***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: CONTEXT Criteria for potentially inappropriate medication use among elderly patients have been used in the past decade in large US epidemiological surveys to identify population s at risk and specifically target risk-management strategies . In contrast , in Europe little information is available about potentially inappropriate medication use and is based on small studies with uncertain generalizability . OBJECTIVE To estimate the prevalence and associated factors of potentially inappropriate medication use among elderly home care patients in European countries . DESIGN , SETTING , AND PARTICIPANTS Retrospective cross-sectional study of 2707 elderly patients receiving home care ( mean [ SD ] age , 82.2 [ 7.2 ] years ) representatively enrolled in metropolitan areas of the Czech Republic , Denmark , Finl and , Icel and , Italy , the Netherl and s , Norway , and the United Kingdom . Patients were prospect ively assessed between September 2001 and January 2002 using the Minimum Data Set in Home Care instrument . MAIN OUTCOME MEASURES Prevalence of potentially inappropriate medication use was documented using all expert panels criteria for community-living elderly persons ( Beers and McLeod ) . Patient-related characteristics independently associated with inappropriate medication use were identified with a multiple logistic regression model . RESULTS Combining all 3 sets of criteria , we found that 19.8 % of patients in the total sample used at least 1 inappropriate medication ; using older 1997 criteria it was 9.8 % to 10.9 % . Substantial differences were documented between Eastern Europe ( 41.1 % in the Czech Republic ) and Western Europe ( mean 15.8 % , ranging from 5.8 % in Denmark to 26.5 % in Italy ) . Potentially inappropriate medication use was associated with patient 's poor economic situation ( adjusted relative risk [ RR ] , 1.96 ; 95 % confidence interval [ CI ] , 1.58 - 2.36 ) , polypharmacy ( RR , 1.91 ; 95 % CI , 1.62- 2.22 ) , anxiolytic drug use ( RR , 1.82 ; 95 % CI , 1.51 - 2.15 ) , and depression ( RR , 1.29 ; 95 % CI , 1.06 - 1.55 ) . Negatively associated factors were age 85 years and older ( RR , 0.78 ; 95 % CI , 0.65 - 0.92 ) and living alone ( RR , 0.76 ; 95 % CI , 0.64 - 0.89 ) . The odds of potentially inappropriate medication use significantly increased with the number of associated factors ( P<.001 ) . CONCLUSIONS Substantial differences in potentially inappropriate medication use exist between European countries and might be a consequence of different regulatory measures , clinical practice s , or inequalities in socioeconomic background . Since financial re sources and selected patient-related characteristics are associated with such prescribing , specific educational strategies and regulations should reflect these factors to improve prescribing quality in elderly individuals in Europe ZusammenfassungZIELE DER STUDIE : 1 . Bestimmung der Prävalenz von Polypharmakotherapie und unangemessenem Arzneimittelgebrauch bei älteren internistischen Patienten in Österreich ; 2 . Einschätzung deren Bedeutung für das Auftreten von unerwünschten Arzneimittelwirkungen ; 3 . Suche nach Prädiktoren für das Auftreten von unerwünschten Arzneimittelwirkungen bei einer älteren Patienten population . METHOD IK : In einer monozentrischen Kohortenstudie wurden über 3 Monate alle neu aufgenommenen Patienten ≥ 75 Jahren eingeschlossen . Die Aufnahmemedikation wurde durch ein multidisziplinäres Team bestehend aus Krankenhausapothekern und Internisten auf ihre angemessene Anwendung hin analysiert und überprüft , ob eine unerwünschte Arzneimittelwirkung aufgetreten war . ERGEBNISSE : Es wurden insgesamt 543 Patienten analysiert ( Altersmedian 82 Jahre , 60,2 % Frauen ) . Die mittlere Medikamentenanzahl bei Aufnahme betrug 7,5 ± 3,8 . Frauen nahmen signifikant mehr Medikamente ein als Männer ( 7,8 vs. 6,8 , p = 0,013 ) . 58,4 % der Patienten erfüllten das gewählte Kriterium für Polypharmakotherapie  ( > 6 Medikamente ) . Folgende Faktoren waren mit  Polypharmakotherapie  assoziiert : weibliches Geschlecht , Pflegebedürftigkeit , hohe Anzahl an Entlassungsdiagnosen und ein hoher Punktwert auf der Charlson Komorbiditäts-Skala . Verzichtbare Medikamente wurden bei 36,3 % aller Patienten gefunden , Medikamente , die für alte Menschen inadäquat sind , bei 30,1 % , Doppelverordnungen bei 7,6 % , Fehldosierungen bei 23,4 % und potenzielle Medikamenteninteraktionen bei 65,8 % . Unerwünschte Arzneimittelwirkungen wurden bei 97/543 Patienten gefunden ( 17,8 % ) . In 56,7 % der Fälle war die unerwünschte Arzneimittelwirkung Grund für die stationäre Aufnahme und bei 18,7 % war eine Arzneimittelinteraktion sehr wahrscheinlich an der Entstehung