scholarly journals Community-dwelling older adults’ awareness of the inappropriate use of proton pump inhibitors

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Mohammad Rababa ◽  
Abeer Rababa’h
Keyword(s):  
Older Adults ◽  
Adverse Effects ◽  
Proton Pump Inhibitors ◽  
Proton Pump ◽  
Primary Care Providers ◽  
Community Dwelling ◽  
Care Providers ◽  
Convenience Sample ◽  
Risks And Benefits

Abstract Background Proton pump inhibitors (PPIs) are effective in treating gastroesophageal reflux, peptic ulcers, and esophagitis. However, the long-term use of PPIs by older adults is associated with adverse health outcomes. There is limited evidence about older adults’ awareness of long-term PPI use and its associated adverse effects. This study aimed to assess older adults’ awareness of the adverse effects of the long-term use of PPIs, and their willingness to stop PPI use given of the risks and benefits of PPI use. Methods this cross-sectional study was conducted on a convenience sample of 120 older adults from three local healthcare centers located in Irbid, Jordan. Older adults’ awareness of PPI use was measured using the Patients’ Perceptions of Proton Pump Inhibitor Risks and Attempts at Discontinuation Survey. Results the majority of the participating older adults were not familiar with any reports linking long-term PPI use with adverse effects, reported no concerns related to the chronic use of PPIs, and reported that they had not discussed the benefits and risks of PPI use with their primary care providers (PCPs). Although the majority of the participants had not previously attempted to stop using PPIs, the majority expressed a willingness to stop PPIs due to their adverse effects, especially if advised to do so by a PCP. The factors associated with the long-term use of PPIs included age, indications for gastrointestinal reflux disease (GERD), improvement of GERD symptoms, and the willingness to reduce or stop PPIs. Being advised by a PCP to stop PPIs (p = 0.049) and having increased concerns about the adverse effects of long-term PPI use (p < 0.0001) were the only two statistically significant predictors of previous attempts to stop PPIs. Conclusions concerns regarding the adverse effects of long-term PPI use were associated with attempts to stop PPIs, especially in cases where this was recommended by a PCP. Discussions between PCPs and patients regarding the risks and benefits of PPIs are necessary in order to ensure that patients do not make inappropriate decisions regarding ongoing PPI therapy. Careful evaluation of the long-term use of PPIs among older adults is required.

scholarly journals Perception of Inappropriate Use of Proton Pump Inhibitors Among Community-Dwelling Older Adults

2020 ◽  
Author(s):  
Mohammad Rababa ◽  
Abeer Rababa'h
Keyword(s):  
Older Adults ◽  
Side Effects ◽  
Proton Pump Inhibitors ◽  
Proton Pump ◽  
Primary Care Providers ◽  
Community Dwelling ◽  
Care Providers ◽  
Cross Sectional ◽  
Convenience Sample

Abstract Background Long-term use of proton pump inhibitors (PPIs) in older adults is a prevalent issue and associated with adverse health outcomes. There is limited evidence about older adults’ perception of PPI use and its associated side effects. This study aimed to examine the knowledge and awareness of older adults about PPI use and its side effects and willingness to stop PPI and its associated factors. Methods This cross-sectional study was conducted on a convenience sample of 120 older adults from three local healthcare centers located in Irbid, Jordan. Older adults’ perception of PPI use was measured by Patients’ Perceptions of Proton Pump Inhibitor Risks and Attempts at Discontinuation Survey. Results The majority of older adults were not familiar with any report linking PPI use with side effects, reported no concern related to the chronic side effects of PPI, and had not discussed the benefits and risks of PPI with their primary care providers (PCPs). Although a majority did not try to stop PPI, most older adults were willing to stop PPI due to its side effects, particularly if recommended by PCPs. Factors associated with long-term use of PPI included age, indication for gastrointestinal reflux disease (GERD), improvement of GERD symptoms, and being comfortable to reduce or stop PPI. Recommendations by PCPs to stop PPI (p = 0.049) and a greater level of concern about long-term side effects of PPI (p < 0.0001) were the only two statistically significant predictors of previous attempts to stop PPIs. Conclusions Concern about PPIs is associated with attempts to stop PPI, particularly with PCPs’ recommendation. The risks and benefits of PPIs should be discussed with PCPs to avoid making inappropriate decisions regarding PPI therapy. The Long-term use of PPIs should be carefully evaluated.

