Drugs & Aging

, Volume 29, Issue 6, pp 477–494 | Cite as

Evidence-Based Strategies for the Optimization of Pharmacotherapy in Older People

  • Eva Topinková
  • Jean Pierre Baeyens
  • Jean-Pierre Michel
  • Pierre-Olivier Lang
Review Article

Abstract

Geriatric pharmacotherapy represents one of the biggest achievements of modern medical interventions. However, geriatric pharmacotherapy is a complex process that encompasses not only drug prescribing but also age-appropriate drug development and manufacturing, appropriate drug testing in clinical trials, rational and safe prescribing, reliable administration and assessment of drug effects, including adherence measurement and age-appropriate outcomes monitoring. During this complex process, errors can occur at any stage, and intervention strategies to improve geriatric pharmacotherapy are targeted at improving the regulatory processes of drug testing, reducing inappropriate prescribing, preventing beneficial drug underuse and use of potentially harmful drugs, and preventing adverse drug interactions. The aim of this review is to provide an update on selected recent developments in geriatric pharmacotherapy, including age discrimination in drug trials, a new healthcare professional qualification and shared competence in geriatric drug therapy, the usefulness of information and communication technologies, and pharmacogenetics. We also review optimizing strategies aimed at medication adherence focusing on complex elderly patients.

Among the current information technologies, there is sufficient evidence that computerized decision-making support systems are modestly but significantly effective in reducing inappropriate prescribing and adverse drug events across healthcare settings. The majority of interventions target physicians, for whom the scientific concept of appropriate prescribing and the acceptability of the alert system used play crucial roles in the intervention’s success. For prescribing optimization, results of educational intervention strategies were inconsistent. The more promising strategies involved pharmacists or multidisciplinary teams including geriatric medicine services. However, methodological weaknesses including population and intervention heterogeneity do not allow for comprehensive meta-analyses to determine the clinical value of individual approaches.

In relation to drug adherence, a recent meta-analysis of 33 randomized clinical trials in older patients found behavioural interventions had significant effects, and these interventions were more effective than educational interventions. For patients with multiple conditions and polypharmacy, successful interventions included structured medication review, medication regimen simplification, administration aids and medication reminders, but no firm conclusion in favour of any particular intervention could be made. Interventions to optimize geriatric pharmacotherapy focused most commonly on pharmacological outcomes (drug appropriateness, adverse drug events, adherence), providing only limited information about clinical outcomes in terms of health status, morbidity, functionality and overall healthcare costs. Little attention was given to psychosocial and behavioural aspects of pharmacotherapy.

There is sufficient potential for improvements in geriatric pharmacotherapy in terms of drug safety and effectiveness. However, just as we require evidence-based, age-specific, pharmacological information for efficient clinical decision making, we need solid evidence for strategies that consistently improve the quality of pharmacological treatments at the health system level to shape ‘age-attuned’ health and drug policy.

Notes

Acknowledgements

The paper was prepared by the authors without any financial support. The research work of Professor Topinková was partly supported by grant No. NT-10-029-4/2008 IGA Ministry of Health, Czech Republic.

