Managing older people with atrial fibrillation and preventing stroke: a review of anticoagulation approaches.

INTRODUCTION: Oral anticoagulants (OACs) are the cornerstone of stroke prevention in atrial fibrillation (AF), but prescribing decisions in older people are complicated. Clinicians must assess the net clinical benefit of OAC in the context of multiple chronic conditions, polypharmacy, frailty and life expectancy. The under-representation of high-risk, older adult sub-populations in clinical trials presents the challenge of choosing the right OAC, where a 'one-size-fits-all' approach cannot be taken. AREAS COVERED: This review discusses OAC approaches for stroke prevention in older people with AF and presents a prescribing aid to support clinicians' decision-making. High-risk older adults with multiple chronic conditions, specifically chronic kidney disease, dementia/cognitive impairment, previous stroke/transient ischemic attack or intracranial hemorrhage, polypharmacy, frailty, low body weight, high falls risk, and those aged ≥75 years are considered. EXPERT OPINION: Non-vitamin K antagonist OACs are the preferred first-line OAC in older adults with AF, including high-risk subpopulations, after individual assessment of stroke and bleeding risk, except those with mechanical heart valves and moderate-to-severe mitral stenosis. Head-to-head comparisons of NOACs are not available, therefore the choice of drug (and dose) should be based on an individual's risk (stroke and bleeding) and incorporate their treatment preferences. Treatment decisions must be person-centered and principles of shared decision-making applied.

Beyond Antiretroviral Treatment: Patterns and Factors Associated With Composite Medication Adherence Before and During the COVID-19 Pandemic in Patients With HIV With Multiple Chronic Conditions.

BACKGROUND: Polypharmacy for multiple chronic conditions (MCCs) poses an increasing challenge in people with HIV (PWH). This research explores medication adherence in PWH with MCCs before and during COVID-19. SETTING: Kaiser Permanente Mid-Atlantic States. METHODS: Medical and pharmacy records of a continuously enrolled cohort (September 2018-September 2021) of adult PWH were used. To estimate medication adherence, monthly proportion of days covered (PDC) was measured individually for antiretrovirals (ARVs), diabetes medications (DMs), renin-angiotensin antagonists (RASMs), and statins (SMs) and combined into composite measures (CMs) with and without ARVs. Descriptive statistics, time-series models, and multivariable population-averaged panel general estimating equations were used to profile trends, effects, and factors associated with adherence. RESULTS: The cohort (n = 543) was predominantly 51-64 years old (59.3%), Black (73.1%), male (69.2%), and commercially insured (65.4%). Two-thirds (63.7%) of patients were taking medications in 2 medication groups (ie, ARVs and either DMs, RASMs, or SMs), 28.9% were taking medications in 3 medication groups, and 7.4% were taking medications in all 4 medication groups. Overall, PDC for CMs without ARVs was 77.2% and 70.2% with ARVs. After March 2020, negative monthly trends in PDC were observed for CMs without ARVs (ß = -0.1%, P = 0.003) and with ARVs (ß = -0.3%, P = 0.001). For CMs with ARVs, Black race (aOR = 0.5; P < 0.001; ref: White) and taking medications for 3 medication groups (aOR = 0.8; P < 0.02; ref: 2) were associated with lower adherence. CONCLUSION: Decreasing medication adherence trends were observed during the COVID-19 pandemic with variations among population subgroups. Opportunity exists to improve medication adherence for non-White populations and those taking medications for MCCs beyond ARVs.

Polypharmacy and prescription medication use in a population-based sample of adolescent and young adult cancer survivors.

