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Lin CL, Su MC, Kao CH, Lin CL, Yang TY. Estimating the incidence rate ratio of common cold among patients with non-apnea sleep disorders: a retrospective cohort study. PSYCHOL HEALTH MED 2023; 28:2897-2907. [PMID: 35282723 DOI: 10.1080/13548506.2022.2050269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Accepted: 03/01/2022] [Indexed: 10/18/2022]
Abstract
The purpose was to explore the potential effects of nonapnea sleep disorders (NSDs) and hypnotic use on the incidence of common cold. This study adapted population-based retrospective cohort study designed. We used the data from the Taiwan National Health Insurance Research Database between 1998 and 2011. In total, 59,476 patients with NSDs were included in the study cohort, and the reference cohort comprised 59,476 propensity score-matched patients. We conducted a Poisson regression analysis to assess the incidence of common cold. The overall incidence of common cold was significantly higher than that in the reference cohort. Compared with the patients of the reference cohort without hypnotic use, those of the NSDs cohort with benzodiazepines and zolpidem use had higher incidence of common cold. In conclusion, study cohort had a higher incidence of developing common cold, and particularly pronounced in NSDs with hypnotic use.
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Affiliation(s)
- Chia-Ling Lin
- Department of Nursing, Chang Gung University of Science and Technology, Taoyuan, Taiwan
| | - Mei-Chen Su
- Department of Nursing, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan
| | - Chia-Hung Kao
- Department of Medicine, China Medical University, Taichung, Taiwan
| | - Cheng-Li Lin
- Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan
| | - Tse-Yen Yang
- Department of Medical Research, China Medical University Hospital, Taichung, Taiwan
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Yang TC, Shoff C, Kim S, Shaw BA. County social isolation and opioid use disorder among older adults: A longitudinal analysis of Medicare data, 2013-2018. Soc Sci Med 2022; 301:114971. [PMID: 35430465 DOI: 10.1016/j.socscimed.2022.114971] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2021] [Revised: 03/12/2022] [Accepted: 04/07/2022] [Indexed: 01/03/2023]
Abstract
This study aims to fill three knowledge gaps: (1) unclear role of ecological factors in shaping older adults' risk of opioid use disorder (OUD), (2) a lack of longitudinal perspective in OUD research among older adults, and (3) underexplored racial/ethnic differences in the determinants of OUD in older populations. This study estimates the effects of county-level social isolation, concentrated disadvantage, and income inequality on older adults' risk of OUD using longitudinal data analysis. We merged the 2013-2018 Medicare population (aged 65+) data to the American Community Survey 5-year county-level estimates to create a person-year dataset (N = 47,291,217 person-years) and used conditional logit fixed-effects modeling to test whether changes in individual- and county-level covariates alter older adults' risk of OUD. Moreover, we conducted race/ethnicity-specific models to compare how these associations vary across racial/ethnic groups. At the county-level, a one-unit increase in social isolation (mean = -0.197, SD = 0.511) increased the risk of OUD by 5.5 percent (OR = 1.055; 95% CI = [1.018, 1.094]) and a one-percentage-point increase in the working population employed in primary industry decreases the risk of OUD by 1 percent (OR = 0.990; 95% CI = [0.985, 0.996]). At the individual-level, increases in the Medicare Hierarchical Condition Categories risk score, physical comorbidity, and mental comorbidity all elevate the risk of OUD. The relationship between county-level social isolation and OUD is driven by non-Hispanic whites, while Hispanic beneficiaries are less sensitive to the changes in county-level factors than any other racial ethnic groups. Between 2013 and 2018, US older adults' risk of OUD was associated with both ecological and individual factors, which carries implications for intervention. Further research is needed to understand why associations of individual factors with OUD are comparable across racial/ethnic groups, but county-level social isolation is only associated with OUD among non-Hispanic white beneficiaries.
