Minimizing inappropriate medications in older populations: a 10-step conceptual framework

Scott, Ian A., Gray, Leonard C., Martin, Jennifer H. and Mitchell, Charles A. (2012) Minimizing inappropriate medications in older populations: a 10-step conceptual framework. American Journal of Medicine, 125 6: 529-537.e4. doi:10.1016/j.amjmed.2011.09.021


Author Scott, Ian A.
Gray, Leonard C.
Martin, Jennifer H.
Mitchell, Charles A.
Title Minimizing inappropriate medications in older populations: a 10-step conceptual framework
Journal name American Journal of Medicine   Check publisher's open access policy
ISSN 0002-9343
1555-7162
Publication date 2012-06
Sub-type Critical review of research, literature review, critical commentary
DOI 10.1016/j.amjmed.2011.09.021
Volume 125
Issue 6
Start page 529
End page 537.e4
Total pages 13
Place of publication Bridgewater, NJ, United States
Publisher Excerpta Medica
Collection year 2013
Language eng
Abstract The increasing burden of harm resulting from the use of multiple drugs in older patient populations represents a major health problem in developed countries. Approximately 1 in 4 older patients admitted to hospitals are prescribed at least 1 inappropriate medication, and up to 20% of all inpatient deaths are attributable to potentially preventable adverse drug reactions. To minimize this drug-related iatrogenesis, we propose a quality use of medicine framework that comprises 10 sequential steps: 1) ascertain all current medications; 2) identify patients at high risk of or experiencing adverse drug reactions; 3) estimate life expectancy in high-risk patients; 4) define overall care goals in the context of life expectancy; 5) define and confirm current indications for ongoing treatment; 6) determine the time until benefit for disease-modifying medications; 7) estimate the magnitude of benefit versus harm in relation to each medication; 8) review the relative utility of different drugs; 9) identify drugs that may be discontinued; and 10) implement and monitor a drug minimization plan with ongoing reappraisal of drug utility and patient adherence by a single nominated clinician. The framework aims to reduce drug use in older patients to the minimum number of essential drugs, and its utility is demonstrated in reference to a hypothetic case study. Further studies are warranted in validating this framework as a means for assisting clinicians to make more appropriate prescribing decisions in at-risk older patients.
Keyword Inappropriate use
Medication
Minimization framework
Older populations
Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Critical review of research, literature review, critical commentary
Collections: Official 2013 Collection
School of Medicine Publications
School of Pharmacy Publications
UQ Diamantina Institute Publications
 
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