Abstract:
BACKGROUND:Limited data are available on the prevalence of inappropriate prescribing of renally cleared drugs in elderly patients in Australia. OBJECTIVES:To quantify and compare the extent of inappropriate prescribing (defined as at least one drug prescribed in an excessive dose or when contraindicated with respect to renal function) of renally cleared drugs in elderly patients across the community and aged care settings, and to determine factors associated with patients being prescribed one or more potentially inappropriate renally cleared drugs. METHODS:This retrospective study examined de-identified Home Medicines Review (HMR) and Residential Medication Management Review (RMMR) cases pertaining to 30,898 patients aged 65 years and over. Only 25 % (n = 7625) of these patients had documented information on their renal function. Among them, 4035 patients were prescribed at least one of the 31 renally cleared drugs examined in this study. For these patients, details including demographics, medications, medical conditions and pathology test results were extracted. Creatinine clearance was estimated using the Cockcroft-Gault formula, and the prevalence of inappropriate prescribing of the 31 drugs was examined on the basis of conformity with the recommendations in the Australian Medicines Handbook. Multivariate logistic regression was performed to determine the factors associated with patients being prescribed one or more potentially inappropriate renally cleared drugs. RESULTS:The mean (± standard deviation) ages of the HMR patients (n = 3315; 59 % female) and RMMR patients (n = 720; 68 % female) were 78.3 ± 7.2 and 86 ± 7.3 years, respectively. Over one quarter of the patients (n = 1135 out of 4035; 28.1 %) prescribed the renally cleared drugs examined in this study had evidence of inappropriate prescribing of at least one of the drugs, with respect to their renal function. The drugs/drug classes most commonly prescribed inappropriately were perindopril, fenofibrate, glibenclamide, gliptins, metformin, olmesartan, bisphosphonates and strontium. The factors independently associated with patients being prescribed one or more potentially inappropriate renally cleared drugs were advancing age [odds ratio (OR) 1.06 per year increase, 95 % confidence interval (CI) 1.05-1.07; P < 0.001], the total number of renally cleared drugs prescribed (OR 1.44 per unit increase, 95 % CI 1.29-1.61; P < 0.001), presence of diabetes (OR 1.51, 95 % CI 1.30-1.76; P < 0.001), presence of heart failure (OR 1.38, 95 % CI 1.13-1.69; P < 0.005) and living in aged care facilities (OR 1.28, 95 % CI 1.06-1.5; P < 0.05). CONCLUSION:Inappropriate prescribing of renally cleared drugs is common in older Australians. Intervention studies to improve prescribing of renally cleared drugs in the elderly appear to be warranted.
journal_name
Drugs Agingjournal_title
Drugs & agingauthors
Khanal A,Peterson GM,Castelino RL,Jose MDdoi
10.1007/s40266-015-0261-1subject
Has Abstractpub_date
2015-05-01 00:00:00pages
391-400issue
5eissn
1170-229Xissn
1179-1969journal_volume
32pub_type
杂志文章相关文献
DRUGS & AGING文献大全abstract:OBJECTIVE:Our objectives were to (1) describe the evolution of the underuse of anticoagulants in older people with atrial fibrillation (AF) and a CHADS2 score ≥ 2 since direct oral anticoagulants (DOACs) were introduced to the market and (2) describe factors associated with this underuse. METHODS:We conducted a retros...
journal_title:Drugs & aging
pub_type: 杂志文章
doi:10.1007/s40266-017-0493-3
更新日期:2017-11-01 00:00:00
abstract::Globally, the number of drug prescriptions is increasing causing more adverse drug events, which is now a significant cause of mortality, morbidity, and disability that has reached epidemic proportions. The risk of adverse drug events is correlated to very old age, multiple co-morbidities, dementia, frailty, and limit...
journal_title:Drugs & aging
pub_type: 杂志文章
doi:10.1007/s40266-018-0554-2
更新日期:2018-07-01 00:00:00
abstract::Nitric oxide (NO) is involved in important physiological functions of the CNS, including neurotransmission, memory and synaptic plasticity. Depending on the redox state of NO, it can act as a neurotoxin or it can have a neuroprotective action. Data suggest that NO may have a role in the pathogenesis of neurodegenerati...