PURPOSE: We examined prescription medication use and identified correlates of polypharmacy-taking multiple medications-in adolescent and young adult cancer survivors (AYAs), who experience early-onset chronic conditions. METHODS: Our cross-sectional study pooled data (2008-2017) from the national Medical Expenditure Panel Survey. We estimated prevalence of polypharmacy (≥ 5 unique prescription medications over an approximate 1-year period) in AYAs (age 18-39 years with a history of cancer) and age- and sex-matched controls, overall and by sociodemographics, clinical factors, and health indicators. We compared survivors' and controls' medication use across therapeutic classes. To identify correlates of polypharmacy among AYAs, we included factors with p < 0.20 in bivariable analysis in a multivariable logistic regression model. RESULTS: AYAs (n = 601) had a higher prevalence of polypharmacy than controls (n = 2,402), overall (31.5% vs. 15.9%, p < .01) and by all sociodemographics, clinical factors, and health indicators. A majority of AYAs with multiple chronic conditions (58.8%, 95% CI 47.3-70.4) or disability (61.3%, 95% CI 52.6-70.0) had polypharmacy. Patterns of AYAs' medication use across therapeutic classes were consistent with their chronic conditions. Nearly one-third used opioid/narcotic analgesics (32.2% vs. 13.7% of controls, p < 0.01). Among AYAs, multiple chronic conditions (aOR 4.68, 95% CI 2.23-9.83) and disability (aOR 3.70, 95% CI 2.23-6.14) were correlated with polypharmacy. CONCLUSIONS: Chronic conditions and disabilities, including aftereffects of cancer treatment, may drive polypharmacy in AYAs. Future research should examine adverse outcomes of polypharmacy and opioid/narcotic use in AYAs. IMPLICATIONS FOR CANCER SURVIVORS: AYAs with chronic conditions or disabilities should be monitored for polypharmacy.

The role of senolytics in osteoporosis and other skeletal pathologies.

The skeletal system undergoes irreversible structural deterioration with aging, leading to increased fracture risk and detrimental changes in mobility, posture, and gait. This state of low bone mass and microarchitectural changes, diagnosed as osteoporosis, affects millions of individuals worldwide and has high clinical and economic burdens. Recently, pre-clinical studies have linked the onset of age-related bone loss with an accumulation of senescent cells in the bone microenvironment. These senescent cells appear to be causal to age-related bone loss, as targeted clearance of these cells leads to improved bone mass and microarchitecture in old mice. Additionally, other pathologies leading to bone loss that result from DNA damage, such as cancer treatments, have shown improvements after clearance of senescent cells. The development of new therapies that clear senescent cells, termed "senolytics", is currently underway and may allow for the modulation of bone loss that results from states of high senescent cell burden, such as aging.

Caregiver involvement in managing medications among older adults with multiple chronic conditions.

OBJECTIVE: We sought to characterize caregiver medication assistance for older adults with multiple chronic conditions. DESIGN: Semi-structured qualitative interviews. SETTING: Community and academic-affiliated primary care practices. PARTICIPANTS: A total of 25 caregivers to older adults participating in an ongoing cohort study with ≥3 chronic conditions. MEASUREMENTS: A semi-structured interview guide, informed by the Medication Self-Management model, aimed to understand health-related and medication-specific assistance caregivers provided. RESULTS: Three typologies of caregiver assistance with medications emerged: Actively Involved, Peripherally Involved, and Not Involved. A total of 10 caregivers were Actively Involved, which was defined as when the caregiver perceived a need for and offered assistance, and the patient accepted the assistance. Peripherally Involved (n = 6) was defined as when the caregiver perceived a need and offered assistance; however, the patient rejected this assistance, yet relied on the caregiver as a backup in managing his or her medications. To combat resistance from the patient, caregivers in this typology disguised assistance and deployed workaround strategies to monitor medication-taking behaviors to ensure safety. Lastly, nine caregivers were classified as Not Involved, defined as when the caregiver did not perceive a need to offer assistance with medications, and the patient managed his or her medicines independently. A strong preference toward autonomy in medication management was shared across all three typologies. CONCLUSION: These findings suggest that caregivers value independent medication management by their care recipient, up until safety is seriously questioned. Clinicians should not assume caregivers are actively and consistently involved in older adults' medication management; instead, they should initiate conversations with patients and caregivers to better understand and facilitate co-management responsibilities, especially among those whose assistance is rejected by older adults.

