Inappropriate drugs in elderly patients with severe cognitive impairment: results from the Shelter study
It has been estimated that Nursing Home (NH) residents with impaired cognitive status receive an average of seven to eight drugs daily. The aim of this study was to determine prevalence and factors associated with use of inappropriate drugs in elderly patients with severe cognitive impairment living...
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| Veröffentlicht in: | PloS one 2012-10, Vol.7 (10), p.e46669-e46669 |
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| creator | Colloca, Giuseppe Tosato, Matteo Vetrano, Davide L. Topinkova, Eva Fialova, Daniela Gindin, Jacob Van der Roest, Henriette G Landi, Francisco Farber, Irena Liperoti, Rosa Bernabei, Roberto Graziano, Onder |
| description | It has been estimated that Nursing Home (NH) residents with impaired cognitive status receive an average of seven to eight drugs daily. The aim of this study was to determine prevalence and factors associated with use of inappropriate drugs in elderly patients with severe cognitive impairment living in NH in Europe.
Cross-sectional data from a sample of 1449 NH residents with severe cognitive impairment, participating in the Services and Health for Elderly in Long TERm care (SHELTER) study were analysed. Inappropriate drug use was defined as the use of drugs classified as rarely or never appropriate in patients with severe cognitive impairment based on the Holmes criteria published in 2008.
Mean age of participating residents was 84.2±8.9 years, 1087 (75.0%) were women. Inappropriate drug use was observed in 643 (44.9%) residents. Most commonly used inappropriate drugs were lipid-lowering agents (9.9%), antiplatelet agents (excluding Acetylsalicylic Acid - ASA -) (9.9%), acetylcholinesterase, inhibitors (7.2%) and antispasmodics (6.9%). Inappropriate drug use was directly associated with specific diseases including diabetes (OR 1.64; 95% CI 1.21-2.24), heart failure (OR 1.48; 95% CI 1.04-2.09), stroke (OR 1.43; 95% CI 1.06-1.93), and recent hospitalization (OR 1.69; 95% CI 1.20-2.39). An inverse relation was shown between inappropriate drug use and presence of a geriatrician in the facility (OR 0.55; 95% CI 0.39-0.77).
Use of inappropriate drugs is common among older EU NH residents. Determinants of inappropriate drug use include comorbidities and recent hospitalization. Presence of a geriatrician in the facility staff is associated with a reduced rate of use of these medications. |
| doi_str_mv | 10.1371/journal.pone.0046669 |
| format | Article |
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Cross-sectional data from a sample of 1449 NH residents with severe cognitive impairment, participating in the Services and Health for Elderly in Long TERm care (SHELTER) study were analysed. Inappropriate drug use was defined as the use of drugs classified as rarely or never appropriate in patients with severe cognitive impairment based on the Holmes criteria published in 2008.
Mean age of participating residents was 84.2±8.9 years, 1087 (75.0%) were women. Inappropriate drug use was observed in 643 (44.9%) residents. Most commonly used inappropriate drugs were lipid-lowering agents (9.9%), antiplatelet agents (excluding Acetylsalicylic Acid - ASA -) (9.9%), acetylcholinesterase, inhibitors (7.2%) and antispasmodics (6.9%). Inappropriate drug use was directly associated with specific diseases including diabetes (OR 1.64; 95% CI 1.21-2.24), heart failure (OR 1.48; 95% CI 1.04-2.09), stroke (OR 1.43; 95% CI 1.06-1.93), and recent hospitalization (OR 1.69; 95% CI 1.20-2.39). An inverse relation was shown between inappropriate drug use and presence of a geriatrician in the facility (OR 0.55; 95% CI 0.39-0.77).
