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Drugs & Aging

Dee Mangin, Gülistan Bahat, Beatrice A Golomb, Laurie Herzig Mallery, Paige Moorhouse, Graziano Onder, Mirko Petrovic, Doron Garfinkel
Globally, the number of drug prescriptions is increasing causing more adverse drug events, which is now a significant cause of mortality, morbidity, and disability that has reached epidemic proportions. The risk of adverse drug events is correlated to very old age, multiple co-morbidities, dementia, frailty, and limited life expectancy, with the major contributor being polypharmacy. Each characteristic alters the risk-benefit balance of medications, typically reducing anticipated benefits and amplifying risk...
July 14, 2018: Drugs & Aging
Gary L O'Brien, Denis O'Mahony, Paddy Gillespie, Mark Mulcahy, Valerie Walshe, Marie N O'Connor, David O'Sullivan, James Gallagher, Stephen Byrne
BACKGROUND: A recent randomised controlled trial conducted in an Irish University teaching hospital that evaluated a physician-implemented medication screening tool, demonstrated positive outcomes in terms of a reduction in incident adverse drug reactions. OBJECTIVE: The present study objective was to evaluate the cost effectiveness of physicians applying this screening tool to older hospitalised patients compared with usual hospital care in the context of the earlier randomised controlled trial...
July 13, 2018: Drugs & Aging
Gail D Anderson, Shahin Hakimian
The incidence of epilepsy is highest in the older adult age group. Seizures in older adults can be more difficult to diagnose because their presentation is often subtle and can easily be mistaken for other conditions. Fortunately, new-onset epilepsy in the older adult is often pharmaco-responsive, with as many as 80-85% of patients achieving remission, often with monotherapy at modest doses. Many physiological and pathological changes occur with aging that can alter the pharmacokinetics of antiseizure drugs (ASDs)...
July 13, 2018: Drugs & Aging
Wade Thompson, Anton Pottegård, Jesper Bo Nielsen, Peter Haastrup, Dorte Ejg Jarbøl
There is a lack of evidence surrounding the efficacy of statins in the oldest old (≥ 80 years of age). As such, there is controversy surrounding use of statins in this population. We sought to evaluate the prevalence of statin use in the oldest old worldwide to understand the scope of this issue. We searched PubMed and grey literature over the last 5 years. Studies had to report the prevalence of statin use in adults ≥ 80 years of age. The first author performed screening and extracted data. Our search produced 1870 hits; 14 articles were considered eligible...
July 10, 2018: Drugs & Aging
Syed Rizvi, Samer Gawrieh
Autoimmune hepatitis (AIH) may present as acute or chronic hepatitis in the elderly. Advanced hepatic fibrosis and cirrhosis are common on first presentation in this population. In this review, we discuss the presentation, approach to diagnosis and management of AIH in the elderly. As polypharmacy is common in the elderly, careful medication use history is essential for detecting drug-induced AIH-like hepatitis. Steroid-sparing or minimizing therapeutic regimens are preferred to treat AIH in the elderly. For the purpose of induction, budesonide or lower dose prednisone in combination with azathioprine (AZA) regimens are preferred over high-dose prednisone monotherapy due to the higher risk of side effects of the later in the elderly...
July 4, 2018: Drugs & Aging
Farhad Pazan, Christel Weiss, Martin Wehling
In the original publication of this article, the members of the FORTA group were provided in such a way that they could not be indexed as collaborators on PubMed. The article should have included an Acknowledgement section as shown below.
July 2, 2018: Drugs & Aging
Riju Ray, Lee Tombs, Michael J Asmus, Isabelle Boucot, David A Lipson, Chris Compton, Ian Naya
OBJECTIVE: The aim of this pooled analysis was to assess the efficacy and safety of umeclidinium/vilanterol (UMEC/VI) 62.5/25 µg dual bronchodilation versus placebo in elderly symptomatic patients with chronic obstructive pulmonary disease (COPD). METHODS: We conducted a post hoc pooled analysis of data from 10 randomized controlled trials (RCTs). Change from baseline (CFB) in trough forced expiratory volume in 1 s (FEV1 ), proportion of FEV1 responders (≥ 100-mL increase from baseline), and safety were analyzed in patients aged < 65, ≥ 65, and ≥ 75 years on Days 28, 56, and 84 (12-week analysis of parallel-group design studies), Days 28, 56, 84, 112, 140, 168, and 169 (24-week analysis of parallel-group design studies), and Days 2, 42, and 84 (12-week analysis of crossover design studies)...