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Affiliation(s)
- Tse-Chuan Yang
- Department of Preventive Medicine and Population Health, University of Texas Medical Branch, Galveston, TX, USA.
| | | | - Seulki Kim
- Department of Sociology, University at Albany, State University of New York, Albany, NY, USA
| | - Benjamin A Shaw
- Division of Community Health Sciences, University of Illinois Chicago, Chicago, IL, USA
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Freire MDBO, Da Silva BGC, Bertoldi AD, Fontanella AT, Mengue SS, Ramos LR, Tavares NUL, Pizzol TDSD, Arrais PSD, Farias MR, Luiza VL, Oliveira MA, Menezes AMB. Benzodiazepines utilization in Brazilian older adults: a population-based study. Rev Saude Publica 2022; 56:10. [PMID: 35319670 PMCID: PMC8926397 DOI: 10.11606/s1518-8787.2022056003740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 06/04/2021] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVE To evaluate the utilization of benzodiazepines (BZD) in Brazilian older adults, based on the Pesquisa Nacional de Acesso, Utilização e Promoção do Uso Racional de Medicamentos (PNAUM - National Survey of Access, Use and Promotion of Rational Use of Medicines). METHODS The PNAUM is a cross-sectional study conducted between 2013 and 2014, representing the Brazilian urban population. In the present study, we included 60 years or older (n = 9,019) individuals. We calculated the prevalence of BZD utilization in the 15 days prior to survey data collection according to independent variables, using a hierarchical Poisson regression model. A semistructured interview performed empirical data collection (household interview). RESULTS The prevalence of BZD utilization in the older adults was 9.3% (95%CI: 8.3-10.4). After adjustments, BZD utilization was associated with female sex (PR = 1.88; 95%CI: 1.52-2.32), depression (PR = 5.31; 95%CI: 4.41-6, 38), multimorbidity (PR = 1.44; 95%CI: 1.20-1.73), emergency room visit or hospitalization in the last 12 months (PR = 1.42; 95%CI: 1.18-1.70 ), polypharmacy (PR = 1.26; 95%CI: 1.01-1.57) and poor or very poor self-rated health (PR = 4.16; 95%CI: 2.10-8.22). Utilization was lower in the North region (PR = 0.18; 95%CI: 0.13-0.27) and in individuals who reported abusive alcohol consumption in the last month (PR = 0.42; 95%CI: 0.19-0.94). CONCLUSION Despite contraindications, results showed a high prevalence of BZD utilization in older adults, particularly in those with depression, and wide regional and sex differences.
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Affiliation(s)
- Marina de Borba Oliveira Freire
- Universidade Federal de PelotasFaculdade de MedicinaPrograma de Pós-Graduação em EpidemiologiaPelotasRSBrasil Universidade Federal de Pelotas . Faculdade de Medicina . Programa de Pós-Graduação em Epidemiologia . Pelotas , RS , Brasil
| | - Bruna Gonçalves Cordeiro Da Silva
- Universidade Federal de PelotasFaculdade de MedicinaDepartamento de Medicina SocialPelotasRSBrasil Universidade Federal de Pelotas . Faculdade de Medicina . Departamento de Medicina Social . Pelotas , RS , Brasil
| | - Andréa Dâmaso Bertoldi
- Universidade Federal de PelotasFaculdade de MedicinaDepartamento de Medicina SocialPelotasRSBrasil Universidade Federal de Pelotas . Faculdade de Medicina . Departamento de Medicina Social . Pelotas , RS , Brasil
| | - Andréia Turmina Fontanella
- Universidade Federal do Rio Grande do SulFaculdade de MedicinaPrograma de Pós-Graduação em EpidemiologiaPorto AlegreRSBrasil Universidade Federal do Rio Grande do Sul . Faculdade de Medicina . Programa de Pós-Graduação em Epidemiologia . Porto Alegre , RS , Brasil
| | - Sotero Serrate Mengue
- Universidade Federal do Rio Grande do SulFaculdade de MedicinaPrograma de Pós-Graduação em EpidemiologiaPorto AlegreRSBrasil Universidade Federal do Rio Grande do Sul . Faculdade de Medicina . Programa de Pós-Graduação em Epidemiologia . Porto Alegre , RS , Brasil
| | - Luiz Roberto Ramos
- Universidade Federal de São PauloEscola Paulista de MedicinaDepartamento de Medicina PreventivaSão PauloSPBrasil Universidade Federal de São Paulo . Escola Paulista de Medicina . Departamento de Medicina Preventiva . São Paulo , SP , Brasil
| | - Noemia Urruth Leão Tavares
- Universidade de BrasíliaFaculdade de Ciências da SaúdeDepartamento de FarmáciaBrasíliaDFBrasil Universidade de Brasília . Faculdade de Ciências da Saúde . Departamento de Farmácia . Brasília , DF , Brasil
