Abstract:
:Psychotropic medications have a high risk of serious adverse events and small effect size for changed behaviours for people with dementia. Non-pharmacological approaches are recommended as first-line treatment for changed behaviours, yet psychotropic medications remain highly prevalent in long-term aged care settings. This narrative review describes the current evidence regarding deprescribing psychotropic medications for people with dementia in long-term care. Deprescribing psychotropic medications can be achieved without harm to the person with dementia, and most people experience no withdrawal symptoms. Interventions to deprescribe psychotropic medications should be multifactorial, including lowering the dose of the medication over time, educational interventions and psychological support. However, implementing this is a significant challenge due to the overreliance on psychotropic medications for behavioural management in long-term aged care. Facilitators to deprescribing psychotropic medications in long-term care include multidisciplinary teams with adequate training, education and managerial support, engaging residents and families and change 'champions'. Deprescribing practices should be person-centred, and an individualised deprescribing protocol should be in place, followed by careful monitoring of the individual. The person with dementia and their family, general practitioner, pharmacist, and allied health and direct care staff should all be involved throughout the deprescribing process. Direct care staff need adequate support, education and training, so they can effectively help the individual and implement person-centred approaches in the absence of psychotropic medications. Effective communication between residents and staff and amongst staff is consistently shown to be an important factor for deciding whether deprescribing of a medication should occur and the successful implementation of deprescribing psychotropic medications.
journal_name
Drugs Agingjournal_title
Drugs & agingauthors
Harrison SL,Cations M,Jessop T,Hilmer SN,Sawan M,Brodaty Hdoi
10.1007/s40266-018-0623-6subject
Has Abstractpub_date
2019-02-01 00:00:00pages
125-136issue
2eissn
1170-229Xissn
1179-1969pii
10.1007/s40266-018-0623-6journal_volume
36pub_type
杂志文章,评审相关文献
DRUGS & AGING文献大全abstract:BACKGROUND:Clinical validation studies of the Healthcare Effectiveness Data and Information Set (HEDIS®) measures of inappropriate prescribing in the elderly are limited. OBJECTIVES:The objective of this study was to examine associations of new exposure to high-risk medication in the elderly (HRME) and drug-disease in...
journal_title:Drugs & aging
pub_type: 杂志文章
doi:10.1007/s40266-013-0086-8
更新日期:2013-08-01 00:00:00
abstract:BACKGROUND:Previous studies have investigated the prevalence of drug-drug interactions (DDIs) among the elderly in different care settings, but data describing the frequency and management of DDIs among acute geriatric patients appear to be absent. OBJECTIVE:The aim of this study was to investigate the severity and in...
journal_title:Drugs & aging
pub_type: 杂志文章
doi:10.1007/s40266-013-0091-y
更新日期:2013-09-01 00:00:00
abstract:BACKGROUND:Older people are exposed to multiple medicines that possess anticholinergic properties. The use of anticholinergic medicines is associated with the risk of morbidity, mortality and cognitive decline, particularly in older people. Anticholinergic exposure can be measured using tools such as the Drug Burden In...
journal_title:Drugs & aging
pub_type: 杂志文章
doi:10.1007/s40266-013-0111-y
更新日期:2013-11-01 00:00:00
abstract:BACKGROUND:Pharmacotherapy with statins (HMG-CoA reductase inhibitors) is the cornerstone for lipid management in individuals with or at risk of developing cardiovascular diseases. Although the clinical benefits of statins are established for both women and men, there is evidence of a gender difference in their use. Th...
journal_title:Drugs & aging
pub_type: 杂志文章
doi:10.1007/s40266-012-0032-1
更新日期:2012-12-01 00:00:00
abstract::Primary hyperparathyroidism is a common metabolic bone disease and currently presents a significant management dilemma. Most of the patients have few relevant symptoms and surgical parathyroidectomy offers the prospect of cure with freedom from the risk of long-term complications or the need for a follow-up. However, ...
journal_title:Drugs & aging
pub_type: 杂志文章,评审
doi:10.2165/00002512-200421150-00004
更新日期:2004-01-01 00:00:00
abstract::Mild hypertension (grade 1 or stage 1 hypertension) is defined as a systolic blood pressure of 140-159 mm Hg or a diastolic pressure of 90-99 mm Hg. According to current guidelines, patients with mild hypertension can be at low, medium, high or very high risk depending on the presence of other risk factors, target org...