Use of inappropriate drugs is common among older EU NH residents. Determinants of inappropriate drug use include comorbidities and recent hospitalization. Presence of a geriatrician in the facility staff is associated with a reduced rate of use of these medications.</description><identifier>ISSN: 1932-6203</identifier><identifier>EISSN: 1932-6203</identifier><identifier>DOI: 10.1371/journal.pone.0046669</identifier><identifier>PMID: 23056394</identifier><language>eng</language><publisher>United States: Public Library of Science</publisher><subject>Acetylcholinesterase ; Acetylsalicylic acid ; Aged ; Aged, 80 and over ; Alzheimer's disease ; Aspirin ; Aspirin - therapeutic use ; Cholinesterase Inhibitors - therapeutic use ; Chronic illnesses ; Cognition Disorders - drug therapy ; Cognitive ability ; Cognitive Impairment ; Cross-Sectional Studies ; Dementia ; Diabetes mellitus ; Drug abuse ; Drug Utilization ; Drugs ; Elderly patients ; Female ; Geriatrics ; Gerontology ; Health Services for the Aged - statistics & numerical data ; Heart ; Heart diseases ; Homes for the Aged - statistics & numerical data ; Humans ; Hypolipidemic Agents - therapeutic use ; Impairment ; Life expectancy ; Long term care ; Long term health care ; Long-Term Care - statistics & numerical data ; Male ; Medicin och hälsovetenskap ; Medicine ; Nursing home patients ; Nursing homes ; Older people ; Parasympatholytics - therapeutic use ; Patients ; Prescription drugs ; Shelters</subject><ispartof>PloS one, 2012-10, Vol.7 (10), p.e46669-e46669</ispartof><rights>COPYRIGHT 2012 Public Library of Science</rights><rights>Colloca et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License: https://creativecommons.org/licenses/by/4.0/ (the “License”), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><rights>2012 Colloca et al 2012 Colloca et al</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c765t-e8d6bbd92a05d07f4ee798637c38a905ecd34ce53b40fac5f67806a999c415313</citedby></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC3463565/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC3463565/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,552,727,780,784,864,885,2102,2928,23866,27924,27925,53791,53793,79600,79601</link.rule.ids><backlink>$$Uhttp://dx.doi.org/10.1371/journal.pone.0046669$$D View full text (Access may be restricted)$$Hfree_for_read</backlink><backlink>$$Uhttp://igdc.huji.ac.il/home/Maagar/Details.aspx?AN=3484$$D View record in IGDC$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/23056394$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink><backlink>$$Uhttp://kipublications.ki.se/Default.aspx?queryparsed=id:125437998$$DView record from Swedish Publication Index$$Hfree_for_read</backlink></links><search><contributor>Bayer, Antony</contributor><creatorcontrib>Colloca, Giuseppe</creatorcontrib><creatorcontrib>Tosato, Matteo</creatorcontrib><creatorcontrib>Vetrano, Davide L.</creatorcontrib><creatorcontrib>Topinkova, Eva</creatorcontrib><creatorcontrib>Fialova, Daniela</creatorcontrib><creatorcontrib>Gindin, Jacob</creatorcontrib><creatorcontrib>Van der Roest, Henriette G</creatorcontrib><creatorcontrib>Landi, Francisco</creatorcontrib><creatorcontrib>Farber, Irena</creatorcontrib><creatorcontrib>Liperoti, Rosa</creatorcontrib><creatorcontrib>Bernabei, Roberto</creatorcontrib><creatorcontrib>Graziano, Onder</creatorcontrib><creatorcontrib>SHELTER project</creatorcontrib><creatorcontrib>SHELTER project</creatorcontrib><title>Inappropriate drugs in elderly patients with severe cognitive impairment: results from the Shelter study</title><title>PloS one</title><addtitle>PLoS One</addtitle><description>It has been estimated that Nursing Home (NH) residents with impaired cognitive status receive an average of seven to eight drugs daily. The aim of this study was to determine prevalence and factors associated with use of inappropriate drugs in elderly patients with severe cognitive impairment living in NH in Europe.
Cross-sectional data from a sample of 1449 NH residents with severe cognitive impairment, participating in the Services and Health for Elderly in Long TERm care (SHELTER) study were analysed. Inappropriate drug use was defined as the use of drugs classified as rarely or never appropriate in patients with severe cognitive impairment based on the Holmes criteria published in 2008.
Mean age of participating residents was 84.2±8.9 years, 1087 (75.0%) were women. Inappropriate drug use was observed in 643 (44.9%) residents. Most commonly used inappropriate drugs were lipid-lowering agents (9.9%), antiplatelet agents (excluding Acetylsalicylic Acid - ASA -) (9.9%), acetylcholinesterase, inhibitors (7.2%) and antispasmodics (6.9%). Inappropriate drug use was directly associated with specific diseases including diabetes (OR 1.64; 95% CI 1.21-2.24), heart failure (OR 1.48; 95% CI 1.04-2.09), stroke (OR 1.43; 95% CI 1.06-1.93), and recent hospitalization (OR 1.69; 95% CI 1.20-2.39). An inverse relation was shown between inappropriate drug use and presence of a geriatrician in the facility (OR 0.55; 95% CI 0.39-0.77).
