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Moore LC, Woodruff NA, Seal KH, Feinberg T, Purcell N. Natural Product Use Among Veterans with Chronic Pain: A Qualitative Study of Attitudes and Communication with Healthcare Providers. J Gen Intern Med 2024:10.1007/s11606-024-08746-2. [PMID: 38689119 DOI: 10.1007/s11606-024-08746-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 03/27/2024] [Indexed: 05/02/2024]
Abstract
BACKGROUND Despite mixed evidence regarding the safety and efficacy of natural products, many are marketed for pain and related symptoms. Use of these products is prevalent among veterans, who have disproportionately high rates of chronic pain. To date, however, there is limited research on veterans' beliefs and attitudes about natural products and their communication with healthcare providers about their natural product use. OBJECTIVE To explore how veterans experiencing chronic pain make decisions about natural product use, to investigate veterans' beliefs about the safety and efficacy of these products, and to examine veterans' experiences discussing natural products with their providers. DESIGN Qualitative sub-study conducted as a supplement to a pragmatic randomized controlled trial for chronic pain management. PARTICIPANTS Twenty veterans experiencing chronic pain who reported using natural products for pain management or related health concerns. APPROACH Qualitative interviews with veterans were conducted over the phone and audio-recorded. Interviews were guided by an original semi-structured interview guide and qualitative data were analyzed using a template-based rapid analysis technique. KEY RESULTS Veterans with chronic pain may perceive natural products as safer than pharmaceutical products and may prefer to use natural products. Talking with providers about natural products is important to veterans, who would like information regarding the safety and potential for interaction of natural products with pharmaceutical products. However, veterans were frequently disappointed with these conversations. Veterans felt their providers demonstrated biases against natural products, which negatively impacted patient-provider relationships. CONCLUSIONS Veterans wish to have more productive conversations with providers about natural products. They value providers' open-mindedness towards natural products and transparency about limitations in their knowledge. Suggestions for how providers and healthcare systems might better support veterans interested in natural products are discussed.
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Affiliation(s)
- Liliana Celesia Moore
- Integrative Health Service, San Francisco VA Health Care System, San Francisco, CA, USA.
- Northern California Institute for Research and Education, San Francisco, CA, USA.
- San Francisco VA Health Care System, 4150 Clement St. (11A1, T-31), San Francisco, CA, USA.
| | - Nicole A Woodruff
- Integrative Health Service, San Francisco VA Health Care System, San Francisco, CA, USA
- Northern California Institute for Research and Education, San Francisco, CA, USA
| | - Karen H Seal
- Integrative Health Service, San Francisco VA Health Care System, San Francisco, CA, USA
- University of California, San Francisco, San Francisco, CA, USA
| | - Termeh Feinberg
- Department of Biostatistics, Yale University School of Public Health, New Haven, CT, USA
- VA Connecticut PRIME Center, West Haven, CT, USA
- Kelly Government Solutions, Rockville, CT, USA
| | - Natalie Purcell
- Integrative Health Service, San Francisco VA Health Care System, San Francisco, CA, USA
- University of California, San Francisco, San Francisco, CA, USA
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2
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Hoffmann U. [Management of polypharmacy in older people with multimorbidity]. INNERE MEDIZIN (HEIDELBERG, GERMANY) 2024; 65:9-16. [PMID: 38059997 DOI: 10.1007/s00108-023-01630-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/03/2023] [Indexed: 12/08/2023]
Abstract
If the individual diagnoses of older people with multimorbidity are treated according to guidelines and by different specialists, confusing medication plans are sometimes the consequence. Therefore, a regular and structured drug evaluation is essential. As the life goals of patients can be very different, especially in older age, certain preliminary considerations should be made when starting, prescribing or discontinuing medication, taking into account the individual situation, including geriatric aspects. Updated so-called positive and negative lists provide assistance as to which medications are suitable or unsuitable for older people. Discontinuing certain medications when the life expectancy is reduced certainly makes sense but undertreatment of symptoms that cause distress to people, such as pain, should definitely be avoided.
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Affiliation(s)
- Ute Hoffmann
- Klinik für Allgemeine Innere Medizin und Geriatrie, Krankenhaus Barmherzige Brüder, Prüfeninger Str. 86, 93049, Regensburg, Deutschland.
- Klinik für Alterstraumatologie, Krankenhaus Barmherzige Brüder, Regensburg, Deutschland.
- Zentrum für Ernährungsmedizin, Krankenhaus Barmherzige Brüder, Regensburg, Deutschland.
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Winter SG, Sedgwick C, Wallace-Lacey A, Dickerson K, Battar S, Hung W. Informatics Tools in Deprescribing and Medication Optimization in Older Adults: Development and Dissemination of VIONE Methodology in a High Reliability Organization. Clin Ther 2023; 45:928-934. [PMID: 37690914 DOI: 10.1016/j.clinthera.2023.07.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 07/28/2023] [Accepted: 07/29/2023] [Indexed: 09/12/2023]
Abstract
PURPOSE Polypharmacy is common in older adults, with almost 20% of older adults taking ≥10 medications. They are at great risk for adverse events related to potentially inappropriate medications (PIMs). Although evidence-based methods for deprescribing have been successful at reducing polypharmacy and improving quality of medication use, there are several challenges to implementing these methods on a large scale. VIONE, a medication deprescribing methodology, was developed to reduce polypharmacy and PIMs across the Veterans Health Administration (VHA). (VIONE stands for Vital, Important, Optional, Not indicated, and Every medication has an indication.) This study describes the tools created for implementation of VIONE and the dashboards used to track VIONE implementation and subsequent deprescribing across the VHA; their use and sustainment are examined in a health system-wide adoption of this deprescribing practice in a high reliability organization (HRO). METHODS VIONE was disseminated by the VHA via the Diffusion of Excellence Initiative. Dissemination included an implementation toolkit and four dashboards that collect and display data from the electronic medical record to monitor utilization of VIONE, track medication discontinuations, and prospectively identify veterans who may be candidates for deprescribing. FINDINGS Between 2016 and the present, VIONE has been adopted at >130 medical centers and influenced almost 700,000 unique patients. In addition, a total of >1.6 million medication orders have been discontinued by >15,000 providers. IMPLICATIONS The VIONE methodology and informatics tools were widely disseminated and successfully adopted and sustained nationally in a high reliability organization, leading to a reduction in PIM use by older adults and improved quality and patient safety. Future efforts should continue to consider ways to leverage electronic medical record data and other relevant informatics tools to provide customized clinical decision support to further medication optimization and deprescribing efforts.
