Special ArticleResearch Priorities for Optimizing Geriatric Pharmacotherapy: An International Consensus
Section snippets
Methods
The 2-day inaugural Optimizing geriatric Pharmacotherapy through Pharmacoepidemiology Network (OPPEN) workshop was hosted by the Aging Research Center, Karolinska Institutet. Five research groups devoted to geriatric pharmacotherapy and pharmacoepidemiology from Australia, Belgium, Finland, Italy, and Sweden were represented. Participants included 2 geriatricians, 5 pharmacists, 2 social scientists, a clinical pharmacologist, a nurse, and a biostatistician. Using a modified nominal group
Underuse, Overuse, and Misuse of Medications
The prevalence of inappropriate medication use continues to increase in older people residing in the community and residential aged care settings.3 It has been reported that the majority of emergency hospitalizations for recognized ADEs in older adults result from relatively few commonly used medications.11 For example, up to 60% of US emergency department visits for ADEs in older adults (aged ≥65 years) are the result of 3 drug classes (anticoagulants, diabetes agents, and opioid analgesics).12
Conclusions
Geriatric pharmacotherapy is understudied and treatment recommendations are often based on studies of younger, healthier populations. A range of research priorities were identified for the field of geriatric pharmacotherapy. Issues related to clinical care, health service delivery, research methodologies, and generalizability and application of findings were elucidated. Future studies should aim to address these current gaps and needs to improve medication and health outcomes in older people.
References (87)
- et al.
Prevalence and factors associated with polypharmacy in long-term care facilities: A systematic review
J Am Med Dir Assoc
(2015) - et al.
Prevalence of potentially inappropriate medication use in older adults living in nursing homes: A systematic review
J Am Med Dir Assoc
(2016) - et al.
Medication management policy, practice and research in Australian residential aged care: Current and future directions
Pharmacol Res
(2017) - et al.
Polypharmacy and medication regimen complexity as risk factors for hospitalization among residents of long-term care facilities: A prospective cohort study
J Am Med Dir Assoc
(2016) - et al.
Polypharmacy is associated with higher frailty risk in older people: An 8-year longitudinal cohort study
J Am Med Dir Assoc
(2017) - et al.
Exploration of 100 commonly used drugs and supplements on cognition in older adults
Alzheimers Dement
(2013) - et al.
Geriatric conditions as predictors of increased number of hospital admissions and hospital bed days over one year: Findings of a nationwide cohort of older adults from Taiwan
Arch Gerontol Geriatr
(2014) - et al.
Choosing wisely? Measuring the burden of medications in older adults near the end of life: Nationwide, Longitudinal Cohort Study
Am J Med
(2017) - et al.
Representation of older patients in clinical trials for drug approval in Japan
J Nutr Health Aging
(2014) - et al.
Polypharmacy cutoff and outcomes: Five or more medicines were used to identify community-dwelling older men at risk of different adverse outcomes
J Clin Epidemiol
(2012)
Effects of person-centred care after an event of acute coronary syndrome: Two-year follow-up of a randomised controlled trial
Int J Cardiol
Nursing home placement in the Donepezil and Memantine in Moderate to Severe Alzheimer's Disease (DOMINO-AD) trial: Secondary and post-hoc analyses
Lancet Neurol
Polypharmacy in nursing home residents with severe cognitive impairment: Rresults from the SHELTER Study
Alzheimers Dement
Polypharmacy among adults aged 65 years and older in the United States: 1988‒2010
J Gerontol A Biol Sci Med Sci
The effects of polypharmacy in older adults
Clin Pharmacol Ther
Medication regimen complexity and number of medications as factors associated with unplanned hospitalizations in older people: A population-based cohort study
J Gerontol A Biol Sci Med Sci
Adverse drug events and medication errors in Australia
Int J Qual Health Care
Pharmacoepidemiology in the postmarketing assessment of the safety and efficacy of drugs in older adults
J Gerontol A Biol Sci Med Sci
Nominal group technique: An effective method for obtaining group consensus
Int J Nurs Pract
Emergency hospitalizations for adverse drug events in older Americans
N Engl J Med
US emergency department visits for outpatient adverse drug events, 2013‒2014
JAMA
Alternative medications for medications in the use of high-risk medications in the elderly and potentially harmful drug-disease interactions in the elderly quality measures
J Am Geriatr Soc
