Drugs & Aging最新文献

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.

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.

Background: Nonsteroidal anti-inflammatory drugs (NSAIDs) are widely used for pain management but are associated with nephrotoxicity, particularly in senior populations. While the acute nephrotoxicity of NSAIDs is well established, evidence on their long-term effects on renal function-particularly in community-dwelling older adults-has been mixed across studies.

Objectives: This study investigated the association between NSAID use and chronic kidney disease (CKD) risk in the general senior population.

Methods: Data from the National Health Insurance Service-Senior Cohort (NHIS-SC) in South Korea were analyzed, including 1812 participants (604 NSAID users and 1208 controls) matched 1:2 by propensity score. Kidney dysfunction was defined as glomerular filtration rate (eGFR) < 60 mL/min/1.73m² with a ≥ 10% decline from baseline. Hazard ratios (HRs) for CKD were estimated using Cox regression.

Results: NSAID use was associated with an increased CKD risk (HR 1.46; 95% confidence interval (CI) 1.11-1.93) and faster eGFR decline. Subgroup analysis showed elevated risks for Cox-1 (HR 1.53) and Cox-2 inhibitors (HR 1.61). End-stage renal disease (ESRD) incidence was rare and not significant.

Conclusions: NSAIDs increase CKD risk and accelerate kidney function decline in senior individuals. Cautious prescription and regular kidney monitoring are recommended, and further randomized trials are needed.

Background: Sacubitril/valsartan, an angiotensin receptor neprilysin inhibitor (ARNI), has become a cornerstone therapy for heart failure (HF) since its approval over a decade ago. However, concerns have emerged about potential cognitive risks, as neprilysin inhibition may contribute to the accumulation of amyloid-beta (Aβ) in the brain-a hallmark of Alzheimer's disease, the most common form of dementia.

Objective: Given the already elevated risk of dementia in patients with HF and the widespread use of sacubitril/valsartan, this meta-analysis aimed to evaluate whether its use is associated with an increased risk of all-cause dementia in HF populations.

Methods: A systematic literature search was conducted on 23 March 2025, to identify eligible studies comparing the risk of dementia in patients receiving sacubitril/valsartan versus those receiving placebo, no treatment, or other HF medications. Risk ratios (RRs) and 95% confidence intervals (CIs) were pooled using a random-effects model.

Results: Six studies, comprising 101,074 participants and published between 2017 and 2024, were included in the meta-analysis. Treatment with sacubitril/valsartan was associated with a significant 15% reduction in the risk of all-cause dementia (RR = 0.85; 95% CI: 0.74-0.98; p = 0.02). Leave-one-out sensitivity and subgroup analyses confirmed the robustness of the findings.

Conclusions: This meta-analysis suggests that sacubitril/valsartan is associated with a reduced risk of dementia in patients with HF, helping to alleviate previous concerns about potential cognitive adverse effects. These findings support the continued use of sacubitril/valsartan as a foundational therapy in this high-risk population.

Managing diabetes in older adults requires balancing long-term glycaemic control with the prevention of hypoglycaemia, to which this population is particularly vulnerable owing to frailty, multimorbidity and cognitive decline. Guidelines recommend individualized glucose targets for older adults, particularly those with multimorbidity or increased hypoglycaemia risk. For individuals with frailty or cognitive impairment, relaxed HbA1c targets are often appropriate to reduce the risk of adverse events. While HbA1c is widely used, it has important limitations in this population due to its inability to reflect daily glucose fluctuations. Continuous glucose monitoring (CGM) or self-monitoring of blood glucose provide more granular data to guide therapy. This review explores the pathophysiology, complications, and management of hypoglycaemia in older adults, emphasizing individualized care, safer pharmacotherapies (e.g. DPP-4 inhibitors, GLP-1 receptor agonists, ultra-long-acting insulins), and emerging technologies (continuous glucose monitoring, artificial Intelligence-guided insulin delivery and telehealth).

Interleukin (IL)-6 plays a central role in amplifying inflammation, and its inhibition is beneficial in managing immune-mediated inflammatory diseases (IMIDs) such as rheumatoid arthritis (RA). IL-6 signaling inhibition is associated with a slightly increased risk of infections in patients with RA, and older age has been identified as a risk factor for severe adverse events, including infections. Therefore, the combination of an aging population and the increasing use of IL-6R inhibitors in RA treatment highlights the importance of carefully evaluating the safety and effectiveness of these therapies in older patients with RA. Recent postmarketing surveillance (PMS) data on the safety and effectiveness of sarilumab (SAR) in Japanese patients with RA, along with PMS data from Japan and registry data from France and Germany of tocilizumab (TCZ), provide valuable insights for both current and future management of RA. These data suggest that anti-IL-6R therapies are generally well tolerated among older patients with RA and do not appear to increase the risk of cardiovascular events or malignancies. While the effectiveness of TCZ was somewhat lower in older patients compared with younger ones, the effectiveness of SAR was similar across age groups. Consequently, the use of anti-IL-6R antibodies is anticipated to expand to other IMIDs beyond RA, particularly in increasingly superaged societies worldwide.

Background and objectives: Older adults living with dementia are a heterogeneous group, which can make studying optimal medication management challenging. Unsupervised machine learning is a group of computing methods that rely on unlabeled data-that is, where the algorithm itself is discovering patterns without the need for researchers to label the data with a known outcome. These methods may help us to better understand complex prescribing patterns in this population. The objective of our study was to use clustering methods to determine whether common prescribing clusters exist in older adults newly identified as living with dementia in Ontario, Canada and to examine the association between individual clinical and demographic characteristics and those clusters.

Methods: Data were derived from population-based health administrative databases, including medication dispensation data. The hierarchical clustering algorithm started with each individual and merged individuals with the most similar prescribing patterns into a group, continuing this process stepwise until only one cluster remained. The optimal number of clusters was selected through clinical review and fit statistics. We examined the association between individual characteristics and prescribing clusters using bivariate multinomial models.

Results: In 99,046 individuals living with new dementia, we identified six prevalent clusters of individuals with common medication subclass patterns: higher dispensation of angiotensin-converting enzyme-specific cardiovascular (22.6% of the population), central nervous system-active (21.3%), hypothyroidism (22.9%), respiratory (3.9%), and angiotensin receptor blocker-specific cardiovascular (6.1%), as well as a group with lower dispensation of medications in general (23.1%). Specific demographic, clinical, and health-service-use characteristics were associated with assigned clusters.

Conclusions: Within individuals living with dementia, prescribing clusters reflected meaningful differences in clinical and demographic characteristics. The results suggest that applying clustering methods to pharmacological data may be useful in estimating complex comorbidity patterns to better describe a heterogeneous population of people living with dementia. Future studies could examine whether these clusters better predict health service use, disease progression, or medication-related adverse events compared with other measures.