3,007 research outputs found
Multimorbidity and polypharmacy in the elderly: lessons from REPOSI
No full textThe dramatic demographic changes that are occurring in the third millennium are modifying the mission of generalist professionals such as primary care physicians and internists. Multiple chronic diseases and the related prescription of multiple medications are becoming typical problems and present many challenges. Unfortunately, the available evidence regarding the efficacy of medications has been generated by clinical trials involving patients completely different from those currently admitted to internal medicine: much younger, affected by a single disease and managed in a highly controlled research environment. Because only registries can provide information on drug effectiveness in real-life conditions, REPOSI started in 2008 with the goal of acquiring data on elderly people acutely admitted to medical or geriatric hospital wards in Italy. The main goals of the registry were to evaluate drug prescription appropriateness, the relationship between multimorbidity/polypharmacy and such cogent outcomes as hospital mortality and re-hospitalization, and the identification of disease clusters that most often concomitantly occur in the elderly. The findings of 3-yearly REPOSI runs (2008, 2010, 2012) suggest the following pertinent tasks for the internist in order to optimally handle their elderly patients: the management of multiple medications, the need to become acquainted with geriatric multidimensional tools, the promotion and implementation of a multidisciplinary team approach to patient health and care and the corresponding involvement of patients and their relatives and caregivers. There is also a need for more research, tailored to the peculiar features of the multimorbid elderly patient
Multimorbidity and polypharmacy in the elderly: Lessons from REPOSI
No full textThe dramatic demographic changes that are
occurring in the third millennium are modifying the mission
of generalist professionals such as primary care physicians
and internists. Multiple chronic diseases and the
related prescription of multiple medications are becoming
typical problems and present many challenges. Unfortunately,
the available evidence regarding the efficacy of
medications has been generated by clinical trials involving
patients completely different from those currently admitted
to internal medicine: much younger, affected by a single
disease and managed in a highly controlled research
environment. Because only registries can provide information
on drug effectiveness in real-life conditions,
REPOSI started in 2008 with the goal of acquiring data on
elderly people acutely admitted to medical or geriatric
hospital wards in Italy. The main goals of the registry were
to evaluate drug prescription appropriateness, the relationship
between multimorbidity/polypharmacy and such
cogent outcomes as hospital mortality and re-hospitalization,
and the identification of disease clusters that most
often concomitantly occur in the elderly. The findings of
3-yearly REPOSI runs (2008, 2010, 2012) suggest the
following pertinent tasks for the internist in order to
optimally handle their elderly patients: the management of
multiple medications, the need to become acquainted with
geriatric multidimensional tools, the promotion and
implementation of a multidisciplinary team approach to
patient health and care and the corresponding involvement
of patients and their relatives and caregivers. There is also
a need for more research, tailored to the peculiar features of
the multimorbid elderly patien
Multimorbidity and polypharmacy in the elderly: lessons from REPOSI.
No full textThe dramatic demographic changes that are occurring in the third millennium are modifying the mission of generalist professionals such as primary care physicians and internists. Multiple chronic diseases and the related prescription of multiple medications are becoming typical problems and present many challenges. Unfortunately, the available evidence regarding the efficacy of medications has been generated by clinical trials involving patients completely different from those currently admitted to internal medicine: much younger, affected by a single disease and managed in a highly controlled research environment. Because only registries can provide information on drug effectiveness in real-life conditions, REPOSI started in 2008 with the goal of acquiring data on elderly people acutely admitted to medical or geriatric hospital wards in Italy. The main goals of the registry were to evaluate drug prescription appropriateness, the relationship between multimorbidity/polypharmacy and such cogent outcomes as hospital mortality and re-hospitalization, and the identification of disease clusters that most often concomitantly occur in the elderly. The findings of 3-yearly REPOSI runs (2008, 2010, 2012) suggest the following pertinent tasks for the internist in order to optimally handle their elderly patients: the management of multiple medications, the need to become acquainted with geriatric multidimensional tools, the promotion and implementation of a multidisciplinary team approach to patient health and care and the corresponding involvement of patients and their relatives and caregivers. There is also a need for more research, tailored to the peculiar features of the multimorbid elderly patient
