Drugs & Aging最新文献

Polypharmacy is very common among older adults and is associated with poor health outcomes. This scoping review aimed to understand the underlying factors for poor medication taking by older patients and potential solutions to mitigate these risks. The ability to take medications and adherence are affected by various factors related to patients, treatments, health conditions and socio-demographics, healthcare providers and the healthcare systems. Educational and behavioural interventions are used alone or in combination for the optimisation medication use. Medication review and deprescribing, including regimen simplification, by trained practitioners has the potential to enhance patient safety and reduce healthcare costs. Engaging the patient and family may bring about additional benefits. Various technology-based interventions to promote self-efficacy are evolving and are used to support consumer self-management.

Background: Chronic pain is a prevalent and disabling condition whose management becomes increasingly complex with aging and frailty. While chronological age often guides clinical decisions, frailty offers a more biologically grounded approach.

Aims: We sought to examine the independent associations of chronological age, frailty, and sex with pain management variables in a community-based adult population.

Methods: A cross-sectional study was conducted in 455 adults with chronic non-cancer pain. Frailty was assessed using a 31-item frailty index (FI) on the basis of the deficit accumulation model. A total of 169 pain-related variables were collected. Multivariable regression models were used to explore associations between age, FI, sex, and pain management outcomes.

Results: Frailty was independently associated with nonsteroidal anti-inflammatory drug (NSAID) self-medication (odds ratio [OR] 1.03, 95% confidence interval [CI]: 1.01-1.04), greater use of nonpharmacological interventions (sr = 0.13), consumption of multiple analgesic classes (including paracetamol, opioids, and adjuvants), and absence of baseline pain control (OR 0.96, 95% CI 0.93-0.98). In contrast, older age was the main negative predictor of NSAID and anxiolytic prescriptions and physiotherapy use. Notably, frailty and age showed opposite associations for several outcomes, including number of prescribed analgesics and healthcare utilization.

Conclusions: Frailty, as a proxy for biological age, was more strongly associated with pain management patterns than chronological age. Sole reliance on age may lead to undertreatment and ageist biases. These findings should, however, be interpreted with caution given the cross-sectional observational design, which precludes causal inference. Incorporating frailty into pain care strategies may nonetheless support more personalized, effective, and safer management across the adult lifespan.

Background: Optimal anticoagulation strategies in octogenarians remain controversial owing to age-related risks of thromboembolism and bleeding. This study evaluates real-world outcomes of reduced-dose edoxaban (15-30 mg daily) in very old populations.

Methods: We conducted a retrospective cohort study of 217 patients (aged ≥ 80 years) receiving edoxaban at Peking University First Hospital (2022-2023). Patients were stratified by dosage (30 mg once daily [QD] [n = 95] versus 15 mg QD [n = 122]). Outcomes included pharmacodynamics (anti-Xa levels), clinical endpoints (bleeding, thrombosis, and mortality), and survival analysis.

Results: The 15-mg-QD group was older (90.0 versus 85.8 years, P = 0.001) and had reduced activities of daily living (ADL) scores (65.5% versus 82.6, P = 0.003) and reduced estimated glomerular filtration rate (eGFR) (58.6 versus 62.6 mL/min/1.73 m², P = 0.005). Anti-Xa peak levels were 0.56 ± 0.25 IU/mL (30 mg) versus 0.35 ± 0.15 IU/mL (15 mg). Over 15.8 ± 9.8 months follow-up, mortality was reduced in the 30-mg group (0.7% versus 3.5%, P = 0.044), with comparable bleeding (3.5% overall) and thrombosis (0.7%) rates.

Conclusions: Reduced-dose edoxaban demonstrates a favorable safety-efficacy profile in advanced-age patients, necessitating comprehensive bleeding-ischemic risk assessment to optimize individualized anticoagulation regimens.

