Drugs & Aging最新文献

Background: The aim of this study was to assess the prevalence of potentially inappropriate medication (PIM) use among adults ≥ 65 years, overall and for population subgroups, and factors associated with prevalent PIM use.

Methods: Participant and medications data from the Atherosclerosis Risk in Communities (ARIC), Multi-ethnic Study of Atherosclerosis (MESA), and Action for Health in Diabetes (Look AHEAD) were used. The total number of individuals contributing to analysis was 9439 for ARIC, 5223 for MESA, and 3771 for Look AHEAD. Participants' medication data were collected at study exams with medication inventories. Prevalence of any PIM use (yes/no), total number of PIMs used, and the major drug classes of PIMs used within a cohort were identified using Beers Criteria closest to the time of study exam (1997 onward) for all participants aged 65 years or older. Multivariable adjusted logistic regression was used to assess demographic and clinical factors associated with prevalence of any Beers Criteria PIM at the first exam after turning 65 years of age, separately for each cohort.

Results: The prevalence of PIM use at the first exam at ≥ 65 years was 67% in ARIC, 51% in MESA, and 70% in Look AHEAD. The most prevalently used PIM classes across cohorts were non-aspirin pain medications, proton-pump inhibitors, and sulfonylureas. Higher body mass index and diabetes were consistently associated with greater odds of PIM use across cohorts.

Conclusions: Use of potentially inappropriate prescription and nonprescription medications was highly prevalent across three diverse cohorts and highlights the need for clinicians and pharmacists to review patient medication lists and optimize management of medications.

Background: Geriatric inpatients are vulnerable to medication-related harm, yet effective interventions remain scarce. The ASPIRE randomized controlled trial evaluated a pharmacist-led intervention aimed at reducing unplanned hospital revisits through comprehensive medication reviews targeting inappropriate pharmacotherapy and polypharmacy.

Methods: This study assessed the intervention's impact on medication appropriateness and medication burden at admission, discharge, and 1 month post-discharge in patients admitted to an acute geriatric ward. Medication appropriateness was measured using the Medication Appropriateness Score (MAS), summating STOPP and START criteria version 3, and by tracking reductions in potentially inappropriate medications (PIMs) as measured by STOPP and potential prescribing omissions (PPOs) according to START. Medication burden was assessed through changes in total medication count, polypharmacy (≥ 5 drugs), and excessive polypharmacy (≥ 10 drugs). Univariable and multivariable linear mixed models and generalized estimating equations were applied for continuous and dichotomous outcomes respectively. Data were collected from electronic health records and contact with patients, family members, and healthcare professionals.

Results: The trial included 415 intervention and 410 control patients with a mean age of 86.3 (± 5.9) years. Multivariable linear mixed models showed significant improvements in MAS (β = - 0.97 at discharge, β = - 0.93 1 month post-discharge), PIMs (β = -0.85 at both time points) and PPOs (β = - 0.25 at discharge, β = - 0.24 1 month post-discharge) between intervention and control patients (all p < 0.0001). There was no reduction in medication count, polypharmacy, or excessive polypharmacy.

Conclusions: The ASPIRE intervention significantly improved medication appropriateness in patients admitted to an acute geriatric ward without reducing overall medication burden, resulting in a shift from inappropriate to appropriate polypharmacy.

Trial registration number and date of registration: NCT04617340, 2020-10-29.

The aging population is steadily increasing, representing a significant portion of the global population. Vitamin D deficiency is highly prevalent, particularly among older adults and has been implicated in the pathogenesis of various chronic diseases. In June 2024, a clinical practice guideline was published by the Endocrine Society, recommending empiric vitamin D supplementation for those over 75 years old, suggesting that it could reduce mortality in this age group. Meanwhile, for the general population aged 50-74 years, not only was empiric supplementation not suggested but neither was routine testing of vitamin D levels. This review discusses the pathophysiological changes associated with aging, the conditions commonly affecting older adults that may be positively impacted by vitamin D, and the potential negative effects of such supplementation. By examining the current knowledge in the field, we aim to provide practical insights into the effects of vitamin D in individuals older than 75 years and to explore the potential benefits of expanding supplementation to include younger older adults, specifically those aged 65-74 years.

Osteoarthritis (OA) is a leading cause of disability worldwide, characterised by chronic pain and reduced quality of life. Despite its prevalence, pharmacotherapy options remain limited. Inflammation has emerged as a promising target, with anti-inflammatory agents used in other rheumatological conditions, such as methotrexate (MTX), being explored for OA treatment. MTX is a cornerstone therapy in rheumatoid arthritis (RA), owing to its broad immunomodulatory properties and well-established clinical efficacy. This review summarises evidence from seven randomised controlled trials and two observational studies investigating MTX in knee and hand OA. Studies varied considerably in terms of sample size, study population, MTX dosage and follow-up duration. Overall, study outcomes were conflicting in terms of MTX effect on OA symptoms. However, trials with larger sample sizes and higher MTX doses (> 15 mg/week) consistently reported benefits for pain in knee and hand OA, with a favourable safety profile, supporting MTX as a potential OA treatment. There is still a need for further research to refine dosing strategies, assess longer term use and evaluate cost-effectiveness. Given the complex heterogeneity of OA, stratification by OA phenotype, particularly consideration of local and systemic inflammation, may also be important to underpin selection of a population most likely to respond to MTX treatment. Considerations for the use of MTX in older adults, where comorbidities and polypharmacy may impact use, will also be essential for clinical implementation.

