Number Of Regular Medications Research Articles

Success of Simpler Modified Fried Frailty Scale to Predict Mortality among Nursing Home Residents.

Fried frailty scale is the very first and most commonly used assessment scale for an operational definition of frailty with its demonstrated success as a predictor of mobility limitations and mortality. However, it is impractical for use in routine clinical practice. We aimed to study whether a simpler modified Fried frailty scale could predict mortality among nursing home residents. Retrospective longitudinal follow-up study. Nursing home. Baseline evaluation was performed in 2009. Mortality was assessed after 4 year. Two hundred-twenty-four participants were included. Residents were assessed for demographic characteristics, falls, dementia, the number of regular medications and chronic diseases, body composition by bioimpedance analysis, basic and instrumental activities of daily living besides frailty status by a modified Fried frailty scale. The residents were assessed for mortality after a median follow-up time of 46 months. The association of frailty with mortality was analyzed by the Kaplan-Meier Log-rank test and multivariate Cox Regression analysis. Mortality occurred in 90 (40.2%) of the residents. In multivariate analysis, frailty was an independent predictor of death (Hazzard ratio= 1.4, 95% confidence interval= 1.03-2.6, p=0.03) when adjusted by age, sex, presence of malnutrition, low muscle mass, number of chronic diseases and regular medications. Our results suggest that the simpler modified Fried frailty scale can be used as a screening tool for frailty in everyday practice as a tool to identify risky patients for mortality. Future reports studying its role in predicting other adverse outcomes associated with frailty are needed.

Deprescribing in Older People Approaching End of Life: A Randomized Controlled Trial Using STOPPFrail Criteria.

Older people approaching end of life are commonly prescribed multiple medications, many of which may be inappropriate or futile. Our objective was to examine the effect of applying the STOPPFrail, a recently developed deprescribing tool, to the medication regimens of older patients with advanced frailty. Randomized controlled trial. Two acute hospitals in Ireland. Adults 75 years or older (n = 130) with advanced frailty and polypharmacy (five or more drugs), transferring to long-term nursing home care. A STOPPFrail-guided deprescribing plan was presented to attending physicians who judged whether or not to implement recommended medication changes. The primary outcome was the change in the number of regular medications at 3 months. Secondary outcomes included unscheduled hospital presentations, falls, quality of life, monthly medication costs, and mortality. Intervention (n = 65) and control group (n = 65) participants were prescribed a mean (plus or minus standard deviation [SD]) of 11.5 (±3.0) and 10.9 (±3.5) medications, respectively, at baseline. The mean (SD) change in the number of medications at 3 months was -2.6 (±2.73) in the intervention group and -.36 (±2.60) in the control group (mean difference = 2.25 ± .54; 95% confidence interval [CI] = 1.18-3.32; P < .001). The mean change in monthly medication cost was -$74.97 (±$148.32) in the intervention group and -$13.22 (±$110.40) in the control group (mean difference $61.74 ± $26.60; 95% CI = 8.95-114.53; P = .02). No significant differences were found between groups for any of the other secondary outcomes. STOPPFrail-guided deprescribing significantly reduced polypharmacy and medication costs in frail older people. No significant differences between groups were observed with regard to falls, hospital presentations, quality of life, and mortality, although the trial was likely underpowered to detect differences in these outcomes. J Am Geriatr Soc 68:762-769, 2020.

206 Deprescribing in Frail Older People Transitioning to Long-term Care: a Randomized Controlled Trial Using STOPPFrail Criteria

