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Background :Potentially inappropriate medication prescriptions (PIMP) are responsible for undesirable side­ effects which increase morbidity and mortality among elderly persons.Objective :The aim of this study was to identify potentially inappropriate prescribing of psychotropic drugs and opiates, using STOPP-START (Screening Tool of Older Person's potentially inappropriate Prescriptions- Screening Tool to Alert doctors to Right Treatment) criteria, among patients followed in 2013 by the geriatric liaison team (GLT) of Saint-Luc University Clinics. The second objective was to analyze the use of psychotropic drugs within this same population.Methods: A retrospective study was carried out using data collected from the 1st of January 2013 to 31 December 2013 by the GLT of Saint-Luc University Clinics. Patient's treatments and medical history were analyzed using START criteria related to central nervous system and STOPP criteria related to the following categories: (a) central nervous system and psychotropic ic drugs ; (b) drugs that adversely affect fallers ; (c) analgesic drugs ; (d) duplicate drug classes (SSRls and opiates). Potential risk factors for PIMP were evaluated with the use of logistic regression.Results:STOPP criteria identified 231 PIMP in 152 of the 495 patients (30.71%). The most common were: use of benzodiazepines in patients who are prone to falls (42.42%), long-term use of long-acting benzodiazepines (19.05%), use of opiates in patients who are prone to falls (13.85%) , opiates in dementia patients (6.49%), use of neuroleptics in taller patients (6.06%). The two analyzed START criteria identified 93 potential therapeutic omissions in 93 of the 495 patients (18.79%), the most frequent was the absence of antidepressant treatment in depressive subjects (95.70%). According to multivariate analysis risk factors for PIMP were polypharmacy (OR 3.01, Clss%1.75-5.20, p < 0.001), history of previous falls (OR 6.46, Cl95% 4.11-10.16, p < 0.001), depressive affects (OR 1.90, Cl95% 1.23-2 .94, p = 0.004) et le female gender (OR 1.69, Clss%1.08-2.65, p =0.02).Conclusions :PIMP is a major problem in geriatrics. The use of STOPP-START criteria highlighted the high prevalence of psychotropic and opiate inappropriate prescriptions and omissions in older adults. Les prescriptions médicamenteuses potentiellement inappropriées (PMPI) sont responsables d'effets secondaires indésirables qui augmentent la morbidité et la mortalité des personnes âgées.Objectif: L'objectif général de cette étude est d'évaluer le caractère inapproprié des prescriptions de psychotropes et d'opiacés, selon les critères STOPP-START (Screening Tool of Older Person's potentially inappropriate Prescriptions- Screening Tool to Alert doctors to Right Treatment), chez les patients suivis en 2013 par l'équipe de gériatrie de liaison (EGL) des cliniques universitaires Saint-Luc. Le second objectif est d'analyser l'utilisation des psychotropes dans cette population.Méthodes: Une étude rétrospective a été réalisée à partir des données récoltées, entre le 1er janvier 2013 et le 31 décembre 2013, par l'EGL de Saint-Luc. Les traitements et antécédents médicaux des patients ont été analysés à l'aide des critères START relatifs au système nerveux central et des critères STOPP relatifs aux catégories suivantes : (a) psychotropes et système nerveux central ; (b) médicaments associés à un risque accru de chute ; (c) traitements antalgiques ; (d) prescription conjointe de deux médicaments d'une même classe thérapeutique (ISRS et opiacés). Les facteurs de risque de ces PMPI ont été recherchés à l'aide de la régression logistique.Résultats :Les critères STOPP ont identifié 231 PMPI chez 152 des 495 patients (30.71 %). Les plus fréquentes étajent : l'utilisation de benzodiazépines par des sujets chuteurs (42.42 %), la prise de benzodiazépines de longue demi-vie d'action (19.05 %), l'utilisation d'opiacés par des sujets chuteurs (13.85 %), la présence d'un traitement opiacé chez des patients déments (6.49 %) et la prise de neuroleptiques chez des sujets chuteurs (6.06 %). Les deux critères START ont permis d'identifier 93 potentielles omissions thérapeutiques chez 93 des 495 patients (18.79 %), la plus fréquente correspond à l'absence de traitement antidépresseur chez un sujet dépressif (95.70 %). Selon l'analyse multivariée, les facteurs de risque de la PMPI sont la polymédication (OR 3.01, IC95o;. 1.75-5.20, p < 0.001}, les antécédents de chutes (OR 6.46, ICg5o;. 4.11-10.16, p < 0.001), les affects dépressifs (OR 1.90, IC95o;. 1.23-2.94, p = 0.004) et le sexe féminin (OR 1.69, ICgso0 1.08-2.65, p = 0.02).Conclusion : La PMPI est un problème majeur en gériatrie. L'utilisation des critères STOPP­ START a mis en évidence la prévalence élevée des prescriptions inappropriées et fos omissions de prescriptions de psychotropes et opiacés chez les sujets âgés.