| | - Tatiane da Silva Dal Pizzol
- Universidade Federal do Rio Grande do SulFaculdade de FarmáciaDepartamento de Produção e Controle de MedicamentosPorto AlegreRSBrasil Universidade Federal do Rio Grande do Sul . Faculdade de Farmácia . Departamento de Produção e Controle de Medicamentos . Porto Alegre , RS , Brasil
| | - Paulo Sérgio Dourado Arrais
- Universidade Federal do CearáFaculdade de Farmácia, Odontologia e EnfermagemDepartamento de FarmáciaFortalezaCEBrasil Universidade Federal do Ceará . Faculdade de Farmácia, Odontologia e Enfermagem . Departamento de Farmácia . Fortaleza , CE , Brasil
| | - Mareni Rocha Farias
- Universidade Federal de Santa CatarinaCentro de Ciências da SaúdeDepartamento de Ciências FarmacêuticasFlorianópolisSCBrasil Universidade Federal de Santa Catarina . Centro de Ciências da Saúde . Departamento de Ciências Farmacêuticas . Florianópolis , SC , Brasil
| | - Vera Lucia Luiza
- Fundação Oswaldo CruzEscola Nacional de Saúde Pública Sergio AroucaDepartamento de Política de Medicamentos e Assistência FarmacêuticaRio de JaneiroRJBrasil Fundação Oswaldo Cruz . Escola Nacional de Saúde Pública Sergio Arouca . Departamento de Política de Medicamentos e Assistência Farmacêutica . Rio de Janeiro , RJ , Brasil
| | - Maria Auxiliadora Oliveira
- Fundação Oswaldo CruzEscola Nacional de Saúde Pública Sergio AroucaDepartamento de Política de Medicamentos e Assistência FarmacêuticaRio de JaneiroRJBrasil Fundação Oswaldo Cruz . Escola Nacional de Saúde Pública Sergio Arouca . Departamento de Política de Medicamentos e Assistência Farmacêutica . Rio de Janeiro , RJ , Brasil
| | - Ana Maria Baptista Menezes
- Universidade Federal de PelotasFaculdade de MedicinaDepartamento de Medicina SocialPelotasRSBrasil Universidade Federal de Pelotas . Faculdade de Medicina . Departamento de Medicina Social . Pelotas , RS , Brasil
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Liu Z, Yang C. The impact of sleep medications on physical activity among diabetic older adults. Geriatr Nurs 2020; 41:400-405. [DOI: 10.1016/j.gerinurse.2019.12.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Revised: 12/13/2019] [Accepted: 12/14/2019] [Indexed: 01/01/2023]
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An JH, Park MJ, Fava M, Mischoulon D, Kim H, Jang J, Hong JP, Park JS, Jeon HJ. Comparisons Between Successful Versus Unsuccessful Switches From Benzodiazepines or Zolpidem (Z-Drug) to Controlled-Release Melatonin in Patients With Major Depressive Disorder and Insomnia. Front Psychiatry 2020; 11:444. [PMID: 32508689 PMCID: PMC7248372 DOI: 10.3389/fpsyt.2020.00444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Accepted: 05/01/2020] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVES Chronic use of benzodiazepines and zolpidem (BDZ/Z-drugs) leads to dependency, cognitive impairment, and falls. Although controlled-release melatonin (Melatonin CR) may be an alternative, a switch in clinical settings has proven difficult. We investigated the factors associated with successful switch to Melatonin CR in patients with major depressive disorder (MDD) and insomnia. METHODS This retrospective observational study involved 170 patients diagnosed with MDD and insomnia, and aged older than 55 years, who were treated with BDZ/Z-drug for at least the past 90 days and never before exposed to Melatonin CR. All patients were treated with a standard antidepressant therapy and Melatonin CR for their insomnia. A successful switch was defined as three or more consecutive prescriptions of Melatonin CR separated by at least one-month interval, after discontinuation of the BDZ/Z-drug. RESULTS Seventy-nine patients (46.5%) who switched successfully showed no significant differences in sex, age, education, and occupational status compared with the unsuccessful group. The types of antidepressants used or BDZ/Z-drug treatment did not differ significantly between the two groups. Fewer somatic symptoms were observed in the successful group. In the multivariate analysis, the successful group showed significantly less somatic anxiety, shorter duration from first BDZ/Z-drug use to the first antidepressant use, and shorter total duration of BDZ/Z-drug therapy. CONCLUSIONS A successful switch from BDZ/Z-drug to Melatonin CR was associated with less baseline somatic anxiety, earlier use of antidepressants, and shorter total duration of BDZ/Z-drug use, but was less strongly associated with the type of antidepressants in MDD patients with insomnia.