journal_title:Drugs & aging
pub_type: 杂志文章,评审
doi:10.2165/00002512-199812040-00001
更新日期:1998-04-01 00:00:00
abstract::Streptococcus pneumoniae has been recognised as a major cause of pneumonia since the time of Sir William Osler. Drug-resistant S. pneumoniae (DRSP), which have gradually become resistant to penicillins as well as more recently developed macrolides and fluoroquinolones, have emerged as a consequence of indiscriminate u...
journal_title:Drugs & aging
pub_type: 杂志文章,评审
doi:10.2165/00002512-200421130-00003
更新日期:2004-01-01 00:00:00
abstract::The number of older patients is increasing globally. Combined with the growing number of ambulatory surgeries, many older patients will undergo ambulatory surgery in the future. The ambulatory setting offers many advantages: early mobilization, higher patient satisfaction, lower costs, and a low incidence of several c...
journal_title:Drugs & aging
pub_type: 杂志文章,评审
doi:10.1007/s40266-020-00803-9
更新日期:2020-12-01 00:00:00
abstract::CATT (Comparison of Age-related macular degeneration [AMD] Treatment Trials) examined the efficacy of ranibizumab and bevacizumab for the treatment of neovascular AMD. This prospective, randomized, but unblinded trial revealed a significant improvement in vision with both treatments in terms of visual acuity; importan...
journal_title:Drugs & aging
pub_type: 杂志文章
doi:10.2165/11594720-000000000-00000
更新日期:2011-11-01 00:00:00
abstract::The focus of this review is hormone replacement therapy (HRT) with continuous oral 17 beta-estradiol (herein referred to as estradiol) 2 mg/day plus sequential oral dydrogesterone 10 or 20 mg/day for 14 days of each 28-day cycle. According to data from nonblind trials, this regimen relieves climacteric symptoms, prese...
journal_title:Drugs & aging
pub_type: 杂志文章,评审
doi:10.2165/00002512-199711040-00006
更新日期:1997-10-01 00:00:00
abstract::Parkinson's disease (PD) is the second most common neurodegenerative disorder affecting 1 to 3% of individuals over the age of 65 years. While effective therapy exists for treating the bradykinesia, rigidity and tremor associated with the disease, the cause is unknown. There is no treatment available to prevent or slo...
journal_title:Drugs & aging
pub_type: 杂志文章,评审
doi:10.2165/00002512-200118110-00001
更新日期:2001-01-01 00:00:00
abstract::Amitriptyline is a tricyclic antidepressant agent which also has analgesic properties. Whether its analgesic effects are linked to its mood-altering activity or attributable to a discrete pharmacological action (or a combination of both) is unknown. Clinical trials demonstrate that oral amitriptyline achieves at least...
journal_title:Drugs & aging
pub_type: 杂志文章,评审
doi:10.2165/00002512-199608060-00008
更新日期:1996-06-01 00:00:00
abstract::Dopamine agonists (DAs) are frequently used in the management of Parkinson's disease (PD), a complex multisystem disorder influenced substantially by age-related factors. Over 80% of PD patients present after age 60 years and may have clinical features exacerbated by age-related comorbidities or decline in physiologic...
journal_title:Drugs & aging
pub_type: 杂志文章
doi:10.1007/s40266-018-0629-0
更新日期:2019-03-01 00:00:00
abstract:BACKGROUND AND OBJECTIVE:The practice of hiding medicines in nursing home patients' food or beverages is described in only a few scientific papers. An earlier study conducted in 1999/2000 showed that covert medication was common in Norwegian nursing homes, with 11% of patients in regular nursing home units (RUs) and 17...
journal_title:Drugs & aging
pub_type: 杂志文章
doi:10.2165/00002512-200926040-00004
更新日期:2009-01-01 00:00:00
abstract::The elderly population has much to gain from the advances of molecular medicine, although at present genetic pharmacology remains mostly at the conceptual level. Cancer, in particular, is an increasing health burden and the majority (over 70%) of gene therapy trials are aimed at tackling this problem. Available strate...
