Drugs & Aging最新文献

Background: Gabapentin is increasingly prescribed to older adults, yet prescribing patterns and characteristics of gabapentin initiators remain unclear.

Methods: We conducted a retrospective cohort study of gabapentin initiators using a random sample of age-eligible fee-for-service Medicare beneficiaries (2012-2021) enrolled in Parts A, B, and D. Gabapentin initiators were identified from pharmacy claims. We required 180 days of continuous enrollment (washout period) prior to initiation (index date) for inclusion. We analyzed demographics, healthcare utilization within 3 months of initiation, chronic conditions, medication history during washout period, and patterns of gabapentin use. Subgroup analyses compared initiators by duration of continuous gabapentin use (≤ 90 days, 91-180 days, and > 180 days).

Results: The prevalence of gabapentin prescriptions increased over time, from 6.7% (2013) to 10.2% (2021). Among 247,612 gabapentin initiators (mean age 76.1 years, 61.5% female, 89.2% white), chronic pain (32.6%) was the most commonly documented condition, while epilepsy and postherpetic neuralgia, the approved indications for gabapentin, were documented in fewer than 0.5% of initiators. Among initiators, 38.9% had prior opioid use, and 13.2% were co-prescribed gabapentin and opioids at initiation. About 30% had a history of antidepressant use, predominantly selective serotonin reuptake inhibitors (17.2%). Subgroup analyses showed similar demographics and prescription patterns across subgroups. However, gabapentin initiators with > 180 days continuous use had more neuropathic pain and chronic condition diagnoses documented, fewer opioid co-prescriptions at index, and lower hospitalization rates.

Conclusions: Gabapentin was frequently prescribed, apparently off-label, in older adults with a high burden of chronic pain and comorbidities; initiators often had co-prescriptions of gabapentin with opioids. Future research is needed to investigate factors associated with extended gabapentin use (> 180 days) and its appropriateness in this population.

Background: Prior studies have suggested potential benefits of antihypertensive medication (AHM) in preventing atrial fibrillation. It remains uncertain whether these benefits are uniform across different AHM classes. This study aims to compare the risk of AF across AHM classes in older adults.

Methods: This study included 8942 individuals from a randomized trial of aspirin, who were aged ≥ 65 years, free of cardiovascular disease (CVD) and AF, treated with any AHM at baseline. Exposures of interest included four first-line AHM medications: angiotensin-converting-enzyme inhibitors (ACEIs), angiotensin-receptor blockers (ARBs), calcium channel blockers (CCBs), and diuretics. Participants were assigned a diagnosis of probable, possible or no AF via a clinical algorithm. Possible AF cases were excluded. Cox proportional-hazards model was used to compare risk of probable AF among baseline users of different AHM classes, adjusting for potential confounders and blood pressure.

Results: Over 4.5 years, 535 (6.0%) participants developed probable AF. CCB-based therapy, alone or in combination, showed the lowest AF risk among all classes (HR [95% CI] for CCB-based therapy versus ARB-, ACEI-, and diuretic-based therapy, alone or in combination: 0.74 [0.57-0.98], 0.85 [0.64-1.13], and 0.81 [0.62-1.06], respectively). A lower AF risk was also observed with CCB monotherapy (HR from 0.58-0.71 compared with monotherapy of other classes).

Conclusions: CCB-based AHM therapy was linked to a lower risk of probable AF events compared with non-CCB regimens in older adults who were initially free of CVD and AF and treated with any AHM. Additional studies are warranted to clarify the mechanisms underlying this association.

Sarcopenia and cachexia are two common and overlapping but distinct muscle wasting syndromes that predict adverse outcomes and undermine quality of life among older adults with cancer. Despite their prognostic value and negative effects on older patients' well-being, sarcopenia and cachexia are not routinely or adequately assessed and managed in clinical oncology practice. However, efforts to recognize and manage sarcopenia and cachexia at diagnosis and during follow-up may have beneficial effects on muscle mass, physical function, and quality of life among older adults with cancer, although evidence on long-term clinical outcomes in response to targeted interventions has yet to be established. This comprehensive review attempts to (i) delineate the differences in the pathophysiology and clinical manifestations between sarcopenia and cachexia, (ii) clarify how sarcopenia and cachexia are defined in the geriatric oncology literature, (iii) describe methods for assessing sarcopenia and cachexia in clinical practice, (iv) review the prognostic value of sarcopenia and cachexia among older patients, particularly those undergoing systemic cancer treatment, and (v) discuss evidence-based strategies aimed at managing sarcopenia and cachexia for older adults with cancer.

Early-phase clinical trials (EPCTs) are critical for evaluating the safety, tolerability, efficacy and pharmacokinetics of novel oncology therapies. However, older adults are underrepresented in all phases of oncology clinical trials, including early-phase trials, creating a significant gap in evidence-based cancer management in this population, which translates into clinical practice. This is despite cancer incidence increasing with age, and a substantial proportion of cancer diagnoses occurring in individuals aged ≥ 65 years. Ageing is associated with physiological, physical and psychosocial changes which could underlie the hesitancy to include older adults in early-phase clinical trials, due to concerns of excessively compromising their safety and quality of life. However, the landscape of EPCTs has changed with higher safety and efficacy data. This review explores the current landscape of older adults in early-phase clinical trials, including the participation rate, the outcomes, and the multifaceted challenges contributing to the underrepresentation of older adults, and examines the potential strategies to enhance the inclusivity of older adults for treating older adults with cancer.