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Affiliation(s)
- Shira G Winter
- Icahn School of Medicine at Mount Sinai, New York, New York, USA.
| | - Christopher Sedgwick
- Department of Veterans Affairs, VA Heartland Network (Veterans Integrated Service Network 15), Kansas City, Missouri, USA
| | - Ashleigh Wallace-Lacey
- Clinical Pharmacy Practice Office, VISN 15 Heartland Network, Department of Veterans Affairs, VA Heartland Network (VISN 15), Kansas City, Missouri, USA
| | - Kimberly Dickerson
- Little Rock VA Medical Center, Central Arkansas Veterans Healthcare System, Little Rock, Arkansas, USA
| | - Saraswathy Battar
- West Palm Beach VA Medical Center, West Palm Beach, Florida, USA; Florida Atlantic University, Boca Raton, Florida, USA
| | - William Hung
- Icahn School of Medicine at Mount Sinai, New York, New York, USA; Geriatric Research, Education and Clinical Center, James J. Peters VA Medical Center, Bronx, New York, USA
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4
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Wang Z, Jones G, Blizzard L, Aitken D, Zhou Z, Wang M, Balogun S, Cicuttini F, Antony B. Prevalence and correlates of the use of complementary and alternative medicines among older adults with joint pain. Int J Rheum Dis 2023; 26:1760-1769. [PMID: 37431712 DOI: 10.1111/1756-185x.14822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 08/04/2022] [Accepted: 06/26/2023] [Indexed: 07/12/2023]
Abstract
BACKGROUND There is increasing use of complementary and alternative medicines (CAMs) alone or as an adjuvant therapy to conventional medicines in osteoarthritis (OA) patients. OBJECTIVES This study aimed to describe the prevalence and correlates of the use of CAMs among community-dwelling older adults. METHODS Data from the Tasmania Older Adult Cohort Study (TASOAC, n = 1099) were used to describe the prevalence of CAM use. Correlates of CAM use were assessed by comparing CAM users and non-users. To further assess correlates of CAM use, participants with at least one joint with pain were classified into four categories: CAM-only, analgesics-only, co-therapy, and "neither CAMs nor analgesics" (NCNA). RESULTS In all, 385 (35.0%) of our participants reported use of CAMs, among which vitamins/minerals were used most (22.6%, n = 232). Compared with CAM non-users, CAM users were more likely to be female, were less likely to be overweight, were better educated, had more joints with OA, had fewer WOMAC scores, and did more steps per day. Among participants with any joint pain, the CAM-only group were less likely to be overweight, consumed more alcohol, had higher quality of life, had more steps per day, and had fewer pain-related symptoms compared with the analgesic-only group. CONCLUSION Complementary and alternative medicines were commonly used among Tasmanian older adults, with 35% of the population using CAMs either alone or in combination with conventional analgesics. CAM users were more likely to be female, be better educated, have more joints with OA, and had healthier lifestyles, including lower body mass index and higher number of steps per day.
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Affiliation(s)
- Zhiqiang Wang
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - Graeme Jones
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - Leigh Blizzard
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - Dawn Aitken
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - Zhen Zhou
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - Mengmeng Wang
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - Saliu Balogun
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
- College of Health & Medicine, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Flavia Cicuttini
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Benny Antony
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
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Haines KL, Gorenshtein L, Lumpkin S, Grisel B, Gallagher S. Optimal Nutrition in the Older Adult: Beneficial Versus Ineffective Supplements. Curr Nutr Rep 2023:10.1007/s13668-023-00459-y. [PMID: 36689099 DOI: 10.1007/s13668-023-00459-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/19/2022] [Indexed: 01/24/2023]
Abstract
PURPOSE OF REVIEW Proper nutrition in older adults is essential, as nutritional deficiencies are common in this population. This review aims to summarize the benefits and risks of nutritional supplementation in the older adult population including the efficacy of various supplements, their risks, and common drug interactions with frequently prescribed medications. RECENT FINDINGS In recent years, a growing percentage of older adults have been found to take multiple daily nutritional supplements. This population has complex nutritional needs due to the physiology of aging and the presence of comorbidities. However, many primary care providers are unaware of the benefits and drawbacks of nutritional supplementation in the elderly. This review summarizes the current literature to provide more clarity to providers on how to support this population's nutritional needs. Nutritional supplementation is essential for elderly populations who may not be able to obtain adequate nutrition from dietary sources. Supplements vary widely in efficacy and safety. As such, supplementation should be individualized and guided by a qualified healthcare provider to ensure patients receive effective, beneficial nutrition.
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Affiliation(s)
- Krista L Haines
- Division of Trauma, Critical Care, and Acute Care Surgery, Department of Surgery, Duke University Medical Center, Durham, NC, USA.
| | | | - Stephanie Lumpkin
- Department of Surgery, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | | | - Scott Gallagher
- Division of Trauma, Critical Care, and Acute Care Surgery, Department of Surgery, Duke University Medical Center, Durham, NC, USA
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Chiba T, Tousen Y, Nishijima C, Umegaki K. The Prevalence of Dietary Supplements That Claim Estrogen-like Effects in Japanese Women. Nutrients 2022; 14:4509. [PMID: 36364772 PMCID: PMC9653890 DOI: 10.3390/nu14214509] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 10/21/2022] [Accepted: 10/24/2022] [Indexed: 08/13/2023] Open
Abstract
Recently, adverse events, such as irregular vaginal bleeding and menstrual disorders, associated with the use of dietary supplements containing Pueraria mirifica, have been reported in Japan. P. mirifica contains phytoestrogens, such as deoxymiroestrol and miroestrol. Therefore, we investigated the use of supplements that claim to have estrogen-like effects (i.e., estrogen-like supplements) in Japanese women aged from 15 to 69 years old in an online survey. The prevalence of estrogen-like supplement use was 5%, accounting for approximately 15% of the sample, including ex-users. The majority of the users were in their 40s and 50s, mainly using these supplements for the treatment of menopausal symptoms. In contrast, the younger generation mainly used them for beauty purposes, such as weight loss, mastogenic effects, and skin care. Many of them visited a clinic or took medicines for menstrual-related troubles. In all age groups, soybeans/isoflavones were the most commonly used, followed by equol and placenta. Participants in their teens and 20s also used P. mirifica. Among them, 16.2% had experienced adverse events, including irregular vaginal bleeding, breast swelling and pain, and heavy menstruation. In conclusion, estrogen-like supplement use is associated with adverse events; thus, it is necessary to pay attention to the use of these supplement. Furthermore, because the purpose of use differs depending on generation, caution according to each generation is necessary.
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Affiliation(s)
- Tsuyoshi Chiba
- Department of Food Function and Labeling, National Institute of Health and Nutrition, National Institutes of Biomedical Innovation, Health and Nutrition, Tokyo 162-8363, Japan
| | - Yuko Tousen
- Department of Food Function and Labeling, National Institute of Health and Nutrition, National Institutes of Biomedical Innovation, Health and Nutrition, Tokyo 162-8363, Japan
| | - Chiharu Nishijima
- Department of Food Function and Labeling, National Institute of Health and Nutrition, National Institutes of Biomedical Innovation, Health and Nutrition, Tokyo 162-8363, Japan
| | - Keizo Umegaki
- Department of Food Safety and Management, Showa Women’s University, Tokyo 154-8533, Japan
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Abstract
The world population is aging due to increasing life expectancy. The rate of drug use increases, and inappropriate prescribing is frequently encountered with advancing age. In addition, misuse and abuse of prescription drugs is a serious problem in older adults. It is challenging to detect substance and drug abuse in older patients because it may have fewer consequences in social, legal, and occupational fields. However, there is not enough information about the screening, evaluation, diagnosis, and treatment of abuse. Therefore, the awareness of health care professionals and others involved in older patients' care should be raised about the misuse and abuse of drugs.
