Consumer and multidisciplinary clinician experiences after implementation of the Drug Burden Index intervention bundle to facilitate deprescribing in older inpatients: A mixed method study.

Rationale: The Drug Burden Index (DBI) measures exposure to anticholinergic and sedative drugs, which are associated with harm in older adults. To facilitate deprescribing in older Australian inpatients, we piloted an intervention bundle integrating the DBI in Electronic Medical Records, clinician deprescribing guides, consumer information leaflets and a stewardship pharmacist.

Objectives: To understand (i) hospital clinician experiences of using the bundle and (ii) consumer (patient and carer) and General Practitioner (GP) experiences of in-hospital deprescribing, following bundle implementation.

Prescribing patterns in people living with dementia in the community: A cross-sectional study.

Objectives: To identify the prevalence of and factors associated with medication use in people living with dementia in the community.

Methods: A cross-sectional study using baseline data from a randomised controlled trial known as the Interdisciplinary Home-bAsed Reablement Program (I-HARP) between 2018 and 2021 in Sydney, Australia. Participants included people with mild-moderate dementia and their carers.

Effects of Adopting Preventive Drug Lists on Medication Costs and Disparities by Income Over 2 Years: A Natural Experiment for Translation in Diabetes (NEXT-D) Study.

Objective: To examine the association between preventive drug lists (PDLs) and changes in medication costs among patients with diabetes insured in commercial health plans over 2 follow-up years.

Research Design And Methods: We conducted a quasiexperimental study using the Optum deidentified Clinformatics Data Mart Database (January 2003 to December 2017). The intervention group included 5,582 patients with diabetes age 12-64 years switched by employers to PDL coverage; the control group included 5,582 matched patients whose employers offered no PDL.

Prevalence of Adverse Drug Reactions in Hospital Among Older Patients with and Without Dementia.

Background: Older inpatients with dementia are at an increased risk of an adverse drug reaction (ADR) during hospitalization.

Objective: To quantify the prevalence of ADRs in older inpatients according to dementia status and ADR definition approach and to identify risk factors of ADRs during hospitalization.

Methods: This was a retrospective cohort study of 2000 inpatients aged ≥ 75 years admitted consecutively to six Sydney hospitals (1 July 2016 to 31 May 2017).

The Australian Frailty Network: Development of a consumer-focussed national response to frailty.

Frailty is an important concept in the care of older adults. Over the past two decades, significant advances have been made in measuring frailty. While it is now well-recognised that frailty status is an important determinant of outcomes from medical illnesses or surgical interventions, frailty measurement is not currently routinely integrated into clinical practice.

Mobile applications on app stores for deprescribing: A scoping review.

Deprescribing is an evidence-based intervention to reduce potentially inappropriate medication use. Yet its implementation faces barriers including inadequate resources, training and time. Mobile applications (apps) on app stores could address some barriers by offering educational content and interactive features for medication assessment and deprescribing guidance.

Pre-clinical Models for Geriatric Pharmacotherapy.

With ageing of the population worldwide and discovery of new medications for prevention and management of age-related conditions, there is increasing use of medications by older adults. There are international efforts to increase the representativeness of participants in clinical trials to match the intended real-world users of the medications across a range of characteristics including age, multimorbidity, polypharmacy and frailty. Currently, much of the data on medication-related harm in older adults are from pharmacovigilance studies.

Drug Burden Index Is a Modifiable Predictor of 30-Day Hospitalization in Community-Dwelling Older Adults With Complex Care Needs: Machine Learning Analysis of InterRAI Data.

Background: Older adults (≥65 years) account for a disproportionately high proportion of hospitalization and in-hospital mortality, some of which may be avoidable. Although machine learning (ML) models have already been built and validated for predicting hospitalization and mortality, there remains a significant need to optimize ML models further. Accurately predicting hospitalization may tremendously affect the clinical care of older adults as preventative measures can be implemented to improve clinical outcomes for the patient.