Proton pump inhibitors (PPIs) are amongst the most commonly prescribed medications worldwide. Clinical practice guidelines identify clear indications for short-term and long-term use; however, many older adults are prescribed potentially unnecessary PPIs. Multiple concerns exist with unnecessary PPI therapy, including the potential long-term risk of adverse effects. An association between PPI use and fractures, dementia, and respiratory and gastrointestinal infections has been suggested in observational data; however, there is a paucity of high-quality data supporting a causative relationship. Despite this, PPIs remain a target for medication optimization in older adults because of the high rate of unnecessary use, cost, and contribution to pill burden and polypharmacy. A multidimensional approach is required to reduce unnecessary PPI's, including the alignment of initial prescribing with evidence-based indications, reassessment of existing prescriptions, enhancement of knowledge and resources for patients and prescribers, and support for deprescribing. To increase deprescribing success, barriers to PPI deprescribing must be addressed, including the fear of symptom recurrence, insufficient time and education, and lack of concern regarding long-term use. Deprescribing strategies, such as tapering, can aid in success, as can the utilization of nonpharmacological and lower risk options for managing symptoms of gastric-acid-related disorders.

Background: Heart failure with reduced ejection fraction is increasingly prevalent in older adults, yet data on guideline-directed therapies in the oldest age groups remain limited.

Objective: To assess outcomes of sacubitril/valsartan in adults aged ≥75 years, across age strata (≥75, ≥80, ≥85, ≥90 years; 75-79, 80-84, 85- 89 years), focusing on cardiovascular, heart failure, and all-cause hospitalizations, and mortality.

Methods: This retrospective study evaluated all patients aged ≥ 75 years in Belgium with chronic heart failure with reduced ejection fraction who started sacubitril/valsartan between 1 November, 2016 and 31 December, 2018.

Results: A total of 1705 patients were divided into the following age groups: 75-79, 80-84, 85-89, and ≥ 90 years. Cardiovascular hospitalization rates significantly decreased across all age groups after sacubitril/valsartan initiation. Patients aged 75-79 years showed a reduction from 0.74 events/year (95% confidence interval [CI] 0.68-0.81) prior to treatment to 0.54 (95% CI 0.47-0.62, p < 0.001) after initiation. Rates fell from 0.73 (95% CI 0.66-0.80) to 0.53 (95% CI 0.44-0.65, p < 0.001) in those aged 80-84 years, from 0.62 (95% CI 0.52-0.74) to 0.44 (95% CI 0.35-0.57, p < 0.01) in those aged 85-89 years, and from 0.78 (95% CI 0.59-1.03) to 0.42 (95% CI 0.22-0.83, p < 0.01) in patients aged ≥ 90 years. Heart failure-related hospitalization rates also showed consistent reductions: 0.34 (95% CI 0.30-0.39) prior to treatment to 0.28 (95% CI 0.22-0.34) after initiation in patients aged 75-79 years, and from 0.38 (95% CI 0.33-0.43) to 0.30 (95% CI 0.23-0.39) in those aged 80-84 years (all p < 0.05). The rates decreased from 0.35 (95% CI 0.28-0.44) to 0.27 (95% CI 0.20-0.38, p = 0.08) in those aged 85-89 years and from 0.52 (95% CI 0.36-0.76) to 0.29 (95% CI 0.12-0.75, p < 0.05) in the oldest patients aged ≥ 90 years.

Conclusions: Broader application of guideline-directed medical therapy in geriatric heart failure with reduced ejection fraction care should be prioritized.

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.

Systemic lupus erythematosus (SLE) is widely recognized as a systemic autoimmune disease predominantly affecting young women. However, since the initial report in 1959, cases of late-onset SLE have been increasingly documented. Late-onset SLE, commonly defined as disease onset at or after 50 years of age, sometimes exhibits different clinical characteristics compared with the typical SLE phenotype. There is a higher proportion of male patients and a lower frequency of skin rash, renal involvement, neuropsychiatric manifestations, hypocomplementemia, and anti-DNA antibody seropositivity, whereas serositis is observed more frequently. Furthermore, although disease activity in late-onset SLE is generally lower, it is associated with more severe irreversible organ damage and a poorer prognosis. Data shows that the use of immunosuppressive drugs in late-onset SLE is lower, which may be due to delay in diagnosis, different manifestations, and the presence of comorbidities. However, the clinical situation would have merited their use. Given the aging of the global population, the prevalence of late-onset SLE is expected to increase. A thorough understanding of the characteristics of late-onset SLE may facilitate early diagnosis and appropriate treatment, ultimately improving patient outcomes. This review summarizes the reported characteristics of late-onset SLE and discusses the key considerations for its accurate diagnosis and effective management.