1,721,176 research outputs found
Nutrient (zinc and vitamin E)-gene interactions related to inflammatory and antioxidant response in aging and inflammation
No full textAging is an inevitable biological process with gradual and spontaneous biochemical and physiological changes and increased susceptibility to diseases. Some nutritional factors (zinc and vitamin E) may remodel these changes leading to a possible avoidance of diseases with subsequent healthy aging, because they are involved in improving immune functions and antioxidant defence. The polymorphisms of some genes codifying proteins related to inflammation are predictive on the one hand of longevity, while, on the other hand, they are associated with atherosclerosis. Since the health life span has a strong genetic component, which is in turn also affected by nutritional factors such as zinc and vitamin E, these polymorphisms can be useful tools for establishing the real beneficial effects of zinc or vitamin E in older subjects to prevent or delay as much as possible the appearance of age-related diseases. Therefore, zinc or vitamin E and gene interactions are crucial to healthy aging. © SINPE-GASAPE
Underprescription of beneficial medicines in older adults. Causes, consequences and prevention
No full textUnderprescription of potentially useful drugs is widespread among older people and may herald several adverse outcomes. We aimed to review the evidence pertaining to the epidemiology, causes and consequences of underprescribing, as well as recent advances in the development of interventions able to reduce underprescribing and improve outcomes in older people. Underprescribing is highly prevalent across different settings, including in the community, hospitals and nursing homes. Multimorbidity, polypharmacy, ageism, lack of scientific evidence, fear of adverse events and economic problems may contribute to the underprescription of indicated drugs, although in some patients, a limited life expectancy, the lack of a favourable risk-to-benefit ratio or a patient's refusal might represent appropriate reasons not to prescribe a drug. Selected interventions may help to improve the quality of prescriptions and reduce the burden of underprescribing. Among these, comprehensive geriatric assessment (CGA) has been demonstrated to effectively improve prescribing practice. Interventions based on service delivery changes, such as those that include a clinical pharmacist or a case manager in the process of care, were also found to improve the quality of pharmacological prescriptions. Educational interventions may also be effective in reducing underprescribing. More recently, the clinical application of the Screening Tool to Alert Doctors to Right Treatment (START) criteria has been able to significantly reduce underprescribing. Since START criteria are easier to apply in clinical practice than other instruments, it is conceivable that their systematic use may contribute to reducing underprescribing and to improving health outcomes in older patients
Underprescription of beneficial medicines in older adults. Causes, consequences and prevention
No full textUnderprescription of potentially useful drugs is widespread among older people and may herald several adverse outcomes. We aimed to review the evidence pertaining to the epidemiology, causes and consequences of underprescribing, as well as recent advances in the development of interventions able to reduce underprescribing and improve outcomes in older people. Underprescribing is highly prevalent across different settings, including in the community, hospitals and nursing homes. Multimorbidity, polypharmacy, ageism, lack of scientific evidence, fear of adverse events and economic problems may contribute to the underprescription of indicated drugs, although in some patients, a limited life expectancy, the lack of a favourable risk-to-benefit ratio or a patient's refusal might represent appropriate reasons not to prescribe a drug. Selected interventions may help to improve the quality of prescriptions and reduce the burden of underprescribing. Among these, comprehensive geriatric assessment (CGA) has been demonstrated to effectively improve prescribing practice. Interventions based on service delivery changes, such as those that include a clinical pharmacist or a case manager in the process of care, were also found to improve the quality of pharmacological prescriptions. Educational interventions may also be effective in reducing underprescribing. More recently, the clinical application of the Screening Tool to Alert Doctors to Right Treatment (START) criteria has been able to significantly reduce underprescribing. Since START criteria are easier to apply in clinical practice than other instruments, it is conceivable that their systematic use may contribute to reducing underprescribing and to improving health outcomes in older patients
Inappropriate drug prescriptions among older nursing home residents: the Italian perspective
No full textOlder people take up a large proportion of health care, including drugs, and evidence shows that drug prescribing to this group is often inappropriate. Negative consequences of potential inappropriate drug prescription (PIDP) include adverse drug events, high healthcare service utilization and high costs for the patients and society. Although nursing home residents are the most vulnerable persons exposed to PIDP, few observational studies have investigated the prevalence, the factors associated with and the consequences of PIDP. Epidemiological studies assessing PIDP mainly based on the Beers' criteria showed that approximately half of US and Canadian nursing home residents have at least one PIDP in this setting. The most frequent inappropriate prescriptions concern neuroleptics and long-term benzodiazepines. Nursing home residents aged 80 years or more, those taking a low number of drugs, cognitive or communication problems are less exposed to PIDP compared with residents younger than 80 years, living in facilities with a high number of beds and a lower registered nurse-to-resident ratio. In European countries, the prevalence of PIDP among older nursing home residents was comparable to or higher than that observed in US and Canadian nursing homes. To date, the issue of PIDP has never been investigated in a representative sample of Italian nursing home residents. In a preliminary study performed by our group in 496 nursing home residents randomly selected from 40 nursing homes in Umbria, the prevalence of residents taking at least one or two inappropriate medications was 28% and 7%, respectively. The prevalence of PIDP considering diagnosis (18%) as well as those regardless of diagnosis (17%), as determined by Beers' criteria, were equally distributed in older Italian nursing home residents and no difference was found between sexes. Overall, this review reveals that the prevalence of PIDP is high in both North American and European nursing homes and highlights the urgent need for intervention trials testing strategies to reduce the health and social burden of PIDP
Inappropriate drug prescriptions among older nursing home residents: the Italian perspective
No full textOlder people take up a large proportion of health care, including drugs, and evidence shows that drug prescribing to this group is often inappropriate. Negative consequences of potential inappropriate drug prescription (PIDP) include adverse drug events, high healthcare service utilization and high costs for the patients and society. Although nursing home residents are the most vulnerable persons exposed to PIDP, few observational studies have investigated the prevalence, the factors associated with and the consequences of PIDP. Epidemiological studies assessing PIDP mainly based on the Beers' criteria showed that approximately half of US and Canadian nursing home residents have at least one PIDP in this setting. The most frequent inappropriate prescriptions concern neuroleptics and long-term benzodiazepines. Nursing home residents aged 80 years or more, those taking a low number of drugs, cognitive or communication problems are less exposed to PIDP compared with residents younger than 80 years, living in facilities with a high number of beds and a lower registered nurse-to-resident ratio. In European countries, the prevalence of PIDP among older nursing home residents was comparable to or higher than that observed in US and Canadian nursing homes. To date, the issue of PIDP has never been investigated in a representative sample of Italian nursing home residents. In a preliminary study performed by our group in 496 nursing home residents randomly selected from 40 nursing homes in Umbria, the prevalence of residents taking at least one or two inappropriate medications was 28% and 7%, respectively. The prevalence of PIDP considering diagnosis (18%) as well as those regardless of diagnosis (17%), as determined by Beers' criteria, were equally distributed in older Italian nursing home residents and no difference was found between sexes. Overall, this review reveals that the prevalence of PIDP is high in both North American and European nursing homes and highlights the urgent need for intervention trials testing strategies to reduce the health and social burden of PIDP
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