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      Inappropriate Use of Medication by Elderly, Polymedicated, or Multipathological Patients with Chronic Diseases

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          Abstract

          The growth of the aging population leads to the increase of chronic diseases, of the burden of multimorbility, and of the complexity polypharmacy. The prevalence of medication errors rises in patients with polypharmacy in primary care, and this is a major concern to healthcare systems. This study reviews the published literature on the inappropriate use of medicines in order to articulate recommendations on how to reduce it in chronic patients, particularly in those who are elderly, polymedicated, or multipathological. A systematic review of articles published from January 2000 to October 2015 was performed using MEDLINE, EMBASE, PsychInfo, Scopus, The Cochrane Library, and Index Medicus databases. We selected 80 studies in order to analyse the content that addressed the question under consideration. Our literature review found that half of patients know what their prescribed treatment is; that most of elderly people take five or more medications a day; that in elderly, polymedicated people, the probability of a medication error occurring is higher; that new tools have been recently developed to reduce errors; that elderly patients can understand written information but the presentation and format is an important factor; and that a high percentage of patients have remaining doubts after their visit. Thus, strategies based on the evidence should be applied in order to reduce medication errors.

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          Incidence and preventability of adverse drug events among older persons in the ambulatory setting.

          Jerry Gurwitz (2003)
          Adverse drug events, especially those that may be preventable, are among the most serious concerns about medication use in older persons cared for in the ambulatory clinical setting. To assess the incidence and preventability of adverse drug events among older persons in the ambulatory clinical setting. Cohort study of all Medicare enrollees (30 397 person-years of observation) cared for by a multispecialty group practice during a 12-month study period (July 1, 1999, through June 30, 2000), in which possible drug-related incidents occurring in the ambulatory clinical setting were detected using multiple methods, including reports from health care providers; review of hospital discharge summaries; review of emergency department notes; computer-generated signals; automated free-text review of electronic clinic notes; and review of administrative incident reports concerning medication errors. Number of adverse drug events, severity of the events (classified as significant, serious, life-threatening, or fatal), and whether the events were preventable. There were 1523 identified adverse drug events, of which 27.6% (421) were considered preventable. The overall rate of adverse drug events was 50.1 per 1000 person-years, with a rate of 13.8 preventable adverse drug events per 1000 person-years. Of the adverse drug events, 578 (38.0%) were categorized as serious, life-threatening, or fatal; 244 (42.2%) of these more severe events were deemed preventable compared with 177 (18.7%) of the 945 significant adverse drug events. Errors associated with preventable adverse drug events occurred most often at the stages of prescribing (n = 246, 58.4%) and monitoring (n = 256, 60.8%), and errors involving patient adherence (n = 89, 21.1%) also were common. Cardiovascular medications (24.5%), followed by diuretics (22.1%), nonopioid analgesics (15.4%), hypoglycemics (10.9%), and anticoagulants (10.2%) were the most common medication categories associated with preventable adverse drug events. Electrolyte/renal (26.6%), gastrointestinal tract (21.1%), hemorrhagic (15.9%), metabolic/endocrine (13.8%), and neuropsychiatric (8.6%) events were the most common types of preventable adverse drug events. Adverse drug events are common and often preventable among older persons in the ambulatory clinical setting. More serious adverse drug events are more likely to be preventable. Prevention strategies should target the prescribing and monitoring stages of pharmaceutical care. Interventions focused on improving patient adherence with prescribed regimens and monitoring of prescribed medications also may be beneficial.
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            A systematic review of barriers to medication adherence in the elderly: looking beyond cost and regimen complexity.

