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Polypharmacy

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281. Who’s responsible for polypharmacy in the elderly?

Who’s responsible for polypharmacy in the elderly? Who's responsible for polypharmacy in the elderly? Who’s responsible for polypharmacy in the elderly? | | November 20, 2017 211 Shares There’s a common affliction that’s rampant in my practice, but it’s not a gastrointestinal condition. It’s called polypharmacy, and it refers to patients who are receiving a pile of prescription and other medications. I see this daily in the office and in the hospital. It’s common enough to see patients who (...) are receiving 10 or more medications, usually from 3 or 4 medical specialists. Of course, every doctor feels that he is prescribing only what is truly necessary. If an individual has an internist, a cardiologist, a gastroenterologist, a urologist and a dermatologist — which is not unusual — and each prescribes only 2 or 3 essential medicines, then polypharmacy is created. Each day, the patient swallows a chemistry set. First of all, I don’t know how these patients, who are often elderly, manage

2017 KevinMD blog

282. Prevalence and clinical correlates of polypharmacy in bipolar disorder: a systematic review and metaanalysis

Prevalence and clinical correlates of polypharmacy in bipolar disorder: a systematic review and metaanalysis Print | PDF PROSPERO This information has been provided by the named contact for this review. CRD has accepted this information in good faith and registered the review in PROSPERO. CRD bears no responsibility or liability for the content of this registration record, any associated files or external websites. Email salutation (e.g. "Dr Smith" or "Joanne") for correspondence: Organisation

2015 PROSPERO

283. Polypharmacy in the treatment of respiratory tract infections

Polypharmacy in the treatment of respiratory tract infections Print | PDF PROSPERO This information has been provided by the named contact for this review. CRD has accepted this information in good faith and registered the review in PROSPERO. CRD bears no responsibility or liability for the content of this registration record, any associated files or external websites. Email salutation (e.g. "Dr Smith" or "Joanne") for correspondence: Organisation web address: Timing and effect measures Timing

2015 PROSPERO

284. Efficacy and tolerability of antipsychotic polypharmacy for schizophrenia spectrum disorders. A systematic review and meta-analysis of individual patient data

Efficacy and tolerability of antipsychotic polypharmacy for schizophrenia spectrum disorders. A systematic review and meta-analysis of individual patient data Print | PDF PROSPERO This information has been provided by the named contact for this review. CRD has accepted this information in good faith and registered the review in PROSPERO. CRD bears no responsibility or liability for the content of this registration record, any associated files or external websites. Email salutation (e.g. "Dr

2015 PROSPERO

285. Contribution of polypharmacy and potentially inappropriate medication use to inferior survival in older patients with aggressive lymphoma. (Abstract)

Contribution of polypharmacy and potentially inappropriate medication use to inferior survival in older patients with aggressive lymphoma.

2016 Journal of Clinical Oncology

286. Exploring the Impact of Human Papillomavirus Status, Comorbidity, Polypharmacy, and Treatment Intensity on Outcome of Elderly Oropharyngeal Cancer Patients Treated With Radiation Therapy With or Without Chemotherapy. (Abstract)

Exploring the Impact of Human Papillomavirus Status, Comorbidity, Polypharmacy, and Treatment Intensity on Outcome of Elderly Oropharyngeal Cancer Patients Treated With Radiation Therapy With or Without Chemotherapy.

2016 Biology and Physics

287. Acute Pancreatitis Associated With Antipsychotic Medication: Evaluation of Clinical Features, Treatment, and Polypharmacy in a Series of Cases. (Abstract)

Acute Pancreatitis Associated With Antipsychotic Medication: Evaluation of Clinical Features, Treatment, and Polypharmacy in a Series of Cases. Antipsychotic-associated acute pancreatitis presents like pancreatitis from other causes, requiring clinical judgment, tests, and decision support to establish the diagnosis. Many new cases of atypical antipsychotic pancreatitis have been established, and current decision supports are out of date as antipsychotic polypharmacy is being recognized. Given (...) were selected for normally and non-normally distributed data.We summarized 41 cases of acute pancreatitis associated with antipsychotics, and cases were younger men (59%) (mean age, 39 years). Alcohol, diabetes, and previous lithiasis appeared in 27%; polypharmacy was associated with 53% of cases, and 80% had concomitant use of other medication linked to pancreatitis.The median lipase, amylase, and alkaline phosphate during acute presentation were 1210 IU/L (range, 243-5482 IU/L), 492 IU/L (range

