scholarly journals Medication-Related Problems in Older People with Multimorbidity in Catalonia: A Real-World Data Study with 5 Years’ Follow-Up

2021 ◽  
Vol 10 (4) ◽  
pp. 709
Author(s):  
Amelia Troncoso-Mariño ◽  
Albert Roso-Llorach ◽  
Tomás López-Jiménez ◽  
Noemí Villen ◽  
Ester Amado-Guirado ◽  
...  
Keyword(s):  
Liver Disease ◽  
Older People ◽  
Potentially Inappropriate Medications ◽  
Real World Data ◽  
Health Records ◽  
Cox Models ◽  
Explanatory Variables ◽  
Hazard Ratios ◽  
Inappropriate Medications

Aging, multimorbidity, and polypharmacy are associated with medication-related problems (MRPs). This study aimed to assess the association that multimorbidity and mortality have with MRPs in older people over time. We followed multimorbid, older (65–99 years) people in Catalonia from 2012 to 2016, using longitudinal data and Cox models to estimate adjusted hazard ratios (HR). We reviewed electronic health records to collect explanatory variables and MRPs (duplicate therapy, drug–drug interactions, potentially inappropriate medications (PIM), and contraindicated drugs in chronic kidney disease (CKD) or liver disease). There were 723,016 people (median age: 74 years; 58.9% women) who completed follow-up. We observed a significant (p < 0.001) increase in the proportion with at least one MRP (2012: 66.9% to 2016: 75.5%); contraindicated drugs in CKD (11.1 to 18.5%) and liver disease (3.9 to 5.3%); and PIMs (62.5 to 71.1%), especially drugs increasing fall risk (67.5%). People with ≥10 diseases had more MRPs (in 2016: PIMs, 89.6%; contraindicated drugs in CKD, 34.4%; and in liver disease, 9.3%). All MRPs were independently associated with mortality, from duplicate therapy (HR 1.06; 95% confidence interval (CI) 1.04–1.08) to interactions (HR 1.60; 95% CI 1.54–1.66). Ensuring safe pharmacological treatment in elderly, multimorbid patient remains a challenge for healthcare systems.

Optimizing pharmacotherapy for older patients

2017 ◽  
pp. 183-188 ◽  
Author(s):  
Denis O’Mahony
Keyword(s):  
Older People ◽  
Adverse Drug Events ◽  
Economic Consequences ◽  
High Risk Population ◽  
Potentially Inappropriate Medications ◽  
Inappropriate Drugs ◽  
Prescribing Omissions ◽  
The Relationship ◽  
Global Population ◽  
Inappropriate Medications

The prevalence of complex multimorbidity is increasing steadily in tandem with global population ageing. Complex multimorbidity is in turn intimately associated with polypharmacy, the relationship being one of cause-and-effect. Polypharmacy commonly leads to prescription of inappropriate drugs, resulting in a substantially higher risk of drug-related problems, principally adverse drug–drug and drug–disease interactions. These problems become manifest in the form of common geriatric symptoms such as falls, acute confusion, and incontinence and commonly result in increased healthcare utilization, including hospitalization, with obvious economic consequences. In addition, adverse drug reactions and adverse drug events lead to death in older people. The challenge of optimization of pharmacotherapy in older people with complex multimorbidity is a major one. There is increasing evidence that avoidance of potentially inappropriate medications (PIMs) and potential prescribing omissions (PPOs) using validated PIM and PPO criteria lists leads to better and safer pharmacotherapy in this high-risk population.

scholarly journals Cardiovascular Health and Stroke in Older British Men

Stroke ◽  
2020 ◽  
Vol 51 (11) ◽  
pp. 3286-3294
Author(s):  
Ayesha Ahmed ◽  
Snehal M. Pinto Pereira ◽  
Lucy Lennon ◽  
Olia Papacosta ◽  
Peter Whincup ◽  
...  
Keyword(s):  
Physical Activity ◽  
Older Adults ◽  
Cardiovascular Health ◽  
Population Attributable Fraction ◽  
Cox Models ◽  
Population Attributable Fractions ◽  
Hazard Ratios ◽  
Attributable Fractions ◽  
Time Point