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Affiliation(s)
- Ji Hyun An
- Department of Psychiatry, Depression Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Mi Jin Park
- Department of Psychiatry, Depression Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Maurizio Fava
- Depression Clinical and Research Program, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - David Mischoulon
- Depression Clinical and Research Program, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Hyewon Kim
- Department of Psychiatry, Depression Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Jihoon Jang
- Department of Psychiatry, Depression Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Jin Pyo Hong
- Department of Psychiatry, Depression Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Jun Sang Park
- Department of Medicine, Ajou University School of Medicine, Suwon, South Korea
| | - Hong Jin Jeon
- Department of Psychiatry, Depression Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
- Department of Health Sciences & Technology, Samsung Advanced Institute for Health Sciences & Technology (SAIHST), Sungkyunkwan University, Seoul, South Korea
- Department of Medical Device Management & Research, Samsung Advanced Institute for Health Sciences & Technology (SAIHST), Sungkyunkwan University, Seoul, South Korea
- Department of Clinical Research Design & Evaluation, Samsung Advanced Institute for Health Sciences & Technology (SAIHST), Sungkyunkwan University, Seoul, South Korea
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Papastergiou J, Luen M, Tencaliuc S, Li W, van den Bemt B, Houle S. Medication management issues identified during home medication reviews for ambulatory community pharmacy patients. Can Pharm J (Ott) 2019; 152:334-342. [PMID: 31534588 DOI: 10.1177/1715163519861420] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Background The health risks associated with poor medication practices in the home suggest that patients would benefit from home-based medication reviews that could detect and resolve these issues. However, remuneration for home visits often excludes ambulatory, nonhomebound patients. A subset of these patients have issues that cannot be adequately identified and resolved during the course of a typical pharmacy-based medication review. Purpose This study aims to characterize the prevalence and nature of "hidden in the home" medication management issues in nonhomebound patients. Methods Pharmacists facilitated subject enrollment among patients at 6 community pharmacies in Toronto over a 15-month period, from January 2016 to March 2017. Patients taking 5 or more chronic medications who were ambulatory (able to visit the pharmacy) and scored 3 points or higher on a prescreening questionnaire were invited to participate. Visits included a standard medication review, the identification of drug therapy problems and an assessment of the patient's medication and organization/storage practices, followed by a medication cabinet cleanup. Results One hundred patients were recruited, with a mean age of 76.9 years and taking on average 10 chronic medications. Pharmacists identified a total of 275 drug therapy problems (2.75 per patient). The most common issues reported additional therapy required (23.6%), nonadherence (23.3%) and adverse drug reactions (17.8%). For those patients 65 years or older (87%), 32% were found to be using at least 1 medication on the Beers Criteria list, while 6% were using 3 or more. Sulfonylureas, non-steroidal anti-inflammatory drugs and short-acting benzodiazepines were the most commonly implicated drugs. Medications were removed from the homes of 67% of the patients, with expiry of medication being the most common reason for removal (54.2%). The mean duration of a home visit was 49.5 minutes. Conclusion Pharmacist-directed home medication reviews offer an effective mechanism to address the pharmacotherapy issues of patients taking multiple medications. These findings highlight the frequency of medication management issues in this group and suggest that home medication reviews could serve to minimize inappropriate use of medication and maximize health care cost savings in this unique patient population. Can Pharm J (Ott) 2019;152:xx-xx.
