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Polypharmacy

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41. Geriatric Polypharmacy: Pharmacist as Key Facilitator in Assessing for Falls Risk: 2019 Update. (PubMed)

Geriatric Polypharmacy: Pharmacist as Key Facilitator in Assessing for Falls Risk: 2019 Update. This article highlights the significant health impact of falls among older adults. An emphasis is placed on the vital role of the pharmacist, regardless of practice setting, in assessing and reducing falls risk for this growing population. In addition, the importance of a stepwise comprehensive approach to falls assessment by pharmacists in collaboration with other clinicians is elucidated.Copyright

2019 Clinics in Geriatric Medicine

42. Comparison of 71 bipolar disorder pharmacotherapies for kidney disorder risk: The potential hazards of polypharmacy. (Full text)

Comparison of 71 bipolar disorder pharmacotherapies for kidney disorder risk: The potential hazards of polypharmacy. This study compared the largest set of bipolar disorder pharmacotherapies to date (71 drugs and drug combinations) for risk of kidney disorders (KDs).This retrospective observational study used the IBM MarketScan® database to analyze data on 591,052 adults with bipolar disorder without prior nephropathy, for onset of KDs (of "moderate" or "high" severity) following (...) to compare more complex polypharmacies, higher HRs were consistently observed. Most regimens containing lithium, MSAs, or antipsychotics had a higher risk than "No drug" (p < 0.05). The risk for "all" and "severe" KDs was highest respectively on monoamine oxidase inhibitors (MAOIs) (HR = 2.66, p = 5.73 × 10-5), and a lithium-containing four-class combination (HR = 5.30, p = 2.46 × 10-9). The HR for lithium monotherapy was 1.82 (p = 4.73 × 10-17) for "severe" KDs.The limitations inherent

2019 Journal of Affective Disorders

43. Polypharmacy and drug-drug interactions in older and younger people living with HIV: the POPPY study. (Full text)

Polypharmacy and drug-drug interactions in older and younger people living with HIV: the POPPY study. Polypharmacy (use of ≥ 5 medications) increases the risk of drug-drug interactions and can lead to negative health outcomes. This study aimed to review the medications of people living with HIV (PLWH) and HIV negative controls in the POPPY study and evaluate the frequency of polypharmacy and potential drug-drug interactions (PDDI).Potential drug-drug interactions between non-antiretroviral (ARV (...) ) drugs were analysed using the Lexicomp® database, and PDDI between non-ARV and ARV drugs using the Liverpool drug interaction database. Between-group differences were assessed using Chi-squared, Mann-Whitney U and Kruskal Wallis tests.This analysis included 698 PLWH ≥50 years, 374 PLWH <50 years and 304 HIV-negative controls ≥50 years. The prevalence of polypharmacy was 65.8% in older PLWH, 48.1% in younger PLWH, and 13.2% in the HIV negative group. When ARVs were excluded 29.8% of older PLWH

2019 Antiviral Therapy

44. Shared Decision-Making in Chronic Patients with Polypharmacy: An Interventional Study for Assessing Medication Appropriateness. (Full text)

Shared Decision-Making in Chronic Patients with Polypharmacy: An Interventional Study for Assessing Medication Appropriateness. Potentially inappropriate medications are associated with polypharmacy and polypathology. Some interventions such as pharmacotherapy reviews have been designed to reduce the prescribing of inappropriate medications. The objective of this study is to evaluate how effective a decision-making support tool is for determining medication appropriateness in patients with one (...) or more chronic diseases (hypertension, dyslipidaemia, and/or diabetes) and polypharmacy in the primary care setting. For this, a quasi-experimental study (randomised, controlled and multicentre) has been developed. The study compares an intervention group, which assesses medication appropriateness by applying a decision support tool, with a control group that follows the usual clinical practice. The intervention included a decision support tool in paper format, where participants were informed about