Abstract Background Older people with advanced frailty are among the highest consumers of prescription medications. When life expectancy is limited, the use of multiple medications may be unnecessary or burdensome. STOPPFrail criteria were recently developed to assist clinicians with deprescribing decisions in frail older people approaching end-of-life. The aim of this study was to examine whether long-term medications could be safely discontinued in frail older people using STOPPFrail criteria. Methods We recruited hospitalized adults aged ≥75 years with polypharmacy (≥5 long-term medications) that were transitioning to nursing home care. Participants were eligible if their Clinical Frailty Scale score was ≥7 and if their attending physician indicated that he/she “would not be surprised if the patient died in the next 12 months”. Patients were randomized to single time point pre-discharge STOPPFrail-guided deprescribing or routine pharmaceutical care. The primary outcome was change in the number of regular medications at 3 months. Secondary outcomes included emergency hospital transfers, incident falls, fractures and mortality. Results Results are presented for the first 100 enrolled patients. The mean (±standard deviation [SD]) age of study participants was 85.1 (±5.7) and 61% were female. Intervention (n = 49) and control group (n = 51) participants were prescribed a mean (±SD) of 11.5 (±3.0) and 10.9 (±3.5) regular medications, respectively, at baseline. The mean (±SD) change in the number of regular medications at 3 months was -2.7 (±2.8) in the intervention group and -0.6 (±2.6) in the control group (estimated difference 2.1 ±0.6, 95% confidence interval 0.8 -3.3, p=0.001). Ten intervention participants and 14 control participants died within 3 months of randomization (20.4% vs 27.4%, p=0.49). There was no significant difference between groups for emergency hospital transfers, incident falls or fractures. Conclusion STOPPFrail-guided deprescribing significantly reduced medication burden in frail older people without adversely affecting clinical outcomes in the prospective 3 months.

Please reconcile, not wait a while

A quality improvement project to increase the rate of paediatric medicines reconciliation was carried out in a district general hospital between April and July 2018. Baseline data collected from our...

PL04: Comparison of the cost and the quality of the care provided to low acuity patients in an emergency department and a walk-in clinic

Introduction: Low acuity patients have been controversially tagged as a source of emergency department (ED) misuse. Authorities for many Canadian health regions have set up policies so these patients preferably present to walk-in clinics (WIC). We compared the cost and quality of the care given to low acuity patients in an academic ED and a WIC of Québec City during fiscal year 2015-16. Methods: We conducted an ambidirectional (prospective and retrospective) cohort study using a time-driven activity-based costing method. This method uses duration of care processes (e.g., triage) to allocate to patient care all direct costs (e.g., personnel, consumables), overheads (e.g., building maintenance) and physician charges. We included consecutive adult patients, ambulatory at all time and discharged from the ED or WIC with a diagnosis of upper respiratory tract infection (URTI), urinary tract infection (UTI) or low back pain. Mean cost [95%CI] per patient per condition was compared between settings after risk-adjustment for age, sex, vital signs, number of regular medications and co-morbidities using generalized log-gamma regression models. Proportions [95%CI] of antibiotic prescription and chest X-Ray use in URTI, compliance with provincial guidelines on use of antibiotics in UTI, and column X-Ray use in low back pain were compared between settings using a Pearson Chi-Square test. Results: A total of 409 patients were included. ED and WIC groups were similar in terms of age, sex and vital signs on presentation, but ED patients had a greater burden of comorbidities. Adjusted mean cost (2016 CAN$) of care was significantly higher in the ED than in the WIC (p &amp;lt; 0.0001) for URTI (78.42[64.85-94.82] vs. 59.43[50.43-70.06]), UTI (78.88[69.53-89.48] vs. 53.29[43.68-65.03]), and low back pain (87.97[68.30-113.32] vs. 61.71[47.90-79.51]). For URTI, antibiotics were more frequently prescribed in the WIC (44.1%[34.3-54.3] vs. 5.8%[1.2-16.0]; p &amp;lt; 0.0001) and chest X-Rays, more frequently used in the ED (26.9%[15.6-41.0] vs. 13.7%[7.7-22.0]; p = 0.05). No significant differences were observed in the compliance with guidelines on use of antibiotics in UTI and in the use of column X-Ray in low back pain. Conclusion: Total cost of care for low acuity patients is lower in walk-in clinics than in EDs. However, our results suggest that quality-of-care issues should be considered in determining the best alternate setting for treating ambulatory emergency patients.

