Prevention of adverse drug reactions in hospitalized older patients with multi-morbidity and polypharmacy: the SENATOR* randomized controlled clinical trial.

Abstract:

BACKGROUND:Multi-morbidity and polypharmacy increase the risk of non-trivial adverse drug reactions (ADRs) in older people during hospitalization. Despite this, there are no established interventions for hospital-acquired ADR prevention. METHODS:We undertook a pragmatic, multi-national, parallel arm prospective randomized open-label, blinded endpoint (PROBE) controlled trial enrolling patients at six European medical centres. We randomized 1,537 older medical and surgical patients with multi-morbidity and polypharmacy on admission in a 1:1 ratio to SENATOR software-guided medication optimization plus standard care (intervention, n = 772, mean number of daily medications = 9.34) or standard care alone (control, n = 765, mean number of daily medications = 9.23) using block randomization stratified by site and admission type. Attending clinicians in the intervention arm received SENATOR-generated advice at a single time point with recommendations they could choose to adopt or not. The primary endpoint was occurrence of probable or certain ADRs within 14 days of randomization. Secondary endpoints were primary endpoint derivatives; tertiary endpoints included all-cause mortality, re-hospitalization, composite healthcare utilization and health-related quality of life. RESULTS:For the primary endpoint, there was no difference between the intervention and control groups (24.5 vs. 24.8%; OR 0.98; 95% CI 0.77-1.24; P = 0.88). Similarly, with secondary and tertiary endpoints, there were no significant differences. Among attending clinicians in the intervention group, implementation of SENATOR software-generated medication advice points was poor (~15%). CONCLUSIONS:In this trial, uptake of software-generated medication advice to minimize ADRs was poor and did not reduce ADR incidence during index hospitalization.

journal_name

Age Ageing

journal_title

Age and ageing

authors

O'Mahony D,Gudmundsson A,Soiza RL,Petrovic M,Jose Cruz-Jentoft A,Cherubini A,Fordham R,Byrne S,Dahly D,Gallagher P,Lavan A,Curtin D,Dalton K,Cullinan S,Flanagan E,Shiely F,Samuelsson O,Sverrisdottir A,Subbarayan S,V

doi

10.1093/ageing/afaa072

subject

Has Abstract

pub_date

2020-07-01 00:00:00

pages

605-614

issue

4

eissn

0002-0729

issn

1468-2834

pii

5827768

journal_volume

49

pub_type

杂志文章
  • The combination of bedside swallowing assessment and oxygen saturation monitoring of swallowing in acute stroke: a safe and humane screening tool.

    abstract:BACKGROUND:dysphagia is common in acute stroke. Accurate detection of the presence or absence of aspiration by bedside swallowing assessment is difficult without objective methods, tending to over-diagnose aspiration. As a result, some patients suffer restricted oral intake unnecessarily. OBJECTIVE:we examined the pre...

    journal_title:Age and ageing

    pub_type: 杂志文章

    doi:10.1093/ageing/29.6.495

    authors: Smith HA,Lee SH,O'Neill PA,Connolly MJ

    更新日期:2000-11-01 00:00:00

  • A study of religious attitudes of the elderly.

    abstract::A study is reported of the religious beliefs, attitudes, and practice of old people in the West of Scotland, based on a questionnaire given to 501 people aged 65 years and over randomly selected from those living at home. Almost all had had a full range of religious instruction, and regarded their parents as religious...

    journal_title:Age and ageing

    pub_type: 杂志文章

    doi:10.1093/ageing/7.1.40

    authors: Reid WS,Gilmore AJ,Andrews GR,Caird FI

    更新日期:1978-02-01 00:00:00

  • Advanced care planning in care homes for older people: a qualitative study of the views of care staff and families.

    abstract:OBJECTIVE:to explore views on advance care planning in care homes for older people. DESIGN:qualitative exploration of views from care home staff and the family of residents in care homes for older people. SETTING:all care homes for the elderly in two London Boroughs. PARTICIPANTS:staff (care managers, nurses and car...

