Contenuto dell'articolo principale
Abstract
INTRODUZIONE: La popolazione anziana, fragile, affetta da cronicità e in politerapia, spesso vive esperienze di reazioni o effetti avversi farmaco-correlati. Il deprescribing è un processo sistematico di identificazione e di interruzione di farmaci nei momenti in cui i danni potenziali o esistenti superano i benefici potenziali. Il deprescribing è un processo multidisciplinare, in cui il ruolo dell’infermiere necessita di essere approfondito.
METODO: è stata condotta una revisione della letteratura partendo dalle banche dati: PubMed, Cinahl, Scopus e Cochrane Library.
RISULTATI: sono stati inclusi quattordici articoli che hanno discusso il ruolo infermieristico nel processo di deprescribing. L’infermiere somministra la terapia e valuta gli effetti positivie negativi dei farmaci, si confronta col medico per eventuali sospensioni o riduzioni della terapia. Discute con l’assistito della terapia, comprendendo le convinzioni dell’assistito rispetto ai farmaci ed evidenziando il “burden” della politerapia. Educa e coinvolge l’assistito nel processo di deprescribing, confrontandosi con esso e con i famigliari e il caregiver. Per avere migliori esiti dal deprescribing è necessaria la collaborazione multidisciplinare e il confronto all’interno dell’equipe. Gli infermieri sono consapevoli di avere un ruolo nel processo dei deprescribing, ma chiedono maggiore formazione evidence based.
CONCLUSIONI: l’infermiere ha un ruolo importante nell’implementare il processo di depre-scribing. La formazione al deprescribing deve essere incentivata, per un agire professionale più consapevole e responsabile. Nessuno degli articoli revisionati si riferiva al contesto italiano, i risultati pertanto potrebbero non essere del tutto applicabili. Andrebbero effettuati studi rela-tivi al deprescribing nel contesto italiano.
PAROLE CHIAVE: de-prescrizione, poli-terapia, popolazione anziana, ruolo infermieristico
Parole chiave
Dettagli dell'articolo
Riferimenti
- Ailabouni, N., Tordoff, J., Mangin, D., & Nishtala, P. S. (2017). Do residents need all their medications? A cross-sectional survey of RNs’ views on deprescribing and the role of clinical pharmacists. Journal of Gerontological Nursing, 43(10), 13–20. https://doi.org/ 10.3928/ 00989134-20170914-05
- Brandt, N. J. (2016). Optimizing Medication Use Through Deprescribing. Journal of Gerontological Nursing, 42(1), 10–14. https://doi.org/10.3928/00989134-20151218-08
- Burato, S., Leonardi, L., Antonazzo, I. C., Raschi, E., Ajolfi, C., Baraghini, M., Chiarello, A., Delmonte, V., Di Castri, L., Donati, M., Fadda, A., Fedele, D., Ferretti, A., Gabrielli, L., Gobbi, S., Lughi, S., Mazzari, M., Pieraccini, F., Renzetti, A., … Poluzzi, E. (2021). Comparing the Prevalence of Polypharmacy and Potential Drug-Drug Interactions in Nursing Homes and in the Community Dwelling Elderly of Emilia Romagna Region. Frontiers in Pharmacology, 11(February), 1–7. https://doi.org/ 10.3389/fphar.2020.624888
- Foley, R.-A., Hurard, L. L., Cateau, D., Koutaissoff, D., Bugnon, O., & Niquille, A. (2020). Physicians’, Nurses’ and Pharmacists’ Perceptions of Determinants to Deprescribing in Nursing Homes Considering Three Levels of Action: A Qualitative Study. Pharmacy (Basel, Switzerland), 8(1). https://doi.org/10.3390/ pharmacy 8010017
- Fournier, A., Anrys, P., Beuscart, J.-B., Dalleur, O., Henrard, S., Foulon, V., & Spinewine, A. (2020). Use and Deprescribing of Potentially Inappropriate Medications in Frail Nursing Home Residents. Drugs and Aging, 37(12), 917–924. https://doi.org/10.1007/s40266-020-00805-7
- Kaufman, G. (2018). Polypharmacy in older people: The need for deprescribing. Practice Nursing, 29(8), 390–396. https://doi.org/10.12968/pnur.2018.29.8.390
- Koller, K., & Rockwood, K. (2013). Frailty in older adults: implications for end-of-life care. Cleveland Clinic Journal of Medicine, 80(3), 168–174. https://doi.org /10.3949/ccjm.80a.12100
- Linsky, A., Meterko, M., Bokhour, B. G., Stolzmann, K., & Simon, S. R. (2019). Deprescribing in the context of multiple providers: Understanding patient preferences. American Journal of Managed Care, 25(4), 192–198.
