Potentially inappropriate prescribing in elderly: assessing doctor knowledge,confidence and barriers

Introduction Inappropriate medication prescribing by doctors is an important preventable cause of morbidity and mortality in the elderly. This study investigates doctor knowledge about potentially inappropriate prescribing (PIP) in elderly, their confidence in prescribing for the elderly and explores perceived barriers. Methods Family and Internal Medicine resident and attending doctors at three teaching hospitals were asked to complete a survey. Six clinical vignettes based on the 2003 Beers criteria were used to evaluate doctor knowledge about medications to avoid in the elderly. Confidence in prescribing for the elderly and perceived barriers to appropriate prescribing in elderly was assessed using a 5‐point Likert scale. Results Eighty‐nine doctors completed the survey, for a response rate of 45%. Forty‐four per cent of surveyed doctors estimated that over 25% of their practice consisted of patients 65 years or older. When knowledge of PIP was assessed via vignettes, the mean correct response was 3.9 (SD: 1.1, min = 1, max = 6). Only 14% of those doctors scoring ≤4 vignettes correctly had used the Beers criteria for prescribing; 31% of the doctors answering ≥5 vignettes correctly had used the Beers criteria (P = 0.08). Overall, 75% of doctors felt confident about their prescribing irrespective of their knowledge scores. Seventy per cent of surveyed doctors cited at least seven different barriers to appropriate prescribing in elderly. Conclusions Many primary care doctors possess a poor knowledge of PIP and are unaware of prescribing guidelines such as the Beers criteria. Our survey indicates that doctor usage of the Beers criteria might correlate with improved judgement in prescribing for the elderly. Most doctors report multiple barriers to appropriate prescribing in the elderly. Lack of formal education about prescribing guidelines was the only barrier that correlated with the doctors' level of training.     

Continued prescribing of inappropriate drugs in general practice

Seven general practitioners used various methods to identify patients in their practices whom they had inherited and whose medication they regarded as inappropriate in the light of current knowledge. Information was collected in each case about the drug concerned, the patient, the original pre–scriber, and the reason for continued prescribing. Each patient was also interviewed. Altogether, 25 different drugs were prescribed for 40 patients: in 16 the inappropriate drug was one acting on the brain, in 13 an antihypertensive, in seven it was given for heart disease and in three, for asthma. The influence of the original prescriber, and the patient's dependence on the drug, helped to explain its continued use. Almost half the patients said that they might consider changing their medication. The study underlines the importance of reviewing long–term medication and offers a method of scrutinizing repeat prescribing in general practice. Community pharmacists could help in this process.     

Urinary incontinence: correlates among cognitively impaired elderly veterans.

1. Although a range of factors can contribute to urinary incontinence in long-term care residents, it is more closely associated with a decline in both cognitive and functional status. 2. Although all subjects had to be cognitively impaired to participate in the study, the incontinent group had a significantly lower mean score on the mental status examination than did the continent group. 3. Incontinent subjects were more dependent in activities of daily living and took significantly longer to carry out functional tasks specifically related to toileting. 4. Urinary incontinence was strongly associated with a history of urinary tract infections, positive urine cultures, epididymitis, hematuria, and fecal incontinence. Medical diagnosis, medications, and affective status were not associated with the problem.     

Sex differences among treatment clients with cocaine-related problems

Background: In a sample of treatment clients with cocaine-related problems, the present study examined sex differences in measures across six key domains, including socio-demographics, mental health, substance use, physical health, sexual health and psychosocial health.

Methods: Data were utilized from a cross-sectional study of treatment clients in Ontario and British Columbia, Canada (N?=?417). t-Tests were used to examine sex differences in continuous measures, while Fisher’s exact tests were used for dichotomous measures. A Bonferroni correction was applied to adjust for multiple comparisons. For measures that were significant in these tests, multivariable analyses were also conducted.

Results: Females were found to be more likely than males to have lower personal and household incomes, report membership in sexual minority groups and engage in high risk sexual behaviors, including trading sex for money, trading sex for drugs and having sex when they did not want to. Males were more likely than females to report higher sexual compulsion scores and have paid for sex.

Conclusion: Overall, the health-related needs of treatment clients with cocaine-related problems appear to differ by sex, especially in relation to sexual health. As such, setting of treatment priorities by treatment providers should reflect these important differences.     