2019 Journal of clinical medicine Controlled trial quality: uncertain

45. Polypharmacy Increases Risk of Dyspnea Among Adults With Serious, Life-Limiting Diseases. (PubMed)

Polypharmacy Increases Risk of Dyspnea Among Adults With Serious, Life-Limiting Diseases. Polypharmacy is associated with dyspnea in cross-sectional studies, but associations have not been determined in longitudinal analyses. Statins are commonly prescribed but their contribution to dyspnea is unknown. We determined whether polypharmacy was associated with dyspnea trajectory over time in adults with advanced illness enrolled in a statin discontinuation trial, overall, and in models stratified (...) by statin discontinuation.Using data from a parallel-group unblinded pragmatic clinical trial (patients on statins ≥3 months with life expectancy of 1 month to 1 year, enrolled in the parent study between June 3, 2011, and May 2, 2013, n = 308/381 [81%]), we restricted analyses to patients with available baseline medication count and ≥1 dyspnea score. Polypharmacy was assessed by self-reported chronic medication count. Dyspnea trajectory group, our primary outcome, was determined over 24 weeks using

2019 American Journal of Hospice and Palliative Medicine

46. A qualitative exploration of the experiences of community dwelling older adults with sensory impairment/s receiving polypharmacy on their pharmaceutical care journey. (Full text)

A qualitative exploration of the experiences of community dwelling older adults with sensory impairment/s receiving polypharmacy on their pharmaceutical care journey. Most developed countries have increasing numbers of community dwelling older people with both multi-morbidity and sensory impairment that includes visual, hearing or dual impairment. Older people with sensory impairment are more likely to have chronic health conditions and to be in receipt of polypharmacy (>4 medicines (...) ). It is important to understand their experience of pharmaceutical care provision to facilitate a safe, appropriate and person centred approach.this study explored the pharmaceutical care experiences and perspectives of older people with sensory impairment receiving polypharmacy.exploratory qualitative study with semi-structured telephone or face-to-face interviews with community dwelling older adults with sensory impairment receiving polypharmacy in Scotland in 2016.in total, 23 interviews were conducted

2019 Age and ageing

47. Confronting Medicine's Dichotomies: Older Adults' Use of Interpretative Repertoires in Negotiating the Paradoxes of Polypharmacy and Deprescribing. (PubMed)

Confronting Medicine's Dichotomies: Older Adults' Use of Interpretative Repertoires in Negotiating the Paradoxes of Polypharmacy and Deprescribing. To address the risks associated with polypharmacy, health care providers are investigating the feasibility of deprescribing programs as part of routine medical care to reduce medication burden to older adults. As older adults are enrolled in these programs, they are confronted with two dominant and legitimate accounts of medications, labeled

2019 Qualitative Health Research

48. Polypharmacy among Older Individuals with COPD: Trends between 2000 and 2015 in Quebec, Canada. (PubMed)

Polypharmacy among Older Individuals with COPD: Trends between 2000 and 2015 in Quebec, Canada. The treatment of chronic obstructive pulmonary disease (COPD) and concomitant diseases requires several medications. Yet there is little data on how the pharmacological burden progressed over time among older individuals with COPD. We aimed to: 1) describe the proportion of older adults with COPD in Quebec, Canada, that were exposed to polypharmacy (≥10, ≥15 or ≥20 medications/year) between 2000 (...) between the years. The average number of drugs used increased from 12.0 in 2000 to 14.8 in 2015. The proportion of individuals exposed to polypharmacy increased (≥10 drugs: 62.0% to 74.6%;≥15 drugs: 31.2% to 45.4%; ≥20 drugs: 12.3% to 22.4%). The proportion of individuals receiving long-acting bronchodilators increased from 18.7% in 2000 to 69.6% in 2015. The use of short-acting bronchodilators decreased from 81.5% to 67.9%, and that of inhaled corticosteroids from 60.6% to 26.0%. The proportion

2019 COPD

49. Polypharmacy and Kidney Function in Community-Dwelling Adults Age 60 Years and Older: A Prospective Observational Study. (Full text)

Polypharmacy and Kidney Function in Community-Dwelling Adults Age 60 Years and Older: A Prospective Observational Study. Information on the impact of polypharmacy on kidney function in older adults is limited. We prospectively investigated the association between intake of total number of drugs or nonsteroidal anti-inflammatory drugs (NSAIDs) and kidney function.Our study is a prospective observational analysis of the 2-year Zurich Multiple Endpoint Vitamin D Trial in Knee Osteoarthritis

2019 Journal of the American Medical Directors Association

50. Addressing the polypharmacy challenge in older people with multimorbidity (APOLLO-MM): study protocol for an in-depth ethnographic case study in primary care. (Full text)