2016 Journal of Clinical Psychopharmacology

288. Development of an intervention to improve appropriate polypharmacy in older people in primary care using a theory-based method. Full Text available with Trip Pro

Development of an intervention to improve appropriate polypharmacy in older people in primary care using a theory-based method. It is advocated that interventions to improve clinical practice should be developed using a systematic approach and intervention development methods should be reported. However, previous interventions aimed at ensuring that older people receive appropriate polypharmacy have lacked details on their development. This study formed part of a multiphase research project (...) which aimed to develop an intervention to improve appropriate polypharmacy in older people in primary care.The target behaviours for the intervention were prescribing and dispensing of appropriate polypharmacy to older patients by general practitioners (GPs) and community pharmacists. Intervention development followed a systematic approach, including previous mapping of behaviour change techniques (BCTs) to key domains from the Theoretical Domains Framework that were perceived by GPs and pharmacists

2016 BMC Health Services Research

289. Guidance to manage inappropriate polypharmacy in older people: systematic review and future developments. Full Text available with Trip Pro

Guidance to manage inappropriate polypharmacy in older people: systematic review and future developments. Single disease state led evidence-based guidelines do not provide sufficient coverage of issues of multimorbidities, with the cumulative impact of recommendations often resulting in overwhelming medicines burden. Inappropriate polypharmacy increases the likelihood of adverse drug events, drug interactions and non-adherence. Areas covered: A detailed description of a pan-European initiative (...) , 'Stimulating Innovation Management of Polypharmacy and Adherence in the Elderly, SIMPATHY', which is a project funded by the European Commission to support innovation across the European Union. This includes a systematic review of the literature aiming to summarize and review critically current policies and guidelines on polypharmacy management in older people. The policy driven, evidence-based approach to managing inappropriate polypharmacy in Scotland is described, with consideration of a change

2016 Expert opinion on drug safety

290. Frailty, Kidney Function, and Polypharmacy: The Atherosclerosis Risk in Communities (ARIC) Study. Full Text available with Trip Pro

Frailty, Kidney Function, and Polypharmacy: The Atherosclerosis Risk in Communities (ARIC) Study. Frail individuals are at increased risk for poor outcomes, including adverse drug events. Kidney function is often compromised in frailty and is a key consideration in medication choice and dosing; however, creatinine-based measures of kidney function may be biased in frail individuals.Observational study.4,987 community-dwelling older men and women with complete data who participated in visit 5

2016 American Journal of Kidney Diseases

291. Health professional perspectives on the management of multimorbidity and polypharmacy for older patients in Australia. Full Text available with Trip Pro

Health professional perspectives on the management of multimorbidity and polypharmacy for older patients in Australia. delivering appropriate care for patients with multimorbidity and polypharmacy is increasingly challenging. Challenges for individual healthcare professions are known, but only little is known about overall healthcare team implementation of best practice for these patients.to explore current approaches to multimorbidity management, and perceived barriers and enablers to deliver (...) appropriate medications management for community-dwelling patients with multimorbidity and polypharmacy, from a broad range of healthcare professional (HCP) perspectives in Australia.this qualitative study used semi-structured interviews to gain in-depth understanding of HCPs' perspectives on the management of multimorbidity and polypharmacy. The interview guide was based on established principles for the management of multimorbidity in older patients. HCPs in rural and metropolitan Victoria and South

2016 Age and ageing

292. Theory-Based Interventions to Improve Medication Adherence in Older Adults Prescribed Polypharmacy: A Systematic Review. Full Text available with Trip Pro

