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Dr Sharmin Bala

PositionPhD Student
DepartmentDepartment of Preventive and Social Medicine
QualificationsMBBS (Bachelors in Medicine and Surgery) MD (Post-graduation in Clinical Pharmacology)
Research summaryAssessing medication appropriateness in the geriatric population of New Zealand
Teaching
  • Pharmacology
  • Clinical Pharmacy
  • Cessation of smoking module (as part of the University of Otago Interprofessional Education programme)
Memberships
  • Alzheimer's Association International Society to Advance Alzheimer's Research and Treatment
  • APSA: Australasian Pharmaceutical Science Association
  • ASCEPT:The Australasian Society of Clinical and Experimental Pharmacologists and Toxicologists
  • Indian Pharmacological Society
  • Sir H N Reliance Medical Research Society
  • Stop Gaps Choral Ensemble and Cultural Academy
Clinical
  1. Recipient of the prestigious HOPE Selwyn Foundation award for Research in Aging
  2. Participated in the interRAI database (inSPIRe) training workshop at Brisbane, 2018
  3. Presented my research work at the New Zealand Association of Aging Conference, Auckland, 2018
  4. Presented a paper at the 4th Pharmacoepidemiology Research Network Symposium, University of Otago
  5. Presented a poster at the Alzheimer's Association International Conference 2019, LA

Research

Several medications have to be prescribed with caution in older adults due to their compromised biological functions that can impact and reduce drug clearance.

Dementia is one of the principal syndromes linked with disability and dependence among older adults, and is a major challenge to individuals, communities, and societies globally.

The global incidence of dementia is expected to rise to 81 million by 2040, primarily due to the progressive nature of the disorder, which involves worsening neurocognitive impairment and loss of basic functions in daily life.

In 2016, the estimated prevalence of dementia in New Zealand was more than 62,000, which is predicted to increase to around 170,000 in 2050. One in every four ‘international Resident Assessment Instrument- Home Care evaluated individuals in 2016-17 in New Zealand were diagnosed with dementia, of which 35% needed extensive assistance or were completely dependent, and 30% had daily episodes of disturbing behaviours, like wandering or being abusive.

Potentially inappropriate medications are defined as the prescribing of drugs where the risk outweighs the benefit and, could also represent under prescribing of beneficial treatments.

Prescribing medications for older adults with dementia is challenging because of the risks associated with cognitive decline, behavioural and psychological disturbances, multiple medications, and their associated costs. It is also proven that older adults with dementia experience a greater sensitivity to the adverse effects of medications acting on the Central Nervous System. A systematic review among older adults with cognitive impairment and dementia reported a varied prevalence of prescription of potentially inappropriate medications of 10% to over 55% across Europe, Australia, and the United States.

In one of our studies using the interRAI-Home Care dataset, we observed that there is a high prevalence of prescription of potentially inappropriate anticholinergic medications in older adults with dementia, in spite of knowing that the prescription is associated with negative outcomes like risk of delirium, worsening cognitive impairment, peripheral side effects, and increased mortality.

As a part of the big picture, I am focussing on delineating medications with anticholinergic properties which are commonly used in for dementia. The overarching aim of my thesis is to assess medication appropriateness in the geriatric population of New Zealand with a view to developing an alternative prescribing tool for currently prescribed inappropriate anticholinergic medications in older adults diagnosed with dementia. A Delphi consensus will be utilised to validate the appropriate tool for prescribing medications; following which we intend to conduct a pilot study in residential aged care homes in New Zealand to further enhance the validity and reliability of the tool for prescribing alternative medications to anticholinergics in dementia.

