Effectiveness of a Person-Centered Prescription Model in Hospitalized Older People at the End of Life According to Their Disease Trajectories and Frailty Index.

This study aimed to comparatively analyze the effect of the person-centered prescription (PCP) model on pharmacotherapeutic indicators and the costs of pharmacological treatment between a dementia-like trajectory and an end-stage organ failure trajectory, and two states of frailty (cut-off point 0.5). A randomized controlled trial was conducted with patients aged ≥65 years admitted to a subacute hospital and identified by the Necessity of Palliative Care test to require palliative care. Data were collected from February 2018 to February 2020. Variables assessed included sociodemographic, clinical, degree-of-frailty, and several pharmacotherapeutic indicators and the 28-day medication cost. Fifty-five patients with dementia-like trajectory and 26 with organ failure trajectory were recruited observing significant differences at hospital admission in the mean number of medications (7.6 vs. 9.7; p < 0.004), the proportion of people on more than 10 medications (20.0% vs. 53.8%; p < 0.002), the number of drug-drug interactions (2.7 vs. 5.1; p < 0.006), and the Medication Regimen Complexity Index (MRCI) (25.7 vs. 33.4; p < 0.006), respectively. Also, regarding dementia-like patients, after application of the PCP model, these patients improved significantly in the intervention group compared to the control group in the mean number of chronic medications, STOPP Frail Criteria, MRCI and the 28-day cost of regular medications (p < 0.05) between admission and discharge. As for the PCP effect on the control and the intervention group at the end-stage organ failure, we did not observe statistically significant differences. On the other hand, when the effect of the PCP model on different degrees of frailty was evaluated, no unequal behavior was observed.

Application of a person-centered prescription model improves pharmacotherapeutic indicators and reduces costs associated with pharmacological treatment in hospitalized older patients at the end of life.

Objective: This study sought to investigate whether applying an adapted person-centered prescription (PCP) model reduces the total regular medications in older people admitted in a subacute hospital at the end of life (EOL), improving pharmacotherapeutic indicators and reducing the expense associated with pharmacological treatment. Design: Randomized controlled trial. The trial was registered with ClinicalTrials.gov (NCT05454644). Setting: A subacute hospital in Basque Country, Spain. Subjects: Adults ≥65 years (n = 114) who were admitted to a geriatric convalescence unit and required palliative care. Intervention: The adapted PCP model consisted of a systematic four-step process conducted by geriatricians and clinical pharmacists. Relative to the original model, this adapted model entails a protocol for the tools and assessments to be conducted on people identified as being at the EOL. Measurements: After applying the adapted PCP model, the mean change in the number of regular drugs, STOPPFrail (Screening Tool of Older Persons' Prescriptions in Frail adults with limited life expectancy) criteria, drug burden index (DBI), drug-drug interactions, medication regimen complexity index (MRCI) and 28-days medication cost of chronic prescriptions between admission and discharge was analyzed. All patients were followed for 3 months after hospital discharge to measure the intervention's effectiveness over time on pharmacotherapeutic variables and the cost of chronic medical prescriptions. Results: The number of regular prescribed medications at baseline was 9.0 ± 3.2 in the intervention group and 8.2 ± 3.5 in the control group. The mean change in the number of regular prescriptions at discharge was -1.74 in the intervention group and -0.07 in the control group (mean difference = 1.67 ± 0.57; p = 0.007). Applying a PCP model reduced all measured criteria compared with pre-admission (p < 0.05). At discharge, the mean change in 28-days medication cost was significantly lower in the intervention group compared with the control group (-34.91€ vs. -0.36€; p < 0.004). Conclusion: Applying a PCP model improves pharmacotherapeutic indicators and reduces the costs associated with pharmacological treatment in hospitalized geriatric patients at the EOL, continuing for 3 months after hospital discharge. Future studies must investigate continuity in the transition between hospital care and primary care so that these new care models are offered transversally and not in isolation.

