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Book Details
Abstract
With the use of multiple medications in the elderly patient comes the risk of drug-related problems. This issue covers polypharmacy in the elderly patient with topics that include: The Interplay between Polypharmacy, Geriatric Conditions, and Adverse Drug Reactions, Factors Leading to Excessive Polypharmacy, Clinical Practice Guidelines for Chronic Diseases and How They Contribute to Polypharmacy, Polypharmacy in Nursing Home Residents, Psychotropic Polypharmacy, Deprescribing Trials: Methods to Reduce Polypharmacy and the Impact on Prescribing and Clinical Outcomes, Ethical Framework for Medication Discontinuation in Nursing Home Residents with Limited Life Expectancy, Pharmacokinetics in the Elderly and the Interaction with Polypharmacy, Medication Adherence to Multi-drug Regimens, Improvements in Electronic Prescribing to Reduce Inappropriate Medication Use and Polypharmacy, and Tools to Decrease Polypharmacy.
Table of Contents
| Section Title | Page | Action | Price |
|---|---|---|---|
| Front Cover | Cover | ||
| Clinics in Geriatric Medicine | i | ||
| Copyright Page | ii | ||
| Table of Contents | vii | ||
| Contributors | iii | ||
| Preface: Polypharmacy | xiii | ||
| Chapter 1. Factors Leading to Excessive Polypharmacy | 159 | ||
| NUMBER OF MEDICATIONS | 159 | ||
| OCCURRENCE OF POLYPHARMACY | 160 | ||
| CONSEQUENCES OF POLYPHARMACY | 161 | ||
| FACTORS ASSOCIATED WITH POLYPHARMACY | 162 | ||
| PATIENT-RELATED FACTORS | 163 | ||
| CLINICAL CONDITIONS | 164 | ||
| PHYSICIAN-RELATED FACTORS | 165 | ||
| FACTORS RELATED TO THE INTERACTION BETWEEN PATIENT AND PHYSICIAN | 166 | ||
| SUMMARY | 167 | ||
| REFERENCES | 167 | ||
| Chapter 2. Polypharmacy, Adverse Drug Reactions, and Geriatric Syndromes | 173 | ||
| EPIDEMIOLOGY | 174 | ||
| CONSEQUENCES OF POLYPHARMACY | 175 | ||
| CLINICAL APPROACH TO IMPROVING POLYPHARMACY | 180 | ||
| SUMMARY | 182 | ||
| REFERENCES | 183 | ||
| Chapter 3. Clinical Practice Guidelines for Chronic Diseases—Understanding and Managing Their Contribution to Polypharmacy | 187 | ||
| DEFINITIONS AND EPIDEMIOLOGY OF POLYPHARMACY | 188 | ||
| PROBLEM OF POLYPHARMACY | 188 | ||
| BURDEN OF MULTIPLE ILLNESSES | 188 | ||
| COST TO THE HEALTH CARE SYSTEMS | 189 | ||
| IS POLYPHARMACY ALWAYS BAD? | 190 | ||
| ANALYZING EVIDENCE-BASED MEDICINE IN THE CONTEXT OF MULTIPLE DISEASES | 191 | ||
| WAYS OF DECREASING POLYPHARMACY WITHOUT TENSION WITH GUIDELINES | 191 | ||
| GUIDELINES VERSUS POLYPHARMACY | 192 | ||
| REFERENCES | 194 | ||
| Chapter 4. Factors Associated With Polypharmacy in Nursing Home Residents | 199 | ||
| METHODS | 199 | ||
| RESULTS | 200 | ||
| DISCUSSION | 213 | ||
| SUMMARY | 214 | ||
| DISCLOSURE | 214 | ||
| REFERENCES | 214 | ||
| Chapter 5. Outcomes of Polypharmacy in Nursing Home Residents | 217 | ||
| METHODS | 217 | ||
| RESULTS | 217 | ||
| SUMMARY | 231 | ||