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Affiliation(s)
- John Papastergiou
- Shoppers Drug Mart (Papastergiou, Tencaliuc, Li), Toronto.,Leslie Dan Faculty of Pharmacy (Papastergiou, Luen), University of Toronto, Toronto, Ontario.,Sint Maartenskliniek (van den Bemt), Nijmegen, the Netherlands.,School of Pharmacy (Papastergiou, Houle), University of Waterloo, Waterloo, Ontario
| | - Mathew Luen
- Shoppers Drug Mart (Papastergiou, Tencaliuc, Li), Toronto.,Leslie Dan Faculty of Pharmacy (Papastergiou, Luen), University of Toronto, Toronto, Ontario.,Sint Maartenskliniek (van den Bemt), Nijmegen, the Netherlands.,School of Pharmacy (Papastergiou, Houle), University of Waterloo, Waterloo, Ontario
| | - Simona Tencaliuc
- Shoppers Drug Mart (Papastergiou, Tencaliuc, Li), Toronto.,Leslie Dan Faculty of Pharmacy (Papastergiou, Luen), University of Toronto, Toronto, Ontario.,Sint Maartenskliniek (van den Bemt), Nijmegen, the Netherlands.,School of Pharmacy (Papastergiou, Houle), University of Waterloo, Waterloo, Ontario
| | - Wilson Li
- Shoppers Drug Mart (Papastergiou, Tencaliuc, Li), Toronto.,Leslie Dan Faculty of Pharmacy (Papastergiou, Luen), University of Toronto, Toronto, Ontario.,Sint Maartenskliniek (van den Bemt), Nijmegen, the Netherlands.,School of Pharmacy (Papastergiou, Houle), University of Waterloo, Waterloo, Ontario
| | - Bart van den Bemt
- Shoppers Drug Mart (Papastergiou, Tencaliuc, Li), Toronto.,Leslie Dan Faculty of Pharmacy (Papastergiou, Luen), University of Toronto, Toronto, Ontario.,Sint Maartenskliniek (van den Bemt), Nijmegen, the Netherlands.,School of Pharmacy (Papastergiou, Houle), University of Waterloo, Waterloo, Ontario
| | - Sherilyn Houle
- Shoppers Drug Mart (Papastergiou, Tencaliuc, Li), Toronto.,Leslie Dan Faculty of Pharmacy (Papastergiou, Luen), University of Toronto, Toronto, Ontario.,Sint Maartenskliniek (van den Bemt), Nijmegen, the Netherlands.,School of Pharmacy (Papastergiou, Houle), University of Waterloo, Waterloo, Ontario
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Falci DM, Mambrini JVDM, Castro-Costa É, Firmo JOA, Lima-Costa MF, de Loyola AI. Use of psychoactive drugs predicts functional disability among older adults. Rev Saude Publica 2019; 53:21. [PMID: 30726502 PMCID: PMC6390663 DOI: 10.11606/s1518-8787.2019053000675] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Accepted: 03/29/2018] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE Investigate whether the use of psychoactive drugs would be a predictor of incidence of functional disability among seniors living in community. METHODS It is a population-based longitudinal study, developed between January 1, 1997 and December 31, 2011, with older adults living in community. The association between the use of psychoactive drugs and the development of functional disability for instrumental (IADLs) and basic (BADLs) activities of daily living was tested using the extended Cox proportional hazards model, which considers the measure of exposure of interest throughout the follow-up period. The analyses were stratified by sex and adjusted by sociodemographic characteristics, health behavior and health conditions. RESULTS After multivariate adjustment, the use of two or more psychoactive drugs in the female stratum was associated with disability for both IADLs (HR = 1.58; 95%CI 1.17-2.13) and BADLs (HR = 1.43; 95%CI 1.05-1.94), the use of benzodiazepines was associated with disability for IADLs (HR = 1.32; 95%CI 1.07-1.62), and the use of antidepressants was associated with disability for both IADLs (HR = 1.51; 95%CI 1.16-1.98) and BADLs (HR = 1.44; 95%CI 1.10-1.90). In the male stratum, the use of antipsychotics was associated with disability for IADLs (HR = 3.14; 95%CI 1.49-6.59). CONCLUSIONS The study showed a prospective association between the use of psychoactive drugs and functional disability. These results indicate the need to carefully assess the prescription of psychoactive drugs for older adults and monitor their usage in order to detect damages to the health of users.
