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Article ; Online: Development of a list of Australian potentially inappropriate medicines using the Delphi technique.

Wang, Kate N / Etherton-Beer, Christopher D / Sanfilippo, Frank / Page, Amy T

2024

Abstract: Background: Older people are at high risk of medicines-related harms. otentially inappropriate medicines (PIMs) list has been developed to assist clinicians and researchers to identify medicines with risks that may potentially outweigh their benefits in ...

Abstract	Background: Older people are at high risk of medicines-related harms. otentially inappropriate medicines (PIMs) list has been developed to assist clinicians and researchers to identify medicines with risks that may potentially outweigh their benefits in order to improve medication management and safety. Aim: To develop a list of PIMs for older people specific to Australia. Methods: The study obtained expert consensus through the utilisation of the Delphi technique in Australia. A total of 33 experts partook in the initial round, while 32 experts engaged in the subsequent round. The primary outcomes encompass medicines assessed as potentially inappropriate, the specific contexts in which their inappropriateness arises and potentially safer alternatives. Results: A total of 16 medicines or medicine classes had one or more medicines deemed as potentially inappropriate in older people. Up to 19 medicines or medicine classes had specific conditions that make them more potentially inappropriate, while alternatives were suggested for 16 medicines or classes. Conclusion: An explicit PIMs list for older people living in Australia has been developed containing 19 drugs/drug classes. The PIMs list is intended to be used as a guide for clinicians when assessing medication appropriateness in older people in Australian clinical settings and does not substitute individualised treatment advice from clinicians.
Language	English
Publishing date	2024-02-02
Publishing country	Australia
Document type	Journal Article
ZDB-ID	2045436-3
ISSN	1445-5994 ; 1444-0903
ISSN (online)	1445-5994
ISSN	1444-0903
DOI	10.1111/imj.16322
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Article ; Online: Mild cognitive impairment: To diagnose or not to diagnose.

Wang, Kate N / Page, Amy T / Etherton-Beer, Christopher D

Australasian journal on ageing

2021 Volume 40, Issue 2, Page(s) 111–115

Abstract: Older people living with mild cognitive impairment (MCI) have a slight but noticeable decline in their cognitive function, though do not meet the diagnostic criteria for dementia. MCI is controversial, with some saying it is a condition that does not ... ...

Abstract	Older people living with mild cognitive impairment (MCI) have a slight but noticeable decline in their cognitive function, though do not meet the diagnostic criteria for dementia. MCI is controversial, with some saying it is a condition that does not require diagnosis, and others stating that it is a genuine clinical syndrome. Many people with MCI will improve, and most will not progress to dementia. Managing co-morbidities and exercising are likely to be the best treatment options. With limited evidence for effective interventions and uncertainty as to the prognostic value of the condition, the benefit of diagnosing MCI remains unclear.
MeSH term(s)	Aged ; Cognition ; Cognitive Dysfunction/diagnosis ; Cognitive Dysfunction/epidemiology ; Dementia/diagnosis ; Exercise ; Humans
Language	English
Publishing date	2021-02-18
Publishing country	Australia
Document type	Journal Article
ZDB-ID	1457406-8
ISSN	1741-6612 ; 0726-4240 ; 1440-6381
ISSN (online)	1741-6612
ISSN	0726-4240 ; 1440-6381
DOI	10.1111/ajag.12913
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Article ; Online: Poisoning among older people with dementia: a wake up call.

Etherton-Beer, Christopher D

International psychogeriatrics

2015 Volume 27, Issue 11, Page(s) 1755–1756

Abstract: Medical care can be both "a blessing and a curse". The contributions of medicines to increased human lifespan and falling mortality from the major cardiovascular diseases are undisputed. However, in lockstep with remarkable extension of human lifespan ... ...