Risk factors associated with COVID-19 infection and mortality in nursing homes / Factores de riesgo asociados con la infección y mortalidad por COVID-19 en centros residenciales

Objective: The aim of this paper was to analyse the association of demographic, clinical and pharmacological risk factors with the presence of SARS-COV-2 virus infection, as well as to know the variables related to mortality from COVID-19 in nursing home (NH) residents. Design: Retrospective case–control study. The study variables of those residents who acquired the infection (case) were compared with those of the residents who did not acquire it (control). A subgroup analysis was carried out to study those variables related to mortality. Site: Nursing homes in the region of Guipúzcoa (Spain). Participants and interventions: 4 NHs with outbreaks of SARS-CoV-2 between March and December 2020 participated in the study. The infectivity and, secondary, mortality was studied, as well as demographic, clinical and pharmacological variables associated with them. Data were collected from the computerised clinical records. Main measurements: Infection and mortality rate. Risk factors associated with infection and mortality. Results: 436 residents were studied (median age 87 years (IQR 11)), 173 acquired SARS-CoV-2 (39.7%). People with dementia and Global Deterioration Scale ≥6 were less likely to be infected by SARS-CoV-2 virus [OR=0.65 (95% CI 0.43–0.97; p<.05)]. Overall case fatality rate was 10.3% (a mortality of 26% among those who acquired the infection). COVID-19 mortality was significantly associated with a Global Deterioration Scale ≥6 (OR=4.9 (95% CI 1.5–16.1)), COPD diagnosis (OR=7.8 (95% CI 1.9–31.3)) and antipsychotic use (OR=3.1 (95% CI 1.0–9.0)). Conclusions: Advanced dementia has been associated with less risk of SARS-CoV-2 infection but higher risk of COVID-19 mortality. COPD and chronic use of antipsychotics have also been associated with mortality. These results highlight the importance of determining the stage of diseases such as dementia as well as maintaining some caution in the use of some drugs such as antipsychotics.(AU)

Objetivo: El objetivo de este trabajo fue analizar la asociación de factores de riesgo demográficos, clínicos y farmacológicos con la presencia de infección por virus SARS-CoV-2, así como conocer las variables relacionadas con la mortalidad por COVID-19 en residentes institucionalizados en centros residenciales. Diseño: Casos y controles retrospectivo. Se compararon las variables de estudio de aquellos residentes que adquirieron la infección (caso) con las de los residentes que no la adquirieron (control). Se realizó un análisis de subgrupos para conocer aquellas variables relacionadas con la mortalidad. Emplazamiento: Centros residenciales de la provincia de Guipúzcoa (España). Participantes e intervenciones: Cuatro centros residenciales con brotes de SARS-CoV-2, entre marzo y diciembre del 2020. Se estudiaron la infectividad y, de manera secundaria, la mortalidad, así como variables demográficas, clínicas y farmacológicas asociadas con las mismas. Los datos fueron recogidos de las historias clínicas informatizadas. Mediciones principales: Tasa de infección y mortalidad. Factores de riesgo asociados a la infección y a la mortalidad. Resultados: Se estudió a 436 residentes (mediana de edad 87 años [RIC 11]), 173 de ellos adquirieron la infección (39,7%). Los residentes con demencia y un índice en la Global Deterioration Scale ≥6 tuvieron menor probabilidad de infectarse por el virus SARS-CoV-2 (OR=0,65 [IC del 95%, 0,43-0,97; p<0,05]). La tasa de mortalidad global fue del 10,3% (del 26% entre aquellos que adquirieron la infección). La mortalidad por COVID-19 se asoció de manera significativa con un índice Global Deterioration Scale ≥6 (OR=4,9 [IC del 95%, 1,5-16,1]), tener un diagnóstico de EPOC (OR=7,8 [IC del 95%, CI 1,9-31,3]) y con el uso de antipsicóticos (OR=3,1 [IC del 95%, CI 1,0-9,0]).(AU)

Risk factors associated with COVID-19 infection and mortality in nursing homes.