References

  1. 1.
    Stegemann S, Ecker F, Maio M, et al. Geriatric drug therapy: neglecting the inevitable majority. Ageing Res Rev 2010; 9: 384–98PubMedCrossRefGoogle Scholar
  2. 2.
    International Conference on Harmonisation of Technical Requirements for Registration of Pharmaceuticals for Human Use. Final concept paper E7 (R1). Studies in support of special populations: geriatrics. 2008 [online]. Available from URL: http://www.ich.org/fileadmin/Public_Web_Site/ICH_Products/Guidelines/Efficacy/E7/Q_As/E7R1_Final_Concept_Paper.pdf [Accessed 2012 Apr 17]
  3. 3.
    O’Connor MN, Gallagher P, O’Mahony D. Inappropriate prescribing: criteria, detection and prevention. Drugs Aging 2012; 29 (6): 437–52PubMedCrossRefGoogle Scholar
  4. 4.
    Cherubini A, Corsonello A, Lattanzio F. Underprescription of beneficial medicines in older people: causes, consequences and prevention. Drugs Aging 2012; 29 (6): 463–75PubMedCrossRefGoogle Scholar
  5. 5.
    Petrovic M, van der Cammen T, Onder G. Adverse drug reactions in older people: detection and prevention. Drugs Aging 2012; 29 (6): 453–62PubMedCrossRefGoogle Scholar
  6. 6.
    Spinewine A, Fialova D, Byrne S. The role of the pharmacist in optimizing pharmacotherapy in older people. Drugs Aging 2012; 29 (6): 495–510PubMedCrossRefGoogle Scholar
  7. 7.
    Hanlon JT, Handler SM, Maher R, et al. Geriatric pharmacotherapy and polypharmacy. In: Fillit H, Rockwood K, Woodhouse K, editors. Brocklehurst’s textbook of geriatric medicine. 7th ed. London: Churchill Livingstone, 2010: 880–5CrossRefGoogle Scholar
  8. 8.
    Corsonello A, Pedone C, Incalzi RA. Age-related pharmacokinetic and pharmacodynamic changes and related risk of adverse drug reactions. Curr Med Chem 2010; 17: 571–84PubMedCrossRefGoogle Scholar
  9. 9.
    Handler SM, Wright RM, Ruby CM, et al. Epidemiology of medication-related adverse events in nursing homes. Am J Geriatr Pharmacother 2006; 4: 264–72PubMedCrossRefGoogle Scholar
  10. 10.
    van Spall HG, Toren A, Kiss A, et al. Eligibility criteria of randomized controlled trials published in high-impact general medical journals: a systematic sampling review. JAMA 2007; 297: 1233–40PubMedCrossRefGoogle Scholar
  11. 11.
    Cherubini A, Oristrell J, Pla X, et al. The persistent exclusion of older subjects from ongoing clinical trials in heart failure. Arch Intern Med 2011; 171 (6): 550–6PubMedCrossRefGoogle Scholar
  12. 12.
    Crome P, Lally F, Cherubini A, et al. Exclusion of older people from clinical trials: professional views from nine European countries participating in the PREDICT study. Drugs Aging 2011; 28: 1–11CrossRefGoogle Scholar
  13. 13.
    PREDICT [online]. Available from URL: http://www.predicteu.org/index.html [Accessed 2012 Apr 12]
  14. 14.
    Cherubini A, Del Signore S, Ouslander J, et al. Fighting against age discrimination in clinical trials. J Am Geriatr Soc 2010; 58 (9): 1791–6PubMedCrossRefGoogle Scholar
  15. 15.
    Gemmill M. Research note: chronic disease management in Europe. London: The London School of Economics and Political Sciences, for the Commission, Directorate-General “Employment, Social Affairs and Equal Opportunities” Unit E1-Social and Demographic Analysis, 2008Google Scholar
  16. 16.
    Saltvedt I, Spigset O, Ruths S, et al. Patterns of drug prescription in a geriatric evaluation and management unit as compared with the general medical wards: a randomised study. Eur J Clin Pharmacol 2005; 61 (12): 921–8PubMedCrossRefGoogle Scholar
  17. 17.