beteiligt . Risikofaktoren für unerwünschte Arzneimittelwirkungen waren weibliches Geschlecht , Polymorbidität , Niereninsuffizienz und unangemessener Arzneimittelverordnung . SCHLUSSFOLGERUNG : Polypharmakotherapie , unangemessene Verschreibung und unerwünschte Arzneimittelwirkungen sind bei älteren internistischen Patienten in dem untersuchten österreichischen Zentrum vergleichbar häufig wie in and eren westlichen Ländern . Zur Verbesserung der Arzneimittelsicherheit bei dieser Hochrisikogruppe erscheint uns eine bessere Verschreibungsqualität bedeutsamer als eine Verminderung der Medikamentenanzahl . Summary OBJECTIVE : The aim of the study was to assess the prevalence of polypharmacy and inappropriate drug use in elderly internal-medicine patients in one Austrian center and to define the impact of these and other identified predictors on the occurrence of adverse drug events . METHODS : All patients ≥ 75 years admitted to selected internal wards of a university hospital were included in a monocentric prospect i ve cohort study over a period of three months . The pre-admission medication of the patients was analyzed with respect to appropriateness by a multidisciplinary team consisting of pharmacists and physicians trained in internal medicine . The medication was evaluated for the occurrence of adverse drug events . RESULTS : A total of 543 patients were analyzed ( median age 82 years ; 60.2 % female ) . The mean number of drugs taken was 7.5 ± 3.8 , with women taking significantly more drugs than men ( 7.8 vs. 6.8 , P = 0.013 ) . Overall , 58.4 % of the patients fulfilled the given criteria for polypharmacy ( > 6 drugs ) . The following factors were associated with polypharmacy : female sex , need for nursing care , high number of discharge diagnoses and high Charlson comorbidity score . Unnecessary drugs were found prescribed in 36.3 % of all patients , drugs to avoid ( Beers criteria ) in 30.1 % , duplication in 7.6 % , wrong dosage in 23.4 % and possible drug-drug interactions in 65.8 % . Adverse drug events were identified in 17.8 % of the patients ( 97/543 ) , among whom the adverse drug event was the reason for hospital admission in 56.7 % of the cases and a drug-drug interaction was involved in 18.7 % . Risk factors for adverse drug events were female sex , polymorbidity , renal dysfunction and inappropriate prescribing . CONCLUSION : Polypharmacy , inappropriate prescribing and adverse drug events were highly prevalent in a cohort of elderly internal-medicine patients in Austria . To improve drug safety in this high-risk population , appropriate prescribing might be more important than simply reducing the number of prescribed drugs OBJECTIVES To determine whether a medication review by a specialized team would promote regimen changes in elders taking multiple medications and to measure the effect of regimen changes on monthly cost and functioning . DESIGN A r and omized-controlled trial . SETTING Health center ambulatory clinic . PARTICIPANTS Community-dwelling older adults taking five or more medications were assessed at baseline and 6 weeks . A  medication-change intervention group of 57 elders was compared with a control group of 76 elder adults . INTERVENTION The primary intervention was a comprehensive review and recommended modification of a patient 's medication regimen . Changes were endorsed by each patient 's primary physician and discussed with each patient . MEASUREMENTS Measures were the Timed Manual Performance Test , Physical Performance Test , Functional Reach Assessment , subtests from the Wechsler Adult Intelligence Scale , a modified R and t Memory Test , the Center for Epidemiological Studies -Depression Scale , the Self-Rating Anxiety Scale , and the R and 36-item Health Survey 1.0 . Comorbidity was determined using the International Classification of Diseases , Ninth Revision , Clinical Modification . Medication usage was determined using brown bag review . RESULTS Intervention subjects decreased their medications by an average of 1.5 drugs . No differences in functioning were observed between groups . Intervention subjects saved an average $ 26.92 per month in wholesale medication costs ; control subjects saved $ 6.75 per month ( P<.006 ) . CONCLUSION Although the intervention significantly reduced the medications taken and monthly cost , most patients were resistant to reducing medications to the recommended level . Further study is needed to underst and patient resistance to reducing adverse polypharmacy and to devise better strategies for addressing this important problem in geriatric health . Greater focus on prescriber behavior is recommended OBJECTIVES to evaluate specialist geriatric input and medication review in patients in high-dependency