Polypharmacy and Cognition Function Among Rural Adults.

BACKGROUND: Polypharmacy (using≥5 medications) is associated with poor health outcomes. Mixed results from past studies surrounding chronic medication use, control of chronic conditions, and their effects on cognitive performance warrant further attention. OBJECTIVE: Investigate a link between polypharmacy and cognition function in rural-dwelling adults in Texas, USA. METHODS: Project FRONTIER (Facing Rural Obstacles to Healthcare Now Through Intervention, Education & Research) is a cross-sectional epidemiological study using community-based participatory research in three counties of Texas. Residents age > 40 were eligible for inclusion. The primary outcome is cognitive impairment, and exposures of interest are polypharmacy; comorbidities; and diabetes, hypertension, and depression medication. Logistic regression was used to assess association. RESULTS: Six hundred eighty-nine individuals participated; the mean age was 61, and the majority were female (68.7%).The median number of medications taken by participants was 3.3 (IQR: 0-5); the rate of polypharmacy was 29.6%. Anti-hypertensive agents were the most common medications (15%) used. Polypharmacy users were 2.84 times more likely to have cognitive impairment [OR: 2.84, 95%CI (1.32-6.09)] than those using < 5 medications. Participants on hypertensive medications had 1.85 times higher odds [OR: 1.85, 95%CI (1.14-3.01)] of having cognitive impairment than those who did not have cognitive impairment. CONCLUSION: Polypharmacy increases the odds of cognitive impairment. The odds of presenting with cognitive impairment increased as the number of medications increased. Additionally, we identified a large, concerning number of participants with pharmacotherapy and poor chronic disease management. A larger study should examine medication adherence among rural elders to manage chronic disease and any healthcare barriers to adherence.

Economic Evaluations of Interventions to Optimize Medication Use in Older Adults with Polypharmacy and Multimorbidity: A Systematic Review.

PURPOSE: To conduct a systematic review of the economic impact of interventions intended at optimizing medication use in older adults with multimorbidity and polypharmacy. METHODS: We searched Ovid-Medline, Embase, CINAHL, Ageline, Cochrane, and Web of Science, for articles published between 2004 and 2020 that studied older adults with multimorbidity and polypharmacy. The intervention studied had to be aimed at optimizing medication use and present results on costs. RESULTS: Out of 3,871 studies identified by the search strategy, eleven studies were included. The interventions involved different provider types, with a majority described as a multidisciplinary team involving a pharmacist and a general practitioner, in the decision-making process. Interventions were generally associated with a reduction in medication expenditure. The benefits of the intervention in terms of clinical outcomes remain limited. Five studies were cost-benefit analyses, which had a net benefit that was either null or positive. Cost-utility and cost-effectiveness analyses resulted in incremental cost-effectiveness ratios that were generally within the willingness-to-pay thresholds of the countries in which the studies were conducted. However, the quality of the studies was generally low. Omission of key cost elements of economic evaluations, including intervention cost and payer perspective, limited interpretability. CONCLUSION: Interventions to optimize medication use may provide benefits that outweigh their implementation costs, but the evidence remains limited. There is a need to identify and address barriers to the scaling-up of such interventions, starting with the current incentive structures for pharmacists, physicians, and patients.

Polypharmacy among older Brazilians: prevalence, factors associated, and sociodemographic disparities (ELSI-Brazil)

