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Executive Summary: Treatment of Osteoporosis and Osteoarthritis in the Oldest Old. 内容摘要:老年人骨质疏松症和骨关节炎的治疗。
IF 3.4 3区 医学 Q2 GERIATRICS & GERONTOLOGY Pub Date : 2025-03-01 Epub Date: 2025-02-24 DOI: 10.1007/s40266-025-01184-7
Nicola Veronese, Nicholas C Harvey, René Rizzoli, Nicholas R Fuggle, Jean-Yves Reginster

This is the executive summary of a work by the European Society for Clinical and Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal Diseases (ESCEO) (Nicholas Fuggle et al. in Drugs, 2024).

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引用次数: 0
An Educational Intervention to Promote Central Nervous System-Active Deprescribing in Dementia: A Pilot Study. 教育干预促进痴呆患者中枢神经系统主动降药:一项试点研究。
IF 3.4 3区 医学 Q2 GERIATRICS & GERONTOLOGY Pub Date : 2025-03-01 Epub Date: 2025-01-20 DOI: 10.1007/s40266-024-01178-x
Noah M Barnett, Sarah E Vordenberg, H Myra Kim, Molly Turnwald, Julie Strominger, Amanda N Leggett, Esther Akinyemi, Frederic C Blow, Alyssa Vanderziel, Celeste Pappas, Donovan T Maust

Background: Central nervous system (CNS)-active polypharmacy (defined as concurrent exposure to three or more antidepressant, antipsychotic, antiseizure, benzodiazepine, opioid, or nonbenzodiazepine benzodiazepine receptor agonists) is associated with significant potential harms in persons living with dementia (PLWD).We conducted a pilot trial to assess a patient nudge intervention's implementation feasibility and preliminary effectiveness to prompt deprescribing conversations between PLWD experiencing CNS-active polypharmacy and their primary care clinicians ("clinicians").

Methods: We used the electronic health record to identify PLWD prescribed CNS-active polypharmacy in primary care clinics from two health systems. Clinics were assigned to intervention (n = 10) or control (n = 12), with PLWD in intervention clinics mailed an educational brochure to prompt discussion with clinicians about the appropriateness of their CNS-active regimen. We conducted chart reviews for evidence of documentation related to these medications and used the electronic health record (EHR) to assess preliminary effectiveness 120 days after sending the brochure (e.g., number of CNS-active medications prescribed, change in total standardized daily dose [TSDD] of CNS-active medications, and change in prevalence of CNS-active polypharmacy). We interviewed 10 clinicians from intervention clinics to assess their perceptions about the acceptability of the intervention.

Results: PLWD in the intervention group (n = 61) and control group (n = 68) had an average age of 72.4 years (standard deviation [SD] 9.7), 62.8% were female, and 84.5% were white. We did not find any documented evidence of conversations related to CNS-active medications between PLWD who received the brochure and their primary care clinicians. After 120 days, there was no significant between-group difference in the mean number of CNS-active medications prescribed (- 1.0 [SD 1.3] versus - 1.0 [SD 1.3]), mean TSDD (- 1.6 [SD 6.0] versus - 1.3 [SD 5.8]), or the percentage of patients with CNS-active polypharmacy (52.6% versus 50.4%). Interviews with clinicians suggested they were aware that combinations of CNS-active medications were not ideal; however, they reported inheriting patients who were already on these medications, and they did not have sufficient clinic time or access to safer alternatives to overcome patient hesitation to deprescribe.

Conclusions: A direct-to-patient mailed educational brochure did not demonstrate feasibility in provoking deprescribing conversations between PLWD and clinicians or preliminary effectiveness in decreasing CNS-active polypharmacy.