    journal_title:Age and ageing

    pub_type: 杂志文章

    doi:10.1093/ageing/afr006

    authors: Stewart F,Goddard C,Schiff R,Hall S

    更新日期:2011-05-01 00:00:00

  • Analysis of the diminished skin perfusion in elderly people by laser Doppler flowmetry.

    abstract::Clinical observations suggest an age-associated decline in skin perfusion but there are few quantitative in vivo data on skin perfusion at various ages. We studied skin perfusion of the dorsum of the foot by determining the capillary blood flow velocity (CBFV) expressed in millivolts (mV), using laser Doppler flowmetr...

    journal_title:Age and ageing

    pub_type: 杂志文章

    doi:10.1093/ageing/21.4.237

    authors: Weiss M,Milman B,Rosen B,Eisenstein Z,Zimlichman R

    更新日期:1992-07-01 00:00:00

  • New horizons in care home medicine.

    abstract::Care home medicine has been an under-researched area, but over the last decade there has been a substantial growth in publications. Most of these have focused on the 'geriatric giants' of falls, incontinence and mental health issues (especially dementia, behavioural disturbance and depression) as well as other key top...

    journal_title:Age and ageing

    pub_type: 杂志文章

    doi:10.1093/ageing/aft186

    authors: Burns E,Nair S

    更新日期:2014-01-01 00:00:00

  • Intensive care-management at home: an alternative to institutional care?

    abstract:BACKGROUND:Care management and assessment of need are the cornerstones of the community care reforms in the UK. Although much of the research base has been on highly vulnerable older people, in practice, care management has been implemented for a wider group. OBJECTIVE:To examine how intensive care-management at home ...

    journal_title:Age and ageing

    pub_type: 杂志文章

    doi:10.1093/ageing/30.5.409

    authors: Challis D,Darton R,Hughes J,Stewart K,Weiner K

    更新日期:2001-09-01 00:00:00

  • Oxybutynin chloride for geriatric urinary dysfunction: a double-blind placebo-controlled study.

    abstract::Twenty-four incontinent elderly institutionalized subjects with detrusor instability participated in a double-blind placebo-controlled trial of oxybutynin chloride. Patients were randomly assigned to oral oxybutynin 5 mg or placebo twice daily. Administration continued for 8 days; a 6-day washout period was followed b...

    journal_title:Age and ageing

    pub_type: 临床试验,杂志文章,随机对照试验,评审

    doi:10.1093/ageing/18.3.195

    authors: Zorzitto ML,Holliday PJ,Jewett MA,Herschorn S,Fernie GR

    更新日期:1989-05-01 00:00:00

  • Absence of ageism in access to critical care: a cross-sectional study.

    abstract:BACKGROUND:in recent years, the NHS has been accused of ageism frequently and from many fronts. Previous studies have shown that the number of critical care beds in the UK is inadequate to meet the needs of the population. This study asks whether there is discrimination against older people in access to these critical ...

    journal_title:Age and ageing

    pub_type: 杂志文章

    doi:10.1093/ageing/32.4.382

    authors: Hubbard RE,Lyons RA,Woodhouse KW,Hillier SL,Wareham K,Ferguson B,Major E

    更新日期:2003-07-01 00:00:00

  • Prognostic factors for continued or rebleeding and death from gastrointestinal haemorrhage in the elderly.

    abstract::We analysed 103 episodes of upper gastrointestinal bleeding in 88 elderly patients (age 76 +/- 7.7 years) to determine which of a group of 52 clinical and laboratory variables, measured on admission, best predicted continued or rebleeding, and death in these patients. Variables which related directly to the size of th...

    journal_title:Age and ageing

    pub_type: 杂志文章

    doi:10.1093/ageing/16.4.208

    authors: Booker JA,Johnston M,Booker CI,Tydd T,Mitchell R

    更新日期:1987-07-01 00:00:00

  • Beta-thromboglobulin and the diagnosis of thrombosis in elderly patients.

    abstract::The plasma concentration of beta-thromboglobulin was estimated in elderly in-patients using a radio-immuno-assay technique. There were highly significance differences between the mean values of patients with arterial or venous thrombosis, as compared with controls. The ability of the test to detect thrombosis above th...