Publications

Nishtala, P. S., & Bala, S. S. (2019). Sources of data used in pharmacoepidemiology and pharmacovigilance. In Z. U.-D. Babar (Ed.), Encyclopedia of pharmacy practice and clinical pharmacy (Vol. 2). (1st ed.) (pp. 391-399). Amsterdam, The Netherlands: Elsevier. doi: 10.1016/B978-0-12-812735-3.00206-5

Bala, S. S., Chen, T. F., & Nishtala, P. S. (2019). Reducing potentially inappropriate medications in older adults: A way forward. Canadian Journal on Aging. Advance online publication. doi: 10.1017/S0714980819000084

Bala, S. S., Narayan, S. W., & Nishtala, P. S. (2018). Potentially inappropriate medications in community-dwelling older adults undertaken as a comprehensive geriatric risk assessment. European Journal of Clinical Pharmacology, 74(5), 645-653. doi: 10.1007/s00228-018-2412-x

Bala, S. S., Jamieson, H. A., & Nishtala, P. S. (2018). Determinants of prescribing potentially inappropriate medications in a nationwide cohort of community dwellers with dementia receiving a comprehensive geriatric assessment. International Journal of Geriatric Psychiatry. Advance online publication. doi: 10.1002/gps.5004

Bala, S. S., Jamieson, H. A., & Nishtala, P. S. (2018). Factors associated with inappropriate prescribing among older adults with complex care needs who have undergone the interRAI assessment. Current Medical Research & Opinion. Advance online publication. doi: 10.1080/03007995.2018.1543185

Chapter in Book - Research

Nishtala, P. S., & Bala, S. S. (2019). Sources of data used in pharmacoepidemiology and pharmacovigilance. In Z. U.-D. Babar (Ed.), Encyclopedia of pharmacy practice and clinical pharmacy (Vol. 2). (1st ed.) (pp. 391-399). Amsterdam, The Netherlands: Elsevier. doi: 10.1016/B978-0-12-812735-3.00206-5

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Journal - Research Article

Bala, S. S., Chen, T. F., & Nishtala, P. S. (2019). Reducing potentially inappropriate medications in older adults: A way forward. Canadian Journal on Aging. Advance online publication. doi: 10.1017/S0714980819000084

Bala, S. S., Narayan, S. W., & Nishtala, P. S. (2018). Potentially inappropriate medications in community-dwelling older adults undertaken as a comprehensive geriatric risk assessment. European Journal of Clinical Pharmacology, 74(5), 645-653. doi: 10.1007/s00228-018-2412-x

Bala, S. S., Jamieson, H. A., & Nishtala, P. S. (2018). Factors associated with inappropriate prescribing among older adults with complex care needs who have undergone the interRAI assessment. Current Medical Research & Opinion. Advance online publication. doi: 10.1080/03007995.2018.1543185

Bala, S. S., Jamieson, H. A., & Nishtala, P. S. (2018). Determinants of prescribing potentially inappropriate medications in a nationwide cohort of community dwellers with dementia receiving a comprehensive geriatric assessment. International Journal of Geriatric Psychiatry. Advance online publication. doi: 10.1002/gps.5004

Bala, S., & Chhabria, P. (2017). Rising prevalence of osteopenia in young and middle aged men in south Mumbai: An alarming situation. Madridge Journal of Behavioral & Social Sciences, 1(1), 32-36. doi: 10.18689/mjbss.2017-105

Bala, S. S., Chincholkar, A., Wagh, R., Mutalik, M., Siddiqui, W., & Gupta, M. (2015). A comparative study of efficacy of neem seed oil, terbinafine cream and a combination of both terbinafine cream and neem seed oil applied topically in the treatment of clinical dermatophystosis. World Journal of Pharmacy & Pharmaceutical Sciences, 4(10), 1263-1274. Retrieved from http://www.wjpps.com/

Bala, S. S., Chincholkar, A. S., Wagh, R. J., & Mutalik, M. M. (2014). A retrospective study of prescription patterns of antimicrobials in an urban health centre run by a medical college. International Journal of Medical Research & Health Sciences, 3(1), 88-91. Retrieved from http://www.ijmrhs.com/

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Journal - Research Other

Bala, S. S., Pawar, V. G., & Shivaprakash, S. (2018). Assessment of the cautionary antimicrobial consumption pattern using defined daily dose as a part of the Antimicrobial Stewardship Programme [Short communication]. Journal of the Academy of Clinical Microbiologists, 20(1), 52-56. doi: 10.4103/jacm.jacm_26_17

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