Drugs & Aging最新文献

Cardiovascular disease remains the leading cause of morbidity and mortality among older adults, who often face unique challenges in preventive care due to multimorbidity, frailty, and polypharmacy. The polypill, a fixed-dose combination of multiple cardiovascular medications, has emerged as a promising strategy to improve adherence, simplify treatment, and reduce the burden of major cardiovascular events. This review aims to synthesize current evidence supporting polypill use in both primary and secondary prevention, with a particular focus on older populations. Landmark clinical trials such as TIPS, HOPE-3, PolyIran, and SECURE have demonstrated favorable outcomes related to blood pressure and lipid reduction, medication adherence, and cardiovascular event prevention. In addition, real-world data suggest improved cost-effectiveness and feasibility across diverse healthcare settings. Despite these benefits, implementation remains limited by barriers including inflexible dosing, provider hesitancy, variable guideline endorsements, and regulatory challenges. Special considerations in geriatric populations such as heightened sensitivity to adverse drug reactions and the need for individualized care further underscores the importance of thoughtful integration into practice. As the global population ages, strategic adoption of polypill-based prevention can help address health disparities, streamline cardiovascular care, and improve outcomes in older adults worldwide.

Osteoporosis is the most common metabolic bone disease and the main cause of fractures in older adults. Although it is commonly described as a silent disease, the bone pain caused by fragility fractures is its main symptom. Besides acute pain, fragility fractures may trigger a sequence of events that perpetuate and progress into chronic pain. The pathogenesis of musculoskeletal pain in patients with osteoporosis is complex and largely depends on skeletal and muscular changes, unbalanced bone turn-over, alterations in bone innervation, and central sensitization. Pain, in the context of bone fragility, represents an outstanding contributor to functional limitation, disability, and impaired quality of life. Pain prevention is closely related to identification of osteoporosis risk factors and early diagnosis and treatment of bone fragility. The management of pain in patients with severe osteoporosis also benefits from a multidimensional approach combining nonpharmacological with pharmacological therapies (e.g., physical exercise, nutrition, analgesics, and anti-osteoporotic drugs, as appropriate). This review aims to examine the mechanisms of pain in osteoporosis and provide an evidence-based overview of current and emerging treatment strategies.

Objectives: Gout is an inflammatory arthritis caused by monosodium urate crystal deposition in the joints. Its clinical presentation varies by age of onset. This study compared the clinical features and treatment patterns of older-onset gout and common-age-of-onset gout.

Methods: We analyzed data from the Urate Lowering TheRApy in Gout registry. Eligible participants were aged ≥ 18 years and met the 2015 American College of Rheumatology/European League Against Rheumatism classification criteria for gout. Older-onset gout was defined as gout diagnosed at or after age 65 years, and common-age-of-onset gout as gout diagnosed before age 65 years. Demographics, clinical features, treatment patterns, quality of life, and laboratory findings were collected at baseline and 6 months.

Results: Among 477 patients, 105 (22.0%) had older-onset gout and 372 (78.0%) had common-age-of-onset gout. The older-onset group included more women (25.7 versus 2.4%, P < 0.001) and showed higher frequencies of radiographic gout-related joint damage (erosion) (30.5 versus 19.6%, P = 0.018), comorbidities (e.g., hypertension, cardiovascular disease, chronic kidney disease, and malignancy), and glucocorticoid use for flare prophylaxis. In contrast, the common-age-of-onset group had higher body mass index (BMI), more frequent flares, unhealthier lifestyle habits (e.g., smoking, alcohol), and higher rates of nonsteroidal anti-inflammatory drug (NSAID) and benzbromarone use. Febuxostat was more frequently prescribed in the older-onset group (71.4 versus 58.9%, P = 0.019), while benzbromarone use was more common in the common-age-of-onset group (7.3 versus 0%, P = 0.004). The febuxostat dose was lower in the older-onset group. After 6 months, both groups showed similar follow-up adherence, flare frequency, and healthcare utilization.

Conclusions: Older-onset gout and common-age-of-onset gout have distinct clinical characteristics, particularly in comorbidities, lifestyle factors, and treatment patterns. Gout management should be tailored on the basis of age at onset.

Charcot neuropathic osteoarthropathy (CNO) is a condition that develops in the presence of neuropathy, most commonly diabetes-related neuropathy. Owing to the neuropathy, microtrauma to the bones occur without the individual feeling them. With continued walking, bone inflammation, resorption, microfractures and structural changes occur in the bones, which result in irreversible deformities. Diagnosing this condition is often difficult and requires advanced imaging techniques, such as scintigraphy or magnetic resonance imaging, as X-ray changes may not be specific. Treatment of CNO includes immobilization, offloading, recalcification (supplementation of vitamin D and calcium) and in the most advanced cases, surgical treatment. This narrative review aims to synthesize the recent research and clinical implications relating to Charcot foot to help healthcare professionals to stay up-to-date in this relevant topic.