- Liu, L. M. (2014). Deprescribing: An Approach to Reducing Polypharmacy in Nursing Home Residents. Journal for Nurse Practitioners, 10(2), 136–139. https://doi.org/ 10.1016/j.nurpra.2013.09.010
- Lo, S. Y., Reeve, E., Page, A. T., Zaidi, S. T. R., Hilmer, S. N., Etherton-Beer, C., McLachlan, A., Pont, L., Naganathan, V., Tabish, S., Sarah, R. Z., Etherton, C., Andrew, B., Lisa, M., & Vasi, P. (2021). Attitudes to Drug Use in Residential Aged Care Facilities: A Cross-Sectional Survey of Nurses and Care Staff. Drugs & Aging, 38(8), 697–711. https://doi.org/10.1007/s40266-021-00874-2
- LOWN Institute. (2019). Medication Overload: America’s Other Drug Problem. How the Drive to Prescribe is Harming Older Adults. https://lowninstitute.org/ medication-overload-how-the-drive-to-prescribe-is-harming-older-americans/
- Naughton, C., & Hayes, N. (2017). Deprescribing in older adults: A new concept for nurses in administering medicines and as prescribers of medicine. European Journal of Hospital Pharmacy, 24(1), 47–50. https://doi.org/10.1136/ejhpharm-2016-000908
- Page, A. T., Clifford, R. M., Potter, K., Schwartz, D., & Etherton-Beer, C. D. (2016). The feasibility and effect of deprescribing in older adults on mortality and health: a systematic review and meta-analysis. British Journal of Clinical Pharmacology, 583–623. https://doi.org /10.1111/bcp.12975
- Reeve, E., Low, L. F., & Hilmer, S. N. (2019). Attitudes of Older Adults and Caregivers in Australia toward Deprescribing. Journal of the American Geriatrics Society, 67(6), 1204–1210. https://doi.org/10.1111/jgs.15804
- Scott, I. A., Gray, L. C., Martin, J. H., & Mitchell, C. A. (2012). Minimizing inappropriate medications in older populations: A 10-step conceptual framework. American Journal of Medicine, 125(6), 529-537.e4. https://doi.org/10.1016/j.amjmed.2011.09.021
- Sirois, C., Turner, J. P., & Hébert, J. (2021). Health professionals’ perspectives regarding polypharmacy in older patients with cancer: A mixed-design exploratory study. Journal of Geriatric Oncology, 12(6), 881–887. https://doi.org/10.1016/j.jgo.2021.02.027
- Slater, N., White, S., Venables, R., & Frisher, M. (2018). Factors associated with polypharmacy in primary care: A cross-sectional analysis of data from the English Longitudinal Study of Ageing (ELSA). BMJ Open, 8(3), 1–9. https://doi.org/10.1136/bmjopen-2017-020270
- Sun, W., Grabkowski, M., Zou, P., & Ashtarieh, B. (2021a). The Development of a Deprescribing Competency Framework in Geriatric Nursing Education. Western Journal of Nursing Research, 43(11), 1939459211023805. https://doi.org/10.1177/0193 9459211023805
- Sun, W., Tahsin, F., Abbass Dick, J., Barakat, C., Turner, J., Wilson, D., Reid-Haughian, C., & Ashtarieh, B. (2021b). Educating Homecare Nurses about Deprescribing of Medications to Manage Polypharmacy for Older Adults. Western Journal of Nursing Research, 43(11), 1034–1042. https://doi.org/10.1177/0193945920982599
- Sun, W., Tahsin, F., Barakat-Haddad, C., Turner, J. P., Haughian, C. R., & Abbass-Dick, J. (2019). Exploration of home care nurse’s experiences in deprescribing of medications: A qualitative descriptive study. BMJ Open, 9(5). https://doi.org/10.1136/ bmjopen-2018-025606