Use of inappropriate drugs is common among older EU NH residents. Determinants of inappropriate drug use include comorbidities and recent hospitalization. Presence of a geriatrician in the facility staff is associated with a reduced rate of use of these medications.</description><subject>Acetylcholinesterase</subject><subject>Acetylsalicylic acid</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Alzheimer's disease</subject><subject>Aspirin</subject><subject>Aspirin - therapeutic use</subject><subject>Cholinesterase Inhibitors - therapeutic use</subject><subject>Chronic illnesses</subject><subject>Cognition Disorders - drug therapy</subject><subject>Cognitive ability</subject><subject>Cognitive Impairment</subject><subject>Cross-Sectional Studies</subject><subject>Dementia</subject><subject>Diabetes mellitus</subject><subject>Drug abuse</subject><subject>Drug Utilization</subject><subject>Drugs</subject><subject>Elderly patients</subject><subject>Female</subject><subject>Geriatrics</subject><subject>Gerontology</subject><subject>Health Services for the Aged - statistics & numerical data</subject><subject>Heart</subject><subject>Heart diseases</subject><subject>Homes for the Aged - statistics & numerical data</subject><subject>Humans</subject><subject>Hypolipidemic Agents - therapeutic use</subject><subject>Impairment</subject><subject>Life expectancy</subject><subject>Long term care</subject><subject>Long term health care</subject><subject>Long-Term Care - statistics & numerical data</subject><subject>Male</subject><subject>Medicin och hälsovetenskap</subject><subject>Medicine</subject><subject>Nursing home patients</subject><subject>Nursing homes</subject><subject>Older people</subject><subject>Parasympatholytics - therapeutic use</subject><subject>Patients</subject><subject>Prescription drugs</subject><subject>Shelters</subject><issn>1932-6203</issn><issn>1932-6203</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2012</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>DWQXO</sourceid><sourceid>GNUQQ</sourceid><sourceid>D8T</sourceid><sourceid>DOA</sourceid><recordid>eNqNk21r1TAUx4sobk6_gWhBEH1xr2nz0MYXwhg-XBgMnPo2pOlpm5k2XZJu3m9vrrebq-yFDaXl5Hf-yfknJ0meZ2id4SJ7d2EnN0izHu0Aa4QIY4w_SA4zjvMVyxF-eOf_IHni_QVCFJeMPU4Ocowow5wcJt1mkOPo7Oi0DJDWbmp9qocUTA3ObNNRBg1D8Om1Dl3q4QocpMq2gw76ClLdj1K7PhLvUwd-MpFsnO3T0EF63oEJ4FIfpnr7NHnUSOPh2fw9Sr5_-vjt5Mvq9Ozz5uT4dKUKRsMKyppVVc1ziWiNioYAFLxkuFC4lBxRUDUmCiiuCGqkog0rSsQk51yRjOIMHyUv97qjsV7MJnmRYUIRxihnkdjsidrKCxEL76XbCiu1-BOwrhXSBa0MCFyXtFE5zxRjpIScM0KrPGdFnmUNRL2jhO-1_DWMU7VQi67WYo7_1LtXeBBZTgkuOC9j7od5p1PVQ62iiU6apcRiZtCdaO2VwIRhymgUeDMLOHs5gQ-i116BMXIAO8Wa41NSFheL6Kt_0PudmalWxuL10Ni4rtqJiuO4a5yTLN9pre-h4qih1yrexkbH-CLh7SIhMgF-hVZO3ovN-df_Z89-LNnXd9gOpAmdt2YK2g5-CZI9qJz13kFza3KGxK6ZbtwQu2YSczPFtBd3D-g26aZ7_gK6rZWodGW0bZ0cO63iIZUE_wZWTCV_</recordid><startdate>20121003</startdate><enddate>20121003</enddate><creator>Colloca, Giuseppe</creator><creator>Tosato, Matteo</creator><creator>Vetrano, Davide L.</creator><creator>Topinkova, Eva</creator><creator>Fialova, Daniela</creator><creator>Gindin, Jacob</creator><creator>Van der Roest, Henriette G</creator><creator>Landi, Francisco</creator><creator>Farber, Irena</creator><creator>Liperoti, Rosa</creator><creator>Bernabei, Roberto</creator><creator>Graziano, Onder</creator><general>Public Library of Science</general><general>Public Library of Science (PLoS)</general><scope>AGDVQ</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>IOV</scope><scope>ISR</scope><scope>3V.</scope><scope>7QG</scope><scope>7QL</scope><scope>7QO</scope><scope>7RV</scope><scope>7SN</scope><scope>7SS</scope><scope>7T5</scope><scope>7TG</scope><scope>7TM</scope><scope>7U9</scope><scope>7X2</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8C1</scope><scope>8FD</scope><scope>8FE</scope><scope>8FG</scope><scope>8FH</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABJCF</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>ARAPS</scope><scope>ATCPS</scope><scope>AZQEC</scope><scope>BBNVY</scope><scope>BENPR</scope><scope>BGLVJ</scope><scope>BHPHI</scope><scope>C1K</scope><scope>CCPQU</scope><scope>D1I</scope><scope>DWQXO</scope><scope>FR3</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>H94</scope><scope>HCIFZ</scope><scope>K9.