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Erschienen in: Drugs & Aging 7/2011

01.07.2011 | Current Opinion

Polypharmacy in the Elderly

Can Comprehensive Geriatric Assessment Reduce Inappropriate Medication Use?

verfasst von: Dr Giuseppe Sergi, Marina De Rui, Silvia Sarti, Enzo Manzato

Erschienen in: Drugs & Aging | Ausgabe 7/2011

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Abstract

Polypharmacy is a problem of growing interest in geriatrics with the increase in drug consumption in recent years, particularly among people aged >65 years. The main reasons for polypharmacy are longer life expectancy, co-morbidity and the implementation of evidence-based clinical practice guidelines. However, polypharmacy also has important negative consequences, such as a higher risk of adverse drug reactions and a decline in medication efficacy because of reduced compliance.
Comprehensive geriatric assessment (CGA) has proved effective in reducing the number of prescriptions and daily drug doses for patients by facilitating discontinuation of unnecessary or inappropriate medications. CGA has also demonstrated an ability to optimize treatment by increasing the number of drugs taken in cases where under-treatment has been identified. Greater multidimensional and multidisciplinary efforts are nonetheless needed to tackle polypharmacy-related problems in frail elderly patients.
CGA should help geriatrics staff identify diseases with higher priority for treatment, thereby achieving better pharmacological treatment overall in elderly patients. The patient’s prognosis should also be considered in the treatment prioritization process.
The most appropriate medication regimen should combine existing evidence-based clinical practice guidelines with data gathered from CGA, including social and economic considerations. Furthermore, for prescriptions to remain appropriate, the elderly should periodically undergo medication review, particularly as the risk or presence of multiple co-morbidities increases.
This article aims to highlight the increasing impact of polypharmacy in the elderly and to underscore the role of CGA in achieving the most appropriate pharmacological treatment in this age group.
Literatur
1.
Zurück zum Zitat Hovstadius B, Hovstadius K, Astrand B, et al. Increasing polypharmacy: an individual-based study of the Swedish population 2005–2008. BMC Clin Pharmacol 2010; 10: 16PubMedCrossRef Hovstadius B, Hovstadius K, Astrand B, et al. Increasing polypharmacy: an individual-based study of the Swedish population 2005–2008. BMC Clin Pharmacol 2010; 10: 16PubMedCrossRef
2.
Zurück zum Zitat Haider SI, Johnell K, Thorslund M, et al. Trends in polypharmacy and potential drug-drug interactions across educational groups in elderly patients in Sweden for the period 1992–2002. Int J Clin Pharmacol Ther 2007 Dec; 45(12): 643–53PubMed Haider SI, Johnell K, Thorslund M, et al. Trends in polypharmacy and potential drug-drug interactions across educational groups in elderly patients in Sweden for the period 1992–2002. Int J Clin Pharmacol Ther 2007 Dec; 45(12): 643–53PubMed
3.
Zurück zum Zitat Marengoni A, Rizzuto D, Wang HX, et al. Patterns of chronic multimorbidity in the elderly population. J Am Geriatr Soc 2009 Feb; 57(2): 225–30PubMedCrossRef Marengoni A, Rizzuto D, Wang HX, et al. Patterns of chronic multimorbidity in the elderly population. J Am Geriatr Soc 2009 Feb; 57(2): 225–30PubMedCrossRef
4.
Zurück zum Zitat Franceschi M, Scarcelli C, Niro V, et al. Prevalence, clinical features and avoidability of adverse drug reactions as cause of admission to a geriatric unit: a prospective study of 1756 patients. Drug Saf 2008; 31(6): 545–56PubMedCrossRef Franceschi M, Scarcelli C, Niro V, et al. Prevalence, clinical features and avoidability of adverse drug reactions as cause of admission to a geriatric unit: a prospective study of 1756 patients. Drug Saf 2008; 31(6): 545–56PubMedCrossRef
5.
Zurück zum Zitat Barat I, Andreasen F, Damsgaard EM. Drug therapy in the elderly: what doctors believe and patients actually do. Br J Clin Pharmacol 2001 Jun; 51(6): 615–22PubMedCrossRef Barat I, Andreasen F, Damsgaard EM. Drug therapy in the elderly: what doctors believe and patients actually do. Br J Clin Pharmacol 2001 Jun; 51(6): 615–22PubMedCrossRef
6.