Theory-Based Interventions to Improve Medication Adherence in Older Adults Prescribed Polypharmacy: A Systematic Review. Previous interventions have shown limited success in improving medication adherence in older adults, and this may be due to the lack of a theoretical underpinning.This review sought to determine the effectiveness of theory-based interventions aimed at improving medication adherence in older adults prescribed polypharmacy and to explore the extent to which psychological theory (...) informed their development.Eight electronic databases were searched from inception to March 2015, and extensive hand-searching was conducted.Interventions delivered to older adults (populations with a mean/median age of ≥65 years) prescribed polypharmacy (four or more regular oral/non-oral medicines) were eligible. Studies had to report an underpinning theory and measure at least one adherence and one clinical/humanistic outcome.Data were extracted independently by two reviewers and included details

2016 Drugs & Aging

293. Is Polypharmacy Associated with Frailty in Older People? Results From the ESTHER Cohort Study. Full Text available with Trip Pro

Is Polypharmacy Associated with Frailty in Older People? Results From the ESTHER Cohort Study. To investigate the relationship between polypharmacy and frailty.Longitudinal, observational cohort study.Saarland, Germany.3,058 community-dwelling adults aged between 57 and 84 years.Frailty was assessed according to the frailty phenotype, described by Fried et al. Polypharmacy and hyperpolypharmacy were defined as the concomitant use of five or more and 10 or more drugs, respectively. We assessed (...) associations between polypharmacy and prevalent and incident frailty within 3 years of follow-up by logistic regression models controlled for multiple potential confounders including comorbidity. Additionally, cubic splines were used to assess dose-response associations.Polypharmacy was reported in 39.1% (n = 1,194), and hyperpolypharmacy in 8.9% (n = 273) of participants. Prevalent frailty was present in 271 (8.9%) participants; 186 (9.3%) of 1,998 non-frail participants with follow-up data became frail

2016 Journal of the American Geriatrics Society

294. Delirium is not associated with anticholinergic burden or polypharmacy in older patients on admission to an acute hospital: an observational case control study. Full Text available with Trip Pro

Delirium is not associated with anticholinergic burden or polypharmacy in older patients on admission to an acute hospital: an observational case control study. Older people are commonly prescribed multiple medications, including medications with anticholinergic effects. Polypharmacy and anticholinergic medications may be risk factors for the development of delirium.Patients from a medical admission unit who were over 70, with DSM-IV diagnosed delirium and patients without delirium, were (...) prescribed ≥5 drugs and 29.0 % ≥10 drugs. The median ACB score was 1 and the median ADS score was 1.5. 73.4 % of patients had an ACB score of ≥1 and 73.0 % had a ADS score ≥1. There was no association between: number of drugs prescribed, rate of polypharmacy, rate of excessive polypharmacy, ACB score and ADS score, and a diagnosis of delirium on admission. Only acetylcholinesterase inhibitor use predicted delirium (OR 3.86, p = 0.04) and the number of drugs prescribed was negatively correlated with age

2016 BMC Geriatrics

295. 'Potentially inappropriate or specifically appropriate?' Qualitative evaluation of general practitioners views on prescribing, polypharmacy and potentially inappropriate prescribing in older people. Full Text available with Trip Pro

'Potentially inappropriate or specifically appropriate?' Qualitative evaluation of general practitioners views on prescribing, polypharmacy and potentially inappropriate prescribing in older people. Potentially inappropriate prescribing (PIP) is common in older people in primary care, as evidenced by a significant body of quantitative research. However, relatively few qualitative studies have investigated the phenomenon of PIP and its underlying processes from the perspective of general (...) and July 2013. Interviews were conducted by one interviewer and audio recorded. Interviews were transcribed verbatim and a thematic analysis was conducted.Seventeen semi-structured interviews were conducted (13 male; 4 female). Three main, inter-related themes emerged (complex prescribing environment, paternalistic doctor-patient relationship, and relevance of PIP concept). Patient complexity (e.g. polypharmacy, multimorbidity), as well as prescriber complexity (e.g. multiple prescribers, poor

2016 BMC Family Practice

296. Older age, chronic medical conditions and polypharmacy in Himalayan trekkers in Nepal: an epidemiologic survey and case series. Full Text available with Trip Pro