</scope><scope>KB.</scope><scope>KB0</scope><scope>KL.</scope><scope>L6V</scope><scope>LK8</scope><scope>M0K</scope><scope>M0S</scope><scope>M1P</scope><scope>M7N</scope><scope>M7P</scope><scope>M7S</scope><scope>NAPCQ</scope><scope>P5Z</scope><scope>P62</scope><scope>P64</scope><scope>PATMY</scope><scope>PDBOC</scope><scope>PIMPY</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>PTHSS</scope><scope>PYCSY</scope><scope>RC3</scope><scope>7X8</scope><scope>5PM</scope><scope>ADTPV</scope><scope>AOWAS</scope><scope>D8T</scope><scope>ZZAVC</scope><scope>DOA</scope></search><sort><creationdate>20121003</creationdate><title>Inappropriate drugs in elderly patients with severe cognitive impairment: results from the Shelter study</title><author>Colloca, Giuseppe ; Tosato, Matteo ; Vetrano, Davide L. ; Topinkova, Eva ; Fialova, Daniela ; Gindin, Jacob ; Van der Roest, Henriette G ; Landi, Francisco ; Farber, Irena ; Liperoti, Rosa ; Bernabei, Roberto ; Graziano, Onder</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c765t-e8d6bbd92a05d07f4ee798637c38a905ecd34ce53b40fac5f67806a999c415313</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2012</creationdate><topic>Acetylcholinesterase</topic><topic>Acetylsalicylic acid</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Alzheimer's disease</topic><topic>Aspirin</topic><topic>Aspirin - therapeutic use</topic><topic>Cholinesterase Inhibitors - therapeutic use</topic><topic>Chronic illnesses</topic><topic>Cognition Disorders - drug therapy</topic><topic>Cognitive ability</topic><topic>Cognitive Impairment</topic><topic>Cross-Sectional Studies</topic><topic>Dementia</topic><topic>Diabetes mellitus</topic><topic>Drug abuse</topic><topic>Drug Utilization</topic><topic>Drugs</topic><topic>Elderly patients</topic><topic>Female</topic><topic>Geriatrics</topic><topic>Gerontology</topic><topic>Health Services for the Aged - statistics & numerical data</topic><topic>Heart</topic><topic>Heart diseases</topic><topic>Homes for the Aged - statistics & numerical data</topic><topic>Humans</topic><topic>Hypolipidemic Agents - therapeutic use</topic><topic>Impairment</topic><topic>Life expectancy</topic><topic>Long term care</topic><topic>Long term health care</topic><topic>Long-Term Care - statistics & numerical data</topic><topic>Male</topic><topic>Medicin och hälsovetenskap</topic><topic>Medicine</topic><topic>Nursing home patients</topic><topic>Nursing homes</topic><topic>Older people</topic><topic>Parasympatholytics - 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Academic</collection><collection>PubMed Central (Full Participant titles)</collection><collection>SwePub</collection><collection>SwePub Articles</collection><collection>SWEPUB Freely available online</collection><collection>SwePub Articles full text</collection><collection>DOAJ Directory of Open Access Journals</collection><jtitle>PloS one</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Colloca, Giuseppe</au><au>Tosato, Matteo</au><au>Vetrano, Davide L.</au><au>Topinkova, Eva</au><au>Fialova, Daniela</au><au>Gindin, Jacob</au><au>Van der Roest, Henriette G</au><au>Landi, Francisco</au><au>Farber, Irena</au><au>Liperoti, Rosa</au><au>Bernabei, Roberto</au><au>Graziano, Onder</au><au>Bayer, Antony</au><aucorp>SHELTER project</aucorp><aucorp>SHELTER project</aucorp><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Inappropriate drugs in elderly patients with severe cognitive impairment: results from the Shelter study</atitle><jtitle>PloS one</jtitle><addtitle>PLoS One</addtitle><date>2012-10-03</date><risdate>2012</risdate><volume>7</volume><issue>10</issue><spage>e46669</spage><epage>e46669</epage><pages>e46669-e46669</pages><issn>1932-6203</issn><eissn>1932-6203</eissn><abstract>It has been estimated that Nursing Home (NH) residents with impaired cognitive status receive an average of seven to eight drugs daily. The aim of this study was to determine prevalence and factors associated with use of inappropriate drugs in elderly patients with severe cognitive impairment living in NH in Europe.