Zurück zum Zitat Rubenstein LZ, Josephson KR, Wieland GD, et al. Effectiveness of a geriatric evaluation unit: a randomized clinical trial. N Engl J Med 1984 Dec 27; 311(26): 1664–70PubMedCrossRef Rubenstein LZ, Josephson KR, Wieland GD, et al. Effectiveness of a geriatric evaluation unit: a randomized clinical trial. N Engl J Med 1984 Dec 27; 311(26): 1664–70PubMedCrossRef
7.
Zurück zum Zitat Stuck AE, Aronow HU, Steiner A, et al. A trial of annual in-home comprehensive geriatric assessments for elderly people living in the community. N Engl J Med 1995 Nov 2; 333(18): 1184–9PubMedCrossRef Stuck AE, Aronow HU, Steiner A, et al. A trial of annual in-home comprehensive geriatric assessments for elderly people living in the community. N Engl J Med 1995 Nov 2; 333(18): 1184–9PubMedCrossRef
8.
Zurück zum Zitat Tulner LR, van Campen JP, Frankfort SV, et al. Changes in under-treatment after comprehensive geriatric assessment: an observational study. Drugs Aging 2010 Oct 1; 27(10): 831–43PubMedCrossRef Tulner LR, van Campen JP, Frankfort SV, et al. Changes in under-treatment after comprehensive geriatric assessment: an observational study. Drugs Aging 2010 Oct 1; 27(10): 831–43PubMedCrossRef
9.
Zurück zum Zitat Lampela P, Hartikainen S, Lavikainen P, et al. Effects of medication assessment as part of a comprehensive geriatric assessment on drug use over a 1-year period: a population-based intervention study. Drugs Aging 2010 Jun 1; 27(6): 507–21PubMedCrossRef Lampela P, Hartikainen S, Lavikainen P, et al. Effects of medication assessment as part of a comprehensive geriatric assessment on drug use over a 1-year period: a population-based intervention study. Drugs Aging 2010 Jun 1; 27(6): 507–21PubMedCrossRef
10.
Zurück zum Zitat Bjerrum L, Søgaard J, Hallas J, et al. Polypharmacy: correlations with sex, age and drug regimen: a prescription database study. Eur J Clin Pharmacol 1998 May; 54(3): 197–202PubMedCrossRef Bjerrum L, Søgaard J, Hallas J, et al. Polypharmacy: correlations with sex, age and drug regimen: a prescription database study. Eur J Clin Pharmacol 1998 May; 54(3): 197–202PubMedCrossRef
11.
Zurück zum Zitat Jyrkkä J, Enlund H, Korhonen MJ, et al. Patterns of drug use and factors associated with polypharmacy and excessive polypharmacy in elderly persons: results of the Kuopio 75+ study: a cross-sectional analysis. Drugs Aging 2009; 26(6): 493–503PubMedCrossRef Jyrkkä J, Enlund H, Korhonen MJ, et al. Patterns of drug use and factors associated with polypharmacy and excessive polypharmacy in elderly persons: results of the Kuopio 75+ study: a cross-sectional analysis. Drugs Aging 2009; 26(6): 493–503PubMedCrossRef
12.
Zurück zum Zitat Crentsil V, Ricks MO, Xue QL, et al. A pharmacoepidemiologic study of community-dwelling, disabled older women: factors associated with medication use. Am J Geriatr Pharmacother 2010 Jun; 8(3): 215–24PubMedCrossRef Crentsil V, Ricks MO, Xue QL, et al. A pharmacoepidemiologic study of community-dwelling, disabled older women: factors associated with medication use. Am J Geriatr Pharmacother 2010 Jun; 8(3): 215–24PubMedCrossRef
13.
Zurück zum Zitat Harugeri A, Joseph J, Parthasarathi G, et al. Prescribing patterns and predictors of high-level polypharmacy in the elderly population: a prospective surveillance study from two teaching hospitals in India. Am J Geriatr Pharmacother 2010 Jun; 8(3): 271–80PubMedCrossRef Harugeri A, Joseph J, Parthasarathi G, et al. Prescribing patterns and predictors of high-level polypharmacy in the elderly population: a prospective surveillance study from two teaching hospitals in India. Am J Geriatr Pharmacother 2010 Jun; 8(3): 271–80PubMedCrossRef
14.