Background and Purpose: Research exploring the utility of cardiovascular health (CVH) and its Life’s Simple 7 (LS7) components (body mass index, blood pressure [BP], glucose, cholesterol, physical activity, smoking, and diet) for prevention of stroke in older adults is limited. In the British Regional Heart Study, we explored (1) prospective associations of LS7 metrics and composite CVH scores with, and their impact on, stroke in middle and older age; and (2) if change in CVH was associated with subsequent stroke. Methods: Men without cardiovascular disease were followed from baseline recruitment (1978–1980), and again from re-examination 20 years later, for stroke over a median period of 20 years and 16 years, respectively. LS7 were measured at each time point except baseline diet. Cox models estimated hazard ratios (95% CI) of stroke for (1) ideal and intermediate versus poor levels of LS7; (2) composite CVH scores; and (3) 4 CVH trajectory groups (low-low, low-high, high-low, high-high) derived by dichotomising CVH scores from each time point across the median value. Population attributable fractions measured impact of LS7. Results: At baseline (n=7274, mean age 50 years), healthier levels of BP, physical activity, and smoking were associated with reduced stroke risk. At 20-year follow-up (n=3798, mean age 69 years) only BP displayed an association. Hazard ratios for intermediate and ideal (versus poor) levels of BP 0.65 (0.52–0.81) and 0.40 (0.24–0.65) at baseline; and 0.84 (0.67–1.05) and 0.57 (0.36–0.90) at 20-year follow-up. With reference to low-low trajectory, the low-high trajectory was associated with 40% reduced risk, hazard ratio 0.60 (0.44–0.83). Associations of CVH scores weakened, and population attributable fractions of LS7 reduced, from middle to old age; population attributable fraction of nonideal BP from 53% to 39%. Conclusions: Except for BP, CVH is weakly associated with stroke at older ages. Prevention strategies for older adults should prioritize BP control but also enhance focus beyond traditional risk factors.

scholarly journals Influence of Education Level of Older Patients on Polypharmacy, Potentially Inappropriate Medications Listed in Beer’s Criteria, and Unplanned Hospitalization: A Cross-Sectional Study in Lahore, Pakistan

Medicina ◽  
2018 ◽  
Vol 54 (4) ◽  
pp. 57 ◽  
Author(s):  
Muhammad Sarwar ◽  
Sadia Iftikhar ◽  
Muhammad Sarfraz
Keyword(s):  
Older People ◽  
Older Patients ◽  
Formal Education ◽  
Cross Sectional Study ◽  
Education Level ◽  
P Value ◽  
Potentially Inappropriate Medications ◽  
Sectional Study ◽  
Cross Sectional ◽  
Inappropriate Medications

Objective: To evaluate influence of education level of older patients on polypharmacy, potentially inappropriate medications (PIMs) listed in Beer’s Criteria, and unplanned hospitalization. Methods: A cross-sectional study was conducted among older people aged ≥65 years between 1 December 2017 and 28 February 2018. For data analysis, descriptive statistics and logistic regression analysis were employed. Results: Among 385 older patients, 88.8% were prescribed PIMs and 56.4% underwent PIMs associated unplanned hospitalization. Older people were less exposed to polypharmacy or excessive polypharmacy as their education levels increased (no formal education vs. primary vs. secondary vs. tertiary, 74% vs. 69.8% vs. 60.5% vs. 58.1%). Patients having higher education were also accompanied by significantly lower prescription of PIMs (no formal education vs. primary vs. secondary vs. tertiary, 96% vs. 87.3% vs. 84.5% vs. 79.1%) as well as unplanned hospitalization (no formal education vs. primary vs. secondary vs. tertiary, 64.7% vs. 76.2% vs. 40.3% vs. 46.5%). Results of regression analysis revealed that no formal education (OR = 1.202, 95% CI = 1.032–2.146, p-value = 0.003) and primary education level (OR = 1.175, 95% CI = 1.014–1.538, p-value = 0.039) were significantly associated with the use of polypharmacy among older people. On the other hand, no formal education was significantly associated with the prescription of PIMs (OR = 1.898, 95% CI = 1.151–2.786, p-value = 0.007). Furthermore, older people with no formal education (OR = 1.402, 95% CI = 1.123–1.994, p-value = 0.010) and primary education level (OR = 1.775, 95% CI = 1.281–3.018, p-value = <0.001) were significantly more likely to undergo unplanned hospitalization. Conclusions: Patients having low literacy level are more likely to receive PIMs, polypharmacy, and undergo unplanned hospitalization in comparison to highly educated patients. Hence, promotion of health literacy for patients is crucial to overcome these problems.