            Walid F Gellad, Jerry L. Grenard, Zachary Marcum (2011)
            Medication nonadherence is a common problem among the elderly. To conduct a systematic review of the published literature describing potential nonfinancial barriers to medication adherence among the elderly. The PubMed and PsychINFO databases were searched for articles published in English between January 1998 and January 2010 that (1) described "predictors," "facilitators," or "determinants" of medication adherence or that (2) examined the "relationship" between a specific barrier and adherence for elderly patients (ie, ≥65 years of age) in the United States. A manual search of the reference lists of identified articles and the authors' files and recent review articles was conducted. The search included articles that (1) reviewed specific barriers to medication adherence and did not solely describe nonmodifiable predictors of adherence (eg, demographics, marital status), (2) were not interventions designed to address adherence, (3) defined adherence or compliance and specified its method of measurement, and (4) involved US participants only. Nonsystematic reviews were excluded, as were studies that focused specifically on people who were homeless or substance abusers, or patients with psychotic disorders, tuberculosis, or HIV infection, because of the unique circumstances that surround medication adherence for each of these populations. Nine studies met inclusion criteria for this review. Four studies used pharmacy records or claims data to assess adherence, 2 studies used pill count or electronic monitoring, and 3 studies used other methods to assess adherence. Substantial heterogeneity existed among the populations studied as well as among the measures of adherence, barriers addressed, and significant findings. Some potential barriers (ie, factors associated with nonadherence) were identified from the studies, including patient-related factors such as disease-related knowledge, health literacy, and cognitive function; drug-related factors such as adverse effects and polypharmacy; and other factors including the patient-provider relationship and various logistical barriers to obtaining medications. None of the reviewed studies examined primary nonadherence or nonpersistence. Medication nonadherence in the elderly is not well described in the literature, despite being a major cause of morbidity, and thus it is difficult to draw a systematic conclusion on potential barriers based on the current literature. Future research should focus on standardizing medication adherence measurements among the elderly to gain a better understanding of this important issue. Published by EM Inc USA.
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              Polypharmacy in the elderly: A literature review

              Maryann Fulton, Elizabeth Riley Allen (2005)
              To review the body of literature addressing polypharmacy in individuals aged 60 years and older to (a) determine primary care providers' definition of polypharmacy, (b) explore how polypharmacy was assessed in primary care, and (c) seek tested interventions that address polypharmacy.
              Article 0 comments Cited 105 times – based on 0 reviews     Review now
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                Author and article information

                Journal
                Journal ID (nlm-ta): Int J Environ Res Public Health
                Journal ID (iso-abbrev): Int J Environ Res Public Health
                Journal ID (publisher-id): ijerph
                Title: International Journal of Environmental Research and Public Health
                Publisher: MDPI
                ISSN (Print): 1661-7827
                ISSN (Electronic): 1660-4601
                Publication date (Electronic): 10 February 2018
                Publication date (Print): February 2018
                Volume: 15
                Issue: 2
                Electronic Location Identifier: 310
                Affiliations
                [1 ]Health Psychology Department, Miguel Hernandez University, 03202 Elche, Alicante, Spain; v.perez@ 123456umh.es (V.P.-J.); jose.mira@ 123456umh.es (J.J.M.)
                [2 ]Sant Joan-Alacant Health District, Conselleria Sanitat, 03202 Elche, Alicante, Spain; jbasora@ 123456semfyc.es
                [3 ]Clinical Medicine Department, Miguel Hernandez University, 03550 San Juan de Alicante, Alicante, Spain; vte.gil@ 123456gmail.com (V.F.G.-G.); adriannalp@ 123456hotmail.com (A.L.-P.); dorozcobeltran@ 123456gmail.com (D.O.-B.)
                Author notes
                [* ]Correspondence: atencion.primaria@ 123456umh.es ; Tel.: +34-965-919-309
                Author information
                https://orcid.org/0000-0001-6497-083X
                https://orcid.org/0000-0002-2117-0178
                Article
                Publisher ID: ijerph-15-00310
                DOI: 10.3390/ijerph15020310
                PMC ID: 5858379
                PubMed ID: 29439425
                SO-VID: be8350fd-b3bd-4a27-8035-c43c38d7f9a0
                Copyright © © 2018 by the authors.
                License:

                Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license ( http://creativecommons.org/licenses/by/4.0/).

                History
                Date received : 21 December 2017
                Date accepted : 08 February 2018
                Categories
                Subject: Review

                ScienceOpen disciplines: Public health
                Keywords: chronic disease,physicians,primary care,patient medication knowledge,patient safety,medication errors,polypharmacy
                Data availability:
                ScienceOpen disciplines: Public health
                Keywords: chronic disease, physicians, primary care, patient medication knowledge, patient safety, medication errors, polypharmacy

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