Zurück zum Zitat Dwyer LL, Han B, Woodwell DA, et al. Polypharmacy in nursing home residents in the United States: results of the 2004 National Nursing Home Survey. Am J Geriatr Pharmacother 2010 Feb; 8(1): 63–72PubMedCrossRef Dwyer LL, Han B, Woodwell DA, et al. Polypharmacy in nursing home residents in the United States: results of the 2004 National Nursing Home Survey. Am J Geriatr Pharmacother 2010 Feb; 8(1): 63–72PubMedCrossRef
15.
Zurück zum Zitat Lapi F, Pozzi C, Mazzaglia G, et al. Epidemiology of sub-optimal prescribing in older, community-dwellers: a two wave, population-based survey in Dicomano, Italy. Drugs Aging 2009; 26(12): 1029–38PubMedCrossRef Lapi F, Pozzi C, Mazzaglia G, et al. Epidemiology of sub-optimal prescribing in older, community-dwellers: a two wave, population-based survey in Dicomano, Italy. Drugs Aging 2009; 26(12): 1029–38PubMedCrossRef
16.
Zurück zum Zitat Corsonello A, Pedone C, Corica F, et al. Polypharmacy in elderly patients at discharge from the acute care hospital. Ther Clin Risk Manag 2007 Mar; 3(1): 197–203PubMedCrossRef Corsonello A, Pedone C, Corica F, et al. Polypharmacy in elderly patients at discharge from the acute care hospital. Ther Clin Risk Manag 2007 Mar; 3(1): 197–203PubMedCrossRef
17.
Zurück zum Zitat Fillenbaum GG, Horner RD, Hanlon JT, et al. Factors predicting change in prescription and nonprescription drug use in a community-residing black and white elderly population. J Clin Epidemiol 1996 May; 49(5): 587–93PubMedCrossRef Fillenbaum GG, Horner RD, Hanlon JT, et al. Factors predicting change in prescription and nonprescription drug use in a community-residing black and white elderly population. J Clin Epidemiol 1996 May; 49(5): 587–93PubMedCrossRef
18.
Zurück zum Zitat Tinetti ME, Bogardus Jr ST, Agostini JV. Potential pitfalls of disease-specific guidelines for patients with multiple conditions. N Engl J Med 2004 Dec 30; 351(27): 2870–4PubMedCrossRef Tinetti ME, Bogardus Jr ST, Agostini JV. Potential pitfalls of disease-specific guidelines for patients with multiple conditions. N Engl J Med 2004 Dec 30; 351(27): 2870–4PubMedCrossRef
19.
Zurück zum Zitat Boyd CM, Darer J, Boult C, et al. Clinical practice guidelines and quality of care for older patients with multiple comorbid diseases: implications for pay for performance. JAMA 2005 Aug 10; 294(6): 716–24PubMedCrossRef Boyd CM, Darer J, Boult C, et al. Clinical practice guidelines and quality of care for older patients with multiple comorbid diseases: implications for pay for performance. JAMA 2005 Aug 10; 294(6): 716–24PubMedCrossRef
20.
Zurück zum Zitat Mansur N, Weiss A, Beloosesky Y. Relationship of in-hospital medication modifications of elderly patients to postdischarge medications, adherence, and mortality. Ann Pharmacother 2008 Jun; 42(6): 783–9PubMedCrossRef Mansur N, Weiss A, Beloosesky Y. Relationship of in-hospital medication modifications of elderly patients to postdischarge medications, adherence, and mortality. Ann Pharmacother 2008 Jun; 42(6): 783–9PubMedCrossRef
21.
Zurück zum Zitat Viktil KK, Blix HS, Moger TA, et al. Polypharmacy as commonly defined is an indicator of limited value in the assessment of drug-related problems. Br J Clin Pharmacol 2007 Feb; 63(2): 187–95PubMedCrossRef Viktil KK, Blix HS, Moger TA, et al. Polypharmacy as commonly defined is an indicator of limited value in the assessment of drug-related problems. Br J Clin Pharmacol 2007 Feb; 63(2): 187–95PubMedCrossRef
22.
Zurück zum Zitat Corsonello A, Pedone C, Corica F, et al. Concealed renal insufficiency and adverse drug reactions in elderly hospitalized patients. Arch Intern Med 2005 Apr 11; 165(7): 790–5PubMedCrossRef Corsonello A, Pedone C, Corica F, et al. Concealed renal insufficiency and adverse drug reactions in elderly hospitalized patients. Arch Intern Med 2005 Apr 11; 165(7): 790–5PubMedCrossRef
23.