Abstract	Medical care can be both "a blessing and a curse". The contributions of medicines to increased human lifespan and falling mortality from the major cardiovascular diseases are undisputed. However, in lockstep with remarkable extension of human lifespan has been increase in the numbers of people living with chronic age related neurodegenerative conditions and frailty. In frail, multi-morbid populations, with limited homeostatic reserve and life expectancy, the balance between the risk and harms of medicines can be in equipoise. In this context the number of older people living with dementia is increasing, and understanding threats to the quality of life of people with dementia is of growing significance. Among the myriad potential causes of harm to older people with dementia, in this issue of the journal Mitchell and colleagues present new Australian data reminding us of the importance of admissions due to both intentional and unintentional poisoning.
Language	English
Publishing date	2015-11
Publishing country	England
Document type	Comment ; Journal Article
ZDB-ID	1038825-4
ISSN	1741-203X ; 1041-6102
ISSN (online)	1741-203X
ISSN	1041-6102
DOI	10.1017/S1041610215001416
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Article ; Online: Vascular cognitive impairment in dementia.

Etherton-Beer, Christopher D

Maturitas

2014 Volume 79, Issue 2, Page(s) 220–226

Abstract: Vascular risk factors and cerebrovascular disease are common causes of dementia. Shared risk factors for vascular dementia and Alzheimer's disease, as well as frequent coexistence of these pathologies in cognitively impaired older people, suggests ... ...

Abstract	Vascular risk factors and cerebrovascular disease are common causes of dementia. Shared risk factors for vascular dementia and Alzheimer's disease, as well as frequent coexistence of these pathologies in cognitively impaired older people, suggests convergence of the aetiology, prevention and management of the commonest dementias affecting older people. In light of this understanding, the cognitive impairment associated with cerebrovascular disease is an increasingly important and recognised area of the medicine of older people. Although the incidence of cerebrovascular events is declining in many populations, the overall burden associated with brain vascular disease will continue to increase associated with population ageing. A spectrum of cognitive disorders related to cerebrovascular disease is now recognised. Cerebrovascular disease in older people is associated with specific clinical and imaging findings. Although prevention remains the cornerstone of management, the diagnosis of brain vascular disease is important because of the potential to improve clinical outcomes through clear diagnosis, enhanced control of risk factors, lifestyle interventions and secondary prevention. Specific pharmacological intervention may also be indicated for some patients with cognitive impairment and cerebrovascular disease. However the evidence base to guide intervention remains relatively sparse.
MeSH term(s)	Alzheimer Disease/epidemiology ; Alzheimer Disease/prevention & control ; Alzheimer Disease/psychology ; Cerebral Infarction/epidemiology ; Cerebral Infarction/prevention & control ; Cerebral Infarction/psychology ; Cerebrovascular Disorders/epidemiology ; Cerebrovascular Disorders/prevention & control ; Cerebrovascular Disorders/psychology ; Cognition Disorders/epidemiology ; Cognition Disorders/prevention & control ; Cognition Disorders/psychology ; Dementia, Vascular/epidemiology ; Dementia, Vascular/prevention & control ; Dementia, Vascular/psychology ; Humans ; Hydroxymethylglutaryl-CoA Reductase Inhibitors/therapeutic use ; Hypercholesterolemia/drug therapy ; Hypercholesterolemia/epidemiology ; Risk Factors ; Risk Reduction Behavior ; Secondary Prevention
Chemical Substances	Hydroxymethylglutaryl-CoA Reductase Inhibitors
Language	English
Publishing date	2014-10
Publishing country	Ireland
Document type	Journal Article ; Review
ZDB-ID	80460-5
ISSN	1873-4111 ; 0378-5122
ISSN (online)	1873-4111
ISSN	0378-5122
DOI	10.1016/j.maturitas.2014.06.004
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Zs.A 1432: Show issues			Location: Je nach Verfügbarkeit (siehe Angabe bei Bestand) bis Jg. 1994: Bestellungen von Artikeln über das Online-Bestellformular Jg. 1995 - 2021: Lesesall (1.OG) ab Jg. 2022: Lesesaal (EG)
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Article ; Online: Exploring stakeholder roles in medication management for people living with dementia.

Cross, Amanda J / Etherton-Beer, Christopher D / Clifford, Rhonda M / Potter, Kathleen / Page, Amy T

Research in social & administrative pharmacy : RSAP

2020 Volume 17, Issue 4, Page(s) 707–714

Abstract: Background: Therapeutic decision making, prescribing, administering and managing medications can be difficult for people with dementia.: Objectives: To explore stakeholder roles in medication management for people with dementia, including barriers ... ...

