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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 older adults in New Zealand with a view to develop an appropriate tool for prescribing alternatives to anticholinergic medications in individuals with dementia.
Teaching
  • Early Learning in Medicine: Integrated Cases, and Early Professional Experience
  • Inter-professional Education
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

Research

Older adults comprise a significant proportion of the population of New Zealand (NZ) and are known to be prescribed the highest number of medications. Several medications have to be prescribed with caution in older adults due to their compromised biological functions that can reduce drug clearance. Potentially inappropriate medications (PIMs) may be defined as the prescription of drugs where the risks outweigh the clinical benefits or there may be under-prescribing of beneficial treatments. In the first phase of our project, we observed a high prevalence of prescription of potentially inappropriate medications in community dwelling older adults in NZ. We then analysed the factors associated with prescribing PIMS, and found that individuals diagnosed with certain disorders like dementia, insomnia, depression, cancer, anxiety; or those who were hospitalised were more likely to be prescribed PIMs than the other individuals. A literature review of the existing tools for reducing PIMS was then undertaken to assess the merits and demerits of each tool with a view to suggest methods to reduce inappropriate prescribing, which include meticulously reviewing prescriptions and de-prescribing as a way forward.

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 worldwide. 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 one of our studies utilising the international Resident Assessment Instrument Home Care (interRAI) dataset, we observed that the prevalence of dementia was 13%, of which 67% were prescribed PIMs, and the medications with anticholinergic properties (MAP) constituted 60%. MAP are specifically associated with negative outcomes in older adults diagnosed with dementia, such as worsening of cognitive function, sustained cognitive defects, and increased mortality. They are notorious for their central side effects such as impaired concentration, confusion, attention deficit, and impairment of memory, and peripheral side effects, which include dry mouth, constipation, urinary retention, and bowel obstruction. MAP may also inhibit the potential benefits of cholinesterase inhibitors, which is the main pharmacological class, currently approved for the management of dementia.

Based on the current literature review of the anticholinergic burden (ACB) scales and serum anticholinergic activity of various medications, we collated known information of the level of anticholinergic activity for each medication, and developed recommendations for prescribers, focussing on pharmacological alternatives for the currently prescribed MAP for older adults with dementia presenting with co-morbidities.

The implementation of the recommendations for prescribing therapeutic alternatives to anticholinergic medications in this vulnerable population along with an awareness created among prescribers has the potential to reduce untoward effects associated with the prescription of anticholinergic medications, slower cognitive decline, and decrease the risk of mortality; supporting individuals with dementia to live longer independently.

Media releases

Oral presentations

  1. Bala SS, Jamieson HA, Nishtala PS. A high prevalence of prescribing potentially inappropriate medications in a nationwide cohort of community dwellers with dementia. New Zealand Association of Gerontology. 8 September 2018. Auckland, New Zealand.
  2. Bala SS, Jamieson HA, Nishtala PS. Predictors of inappropriate prescribing among older adults with complex care needs who have undergone the interRAI assessment. 4th Pharmacoepidemiology Research Network Symposium, University of Otago. 21 November 2018. Dunedin, New Zealand.
  3. Bala SS, Jamieson HA, Nishtala PS. Factors associated with prescribing potentially inappropriate medications in community dwellers with dementia receiving the interRAI assessment in New Zealand. PSM In-House convention. 11 February 2019. Dunedin New Zealand.
  4. Bala SS, Jamieson HA, Nishtala PS, Braund R. Validation of a guideline recommending pharmacological alternatives for medications with anticholinergic properties prescribed to individuals with dementia. Knowledge Exchange Day. 18 October 2019. Auckland New Zealand.
  5. Bala SS, Jamieson HA, Nishtala PS, Braund R. Recommendations of pharmacological alternatives for anticholinergic class of medications prescribed to individuals with dementia. Australasian Society of Clinical and Experimental Pharmacologists and Toxicologists-Population Approach Group in Australia and New Zealand (ASCEPT-PAGANZ). 27 November 2019. Queenstown, New Zealand.
  6. Bala SS, Jamieson HA, Nishtala PS, Braund R. Validated guidelines for pharmacological alternatives to currently prescribed medications with anticholinergic properties in older adults with dementia. 5th Pharmacoepidemiology Research Network Symposium, University of Otago. 20 November 2019. Dunedin, New Zealand.

Poster presentation

Bala SS, Jamieson HA, Nishtala PS, Braund R. Establishing guidelines for pharmacological alternatives to currently prescribed anticholinergic medications in older adults with dementia. Alzheimer’s Association International Conference (AAIC). July 2019. Los Angeles, USA.

Workshop

inSPIRe workshop: interRAI database training in inSPIRe, an eight day interactive meeting coordinated by interRAI Fellows to support early career researchers. University of Queensland. 4-12 November 2019. Brisbane, Australia.

Competitions

  1. Bala SS, Jamieson AH, Nishtala PN. National prescribing indicators for older adults. Three minute thesis competition. Health Sciences Division, University of Otago. 20 July 2017. Dunedin New Zealand.
  2. Bala SS, Jamieson AH, Nishtala PN. Appropriate prescribing for older adults in New Zealand. Three minute thesis competition. Health Sciences Division, University of Otago. 20 July 2018 Dunedin New Zealand.
  3. Bala SS, Jamieson AH, Nishtala PN, Braund R. Establishing guidelines for pharmacological alternatives to currently prescribed medications with anticholinergic properties in older adults with dementia. Three minute thesis competition. Health Sciences Division, University of Otago. 8 July 2019. Dunedin, New Zealand.

Awards

  1. University of Otago Doctoral Scholarship
  2. HOPE Foundation for Research in Aging Scholarship
  3. Travel grant for presenting at the ASCEPT-PAGANZ Conference 2019
  4. Conference and travel grant for presenting at the AAIC 2019
  5. Travel grant for presenting at the Knowledge Exchange Day 2019

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., Jamieson, H. A., & Nishtala, P. S. (2019). Factors associated with inappropriate prescribing among older adults with complex care needs who have undergone the interRAI assessment. Current Medical Research & Opinion, 35(5), 917-923. doi: 10.1080/03007995.2018.1543185

Bala, S. S., Jamieson, H. A., & Nishtala, P. S. (2019). 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, 34, 153-161. doi: 10.1002/gps.5004

Bala, S. S., Chen, T. F., & Nishtala, P. S. (2019). Reducing potentially inappropriate medications in older adults: A way forward. Canadian Journal on Aging, 38(4), 419-433. 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

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., Jamieson, H. A., & Nishtala, P. S. (2019). Factors associated with inappropriate prescribing among older adults with complex care needs who have undergone the interRAI assessment. Current Medical Research & Opinion, 35(5), 917-923. doi: 10.1080/03007995.2018.1543185

Bala, S. S., Jamieson, H. A., & Nishtala, P. S. (2019). 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, 34, 153-161. doi: 10.1002/gps.5004

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., & 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., Chen, T. F., & Nishtala, P. S. (2019). Reducing potentially inappropriate medications in older adults: A way forward. Canadian Journal on Aging, 38(4), 419-433. doi: 10.1017/S0714980819000084

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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