BACKGROUND: Falls are a significant public health problem and constitute a major cause of injuries and mortality. Risk factors for falls are multifactorial and include medication use.
OBJECTIVE: To develop and investigate the content validity of the Medication-Related fall (MRF) screening and scoring tool.
METHODS: The MRF tool was developed from clinical practice guidelines addressing medication-related problems, and additional medications identified by specialist pharmacists across a region of the United Kingdom (Northern Ireland). Medication classes were categorised according to their \'potential to cause falls\' as: high-risk (three points), moderate-risk (two points) or low-risk (one point). The overall medication-related falls risk for the patient was determined by summing the scores for all medications. The MRF was validated using Delphi consensus methodology, whereby three iterative rounds of surveys were conducted using SurveyMonkey®. Twenty-two experts from 10 countries determined their agreement with the falls risk associated with each medication on a 5-point Likert scale. Only medications with at least 75% of respondents agreeing or strongly agreeing were retained in the next round.
RESULTS: Consensus was reached for 19 medications/medication classes to be included in the final version of the MRF tool; ten were classified as high-risk, eight as moderate-risk and one as low-risk.
CONCLUSIONS: The MRF tool is simple and has the potential to be integrated into medicines optimisation to reduce falls risk and negative fall-related outcomes. The score from the MRF tool can be used as a clinical parameter to assess the need for medication review and clinical interventions.

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OBJECTIVE: The objective of this registry study is to assess the utilization of pharmacogenomic (PGx) drugs among patients with chronic kidney disease (CKD).
METHODS: This study was a retrospective study of patients affiliated with the Department of Nephrology, Aalborg University Hospital, Denmark in 2021. Patients diagnosed with CKD were divided into CKD without dialysis and CKD with dialysis. PGx prescription drugs were retrieved from the Patient Administration System. Actionable dosing guidelines (AG) for specific drug-gene pairs for CYP2D6, CYP2C9, CYP2C19 and SLCO1B1 were retrieved from the PharmGKB homepage.
RESULTS: Out of 1241 individuals, 25.5% were on dialysis. The median number of medications for each patient was 9 within the non-dialysis group and 16 within the dialysis group. Thirty-one distinct PGx drugs were prescribed. Altogether, 76.0% (943 individuals) were prescribed at least one PGx drug and the prevalence of prescriptions of PGx drugs was higher in the dialysis group compared to the non-dialysis group. The most frequently prescribed drugs with AG were metoprolol, pantoprazole, atorvastatin, simvastatin and warfarin.
CONCLUSIONS: This study demonstrated that a substantial proportion of patients with CKD are exposed to drugs or drug combinations for which there exists AG related to PGx of CYP2D6, CYP2C19, CYP2C9 and SLCO1B1.

OBJECTIVE: This study aimed to evaluate the use of potentially inappropriate medications (PIMs) and to examine the number of oral medicines based on the swallowing function and activities of daily living (ADL) categories in a geriatric medical care ward.
METHODS: A prospective investigation of oral medication use of 124 consecutive patients (male, n=58; female, n=66) admitted to a geriatric medical care ward was conducted from November 2019 to October 2020. Nutritional routes and ADL categories were quantitatively assessed, and the respective medication quantities were subjected to a statistical analysis.
RESULTS: The average number of oral medications was 5.8 at acute care admission, 4.4 upon transfer to the geriatric medical care ward and 4.8 at discharge. Approximately 30% of oral medications were classified as PIMs, including antithrombotic agents, diuretics, antidiabetic drugs, magnesium oxide, sleep and anxiolytic medications, and antipsychotic drugs. Magnesium oxide, antipsychotic drugs, sleep and anxiolytic medications were frequently discontinued during the patient\'s stay at the geriatric medical care ward. The proportion of PIMs significantly decreased from 35.1% at admission, to 28.8% at ward transfer, and 24.3% at discharge (P<0.01). The number of oral medicines at discharge varied based on the nutritional route, with averages of 5.5 for oral intake, 3.6 for enteral nutrition, and 0.7 for venous nutrition. It also varied based on ADL categories, with averages of 6.0 for ADL 1, 5.8 for ADL 2, and 3.8 for ADL 3.
CONCLUSIONS: The use of PIMs decreased in the geriatric medical care ward. A reduced swallowing function and lower ADL were associated with a decrease in the quantity of oral medicines.

Potentially inappropriate medication use is prevalent among older adults in primary care, leading to increased morbidity, adverse drug reactions, hospitalizations, and mortality. This study aimed to develop and validate a tool for identifying PIMs in older adults within the primary care setting. The tool is composed of a list of criteria and was created based on consensus among experts from three Spanish-speaking countries, including two from Latin America.
A literature review was conducted to identify existing tools, and prescription patterns were evaluated in a cohort of 36,111 older adults. An electronic Delphi method, consisting of two rounds, was used to reach a formal expert consensus. The panel included 18 experts from Spain, Colombia, and Argentina. The content validity index, validity of each content item, and Kappa Fleiss statistical measure were used to establish reliability.
Round one did not yield a consensus, but a definitive consensus was reached in round two. The resulting tool consisted of a list of 5 general recommendations per disease, along with 33 criteria related to potential problems, recommendations, and alternative therapeutic options. The overall content validity of the tool was 0.87, with a Kappa value of 0.69 (95% CI 0.64-0.73; Substantial).
The developed criteria provide a novel list that allows for a comprehensive approach to pharmacotherapy in older adults, intending to reduce inappropriate medication use, ineffective treatments, prophylactic therapies, and treatments with an unfavorable risk-benefit ratio for the given condition. Further studies are necessary to evaluate the impact of these criteria on health outcomes.