scholarly journals Olfaction and incident Parkinson disease in US white and black older adults

Neurology ◽  
2017 ◽  
Vol 89 (14) ◽  
pp. 1441-1447 ◽  
Author(s):  
Honglei Chen ◽  
Srishti Shrestha ◽  
Xuemei Huang ◽  
Samay Jain ◽  
Xuguang Guo ◽  
...  
Keyword(s):  
Older Adults ◽  
Parkinson Disease ◽  
Cox Models ◽  
Body Composition Study ◽  
Multiple Data ◽  
Hazard Ratios ◽  
Health Aging ◽  
Study Participants ◽  
Smell Identification

Objective:To investigate olfaction in relation to incident Parkinson disease (PD) in US white and black older adults.Methods:The study included 1,510 white (mean age 75.6 years) and 952 black (75.4 years) participants of the Health, Aging, and Body Composition study. We evaluated the olfaction of study participants with the Brief Smell Identification Test (BSIT) in 1999–2000. We retrospectively adjudicated PD cases identified through August 31, 2012, using multiple data sources. We used multivariable Cox models to estimate hazard ratios (HRs) and 95% confidence intervals (CIs).Results:During an average of 9.8 years of follow-up, we identified a total of 42 incident PD cases, including 30 white and 12 black participants. Overall, poor sense of smell, as indicated by a lower BSIT score, was associated with higher risk of PD. Compared with the highest tertile of BSIT (t3), the HR was 1.3 (95% CI 0.5–3.6) for the second tertile (t2) and 4.8 (95% CI 2.0–11.2) for the lowest tertile (t1) (ptrend < 0.00001). Further analyses revealed significant associations for incident PD in both the first 5 years of follow-up (HRt1/[t2+t3] 4.2, 95% CI 1.7–10.8) and thereafter (HRt1/[t2+t3] 4.1, 95% CI 1.7–9.8). This association appeared to be stronger in white (HRt1/[t2+t3] 4.9, 95% CI 2.3–10.5) than in black participants (HRt1/[t2+t3] 2.5, 95% CI 0.8–8.1), and in men (HRt1/[t2+t3] 5.4, 95% CI 2.3–12.9) than in women (HRt1/[t2+t3] 2.9, 95% CI 1.1–7.8).Conclusions:Poor olfaction predicts PD in short and intermediate terms; the possibility of stronger associations among men and white participants warrants further investigation.

scholarly journals Decreasing trends in potentially inappropriate medications in older people: a nationwide repeated cross-sectional study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Solène Drusch ◽  
Thien Le Tri ◽  
Joël Ankri ◽  
Mahmoud Zureik ◽  
Marie Herr
Keyword(s):  
Older People ◽  
Antihypertensive Drugs ◽  
Cross Sectional Study ◽  
Anticholinergic Drugs ◽  
Potentially Inappropriate Medications ◽  
Linear Regression Models ◽  
Health Insurance Data ◽  
Annual Percent Change ◽  
Cross Sectional ◽  
Inappropriate Medications

