Anticholinergic and sedative drug burden in community-dwelling older people: a national database study

ObjectivesThe Drug Burden Index (DBI) tool quantifies individual exposure to anticholinergic and sedative medications. The DBI has been internationally validated against adverse health outcomes in older people. DBI exposure has not been reported in the Irish older population. This study aimed to: (1) develop a list of drugs with clinically significant anticholinergic and/or sedative effects (DBI medications) relevant to Ireland; (2) examine, using the DBI formula, the prevalence of exposure to DBI medications in Irish older people and (3) explore patient factors associated DBI exposure.DesignA cross-sectional national pharmacy claims database study.SettingCommunity setting using the General Medical Services (GMS) scheme pharmacy claims database maintained by the Health Service Executive Primary Care Reimbursement Services.ParticipantsIrish older individuals (aged ≥65 years) enrolled in the GMS scheme and dispensed at least one prescription item in 2016 (n=428 516).Main outcome measuresPrevalence of exposure to DBI medications and patient factors associated with DBI exposure.Results282 874 (66%) of the GMS population aged ≥65 years were exposed to at least one DBI medication in 2016. Prevalence of exposure to DBI medications was significantly higher in females than males (females 71.6% vs males 58.7%, adjusted OR 1.65, 95% CI 1.63 to 1.68). Prevalence of DBI exposure increased progressively with the number of chronic drugs used, rising from 42.7% of those prescribed 0–4 chronic drugs to 95.4% of those on ≥12 chronic drugs (adjusted OR 27.8, 95% CI 26.7 to 29.0). The most frequently used DBI medications were codeine/paracetamol combination products (20.1% of patients), tramadol (11.5%), zopiclone (9.5%), zolpidem (8.5%), pregabalin (7.9%) and alprazolam (7.8%).ConclusionsThe majority of older people in Ireland are exposed to medications with anticholinergic and/or sedative effects, particularly females and those with multiple comorbidities. The high use of low-dose codeine/paracetamol combination products, Z-drugs and benzodiazepines, suggests there are opportunities for deprescribing.

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Adherence to dosing schedule of denosumab therapy for osteoporosis during COVID-19 lockdown: an electronic medical record and pharmacy claims database study from Asia

Osteoporosis International ◽

10.1007/s00198-021-06085-0 ◽

2021 ◽

Author(s):

Manju Chandran ◽

Ying Hao ◽

Ann Kerwen Kwee ◽

Mcvin Hua Heng Cheen ◽

Yun Ann Chin ◽

...

Keyword(s):

Medical Record ◽

Electronic Medical Record ◽

Dosing Schedule ◽

Claims Database ◽

Database Study ◽

Pharmacy Claims

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Predictors of Major Depressive Disorder in Older People

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph182211894 ◽

2021 ◽

Vol 18 (22) ◽

pp. 11894

Author(s):

Susana Sousa ◽

Constança Paúl ◽

Laetitia Teixeira

Keyword(s):

Major Depressive Disorder ◽

Depressive Disorder ◽

Older People ◽

Social Factors ◽

Common Mental Disorders ◽

Community Dwelling ◽

Major Depressive ◽

Factors Associated ◽

Status Mobility ◽

Community Dwelling Older People

Major depressive disorder (MDD) is one of the most common mental disorders in older people. There are several biological, psychological, and social factors associated with this disorder. This study aimed to describe the depressive state to identify the associated factors and potential predictors of MDD in a population of community-dwelling older people with probable MDD. The sample consisted of 378 participants with probable dementia, with 47.3% of them presenting MDD. The factors that were found to be associated with MDD were sex, living status, mobility, and nutritional status. Knowing the factors that can predict a condition such as MDD is extremely important, both for prevention and for the customization of interventions.

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Prevalence and Risk of Polypharmacy among Community-Dwelling, Elderly Kuwaiti Patients

Medical Principles and Practice ◽

10.1159/000503298 ◽

2019 ◽

Vol 29 (2) ◽

pp. 166-173 ◽

Cited By ~ 1

Author(s):

Nabil Ahmed Badawy ◽

Shokria Adely Labeeb ◽

Mawaheb Falah Alsamdan ◽

Badria Faleh Alazemi

Keyword(s):

Risk Factors ◽

Hospital Admissions ◽

Antihypertensive Drugs ◽

Female Gender ◽

Community Dwelling ◽

Older Individuals ◽

Cross Sectional ◽

Factors Associated ◽

High Prevalence ◽

Study Population

Objectives: To estimate the prevalence of polypharmacy in community-dwelling, older Kuwaiti patients, describe the number and types of drugs used, and identify risk factors associated with polypharmacy. Subjects and Methods: This was a descriptive cross-sectional questionnaire-based survey in which we interviewed 500 community-dwelling Kuwaiti adults over 65 years of age. The data collection occurred during a 4-month period from March to July 2017. Results: Fifty-two percent (n = 260) of the patients were males, with a mean age of 71.73 ± 5.32 years. The prevalence of polypharmacy (5–8 drugs) and excessive polypharmacy (>8 drugs) was 58.4% (n = 292) and 10.2% (n = 51), respectively. The risk factors associated with an increased number of medicines used were: female gender (p = 0.019), a lower level of education (p = 0.003), a high number of hospital admissions (p = 0.000), clinics visited by the patient (p =0.000), and number of comorbidities (p = 0.000). The most commonly used medications (82.6% of the study population) were blood glucose-lowering agents, excluding insulin. Other commonly used medications were antihypertensive drugs and lipid-modifying agents. Conclusion: A significant sector of the older Kuwaiti patient population has a high prevalence of polypharmacy and is thus exposed to its potential hazards. The current study highlights the need to revise the drug-dispensing policy among community-dwelling, older Kuwaiti people, as well as to initiate educational programs among healthcare practitioners concerning prescribing issues in older individuals.