Polypharmacy in very elderly hospitalised patients: a single centre study

Objectives:&#x0D; To quantify the extent of polypharmacy and potentially inappropriate medications (PIMS) in very elderly hospitalised patients.&#x0D; Method:&#x0D; A retrospective audit of prescribed medications among hospitalised medical patients (?80 years). The number of regular medications was categorised as: non-polypharmacy (0-4 drugs), polypharmacy (5-9 drugs) and hyper-polypharmacy (? 10 drugs).&#x0D; Results:&#x0D; 318 patient records were reviewed with a mean age of 86.3 years, Polypharmacy was identified in 50.6% of patients and hyper-polypharmacy in 31.2%, while only 18.2% of patients had non-polypharmacy. 62.3% of patients received at least one psychotropic agent, most commonly anti-depressants (26.1%) followed by sedatives (19.5%). Antidepressant use correlated significantly with a history of falls, P=0.005. Other commonly prescribed medications were proton-pump inhibitors (53.5%), diuretics (48.1%), statins (45.6%), beta-blockers (34.3%) and anti-coagulation agents (21.7%).&#x0D; Conclusion:&#x0D; Our study showed that over 80% of hospitalised very elderly patients were exposed to polypharmacy, and many patients were prescribed PIMS.

Risk factors for surgical site infection following spinal instrumentation surgery.

In spinal instrumentation surgeries, surgical site infection (SSI) is one of the complications to be avoided. However, spinal instrumentation surgeries have a higher rate of SSI than other clean orthopedic surgeries. The purpose of this study was to investigate the risk factors for SSI following spinal instrumentation surgeries and contribute to the prevention of SSIs by identifying high-risk patients. Records of 431 patients who underwent spinal instrumentation surgeries from 2011 to 2014 with a minimum follow-up period of 90 days were retrospectively reviewed. Associations of SSI with various preoperative, operative, and postoperative factors were statistically analyzed with univariate and stepwise multivariate logistic regression analysis. Deep or superficial SSIs were observed in 15 patients (3.5%). Univariate analysis revealed significant association of SSI with diabetes mellitus (odds ratio [OR] 4.7, 95% confidence interval [CI] 1.5-14.4; p=0.012) and serum albumin ≤3.5g/dl (OR 3.35, 95% CI 1.1-10.38, p=0.012). The number of regular medications prescribed in patients with SSI (8.2±5.4) was significantly more than that in patients without SSI (3.8±4.4) (p=0.001), and the cut-off value of the number of medications was 7, as derived from receiver operating characteristics analysis. Multivariate analysis revealed that the number of regular medications ≥7 was an independent risk factor significantly associated with SSIs (OR 7.3, 95% CI 2.3-24.0, p=0.001). Our study demonstrated that an important risk factor for SSI after spinal instrumentation surgery was number of regular medications≥7. Number of regular medications is a simple and valuable risk index for SSI, which reflects the influence of medications and comorbidities.

Potentially Harmful Medication Use and Decline in Health-Related Quality of Life among Community-Dwelling Older Adults.

BackgroundSeveral scales to quantify the impact of potentially harmful medications (PHMs) have been shown to predict mortality and functional decline; however, the effect of PHMs on quality of life (QoL) has not been well-studied.ObjectiveThe aims of this study were to investigate an association between PHM use and change in health-related QoL among community-dwelling older adults, and to compare the predictive capacity of PHM scales.MethodsWe conducted a retrospective cohort study using prescription claims data and survey responses. A total of 426 community-dwelling adults aged 65 years or older who visited senior centers and had received prescriptions through a statewide prescription drug subsidy program were included. Anticholinergic Cognitive Burden (ACB), Drug Burden Index-sedative component (DBI-Se), Drug Burden Index-anticholinergic component (DBI-ACh), and the number of regular medications and Beers list medications were calculated from the claims data between baseline and 12 months. In addition, change in the EuroQoL five-dimensions questionnaire (EQ-5D) between baseline and 6- and 12-month follow-up were measured as the main outcome. A linear mixed model was used for the analysis.ResultsAfter adjusting for covariates, both DBI-Se (coefficients − 0.076, 95% confidence interval [CI] − 0.131 to − 0.020) and DBI-Ach (coefficients − 0.095, 95% CI − 0.188 to − 0.002) significantly predicted a decline in EQ-5D index. The ACB, number of regular medications, and number of Beers medications did not have a significant association with EQ-5D changes.ConclusionsPHM measures incorporating dose revealed a better predictive capacity for QoL change. Reducing cumulative drug dose, as well as stopping medications, would be important for the well-being of this population.Electronic supplementary materialThe online version of this article (10.1007/s40801-017-0123-8) contains supplementary material, which is available to authorized users.