BACKGROUND: Polypharmacy has become an increasingly public health issue as population age and novel drugs are developed. Yet, evidence on low- and middle-income countries (LMIC) is still scarce. OBJECTIVE: This work aims to estimate the prevalence of polypharmacy among Brazilians aged 50 and over, and investigate associated factors. METHODS: A cross-sectional study was conducted using data from the baseline assessment of the Brazilian Longitudinal Study of Aging (ELSI-Brazil), a nationally representative study of persons aged 50 years and older (n=9,412). Univariate and bivariate analyses described the sample. Robust Poisson regression was used to estimate prevalence ratios and predict probabilities of polypharmacy. RESULTS: Prevalence of polypharmacy was estimated at 13.5% among older adults in Brazil. Important disparities were observed in regard to gender (16.1% among women and 10.5% among men), race (16.0% among whites and 10.1% among blacks) and geographic region (ranging from 5.1% in the North to 18.7% in the South). The multivariate analysis showed that polypharmacy is associated with various sociodemographic/individual factors (age, gender, race, education, region, health status, body mass index) as well as with several variables of healthcare access/utilization (number of visits, same physician, provider's knowledge of patient's medications, gate-keeper, and difficulty managing own medication). Overall, the more utilization of health services, the higher the probability of polypharmacy, after adjusting for all other model covariates. CONCLUSIONS: Polypharmacy prevalence is relatively low in Brazil, compared to European countries. After controlling for variables of healthcare need and demographic characteristics, there is still substantial residual variance in polypharmacy prevalence. Policies to identify inappropriate prescribing and reduce regional discrepancies are necessary

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Development of a centralized, remote clinical pharmacy service to enhance primary care

More than 50% of Americans possess at least one chronic condition and another 25% suffer from two or more, leaving primary care teams tasked to care for the chronic, acute, and preventive care needs of their large patient panels. Pharmacists can reduce the burden on busy providers by effectively managing chronic diseases as members of health care teams. Many private physician practices lack the resources to include pharmacists on their teams. A centralized, remote clinical pharmacy services model allows pharmacists to remotely manage chronic disease in patients in collaboration with primary care providers. The purpose of this report is to describe how a centralized, remote clinical pharmacy team was developed, trained, and effectively integrated into multiple, diverse primary care settings across the U.S

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Análisis de los problemas relacionados con la medicación en pacientes polimedicados mayores de 64 años en atención primaria. Un estudio descriptivo transversal / Analysis of drug-related problems in polymedicated patients over the age of 64 in primary care. A cross-sectional descriptive study

OBJETIVO: Identificar los problemas relacionados con la medicación mediante los criterios STOPP/START en pacientes polimedicados mayores de 64 años con 12 o más fármacos. MÉTODO: Estudio descriptivo transversal. Se analizaron 172 casos seleccionados aleatoriamente del registro de 1.500 pacientes polimedicados del Programa de Mejora de la Calidad en el Paciente Crónico y Polimedicado del Servicio Gallego de Salud para el área de Santiago en el 2017. Se registraron los problemas relacionados con los medicamentos y los resultados negativos asociados a la medicación. El incumplimiento terapéutico se evaluó mediante el test de Morisky-Green-Levine. Las intervenciones enfermeras se registraron a partir del informe enfermero del programa. Se realizó análisis bivariante de los datos y la asociación entre las variables se estimó mediante el cálculo de la odds ratio. RESULTADO: El 56,4% de las pacientes eran mujeres. La media de edad fue de 77,34±10,11 años. El problema más habitual fue la probabilidad de presentar efectos adversos, observándose en el 64,1% de los pacientes. Las mujeres presentaron mayor probabilidad de presentar este problema que los varones (OR: 1,37; IC 95%: 1,06-1,78). Un 18% de los pacientes se consideraron no cumplidores del tratamiento prescrito, según el test de Morisky-Green-Levine. Un 25,6% de los pacientes recibieron intervenciones de educación sanitaria. CONCLUSIONES: La enfermera debe reevaluar periódicamente la medicación de los pacientes para comprobar adherencia al tratamiento y conocer si están provocando algún tipo de efecto adverso, así como incorporar a su actividad intervenciones de educación para la salud en este campo