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Impact of Malnutrition on Low Muscle Mass in Community-Dwelling Older People in Singapore: Findings from the SHIELD study

Current Developments in Nutrition ◽

10.1093/cdn/nzaa040_080 ◽

2020 ◽

Vol 4 (Supplement_2) ◽

pp. 80-80

Author(s):

Siew Ling Tey ◽

Samuel Teong Huang Chew ◽

Yatin Berde ◽

Geraldine Baggs ◽

Choon How How ◽

...

Keyword(s):

At Risk ◽

Nutritional Status ◽

Bone Mass ◽

Older People ◽

Muscle Mass ◽

Community Dwelling ◽

Risk Category ◽

Calf Circumference ◽

Factors Associated ◽

Community Dwelling Older People

Abstract Objectives Malnutrition contributes to loss of muscle mass. There is limited information on the prevalence of low muscle mass in community-dwelling older people who are (not) at risk of malnutrition. Factors associated with muscle mass are also not well characterized. This cross-sectional study aimed to determine the prevalence of low appendicular skeletal muscle mass index (ASMI; ASM/height2) in older people with normal nutritional status (Malnutrition Universal Screening Tool, MUST risk category = low) and those at risk of malnutrition (MUST risk category = medium or high), and to determine factors associated with ASMI. Methods Strengthening Health In ELDerly through nutrition (SHIELD) is a study involving 1211 (400 with normal nutritional status and 811 at risk of malnutrition) community-dwelling older people aged ≥65 years in Singapore. Low ASMI was determined by bioelectrical impedance analysis (Asian Working Group for Sarcopenia, 2014). Results One in five (20.6%) nourished participants had low ASMI vs. four in five (81.3%) participants at risk of malnutrition had low ASMI (P < 0.0001). Older people with low ASMI were more likely to be admitted to the hospital, had longer length of stay, 25-hydroxyvitamin D deficiency, and lower education level, compared to those with normal ASMI (all P ≤ 0.0472). In the multiple linear regression model, age (coefficient, b = −0.013 kg/m2; P < 0.001), gender (female: b = −0.963 kg/m2; P < 0.001), calf circumference (b = 0.042 kg/m2; P < 0.001), bone mass (b = 0.593 kg/m2; P < 0.001), BMI (b = 0.129 kg/m2; P < 0.001), and Physical Activity Scale for the Elderly (PASE) score (b = 0.001 kg/m2; P = 0.048) were associated with ASMI. Conclusions Community-dwelling older people at risk of malnutrition had four-fold greater risk of having low ASMI as compared to nourished counterparts. Increasing age was associated with lower ASMI, whereas calf circumference, bone mass, BMI, PASE score, and being male were positively associated with ASMI. These findings highlight the importance of screening for low muscle mass and maintaining muscle health as part of the overall malnutrition management in this population group. Funding Sources The Economic Development Board of Singapore, Abbott Nutrition, and Changi General Hospital funded this study.

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A theoretical and empirical review of psychological factors associated with falls-related psychological concerns in community-dwelling older people

International Psychogeriatrics ◽

10.1017/s1041610214002701 ◽

2015 ◽

Vol 27 (7) ◽

pp. 1071-1087 ◽

Cited By ~ 33

Author(s):

C. C. Hughes ◽

I. I. Kneebone ◽

F. Jones ◽

B. Brady

Keyword(s):

Older People ◽

Psychological Factors ◽

Community Dwelling ◽

Activity Level ◽

Future Research ◽

Negative Consequences ◽

Factors Associated ◽

Moderate Evidence ◽

Tentative Evidence ◽

Community Dwelling Older People

ABSTRACTBackground:Four constructs are encompassed by the term “falls-related psychological concerns” (FrPC); “fear of falling” (FOF), “falls-related self-efficacy” (FSe), “balance confidence” (BC) and “outcome expectancy” (OE). FrPC are associated with negative consequences including physical, psychological, and social. Identifying factors associated with FrPC could inform interventions to reduce these concerns.Methods:Sixty-two empirical papers relating to psychological factors associated with FrPC in community-dwelling older people (CDOP) were reviewed. Four levels of evidence were used when evaluating the literature: good, moderate, tentative, and none.Results:Evidence that anxiety predicted FOF, BC, and OE was tentative. Moderate evidence was found for anxiety predicting FSe. Good evidence was found for depression predicting FSe. Moderate evidence was found for depression predicting both FOF and BC. No evidence was found for depression predicting OE. Tentative evidence was found for FSe predicting depression. Good and moderate evidence was found for quality of life (QoL) being predicted by FOF and BC respectively. Tentative evidence was found for FSe predicting QoL. Moderate evidence was found for QoL predicting both FSe and BC. No evidence was found for QoL predicting FOF. Good and moderate evidence was found for activity avoidance/restriction (AA/AR) being predicted by FOF and FSe respectively. Tentative evidence was found for BC and OE predicting AA/AR, as well as for AA/AR predicting FOF. Moderate evidence for activity level (AL) predicting FOF was identified, however the evidence of this predicting FSe and BC was tentative. Evidence for FOF, FSe, and BC predicting AL was tentative as was evidence to suggest FOF predicted coping.Conclusions:Mixed evidence has been found for the association of psychological factors in association with FrPCs. Future research should employ theoretically grounded concepts, use multivariate analysis and longitudinal designs.

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