- Tjia, J., DeSanto-Madeya, S., Mazor, K. M., Han, P., Nguyen, B., Curran, T., Gallagher, J., & Clayton, M. F. (2019). Nurses’ Perspectives on Family Caregiver Medication Management Support and Deprescribing. Journal of Hospice and Palliative Nursing : JHPN : The Official Journal of the Hospice and Palliative Nurses Association, 21(4), 312–318. https://doi.org/10.1097/NJH.0000000000000574
- Turner, J. P., Edwards, S., Stanners, M., Shakib, S., & Bell, J. S. (2016). What factors are important for deprescribing in Australian long-term care facilities? Perspectives of residents and health professionals. BMJ Open, 6(3), e009781.https://doi.org/10.1136/bmjopen-2015-009781
- Wright, D. J., Scott, S., & Buck, J. (2019). Role of nurses in supporting proactive deprescribing. Nursing Standard, 44–50. https://doi.org/10.7748/ns.2019
Riferimenti
Ailabouni, N., Tordoff, J., Mangin, D., & Nishtala, P. S. (2017). Do residents need all their medications? A cross-sectional survey of RNs’ views on deprescribing and the role of clinical pharmacists. Journal of Gerontological Nursing, 43(10), 13–20. https://doi.org/ 10.3928/ 00989134-20170914-05
Brandt, N. J. (2016). Optimizing Medication Use Through Deprescribing. Journal of Gerontological Nursing, 42(1), 10–14. https://doi.org/10.3928/00989134-20151218-08
Burato, S., Leonardi, L., Antonazzo, I. C., Raschi, E., Ajolfi, C., Baraghini, M., Chiarello, A., Delmonte, V., Di Castri, L., Donati, M., Fadda, A., Fedele, D., Ferretti, A., Gabrielli, L., Gobbi, S., Lughi, S., Mazzari, M., Pieraccini, F., Renzetti, A., … Poluzzi, E. (2021). Comparing the Prevalence of Polypharmacy and Potential Drug-Drug Interactions in Nursing Homes and in the Community Dwelling Elderly of Emilia Romagna Region. Frontiers in Pharmacology, 11(February), 1–7. https://doi.org/ 10.3389/fphar.2020.624888
Foley, R.-A., Hurard, L. L., Cateau, D., Koutaissoff, D., Bugnon, O., & Niquille, A. (2020). Physicians’, Nurses’ and Pharmacists’ Perceptions of Determinants to Deprescribing in Nursing Homes Considering Three Levels of Action: A Qualitative Study. Pharmacy (Basel, Switzerland), 8(1). https://doi.org/10.3390/ pharmacy 8010017
Fournier, A., Anrys, P., Beuscart, J.-B., Dalleur, O., Henrard, S., Foulon, V., & Spinewine, A. (2020). Use and Deprescribing of Potentially Inappropriate Medications in Frail Nursing Home Residents. Drugs and Aging, 37(12), 917–924. https://doi.org/10.1007/s40266-020-00805-7
Kaufman, G. (2018). Polypharmacy in older people: The need for deprescribing. Practice Nursing, 29(8), 390–396. https://doi.org/10.12968/pnur.2018.29.8.390
Koller, K., & Rockwood, K. (2013). Frailty in older adults: implications for end-of-life care. Cleveland Clinic Journal of Medicine, 80(3), 168–174. https://doi.org /10.3949/ccjm.80a.12100
Linsky, A., Meterko, M., Bokhour, B. G., Stolzmann, K., & Simon, S. R. (2019). Deprescribing in the context of multiple providers: Understanding patient preferences. American Journal of Managed Care, 25(4), 192–198.