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Affiliation(s)
- Denise Mourão Falci
- Instituto René Rachou. Fundação Oswaldo Cruz. Programa de Pós-Graduação em Saúde Coletiva. Belo Horizonte, MG, Brasil
| | - Juliana Vaz de Melo Mambrini
- Instituto René Rachou. Fundação Oswaldo Cruz. Programa de Pós-Graduação em Saúde Coletiva. Belo Horizonte, MG, Brasil
- Instituto René Rachou. Fundação Oswaldo Cruz. Núcleo de Estudos em Envelhecimento e Saúde Pública. Belo Horizonte, MG, Brasil
| | - Érico Castro-Costa
- Instituto René Rachou. Fundação Oswaldo Cruz. Núcleo de Estudos em Envelhecimento e Saúde Pública. Belo Horizonte, MG, Brasil
| | - Josélia Oliveira Araújo Firmo
- Instituto René Rachou. Fundação Oswaldo Cruz. Programa de Pós-Graduação em Saúde Coletiva. Belo Horizonte, MG, Brasil
- Instituto René Rachou. Fundação Oswaldo Cruz. Núcleo de Estudos em Envelhecimento e Saúde Pública. Belo Horizonte, MG, Brasil
| | - Maria Fernanda Lima-Costa
- Instituto René Rachou. Fundação Oswaldo Cruz. Programa de Pós-Graduação em Saúde Coletiva. Belo Horizonte, MG, Brasil
- Instituto René Rachou. Fundação Oswaldo Cruz. Núcleo de Estudos em Envelhecimento e Saúde Pública. Belo Horizonte, MG, Brasil
| | - Antônio Ignácio de Loyola
- Instituto René Rachou. Fundação Oswaldo Cruz. Programa de Pós-Graduação em Saúde Coletiva. Belo Horizonte, MG, Brasil
- Instituto René Rachou. Fundação Oswaldo Cruz. Núcleo de Estudos em Envelhecimento e Saúde Pública. Belo Horizonte, MG, Brasil
- Universidade Federal de Minas Gerais. Escola de Enfermagem. Departamento de Enfermagem Aplicada. Belo Horizonte, MG, Brasil
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Overdosing of benzodiazepines/Z-drugs and falls in older adults: Costs for the health system. Exp Gerontol 2018; 110:42-45. [DOI: 10.1016/j.exger.2018.05.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Revised: 04/30/2018] [Accepted: 05/03/2018] [Indexed: 02/01/2023]
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9
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Picton JD, Marino AB, Nealy KL. Benzodiazepine use and cognitive decline in the elderly. Am J Health Syst Pharm 2018; 75:e6-e12. [DOI: 10.2146/ajhp160381] [Citation(s) in RCA: 104] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Affiliation(s)
| | | | - Kimberly Lovin Nealy
- Cabarrus Family Medicine—Prosperity Crossing, Charlotte, NC
- Wingate University School of Pharmacy, Wingate, NC
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10
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Long-term use of antipsychotics in community-dwelling dementia patients: prevalence and profile accounting for unobservable time bias because of hospitalization. Int Clin Psychopharmacol 2017; 32:13-19. [PMID: 27741029 DOI: 10.1097/yic.0000000000000150] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The aim of this study was to assess the prevalence of long-term antipsychotic (AP) use in community-dwelling patients with dementia considering hospitalization periods as AP exposure or not. A retrospective study was carried out from 2009 to 2012 on a PACA-Alzheimer cohort (which included 31 963 patients in 2009 and 36 442 in 2012 from 5 million inhabitants). Three groups of patients were identified according to the longest exposure to APs without