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Affiliation(s)
- Esra Ates Bulut
- Department of Geriatric Medicine, Adana City Training and Research Hospital, Adana, Turkey
| | - Ahmet Turan Isik
- Unit for Brain Aging and Dementia, Department of Geriatric Medicine, Dokuz Eylul University, School of Medicine, 35340 Balcova, IZMIR, Turkey.
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8
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Youn BY, Song HJ, Yang K, Cheon C, Ko Y, Jang BH, Shin YC, Ko SG. Bibliometric Analysis of Integrative Medicine Studies from 2000 to 2019. THE AMERICAN JOURNAL OF CHINESE MEDICINE 2021; 49:829-841. [PMID: 33829965 DOI: 10.1142/s0192415x21500397] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Integrative medicine has become a vital component of patient care. It provides patient-centered care that is focused on prevention and overall well-being. As there has been a growing number of patients favoring a blend of conventional, complementary and alternative approaches, integrative medicine has exceeded beyond the evaluation of complementary therapies. However, it is noteworthy that there has been a dilemma of providing substantial evidence supporting the efficacy of some complementary and alternative therapies. This study's goals were to analyze publication trends, most productive journals, most productive funding agencies, most productive authors, most relevant keywords, and countries in the field of integrative medicine research. Additionally, science mapping included country collaboration analysis and thematic evolution analysis. The findings from this study showed a constant rise in annual growth of publications from 2000 to 2019; the United States was dominant in various analysis categories. In conclusion, a comprehensive review of the evolution of research of integrative medicine will help healthcare providers understand an overview of the present status while encouraging more evidence-based research for the betterment of integrative patient care.
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Affiliation(s)
- Bo-Young Youn
- Department of Global Public Health and Korean Medicine Management, Graduate School, College of Korean Medicine, Kyung Hee University, Seoul 02447, Republic of Korea
| | - Hyun Jong Song
- Department of Applied Korean Medicine, Graduate School, College of Korean Medicine, Kyung Hee University, Seoul 02447, Republic of Korea
| | - Keeyoung Yang
- Department of Applied Korean Medicine, Graduate School, College of Korean Medicine, Kyung Hee University, Seoul 02447, Republic of Korea
| | - Chunhoo Cheon
- Department of Preventive Medicine, College of Korean Medicine, Kyung Hee University, Seoul 02447, Republic of Korea
| | - Youme Ko
- Department of Preventive Medicine, College of Korean Medicine, Kyung Hee University, Seoul 02447, Republic of Korea
| | - Bo-Hyoung Jang
- Department of Global Public Health and Korean Medicine Management, Graduate School, College of Korean Medicine, Kyung Hee University, Seoul 02447, Republic of Korea.,Department of Preventive Medicine, College of Korean Medicine, Kyung Hee University, Seoul 02447, Republic of Korea
| | - Yong-Cheol Shin
- Department of Preventive Medicine, College of Korean Medicine, Kyung Hee University, Seoul 02447, Republic of Korea
| | - Seong-Gyu Ko
- Department of Global Public Health and Korean Medicine Management, Graduate School, College of Korean Medicine, Kyung Hee University, Seoul 02447, Republic of Korea.,Department of Preventive Medicine, College of Korean Medicine, Kyung Hee University, Seoul 02447, Republic of Korea
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9
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Wahab MSA, Zaini MH, Ali AA, Sahudin S, Mehat MZ, Hamid HA, Mustaffa MF, Othman N, Maniam S. The use of herbal and dietary supplement among community-dwelling elderly in a suburban town of Malaysia. BMC Complement Med Ther 2021; 21:110. [PMID: 33794868 PMCID: PMC8017757 DOI: 10.1186/s12906-021-03287-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Accepted: 03/22/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The use of herbal and dietary supplement (HDS) in health and disease management has gained global attention. HDS are generally accepted by the public and are associated with positive health behaviours. However, several reports have been documented with regards to their potential adverse effects and interaction with conventional medicines. Limited data is currently available on the use of HDS among elderly population in Malaysia. This present study aims to investigate the prevalence of and pattern of HDS use among a sample of community-dwelling elderly in a suburban town in Malaysia. METHODS A cross-sectional survey was conducted between March and May 2019 among the elderly aged ≥60 years old. The participants with the following criteria were included in the study: aged ≥60 years, residing in Puncak Alam and able to understand Malay or English language. Data were collected using a pre-validated questionnaire. All statistical analysis was conducted using IBM SPSS ver. 23. RESULTS Overall, 336 out of 400 elderly responded to the survey, achieving a response rate of 84%. This study observed that almost 50% of the respondents were using at least one type of HDS in the past one month of the survey. Among HDS non-users, most of them preferred to use modern medicines (62.6%, 114/182). Among the HDS users, 75.3% (116/154) were using at least one type of modern medicine (prescription or over-the-counter medicine). Multivariate analysis showed that having good to excellent perceived health (adjusted OR = 2.666, 95% CI = 1.592-4.464), having felt sick at least once in the past one month (adjusted OR = 2.500, 95% CI = 1.426-4.383), and lower body mass index (adjusted OR = 0.937, 95% CI = 0.887-0.990) were associated with HDS use. It was noted that only a small percentage of HDS users (16.2%, 25/154) had informed healthcare providers on their HDS use. CONCLUSION The use of HDS is common among the elderly sampled. Hence, healthcare providers should be more vigilant in seeking information of HDS use for disease management in their elderly patients. Campaigns that provide accurate information regarding the appropriate use of HDS among the elderly are pertinent to prevent misinformation of the products.