MULTIMORBIDITY AND POLYPHARMACY IN THE ELDERLY: LESSONS FROM REPOSI
No full textThe dramatic demographic changes that are occurring in the third millennium are modifying the mis-sion of generalist professionals such as primary care phy-sicians and internists. Multiple chronic diseases and the related prescription of multiple medications are becoming typical problems and present many challenges. Unfortu-nately, the available evidence regarding the efficacy of medications has been generated by clinical trials involving patients completely different from those currently admitted to internal medicine: much younger, affected by a single disease and managed in a highly controlled research environment. Because only registries can provide infor-mation on drug effectiveness in real-life conditions, REPOSI started in 2008 with the goal of acquiring data on elderly people acutely admitted to medical or geriatric hospital wards in Italy. The main goals of the registry were to evaluate drug prescription appropriateness, the rela-tionship between multimorbidity/polypharmacy and such cogent outcomes as hospital mortality and re-hospitaliza-tion, and the identification of disease clusters that most often concomitantly occur in the elderly. The findings of 3-yearly REPOSI runs (2008, 2010, 2012) suggest the following pertinent tasks for the internist in order to optimally handle their elderly patients: the management of multiple medications, the need to become acquainted with geriatric multidimensional tools, the promotion and implementation of a multidisciplinary team approach to patient health and care and the corresponding involvement of patients and their relatives and caregivers. There is also a need for more research, tailored to the peculiar features of the multimorbid elderly patient
Correction to: Hyperglycemia at admission, comorbidities, and in-hospital mortality in elderly patients hospitalized in internal medicine wards: data from the RePoSI Registry
Get PDFCorrection to: Acta Diabetologica
https:// doi. org/ 10. 1007/ s00592- 021- 01716-8
Authors would like to update the list of Reposi Investigators as collaborators and update "on behalf of the RePoSi Col-laborators" to the end of authors list.
The original article has been correcte
Prescription of ACE-Is/ARBs in patients with cardio-renal disease: a multicenter retrospective cohort study from the REPOSI registry
No full textCardio-renal disease is a common clinical condition leading to increased morbidity and mortality. Angiotensin-converting enzyme inhibitors (ACE-Is) and angiotensin II receptor blockers (ARBs) are the cornerstone of treatment of chronic cardio-renal disease. Using data from the REPOSI register, we performed a multicenter, observational, retrospective study to determine which factors are associated with the non-prescription or discontinuation of ACE-Is/ARBS in a cohort of 889 cardio-renal patients hospitalized in 109 Italian internal medicine and geriatric wards. Only 55% of the patients with cardio-renal disease of the investigated cohort were on treatment with ACE-Is or ARBs at admission. The primary end point was ACE-Is/ARBs use at discharge. Patients with lower probability of receiving ACE-Is/ARBs at discharge were older and hospitalized for longer periods. Furthermore, patients with advanced chronic kidney disease (advanced CKD: eGFR ≤ 29 mL/min/1.73m2) had a much lower (54%) probability of being discharged or continuing ACE-Is/ARBs treatment than those with eGFR ≥ 60 mL/min/1.73m2. A more prominent lower probability was found comparing advanced CKD patients with G3 stage CKD patients (eGFR: 59–30 mL/min/1.73m2) in multivariate analyses (OR and 95%CI: 0.37, 0.24–0.57. multivariate p-value < 0.001). The probability of stopping treatment in patients already on treatment with ACE-Is/ARBs at hospital admission (secondary end point) almost reached a threefold increase (OR and 95%CI: 2.82, 1.69–4.71. multivariate p-value < 0.001) when the advanced CKD group was compared with G3 CKD patients. The data of our study are not in line with the recently published updated KDIGO 2024 Guidelines, which recommend patients with advanced CKD to continue treatment with ACE-Is/ARBs
Prescription appropriateness of anti-diabetes drugs in elderly patients hospitalized in a clinical setting: evidence from the REPOSI Register
