Sex Differences in Characteristics Associated with Potentially Inappropriate Medication Use and Associations with Functional Capacity in Older Participants of the Berlin Aging Study II

Introduction: Medication safety is a vital aim in older adults’ pharmacotherapy. Increased morbidity and vulnerability require particularly careful prescribing. Beneath avoiding unnecessary polypharmacy and prescribing omissions, physicians have to be aware of potentially inappropriate medications (PIMs) and related outcomes to optimize older adults’ drug therapy, and to reduce adverse drug events. Objective: The aim of this study was to identify participants characteristics associated with PIM use and associations of PIM use with functional capacity with a focus on sex differences. Methods: Multivariable logistic regression analyses of cross-sectional Berlin Aging Study II (BASE-II) data (N = 1,382, median age 69 years, interquartile range 67–71, 51.3% women) were performed with PIM classification according to the EU(7)-PIM list. Results: In the overall study population, higher education was associated with lower odds of PIM use (odds ratio [OR] 0.93, confidence interval [CI] 95% 0.87–0.99, p = 0.017). Falls (OR 1.53, CI 95% 1.08–2.17, p = 0.016), frailty/prefrailty (OR 1.68, 1.17–2.41, p = 0.005), and depression (OR 2.12, CI 95% 1.32–3.41, p = 0.002) were associated with increased odds of PIM use. A better nutritional status was associated with lower odds of PIM use (OR 0.88, CI 95% 0.81–0.97, p = 0.008). In the sex-stratified analysis, higher education was associated with lower odds of PIM use in men (OR 0.90, CI 95% 0.82–0.99, p = 0.032). Frailty/prefrailty was associated with increased odds of PIM use in men (OR 2.04, CI 95% 1.18–3.54, p = 0.011) and a better nutritional status was associated with lower odds of PIM use in men (OR 0.83, CI 95% 0.72–0.96, p = 0.011). Falls in the past 12 months were related to an increased prevalence of PIM use in women (OR 1.74, CI 95% 1.10–2.75, p = 0.019). Depression was associated with a higher prevalence of PIM use in both men (OR 2.74, CI 95% 1.20–6.24, p = 0.016) and women (OR 2.06, CI 95% 1.14–3.71, p = 0.017). We did not detect sex differences regarding the overall use of drugs with anticholinergic effects, but more men than women used PIMs referring to the cardiovascular system (p = 0.036), while more women than men used PIMs referring to the genitourinary system and sex hormones (p < 0.001). Conclusion: We found similarities, but also differences between men and women as to the associations between PIM use and participants’ characteristics and functional capacity assessments. The association of lower education with PIM use may suggest that physicians’ prescribing behavior is modified by patient education, a relationship that could evolve from more critical attitudes of educated patients towards medication use. We conclude that sex differences in associations of PIM use with functional capacities might be partly attributable to sex differences in drug classes used, but not with regard to anticholinergics, as these are used to a similar extent in men and women in the cohort studied here.

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Pharmacist-Led Collaborative Medication Management for the Elderly with Chronic Kidney Disease and Polypharmacy

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18084370 ◽

2021 ◽

Vol 18 (8) ◽

pp. 4370

Author(s):

A Kim ◽

Hayeon Lee ◽

Eun-Jeong Shin ◽

Eun-Jung Cho ◽

Yoon-Sook Cho ◽

...

Keyword(s):

