{"title":"Optimizing inpatient rehabilitation use in older adults with trauma: A collaborative geriatric trauma approach","authors":"Garrett Trang BS, Maeliss Gelas BS, Kristina Balangue MD, Natasha Keric MD, Nimit Agarwal MD, AGSF","doi":"10.1111/jgs.19285","DOIUrl":"10.1111/jgs.19285","url":null,"abstract":"","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"73 3","pages":"973-975"},"PeriodicalIF":4.3,"publicationDate":"2024-11-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142718109","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Anna Hung PharmD, PhD, MS, Matthew E. Growdon MD, MPH
<p>Older adults with dementia are much more likely than those without dementia to experience polypharmacy, defined as taking at least five medications. Approximately 72% of older adults with dementia, versus only 44% of those without dementia, experience polypharmacy.<span><sup>1</sup></span> Although multiple medications may be prescribed to treat multiple chronic conditions, polypharmacy in older adults is associated with increased risks of adverse drug events,<span><sup>2</sup></span> cognitive and physical impairment,<span><sup>3</sup></span> frailty, falls, and mortality.<span><sup>4</sup></span> For older adults with dementia, the most common contributors to polypharmacy include cardiovascular medications and medications acting on the central nervous system.<span><sup>1</sup></span> An estimated 73% of adults aged 65 and over with dementia use at least one cardiovascular medication, and an estimated 85% use at least one medication acting on the central nervous system.<span><sup>1, 5</sup></span> Yet another risk beyond polypharmacy alone is the concomitant use of three or more medications all acting on the central nervous system, termed central nervous system-active polypharmacy. These medications typically include: antiepileptics, antidepressants, antipsychotics, benzodiazepines, nonbenzodiazepine benzodiazepine receptor agonist hypnotics (i.e., z-drugs), opioids, and skeletal muscle relaxants.<span><sup>6</sup></span> The concomitant use of these medications is associated with increased risks of falls,<span><sup>7</sup></span> cognitive decline,<span><sup>8</sup></span> emergency room visits, and hospitalizations.<span><sup>9, 10</sup></span> The 2023 Beers Criteria recommend against central nervous system-active polypharmacy.<span><sup>6</sup></span></p><p>Older adults with dementia are more likely to experience central nervous system-active polypharmacy because many of the medications can be used to manage neuropsychiatric symptoms, such as agitation, aggression, sleep disorders, mood disorders, and psychotic symptoms, related to the underlying dementia. This is concerning because antipsychotics, benzodiazepines, and z-drugs are specifically advised against in persons with dementia.<span><sup>6</sup></span> In 2005, the Food and Drug Administration added a black box warning for atypical antipsychotics for persons with dementia due to increased mortality risks, and in 2008, the black box warning was expanded to all antipsychotics (including typical antipsychotics). Nonetheless, in community-dwelling older adults living with dementia in the United States, 14% in 2018 concomitantly used at least three medications acting on the central nervous system for at least 30 overlapping days.<span><sup>11</sup></span></p><p>In this month's issue, Dr. Vordenberg and colleagues sought to understand how the 14% came to be, by analyzing 2019 prescription claims data from a cohort of community-dwelling Medicare beneficiaries aged 65 and above with Alzhei
{"title":"Deprescribing considerations for central nervous system-active polypharmacy in patients with dementia","authors":"Anna Hung PharmD, PhD, MS, Matthew E. Growdon MD, MPH","doi":"10.1111/jgs.19294","DOIUrl":"10.1111/jgs.19294","url":null,"abstract":"<p>Older adults with dementia are much more likely than those without dementia to experience polypharmacy, defined as taking at least five medications. Approximately 72% of older adults with dementia, versus only 44% of those without dementia, experience polypharmacy.<span><sup>1</sup></span> Although multiple medications may be prescribed to treat multiple chronic conditions, polypharmacy in older adults is associated with increased risks of adverse drug events,<span><sup>2</sup></span> cognitive and physical impairment,<span><sup>3</sup></span> frailty, falls, and mortality.<span><sup>4</sup></span> For older adults with dementia, the most common contributors to polypharmacy include cardiovascular medications and medications acting on the central nervous system.<span><sup>1</sup></span> An estimated 73% of adults aged 65 and over with dementia use at least one cardiovascular medication, and an estimated 85% use at least one medication acting on the central nervous system.<span><sup>1, 5</sup></span> Yet another risk beyond polypharmacy alone is the concomitant use of three or more medications all acting on the central nervous system, termed central nervous system-active polypharmacy. These medications typically include: antiepileptics, antidepressants, antipsychotics, benzodiazepines, nonbenzodiazepine benzodiazepine receptor agonist hypnotics (i.e., z-drugs), opioids, and skeletal muscle relaxants.<span><sup>6</sup></span> The concomitant use of these medications is associated with increased risks of falls,<span><sup>7</sup></span> cognitive decline,<span><sup>8</sup></span> emergency room visits, and hospitalizations.<span><sup>9, 10</sup></span> The 2023 Beers Criteria recommend against central nervous system-active polypharmacy.<span><sup>6</sup></span></p><p>Older adults with dementia are more likely to experience central nervous system-active polypharmacy because many of the medications can be used to manage neuropsychiatric symptoms, such as agitation, aggression, sleep disorders, mood disorders, and psychotic symptoms, related to the underlying dementia. This is concerning because antipsychotics, benzodiazepines, and z-drugs are specifically advised against in persons with dementia.<span><sup>6</sup></span> In 2005, the Food and Drug Administration added a black box warning for atypical antipsychotics for persons with dementia due to increased mortality risks, and in 2008, the black box warning was expanded to all antipsychotics (including typical antipsychotics). Nonetheless, in community-dwelling older adults living with dementia in the United States, 14% in 2018 concomitantly used at least three medications acting on the central nervous system for at least 30 overlapping days.<span><sup>11</sup></span></p><p>In this month's issue, Dr. Vordenberg and colleagues sought to understand how the 14% came to be, by analyzing 2019 prescription claims data from a cohort of community-dwelling Medicare beneficiaries aged 65 and above with Alzhei","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"73 2","pages":"343-346"},"PeriodicalIF":4.3,"publicationDate":"2024-11-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jgs.19294","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142735361","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Ariel R. Green MD, PhD, MPH, Daniel Martin MA, Andrew Jessen MS, Mingche M. J. Wu MPH, Andrea E. Daddato PhD, MS, Rosalphie Quiles Rosado PhD, Kelly T. Gleason PhD, RN, Aleksandra Wec BA, Jennifer L. Wolff PhD, Casey O. Taylor PhD, Elizabeth A. Bayliss MD, MSPH