540121 research-article2014
WJNXXX10.1177/0193945914540121Western Journal of Nursing Research
Midwest Nursing Research Society PhD Student Award Abstract
State of the Science on Potentially Inappropriate Medications in Community-Dwelling Older Adults
Western Journal of Nursing Research 2014, Vol. 36(10) 1380–1381 © The Author(s) 2014 Reprints and permissions: sagepub.com/journalsPermissions.nav DOI: 10.1177/0193945914540121 wjn.sagepub.com
Potentially inappropriate medication (PIM) use in older adults is a worldwide health problem associated with adverse drug events (ADEs), hospital admissions, readmissions, and health costs. The purpose of this state of the science (SOS) review is to appraise literature addressing PIMs in communitydwelling older adults. A database search used CINAHL, MEDLINE, Biomedical reference collection, and PUBMED. The authors also performed a manual search of reference lists. Articles were included if participants in the study sample were 65 years of age or older, independent and communitydwelling, the primary aim was to reduce inappropriate medications, and published in the English language. Studies were excluded if conducted in nursing home/skilled care, acute inpatient settings, examined PIMs use with specific diseases, or testing instruments. The terms potentially inappropriate medications, drugs, prescriptions, polypharmacy, elderly, older adult, aged adult, interventions, community-dwelling, and home-dwelling were searched from January 1991 to June 2013 (N = 379). After abstract review, 67 articles were selected. Most were retrospective correlational designs (n = 38); only 19 prospective correlation and 10 intervention studies were included. The current SOS reveals that PIMs use in community-dwelling older adults has been studied without clear analysis of the concept. Considerable evidence describes the prevalence of PIMs use, but few studies associate the use of PIMs with health outcomes such as ADEs and functional status. The prevalence of potentially inappropriate prescribing was addressed in the community outpatient, ambulatory clinic, and pharmacy settings. Trends among interventions were to prevent use of PIMs by changing the behavior of the prescribing physician and pharmacist. Notable gaps included the lack of emphasis on the patient/family rather than the physician/pharmacist team. Rigorous evidence is needed on interventions to prevent or decrease use of PIMs in communitydwelling older adults. Nurses should use criteria to identify the use of PIMs
Downloaded from wjn.sagepub.com at UNIV OF GEORGIA LIBRARIES on June 3, 2015
1381
Shade et al.
and collaborate with patients and other health professionals to limit their use. Educators must teach students to identify PIMs use among patients. Future intervention studies must focus on preventing the use of PIMs, reducing ADEs, and improving health and system outcomes. Marcia Shade MSN, BS, RN, PhD student Ann M. Berger, PhD, APRN, AOCNS, FAAN Claudia Chaperon, PhD, APRN, GNP-BC University of Nebraska Medical Center, Omaha, USA
Downloaded from wjn.sagepub.com at UNIV OF GEORGIA LIBRARIES on June 3, 2015
WJNXXX10.1177/0193945914540121Western Journal of Nursing Research
Midwest Nursing Research Society PhD Student Award Abstract
State of the Science on Potentially Inappropriate Medications in Community-Dwelling Older Adults
Western Journal of Nursing Research 2014, Vol. 36(10) 1380–1381 © The Author(s) 2014 Reprints and permissions: sagepub.com/journalsPermissions.nav DOI: 10.1177/0193945914540121 wjn.sagepub.com
Potentially inappropriate medication (PIM) use in older adults is a worldwide health problem associated with adverse drug events (ADEs), hospital admissions, readmissions, and health costs. The purpose of this state of the science (SOS) review is to appraise literature addressing PIMs in communitydwelling older adults. A database search used CINAHL, MEDLINE, Biomedical reference collection, and PUBMED. The authors also performed a manual search of reference lists. Articles were included if participants in the study sample were 65 years of age or older, independent and communitydwelling, the primary aim was to reduce inappropriate medications, and published in the English language. Studies were excluded if conducted in nursing home/skilled care, acute inpatient settings, examined PIMs use with specific diseases, or testing instruments. The terms potentially inappropriate medications, drugs, prescriptions, polypharmacy, elderly, older adult, aged adult, interventions, community-dwelling, and home-dwelling were searched from January 1991 to June 2013 (N = 379). After abstract review, 67 articles were selected. Most were retrospective correlational designs (n = 38); only 19 prospective correlation and 10 intervention studies were included. The current SOS reveals that PIMs use in community-dwelling older adults has been studied without clear analysis of the concept. Considerable evidence describes the prevalence of PIMs use, but few studies associate the use of PIMs with health outcomes such as ADEs and functional status. The prevalence of potentially inappropriate prescribing was addressed in the community outpatient, ambulatory clinic, and pharmacy settings. Trends among interventions were to prevent use of PIMs by changing the behavior of the prescribing physician and pharmacist. Notable gaps included the lack of emphasis on the patient/family rather than the physician/pharmacist team. Rigorous evidence is needed on interventions to prevent or decrease use of PIMs in communitydwelling older adults. Nurses should use criteria to identify the use of PIMs
Downloaded from wjn.sagepub.com at UNIV OF GEORGIA LIBRARIES on June 3, 2015
1381
Shade et al.
and collaborate with patients and other health professionals to limit their use. Educators must teach students to identify PIMs use among patients. Future intervention studies must focus on preventing the use of PIMs, reducing ADEs, and improving health and system outcomes. Marcia Shade MSN, BS, RN, PhD student Ann M. Berger, PhD, APRN, AOCNS, FAAN Claudia Chaperon, PhD, APRN, GNP-BC University of Nebraska Medical Center, Omaha, USA
Downloaded from wjn.sagepub.com at UNIV OF GEORGIA LIBRARIES on June 3, 2015