Older Adults ◽

Chronic Kidney Disease ◽

Kidney Disease ◽

Medication Management ◽

Medication Use ◽

Potentially Inappropriate Medications ◽

Management Service ◽

Ckd Stage ◽

The Impact

Inappropriate polypharmacy is likely in older adults with chronic kidney disease (CKD) owing to the considerable burden of comorbidities. We aimed to describe the impact of pharmacist-led geriatric medication management service (MMS) on the quality of medication use. This retrospective descriptive study included 95 patients who received geriatric MMS in an ambulatory care clinic in a single tertiary-care teaching hospital from May 2019 to December 2019. The average age of the patients was 74.9 ± 7.3 years; 40% of them had CKD Stage 4 or 5. Medication use quality was assessed in 87 patients. After providing MMS, the total number of medications and potentially inappropriate medications (PIMs) decreased from 13.5 ± 4.3 to 10.9 ± 3.8 and 1.6 ± 1.4 to 1.0 ± 1.2 (both p < 0.001), respectively. Furthermore, the number of patients who received three or more central nervous system-active drugs and strong anticholinergic drugs decreased. Among the 354 drug-related problems identified, “missing patient documentation” was the most common, followed by “adverse effect” and “drug not indicated.” The most frequent intervention was “therapy stopped”. In conclusion, polypharmacy and PIMs were prevalent in older adults with CKD; pharmacist-led geriatric MMS improved the quality of medication use in this population.

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Potentially inappropriate medication in older participants of the Berlin Aging Study II (BASE-II) – Sex differences and associations with morbidity and medication use

PLoS ONE ◽

10.1371/journal.pone.0226511 ◽

2019 ◽

Vol 14 (12) ◽

pp. e0226511 ◽

Cited By ~ 1

Author(s):

Sarah Toepfer ◽

Juliane Bolbrinker ◽

Maximilian König ◽

Elisabeth Steinhagen-Thiessen ◽

Reinhold Kreutz ◽

...

Keyword(s):

Sex Differences ◽

Inappropriate Medication ◽

Medication Use ◽

Potentially Inappropriate Medication ◽

Aging Study

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Use of potentially inappropriate medications among ambulatory home-dwelling elderly patients with dementia: A review of the literature

Canadian Pharmacists Journal / Revue des Pharmaciens du Canada ◽

10.1177/1715163517701770 ◽

2017 ◽

Vol 150 (3) ◽

pp. 169-183 ◽

Cited By ~ 12

Author(s):

Tejal Patel ◽

Karen Slonim ◽

Linda Lee

Keyword(s):

Older Adults ◽

Cognitive Impairment ◽

Adverse Events ◽

Inappropriate Medication ◽

Medication Use ◽

Adverse Outcomes ◽

Potentially Inappropriate Medication ◽

Potentially Inappropriate Medications ◽

Inappropriate Medication Use ◽

Inappropriate Medications

Background: Older adults with dementia are at high risk for drug-related adverse outcomes. While much is known about potentially inappropriate medication use in older adults, its prevalence and characteristics among those with dementia are not as well elucidated. We conducted a literature review to examine the prevalence of potentially inappropriate medication use among home-dwelling older adults with dementia. Our secondary aim was to determine the most frequently implicated medications and factors associated with potentially inappropriate medication use. Methods: MEDLINE, EMBASE, CINAHL, and International Pharmaceutical Abstracts were searched between 1946 and 2014 for articles that referenced potentially inappropriate medication use and types of dementia. One reviewer screened all titles and abstracts from the initial search and full-text articles after the initial screen for eligibility, then 2 reviewers independently abstracted data from included studies. Results: Searches yielded 81 articles, of which 7 met inclusion criteria. Prevalence of potentially inappropriate medication use varied from 15% to 46.8%. No single drug or drug class was reported consistently across all studies as the most frequent potentially inappropriate medication, but anticholinergics and benzodiazepines, drugs that affect cognition, were among the most common medications or pharmacological classes listed. Discussion: Older adults with dementia may be particularly vulnerable to potentially inappropriate medications because of cognitive impairment from their condition and the greater likelihood of experiencing adverse events from medications. Given this population’s greater susceptibility to adverse events, more intense medication and patient monitoring may be warranted, especially among those taking anticholinergics and benzodiazepines, as these drugs can contribute to cognitive impairment.

