1
|
Muhammad T, Pai M, Afsal K, Saravanakumar P, Irshad CV. The association between loneliness and life satisfaction: examining spirituality, religiosity, and religious participation as moderators. BMC Geriatr 2023; 23:301. [PMID: 37193948 DOI: 10.1186/s12877-023-04017-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 05/04/2023] [Indexed: 05/18/2023] Open
Abstract
BACKGROUND Future cohort of older adults may have to rely on non-family sources and forms of support, religion being one of them. This may be especially so, considering the recent longitudinal evidence that individuals are inclined to become more religious with increasing age. Thus, the purpose of the present study was to assess the association between loneliness and life satisfaction among older adults in India, and the extent to which the association between loneliness and life satisfaction is moderated by spirituality, religiosity, and religious participation. METHODS Data come from the Longitudinal Ageing Study in India, with a sample of 31,464 individuals aged 60 years and above. Multivariable logistic regression models were employed to examine the independent association of loneliness and life satisfaction. Further, an interaction analysis was conducted to examine the extent to which the association between perceived loneliness and life satisfaction is moderated by spirituality, religiosity and religious participation among older Indians. RESULTS The prevalence of low life satisfaction (LLS) was 30.84%; a total of 37.25% of participants reported feeling lonely, 12.54% reported a lack of spiritual experience, 21.24% reported not being religious, and 19.31% reported not participating in religious activities. Older adults who felt lonely had higher odds of LLS relative to peers who were not lonely. Further, the adverse impact of loneliness on LLS among older Indians is moderated by their spirituality, religiosity, and religious participation. Specifically, the adverse impact of loneliness on LLS was less negatively pronounced among older adults who were spiritual, religious, and engaged in religious activities. CONCLUSIONS The study found an independent association between loneliness and lower life satisfaction among older adults in India. It also revealed that religiosity, spirituality and religious participation moderate the association between loneliness and lower life satisfaction. These findings, which underscore the health promoting benefits of religiosity and religious engagement, may be used to build on the interaction between religious and faith-based groups and public health professionals.
Collapse
Affiliation(s)
- T Muhammad
- Department of Family & Generations, International Institute for Population Sciences, Mumbai, 400088, India.
| | - Manacy Pai
- Department of Sociology and Criminology, Kent State University, Kent, OH, 44242, USA
| | - K Afsal
- Department of Migration & Urban Studies, International Institute for Population Sciences, Mumbai, 400088, India
| | - Priya Saravanakumar
- School of Nursing and Midwifery, Faculty of Health, University of Technology Sydney, Building 10, Level 7, 235 Jones St, Ultimo, NSW, 2007, Australia
| | - C V Irshad
- School of Social Sciences and Languages, Vellore Institute of Technology, Vellore, 632014, India
| |
Collapse
|
2
|
Ebrahimoghli R, Janati A, Gharaee H, Aghaei MH. Polypharmacy Pattern in Iran: A Comprehensive Analysis of a Large Prescription Database. IRANIAN JOURNAL OF PHARMACEUTICAL RESEARCH : IJPR 2022; 21:e131304. [PMID: 36915408 PMCID: PMC10007994 DOI: 10.5812/ijpr-131304] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 11/12/2022] [Accepted: 12/20/2022] [Indexed: 02/19/2023]
Abstract
Background Polypharmacy is a significant patient safety concern. Objectives This study aims to estimate the prevalence of polypharmacy, its continuity and associated factors, and common medication classes among a large outpatient population in East Azerbaijan province, Iran. Methods A retrospective prescription data analysis was performed. The cohort included all ≥ 20 years old subjects with at least one prescription filled during the main three-month study period (2020 March 1 - 2020 May 31). Polypharmacy was defined as being exposed to more than four different medications during the main study period, and continuous polypharmacy was defined as being exposed to more than four medications during both the main study period and follow-up period (2020 October 1 - 2020 December 31). The frequency and prevalence of polypharmacy, along with predictive factors, were estimated. We performed multivariate logistic regression and estimated odds ratios (ORs) to investigate the risk factors for polypharmacy. Results 307,820 patients included (mean age 49.8 years, 62.9% female, mean drug use 3.7 (SD = 2.6). Polypharmacy was observed in 28.3% (CI: 28.1 - 28.4), of which 36.6% experienced continuous polypharmacy. The odds of being exposed to polypharmacy increased with being female, increasing age, and exposure to chronic conditions. The groups of medications most utilized by polypharmacy patients were those indicated for gastro-esophageal reflux diseases, beta-blocking agents, antidepressants, blood glucose-lowering drugs, and antithrombotic agents. Conclusions Strategies should be formulated to inform healthcare policymakers and providers about the magnitude of the polypharmacy phenomenon, associated factors, and the common medication classes involved.