People with dementia (PWD) are frequently exposed to polypharmacy and potentially inappropriate medication use, in which the risks of medication use outweigh the benefits or the medication is not aligned with treatment goals. Appropriate deprescribing of unnecessary or potentially inappropriate medications is essential to high-quality care for PWD, to avoid iatrogenic harm and improve health and well-being for patients and their care partners. In this article, we review the risks of polypharmacy in PWD and evidence for the safety and efficacy of deprescribing in this population. Building off existing deprescribing frameworks for older adults with multimorbidity and limited life expectancy, we provide a roadmap for deprescribing in PWD that addresses the unique challenges of living dementia, including the variable disease course, high prevalence of distressing behavioral symptoms, and central role of care partners. The steps include: (1) identify potential targets for deprescribing by eliciting medication-related goals and considering tradeoffs, (2) develop a tapering plan, (3) complete additional actions that are necessary before deprescribing, and (4) provide close follow-up. Lastly, we provide evidence-based strategies for communicating with patients and their care partners about deprescribing, adapted from the FRAME tool.

Background and objective: Apixaban is the most prescribed direct-acting oral anticoagulant drug. According to its product information, clearance is only partially renal. However, little is known about the impact of renal function on apixaban pharmacokinetics in real-world settings. The aim of this study was therefore to investigate serum concentrations of apixaban in relation to renal function in acutely hospitalised, older patients.

Methods: The study was conducted with a prospective, observational design. Apixaban-treated patients ≥ 65 years acutely admitted to Haukeland University Hospital in Bergen, Norway, during a four-month period were included. Serum concentrations of apixaban were measured at hospitalization and assessed in relation to glomerular filtration rate (GFR). Spearman rank test was used to investigate correlation between GFR and dose-adjusted serum concentrations of apixaban. In addition, dose-adjusted serum concentrations were compared between GFR subgroups by Mann-Whitney tests.

Results: In total, 36 patients were included (median age 84.5 years, range 68-96 years). Median GFR at admission was 43 ml/min (range 17-119 ml/min). Dose-adjusted apixaban serum concentrations correlated significantly with GFR (Spearman r = - 0.54, p = 0.0008). Compared with patients with GFR > 90 ml/min, apixaban dose-adjusted serum concentrations were 3.3-fold, 1.8-fold and 2.0-fold higher in patients with GFR < 30 ml/min (p = 0.01), 30-59 ml/min (p = 0.04) and 60-89 ml/min (n.s.), respectively.

Conclusions: The study shows that dose-adjusted serum concentration of apixaban significantly correlates with renal function in older, acute hospitalized patients. These real-life data indicate that apixaban-treated patients with GFR < 30 ml/min may require around 70% lower dose than normal to achieve sufficient antithrombotic effect and prevent risk of bleedings.

Introduction: A prescribing cascade occurs when a medication is prescribed to manage a side effect of another medication. Prescribing cascades represent a key component of problematic prescribing and can result in harm to patients, especially older adults with multimorbidity and polypharmacy.

Objective: The objective of this study was to explore factors influencing hospital physicians' recognition of prescribing cascades using the Theoretical Domains Framework (TDF), a validated theory-based qualitative methodology.

Methods: Semi-structured interviews were conducted in May-July 2024 with hospital physicians of all grades. Interviews were audio-recorded and transcribed verbatim. Transcripts underwent conventional and directed content analysis to identify themes and TDF domains.

Results: From 14 interviews, four predominant TDF domains were identified: (i) environmental context and resources: busy work conditions, lack of up-to-date medication lists and limited information technology (IT) infrastructure hinder prescribing cascade recognition; (ii) knowledge: physicians demonstrated limited knowledge of the term 'prescribing cascade' and highlighted education and training deficiencies at undergraduate and postgraduate level; (iii) skills: recognition skills are often developed through experiential learning while working (especially with geriatric medicine consultants) and (iv) social/professional role and identity: physicians perceived themselves as primarily responsible for recognising prescribing cascades, while pharmacists enable their recognition through medication reconciliation, medication review and ward round participation.

Conclusions: This study highlights significant gaps in the knowledge and understanding of prescribing cascades among hospital physicians, as well as potential targets for future intervention. Focused education, integrated IT solutions, and a collaborative physician-pharmacist approach would likely improve prescribing cascade recognition in at-risk older people with multimorbidity and polypharmacy.

Frailty is associated with impaired immune function, functional decline, and increased vulnerability to both infection and adverse medication effects. Recurrent urinary tract infection (rUTI) is a common and burdensome condition among older persons, particularly those living with frailty. Despite this, frail individuals remain underrepresented in clinical research guiding rUTI prevention. This review outlines current evidence on rUTI prevention strategies in older persons living with frailty. It highlights feasible tools for frailty assessment and explores how frailty contributes to infection risk and impacts the effectiveness and safety of preventive interventions. Nonpharmacological strategies-including continence management, minimization of catheter use, hydration support, and carer education-form the foundation of prevention. Locally applied vaginal estrogen is the best-supported pharmacological option in postmenopausal women. Evidence for cranberry products, D-mannose, and probiotics remains inconsistent in frail populations, while methenamine hippurate offers a promising, well-tolerated alternative to antibiotics. Prophylactic antibiotic use may reduce recurrence in selected patients but carries significant risks, including Clostridioides difficile infection and antimicrobial resistance. Clinical decision-making should be guided by individualized risk assessment, careful consideration of treatment burden, and regular reassessment of both benefits and harms. Further research is urgently needed to inform evidence-based prevention strategies for this vulnerable population.