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Emotional Control in Adulthood

Psychological Reports ◽

10.2466/pr0.1997.80.2.499 ◽

1997 ◽

Vol 80 (2) ◽

pp. 499-507 ◽

Cited By ~ 27

Author(s):

Jasmin Tahmaseb McConatha ◽

Frances Marshall Leone ◽

Jill M. Armstrong

Keyword(s):

Older Adults ◽

Sex Differences ◽

Emotional Control ◽

Emotional Intensity ◽

Socioemotional Selectivity Theory ◽

Emotional Experiences ◽

Men And Women ◽

Socioemotional Selectivity ◽

Similarities And Differences ◽

Age And Sex

Although it is widely believed that emotions vary with age, there is a dearth of information on emotional experiences in later adulthood. Several researchers think that older adults experience less emotional intensity than younger people while others have suggested that aging is accompanied by a decrease in positive affect and an increase in negative emotions. Sex similarities and differences in emotionality have also been documented. This study focuses on age and sex similarities and differences in emotional control. Three hundred and twenty seven men and women aged 19 to 92 years were administered two emotion measures. The results support previous research which suggests that the control of emotions increases with age. In evaluating sex differences in emotional control, women scored as more emotionally expressive than men, a finding which is consistent with previous research. Results are discussed in relation to socioemotional selectivity theory.

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Relationship between anthropometric nutritional status and functional capacity in older adults living in the community

Revista médica de Chile ◽

10.4067/s0034-98872020000100069 ◽

2020 ◽

Vol 148 (1) ◽

pp. 69-77

Author(s):

Francisco Guede-Rojas ◽

Daniel Jerez-Mayorga ◽

David Ulloa-Díaz ◽

Adolfo Soto-Martínez ◽

Rodrigo Ramírez-Campillo ◽

...

Keyword(s):

Older Adults ◽

Nutritional Status ◽

Functional Capacity

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The Relationship between Nutritional Status and Functional Capacity: A Contribution Study in Institutionalised Portuguese Older Adults

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18073789 ◽

2021 ◽

Vol 18 (7) ◽

pp. 3789

Author(s):

Catarina Caçador ◽

Edite Teixeira-Lemos ◽

Jorge Oliveira ◽

João Pinheiro ◽

Filipa Mascarenhas-Melo ◽

...

Keyword(s):

Older Adults ◽

Cognitive Impairment ◽

Nutritional Status ◽

Functional Capacity ◽

Mini Nutritional Assessment ◽

Well Being ◽

Functional Independence ◽

Nutritional Risk ◽

Demographic Aging ◽

The Relationship

Demographic aging of the population allied with the new family structures and societal dynamics is generating an increasing demand for institutions for older adults. Nutritional status is a key health determinant that impacts the quality of life among older adults. Hence, the aim of the present study was to evaluate the relationship between nutritional status and nutritional risk, functional capacity, and cognition in institutionalised Portuguese older adults by a cross-sectional study in 15 institutions. Nutritional status (body mass index (BMI), waist circumference (WC), nutritional risk (mini nutritional assessment (MNA)), degree of functional independence (Barthel index (BI)), and cognitive ability (mini mental state examination (MMSE)) were assessed. Of the 214 older adults evaluated, 28.0% were at risk of malnutrition, 69.6% were mildly functional dependent, and 39.3% presented minor cognitive impairment. The risk of malnutrition increased functional dependence and cognitive impairment. The MNA score, but not the BMI or WC, was related to disability and deficits in cognition. A differential interdependence was found between nutritional, cognitive, and functional status. Strategies to improve self-care and well-being in nursing homes should consider a correct diet and a closer evaluation of nutritional risk to preserve cognition, independence, and autonomy.

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Dietary intakes, anthropometric status, and anaemia prevalence among older adults in Effutu Municipality, Ghana

Nutrition and Healthy Aging ◽

10.3233/nha-200092 ◽

2020 ◽

pp. 1-11

Author(s):

Elsie Nana Aba Abbiw Hayfron ◽

Reginald Adjetey Annan ◽

Anthony Kwaku Edusei ◽

Charles Apprey ◽

Odeafo Asamoah-Boakye

Keyword(s):

