Investigation of a possible association of potentially inappropriate medication for older adults and frailty in a prospective cohort study from Germany

Abstract Objective potentially inappropriate medications (PIMs) are commonly defined as drugs that should be avoided in older adults because they are considered to have a negative risk-benefit ratio. PIMs are suspected to increase the risk for frailty, but this has yet to be examined. Design prospective population-based cohort study. Setting and participants a German cohort of community-dwelling older adults (≥60 years) was followed from October 2008 to September 2016. Methods in propensity score-adjusted logistic and Cox regression models, associations between baseline PIM use and prevalent/incident frailty were investigated. Frailty was assessed using the definition by Fried and co-workers, PIM were defined with the 2015 BEERS criteria, the BEERS criteria to avoid in cognitively impaired patients (BEERS dementia PIM), the EU(7)-PIM and the PRISCUS list. Results of 2,865 participants, 261 were frail at baseline and 423 became frail during follow-up. Only BEERS dementia PIM use was statistically significantly associated with prevalent frailty (odds ratio (95% confidence interval), 1.51 (1.04–2.17)). The strength of the association was comparable for all frailty components. Similarly, in longitudinal analyses, only BEERS dementia PIM use was associated with incident frailty albeit not statistically significant (hazard ratio, 1.19 (0.84–1.68)). Conclusions the association of PIM use and frailty seems to be restricted to drug classes, which can induce frailty symptoms (anticholinergics, benzodiazepines, z-substances and antipsychotics). Physicians are advised to perform frailty assessments before and after prescribing these drug classes to older patients and to reconsider treatment decisions in case of negative performance changes.

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Inappropriate Medication Use In Older Adults According To Beers Criteria In A Tertiary Referral Hospital, In Bolu, Turkey

Russian Open Medical Journal ◽

10.15275/rusomj.2021.0211 ◽

2021 ◽

Vol 10 (2) ◽

Author(s):

Burcin M. Atak ◽

Gulali Aktas ◽

Tuba T. Duman ◽

Ozge Kurtkulagi ◽

Satilmis Bilgin ◽

...

Keyword(s):

Older Adults ◽

Inappropriate Medication ◽

Bleeding Risk ◽

Beers Criteria ◽

Potentially Inappropriate Medications ◽

Tertiary Referral Hospital ◽

Inappropriate Use ◽

Increased Risk ◽

Risk Of Falls ◽

Inappropriate Medications

Aims — We aimed to study the medications used by older adults for any potentially inappropriate medications. Material and Methods — A hundred and four consecutive subjects over 65 years of age who visited our clinic were enrolled in the study. Possible inappropriate medications were defined according to Beers Criteria. Results — A total of 57 women and 49 men were enrolled in the study. Mean ages of the women and men were 78.6±6.1 years and 77.4±5.4 years, respectively (p=0.30). While 18 subjects (17%) had no increased risk due to inappropriate use of medications, 30 were on inappropriate medications that increased renal failure risk, 5 were on inappropriate medication that amplified neurological side effects, 12 were on inappropriate medications that augmented bleeding risk, 20 were on inappropriate medication that lack safety and efficacy data, and 30 were on inappropriate medication that amplified the risk of falls. The number of increased risks according to Beers Criteria was significantly and positively correlated with number of medications used (r=0.366, p<0.001) and the number of comorbidities (r=0.312, p=0.001). Conclusion — The number of increased risks due to inappropriate use of medicines in older adults is positively correlated with the number of medicines used and the number of accompanied diseases. Therefore we suggest that the medicines used by older people should be reviewed in all settings, and unnecessary drugs should be avoided to be prescribed.

