Aim: Elucidating factors affecting medication management in patients with cognitive dysfunction is useful toward providing support for those taking medication. In this study, we investigated factors affecting medication management in patients with cognitive dysfunction.Methods: From February 2013 to September 2017, a retrospective medical chart review was conducted. The survey items included age, sex, patient’s educational level, number of daily doses, number of daily medications, frailty, vitality index, Barthel index, mini mental state examination (MMSE), instrumental activities of daily living (IADL) for each men and women, respective, geriatric depression scale (GDS)-15, long-term care insurance, use of medications three or more times a day, MMSE scores of 22 or less, women’s IADL, and medication management.
Results: Among 129 elderly patients (42 men and 87 women), use of medications three or more times a day, long-term care insurance, and women’s IADL were involved in medication management. However, age, sex, patient’s educational level, frailty, number of daily doses, number of daily medications, vitality index, Barthel index, and MMSE scores were not related to in medication management. The IADL scores were highest in women who did not use medications and had long-term care insurance.
Conclusions: Factors affecting medication management in patients with cognitive dysfunction are the use of medications three or more times a day and independence in IALD in women who do not have long-term care insurance.
Aim: With societal aging, the number of elderly individuals with osteoarthritis is increasing. Antibiotics to prevent postoperative infection and nonsteroidal anti-inflammatory drugs (NSAIDs) to manage postoperative analgesia are essential in the treatment of osteoarthritis; however, caution should be exercised because these drugs may cause renal dysfunction. Monitoring the renal function is important in elderly individuals because of the aging-associated physiological decline in renal function. The present study aimed to determine the factors affecting renal function in elderly patients with osteoarthritis.
Methods: Patients (n＝1077) admitted to the orthopedic ward of Teikyo University for 2 years from January 1, 2017, were enrolled. Eligibility criterion was patients aged >65 years with osteoarthritis. Multiple regression analysis adjusted for confounders was performed using the estimated glomerular filtration rate at discharge as the objective variable. Patient background, medications, and laboratory data were considered explanatory variables.
Results: Overall, 171 patients (24 males and 147 females; mean age, 76.5 years) were included. Multiple regression analysis showed that estimated glomerular filtration rate at discharge was significantly associated with estimated glomerular filtration rate at admission, antiplatelet drug use, and female sex. The estimated glomerular filtration rate at discharge in the antiplatelet group was significantly lower than that in the non-antiplatelet group.
Conclusions: Antiplatelet drugs may negatively affect estimated glomerular filtration rate at discharge in elderly patients with osteoarthritis. Patients receiving antiplatelet drugs should be carefully monitored for renal function and be switched to other drugs, if required, considering the risk of renal dysfunction due to postoperative antibiotic and NSAIDs use.
Aim: In this study, the dispensing database of health insurance pharmacies was used to investigate the actual status of taking multiple medications in patients with chronic diseases across all age classes, including the number of drugs by age class, frequency of medication with six or more drugs, number of drugs by medical efficacy.
Methods: Medical records of 49,842 patients between August 1 and October 31, 2016 were collected from Taiyo Medical Supply. The prescription period was >28 days. Patients were divided into polypharmacy group (>6 drugs) and non-polypharmacy group (<5 drugs).
Results: Total number of patients were 25,148. The number of drugs by age and the percentage of the polypharmacy group continued to increase till the age of >90 years. In the polypharmacy group, patients were older, visited more medical institutions, and consulted more physicians than those in the non-polypharmacy group did.
Conclusions: Drug prescription increased with age and continued to increase beyond the average life expectancy. Number of physicians were factors that affected taking multiple medications.
Serotonin syndrome refers to the adverse events caused by serotonin-based drugs such as antidepressants. Its clinical manifestations include psychiatric and neurovegetative symptoms. In this communication, we report our experience with an 83-year-old woman receiving antidepressants, who developed subjective symptoms such as heavy sweating, dizziness, and tremor after starting treatment with dextromethorphan. Treatment with antidepressants was continued, but five months later, the patient experienced symptoms of heavy sweating, elevated blood pressure, tremor, and anxiety. In her case, serotonin syndrome was suspected by a pharmacist working in a pharmacy, who promptly carried out early intervention and assisted in the prevention of recurrence. In elderly patients who are prescribed dextromethorphan and antidepressants, the possibility of occurrence of serotonin syndrome needs to be taken into consideration in the follow-up of the clinical course.
Aim: Short-term use of vancomycin may cause kidney injury in elderly patients. We analyzed the risk factors for kidney injury in elderly patients who received vancomycin temporarily.
Methods: We investigated 98 vancomycin-treated (<15 days) elderly patients (≥ 75 years). The treatment caused kidney injury in 13 patients. A multivariate logistic regression analysis identified the risk factors for kidney injury.
Results: The statistical analysis identified three independent risk factors as combined precursors of kidney injury: use of non-steroidal anti-inflammatory drugs (OR: 43.1, 95% CI: 3.9-474.0), elevated trough concentration (OR: 55.2, 95% CI: 3.7-826.0), and a total combination of ≥ 9 drugs (OR: 6.8, 95% CI: 1.2-38.8).
Conclusion: Usage of non-steroidal anti-inflammatory drugs, ≥ 9 drugs in combination, and an elevated trough concentration may induce kidney injury in elderly patients who receive vancomycin temporarily.
This study investigated the current status and problems of pharmacist intervention in welfare facilities for older adults requiring long-term care (hereafter referred to as “welfare facilities”) and health care facilities for such individuals (hereafter referred to as “health care facilities”). A questionnaire was administered to 116 welfare facilities and 71 heath care facilities in Ibaraki Prefecture. The results showed that the rate of pharmacist intervention was higher in health care facilities (72.2%) than in welfare facilities (48.8%), and difficulty in taking medication and trouble with medication via tube were reported regardless of pharmacist intervention in both facilities. The rate of pharmacist intervention was low regarding the items related to drug compliance. To solve these problems, pharmacists need to actively collaborate with other professional and share information. We believe that it is important for pharmacists to always share patient information in cooperation with the facility in order to improve the compliance and avoid side effects for all long-term care insurance facilities.