Investigating the Frequency and Nature of Medication-Related Problems in the Women's Health Unit of an Australian Tertiary Teaching Hospital.

Despite the large burden medication-related morbidity and mortality places on the Australian health care system, there is little known about the extent of this problem in a women's health (obstetric and gynecology) setting. Determine the frequency and nature of medication-related problems (MRPs) occurring in a women's health unit (WHU) of an Australian teaching hospital. A prospective audit of consecutive cases of patients treated in the WHU at a tertiary-level teaching hospital was undertaken by a clinical pharmacist over a 5-week period. Data collected included the following: patient characteristics, type of MRP (using a modified version of the Hepler-Strand classification system), medication involved (according to the World Health Organisation Anatomical Therapeutic Chemical classification system), and clinical significance (using a 2-level severity index). A total of 454 potential MRPs were identified over the 5-week period among 241 patients. A total of 39 MRPs (8.6%) identified were deemed to be of moderate/high clinical significance. The highest number of MRPs (221; 49%) was identified among women admitted following a cesarean delivery, with 83 of 85 women in this group experiencing at least 1 MRP. Additional factors associated with an increased likelihood of patients experiencing a MRP included increased age, length of hospital stay, and number of regular medications taken prior to and during admission (P < 0.05). The widespread nature of identified MRPs in this setting suggests that various approaches to minimizing these problems and mitigating the associated burden on the health care system are warranted.

Improving the transition of elderly patients with multiple comorbidities into the community: impact of a pharmacist in a General Medicine outpatient follow‐up clinic

AbstractAimTo investigate the impact of extending the traditional roles of pharmacists from that of providing a service to inpatients under the General Medical Unit in the acute hospital setting, to the enhancement of continuity of care and reduction in medication misadventure by implementing clinical pharmacy services in the outpatient follow‐up clinic.MethodA prospective pilot study was conducted in the General Medical Unit post‐discharge follow‐up clinic between March 2012 and February 2014. Each patient enrolled in the study was reviewed by a pharmacist through a scheduled 20 min consultation after their appointment with the medical doctor. Patient's demographic data, number of days from discharge to clinic review and number of regular medications were collected. Drug‐related problems (DRPs) identified by the pharmacist were recorded. Any discrepancies from the discharge medication plan identified by the pharmacist were also recorded, in addition to compliance issues, initiation of dose‐administration aids and referrals to the outreach pharmacy service.ResultsEighty‐seven patients were enrolled (average age: 73 years) with an average time between discharge and clinic review of 25 days. The most frequent intervention made by the pharmacist was therapeutic drug monitoring (74%) followed by counselling on new or changed medications (49%). The pharmacist identified a number of patients who had continued taking medications that were ceased during their admission (15%) and patients who were not taking medications which had been initiated during hospitalisation (15%). Ten patients (11%) were taking the wrong dose of at least one medication. At least one DRP was identified in 77 (89%) patients, and discrepancies between the discharge medication plan and what the patient was taking at the time of the clinic visit were identified in 33 patients (38%).ConclusionMedication discrepancies often occur at transitions of care. Our data highlight the potential role of a pharmacist in this setting and the importance that the medication management plan put in place at the time of discharge should be communicated to the appropriate healthcare practitioners and the patient.

