Potentially inappropriate prescribing in a population of frail elderly people.

Background Frailty is a clinical syndrome highly predictive of functional decline after a stress or a medical event, such as adverse drug events. Objective To describe the prevalence of potentially inappropriate prescribing in a population of frail elderly patients. Setting Geriatric day hospital for assessment of frailty and prevention of disability, Toulouse, France. Method A cross-sectional study performed from January to April 2014. Two pharmacists retrospectively analyzed the prescriptions of elderly patients who were sent to the day hospital to assess their frailty and to be given a personalized plan of care and prevention. Potentially inappropriate prescribing was defined by combining explicit criteria: Laroche list, screening tool of older people's prescriptions, and screening tool to alert to right treatment with an implicit method (drug utilization review for each medication). Prescriptions' optimizations were then suggested to the geriatricians of the day hospital and classified according to criteria defined by the French Society of Clinical Pharmacy. Main outcome measure Prevalence of potentially inappropriate prescribing. Results Among the 229 patients included, 71.2% had potentially inappropriate prescribing. 76 patients (33.2%) had at least one drug without any valid indication. 51 (22.3%) had at least one drug with an unfavorable benefit-to-risk ratio according to their clinical and biological data, 42 (18.3%) according to the Laroche list and 38 (16.6%) had at least one drug with questionable efficacy. Conclusion Our work shows that the incidence of PIP is high in the frail elderly and that, in most cases, it could be avoided with an adequate and regular reassessment of the prescriptions. In future, prescription optimization will be integrated into the personalized medical care plan to further prevent drug-related disability.

Potentially inappropriate drug prescribing and associated factors in nursing homes.

IMPORTANCE: Polymedication is frequent in nursing home (NH) residents. This increases the risk of potentially inappropriate drug prescribing (PIDP), which can lead to adverse drug events, such as falls and hospitalization. OBJECTIVE: To identify PIDP in NH residents and to investigate subject-related and NH structural and organizational factors associated with PIDP. DESIGN: Cross-sectional study. SETTING: A total of 175 NHs in Midi-Pyrénées region, South-Western France. PARTICIPANTS: A total of 974 subjects randomly selected from the 6275 NH residents participating in the IQUARE study. EXPOSURE: Patients with PIDP. MAIN OUTCOMES AND MEASURES: PIDP was the main outcome measure. It was defined using a specific indicator, based on the Summary of Product Characteristics, on the Laroche list, and on residents' clinical data. PIDP was defined as the presence of at least 1 of the following criteria: (1) drug with an unfavorable benefit-to-risk ratio; (2) drug with questionable efficacy according to the Laroche list; (3) absolute contraindication; (4) significant drug-drug interaction. Associated factors were identified by using multivariable logistic regression models. RESULTS: Among the 974 residents included, 71% had PIDP. PIDP was more frequent in patients without dementia, with several comorbidities and taking multiple medications. In the multivariable analysis, age (odds ratio [OR] 1.02; 95% confidence interval [CI] 1.01-1.03) and Charlson Comorbidity Index (CCI; P = .003, CCI = 1 versus 0: OR1/0 1.22; 95% CI 0.85-1.74, CCI ≥ 2 versus 0: OR2/0 1.72; 95% CI 1.23-2.41) were associated with an increased likelihood of PIDP. By contrast, dementia was associated with a lower likelihood of PIDP (OR 0.70; 95% CI 0.53-0.94). Among NH structural and organizational characteristics, the access to psychiatric advice and/or to hospitalization in a psychiatric unit (OR 1.36; 95% CI 1.02-1.82) and the presence of a reevaluation of drug prescriptions (OR 1.45; 95% CI 1.07-1.96) were associated with an increased likelihood of PIDP. CONCLUSIONS AND RELEVANCE: Our work suggests that some NH characteristics are associated with an increased likelihood of PIDP. Gaining a better understanding of the factors influencing PIDP, especially structural and organizational NH factors, can help to determine the interventions that should be implemented.

[Pastel in the urine bag]. / Du pastel dans la poche à urine.

Purple urine bag syndrome is a relatively unknown phenomenon in which the urine bag and the collector of chronically catheterized patients turn purple or blue. It affects predominantly women, and is mainly reported in elderly patients. The mechanism seems to be related to the appearance in the urine of two compounds that have been identified as indigo (blue) and indirubin (red) which bind to the urine bag and the collector. Several associated factors are usually mentioned such as constipation, alkaline urine, bed rest, institutionalization or cognitive impairment. They are risk factor of this phenomenon. On the other hand, an infection or a urinary bacterial colonization is necessary and high bacterial counts seem to be the critical step in the development of the purple urine bag syndrome. We report on two cases of purple urine bag syndrome observed in two patients being treated in a long-term care unit. Both of whom were diagnosed with indwelling urinary bacterial colonization, with Escherichia coli and Pseudomonas aeruginosa respectively.