Document Detail

Minimizing inappropriate medications in older populations: a 10-step conceptual framework.
MedLine Citation:
PMID:  22385783     Owner:  NLM     Status:  MEDLINE    
The increasing burden of harm resulting from the use of multiple drugs in older patient populations represents a major health problem in developed countries. Approximately 1 in 4 older patients admitted to hospitals are prescribed at least 1 inappropriate medication, and up to 20% of all inpatient deaths are attributable to potentially preventable adverse drug reactions. To minimize this drug-related iatrogenesis, we propose a quality use of medicine framework that comprises 10 sequential steps: 1) ascertain all current medications; 2) identify patients at high risk of or experiencing adverse drug reactions; 3) estimate life expectancy in high-risk patients; 4) define overall care goals in the context of life expectancy; 5) define and confirm current indications for ongoing treatment; 6) determine the time until benefit for disease-modifying medications; 7) estimate the magnitude of benefit versus harm in relation to each medication; 8) review the relative utility of different drugs; 9) identify drugs that may be discontinued; and 10) implement and monitor a drug minimization plan with ongoing reappraisal of drug utility and patient adherence by a single nominated clinician. The framework aims to reduce drug use in older patients to the minimum number of essential drugs, and its utility is demonstrated in reference to a hypothetic case study. Further studies are warranted in validating this framework as a means for assisting clinicians to make more appropriate prescribing decisions in at-risk older patients.
Ian A Scott; Leonard C Gray; Jennifer H Martin; Charles A Mitchell
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Publication Detail:
Type:  Case Reports; Journal Article; Review     Date:  2012-03-03
Journal Detail:
Title:  The American journal of medicine     Volume:  125     ISSN:  1555-7162     ISO Abbreviation:  Am. J. Med.     Publication Date:  2012 Jun 
Date Detail:
Created Date:  2012-05-25     Completed Date:  2012-07-16     Revised Date:  2013-02-27    
Medline Journal Info:
Nlm Unique ID:  0267200     Medline TA:  Am J Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  529-37.e4     Citation Subset:  AIM; IM    
Copyright Information:
Copyright © 2012 Elsevier Inc. All rights reserved.
Department of Internal Medicine and Clinical Epidemiology, Princess Alexandra Hospital, Brisbane, Australia.
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MeSH Terms
Aged, 80 and over
Drug Administration Schedule
Drug Toxicity / prevention & control*
Iatrogenic Disease / prevention & control*
Life Expectancy*
Comment In:
Am J Med. 2013 Feb;126(2):e9   [PMID:  23331457 ]
Am J Med. 2012 Jun;125(6):523-4   [PMID:  22513193 ]

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