University of Groningen Deprescribing in older people van der Meer, Helene Grietje IMPORTANT NOTE: You are advised to consult the publisher's version (publisher's PDF) if you wish to cite from it. Please check the document version below. Document Version Publisher's PDF, also known as Version of record Publication date: 2019 Link to publication in University of Groningen/UMCG research database Citation for published version (APA): van der Meer, H. G. (2019). Deprescribing in older people: development and evaluation of complex healthcare interventions. Rijksuniversiteit Groningen. Copyright Other than for strictly personal use, it is not permitted to download or to forward/distribute the text or part of it without the consent of the author(s) and/or copyright holder(s), unless the work is under an open content license (like Creative Commons). The publication may also be distributed here under the terms of Article 25fa of the Dutch Copyright Act, indicated by the “Taverne” license. 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Download date: 30-09-2021 UITNODIGING DEPRESCRIBING PEOPLE IN OLDER Voor het bijwonen van de openbare verdediging van het proefschrift: DEPRESCRIBING IN OLDER PEOPLE DEPRESCRIBING Development and evaluation of complex IN OLDER PEOPLE healthcare interventions Helene Grietje (Heleen) van der Meer was born on Development and evaluation of complex door healthcare interventions 5 August 1990 in Papenburg, Germany, to Wytze Jan HELEEN VAN DER MEER van der Meer, dentist, and Klaaske van der Meer- Jansen, cardiac care nurse. She grew up in Germany together with her younger sister and brother. In 2009 Heleen van der Meer op vrijdag she obtained her Abitur (final exam) at the Gymnasium 2 november om 16.15 Papenburg and started her studies in pharmacy at the in het Academiegebouw University of Groningen. van de Rijkuniversiteit Groningen, Broerstraat 5 Heleen first became acquainted with research in the te Groningen. Heleen vanHeleen der Meer field of pharmacotherapy during her Bachelors studies. The foundation for her doctoral thesis was laid during Na afloop bent u van harte uitgenodigd the project she undertook in Sydney, Australia under voor de receptie supervision of Dr. Lisa Pont and Prof. Dr. Katja Taxis for in het Academiegebouw. her Masters in Pharmacy in 2013/14. On her return to the Netherlands, she accepted a temporary appoint- ment as a researcher with Prof. Taxis and in the same Heleen van der Meer year gave her first podium presentation at an inter- Helmersstraat 36 national scientific conference in Boston, US. She was 2513 RZ Den Haag awarded her Masters in Pharmacy in 2016 and com- 0648897302 pleted her PhD in 2018. Heleen lives in The Hague and [email protected] works as a postdoctoral researcher under supervision of Prof. Taxis on the development and implementation of patient material for deprescribing in older people. PARANIMFEN In addition to her studies and PhD research, Heleen has Karlien Sambell been active within various committees. For example, [email protected] in 2016/17 she organized the PhD Day, a career event for 900 PhD students/postdocs. Furthermore she loves Linda van Eikenhorst tennis and sailing and she has a passion for traveling. [email protected] DEPRESCRIBING IN OLDER PEOPLE Development and evaluation of complex healthcare interventions Heleen van der Meer Deprescribing in older people Deprescribing in older people Development and evaluation of complex healthcare interventions Development and evaluation of complex healthcare interventions Proefschrift Proefschrift ter verkrijging van de graad van doctor aan de Rijksuniversiteit Groningen Colophon ter verkrijging op gezagvan van de de graad van doctor aan de The research presented in this thesis was financially supported by the Royal rector magnificusRijksuniversiteit prof. dr. E. SterkenGroningen Dutch Pharmacists Association (KNMP) and Stichting Stoffels Hornstra. en volgens besluit van hetop College gezag voorvan de Promoties. rector magnificus prof. dr. E. Sterken Cover concept: Heleen van der Meer De openbareen volgens verdediging besluit van zal het plaatsvinden College voor op Promoties. Cover and layout design: Lovebird design. www.lovebird-design.com vrijdagDe openbare 22 maart verdediging2019 om 16.15 zal uur plaatsvinden op Printing: Eikon+ vrijdag 2 november 2018 om 16.15 uur ISBN (e-book): 978-94-034-0954-2 ISBN (printed book): 978-94-034-0955-9 door Printing of this thesis was financially supported by the Groningen Graduate door School of Science