Polypharmacy is associated with a variety of adverse outcomes in older adults including falls, adverse drug events, hospitalization, mortality, and measures of function and cognition.1 Primary care providers seek tools to address polypharmacy.2 This medication review worksheet facilitates a targeted chart review, the development of an indication-matched medication list, and the use of available resources related to potentially inappropriate medications,3,4,5,6 common disease-specific guidelines,7,8,9,10 and helpful calculators11,12,13,14 to develop an evidence-based deprescribing plan for use in geriatric primary care patients.
1. Fried, TR, O'Leary J, Towle V, et al. Health outcomes assoicated with polypharmacy in community-dwelling older adults: a systematic review. J Am Geriatr Soc, 62: 2261-2272, 2014.
2. Anthierens S, Tansens A, Petrovic M, et al. Qualitative insights into general practitioners views on polypharmacy. BMC Family Practice, 11(65): 1-6, 2010.
3. American Geriatrics Society 2015 Beers Criteria Update Expert Panel. American Geriatrics Society 2015 Updated Beers criteria for potentially inappropriate medication use in older adults. J Am Geriatr Soc, Epub ahead of print, 2015.
4. Steinman MA, Beizer JL, DuBeau CE, et al. How to use the American Geriatrics Society 2015 Beers criteria-a guide for patients, clinicians, health systems, and payors. J Am Geriatr Soc, Epub ahead of print, 2015.
5. Hanlon JT, Semla TP, Schmader KE. Alternative medications for medications in the use of high-risk medications in the elderly and potentially harmful drug-disease interactions in the elderly quality measures. J Am Geriatr Soc, Epub ahead of print, 2015.
6. O'Mahony D, O'Sullivan D, Byrne S, et al. STOPP/START criteria for potentially inappropriate prescribing in odler people: version 2. Age and Ageing, 0:1-6, 2014.
7. James PA, Oparil S, Carter BL, et al. 2014 Evidence-based guideline for the management of high blood pressure in adults: report from the panel members appointed to the Eight Joint National Committee (JNC 8). JAMA, 311(5): 507-20, 2014.
8. Stone NJ, Robinson J, Lichtenstein AH, et al. 2013 ACC/AHA Guideline on the treatment of blood cholesterol to reduce atherosclerotic cardiovascular risk in adults: a report of the American College of Cardiology/American Heart Association task force on practice guidelines. Circulation, 129(25 Suppl 2):S1-45, 2014.
9. American Geriatrics Society Expert Panel on the Care of Older Adults with Diabetes Mellitus. Guidelines abstracted from the American Geriatrics Society guidelines for improving the care of older adults with diabetes mellitus: 2013 update. J Am Geriatr Soc, 61:2020-26, 2013.
10. American Diabetes Association. Standards of medical care in diabetes-2014. Diabetes Care, 37(S1):14-80, 2014.
11. Multiple creatinine clearance methods. Global RPh. Available http://www.globalrph.com/multiple_crcl_2012.htm
12. Hwang C. CHA2DS2-VASc score for atrial fibrillation stroke risk. MD+Calc. Available http://www.mdcalc.com/cha2ds2-vasc-score-for-atrial-fibrillation-stroke-risk/
13. Andrade, J. HAS-BLED Score. QxMD. Available http://www.qxmd.com/calculate-online/cardiology/has-bled-score-bleeding-in-atrial-fibrillation
14. 2013 Prevention Guidelines Tools: CV Risk Calculator. American Heart Association and American College of Cardiology. Available at http://my.americanheart.org/professional/StatementsGuidelines/PreventionGuidelines/Prevention-Guidelines_UCM_457698_SubHomePage.jsp
This medication review worksheet will help trainees to:
1. Complete a targeted chart review
2. Reconcile a patient's medications by indication
3. Develop an evidence-based strategy for deprescribing potentially inappropriate medications