journal_title:Drugs & aging
pub_type: 杂志文章,评审
doi:10.2165/00002512-200017020-00004
更新日期:2000-08-01 00:00:00
abstract:OBJECTIVE:There is poor evidence supporting the use of any pharmacologic treatments for neuropsychiatric disorders following traumatic brain injury (TBI), especially among older adults. Informed by our recent characterization of psychotropic medication use among Medicare beneficiaries with TBI, the objective of this st...
journal_title:Drugs & aging
pub_type: 杂志文章
doi:10.1007/s40266-018-0570-2
更新日期:2018-08-01 00:00:00
abstract:BACKGROUND:Since 1998, a prospective payment system (PPS) for Medicare services provided by nursing homes in the US has been in operation. Concerns have been expressed that the PPS may affect the quality of care delivered to residents. This study evaluates the impact of the PPS on pharmacological secondary ischaemic st...
journal_title:Drugs & aging
pub_type: 杂志文章
doi:10.2165/00002512-200623010-00006
更新日期:2006-01-01 00:00:00
abstract::Alzheimer's disease is the most common major neurocognitive disorder with substantial social and economic impacts. This article is an update on current pharmacotherapy, advancements in biomarker use, and drugs in the pipeline for this disease. To date, no new drug has qualified to be added to the current therapeutic a...
journal_title:Drugs & aging
pub_type: 杂志文章,评审
doi:10.1007/s40266-017-0499-x
更新日期:2017-11-01 00:00:00
abstract:BACKGROUND AND OBJECTIVE:Osteoarthritis (OA) is a highly prevalent and chronic condition characterized by pain and physical disability. Currently, many treatments are available, and they primarily target pain relief. The objectives of this study were to systematically review economic evaluations for pharmaceutical mana...
journal_title:Drugs & aging
pub_type: 杂志文章,评审
doi:10.1007/s40266-013-0062-3
更新日期:2013-05-01 00:00:00
abstract::Although the frequency of physician consultations and the sale of over-the-counter remedies establish the high prevalence of acute cough in the elderly, epidemiological studies have tended to be imprecise. However, respiratory tract infections in nose, larynx and/or bronchi, either viral or bacterial or both, are by f...
journal_title:Drugs & aging
pub_type: 杂志文章,评审
doi:10.2165/00002512-200421040-00003
更新日期:2004-01-01 00:00:00
abstract::Problems associated with aging will become one of the leading health dilemmas of the next century. Age-associated diseases, including those affecting the neuronal system, are increasing in frequency. Age-related deficiencies in the brain result in impaired motor functions, sleep, behaviour and cognitive functions. Goo...
journal_title:Drugs & aging
pub_type: 杂志文章,评审
doi:10.2165/00002512-199405050-00006
更新日期:1994-11-01 00:00:00
abstract:BACKGROUND:Treatment of postherpetic neuralgia (PHN) is more complicated in elderly patients, and multiple daily dosing, complex titration, and high incidences of adverse events can be limiting for many pharmacological treatment options. OBJECTIVE:The aim of this study was to determine whether the efficacy and tolerab...
journal_title:Drugs & aging
pub_type: 杂志文章
doi:10.1007/s40266-013-0126-4
更新日期:2013-12-01 00:00:00
abstract::Cerebral deposition of amyloid plaques containing amyloid beta-peptide (Abeta) has traditionally been considered the central feature of Alzheimer's disease (AD). Abeta is derived from amyloid precursor protein (APP), which is cleaved by several different proteases: alpha-, beta- and gamma-secretase. In the past decade...
journal_title:Drugs & aging
pub_type: 杂志文章,评审
doi:10.2165/00002512-200522001-00003
更新日期:2005-01-01 00:00:00
abstract::Periods of intense hormonal fluctuations have been associated with heightened prevalence and exacerbation of underlying psychiatric illness, particularly the occurrence of premenstrual dysphoria, puerperal depression and depressive symptoms during perimenopause. It has been speculated that sex steroids such as estroge...