Collapse
Affiliation(s)
- Reza Ebrahimoghli
- Department of Nursing, Institute of Health Education, Ardabil University of Medical Sciences, Ardabil, Iran
| | - Ali Janati
- Department of Health Policy and Management, School of Management and Medical Informatics, Tabriz University of Medical Sciences, Tabriz, Iran
- Corresponding Author: Department of Health Policy and Management, School of Management and Medical Informatics, Tabriz University of Medical Sciences, Tabriz, Iran.
| | - Hojatolah Gharaee
- Department of Health Management and Economics, School of Public Health, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Mir Hossein Aghaei
- Department of Nursing, Institute of Health Education, Ardabil University of Medical Sciences, Ardabil, Iran
| |
Collapse
|
3
|
Christopher C, KC B, Shrestha S, Blebil AQ, Alex D, Mohamed Ibrahim MI, Ismail N. Medication use problems among older adults at a primary care: A narrative of literature review. Aging Med (Milton) 2022; 5:126-137. [PMID: 35783113 PMCID: PMC9245166 DOI: 10.1002/agm2.12203] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 02/21/2022] [Accepted: 02/27/2022] [Indexed: 11/09/2022] Open
Abstract
Appropriate medication use is one of the most significant challenges among the older population. Although medication use problems are well documented at the secondary and tertiary health care level, the evidence at the primary care level of OECD region is limited. A narrative review of existing literature was conducted through a nonsystematic search for original articles through electronic search databases, Ovid Medline, Google Scholar from 2001 to 2021, and a combination of citation references. Medication use problems are prevalent in older adults at the primary care level. The main issues of medication use identified were as follows; nonadherence, adverse drug events, accessibility, polypharmacy, inappropriate medications, belief about medications, lack of knowledge and awareness, and lack of deprescribing. In addition, the current review has identified the possibilities of the problems: many medications, forgetfulness, lack of deprescribing, lack of communication, poor understanding, and limited awareness of inappropriate medications. This review found that various medication use problems subclusters were identified to impact the health care need among older adults. Therefore, effective interventions targeting these issues need to be developed to reduce medication use problems among older adults at a primary care level.
Collapse
Affiliation(s)
| | - Bhuvan KC
- School of PharmacyMonash University MalaysiaSubang JayaMalaysia
| | - Sunil Shrestha
- School of PharmacyMonash University MalaysiaSubang JayaMalaysia
| | - Ali Qais Blebil
- School of PharmacyMonash University MalaysiaSubang JayaMalaysia
| | - Deepa Alex
- Jeffrey Cheah School of Medicine and Health SciencesMonash University MalaysiaSubang JayaMalaysia
| | | | | |
Collapse
|
4
|
Impact of CDC warning on co-prescribing of opioids and benzodiazepines in older allogeneic hematopoietic cell transplant recipients. Bone Marrow Transplant 2022; 57:1079-1085. [DOI: 10.1038/s41409-022-01654-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Revised: 03/08/2022] [Accepted: 03/21/2022] [Indexed: 11/08/2022]
|
5
|
Akhtar A, Hassali MAA, Zainal H, Ali I, Iqbal MS, Khan AH. Respiratory-tract infections among geriatrics: prevalence and factors associated with the treatment outcomes. Ther Adv Respir Dis 2021; 15:1753466620971141. [PMID: 33910420 PMCID: PMC8108383 DOI: 10.1177/1753466620971141] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Background: Geriatric individuals are more susceptible to different infections, especially respiratory-tract infections (RTIs) due to their compromised immune system. Hence, the objectives of the present study were to evaluate the prevalence, medication regimen complexity and factors associated with the treatment outcomes of different RTIs among geriatrics. Methods: A retrospective cross-sectional study (5 years) was conducted at the respiratory department, Hospital Pulau Pinang. Patients aged ⩾65 years with confirmed diagnosis of RTI were included in the study. Results: A total of 474 patients were included, and the most prevalent RTIs were community-acquired pneumonia (65.6%) followed by chronic obstructive pulmonary disease (20.7%), bronchitis (8.2%) and hospital-acquired pneumonia (5.5%). Amoxicillin/clavulanate (69.8%), ampicillin/sulbactam (9.1%) and cefuroxime (6.5%) are the most common antibiotics prescribed to treat RTIs among geriatrics. Smoking, alcohol consumption, polypharmacy and presence of other co-morbidities are statistically significant factors associated with treatment outcomes of RTIs among geriatrics. Conclusion: Prevalence of community-acquired pneumonia (65.6%) among older patients aged 65 years and older higher than other RTIs. Smoking, alcohol use, presence of polypharmacy and other co-morbidities are important factors associated with the treatment outcomes of RTIs. The reviews of this paper are available via the supplemental material section.