背景:中枢神经系统(CNS)活性多药(定义为同时暴露于三种或三种以上抗抑郁药、抗精神病药、抗癫痫药、苯二氮卓类药物、阿片类药物或非苯二氮卓类药物苯二氮卓受体激动剂)与痴呆(PLWD)患者显著的潜在危害相关。我们进行了一项试点试验,以评估患者轻推干预的实施可行性和初步有效性,以促进患有中枢神经系统活跃的多重用药的PLWD与其初级保健医生(“临床医生”)之间的描述对话。方法:我们使用电子健康记录来识别来自两个卫生系统的初级保健诊所的PLWD处方cns活性多药。诊所被分配到干预组(n = 10)或对照组(n = 12),干预组的PLWD诊所邮寄了一份教育小册子,以促使临床医生讨论他们的中枢神经系统活跃方案的适当性。我们对与这些药物相关的文件证据进行了图表审查,并使用电子健康记录(EHR)在发送宣传册120天后评估初步有效性(例如,规定的中枢神经系统活性药物的数量,中枢神经系统活性药物的总标准化日剂量[TSDD]的变化,以及中枢神经系统活性药物的流行率的变化)。我们采访了来自干预诊所的10名临床医生,以评估他们对干预可接受性的看法。结果:干预组(n = 61)和对照组(n = 68) PLWD患者平均年龄为72.4岁(标准差[SD] 9.7),女性占62.8%,白人占84.5%。我们没有发现任何书面证据表明收到宣传册的PLWD与其初级保健临床医生之间有关于中枢神经系统活性药物的对话。120天后,两组间在平均服用中枢神经系统活性药物的数量(- 1.0 [SD 1.3] vs - 1.0 [SD 1.3])、平均TSDD (- 1.6 [SD 6.0] vs - 1.3 [SD 5.8])和服用中枢神经系统活性药物的患者比例(52.6% vs 50.4%)方面均无显著差异。与临床医生的访谈表明,他们意识到中枢神经系统活性药物的组合并不理想;然而,他们报告说,他们继承了已经在使用这些药物的患者,他们没有足够的临床时间或获得更安全的替代品来克服患者对撤销处方的犹豫。结论:直接邮寄给患者的教育宣传册在激发PLWD和临床医生之间的处方对话方面并不可行,在减少中枢神经系统活性的多药治疗方面也没有初步的效果。
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引用次数: 0
Perioperative Anticholinergic Medication Use and Incident Dementia among Older Surgical Patients: a Retrospective Cohort Study using Real-World Data.
IF 3.4 3区 医学 Q2 GERIATRICS & GERONTOLOGY Pub Date : 2025-03-01 Epub Date: 2025-02-04 DOI: 10.1007/s40266-025-01185-6
Emma Holler, Sanjay Mohanty, Molly Rosenberg, Corey Kalbaugh, Zina Ben Miled, Malaz Boustani, Christina Ludema

Background: Inpatient anticholinergic medications have been associated with a higher likelihood of postoperative delirium in older adults. However, it remains unclear whether administering anticholinergic medications after surgery adversely affects long-term cognitive function.

Objective: We aimed to evaluate the relationship between in-hospital anticholinergic medications and time to incident dementia in a cohort of older surgical patients. We also sought to determine whether the association between in-hospital anticholinergic drugs and dementia differed by sex and prehospital anticholinergic exposure.

Methods: This was a retrospective analysis of electronic health record data from a regional health information exchange. The study population included patients aged 50 years and older who underwent major surgery requiring an inpatient stay between 2014 and 2021. Orders for anticholinergic medications were identified using the anticholinergic cognitive burden (ACB) scale. A Cox proportional hazards model was used to estimate the association between inpatient orders for strong anticholinergics and incident dementia after hospital discharge. Cause-specific hazards were modeled. Stratification and relative excess risk due to interaction (RERI) were used to investigate multiplicative and additive interaction, respectively.

Results: In total, 66,420 surgical encounters were analyzed. Approximately 90% of patients received one or more strong anticholinergics during hospitalization, and 3806 patients developed dementia during a median follow-up of 3.4 years. The median time to dementia was 2.2 years. Each one-order increase in inpatient anticholinergic medications was associated with a 0.60% increase in dementia risk (HR 1.006; 95% CI 1.003-1.008). This association was stronger among patients who were prescribed anticholinergics before hospitalization (RERI 0.10; 95% CI 0.08-1.12; p = 0.0122).

Conclusions: Perioperative anticholinergics may increase the risk of dementia after major surgery. Avoiding these medications in hospitalized older adults may improve long-term cognitive outcomes.

