Potentially inappropriate prescribing and frailty in hospitalised older adults
Loading...
Files
Full Text E-thesis
Date
2024
Authors
Randles, Mary
Journal Title
Journal ISSN
Volume Title
Publisher
University College Cork
Published Version
Abstract
Continued advances in medical therapeutics have undoubtedly contributed the global increase in longevity and health gains over the last century. However, this increase in life expectancy has led to a concomitant rise in older adults experiencing frailty and co-morbidity. More older people are now chronically treated for conditions that may have previously been l acutely life limiting (cardiovascular disease, diabetes, chronic kidney disease, some cancers) often with complex evidence-based therapies. Previously, prescribing tools have been developed and validated to identify and reduce Potentially Inappropriate Prescribing (PIP) in the general older adult population and in the frailest cohort of older patients. Different levels of frailty may require a tailored approach to prescribing. In robust older people the focus of therapy may be preventative. As characteristics of frailty emerge; vigilance is required to ensure that delirium, falls and functional decline are not provoked by inappropriate medication use. Finally, as older people become increasingly frail, the use of multiple medications may result in more harm than benefit. Nonetheless, there remains a lack of evidence regarding the prevalence of inappropriate prescribing in frail older adults presenting acutely to hospital in Ireland.
This doctoral thesis was initiated in 2020 to explore the relationship between frailty and potentially appropriate prescribing with the goal of identifying the forms of inappropriate prescribing experienced by frail older people presenting acutely to hospital. The manuscript comprises of 9 chapters. The first chapter is an introduction, divided into 3 sections: (i) what is frailty and why is it important? (ii) potentially inappropriate prescribing, (iii) potentially inappropriate prescribing and frailty. The 4 main studies are included in chapters 2-5. Chapter 2 examines the association between frailty and PIP as defined by STOPP/START Version 2 criteria in a population of acutely hospitalised older adults. Chapter 3, evaluates the prevalence of falls risk increasing drug (FRID) use in older people who have experienced a fall in the previous 12 months. Chapter 4, explores
the prevalence of potential drug-drug interactions and frailty in a cohort of acutely hospitalised older adults. Chapter 5, describes the development of an explicit list of prescribing cascades based on the published literature and expert opinion its application to investigate the prevalence of potential cascades at admission and discharge from hospital in multimorbid older people hospitalized with acute illness. In chapter 6 I discuss the findings of studies included in this thesis and potential implications for future research and clinical practice. References and appendices are detailed in chapters 7 and 8 respectively.
Description
Keywords
Frailty , Prescribing , Prescribing cascades , Medication managment , Theraputics
Citation
Randles, M. 2024. Potentially inappropriate prescribing and frailty in hospitalised older adults. MD Thesis, University College Cork.