Collapse
Affiliation(s)
- Ali Akhtar
- School of Pharmaceutical Sciences, Universiti Sains Malaysia, Pinang, Pulau Pinang, Malaysia
| | | | - Hadzliana Zainal
- Discipline of Clinical Pharmacy, Universiti Sains Malaysia, Palau Pinang, Malaysia
| | - Irfhan Ali
- Respiratory Department, Hospital Pulau Pinang, Ministry of Health, Palau Pinang, Malaysia
| | - Muhammad Shahid Iqbal
- Department of Clinical Pharmacy, College of Pharmacy, Prince Sattam Bin Abdulaziz University, Al-Kharj, Saudi Arabia
| | | |
Collapse
|
6
|
Davies LE, Kingston A, Todd A, Hanratty B. Characterising polypharmacy in the very old: Findings from the Newcastle 85+ Study. PLoS One 2021; 16:e0245648. [PMID: 33465141 PMCID: PMC7815158 DOI: 10.1371/journal.pone.0245648] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Accepted: 01/05/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Polypharmacy is potentially harmful and under-researched amongst the fastest growing subpopulation, the very old (aged ≥85). We aimed to characterise polypharmacy using data from the Newcastle 85+ Study-a prospective cohort of people born in 1921 who turned 85 in 2006 (n = 845). METHODS The prevalence of polypharmacy at baseline (mean age 85.5) was examined using cut-points of 0, 1, 2-4, 5-9 and ≥10 medicines-so-called 'no polypharmacy', 'monotherapy', 'minor polypharmacy', 'polypharmacy' and 'hyperpolypharmacy.' Cross-tabulations and upset plots identified the most frequently prescribed medicines and medication combinations within these categories. Mixed-effects models assessed whether gender and socioeconomic position were associated with prescribing changes over time (mean age 85.5-90.5). Participant characteristics were examined through descriptive statistics. RESULTS Complex multimorbidity (44.4%, 344/775) was widespread but hyperpolypharmacy was not (16.0%, 135/845). The median medication count was six (interquartile range 4-8). Preventative medicines were common to all polypharmacy categories, and prescribing regimens were diverse. Nitrates and oral anticoagulants were more frequently prescribed for men, whereas bisphosphonates, non-opioid analgesics and antidepressants were more common in women. Cardiovascular medicines, including loop diuretics, tended to be more frequently prescribed for socioeconomically disadvantaged people (<25th centile Index of Multiple Deprivation (IMD)), despite no difference in the prevalence of cardiovascular disease (p = 0.56) and diabetes (p = 0.92) by IMD. CONCLUSION Considering their complex medical conditions, prescribing is relatively conservative amongst 85-year-olds living in North East England. Prescribing shows significant gender and selected socioeconomic differences. More support for managing preventative medicines, of uncertain benefit, might be helpful in this population.
