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Drugs & Aging

Mitsuhiro Akiyama, Tsutomu Takeuchi
IgG4-related disease is a heterogeneous immune-mediated fibroinflammatory condition that can affect every single organ. This disease is more prevalent in the elderly (the mean age of patients is above 60 years) and the prevalence rate is estimated to be over 4.6 per 100,000 population. Before making a diagnosis, the exclusion of malignancies, lymphoma, anti-neutrophil cytoplasmic antibody-associated vasculitis, multicentric Castleman disease, and other mimickers is crucial for appropriate treatment. Broad management guidelines have been published emphasizing the need for prompt treatment and the use of glucocorticoids as first-line drug therapy for induction of remission...
March 15, 2018: Drugs & Aging
Janani Thillainadesan, Danijela Gnjidic, Sarah Green, Sarah N Hilmer
BACKGROUND: Polypharmacy and potentially inappropriate medications (PIMs) are prevalent in older adults in hospital, and are associated with negative outcomes including adverse drug reactions, falls, confusion, hospitalisation and death. Deprescribing may reduce inappropriate polypharmacy and use of inappropriate medications. OBJECTIVE: The aim of this systematic review was to investigate the efficacy of deprescribing interventions in older inpatients to reduce PIMs and impact on clinical outcomes...
March 14, 2018: Drugs & Aging
Emma D Deeks
In the original publication the name of the fourth reviewer was incorrectly published.
March 9, 2018: Drugs & Aging
Abdul Aziz Al Wazzan, Eline Tommelein, Katrien Foubert, Stefano Bonassi, Graziano Onder, Annemie Somers, Mirko Petrovic, Koen Boussery
BACKGROUND: Renal function progressively worsens with age. Potentially inappropriate prescribing (PIP) of renally excreted active drugs (READs) is common in older adults, leading to an increased rate of iatrogenic illness. The Ghent Older People's Prescription community Pharmacy Screening (GheOP3 S-) tool is an effective, explicit instrument that was developed for community pharmacists (CPs) to detect PIP. So far, this tool does not assess PIP of the frequently used READs in older patients with renal impairment...
March 5, 2018: Drugs & Aging
Avital Hershkovitz, Corina Angel, Shai Brill, Ran Nissan
BACKGROUND: Anticholinergic (AC) drugs are associated with significant impairment in cognitive and physical function which may affect rehabilitation in older people. We aimed to evaluate whether AC burden is associated with rehabilitation achievement in post-acute hip-fractured patients. METHODS: A retrospective cohort study carried out in a post-acute geriatric rehabilitation center on 1019 hip-fractured patients admitted from January 2011 to October 2015. The Anticholinergic Cognitive Burden Scale (ACB) was used to quantify the AC burden...
March 3, 2018: Drugs & Aging
Jacques E Chelly, Peter G Lacouture, Christian Russel D Reyes
BACKGROUND: Hydroxypropyl-β-cyclodextrin-diclofenac (HPβCD-diclofenac) is an NSAID used to treat acute moderate-to-severe postoperative pain. This post hoc analysis investigated the safety of HPβCD-diclofenac in patients aged ≥ 65 years. METHODS: Data from three phase III trials of HPβCD-diclofenac in adult patients with acute moderate-to-severe postoperative pain were pooled (NCT00448110, NCT00507026, and NCT00726388). Patients who received one or more dose of HPβCD-diclofenac or placebo were included and stratified according to age: < 65, 65-74, or ≥ 75 years...
March 1, 2018: Drugs & Aging
Scott Martin Vouri, Mario Schootman, Seth A Strope, Stanley J Birge, Margaret A Olsen
BACKGROUND: Oral oxybutynin has been associated with the development of cognitive impairment. OBJECTIVE: The objective of this study was to describe the use of oral oxybutynin versus other antimuscarinics (e.g., tolterodine, darifenacin, solifenacin, trospium, fesoterodine, transdermal oxybutynin) in older adults with documented cognitive impairment. METHODS: This is a population-based retrospective analysis of antimuscarinic new users aged ≥ 66 years from January 2008 to December 2011 (n = 42,886) using a 5% random sample of Medicare claims linked with Part D data...
