Drugs & Aging最新文献

Background: Osteoporosis (OP) represents a public health challenge, with OP fractures associated with high morbidity, mortality, and economic burden, and fracture risk increasing with age. We evaluated the treatment gap, subsequent fracture rate, and medical costs among patients with OP hip fracture in Italy.

Methods: From two regional administrative databases, our retrospective cohort study included adults aged ≥ 50 years hospitalized for a first OP hip fracture (index fracture; 1 January 2015 to 31 December 2018).

Study outcomes: percentage of patients not prescribed OP treatment in the 6 months following index fracture; fracture and mortality rates (mortality data only available for one region), direct medical costs, persistence and adherence to OP treatment in the 12 months following index fracture (follow-up).

Results: Of 23,961 eligible patients, 87.8% (n = 21,028) were not prescribed OP treatment in the 6 months post-index fracture, with low 12-month persistence (33.7%) and adherence (9.6%) among treated patients. During follow-up, fracture and mortality rates were 36.9 and 280.9 per 1000 patient-years, respectively; higher in non-treated versus treated (39.3 versus 24.0 and 303.7 versus 126.7) patients. Mean (SD) cost per patient was €4963 (€5509); higher in non-persistent versus persistent patients (€5832 versus €4817).

Conclusions: Among patients from two Italian regions experiencing a first hip fracture, we observed a large treatment gap, and high subsequent fracture rates and medical costs. Considering fracture risk increases with age and a globally aging population, these costs are likely to increase and pose a substantial burden on the Italian health service.

Antineutrophil cytoplasmic antibody (ANCA)-associated vasculitides (AAV) predominantly affect individuals aged 55-75 years, with granulomatosis with polyangiitis (GPA) being diagnosed most often between 55 and 65 years and microscopic polyangiitis (MPA) between 65 and 75 years. Owing to the general increase in life expectancy, the average age at diagnosis increases, encompassing also those over 75 years old. Unfortunately, the exclusion of these older patients from many clinical trials has limited our understanding of the progression of these diseases in older subjects. The role of immunosenescence and aging in AAV pathogenesis and progression is underexplored, despite potential implications in the understanding of the disease, and potentially for disease management. Although AAV manifestations are largely consistent across age groups, certain features, such as renal involvement and the association with interstitial lung disease, may be more prevalent in older patients. Frailty must be a key consideration in therapeutic decision-making, especially when balancing the efficacy of immunosuppressants with potential side effects. Recent evidence supports the use of rituximab in addition to low-dose glucocorticoids for remission induction in life- or organ-threatening AAV, including in older populations. Furthermore, preliminary evidence supports that avacopan might be as efficient as glucocorticoids in these patients. The immunosuppressive treatment of AAV reduces the immune response to environmental pathogens, with rituximab worsening age-related hypogammaglobulinemia. Thus, prophylactic measures, including vaccination and Pneumocystis pneumonia prevention, as well as strategies to mitigate glucocorticoid side effects, should be implemented in AAV management.

Objective: This study complements evidence from randomized controlled trials on the harms (e.g., hypoglycemia) of sulfonylureas compared with dipeptidyl peptidase-4 inhibitors (DPP4i) in the treatment of type 2 diabetes in older adults using real-world data. Existing evidence suggests an increased risk of hypoglycemia, falls, fractures, and cardiovascular events.

Methods: Using target trial emulation, we analyzed a retrospective cohort drawn from German routine claims data. We included patients older than 65 years who initiated DPP4i (sitagliptin, vildagliptin, or saxagliptin) or sulfonylureas (glibenclamid or glimepirid) as add on to metformin between 2011 and 2018. Confounding was adjusted for through overlap weighting, and the average treatment effects were estimated in the overlap population using generalized linear models.

Results: Among 171,318 eligible patients, 111,865 (65%) received DPP4i and 59,453 (35%) sulfonylureas. Patients treated with DPP4i had a higher prevalence of all observed comorbidities. Applying overlap weights to adjust for confounding, patients treated with DPP4i had a higher rate of combined all-cause hospitalizations and outpatient visits compared with those treated with sulfonylureas (rate ratio = 1.03, 95% CI 1.02-1.03) in the total population. In contrast, we found a protective effect of DPP4i on the risk for severe hypoglycemia in the subgroups of new users (ratio rate (RR) = 0.51, 95% CI 0.33, 0.76) and patients with severe renal insufficiency (RR = 0.31, 95% CI 0.16, 0.61).

Conclusions: Deprescribing sulfonylureas and using DPP4i instead may slightly reduce harm in some subgroups of older adults, which supports recommendations of existing lists of potentially inappropriate medications.

Objective: Assess the association of opioids and gabapentinoids with changes in frailty among Medicare beneficiaries who used opioids for 90 or more consecutive days.

Methods: Using a Medicare sample between 2014 and 2020, this study included long-term opioid users who were eligible for Medicare parts A, B, and D for 3 years and had no prior gabapentinoid use. The study was broken into three 1-year periods: lookback, exposure, and outcome. The exposure of interest was gabapentinoid and opioid use measured in period 2. The primary outcome was difference in frailty between periods 1 and 3. Linear regression was used to assess the difference in frailty change by gabapentinoid and opioid use. Multinomial regression was also used to assess the odds of categorical frailty change by gabapentinoid and opioid use.

