Drugs & Aging最新文献

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.

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.

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.