continuing care . DESIGN prospect i ve , r and omised , controlled trial . SETTING two residential continuing care hospitals . PARTICIPANTS two hundred and twenty-five permanent patients . INTERVENTION patients were r and omised to either specialist geriatric input or regular input . The specialist group had a medical assessment by a geriatrician and medication review by a multidisciplinary expert panel . Regular input consisted of review as required by a medical officer attached to each ward . Re assessment occurred after 6 months . RESULTS one hundred and ten patients were r and omised to specialist input and 115 to regular input . These were comparable for age , gender , dependency levels and cognition . After 6 months , the total number of medications per patient per day fell from 11.64 to 11.09 in the specialist group ( P = 0.0364 ) and increased from 11.07 to 11.5 in the regular group ( P = 0.094 ) . There was no significant difference in mortality or frequency of acute hospital transfers ( 11 versus 6 in the specialist versus regular group , P = 0.213 ) . CONCLUSION specialist geriatric assessment and medication review in hospital continuing care result ed in a reduction in medication use , but at a significant cost . No benefits in hard clinical outcomes were demonstrated . However , qualitative benefits and lower costs may become evident over longer periods OBJECTIVE : To investigate actual cost and adverse effect outcomes associated with a pharmacotherapy consultation in ambulatory care patients receiving polypharmacy . METHODS : Patients receiving five or more chronic medications were r and omized to receive pharmacotherapy consultation or usual medical care .  Outcomes measured were changes in drug costs , medical costs , and drug-related symptoms six months after the consultation . Data were analyzed with unpaired Student 's t-test for continuous data . χ2 Analysis was used for categorical data . Patients and physicians were surveyed about their perceptions of the consultations after the study period . RESULTS : Drug and medical costs did not differ before and after the consultation . More patients in the consultation group had adverse symptom scores improve by two or more points , and fewer had symptom scores worsen by two or more points than in the control group . Seventy percent of patients and 76 % of physicians believed that the consult was beneficial . CONCLUSIONS : Polypharmacy patients are the most likely to have drug-related problems and require intervention . Of all the interventions performed in this study , 73 % of the original problems were recognized only through a patient interview , suggesting that an interpersonal relationship remains critical to the provision of pharmaceutical care . Although patients and physicians see intuitive value in pharmaceutical care , pharmacists need to exert more energy in the direction of marketing the profession . Finally , there are numerous difficulties in measuring the benefits of these interventions , possibly making broad-based interventions in complicated patients too difficult to assess accurately . Future studies should focus on patients with limited , specific problems or on interventions with narrow goals Background Polypharmacy in the Swedish elderly population is currently a prioritised area of research with a focus on reducing the use of potentially inappropriate medications ( PIMs ) . Multi-professional interventions have previously been tested for their ability to improve drug therapy in frail elderly patients . Objective This study aim ed to assess a structured model for pharmacist-led medication review s in primary health care in southern Sweden and to measure its effects on numbers of patients with PIMs ( using the definition of the Swedish National Board of Health and Welfare ) 
    Output:
    
No effect of medication review was found on clinical outcomes ( mortality , hospital admissions/healthcare use , the number of patients falling , physical and cognitive functioning ) , except a decrease in the number of falls per patient .
Furthermore no effect was found on quality of life and evidence was inconclusive about the effect on economical outcome measures .
However , an effect was found on most drug-related problems : medication review result ed in a decrease in the number of drug-related problems , more changes in medication , more drugs with dosage decrease and a greater decrease or smaller increase of the number of drugs .
Conclusions An isolated medication review during a short term intervention period has an effect on most drug-related outcomes , minimal effect on clinical outcomes and no effect on quality of life .
No conclusion can be drawn about the effect on economical outcome measures .