    Schmader KE, Hanlon JT, Pieper CF, et al. Effects of geriatric evaluation and management on adverse drug reactions and suboptimal prescribing in the frail elderly. Am J Med 2004; 116: 394–401PubMedCrossRefGoogle Scholar
  18. 18.
    Busse R, Blümel M, Scheller-Kreinsen D, et al. Tackling chronic disease in Europe: strategies, interventions and challenges. Observatory Studies Series No. 20. Copenhagen: WHO Regional Office for Europe, on behalf of the European Observatory on Health Systems and Policies, 2010: 111Google Scholar
  19. 19.
    Blum K. Nurse practitioners in Eastern Germany. Health Policy Monitor, 2006 Oct 8 [online]. Available from URL: http://www.hpm.org/survey/de/b8/3 [Accessed 2011 Aug 28]
  20. 20.
    Bernabei R, Onder G, Landi F. Comprehensive care for older adults: case management approach. J Am Geriatr Soc 2010; 58 (6): 1202–3PubMedCrossRefGoogle Scholar
  21. 21.
    Wehling M. Guideline-driven polypharmacy in elderly, multimorbid patients is basically flawed: there are almost no guidelines for these patients. J Am Geriatr Soc 2011; 59 (2): 376–7PubMedCrossRefGoogle Scholar
  22. 22.
    Van den Akker M, Buntinx F, Metsemakers JF, et al. Multimorbidity in general practice: prevalence, incidence, and determinants of co-occurring chronic and recurrent diseases. J Clin Epidemiol 1998; 51: 367–75PubMedCrossRefGoogle Scholar
  23. 23.
    Boyd CM, Darer J, Boult C, et al. Clinical practice guidelines and quality of care for older patients with multiple comorbid diseases: implications for pay for performance. JAMA 2005; 294: 716–24PubMedCrossRefGoogle Scholar
  24. 24.
    Tinetti ME, Bogardus Jr ST, Agostini JV. Potential pitfalls of disease-specific guidelines for patients with multiple conditions. N Engl J Med 2004; 351: 2870–4PubMedCrossRefGoogle Scholar
  25. 25.
    Fusco D, Lattanzio F, Tosato M, et al. Development of CRIteria to assess appropriate Medication use among Elderly complex patients (CRIME) project: rationale and methodology. Drugs Aging. 2009; 26 Suppl. 1: 3–13PubMedCrossRefGoogle Scholar
  26. 26.
    Vogt-Ferrier N. Reviewing a complicated geriatric regimen. Eur Ger Med 2010; 1: 198–202CrossRefGoogle Scholar
  27. 27.
    Pilotto A, Panza F, Seripa D. Pharmacogenetics in geriatric medicine: challenges and opportunities for clinical practice. Curr Drug Metab 2011; 12: 621–34PubMedCrossRefGoogle Scholar
  28. 28.
    Roden DM, Altman RB, Benowitz NL, et al., Pharmacogenetics Research Network. Pharmacogenomics: challenges and opportunities. Ann Intern Med 2006; 145 (10): 749–57PubMedCrossRefGoogle Scholar
  29. 29.
    Pilotto A, Seripa D, Franceschi M, et al. Genetic susceptibility to nonsteroidal anti-inflammatory drug-related gastroduodenal bleeding: role of cytochrome P450 2C9 polymorphisms. Gastroenterology 2007; 133 (2): 465–71PubMedCrossRefGoogle Scholar
  30. 30.
    Higashi MK, Veenstra DL, Kondo LM, et al. Association between CYP2C9 genetic variants and anticoagulation-related outcomes during warfarin therapy. JAMA 2002; 287 (13): 1690–8PubMedCrossRefGoogle Scholar
  31. 31.
    Pilotto A, Franceschi M, D’Onofrio G, et al. Effect of a CYP2D6 polymorphism on the efficacy of donepezil in Alzheimer’s disease patients. Neurology 2009; 73 (10): 761–7PubMedCrossRefGoogle Scholar
  32. 32.
    Savino M, Seripa D, Gallo AP, et al. Effectiveness of a high-throughput genetic analysis in the identification of responders/non-responders to CYP2D6-metabolized drugs. Clin Lab 2011; 57: 887–93PubMedGoogle Scholar
  33. 33.
    Klotz U. Clinical impact of CYP2C19 polymorphism on the action of proton pump inhibitors: a review of a special problem. Int J Clin Pharmacol Ther 2006; 44 (7): 297–302PubMedGoogle Scholar