背景:住院患者服用抗胆碱能药物与老年人术后谵妄的可能性增加有关。然而,手术后服用抗胆碱能药物是否会对长期认知功能产生不利影响,目前仍不清楚:我们旨在评估老年手术患者队列中的院内抗胆碱能药物与痴呆发生时间之间的关系。我们还试图确定院内抗胆碱能药物与痴呆之间的关系是否因性别和院前抗胆碱能药物接触而有所不同:这是一项对地区健康信息交换中心电子健康记录数据的回顾性分析。研究对象包括在2014年至2021年期间接受大手术并需要住院治疗的50岁及以上患者。使用抗胆碱能认知负担(ACB)量表确定了抗胆碱能药物的订单。采用 Cox 比例危险模型来估算住院患者使用强抗胆碱能药物与出院后发生痴呆之间的关系。对特定病因危害进行了建模。分层和交互作用导致的相对超额风险(RERI)分别用于研究乘法和加法交互作用:共分析了 66,420 例手术。约90%的患者在住院期间服用了一种或多种强效抗胆碱能药物,3806名患者在中位随访3.4年期间患上了痴呆症。出现痴呆症的中位时间为 2.2 年。住院患者服用的抗胆碱能药物每增加一阶,痴呆风险就会增加 0.60%(HR 1.006;95% CI 1.003-1.008)。在住院前已服用抗胆碱能药物的患者中,这种关联性更强(RERI 0.10;95% CI 0.08-1.12;P = 0.0122):结论:围手术期服用抗胆碱能药物可能会增加大手术后痴呆的风险。结论:围术期抗胆碱能药物可能会增加大手术后痴呆的风险,住院老年人避免使用这些药物可能会改善长期认知结果。
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引用次数: 0
Safety and Efficacy of Sodium-Glucose Cotransporter 2 Inhibitors in Older Adults with Variable Disease States: A Meta-analysis of Large Placebo-Controlled Trials.
IF 3.4 3区 医学 Q2 GERIATRICS & GERONTOLOGY Pub Date : 2025-03-01 Epub Date: 2025-02-22 DOI: 10.1007/s40266-025-01183-8
Syeda Ayesha Shah, Hasan Mushahid, Ali Salman, Syed Husain Farhan, Fakhar Latif, Rabbia Siddiqi, Abdulqadir J Nashwan, Dmitry Abramov, Abdul Mannan Khan Minhas

Background: Recent guidelines recommend the use of sodium-glucose cotransporter 2 (SGLT-2) inhibitors (SGLT2i) in patients suffering from cardiorenal diseases. However, the safety and efficacy of SGLT2i in older adults with atherosclerotic cardiovascular disease (ASCVD), heart failure (HF), and chronic kidney disease (CKD) remain unclear.

Methods: Online databases were queried from inception to 11 July 2023 to identify primary or secondary analyses for inclusion. Efficacy outcomes included all-cause mortality, cardiovascular (CV) death, hospitalization for heart failure (HHF), major adverse cardiac events (MACE), CV death/HHF composite, and cardiorenal composite events. Safety endpoints included acute kidney injury (AKI), serious adverse events, genital infections, limb amputation, fractures, urinary tract infections (UTI), and volume depletion. Data were pooled using a random-effects model to derive risk ratios (RRs) and 95% confidence intervals (CIs).

Results: Eight trials with 32,541 older adults identified in primary or secondary analyses were included. In older adults, SGLT2i reduced the risk of all-cause mortality (RR 0.88; 95% CI 0.83- 0.95), CV death (RR 0.82; 95% CI 0.74-0.92), HHF (RR 0.72; 95% CI 0.66-0.79), MACE (RR 0.87; 95% CI 0.77-0.99), CV death/HHF composite (RR 0.78; 95% CI 0.70-0.88), and cardiorenal composite events (RR 0.77; 95% CI 0.70-0.85). For safety endpoints, SGLT2i decreased the risk of serious adverse events (RR 0.92; 95% CI 0.89-0.95) and increased the risk of genital infections (RR 3.48; 95% CI 2.58-4.69).

Conclusions: This analysis of randomized trials demonstrates that SGLT2i are efficacious in older adults. However, since older individuals are often underrepresented in most clinical trials, further research targeting this growing demographic is essential.