OBJECTIVE: To identify drug-related problems using the STOPP/START criteria of patients over 64 years polymedicated with 12 or more drugs. METHOD: Descriptive cross-sectional. We analysed 172 cases randomly selected from the register of 1500 polymedicated patients of the Quality Improvement Programme for Chronic and Polymedicated Patients of the Galician Health Service for the area of Santiago in 2017. Drug-related problems and the negative results associated with medication were recorded. Treatment compliance was assessed by the Morisky-Green-Levine test. Nursing interventions were recorded based on the Programme's nursing report. Bivariate analysis of the data was performed and the association between the variables was estimated by calculating the odds ratio (OR). RESULTS: The 56.4% of the patients were women. The mean age was 77.34±10.11 years. The most common problem was the likelihood of presenting adverse effects, observed in 64.1% of the patients. Women were more likely to have this problem than men (OR: 1.37; 95% CI: 1.06-1.78). Eighteen percent of the patients were considered non-compliant with the prescribed treatment, according to the Morisky-Green-Levine test. Of the patients, 25.6% had received health education interventions. CONCLUSIONS: Nurses must periodically re-evaluate patient medication to check adherence to treatment and determine whether it is causing any type of adverse effect, as well as incorporate health education interventions in this field into their activity

The use of geroprotectors to prevent multimorbidity: Opportunities and challenges.

Over 60 % of people over the age of 65 will suffer from multiple diseases concomitantly but the common approach is to treat each disease separately. As age-associated diseases have common underlying mechanisms there is potential to tackle many diseases with the same pharmacological intervention. These are known as geroprotectors and could overcome the problems related to polypharmacy seen with the use of the single disease model. With some geroprotectors now reaching the end stage of preclinical studies and early clinical trials, there is a need to review the evidence and assess how they can be translated practically and effectively into routine practice. Despite promising evidence, there are many gaps and challenges in our understanding that must be addressed to make geroprotective medicine effective in the treatment of age-associated multimorbidity. Here we highlight the key barriers to clinical translation and discuss whether geroprotectors such as metformin, rapamycin and senolytics can tackle all age-associated diseases at the same dose, or whether a more nuanced approach is required. The evidence suggests that geroprotectors' mode of action may differ in different tissues or in response to different inducers of accelerating ageing, suggesting that a blunt 'one drug for many diseases' approach may not work. We make the case for the use of artificial intelligence to better understand multimorbidity, allowing identification of clusters and networks of diseases that are significantly associated beyond chance and the underpinning molecular pathway of ageing causal to each cluster. This will allow us to better understand the development of multimorbidity, select a more homogenous group of patients for intervention, match them with the appropriate geroprotector and identify biomarkers specific to the cluster.

Intervenciones desde la farmacia comunitaria en los pacientes adultos que reciben atención de la salud a domicilio: revisión exploratoria / Community pharmacy interventions in adult patients receiving home health care: an exploratory review

OBJETIVOS: Revisar la literatura científica relacionada con las intervenciones desde la farmacia comunitaria en los pacientes adultos que recibieron atención de la salud a domicilio. MÉTODOS: Revisión exploratoria de los artículos recuperados de las bases de datos bibliográficas MEDLINE (PubMed), Embase, Cochrane Library, Scopus y Web of Science hasta marzo de 2020. La ecuación de búsqueda se formuló́ mediante los descriptores "Home Care Services" y "Pharmacies" o "Community Pharmacy Services", utilizando también los Entry Terms relacionados y los filtros: «Humans» y «Adult: 19+ years». La calidad de los artículos se evaluó́ mediante el cuestionario STROBE. RESULTADOS: De las 307 referencias recuperadas, tras aplicar los criterios de inclusión y exclusión, se seleccionaron 44 artículos: 11 estudios descriptivos transversales y 10 ensayos aleatorizados controlados. En 19 (43%) de estos se observó que las intervenciones realizadas desde la farmacia comunitaria aumentaron la adherencia fármaco-terapéutica. También, un mejor conocimiento sobre los medicamentos (administración, seguridad, dosis, posología) en 17 (38,6%) trabajos y en 13 (29,5%) estudios se consiguió la prevención o resolución de los PRM. Al evaluar la calidad de los artículos seleccionados para la revisión mediante el cuestionario STROBE, las puntuaciones oscilaron entre un mínimo de 11 y un máximo de 20,8 sobre una puntuación máxima de 22. CONCLUSIONES: La intervención farmacéutica, a través de la farmacia comunitaria, aportó beneficios en la población más adulta, mediante el aumento de la adherencia farmacoterapéutica, la disminución de los problemas relacionados con los medicamentos y la mejora en el almacenamiento y conservación de los mismos

