Resources for the Comprehensive Geriatric Assessment based
Proactive and Personalised Primary Care of the Elderly
Increasing numbers of prescribed medications correlate with frailty, falls and hospital admissions, and substantial numbers of older people’s admissions to hospital are caused by or related to their medications.
Appropriate use of medications, prescribed or otherwise, is the cornerstone of good management of medical conditions.
Adverse drug reactions (ADRs) in older people currently represent a serious and growing public health problem (Scott I, 2010).
Older people, particularly those with frailty, are more likely to have multiple comorbidities and to be taking multiple medications.
This increases the risk of interactions, but additionally they are more likely to experience drug side effects and to have additional prescriptions written to counter such unintended effects .
Polypharmacy is a term commonly used in this context though it simply means the patient is on many medications (typically a cut-off of 4 or 5 is accepted as a threshold suggesting increased risk of interactions and complications).
Polypharmacy and inappropriate prescribing (IP) are well-known risk factors for ADRs, which commonly cause adverse clinical outcomes in older people (Onder G, 2013)]. IP encompasses potentially inappropriate medications (PIMs) and potential prescribing omissions (PPOs) (O'Connor, 2012).
One patient may be taking only 3 medications, all of which are unnecessary or detrimental, while another may be taking 10, completely appropriate medications at optimal doses with evidence-based indications.
Medication review is, put simply, a process by which a patient’s use of medication is carefully reviewed to ensure that each medication taken is used appropriately, optimally, and that its benefits outweigh its harms.
It is a key part of a comprehensive geriatric assessment.
Many parts of the process can be completed by a suitably trained pharmacist but a full review process is likely to require medical input for clinical assessment of symptoms and diagnoses that may be medication-related.
It should be noted that a medication review does not imply a large or whole-scale reduction in prescribing (although that is often the case), and in fact some medications may be increased (to more effective doses) or added (if important indications have not been addressed ).
Tools are available to support medication review. There are two types of tool:
Explicit criteria-based prescribing tools
which have been developed using expert reviews and opinions and are drug or disease-oriented.
E.g. STOPP/START, Beers criteria
Implicit criteria-based tools
which use patient-specific information in order to judge whether a specific medicine is appropriate.7,10,22 They review the following aspects of prescribing for the individual: indication, effectiveness, dose, correct directions, practical directions, drug-drug / drug-disease interactions, duplication, duration of therapy
2012 AGS Beers Criteria
Decision aid for supporting medication review. It consists of a series of rules/suggestions related to high-yield problems in prescribing for older people, both in terms of reducing medication burden (STOPP) and adding in potentially benefical therapy (START)
Screening Tool Of Older People's Prescriptions (STOPP) Screening Tool to Alert to Right Treatment (START)
Decision aid for supporting medication review. It consists of a series of medications to avoid related to common problems in prescribing for older people generally, and in relation to particular medical conditions. Several of the medications are specific to the USA.
The Medication Review is one of 5 sub-domains of the
The Medical Assessment is one of 8 domains of the
Comprehensive Geriatric Assessment (CGA)
Back To : Medical Assessment
Back To : Comprehensive Geriatric Assessment
Medication Appropriateness Index
Framework for assessment of medications for older people. The MAI can be applied progressively to each medication to decide, individually and in combination with other medicines, whether the cost:benefit decision to prescribe the medication in question is appropriate.
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