Content validation of a tool for assessing risks for drug-related problems to be used by practical nurses caring for home-dwelling clients aged ≥65 years: a Delphi survey.

PURPOSE: Home care services are becoming a critically important part of health care delivery as populations are aging. Those using home care services are increasingly older, more frail than previously, and use multiple medications, making them vulnerable to drug-related problems (DRPs). Practical nurses (PN) visit home-dwelling aged clients frequently and, thus, are ideally situated to identify potential DRPs and, if needed, to communicate them to physicians for resolution. This study developed and validated the content of a tool to be used by PNs for assessing DRP risks for their home-dwelling clients aged ≥65 years. METHODS: The first draft of the tool was based on two systematic literature reviews and clinical experience of our research group. Content validity of the tool was determined by a three-round Delphi survey with a panel of 18 experts in geriatric care and pharmacotherapy. An agreement by ≥80% of the panel on an item was required. RESULTS: The final tool consists of 18 items that assess risks for DRPs in home-dwelling aged clients. It is divided into four sections: (1) Basic Client Data, (2) Potential Risks for DRPs in Medication Use, (3) Characteristics of the Client's Care and Adherence, and (4) Recommendations for Actions to Resolve DRPs. CONCLUSIONS: The Delphi process resulted in a structured DRP Risk Assessment Tool that is focused on the highest priority DRPs that should be identified and resolved. The tool also assists the PNs to identify solutions to these problems, which is a unique feature compared to similarly purposed prior tools.

[Inappropriate medication use among the aged. Review of the criteria]. / Iäkkäiden hoidossa vältettävät lääkkeet: katsaus suosituksiin.

Inappropriate medication use among the aged review of the criteria Several criteria have been developed to assess inappropriate prescribing among individuals aged > or = 65 years. The criteria are classified as explicit (criterion-based) or implicit (judgment-based) and most of them have been validated using consensus methods. The criteria are based on risk-benefit definition of appropriateness; benzodiazepines and anticholinergics being the most often listed inappropriate medications. Many criteria also list inappropriate medication use due to drug-disease or drug-syndrome interactions. Avoiding unnecessary duplication is mentioned in the newest criteria. Fimea's database of medication for the elderly has been developed to support rational geriatric pharmacotherapy in Finnish healthcare. In addition to Fimea's database national evidence-based Current Care Guidelines on geriatric pharmacotherapy are needed.