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  1. Artikel ; Online: Diabetes treatment deintensification in Australians with dementia compared to the general population: A national cohort study.

    Picton, Leonie J / George, Johnson / Bell, J Simon / Ilomaki, Jenni S

    Journal of the American Geriatrics Society

    2023  Band 71, Heft 8, Seite(n) 2506–2519

    Abstract: Background: Diagnosis of dementia may change peoples' goals of care. In people with diabetes, this may lead to relaxing treatment targets and reducing the use of diabetes medications. The aim of this study was to examine changes in diabetes medication ... ...

    Abstract Background: Diagnosis of dementia may change peoples' goals of care. In people with diabetes, this may lead to relaxing treatment targets and reducing the use of diabetes medications. The aim of this study was to examine changes in diabetes medication use before and after initiating medication for dementia.
    Methods: A national cohort of people aged 65-97 years, living with dementia and diabetes, and a general population cohort with diabetes matched for age, sex, and index date were extracted from the Australian national medication claims database. Trajectories of diabetes medication use, expressed as mean defined daily dose (DDD) each month for each individual from 24 months before to 24 months after the index date, were estimated using group-based trajectory modeling (GBTM). Cohorts were analyzed separately.
    Results: People with dementia (N = 1884) and the matched general population (N = 7067) had a median age of 80 years (interquartile range 76-84) and 55% were female. In both models, people exhibited one of five diabetes medication trajectories, with 16.5% of people with dementia and 24.0% of the general population assigned to trajectories that represented deintensification. In the general population model, those on deintensifying trajectories were older than those on stable trajectories (median 83 vs. 79 years). In the dementia cohort model, those on high or low deintensifying trajectories were slightly older (median age 81 or 82, respectively, vs. 80 years) and had at least 1 more comorbidity (median 8 or 7, respectively, vs. 6) than those on stable trajectories.
    Conclusions: Initiating medication for dementia does not appear to be a trigger for deintensification of diabetes treatment regimens. Deintensification was more common in the general population; people living with dementia are potentially overtreated for diabetes.
    Mesh-Begriff(e) Aged, 80 and over ; Female ; Humans ; Male ; Australia/epidemiology ; Cohort Studies ; Dementia/epidemiology ; Diabetes Mellitus/drug therapy ; Diabetes Mellitus/epidemiology ; Hypoglycemic Agents/therapeutic use ; Aged
    Chemische Substanzen Hypoglycemic Agents
    Sprache Englisch
    Erscheinungsdatum 2023-06-09
    Erscheinungsland United States
    Dokumenttyp Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 80363-7
    ISSN 1532-5415 ; 0002-8614
    ISSN (online) 1532-5415
    ISSN 0002-8614
    DOI 10.1111/jgs.18452
    Datenquelle MEDical Literature Analysis and Retrieval System OnLINE

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  2. Artikel ; Online: Development and validation of the Medication Regimen Simplification Guide for Residential Aged CarE (MRS GRACE).

    Chen, Esa Yh / Sluggett, Janet K / Ilomäki, Jenni / Hilmer, Sarah N / Corlis, Megan / Picton, Leonie J / Dean, Laura / Alderman, Christopher P / Farinola, Nicholas / Gailer, Joy / Grigson, Jane / Kellie, Andrew R / Putsey, Peter Jc / Yu, Solomon / Bell, J Simon

    Clinical interventions in aging

    2018  Band 13, Seite(n) 975–986

    Abstract: Background: Residents of aged care facilities use increasingly complex medication regimens. Reducing unnecessary medication regimen complexity (eg, by consolidating the number of administration times or using alternative formulations) may benefit ... ...

    Abstract Background: Residents of aged care facilities use increasingly complex medication regimens. Reducing unnecessary medication regimen complexity (eg, by consolidating the number of administration times or using alternative formulations) may benefit residents and staff.
    Objective: To develop and validate an implicit tool to facilitate medication regimen simplification in aged care facilities.
    Method: A purposively selected multidisciplinary expert panel used modified nominal group technique to identify and prioritize factors important in determining whether a medication regimen can be simplified. The five prioritized factors were formulated as questions, pilot-tested using non-identifiable medication charts and refined by panel members. The final tool was validated by two clinical pharmacists who independently applied the tool to a random sample of 50 residents of aged care facilities to identify opportunities for medication regimen simplification. Inter-rater agreement was calculated using Cohen's kappa.
    Results: The Medication Regimen Simplification Guide for Residential Aged CarE (MRS GRACE) was developed as an implicit tool comprising of five questions about 1) the resident; 2) regulatory and safety requirements; 3) drug interactions; 4) formulation; and 5) facility and follow-up considerations. Using MRS GRACE, two pharmacists independently simplified medication regimens for 29/50 and 30/50 residents (Cohen's kappa=0.38, 95% CI 0.12-0.64), respectively. Simplification was possible for all residents with five or more administration times. Changing an administration time comprised 75% of the two pharmacists' recommendations.
    Conclusions: Using MRS GRACE, two clinical pharmacists independently simplified over half of residents' medication regimens with fair agreement. MRS GRACE is a promising new tool to guide medication regimen simplification in aged care.
    Mesh-Begriff(e) Aged ; Aged, 80 and over ; Clinical Protocols ; Delivery of Health Care/standards ; Female ; Guidelines as Topic ; Humans ; Male ; Medication Therapy Management/organization & administration ; Pharmacists/standards ; Prescription Drugs/therapeutic use
    Chemische Substanzen Prescription Drugs
    Sprache Englisch
    Erscheinungsdatum 2018-05-18
    Erscheinungsland New Zealand
    Dokumenttyp Journal Article ; Validation Study ; Video-Audio Media
    ZDB-ID 2364924-0
    ISSN 1178-1998 ; 1176-9092
    ISSN (online) 1178-1998
    ISSN 1176-9092
    DOI 10.2147/CIA.S158417
    Datenquelle MEDical Literature Analysis and Retrieval System OnLINE

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