OBJECTIVE: The aim of this paper was to analyse the association of demographic, clinical and pharmacological risk factors with the presence of SARS-COV-2 virus infection, as well as to know the variables related to mortality from COVID-19 in nursing home (NH) residents. DESIGN: Retrospective case-control study. The study variables of those residents who acquired the infection (case) were compared with those of the residents who did not acquire it (control). A subgroup analysis was carried out to study those variables related to mortality. SITE: Nursing homes in the region of Guipúzcoa (Spain). PARTICIPANTS AND INTERVENTIONS: 4 NHs with outbreaks of SARS-CoV-2 between March and December 2020 participated in the study. The infectivity and, secondary, mortality was studied, as well as demographic, clinical and pharmacological variables associated with them. Data were collected from the computerised clinical records. MAIN MEASUREMENTS: Infection and mortality rate. Risk factors associated with infection and mortality. RESULTS: 436 residents were studied (median age 87 years (IQR 11)), 173 acquired SARS-CoV-2 (39.7%). People with dementia and Global Deterioration Scale ≥6 were less likely to be infected by SARS-CoV-2 virus [OR=0.65 (95% CI 0.43-0.97; p<.05)]. Overall case fatality rate was 10.3% (a mortality of 26% among those who acquired the infection). COVID-19 mortality was significantly associated with a Global Deterioration Scale ≥6 (OR=4.9 (95% CI 1.5-16.1)), COPD diagnosis (OR=7.8 (95% CI 1.9-31.3)) and antipsychotic use (OR=3.1 (95% CI 1.0-9.0)). CONCLUSIONS: Advanced dementia has been associated with less risk of SARS-CoV-2 infection but higher risk of COVID-19 mortality. COPD and chronic use of antipsychotics have also been associated with mortality. These results highlight the importance of determining the stage of diseases such as dementia as well as maintaining some caution in the use of some drugs such as antipsychotics.

Psychotropic Drug Prescription in Nursing Homes During the COVID-19 Pandemic.

BACKGROUND: To limit the introduction of coronavirus disease 2019 (COVID-19) into nursing homes, restrictive measures and social distancing were implemented; however, these caused an increase in affective disorders such as depression and anxiety and an alteration of the behavioral and psychological symptoms of dementia. Therefore, it is expected that prescription trends of psychotropic drugs in nursing homes during the pandemic may have changed significantly. OBJECTIVE: This study aims to compare patterns of prescribing psychotropic drugs in nursing homes during the COVID-19 pandemic to those of the pre-pandemic period. METHODS: This cross-sectional multicenter study was conducted in geriatric units and psychogeriatric units in seven nursing homes in Gipuzkoa, Spain. On 1 March, 2020, data regarding 511 residents in geriatric units and 163 in psychogeriatric units were recorded. This study examined utilization percentages for psychotropic drugs before the pandemic (April 2018-March 2020) and during the pandemic (April 2020-March 2021) in light of projected usage based on previous years. Following the Anatomical, Therapeutic, Chemical Classification System, four therapeutic groups were analyzed: antipsychotics (N05A), benzodiazepines (N05B and N05C), antidepressants (N06A), and antiepileptic drugs (N03A). RESULTS: In the case of geriatric units, a downward trend of prescription was reversed for antipsychotics (-0.41; 95% confidence interval [CI] -1.41, 0.60). Benzodiazepine use also decreased less than expected (-2.00; 95% CI -3.00, -1.00). Antidepressant use increased more than predicted (0.02; 95% CI -0.97, 1.01), as did antiepileptic drug use (2.93; 95% CI 2.27, 3.60). In the psychogeriatric units, the drop in antipsychotic utilization was less than expected (-2.31; 95% CI -3.68, -0.93). Although it was expected that the prescription of benzodiazepines would decrease, usage remained roughly the same (-0.28; 95% CI -2.40, 2.34). Utilization of antidepressants (8.57; 95% CI 6.89, 10.24) and antiepileptic drugs (6.10; 95% CI 3.20, 9.00) increased significantly, which was expected, based on the forecast. CONCLUSIONS: For all categories, usage of psychotropic drugs was higher than anticipated based on the forecast; this increase might be related to the worsening of emotional and behavioral disorders caused by the restrictive measures of the COVID-19 pandemic.

Determination of the cross-contamination and validation of the cleaning process for an automated personalised dosing system.

