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Introduction Older patients with multimorbidity usually present with progressively worse impairment, resulting in a limited life prognosis. Consequently, drug therapy, which was previously appropriate can become inappropriate and be associated with negative health outcomes. The main objective is to identify inappropriate prescriptions in older patients and to optimize them according to patient directed care goals, established through the application of the patient-centered prescription model, which is based on a shared decision-making process including the patient, physicians and a clinical pharmacist. Methods This was a prospective observational study of patients admitted to an Acute Care Elderly Unit. Comprehensive Geriatric Assessment was applied to each patient in order to identify advanced frailty as an indicator of an end of life situation. In order to identify inappropriate prescriptions, each patient's pharmacotherapeutic plan was assessed by applying the Patient-Centered Prescription Model, a three-step process: (i) patient centered assessment, where care goals were established, setting the stage for the second and third steps; (ii) diagnosis-centered assessment; (iii) medication-centered assessment. Results Three hundred and nine patients (mean age 86.7 years) were included. Inappropriate prescribing occurred in 39.8% of patients, more frequently amongst end-of-life patients (47.2%) ( P < 0.05). During admission, 93.4% of patients with inappropriate prescriptions received an optimized therapeutic plan. Conclusions A high prevalence of inappropriate prescriptions among patients with multimorbidity was detected, especially in patients at end of life. The patient-centered prescription model helps to identify frail patients on potentially inappropriate prescriptions by means of a holistic review of each patient's situation, in a shared decision-making process. [ABSTRACT FROM AUTHOR]

Abstract: Background: Advanced dementia is a prevalent health problem in geriatric patients. These patients usually suffer from several chronic diseases, frequently leading to an end-of-life situation lasting months or years, generating complex and often inappropriate medication regimens. Objectives: Describe the re-orientation of drug therapy in patients with advanced dementia utilizing a systematic medication review process. Methods: This non-experimental pre-post analysis included all patients with advanced dementia admitted to acute geriatric unit (AGU) over one year. Medications were reviewed by a multidisciplinary team and together with the patient caregivers; new therapeutic objectives based on end-of-life care principles were established. Medications were classified as preventive, therapeutic, or symptomatic. The average number of medications per patient pre- and post-admission was compared. Results: We included 73 patients (mean age 86.1years, mean Barthel Index: 14.5/100). At admission, patients had a mean of 7.27 drugs compared to 4.82 at discharge (66.85% reduction, P <0.05). The main drugs withdrawn were cardiovascular and hematological (35.76%). Drugs for prevention decreased by 66.85% (from 1.8 to 0.6, P <0.05) and those for symptomatic care decreased by 17,52% (from 2.34 to 1.93, P <0.05). Conclusion: Medication therapy plans in patients with advanced dementia often do not meet their therapeutic goals. The proposed methodology is a useful tool to assess therapeutic appropriateness. [Copyright &y& Elsevier]