Abstract	Background: Therapeutic decision making, prescribing, administering and managing medications can be difficult for people with dementia. Objectives: To explore stakeholder roles in medication management for people with dementia, including barriers and enablers to achieving those roles. Methods: Focus groups were held with stakeholders (consumers, general practitioners, nurses and pharmacists) from both rural and metropolitan communities in two Australian states. Focus groups were audio-recorded, transcribed and thematically analysed using an inductive approach. Results: Nine focus groups were held with 55 participants. Four major themes were identified: supporting the role of the person with dementia, carer roles and challenges, health professional roles, and process and structure barriers to medication management. Stakeholders discussed the importance of advance care planning, and the potential benefits of early implementation of dose administration aids to support patients in self-managing their medication. Carers were seen to have a vital role as patient advocates, but carer burden and changes in the patient-carer roles acted as barriers to this role. General practitioners were perceived as the main care coordinator for a person with dementia, with effective interprofessional collaboration and communication with allied health professionals and specialists further enabling optimisation of medication use. A lack of evidence, guidelines and practitioner training to guide prescribing and deprescribing decisions in people with dementia were mentioned as barriers to medication management. Conclusion: Medication management is increasingly challenging for people with dementia and each stakeholder perceives that they have a different role and faces different barriers and enablers. Future research should focus on improving the evidence base to guide prescribing, facilitating stakeholder communication and ensuring early documentation of patient wishes for the future.
MeSH term(s)	Australia ; Caregivers ; Dementia/drug therapy ; General Practitioners ; Humans ; Medication Therapy Management ; Stakeholder Participation
Language	English
Publishing date	2020-06-06
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2192059-X
ISSN	1934-8150 ; 1551-7411
ISSN (online)	1934-8150
ISSN	1551-7411
DOI	10.1016/j.sapharm.2020.06.006
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Article ; Online: Correction: A mixed methods process evaluation of a person-centred falls prevention program.

Morris, Rebecca L / Hill, Keith D / Ackerman, Ilana N / Ayton, Darshini / Arendts, Glenn / Brand, Caroline / Cameron, Peter / Etherton-Beer, Christopher D / Flicker, Leon / Hill, Anne-Marie / Hunter, Peter / Lowthian, Judy A / Morello, Renata / Nyman, Samuel R / Redfern, Julie / Smit, De Villiers / Barker, Anna L

BMC health services research

2023 Volume 23, Issue 1, Page(s) 695

Language	English
Publishing date	2023-06-27
Publishing country	England
Document type	Published Erratum
ZDB-ID	2050434-2
ISSN	1472-6963 ; 1472-6963
ISSN (online)	1472-6963
ISSN	1472-6963
DOI	10.1186/s12913-023-09743-7
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Article ; Online: Prevalence of oropharyngeal antibiotic-resistant flora among residents of aged care facilities: a pilot study.

Etherton-Beer, Christopher D / Inglis, Tim / Waterer, Grant

Respirology (Carlton, Vic.)

2015 Volume 20, Issue 7, Page(s) 1139–1141

Abstract: Residents in 11 long-term care facilities, and presenting to a single tertiary hospital site, were sampled to estimate prevalence of oropharyngeal colonization with resistant Gram-negative bacteria. From 124 residents, only one isolate (0.8%; 95% ... ...

Abstract	Residents in 11 long-term care facilities, and presenting to a single tertiary hospital site, were sampled to estimate prevalence of oropharyngeal colonization with resistant Gram-negative bacteria. From 124 residents, only one isolate (0.8%; 95% confidence interval 0.0%, 4.4) was multi-resistant (an extended-spectrum β-lactamase producing Escherichia coli) indicating that different treatment recommendations for respiratory infections in this population may not be justified.
MeSH term(s)	Aged ; Australia/epidemiology ; Colony Count, Microbial/statistics & numerical data ; Drug Resistance, Bacterial ; Female ; Gram-Negative Bacteria/isolation & purification ; Gram-Negative Bacteria/physiology ; Hospitalization/statistics & numerical data ; Humans ; Infection Control/methods ; Male ; Oropharynx/microbiology ; Pilot Projects ; Prevalence ; Residential Facilities
Language	English
Publishing date	2015-10
Publishing country	Australia
Document type	Letter ; Observational Study
ZDB-ID	1435849-9
ISSN	1440-1843 ; 1323-7799
ISSN (online)	1440-1843
ISSN	1323-7799
DOI	10.1111/resp.12545
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Article ; Online: The feasibility and effect of deprescribing in older adults on mortality and health: a systematic review and meta-analysis.