    journal_title:Age and ageing

    pub_type: 杂志文章

    doi:10.1093/ageing/8.1.13

    authors: Denham MJ,Fisher M,James G,Hassan M,Hodkinson HM

    更新日期:1979-02-01 00:00:00

  • Does vitamin D stop inpatients falling? A randomised controlled trial.

    abstract:BACKGROUND:Vitamin D deficiency is common in older people and may increase risk of falls and fracture. Hospital inpatients are at particular risk of falling. Previous studies suggest that vitamin D improves neuromuscular function and reduces falls. OBJECTIVE:To determine whether routine supplementation with vitamin D ...

    journal_title:Age and ageing

    pub_type: 杂志文章,随机对照试验

    doi:10.1093/ageing/afm087

    authors: Burleigh E,McColl J,Potter J

    更新日期:2007-09-01 00:00:00

  • Impact of lifestyle factors on fracture risk in older patients with cardiovascular disease: a prospective cohort study of 26,335 individuals from 40 countries.

    abstract:BACKGROUND:fractures are a major health concern among the elderly. People at risk for cardiovascular disease (CVD) are at an increased risk for fractures. The aim of this study was to assess the individual and combined effect of the CVD risk factors of smoking, alcohol consumption and physical activity on fracture risk...

    journal_title:Age and ageing

    pub_type: 杂志文章,多中心研究

    doi:10.1093/ageing/afu009

    authors: Khatib R,Yusuf S,Barzilay JI,Papaioannou A,Thabane L,Gao P,Joseph PG,Teo K,Mente A

    更新日期:2014-09-01 00:00:00

  • Caring for elderly dependents: effects on the carers' quality of life.

    abstract::This study describes a survey of 256 informal carers and elderly people they support, and examines the impact of the caring role upon quality of life. Carers reported that many aspects of their physical and mental health as well as their social and family lives were affected by their caring. For many the caring activi...

    journal_title:Age and ageing

    pub_type: 杂志文章

    doi:10.1093/ageing/21.6.421

    authors: Jones DA,Peters TJ

    更新日期:1992-11-01 00:00:00

  • Improving the recording of the clinical assessment of stroke patients using a clerking pro forma.

    abstract::In this study we examine whether the introduction of a clerking pro forma improves the completeness of the recording of the management of stroke patients and we review methodological issues important in this type of audit. We prospectively identified 244 consecutive stroke patients before and after the introduction of...

    journal_title:Age and ageing

    pub_type: 杂志文章

    doi:10.1093/ageing/24.1.43

    authors: Davenport RJ,Dennis MS,Warlow CP

    更新日期:1995-01-01 00:00:00

  • Short- and long-term prognosis for very old stroke patients. The Copenhagen Stroke Study.

    abstract:BACKGROUND AND PURPOSE:The very old are expected to become a growing part of the stroke population in the industrialised part of the world. The aims of this study were to evaluate clinical characteristics of patients aged 85 years or more at stroke onset and to investigate very old age as an independent predictor of sh...

    journal_title:Age and ageing

    pub_type: 杂志文章

    doi:10.1093/ageing/afh052

    authors: Kammersgaard LP,Jørgensen HS,Reith J,Nakayama H,Pedersen PM,Olsen TS,Copenhagen Stroke Study.

    更新日期:2004-03-01 00:00:00

  • Cholesterol and long-term mortality after acute myocardial infarction in elderly patients.

    abstract:METHOD:We investigated the association of total serum cholesterol concentrations and subsequent overall and coronary mortality in 304 patients aged > or =65 discharged from hospital after acute myocardial infarction. RESULTS:There was no association between total cholesterol concentrations and mortality due to either ...

    journal_title:Age and ageing

    pub_type: 杂志文章

    doi:10.1093/ageing/28.3.313

    authors: Bo M,Fiandra U,Fonte G,Bobbio M,Fabris F

    更新日期:1999-05-01 00:00:00

  • Effect of intermittent cyclical disodium etidronate therapy on bone mineral density in men with vertebral fractures.