journal_title:Drugs & aging
pub_type: 杂志文章,评审
doi:10.2165/00002512-200421010-00001
更新日期:2004-01-01 00:00:00
abstract:BACKGROUND:Age-related changes in the concentration-effect relationship of (+)-O-desmethyl-tramadol [(+)-ODM], tramadol's active metabolite, are not documented in the elderly. OBJECTIVE:The objective of this study was to characterize, in elderly and young subjects, the (+)-ODM pharmacokinetic and pharmacodynamic relat...
journal_title:Drugs & aging
pub_type: 杂志文章,随机对照试验
doi:10.1007/s40266-019-00681-w
更新日期:2019-08-01 00:00:00
abstract::In general, the pharmacological treatment of non-psychotic major depressive disorder in old age is only partially successful, with only approximately 50% of older depressed adults improving with initial antidepressant monotherapy. Many factors may predict a more difficult-to-treat depression, including coexisting anxi...
journal_title:Drugs & aging
pub_type: 杂志文章,评审
doi:10.2165/00002512-200724100-00002
更新日期:2007-01-01 00:00:00
abstract:BACKGROUND AND OBJECTIVE:Multiple drug use is common among old, frail nursing home residents who are, as a consequence, susceptible to adverse effects and drug interactions. This study uses the updated Beers criteria for potentially inappropriate drug (PID) use in older adults to determine the extent and nature of PIDs...
journal_title:Drugs & aging
pub_type: 杂志文章
doi:10.2165/00002512-200825080-00005
更新日期:2008-01-01 00:00:00
abstract::Chronic non-terminal diseases, including postmenopausal osteoporosis, are associated with poor treatment compliance and persistence. The longer a patient with osteoporosis complies and persists with treatment, the lower the risk of fracture. Retrospective studies with emphasis on real-world data have led to a greater ...
journal_title:Drugs & aging
pub_type: 杂志文章
doi:10.2165/11586880-000000000-00000
更新日期:2011-04-01 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::The number of older adults with diabetes is rapidly increasing worldwide. A variety of factors contribute to the age-related increase in the incidence of diabetes. The lack of empiric evidence in the field has limited the management guidelines to mostly expert opinion. Given uncertainty over the rate at which to lower...
journal_title:Drugs & aging
pub_type: 杂志文章,评审
doi:10.1007/s40266-018-0598-3
更新日期:2018-12-01 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::Pharmacological treatment of depression in old age is associated with an increased risk of adverse pharmacokinetic and pharmacodynamic drug interactions. Elderly patients may have multiple disease states and, therefore, may require a variety of other drugs. In addition to polypharmacy, other factors such as age-relate...
journal_title:Drugs & aging
pub_type: 杂志文章,评审
doi:10.2165/00002512-200219040-00004
更新日期:2002-01-01 00:00:00
abstract::NSAIDs are a widely used class of analgesic and anti-inflammatory drugs that act by inhibiting the cyclo-oxygenase (COX) enzyme. However, because of their nonspecificity of action, use of these agents as long-term therapy for chronic pain in diseases such as rheumatoid arthritis (RA) and osteoarthritis (OA) is often d...
journal_title:Drugs & aging
pub_type: 杂志文章,评审
doi:10.2165/00002512-200724060-00001
更新日期:2007-01-01 00:00:00
abstract:OBJECTIVE:To assess, by smoothness index (SI), distribution of the antihypertensive effect of extended-release (ER) felodipine over 24 hours in elderly patients with hypertension. METHODS:After a 4-week washout phase, 35 elderly patients (mean age 69 +/- 4 years) with mild-to-moderate hypertension received 2 weeks' tr...
journal_title:Drugs & aging
pub_type: 临床试验,杂志文章,多中心研究,随机对照试验
doi:10.2165/00002512-200219070-00007
更新日期:2002-01-01 00:00:00
abstract::Urothelial carcinoma, or bladder cancer, is a malignancy that most commonly affects older patients. The median age at diagnosis is 73 years, and care of these patients requires consideration not just of the disease-related factors such as stage and histology, but also of patient-related factors. Many of these patients...
journal_title:Drugs & aging
pub_type: 杂志文章,评审
doi:10.1007/s40266-018-0540-8
更新日期:2018-05-01 00:00:00
abstract::Man and higher primates have adrenals that secrete large amounts of dehydroepiandrosterone (DHEA) [prasterone] and its sulphate (DHEAS) [PB 008]. A remarkable feature of plasma DHEAS levels in humans is their great decrease with aging. Researchers have postulated that this age-related decline of DHEAS levels may expla...