scholarly journals Long Term Use of Proton Pump Inhibitors: Where to Draw the Line

2018 ◽  
Vol 1 (1) ◽  
pp. 20-35
Author(s):  
M. Manzurul Haque
Keyword(s):  
Adverse Effects ◽  
Proton Pump Inhibitors ◽  
Proton Pump ◽  
Community Acquired Pneumonia ◽  
Ulcer Disease ◽  
Increased Risk ◽  
Prospective Trials ◽  
Evidence Based Therapy ◽  
Clostridium Difficile Associated Diarrhea

Proton pump inhibitors are the leading evidence-based therapy for acid related upper gastrointestinal disorders including dyspepsia, GERD and peptic ulcer disease. These are among the most frequently prescribed drugs globally. However, PPIs have been subjected to studies and have been associated with increased risk of adverse effects like Clostridium difficile-associated diarrhea, community-acquired pneumonia, bone fracture, reduced intestinal absorption of vitamins and minerals, and more recently kidney damage and dementia etc. In this review the recent literature regarding these adverse effects and their association with long-term proton pump inhibitor treatment is discussed. The objective of this review is to analyse the potential adverse effects of long-term PPI use and summarize the clinical implications. We documented a considerable increase in the use of PPIs over the last decade. This increase is due to over-prescription and use of PPIs for inappropriate indications. On the other hand, some patients may have had PPI therapy discontinued abruptly or inappropriately due to safety concerns. However the patients with a proven indication for a PPI should continue to receive it in the lowest effective dose for a shortest possible time. Finally, in most cases and based on the available evidence, PPIs benefits seem to outweigh potential adverse effects. Large randomized prospective trials are required to more firmly establish direct cause and effect relationships between PPIs and adverse events.

scholarly journals Opportunities and Barriers to Medication Safety in Community-Dwelling Older Adults

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 611-612
Author(s):  
Fatoumata Jallow ◽  
Elisa Stehling ◽  
Zara Sajwani ◽  
Kathryn Daniel ◽  
Yan Xiao
Keyword(s):  
Older Adults ◽  
Primary Care ◽  
Medication Safety ◽  
Medication Management ◽  
Primary Care Providers ◽  
Vulnerable Population ◽  
Community Dwelling ◽  
Care Providers ◽  
Essential Information ◽  
Barriers And Enablers

Abstract Community-dwelling multi-morbid older adults are a vulnerable population for medication safety-related threats. We interviewed a sample of these older adults recruited from local retirement communities and from primary care practices to learn their perceptions of barriers and enablers for their medication safety. The present study is part of the Partnership in Resilience for Medication Safety (PROMIS) study. One of the aims of this project is to identify barriers and opportunities to improve older adults' medication safety. These interviews were conducted during COVID-19 pandemic conditions. Results from this qualitative study suggest that trust between these older adults and their healthcare providers is an essential component of medication safety. Overarching themes include disruptions in medication management, caregivers caring for each other, patient safety practices or habits, and medication management literacy. Participants also shared strain due to lack of skills to navigate telemedicine visits, trust in Primary Care Providers (PCPs) and pharmacists to prescribe and dispense safely for them, reliance on PCPs and pharmacists to give essential information about medications without having to be asked. Our interviews illustrated large variations in older adults’ perceived role in medication safety, with some developing expertise in understanding how medications work for them and how long-term medications should be periodically reviewed. The types of information needs and supports from PCPs were likely different. Understanding these barriers and enablers for safe medication management can help us develop medication safety improvements for this vulnerable population.

