Adherence and Polymedication in Older Adults

A special issue of Geriatrics (ISSN 2308-3417).

Deadline for manuscript submissions: closed (10 July 2023) | Viewed by 9879

Special Issue Editor


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Guest Editor
1. Department of Geriatrics, Halle University Hospital, 06120 Halle, Germany
2. Center for Geriatrics in the Southern Saxonia-Anhalt (ZASSA), 06120 Halle, Germany
Interests: adherence; malnutrition; quality of life; health services research; Parkinson’s disease; gait disorders; falls

Special Issue Information

Dear Colleagues,

The treatment of chronic disorders commonly includes the long-term use of pharmacotherapy and non-pharmacological therapy. However, their full benefits are often not realized because many patients either do not or cannot take medications as agreed with their physicians. This nonadherence is a major issue and is associated with increased morbidity, mortality, and immense costs for the healthcare system. In particular, in older adults, nonadherence contributes to adverse drug events, increased length of stay and readmissions to hospitals, and a lower quality of life. Therefore, increasing the effectiveness of adherence interventions may have a great impact on the health of the older population. Although many factors contributing to nonadherence were studied in different cohorts and settings, many open questions remain. Among others, we need more research about methodological aspects and more longitudinal studies addressing the dynamic nature of nonadherence.

This Special Issue on Geriatrics will focus on risk factors of nonadherence, facilitators of adherence, new methodologies and technologies to measure adherence, the relationship between adherence and patient-reported outcomes, and strategies to improve adherence and self-management in older adults.

Prof. Dr. Tino Prell
Guest Editor

Manuscript Submission Information

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Keywords

  • adherence
  • self-management
  • polymedication
  • quality of life
  • healthcare

Published Papers (4 papers)