OBJECTIVE: To determine the degree of cross-contamination and to validate a cleaning process for an Automated Personalised Dosing System (APDS), respecting the permitted residue transfer limits. METHOD: An analytical determination by high pressure liquid chromatography with mass spectrometry was performed for 11 drugs considered critical for their potential for contamination, toxicity (National Institute for Occupational Safety and Health (NIOSH) List 2016) and/or narrow therapeutic index. The test was carried out for three consecutive weeks, seven repetitions per week, in a state of maximum contamination and maximum cleanliness. The main validation criterion of the cleaning protocol was to quantify that the active ingredients measured were below the Permitted Daily Exposure index or fraction 1/1000 of the minimum daily dose, both in a state of maximum contamination and when the APDS is in a clean condition, for an average number of tablets consumed per person per day. RESULTS: In all the samples analysed, some compound could always be quantified below 2% of the permitted transfer limits, highlighting the presence of paracetamol and carbamazepine. In the state of maximum contamination, the mean±SD values of paracetamol and carbamazepine were 5.83±1.56 µg and 0.22±0.07 µg, respectively, without significant differences in mean values over the 3 weeks of the study. After the cleaning protocol was executed, only paracetamol and carbamazepine were detected, with the average values being 4.67 µg (95% CI 3.92 to 5.43, p<0.05) and 0.07 µg (95% CI 0.03 to 0.10, p<0.05) lower than the state of maximum contamination, respectively. CONCLUSIONS: In all cases the level of cross-contamination for an APDS was below the pre-established limits. The cleaning protocol has been validated, confirming APDS decontamination of the most critical medicines.

Evaluación del tratamiento antitrombótico en pacientes geriátricos institucionalizados con fibrilación auricular no valvular / Evaluation of antithrombotic treatment in institutionalized geriatric patients with nonvalvular atrial fibrillation

Objetivo: Los objetivos de este trabajo son estudiar el tipo de tratamiento antitrombótico y sus complicaciones en pacientes institucionalizados con fibrilación auricular no valvular y evaluar el grado de controlanticoagulante con medicamentos tipo antivitamina K.Método: Estudio observacional de seguimiento prospectivo realizado en siete centros gerontológicos durante el año 2016, valorandoen aquellos residentes con fibrilación auricular no valvular la terapiaantitrombótica establecida y las incidencias embólicas, hemorrágicasy la mortalidad. En los residentes anticoagulados con antivitamina K semidió el control de la anticoagulación, estimándose un mal control si elmétodo de Rosendaal fuese < 65% o el tiempo en rango terapéuticodirecto < 60%.Resultados: De los 699 residentes analizados, el 20,6% tenían undiagnóstico de fibrilación auricular no valvular, con una edad media de85,83 años. El riesgo cardioembólico fue alto (CHA2DS2-VASc medio4,79), así como el riesgo hemorrágico (HAS-BLED medio 3,04). El 50%estaban anticoagulados, principalmente con antivitamina K, de los cualesal menos el 56% no se encontraban dentro del rango terapéutico. Un16% de los residentes no tenían prescrita terapia antitrombótica, destacando en éstos una mayor dependencia funcional, cognitiva y edad más avanzada. Se encontró una mayor frecuencia de ingresos hospitalarios de causa cardiovascular y de sangrados en aquellos residentes anticoagulados, aunque no hubo diferencias significativas. (AU)

Objective: The goals of this study were to analyze the type of antithrombotic treatment administered to institutionalized patients with nonvalvularatrial fibrillation (and any ensuing complications) and to evaluate thedegree of anticoagulation control achieved with vitamin K antagonists.Method: This was a prospective observational follow-up study carriedout in seven elderly care facilities during 2016. Patients with nonvalvular atrial fibrillation were evaluated for their antithrombotic therapy andany embolic or hemorrhagic events, as well as for mortality. Subjects onanticoagulation treatment with VKAs were evaluated for anticoagulationcontrol, with control considered poor if the mean time in therapeutic rangewas < 65% when measured with Rosendaal’s method or < 60% whendetermined by the direct method.Results: Of the 699 residents evaluated, 20.6% had a diagnosis ofNVAF. Average age was 85.83 years. Both the cardioembolic (meanCHA2DS2-VASc score: 4.79), and the hemorrhagic (mean HAS-BLEDscore: 3.04) risk were high. Fifty percent received anticoagulationtreatment, mainly with vitamin K antagonists, of whom at least 56% werenot within the therapeutic range. Sixteen percent of the residents, theoldest and most functionally and cognitively dependent ones, had notbeen prescribed any antithrombotic therapy. A higher frequency of hospital admissions induced by cardiovascular and bleeding events was found in these residents, although differences were not statistically significant. (AU)

Evaluation of antithrombotic treatment in institutionalized geriatric patients with nonvalvular atrial fibrillation.