Abstract 13768: Adoption and Effectiveness of an Mhealth Intervention for Hypertension in Older Adults: A Pilot Clinical Trial

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Matthew F Muldoon ◽  
Julian Einhorn ◽  
Jonathan Yabes ◽  
Danielle Burton ◽  
Bruce Rollman ◽  
...  
Keyword(s):  
Older Adults ◽  
Primary Care ◽  
Clinical Trial ◽  
Self Efficacy ◽  
Intervention Group ◽  
Primary Care Providers ◽  
Text Messages ◽  
Community Dwelling ◽  
Effect Estimate ◽  
Care Providers

Introduction: Hypertension is uncontrolled in 50% of diagnosed adults in the US, and especially in older adults. Home blood pressure monitoring (HBPM) can improve hypertension management by providing clinicians with up-to-date information on BP control and by improving patients’ adherence to prescribed medications and other healthy behaviors. MyBP is a patient-facing HBPM aide that provides video-based education and supports BP self-monitoring with recurring feedback using proactive, bidirectional, automated text messages. Summary reports are routed to primary care providers. Hypothesis: In this proof-of-concept, pragmatic clinical trial, we tested the hypothesis that MyBP will improve hypertension self-efficacy and lower BP in older adults. Methods: Community-dwelling adults ≥55 y/o with uncontrolled hypertension were recruited from primary care offices. Enrollees were provided a standard automatic BP cuff and randomized 2:1 to MyBP vs treatment-as-usual (control). Engagement with MyBP was defined as the proportion of BP reading prompts for which a reading was submitted, tracked over successive 2-week monitoring periods. Study BP data were acquired independently of MyBP from all participants by single-blind, phone-supervised home BP measurements. Results: Participants (N=62; 40 women, 33 Blacks, 38 without a college degree, mean age 66, mean office BP 164/91, mean # BP medications 2.6) were randomized to MyBP (41) vs. control (n=21). In the MyBP group, engagement with HBPM averaged over 80%, without notable attrition over the 5-month study period. Regression analyses revealed an interaction between baseline systolic BP and group assignment on change in systolic BP [interaction effect estimate -0.59 (-1.00, -0.19)], such that patients who had a higher baseline systolic BP and were assigned to MyBP showed a greater decline in systolic BP when compared to control patients. Hypertension self-efficacy also improved in the intervention group compared to controls [estimate 0.556 (0.104,1.008)]. Conclusions: In this pragmatic, pilot clinical trial, older adults with hypertension used a novel mHealth technology at high levels, reported improved hypertension self-efficacy, and experienced a decline in BP if home BP was elevated at baseline.

scholarly journals Patient Awareness of Reported Adverse Effects Associated with Proton Pump Inhibitors in a Medically Underserved Community

Healthcare ◽  
2020 ◽  
Vol 8 (4) ◽  
pp. 499
Author(s):  
Brian White ◽  
Matthew Drew ◽  
John Gaughan ◽  
Sangita Phadtare
Keyword(s):  
Adverse Effects ◽  
Proton Pump Inhibitors ◽  
Proton Pump ◽  
Low Income ◽  
Patient Population ◽  
Medically Underserved ◽  
High Dose ◽  
Patient Awareness ◽  
Demographic Attributes

Reports of adverse effects associated with proton pump inhibitors (PPIs) are concerning because of high usage and over-the-counter availability. We sought to determine the awareness of PPI adverse effects among our patient population, which is medically underserved, low-income, and racially diverse. A 21-item survey was administered to gastroenterology-clinic outpatients. It collected information about age, gender, education, race, specialty of the prescriber, specific PPI, indication, knowledge of dose, adherence, duration of use and awareness of any risks. Medical records were reviewed to verify survey responses pertaining to indication, dosing, and adherence. A vast majority (96%) of 101 participants were not aware of PPI adverse effects. In total, 63% of the patients completed a high school education or less, which was associated with a higher risk of long-term PPI use than completion of at least an undergraduate degree (p = 0.05). In contrast to other studies, the shockingly low patient awareness about PPI adverse effects in our patient population is particularly concerning, especially as it is tied to their demographic attributes. This may lead to long-term and high-dose PPI use. Our study highlights the need for effective provider-driven education regarding medication risks, especially in the communities with significant health disparities.