    abstract:OBJECTIVES:to investigate the effects of oral intermittent cyclical etidronate therapy on bone mineral density (BMD) in men with idiopathic vertebral osteoporosis. DESIGN:consecutive case series. SETTING:regional specialist clinic for metabolic bone disease. SUBJECTS:42 men aged 35-81 (median 60.5) with established ...

    journal_title:Age and ageing

    pub_type: 杂志文章

    doi:10.1093/ageing/26.5.359

    authors: Anderson FH,Francis RM,Bishop JC,Rawlings DJ

    更新日期:1997-09-01 00:00:00

  • Gastrointestinal investigations for anaemia in the elderly: a prospective study.

    abstract::Of 60 patients referred for geriatric assessment with clinically significant hypochromic anaemia, in the absence of frank bleeding, 44 underwent upper gastrointestinal and 27 lower gastrointestinal investigations. The probability of identifying a potential cause at upper gastrointestinal endoscopy was three times that...

    journal_title:Age and ageing

    pub_type: 杂志文章

    doi:10.1093/ageing/16.6.399

    authors: Calvey HD,Castleden CM

    更新日期:1987-11-01 00:00:00

  • What is the prevalence of loneliness amongst older people living in residential and nursing care homes? A systematic review and meta-analysis.

    abstract:BACKGROUND:the number of older people living in residential and nursing care homes is rising. Loneliness is a major problem for older people, but little is known about the prevalence of loneliness amongst older people living in care homes. AIM:to undertake a systematic review of literature on the prevalence of moderat...

    journal_title:Age and ageing

    pub_type: 杂志文章

    doi:10.1093/ageing/afaa049

    authors: Gardiner C,Laud P,Heaton T,Gott M

    更新日期:2020-08-24 00:00:00

  • An unusual presentation of sporadic Creutzfeldt-Jakob disease.

    abstract::Sporadic Creutzfeld-Jakob disease (CJD) is a rare neurodegenerative disorder. It is uniformly fatal. Clinical signs include myoclonus, visual disturbances, cerebellar ataxia, akinetic mutism and pyramidal/extrapyramidal signs in addition to a rapidly progressive dementia. Premortem diagnosis is challenging due to the ...

    journal_title:Age and ageing

    pub_type: 杂志文章

    doi:10.1093/ageing/afaa013

    authors: Podger H,Ipe A

    更新日期:2020-04-27 00:00:00

  • Effects of a physiotherapist-led stroke training programme for nurses.

    abstract:AIM:to assess the effects of a physiotherapist-led stroke training programme for nurses working in a rehabilitation ward on clinical practice and patient outcome. METHOD:before and after group comparison with outcome assessment by observational and quantitative methods. Non-participant observation before and after the...

    journal_title:Age and ageing

    pub_type: 杂志文章

    doi:10.1093/ageing/28.6.567

    authors: Forster A,Dowswell G,Young J,Sheard J,Wright P,Bagley P

    更新日期:1999-10-01 00:00:00

  • Hypothesis: charges to patients impair the quality of dental care for elderly people.

    abstract::Data on National Health Service (NHS) dental care utilization by the elderly are analysed to consider the distribution of dental care according to the charge status of the patient. Considerable and significant differences are observed in the type and amount of dental care provided to elderly patients exempt and not ex...

    journal_title:Age and ageing

    pub_type: 杂志文章

    doi:10.1093/ageing/18.2.136

    authors: Birch S

    更新日期:1989-03-01 00:00:00

  • Intraventricular haemorrhage and seizures in a patient with dementia: a case of chronic neurobrucellosis.

    abstract::Brucellosis is the most commonly reported zoonosis. Nervous system participation can occur at any stage of the disease either in acute or subacute or chronic form. Isolated nervous system involvement or neurobrucellosis is a relatively rare form of the disease. We describe an unusual case of an older patient with deme...

    journal_title:Age and ageing

    pub_type: 杂志文章

    doi:10.1093/ageing/afz020

    authors: Spyrou A,Natsis KS,Papamichalis E,Mourtzinos H

    更新日期:2019-07-01 00:00:00

  • Confirming long-stay status.