OBJECTIVE: To review the scientific literature related to interventions from the community pharmacy in adult patients who received home health care. METHOD: Exploratory review of the articles retrieved from the bibliographic databases MEDLINE (PubMed), Embase, Cochrane Library, Scopus and Web of Science until March 2020. The search equation was formulated using the descriptors "Home Care Services" and "Pharmacies" or "Community Pharmacy Services", also using the related Entry Terms and filters: "Humans" and "Adult: 19+ years". The quality of the articles was evaluated using the STROBE questionnaire. RESULTS: From the 307 references retrieved, after applying the inclusion and exclusion criteria, 44 articles were selected: 11 cross-sectional descriptive studies and 10 randomized controlled trials. In 19 (43%) of these, it was observed that the interventions carried out by the community pharmacy increased drug-therapeutic adherence. Also, a better knowledge of medications (administration, safety, dosage, dosage) in 17 (38.6%) studies and in 13 (29.5%) studies, the prevention or resolution of DRM was achieved. Once the articles were evaluated by means of the STROBE questionnaire for this review the scores ranged from a minimum of 11 to a maximum of 20.8 out of a maximum score of 22. CONCLUSIONS: Pharmaceutical intervention, through community pharmacy, brought benefits in the older adult population, by increasing pharmacotherapeutic adherence, reducing drug-related problems, and challenges in preserving and storing medications

A systematically collated library of prescribing safety indicators for people with chronic kidney disease.

BACKGROUND: People with chronic kidney disease (CKD) have high levels of co-morbidity and polypharmacy placing them at increased risk of prescribing-related harm. Tools for assessing prescribing safety in the general population using prescribing safety indicators (PSIs) have been established. However, people with CKD pose different prescribing challenges to people without kidney disease. Therefore, PSIs designed for use in the general population may not include all PSIs relevant to a CKD population. The aim of this study was to systematically collate a library of PSIs relevant to people with CKD. METHODS: A systematic literature search identified papers reporting PSIs. CKD-specific PSIs were extracted and categorised by Anatomical Therapeutic Chemical (ATC) classification codes. Duplicate PSIs were removed to create a final list of CKD-specific PSIs. RESULTS: Nine thousand, eight hundred fifty-two papers were identified by the systematic literature search, of which 511 proceeded to full text screening and 196 papers were identified as reporting PSIs. Following categorisation by ATC code and duplicate removal, 841 unique PSIs formed the final set of CKD-specific PSIs. The five ATC drug classes containing the largest proportion of CKD-specific PSIs were: Cardiovascular system (26%); Nervous system (13.4%); Blood and blood forming organs (12.4%); Alimentary and metabolism (12%); and Anti-infectives for systemic use (11.3%). CONCLUSION: CKD-specific PSIs could be used alone or alongside general PSIs to assess the safety and quality of prescribing within a CKD population.

Polypharmacy and mobility outcomes.

Polypharmacy is known to be associated with negative consequences of mobility related conditions such as falls, functional decline and disability. This systematic review highlights the effectiveness of deprescribing interventions on mobility related conditions in older adults in the community dwelling reported taking five or more medications daily.

