Older Adults' Medication Use 6 Months Before and After Hip Fracture: A Population-Based Cohort Study

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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Population-Based Cohort Study of Anti-Infective Medication Use before and after the Onset of Type 1 Diabetes in Children and Adolescents

Antimicrobial Agents and Chemotherapy ◽

10.1128/aac.03080-14 ◽

2014 ◽

Vol 58 (8) ◽

pp. 4666-4674 ◽

Cited By ~ 9

Author(s):

Soulmaz Fazeli Farsani ◽

Patrick C. Souverein ◽

Marja M. J. van der Vorst ◽

Catherijne A. J. Knibbe ◽

Anthonius de Boer ◽

...

Keyword(s):

Type 1 Diabetes ◽

Cohort Study ◽

Children And Adolescents ◽

Reference Group ◽

Medication Use ◽

Population Based ◽

Second Line ◽

Before And After ◽

Reference Cohort

ABSTRACTA population-based cohort study was conducted in the Dutch PHARMO database to investigate prevalence and patterns of anti-infective medication use in children and adolescents with type 1 diabetes (T1D) before and after the onset of this disease. All patients <19 years with at least 2 insulin prescriptions (1999 to 2009) were identified (T1D cohort) and compared with an age- and sex-matched (ratio: 1 up to 4) diabetes-free reference group. The prevalence and average number of anti-infective use was studied from (up to) 8 years before until a maximum of 4 years after the onset of T1D. A total of 925 patients with T1D and 3,591 children and adolescents in the reference cohort (51% boys, mean age of 10.1 [standard deviation, 4.5] years) were included. The overall prevalence of anti-infective use (62.6 compared to 52.6%,P< 0.001) and average number of prescriptions (2.71 compared to 1.42 per child,P< 0.001) in the T1D cohort were significantly higher than those in the reference cohort after the onset of diabetes. This pattern was consistent across sex and age categories and already observed in the year before the onset of type 1 diabetes. Patients in the T1D cohort received more antibacterials (49.8 compared to 40%,P< 0.001), antimycotics (4.0 compared to 1.3%,P< 0.001), antivirals (2.5 compared to 0.4%,P< 0.001), and second-line antibiotics, such as aminoglycosides, quinolones, and third-generation cephalosporins and carbapenems. Our findings that elevated anti-infective use in the T1D cohort exists in the period before the onset of type 1 diabetes and the consumption of more second-line anti-infective compounds in this time period warrant further research.

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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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Changes in hip fracture rate before and after total knee replacement due to osteoarthritis: a population-based cohort study

Yearbook of Orthopedics ◽

10.1016/j.yort.2011.04.017 ◽

2011 ◽

Vol 2011 ◽

pp. 161-162

Author(s):

B.F. Morrey

Keyword(s):

Cohort Study ◽

Hip Fracture ◽

Total Knee Replacement ◽

Knee Replacement ◽

Population Based ◽

Fracture Rate ◽

Before And After ◽

Total Knee

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Medication Use Before and After Hip Fracture: A Population-Based Cohort and Case-Control Study

Drugs & Aging ◽

10.1007/s40266-014-0184-2 ◽

2014 ◽

Vol 31 (7) ◽

pp. 547-553 ◽

Cited By ~ 14

Author(s):

Maurizio Rossini ◽

Ombretta Viapiana ◽

Silvano Adami ◽

Luca Idolazzi ◽

Stefano Buda ◽

...

Keyword(s):

Hip Fracture ◽

Case Control Study ◽

Medication Use ◽

Population Based ◽

Case Control ◽

Before And After ◽

Control Study

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Changes in hip fracture rate before and after total knee replacement due to osteoarthritis: a population-based cohort study

Annals of the Rheumatic Diseases ◽

10.1136/ard.2010.131110 ◽

2010 ◽

Vol 70 (1) ◽

pp. 134-138 ◽

Cited By ~ 22

Author(s):

D. Prieto-Alhambra ◽

M. K. Javaid ◽

J. Maskell ◽

A. Judge ◽

M. Nevitt ◽

...

Keyword(s):

Cohort Study ◽

Hip Fracture ◽

Total Knee Replacement ◽

Knee Replacement ◽

Population Based ◽

Fracture Rate ◽

Before And After ◽

Total Knee

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Reduction in unplanned hospitalizations associated with a physician focused intervention to reduce potentially inappropriate medication use among older adults: a population-based cohort study

BMC Geriatrics ◽

10.1186/s12877-021-02172-3 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

M. Alcusky ◽

R. B. Thomas ◽

N. Jafari ◽

S. W. Keith ◽

A. Kee ◽

...

Keyword(s):

Older Adults ◽

Cohort Study ◽

General Practitioner ◽

Inappropriate Medication ◽

Medication Use ◽

Population Based ◽

Hospitalization Rate ◽

Intervention Period ◽

Post Intervention ◽

Hospitalization Rates

Abstract Background A multimodal general practitioner-focused intervention in the Local Health Authority (LHA) of Parma, Italy, substantially reduced the prevalence of potentially inappropriate medication (PIM) use among older adults. Our objective was to estimate changes in hospitalization rates associated with the Parma LHA quality improvement initiative that reduced PIM use. Methods This population-based longitudinal cohort study was conducted among older residents (> 65 years) using the Parma LHA administrative healthcare database. Crude and adjusted unplanned hospitalization rates were estimated in 3 periods (pre-intervention: 2005–2008, intervention: 2009–2010, post-intervention: 2011–2014). Multivariable negative binomial models estimated trends in quarterly hospitalization rates among individuals at risk during each period using a piecewise linear spline for time, adjusted for time-dependent and time-fixed covariates. Results The pre-intervention, intervention, and post-intervention periods included 117,061, 107,347, and 121,871 older adults and had crude hospitalization rates of 146.2 (95% CI: 142.2–150.3), 146.8 (95% CI: 143.6–150.0), and 140.8 (95% CI: 136.9–144.7) per 1000 persons per year, respectively. The adjusted pre-intervention hospitalization rate was declining by 0.7% per quarter (IRR = 0.993; 95% CI: 0.991–0.995). The hospitalization rate declined more than twice as fast during the intervention period (1.8% per quarter, IRR = 0.982; 95% CI: 0.979–0.985) and was nearly constant post-intervention (IRR: 0.999; 95% CI: 0.997–1.001). Contrasting model predictions for the intervention period (Q1 2009 to Q4 2010), the intervention was associated with 1481 avoided hospitalizations. Conclusion In a large population of older adults, a multimodal general practitioner-focused intervention to decrease PIM use was associated with a decline in the unplanned hospitalization rate. Such interventions to reduce high risk medication use among older adults warrant consideration by health systems seeking to improve health outcomes and reduce high-cost acute care utilization.

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