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OBJECTIVE: The recent consensus statement of ESPEN and EASO recommends reviewing existing datasets to assess the prevalence of sarcopenic obesity based on the new definition and diagnostic criteria. Therefore, this study aimed to determine the prevalence of sarcopenic obesity in a population-based study and to assess the association of this new definition with clinical traits.
METHODS: The KORA (Cooperative Health Research in the Region of Augsburg)-Age baseline examination (2008/2009) comprised 1079 participants aged 65 years and older from southern Germany. Sarcopenic obesity was defined in 998 participants (mean age 75.6 years, 498 women) with complete data according to the 2022 ESPEN and EASO algorithm, which includes reduced handgrip strength, reduced skeletal muscle mass per weight, and elevated fat mass. Body composition was measured using bioelectrical impedance analysis. Associations between sarcopenic obesity and physical activity, disability, multimorbidity, and polypharmacy were assessed using logistic regression analysis.
RESULTS: The overall prevalence of sarcopenic obesity was 4.5 % (5.0 % in men, 4.0 % in women). Sarcopenic obesity was associated with disability (2.87 [CI 1.84-4.48]), multimorbidity (≥ 2 comorbidities; 2.59 [CI 1.23-5.46]), polypharmacy (≥ 5 drugs; 1.96 [CI 1.05-3.63]), cognitive impairment (3.03 [CI 1.51-6.06]) and arthritis (2.66 [CI 1.39-5.07]) after adjusting for age, sex and marital status.
CONCLUSIONS: Sarcopenic obesity is prevalent in the older German population and is associated with several clinical traits. Future longitudinal studies are needed to further elucidate whether the observed associations could be causal.

Falls prevention and management in older adults is a critical global challenge. One of the key risk factors for falls is the use of certain medications. Therefore, to prevent medication-related falls, the following is recommended in the recent World Guidelines for Falls Prevention and Management: (1) assess for fall history and the risk of falls before prescribing potential fall-risk-increasing drugs (FRIDs), (2) use a validated, structured screening and assessment tool to identify FRIDs when performing a medication review, (3) include medication review and appropriate deprescribing of FRIDs as a part of the multifactorial falls prevention intervention, and (4) in long-term care residents, if multifactorial intervention cannot be conducted due to limited resources, the falls prevention strategy should still always include deprescribing of FRIDs.In the present statement paper, the working group on medication-related falls of the World Guidelines for Falls Prevention and Management, in collaboration with the European Geriatric Medicine Society (EuGMS) Task and Finish group on FRIDs, outlines its position on how to implement and execute these recommendations in clinical practice.Preferably, the medication review should be conducted as part of a comprehensive geriatric assessment to produce a personalized and patient-centered assessment. Furthermore, the major pitfall of the published intervention studies so far is the suboptimal implementation of medication review and deprescribing. For the future, it is important to focus on gaining which elements determine successful implementation and apply the concepts of implementation science to decrease the gap between research and practice.

Polypharmacy of additional psychotropics alongside the main treatment drug (antipsychotics in schizophrenia and antidepressants in major depressive disorder) is common in Japan. Our goal is to align psychotropic prescription in Japan with international standards, while reducing the differences between facilities. To achieve this goal, we aimed to compare prescriptions at the time of hospital admission and discharge.
Data on prescriptions at admission and discharge from 2016 to 2020 were collected. We divided the patients into four groups: (1) mono_mono group, monotherapy of the main drug at admission and discharge; (2) mono_poly group, monotherapy at admission and polypharmacy at discharge; (3) poly_poly group, polypharmacy at admission and discharge; and (4) poly_mono group, polypharmacy at admission and monotherapy at discharge. We compared the changes in dosage and number of psychotropics among the four groups.
For both schizophrenia and major depressive disorder, the patients who received monotherapy with the main drug at admission were likely to receive main drug monotherapy at discharge and vice versa. For schizophrenia, the polypharmacy was prescribed more often in the mono_poly group than that in the mono_mono group. The prescription was not changed at all for more than 10% of the patients.
It is critical to avoid a polypharmacy regimen to ensure that guideline-compliant treatment is provided. We expect higher rates of monotherapy with the main drug after the EGUIDE lectures.
The study protocol was registered in the University Hospital Medical Information Network Registry (UMIN000022645).

The aging of our societies leads to a higher prevalence of multimorbidity and therefore polypharmacy, which often results in inappropriate drug treatment. To address this issue, numerous listing approaches, such as the Fit fOR The Aged (FORTA) list have been developed. FORTA\'s positive impact on the quality of medications and relevant clinical outcomes has been shown. Based on new emerging evidence and experiences with the existing FORTA lists, we aimed to update the FORTA lists in several European countries/regions.
Two-step Delphi consensus procedures were conducted in Poland, UK/Ireland, Italy, Spain, the Nordic countries, The Netherlands and France. The existing European FORTA lists served as survey proposals.
Thirty-two experts agreed to take part in this study (return rate: 96.9%). The country/region-specific overall consensus for all items and participants after the first round was > 90%. FORTA lists from six participating countries, plus the FORTA list for the German-speaking countries, were collated into the new EURO-FORTA List, which now contains 267 items aligned to 27 indications. Three items were added to the EURO-FORTA List, and no drugs were deleted. Eight FORTA items were relabeled, and 96.9% of the labels remained unchanged.
In this study, seven new country/region specific FORTA lists, as well as a new overarching EURO-FORTA List, were developed. An overall increase in the mean consensus coefficient and increases for all disease-specific mean consensus coefficients show a wider consensus among participants. The new lists have the potential to improve drug therapy in older people internationally.