Zurück zum Zitat Hanlon JT, Pieper CF, Hajjar ER, et al. Incidence and predictors of all and preventable adverse drug reactions in frail elderly persons after hospital stay. J Gerontol A Biol Sci Med Sci 2006 May; 61(5): 511–5PubMedCrossRef Hanlon JT, Pieper CF, Hajjar ER, et al. Incidence and predictors of all and preventable adverse drug reactions in frail elderly persons after hospital stay. J Gerontol A Biol Sci Med Sci 2006 May; 61(5): 511–5PubMedCrossRef
24.
Zurück zum Zitat Field TS, Gurwitz JH, Avorn J, et al. Risk factors for adverse drug events among nursing home residents. Arch Intern Med 2001 Jul 9; 161(13): 1629–34PubMedCrossRef Field TS, Gurwitz JH, Avorn J, et al. Risk factors for adverse drug events among nursing home residents. Arch Intern Med 2001 Jul 9; 161(13): 1629–34PubMedCrossRef
25.
Zurück zum Zitat Nguyen JK, Fouts MM, Kotabe SE, et al. Polypharmacy as a risk factor for adverse drug reactions in geriatric nursing home residents. Am J Geriatr Pharmacother 2006 Mar; 4(1): 36–41PubMedCrossRef Nguyen JK, Fouts MM, Kotabe SE, et al. Polypharmacy as a risk factor for adverse drug reactions in geriatric nursing home residents. Am J Geriatr Pharmacother 2006 Mar; 4(1): 36–41PubMedCrossRef
26.
Zurück zum Zitat Gnjidic D, Le Couteur DG, Abernethy DR, et al. Drug Burden Index and Beers Criteria: impact on functional outcomes in older people living in self-care retirement villages. J Clin Pharmacol. Epub 2011 Feb 2 Gnjidic D, Le Couteur DG, Abernethy DR, et al. Drug Burden Index and Beers Criteria: impact on functional outcomes in older people living in self-care retirement villages. J Clin Pharmacol. Epub 2011 Feb 2
27.
Zurück zum Zitat Chan M, Nicklason F, Vial JH. Adverse drug events as a cause of hospital admission in the elderly. Intern Med J 2001 May–Jun; 31(4): 199–205PubMedCrossRef Chan M, Nicklason F, Vial JH. Adverse drug events as a cause of hospital admission in the elderly. Intern Med J 2001 May–Jun; 31(4): 199–205PubMedCrossRef
28.
Zurück zum Zitat Onder G, Pedone C, Landi F, et al. Adverse drug reactions as cause of hospital admissions: results from the Italian Group of Pharmacoepidemiology in the Elderly (GIFA). J Am Geriatr Soc 2002 Dec; 50(12): 1962–8PubMedCrossRef Onder G, Pedone C, Landi F, et al. Adverse drug reactions as cause of hospital admissions: results from the Italian Group of Pharmacoepidemiology in the Elderly (GIFA). J Am Geriatr Soc 2002 Dec; 50(12): 1962–8PubMedCrossRef
29.
Zurück zum Zitat Malhotra S, Karan RS, Pandhi P, et al. Drug related medical emergencies in the elderly: role of adverse drug reactions and non-compliance. Postgrad Med J 2001 Nov; 77(913): 703–7PubMedCrossRef Malhotra S, Karan RS, Pandhi P, et al. Drug related medical emergencies in the elderly: role of adverse drug reactions and non-compliance. Postgrad Med J 2001 Nov; 77(913): 703–7PubMedCrossRef
31.
Zurück zum Zitat Lai SW, Liao KF, Liao CC, et al. Polypharmacy correlates with increased risk for hip fracture in the elderly: a population-based study. Medicine (Baltimore) 2010 Sep; 89(5): 295–9CrossRef Lai SW, Liao KF, Liao CC, et al. Polypharmacy correlates with increased risk for hip fracture in the elderly: a population-based study. Medicine (Baltimore) 2010 Sep; 89(5): 295–9CrossRef
32.
Zurück zum Zitat Haleem S, Lutchman L, Mayahi R, et al. Mortality following hip fracture: trends and geographical variations over the last 40 years. Injury 2008 Oct; 39(10): 1157–63PubMedCrossRef Haleem S, Lutchman L, Mayahi R, et al. Mortality following hip fracture: trends and geographical variations over the last 40 years. Injury 2008 Oct; 39(10): 1157–63PubMedCrossRef
33.
