Sunday, 20 May 2018

louis vuitton cabas mezzo A new approach to detecting potentially inappropriate prescribing in old age

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Potentially inappropriate prescribing (IP) is an issue of major importance in the pharmacotherapy of older people globally. To date, Beers’ criteria have been in common research usage for defining potentially inappropriate medications (PIMs) in older people. However, Beers’ criteria have a number of serious flaws and are of doubtful relevance to routine geriatric pharmacotherapy. For these reasons, new geriatric IP criteria have been devised and validated, called screening tool of older persons’ prescriptions (STOPP) and screening tool to alert to right treatment (START) for detection of potential errors of prescribing commission and omission. Prevalence studies in older people in southern Ireland show substantial rates of prescription of one or more PIMs in the primary care setting (22%), in acute hospital care (35%) and in nursing home care (60%) using STOPP criteria. Similarly, prevalence rates of potentially serious prescribing omission are high both in hospital (58%) and in primary care (23%). Prospective data show that STOPP criteria detect adverse drug effects (ADEs) that are causal or contributory to acute hospitalisation in older people 2.8times more frequently than Beers’ criteria. This suggests that ADEs are likely associated with PIMs in older people, contrary to recent research data showing no significant association on the basis of defining PIMs using Beers’ criteria. We have recently shown that as an intervention significantly improves medication appropriateness in hospitalised older people. Whether STOPP/START can prevent ADEs and reduce drug costs remains to be elucidated by means of further randomised controlled trials. The criteria are named after the late Dr. Explicit criteria for determining inappropriate medication use in nursing home residents. Beers initially devised his criteria with the frail elderly nursing home population of the US in mind. Explicit criteria for determining potentially inappropriate medication use by the elderly. Beers’ criteria define potential IP instances in older people, regardless of the clinical setting.

Dr. Beers deserves considerable credit for his criteria as they represent the first well organised list of common errors of prescribing in older people. However, there are several deficiencies in Beers’ criteria that militate against their widespread use in European countries. For instance, several of the Beers ID drugs are obsolete and no longer available in Europe (Table 1). the British National Formulary;
louis vuitton cabas mezzo A new approach to detecting potentially inappropriate prescribing in old age
examples include amitriptyline, nitrofurantoin, amiodarone, doxazosin and propranolol. drug drug interactions or drug class prescription duplication in older people. failure to prescribe anticoagulant drugs in older people with chronic atrial fibrillation considered at high risk for arterial embolism. There are no prospective randomised controlled trials that specifically use Beers’ criteria as an intervention to improve medication appropriateness or minimise adverse drug effects (ADEs). Finally, Beers’ criteria remain essentially a research tool despite their widespread usage in the published literature on IP in old age and are not used in the routine clinical context to any significant degree.

Top of the page Article OutlineGiven the deficiencies of Beers’ criteria, our research group set about drafting a new and different set of potentially IP criteria in older people, based on the following precepts:(i)

they should capture common and important instances of potentially IP;they should be organised according to physiological systems, as is the case with most drug formularies;they should give special attention to drugs that adversely affect elderly patients at risk of falls;they should give special attention to opiate use in older people;
louis vuitton cabas mezzo A new approach to detecting potentially inappropriate prescribing in old age