Is polypharmacy always hazardous? A retrospective cohort analysis using linked electronic health records from primary and secondary care

Prescribing multiple medications is associated with various adverse outcomes, and polypharmacy is commonly considered suggestive of poor prescribing. Polypharmacy might thus be associated with unplanned hospitalization. We sought to test this assumption. Scottish primary care data for 180 815 adults with long-term clinical conditions and numbers of regular medications were linked to national hospital admissions data for the following year. Using logistic regression (age, gender and deprivation adjusted), we modelled the association of prescribing with unplanned admission for patients with different numbers of long-term conditions. Admissions were more common in patients on multiple medications, but admission risk varied with the number of conditions. For patients with one condition, the odds ratio for unplanned admission for four to six medications was 1.25 (95% confidence interval 1.11-1.42) vs. one to three medications, and 3.42 (95% confidence interval 2.72-4.28) for ≥10 medications vs. one to three medications. However, this effect was greatly reduced for patients with multiple conditions; amongst patients with six or more conditions, those on four to six medications were no more likely to have unplanned admissions than those taking one to three medications (odds ratio 1.00; 95% confidence interval 0.88-1.14), and those taking ≥10 medications had a modestly increased risk of admission (odds ratio 1.50; 95% confidence interval 1.31-1.71). Unplanned hospitalization is strongly associated with the number of regular medications. However, the effect is reduced in patients with multiple conditions, in whom only the most extreme levels of polypharmacy are associated with increased admissions. Assumptions that polypharmacy is always hazardous and represents poor care should be tempered by clinical assessment of the conditions for which those drugs are being prescribed.

People's Attitudes, Beliefs, and Experiences Regarding Polypharmacy and Willingness to Deprescribe

To capture people's attitudes, beliefs, and experiences regarding the number of medications they are taking and their feelings about stopping medications. Administration of a validated questionnaire. Multidisciplinary ambulatory consulting service at the Royal Adelaide Hospital. Participants were individuals aged 18 and older (median 71.5) taking at least one regular prescription medication; 100 participants completed all items of the questionnaire, 65 of whom were aged 65 and older. Participants were administered the 15-item Patients' Attitudes Towards Deprescribing (PATD) questionnaire. Participants were taking an average of 10 different prescription and nonprescription (including complementary), regular and as-needed medications. More than 60% felt that they were taking a "large number" of medications, and 92% stated that they would be willing to stop one or more of their current medications if possible. Number of regular medications, age, and number of medical conditions were not found to be correlated with willingness to stop a medication. The findings were similar in older and younger participants. This study has shown that a cohort of mostly older adults were largely accepting of a trial of cessation of medication(s) that their prescriber deemed to be no longer required. Because few factors were associated with willingness to cease medications, all patients should be individually evaluated for deprescribing.

Factors associated with adverse outcome following urologic surgery in patients aged 80 years and older

This study was designed to find predictors for adverse post-operative outcomes in elderly patients aged 80 years and older, who underwent urologic surgery. In this prospective observational study, we analysed data, including age, gender, American Society of Anesthesiologists (ASA) class, co-morbidities, number of regular medications, type and extent of surgery, type of anesthesia, duration of surgery and hospitalization, post-operative morbidity and mortality. We studied the correlations between each pre- and intra-operative parameter to the consequence, to find predictors for adverse outcome. During a 12-month period, 217 patients underwent 294 urologic procedures in our institution. Ninety-eight procedures (33%) were followed by complications and 11 patients (5%) died. Patients who had uneventful surgery and hospitalization were significantly younger than those who experienced morbidity or mortality. There was a significantly higher complication rate among patients with a higher ASA class or with ischemic heart disease, following higher graded or longer operations, and after emergency surgery. Older age is a significant risk factor. Patients with higher ASA class or ischemic heart disease are at higher risk for post-operative complications and thus, require careful follow-up. In this age population, extensive or prolonged surgery should be carefully considered.

