Sex and gender differences in polypharmacy in persons with dementia: A scoping review

Purpose: To date, research studies in most disciplines have not made sex-based analysis a priority despite increasing evidence of its importance. We now understand that both sex and gender impact medication prescribing, use, and effect. This is particularly true for older adults with dementia who have alterations in drug metabolism, drug response, and the permeability of the blood–brain barrier. To better understand the influence of sex and gender on drug use in older adults with dementia, we conducted a scoping review. Methods: This scoping review systematically searched the Medline, Embase, Web of Science, CINAHL, and ProQuest databases to find published reports on polypharmacy in populations of older adults with dementia that included a sex- or gender-based analysis. Results: A total of 12 published reports were identified. Findings were cohort studies and case-control trials that commented on sex-related differences in medication use as a secondary analysis to the studies’ primary objective. These studies showed that community-dwelling women received more potentially inappropriate medications and more psychotropic medications, while nursing home dwelling men received more potentially inappropriate medications, cholinesterase inhibitors, and antipsychotics. None of the identified studies explicitly examined gender-related differences in medication use. Conclusion: This scoping review supports that there is inadequate understanding of both sex and gender differences in drug use in older men and women with dementia. To tailor medication-specific interventions to improve drug therapy for older adults with dementia, it is important that future work includes sex- or gender-based analysis of drug use.

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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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A Scoping Review of Literature on Sex and Gender Differences Among Dementia Spousal Caregivers

The Gerontologist ◽

10.1093/geront/gny177 ◽

2019 ◽

Vol 59 (6) ◽

pp. e802-e815 ◽

Cited By ~ 4

Author(s):

Ifah Arbel ◽

Kathleen S Bingham ◽

Deirdre R Dawson

Keyword(s):

Gender Differences ◽

Scoping Review ◽

Policy Development ◽

Empirical Studies ◽

Spousal Caregivers ◽

Future Research ◽

Sex And Gender ◽

Cross Sectional ◽

And Gender ◽

Sex And Gender Differences

Abstract Background and Objectives Sex and gender differences among dementia spousal caregivers have been investigated, but never systematically reviewed or synthesized. A synthesis of findings can help facilitate specificity in practice and in health policy development. As a first step towards such a synthesis, this scoping review reports the available evidence, identifies research gaps, and suggests possible directions for future research. Research Design and Methods A scoping review methodology was used to identify articles, and to chart and analyze data. Systematic searches for published, empirical studies, with an explicit goal or hypothesis related to sex or gender differences were conducted in seven databases. Results Sixty-one studies met inclusion criteria. Most (n = 45) were quantitative, cross-sectional studies. Caregivers included in the studies were generally 61–70 years old, Caucasian, middle-class, and highly educated. The most extensively investigated differences are: depression, burden, objective physical health, and informal supports. Discussion and Implications This scoping review is the first to summarize and critique the research on sex and gender differences that are specific to dementia spousal caregivers. The review can be used by researchers to make decisions regarding future systematic reviews and primary studies. To further strengthen the evidence base, future studies may benefit from including more caregivers of ethnic minorities, using more qualitative, longitudinal, or experimental designs, and focusing on variables needed to inform caregiving models and theories. Overall, this scoping review contributes to furthering gender-sensitive practices and policies that are better tailored to the specific needs of this population.

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Sex and Gender Differences in Occupational Hazard Exposures: a Scoping Review of the Recent Literature

Current Environmental Health Reports ◽

10.1007/s40572-021-00330-8 ◽

2021 ◽

Author(s):

A. Biswas ◽

S. Harbin ◽

E. Irvin ◽

H. Johnston ◽

M. Begum ◽

...

Keyword(s):

Gender Differences ◽

Scoping Review ◽

Recent Literature ◽

Sex And Gender ◽

Occupational Hazard ◽

And Gender ◽

Sex And Gender Differences

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Sex and gender-based analysis in pharmacy practice research: A scoping review

Research in Social and Administrative Pharmacy ◽

10.1016/j.sapharm.2016.11.007 ◽

2017 ◽

Vol 13 (6) ◽

pp. 1045-1054 ◽

Cited By ~ 5

Author(s):

Lisa McCarthy ◽

Emily Milne ◽

Nancy Waite ◽

Martin Cooke ◽

Katie Cook ◽

...

