Reducing inappropriate prescribing for older adults with advanced frailty: A review based on a survey of practice in four countries

Rónán O'Caoimh, Nicola Cornally, Ciara McGlade, Yang Gao, Eileen O'Herlihy, Anton Svendrovski, Roger Clarnette, Amanda Hanora Lavan, Paul Gallagher, D. William Molloy

Research output: Contribution to journalReview article

1 Citation (Scopus)

Abstract

The management of medications in persons with frailty presents challenges. There is evidence of inappropriate prescribing and a lack of consensus among healthcare professionals on the judicious use of medications, particularly for patients with more severe frailty. This study reviews the evidence on the use of commonly prescribed pharmacological treatments in advanced frailty based on a questionnaire of prescribing practices and attitudes of healthcare professionals at different stages in their careers, in different countries. A convenience sample of those attending hospital grand rounds in Ireland, Canada and Australia/New Zealand (ANZ) were surveyed on the management of 18 medications in advanced frailty using a clinical vignette (man with severe dementia, Clinical Frailty Scale 7/9). Choices were to continue or discontinue (stop now or later) medications. In total, 298 respondents from Ireland (n = 124), Canada (n = 110), and ANZ (n = 64) completed the questionnaire, response rate 97%, including 81 consultants, 40 non-consultant hospital doctors, 134 general practitioners and 43 others (nurses, pharmacists, and medical students). Most felt that statins (88%), bisphosphonates (77%) and cholinesterase inhibitors (76%) should be discontinued. Thyroid replacement (88%), laxatives (83%) and paracetamol (81%) were most often continued. Respondents with experience in geriatric, palliative and dementia care were significantly more likely to discontinue medications. Age, gender and experience working in nursing homes did not contribute to the decision. Reflecting the current literature, there was no clear consensus on inappropriate prescribing, although respondents preferentially discontinued medications for secondary prevention. Experience significantly predicted the number and type discontinued, suggesting that education is important in reducing inappropriate prescribing for people in advanced states of frailty.

Original languageEnglish
Pages (from-to)1-10
Number of pages10
JournalMaturitas
Volume126
DOIs
Publication statusPublished - 1 Aug 2019

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Inappropriate Prescribing
Geriatrics
Hydroxymethylglutaryl-CoA Reductase Inhibitors
Laxatives
Nursing
Cholinesterase Inhibitors
Diphosphonates
Acetaminophen
New Zealand
Ireland
Education
Canada
Dementia
Students
Consensus
Teaching Rounds
Delivery of Health Care
Consultants
Secondary Prevention
Nursing Homes

Cite this

O'Caoimh, R., Cornally, N., McGlade, C., Gao, Y., O'Herlihy, E., Svendrovski, A., ... William Molloy, D. (2019). Reducing inappropriate prescribing for older adults with advanced frailty: A review based on a survey of practice in four countries. Maturitas, 126, 1-10. https://doi.org/10.1016/j.maturitas.2019.04.212
O'Caoimh, Rónán ; Cornally, Nicola ; McGlade, Ciara ; Gao, Yang ; O'Herlihy, Eileen ; Svendrovski, Anton ; Clarnette, Roger ; Lavan, Amanda Hanora ; Gallagher, Paul ; William Molloy, D. / Reducing inappropriate prescribing for older adults with advanced frailty : A review based on a survey of practice in four countries. In: Maturitas. 2019 ; Vol. 126. pp. 1-10.
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O'Caoimh, R, Cornally, N, McGlade, C, Gao, Y, O'Herlihy, E, Svendrovski, A, Clarnette, R, Lavan, AH, Gallagher, P & William Molloy, D 2019, 'Reducing inappropriate prescribing for older adults with advanced frailty: A review based on a survey of practice in four countries' Maturitas, vol. 126, pp. 1-10. https://doi.org/10.1016/j.maturitas.2019.04.212

Reducing inappropriate prescribing for older adults with advanced frailty : A review based on a survey of practice in four countries. / O'Caoimh, Rónán; Cornally, Nicola; McGlade, Ciara; Gao, Yang; O'Herlihy, Eileen; Svendrovski, Anton; Clarnette, Roger; Lavan, Amanda Hanora; Gallagher, Paul; William Molloy, D.