interruption: nonusers, short-term users (≤3 successive months without discontinuation), and long-term users. Sensitivity analyses on hospitalization periods were carried out. The percentage of patients with at least one AP dispensing was stable over the study period (25.6% in 2009 vs. 26.5% in 2012). In 2012, 27.6% were AP long-term users. This increased to 46.7% when hospitalization periods were counted as AP exposure. In comparison with nonusers, AP users took more benzodiazepines and antidepressants. Short-term users were men [odds ratio (OR)=1.2, 95% confidence interval (CI) (1.1-1.3)] older than 85 years old [OR=1.2, 95% CI (1.1-1.2)]. Long-term users were more exposed to benzodiazepines [OR=1.2, 95% CI (1.1-1.4)]. This study showed that long-term use of AP remained frequent in community-dwelling patients with dementia. It also showed that the prevalence of long-term users almost doubled when hospitalization periods were counted as AP exposure. This underlines the need to consider hospitalization periods when assessing medication exposure in populations with frequent periods of hospitalization.
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Maree RD, Marcum ZA, Saghafi E, Weiner DK, Karp JF. A Systematic Review of Opioid and Benzodiazepine Misuse in Older Adults. Am J Geriatr Psychiatry 2016; 24:949-963. [PMID: 27567185 PMCID: PMC5069126 DOI: 10.1016/j.jagp.2016.06.003] [Citation(s) in RCA: 81] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2016] [Revised: 04/28/2016] [Accepted: 06/01/2016] [Indexed: 01/09/2023]
Abstract
OBJECTIVE The authors assessed the prevalence of opioid and benzodiazepine prescription drug misuse in older adults, the risk factors associated with misuse, and age-appropriate interventions. METHODS Following PRISMA guidelines, a literature search of PubMed, PsycINFO, and EMBASE for peer-reviewed journal articles in English through April 2014 with updates through November 2015 was conducted for reports on misuse of prescription benzodiazepines and opioids in older adults. Relevant publications were reviewed that included participants age ≥65 years. Reference lists were manually searched for key identified articles and geriatric journals through April 2016. Information on the study design, sample, intervention, comparators, outcome, time frame, and risk of bias were abstracted for each article. RESULTS Of 4,932 reviewed reports, 15 were included in this systematic review. Thirteen studies assessed the prevalence of prescription drug misuse and included studies related to opioid shopping behavior, assessment of morbidity and mortality associated with opioid and/or benzodiazepine use, frequency and characteristics of opioid prescribing, frequency of substance use disorders and nonprescription use of pain relievers, and health conditions and experiences of long-term benzodiazepine users. One study identified risk factors for misuse, and one study described the effects of provider education and an electronic support tool as an intervention. CONCLUSION There is a dearth of high quality research on prescription drug misuse in older adults. Existing studies are heterogeneous, making it difficult to draw broad conclusions. The need for further research specific to prescription drug misuse among older adults is discussed.