Keyword(s):

Scoping Review ◽

Pharmacy Practice ◽

Practice Research ◽

Sex And Gender ◽

Pharmacy Practice Research ◽

Gender Based ◽

And Gender

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Sex and gender differences in quality of life and related domains for individuals with adult acquired lower-limb amputation: a scoping review

Disability and Rehabilitation ◽

10.1080/09638288.2021.1974106 ◽

2021 ◽

pp. 1-27

Author(s):

Stephanie R. Cimino ◽

Abirami Vijayakumar ◽

Crystal MacKay ◽

Amanda L. Mayo ◽

Sander L. Hitzig ◽

...

Keyword(s):

Quality Of Life ◽

Gender Differences ◽

Scoping Review ◽

Lower Limb ◽

Lower Limb Amputation ◽

Limb Amputation ◽

Sex And Gender ◽

And Gender ◽

Sex And Gender Differences

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Sex and Gender Differences in Kidney Cancer: Clinical and Experimental Evidence

Cancers ◽

10.3390/cancers13184588 ◽

2021 ◽

Vol 13 (18) ◽

pp. 4588

Author(s):

Anna Julie Peired ◽

Riccardo Campi ◽

Maria Lucia Angelotti ◽

Giulia Antonelli ◽

Carolina Conte ◽

...

Keyword(s):

Kidney Cancer ◽

Current Knowledge ◽

Diagnostic Tools ◽

Sex And Gender ◽

Female Sex Hormones ◽

Outcome Difference ◽

Genetics And Genomics ◽

Gender Based ◽

And Gender ◽

Sex And Gender Differences

Sex and gender disparities have been reported for different types of non-reproductive cancers. Males are two times more likely to develop kidney cancer than females and have a higher death rate. These differences can be explained by looking at genetics and genomics, as well as other risk factors such as hypertension and obesity, lifestyle, and female sex hormones. Examination of the hormonal signaling pathways bring further insights into sex-related differences. Sex and gender-based disparities can be observed at the diagnostic, histological and treatment levels, leading to significant outcome difference. This review summarizes the current knowledge about sex and gender-related differences in the clinical presentation of patients with kidney cancer and the possible biological mechanisms that could explain these observations. Underlying sex-based differences may contribute to the development of sex-specific prognostic and diagnostic tools and the improvement of personalized therapies.

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Sleep Among Older Adults

The Social Epidemiology of Sleep ◽

10.1093/oso/9780190930448.003.0006 ◽

2019 ◽

pp. 139-166

Author(s):

Katie L. Stone, PhD ◽

Vicki Li

Keyword(s):

Older Adults ◽

Life Transitions ◽

Age Group ◽

Sex And Gender ◽

And Gender ◽

Social Environmental ◽

Social Environmental Factors ◽

The Impact ◽

Sex And Gender Differences ◽

The U.S

As Americans live longer, growth in the number of older adults is unprecedented. In 2014, 14.5% (46.3 million) of the U.S. population was aged 65 or older, and this is projected to reach 23.5% (98 million) by 2060. This chapter focuses on sleep among older adults, defined as at least 65 years old, and includes a discussion on sleep and retirement. The chapter especially discusses variation of sleep and sleep disorders in this age group and associations with frailty and disease and provides a social determinants perspective. Social/environmental factors that impact sleep in older adults include the impact of retirement, caregiving, institutionalization, and other key life transitions. Important sex and gender differences among older adults are also discussed.

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Collaborative Pharmacist–physician Medication Management for the Elderly With Chronic Kidney Disease and Polypharmacy

10.21203/rs.3.rs-124410/v1 ◽

2020 ◽

Author(s):

A Jeong 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 ◽

Drug Related Problems ◽

Inappropriate Medications

Abstract Background: Inappropriate polypharmacy is likely in older adults with chronic kidney disease owing to the considerable burden of comorbidities. We aimed to evaluate the impact of a collaborative pharmacist–physician geriatric medication management service on the quality of medication use. Methods: We retrospectively reviewed the medical records of patients who received the geriatric medication management service in ambulatory care clinic in a single tertiary-care teaching hospital from May 2019 to December 2019. The quality of medication use was evaluated based on the numbers of medications and potentially inappropriate medications. We also evaluated the types of drug-related problems identified during medication management service and pharmacists’ interventions. Results: Drug use quality was assessed in 87 of 95 patients who received the service. After the provision of medication management service, the total numbers of medications and potentially inappropriate medications decreased from 13.5 ± 4.3 to 10.9 ± 3.8 (p < 0.001) and from 1.6 ± 1.4 to 1.0 ± 1.2 (p<0.001), respectively. Furthermore, the numbers 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” (111, 31.4%).Conclusions: Polypharmacy and potentially inappropriate medications were prevalent in older adults with chronic kidney disease, and geriatric medication management service involving a collaboration between pharmacists and physicians improved the quality of medication use in this population.

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