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Affiliation(s)
- Mohd Shahezwan Abd Wahab
- Faculty of Pharmacy, Universiti Teknologi MARA (UiTM) Cawangan Selangor, Kampus Puncak Alam, 42300, Puncak Alam, Selangor, Malaysia.
| | - Muhammad Helmi Zaini
- Faculty of Pharmacy, Universiti Teknologi MARA (UiTM) Cawangan Selangor, Kampus Puncak Alam, 42300, Puncak Alam, Selangor, Malaysia
| | - Aida Azlina Ali
- Faculty of Pharmacy, Universiti Teknologi MARA (UiTM) Cawangan Selangor, Kampus Puncak Alam, 42300, Puncak Alam, Selangor, Malaysia
| | - Shariza Sahudin
- Faculty of Pharmacy, Universiti Teknologi MARA (UiTM) Cawangan Selangor, Kampus Puncak Alam, 42300, Puncak Alam, Selangor, Malaysia
| | - Muhammad Zulfadli Mehat
- Department of Human Anatomy, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, 43400, Serdang, Malaysia
| | - Hafizah Abdul Hamid
- Department of Human Anatomy, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, 43400, Serdang, Malaysia
| | - Mohd Faiz Mustaffa
- Faculty of Pharmacy, Universiti Teknologi MARA (UiTM) Cawangan Selangor, Kampus Puncak Alam, 42300, Puncak Alam, Selangor, Malaysia
| | - Noordin Othman
- Department of Clinical and Hospital Pharmacy, College of Pharmacy, Taibah University, Al-Madinah Al-Munawwarah, 30001, Saudi Arabia
- Faculty of Pharmacy, PICOMS International University College, 68100, Batu Caves, Kuala Lumpur, Malaysia
| | - Sandra Maniam
- Department of Human Anatomy, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, 43400, Serdang, Malaysia.
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10
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McDaniel JC. Dietary supplement use by older adults with chronic venous leg ulcers: A retrospective, descriptive study. Wound Repair Regen 2020; 28:561-572. [PMID: 32319144 DOI: 10.1111/wrr.12821] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Revised: 02/07/2020] [Accepted: 04/14/2020] [Indexed: 01/06/2023]
Abstract
Nearly 70% of older adults in the U.S. report using ≥1 dietary supplements (DSs) daily. While DSs may have health benefits, there is risk for toxicity or harmful drug-supplement interactions if not taken correctly. Older adults with chronic wounds who use DSs are at increased risk of adverse drug-supplement interactions because they usually have comorbidities requiring polypharmacy management. However, no studies have evaluated DS use in this population. The aim of this retrospective pilot study was to describe DS use by a sample of older adults (n = 40) with chronic venous leg ulcers (CVLUs) who participated in a clinical trial testing the effects of fish oil supplementation on wound healing. At baseline, study personnel assisted all participants in completing an electronic questionnaire about DS use. Descriptive statistics were used to characterize the data. Twenty-five of the 40 participants (62.5%) reported taking ≥1 DS daily. On average, DS users were 65.16 years (SD = 8.51) and the majority were men (64.0%), white (68.0%), and had at least some college education (72.0%). Fifteen (60.0%) reported taking 1-2 DSs/day, and 10 (40.0%) reported taking ≥3/day. The most frequently reported DSs used were multivitamin/mineral complex (60.0%), vitamin D (36.0%), vitamin B complex (28.0%) and calcium (28.0%). Reasons for using DSs were to maintain or improve health (44.0%), improve bone density (12%), and boost the immune system (12%). Supplement users reported consuming an average of 9.12 (SD = 6.46) prescription drugs daily and 21 (84.0%) reported ≥3 chronic health conditions. In summary, DS use in this sample of chronic wound patients was high. Moreover, DS users reported using multiple prescription drugs (2-23/day) concomitantly with DSs. While older adults with CVLUs may benefit from targeted DS therapy, monitoring their DS use to reduce risk for adverse drug-supplement interactions is best practice.
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Affiliation(s)
- Jodi C McDaniel
- College of Nursing, The Ohio State University, Columbus, Ohio, USA
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11
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Mielke N, Huscher D, Douros A, Ebert N, Gaedeke J, van der Giet M, Kuhlmann MK, Martus P, Schaeffner E. Self-reported medication in community-dwelling older adults in Germany: results from the Berlin Initiative Study. BMC Geriatr 2020; 20:22. [PMID: 31964342 PMCID: PMC6974973 DOI: 10.1186/s12877-020-1430-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Accepted: 01/14/2020] [Indexed: 01/10/2023] Open
Abstract
Background Older adults have the highest drug utilization due to multimorbidity. Although the number of people over age 70 is expected to double within the next decades, population-based data on their medication patterns are scarce especially in combination with polypharmacy and potentially inappropriate medication (PIM). Our objective was to analyse the frequency of polypharmacy, pattern of prescription (PD) and over-the-counter (OTC) drug usage, and PIMs according to age and gender in a population-based cohort of very old adults in Germany. Methods Cross-sectional baseline data of the Berlin Initiative Study, a prospective cohort study of community-dwelling adults aged ≥70 years with a standardized interview including demographics, lifestyle variables, co-morbidities, and medication assessment were analysed. Medication data were coded using the Anatomical Therapeutic Chemical (ATC) classification. Age- and sex-standardized descriptive analysis of polypharmacy (≥5 drugs, PD and OTC vs. PD only and regular and on demand drugs vs regular only), medication frequency and distribution, including PIMs, was performed by age (</≥80) and gender. Results Of 2069 participants with an average age of 79.5 years, 97% (95%CI [96%;98%]) took at least one drug and on average 6.2 drugs (SD = 3.5) with about 40 to 66% fulfilling the criteria of polypharmacy depending on the definition. Regarding drug type more female participants took a combination of PD and OTC (male: 68%, 95%CI [65%;72%]); female: 78%, 95%CI [76%;80%]). Most frequently used were drugs for cardiovascular diseases (85%, 95%CI [83%;86%]). Medication frequency increased among participants aged ≥80 years, especially for cardiovascular drugs, antithrombotics, psychoanaleptics and dietary supplements. Among the top ten prescription drugs were mainly cardiovascular drugs including lipid-lowering agents (simvastatin), beta-blockers (metoprolol, bisoprolol) and ACE inhibitors (ramipril). The most common OTC drug was acetylsalicylic acid (35%; 95%CI [33%;37%])). Dose-independent PIM were identified for 15% of the participants. Conclusions Polypharmacy was excessive in older adults, with not only PD but also OTC drugs contributing to the high point prevalence. The medication patterns reflected the treatment of chronic diseases in this age group. There was even an increase in medication frequency between below and above 80 years especially for drugs of cardiovascular diseases, antithrombotic medication, psychoanaleptics, and dietary supplements.
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Affiliation(s)
- Nina Mielke
- Institute of Public Health, Charité Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany.