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Research

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18 pages, 329 KiB  
Article
Identification of Drugs Acting as Perpetrators in Common Drug Interactions in a Cohort of Geriatric Patients from Southern Italy and Analysis of the Gene Polymorphisms That Affect Their Interacting Potential
by Mauro Cataldi, Camilla Celentano, Leonardo Bencivenga, Michele Arcopinto, Chiara Resnati, Annalaura Manes, Loreta Dodani, Lucia Comnes, Robert Vander Stichele, Dipak Kalra, Giuseppe Rengo, Francesco Giallauria, Ugo Trama, Nicola Ferrara, Antonio Cittadini and Maurizio Taglialatela
Geriatrics 2023, 8(5), 84; https://doi.org/10.3390/geriatrics8050084 - 24 Aug 2023
Viewed by 1519
Abstract
Background: Pharmacogenomic factors affect the susceptibility to drug–drug interactions (DDI). We identified drug interaction perpetrators among the drugs prescribed to a cohort of 290 older adults and analysed the prevalence of gene polymorphisms that can increase their interacting potential. We also pinpointed clinical [...] Read more.
Background: Pharmacogenomic factors affect the susceptibility to drug–drug interactions (DDI). We identified drug interaction perpetrators among the drugs prescribed to a cohort of 290 older adults and analysed the prevalence of gene polymorphisms that can increase their interacting potential. We also pinpointed clinical decision support systems (CDSSs) that incorporate pharmacogenomic factors in DDI risk evaluation. Methods: Perpetrator drugs were identified using the Drug Interactions Flockhart Table, the DRUGBANK website, and the Mayo Clinic Pharmacogenomics Association Table. Allelic variants affecting their activity were identified with the PharmVar, PharmGKB, dbSNP, ensembl and 1000 genome databases. Results: Amiodarone, amlodipine, atorvastatin, digoxin, esomperazole, omeprazole, pantoprazole, simvastatin and rosuvastatin were perpetrator drugs prescribed to >5% of our patients. Few allelic variants affecting their perpetrator activity showed a prevalence >2% in the European population: CYP3A4/5*22, *1G, *3, CYP2C9*2 and *3, CYP2C19*17 and *2, CYP2D6*4, *41, *5, *10 and *9 and SLC1B1*15 and *5. Few commercial CDSS include pharmacogenomic factors in DDI-risk evaluation and none of them was designed for use in older adults. Conclusions: We provided a list of the allelic variants influencing the activity of drug perpetrators in older adults which should be included in pharmacogenomics-oriented CDSSs to be used in geriatric medicine. Full article
(This article belongs to the Special Issue Adherence and Polymedication in Older Adults)
19 pages, 842 KiB  
Article
Polypharmacy Patterns in Multimorbid Older People with Cardiovascular Disease: Longitudinal Study
by Noemí Villén, Albert Roso-Llorach, Carlos Gallego-Moll, Marc Danes-Castells, Sergio Fernández-Bertolin, Amelia Troncoso-Mariño, Monica Monteagudo, Ester Amado and Concepción Violán
Geriatrics 2022, 7(6), 141; https://doi.org/10.3390/geriatrics7060141 - 13 Dec 2022
Cited by 2 | Viewed by 2180
Abstract
(1) Introduction: Cardiovascular disease is associated with high mortality, especially in older people. This study aimed to characterize the evolution of combined multimorbidity and polypharmacy patterns in older people with different cardiovascular disease profiles. (2) Material and methods: This longitudinal study drew data [...] Read more.
(1) Introduction: Cardiovascular disease is associated with high mortality, especially in older people. This study aimed to characterize the evolution of combined multimorbidity and polypharmacy patterns in older people with different cardiovascular disease profiles. (2) Material and methods: This longitudinal study drew data from the Information System for Research in Primary Care in people aged 65 to 99 years with profiles of cardiovascular multimorbidity. Combined patterns of multimorbidity and polypharmacy were analysed using fuzzy c-means clustering techniques and hidden Markov models. The prevalence, observed/expected ratio, and exclusivity of chronic diseases and/or groups of these with the corresponding medication were described. (3) Results: The study included 114,516 people, mostly men (59.6%) with a mean age of 78.8 years and a high prevalence of polypharmacy (83.5%). The following patterns were identified: Mental, behavioural, digestive and cerebrovascular; Neuropathy, autoimmune and musculoskeletal; Musculoskeletal, mental, behavioural, genitourinary, digestive and dermatological; Non-specific; Multisystemic; Respiratory, cardiovascular, behavioural and genitourinary; Diabetes and ischemic cardiopathy; and Cardiac. The prevalence of overrepresented health problems and drugs remained stable over the years, although by study end, cohort survivors had more polypharmacy and multimorbidity. Most people followed the same pattern over time; the most frequent transitions were from Non-specific to Mental, behavioural, digestive and cerebrovascular and from Musculoskeletal, mental, behavioural, genitourinary, digestive and dermatological to Non-specific. (4) Conclusions: Eight combined multimorbidity and polypharmacy patterns, differentiated by sex, remained stable over follow-up. Understanding the behaviour of different diseases and drugs can help design individualised interventions in populations with clinical complexity. Full article
(This article belongs to the Special Issue Adherence and Polymedication in Older Adults)
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10 pages, 256 KiB  
Article
“I Think Deprescribing as a Whole Is a Gap!”: A Qualitative Study of Student Pharmacist Perceptions about Deprescribing
by Sydney P. Springer, Alina Cernasev, Rachel E. Barenie, David R. Axon and Devin Scott
Geriatrics 2022, 7(3), 60; https://doi.org/10.3390/geriatrics7030060 - 02 Jun 2022
Cited by 5 | Viewed by 2455
Abstract
Introduction: Older adults often manage multiple medications simultaneously, contributing to significant pill burden. Pill burden is a major concern for both patients and providers alike, and student pharmacists may play a role in decreasing that burden. Few studies exist evaluating student pharmacists’ roles [...] Read more.
Introduction: Older adults often manage multiple medications simultaneously, contributing to significant pill burden. Pill burden is a major concern for both patients and providers alike, and student pharmacists may play a role in decreasing that burden. Few studies exist evaluating student pharmacists’ roles in and perceptions of deprescribing in the healthcare team. Thus, the aim of this study was to explore student pharmacist perceptions regarding deprescribing in their pharmacy curricula. Methods: This study used a focus group discussion (FGD) methodology to facilitate discussion on deprescribing among student pharmacists. The theory of planned behavior (TPB) informed the conceptualization of this study, data collection, and thematic analysis. Student pharmacists enrolled in three different colleges of pharmacy across various geographical regions of the U.S. were recruited to participate in the study. Data collection occurred in the Fall of 2021, and recruitment proceeded until thematic saturation was achieved. The audio recordings were transcribed verbatim, and the transcripts were uploaded into Dedoose®, a qualitative software that facilitated the data analysis. The inductive codes were grouped into categories based on similarities that resulted in the themes. Results: Three colleges, totaling 1366 student pharmacists across different geographic regions of the U.S., were invited to participate in this study (UTHSC, N = 682; UNE, N = 158, University of Arizona, N = 526). Twenty-six student pharmacists participated in four FGDs. Of 26 participants, fourteen self-identified as male and two declined to state their gender identity. The mean age was 24 years old, with participants ranging from 21 to 37 years old. Thematic analysis revealed two major themes: (1) student pharmacists indicated that they possessed limited information about the deprescribing process, which is best illustrated by the following quote: “I think deprescribing as a whole is a gap!”; and (2) student pharmacists recommended increasing emphasis on deprescribing in pharmacy curricula. Conclusions: Student pharmacists identified few educational experiences on deprescribing in their curriculum while demonstrating a strong desire for more emphasis on deprescribing in the pharmacy curricula. This study highlights an opportunity to improve the integration of deprescribing education into pharmacy curricula, and colleges of pharmacy should evaluate whether, where, and to what extent the incorporation of this topic into their curricula is appropriate. Full article
(This article belongs to the Special Issue Adherence and Polymedication in Older Adults)

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10 pages, 1038 KiB  
Perspective
Recent Updates on Risk and Management Plans Associated with Polypharmacy in Older Population
by Asim Muhammed Alshanberi
Geriatrics 2022, 7(5), 97; https://doi.org/10.3390/geriatrics7050097 - 13 Sep 2022
Cited by 5 | Viewed by 2979
Abstract
The concept of polypharmacy encompasses adverse drug reactions and non-adherence factors in elderly individuals. It also leads to the increased use of healthcare services and negative health outcomes. The problem is further alleviated by the odds of potentially inappropriate medications (PIM), which lead [...] Read more.
The concept of polypharmacy encompasses adverse drug reactions and non-adherence factors in elderly individuals. It also leads to the increased use of healthcare services and negative health outcomes. The problem is further alleviated by the odds of potentially inappropriate medications (PIM), which lead to the development of drug-related problems. Since polypharmacy is more commonly observed in the elderly population, urgency is required to introduce operative protocols for preventing and managing this problem. The family medicine model of care can be associated with favorable illness outcomes regarding satisfaction with consultation, treatment adherence, self-management behaviors, adherence to medical advice, and healthcare utilization. Hence, interventions built on family medicine models can provide significant support in improving the outcomes of the older population and their quality of life. In this regard, the authors have taken up the task of explaining the accessible resources which can be availed to improve the application of health care services in the field of geriatric medicine. Full article
(This article belongs to the Special Issue Adherence and Polymedication in Older Adults)
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