Page, Amy T / Clifford, Rhonda M / Potter, Kathleen / Schwartz, Darren / Etherton-Beer, Christopher D

British journal of clinical pharmacology

2016 Volume 82, Issue 3, Page(s) 583–623

Abstract: Aims: Deprescribing is a suggested intervention to reverse the potential iatrogenic harms of inappropriate polypharmacy. The review aimed to determine whether or not deprescribing is a safe, effective and feasible intervention to modify mortality and ... ...

Abstract	Aims: Deprescribing is a suggested intervention to reverse the potential iatrogenic harms of inappropriate polypharmacy. The review aimed to determine whether or not deprescribing is a safe, effective and feasible intervention to modify mortality and health outcomes in older adults. Methods: Specified databases were searched from inception to February 2015. Two researchers independently screened all retrieved articles for inclusion, assessed study quality and extracted data. Data were pooled using RevMan v5.3. Eligible studies included those where older adults had at least one medication deprescribed. The primary outcome was mortality. Secondary outcomes were adverse drug withdrawal events, psychological and physical health outcomes, quality of life, and medication usage (e.g. successful deprescribing, number of medications prescribed, potentially inappropriate medication use). Results: A total of 132 papers met the inclusion criteria, which included 34 143 participants aged 73.8 ± 5.4 years. In nonrandomized studies, deprescribing polypharmacy was shown to significantly decrease mortality (OR 0.32, 95% CI: 0.17-0.60). However, this was not statistically significant in the randomized studies (OR 0.82, 95% CI 0.61-1.11). Subgroup analysis revealed patient-specific interventions to deprescribe demonstrated a significant reduction in mortality (OR 0.62, 95% CI 0.43-0.88). However, generalized educational programmes did not change mortality (OR 1.21, 95% CI 0.86-1.69). Conclusions: Although nonrandomized data suggested that deprescribing reduces mortality, deprescribing was not shown to alter mortality in randomized studies. Mortality was significantly reduced when applying patient-specific interventions to deprescribe in randomized studies.
MeSH term(s)	Deprescriptions ; Humans ; Inappropriate Prescribing/adverse effects ; Inappropriate Prescribing/mortality ; Polypharmacy
Language	English
Publishing date	2016-06-13
Publishing country	England
Document type	Journal Article ; Meta-Analysis ; Review ; Systematic Review
ZDB-ID	188974-6
ISSN	1365-2125 ; 0306-5251 ; 0264-3774
ISSN (online)	1365-2125
ISSN	0306-5251 ; 0264-3774
DOI	10.1111/bcp.12975
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Article ; Online: Embracing Cultural Diversity - Leadership Perspectives on Championing Meaningful Engagement for Residents Living with Advanced Dementia.

du Toit, Sanetta Henrietta Johanna / Baldassar, Loretta / Raber, Christine L / Millard, Adele M / Etherton-Beer, Christopher D / Buchanan, Helen A / du Toit, Daniel S / Collier, Lesley J / Cheung, Gary / Peri, Kathryn / Webb, Eileen A / Lovarini, Meryl

Journal of cross-cultural gerontology

2019 Volume 35, Issue 1, Page(s) 49–67

Abstract: Resource constraints and high staff turnover are perceived as substantial barriers to high quality residential aged care. Achieving relationship-focused, person-centered care (PCC) is an ongoing challenge. This paper reports on an international project ... ...