Zurück zum Zitat Ziere G, Dieleman JP, Hofman A, et al. Polypharmacy and falls in the middle age and elderly population. Br J Clin Pharmacol 2006 Feb; 61(2): 218–23PubMedCrossRef Ziere G, Dieleman JP, Hofman A, et al. Polypharmacy and falls in the middle age and elderly population. Br J Clin Pharmacol 2006 Feb; 61(2): 218–23PubMedCrossRef
34.
Zurück zum Zitat Claxton AJ, Cramer J, Pierce C. A systematic review of the associations between dose regimens and medication compliance. Clin Ther 2001 Aug; 23(8): 1296–310PubMedCrossRef Claxton AJ, Cramer J, Pierce C. A systematic review of the associations between dose regimens and medication compliance. Clin Ther 2001 Aug; 23(8): 1296–310PubMedCrossRef
35.
Zurück zum Zitat Di Bari M, Balzi D, Roberts AT, et al. Prognostic stratification of older persons based on simple administrative data: development and validation of the ‘Silver Code’, to be used in emergency department triage. J Gerontol A Biol Sci Med Sci 2010 Feb; 65(2): 159–64PubMedCrossRef Di Bari M, Balzi D, Roberts AT, et al. Prognostic stratification of older persons based on simple administrative data: development and validation of the ‘Silver Code’, to be used in emergency department triage. J Gerontol A Biol Sci Med Sci 2010 Feb; 65(2): 159–64PubMedCrossRef
36.
Zurück zum Zitat Rubenstein LZ, Abrass IB, Kane RL. Improved care for patients on a new geriatric evaluation unit. J Am Geriatr Soc 1981 Nov; 29(11): 531–6PubMed Rubenstein LZ, Abrass IB, Kane RL. Improved care for patients on a new geriatric evaluation unit. J Am Geriatr Soc 1981 Nov; 29(11): 531–6PubMed
37.
Zurück zum Zitat Sergi G, Perissinotto E, Pisent C, et al., ILSA Working Group. An adequate threshold for body mass index to detect underweight condition in elderly persons: the Italian Longitudinal Study on Aging (ILSA). J Gerontol A Biol Sci Med Sci 2005 Jul; 60(7): 866–71PubMedCrossRef Sergi G, Perissinotto E, Pisent C, et al., ILSA Working Group. An adequate threshold for body mass index to detect underweight condition in elderly persons: the Italian Longitudinal Study on Aging (ILSA). J Gerontol A Biol Sci Med Sci 2005 Jul; 60(7): 866–71PubMedCrossRef
38.
Zurück zum Zitat Pilotto A, Ferrucci L, Franceschi M, et al. Development and validation of a multidimensional prognostic index for one-year mortality from comprehensive geriatric assessment in hospitalized older patients. Rejuvenation Res 2008; 11(1): 151–61PubMedCrossRef Pilotto A, Ferrucci L, Franceschi M, et al. Development and validation of a multidimensional prognostic index for one-year mortality from comprehensive geriatric assessment in hospitalized older patients. Rejuvenation Res 2008; 11(1): 151–61PubMedCrossRef
39.
Zurück zum Zitat Pilotto A, Addante F, Ferrucci L, et al. The multidimensional prognostic index predicts short- and long-term mortality in hospitalized geriatric patients with pneumonia. J Gerontol A Biol Sci Med Sci 2009 Aug; 64(8): 880–7PubMedCrossRef Pilotto A, Addante F, Ferrucci L, et al. The multidimensional prognostic index predicts short- and long-term mortality in hospitalized geriatric patients with pneumonia. J Gerontol A Biol Sci Med Sci 2009 Aug; 64(8): 880–7PubMedCrossRef
40.
Zurück zum Zitat Pilotto A, Addante F, Franceschi M, et al. Multidimensional Prognostic Index based on a comprehensive geriatric assessment predicts short-term mortality in older patients with heart failure. Circ Heart Fail 2010 Jan; 3(1): 14–20PubMedCrossRef Pilotto A, Addante F, Franceschi M, et al. Multidimensional Prognostic Index based on a comprehensive geriatric assessment predicts short-term mortality in older patients with heart failure. Circ Heart Fail 2010 Jan; 3(1): 14–20PubMedCrossRef
41.