Cross-sectional data from a sample of 1449 NH residents with severe cognitive impairment, participating in the Services and Health for Elderly in Long TERm care (SHELTER) study were analysed. Inappropriate drug use was defined as the use of drugs classified as rarely or never appropriate in patients with severe cognitive impairment based on the Holmes criteria published in 2008.
Mean age of participating residents was 84.2±8.9 years, 1087 (75.0%) were women. Inappropriate drug use was observed in 643 (44.9%) residents. Most commonly used inappropriate drugs were lipid-lowering agents (9.9%), antiplatelet agents (excluding Acetylsalicylic Acid - ASA -) (9.9%), acetylcholinesterase, inhibitors (7.2%) and antispasmodics (6.9%). Inappropriate drug use was directly associated with specific diseases including diabetes (OR 1.64; 95% CI 1.21-2.24), heart failure (OR 1.48; 95% CI 1.04-2.09), stroke (OR 1.43; 95% CI 1.06-1.93), and recent hospitalization (OR 1.69; 95% CI 1.20-2.39). An inverse relation was shown between inappropriate drug use and presence of a geriatrician in the facility (OR 0.55; 95% CI 0.39-0.77).
Use of inappropriate drugs is common among older EU NH residents. Determinants of inappropriate drug use include comorbidities and recent hospitalization. Presence of a geriatrician in the facility staff is associated with a reduced rate of use of these medications.</abstract><cop>United States</cop><pub>Public Library of Science</pub><pmid>23056394</pmid><doi>10.1371/journal.pone.0046669</doi><tpages>e46669</tpages><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 1932-6203 |
| ispartof | PloS one, 2012-10, Vol.7 (10), p.e46669-e46669 |
| issn | 1932-6203 1932-6203 |
| language | eng |
| recordid | cdi_plos_journals_1345033026 |
| source | MEDLINE; DOAJ Directory of Open Access Journals; SWEPUB Freely available online; Public Library of Science (PLoS) Journals Open Access; EZB-FREE-00999 freely available EZB journals; PubMed Central; Free Full-Text Journals in Chemistry |
| subjects | Acetylcholinesterase Acetylsalicylic acid Aged Aged, 80 and over Alzheimer's disease Aspirin Aspirin - therapeutic use Cholinesterase Inhibitors - therapeutic use Chronic illnesses Cognition Disorders - drug therapy Cognitive ability Cognitive Impairment Cross-Sectional Studies Dementia Diabetes mellitus Drug abuse Drug Utilization Drugs Elderly patients Female Geriatrics Gerontology Health Services for the Aged - statistics & numerical data Heart Heart diseases Homes for the Aged - statistics & numerical data Humans Hypolipidemic Agents - therapeutic use Impairment Life expectancy Long term care Long term health care Long-Term Care - statistics & numerical data Male Medicin och hälsovetenskap Medicine Nursing home patients Nursing homes Older people Parasympatholytics - therapeutic use Patients Prescription drugs Shelters |
| title | Inappropriate drugs in elderly patients with severe cognitive impairment: results from the Shelter study |
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