Identificación de interacciones medicamentosas potenciales en pacientes geriátricos / Identification of potential drug interactions in geriatric patients

Los pacientes de la tercera edad conforman el grupo etario más medicado de la sociedad, principalmente por el incremento de la prevalencia de enfermedades crónicas, por lo tanto tienen una mayor probabilidad a presentar interacciones medicamentosas debido a otros factores dependientes del estado de su organismo, presentan tres características principales que lo diferencian de otros grupos de edad: polipatología, polifarmacia y cambios fisiológicos relacionados con el envejecimiento que alteran la farmacocinética y farmacodinamia de los medicamentos

The patients of the third age make up the most medicated age group in society, mainly due to the increase in the prevalence of chronic diseases, therefore they are more likely to present drug interactions due to other factors dependent on the state of their organism, they present three main characteristics that differentiate it from other age groups: polypathology, polypharmacy and physiological changes related to aging that alter the pharmacokinetics and pharmacodynamics of medications

Thoughtful Prescribing and Deprescribing.

Polypharmacy, the use of five or more medications, is common in older adults. It can lead to the use of potentially inappropriate medications and severe adverse outcomes. Deprescribing is an essential step of the thoughtful prescribing process and it can decrease the use of potentially inappropriate medications. Studies have demonstrated that deprescribing is feasible in the clinical setting, especially when it incorporates patient preferences, shared decision making, and an interdisciplinary team. Medication-specific algorithms can facilitate deprescribing in the clinical setting.

Overview of High Yield Geriatrics Assessment for Clinic and Hospital.

Geriatric assessment is a comprehensive, multifaceted, and interdisciplinary evaluation of medical, socioeconomic, environmental, and functional concerns unique to older adults; it can be focused or broadened according to the needs of the patient and the concerns of clinical providers. Herein, the authors present a high-yield framework that can be used to assess older adult patients across a variety of settings.

Interacciones farmacológicas potenciales en población mayor de 64 años atendida en Atención Primaria / Potential drug interactions in patients over 64 age attended in Primary Health Care

OBJETIVO: El objetivo principal del presente estudio fue identificar posibles interacciones medicamentosas en pacientes mayores de 64 años en Atención Primaria durante el año 2017, así como estudiar los grupos farmacológicos que se asocian con mayor frecuencia a estas interacciones. MATERIAL Y MÉTODOS: Se llevó a cabo un estudio observacional de tipo descriptivo en el año 2017 en el Centro de Salud Las Fuentes Norte, perteneciente al Sector Sanitario Zaragoza II. La población de estudio fueron todos los pacientes mayores de 64 años de un cupo del citado centro de Zaragoza. Para ello se utilizó el programa informático Bot PLUS 2.0 para identificar los fármacos que con mayor frecuencia se asociaron con la presencia de interacciones farmacológicas potenciales. Otras variables estudiadas fueron el sexo, la edad, la polimedicación, el número de prescripciones activas y la gravedad de las interacciones fármaco-fármaco. RESULTADOS: El 58,78% de los pacientes fueron mujeres y el 60,9% tomaba 5 o más fármacos. Se detectaron un total de 915 interacciones fármaco-fármaco en 254 pacientes (67,6%), de las cuales el 40,8% eran graves, el 14,8% moderadas y el 44,5% leves. El número de interacciones farmacológicas estuvo relacionado con la edad, la polimedicación y el número de prescripciones (p < 0,001). CONCLUSIONES: A pesar de la elevada prevalencia de interacciones medicamentosas potenciales encontrada en los pacientes de este estudio, solo 4 grupos farmacológicos (anticoagulantes orales, diuréticos, antiinflamatorios no esteroideos e inhibidores de la bomba de protones) fueron responsables de la mayoría de ellas

OBJECTIVE: The aim of the study was to identify the presence of possible drug interactions in patients over 64 years of age in Primary Health Care during 2017, as well as to study the pharmacological groups most frequently associated with these interactions. MATERIAL AND METHODS: An observational and descriptive study was carried out in Las Fuentes Norte Primary Health Care in 2017 belonging to the Zaragoza II Health Sector. The study population were all patients over 64 years of a quotas of a Primary Care center in Zaragoza. The Bot PLUS 2.0 computer program was used to identify drugs most frequently associated with the presence of potential drug interactions. Other variables studied were gender, age, multiple medications, prescription drugs, and severity of drug-drug interactions. RESULTS: The study included 58.78% women, and a total of 60.9% patients had taken 5 or more drugs. A total of 915 drug-drug interactions that involved 254 patients (67,6%) were identified, of which 40.08% were relevant, 14.08% moderate, and 44.5% mild. The number of interactions were associated with age, multiple medications, and number of prescriptions (P<.001). CONCLUSIONS: Despite the high prevalence of potential drug-drug interactions found in the present study, only 4 pharmacological groups (oral anticoagulants, diuretics, non-steroidal anti-inflammatory drugs and proton pump inhibitors) were responsible for the majority of them

