suzanne Oparil,Eduardo Ortiz,Efrain Reisin,Michael W. Rich,Douglas D. Schocken,Michael A. Weber,Deborah J. Wesley,Robert A. Harrington,Eric R. Bates,Deepak L. Bhatt,Charles R. Bridges,Mark J. Eisenberg,Victor A. Ferrari,John D. Fisher,Timothy J. Gardner,Federico Gentile,Michael F. Gilson,Mark A. Hlatky,Alice K. Jacobs,Sanjay Kaul,David J. Moliterno,Debabrata Mukherjee,Robert Rosenson,James H. Stein,Howard H. Weitz +36 more
TL;DR: The reader should view the expert consensus document as the best attempt of the ACCF and document cosponsors to inform and guide clinical practice in areas where rigorous evidence may not yet be available or evidence to date is not widely applied to clinical practice.
Journal ArticleDOI
ACCF/AHA 2011 expert consensus document on hypertension in the elderly: A report of the american college of cardiology foundation task force on clinical expert consensus documents
Wilbert S. Aronow,Jerome J Fleg,Carl J. Pepine,Nancy T. Artinian,George L. Bakris,Alan S. Brown,Keith C. Ferdinand,Mary Ann Forciea,William H. Frishman,Cheryl Jaigobin,John B Kostis,Giuseppi Mancia,Suzanne Oparil,Eduardo Ortiz,Efrain Reisin,Michael W. Rich,Douglas D. Schocken,Michael Weber,Deborah J. Wesley +18 more
TL;DR: The ACCF/AHA Expert Consensus Document as discussed by the authors was developed as an expert consensus document by the American College of Cardiology Foundation (ACCF) and the American Heart Association (AHA), in collaboration with the American Academy of Neurology (AAN), AAN, the American Physicians Association (ACP), American Geriatrics Society (AGS), the American Society of Hypertension (ASH), the ASCN), ASCN, ASCP, American Society for Preventive Cardiology (ASPC), the Association of Black Cardiologists (ABC), and the European
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Benefits and risks of self medication.
TL;DR: Monitoring systems, a partnership between patients, physicians and pharmacists and the provision of education and information to all concerned on safe self medication are proposed strategies for maximising benefit and minimising risk.
Journal ArticleDOI
ACCF/AHA 2011 expert consensus document on hypertension in the elderly: a report of the American College of Cardiology Foundation Task Force on Clinical Expert Consensus documents developed in collaboration with the American Academy of Neurology, American Geriatrics Society, American Society for Preventive Cardiology, American Society of Hypertension, American Society of Nephrology, Association of Black Cardiologists, and European Society of Hypertension
Wilbert S. Aronow,Jerome L. Fleg,Carl J. Pepine,Nancy T. Artinian,George L. Bakris,Alan Brown,Keith C. Ferdinand,Mary Ann Forciea,William H. Frishman,Cheryl Jaigobin,John B. Kostis,Giuseppi Mancia,Suzanne Oparil,Eduardo Ortiz,Efrain Reisin,Michael W. Rich,Douglas D. Schocken,Michael Weber,Deborah J. Wesley +18 more
TL;DR: In this paper, Bhatt et al. discuss the role of race conditions in the development of FAHA and discuss the importance of race safety in the FAHA program and its role in FAHA.
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Adverse Drug Reactions as Cause of Hospital Admissions: Results from the Italian Group of Pharmacoepidemiology in the Elderly (GIFA)
Graziano Onder,Graziano Onder,Claudio Pedone,Claudio Pedone,Francesco Landi,Matteo Cesari,Cecilia Della Vedova,Roberto Bernabei,Giovanni Gambassi,Giovanni Gambassi +9 more
TL;DR: The most common clinical manifestations and drugs most frequently responsible for ADR‐related hospital admissions in an older population are described and independent factors predictive of these ADRs are identified.
References
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The costs of adverse drug events in hospitalized patients
David W. Bates,Nathan Spell,David J. Cullen,Elisabeth Burdick,Nan M. Laird,Laura A. Petersen,Stephen D. Small,Bobbie Jean Sweitzer,Lucian L. Leape +8 more
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Comparison of an Antiinflammatory Dose of Ibuprofen, an Analgesic Dose of Ibuprofen, and Acetaminophen in the Treatment of Patients with Osteoarthritis of the Knee
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