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Potentially inappropriate medications in older adults: A review of the 2012 Beers Criteria and the implications in persons with dementia

Mental Health Clinician ◽

10.9740/mhc.n204331 ◽

2014 ◽

Vol 4 (4) ◽

pp. 166-169 ◽

Cited By ~ 1

Author(s):

Nicole J. Brandt ◽

Traci Turner

Keyword(s):

Older Adults ◽

Adverse Drug Events ◽

Beers Criteria ◽

Potentially Inappropriate Medications ◽

Clinical Tool ◽

Drug Classes ◽

Information Set ◽

Sliding Scale ◽

Institutionalized Patients ◽

Inappropriate Medications

In 2012, the American Geriatrics Society (AGS), along with a panel of 11 experts, updated the Beers Criteria which has evolved significantly since its inception in 1991. The Beers Criteria, in general, classifies medications/medication classes as: (1) potentially inappropriate for use in all older adults, (2) potentially inappropriate for older adults with certain diseases or symptoms and (3) requiring extra caution when used in older adults. Although each patient must be evaluated individually, the Beers Criteria is a useful clinical tool that can be used when initiating pharmacologic agents in both ambulatory and institutionalized patients. The concept behind use of the Beers Criteria is that it allows prescribers to readily identify, and avoid, medications associated with negative outcomes in older adults therefore decreasing the risk of adverse drug events (ADEs). Within this review article, there will be a highlight of potentially inappropriate medications (PIMs) commonly seen in clinical practice settings such as antipsychotics, benzodiazepines, non-benzodiazepine sedative-hypnotics, anticholinergics and sliding scale insulin. The focus will be to outline the risk-benefits of these drug classes within the context of persons with dementia. Furthermore, the use of PIMs has both clinical and financial implications in Medicare Star ratings and Healthcare Effectiveness Data and Information Set (HEDIS) measures.

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BODY MASS INDEX TRAJECTORY BEFORE DEATH IN COMMUNITY-DWELLING OLDER ADULTS. POPULATION-BASED COHORT STUDY

10.1101/2021.05.21.21257579 ◽

2021 ◽

Author(s):

Hari Venkatesh Pai ◽

Martin C Gulliford

Keyword(s):

Older Adults ◽

Body Mass Index ◽

Cohort Study ◽

Body Mass ◽

High Body Mass Index ◽

Population Based ◽

Community Dwelling ◽

Housing Tenure ◽

Age Related ◽

Community Dwelling Older Adults

Background and objective: Both low and high body mass index (BMI) have been associated with greater mortality in older adults. This study evaluated the trajectory of BMI in the final years of life. Design: Population-based cohort study. Setting: Community-dwelling adults in the English Longitudinal Study of Ageing between 1998 and 2012. Measurements: Body mass index, years before death and all-cause mortality. Analyses were adjusted for age, gender, educational level, housing tenure and social class. Results: Data were analysed for 16,924 participants with 31,857 BMI records; mean age at study start, 61.6 (SD 10.9) years; mean BMI, 27.5 (4.7) Kg/m2. There were 3,686 participants (4,794 BMI records) who died and 13,238 participants (27,063 BMI records) who were alive at last follow-up. Mean BMI increased with age to 60-69 years but then declined, but the age-related decline was more rapid in decedents. At ages 80-89 years, mean BMI in decedents was 26.1 (4.7) compared with 27.1 (4.4) Kg/m2 in survivors. After adjusting for age and covariates, mean BMI declined in the five years before death. From 9 to 5 years before death or end of study, adjusted mean BMI was 0.51 (95% confidence interval 0.24 to 0.78) Kg/m2 lower for decedents than survivors; and from four to zero years before death, 1.55 (1.26 to 1.84) Kg/m2 lower in decedents. Conclusions: In community-dwelling older adults, mean body mass index enters an accelerating decline during five years before death. Reverse causation may account for the association of lower BMI with mortality.