背景:最新指南建议心肾疾病患者使用钠-葡萄糖共转运体 2(SGLT-2)抑制剂(SGLT2i)。然而,SGLT2i 在患有动脉粥样硬化性心血管疾病(ASCVD)、心力衰竭(HF)和慢性肾脏疾病(CKD)的老年人中的安全性和有效性仍不清楚:查询了从开始到 2023 年 7 月 11 日的在线数据库,以确定纳入的主要或次要分析。疗效结局包括全因死亡率、心血管(CV)死亡、心力衰竭(HHF)住院、主要心脏不良事件(MACE)、CV死亡/HHF复合事件和心肾复合事件。安全性终点包括急性肾损伤(AKI)、严重不良事件、生殖器感染、截肢、骨折、尿路感染(UTI)和容量耗竭。采用随机效应模型对数据进行汇总,得出风险比 (RR) 和 95% 置信区间 (CI):在主要或次要分析中,共纳入了 8 项试验,32541 名老年人从中受益。在老年人中,SGLT2i 可降低全因死亡(RR 0.88;95% CI 0.83-0.95)、CV 死亡(RR 0.82;95% CI 0.74-0.92)、HHF(RR 0.72;95% CI 0.66-0.79)、MACE(RR 0.87;95% CI 0.77-0.99)、CV 死亡/HHF 复合事件(RR 0.78;95% CI 0.70-0.88)和心肾综合事件(RR 0.77;95% CI 0.70-0.85)。在安全性终点方面,SGLT2i降低了严重不良事件的风险(RR 0.92;95% CI 0.89-0.95),增加了生殖器感染的风险(RR 3.48;95% CI 2.58-4.69):这项随机试验分析表明,SGLT2i 对老年人具有疗效。结论:这项随机试验分析表明,SGLT2i 对老年人有疗效。然而,由于老年人在大多数临床试验中往往代表性不足,因此针对这一日益增长的人群开展进一步研究至关重要。
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引用次数: 0
Topical Medications for Chronic Itch in Older Patients: Navigating a Pressing Need.
IF 3.4 3区 医学 Q2 GERIATRICS & GERONTOLOGY Pub Date : 2025-03-01 Epub Date: 2025-01-30 DOI: 10.1007/s40266-024-01174-1
Brooke Bartley, Christina Pierce, Chad Hivnor, Rodrigo Valdes-Rodriguez

Chronic itch in older patients is a common problem, with a significant impact on quality of life. Chronic itch in the older population may be attributable to several causes, such as age-related changes, skin conditions, systemic conditions, medications, and psychological conditions. Given the complexity of itch in this population, comorbidities, and polypharmacy in most geriatric patients, treating chronic itch can be challenging for healthcare providers. Therefore, optimized topical treatment regimens are paramount to help these patients and prevent side effects.

{"title":"Topical Medications for Chronic Itch in Older Patients: Navigating a Pressing Need.","authors":"Brooke Bartley, Christina Pierce, Chad Hivnor, Rodrigo Valdes-Rodriguez","doi":"10.1007/s40266-024-01174-1","DOIUrl":"10.1007/s40266-024-01174-1","url":null,"abstract":"<p><p>Chronic itch in older patients is a common problem, with a significant impact on quality of life. Chronic itch in the older population may be attributable to several causes, such as age-related changes, skin conditions, systemic conditions, medications, and psychological conditions. Given the complexity of itch in this population, comorbidities, and polypharmacy in most geriatric patients, treating chronic itch can be challenging for healthcare providers. Therefore, optimized topical treatment regimens are paramount to help these patients and prevent side effects.</p>","PeriodicalId":11489,"journal":{"name":"Drugs & Aging","volume":" ","pages":"213-233"},"PeriodicalIF":3.4,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143064481","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Dementia Medications and Their Association with Pain Medication Use in Medicare Beneficiaries with Alzheimer's Disease/Alzheimer's Disease-Related Dementias and Chronic Pain.
IF 3.4 3区 医学 Q2 GERIATRICS & GERONTOLOGY Pub Date : 2025-03-01 Epub Date: 2025-02-26 DOI: 10.1007/s40266-025-01181-w
Sadaf Arefi Milani, Jordan Westra, Yong-Fang Kuo, Brian Downer, Mukaila A Raji

Introduction: Chronic pain is prevalent among older adults with Alzheimer's disease (AD) and Alzheimer's disease-related dementias (ADRD). Memantine and acetylcholinesterase inhibitors (ACHEI; donepezil, rivastigmine, and galantamine) are approved for the treatment of dementia symptoms and may also have analgesic properties. However, findings on the clinical utility of these dementia medications for chronic pain treatment are mixed, and little is known about differences in the use of pain medication according to whether an older adult with AD/ADRD is using dementia medications.

Methods: We selected a 20% national sample of Medicare enrollees with a diagnosis of AD/ADRD and chronic pain in 2020. We calculated the odds of having any pain management prescription (opioids, serotonin and norepinephrine reuptake, gapapentinoids, or non-steroidal anti-inflammatory drugs), having an opioid prescription, and having a long-term (≥ 90 days) opioid prescription, by dementia medication (none, memantine, ACHEI, or memantine and ACHEI).