Zurück zum Zitat Kuijpers MA, van Marum RJ, Egberts AC, et al. Relationship between polypharmacy and underprescribing. Br J Clin Pharmacol 2008 Jan; 65(1): 130–3PubMedCrossRef Kuijpers MA, van Marum RJ, Egberts AC, et al. Relationship between polypharmacy and underprescribing. Br J Clin Pharmacol 2008 Jan; 65(1): 130–3PubMedCrossRef
42.
Zurück zum Zitat Steinman MA, Landefeld CS, Rosenthal GE, et al. Polypharmacy and prescribing quality in older people. J Am Geriatr Soc 2006 Oct; 54(10): 1516–23PubMedCrossRef Steinman MA, Landefeld CS, Rosenthal GE, et al. Polypharmacy and prescribing quality in older people. J Am Geriatr Soc 2006 Oct; 54(10): 1516–23PubMedCrossRef
43.
Zurück zum Zitat Rochon PA, Gurwitz JH. Prescribing for seniors: neither too much nor too little. JAMA 1999 Jul 14; 282(2): 113–5PubMedCrossRef Rochon PA, Gurwitz JH. Prescribing for seniors: neither too much nor too little. JAMA 1999 Jul 14; 282(2): 113–5PubMedCrossRef
44.
Zurück zum Zitat Cleeland CS, Gonin R, Hatfield AK, et al. Pain and its treatment in outpatients with metastatic cancer. N Engl J Med 1994 Mar 3; 330(9): 592–6PubMedCrossRef Cleeland CS, Gonin R, Hatfield AK, et al. Pain and its treatment in outpatients with metastatic cancer. N Engl J Med 1994 Mar 3; 330(9): 592–6PubMedCrossRef
45.
Zurück zum Zitat Beers MH, Ouslander JG, Rollingher I, et al. Explicit criteria for determining inappropriate medication use in nursing home residents. UCLA Division of Geriatric Medicine. Arch Intern Med 1991 Sep; 151(9): 1825–32PubMedCrossRef Beers MH, Ouslander JG, Rollingher I, et al. Explicit criteria for determining inappropriate medication use in nursing home residents. UCLA Division of Geriatric Medicine. Arch Intern Med 1991 Sep; 151(9): 1825–32PubMedCrossRef
46.
Zurück zum Zitat Fick DM, Cooper JW, Wade WE, et al. Updating the Beers criteria for potentially inappropriate medication use in older adults: results of a US consensus panel of experts [published erratum appears in Arch Intern Med 2004 Feb 9; 164 (3): 298]. Arch Intern Med 2003 Dec 8–22; 163(22): 2716–24PubMedCrossRef Fick DM, Cooper JW, Wade WE, et al. Updating the Beers criteria for potentially inappropriate medication use in older adults: results of a US consensus panel of experts [published erratum appears in Arch Intern Med 2004 Feb 9; 164 (3): 298]. Arch Intern Med 2003 Dec 8–22; 163(22): 2716–24PubMedCrossRef
47.
Zurück zum Zitat Hanlon JT, Schmader KE, Samsa GP, et al. A method for assessing drug therapy appropriateness. J Clin Epidemiol 1992 Oct; 45(10): 1045–51PubMedCrossRef Hanlon JT, Schmader KE, Samsa GP, et al. A method for assessing drug therapy appropriateness. J Clin Epidemiol 1992 Oct; 45(10): 1045–51PubMedCrossRef
48.
Zurück zum Zitat Gallagher P, Ryan C, Byrne S, et al. STOPP (Screening Tool of Older Person’s Prescriptions) and START (Screening Tool to Alert doctors to Right Treatment): Consensus validation. Int J Clin Pharmacol Ther 2008 Feb; 46(2): 72–83PubMed Gallagher P, Ryan C, Byrne S, et al. STOPP (Screening Tool of Older Person’s Prescriptions) and START (Screening Tool to Alert doctors to Right Treatment): Consensus validation. Int J Clin Pharmacol Ther 2008 Feb; 46(2): 72–83PubMed
49.
Zurück zum Zitat George CJ, Jacobs LG. Geriatrics medication management rounds: a novel approach to teaching rational prescribing with the use of the medication screening questionnaire. J Am Geriatr Soc 2011 Jan; 59(1): 138–42. Epub 2011 Jan 3PubMedCrossRef George CJ, Jacobs LG. Geriatrics medication management rounds: a novel approach to teaching rational prescribing with the use of the medication screening questionnaire. J Am Geriatr Soc 2011 Jan; 59(1): 138–42. Epub 2011 Jan 3PubMedCrossRef
50.