Abstract Background Potentially Inappropriate Medications (PIMs) and polypharmacy are widely used indicators of suboptimal prescribing for older people. The aim of this study was to describe the changes in the prevalence of PIMs and polypharmacy among people aged 75 years and over between 2011 and 2019 in France. Methods PIMs and polypharmacy were assessed among people aged 75 years and over every two years between 2011 and 2019 using the French health insurance data system. Sixteen PIM criteria from the 2015 Beers and STOPP lists were assessed. Polypharmacy (5 to 9 drugs) and hyper-polypharmacy (≥10 drugs) were defined based on the average number of drugs dispensed per quarter. The Annual Percent Change (APC) and 95%CI were assessed using linear regression models after standardization of the prevalence on age and sex. Results The study population included 5,777,645 individuals over 75 years old in 2011 and 6,328,155 in 2019. The prevalence of PIMs decreased from 49.6 to 39.6% over the study period (APC: − 1.19% [− 1.35;-1.04]). Of the sixteen indicators assessed, the prevalence of thirteen decreased between 2011 and 2019. Benzodiazepines were the most frequent PIMs (34.7% in 2011 to 26.9% in 2019), followed by anticholinergic drugs (12.1% in 2011 to 8.3% in 2019), oral non-steroidal anti-inflammatory drugs (11.4 to 7.8%), and PIMs related to antihypertensive drugs (7.4 to 6.0%). Overall, women and individuals aged 85 years and older were more likely to receive PIMs. The prevalence of hyper-polypharmacy decreased from 30.5 to 25.9% over the study period. Conclusion This study, which is the first to assess the change in prevalence of PIMs and polypharmacy over time from comprehensive health data in France, highlights that PIMs and hyper-polypharmacy declined between 2011 and 2019. However, PIMs remains frequent for older people and often involves benzodiazepines.

scholarly journals Chloroquine and hydroxychloroquine: potentially inappropriate medications for older adults?

2020 ◽  
Vol 14 (4) ◽  
pp. 298-302
Author(s):  
Milton Gorzoni
Keyword(s):  
Older Adults ◽  
Adverse Effects ◽  
Older People ◽  
Drug Analysis ◽  
American Geriatrics Society ◽  
Beers Criteria ◽  
Potentially Inappropriate Medications ◽  
Definition Of ◽  
Inappropriate Medications

Introduction: Potentially inappropriate medications (PIMs) for older adults cause more adverse effects than benefits. The 2019 American Geriatrics Society Beers Criteria (2019BC) considered five clinical situations as PIM use in older adults. Can drug analysis, according to these situations, assist in the act of making prescriptions for older people? Seeking a practical example for this question, we assessed drugs currently questioned as to their safe use among older people. Objective: To check if chloroquine and hydroxychloroquine fit the PIM criteria for older adults and whether this analysis is clinically applicable. Method: We systematized the objective based on the five clinical situations defined as PIM use in older adults by the 2019BC. Results: Chloroquine and hydroxychloroquine fulfill, respectively, four and five of these clinical situations. This evaluation allowed the likely definition of these drugs as PIMs for older adults in a simple way, based on a brief analysis of the available literature. Conclusion: Chloroquine and hydroxychloroquine may be considered PIMs for older adults. We expect that this analysis can be replicated with other drugs and reduce iatrogenesis in older people.

scholarly journals COVID-19 vaccine effectiveness among healthcare workers in Portugal: results from a hospital-based cohort study, December 2020 to November 2021

2022 ◽  
Author(s):  
Vânia Gaio ◽  
Adriana Silva ◽  
Palmira Amaral ◽  
João Faro Viana ◽  
Pedro Pinto Leite ◽  
...  
Keyword(s):  
Cohort Study ◽  
Healthcare Workers ◽  
Vaccine Effectiveness ◽  
Symptomatic Infection ◽  
Cox Models ◽  
Mainland Portugal ◽  
Hazard Ratios ◽  
Group Sex ◽  
Tagus Valley