Collapse
Affiliation(s)
- Laurie E. Davies
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Andrew Kingston
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Adam Todd
- School of Pharmacy, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Barbara Hanratty
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
| |
Collapse
|
7
|
Targeting continuity of care and polypharmacy to reduce drug-drug interaction. Sci Rep 2020; 10:21279. [PMID: 33277524 PMCID: PMC7718252 DOI: 10.1038/s41598-020-78236-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Accepted: 11/19/2020] [Indexed: 11/27/2022] Open
Abstract
Drug–drug interaction (DDI) is common among the elderly, and it can have detrimental effects on patients. However, how DDI can be targeted has been under-researched. This study investigates whether DDI can be reduced by targeting continuity of care (COC) through reducing polypharmacy. Population claims data of Taiwan National Health Insurance were used to conduct a 7-year-long longitudinal study on patients aged ≥ 65 years (n = 2,318,766). Mediation analysis with counterfactual method and a 4-way decomposition of the effect of COC on DDI was conducted. Mediation effect through excessive polypharmacy differed from that through lower-level polypharmacy. Compared with the low COC group, the high COC group demonstrated reduced excess relative risk of DDI by 26% (excess relative risk = − 0.263; 95% Confidence Interval (CI) = − 0.263 to − 0.259) to 30% (excess relative risk = − 0.297; 95% CI = − 0.300 to − 0.295) with excessive polypharmacy as the mediator. The risk only reduced by 8% (excess relative risk = − 0.079; 95% CI, − 0.08 to − 0.078) to 10% (excess relative risk = − 0.096; 95% CI, − 0.097 to − 0.095) when the mediator was changed to lower-level polypharmacy. The effect of COC on DDI was mediated by polypharmacy, and the mediation effect was higher with excessive polypharmacy. Therefore, to reduce DDI in the elderly population, different policy interventions should be designed by considering polypharmacy levels to maximize the positive effect of COC on DDI.
Collapse
|
8
|
Bhargava D, Arora M, DeFor TE, Brunstein CG, Thyagarajan B, El Jurdi N, Holtan SG, Rashidi A, Warlick E, Ramesh V, Rogosheske J, Bhatia S, Weisdorf DJ. Use of Potentially Inappropriate Medications in Older Allogeneic Hematopoietic Cell Transplantation Recipients. Biol Blood Marrow Transplant 2020; 26:2329-2334. [PMID: 32919078 PMCID: PMC7683366 DOI: 10.1016/j.bbmt.2020.08.031] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 08/26/2020] [Accepted: 08/29/2020] [Indexed: 01/10/2023]
Abstract
The use of potentially inappropriate medications (PIMs) using Beers criteria and its impact on older allogeneic hematopoietic cell transplantation (HCT) recipients is not known. Here the use of any PIMs and their therapeutic classes in reduced-intensity conditioning allogeneic HCT recipients were compared between older (≥65 years; n = 114) and younger (40 to 64 years; n = 240) patients during their initial HCT admission, defined as the number of days that a patient received 1 or more PIMs between day -14 and day +28. Poisson regression was used to determine rate ratios (RRs) in the 2 groups. In the ≥65 years group, we evaluated the impact of PIMs on Common Terminology Criteria for Adverse Events (CTCAE) grade 3-4 toxicities within 100 days and on overall mortality within 1 year post-HCT. The rate of any PIM use was similar in the older and younger groups (RR, .98; 95% confidence interval [CI], .90 to 1.06; P = .65). In terms of PIM classes, the older group had a 48% higher rate of gastrointestinal (GI) medication use (RR, 1.48; 95% CI, 1.32 to 1.65; P < .01) and a 25% higher rate of genitourinary (GU) medication use (RR, 1.25; 95% CI, 1.02 to 1.53; P = .03). Compared with males, females had a 19% higher rate of central nervous system (CNS) medication use (RR, 1.19; 95% CI, 1.03 to 1.37; P = .02) and a 30% higher rate of benzodiazepine use (RR, 1.30; 95% CI. 1.09 to 1.54; P < .01). A high-risk HCT-CI was associated with a higher rate of use of any PIMs (RR, 1.13; 95% CI, 1.01 to 1.26; P = .02), CNS medications (RR, 1.26; 95% CI, 1.04 to 1.53; P = .02) and GU medications (RR, 1.46; 95% CI, 1.09 to 1.94; P = .01). Compared with matched sibling donor HCT recipients, umbilical cord blood transplantation recipients had higher rates of GI medication use (RR, 1.32; 95% CI, 1.14 to 1.53; P < .01) and anticholinergic medication use (RR, 1.30; 95% CI, 1.06 to 1.61; P = .01). In the ≥65 years group, increasing duration of narcotic use was associated with a 1.3-fold (95% CI, 1.0 to 1.7; P = .05) higher risk of overall mortality and a 1.6-fold (95% CI, 1.02 to 2.69) greater odds of CTCAE grade 3-4 toxicities (P = .04). Our data show that older recipients (≥65 years) were as likely as their younger counterparts to receive PIMs. Among older recipients, the use of PIMs, particularly narcotics, was associated with higher mortality and higher incidence of grade 3-4 toxicities. Identifying and reducing the use of PIMs in older HCT recipients may help decrease the burden of adverse events and associated health care costs.