  34. 34.
    Ulfvarson J, Rahmer PB, Fastbom J, et al. Medication reviews with computerized expert support: evaluation of a method to improve the quality of drug utilization in the elderly. Int J Health Care Qul Assur 2010; 23: 571–82CrossRefGoogle Scholar
  35. 35.
    Hayes TL, Cobbinah K, Dishongh T, et al. A study of medication-taking and unobtrusive, intelligent reminding. Telemed J E Health 2009; 15 (8): 770–6PubMedCrossRefGoogle Scholar
  36. 36.
    Handler SM, Hanlon JT. Detecting adverse drug events using nursing home specific trigger tool. Ann Longterm Care 2010; 18 (5): 17–22PubMedGoogle Scholar
  37. 37.
    Hornick TR, Higgins PA, Stollings C, et al. Initial evaluation of a computer-based medication management tool in a geriatric clinic. Am J Geriatr Pharmacother 2006; 4: 62–9PubMedCrossRefGoogle Scholar
  38. 38.
    Yourman L, Concato J, Agostini JV. Use of computer decision support interventions to improve medication prescribing in older adults: a systematic review. Am J Geriatr Pharmacother 2008; 6: 119–29PubMedCrossRefGoogle Scholar
  39. 39.
    Gurwitz JH, Field TS, Rochon P, et al. Effect of computerized provider order entry with clinical decision support on adverse drug events in the long-term care setting. J Am Geriatr Soc 2008; 56 (12): 2225–33PubMedCrossRefGoogle Scholar
  40. 40.
    Tamblyn R, Huang A, Perreault R, et al. The medical office of the 21st century (MOXXI): effectiveness of computerized decision-making support in reducing inappropriate prescribing in primary care. CMAJ 2003; 169: 549–56PubMedGoogle Scholar
  41. 41.
    Terrell KM, Perkins AJ, Dexter PR, et al. Computerized decision support to reduce potentially inappropriate prescribing to older emergency department patients: a randomized, controlled trial. J Am Geriatr Soc 2009; 57: 1388–94PubMedCrossRefGoogle Scholar
  42. 42.
    Mattison ML, Afonso KA, Ngo LH, et al. Preventing potentially inappropriate medication use in hospitalized older patients with a computerized provider order entry warning system. Arch Intern Med 2010; 170: 1331–6PubMedCrossRefGoogle Scholar
  43. 43.
    Raebel MA, Charles J, Dugan J, et al. Randomized trial to improve prescribing safety in ambulatory elderly patients. J Am Geriatr Soc 2007; 55 (7): 977–85PubMedCrossRefGoogle Scholar
  44. 44.
    van der Sijs H, Aarts J, Vulto A, et al. Overriding of drug safety alerts in computerized physician order entry. J Am Med Inform Assoc 2006; 130: 138–47CrossRefGoogle Scholar
  45. 45.
    Avorn J. Medication use in older patients: better policy could encourage better practice. JAMA 2010; 304 (14): 1606–7PubMedCrossRefGoogle Scholar
  46. 46.
    Jansen PA. Specific needs for research in geriatrics [presentation]. Expertisecentre Pharmacotherapy in Old Persons (EPHOR), 2011 [online]. Available from URL: http://ephor.artsennet.nl/English-website.htm [Accessed 2011 Aug 28]
  47. 47.
    Scott-Cawiezell J, Madsen RW, Pepper GA, et al. Medication safety teams’ guided implementation of electronic medication administration records in five nursing homes. Jt Comm J Qual Patient Saf 2009; 35: 29–35PubMedGoogle Scholar
  48. 48.
    Spinewine A, Schmader K, Barber N, et al. Appropriate prescribing in elderly people: how well can it be measured and optimised? Lancet 2007; 370: 73–84CrossRefGoogle Scholar
  49. 49.
    Kaur S, Mitchell G, Vitetta L, et al. Interventions that can reduce inappropriate prescribing in the elderly: a systematic review. Drugs Aging 2009; 26 (12): 1013–28PubMedCrossRefGoogle Scholar
  50. 50.