Results: Among 103,564 patients, 5.5% received a memantine prescription, 14.4% received an ACHEI prescription, and 8.6% received a prescription for both. Over 70% of all patients had a pain management prescription. The percentage of patients who had an opioid prescription ranged from 54.5% for those without a dementia medication prescription to 44.0% for those with a prescription for both memantine and ACHEI. Similarly, the percentage of patients who had a long-term opioid prescription was highest for those without a dementia medication prescription (12.2%) and lowest for those with a prescription for both memantine and ACHEI (8.8%). Having a prescription for memantine only was associated with lower odds of any pain management prescription (odds ratio [OR]: 0.94; 95% confidence interval [CI]: 0.88-1.00; p < 0.05). Having a prescription for either memantine (OR: 0.79; 95% CI 0.75-0.84), ACHEI (OR: 0.85; 95% CI 0.82-0.89), or both (OR: 0.75; 95% CI 0.72-0.79) was associated with lower odds of having an opioid prescription (p < 0.05). Lastly, having a prescription for either memantine (OR: 0.85; 95% CI 0.77-0.94), ACHEI (OR: 0.92; 95% CI 0.86-0.98), or both (OR: 0.83; 95% CI 0.77-0.90) was associated with lower odds of having a long-term opioid prescription.

Discussion: Older adults with co-occurring AD/ADRD and chronic pain who were on dementia medications had lower odds of being prescribed opioid analgesics. Memantine and ACHEIs should be explored as potential opioid-sparing medications for older adults with AD/ADRD, given their relatively safe profiles. Future studies are needed to examine repurposing dementia medications for pain treatment.

{"title":"Dementia Medications and Their Association with Pain Medication Use in Medicare Beneficiaries with Alzheimer's Disease/Alzheimer's Disease-Related Dementias and Chronic Pain.","authors":"Sadaf Arefi Milani, Jordan Westra, Yong-Fang Kuo, Brian Downer, Mukaila A Raji","doi":"10.1007/s40266-025-01181-w","DOIUrl":"10.1007/s40266-025-01181-w","url":null,"abstract":"<p><strong>Introduction: </strong>Chronic pain is prevalent among older adults with Alzheimer's disease (AD) and Alzheimer's disease-related dementias (ADRD). Memantine and acetylcholinesterase inhibitors (ACHEI; donepezil, rivastigmine, and galantamine) are approved for the treatment of dementia symptoms and may also have analgesic properties. However, findings on the clinical utility of these dementia medications for chronic pain treatment are mixed, and little is known about differences in the use of pain medication according to whether an older adult with AD/ADRD is using dementia medications.</p><p><strong>Methods: </strong>We selected a 20% national sample of Medicare enrollees with a diagnosis of AD/ADRD and chronic pain in 2020. We calculated the odds of having any pain management prescription (opioids, serotonin and norepinephrine reuptake, gapapentinoids, or non-steroidal anti-inflammatory drugs), having an opioid prescription, and having a long-term (≥ 90 days) opioid prescription, by dementia medication (none, memantine, ACHEI, or memantine and ACHEI).</p><p><strong>Results: </strong>Among 103,564 patients, 5.5% received a memantine prescription, 14.4% received an ACHEI prescription, and 8.6% received a prescription for both. Over 70% of all patients had a pain management prescription. The percentage of patients who had an opioid prescription ranged from 54.5% for those without a dementia medication prescription to 44.0% for those with a prescription for both memantine and ACHEI. Similarly, the percentage of patients who had a long-term opioid prescription was highest for those without a dementia medication prescription (12.2%) and lowest for those with a prescription for both memantine and ACHEI (8.8%). Having a prescription for memantine only was associated with lower odds of any pain management prescription (odds ratio [OR]: 0.94; 95% confidence interval [CI]: 0.88-1.00; p < 0.05). Having a prescription for either memantine (OR: 0.79; 95% CI 0.75-0.84), ACHEI (OR: 0.85; 95% CI 0.82-0.89), or both (OR: 0.75; 95% CI 0.72-0.79) was associated with lower odds of having an opioid prescription (p < 0.05). Lastly, having a prescription for either memantine (OR: 0.85; 95% CI 0.77-0.94), ACHEI (OR: 0.92; 95% CI 0.86-0.98), or both (OR: 0.83; 95% CI 0.77-0.90) was associated with lower odds of having a long-term opioid prescription.</p><p><strong>Discussion: </strong>Older adults with co-occurring AD/ADRD and chronic pain who were on dementia medications had lower odds of being prescribed opioid analgesics. Memantine and ACHEIs should be explored as potential opioid-sparing medications for older adults with AD/ADRD, given their relatively safe profiles. Future studies are needed to examine repurposing dementia medications for pain treatment.</p>","PeriodicalId":11489,"journal":{"name":"Drugs & Aging","volume":" ","pages":"267-274"},"PeriodicalIF":3.4,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143499834","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Antidepressants to Manage Osteoarthritic Pain: The Value of Pain Phenotyping.
IF 3.4 3区 医学 Q2 GERIATRICS & GERONTOLOGY Pub Date : 2025-03-01 Epub Date: 2025-02-20 DOI: 10.1007/s40266-025-01182-9
Di Zhang, Leticia A Deveza, Bryan Yijia Tan, Blake Dear, David J Hunter