Collapse
Affiliation(s)
- Divya Bhargava
- Division of Hematology, Oncology and Transplantation, University of Minnesota, Minneapolis, Minnesota
| | - Mukta Arora
- Division of Hematology, Oncology and Transplantation, University of Minnesota, Minneapolis, Minnesota.
| | - Todd E DeFor
- Biostatistics, Clinical and Translational Science Institute, University of Minnesota, Minneapolis, Minnesota
| | - Claudio G Brunstein
- Division of Hematology, Oncology and Transplantation, University of Minnesota, Minneapolis, Minnesota
| | - Bharat Thyagarajan
- Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, Minnesota; Masonic Cancer Center, University of Minnesota, Minneapolis, Minnesota
| | - Najla El Jurdi
- Division of Hematology, Oncology and Transplantation, University of Minnesota, Minneapolis, Minnesota
| | - Shernan G Holtan
- Division of Hematology, Oncology and Transplantation, University of Minnesota, Minneapolis, Minnesota
| | - Armin Rashidi
- Division of Hematology, Oncology and Transplantation, University of Minnesota, Minneapolis, Minnesota
| | - Erica Warlick
- Division of Hematology, Oncology and Transplantation, University of Minnesota, Minneapolis, Minnesota
| | - Vidhyalakshmi Ramesh
- Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, Minnesota; Masonic Cancer Center, University of Minnesota, Minneapolis, Minnesota
| | - John Rogosheske
- Division of Hematology, Oncology and Transplantation, University of Minnesota, Minneapolis, Minnesota
| | - Smita Bhatia
- Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, Birmingham, Alabama
| | - Daniel J Weisdorf
- Division of Hematology, Oncology and Transplantation, University of Minnesota, Minneapolis, Minnesota
| |
Collapse
|
9
|
Schnegg D, Senn N, Bugnon O, Schwarz J, Mueller Y. Drug Prescription in Older Swiss Men and Women Followed in Family Medicine. Drugs Real World Outcomes 2019; 7:87-95. [PMID: 31845213 PMCID: PMC7060976 DOI: 10.1007/s40801-019-00175-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND We sought to estimate the prevalence of polypharmacy, the most prevalent drug classes involved, and the prevalence and type of potentially inappropriate prescribing among older male and female patients in family medicine. METHODS We conducted a secondary analysis of baseline data from a pragmatic cluster-randomised trial on the efficacy of a screening and management tool for geriatric syndromes among older community-dwelling patients (aged ≥ 75 years) included by 42 family physicians. Information on drug prescription and clinical diagnoses (International Classification of Primary Care-2nd Edition [ICPC-2] coded) were extracted manually from medical records. The prevalence of polypharmacy, defined as the use of at least five permanent oral or parenteral drugs, and of potentially inappropriate medications (PIMs), identified according to 2015 updated Beers criteria, were compared between men and women. RESULTS We included 429 patients (269 women and 160 men; mean age 82.9 and 81.8 years, respectively). Polypharmacy was found in 59.9% of them. Analgesics, antithrombotic agents and agents acting on the renin-angiotensin system were the most frequently prescribed drug categories. Three-quarters of patients (76.7%) were prescribed at least one PIM according to Beers criteria, without difference by sex/gender (p = 0.760). The most frequent PIMs were proton-pump inhibitors used for > 8 weeks, diuretics, benzodiazepines, aspirin for primary prevention, and chronic use of non-steroidal anti-inflammatory drugs. Prescription patterns markedly differed by sex/gender, but the number and patterns of inappropriate prescriptions were comparable overall. INTERPRETATION Both polypharmacy and PIMs were very common in older patients followed regularly in family medicine in Switzerland. Interestingly, most PIMs involved only a limited number of medication classes. TRIAL REGISTRATION Clinicaltrials.gov NCT02618291.