    Steinman MA, Hanlon JT. Managing medications in clinically complex elders. JAMA 2010; 304 (14): 1592–601PubMedCrossRefGoogle Scholar
  51. 51.
    Marcum ZA, Handler SV, Wright R, et al. Interventions to improve suboptimal prescribing in nursing homes: a narrative review. Am J Geriatr Pharmacother 2010; 8 (3): 183–200PubMedCrossRefGoogle Scholar
  52. 52.
    Loganathan M, Singh S, Franklin BD, et al. Interventions to optimize prescribing in care homes: systematic review. Age Ageing 2011; 40: 150–62PubMedCrossRefGoogle Scholar
  53. 53.
    Trivalle C, Cartier T, Verny C, et al., for the IMEPAG GROUP. Identifying and preventing adverse drug events in elderly hospitalised patients: a randomised trial of a program to reduce adverse drug effects. J Nutr Health Aging 2010; 14: 57–61PubMedCrossRefGoogle Scholar
  54. 54.
    Crotty M, Halbert J, Rowett D, et al. An outreach geriatric medication advisory service in residential aged care: a randomised controlled trial of case conferencing. Age Ageing 2004; 33: 612–7PubMedCrossRefGoogle Scholar
  55. 55.
    Strandberg TE, Pitkala KH, Berglind S, et al. Multifactorial intervention to prevent recurrent cardiovascular events in patients 75 years or older: the Drugs and Evidence-Based Medicine in the Elderly (DEBATE) study. A randomised controlled trial. Am Heart J 2006; 152: 585–92PubMedCrossRefGoogle Scholar
  56. 56.
    Tulner LR, van Campen JP, Frankfort SV, et al. Changes in under-treatment after comprehensive geriatric assessment: an observational study. Drugs Aging 2010; 27: 831–43PubMedCrossRefGoogle Scholar
  57. 57.
    Lampela P, Hartikainen S, Lavikainen P, et al. Effects of medication assessment as part of a comprehensive geriatric assessment on drug use over a 1-year period: a population-based intervention study. Drugs Aging 2010; 27: 507–21PubMedCrossRefGoogle Scholar
  58. 58.
    Lutters M, Harbarth S, Janssens JP, et al. Impact of a comprehensive, multidisciplinary, educational program on the use of antibiotics in a geriatric university hospital. J Am Geriatr Soc 2004; 52: 112–6PubMedCrossRefGoogle Scholar
  59. 59.
    Hughes CM. Medication non-adherence in the elderly: how big is the problem? Drugs Aging 2004; 21 (12): 793–811PubMedCrossRefGoogle Scholar
  60. 60.
    World Health Organization (WHO). Adherence to long- term therapies: evidence for action. Geneva: WHO, 2003 [online]. Available from URL: http://whqlibdoc.who.int/publications/2003/9241545992.pdf [Accessed 2011 Aug 28]Google Scholar
  61. 61.
    Cooper C, Carpenter I, Katona C, et al. The AdHOC Study of older adults’ adherence to medication in 11 countries. Am J Geriatr Psychiatry 2005; 13 (12): 1067–76PubMedGoogle Scholar
  62. 62.
    Gellad WF, Grenard JL, Marcum ZA. A systematic review of barriers to medication adherence in the elderly: looking beyond cost and regimen complexity. Am J Geriatr Pharmacother 2011; 9: 11–23PubMedCrossRefGoogle Scholar
  63. 63.
    Conn VS, Hafdahl AR, Cooper PS, et al. Interventions to improve medication adherence among older adults: meta-analysis of adherence outcomes among randomized controlled trials. Gerontologist 2009; 49 (4): 447–62PubMedCrossRefGoogle Scholar
  64. 64.
    Haynes R, Ackloo E, Sahota N, et al. Interventions for enhancing medication adherence. Cochrane Database Syst Rev 2008; (4): CD000011Google Scholar
  65. 65.
    Malhotra S, Karan RS, Pandhi P, et al. Drug related medical emergencies in the elderly: role of adverse drug reactions and non-compliance. Postgrad Med 2001; 77: 703–7CrossRefGoogle Scholar
  66. 66.