Prescriptions --- Prescriptions --- Psychotropic Drugs --- Aged --- Potentially Inappropriate Medication List

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In recent decades, life expectancy has been increasing. This is a historical milestone in the history of humanity. We have never lived so long before. In these circumstances, giving the best care to older adults efficiently is one of the greatest challenges of developed countries. This book explores different initiatives that result in the improvement of health conditions of older adults, such as multicomponent physical exercise programs, interventions that try to avoid loneliness and social isolation, and multidisciplinary assessment, and the treatment of frailty and other geriatric syndromes, of the elderly in various settings such as the Emergency Unit, Orthogeriatrics, and Oncogeriatrics. This book offers different manuscripts to readers, each trying to improve life satisfaction, quality of life, and life expectancy in older adults in different scenarios. It is up to us to achieve these goals. We are sure that these interesting chapters will contribute to improving clinical practices. Following the completion of the Special Issue "Health Care for Older Adults" for the international Journal of Environmental Research and Public Health, the Guest Editors felt the satisfaction of having reached 18 published manuscripts and the possibility of transforming this volume into a book. This book was born from the need to show how health and social advances have increased human longevity as never before. We live longer, knowing more and more the epigenetic mechanisms of this longevity, as extended aging also coexists with the least favorable aging trajectories. Among them, a syndrome stands out from the gerontological and geriatric perspective: frailty. Due to the pandemic, a social problem has increased its presence in clinical practice: ageism. Older adults have found it difficult to access the necessary clinical resources due to the simple matter of age. However, at this moment, we are able to detect and to reverse frailty. In the same way, we should aim to prevent loneliness and social isolation, involved in social frailty. Geriatric syndromes are underdiagnosed and undertreated, but clinical and geriatric knowledge provide diagnostic tools and non-pharmacological approaches to prevent and to treat them. All health professionals working together in an interdisciplinary team could improve the clinical practices to develop a quality health care for older adults, improving their life satisfaction and quality of life perception too.

