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1. Prevalence of medication-induced delirium in older people admitted to intensive critical unit: a systematic review

Author

Bruno DA SILVA, Ivis MARTINS, Beatriz HATA, Marcia DOS SANTOS, Priscila PACKEISER, Marilia CAMPOS, João Paulo RODRIGUES, Maria Teresa HERDEIRO, Fátima ROQUE, Helaine CAPUCHO, Maria Olívia ZANETTI, Júlia RASO, Nereida LIMA, Leonardo Regis PEREIRA, and Fabiana VARALLO

Subjects
Public aspects of medicine, RA1-1270, Pharmacy and materia medica, RS1-441, Therapeutics. Pharmacology, RM1-950
Abstract

Objective: to estimate the prevalence of medication-induced delirium and drug-related problems (DRP) in older people hospitalized in intensive care unit (ICU). Methods: A systematic review were conducted in PubMed, EMBASE, LILACS, Ageline, Web of Science, and Cochrane databases (until March 2023). Clinical trials and observational studies that investigated the contribution of medication in the occurrence of delirium and compared with critically ill older patients (aged≥65 years old) without the syndrome were included. We excluded emergency departments, medical wards, primary and secondary healthcare levels, patients with delirium tremens; metabolic encephalopathy; dementia; palliative care; and brain metastasis. The references were entered into Rayyan QCRI. Two pairs of reviewers selected the articles, extracted data, and assessed the risk of bias (ROBINS-I). Results: Of 12,492 studies retrieved, after de-duplication exclusion (n=6,025), title/abstract (n=6,467) and full reading (n=286), two met the inclusion criteria. Both were observational (cohort), developed in high-income countries, with high level of risk of bias (overall). The frequency of delirium and subsyndromal delirium was 15.8% to 33.9%. Independent risk factors were the exposure of opioids and use of corticosteroids. Delirium increased the length of hospital stay in ICU, and the mechanical ventilation. Conclusion: Further studies are necessary to understand the DRP and characteristics of pharmacotherapy associated with delirium in critically ill older people. Adverse drug reactions and deliriogenic load seem to contribute to the occurrence of syndrome.

Published
2024
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2. Assessment of Potentially Inappropriate Medications Using the EU (7)-PIM List, in a Sample of Portuguese Older Adults’ Residents in Nursing Homes

Author

Ana Isabel Plácido, Ana Aguiar, María Piñeiro-Lamas, Fabiana Varallo, Adolfo Figueiras, Maria Teresa Herdeiro, and Fátima Roque

Subjects
Risk Management and Healthcare Policy, medication profile, prescription, Health Policy, Public Health, Environmental and Occupational Health, institutionalized older adults, elderly
Abstract

Ana Isabel Plácido,1 Ana Aguiar,1 María Piñeiro-Lamas,2,3 Fabiana Varallo,4 Adolfo Figueiras,2,3,5 Maria Teresa Herdeiro,6 Fátima Roque1,7 1Research Unit for Inland Development, Polytechnic of Guarda (UDI-IPG), Guarda, Portugal; 2Consortium for Biomedical Research in Epidemiology and Public Health (CIBER en Epidemiología y Salud Pública-CIBERESP), Madrid, Spain; 3Institute of Health Research of Santiago de Compostela (IDIS), Santiago de Compostela, Spain; 4Department of Pharmaceutical Sciences, School of Pharmaceutical Sciences of Ribeirão Preto, University of São Paulo, Ribeirão Preto, São Paulo, Brazil; 5Department of Preventive Medicine and Public Health, Faculty of Medicine, University of Santiago de Compostela, Santiago de Compostela, Spain; 6Institute of Biomedicine (iBiMED-UA), Department of Medical Sciences, University of Aveiro, Aveiro, 3810-193, Portugal; 7Health Sciences Research Centre, University of Beira Interior (CICS-UBI) Covilhã, Covilhã, PortugalCorrespondence: Fátima Roque, Research Unit for Inland Development, Polytechnic of Guarda (UDI-IPG), Avenida Dr. Francisco Sá Carneiro, no. 50, Guarda, 6300-559, Portugal, Tel +35 1-271205220, Email froque@ipg.ptAbstract: Prescription of potentially inappropriate medication (PIM) in older adults is associated with poor clinical outcomes. The EU (7)-PIM list was created for the European market to improve pharmacotherapy in older adults.Purpose: This work aims to characterize the medication profile and assess the presence of PIM, using the EU (7)-PIM list in older adults’ residents at nursing homes.Methods: Retrospective data were collected from the anonymized nursing home records. After PIM identification, a descriptive analysis was performed, and a generalized linear model for dependent negative binomial-type variables was constructed to assess the risk of PIM.Results: Of the 210 participants (mean age 85.10), 82.40% were polymedicated. PIM was observed in 86.4% participants (mean per patient = 2.30± 0.10). The most common PIM were proton pump inhibitors (n = 121, 57.62%), followed by anxiolytics (n = 96, 45.71%). 64.30% of all patients take 2– 4 PIM and 5.80% take five or more PIM. The occurrence of PIM is influenced by the number of prescribed medicines (RR 1.14; 95% CI 1.1.-1.17) and the presence of digestive system diseases (RR 1.05; 95% CI 1.0– 1.09).Conclusion: The high prevalence of PIM observations highlights the necessity of the implementation of guidelines to prevent PIM.Keywords: elderly, institutionalized older adults, medication profile, prescription

Published
2022

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