    Topinkova E, Fialova D, Carpenter GI, et al. Cross-national comparison of drug compliance and non-compliance associated factors in the elderly with polypharmacotherapy. Cas Lek Cesk 2006; 145 (9): 726–32PubMedGoogle Scholar
  67. 67.
    Ingersoll KS, Cohen J. The impact of medication regimen factors on adherence to chronic treatment: a review of literature. J Behav Med 2008; 31: 213–24PubMedCrossRefGoogle Scholar
  68. 68.
    Briesacher BA, Gurwitz JH, Soumerai SB. Patients at-risk for cost-related medication nonadherence: a review of the literature. J Gen Intern Med 2007; 22: 864–71PubMedCrossRefGoogle Scholar
  69. 69.
    Doggrell SA. Adherence to medicines in the older-aged with chronic conditions. Drugs Aging 2010; 27 (3): 239–54PubMedCrossRefGoogle Scholar
  70. 70.
    George J, Elliot RA, Stewart DC. A systematic review of interventions to improve medication taking in elderly patients prescribed multiple medications. Drugs Aging 2008; 25 (4): 307–24PubMedCrossRefGoogle Scholar
  71. 71.
    Williams A, Manias E, Walker R. Interventions to improve medication adherence in people with multiple chronic conditions: a systematic review. J Adv Nurs 2008; 63 (2): 132–43PubMedCrossRefGoogle Scholar
  72. 72.
    Hawe P, Higgins G. Can medication education improve the drug compliance of the elderly? Evaluation of an inhospital program. Patient Educ Couns 1990; 16: 151–60PubMedCrossRefGoogle Scholar
  73. 73.
    Hanlon JT, Weinberger M, Samsa GP, et al. A randomised, controlled trial of a clinical pharmacist intervention to improve inappropriate prescribing in elderly outpatients with polypharmacy. Am J Med 1996; 100: 428–37PubMedCrossRefGoogle Scholar
  74. 74.
    Bernsten C, Bjorkman I, Caramona M, et al. Improving the well-being of elderly patients via community pharmacy-based provision of pharmaceutical care: a multicentre study in seven European countries. Drugs Aging 2001; 18 (1): 63–77PubMedCrossRefGoogle Scholar
  75. 75.
    Grymonpre RE, Williamson DA, Montgomery PR. Impact of a pharmaceutical care model for non-institutionalised elderly: results of a randomised controlled trial. Int J Pharm Prac 2001; 9: 235–41CrossRefGoogle Scholar
  76. 76.
    Nazareth I, Burton A, Shulman S, et al. A pharmacy discharge plan for hospitalized elderly patients — a randomized controlled trial. Age Ageing 2001; 30 (1): 33–40PubMedCrossRefGoogle Scholar
  77. 77.
    Lee JK, Grace KA, Taylor AJ. Effect of a pharmacy care programme on medication adherence and persistence, blood pressure, and low-density lipoprotein cholesterol: a randomized controlled trial. J Am Med Assoc 2006; 296 (21): 2563–71CrossRefGoogle Scholar
  78. 78.
    Sturgess IK, McElnay JC, Hughes CM, et al. Community pharmacy based provision of pharmaceutical care to older patients. Pharm World Sci 2003; 25 (5): 218–26PubMedCrossRefGoogle Scholar
  79. 79.
    Volume CI, Farris KB, Kassam R, et al. Pharmaceutical care research and education project: patient outcomes. J Am Pharm Assoc (Wash) 2001; 41: 411–20Google Scholar
  80. 80.
    Wu JYF, Leung WY, Chang S, et al. Effectiveness of telephone counselling by a pharmacist in reducing mortality in patients receiving polypharmacy: randomised controlled trial. Br Med J 2006; 333 (7567): 522–7CrossRefGoogle Scholar
  81. 81.
    Hayes TL, Larimer N, Adami A, et al. Medication adherence in healthy elders: Small cognitive changes make a big difference. J Aging Health 2009; 21: 567–80PubMedCrossRefGoogle Scholar
  82. 82.
    Insel K, Morrow D, Brewer B, et al. Executive function, working memory, and medication adherence among older adults. J Gerontol 2006; 61: P102–7CrossRefGoogle Scholar
  83. 83.