Older Adults ◽

Vitamin C ◽

Nutritional Status ◽

Nutritional Assessment ◽

Mini Nutritional Assessment ◽

Nutritional Deficiencies ◽

Dietary Intakes ◽

Lower Odds ◽

Nutritional Needs ◽

Anthropometric Status

BACKGROUND: Older adults, both institutionalized and free-living are vulnerable to nutritional deficiencies and poor nutritional status, which affect morbidity and quality of life amongst them. Yet, little attention on nutritional needs is given to this vulnerable group in many developing countries, and very little data exist on the nutritional status of older Ghanaians. OBJECTIVE: This study assessed dietary intakes, anthropometric status, and anaemia prevalence among older adults in Effutu Municipality, Ghana. METHODS: Using a cross-sectional design, anthropometry, repeated 24-hour dietary recall, haemoglobin levels were determined among 150 older adults (60–87 years). The Mini Nutritional Assessment (MNA) questionnaire was used to determine malnutrition prevalence among older adults. RESULTS: None of the older adults met estimated average requirement (EAR) and adequate intake (AI) for vitamin E and calcium respectively, and 72.0%, 71.3%, 99.3%, 98.7%,76.0% had insufficient intake for energy, protein, zinc, folate and vitamin C respectively. Also, 39.3% were anaemic using haemoglobin cut-offs, 12.0% were malnourished based on the MNA tool and 28.0% were underweight based on BMI index. Married older adults (OR = 0.1, p = 0.005, 95% CI = 0.1–0.5) had lower odds for anaemia than those who were divorced. Underweight participants had 11.7 increased odds of being anaemic (OR = 11.7, p = 0.048, 95% CI = 1.0–135.0) than overweight participants. Those who had adequate vitamin C (OR = 0.3, p = 0.018, 95% CI = 0.1–0.8) and folate (OR = 0.2, p = 0.396, 95% CI = 0.1–6.7) intakes had lower odds of being anaemic than those with inadequate vitamin C and folate intakes, while those who had adequate iron (OR = 1.4, p = 0.412, 95% CI = 0.6–3.2) and vitamin B12 (OR = 1.6, p = 0.473, 95% CI = 0.5–5.3) intakes were more likely to be anaemic CONCLUSIONS: Inadequate nutrient intakes, anaemia, underweight and malnutrition prevalence were found among these older adults. Anaemia was associated with being underweight, but not nutrients intake. The nutritional needs of older people should be addressed to reduce risks for disease.

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Sex Differences in Potentially Inappropriate Prescribing Among Older Adults With Multimorbidity

Innovation in Aging ◽

10.1093/geroni/igab046.1295 ◽

2021 ◽

Vol 5 (Supplement_1) ◽

pp. 335-336

Author(s):

Maria Ukhanova ◽

Sheila Markwardt ◽

Jon Furuno ◽

Laura Davis ◽

Brie Noble ◽

...

Keyword(s):

Older Adults ◽

Sex Differences ◽

Inappropriate Prescribing ◽

Secondary Analysis ◽

Potentially Inappropriate Medications ◽

Prescribing Practices ◽

Chi Square ◽

Physical Conditions ◽

Disease Patterns ◽

Drug Classes

Abstract Sex differences in prescribing potentially inappropriate medications (PIMs) for various multimorbidity patterns are not well understood. This study sought to identify sex specific risk of PIMs in older adults with cardiovascular-metabolic patterns. Secondary analysis of the Health and Retirement Study interview data (2004-2014; n=6,341, ≥65 y/o) linked to Medicare claims data was conducted. Four multimorbidity patterns were identified based on the list of 20 chronic conditions and included: ‘cardiovascular-metabolic only’, ‘cardiovascular-metabolic plus other physical conditions’, ‘cardiovascular-metabolic plus mental conditions’, and ‘no cardiovascular-metabolic disease’ patterns. Presence of PIM prescribing was identified using the 2015 American Geriatrics Society Beers Criteria, limited to the list of medications to avoid in older adults. Chi-square tests and logistic regressions were used to identify sex differences in prescribing PIMs across multimorbidity patterns: (1) for PIMs overall and (2) for each PIM drug class. Results indicate that on average women were prescribed PIMs more often than men (39.4% and 32.8%, respectively). Women with cardiovascular-metabolic plus other physical patterns (Adj.OR=1.25, 95% CI: 1.07-1.45) and cardiovascular-metabolic plus mental patterns (Adj.OR=1.25, 95% CI: 1.06-1.48) had higher odds of PIM compared to men, however, there were no sex differences in PIM prescribing in the cardiovascular-metabolic only patterns (Adj.OR=1.13, 95% CI: 0.79-1.62). There was variation by sex across different PIM drug classes. Our study emphasizes the need to further reduce PIM prescribing among older adults, and identifies target populations for potential interventions to improve medication prescribing practices.