Predictors for Adverse Outcome in Patients Aged 80 Years and Older Undergoing Emergent Hip Surgery

Background: Increased life expectancy results in aging of the population. One of the leading medical problems of elderly patients is hip fracture. We studied demographic, surgical and anesthetic parameters of elderly patients who underwent surgery due to osteoporotic hip fracture, to find predictors for peri-operative morbidity and mortality. Methods: This is a retrospective review of prospectively collected data of patients aged 80 years and older who underwent emergent surgery due to osteoporotic femoral neck, subcapital or pertrochanteric fractures. Data was collected on age, gender, co-morbidities, American Society of Anesthesiologists Class, number of regular medications, whether the patient was bedridden or not before the surgery, hemoglobin on admission and on discharge, type of surgery and anesthesia, duration of surgery, duration of hospitalization, post-operative morbidity and mortality. The demographic and peri-operative parameters were analyzed and matched to the post-operative complications and mortality to find predictors for adverse outcome. Results: One hundred and nine patients were included in the study, of whom 22 (20%) had post-operative complications and 10 (9.1%) died. We found an increased complication rate in patients who had chronic obstructive pulmonary disease and in patients who underwent general anesthesia. Patients who were bedridden before the surgery had increased mortality rates. No significant correlation was found between outcome and any other factors. Conclusion: Our results suggest favoring regional anesthesia in elderly patients undergoing emergent femoral neck surgery and acknowledging a higher risk in chronic pulmonary disease or bedridden patients.

Hypnosedative Use and Predictors of Successful Withdrawal in New Patients Attending a Falls Clinic

Many older individuals suffer from difficulty initiating and maintaining sleep, and consequently use hypnosedative medication. The use of sleeping tablets, usually benzodiazepines (BZs) and the newer Z drugs such as zolpidem, is largely unnecessary and problematic since their efficacy is not maintained over an extended period of time and they increase the risk of falls. Withdrawing these medications is challenging because of their propensity for causing dependence and rebound insomnia. To describe the use of anxiolytic and hypnosedative medications by patients attending a falls clinic, determine the success of recommendations to cease or reduce use of these medications, and evaluate patient characteristics influencing the success of these recommendations. Patients with a first appointment at an Australian falls clinic between January 2006 and December 2008 were identified from letters written by the geriatrician or rehabilitation physician who ran the clinic. Patients who were taking a BZ/Z drug, had attended a follow-up appointment at least 2 months after their index appointment and had received a documented recommendation to alter their BZ/Z drug use at the index appointment were included in this study. The associations between compliance with the specialist physician's recommendation to alter the BZ/Z drug and BZ/Z drug dose, frequency and duration, patient's age, sex, residence, co-morbidities and number of regular medications were assessed. Inter-clinician variation in the proportion of patients receiving a follow-up appointment, recording of BZ/Z drug use and the proportion of patients given a recommendation to alter BZ/Z drug use were also analysed in the broader population of all patients receiving a first appointment at the falls clinic in the study period. Data from 302 patient records revealed that 21.5% of patients were using a BZ/Z drug and 27.8% were using any drug for its hypnosedative properties. Over the 3-year study period there was a reduction in BZ use, which was countered by an increase in the use of zolpidem, so that the overall use of BZ/Z drugs did not change. Of those patients taking a BZ/Z drug, 48% (31/65) were followed up and had a documented recommendation to alter their BZ/Z drug use. At least 68% (21/31) of these patients were compliant at follow-up. Patients who were assessed by a geriatrician were more likely to be advised to alter their BZ use than those assessed by a rehabilitation specialist (p = 0.002). Patients were more likely to be compliant if they were given a recommendation to cease their BZ/Z drug compared with advice to reduce the dose or to gradually reduce the dose with the aim of cessation (p = 0.019). There were no sex- or age-specific differences in compliance. Patients who were successful in ceasing or reducing BZ/Z drug use showed nonsignificant trends toward having a reduced number of co-morbidities and regular medications, and lower frequency of use of BZ/Z drugs. We observed a constant proportion of falls clinic patients taking BZs or Z drugs between 2006 and 2008. Specialist recommendation to cease or reduce dosage of these medications was associated with a high success rate.

