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

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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Trajectories of self-rated health in an older general population and their determinants: the Lifelines Cohort Study

BMJ Open ◽

10.1136/bmjopen-2019-035012 ◽

2020 ◽

Vol 10 (2) ◽

pp. e035012

Author(s):

Marlies Feenstra ◽

Barbara C van Munster ◽

Janet L MacNeil Vroomen ◽

Sophia E de Rooij ◽

Nynke Smidt

Keyword(s):

Older Adults ◽

Cohort Study ◽

General Population ◽

Health Risk ◽

Chronic Diseases ◽

Community Dwelling ◽

Endocrine Function ◽

Self Rated Health ◽

Physiological Markers ◽

Community Dwelling Older Adults

ObjectivesPoor self-rated health (SRH) is a strong predictor of premature mortality in older adults. Trajectories of poor SRH are associated with multimorbidity and unhealthy behaviours. Whether trajectories of SRH are associated with deviating physiological markers is unclear. This study identified trajectories of SRH and investigated the associations of trajectory membership with chronic diseases, health risk behaviours and physiological markers in community-dwelling older adults.Study design and settingProspective general population cohort.ParticipantsTrajectories of SRH over 5 years were identified using data of 11 600 participants aged 65 years and older of the Lifelines Cohort Study.Outcome measuresTrajectories of SRH were the main outcome. Covariates included demographics (age, gender, education), chronic diseases, health-risk behaviour (physical activity, smoking, drinking) and physiological markers (body mass index, cardiovascular function, lung function, glucose metabolism, haematological condition, endocrine function, renal function, liver function and cognitive function).ResultsFour stable trajectories were identified, including excellent (n=607, 6%), good (n=2111, 19%), moderate (n=7677, 65%) and poor SRH (n=1205, 10%). Being women (OR: 1.4; 95% CI: 1.0 to 1.9), low education (OR: 2.1; 95% CI: 1.5 to 3.0), one (OR: 10.4; 95% CI: 7.4 to 14.7) or multiple chronic diseases (OR: 37.8; 95% CI: 22.4 to 71.8), smoking (OR: 1.8; 95% CI: 1.0 to 3.2), physical inactivity (OR: 3.1; 95% CI: 1.8 to 5.2), alcohol abstinence (OR: 2.2; 95% CI: 1.4 to 3.2) and deviating physiological markers (OR: 1.5; 95% CI: 1.1 to 2.0) increase the odds for a higher probability of poor SRH trajectory membership compared with excellent SRH trajectory membership.ConclusionSRH of community-dwelling older adults is stable over time with the majority (65%) having moderate SRH. Older adults with higher probabilities of poor SRH often have unfavourable health status.

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Factors associated with potentially inappropriate medication use in community‐dwelling older adults in the United States: a systematic review

International Journal of Pharmacy Practice ◽

10.1111/ijpp.12541 ◽

2019 ◽

Vol 27 (5) ◽

pp. 408-423 ◽

Cited By ~ 5

Author(s):

Stephanie K. Nothelle ◽

Ritu Sharma ◽

Allison Oakes ◽

Madeline Jackson ◽

Jodi B. Segal

Keyword(s):

United States ◽

Systematic Review ◽

Older Adults ◽

Inappropriate Medication ◽

Medication Use ◽

The United States ◽

Community Dwelling ◽

Factors Associated ◽

Inappropriate Medication Use ◽

Community Dwelling Older Adults

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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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Self-Management Behaviours and Change in Frailty Status among Community-Dwelling Older Adults: A National Longitudinal Population-based Cohort Study

10.21203/rs.3.rs-1171960/v1 ◽

2022 ◽

Author(s):

Thi Lien To ◽

Ching-Pyng Kuo ◽

Chih-Jung Yeh ◽

Wen-Chun Liao ◽

Meng-Chih Lee

Keyword(s):

Older Adults ◽

Cohort Study ◽

Chronic Diseases ◽

Community Dwelling ◽

Self Management ◽

Geriatric Syndrome ◽

Frailty Phenotype ◽

Frailty Status ◽

Community Dwelling Older Adults

Abstract Background: Frailty in older adults is a common geriatric syndrome that can be reversed, thus coping strategies for the aging population are essential. Self-management behaviours may represent cost-effective strategies to reverse physical frailty in community-dwelling older adults. This study aimed to describe the changes in frailty status among community-dwelling older adults in Taiwan and investigate the association of self-management behaviours with changes in frailty status over a four-year follow-up period (2007 to 2011).Methods: This data was retrieved from the Taiwan Longitudinal Study of Aging (TLSA), which is a prospective cohort study of 1,283 community-dwelling older adults aged 65 years and older without cognitive impairment. Frailty was assessed based on Fried's frailty phenotype, in which ≥ three criteria indicate frail. Self-management behaviours (maintaining body weight, quitting smoking, drinking less, exercising, diet control, and maintaining a regular lifestyle) were assessed using a questionnaire. Multivariate logistic regression analyses were used to investigate the associations between self-management behaviours and changes in frailty status.Results: The prevalence of frailty was 8.7% at baseline and 8.1% after four years of follow-up, with 196 (15.3%) deaths. Overall, 74.6% of participants remained in the same state (non-frail or frail), 23.5% worsened (non-frail to frail, including missing data, and frail to death), and only 1.95% improved (frail to non-frail). Being aged ≥ 75-years-old, chronic diseases, and an absence of self-management behaviours were associated with higher risks of frailty at baseline and after follow-up. Exercise was significantly associated with a reversal of frailty in community-dwelling older adults (RR, 3.11; 95% CI, 1.95, 4.95) after adjusting for personal and disease covariates, regardless of whether death was coded as frail or not.Conclusions: Self-management behaviours beneficially reverse frailty status; maintaining regular exercise was especially associated with a reversal of frailty in community-dwelling older adults, even among individuals over 75-years-old and with chronic diseases. Older adults should be encouraged to perform adequate physical exercise to prevent the progression of frailty and ameliorate frailty status.

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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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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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