    Arlt S, Lindner R, Rösler A, et al. Adherence to medication in patients with dementia: predictors and strategies for improvement. Drugs Aging 2008; 25 (12): 1033–47PubMedCrossRefGoogle Scholar
  84. 84.
    Applegate WB, Blass JP, Williams TF. Instruments for functional assessment of older patients. N Engl J Med 1990; 322: 1207–14PubMedCrossRefGoogle Scholar
  85. 85.
    Elliott RA, Marriott JL. Standardized assessment of patients’ capacity to manage medications: a systematic review of published instruments. BMC Geriatr 2009; 9: 27. doi: 10.1186/1471-2318-9–27PubMedCrossRefGoogle Scholar
  86. 86.
    Farris KB, Phillips BB. Instruments assessing capacity to manage medications. Ann Pharmacother 2008; 42: 1026–36PubMedCrossRefGoogle Scholar
  87. 87.
    Edelberg HK, Shallenberger E, Wei JY. Medication management capacity in highly functioning community-living older adults: detection of early deficits. J Am Geriatr Soc 1999; 47: 592–6PubMedGoogle Scholar
  88. 88.
    Orwig D, Brandt N, Gruber-Baldini AL. Medication management assessment for older adults in the community. Gerontologist 2006; 46: 661–8PubMedCrossRefGoogle Scholar
  89. 89.
    Patterson TL, Lacro J, McKibbin CL, et al. Medication management ability assessment: results from a performance-based measure in older outpatients with schizophrenia. J Clin Psychopharmacol 2002; 22: 11–9PubMedCrossRefGoogle Scholar
  90. 90.
    Schmidt KS, Lieto JM. Validity of the Medication Administration Test among older adults with and without dementia. Am J Geriatr Pharmacother 2005; 3: 255–61PubMedCrossRefGoogle Scholar
  91. 91.
    Tran T, Elliott RA, Taylor SE, et al. A self-administration of medications program to identify and address potential barriers to adherence in elderly patients. Ann Pharmacother. Epub 2011 Jan 12Google Scholar
  92. 92.
    Lam P, Elliot RA, George J. Impact of a self-administration of medications programme on elderly inpatients’ competence to manage medications: a pilot study. J Clin Pharm Ther 2011; 36 (1): 80–6PubMedCrossRefGoogle Scholar
  93. 93.
    Huisman-Baron M, van der Veen L, Jansen PA, et al. Criteria for drug selection in frail elderly persons. Drugs Aging 2011; 28 (5): 391–402PubMedCrossRefGoogle Scholar
  94. 94.
    Nolte E, McKee M. Integration and chronic care: a review. In: Nolte E, McKee M, editors. Caring for people with chronic conditions: a health system perspective. Maidenhead: Open University Press, 2008: 64–91Google Scholar
  95. 95.
    O’Neil D. Dialogue at Davos for and aging world. J Am Geriatr Soc 2011; 59: 1540–1CrossRefGoogle Scholar
  96. 96.
    Patterson SM, Hughes CM, Lapane K. Assessment of a United States pharmaceutical care model for nursing homes in the United Kingdom. Pharm World Sci 2007; 29: 517–25PubMedCrossRefGoogle Scholar
  97. 97.
    European Commission. i2010 — A European information society for growth and employment. Brussels: European Commission, 2009 [online]. Available from URL: http://ec.europa.eu/information_society/eeurope/i2010/index_en.htm [Accessed 2011 Aug 28]

Copyright information

© Springer International Publishing AG 2012

Authors and Affiliations

  • Eva Topinková
    • 1
  • Jean Pierre Baeyens
    • 2
  • Jean-Pierre Michel
    • 3
  • Pierre-Olivier Lang
    • 3
  1. 1.Department of Geriatric Medicine, First Faculty of MedicineCharles University in PraguePrague 2Czech Republic
  2. 2.Luxembourg UniversityLuxembourg CityLuxembourg
  3. 3.Department of Internal Medicine, Rehabilitation and GeriatricsGeneva Medical School and University HospitalsGenevaSwitzerland

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