No full textDiabetes is an increasing global health burden with the highest prevalence (24.0%) observed in elderly people. Older diabetic adults have a greater risk of hospitalization and several geriatric syndromes than older nondiabetic adults. For these conditions, special care is required in prescribing therapies including anti- diabetes drugs. Aim of this study was to evaluate the appropriateness and the adherence to safety recommendations in the prescriptions of glucose-lowering drugs in hospitalized elderly patients with diabetes. Data for this cross-sectional study were obtained from the REgistro POliterapie-Societa Italiana Medicina Interna (REPOSI) that collected clinical information on patients aged >= 65 years acutely admitted to Italian internal medicine and geriatric non-intensive care units (ICU) from 2010 up to 2019. Prescription appropriateness was assessed according to the 2019 AGS Beers Criteria and anti-diabetes drug data sheets.Among 5349 patients, 1624 (30.3%) had diagnosis of type 2 diabetes. At admission, 37.7% of diabetic patients received treatment with metformin, 37.3% insulin therapy, 16.4% sulfonylureas, and 11.4% glinides. Surprisingly, only 3.1% of diabetic patients were treated with new classes of anti- diabetes drugs. According to prescription criteria, at admission 15.4% of patients treated with metformin and 2.6% with sulfonylureas received inappropriately these treatments. At discharge, the inappropriateness of metformin therapy decreased (10.2%, P < 0.0001). According to Beers criteria, the inappropriate prescriptions of sulfonylureas raised to 29% both at admission and at discharge. This study shows a poor adherence to current guidelines on diabetes management in hospitalized elderly people with a high prevalence of inappropriate use of sulfonylureas according to the Beers criteria
Correction to: Prescription appropriateness of anti-diabetes drugs in elderly patients hospitalized in a clinical setting: evidence from the REPOSI Register
Get PDFDiabetes is an increasing global health burden with the highest prevalence (24.0%) observed in elderly people. Older diabetic adults have a greater risk of hospitalization and several geriatric syndromes than older nondiabetic adults. For these condi- tions, special care is required in prescribing therapies including anti- diabetes drugs. Aim of this study was to evaluate the appropriateness and the adherence to safety recommendations in the prescriptions of glucose-lowering drugs in hospital- ized elderly patients with diabetes. Data for this cross-sectional study were obtained from the REgistro POliterapie–Società Italiana Medicina Interna (REPOSI) that collected clinical information on patients aged ≥ 65 years acutely admitted to Ital- ian internal medicine and geriatric non-intensive care units (ICU) from 2010 up to 2019. Prescription appropriateness was assessed according to the 2019 AGS Beers Criteria and anti-diabetes drug data sheets.Among 5349 patients, 1624 (30.3%) had diagnosis of type 2 diabetes. At admission, 37.7% of diabetic patients received treatment with metformin, 37.3% insulin therapy, 16.4% sulfonylureas, and 11.4% glinides. Surprisingly, only 3.1% of diabetic patients were treated with new classes of anti- diabetes drugs. According to prescription criteria, at admission 15.4% of patients treated with metformin and 2.6% with sulfonylureas received inappropriately these treatments. At discharge, the inappropriateness of metformin therapy decreased (10.2%, P < 0.0001). According to Beers criteria, the inappropriate prescriptions of sulfonylureas raised to 29% both at admission and at discharge. This study shows a poor adherence to current guidelines on diabetes management in hospitalized elderly people with a high prevalence of inappropriate use of sulfonylureas according to the Beers criteria
Hyperglycemia at admission, comorbidities, and in-hospital mortality in elderly patients hospitalized in internal medicine wards: data from the RePoSI Registry
Get PDFAims: The association between hyperglycemia at hospital admission and relevant short- and long-term outcomes in elderly population is known. We assessed the effects on mortality of hyperglycemia, disability, and multimorbidity at admission in internal medicine ward in patients aged ≥ 65 years.
Methods: Data were collected from an active register of 102 internal medicine and geriatric wards in Italy (RePoSi project). Patients were recruited during four index weeks of a year. Socio-demographic data, reason for hospitalization, diagnoses, treatment, severity and comorbidity indexes (Cumulative Illness rating Scale CIRS-SI and CIRS-CI), renal function, functional (Barthel Index), and cognitive status (Short Blessed Test) and mood disorders (Geriatric Depression Scale) were recorded. Mortality rates were assessed in hospital 3 and 12 months after discharge.
Results: Of the 4714 elderly patients hospitalized, 361 had a glycemia level ≥ 250 mg/dL at admission. Compared to subjects with lower glycemia level, patients with glycemia ≥ 250 mg/dL showed higher rates of male sex, smoke and class III obesity. These patients had a significantly lower Barthel Index (p = 0.0249), higher CIRS-SI and CIRS-CI scores (p = 0.0025 and p = 0.0013, respectively), and took more drugs. In-hospital mortality rate was 9.2% and 5.1% in subjects with glycemia ≥ 250 and < 250 mg/dL, respectively (p = 0.0010). Regression analysis showed a strong association between in-hospital death and glycemia ≥ 250 mg/dL (OR 2.07; [95% CI 1.34-3.19]), Barthel Index ≤ 40 (3.28[2.44-4.42]), CIRS-SI (1.87[1.27-2.77]), and male sex (1.54[1.16-2.03]).
Conclusions: The stronger predictors of in-hospital mortality for older patients admitted in general wards were glycemia level ≥ 250 mg/dL, Barthel Index ≤ 40, CIRS-SI, and male sex
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