Effects of medication management in geriatric patients who have fallen: results of the EMMA mixed-methods study.
Background comprehensive medication management (CMM) can reduce medication-related risks of falling. However, knowledge about inter-individual treatment effects and patient-related barriers remains scarce. Objective to gain in-depth insights into how geriatric patients who have fallen view their med...
| Publicado en: | Age & Ageing Vol. 53; no. 4; pp. 1 - 13 |
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| Autores principales: | , , , , , , , , , , |
| Formato: | Artículo |
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Oxford University Press / USA
Apr2024
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| Materias: | |
| Acceso en línea: | Ver este registro en EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ssf&AN=176933280&site=ehost-live header: @attributes: shortDbName: ssf uiTerm: 176933280 longDbName: Social Sciences Full Text (H.W. Wilson) uiTag: AN controlInfo: bkinfo: jinfo: jid: 00020729 AGA jtl: Age & Ageing issn: 00020729 maglogo: N pubinfo: dt: Apr2024 vid: 53 iid: 4 pid: 622 pub: Oxford University Press / USA artinfo: ui: 176933280 10.1093/ageing/afae070 ppf: 1 ppct: 12 formats: tig: atl: Effects of medication management in geriatric patients who have fallen: results of the EMMA mixed-methods study. aug: au: Clemens, Stephanie Iglseder, Bernhard Alzner, Reinhard Kogler, Magdalena Rose, Olaf Kutschar, Patrick Krutter, Simon Kanduth, Karin Dückelmann, Christina Flamm, Maria Pachmayr, Johanna affil: Institute of Pharmacy , Pharmaceutical Biology and Clinical Pharmacy, Paracelsus Medical University , Salzburg , Austria Center of Public Health and Health Services Research, Paracelsus Medical University , Salzburg , Austria Department of Geriatric Medicine , Christian Doppler Klinik, Paracelsus Medical University , Ignaz-Harrer-Straße 79, A-5020, Salzburg , Austria Landesapotheke Salzburg , Salzburg , Austria Institute of Nursing Science and Practice, Paracelsus Medical University , Salzburg , Austria Institute of General Practice , Family Medicine and Preventive Medicine, Paracelsus Medical University , Salzburg , Austria su: Fear Elder care Interprofessional relations Clinical trials Interviewing Content analysis Social support Patients' attitudes Old age Bone fractures -- Psychological aspects Risk assessment Inappropriate prescribing (Medicine) Independent living Insomnia Polypharmacy Treatment effectiveness Discharge planning Pre-tests & post-tests Thematic analysis Medication therapy management Research methodology Accidental falls Patient aftercare sug: subj: Fear Elder care Interprofessional relations Clinical trials Interviewing Content analysis Social support Patients' attitudes Old age Continuing Care Retirement Communities Research and Development in the Physical, Engineering, and Life Sciences (except Biotechnology) Home Health Care Services Other Individual and Family Services Bone fractures -- Psychological aspects Risk assessment Inappropriate prescribing (Medicine) Independent living Insomnia Polypharmacy Treatment effectiveness Discharge planning Pre-tests & post-tests Thematic analysis Medication therapy management Research methodology Accidental falls Patient aftercare keyword: fall-risk-increasing drugs fracture geriatrics medication management older people patient perspectives qualitative research fall-risk-increasing drugs fracture geriatrics medication management older people patient perspectives qualitative research ab: Background comprehensive medication management (CMM) can reduce medication-related risks of falling. However, knowledge about inter-individual treatment effects and patient-related barriers remains scarce. Objective to gain in-depth insights into how geriatric patients who have fallen view their medication-related risks of falling and to identify effects and barriers of a CMM in preventing falls. Design complementary mixed-methods pre–post study, based on an embedded quasi-experimental model. Setting geriatric fracture centre. Methods qualitative, semi-structured interviews framed the CMM intervention, including a follow-up period of 12 weeks. Interviews explored themes of falling, medication-related risks, post-discharge acceptability and sustainability of interventions using qualitative content analysis. Optimisation of pharmacotherapy was assessed via changes in the weighted and summated Medication Appropriateness Index (MAI) score, number of fall-risk-increasing drugs (FRID) and potentially inappropriate medications (PIM) according to the Fit fOR The Aged and PRISCUS lists using parametric testing. Results thirty community-dwelling patients aged ≥65 years, taking ≥5 drugs and admitted after an injurious fall were recruited. The MAI was significantly reduced, but number of FRID and PIM remained largely unchanged. Many patients were open to medication reduction/discontinuation, but expressed fear when it came to their personal medication. Psychosocial issues and pain increased the number of indications. Safe alternatives for FRID were frequently not available. Psychosocial burden of living alone, fear, lack of supportive care and insomnia increased after discharge. Conclusion as patients' individual attitudes towards trauma and medication were not predictable, an individual and longitudinal CMM is required. A standardised approach is not helpful in this population. pubtype: Academic Journal doctype: Article src: R language: English refInfo: copyright: @attributes: flag: N holdings: @attributes: islocal: N |
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