| | - Dörte Huscher
- Institute of Public Health, Charité Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany.,Institute of Biometry and Clinical Epidemiology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Antonios Douros
- Institute of Clinical Pharmacology and Toxicology, Charité - Universitätsmedizin Berlin, Berlin, Germany.,Department of Medicine, McGill University, Montreal, Quebec, Canada.,Centre for Clinical Epidemiology, Lady Davis Institute, Montreal, Quebec, Canada
| | - Natalie Ebert
- Institute of Public Health, Charité Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Jens Gaedeke
- Departement of Nephrology and Medical Intensive Care, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Markus van der Giet
- Departement of Nephrology and Medical Intensive Care, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Martin K Kuhlmann
- Department of Nephrology, Vivantes Klinikum im Friedrichshain, Berlin, Germany
| | - Peter Martus
- Institute of Clinical Epidemiology and Medical Biostatistics, Eberhard Karls-University, Tübingen, Germany
| | - Elke Schaeffner
- Institute of Public Health, Charité Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany
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12
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O’Brien K, Moore A, Percival-Smith S, Venkatraman S, Grubacevic V, Scoble J, Gilham L, Greenway T, Coghill K, Wale J. An investigation into the usability of a drug-complementary medicines interactions database in a consumer group of women with breast cancer. Eur J Integr Med 2020. [DOI: 10.1016/j.eujim.2019.101004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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13
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Aznar-Lou I, Carbonell-Duacastella C, Rodriguez A, Mera I, Rubio-Valera M. Prevalence of Medication-Dietary Supplement Combined Use and Associated Factors. Nutrients 2019; 11:nu11102466. [PMID: 31618867 PMCID: PMC6835757 DOI: 10.3390/nu11102466] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Revised: 10/03/2019] [Accepted: 10/05/2019] [Indexed: 12/26/2022] Open
Abstract
Introduction: The use of medication has increased in recent years in the US while the use of dietary supplements has remained stable but high. Interactions between these two kinds of products may have important consequences, especially in the case of widely used medications such as antihypertensives and antibiotics. The aim of this paper is to estimate the prevalence of potentially serious drug–dietary supplement interactions among tetracyclines, thiazides, and angiotensin II receptor blocker users by means of the NHANES 2013–2014 dataset. Methods: Data from 2013–2014 NHANES were obtained. Potential interactions analysed were tetracyclines with calcium, magnesium, and zinc, thiazides with vitamin D, and angiotensin II receptors blockers with potassium. Prevalence was calculated for each potential interaction. Logistic regression was used to assess associated factors. Results: 864 prescriptions issued to 820 patients were analysed. Overall prevalence of potential interaction was 49%. Older age and higher educational level were strongly associated with being at risk of a potential interaction. Factors such as age, race, civil status, citizenship, country of birth, BMI, and physical activity did not show notable associations. Conclusions: Healthcare professionals should be aware of other medical products when they prescribe or dispense a medication or a dietary supplement, especially to the older population and people with a higher educational level.
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Affiliation(s)
- Ignacio Aznar-Lou
- Teaching, Research & Innovation Unit, Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Parc Sanitari Sant Joan de Déu, 08830 Sant Boi de Llobregat (Barcelona), Spain.
- Centro de Investigación Biomédica en Red en Epidemiología y Salud Pública, CIBERESP, 28029 Madrid, Spain.
| | - Cristina Carbonell-Duacastella
- Teaching, Research & Innovation Unit, Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Parc Sanitari Sant Joan de Déu, 08830 Sant Boi de Llobregat (Barcelona), Spain.
| | - Ana Rodriguez
- Spanish Society of Community and Family Pharmacy (SEFAC), 28045 Madrid, Spain.
| | - Inés Mera
- Spanish Society of Community and Family Pharmacy (SEFAC), 28045 Madrid, Spain.
| | - Maria Rubio-Valera
- Teaching, Research & Innovation Unit, Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Parc Sanitari Sant Joan de Déu, 08830 Sant Boi de Llobregat (Barcelona), Spain.
- Centro de Investigación Biomédica en Red en Epidemiología y Salud Pública, CIBERESP, 28029 Madrid, Spain.
- School of Pharmacy, University of Barcelona, 08028 Barcelona, Spain.
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14
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Wallace TC, Frankenfeld CL, Frei B, Shah AV, Yu CR, van Klinken BJW, Adeleke M. Multivitamin/Multimineral Supplement Use is Associated with Increased Micronutrient Intakes and Biomarkers and Decreased Prevalence of Inadequacies and Deficiencies in Middle-Aged and Older Adults in the United States. J Nutr Gerontol Geriatr 2019; 38:307-328. [PMID: 31502930 DOI: 10.1080/21551197.2019.1656135] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Micronutrient inadequacies are common in older adults and using a multivitamin/multimineral supplement (MVM) may improve their nutritional status. National Health and Nutrition Examination Survey data were analyzed to determine micronutrient intakes based on diet and MVM use in adults aged ≥51 years. Deficiencies were evaluated using nutrient biomarkers. The National Cancer Institute Method was used to estimate usual intakes of 18 micronutrients stratified by age and frequency of MVM use. Compared with food alone, MVM use was associated with higher nutrient intake and lower prevalence of inadequacies of almost all micronutrients examined and improved nutrient biomarker status of folate, iodine, selenium, and vitamins B6, B12, and D. Regular MVM use (≥16 days/month) decreased the odds of clinical deficiency (defined by biomarker status) of vitamins B6 and D but increased the proportion exceeding the tolerable upper intake level of folic acid. Vitamin B6 deficiency in MVM non-users was common and increased with age.
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Affiliation(s)
- Taylor C Wallace
- Department of Nutrition and Food Studies, George Mason University , Fairfax , VA , USA.,Think Healthy Group, Inc. , Washington , DC , USA
| | - Cara L Frankenfeld
- Department of Global and Community Health, George Mason University , Fairfax , VA , USA
| | - Balz Frei
- Department of Biochemistry and Biophysics, Linus Pauling Institute, Oregon State University , Corvallis , OR , USA
| | - Alpa V Shah
- Pfizer Consumer Healthcare , Madison , NJ , USA
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15
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Sciarra T, Ciccotti M, Aiello P, Minosi P, Munzi D, Buccolieri C, Peluso I, Palmery M, Lista F. Polypharmacy and Nutraceuticals in Veterans: Pros and Cons. Front Pharmacol 2019; 10:994. [PMID: 31551790 PMCID: PMC6746907 DOI: 10.3389/fphar.2019.00994] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Accepted: 08/06/2019] [Indexed: 12/14/2022] Open
Affiliation(s)
- Tommaso Sciarra
- Joint Veteran Center, Scientific Department, Army Medical Center, Rome, Italy
| | - Mario Ciccotti
- Joint Veteran Center, Scientific Department, Army Medical Center, Rome, Italy.,Department of Physiology and Pharmacology "V. Erspamer," La Sapienza University of Rome, Rome, Italy
| | - Paola Aiello
- Department of Physiology and Pharmacology "V. Erspamer," La Sapienza University of Rome, Rome, Italy.,Research Centre for Food and Nutrition, Council for Agricultural Research and Economics (CREA-AN), Rome, Italy
| | - Paola Minosi
- Department of Physiology and Pharmacology "V. Erspamer," La Sapienza University of Rome, Rome, Italy.,National Center for Drug Research and Evaluation, Istituto Superiore di Sanità, Rome, Italy
| | - Diego Munzi
- Joint Veteran Center, Scientific Department, Army Medical Center, Rome, Italy
| | - Cosimo Buccolieri
- Joint Veteran Center, Scientific Department, Army Medical Center, Rome, Italy
| | - Ilaria Peluso
- Research Centre for Food and Nutrition, Council for Agricultural Research and Economics (CREA-AN), Rome, Italy
| | - Maura Palmery
- Department of Physiology and Pharmacology "V. Erspamer," La Sapienza University of Rome, Rome, Italy
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16
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Shade MY, Witry M, Robinson K, Kupzyk K. Analysis of oral dietary supplement use in rural older adults. J Clin Nurs 2019; 28:1600-1606. [PMID: 30589152 DOI: 10.1111/jocn.14763] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Revised: 11/27/2018] [Accepted: 12/18/2018] [Indexed: 01/27/2023]
Abstract
AIMS AND OBJECTIVES To describe and explore characteristics associated with oral dietary supplement use and identify potential interactions with prescription medications in a sample of rural community-dwelling older adults. BACKGROUND Older adults use polypharmacy to help manage chronic diseases. Due to healthcare access disparities, rural older adults may consider dietary supplement use as an alternative approach to maintain health and manage disease. Oral dietary supplement use is expected to increase among ageing adults; placing them at risk for potential interactions and adverse events. DESIGN A secondary analysis was conducted on oral dietary supplement, medication and health characteristic data collected on N = 138 participants. The original study was adherent to STROBE guidelines. RESULTS Researchers found that 83% of the rural older adults used oral dietary supplements in addition to their prescribed medications. Participants took additional single-dose vitamins along with their multivitamin; 57% took vitamin D, 52% took calcium, 15% took vitamin C and 13% took additional potassium and vitamin E. Participants also used oral dietary supplements with medications that had a potential for interaction. CONCLUSIONS Compared with national samples of older adults, a high percentage of rural older adults used oral dietary supplements in addition to their prescribed medications. In the rural setting, older adults are at risk for potential drug-oral dietary supplement interactions. RELEVANCE TO CLINICAL PRACTICE Nurses can conduct vigilant medication reconciliation that includes documenting characteristics of oral dietary supplement use. Nurses can assist with providing appropriate dietary supplements education that promotes patient knowledge and prevent inappropriate use; particularly when caring for older adults from rural settings.