Osteoarthritis (OA) is a chronic condition in which pain significantly affects quality of life, often leading to reduced physical activity and disability. Globally, an estimated 595 million people are affected, with the numbers likely to increase owing to an aging population and rising obesity rates. Effective pain management is crucial, yet current treatments, such as nonsteroidal anti-inflammatory drugs (NSAIDs) and opioids, often provide limited relief and come with risks. One reason for this limited success is the insufficient recognition of the importance of psychosocial factors and heterogeneity of patients with OA (such as anxiety and depression), which can exacerbate pain and its impacts. The variability in patient pain experiences highlights the potential value of pain phenotyping, which involves a comprehensive assessment of pain characteristics to tailor treatments to individual needs. Antidepressants, particularly serotonin-norepinephrine reuptake inhibitors (SNRIs), show promise in alleviating both psychological symptoms and OA-related pain, but their effectiveness varies among individuals. Therefore, further research into standardized pain phenotyping methods and their integration into antidepressant treatment is needed to improve efficacy and minimize side effects through more personalized approaches.

{"title":"Antidepressants to Manage Osteoarthritic Pain: The Value of Pain Phenotyping.","authors":"Di Zhang, Leticia A Deveza, Bryan Yijia Tan, Blake Dear, David J Hunter","doi":"10.1007/s40266-025-01182-9","DOIUrl":"10.1007/s40266-025-01182-9","url":null,"abstract":"<p><p>Osteoarthritis (OA) is a chronic condition in which pain significantly affects quality of life, often leading to reduced physical activity and disability. Globally, an estimated 595 million people are affected, with the numbers likely to increase owing to an aging population and rising obesity rates. Effective pain management is crucial, yet current treatments, such as nonsteroidal anti-inflammatory drugs (NSAIDs) and opioids, often provide limited relief and come with risks. One reason for this limited success is the insufficient recognition of the importance of psychosocial factors and heterogeneity of patients with OA (such as anxiety and depression), which can exacerbate pain and its impacts. The variability in patient pain experiences highlights the potential value of pain phenotyping, which involves a comprehensive assessment of pain characteristics to tailor treatments to individual needs. Antidepressants, particularly serotonin-norepinephrine reuptake inhibitors (SNRIs), show promise in alleviating both psychological symptoms and OA-related pain, but their effectiveness varies among individuals. Therefore, further research into standardized pain phenotyping methods and their integration into antidepressant treatment is needed to improve efficacy and minimize side effects through more personalized approaches.</p>","PeriodicalId":11489,"journal":{"name":"Drugs & Aging","volume":" ","pages":"183-193"},"PeriodicalIF":3.4,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143457160","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Regular Use of Oral Nonsteroidal Anti-inflammatory Drugs in a Population of Polish Seniors: Findings from the PolSenior2 Cross-Sectional Survey.
IF 3.4 3区 医学 Q2 GERIATRICS & GERONTOLOGY Pub Date : 2025-03-01 Epub Date: 2025-01-28 DOI: 10.1007/s40266-025-01180-x
Karol Wierzba, Michał Chmielewski, Emilia Błeszyńska-Marunowska, Kacper Jagiełło, Łukasz Wierucki, Tomasz Zdrojewski

Introduction: Older adults represent a growing proportion of the general population. Nonsteroidal anti-inflammatory drugs (NSAIDs) constitute a group of medicines that are both necessary, owing to their anti-inflammatory, analgesic, and cardioprotective abilities, and potentially harmful, owing to their side effects.

Objectives: This study provides a comprehensive analysis of NSAID usage patterns among Polish adults aged 60 years and older. It focused on the regular use (≥ three times per week) of two types of NSAIDs: acetylsalicylic acid (ASA) and non-ASA NSAIDs, examining consumption on the basis of age, sex, educational level, and place of residence.

Methods: Data were collected from the PolSenior2 study, a national cross-sectional survey of 5987 Polish individuals aged 60-106 years, conducted from 2018 to 2019.