Addressing the polypharmacy challenge in older people with multimorbidity (APOLLO-MM): study protocol for an in-depth ethnographic case study in primary care. Polypharmacy is on the rise. It is burdensome for patients and is a common source of error and adverse drug reactions, especially among older adults. Health policy advises clinicians to practice medicines optimisation-a person-centred approach to safe, effective medicines use. There has been little research exploring older patients (...) of observations in the home and clinical settings; interviews with patients and professionals; cultural probe activities; video recordings of clinical consultations and interprofessional talk; documents. Our analysis will illuminate the everyday practices of polypharmacy from a range of lay and professional perspectives; the institutional contexts within which these practices play out and the sense-making work that sustains-or challenges-these practices. Our research will adopt a 'practice theory' lens

2019 BMJ open

51. Comorbidity and polypharmacy among women living with HIV in British Columbia. (PubMed)

Comorbidity and polypharmacy among women living with HIV in British Columbia. To characterize comorbid disease and medication burden among women living with HIV (WLWH) in British Columbia (BC), Canada.We examined baseline data from 267 WLWH and 276 HIV-negative females, ≥19 years, enrolled in the Children and Women: Antiretrovirals and Markers of Aging (CARMA) cohort.Self-reported demographic, medical condition, medication, vitamin, and substance exposure data were collected at baseline CARMA

2019 AIDS

52. Complex polypharmacy in bipolar disorder: Side effect burden, adherence, and response predictors. (PubMed)

Complex polypharmacy in bipolar disorder: Side effect burden, adherence, and response predictors. Complex polypharmacy (CP) is common in bipolar disorder (BD). We assessed the associations between CP, adherence, and side effect burden, and patient traits associated with clinical improvement in relationship to CP.We conducted a secondary analysis of 482 adult BD participants in the Bipolar CHOICE trial. We examined the associations between CP (use of ≥3 BD medications) and non-adherence (missing

2019 Journal of Affective Disorders

53. Polypharmacy and drug-drug interactions in HIV-infected subjects in the region of Madrid, Spain: a population-based study. (Full text)

Polypharmacy and drug-drug interactions in HIV-infected subjects in the region of Madrid, Spain: a population-based study. Drug-drug interactions (DDIs) involving antiretrovirals (ARVs) tend to cause harm if unrecognized, especially in the context of multiple co-morbidity and polypharmacy.A database linkage was established between the regional drug dispensing registry of Madrid and the Liverpool HIV DDI database (January-June 2017). Polypharmacy was defined as the use of ≥5 non-HIV medications (...) , and DDIs were classified by a traffic-light ranking for severity. HIV-uninfected controls were also included.A total of 22,945 patients living with HIV (PLWH) and 6,613,506 uninfected individuals had received medications. Antiretroviral therapy regimens were predominantly based on integrase inhibitors (51.96%). Polypharmacy was significantly higher in PLWH (32.94%) than uninfected individuals (22.16%; P<0.001), and this difference was consistently observed across all age strata except for individuals

2019 Clinical Infectious Diseases

54. Polypharmacy among older Australians, 2006-2017: a population-based study. (Full text)

Polypharmacy among older Australians, 2006-2017: a population-based study. To estimate the prevalence of polypharmacy among Australians aged 70 years or more, 2006-2017.Analysis of a random 10% sample of Pharmaceutical Benefits Scheme (PBS) data for people aged 70 or more who were dispensed PBS-listed medicines between 1 January 2006 and 31 December 2017.Prevalence of continuous polypharmacy (five or more unique medicines dispensed during both 1 April - 30 June and 1 October - 31 December (...) in a calendar year) among older Australians, and the estimated number of people affected in 2017; changes in prevalence of continuous polypharmacy among older concessional beneficiaries, 2006-2017.In 2017, 36.1% of older Australians were affected by continuous polypharmacy, or an estimated 935 240 people. Rates of polypharmacy were higher among women than men (36.6% v 35.4%) and were highest among those aged 80-84 years (43.9%) or 85-89 years (46.0%). The prevalence of polypharmacy among PBS concessional

2019 Medical Journal of Australia

55. Physicians' role in the development of inappropriate polypharmacy among older adults in Iran: a qualitative study. (Full text)