Zurück zum Zitat Walsh EK, Cussen K. ‘Take ten minutes’: a dedicated ten minute medication review reduces polypharmacy in the elderly. Ir Med J 2010 Sep; 103(8): 236–8PubMed Walsh EK, Cussen K. ‘Take ten minutes’: a dedicated ten minute medication review reduces polypharmacy in the elderly. Ir Med J 2010 Sep; 103(8): 236–8PubMed
51.
Zurück zum Zitat Safran DG, Neuman P, Schoen C, et al. Prescription drug coverage and seniors: how well are states closing the gap? Health Aff (Millwood) 2002 Jul–Dec; Suppl. Web Exclusives: W253–68 Safran DG, Neuman P, Schoen C, et al. Prescription drug coverage and seniors: how well are states closing the gap? Health Aff (Millwood) 2002 Jul–Dec; Suppl. Web Exclusives: W253–68
52.
Zurück zum Zitat Doggrell SA. Adherence to medicines in the older-aged with chronic conditions: does intervention by an allied health professional help? Drugs Aging 2010 Mar 1; 27(3): 239–54PubMedCrossRef Doggrell SA. Adherence to medicines in the older-aged with chronic conditions: does intervention by an allied health professional help? Drugs Aging 2010 Mar 1; 27(3): 239–54PubMedCrossRef
53.
Zurück zum Zitat Rich MW, Gray DB, Beckham V, et al. Effect of a multi-disciplinary intervention on medication compliance in elderly patients with congestive heart failure. Am J Med 1996 Sep; 101(3): 270–6PubMedCrossRef Rich MW, Gray DB, Beckham V, et al. Effect of a multi-disciplinary intervention on medication compliance in elderly patients with congestive heart failure. Am J Med 1996 Sep; 101(3): 270–6PubMedCrossRef
54.
Zurück zum Zitat Wu JY, Leung WY, Chang S, et al. Effectiveness of telephone counselling by a pharmacist in reducing mortality in patients receiving polypharmacy: randomised controlled trial. BMJ 2006 Sep 9; 333(7567): 522PubMedCrossRef Wu JY, Leung WY, Chang S, et al. Effectiveness of telephone counselling by a pharmacist in reducing mortality in patients receiving polypharmacy: randomised controlled trial. BMJ 2006 Sep 9; 333(7567): 522PubMedCrossRef
55.
Zurück zum Zitat Holmes HM, Hayley DC, Alexander GC, et al. Reconsidering medication appropriateness for patients late in life. Arch Intern Med 2006 Mar 27; 166(6): 605–9PubMedCrossRef Holmes HM, Hayley DC, Alexander GC, et al. Reconsidering medication appropriateness for patients late in life. Arch Intern Med 2006 Mar 27; 166(6): 605–9PubMedCrossRef
56.
Zurück zum Zitat Garfinkel D, Zur-Gil S, Ben-Israel J. The war against polypharmacy: a new cost-effective geriatric-palliative approach for improving drug therapy in disabled elderly people. Isr Med Assoc J 2007 Jun; 9(6): 430–4PubMed Garfinkel D, Zur-Gil S, Ben-Israel J. The war against polypharmacy: a new cost-effective geriatric-palliative approach for improving drug therapy in disabled elderly people. Isr Med Assoc J 2007 Jun; 9(6): 430–4PubMed
57.
Zurück zum Zitat Garfinkel D, Mangin D. Feasibility study of a systematic approach for discontinuation of multiple medications in older adults: addressing polypharmacy. Arch Intern Med 2010 Oct 11; 170(18): 1648–54PubMedCrossRef Garfinkel D, Mangin D. Feasibility study of a systematic approach for discontinuation of multiple medications in older adults: addressing polypharmacy. Arch Intern Med 2010 Oct 11; 170(18): 1648–54PubMedCrossRef
Metadaten
Titel
Polypharmacy in the Elderly
Can Comprehensive Geriatric Assessment Reduce Inappropriate Medication Use?
verfasst von
Dr Giuseppe Sergi
Marina De Rui
Silvia Sarti
Enzo Manzato
Publikationsdatum
01.07.2011
Verlag
Springer International Publishing
Erschienen in
Drugs & Aging / Ausgabe 7/2011
Print ISSN: 1170-229X
Elektronische ISSN: 1179-1969
DOI
https://doi.org/10.2165/11592010-000000000-00000

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