| DISCLOSURES | 231 | ||
| REFERENCES | 231 | ||
| Chapter 6. Deprescribing Trials: Methods to Reduce Polypharmacy and the Impact on Prescribing and Clinical Outcomes | 237 | ||
| THE RISKS OF POLYPHARMACY | 237 | ||
| CHALLENGES OF DISCONTINUING MEDICATIONS | 238 | ||
| INTERVENTIONS TO REDUCE MEDICATIONS: IMPACT ON PRESCRIBING AND OUTCOMES | 242 | ||
| DEPRESCRIBING TRIALS TO REDUCE MEDICATIONS: IMPACT ON PRESCRIBING AND OUTCOMES | 243 | ||
| EFFECTIVENESS OF TRIALS TO REDUCE MEDICATION EXPOSURE | 249 | ||
| SUMMARY | 249 | ||
| REFERENCES | 251 | ||
| Chapter 7. Ethical Framework for Medication Discontinuation in Nursing Home Residents with Limited Life Expectancy | 255 | ||
| REVIEW OF ETHICAL PRINCIPLES | 256 | ||
| APPLYING A 4-STAGE ETHICAL FRAMEWORK TO PRESCRIBING CHALLENGES: CLINICIAL CASES | 259 | ||
| PRACTICAL ISSUES | 266 | ||
| SUMMARY | 269 | ||
| REFERENCES | 271 | ||
| Chapter 8. Pharmacokinetics and Pharmacodynamic Changes Associated with Aging and Implications for Drug Therapy | 273 | ||
| PHARMACOKINETICS | 274 | ||
| ABSORPTION | 274 | ||
| DISTRIBUTION | 275 | ||
| METABOLISM | 277 | ||
| EXCRETION | 277 | ||
| PHARMACODYNAMICS | 279 | ||
| IMPLICATIONS FOR POLYPHARMACY | 280 | ||
| ADVERSE DRUG REACTIONS | 281 | ||
| DRUG INTERACTIONS | 282 | ||
| SUMMARY | 283 | ||
| REFERENCES | 284 | ||
| Chapter 9. Medication Adherence to Multidrug Regimens | 287 | ||
| MEASUREMENT | 288 | ||
| CONCEPTUAL FRAMEWORK OF BARRIERS TO MEDICATION ADHERENCE | 290 | ||
| EVIDENCE | 293 | ||
| STRATEGIES FOR IMPROVING ADHERENCE | 293 | ||
| LESSONS FOR FUTURE RESEARCH | 296 | ||
| SUMMARY | 297 | ||
| ACKNOWLEDGMENTS | 297 | ||
| REFERENCES | 298 | ||
| Chapter 10. Electronic Prescribing and Other Forms of Technology to Reduce Inappropriate Medication Use and Polypharmacy in Older People: A Review of Current Evidence | 301 | ||
| BACKGROUND | 302 | ||
| OVERVIEW OF CURRENT EVIDENCE FOR E-PRESCRIBING AND OTHER FORMS OF TECHNOLOGY TO REDUCE INAPPROPRIATE MEDICATION USE AND POLYPHARMACY IN OLDER PEOPLE | 305 | ||
| DISCUSSION | 314 | ||
| SUMMARY | 317 | ||
| REFERENCES | 317 | ||
| Chapter 11. Tools to Reduce Polypharmacy | 323 | ||
| INTERVENTIONS TO IMPROVE PRESCRIBING | 324 | ||
| THE BEERS CRITERIA | 325 | ||
| IMPROVED PRESCRIBING IN THE ELDERLY TOOL, ALSO KNOWN AS THE CANADIAN CRITERIA | 325 | ||
| SCREENING TOOL TO ALERT DOCTORS TO RIGHT TREATMENTS AND SCREENING TOOL OF OLDER PERSONS’ POTENTIALLY INAPPROPRIATE PRESCRIPTIONS | 325 | ||
| MEDICATION APPROPRIATENESS INDEX | 330 | ||
| FIT FOR THE AGED CRITERIA | 333 | ||
| THE ASSESS, REVIEW, MINIMIZE, OPTIMIZE, REASSESS | 334 | ||
| GOOD PALLIATIVE-GERIATRIC PRACTICE ALGORITHM | 335 | ||
| PATIENT-FOCUSED DRUG SURVEILLANCE | 336 | ||
| GERIATRIC RISK ASSESSMENT MEDGUIDE | 336 | ||
| PRESCRIBING OPTIMIZATION METHOD | 336 | ||
| ANTICHOLINERGIC RISK SCALE | 337 | ||
| PRISCUS LIST | 337 | ||
| SUMMARY | 338 | ||
| REFERENCES | 339 | ||
| Index | 343 |