    abstract::This paper discusses an assessment procedure for the formal identification of patients requiring long-stay geriatric care. It was introduced immediately prior to the reorganization of geriatric in-patient care at St Pancras Hospital which saw the abolition of mixed wards of acute, rehabilitation, and long-stay patient...

    journal_title:Age and ageing

    pub_type: 杂志文章

    doi:10.1093/ageing/16.1.13

    authors: Golding R,Lugon M,Hodkinson HM

    更新日期:1987-01-01 00:00:00

  • Adverse drug reactions: an investigation on an acute geriatric ward.

    abstract::A total of 521 patients consecutively admitted to an acute geriatric unit were kept under surveillance by one observer during their stay. All drugs given to them and the occurrence of adverse events were recorded. One hundred and seventeen adverse drug reactions occurred in 94 patients representing 18.8% of the 500 pa...

    journal_title:Age and ageing

    pub_type: 杂志文章

    doi:10.1093/ageing/15.4.241

    authors: Leach S,Roy SS

    更新日期:1986-07-01 00:00:00

  • Defining 'recovery' for delirium research: a systematic review.

    abstract:BACKGROUND:Delirium is a common neuropsychiatric disorder. The natural course is of an acute, fluctuating and often transient condition; however, accumulating evidence suggests that delirium can be associated with incomplete recovery. Despite a growing body of research, a lack of clarity exists regarding definition and...

    journal_title:Age and ageing

    pub_type: 杂志文章,评审

    doi:10.1093/ageing/afu152

    authors: Adamis D,Devaney A,Shanahan E,McCarthy G,Meagher D

    更新日期:2015-03-01 00:00:00

  • Long-term physical activity is associated with reduced arterial stiffness in older adults: longitudinal results of the SAPALDIA cohort study.

    abstract:BACKGROUND:longitudinal analyses of physical activity (PA) and arterial stiffness in populations of older adults are scarce. We examined associations between long-term change of PA and arterial stiffness in the Swiss Cohort Study on Air Pollution and Lung and Heart Diseases in Adults (SAPALDIA). METHODS:we assessed PA...

    journal_title:Age and ageing

    pub_type: 杂志文章,多中心研究

    doi:10.1093/ageing/afv172

    authors: Endes S,Schaffner E,Caviezel S,Dratva J,Autenrieth CS,Wanner M,Martin B,Stolz D,Pons M,Turk A,Bettschart R,Schindler C,Künzli N,Probst-Hensch N,Schmidt-Trucksäss A

    更新日期:2016-01-01 00:00:00

  • The levodopa test in Parkinson's disease.

    abstract::The clinical diagnosis of Parkinson's disease may be difficult. In elderly patients there may be other causes of the triad of rigidity, bradykinesia and tremor. This study was designed to assess whether a single levodopa challenge could predict dopa responsiveness in patients with Parkinson's disease. Twenty-two of 27...

    journal_title:Age and ageing

    pub_type: 杂志文章

    doi:10.1093/ageing/24.3.210

    authors: D'Costa DF,Sheehan LJ,Phillips PA,Moore-Smith B

    更新日期:1995-05-01 00:00:00

  • Orthostatic hypotension in an octogenarian--an unusual presentation.

    abstract::Orthostatic hypotension is a common problem in older adults and can be associated with falls, dizziness and syncope and their associated consequences. Therefore, it is important to recognise the condition and institute appropriate management. We report an elderly woman who presented with orthostatic hypotension and wa...

    journal_title:Age and ageing

    pub_type: 杂志文章

    doi:10.1093/ageing/afi061

    authors: Bragg F,Kumar NP

    更新日期:2005-05-01 00:00:00

  • Interleukin-1 production by human monocytes in ageing and disease.

    abstract::Interleukin-1 mediates the febrile response which is often said to be reduced in the elderly. Interleukin-1 production by monocytes cultured in vitro and stimulated with bacterial lipopolysaccharide was measured. Three groups of subjects were studied; 40 normal young, 33 well elderly and 40 elderly with a history of r...

    journal_title:Age and ageing

    pub_type: 杂志文章

    doi:10.1093/ageing/18.1.43

    authors: Rudd AG,Banerjee DK

    更新日期:1989-01-01 00:00:00