The Frailty Guideline, proposed by the Geriatric Expect Group of the European Medicines Agency (EMA), has been published online for public consultation. Please use the link to the Frailty Guideline on the EMA website.

The second OPERAM meeting will take place at 11 and 12 January 2016 in Bunnik close to Utrecht. During this meeting the set up of the OPERAM trial and especially the use of the new version of the STRIPassistant, the implementation of the medication review and adjudication of adverse effects will be discussed. Also the health economics part of the trial and the performance of the systematic reviews and network meta-analysis are topics at this meeting.

At 3 December in Brussel a symposium will be organized concerning “Polymedication and rational use of appropriate medication in older patients”. At this symposium the development and first results of studies of the STRIP-assistant, a digital tool to improve appropriate prescribing, will be presented.

The international seminar ‘Targeting the burden of polypharmacy in the elderly’ (REPOSI 2015) will be held September 24-25 in Milan. The goal of this seminar is to discuss multimorbidity and related polypharmacy to improve the appropriateness of prescribing. The STRIPassistant, a tool of Ephor to optimize prescribing, will be demonstrated. More information is available at the website www.smc-media.com.

Europe-ExPro is an institute that identifies clinical, economic and patient related issues in certain disease areas that require an assessment by experts. Europe-ExPro brings forth expert procedures on these issues. The expert procedure aims to define the relevance between the new treatment option and the existing treatment options. This is done from different perspectives, such as clinical, economic or patient perspective. By evidence based and practice based methods the relevant differences are validated. The expert procedure results in a report for public use and a manuscript available for submission in an appropriate journal. The link to the website is here provided (see Link).

There is lack of consensus on the definition of deprescribing. A review of Reeve et al., accepted for publication in the British Journal of Clinical Pharmacology (Aug 2015), proposes the following definition: „Deprescribing is the process of withdrawal of an inappropriate medication, supervised by a health care professional with the goal of managing polypharmacy and improving outcomes‟. This definition has not yet been externally validated and further work is required to develop an internationally accepted and appropriate definition.

The Norwegian General Practice – Nursing Home criteria (NORGEP-NH) for potentially inappropriate medication use are published online in the Scandinivian Journal of  Primary Health Care. 2015 Jun 23:1-8. The abstract is available at ‘Research’ – ‘Articles”

The results of the effectiveness of the STRIPassistant, a computerized decision support system to improve a medication review, is published in Drugs and Aging. The  study showed that appropriate decisions increased from 58% without the STRIP Assistant to 76% with it (p<0.0001). Inappropriate decisions decreased from 42% without the STRIP Assistant to 24% with it (p<0.0001). The open access article is available on the EPHOR website at Research/articles.

The kick-off meeting of the OPERAM study (OPtimising ThERapy to prevent Avoidable hospital admissions in the Multimorbid elderly) is scheduled at 15 and 16 June in Morges Switzerland. This study will investigate the STRIPassistant a digital tool for the optimization of polypharmacy. A videodemo of the Stripassistant is available. The Stripassistant will be further developed.

EMA’s Pharmacovigilance Risk Assessment Committee (PRAC) has completed a review of medicines containing the antihistamine hydroxyzine. This follows concerns over the risk of possible effects onheart rhythm with these medicines, which are available in most EU countries.

The PRAC considered that hydroxyzine was associated with a small but definite risk of QT interval prolongation and torsade de pointes.

Based on the assessed data, the risk did not differ between indications, and the Committee recommended that hydroxyzine could continue to be used provided that measures to minimise the risk of problems with heart rhythm were taken.

These measures include using the medicine at the lowest effective dose for as short a time as possible. Use is not recommended in the elderly. The maximum daily dose should be no more than 100 mg in adults (50 mg in the elderly if use cannot be avoided). Use must be avoided in patients who already have risk factors for heart rhythm disturbances or are taking other medicines that increase the risk of QT prolongation. Care is also needed in patients taking medicines that slow the heart rate or decrease the level of potassium in the blood, as these also increase the risk of problems with heart rhythm.