Acute ischemic stroke (AIS) is a significant cause of morbidity and mortality among older adults, with its incidence, severity, and complication rates increasing with age. Endovascular thrombectomy (EVT) is the standard treatment for AIS due to a large vessel occlusion (LVO), but many landmark trials have excluded patients aged 80 years and older, resulting in a gap in the available evidence. Nonetheless, meaningful recovery is possible when successful recanalization is achieved, especially in patients with good pre-stroke functionality. When making EVT decisions for older adults, it is crucial to consider the unique challenges presented by this population. These challenges include age-related vascular changes, comorbidities, declining organ function, polypharmacy, altered drug responses, frailty, and baseline cognitive impairment. Anesthesiologists play a crucial role in optimizing outcomes through rapid assessment, careful physiological management, and effective multidisciplinary coordination. Both general anesthesia (GA) and conscious sedation (CS) are valid options for EVT, with the choice depending on patient factors, the complexity of the procedure, and the expertise of the institution. While GA may enhance recanalization rates and improve outcomes, it also carries increased risks such as delayed time from door to groin, hypotension, and a higher incidence of postoperative delirium and pneumonia. In contrast, CS may offer a safer alternative in selected cases, although it can limit the effectiveness of the procedure, potentially impacting reperfusion success. The impact of specific anesthetic agents on outcomes for older patients is still unclear. In addition, age-related changes in cardiovascular, respiratory, renal, and neurological functions, along with polypharmacy, contribute to an increased risk of hemodynamic instability and drug interactions. Older patients also face a higher risk of perioperative complications, such as delirium and cognitive dysfunction, which complicate the management of anesthesia. However, anesthesiologists can positively influence outcomes by managing modifiable factors such as, maintaining blood pressure within guideline-based targets, keeping blood glucose levels between 140 and 200 mg/dL, ensuring normoxia and normocapnia, avoiding hyperthermia, and anticipating technical challenges posed by tortuous, atherosclerotic vessels and resistant clots. This review aims to thoroughly examine anesthesia management for EVT in older adults.

Background: Medication use is increasing in psychiatric populations, particularly those with personality disorders (PDs). Older adults with PDs are at higher risk for adverse drug reactions (ADRs), which may interfere with daily functioning.

Objectives: This study aimed to describe medication use and health-related quality of life (HR-QOL) in older adults with PDs compared with control groups and to evaluate predictors of medication use and HR-QOL.

Methods: The PhArmacotherapy aND pOlypharmacy in oldeR Adults (PANDORA) study is a Dutch multicenter cross-sectional study including 77 older adults with PDs (OA-PD), 54 younger to middle-aged adults with PDs (A-PD), and 88 healthy older adults (OA-H). Medication use was assessed via participant questionnaires and verified against electronic health records for patients. HR-QOL was measured using the EQ-5D-3L (visual analog scale [VAS] and utility score). Statistical analyses were performed with general linear models.

Results: Polypharmacy (≥ 5 medications daily) was present in 55.8% of the OA-PD group. OA-PD used more psychotropic and somatic medications than OA-H (b = - 1.555, p < 0.001 and b = - 1.341, p < 0.001, respectively) and A-PD (b = - 0.753, p < 0.001 and b = - 2.128, p < 0.001, respectively). Medication use was predicted by the number of psychiatric and somatic diagnoses. OA-PD reported lower EQ-VAS (b = 20.659, p < 0.001) and lower EQ-utility scores (b = 0.351, p < 0.001) compared with OA-H. ADRs, rather than the number of medications, significantly predicted HR-QOL (p < 0.001).

Conclusions: Both somatic and psychotropic medication use is highly prevalent in OA-PD. OA-PD report lower HR-QOL compared with OA-H, in which ADRs may be a mediating factor. These findings underline the importance of regular medication reviews in older adults with PDs. Future research should investigate longitudinally the effect of deprescribing on HR-QOL in this population.

Introduction: Antipsychotics are frequently used in hospitalized older adults to manage agitation and delirium, despite limited supporting evidence and known risks. While guidelines recommend low doses and short durations, high doses remain common. This study evaluated the efficacy and safety of low-versus high-dose antipsychotics in hospitalized adults aged ≥ 65 years.

Methods: This retrospective cohort study included patients from two hospitals within a single health system between August 2021 and August 2023. Patients were included if they received inpatient administration of haloperidol, olanzapine, quetiapine, risperidone, or ziprasidone and excluded for prior antipsychotic use, benzodiazepine use, psychiatric comorbidities, or prolonged intensive care unit (ICU) admission. Patients were stratified into low- and high-dose groups. Low doses were haloperidol 0.5-1 mg, olanzapine 2.5-5 mg, quetiapine 12.5-25 mg, risperidone 0.25-1 mg, or ziprasidone 10-20 mg, and doses were considered high if they were above the criteria for a low dose. The primary outcome was a surrogate marker of efficacy: antipsychotic redosing within 6 h. Secondary outcomes included length of stay (LOS), antipsychotic continuation at discharge, and possible antipsychotic-associated adverse events through 90 days post discharge as assessed through index and readmission records. Multivariable logistic regression was used to assess factors associated with antipsychotic redosing within 6 h.