Too many, too few, or too unsafe? Impact of inappropriate prescribing on mortality, and hospitalization in a cohort of community-dwelling oldest old
Br J Clin Pharmacol
Longitudinal evaluation of medication underuse in older outpatients and its association with quality of life
Eur J Clin Pharmacol
Medications associated with falls in older people: Systematic review of publications from a recent 5-year period
Eur J Clin Pharmacol
A prospective cohort study of geriatric syndromes among older medical patients admitted to acute care hospitals
J Am Geriatr Soc
Geriatric conditions in acutely hospitalized older patients: Prevalence and one-year survival and functional decline
PLoS One
Medications associated with geriatric syndromes and their prevalence in older hospitalized adults discharged to skilled nursing facilities
J Hosp Med
Association between acute geriatric syndromes and medication-related hospital admissions
Drugs Aging
Risk of mortality associated with antipsychotic monotherapy and polypharmacy among community-dwelling persons with Alzheimer's disease
J Alzheimers Dis
Use of benzodiazepines and related drugs is associated with a risk of stroke among persons with Alzheimer's disease
Int Clin Psychopharmacol
Antidepressants and mortality risk in a dementia cohort: Data from SveDem, the Swedish Dementia Registry
Acta Psychiatr Scand
Socioeconomic inequalities in access to specialized psychotropic prescribing among older Swedes: A register-based study
Eur J Public Health
Contribution of renal impairment to potentially preventable medication-related hospital admissions
Ann Pharmacother
Prescribing for older people with chronic renal impairment
Aust Fam Physician
Ability of older people with dementia or cognitive impairment to manage medicine regimens: A narrative review
Curr Clin Pharmacol
Frailty and potentially inappropriate medication use at nursing home transition
J Am Geriatr Soc
Frailty, polypharmacy, and potentially inappropriate medications in old people: Findings in a representative sample of the French population
Eur J Clin Pharmacol
Is polypharmacy associated with frailty in older people? Results From the ESTHER Cohort Study
J Am Geriatr Soc
Effect of frailty syndrome on treatment compliance in older hypertensive patients
Clin Interv Aging
The association of medication-use and frailty-related factors with gait performance in older oatients
PLoS One
No evidence that frailty modifies the positive impact of antihypertensive treatment in very elderly people: An investigation of the impact of frailty upon treatment effect in the HYpertension in the Very Elderly Trial (HYVET) study, a double-blind, placebo-controlled study of antihypertensives in people with hypertension aged 80 and over
BMC Med
Multimorbidity and polypharmacy 2017
Cited by (33)
Prevalence of multimorbidity and polypharmacy among adults and older adults: a systematic review
2024, The Lancet Healthy LongevityTrajectories of pro re nata (PRN) medication prescribing and administration in long-term care facilities
2021, Research in Social and Administrative PharmacyCitation Excerpt :Death is the most common reason for exiting an RACF9 and administration of PRN opioids, benzodiazepines and antiemetics is noted to be increased at end-of-life.4,10 Conducting longitudinal studies to determine medication use trajectories is an international priority area for geriatric pharmacotherapy research.11 Despite this, little is known about changes in PRN medication prescribing and administration in RACFs over time.
Medication Management in Frail Older People: Consensus Principles for Clinical Practice, Research, and Education
2021, Journal of the American Medical Directors AssociationCitation Excerpt :Evaluation of the cost-effectiveness of RCTs is equally important, particularly in the frail population who are at risk of receiving less clinical benefits from a potentially costly intervention. Frailty status has been hypothesized to better predict medication response than chronological age.18 Frailty could act as an effect modifier to alter the risk-benefit ratio of preventive treatments in chronic diseases.4,25
What Is Really Needed to Provide Effective, Person-Centered Care for Behavioral Expressions of Dementia? Guidance from The Alzheimer's Association Dementia Care Provider Roundtable
2020, Journal of the American Medical Directors AssociationDeprescribing in Nursing Home Residents on Polypharmacy: Incidence and Associated Factors
2019, Journal of the American Medical Directors AssociationPolypharmacy: Something more than just numbers
2019, Medicina Clinica
ECKT is supported by a NHMRC-ARC Dementia Research Development Fellowship. JSB is supported by a NHMRC Dementia Leadership Fellowship.