journal_title:Drugs & aging
pub_type: 杂志文章,评审
doi:10.2165/00002512-200320020-00001
更新日期:2003-01-01 00:00:00
abstract::Aging per se is associated with abnormalities of the vascular wall linked to both structural and functional changes that can take place at the level of the extracellular matrix, the vascular smooth muscle and the endothelium of blood vessels. Endothelial dysfunction is generally defined as a decrease in the capacity o...
journal_title:Drugs & aging
pub_type: 杂志文章,评审
doi:10.2165/00002512-200320070-00005
更新日期:2003-01-01 00:00:00
abstract:BACKGROUND:The impact of multiple medication exposure on health outcomes among older patients with end-stage kidney disease (ESKD) is unknown. OBJECTIVE:The objective of this study was to identify the impact of medicine exposure on hospitalisation rates and mortality in a prospective longitudinal observational study o...
journal_title:Drugs & aging
pub_type: 杂志文章
doi:10.1007/s40266-018-0582-y
更新日期:2018-11-01 00:00:00
abstract:BACKGROUND:Use of combination pharmacotherapy, including angiotensin-converting enzyme (ACE) inhibitors, angiotensin II type 1 receptor antagonists (angiotensin receptor blockers) and β-adrenoceptor antagonists (β-blockers) in the management of heart failure (HF) can reduce mortality, prevent functional decline and red...
journal_title:Drugs & aging
pub_type: 杂志文章
doi:10.2165/11592420-000000000-00000
更新日期:2011-07-01 00:00:00
abstract::Patients with chronic kidney disease (CKD) are generally affected by secondary hyperparathyroidism (SHPT). High phosphate, low calcium and vitamin D deficiency represent the classical 'triad' involved into the pathogenesis of SHPT in renal insufficiency, in which downregulation of the parathyroid vitamin D receptor an...
journal_title:Drugs & aging
pub_type: 杂志文章,评审
doi:10.2165/00002512-200926060-00002
更新日期:2009-01-01 00:00:00
abstract::This paper reviews the burden and economic consequences of glaucoma upon healthcare systems and patients, especially elderly patients. An extensive review of the literature was conducted, primarily using MEDLINE, but also by examining selected article reference lists, relevant websites and the proceedings of specialis...
journal_title:Drugs & aging
pub_type: 杂志文章,评审
doi:10.2165/00002512-200522040-00004
更新日期:2005-01-01 00:00:00
abstract::Although often less recognized than motor symptoms, non-motor effects represent an important source of disability for many parkinsonian patients. Of these non-motor symptoms, sialorrhoea, defined as the inability to control oral secretions resulting in excessive saliva accumulation in the oropharynx, constitutes perha...
journal_title:Drugs & aging
pub_type: 杂志文章,评审
doi:10.2165/0002512-200825120-00003
更新日期:2008-01-01 00:00:00
abstract::The consumption of medications with anticholinergic activity has been suggested to result in the adverse effects of mental confusion, visual disturbance, and muscle weakness, which may lead to falls. Existing published evidence linking anticholinergic drugs with falls, however, remains weak. This study was conducted t...
journal_title:Drugs & aging
pub_type: 杂志文章
doi:10.1007/s40266-019-00731-3
更新日期:2020-02-01 00:00:00
abstract::Cardiovascular disease has been inseparable from aging in developed societies and, as a result, it is the commonest cause of mortality in elderly populations. Atherosclerosis is associated with the progressive vascular accumulation of cholesterol-laden lipoproteins, and is linearly associated with the plasma level of ...
journal_title:Drugs & aging
pub_type: 杂志文章,评审
doi:10.2165/00002512-199710060-00005
更新日期:1997-06-01 00:00:00
abstract::In contrast with women, who experience a complete and abrupt cessation of ovarian function during the menopause, aging men largely maintain their testicular androgen production. Nevertheless, most cross-sectional studies indicate that there is a partial decrease in testosterone levels with aging, although this has not...
journal_title:Drugs & aging
pub_type: 杂志文章,评审
doi:10.2165/00002512-199711010-00005
更新日期:1997-07-01 00:00:00