Results: A total of 305 patients were included (low dose: n = 176; high dose: n = 129). Redosing within 6 h occurred at similar rates in low versus high groups (n = 25 [14.2%] versus n = 18 [14.0%], p = 0.950). Multivariable regression showed haloperidol use (compared with quetiapine) was associated with higher odds of redosing. Adverse event rates were numerically higher in the high-dose group, including a greater incidence of inpatient pneumonia and mortality, though most deaths occurred in patients receiving palliative care.

Conclusions: Low- and high-dose antipsychotics demonstrated similar short-term efficacy, but higher doses may carry increased risk of adverse events in hospitalized older adults. Clinicians should prioritize low-dose regimens and evaluate the necessity of antipsychotic use in this vulnerable population.

Background: More than one in three older adults use potentially inappropriate medications (PIMs), and those with chronic conditions are more likely to be on multiple PIMs. Deprescribing, defined as stopping or dose-reducing a medication, can avoid harms from PIMs. Despite its benefits, deprescribing is rarely adopted into clinical practice.

Objectives: We examined the effectiveness, sustainability, and safety of a patient-engagement strategy in a pragmatic trial at three facilities.

Methods: Subjects were mailed brochures for one of three PIMs (proton pump inhibitors, high-dose gabapentin, and diabetes agents with hypoglycemia risk) if they had chronic active prescriptions before a primary care provider (PCP) visit. Control subjects received usual care.

Results: There were 2448 patients in the control group (n = 2448) and 2480 patients in the implementation strategy cohort (n = 2480). In a mixed effect multivariable logistic regression model with PCP and site treated as random factors and controlling for patient and PCP characteristics, implementation strategy patients were significantly more likely to have deprescribing at 12-months compared with controls (odds ratio [OR] = 1.19; 95% confidence interval [CI] = 1.04, 1.35; p = 0.012). In a multinomial logistic regression model controlling for patient characteristics, implementation strategy patients were significantly more likely to exhibit sustained deprescribing (deprescribing at 6 and 12 months, OR = 1.32 [95% CI = 1.13, 1.55]) but not short-term (6 months only, OR = 0.96 [95% CI = 0.79, 1.16]) or delayed (12 months only, OR = 0.99 [95% CI = 0.84, 1.17]) deprescribing. There were five potential severe adverse drug withdrawals (0.2% incidence rate) possibly related to deprescribing.

Conclusions: Despite low intensity, patient-directed education materials are an effective and safe implementation strategy to promote and sustain deprescribing.

Trial registration: ClinicalTrials.gov, NCT0429490, NCT04294901.

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.

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.

Purpose: Compared with long-term dual antiplatelet therapy (DAPT, aspirin with clopidogrel or ticagrelor), short-term DAPT followed by single antiplatelet therapy (SAPT, clopidogrel or ticagrelor) has demonstrated superiority in reducing bleeding risk while maintaining non-inferior in cardiovascular benefits in coronary heart disease (CHD) after successful percutaneous coronary intervention (PCI). However, no prospective study has explored the benefits of this short-term regimen on patients with chronic total occlusion (CTO) undergoing PCI.

Methods: Consecutive patients who underwent successful elective CTO-PCI were prospectively enrolled from April 2019 to May 2021. After receiving 1-month DAPT, all patients were divided into two groups: SAPT group (followed by clopidogrel or ticagrelor monotherapy) and DAPT group (continued with dual antiplatelet therapy). Detailed baseline characteristics, angiographic and procedural details, and 1-year follow-up data were collected. The endpoints were major adverse cardiovascular events (MACE) and bleeding.

Results: A total of 701 patients who underwent successful CTO-PCI were enrolled, among whom 330 patients (47.1%) received DAPT and 371 patients (52.9%) received SAPT (clopidogrel or ticagrelor) after 1-month DAPT. Compared with patients receiving DAPT, patients in the SAPT (clopidogrel or ticagrelor) group had a lower rate of previous stroke, fewer left anterior descending coronary artery (LAD) lesions and contrast volume, and fewer lesions per patient, but longer lesion length (P < 0.05). The incidence of MACE (14.5% versus 15.4%; p = 0.742) was not significantly different between the two groups. The DAPT group showed a higher incidence of minor bleeding (BARC types 1 or 2; 12.7% versus 2.3%, p < 0.001) than SAPT (clopidogrel or ticagrelor), while no difference was found for major bleeding (BARC types 3 or 5; 1.2% versus 2.3%, p = 0.261).

Conclusions: Compared with standard 12-month DAPT, 1-month DAPT followed by clopidogrel or ticagrelor monotherapy resulted in lower bleeding risks and similar cardiovascular benefits in CTO-PCI patients.