Collapse
Affiliation(s)
| | - Nicolas Senn
- Department of Family Medicine/Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
| | - Olivier Bugnon
- Department of Family Medicine/Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
| | - Joëlle Schwarz
- Department of Family Medicine/Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
| | - Yolanda Mueller
- Department of Family Medicine/Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland.
| |
Collapse
|
10
|
Polypharmacy Definitions for Multimorbid Older Adults Need Stronger Foundations to Guide Research, Clinical Practice and Public Health. PHARMACY 2019; 7:pharmacy7030126. [PMID: 31470621 PMCID: PMC6789889 DOI: 10.3390/pharmacy7030126] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Revised: 08/08/2019] [Accepted: 08/23/2019] [Indexed: 12/21/2022] Open
Abstract
There are numerous definitions of polypharmacy to describe the use of many medications among older adults, but there is a need to clarify if they are purposive and meaningful. By means of a systematic review, we identified definitions of polypharmacy used in multimorbid older adults (≥65 years). We evaluated if the definitions align among the domains of research, clinical practice, and public health and appraised whether concepts of polypharmacy are based on strong foundations. More than 46 definitions of polypharmacy were retrieved from 348 publications (research: n = 243; clinical practice: n = 88; public health: n = 17). Several thresholds based on the number of medications were mentioned. The majority of the publications (n = 202, 58%) used a minimal threshold of five medications. Heterogeneous qualitative definitions were identified, mostly stating that polypharmacy is “more drugs than needed”. There was no significant divergence between domains as to the type of definitions used, although qualitative definitions were more common in clinical practice. Nearly half (n = 156, 47%) of the publications provided no justification for the polypharmacy definition used. The wide variety of definitions for polypharmacy precludes comparisons, appropriate identification and management of polypharmacy in multimorbid older adults. Standardized definitions would allow more coherent judgments regarding the individual and collective stakes of polypharmacy.
Collapse
|
11
|
Abstract
Several drugs including diuretics and proton-pump inhibitors can cause magnesium loss and hypomagnesemia. Magnesium and drugs use the same transport and metabolism pathways in the body for their intestinal absorption, metabolism, and elimination. This means that when one or more drug is taken, there is always a potential risk of interaction with the magnesium status. Consequently the action of a drug may be adversely affected by magnesium (e.g., magnesium, calcium, and zinc can interfere with the gastrointestinal absorption of tetracycline antibiotics) and simultaneously the physiological function of minerals such as magnesium may be impaired by a drug (e.g., diuretics induce renal magnesium loss). Given the ever-increasing number of drugs on the market and the frequency with which they are used, greater attention must be paid in daily medical and pharmaceutical practice focused in particular on the adverse effects of drug therapy on magnesium status in order to minimize the potential risk to the health of patients.
Collapse
Affiliation(s)
- Uwe Gröber
- Academy of Micronutrient Medicine, Zweigertstr. 55, 45130 Essen, Germany.
| |
Collapse
|
12
|
Chiapella LC, Montemarani Menna J, Mamprin ME. Assessment of polypharmacy in elderly patients by using data from dispensed medications in community pharmacies: analysis of results by using different methods of estimation. Int J Clin Pharm 2018; 40:987-990. [DOI: 10.1007/s11096-018-0663-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Accepted: 05/17/2018] [Indexed: 10/14/2022]
|
13
|
Abstract
This article reviews the history of the treatment of women's sexual problems from the Victorian era to the twenty-first century. The contextual nature of determining what constitutes female sexual psychopathology is highlighted. Conceptions of normal sexuality are subject to cultural vagaries, making it difficult to identify female sexual dysfunctions. A survey of the inclusion, removal, and collapsing of women's sexual diagnoses in the Diagnostic and Statistical Manual of Mental Disorders from 1952 to 2013 illuminates the biases in the various editions. Masters and Johnson's models of sexual response and dysfunction paved the way for the diagnosis and treatment of women's sexual dysfunctions. Their sex therapy paradigm is described. Conceptions of and treatments for anorgasmia, arousal difficulties, vaginismus, dyspareunia, and low desire are reviewed. The medicalization of human sexuality and the splintering of sex therapy are discussed, along with current trends and new directions in sexual health care for women.
Collapse
Affiliation(s)
- Peggy J. Kleinplatz
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario K1G 5Z3, Canada
- School of Psychology, University of Ottawa, Ottawa, Ontario K1N 6N5, Canada
| |
Collapse
|
14
|
Abstract
Introduction: Older people are at risk for polypharmacy due to multiple chronic diseases. Considering the lack of information in this regard, the aim of this study was to investigate the state of polypharmacy among the elderly in the city of Amirkola in northern part of Iran. Materials and Methods: This descriptive/analytical cross-sectional study is a part of Amirkola Health and Aging Project that was conducted on 1616 individuals aged 60 years and over. The data about medications were gathered through interviews and observation of prescriptions and medications consumed by patients. The data were analyzed by SPSS software version 18, and P ≤ 0.05 was regarded significant. Results: In this study, 1616 individuals including 883 men (54.6%) and 733 women (45.3%) were investigated. The average age of individuals was 69.37 ± 7.42. Among the investigated individuals, 526 including 368 men (41.7%) and 158 women (21.6%) consumed no medications. The prevalence of polypharmacy in this study was 23.1%, which was 32.7% in women and 15.2% in men (odds ratio = 1.51, 95% confidence interval: 1.10–1.93). The most prevalent group of medications used in both genders was cardiovascular drugs. Conclusions: Regarding the considerable prevalence of polypharmacy among the elderly, especially in aged women, serious efforts are required to manage polypharmacy. Provision of educational programs for physicians, personnel of pharmacies, and the staff of health-care centers in order for appropriate and safe consumption of medications in aged people is absolutely necessary.