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Affiliation(s)
- Marcia Y Shade
- University of Nebraska Medical Center College of Nursing-Omaha, Omaha, Nebraska.,University of Iowa College of Nursing, Iowa City, Iowa
| | - Matthew Witry
- University of Iowa College of Pharmacy, Iowa City, Iowa
| | | | - Kevin Kupzyk
- University of Nebraska Medical Center College of Nursing-Omaha, Omaha, Nebraska
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17
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Schwartz JB, Schmader KE, Hanlon JT, Abernethy DR, Gray S, Dunbar-Jacob J, Holmes HM, Murray MD, Roberts R, Joyner M, Peterson J, Lindeman D, Tai-Seale M, Downey L, Rich MW. Pharmacotherapy in Older Adults with Cardiovascular Disease: Report from an American College of Cardiology, American Geriatrics Society, and National Institute on Aging Workshop. J Am Geriatr Soc 2018; 67:371-380. [PMID: 30536694 DOI: 10.1111/jgs.15634] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVES To identify the top priority areas for research to optimize pharmacotherapy in older adults with cardiovascular disease (CVD). DESIGN Consensus meeting. SETTING Multidisciplinary workshop supported by the National Institute on Aging, the American College of Cardiology, and the American Geriatrics Society, February 6-7, 2017. PARTICIPANTS Leaders in the Cardiology and Geriatrics communities, (officers in professional societies, journal editors, clinical trialists, Division chiefs), representatives from the NIA; National Heart, Lung, and Blood Institute; Food and Drug Administration; Centers for Medicare and Medicaid Services, Alliance for Academic Internal Medicine, Patient-Centered Outcomes Research Institute, Agency for Healthcare Research and Quality, pharmaceutical industry, and trainees and early career faculty with interests in geriatric cardiology. MEASUREMENTS Summary of workshop proceedings and recommendations. RESULTS To better align older adults' healthcare preferences with their care, research is needed to improve skills in patient engagement and communication. Similarly, to coordinate and meet the needs of older adults with multiple comorbidities encountering multiple healthcare providers and systems, systems and disciplines must be integrated. The lack of data from efficacy trials of CVD medications relevant to the majority of older adults creates uncertainty in determining the risks and benefits of many CVD therapies; thus, developing evidence-based guidelines for older adults with CVD is a top research priority. Polypharmacy and medication nonadherence lead to poor outcomes in older people, making research on appropriate prescribing and deprescribing to reduce polypharmacy and methods to improve adherence to beneficial therapies a priority. CONCLUSION The needs and circumstances of older adults with CVD differ from those that the current medical system has been designed to meet. Optimizing pharmacotherapy in older adults will require new data from traditional and pragmatic research to determine optimal CVD therapy, reduce polypharmacy, increase adherence, and meet person-centered goals. Better integration of the multiple systems and disciplines involved in the care of older adults will be essential to implement and disseminate best practices. J Am Geriatr Soc 67:371-380, 2019.
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Affiliation(s)
- Janice B Schwartz
- Divisions of Geriatrics and Clinical Pharmacology, Departments of Medicine and Bioengineering and Therapeutic Sciences, University of California, San Francisco, San Francisco, California
| | - Kenneth E Schmader
- Division of Geriatrics, Department of Medicine, Duke University Medical Center, Durham, North Carolina.,Geriatric Research, Education, and Clinical Center, Durham Veterans Affairs Medical Center, Durham, North Carolina
| | - Joseph T Hanlon
- Division of Geriatrics, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Darrell R Abernethy
- Office of Clinical Pharmacology, U.S. Food & Drug Administration, Silver Spings, Maryland
| | - Shelly Gray
- Department of Pharmacy, University of Washington, Seattle, Washington
| | | | - Holly M Holmes
- Geriatric and Palliative Medicine, Department of Medicine, McGovern Medical School, Houston, Texas
| | - Michael D Murray
- Department of Pharmacy Practice, Regenstrief Institute, Purdue University, West Lafayette, Indiana
| | - Robert Roberts
- Department of Medicine, College of Medicine, University of Arizona, Phoenix, Arizona
| | - Michael Joyner
- Departments of Anesthesiology and Perioperative Medicine and Physiology and Biomedical Engineering, Mayo Clinic, Rochester, Minnesota
| | - Josh Peterson
- Departments of Biomedical Informatics and Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - David Lindeman
- CITRIS and the Banatao Institute, University of California, Berkeley, California
| | - Ming Tai-Seale
- Division of Health Policy, Department of Family Medicine and Public Health, University of California, San Diego, San Diego, California
| | - Laura Downey
- Concordance Health Solutions, West Lafayette, Indiana.,Krannert School of Management, Purdue University, West Lafayette, Indiana
| | - Michael W Rich
- Cardiovascular Division, Department of Internal Medicine, Washington University, St. Louis, Missouri
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18
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Agbabiaka TB, Spencer NH, Khanom S, Goodman C. Prevalence of drug-herb and drug-supplement interactions in older adults: a cross-sectional survey. Br J Gen Pract 2018; 68:e711-e717. [PMID: 30249608 PMCID: PMC6145997 DOI: 10.3399/bjgp18x699101] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Accepted: 07/08/2018] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Polypharmacy is common among older adults, with increasing numbers also using prescription drugs with herbal medicinal products (HMPs) and dietary supplements. There is no reliable evidence from the UK on concurrent use of HMPs and dietary supplements with prescription drugs in older adults. AIM To establish prevalence of concurrent prescription drugs, HMPs, and dietary supplements among UK community-dwelling older adults and identify potential interactions. DESIGN AND SETTING Cross-sectional survey of older adults registered at two general practices in South East England. METHOD A questionnaire asking about prescription medications, HMPs, and sociodemographic information was posted to 400 older adults aged ≥65 years, identified as taking ≥1 prescription drug. RESULTS In total 155 questionnaires were returned (response rate = 38.8%) and the prevalence of concurrent HMPs and dietary supplements with prescriptions was 33.6%. Females were more likely than males to be concurrent users (43.4% versus 22.5%; P = 0.009). The number of HMPs and dietary supplements ranged from 1 to 8, (mean = 3, median = 1; standard deviation = 1.65). The majority of concurrent users (78.0%) used dietary supplements with prescription drugs. The most commonly used dietary supplements were cod liver oil, glucosamine, multivitamins, and vitamin D. Others (20.0%) used only HMPs with prescription drugs. Common HMPs were evening primrose oil, valerian, and Nytol Herbal® (a combination of hops, gentian, and passion flower). Sixteen participants (32.6%) were at risk of potential adverse drug interactions. CONCLUSION GPs should routinely ask questions regarding herbal and supplement use, to identify and manage older adults at potential risk of adverse drug interactions.