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Cerebrovascular Correlates of Dementia in Community-Dwelling Older Adults Living in Rural Communities – The Three Villages Study. Rationale and Protocol of a Population-Based Prospective Cohort Study

Journal of Stroke and Cerebrovascular Diseases ◽

10.1016/j.jstrokecerebrovasdis.2020.104656 ◽

2020 ◽

Vol 29 (4) ◽

pp. 104656 ◽

Cited By ~ 1

Author(s):

Oscar H. Del Brutto ◽

Robertino M. Mera ◽

Victor J. Del Brutto ◽

Aldo F. Costa ◽

Bettsy Y. Recalde

Keyword(s):

Older Adults ◽

Cohort Study ◽

Rural Communities ◽

Prospective Cohort Study ◽

Prospective Cohort ◽

Population Based ◽

Community Dwelling ◽

Community Dwelling Older Adults

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Prescription of potentially inappropriate medication in Korean older adults based on 2012 Beers Criteria: a cross-sectional population based study

BMC Geriatrics ◽

10.1186/s12877-016-0285-3 ◽

2016 ◽

Vol 16 (1) ◽

Cited By ~ 15

Author(s):

You-Seon Nam ◽

Jong Soo Han ◽

Ju Young Kim ◽

Woo Kyung Bae ◽

Kiheon Lee

Keyword(s):

Older Adults ◽

Inappropriate Medication ◽

Population Based ◽

Potentially Inappropriate Medication ◽

Beers Criteria ◽

Cross Sectional ◽

Population Based Study

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Urgency urinary incontinence, loss of independence, and increased mortality in older adults: A cohort study

PLoS ONE ◽

10.1371/journal.pone.0245724 ◽

2021 ◽

Vol 16 (1) ◽

pp. e0245724

Author(s):

Takashi Yoshioka ◽

Tsukasa Kamitani ◽

Kenji Omae ◽

Sayaka Shimizu ◽

Shunichi Fukuhara ◽

...

Keyword(s):

Older Adults ◽

Urinary Incontinence ◽

Cohort Study ◽

Hazard Analysis ◽

Population Based ◽

Incidence Rates ◽

Community Dwelling ◽

Urgency Urinary Incontinence ◽

Longitudinal Association ◽

Community Dwelling Older Adults

Objectives To investigate the longitudinal association of urgency urinary incontinence (UUI) with loss of independence (LOI) or death among independent community-dwelling older adults. Design Population-based cohort study. Setting The Locomotive Syndrome and Health Outcome in Aizu Cohort Study (LOHAS), Minami-Aizu Town and Tadami Town, Fukushima, Japan. Participants A total of 1,580 participants aged ≥65 years who underwent a health check-up conducted by LOHAS in 2010. Measurements Exposure was defined as the presence of UUI, which was measured by a questionnaire based on the definition of UUI from the International Continence Society. The primary outcome was defined as incidence of LOI or death. After the check-up in 2010, the outcome was monitored until March 2014. A multivariable Cox proportional hazard analysis was performed to estimate the hazard ratio for the outcome. Ten potential confounders were adjusted in the analysis. Furthermore, we defined the secondary outcomes as two separate outcomes, LOI and death, and performed the same analysis. Results Among all participants, 328 reported UUI. The incidence rates of the outcome were 20.4 and 11.4 (per 1,000 person–years) among participants with and without UUI, respectively. After multivariable adjustment, those who experienced UUI showed a substantial association with LOI or death (HR, 1.65; 95% CI, 1.01–2.68). However, they did not show such an association with LOI alone (HR, 1.07; 95% CI, 0.49–2.33). On the other hand, those with UUI exhibited a substantial association with death (HR, 2.23; 95% CI, 1.22–4.31). Conclusions In this study, UUI was associated with the occurrence of LOI or death; however, UUI is not associated with the occurrence of LOI alone among independent community-dwelling older adults. Our results suggest that there may be a difference between UUI-associated diseases that cause LOI and those that cause death.

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Potentially inappropriate medications in older adults: a population-based cohort study

Family Practice ◽

10.1093/fampra/cmz060 ◽

2019 ◽

Cited By ~ 8

Author(s):

Barbara Roux ◽

Caroline Sirois ◽

Marc Simard ◽

Marie-Eve Gagnon ◽

Marie-Laure Laroche

Keyword(s):