Results: The study found that 30.7% [95% confidence interval (CI) 28.8-32.7)]of Polish seniors regularly used NSAIDs, with 26.2% (95% CI 24.5-28.0) regularly using ASA, 6.3% (95% CI 5.3-7.2) regularly using non-ASA NSAIDs, and 1.9% (95% CI 1.4-2.3) reporting regular use of both. An age-related increase in regular NSAID use, including ASA, was observed. Women were more likely than men to use non-ASA NSAIDs regularly, whereas men in the 70-79 age group were more likely to use ASA. A lower level of education was associated with more frequent NSAID use.

Conclusions: The findings have implications for healthcare practitioners and policymakers, emphasizing the need for careful management of NSAID use. The study contributes to a more nuanced understanding of NSAID usage and underscores the necessity for tailored healthcare strategies to ensure safe and effective medication use among older adults.

{"title":"Regular Use of Oral Nonsteroidal Anti-inflammatory Drugs in a Population of Polish Seniors: Findings from the PolSenior2 Cross-Sectional Survey.","authors":"Karol Wierzba, Michał Chmielewski, Emilia Błeszyńska-Marunowska, Kacper Jagiełło, Łukasz Wierucki, Tomasz Zdrojewski","doi":"10.1007/s40266-025-01180-x","DOIUrl":"10.1007/s40266-025-01180-x","url":null,"abstract":"<p><strong>Introduction: </strong>Older adults represent a growing proportion of the general population. Nonsteroidal anti-inflammatory drugs (NSAIDs) constitute a group of medicines that are both necessary, owing to their anti-inflammatory, analgesic, and cardioprotective abilities, and potentially harmful, owing to their side effects.</p><p><strong>Objectives: </strong>This study provides a comprehensive analysis of NSAID usage patterns among Polish adults aged 60 years and older. It focused on the regular use (≥ three times per week) of two types of NSAIDs: acetylsalicylic acid (ASA) and non-ASA NSAIDs, examining consumption on the basis of age, sex, educational level, and place of residence.</p><p><strong>Methods: </strong>Data were collected from the PolSenior2 study, a national cross-sectional survey of 5987 Polish individuals aged 60-106 years, conducted from 2018 to 2019.</p><p><strong>Results: </strong>The study found that 30.7% [95% confidence interval (CI) 28.8-32.7)]of Polish seniors regularly used NSAIDs, with 26.2% (95% CI 24.5-28.0) regularly using ASA, 6.3% (95% CI 5.3-7.2) regularly using non-ASA NSAIDs, and 1.9% (95% CI 1.4-2.3) reporting regular use of both. An age-related increase in regular NSAID use, including ASA, was observed. Women were more likely than men to use non-ASA NSAIDs regularly, whereas men in the 70-79 age group were more likely to use ASA. A lower level of education was associated with more frequent NSAID use.</p><p><strong>Conclusions: </strong>The findings have implications for healthcare practitioners and policymakers, emphasizing the need for careful management of NSAID use. The study contributes to a more nuanced understanding of NSAID usage and underscores the necessity for tailored healthcare strategies to ensure safe and effective medication use among older adults.</p>","PeriodicalId":11489,"journal":{"name":"Drugs & Aging","volume":" ","pages":"245-255"},"PeriodicalIF":3.4,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143052064","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Factors Influencing General Practitioners' Deprescribing Decisions for Older Adults, with Insights into Frailty: a Qualitative Study in Greek Primary Care.
IF 3.4 3区 医学 Q2 GERIATRICS & GERONTOLOGY Pub Date : 2025-02-21 DOI: 10.1007/s40266-025-01188-3
Alexandros Paraskevopoulos, Björn Wettermark, Ioanna Tsiligianni

Introduction: Polypharmacy is increasing among older individuals worldwide. Deprescribing has been suggested as a strategy to reduce polypharmacy, but it has had a limited impact.

Objective: This study investigated the facilitators and barriers to deprescribing in older adults, as perceived by primary care general practitioners, focusing particularly on factors influencing deprescribing in frail individuals.

Methods: A qualitative approach was employed and semistructured interviews were conducted between 9 April and 29 May 2024 with a sample of 30 general practitioners working in primary care facilities in Crete, Greece. The interviews were recorded and transcribed verbatim. Thematic analysis was performed on the basis of the Theoretical Domains Framework.

Results: Several barriers to deprescribing were revealed, including a lack of expertise and motivation, inadequate communication skills, time constraints, and negative beliefs toward deprescribing held by physicians and patients. The lack of an established role for general practitioners in primary care, the absence of a national initiative targeting polypharmacy, and the influence of pharmacists and pharmaceutical representatives were highlighted as challenges. The identified facilitators included the incorporation of deprescribing recommendations and considerations for frail patients into guidelines, fostering a strong doctor-patient relationship, promoting shared decision-making, facilitating effective collaboration with caregivers, and utilizing nonpharmacological therapy.

