| Minimizing inappropriate medications in older populations: a 10-step conceptual framework. | |
| | |
MedLine Citation:
|
PMID: 22385783 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
|
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. |
| | |
Authors:
|
Ian A Scott; Leonard C Gray; Jennifer H Martin; Charles A Mitchell |
Related Documents
:
|
22887783 - Halloysite clay nanotubes for resveratrol delivery to cancer cells. 9916313 - Isocratic, simultaneous reversed-phase high-performance liquid chromatographic estimati... 6813793 - The effect of quality assurance review on implementation of an automatic stop-order pol... |
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. |
Affiliation:
|
Department of Internal Medicine and Clinical Epidemiology, Princess Alexandra Hospital, Brisbane, Australia. ian_scott@health.qld.gov.au |
Export Citation:
|
APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
|
Aged Aged, 80 and over Drug Administration Schedule Drug Toxicity / prevention & control* Female Goals Humans Iatrogenic Disease / prevention & control* Life Expectancy* Polypharmacy* |
| Comments/Corrections | |
Comment In:
|
Am J Med. 2013 Feb;126(2):e9
[PMID:
23331457
]
Am J Med. 2012 Jun;125(6):523-4 [PMID: 22513193 ] |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
Previous Document: Motivational dynamics of eating regulation: a self-determination theory perspective.
Next Document: Amiodarone-associated optic neuropathy: a critical review.