February 28, 2018: Drugs & Aging
Mary Lee, Roohollah Sharifi
Phosphodiesterase type 5 inhibitors (PDE5Is) are the drug of choice for medical management of erectile dysfunction (ED). On-demand PDE5Is have an overall efficacy of 60-70% for ED; 30-35% of patients fail to respond to a PDE5I, and 30-50% of non-responders can be salvaged with detailed counseling on proper use and physician follow-up to ensure that the patient has been prescribed an appropriate and full PDE5I clinical trial. True non-responders may be offered intracavernosal injections of erectogenic drugs, intraurethral alprostadil, or surgical insertion of a penile prosthesis...
February 20, 2018: Drugs & Aging
Marianne Reimers, Maria Eriksdotter, Åke Seiger, Johan Fastbom
BACKGROUND: The number of drugs prescribed for old people has been rising in recent decades. With increasing age and multiple medications, the risk of complications and drug prescription complexity increases. Multiple changes to prescriptions could be a factor that improves treatment quality. OBJECTIVES: Our objective was to investigate trends in drug prescriptions and factors that contribute to prescription changes. Specific objectives were to find out whether high numbers of prescription changes are significantly correlated with age, sex, comorbidity, length of care episode, and number of drugs...
February 19, 2018: Drugs & Aging
Eliseo Pascual, Francisca Sivera, Mariano Andrés
Hyperuricaemia is an independent risk factor for renal function decline. Evidence is emerging that urate-lowering therapy might be beneficial in subjects with renal impairment. We  review the association between renal impairment and gout, some of the related pathogenic processes and the possible impact of gout treatment on the progression of renal impairment. Nevertheless, the management of gout is more complex in the presence of chronic kidney disease. The main aim of gout therapy is to fully dissolve the urate crystals, thus curing the disease...
February 13, 2018: Drugs & Aging
Emma D Deeks
Denosumab (Prolia®; Pralia®) is a human monoclonal antibody targeting the key bone resorption mediator RANKL. The drug is administered via subcutaneous injection once every 6 months and is approved for various indications, including the treatment of postmenopausal (PM) women with osteoporosis at increased/high risk of fracture or failure/intolerance of other osteoporosis therapies (indications featured in this review). Denosumab showed benefit in several phase 3 or 4 studies in PM women with osteoporosis or low bone mineral density (BMD), including the pivotal 3-year double-blind FREEDOM trial and its 7-year open-label extension...
February 12, 2018: Drugs & Aging
Nicolaas D Vlieland, Bart J F van den Bemt, Charlotte L Bekker, Marcel L Bouvy, Toine C G Egberts, Helga Gardarsdottir
BACKGROUND: Whereas storage conditions are regulated and closely monitored in every stage of the drug supply chain before drug dispensing, it is unknown if patients store drugs at home according to storage recommendations. OBJECTIVE: The objective of this study was to investigate how older patients store their prescription drugs at home and to what extent they comply with drug storage recommendations. METHODS: We conducted a cross-sectional study between October 2015 and March 2016...
February 8, 2018: Drugs & Aging
Gizat M Kassie, Tuan A Nguyen, Lisa M Kalisch Ellett, Nicole L Pratt, Elizabeth E Roughead
BACKGROUND: Medicines are potentially modifiable risk factors for postoperative delirium. However, the extent to which preoperative medicines are included in risk prediction models (RPMs) is unknown. OBJECTIVE: This systematic review aimed to assess the extent of inclusion of preoperative medications in RPMs for postoperative delirium. METHODS: Articles were systematically searched from MEDLINE, EMBASE and CINAHL using Medical Subject Headings (MeSH) where possible and keywords for postoperative delirium and prediction model...
February 8, 2018: Drugs & Aging
Manan A Jhaveri, Vignan Manne, Kris V Kowdley
Since the introduction of direct-acting antivirals (DAAs), the outcomes of hepatitis C (HCV) treatment have shown an improvement in cure rates with minimal side effects. However, to date, the safety and efficacy of DAAs have not been specifically examined in elderly patients. The treatment of HCV in the era of pegylated interferon and ribavirin was more challenging among elderly patients due to the increased prevalence of multiple comorbid conditions associated with an increased risk of side effects, including anemia, and high rates of discontinuation, likely as a result of poor tolerability, resulting in lower rates of sustained virologic response (SVR)...
