Please select the eligibility criteria that correspond to the clinical trial below.
Title: Optimization of Drug Prescribing in an Elderly Population of Geriatric Consultations and Living at Home
Brief Summary: Aging is often associated with multiple chronic conditions conducting increased consumption of drugs. Drug therapy is necessary for the treatment of many diseases. However, misuse of drugs, particularly linked to the potentially inappropriate prescribing and polypharmacy, increases the iatrogenic risks and can lead to adverse events such as falls, cognitive decline, increased use to the health system: hospital admissions, emergency room visits, and institutionalization. These problems are common since about 20% of emergency room use in elderly patients due to an adverse event related to drugs. Nearly 28% of adverse events related to drug prescriptions could be avoided.

Interventions to optimize drug therapy showed a reduction in the number of potentially inappropriate medications, but their impact on health, has rarely been evaluated. If an association with death has been established, the link with the loss of functional autonomy, which leads to reduced quality of life and significant cost of care, has not been investigated. The evolution towards functional disabilities, frequent with aging has many causes, among which some could be prevented. The optimization of drug prescriptions could thereby delay or prevent the loss of functional autonomy by reducing the risk of adverse events, such as falls or cognitive decline and improving the management of chronic diseases. Our hypothesis is that an optimization program of the drug prescribing may slow progression to functional dependence. To assess the effect of the optimization program of drug prescribing on the level of functional autonomy, a multicenter Randomized Controlled Trial will be conducted in geriatric and memory consultations.

Expected results The implementation of the "OPTIM" program should enable optimization of drug prescribing in elderly patients and therefore slow or prevent progression to addiction. It should also help to develop and strengthen collaboration and communication between the team of geriatric consultation, the clinician pharmacist and referring physicians in town (private practice). In addition, pharmaceutical notice sent to referring physicians should help raise awareness of the prescription of drugs in these patients.


Options:
A: Inclusion Criteria:

* The subjects of this study will be physician providers and residents and medical students practicing under the supervision of a faculty emergency physician. Specific study subjects will include emergency medicine faculty physicians; emergency medicine and internal medicine residents; emergency medicine, surgery, and internal medicine interns; and medical students taking care of patients in our emergency department.

Exclusion Criteria:

* We will not include the members of the research team in this study.
B: Inclusion Criteria:

* Patients aged 65 and over;
* Patients received for the first time in a geriatric or memory consultation of a study recruiting centers;
* Patients living at home;
* Patients with the ability to express themselves orally or in writing in French sufficiently to carry out clinical assessments;
* Patients who led the last drugs prescription from his referring physician, at the geriatric/memory consultation (in current practice, patients should take the last prescription established by the referring physician);
* Patients accompanied by a caregiver.

Exclusion Criteria:

* Patients with no discernment;
* Patient put under legal protection;
C: Inclusion Criteria:

* Signed informed consent by the patient or a caregiver if the patient is incompetent to sign
* Consecutive inclusion of all newly admitted patients to the wards coming from home or the emergency room department

Exclusion Criteria:

* Patients not admitted to the hospital from home or a nursing home
* Patients unable to communicate in Dutch
* Patients admitted for palliative care
* Patients who do not take any drugs at admission
D: Inclusion Criteria:

* Speaks either English or Spanish
* Willing to obtain all long-term prescriptions from one community pharmacy during the 90-day study period
* Diagnosed with at least one of the following conditions: high blood pressure, hyperlipidemia, heart failure, coronary artery disease, heart attack, stroke, transient ischemic attack, asthma, chronic obstructive pulmonary disease (COPD), diabetes, or receiving oral anticoagulation therapy
* Admitted to the general medicine, family medicine, cardiology, or orthopedics services hospital department

Exclusion Criteria:

* Does not have a working telephone
* Has a hearing impairment that does not allow the use of a telephone
* Enrolled in Iowa Care (i.e., individual has no community physician or community pharmacist following hospital discharge)
* Life expectancy estimated at less than 6 months at the time of study entry
* Dementia or cognitive impairment
* Severe psychiatric or psychosocial factors, including substance abuse, that may impair the desire or ability to complete all aspects of the study
* Admission to the psychiatric, surgery, or hematology/oncology services hospital department

Answer: B