Optimization of drug therapy in elderly individuals admitted to a geriatric unit

Antoine Piau,1 Yoann Huet,1 Adeline Gallini,2,3 Laurine Andre,1–3 Bruno Vellas,1–3 Fati Nourhashemi1–3 1Gérontopôle, Centre Hospitalier Universitaire Toulouse, Toulouse, France; 2UMR1027, INSERM-University of Toulouse, Toulouse, France; 3Department...

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Autores principales:	Piau A, Huet Y, Gallini A, Andre L, Vellas B, Nourhashemi F
Formato:	article
Lenguaje:	EN
Publicado:	Dove Medical Press 2017
Materias:	elderly inappropriate prescriptions geriatric unit Geriatrics RC952-954.6
Acceso en línea:	https://doaj.org/article/e348535748a74099bdf2be4046da4f89
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spelling	oai:doaj.org-article:e348535748a74099bdf2be4046da4f892021-12-02T06:50:58ZOptimization of drug therapy in elderly individuals admitted to a geriatric unit1178-1998https://doaj.org/article/e348535748a74099bdf2be4046da4f892017-10-01T00:00:00Zhttps://www.dovepress.com/optimization-of-drug-therapy-in-elderly-individuals-admitted-to-a-geri-peer-reviewed-article-CIAhttps://doaj.org/toc/1178-1998Antoine Piau,1 Yoann Huet,1 Adeline Gallini,2,3 Laurine Andre,1–3 Bruno Vellas,1–3 Fati Nourhashemi1–3 1Gérontopôle, Centre Hospitalier Universitaire Toulouse, Toulouse, France; 2UMR1027, INSERM-University of Toulouse, Toulouse, France; 3Department of Epidemiology and Public Health, Centre Hospitalier Universitaire Toulouse, Toulouse, France Background: A substantial share of adverse drug events involves inappropriate prescribing (IP). Specialized geriatric units are supposed to pay particular attention to prescribing appropriateness and to promoting a higher prescribing quality.Objective: The objective of this study was to evaluate the reality of such assessment and optimization in real life (usual care) in a population of elderly individuals admitted to a geriatric unit.Method: This is an observational study including all older patients admitted to an acute geriatric unit over a 6-month period. As part of usual care, the geriatrician is supposed to detect potentially inappropriate medication and potential prescribing omission using validated tools. The primary outcome was the prevalence rate of therapeutic modifications motivated by treatment optimization (stop, switch, or introduction). Multivariate logistic regression analyses were performed to identify the factors associated with therapeutic discontinuation.Results: A total of 216 patients were included. The mean age was 85.7 years. Included patients had an average of 7.2±3.3 drugs at admission and 5.8±2.7 at discharge. IP was highly prevalent in our study where about 63% of the patients had experienced at least one modification because of overuse. The most commonly discontinued medications were drugs used to treat gastroesophageal reflux disease and peptic ulcer disease and serotonin reuptake inhibitor antidepressants. The most commonly introduced medications were analgesics and warfarin. By using multivariate analysis, we found that patient age and number of drugs on admission were significantly associated with medication discontinuation during hospital stay.Conclusion: In this real-life study of all patients admitted to a Geriatric Post Emergency Unit, 83% of the patients had a treatment modification during hospital stay. The most original result of our study is the clear reduction in polypharmacy during hospitalization. Keywords: elderly, inappropriate prescriptions, geriatric unit, overuse, misuse, underusePiau AHuet YGallini AAndre LVellas BNourhashemi FDove Medical Pressarticleelderlyinappropriate prescriptionsgeriatric unitGeriatricsRC952-954.6ENClinical Interventions in Aging, Vol Volume 12, Pp 1691-1696 (2017)
institution	DOAJ
collection	DOAJ
language	EN
topic	elderly inappropriate prescriptions geriatric unit Geriatrics RC952-954.6
spellingShingle	elderly inappropriate prescriptions geriatric unit Geriatrics RC952-954.6 Piau A Huet Y Gallini A Andre L Vellas B Nourhashemi F Optimization of drug therapy in elderly individuals admitted to a geriatric unit
description	Antoine Piau,1 Yoann Huet,1 Adeline Gallini,2,3 Laurine Andre,1–3 Bruno Vellas,1–3 Fati Nourhashemi1–3 1Gérontopôle, Centre Hospitalier Universitaire Toulouse, Toulouse, France; 2UMR1027, INSERM-University of Toulouse, Toulouse, France; 3Department of Epidemiology and Public Health, Centre Hospitalier Universitaire Toulouse, Toulouse, France Background: A substantial share of adverse drug events involves inappropriate prescribing (IP). Specialized geriatric units are supposed to pay particular attention to prescribing appropriateness and to promoting a higher prescribing quality.Objective: The objective of this study was to evaluate the reality of such assessment and optimization in real life (usual care) in a population of elderly individuals admitted to a geriatric unit.Method: This is an observational study including all older patients admitted to an acute geriatric unit over a 6-month period. As part of usual care, the geriatrician is supposed to detect potentially inappropriate medication and potential prescribing omission using validated tools. The primary outcome was the prevalence rate of therapeutic modifications motivated by treatment optimization (stop, switch, or introduction). Multivariate logistic regression analyses were performed to identify the factors associated with therapeutic discontinuation.Results: A total of 216 patients were included. The mean age was 85.7 years. Included patients had an average of 7.2±3.3 drugs at admission and 5.8±2.7 at discharge. IP was highly prevalent in our study where about 63% of the patients had experienced at least one modification because of overuse. The most commonly discontinued medications were drugs used to treat gastroesophageal reflux disease and peptic ulcer disease and serotonin reuptake inhibitor antidepressants. The most commonly introduced medications were analgesics and warfarin. By using multivariate analysis, we found that patient age and number of drugs on admission were significantly associated with medication discontinuation during hospital stay.Conclusion: In this real-life study of all patients admitted to a Geriatric Post Emergency Unit, 83% of the patients had a treatment modification during hospital stay. The most original result of our study is the clear reduction in polypharmacy during hospitalization. Keywords: elderly, inappropriate prescriptions, geriatric unit, overuse, misuse, underuse
format	article
author	Piau A Huet Y Gallini A Andre L Vellas B Nourhashemi F
author_facet	Piau A Huet Y Gallini A Andre L Vellas B Nourhashemi F
author_sort	Piau A
title	Optimization of drug therapy in elderly individuals admitted to a geriatric unit
title_short	Optimization of drug therapy in elderly individuals admitted to a geriatric unit
title_full	Optimization of drug therapy in elderly individuals admitted to a geriatric unit
title_fullStr	Optimization of drug therapy in elderly individuals admitted to a geriatric unit
title_full_unstemmed	Optimization of drug therapy in elderly individuals admitted to a geriatric unit
title_sort	optimization of drug therapy in elderly individuals admitted to a geriatric unit
publisher	Dove Medical Press
publishDate	2017
url	https://doaj.org/article/e348535748a74099bdf2be4046da4f89
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Optimization of drug therapy in elderly individuals admitted to a geriatric unit

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