In: Maturitas, Vol. 126, 01.08.2019, p. 1-10.

Research output: Contribution to journalReview article

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T1 - Reducing inappropriate prescribing for older adults with advanced frailty

T2 - A review based on a survey of practice in four countries

AU - O'Caoimh, Rónán

AU - Cornally, Nicola

AU - McGlade, Ciara

AU - Gao, Yang

AU - O'Herlihy, Eileen

AU - Svendrovski, Anton

AU - Clarnette, Roger

AU - Lavan, Amanda Hanora

AU - Gallagher, Paul

AU - William Molloy, D.

PY - 2019/8/1

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N2 - The management of medications in persons with frailty presents challenges. There is evidence of inappropriate prescribing and a lack of consensus among healthcare professionals on the judicious use of medications, particularly for patients with more severe frailty. This study reviews the evidence on the use of commonly prescribed pharmacological treatments in advanced frailty based on a questionnaire of prescribing practices and attitudes of healthcare professionals at different stages in their careers, in different countries. A convenience sample of those attending hospital grand rounds in Ireland, Canada and Australia/New Zealand (ANZ) were surveyed on the management of 18 medications in advanced frailty using a clinical vignette (man with severe dementia, Clinical Frailty Scale 7/9). Choices were to continue or discontinue (stop now or later) medications. In total, 298 respondents from Ireland (n = 124), Canada (n = 110), and ANZ (n = 64) completed the questionnaire, response rate 97%, including 81 consultants, 40 non-consultant hospital doctors, 134 general practitioners and 43 others (nurses, pharmacists, and medical students). Most felt that statins (88%), bisphosphonates (77%) and cholinesterase inhibitors (76%) should be discontinued. Thyroid replacement (88%), laxatives (83%) and paracetamol (81%) were most often continued. Respondents with experience in geriatric, palliative and dementia care were significantly more likely to discontinue medications. Age, gender and experience working in nursing homes did not contribute to the decision. Reflecting the current literature, there was no clear consensus on inappropriate prescribing, although respondents preferentially discontinued medications for secondary prevention. Experience significantly predicted the number and type discontinued, suggesting that education is important in reducing inappropriate prescribing for people in advanced states of frailty.

AB - The management of medications in persons with frailty presents challenges. There is evidence of inappropriate prescribing and a lack of consensus among healthcare professionals on the judicious use of medications, particularly for patients with more severe frailty. This study reviews the evidence on the use of commonly prescribed pharmacological treatments in advanced frailty based on a questionnaire of prescribing practices and attitudes of healthcare professionals at different stages in their careers, in different countries. A convenience sample of those attending hospital grand rounds in Ireland, Canada and Australia/New Zealand (ANZ) were surveyed on the management of 18 medications in advanced frailty using a clinical vignette (man with severe dementia, Clinical Frailty Scale 7/9). Choices were to continue or discontinue (stop now or later) medications. In total, 298 respondents from Ireland (n = 124), Canada (n = 110), and ANZ (n = 64) completed the questionnaire, response rate 97%, including 81 consultants, 40 non-consultant hospital doctors, 134 general practitioners and 43 others (nurses, pharmacists, and medical students). Most felt that statins (88%), bisphosphonates (77%) and cholinesterase inhibitors (76%) should be discontinued. Thyroid replacement (88%), laxatives (83%) and paracetamol (81%) were most often continued. Respondents with experience in geriatric, palliative and dementia care were significantly more likely to discontinue medications. Age, gender and experience working in nursing homes did not contribute to the decision. Reflecting the current literature, there was no clear consensus on inappropriate prescribing, although respondents preferentially discontinued medications for secondary prevention. Experience significantly predicted the number and type discontinued, suggesting that education is important in reducing inappropriate prescribing for people in advanced states of frailty.

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