Liu, L. M. (2014). Deprescribing: An Approach to Reducing Polypharmacy in Nursing Home Residents. Journal for Nurse Practitioners, 10(2), 136–139. https://doi.org/ 10.1016/j.nurpra.2013.09.010
Lo, S. Y., Reeve, E., Page, A. T., Zaidi, S. T. R., Hilmer, S. N., Etherton-Beer, C., McLachlan, A., Pont, L., Naganathan, V., Tabish, S., Sarah, R. Z., Etherton, C., Andrew, B., Lisa, M., & Vasi, P. (2021). Attitudes to Drug Use in Residential Aged Care Facilities: A Cross-Sectional Survey of Nurses and Care Staff. Drugs & Aging, 38(8), 697–711. https://doi.org/10.1007/s40266-021-00874-2
LOWN Institute. (2019). Medication Overload: America’s Other Drug Problem. How the Drive to Prescribe is Harming Older Adults. https://lowninstitute.org/ medication-overload-how-the-drive-to-prescribe-is-harming-older-americans/
Naughton, C., & Hayes, N. (2017). Deprescribing in older adults: A new concept for nurses in administering medicines and as prescribers of medicine. European Journal of Hospital Pharmacy, 24(1), 47–50. https://doi.org/10.1136/ejhpharm-2016-000908
Page, A. T., Clifford, R. M., Potter, K., Schwartz, D., & Etherton-Beer, C. D. (2016). The feasibility and effect of deprescribing in older adults on mortality and health: a systematic review and meta-analysis. British Journal of Clinical Pharmacology, 583–623. https://doi.org /10.1111/bcp.12975
Reeve, E., Low, L. F., & Hilmer, S. N. (2019). Attitudes of Older Adults and Caregivers in Australia toward Deprescribing. Journal of the American Geriatrics Society, 67(6), 1204–1210. https://doi.org/10.1111/jgs.15804
Scott, I. A., Gray, L. C., Martin, J. H., & Mitchell, C. A. (2012). Minimizing inappropriate medications in older populations: A 10-step conceptual framework. American Journal of Medicine, 125(6), 529-537.e4. https://doi.org/10.1016/j.amjmed.2011.09.021
Sirois, C., Turner, J. P., & Hébert, J. (2021). Health professionals’ perspectives regarding polypharmacy in older patients with cancer: A mixed-design exploratory study. Journal of Geriatric Oncology, 12(6), 881–887. https://doi.org/10.1016/j.jgo.2021.02.027
Slater, N., White, S., Venables, R., & Frisher, M. (2018). Factors associated with polypharmacy in primary care: A cross-sectional analysis of data from the English Longitudinal Study of Ageing (ELSA). BMJ Open, 8(3), 1–9. https://doi.org/10.1136/bmjopen-2017-020270
Sun, W., Grabkowski, M., Zou, P., & Ashtarieh, B. (2021a). The Development of a Deprescribing Competency Framework in Geriatric Nursing Education. Western Journal of Nursing Research, 43(11), 1939459211023805. https://doi.org/10.1177/0193 9459211023805
Sun, W., Tahsin, F., Abbass Dick, J., Barakat, C., Turner, J., Wilson, D., Reid-Haughian, C., & Ashtarieh, B. (2021b). Educating Homecare Nurses about Deprescribing of Medications to Manage Polypharmacy for Older Adults. Western Journal of Nursing Research, 43(11), 1034–1042. https://doi.org/10.1177/0193945920982599
Sun, W., Tahsin, F., Barakat-Haddad, C., Turner, J. P., Haughian, C. R., & Abbass-Dick, J. (2019). Exploration of home care nurse’s experiences in deprescribing of medications: A qualitative descriptive study. BMJ Open, 9(5). https://doi.org/10.1136/ bmjopen-2018-025606
Tjia, J., DeSanto-Madeya, S., Mazor, K. M., Han, P., Nguyen, B., Curran, T., Gallagher, J., & Clayton, M. F. (2019). Nurses’ Perspectives on Family Caregiver Medication Management Support and Deprescribing. Journal of Hospice and Palliative Nursing : JHPN : The Official Journal of the Hospice and Palliative Nurses Association, 21(4), 312–318. https://doi.org/10.1097/NJH.0000000000000574
Turner, J. P., Edwards, S., Stanners, M., Shakib, S., & Bell, J. S. (2016). What factors are important for deprescribing in Australian long-term care facilities? Perspectives of residents and health professionals. BMJ Open, 6(3), e009781.https://doi.org/10.1136/bmjopen-2015-009781
Wright, D. J., Scott, S., & Buck, J. (2019). Role of nurses in supporting proactive deprescribing. Nursing Standard, 44–50. https://doi.org/10.7748/ns.2019