Long-term use of proton pump inhibitors among community-dwelling persons with and without Alzheimer’s disease

2017 ◽  
Vol 73 (9) ◽  
pp. 1149-1158 ◽  
Author(s):  
Heidi Juntunen ◽  
Heidi Taipale ◽  
Antti Tanskanen ◽  
Anna-Maija Tolppanen ◽  
Jari Tiihonen ◽  
...  
Keyword(s):  
Alzheimer’S Disease ◽  
Alzheimer's Disease ◽  
Proton Pump Inhibitors ◽  
Proton Pump ◽  
Community Dwelling

scholarly journals Adverse effects of proton-pump inhibitor use in older adults: a review of the evidence

2017 ◽  
Vol 8 (9) ◽  
pp. 273-297 ◽  
Author(s):  
Marina L. Maes ◽  
Danielle R. Fixen ◽  
Sunny Anne Linnebur
Keyword(s):  
Older Adults ◽  
Adverse Effects ◽  
Proton Pump ◽  
Vitamin B12 Deficiency ◽  
Community Acquired Pneumonia ◽  
Increased Risk ◽  
Pubmed Search ◽  
Post Marketing ◽  
Meta Analyses

Proton-pump inhibitors (PPIs) are a widely prescribed class of medications used to treat acid-related disorders and use has significantly increased over the last few decades. PPIs are often inappropriately prescribed and since they have been on the market, a number of post-marketing studies have been published demonstrating associations between longer duration of PPI therapy and a number of adverse effects that are a concern in older adults. The objective of this review is to discuss the existing literature of potential adverse effects with long-term PPI use in older adults and to summarize the implications in clinical practice. A PubMed search was conducted to identify studies evaluating the potential long-term adverse effects of PPI therapy in older adults, and publications were selected based on relevant criteria. PPIs have been associated with an increased risk of a number of adverse effects including osteoporotic-related fractures, Clostridium difficile infection, community-acquired pneumonia, vitamin B12 deficiency, kidney disease, and dementia, demonstrated by a number of case-control, cohort studies, and meta-analyses. Older adults should be periodically evaluated for the need for continued use of PPI therapy given the number of potential adverse effects associated with long-term use.

Assessment of primary care practitioners’ attitudes and interest in pharmacogenomic testing

2020 ◽  
Vol 21 (15) ◽  
pp. 1085-1094
Author(s):  
D Max Smith ◽  
Tarlan Namvar ◽  
Ryan P Brown ◽  
T Blaise Springfield ◽  
Beth N Peshkin ◽  
...  
Keyword(s):  
Primary Care ◽  
Health System ◽  
Proton Pump Inhibitors ◽  
Proton Pump ◽  
Primary Care Providers ◽  
Test Results ◽  
Care Providers ◽  
Primary Care Practitioners

Aims: Identify the attitudes and interests of primary care providers (PCPs) in applying clinical pharmacogenomics (PGx) test results. Materials & methods: A questionnaire was designed and then disseminated to PCPs across the MedStar Health System. Results: Ninety of 312 (29%) PCPs responded and were included in analyses. Seventy-six (84%) had heard of PGx and 12 (13%) previously ordered PGx testing. Most, 68 (76%), believed PGx can improve care; however, a minority, 23 (26%), reported confidence in using PGx in prescribing decisions. Sixty-four (70%) wanted a pharmacist consultation. PCPs desired PGx for antidepressants (75%), proton pump inhibitors (72%) and other medications. Conclusion: Most PCPs felt unprepared to interpret PGx results and desired pharmacist consultations. These data can inform future PGx implementations with PCPs.

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