Adverse drug reactions and targets for deprescribing in high risk older adults

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dc.check.embargoformatEmbargo not applicable (If you have not submitted an e-thesis or do not want to request an embargo)en
dc.check.infoNot applicableen
dc.check.opt-outNot applicableen
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dc.contributor.advisorO'Mahony, Denisen
dc.contributor.advisorGallagher, Paulen
dc.contributor.authorLavan, Amanda H.
dc.contributor.funderFP7 Healthen
dc.date.accessioned2018-09-18T10:50:00Z
dc.date.available2018-09-18T10:50:00Z
dc.date.issued2018
dc.date.submitted2018
dc.description.abstractOver the last twenty years, many prescribing tools have been developed and validated to identify inappropriate prescribing (IP) in older adults and assist physicians in medication optimisation. However, these prescribing tools have predominantly focused on identifying IP in the general older adult population, rather than targeting the population cohort that is growing at the fastest rate and that is at the highest risk of IP and adverse drug reactions (ADRs) i.e. older frailer multimorbid patients with a poor survival prognosis. Extensive research on the prevalence of ADRs has been published. However many different definitions of ADRs and many different ADR causality tools have been employed across different studies, making it difficult to compare the results of studies. To confound this area of investigation further, many ADR causality tools are not appropriate to use in older frail multimorbid adults. In addition, a limited amount of research has occurred identifying the morbidity associated with ADRs in older adults. To date, there is no standardized approach to identifying, assessing and reporting ADRs in older adults. This doctoral thesis was designed to (i) standardise the identification, assessment and reporting of ADRs in older adults, (ii) assess ADRs using this new methodology in high risk populations, and (iii) develop and validate a new usable set of criteria called STOPPFrail (Screening Tool of Older Persons Prescriptions in Frail adults with limited life expectancy) to assist deprescribing in older frail multimorbid adults with a poor survival prognosis i.e. patients where the role of preventative therapy is questionable. This thesis comprises eleven chapters. The first chapter is an introduction, divided into four sections i.e. (i) demographic changes and the proportional increase in high risk older adults, (ii) prescribing considerations for older adults, (iii) consequences of IP including ADRs and (iv) potential targets for intervention. The second chapter proposes a methodologically robust way of identifying, assigning causality and reporting ADRs and tests this theory on physicians, pharmacists, biomedical scientists and nurses. The third chapter uses this new ADR methodology to identify the prevalence of ADRs in older adults presenting to hospital. The fourth chapter compares older and younger adults with cancer in terms of multimorbidity, medication use and ADRs using the same methodology proposed in Chapter 2. The fifth chapter develops and validates STOPPFrail criteria, an explicit prescribing tool to assist deprescribing in frail older adults with a poor one year survival prognosis. The sixth chapter describes the inter-rater reliability (IRR) of STOPPFrail criteria between physicians. The seventh chapter, applies STOPPFrail criteria to two representative populations i.e. a proportion of older adults deemed suitable for nursing home care and a proportion of older adults presenting for hospitalisation. Chapter eight considers the relevance of the research data developed in this thesis as well as questions any issues arising from these research studies. Chapter nine contains peer-reviewed articles that were published and awards received during the writing of this thesis. Finally, chapters ten and eleven list the references and appendices, respectively.en
dc.description.statusNot peer revieweden
dc.description.versionAccepted Version
dc.format.mimetypeapplication/pdfen
dc.identifier.citationLavan, A. H. 2018. Adverse drug reactions and targets for deprescribing in high risk older adults. PhD Thesis, University College Cork.en
dc.identifier.endpage382en
dc.identifier.urihttps://hdl.handle.net/10468/6800
dc.language.isoenen
dc.publisherUniversity College Corken
dc.relation.projectinfo:eu-repo/grantAgreement/EC/FP7::SP1::HEALTH/305930/EU/Development and clinical trials of a new Software ENgine for the Assessment & Optimization of drug and non-drug Therapy in Older peRsons/SENATORen
dc.rights© 2018, Amanda Hanora Lavan.en
dc.rights.urihttp://creativecommons.org/licenses/by-nc-nd/3.0/en
dc.subjectDeprescribingen
dc.subjectAdverse drug reactionsen
dc.subjectPoor prognosisen
dc.subjectExplicit prescribing toolen
dc.subjectOlder adultsen
dc.subjectOncologyen
dc.thesis.opt-outfalse
dc.titleAdverse drug reactions and targets for deprescribing in high risk older adultsen
dc.typeDoctoral thesisen
dc.type.qualificationlevelDoctoralen
dc.type.qualificationnamePhDen
ucc.workflow.supervisordenis.omahony@ucc.ie
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