Abstract	Resource constraints and high staff turnover are perceived as substantial barriers to high quality residential aged care. Achieving relationship-focused, person-centered care (PCC) is an ongoing challenge. This paper reports on an international project that explored how residential care leadership understand meaningful engagement for residents with dementia from culturally and linguistically diverse (CALD) backgrounds. This paper critically appraises the process, and outcomes, of an adapted Delphi method. Participants were the residential care leadership (i.e. staff in supervisory capacity) from four international facilities. Participation in the Delphi process was limited even though surveys were designed to require minimal time for completion. No participants opted for the alternative option of being interviewed. Findings indicate that residential care leadership recognised the importance of meaningful engagement for residents from CALD backgrounds. Limitations of time, resources and policy infrastructure were cited as barriers to achieving PCC. These findings suggest that facility leadership understand the importance of PCC, but identify multiple barriers rather than enablers for delivering PCC. Alternative methods, such as collecting data in interactive sessions allowing real-time discussion should be initiated to more effectively engage residential care leaders for a collaborative approach to explore PCC practices.
MeSH term(s)	Assisted Living Facilities/standards ; Australia ; Cultural Diversity ; Delphi Technique ; Dementia/psychology ; Humans ; Leadership ; Linguistics ; New Zealand ; Patient Participation ; Patient-Centered Care/standards ; South Africa ; United Kingdom
Language	English
Publishing date	2019-12-20
Publishing country	Netherlands
Document type	Journal Article
ZDB-ID	644348-5
ISSN	1573-0719 ; 0169-3816
ISSN (online)	1573-0719
ISSN	0169-3816
DOI	10.1007/s10823-019-09387-3
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Zs.A 2854: Show issues

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Article ; Online: Deprescribing in frail older people--Do doctors and pharmacists agree?

Page, Amy T / Etherton-Beer, Christopher D / Clifford, Rhonda M / Burrows, Sally / Eames, Marnee / Potter, Kathleen

Research in social & administrative pharmacy : RSAP

2016 Volume 12, Issue 3, Page(s) 438–449

Abstract: Background: Deprescribing may reduce harmful polypharmacy in older people and is an accepted clinical practice; however, data to guide deprescribing decisions are scarce.: Objectives: This study aimed to determine if physicians and pharmacists agree ... ...

Abstract	Background: Deprescribing may reduce harmful polypharmacy in older people and is an accepted clinical practice; however, data to guide deprescribing decisions are scarce. Objectives: This study aimed to determine if physicians and pharmacists agree on medicines to deprescribe. Methods: Two physicians and two pharmacists independently applied a deprescribing decision-making aid to clinical and medicines data collected during a deprescribing trial of frail older people in four residential aged care facilities. The consensus list of medicines selected for deprescribing by the physicians was compared with the consensus list selected by the pharmacists. Lin's concordance correlation coefficient (CCC) was used to assess agreement in the number of medicines, and agreement on each specific medicine was assessed using the level 2 intra-cluster correlation (ICC) for medicine within patient. Results: Physicians and pharmacists had substantial agreement on the number of medicines to deprescribe (CCC = 0.70; 95% CI: 0.58, 0.82), with a difference of 1.8 ± 2.0 total targeted medicines. For specific medicines, the agreement was moderate (ICC = 0.45, 95% CI: 0.32, 0.58). When considering only orally administered medicines, physicians and pharmacists had substantial agreement (CCC = 0.73; 95% CI: 0.61, 0.84) in the number of medicines, but only moderate agreement for the specific medicines (ICC = 0.44, 95% CI: 0.30, 0.59). Conclusions: Physicians and pharmacists had substantial agreement in the number of medicines they targeted to deprescribe and to continue, but physicians targeted a greater number of medicines for deprescribing than pharmacists. However, they had only moderate agreement in the specific medicines to deprescribe. This suggests that the deprescribing decision-making aid is a useful tool for health professionals to use when considering medicines to deprescribe.
MeSH term(s)	Aged ; Aged, 80 and over ; Consensus ; Decision Making ; Decision Support Techniques ; Deprescriptions ; Female ; Frail Elderly ; Humans ; Male ; Pharmacists ; Physicians
Language	English
Publishing date	2016-05
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2192059-X
ISSN	1934-8150 ; 1551-7411
ISSN (online)	1934-8150
ISSN	1551-7411
DOI	10.1016/j.sapharm.2015.08.011
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