Conclusions: General practitioners encounter both barriers and facilitators when making deprescribing decisions for older adults, particularly those with frailty syndrome. Researchers and policymakers can use the findings of this research to guide future interventions and promote successful deprescribing practices.

{"title":"Factors Influencing General Practitioners' Deprescribing Decisions for Older Adults, with Insights into Frailty: a Qualitative Study in Greek Primary Care.","authors":"Alexandros Paraskevopoulos, Björn Wettermark, Ioanna Tsiligianni","doi":"10.1007/s40266-025-01188-3","DOIUrl":"https://doi.org/10.1007/s40266-025-01188-3","url":null,"abstract":"<p><strong>Introduction: </strong>Polypharmacy is increasing among older individuals worldwide. Deprescribing has been suggested as a strategy to reduce polypharmacy, but it has had a limited impact.</p><p><strong>Objective: </strong>This study investigated the facilitators and barriers to deprescribing in older adults, as perceived by primary care general practitioners, focusing particularly on factors influencing deprescribing in frail individuals.</p><p><strong>Methods: </strong>A qualitative approach was employed and semistructured interviews were conducted between 9 April and 29 May 2024 with a sample of 30 general practitioners working in primary care facilities in Crete, Greece. The interviews were recorded and transcribed verbatim. Thematic analysis was performed on the basis of the Theoretical Domains Framework.</p><p><strong>Results: </strong>Several barriers to deprescribing were revealed, including a lack of expertise and motivation, inadequate communication skills, time constraints, and negative beliefs toward deprescribing held by physicians and patients. The lack of an established role for general practitioners in primary care, the absence of a national initiative targeting polypharmacy, and the influence of pharmacists and pharmaceutical representatives were highlighted as challenges. The identified facilitators included the incorporation of deprescribing recommendations and considerations for frail patients into guidelines, fostering a strong doctor-patient relationship, promoting shared decision-making, facilitating effective collaboration with caregivers, and utilizing nonpharmacological therapy.</p><p><strong>Conclusions: </strong>General practitioners encounter both barriers and facilitators when making deprescribing decisions for older adults, particularly those with frailty syndrome. Researchers and policymakers can use the findings of this research to guide future interventions and promote successful deprescribing practices.</p>","PeriodicalId":11489,"journal":{"name":"Drugs & Aging","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143472325","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Unveiling Cognitive Impairment in Older Adults with Cancer on Systemic Anticancer Therapy: A Comprehensive Review.
IF 3.4 3区 医学 Q2 GERIATRICS & GERONTOLOGY Pub Date : 2025-02-20 DOI: 10.1007/s40266-025-01186-5
Raquel Paramo Fernandez, Gemma Fargas Baella, Vanya Slavova-Boneva, Nicolò Matteo Luca Battisti

Cancer-related cognitive impairment significantly affects cancer management and decision-making. While the exact mechanisms underlying cancer-related cognitive dysfunction remain complex and multifaceted, different factors have been identified that may help predict which patients are at increased risk for cognitive decline. In this article, we provide a comprehensive overview of systemic cancer therapy-induced cognitive impairment in older adults, including signs and symptoms, diagnosis, and management. In addition, we discuss the evidence available on the impact of endocrine therapy, cytotoxic chemotherapy, immunotherapy and targeted agents on cognition in this population.

{"title":"Unveiling Cognitive Impairment in Older Adults with Cancer on Systemic Anticancer Therapy: A Comprehensive Review.","authors":"Raquel Paramo Fernandez, Gemma Fargas Baella, Vanya Slavova-Boneva, Nicolò Matteo Luca Battisti","doi":"10.1007/s40266-025-01186-5","DOIUrl":"https://doi.org/10.1007/s40266-025-01186-5","url":null,"abstract":"<p><p>Cancer-related cognitive impairment significantly affects cancer management and decision-making. While the exact mechanisms underlying cancer-related cognitive dysfunction remain complex and multifaceted, different factors have been identified that may help predict which patients are at increased risk for cognitive decline. In this article, we provide a comprehensive overview of systemic cancer therapy-induced cognitive impairment in older adults, including signs and symptoms, diagnosis, and management. In addition, we discuss the evidence available on the impact of endocrine therapy, cytotoxic chemotherapy, immunotherapy and targeted agents on cognition in this population.</p>","PeriodicalId":11489,"journal":{"name":"Drugs & Aging","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143457164","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
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Drugs & Aging
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