June 27, 2018: Drugs & Aging
Hui Ting Ang, Ka Keat Lim, Yu Heng Kwan, Pui San Tan, Kai Zhen Yap, Zafirah Banu, Chuen Seng Tan, Warren Fong, Julian Thumboo, Truls Ostbye, Lian Leng Low
BACKGROUND: Falls in individuals aged ≥ 60 years may result in injury, hospitalisation or death. The role of anti-hypertensive medications in falls among older adults is unclear. OBJECTIVE: The objective of this study was to assess the association of six anti-hypertensive medication classes, namely α-blockers (AB), angiotensin converting enzyme inhibitors (ACEi), angiotensin receptor blockers (ARB), β-blockers (BB), calcium channel blockers (CCB) and diuretics, with the risk of falls, injurious falls or recurrent falls in individuals aged ≥ 60 years compared with non-users...
June 23, 2018: Drugs & Aging
Roberta Galeazzi, Fabiola Olivieri, Liana Spazzafumo, Giuseppina Rose, Alberto Montesanto, Simona Giovagnetti, Sara Cecchini, Gelsomina Malatesta, Raffaele Di Pillo, Roberto Antonicelli
OBJECTIVE: The clinical efficacy of clopidogrel in secondary prevention of vascular events is hampered by marked inter-patient variability in drug response, which partially depends on genetic make-up. The aim of this pilot prospective study was to evaluate 12-month cardiovascular outcomes in elderly patients with acute coronary syndrome (ACS) receiving dual antiplatelet therapy (aspirin and clopidogrel) according to the clustering of CYP2C19 and ABCB1 genetic variants. METHODS: Participants were 100 consecutive ACS patients who were genotyped for CYP2C19 (G681A and C-806T) and ABCB1 (C3435T) polymorphisms, which affect clopidogrel metabolism and bioavailability, using PCR-restriction fragment length polymorphism...
June 23, 2018: Drugs & Aging
Jennifer K Burton, Richard Papworth, Caroline Haig, Colin McCowan, Ian Ford, David J Stott, Terence J Quinn
BACKGROUND: Statins have been associated with later life, long-term care admission in observational studies. However, by preventing vascular events, statins may also prevent or delay admission. We wished to determine statin and long-term care admission associations in a randomised controlled trial context, and describe associations between long-term care admission and other clinical and demographic factors. METHODS: We used extended follow-up of two randomised trial populations, using national data to assign the long-term care admission outcome, and included individuals screened or recruited to two large randomised trials of pravastatin 40 mg daily-the West of Scotland Coronary Prevention Study (WOSCOPS) and the pravastatin in elderly individuals at risk of vascular disease (PROSPER) study...
June 19, 2018: Drugs & Aging
Dominik Stämpfli, Fabienne Boeni, Andy Gerber, Victor A D Bättig, Kurt E Hersberger, Markus L Lampert
BACKGROUND: Inappropriate prescribing is linked to increased risks for adverse drug reactions and hospitalisation. Combining explicit and implicit criteria of inappropriate prescribing with the information obtained in patient interviews seems beneficial with regard to the identification of drug-related problems (DRPs) in hospitalised patients. OBJECTIVE: We aimed to investigate the inclusion of pharmacist interviews as part of medication reviews (including the use of explicit and implicit criteria of inappropriate prescribing) to identify DRPs in older inpatients...
June 19, 2018: Drugs & Aging
Paola Mian, Karel Allegaert, Isabel Spriet, Dick Tibboel, Mirko Petrovic
Paracetamol is the most commonly used analgesic in older people, and is mainly dosed according to empirical dosing guidelines. However, the pharmacokinetics and thereby the effects of paracetamol can be influenced by physiological changes occurring with ageing. To investigate the steps needed to reach more evidence-based paracetamol dosing regimens in older people, we applied the concepts used in the paediatric study decision tree. A search was performed to retrieve studies on paracetamol pharmacokinetics and safety in older people (> 60 years) or studies that performed a (sub) analysis of pharmacokinetics and/or safety in older people...
June 19, 2018: Drugs & Aging
Laurent Lafarge, Fouzi Khayi, Anis Bel-Kamel, Nicolas Charhon, Laura Sarfati, Benoit Falquet, Michel Ducher, Laurent Bourguignon
BACKGROUND: Oral vitamin K antagonists (VKAs) are commonly used in older adults. To ensure the efficiency and safety of these drugs, the international normalized ratio (INR) must be monitored. The time in therapeutic range (TTR) is an internationally recommended assessment of the anticoagulation quality. OBJECTIVE: Our study aimed to assess the TTR of VKAs in a hospitalized geriatric population and identify factors associated with low TTR. METHODS: This was a multicenter retrospective study of data from 1899 patients with a mean age of 87 years between 2013 and 2015 in the geriatric units of four French hospitals...