Older age, chronic medical conditions and polypharmacy in Himalayan trekkers in Nepal: an epidemiologic survey and case series. The number of tourists in Nepal doubled between 2003 and 2013 is nearly 800 000. With the increased popularity of trekking, the number of those with pre-existing medical conditions requiring access to healthcare is likely to increase. We therefore sought to characterize the demographics and health status of trekkers on the Everest Base Camp route in the Solukhumbu (...) represented. Excluding acetazolamide, older trekkers (age >50 years) were more likely than younger ones to take medications (OR = 2.17; 95% CI 1.57-3.00; P <0.05). Acetazolamide use was not related to age.Our findings illustrate a wide variety of medical conditions present in trekkers in Nepal with wide-ranging potential complications that could pose difficulties in areas where medical care is scarce and evacuation difficult. Our cases illustrate the potential problems polypharmacy poses in trekkers

2016 Journal of Travel Medicine

297. Polypharmacy-an Upward Trend with Unpredictable Effects. Full Text available with Trip Pro

Polypharmacy-an Upward Trend with Unpredictable Effects. Guideline-oriented treatments can lead to polypharmacy, i.e., the simultaneous long-term use of multiple drugs. Polypharmacy mainly affects elderly patients. The goal of this review is to survey the current scientific evidence about polypharmacy, focusing on clinical endpoints, and to point out implications for medical practice and research.This selective literature review is based on pertinent publications that were retrieved (...) by a selective search in PubMed employing the terms "polypharmacy AND general practice." Selected references were considered as well.In Germany, polypharmacy currently affects approximately 42% of persons over age 65, with an ongoing upward trend. 20-25% of these patients receive potentially inappropriate drugs. Approximately 86% of the daily doses of drugs taken by persons over age 65 are prescribed by general practitioners. There is inconsistent evidence on the question whether polypharmacy affects

2016 Deutsches Arzteblatt international

298. Adverse Outcomes in Relation to Polypharmacy in Robust and Frail Older Hospital Patients. (Abstract)

Adverse Outcomes in Relation to Polypharmacy in Robust and Frail Older Hospital Patients. To explore the relationship between polypharmacy and adverse outcomes among older hospital inpatients stratified according to their frailty status.A prospective study of 1418 patients, aged 70 and older, admitted to 11 hospitals across Australia.The interRAI Acute Care (AC) assessment tool was used for all data collection, including the derivation of a frailty index calculated using the deficit (...) accumulation method. Polypharmacy was categorized into 3 groups based on the number of regular drugs prescribed. Recorded adverse health outcomes were falls, delirium, functional and cognitive decline, discharge to a higher level of care and in-hospital mortality.Patients had a mean (SD) age of 81 (6.8) years and 55% were women. Polypharmacy (5-9 drugs per day) was observed in 48.2% (n = 684) and hyper-polypharmacy (≥10 drugs) in 35.0% (n = 497). Severe cognitive impairment was significantly associated

2016 Journal of the American Medical Directors Association

299. Comorbidity and polypharmacy in people with dementia: insights from a large, population-based cross-sectional analysis of primary care data. Full Text available with Trip Pro

Comorbidity and polypharmacy in people with dementia: insights from a large, population-based cross-sectional analysis of primary care data.

2016 Age and ageing

300. Defining polypharmacy in the elderly: a systematic review protocol. Full Text available with Trip Pro

Defining polypharmacy in the elderly: a systematic review protocol. Ageing--along with its associated physiological and pathological changes--places individuals at a higher risk of multimorbidity and treatment-related complications. Today, polypharmacy, a common and important problem related to drug use, occurs subsequent to this multimorbidity in the elderly in all populations. In recent decades, several scientific investigations have studied polypharmacy and its correlates, using different (...) approaches and definitions, and their results have been inconclusive. Differences in definitions and approaches in these studies form a barrier against reaching a conclusion regarding the risk factors and consequences of polypharmacy. It is therefore imperative to establish an appropriate definition of polypharmacy.A systematic review will be conducted using PubMed, Scopus, Web of Science, EMBASE, PsycINFO and AgeLine bibliographic databases, as well as the grey literature on polypharmacy in older adults

2016 BMJ open

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