OBJECTIVE: The goals of this study were to analyze the type of  ntithrombotic treatment administered to institutionalized patients with  nonvalvular atrial fibrillation (and any ensuing complications) and to  evaluate the degree of anticoagulation control achieved with vitamin K  antagonists. Method: This was a prospective observational follow-up study  carried out in seven elderly care facilities during 2016. Patients with  nonvalvular atrial fibrillation were evaluated for their antithrombotic  therapy and any embolic or hemorrhagic events, as well as for mortality.  Subjects on anticoagulation treatment with VKAs were evaluated for  anticoagulation control, with control considered poor if the mean time in  therapeutic range was < 65% when measured with Rosendaal's method or < 60% when determined by the direct method. RESULTS: Of the 699 residents evaluated, 20.6% had a diagnosis of NVAF.  Average age was 85.83 years. Both the cardioembolic (mean CHA2DS2- VASc score: 4.79), and the hemorrhagic (mean HAS-BLED score: 3.04)  risk were high. Fifty percent received anticoagulation treatment, mainly  with vitamin K antagonists, of whom at least 56% were not within the  therapeutic range. Sixteen percent of the residents, the oldest and most  functionally and cognitively dependent ones, had not been prescribed any  antithrombotic therapy. A higher frequency of hospital admissions induced  by cardiovascular and bleeding events was  found in these residents,  although differences were not statistically significant. CONCLUSIONS: Half of institutionalized geriatric patients with nonvalvular atrial fibrillation are anticoagulated, a third on antiplatelet  therapy, and some without any antithrombotic treatment. This study  howed that as functionality decreases, treatment strategies are  increasingly aimed at therapeutic deintensification. Given that the degree  of anticoagulation control with vitamin K antagonists is inadequate in 56%  of cases, it is essential to monitor the time in therapeutic range to  optimize treatment as needed.

Objetivo: Los objetivos de este trabajo son estudiar el tipo de tratamiento antitrombótico y sus complicaciones en pacientes  institucionalizados con fibrilación auricular no valvular y evaluar el grado  de control anticoagulante con medicamentos tipo antivitamina K.Método: Estudio observacional de seguimiento prospectivo realizado en  siete centros gerontológicos durante el año 2016, valorando en aquellos  residentes con fibrilación auricular no valvular la terapia antitrombótica  establecida y las incidencias embólicas, hemorrágicas y la mortalidad. En  los residentes anticoagulados con antivitamina K se midió el control de la  anticoagulación, estimándose un mal control si el método de Rosendaal  fuese < 65% o el tiempo en rango terapéutico directo < 60%.Resultados: De los 699 residentes analizados, el 20,6% tenían un diagnóstico de fibrilación auricular no valvular, con una edad media de 85,83 años. El riesgo cardioembólico fue alto (CHA2DS2-VASc medio 4,79), así como el riesgo hemorrágico (HAS-BLED medio 3,04). El  50% estaban anticoagulados, principalmente con antivitamina K, de los  cuales al menos el 56% no se encontraban dentro del rango terapéutico.  Un 16% de los residentes no tenían prescrita terapia antitrombótica,  destacando en éstos una mayor dependencia funcional, cognitiva y edad  más avanzada. Se encontró una mayor frecuencia de ingresos  hospitalarios  de causa cardiovascular y de sangrados en aquellos  residentes anticoagulados, aunque no hubo diferencias significativas.Conclusiones: La mitad de los pacientes geriátricos institucionalizados con fibrilación auricular no valvular están  anticoagulados, un tercio antiagregados y algunos sin tratamiento  antitrombótico, observando que a medida que disminuye la funcionalidad  las estrategias van en la línea de una desintensificación terapéutica. El  grado de control anticoagulante con antivitamina K es inadecuado en el  56% de los casos, por lo que es imprescindible monitorizar el tiempo en  rango terapéutico para optimizar el tratamiento cuando sea necesario.

[Prevalence of prescription of anticholinergic/sedative burden drugs among older people with dementia living in nursing homes]. / Prevalencia de prescripción de fármacos con carga anticolinérgica/sedante en adultos mayores institucionalizados con demencia.