Aim: The aim of this repeated cross-sectional study was to estimate polypharmacy prevalence and trends in Australian adults between 2013 and 2024.

Methods: Dispensing records of medicines subsidised by the Australian Pharmaceutical Benefits Scheme (PBS) were analysed for a nationally representative 10% sample of PBS-eligible beneficiaries.

Outcomes: The outcomes for this study were annual polypharmacy and hyperpolypharmacy prevalence, defined as ≥5 and ≥10 regular medicines, respectively, and average annual percentage change (AAPC), overall and by gender-stratified age groups. These groups are defined broadly as adult (18-64 years) and older adult (≥65 years), and as younger adulthood (18-39 years), middle (40-64 years), early older (65-84 years) and later older (85+ years) age.

Results: Polypharmacy prevalence rose from 8.0% in 2013 to 9.2% (AAPC+1.4%), with two million Australians exposed in 2024. Although prevalence was initially higher among women, by 2024 men had surpassed women from middle age onward. Increasing AAPC was observed among adult and older adult men (+1.0%, +1.3%), while remaining stable among women. Finer age strata showed growth among men in middle, early older, and later older age (+1.7%, +1.0%, +3.4%) and divergent trends among women, with increases in younger adulthood (+1.8%) and declines in early older age (- 0.7%).

Conclusion: Shifting gender trends appear driven by stabilising or declining prevalence among women alongside sustained growth among men. By 2024, men exceeded women from middle age onward, suggesting a changing prescribing landscape. These patterns highlight the need for targeted interventions, and gender-stratified monitoring to ensure prescribing is appropriate. The long-term consequences of increasing polypharmacy in younger and middle-aged adults remain unclear and warrant further investigation.

Background: Global aging makes polypharmacy in older adults a critical concern. Pharmacist-led deprescribing shows promise, but lacks routine implementation. Japan introduced "the Medication Adjustment Support Fee (the Adjustment Fee)" in 2018 for deprescribing medications in patients with polypharmacy based on pharmacists' recommendations.

Objective: We aimed to investigate: (1) medication distribution among older patients; (2) medications most frequently deprescribed based on pharmacists' recommendations; and (3) factors associated with successful deprescribing.

Methods: This retrospective study analysed patients aged ≥ 65 years who had prescriptions dispensed for ≥ 60 days from 2069 community pharmacies (April 2020-September 2023). Eligibility for the adjustment fee required six or more oral medications for ≥ 4 weeks, with pharmacists receiving remuneration when two or more medications were deprescribed and sustained for ≥ 4 weeks. We examined: (1) medication distribution in older patients; (2) most frequently deprescribed medications based on pharmacists' recommendations; and (3) factors associated with deprescribing using multi-level logistic regression.

Results: Amongst 1,458,323 older patients, 36.9% (537,884) met the eligibility criteria for the adjustment fee, but only 0.08% had medications deprescribed based on pharmacist recommendations. At the pharmacy level, 10% of pharmacies (213/2069) claimed the fee at least once. The most frequently deprescribed medications were rebamipide (0.05%), mecobalamin (0.06%) and magnesium oxide (0.02%). Older age, higher number of medications taken, presence of a family pharmacist, and longer evaluation periods were significantly associated with claiming for the adjustment fee (p < 0.001 for all).

Conclusions: Pharmacist-led deprescribing is infrequently implemented. Future studies could investigate the potential of strengthened incentives, enhanced collaboration, and robust protocols to optimize medication management in older adults.

Background: Knowledge of multiple medication use and medication adherence is important to assess treatment effectiveness and prevent worsening of disease, re-hospitalization, and increased healthcare costs. Limited data exist on individuals with hyperpolypharmacy (ten or more concurrent medications) and their adherence.

Objective: The objective of the study was to identify potential factors associated with hyperpolypharmacy, and medication adherence in participants with hyperpolypharmacy, as well as explore the relationship between hyperpolypharmacy and medication adherence.

Methods: This is a cross-sectional analysis of baseline data from OPERAM, a multicenter study across four large European hospitals. Adults aged ≥ 70 years with multimorbidity and polypharmacy (five or more regular medications) were included. Demographic, clinical, and healthcare utilization data were assessed. Outcomes were hyperpolypharmacy and low/medium medication adherence (i.e., a score < 8 out of a maximum of 8) based on the Morisky Medication Adherence Scale-8 (MMAS-8^©). Multivariable logistic regression was used to identify factors associated with hyperpolypharmacy or low/medium adherence.