Older Adults ◽

Cohort Study ◽

Chronic Diseases ◽

Medication Use ◽

Population Based ◽

Community Dwelling ◽

The Public ◽

Factors Associated ◽

Community Dwelling Older Adults ◽

Public Drug

Abstract Background Non-optimal medication use among older adults is a public health concern. A concrete picture of potentially inappropriate medication (PIM) use is imperative to ensure optimal medication use. Objective To assess the prevalence of PIMs in community-dwelling older adults and identify associated factors. Methods A retrospective population-based cohort study was conducted using the Quebec Integrated Chronic Disease Surveillance System (QICDSS). The QICDSS includes data on drug claims for community-dwelling older adults with chronic diseases or at risk of developing chronic diseases aged ≥65 years who are insured by the public drug insurance plan. Individuals aged ≥66 years who were continuously insured with the public drug plan between 1 April 2014 and 31 March 2016 were included. PIMs were defined using the 2015 Beers criteria. We conducted multivariate robust Poisson regression analyses to explore factors associated with PIM use. Results A total of 1 105 295 individuals were included. Of these, 48.3% were prescribed at least one PIM. The most prevalent PIMs were benzodiazepines (25.7%), proton-pump inhibitors (21.3%), antipsychotics (5.6%), antidepressants (5.0%) and long-duration sulfonylureas (3.3%). Factors associated with PIM exposure included being a woman [rate ratio (RR): 1.20; 95% confidence interval (CI): 1.20–1.21], increased number of medications and having a high number of chronic diseases, especially mental disorders (RR: 1.50; 95% CI: 1.49–1.51). Conclusion Almost one out of two community-dwelling older adults use a PIM. It is imperative to reduce the use of PIMs, by limiting their prescription and by promoting their deprescribing, which necessitates not only the active involvement of prescribers but also patients.

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N-Terminal Prosomatostatin and Risk of Vascular Dementia

Cerebrovascular Diseases ◽

10.1159/000479940 ◽

2017 ◽

Vol 44 (5-6) ◽

pp. 259-265 ◽

Cited By ~ 3

Author(s):

Hannes Holm ◽

Katarina Nägga ◽

Erik D. Nilsson ◽

Fabrizio Ricci ◽

Eduardo Cinosi ◽

...

Keyword(s):

Alzheimer’S Disease ◽

Older Adults ◽

Alzheimer's Disease ◽

Vascular Dementia ◽

Cox Regression ◽

Population Based ◽

Community Dwelling ◽

Incident Dementia ◽

Increased Risk ◽

Study Participants

Background: Increased somatostatin plasma concentration has been found in patients with vascular dementia. However, it is unknown whether or not somatostatin levels may predict dementia development in the general population. To this end, we sought to assess the association of circulating N-terminal prosomatostatin (NT-proSST) with incident dementia among community-dwelling older adults. Methods: In the prospective population-based Malmö Preventive Project, 5,347 study participants (mean age: 69 ± 6years; 70% men) provided plasma for the determination of NT-proSST concentration. Of these, 373 participants (7%) were diagnosed with dementia (120 Alzheimer's disease, 83 vascular, 102 mixed, and 68 other aetiology) during a follow-up period of 4.6 ± 1.3 years. The association of NT-proSST with the risk of dementia and its subtypes was studied using multivariable-adjusted Cox regression models controlling for age, gender, body mass index, systolic blood pressure, antihypertensive treatment, smoking, diabetes, lipid levels and prevalent stroke. Results: Higher levels of NT-proSST were significantly associated with an increased risk of vascular dementia (hazard ratio [HR] per 1 SD: 1.29; 95% CI 1.05-1.59; p = 0.016), whereas no association was observed with Alzheimer's disease (HR per 1 SD: 0.99; 95% CI 0.81-1.20; p = 0.91), all-cause dementia (HR per 1 SD: 1.04; 95% CI 0.94-1.16; p = 0.44), and mixed dementia (HR per 1 SD: 0.98; 95% CI 0.79-1.21; p = 0.84). Levels of NT-proSST above 563 pmol/L (highest quartile) conferred distinctly increased risk of vascular dementia (HR 1.66; 95% CI 1.05-2.63; p = 0.029) compared with lower values. Conclusions: Higher levels of circulating N-terminal-prosomatostatin are associated with increased incidence of vascular dementia. Our findings might be of importance for the understanding of dementia development in older adults.

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