BACKGROUND AND OBJECTIVE: Dementia is one of the most frequent diseases in the elderly, being its prevalence of up to 64% in institutionalized people. In this population, in addition to antidementia drugs, it is common to prescribe drugs with anticholinergic/sedative burden that, due to their adverse effects, could worsen their functionality and cognitive status. The objective is to estimate the prevalence of the use of drugs with anticholinergic/ sedative burden in institutionalized older adults with dementia and to assess the associated factors. MATERIALS AND METHODS: A cross-sectional study developed in older with dementia living in nursing homes. The prevalence of prescription of anticholinergic/sedative drugs was estimated according to the Drug Burden Index (DBI). A comparative analysis of the DBI score was performed between different types of dementia as well as among various factors and according to the anticholinergic/sedative risk, establishing as a cut-off point of DBI≥1 (high anticholinergic/sedative risk). RESULTS: 178 residents were included. 83.7% had some drug with anticholinergic/sedative burden according to DBI. 50% had a DBI≥1 score. Residents with vascular dementia had a mean DBI of 1.34 (SD 0.84), a significantly higher score than residents with Alzheimer's disease (0.41, 95% CI 0.04-0.78).). Likewise, a higher DBI was associated with more polypharmacy (3.36; 95% CI 2.64-4.08), more falls, hospital admissions and emergency room visits (P<.05). CONCLUSIONS: Polypharmacy and prescription of anticholinergic/sedative drugs is frequent among institutionalized older adults with dementia, finding an association between DBI, falls and hospital admissions or emergency department visits. Therefore, it is necessary to propose interdisciplinary pharmacotherapeutic optimization strategies.

Prevalencia de diabetes mellitus tipo 2 y su tratamiento farmacológico en personas institucionalizadas en centros residenciales / Patients in Nursing Homes: type 2 diabetes mellitus prevalence and its pharmacologic therapy

OBJETIVO: Determinar la prevalencia de diabetes mellitus tipo 2 y sus características clínicas, tratamiento farmacológico específico y problemas derivados en personas institucionalizadas en centros residenciales. MÉTODO: Estudio observacional, transversal llevado a cabo en marzo de 2019 en seis centros residenciales en personas con diagnóstico de diabetes mellitus tipo 2. Se recogieron variables demográficas, clínicas y bioquímicas, tratamiento farmacológico específico y eventos de hipoglucemia y caídas el año anterior. RESULTADOS: La prevalencia de diabetes mellitus tipo 2 fue del 21,7%. El 70,90% de los pacientes tuvieron una glucohemoglobina ≤ 7% el último año, mostrando el 92% de los pacientes una fragilidad moderada-severa. Se encontraron 0,4 hipoglucemias/residente-año, siendo más frecuentes en pacientes insulinizados y en aquellos con función renal deteriorada. Sin embargo, no se encontraron más caídas en pacientes insulinizados (p > 0,05). El tratamiento de la diabetes fue adecuado de acuerdo a las recomendaciones de tratamiento en personas mayores. CONCLUSIONES: Se observa una prevalencia de diabetes tipo 2 ligeramente inferior a lo encontrado en la literatura especializada, con un control estricto de la enfermedad y una apropiada adecuación farmacoterapéutica según las recomendaciones de la European Diabetes Working Party for Older People. Los pacientes insulinizados y aquellos con función renal deteriorada tienen mayor riesgo de hipoglucemia

OBJECTIVE: To determine type 2 diabetes mellitus prevalence, clinical features, specific pharmacologic treatment and problems faced in nursing home patients.METHOD: Observational, cross-sectional study conducted in March 2019 in six nursing homes, examining persons diagnosed with type 2 dia-betes mellitus. Demographic, clinical and biochemical variables, specific pharmacologic therapy and hypoglycemia events as well as falls during the previous year were collected.RESULTS: Prevalence of type 2 diabetes mellitus was 21.7%. 70.90% of the patients had glycated hemoglobin ≤ 7% last year, with 92% of the patients having a moderate-severe frailty. 0.4 hypoglycemia/resident-year were found, being more frequent in patients receiving insulinization and in those with impaired renal function. However, no further falls were found in insulinized patients (p > 0.05). Diabetes therapy was adequate according to treatment recommendations for the elderly. CONCLUSIONS: Prevalence of type 2 diabetes is slightly lower than that found in the literature, finding a strict control of the disease and an appro-priate pharmacotherapeutic adequacy according to the recommendations by the European Diabetes Working Party for Older People. Insulinized patients and those with impaired renal function have a higher risk of hypo-glycemia

Patients in Nursing Homes: type 2 diabetes mellitus prevalence and its pharmacologic therapy.