Addressing the gaps in evaluation of new drugs for older adults: Strategies from the International Union of Basic and Clinical Pharmacology (IUPHAR) Geriatric Committee.

The International Union of Basic and Clinical Pharmacology (IUPHAR) Geriatric Committee aims to improve the use of drugs in older adults and develop new therapeutic approaches for the syndromes and diseases of old age through advocacy, education, and research. In the present paper, we propose strategies relevant to drug development and evaluation, spanning preclinical and the full range of clinical studies. Drugs for older adults need to consider not only age, but also other characteristics common in geriatric patients, such as multimorbidity, polypharmacy, falls, cognitive impairment, and frailty.

Evidence-based Medication knowledge Brokers in Residential Aged CarE (EMBRACE): protocol for a helix-counterbalanced randomised controlled trial.

Introduction: Clinical practice guidelines recommend against the routine use of psychotropic medications in residential aged care facilities (RACFs). Knowledge brokers are individuals or groups who facilitate the transfer of knowledge into practice. The objective of this trial is to evaluate the effectiveness and cost-effectiveness of using knowledge brokers to translate Australia's new Clinical Practice Guidelines for the Appropriate Use of Psychotropic Medications in People Living with Dementia and in Residential Aged Care.

The outcomes of considering goals of care in medication reviews for older adults: a systematic review.

Introduction: This is a systematic review of prescribing, clinical, patient-reported, and health utilization outcomes of goal-directed medication reviews in older adults.

Methods: A systematic review was conducted using MEDLINE, EMBASE, SCOPUS and CINAHL databases to identify studies examining outcomes of goal-directed medication reviews in humans, with mean/median age ≥ 60 years and in English.

Results: Seventeen out of 743 articles identified were included.

Beneficial and harmful effects of physical activity on care-seeking for low back pain: the AUTBACK study.

Purpose: People who seek more care for low back pain (LBP) tend to experience poorer recovery (e.g. higher pain and disability levels).

TANGO: Development of Consumer Information Leaflets to Support TAperiNG of Opioids in Older Adults with Low Back Pain and Hip and Knee Osteoarthritis.

Introduction: Globally, the rate of opioid prescription is high for chronic musculoskeletal conditions despite guidelines recommending against their use as their adverse effects outweigh their modest benefit. Deprescribing opioids is a complex process that can be hindered by multiple prescriber- and patient-related barriers. These include fear of the process of, or outcomes from, weaning medications, or a lack of ongoing support.

NEMoE: a nutrition aware regularized mixture of experts model to identify heterogeneous diet-microbiome-host health interactions.

Background: Unrevealing the interplay between diet, the microbiome, and the health state could enable the design of personalized intervention strategies and improve the health and well-being of individuals. A common approach to this is to divide the study population into smaller cohorts based on dietary preferences in the hope of identifying specific microbial signatures. However, classification of patients based solely on diet is unlikely to reflect the microbiome-host health relationship or the taxonomic microbiome makeup.

Invasive and Infections in Australia: A Multicenter Retrospective Cohort Study.

Background: Management of infections remains challenging. We described predisposing factors, clinical manifestations, and outcomes of these rare mold infections, including predictors of early (1-month) and late (18-month) all-cause mortality and treatment failure.

Methods: We conducted a retrospective Australian-based observational study of proven/probable infections from 2005 to 2021.

The effect of physical activity on health outcomes in people with moderate-to-severe traumatic brain injury: a rapid systematic review with meta-analysis.

Background: In 2020, the World Health Organization (WHO) released the first global physical activity and sedentary behaviour guidelines for children and adults living with disability. The evidence informing the guidelines though is not specific to people living with traumatic brain injury (TBI), but rather comes from other disabling conditions such as Parkinson's disease, and stroke. There remains a clear lack of direct evidence of the effects of physical activity for people living with TBI.