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Affiliation(s)
- Taofikat B Agbabiaka
- Centre for Research in Public Health and Community Care (CRIPACC), University of Hertfordshire, Hatfield; evidence & evaluation lead, patient safety, Medical Directorate, NHS Improvement, London
| | - Neil H Spencer
- Hertfordshire Business School, University of Hertfordshire, de Havilland Campus, Hatfield
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19
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Common Medication Management Approaches for Older Adults in the Emergency Department. Clin Geriatr Med 2018; 34:415-433. [DOI: 10.1016/j.cger.2018.04.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
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20
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Eloge J, Napier TC, Dantz B. OPQRST(U): Integrating substance use disorders or "Use" into the medical history. Subst Abus 2018; 39:505-508. [PMID: 29693496 DOI: 10.1080/08897077.2018.1469104] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Substance use disorders (SUDs) are pervasive in the United States, with 20.1 million cases in 2016, of which only 19% receive treatment. SUDs permeate all medical specialties and should be considered in the differential diagnosis of every chief complaint. Acknowledging the salience of SUDs provides a unique opportunity for early identification and intervention. Thus, SUDs should be reflected prominently in the history of the present illness rather than in the social history. To this effect, we propose the inclusion of Use (U) in the history of present illness and incorporating "U" into the pedagogical mnemonic of OPQRST that is commonly used in medical training. Obtaining this history will help determine if and which abused substances may be contributing to the chief complaint. We also suggest the incorporation of an additional acronym, SORTED, to account for the various domains of Use, including Street (illicit drugs), OTCs (over-the-counter medications), Rx (prescriptions, including nonmedicinal use of pharmaceutical drugs), Tobacco (including e-cigarettes), EtOH (alcohol), and Dietary (caffeine, vitamins, and herbal supplements) agents. We discuss how utilizing OPQRSTU will help reshape the way medical students think about SUDs and will facilitate detection and diagnosis of all domains of SUDs.
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Affiliation(s)
- Joshua Eloge
- a Rush Medical College , Chicago , Illinois , USA
| | - T Celeste Napier
- b Center for Compulsive Behavior and Addiction , Rush University Medical Center , Chicago , Illinois , USA
| | - Bezalel Dantz
- c Department of Psychiatry , Rush University Medical Center , Chicago , Illinois , USA
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21
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Agbabiaka TB, Wider B, Watson LK, Goodman C. Concurrent Use of Prescription Drugs and Herbal Medicinal Products in Older Adults: A Systematic Review. Drugs Aging 2018; 34:891-905. [PMID: 29196903 PMCID: PMC5730633 DOI: 10.1007/s40266-017-0501-7] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Background The use of herbal medicinal products (HMPs) is common among older adults; however, little is known about concurrent use with prescription drugs, as well as potential interactions associated with such combinations. Objective The aim of this systematic review was to identify and evaluate the literature on concurrent prescription and HMP use among older adults to assess prevalence, patterns, potential interactions and factors associated with this use. Methods Systematic searches were conducted in the MEDLINE, PsycINFO, EMBASE, CINAHL, AMED, Web of Science and Cochrane databases from inception to May 2017 for studies reporting concurrent use of prescription medicines with HMPs in adults ≥ 65 years of age. Quality was assessed using the Joanna Briggs Institute checklists. And the Evidence for Policy and Practice Information and Co-ordinating Centre (EPPI-Centre) three-stage approach to mixed method research was used to synthesise data. Results Twenty-two studies were included. A definition of HMPs or what was considered an HMP was frequently missing. Prevalence of concurrent use by older adults varied widely between 5.3 and 88.3%. Prescription medicines most combined with HMPs were antihypertensive drugs, β-blockers, diuretics, antihyperlipidemic agents, anticoagulants, analgesics, antihistamines, antidiabetics, antidepressants and statins. The HMPs most frequently used were Ginkgo biloba, garlic, ginseng, St John’s wort, Echinacea, saw palmetto, evening primrose oil and ginger. Potential risks of bleeding due to the use of Ginkgo biloba, garlic or ginseng with aspirin or warfarin was the most reported herb–drug interaction. Some data suggest being female, and having a lower household income and less than a high-school education were associated with concurrent use. Conclusion The prevalence of concurrent prescription drugs and HMP use among older adults is substantial and potential interactions have been reported. Knowledge of the extent and manner in which older adults combine prescription drugs will aid healthcare professionals in appropriately identifying and managing patients at risk. Systematic Review Registration Number: PROSPERO 2014:CRD42014009091. Electronic supplementary material The online version of this article (10.1007/s40266-017-0501-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Taofikat B Agbabiaka
- Centre for Research in Primary and Community Care (CRIPACC), University of Hertfordshire, Hatfield, UK. .,Patient Safety, Medical Directorate, NHS Improvement, London, UK.