Results: Of 2005 patients with multimorbidity and polypharmacy, 1029 (51%) exhibited hyperpolypharmacy. In multivariable analyses, the following factors were significantly associated with hyperpolypharmacy: increasing number of comorbidities (p for linear trend < 0.001), nursing home residency (odds ratio [OR] 2.20, 95% confidence interval [CI] 1.42-3.41), and visits to specialists/emergency department (OR 1.60, 95% CI 1.16-2.19) or any hospitalizations (OR 1.89, 95% CI 1.42-2.52) compared with visits to primary care physicians only. In the subgroup of 978 hyperpolypharmacy-only adults with available adherence data, 517 (53%) had low/medium medication adherence. In multivariable analyses, the odds of low/medium medication adherence increased with increasing number of comorbidities (p for linear trend 0.005) but decreased with older age (OR 0.69, 95% CI 0.52-0.92 for ≥ 80 versus < 80 years) and receipt of community nurse care (OR 0.59, 95% CI 0.44-0.81).

Conclusions: More than half of older adults with hyperpolypharmacy had suboptimal medication adherence. Our findings suggest that primary care physicians may contribute to reducing hyperpolypharmacy, while introduction of community nurse visits could improve medication adherence.

Glucocorticoid-induced osteoporosis is the most common cause of secondary osteoporosis and constitutes an important health problem, associated with an increased risk of fractures, significant morbidity and mortality, and long-term decreased quality of life. Aging is linked to extensive multimorbidity, polypharmacy, physical and mental disability, and an increased risk of falls, rendering management of glucocorticoid-induced osteoporosis in the older population particularly challenging. On a pathophysiological level, aging is associated with declining osteoblast activity, increased osteoclast activity, and increased bone marrow adiposity; effects that are all accentuated by glucocorticoids. In this narrative review, we discuss the pathophysiology of glucocorticoid-induced osteoporosis, and focus on the mechanism of action, pharmacokinetics, and pharmacodynamics of the various pharmaceutical agents used in the treatment of glucocorticoid-induced osteoporosis, as well as their efficacy, tolerability and safety, especially in older individuals.

Purpose: With pain treatment shifting away from opioids, alternative analgesics-such as gabapentinoids-are increasingly being used. This study investigated the prevalence and indications for gabapentinoid use among geriatric outpatients, a population particularly vulnerable to central nervous system (CNS)-active drugs.

Methods: A retrospective cross-sectional chart review was conducted among patients visiting the geriatric falls clinic at Aalborg University Hospital, Denmark, in 2013-14, 2018-19 and 2023. Demographic data, comorbidities, medication status, fall frequency, in-clinic measurements, reported pain and dizziness, frailty status, as well as indications for gabapentinoid prescriptions were extracted and classified according to guidelines.

Results: A total of 773 patients were screened, and 635 included (2013/2018/2023, n = 144/265/226). The mean age was 81.2 years, 59% were female, and nearly half of the patients were frail (Clinical Frailty Scale (CFS) ≥ 5). Chronic pain was increasingly reported at the falls clinic (46/62/68%, p < 0.001). Gabapentinoid use increased with time (3.5/10.9/15%, p = 0.002), while opioid use decreased (29.2/19.2/11.9%, p < 0.001). A total of 65 patients took gabapentinoids for pain, of which 42 (62%) were not supported by guidelines; 18 (26%) were vaguely supported, while only five (7%) were clearly supported by guidelines. Most had been on gabapentinoids for > 1 year, and deprescription was initiated in approximately 40%.

Conclusions: A marked increase in gabapentinoid use among patients assessed at the geriatric falls clinic was found, with a corresponding decrease in opioid use. The majority of gabapentinoid prescriptions were for indications not supported by guidelines.

Background: Lecanemab is the first anti-amyloid monoclonal antibody with full approval in the US for the treatment of early Alzheimer's disease (AD). This observational study aimed to provide information about patient demographics, clinical characteristics, provider specialty, and lecanemab utilization patterns.

Methods: This observational study used open administrative claims from the PurpleLab, a database encompassing medical and pharmacy claims derived from diverse sources, such as clearinghouses and Pharmacies. We included patients receiving one or more lecanemab doses between January 6, 2023 and October 31, 2024, and having continuous clinical activity ≥ 6 months prior to the first lecanemab infusion. The observation period ran from the first lecanemab infusion to the latest clinical activity or data availability. Treatment gaps were calculated as the number of gap days in lecanemab supply between consecutive infusions.

Results: Among the study population (n = 4261), mean age was 75.2 years, 77.8% were White, 98.4% lived in urban settings, 81.7% were treated by neurologists, 77.3% had AD, and 31.7% had mild cognitive impairment. Mean follow-up period was 171.1 days. Lecanemab infusions averaged 1.9 per patient per month (SD 1.0), 16.3 days apart (SD 11.0), and 2.8% of patients experienced a treatment interruption ≥90 days.

Conclusions: Lecanemab utilization followed US FDA-approved prescribing information. Disparities for minority and rural-based populations were observed suggesting opportunities to improve access for underserved populations.