journal_title:Drugs & aging
pub_type: 杂志文章,评审
doi:10.2165/00002512-200320130-00001
更新日期:2003-01-01 00:00:00
abstract::While hormonal therapy has been the usual and appropriate treatment of advanced or metastatic prostatic cancer for the past 50 years, the recent development of new therapeutic agents as medical alternatives to orchidectomy has drastically altered the options and perspectives in the treatment of this disease. Estrogens...
journal_title:Drugs & aging
pub_type: 杂志文章,评审
doi:10.2165/00002512-199101050-00003
更新日期:1991-09-01 00:00:00
abstract::A low bone mineral density (BMD) is presently regarded as the most important risk factor for the development of osteoporosis. BMD is a function of peak bone mass attained during growth and subsequent age-related bone loss. BMD can be measured accurately and precisely, although the rate of bone loss is more difficult t...
journal_title:Drugs & aging
pub_type: 杂志文章,评审
doi:10.2165/00002512-199812001-00001
更新日期:1998-01-01 00:00:00
abstract::Skin and soft tissue infections are quite common in elderly people. A number of special conditions and circumstances need to be considered in the diagnosis and therapy. It is important to try to establish the causative organism, exclude other cutaneous disorders and identify precipitating factors. Treatment modalities...
journal_title:Drugs & aging
pub_type: 杂志文章,评审
doi:10.2165/00002512-200219050-00002
更新日期:2002-01-01 00:00:00
abstract::Despite advances in antimicrobial chemotherapy over recent decades, morbidity and mortality secondary to infection continues to rise. In addition, the incidence of infection caused by resistant organisms has also increased. Concurrently, the elderly are living longer than prior generations, often with disabling chroni...
journal_title:Drugs & aging
pub_type: 杂志文章,评审
doi:10.2165/00002512-199813060-00004
更新日期:1998-12-01 00:00:00
abstract::Psoriatic arthritis (PsA) can start in subjects aged over 60 years, defined as late-onset PsA. In late-onset PsA, the weight of family history and genetic background appears less significant when compared with younger onset PsA, whereas obesity and smoking have been suggested as potential risk factors. In patients wit...
journal_title:Drugs & aging
pub_type: 杂志文章,评审
doi:10.1007/s40266-019-00688-3
更新日期:2019-10-01 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::Asthma is a common airway disease found in people of all ages, although most studies of asthma therapies are focused on adolescent and young adults. Little information exists on the use of asthma therapeutics in the older patient (>65 years of age). The newest therapeutic class to be released in the US for the treatme...
journal_title:Drugs & aging
pub_type: 杂志文章,评审
doi:10.2165/00002512-200623060-00002
更新日期:2006-01-01 00:00:00
abstract::Attempts to control pneumococcal infection by vaccination, undertaken initially in 1911, have gone through 3 phases during the subsequent 8 decades. Initially, vaccines of killed pneumococcal cells prepared in a variety of ways were used in epidemic settings with inconclusive results, although administered to approxim...
journal_title:Drugs & aging
pub_type: 历史文章,杂志文章
doi:10.2165/00002512-199915001-00001
更新日期:1999-01-01 00:00:00
abstract:BACKGROUND AND OBJECTIVE:Inappropriate prescribing is an important and possibly preventable risk factor for adverse drug reactions (ADRs) in the elderly, and hospital-based studies have shown that a large proportion of admissions is a result of ADRs. However, little is known about how inappropriate drug use (IDU) affec...
journal_title:Drugs & aging
pub_type: 杂志文章
doi:10.2165/00002512-200522010-00005
更新日期:2005-01-01 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::Influenza infection is an acute respiratory disease with a high morbidity and significant mortality, particularly among the elderly and individuals with chronic diseases. The majority of countries now recommend annual influenza vaccination for all people aged 65 years or older, and for those with high risk conditions....
journal_title:Drugs & aging
pub_type: 杂志文章,评审
doi:10.2165/00002512-199915030-00001
更新日期:1999-09-01 00:00:00
abstract::Intracavernous alprostadil (synthetic prostaglandin E1) is a vasodilating agent which acts by relaxing the smooth muscles of the corpus cavernosum and by increasing the diameter of cavernous arteries; this leads to erection. Following intracavernous administration, alprostadil is either locally metabolised or rapidly ...
journal_title:Drugs & aging
pub_type: 杂志文章,评审
doi:10.2165/00002512-199608010-00009
更新日期:1996-01-01 00:00:00