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Affiliation(s)
- RD Maree
- Department of Psychiatry, University of Pittsburgh School of Medicine
| | - ZA Marcum
- School of Pharmacy, University of Washington
| | - E Saghafi
- Department of Information Science, University of Pittsburgh School of Medicine
| | - DK Weiner
- Department of Psychiatry, University of Pittsburgh School of Medicine,Department of Anesthesiology, University of Pittsburgh School of Medicine,Department of Medicine, University of Pittsburgh School of Medicine,Geriatric Research, Education & Clinical Center, VA Pittsburgh Healthcare System
| | - JF Karp
- Department of Psychiatry, University of Pittsburgh School of Medicine,Department of Anesthesiology, University of Pittsburgh School of Medicine,Geriatric Research, Education & Clinical Center, VA Pittsburgh Healthcare System
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Depression and Depression Treatment in a Population-Based Study of Individuals Over 60 Years Old Without Dementia. Am J Geriatr Psychiatry 2016; 24:615-623. [PMID: 27297634 DOI: 10.1016/j.jagp.2016.03.009] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2015] [Revised: 03/15/2016] [Accepted: 03/22/2016] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To estimate the prevalence of depression in a population-based sample of older adults, and to identify the individual profile of people who received depression treatment. DESIGN Cross-sectional. SETTING Central area (Kungsholmen) in Stockholm, Sweden. PARTICIPANTS A randomized population-based sample of individuals aged 60 years and older (N = 3,084) without dementia from the Swedish National Study of Aging and Care in Kungsholmen examined between 2001 and 2004. MEASUREMENTS Experienced physicians carried out a semi-structured psychiatric examination including the Comprehensive Psychopathological Rating Scale. Depression was diagnosed according to DSM-IV-TR and DSM-5 criteria. Information regarding drug treatment and psychotherapy was collected during the examination and is based on self-report. RESULTS The prevalence of depression was 5.9% (major depression: 0.8%, minor depression: 5.1%). In the total sample, 8.3% were prescribed an antidepressant and 0.9% were treated with psychotherapy. Among individuals with depression, fewer than one-third received treatment with psychotherapy or antidepressants, but almost half were prescribed anxiolytic or hypnotic drugs. Individuals with self-reported depression and anxiety were more likely to receive depression treatment whereas individuals with depression who reported insomnia were less likely to receive depression treatment. CONCLUSIONS Our findings indicate that even in a central urban area of a country with an advanced healthcare system depression in old age is often unrecognized and untreated. In addition, almost half of those with depression received potentially inappropriate drug treatment with anxiolytics or hypnotics.
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Kamell A, Smith LK. Attitudes Toward Use of Benzodiazepines among U.S. Hospice Clinicians: Survey and Review of the Literature. J Palliat Med 2016; 19:516-22. [PMID: 27002463 DOI: 10.1089/jpm.2015.0376] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Benzodiazepines are commonly used in inpatient hospices internationally. U.S. hospice clinician views toward benzodiazepines are unknown. OBJECTIVES Study objectives were (1) to assess inpatient hospice clinician attitudes towards the benefits of benzodiazepines for various indications and (2) to compare these attitudes to current clinical recommendations and literature. METHODS A survey was developed and distributed to hospices with inpatient units nationwide. Results were analyzed, then compared to current clinical guidelines. Literature review was performed. U.S. hospice physicians and nurses were the study subjects. Participants were asked to indicate their level of agreement regarding benefit from benzodiazepines for various end-of-life symptoms and to answer questions regarding benzodiazepines in delirium. RESULTS Of 143 surveys returned, 128 surveys were completed. For anxiety, 80% of participants agreed that benzodiazepines were beneficial for restlessness, dyspnea 77%, insomnia 68%, dying process 65%, agitation 57%, nausea 54%, hyperactive delirium 42%, and severe pain 38%. Nurses found benzodiazepines beneficial for more indications than physicians. Over 50% reported benzodiazepines on their order sets for agitation, insomnia, acute anxiety, chronic anxiety, chronic panic, restlessness, seizures, and withdrawal. Among physicians, 39% believe that benzodiazepines are overused within their own hospice. A literature review found very limited evidence of overall benefit from benzodiazepines for the symptoms listed above. In addition, this revealed significant evidence for risks and harms from benzodiazepines, particularly in patients at risk for delirium. CONCLUSIONS Benzodiazepines are viewed favorably by most hospice nurses and many hospice physicians for various indications, despite little supportive clinical evidence along with significant potential for harm.
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