Public health & preventive medicine --- neck stabilization exercise --- nonspecific neck pain --- salt pack --- thermotherapy --- anticholinergic drugs --- pneumonia --- elderly --- potentially inappropriate medication --- pharmacoepidemiology --- infrared thermography --- cutaneous temperature --- skin blood flow --- dementia --- body temperature --- thermal sensation --- thermal comfort --- imaging --- mapping --- environmental temperature --- frailty --- COVID-19 --- aging --- physical activity --- mental health --- social relationships --- social frailty --- older adults --- life satisfaction --- accidental falls --- research hotspot --- CiteSpace --- knowledge domain visualization --- geriatric syndromes --- healthy aging --- exercise --- histones --- DNA methylation --- non-coding RNA --- hip fractures --- geriatric assessment --- orthogeriatric care --- functional recovery --- mortality --- hip fracture surgery --- multidisciplinary care --- predictive model --- hip fracture --- gait recovery --- feasibility --- frailty index --- psychometrics --- reliability --- validity --- ageing --- qualitative research --- primary health care --- loneliness --- social capital --- colorectal cancer --- comprehensive geriatric assessment --- geriatric liaison --- multicomponent programs --- functional capacity --- occupational therapy --- occupational function --- social network --- social isolation --- posterior occlusal support --- maximum occlusal force --- masticatory function --- standing motion --- removable prostheses --- Eichner index --- fracture fixation --- geriatric --- intertrochanteric fractures --- prognostic factors --- Thai --- aged people --- STOPP/START --- Beers criteria --- medical prescriptions for chronic pathologies --- inappropriate prescribing --- nursing --- delirium --- machine learning technique --- random forest --- neck stabilization exercise --- nonspecific neck pain --- salt pack --- thermotherapy --- anticholinergic drugs --- pneumonia --- elderly --- potentially inappropriate medication --- pharmacoepidemiology --- infrared thermography --- cutaneous temperature --- skin blood flow --- dementia --- body temperature --- thermal sensation --- thermal comfort --- imaging --- mapping --- environmental temperature --- frailty --- COVID-19 --- aging --- physical activity --- mental health --- social relationships --- social frailty --- older adults --- life satisfaction --- accidental falls --- research hotspot --- CiteSpace --- knowledge domain visualization --- geriatric syndromes --- healthy aging --- exercise --- histones --- DNA methylation --- non-coding RNA --- hip fractures --- geriatric assessment --- orthogeriatric care --- functional recovery --- mortality --- hip fracture surgery --- multidisciplinary care --- predictive model --- hip fracture --- gait recovery --- feasibility --- frailty index --- psychometrics --- reliability --- validity --- ageing --- qualitative research --- primary health care --- loneliness --- social capital --- colorectal cancer --- comprehensive geriatric assessment --- geriatric liaison --- multicomponent programs --- functional capacity --- occupational therapy --- occupational function --- social network --- social isolation --- posterior occlusal support --- maximum occlusal force --- masticatory function --- standing motion --- removable prostheses --- Eichner index --- fracture fixation --- geriatric --- intertrochanteric fractures --- prognostic factors --- Thai --- aged people --- STOPP/START --- Beers criteria --- medical prescriptions for chronic pathologies --- inappropriate prescribing --- nursing --- delirium --- machine learning technique --- random forest

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Polypharmacy is a necessary and important aspect of drug treatment; however, it becomes a challenge when the medication risks outweigh the benefits for an individual patient. Drug–drug interactions and the introduction of prescribing cascades are common features of polypharmacy, which can lead to ineffectiveness and increased risk of adverse drug reactions (ADR). Genes encoding CYP450 isozymes and other drug-related biomarkers have attracted considerable attention as targets for pharmacogenetic (PGx) testing due to their impact on drug metabolism and response. This Special Issue is devoted to explore the status and initiatives taken to circumvent ineffectiveness and to improve medication safety for polypharmacy patients. Specific areas include drug–drug interactions and consequences thereof in therapeutic management, including PK- and PD-profiling; the application of PGx-based guidance and/or decision tools for drug–gene and drug–drug gene interactions; medication reviews; development and application of deprescribing tools; and drivers and barriers to overcome for successful implementation in the healthcare system.