Physicians' role in the development of inappropriate polypharmacy among older adults in Iran: a qualitative study. The use of unnecessary or excessive medications (inappropriate polypharmacy) is a major health challenge among older adults which is driven by several factors. This study aims to provide in-depth descriptions of the physician's role in the development of inappropriate polypharmacy among older adults in Iran.Qualitative content analysis of interviews, field notes and other relevant (...) perspectives which highlight the role of physicians in the development of inappropriate polypharmacy among older adults in Iran under the main concept of poor medical practice.This study provides valuable insight on the role of physicians in the development of inappropriate polypharmacy among the elderly in the healthcare setting in Iran by exploring the viewpoints of physicians, patients, caregivers and pharmacists. Physicians can be an influential factor in tackling this challenge through proper

2019 BMJ open

56. How do potentially inappropriate medications and polypharmacy affect mortality in frail and non-frail cognitively impaired older adults? A cohort study. (Full text)

How do potentially inappropriate medications and polypharmacy affect mortality in frail and non-frail cognitively impaired older adults? A cohort study. To test whether the use of potentially inappropriate central nervous system acting medications, proton pump inhibitors (PPIs) or polypharmacy are associated with mortality in cognitively impaired older adults and whether frailer people are at greater risk of harm.A cohort study nested within the Cognitive Function and Ageing Study II (...) , a population representative cohort study of the older population in Cambridgeshire, Nottingham and Newcastle, UK.A total of 1154 cognitively impaired participants, aged 65 years or older.Any use of antipsychotics, antidepressants, other anticholinergic medication, benzodiazepines or PPIs, polypharmacy (5-9) and hyperpolypharmacy (≥10 reported medications) were ascertained at baseline. Frailty was assessed using the Fried criteria.Mortality up to 8 years follow-up. HRs associated with potentially

2019 BMJ open

57. The Association Between Polypharmacy and Physical Function in Older Adults: a Systematic Review. (PubMed)

The Association Between Polypharmacy and Physical Function in Older Adults: a Systematic Review. Reduced physical function and polypharmacy (PPha) are two highly prevalent negative effects of aging, which are expected to increase more, since demographic aging is expected to grow rapidly within the next decades. Previous research suggests that polypharmacy (PPha) is a predictor of poor physical function and vice versa in older adults and therefore we conducted a systematic review

2019 Journal of General Internal Medicine

58. Switching to antipsychotic monotherapy vs. staying on antipsychotic polypharmacy in schizophrenia: A systematic review and meta-analysis. (PubMed)

Switching to antipsychotic monotherapy vs. staying on antipsychotic polypharmacy in schizophrenia: A systematic review and meta-analysis. While recent meta-analyses have reported the superiority of antipsychotic polypharmacy (APP) over antipsychotic monotherapy (APM) in schizophrenia, switching to APM can be beneficial in terms of side effects. To determine whether patients receiving APP should switch to APM or stay on APP, we conducted a systematic review and meta-analysis.Randomized

2019 Schizophrenia Research

59. Risk Factors for Polypharmacy in Elderly Patients With Cancer Pain. (PubMed)

Risk Factors for Polypharmacy in Elderly Patients With Cancer Pain. Polypharmacy (PP) is a burden in elderly patients with cancer pain; however, risk factors for PP remain unclear. The purpose of this study was to investigate the risk factors for PP in this patient population.We retrospectively reviewed the medical charts of patients aged ≥65 years with cancer pain who were treated at Osaka University Hospital between February 2014 and June 2016 according to the World Health Organization 3-step

2019 American Journal of Hospice and Palliative Medicine

60. Antidepressant prescription patterns and CNS polypharmacy with antidepressants among children, adolescents, and young adults: a population-based study in Sweden. (Full text)

Antidepressant prescription patterns and CNS polypharmacy with antidepressants among children, adolescents, and young adults: a population-based study in Sweden. This study examines trends in antidepressant drug dispensations among young people aged 0-24 years in Sweden during the period 2006-2013, as well as prescription patterns and central nervous system (CNS) polypharmacy with antidepressants. Using linkage of Swedish national registers, we identified all Swedish residents aged 0-24 years (...) categories were prescribed selective serotonin reuptake inhibitors, received their prescriptions from psychiatric specialist care, and had treatment periods of over 12 months. Prevalence of CNS polypharmacy (dispensation of other CNS drug classes in addition to antidepressants) increased across age categories, with an overall increase in prevalence from 52.4% in 2006 to 62.1% in 2013. Children experienced the largest increase in polypharmacy of three or more psychotropic drug classes (4.4-10.1

2019 European child & adolescent psychiatry

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