Transcript Medicines management in the elderly

Medicines management in the
elderly
Trudi McIntosh and Kim Munro
School of Pharmacy and Life Sciences
RGU
Objectives
• To use patient profiles, patient ‘voices’ and
validated assessment tools to identify and
prioritise elderly patients at risk of medication
misadventure
• To consider options to rationalise these patients’
medication regimens to reduce this risk
• To consider own prescribing practice in relation to
risks of medication misadventure
Medication misadventure?
Aging population:
• co-morbidities
• polypharmacy + complex medication regimens
• increased risk of interactions
• effect of aging on metabolism of drugs
• reduced dexterity
• possible cognitive decline
• social circumstances
• etc
Guidance: national and local
• Polypharmacy Guidance 2012 Scottish
Government
http://www.central.knowledge.scot.nhs.uk/upload/Polypharmacy%20full%20
guidance%20v2.pdf
• NHS Grampian guidance on reducing
polypharmacy in frail older people
http://www.nhsgrampian.com/grampianfoi/files/PolyPh_538_0912.pdf
Tools to assess ‘risk’
• Beers criteria: potentially inappropriate
medication use in older adults
• STOPP-START: screening tools for potentially
inappropriate meds/ right meds
• Morisky medication adherence scale
• Medication regimen complexity index
• Anticholinergic risk scale
plus others
Initial thoughts
Miss Agnes Smith and Mrs Susan Green
• Patient profile + Polypharmacy Guidance, Scottish
Government. Initial thoughts?
• Complexity?
• Medication Regimen Complexity Index
Adherence
Miss Agnes Smith and Mrs Susan Green
• Patient interviews
• Video clip: ‘Morisky questions’ to assess
adherence
Anticholinergic risk scale
• Anticholinergic burden may contribute to falls,
delirium, cognitive impairment, dry mouth,
constipation etc
• Assess patients’ risk of medicine misadventure
due to anticholinergic risk
Prioritisation and rationalisation
• How will you prioritise the patients?
• How might you start to rationalise their
medications?
• Impact on your own prescribing practice?
References
•
Fick, D.M. et al. 2003. Updating the Beers criteria for potentially inappropriate
medication use in older adults: results of a US consensus panel of experts Archives
of Internal Medicine, 163(22), pp. 2716–2724.
•
Gallagher P, et al. 2008. STOPP (Screening Tool of Older Persons’ Prescriptions) and
START (Screening Tool to Alert Doctors to Right Treatment): Consensus Validation.
Int J Clin Pharmacol Therapy, 46(2), pp.72 – 83.
•
George, J. et al., 2004. Development and validation of the medication regimen
complexity index. The Annals of Pharmacotherapy, 38(9), pp. 1369-1376.
•
Morisky, D.E., Green, L.W. and Levine, D.M., 1986. Concurrent and predictive
validity of a self-reported measure of medication adherence. Med Care,;24, pp. 6774.
•
Rudolph, J.L. et al.,2008. The anticholinergic risk scale and anticholinergic adverse
effects in older persons. Archives of Internal Medicine, 168(5), pp.508-513.