Collapse
Affiliation(s)
- Seyed Reza Hosseini
- Social Determinants of Health Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran
| | - Ali Zabihi
- Nursing Care Research Center, Babol University of Medical Sciences, Babol, Iran
| | | | - Ali Bijani
- Social Determinants of Health Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran
| |
Collapse
|
15
|
Wolf IK, Du Y, Knopf H. Changes in prevalence of psychotropic drug use and alcohol consumption among the elderly in Germany: results of two National Health Interview and Examination Surveys 1997-99 and 2008-11. BMC Psychiatry 2017; 17:90. [PMID: 28279159 PMCID: PMC5345233 DOI: 10.1186/s12888-017-1254-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2016] [Accepted: 03/04/2017] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Psychotropic drug use and alcohol consumption among older adults need to be monitored over time as their use or combined use bears risks of harms. Representative data on changes in prevalence, patterns and co-relates of substance use are lacking in Germany. METHODS Participants were older adults (60-79 years) from two German National Health Surveys: 1997-99 (GNHIES98, N = 1,606) and 2008-11 (DEGS1, N = 2,501). Included were drugs acting on the nervous system used during the last 7 days. Alcohol consumption was measured by frequency (daily drinking) and quantity (risky drinking: ≥20/10 g/day alcohol for men/women). Changes in prevalence adjusted for potential socio-economic and health-related confounders were calculated by logistic regression models approximated by the SAS LSMEANS statement. RESULTS The prevalence of overall psychotropic drug use (20.5% vs. 21.4%) remained constant between the two surveys. Significant changes were observed in the use of some psychotropics (all GNHIES98 vs. DEGS1): Synthetic antidepressants (3.9% vs. 6.9%), St. John's wort (2.9% vs. 1.1%), benzodiazepines (3.7% vs. 2.5%), benzodiazepine related drugs (0.2% vs. 0.8%), narcotic analgesics (3.0% vs. 4.1%), anti-dementia drugs (2.2% vs. 4.2%) and anti-epileptics (1.0% vs. 2.3%). Significant changes were also observed in long-term use of synthetic anti-depressants (3.2% vs. 5.9%), St. John's wort (2.0% vs. 0.6%) and opioid analgesics (1.0% vs. 2.2%). Further, we found significant changes in benzodiazepines use (3.3% vs. 1.4%) among men, opioids use (2.9% vs. 7.3%) among people with a lower social status, and overall psychotropics (26.8% vs. 32.5%) as well as opioids use (4.4% vs. 8.1%) among those with a worse health status. Moderate alcohol consumption increased significantly (58.0% vs. 66.9%). Risky drinking remained unchanged (16.6% vs. 17.0%). In spite of significant increases in daily alcohol drinking (13.2% vs. 18.4%) psychotropic drug use combined with daily drinking remained unchanged (1.8% vs. 2.7%). CONCLUSIONS Although prevalence of overall psychotropic drug use remained stable, changes in the use of some psychotropic drug groups and alcohol consumption patterns have been observed. Further studies are required to investigate resulting health consequences and public health relevance of those outcomes.