Incidence and Risk Factors of Falling in the Postoperative Lower Limb Amputee While on the Surgical Ward

To determine the incidence and risk factors of falling among amputees during the postoperative time on the surgical ward. Retrospective cohort. Three tertiary acute care hospitals. Subjects aged 18 years or older undergoing either a primary or revision amputation at the transtibial, knee disarticulation, or transfemoral levels. Subjects were excluded if they underwent bilateral amputations. A total of 466 charts were identified, and 370 subjects were included in the analysis. All outcome measurements were devised before data collection. The primary outcome variable was the presence of at least one fall. Details regarding falls, including the date, time, and location of the first fall, were recorded. In addition, the total number of falls and any associated injuries were documented. Secondary outcome variables included type and number of medical comorbidities, cognitive deficits, and regular use of specific medications. Sixty-one of 370 subjects fell at least once, giving an incidence of 16.5% (95% confidence interval [95% CI] 12.7%-20.3%). No difference was noted between the fall and no fall groups for gender, mean age, number of regular medications, and number of medical comorbidities. The fall group demonstrated a significantly longer length of stay (difference of means 32.5 days, 95% CI 17.4-47.5, P < .001). Injuries were sustained in 60.7% of those who fell. Multiple logistic regression analysis identified the major risk factors for falling as dysvascular etiology (odds ratio [OR] 2.418, 95% CI 1.043-5.606), transtibial level (OR 2.127, 95% CI 1.050-4.309), and right-sided amputation (OR 1.933, 95% CI 1.073-3.483). Falls and associated injuries occur commonly in the postoperative lower limb amputee on the surgical ward. Risk factors for falling include dysvascular etiology, transtibial level, and right-sided amputation. Further studies are required to characterize the mechanisms of falling in this patient population and to develop appropriate fall-prevention strategies.

Patients Aged 80 and Older Undergoing Orthopedic or Urologic Surgery: A Prospective Study Focusing on Perioperative Morbidity and Mortality

Background: The population is progressively aging and an increasing number of elderly patients face surgical treatment. Objective: The current study was designed to examine the perioperative morbidity and mortality of elderly patients undergoing orthopedic or urologic surgery and look for predictors for adverse outcome. Methods: This is a prospective study of elderly patients, 80 years of age and older, who underwent elective or emergent orthopedic or urologic surgery in our institution during a 5-month period. Data were collected on age, gender, chronic diseases, number of regular medications, whether or not the patient was bedridden before surgery, American Society of Anesthesiologists (ASA) class, type of surgery and anesthesia, duration of hospitalization, and 30-day postoperative morbidity and mortality. We studied correlations between pre- and intraoperative parameters and postoperative complications. Results: During the study period, 39 patients underwent urologic surgery and 147 patients underwent orthopedic surgery. Age ranged from 80 to 98 years (85 ± 4.2 years, mean ± SD). One patient had an intraoperative complication, 5 patients had postoperative complications within 1 day of surgery, and 23 had complications within 1 month of surgery. Five (2.7%) patients, all of whom were operated urgently, died after surgery. Postoperative complications correlated significantly to poor ASA class (p = 0.01), urgency of the procedure (p = 0.03), and extent (p = 0.02) and duration (p = 0.01) of surgery. No significant correlation was found between outcome and any other pre- or intraoperative factors. Conclusions: Elderly surgical patients with poor ASA class or following urgent, extensive or long surgery are at a higher risk for postoperative morbidity and mortality, mandating special perioperative care.

Medication use among older Australian veterans and war widows.

This study aimed to review the medications used by a group of Australian war veterans and widows, to identify type and number of medications used and potential inappropriate prescribing. Label details of 4304 medications used by 887 participants were recorded and classified according to the Anatomical Therapeutic Chemical code. The median number of regular medications being used was four (interquartile range 2-7), with a median of one other medication (interquartile range 1-2) being taken as needed. Over half (53%) the participants were taking four or more regular medications. There were 26 potential interactions among 25 people. Polypharmacy was a considerable problem for this group of older Australians.