OBJECTIVE: To determine type 2 diabetes mellitus prevalence, clinical features, specific pharmacologic treatment and problems faced in nursing home patients. METHOD: Observational, cross-sectional study conducted in March 2019  in six nursing homes, examining persons diagnosed with type 2 diabetes mellitus. Demographic, clinical and biochemical variables,  specific pharmacologic therapy and hypoglycemia events as well as falls  during the previous year were collected. RESULTS: Prevalence of type 2 diabetes mellitus was 21.7%. 70.90% of the patients had glycated hemoglobin ≤ 7% last year, with 92% of  the patients having a moderate-severe frailty. 0.4  hypoglycemia/resident-year were found, being more frequent in patients receiving insulinization and in those with impaired renal function.  However, no further falls were found in insulinized patients (p > 0.05).  Diabetes therapy was adequate according to treatment  recommendations for the elderly. CONCLUSIONS: Prevalence of type 2 diabetes is slightly lower than that found in the literature, finding a strict control of the disease and an  appropriate pharmacotherapeutic adequacy according to the  recommendations by the European Diabetes Working Party for Older  People. Insulinized patients and those with impaired renal function have  a higher risk of hypoglycemia.

Objetivo: Determinar la prevalencia de diabetes mellitus tipo 2 y sus características clínicas, tratamiento farmacológico específico y  problemas derivados en personas institucionalizadas en centros  residenciales.Método: Estudio observacional, transversal llevado a cabo en marzo de  2019 en seis centros residenciales en personas con diagnóstico de diabetes mellitus tipo 2. Se recogieron variables demográficas,  clínicas y bioquímicas, tratamiento farmacológico específico y eventos  de hipoglucemia y caídas el año anterior.Resultados: La prevalencia de diabetes mellitus tipo 2 fue del 21,7%. El 70,90% de los pacientes tuvieron una glucohemoglobina ≤  7% el último año, mostrando el 92% de los pacientes una fragilidad  moderada-severa. Se encontraron 0,4 hipoglucemias/residente-año,  siendo más frecuentes en pacientes insulinizados y en aquellos con  función renal deteriorada. Sin embargo, no se encontraron más caídas  en pacientes insulinizados (p > 0,05). El tratamiento de la diabetes fue  adecuado de acuerdo a las recomendaciones de tratamiento en  personas mayores.Conclusiones: Se observa una prevalencia de diabetes tipo 2  ligeramente inferior a lo encontrado en la literatura especializada, con  un control estricto de la enfermedad y una apropiada adecuación  farmacoterapéutica según las recomendaciones de la European Diabetes Working Party for Older People. Los pacientes insulinizados y aquellos  con función renal deteriorada tienen mayor riesgo de hipoglucemia.

Medicine optimization strategy in an acute geriatric unit: The pharmacist in the geriatric team.

AIM: Older patients admitted to acute geriatric units (AGU) frequently use many medications and are particularly vulnerable to adverse drug events, so specific interventions in this setting are required. In the present study, we describe a new medicine optimization strategy in an AGU, and explore its potential in reducing polypharmacy and improving medication appropriateness. METHODS: The present prospective study included patients aged ≥75 years who were admitted to an AGU in a tertiary hospital. An intervention based on a pharmacist clinical interview, medication history and a structured medication review within a comprehensive geriatric assessment was proposed. The differences regarding polypharmacy as the primary outcome (≥5 chronic drugs), hyperpolypharmacy (≥10), number of drugs, drug-related problems and Screening Tool of Older Person's Prescription/Screening Tool to Alert Doctors to Right Treatment criteria between admission and discharge were evaluated. RESULTS: From October 2016 to April 2017, 234 patients were enrolled, aged 87.6 years (SD 4.6 years); 143 (61.1%) were women. The intervention resulted in a statistically significant improvement in polypharmacy (-10.2%, 95% CI -15.3, -5.2), hyperpolypharmacy (-16.6%, 95% CI -22.3 -11.0), number of medications (-1.4, 95% CI -1.8, -1.0), Screening Tool of Older Person's Prescription criteria (-19.2%, 95% CI -24.9, -13.6), Screening Tool to Alert Doctors to Right Treatment criteria (-6.8%, 95% CI -10.1, -3.5) and drug-related problems (-2.7, 95% CI -2.9, -2.4; P ≤ 0.001 for all). CONCLUSIONS: A systematic pharmacist-led intervention at hospital admission to an AGU within a comprehensive geriatric assessment was associated to a decrease in polypharmacy, drug-related problems and potentially inappropriate prescribing. Geriatr Gerontol Int 2019; 19: 530-536.