and Engineering (GSSE), the University of Groningen and Stichting Koninklijke Nederlandse Maatschappij ter Bevordering der Pharmacie (KNMP) Fondsen, and is gratefully acknowledged. Helene Grietje van der Meer © Copyright, 2018, Heleen van der Meer geborenHelene op 5Grietje augustus van1990 der Meer All rights reserved. No part of this publication may be reproduced or transmit- te Papenburg, Duitsland ted in any form or by any means, without written permission of the author. geboren op 5 augustus 1990 te Papenburg, Duitsland Promotor CONTENTS Prof. dr. K. Taxis Dr. L.G. Pont CHAPTER 1 General Introduction And Thesis Outline 7 Co-promotor Dr. H. Wouters CHAPTER 2 Changes In Prescribing Symptomatic And Beoordelingscommissie Prof. dr. P. Denig Preventive Medications In The Last Year Of Prof. dr. M.L. Bouvy Life In Older Nursing Home Residents 19 Prof. dr. R.H. Vander Stichele CHAPTER 3 Anticholinergic and sedative medication use in older community-dwelling people: a national population study in the Netherlands 43 CHAPTER 4 Decreasing the load? Is a multidisciplinary multistep medication review in older people an effective intervention to reduce a patient’s drug burden index? Protocol of a randomised controlled trial 63 CHAPTER 5 Reducing the anticholinergic and sedative load in older patients on polypharmacy by pharmacist-led medication review: A randomised controlled trial 81 CHAPTER 6 Feasibility, acceptability and potential effectiveness of an information technology based, pharmacist-led intervention to prevent an increase in anticholinergic and sedative load among older community-dwelling individuals. 109 CHAPTER 7 General discussion 137 CHAPTER 8 Summary 151 Samenvatting 157 Acknowledgements — Dankwoord 163 List of publications 169 Deprescribing in older people General introduction and thesis outline 1 CHAPTER 1 GENERAL INTRODUCTION AND THESIS OUTLINE 6 7 General introduction and thesis outline PRESCRIBING IN OLDER PEOPLE Worldwide, the population of older people is estimated to in- 1 crease from 524 million in 2010 to 1.5 billion in 2050. [1] With ageing, the number of individuals with one or more chronic dis- eases is growing. [2] Medications are the most common interven- tion to cure, prevent or relief symptoms of a disease. Older people aged 65 years and over use more medications than any other age group, 45–75% of this population uses 5 or more medications and 15–30% uses 10 or more medications. [3] Several important factors complicate medication use in older people. Firstly, use of multiple medications increases the risk to experience adverse drug reactions (ADR). [4] Secondly, age-re- lated changes in pharmacokinetic and dynamic responses to a medication may decrease an older person’s tolerance to medi- cations. [5] Thirdly, scientific evidence on benefits and risks of medications in older people is often absent, as frail older people are rarely included in clinical trials to evaluate medication effi- cacy and safety. [6] Prescribing of medications that might be inappropriate in older people has been widely studied. A number of definitions of po- tentially inappropriate prescribing (PIP) have been proposed and several criteria have been developed to detect PIP. [7, 8] The screening tool of older people’s prescriptions (STOPP) and screen- ing tool to alert to right treatment (START) criteria [9] and Beers criteria [10] are among the best known. PIP is common among older people [11–14] and has been associated with increased ADRs, morbidity, hospitalisations and decreased quality of life. [15–20] In this thesis, potentially inappropriate prescribing in two specific patient populations is explored. Firstly, prescribing of preventive medications at the end of life in older nursing home residents. Secondly, prescribing of anticholinergic and sedative medications in older community-dwelling patients. 9 Deprescribing in older people General introduction and thesis outline PREVENTIVE MEDICATIONS AT THE END OF LIFE DEPRESCRIBING Toward the end of life, in addition to considerations around The term deprescribing was first introduced in Australia, in 2003. 1 potential medication related benefits and harms, the decision [33] While the term was new, the process of withdrawing inap- to prescribe a medication should also take life expectancy into propriate medications was not. [34] Since the introduction of the consideration. As life expectancy decreases, the goals of care may term deprescribing, several definitions have been proposed. Based change from decreasing mortality