June 8, 2018: Drugs & Aging
Gray Jodon, Stacy M Fischer, Elizabeth R Kessler
Urothelial carcinoma, or bladder cancer, is a malignancy that most commonly affects older patients. The median age at diagnosis is 73 years, and care of these patients requires consideration not just of the disease-related factors such as stage and histology, but also of patient-related factors. Many of these patients have concurrent medical morbidities and additional changes related to the aging process. Older patients with cancer are a unique population requiring additional considerations and assessment in treatment decision-making...
May 9, 2018: Drugs & Aging
Iacopo Franconi, Giovanni Guaraldi
Over the past 15 years, a significant increase in new HIV/AIDS diagnoses has been observed in the elderly population. This new epidemiological shift has been attributed to a longer sex life, lifestyle and changes in sexual behavior, poor sexual health education, and misconceptions about the absence of sexually transmitted disease in later life. Although many biomedical and behavioral interventions have proven useful to prevent sexually transmitted infections and HIV, pre-exposure prophylaxis (PrEP) has been shown to be the most successful biomedical intervention to prevent HIV in high-risk individuals...
May 8, 2018: Drugs & Aging
Tomas J Welsh, Veronika van der Wardt, Grace Ojo, Adam L Gordon, John R F Gladman
BACKGROUND: Cumulative anticholinergic exposure (anticholinergic burden) has been linked to a number of adverse outcomes. To conduct research in this area, an agreed approach to describing anticholinergic burden is needed. OBJECTIVE: This review set out to identify anticholinergic burden scales, to describe their rationale, the settings in which they have been used and the outcomes associated with them. METHODS: A search was performed using the Healthcare Databases Advanced Search of MEDLINE, EMBASE, Cochrane, CINAHL and PsycINFO from inception to October 2016 to identify systematic reviews describing anticholinergic burden scales or tools...
May 8, 2018: Drugs & Aging
Tomáš Bolek, Matej Samoš, Ingrid Škorňová, Lucia Stančiaková, Ján Staško, Peter Galajda, Peter Kubisz, Marián Mokáň
BACKGROUND: The number of elderly individuals with non-valvular atrial fibrillation (NV-AF) requiring long-term anticoagulation is rising. The pharmacokinetics of oral anticoagulants in elderly individuals may differ from that for younger patients. The aim of this study was to assess the dabigatran levels in elderly patients with NV-AF. PATIENTS AND METHODS: A pilot prospective post-marketing study in patients with NV-AF on dabigatran therapy was performed; we enrolled 21 consecutive elderly patients (aged ≥ 75 years) on a reduced dabigatran regimen (110 mg twice daily) and compared them with 13 younger (≤ 70 years) individuals on reduced dabigatran therapy due to renal impairment and with 16 younger patients on standard dabigatran therapy (150 mg twice daily)...
May 8, 2018: Drugs & Aging
Katharina Luise Schneider, Kathrin Kastenmüller, Klaus Weckbecker, Markus Bleckwenn, Miriam Böhme, Julia Carolin Stingl
INTRODUCTION: Drug-drug interactions (DDIs) are an important risk factor for adverse drug reactions. Older, polymedicated patients are particularly affected. Although antithrombotics have been detected as high-risk drugs for DDIs, data on older patients exposed to them are scarce. METHODS: Baseline data of 365 IDrug study outpatients (≥ 60 years, use of an antithrombotic and one or more additional long-term drug) were analyzed regarding potential drug-drug interactions (pDDIs) with a clinical decision support system...
June 2018: Drugs & Aging
Ane Erdal, Elisabeth Flo, Dag Aarsland, Clive Ballard, Dagrun D Slettebo, Bettina S Husebo
BACKGROUND: Chronic pain and depression often co-occur, and pain may exacerbate depression in people with dementia. OBJECTIVE: The objective of this study was to assess the efficacy and safety of analgesic treatment for depression in nursing home patients with advanced dementia and clinically significant depressive symptoms. METHODS: We conducted a multicentre, parallel-group, double-blind, placebo-controlled trial in 47 nursing homes, including 162 nursing home patients aged ≥ 60 years with dementia (Mini-Mental State Examination ≤ 20) and depression (Cornell Scale for Depression in Dementia ≥ 8)...
June 2018: Drugs & Aging
Brendan J Ng, David G Le Couteur, Sarah N Hilmer
Benzodiazepines (BZDs; including the related Z-drugs) are frequently targets for deprescribing; long-term use in older people is harmful and often not beneficial. BZDs can result in significant harms, including falls, fractures, cognitive impairment, car crashes and a significant financial and legal burden to society. Deprescribing BZDs is problematic due to a complex interaction of drug, patient, physician and systematic barriers, including concern about a potentially distressing but rarely fatal withdrawal syndrome...
June 2018: Drugs & Aging
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