Results: Overall, the changes in frailty between assessment periods were small. Those who had no continued opioid/no gabapentinoid use showed decreases in frailty (- 0.0005), while each of the other three groups increased in frailty between the assessment periods (opioids only, 0.0040; gabapentinoids only, 0.0136; opioids + gabapentinoids, 0.0142). In addition, each of the drug groups showed increased odds for large increases in frailty compared with those who had no continued opioid/no gabapentinoid use (opioids only, odds ratio (OR): 1.25, 95% confidence interval (CI) 1.04-1.49; gabapentinoids only, OR: 3.12, 95% CI 1.75-5.55; opioids + gabapentinoids, OR: 2.30, 95% CI 1.85-2.87).

Conclusions: Using gabapentinoids, opioids, or a combination of the two showed greater increases in frailty compared with those who used neither drug after long-term opioid use.

Rheumatoid arthritis (RA) is a chronic autoimmune condition disproportionately affecting older adults (> 60 years), who often experience increased disease severity and comorbidities, including cancer. A comprehensive review of the literature was conducted, examining the prevalence of malignancy in patients with RA, associated risk factors, and treatment challenges, including management considerations such as psychological distress and lifestyle modifications. Clinical guidelines and consensus statements were summarized to provide practical insights for optimizing care. Older adults with RA are at an elevated risk for developing cancer due to chronic inflammation, immunosenescence from aging, and shared risk factors such as smoking. Patients with RA tend to have poorer cancer survival rates than individuals without RA, particularly for lung cancer and lymphoma. Immunosuppressive therapies used to treat RA may modestly increase cancer risks but are critical for disease control. Current guidelines emphasize discontinuation or adjustment of RA therapies upon cancer diagnosis, with tailored approaches based on cancer type and stage. Non-pharmacologic interventions, including lifestyle modifications and psychological support, play a vital role in improving quality of life and mitigating disease flares during cancer treatment. The management of RA in older adults with a history of cancer requires a personalized, multidisciplinary approach that balances the need for RA symptom control without affecting cancer outcomes. Shared decision-making, incorporating patient preferences and comorbidities, is critical for optimizing care. Further research is needed to strengthen evidence-based guidelines for this population and address gaps in understanding treatment safety and efficacy.

Introduction: Antipsychotics (APs) and proton pump inhibitors (PPIs) are commonly prescribed in long-term care (LTC) despite potential risks with prolonged use.

Objective: This study evaluates the frequency of AP and PPI prescriptions and assesses the impact of "prescribing portraits" on deprescribing in LTC residents at 2 LTC facilities in British Columbia.

Methods: This multicenter, prospective quality improvement (QI) study was conducted at two LTC homes: Holy Family Hospital (site A) and Queen's Park Care Centre (site B). The QI approach involved collecting data on prescribing appropriateness, implementing a real-time intervention, and tracking its impact. Prescribing portraits-personalized reports detailing individual prescribing patterns, evidence-based indications, and deprescribing recommendations-were presented to prescribers by clinical pharmacists. The primary outcomes were the proportion of prescriptions eligible for deprescribing and the deprescribing rate at 3 months post-intervention.

Results: At site A, 21 of 48 residents receiving AP were identified as eligible for deprescribing, with 31.6% receiving deprescribing orders within 3 months. Among 12 residents previously assessed in our earlier QI study at site A who remained on PPIs, 33% were newly deprescribed after reassessment in this study. At site B, 23 of 48 residents on antipsychotics were eligible, with a deprescribing rate of 20%. For PPIs, 31 of 38 residents were considered eligible at site B, and 36% had deprescribing orders initiated.

Conclusions: Integrating prescribing portraits into multidisciplinary medication reviews promotes appropriate deprescribing of APs and PPIs in LTC, encouraging safer prescribing practices and improving medication safety.

Appropriate drug treatment can enhance the likelihood of experiencing healthy aging and maintaining functional ability up to very late in life. Strong evidence exists that overall drugs can help prevent and manage diseases. However, such evidence is mostly available from studies that are not representative of older people and do not include functional/well-being outcomes. Therapeutic drugs can also impair physical and cognitive function and social interactions, particularly in the context of polypharmacy, multimorbidity and frailty. Certain drugs can affect the ability to exercise and consume a healthy diet, which are key nonpharmacological interventions that promote healthy aging. Yet, exercise and nutritional interventions can help manage adverse drug reactions. In the future, drugs (gerotherapeutics) may be developed that slow the aging process, which should prevent or delay the incidence and progression of many chronic diseases, improving healthy aging.

Introduction: Whether risk factors for vancomycin-induced nephrotoxicity (VIN) development reported in recent years are also risk factors in the older population has not yet been fully investigated. This study aimed to investigate the risk factors for VIN development in the older population and to examine factors influencing kidney prognosis after VIN development.

Methods: A total of 468 patients aged ≥ 75 years were included in this study. Factors related to VIN onset in older adults were examined through logistic regression analysis.

Results: A total of 40 patients (8.5%) with VIN were identified. Univariate analysis revealed significant differences in body mass index (BMI), combined use of tazobactam/piperacillin (T/P), and intensive care unit admission between the VIN and non-VIN groups (P = 0.042, 0.005, and 0.040, respectively). Multivariate analysis identified the combined use of T/P as a factor related to VIN. In patients aged 85 years or older, the concomitant use of T/P and intensive care unit (ICU) admission were identified as factors related to VIN. Compared with the VIN recovery group, the nonrecovery group had a longer time to VIN onset and a higher proportion of patients on concomitant diuretics.

Conclusions: This study revealed that the combined use of T/P and ICU admission were risk factors for VIN in older individuals. Additionally, the time until VIN onset and the concomitant use of diuretics may affect the kidney prognosis of older patients who develop VIN. When administering vancomycin to older patients, it is necessary to eliminate or be cautious of these factors in relation to VIN development and kidney prognosis.