Introduction: Healthcare workers (HCW) were amongst the first prioritized for COVID-19 vaccination but data on COVID–19 vaccine effectiveness among HCW is still limited. This study aims to estimate the COVID–19 vaccine effectiveness (VE) against SARS–CoV–2 symptomatic infection among HCW from Portuguese hospitals. Methods: In this prospective cohort study, we analysed data from HCW (all professional categories) from two central hospitals in the Lisbon and Tagus Valley and Centre regions of mainland Portugal between December 2020 and November 2021. VE against symptomatic SARS–CoV–2 infection was estimated as one minus the confounder adjusted hazard ratios by Cox models considering age group, sex, presence of chronic disease and occupational exposure to patients diagnosed with COVID–19 as adjustment variables. Results: During the 11 months of follow up, the 2213 HCW contributed a total of 1950 person-years at risk and 171 SARS–CoV–2 events occurred. The COVID–19 incidence rate for unvaccinated HCW was 348.7 per 1000 person-years while for fully vaccinated HCW was 43.0 per 1000 person-years. We observed a VE against symptomatic SARS–CoV–2 infection of 73.9% (95% CI: 26.2–90.8%) for complete vaccination status. Conclusion: This cohort study found a high COVID-19 VE against symptomatic SARS–CoV–2 infection in Portuguese HCW, which is in concordance with previous studies from other countries. Monitoring of VE in this HCW cohort continues during the winter 2021/2022 to evaluate potential VE decay and booster vaccine effect. Keywords: Vaccine effectiveness, SARS–CoV–2 , COVID–19, symptomatic infection, healthcare workers.

Predictors of clinical metastases and survival among nonmetastatic prostate cancer (PC) patients (pts) treated with androgen-deprivation therapy (ADT) in Sweden.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. e16066-e16066
Author(s):  
Rohini Khorana Hernandez ◽  
Johan Mesterton ◽  
Jonas Banefelt ◽  
Jan Stålhammar ◽  
Patrik Sobocki ◽  
...  
Keyword(s):  
Disease Progression ◽  
Specific Antigen ◽  
Significant Risk ◽  
Standard Of Care ◽  
Primary Therapy ◽  
Time Varying ◽  
Real World Data ◽  
Hazard Ratios ◽  
Increased Risk

e16066 Background: ADT is the standard of care in Sweden for PC pts with signs of recurrence after primary therapy (tx). Studies of predictors of metastasis (mets) and survival have largely focused on pt characteristics at cancer diagnosis. Time-varying factors, such as prostate-specific antigen (PSA) levels, may have greater impact on a pt’s risk of disease progression. This study examines predictors of mets and survival among men with PC treated with ADT. Methods: Using electronic medical records from Swedish urology clinics linked to national registries (Cancer Registry, National Pt Registry, Cause of Death Registry), we identified men with PC and no evidence of mets treated with ≥6 months (mos) ADT (gonadotropin-releasing hormone agonists/antagonists or bilateral orchiectomy) between 2000-2010 with ≥2 PSA values. Men were followed from ADT index date to mets, death, or end of follow-up (12/31/2010). Multivariate competing risks regression analysis was used to estimate hazard ratios (HR) and 95% CIs; predictors and covariates of interest included PC diagnosis year (yr), age, comorbidities, anti-androgen tx, region, and time-varying characteristics (PSA absolute value, PSA doubling time [DT]). Results: Cohort was 446 men with mean follow-up of 3.3 yrs. Most mets were to the bone (7-yr cumulative incidence 25% for bone, 30% for any mets). Median survival was 6 yrs (5.9 mos after bone mets, 6.1 mos after any mets). Higher PSA and shorter PSA DT were strong predictors of all outcomes. In particular, PSA DT ≤ 6 mos was associated with increased risk of bone mets (13.9 [8.0 – 24.1]), any mets (7.9 [4.9 – 12.8]), mortality (5.7 [3.9 – 8.5]), and bone mets-free survival (6.9 [4.7–10.1]) when compared to PSA DT > 6 mos. HRs were adjusted for age, Charlson comorbidity index, anti-androgen tx, and region. Conclusions: PC pts treated with ADT are at significant risk of bone mets, any mets, and death. This study based on real-world data demonstrates the importance of PSA measured after ADT initiation in defining high risk of these outcomes, particularly PSA DT ≤6 mos. PC pts may benefit from new tx to prevent disease progression since survival is short after bone or other mets.

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