Medicine --- Pharmaceutical industries --- acute kidney injury --- early biomarker --- plasma neutrophil gelatinase-associated lipocalin --- soluble urokinase plasminogen activator receptor --- medication optimization --- older patients --- emergency department --- multimorbidity --- polypharmacy --- potentially inappropriate medication use --- older adults --- prevalence --- determinants --- chronic --- outpatient --- 2019 Beers criteria --- Ethiopia --- pharmacogenomics --- persons with diabetes --- drug–drug interactions --- drug–gene interactions --- cytochrome P450 --- SLCO1B1 --- drug interaction checkers --- adverse drug reactions --- pharmacogenetics --- personalized medicine --- phenprocoumon --- DOACs --- bleeding --- thromboembolism --- HLA --- drug hypersensitivity --- abacavir --- allopurinol --- flucloxacillin --- antiepileptic drugs --- cost-effectiveness --- shared medication record --- medication reconciliation --- drug information service --- hospital pharmacy service --- electronic prescribing --- electronic medical record --- clinical pharmacist --- CYP2D6 --- CYP2D7P --- CYP2D8P --- copy number variation --- CNV --- genotyping --- 5’nuclease assay --- HRM --- high resolution melting --- drug metabolization --- extracellular vesicles --- exosomes --- microvesicles --- pharmacogene expression --- medication review --- deprescriptions --- quality of life --- aged --- aged, 80 and over --- nursing homes --- deprescribing --- medication-based risk score --- health outcomes --- cytochromes --- CYP1A2 --- adverse drug reaction --- antipsychotics --- olanzapine --- clozapine --- loxapine --- children --- youth --- digital decision-support --- health services research --- general practice --- process evaluation --- antidepressants --- utility --- population-based --- appropriateness --- medication adherence --- digital health

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Polypharmacy is a necessary and important aspect of drug treatment; however, it becomes a challenge when the medication risks outweigh the benefits for an individual patient. Drug–drug interactions and the introduction of prescribing cascades are common features of polypharmacy, which can lead to ineffectiveness and increased risk of adverse drug reactions (ADR). Genes encoding CYP450 isozymes and other drug-related biomarkers have attracted considerable attention as targets for pharmacogenetic (PGx) testing due to their impact on drug metabolism and response. This Special Issue is devoted to explore the status and initiatives taken to circumvent ineffectiveness and to improve medication safety for polypharmacy patients. Specific areas include drug–drug interactions and consequences thereof in therapeutic management, including PK- and PD-profiling; the application of PGx-based guidance and/or decision tools for drug–gene and drug–drug gene interactions; medication reviews; development and application of deprescribing tools; and drivers and barriers to overcome for successful implementation in the healthcare system.

acute kidney injury --- early biomarker --- plasma neutrophil gelatinase-associated lipocalin --- soluble urokinase plasminogen activator receptor --- medication optimization --- older patients --- emergency department --- multimorbidity --- polypharmacy --- potentially inappropriate medication use --- older adults --- prevalence --- determinants --- chronic --- outpatient --- 2019 Beers criteria --- Ethiopia --- pharmacogenomics --- persons with diabetes --- drug–drug interactions --- drug–gene interactions --- cytochrome P450 --- SLCO1B1 --- drug interaction checkers --- adverse drug reactions --- pharmacogenetics --- personalized medicine --- phenprocoumon --- DOACs --- bleeding --- thromboembolism --- HLA --- drug hypersensitivity --- abacavir --- allopurinol --- flucloxacillin --- antiepileptic drugs --- cost-effectiveness --- shared medication record --- medication reconciliation --- drug information service --- hospital pharmacy service --- electronic prescribing --- electronic medical record --- clinical pharmacist --- CYP2D6 --- CYP2D7P --- CYP2D8P --- copy number variation --- CNV --- genotyping --- 5’nuclease assay --- HRM --- high resolution melting --- drug metabolization --- extracellular vesicles --- exosomes --- microvesicles --- pharmacogene expression --- medication review --- deprescriptions --- quality of life --- aged --- aged, 80 and over --- nursing homes --- deprescribing --- medication-based risk score --- health outcomes --- cytochromes --- CYP1A2 --- adverse drug reaction --- antipsychotics --- olanzapine --- clozapine --- loxapine --- children --- youth --- digital decision-support --- health services research --- general practice --- process evaluation --- antidepressants --- utility --- population-based --- appropriateness --- medication adherence --- digital health