Collapse
Affiliation(s)
- Ingrid-Katharina Wolf
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, General-Pape-Str. 64-66, D-12101, Berlin, Germany.
| | - Yong Du
- 0000 0001 0940 3744grid.13652.33Department of Epidemiology and Health Monitoring, Robert Koch Institute, General-Pape-Str. 64-66, D-12101 Berlin, Germany
| | - Hildtraud Knopf
- 0000 0001 0940 3744grid.13652.33Department of Epidemiology and Health Monitoring, Robert Koch Institute, General-Pape-Str. 64-66, D-12101 Berlin, Germany
| |
Collapse
|
16
|
Geschlechterunterschiede in der Pharmakotherapie. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2014; 57:1067-73. [DOI: 10.1007/s00103-014-2012-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
|
17
|
Skoog J, Midlöv P, Borgquist L, Sundquist J, Halling A. Can gender difference in prescription drug use be explained by gender-related morbidity?: a study on a Swedish population during 2006. BMC Public Health 2014; 14:329. [PMID: 24713023 PMCID: PMC3983669 DOI: 10.1186/1471-2458-14-329] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2013] [Accepted: 04/01/2014] [Indexed: 11/10/2022] Open
Abstract
Background It has been reported that there is a difference in drug prescription between males and females. Even after adjustment for multi-morbidity, females tend to use more prescription drugs compared to males. In this study, we wanted to analyse whether the gender difference in drug treatment could be explained by gender-related morbidity. Methods Data was collected on all individuals 20 years and older in the county of Östergötland in Sweden. The Johns Hopkins ACG Case-Mix System was used to calculate individual level of multi-morbidity. A report from the Swedish National Institute of Public Health using the WHO term DALY was the basis for gender-related morbidity. Prescription drugs used to treat diseases that mainly affect females were excluded from the analyses. Results The odds of having prescription drugs for males, compared to females, increased from 0.45 (95% confidence interval (CI) 0.44-0.46) to 0.82 (95% CI 0.81-0.83) after exclusion of prescription drugs that are used to treat diseases that mainly affect females. Conclusion Gender-related morbidity and the use of anti-conception drugs may explain a large part of the difference in prescription drug use between males and females but still there remains a difference between the genders at 18%. This implicates that it is of importance to take the gender-related morbidity into consideration, and to exclude anti-conception drugs, when performing studies regarding difference in drug use between the genders.
Collapse
Affiliation(s)
- Jessica Skoog
- Department of Clinical Sciences in Malmö, Center for Primary Health Care Research, Lund University, SE-205 02 Malmö, Sweden.
| | | | | | | | | |
Collapse
|
18
|
Factors associated with potentially inappropriate medications use by the elderly according to Beers criteria 2003 and 2012. Int J Clin Pharm 2013; 36:316-24. [DOI: 10.1007/s11096-013-9880-y] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2013] [Accepted: 11/07/2013] [Indexed: 10/26/2022]
|
19
|
Kunath F, Keck B, Bertz S, Brookman-May S, May M, Vergho D, Hartmann A, Riedmiller H, Wullich B, Burger M. Is gender becoming relevant in uro-oncological research? A bibliographical analysis. World J Urol 2013; 31:1065-72. [PMID: 23568444 DOI: 10.1007/s00345-013-1069-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2012] [Accepted: 03/27/2013] [Indexed: 12/11/2022] Open
Abstract
INTRODUCTION Gender differences are increasingly recognized as important in numerous diseases and found to be relevant in various cancer entities. While a larger number of manuscripts on gender effects in gastro-intestinal and pulmonary neoplasms have been published, urological malignancies involving men and women alike seem less studied in this regard. The present analysis aimed at describing the role of gender effects in general oncological and uro-oncological research and is the first such bibliometrical analysis. METHODS The electronic database MEDLINE was searched for relevant medical subject headings from January 1991 to December 2011. Publication types, publishing journal and impact factors were identified. Trends were assessed by linear regression. RESULTS The numbers of annual publications on all major tumour entities and on urological malignancies increased similarly. While the portion of publications on gender effects was below 1 % for each tumour entity, the annual increase of novel publications on gender effects was significant in most and prominent in pulmonary (1.87, 95 % CI 1.11-2.63; <0.0001) and colorectal neoplasms (2.16, 95 % CI 1.49-2.82; <0.0001). While the annual increase of novel publications on gender effects was significant in bladder cancer (0.33, 95 % CI 0.11-0.54; 0.005), it failed level of significance in renal cell cancer (0.25, 95 % CI -0.19-0.24; 0.82). CONCLUSION While the overall role of gender effect seems small in general oncological research, it is increasing steadily. In uro-oncological research, such trend is also visible in bladder but not in renal cell cancer. Respective awareness on importance of gender effects should be raised.
Collapse
Affiliation(s)
- Frank Kunath
- Department of Urology, University of Erlangen, Erlangen, Germany
| | | | | | | | | | | | | | | | | | | |
Collapse
|