February 7, 2018: Drugs & Aging
Silvia Giovannini, Henriëtte G van der Roest, Angelo Carfì, Harriet Finne-Soveri, Vjenka Garms-Homolová, Anja Declercq, Pálmi V Jónsson, Hein van Hout, Davide L Vetrano, Ester Manes Gravina, Roberto Bernabei, Graziano Onder
BACKGROUND: Home care (HC) patients are characterized by a high level of complexity, which is reflected by the prevalence of multimorbidity and the correlated high drug consumption. This study assesses prevalence and factors associated with polypharmacy in a sample of HC patients in Europe. METHODS: We conducted a cross-sectional analysis on 1873 HC patients from six European countries participating in the Identifying best practices for care-dependent elderly by Benchmarking Costs and outcomes of community care (IBenC) project...
February 6, 2018: Drugs & Aging
Andreas Körber, Charis Papavassilis, Vaishali Bhosekar, Maximilian Reinhardt
BACKGROUND: Psoriasis is a chronic inflammatory skin disease, affecting patients of a wide age range, including elderly patients. Elderly patients can respond differently to drug treatments and can be more vulnerable to adverse reactions. There are limited data on biologic therapies for psoriasis in elderly subjects. Secukinumab, a fully human monoclonal antibody that selectively neutralizes IL-17A, has proven significant efficacy in the treatment of moderate to severe psoriasis. AIMS: A post-hoc analysis of three phase III trials (ERASURE, FIXTURE and CLEAR) was performed to evaluate the efficacy and safety of secukinumab in elderly subjects...
February 5, 2018: Drugs & Aging
Ariel R Green, Liza M Reifler, Cynthia M Boyd, Linda A Weffald, Elizabeth A Bayliss
BACKGROUND: Drugs with anticholinergic properties are considered potentially inappropriate in patients with cognitive impairment because harms-including delirium, falls, and fractures-may outweigh benefits. OBJECTIVE: To highlight opportunities to improve clinical decision making and care for patients with cognitive impairment and multiple chronic conditions, we identified distinct subgroups of patients with mild cognitive impairment (MCI) and dementia who had high cumulative anticholinergic burden and specific patterns of anticholinergic use...
February 5, 2018: Drugs & Aging
Eveline L van Velthuijsen, Sandra M G Zwakhalen, Evelien Pijpers, Liesbeth I van de Ven, Ton Ambergen, Wubbo J Mulder, Frans R J Verhey, Gertrudis I J M Kempen
BACKGROUND: Delirium in older hospitalised patients is a common and serious disorder. Polypharmacy and certain medications are risk factors for developing delirium. A medication review could benefit older hospitalised patients with delirium. OBJECTIVES: (1) Evaluate the effects of medication review on length of delirium, length of hospital stay, mortality, and discharge destination; and (2) describe and analyse the proposed changes to medication and its implementation by the treating physician...
February 2, 2018: Drugs & Aging
Catherine Terret, Chiara Russo
As its incidence increases with age, breast cancer in elderly patients takes on a growing importance in clinical oncology practice. Management decisions are challenging because there is a lack of high-quality evidence in this heterogeneous population. Epidemiological studies have shown that breast cancer mortality does not decrease substantially in the older population compared with younger adults. Recent data suggest a phenotype somewhat different from that of younger patients, also confirmed at the molecular level...
January 31, 2018: Drugs & Aging
Daniel J Hoyle, Ivan K Bindoff, Lisa M Clinnick, Gregory M Peterson, Juanita L Westbury
BACKGROUND: Antipsychotic and benzodiazepine medications are widely used in nursing homes despite only modest efficacy and the risk of severe adverse effects. Numerous interventions have been implemented to reduce their use. However, the outcomes for the residents and staff and the economic impact on the healthcare system remain relatively understudied. OBJECTIVE: The aim was to examine the clinical and economic outcomes reported within interventions to reduce antipsychotic and/or benzodiazepine use in nursing homes...
January 27, 2018: Drugs & Aging
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