Simplicidad del régimen de medicación y supervivencia en pacientes pluripatológicos / Simplified medication regimen and survival in polypathological patients

OBJETIVO: Determinar si un régimen medicamentoso más simple en pacientes pluripatológicos se asocia con la supervivencia. MÉTODOS: En un estudio de cohortes multicéntrico se incluyeron pacientes pluripatológicos hospitalizados en servicios de medicina interna entre el 1 de marzo y el 30 de junio de 2011. Se excluyeron los reingresos y los fallecidos. Se recogieron datos de edad, sexo, residencia, enfermedad, índices de Charlson, Barthel y Lawton-Brody, Short Portable Mental State Questionnaire, escala de Gijón, número de ingresos en el año previo, delirio, necesidad de cuidador e índice PROFUND. Se calculó la complejidad terapéutica con el Medication Regimen Complexity Index. Se hizo un seguimiento de 4 años. Para determinar los factores asociados con la mortalidad por todas las causas se construyó un modelo de regresión de Cox. RESULTADOS: Se incluyeron 233 pacientes pluripatológicos con una edad media de 79,8 (8,6) años. La puntuación media en el Medication Regimen Complexity Index fue 32 (15,2). A los 4 años fallecieron 161 (72,2%) pacientes, 36 con régimen de medicación más simple. La edad (HR 1,060; IC95% 1,032-1,089; p < 0,001), las neoplasias (HR 2,477; IC95% 1,564-3,923; p < 0,001) y el número de ingresos en el año previo (HR 1,251; IC95% 1,100-1,423; p = 0,001) se asociaron de forma independiente con la mortalidad, y la puntuación del índice de Barthel (HR 0,991; IC95% 0,983-0,998; p < 0,001) y la simplicidad del régimen de medicación (HR 0,634; IC95% 0,414-0,970; p = 0,036) con menor mortalidad. CONCLUSIONES: En los pacientes pluripatológicos los regímenes de medicación más simples se asocian con una menor mortalidad

OBJECTIVE: To determine if a more simplified medication regimen is associated with survival in polypathological patients. METHODS: Multicentre cohort study. We included polypathological patients admitted to internal medicine wards between March 1st and June 30rd, 2011. Patients that died during admission and readmissions were excluded. Data were collected about age, gender, home, comorbidity, Charlson, Barthel and Lawton-Brody indexes, Short Portable Mental State Questionnaire, socio-familial Gijón scale, admissions in the previous year, delirium, need of a caregiver and PROFUND index. The therapy complexity was measured with the Medication Regimen Complexity Index. The follow-up lasted 4-years. To determine the factors associated with mortality we performed a Cox proportional regression model. RESULTS: Overall 223 polypathological patients were included, with a mean age of 79.8 (8.6) years. Mean score in Medication Regimen Complexity Index was 32.0 (15.2). After 4 years, 161 (72.2%) patients died, 36 with a more simplified medication regimen. Age (HR 1.060, 95%CI 1.032-1.089; P<.001), neoplasms (HR 2.477, 95%CI 1.564-3.923; P<.001), and the number of admissions in the previous year (HR 1.251, 95%CI 1.100-1.423; P=.001) were independently associated with 4-year mortality, and Barthel index score (HR .991, 95%CI .983-0.998; P<.001) and a more simplified medication regimen (HR 0.634 95%CI 0.414-.970; p=.036) with lower mortality. CONCLUSIONS: In polypathological patients, the more simplified medication regimens are associated with a lower mortality