Ethnic differences in death anxiety among the elderly

The Dickstein Death Concern Scale was used to examine the death anxieties of a sample of elderly people in north and central Florida consisting of whites and blacks, males and females. Analysis of the data revealed that black elderly males display the greatest death anxiety, followed in decreasing order by black females, white females, and white males. Analysis of variance yielded a statistically significant main effect attributable to race. The overall effects attributed to sex were not significant, nor were there any significant interactions. The implications of these findings for practicing counselors were considered.     

Prevention of potentially inappropriate prescribing for elderly patients: a randomized controlled trial using STOPP/START criteria

Inappropriate prescribing is particularly common in older patients and is associated with adverse drug events (ADEs), hospitalization, and wasteful utilization of resources. We randomized 400 hospitalized patients aged ≥ 65 years to receive either the usual pharmaceutical care (control) or screening with STOPP/START criteria followed up with recommendations to their attending physicians (intervention). The Medication Appropriateness Index (MAI) and Assessment of Underutilization (AOU) index were used to assess prescribing appropriateness, both at the time of discharge and for 6 months after discharge. Unnecessary polypharmacy, the use of drugs at incorrect doses, and potential drug-drug and drug-disease interactions were significantly lower in the intervention group at discharge (absolute risk reduction 35.7%, number needed to screen to yield improvement in MAI = 2.8 (95% confidence interval 2.2-3.8)). Underutilization of clinically indicated medications was also reduced (absolute risk reduction 21.2%, number needed to screen to yield reduction in AOU = 4.7 (95% confidence interval 3.4-7.5)). Significant improvements in prescribing appropriateness were sustained for 6 months after discharge.     

Monitoring hydration status in elderly veterans

Dehydration is a common water and electrolyte disorder in long-term care residents. Practical methods to detect and monitor dehydration are needed. This study determined whether urine color measured by a urine color chart reflects hydration status. The study employed a repeated measures design with two observations during a 10-hour period. Urine color was compared to the criterion standard of urine specific gravity and osmolality. The sample included 89 participants from two Veterans' Affairs facilities. Urine color was graded on an eight-level color chart. Urine specific gravity and osmolality, serum sodium and osmolality, hematocrit, blood urea nitrogen (BUN), and creatinine were measured using standard laboratory procedures. Significant positive associations existed between urine color and both urine specific gravity and urine osmolality and between urine osmolality and serum sodium and the blood urea nitrogen to creatinine ratio. Although further testing is needed, the color chart has potential as a low-cost technology to monitor dehydration.     

老年男性和女性结直肠癌患者危险因素及预后对比研究

目的探讨老年男性和女性结肠癌患者危险因素以及预后,并进行对比分析。方法该院2007年7月至2010年3月老年结直肠癌患者694例,分为男性组414例和女性组280例。分析2组患者发病情况差异及预后。结果 2组患者均以直肠、乙状结肠、升结肠为主,差异无统计学意义(P0.05)。男性组以便血(47.10%)、肠梗阻(17.63%)和腹部肿块(34.78%)为主要改变;女性组以腹痛(36.07%)和其他症状(2.86%)为主要改变,2组首发症状比较,除排便习惯外,其他症状差异均有统计学意义(P0.05)。手术方式和是否化疗差异无统计学意义(P0.05)。男性组患者的病理类型主要是腺癌(75.12%),女性组主要为黏液癌(59.29%),差异有统计学意义(P0.05)。2组分化程度差异无统计学意义(P0.05)。男性组患者溃疡19.57%,隆起24.40%,菜花50.48%,浸润5.56%,女性组分别为7.50%、49.29%、40.36%、2.86%。男性组以溃疡、菜花、浸润型为主,女性组以隆起型多见,差异有统计学意义(P0.05)。男性组患者以Ⅱ期、Ⅲ期、Ⅳ期多见,女性组Ⅰ期多见,差异有统计学意义(P0.05)。694例患者全部完成随访,失访率为0。男性组1年生存率为(0.897±0.016),3年生存率为(0.652±0.032),女性组分别为(0.983±0.027)和(0.883±0.049),差异有统计学意义(t=4.230、4.355,P0.05)。结论对不同性别的老年结直肠癌患者,要注意其不同危险因素,以利于早期诊断和治疗。