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Nutritional Status of Older Adults Who Are Overweight or Obese Compared to Those with a Healthy Weight, NHANES 2011–2014 (P01-001-19)

Current Developments in Nutrition ◽

10.1093/cdn/nzz028.p01-001-19 ◽

2019 ◽

Vol 3 (Supplement_1) ◽

Author(s):

Shinyoung Jun ◽

Alexandra Cowan ◽

Anindya Bhadra ◽

Kevin Dodd ◽

Johanna Dwyer ◽

...

Keyword(s):

Risk Factors ◽

Older Adults ◽

Nutritional Status ◽

Dietary Supplements ◽

Cardiometabolic Risk ◽

Healthy Eating Index ◽

Cardiometabolic Risk Factors ◽

Self Report ◽

Healthy Weight ◽

Men And Women

Abstract Objectives The purpose was to evaluate nutritional status, food security, and related health factors of older adults who were overweight or obese compared to those with a healthy weight. Methods Data from 2969 adults aged ≥60 years from NHANES 2011–2014 were analyzed. Participants were categorized by sex and body weight status as healthy weight (body mass index (BMI, kg/m2) 18.5–24.9), overweight (BMI 25–29.9), or obese (BMI ≥ 30); underweight individuals were excluded. Healthy Eating Index (HEI)-2015 scores and total usual micronutrient intakes from foods and dietary supplements were estimated using two 24-hour dietary recalls and the National Cancer Institute method. Nutritional biomarkers, including serum vitamin D, vitamin B-12, and methylmalonic acid, and cardiometabolic risk factors were also assessed. Results A substantial proportion of older adults (>30%) had intakes below Estimated Average Requirements (EAR) for calcium, magnesium, and vitamins C and D even with dietary supplements. Men and women with obesity had a higher prevalence of usual magnesium intakes <EAR compared to those with a healthy weight; among women only, the same was true for calcium, vitamins B-6 and D. Both men and women with obesity had significantly lower HEI-2015 scores than those with a healthy weight. The proportion of those with serum 25-hydroxyvitamin D < 40 nmol/L was higher in women with obesity (12%) than in women with a healthy weight (6%). Men and women who were overweight or obese were more likely to self-report fair/poor health, use ≥5 medications, and have cardiometabolic risk factors, including elevated blood pressure, triglycerides, and fasting blood glucose, and reduced high-density lipoprotein cholesterol, compared to individuals with a healthy weight. Women with obesity were more likely to be food-insecure and depressed, while men with obesity were less likely to consume government/community meals, compared to their counterparts. Conclusions Older adults with obesity had higher risk of inadequate intakes for several key micronutrients, lower overall dietary quality, and higher prevalence of cardiometabolic risk factors compared to older adults with a healthy weight. Funding Sources This work was supported by the National Institutes of Health.

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Well-being and health from age 70 to 100: findings from the Berlin Aging Study

European Review ◽

10.1017/s1062798701000424 ◽

2001 ◽

Vol 9 (4) ◽

pp. 461-477 ◽

Cited By ~ 32

Author(s):

JACQUI SMITH

Keyword(s):

Functional Capacity ◽

Life Quality ◽

Well Being ◽

Older Individuals ◽

Successful Ageing ◽

Men And Women ◽

Positive Side ◽

Aging Study ◽

Health Related ◽

Over Time

An individual's personal sense of well-being (SWB) is an indicator of psychological adjustment and successful ageing. Health and functional capacity are viewed as important sources of life quality in old age but very little is known about their effects on SWB over time. Can older individuals maintain SWB despite declining health? Longitudinal data from the Berlin Aging Study, a locally representative sample of men and women aged 70 to 100+, indicate that cumulative health-related chronic life strains that characterize the Fourth Age set a constraint on the potential of the older individual to experience the positive side of life.

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