| | - Barbara Wider
- Institute of Health Research, University of Exeter Medical School, Exeter, UK
| | - Leala K Watson
- Institute of Health Research, University of Exeter Medical School, Exeter, UK
| | - Claire Goodman
- Centre for Research in Primary and Community Care (CRIPACC), University of Hertfordshire, Hatfield, UK
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22
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Optimization of Drug Prescription and Medication Management in Older Adults with Cardiovascular Disease. Drugs Aging 2017; 34:803-810. [DOI: 10.1007/s40266-017-0494-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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Gahche JJ, Bailey RL, Potischman N, Dwyer JT. Dietary Supplement Use Was Very High among Older Adults in the United States in 2011-2014. J Nutr 2017; 147:1968-1976. [PMID: 28855421 PMCID: PMC5610553 DOI: 10.3945/jn.117.255984] [Citation(s) in RCA: 105] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2017] [Revised: 06/21/2017] [Accepted: 08/07/2017] [Indexed: 12/31/2022] Open
Abstract
Background: Dietary supplements (DSs) have the potential to be both beneficial and harmful to health, especially in adults aged ≥60 y, and therefore it is important to monitor the patterns of their use.Objective: This study evaluated DS use by adults aged ≥60 y to characterize the use of DSs, determine the motivations for use, and examine the associations between the use of DSs and selected demographic, lifestyle, and health characteristics.Methods: Data from 3469 older adults aged ≥60 y from the 2011-2014 NHANES were analyzed. DSs used in the past 30 d were ascertained via an interviewer-administered questionnaire in participants' homes. The prevalence of overall DS use and specific types of DSs were estimated. The number of DSs reported and the frequency, duration, and motivation(s) for use were assessed. Logistic regression models were constructed to examine the association between DS use and selected characteristics.Results: Seventy percent of older adults in the United States reported using ≥1 DS in the past 30 d; 54% of users took 1 or 2 products, and 29% reported taking ≥4 products. The most frequently reported products were multivitamin or mineral (MVM) (39%), vitamin D only (26%), and omega-3 fatty acids (22%). Women used DSs almost twice as often as men [adjusted OR (aOR), 1.8; 95% CI: 1.5, 2.3). Those not reporting prescription medications were less likely to take a DS than those reporting ≥3 prescription medications (aOR, 0.4; 95% CI: 0.3, 0.6). The most frequently reported motivation for DS use was to improve overall health (41%).Conclusions: Use of DSs among older adults continues to be high in the United States, with 29% of users regularly taking ≥4 DSs, and there is a high concurrent usage of them with prescription medications.
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Affiliation(s)
- Jaime J Gahche
- Office of Dietary Supplements, National Institutes of Health, Bethesda, MD;
| | - Regan L Bailey
- Department of Nutrition Science, Purdue University, West Lafayette, IN; and
| | - Nancy Potischman
- Office of Dietary Supplements, National Institutes of Health, Bethesda, MD
| | - Johanna T Dwyer
- Office of Dietary Supplements, National Institutes of Health, Bethesda, MD;,Jean Mayer USDA Human Nutrition Research Center on Aging, Tufts University, Boston, MA
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24
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Peklar J, Kos M, O’Dwyer M, McCarron M, McCallion P, Kenny RA, Henman MC. Medication and supplement use in older people with and without intellectual disability: An observational, cross-sectional study. PLoS One 2017; 12:e0184390. [PMID: 28877256 PMCID: PMC5587307 DOI: 10.1371/journal.pone.0184390] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2017] [Accepted: 08/23/2017] [Indexed: 11/25/2022] Open
Abstract
Introduction Understanding the medication and supplement use of aging people is critical to ensuring that health service providers in primary care can optimise use of these agents. An increasing number of people with different levels of intellectual disability (ID) are living in the community and becoming for the first time substantial users of primary health care services. This, however, brings new challenges that need to be addressed at the primary health care level. We quantified the use of medicines and food supplements and described the associated patterns of morbidity in the two comparable cohorts of aging population with and without intellectual disability. Method This research aligned participants of 50 years and over who lived in the community from two nationally representative cohorts of older people; those with ID from the Intellectual Disability Supplement (n = 238) and those without ID (n = 8,081) from the Irish Longitudinal Study on Ageing. Results Data showed that both medication and supplement use in the two groups was prevalent but that those with ID received more of both medications and supplements (e.g. polypharmacy was 39.0% in ID vs. 18.1% in non-ID cohort). Moreover, based on an analysis of the therapeutic groups and medications used that treatment was more intense in the ID cohort (95.8 vs. 7.0 International Non-proprietary Names per 100 participants). Supplement use was almost twice as prevalent in the ID group but substantially less diverse with only 10 types of supplements reported. Morbidity was higher in the ID group and showed a higher prevalence of neurological and mental health disorders. Conclusion The results highlight that the burden of therapy management and the potential risks in those ageing with ID differs substantially from those ageing without ID. Understanding the medication and supplement use of people aging with intellectual disability (ID) is critical to ensuring that health service providers in primary/ambulatory care can optimise use of these agents.
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Affiliation(s)
- Jure Peklar
- Faculty of Pharmacy, University of Ljubljana, Ljubljana, Slovenia
- * E-mail:
| | - Mitja Kos
- Faculty of Pharmacy, University of Ljubljana, Ljubljana, Slovenia
| | - Máire O’Dwyer
- School of Pharmacy and Pharmaceutical Sciences, Trinity College Dublin, Dublin, Ireland
- IDS-TILDA School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland
| | - Mary McCarron
- IDS-TILDA School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland
- Dean of the Faculty of Health Sciences, Trinity College Dublin, Dublin, Ireland
| | - Philip McCallion
- School of Social Work, Temple University, Philadelphia, Pennsylvania, United States of America
| | - Rose Anne Kenny
- The Irish Longitudinal Study on Ageing (TILDA), Trinity College Dublin, Dublin, Ireland
- Trinity College Institute of Neuroscience (TCIN), Trinity College Dublin, Dublin, Ireland
| | - Martin C. Henman
- School of Pharmacy and Pharmaceutical Sciences, Trinity College Dublin, Dublin, Ireland
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Pannu T, Sharkey S, Burek G, Cretu D, Hill MD, Hogan DB, Poulin MJ. Medication use by middle-aged and older participants of an exercise study: results from the Brain in Motion study. Altern Ther Health Med 2017; 17:105. [PMID: 28187744 PMCID: PMC5303244 DOI: 10.1186/s12906-017-1595-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2015] [Accepted: 01/20/2017] [Indexed: 12/18/2022]
Abstract
Background Over the past 50 years, there has been an increase in the utilization of prescribed, over-the-counter (OTC) medications, and natural health products. Although it is known that medication use is common among older persons, accurate data on the patterns of use, including the quantity and type of medications consumed in a generally healthy older population from a Canadian perspective are lacking. In this study, we study the pattern of medication use in a sedentary but otherwise healthy older persons use and determined if there was an association between medication use and aerobic fitness level. Methods All participants enrolled in the Brain in Motion study provided the name, formulation, dosage and frequency of any medications they were consuming at the time of their baseline assessment. Maximal aerobic capacity (VO2max) was determined on each participant. Results Two hundred seventy one participants (mean age 65.9 ± 6.5 years; range 55–92; 54.6% females) were enrolled. Most were taking one or more (1+) prescribed medication (n = 204, 75.3%), 1+ natural health product (n = 221, 81.5%) and/or 1+ over-the-counter (OTC) drug (n = 174, 64.2%). The most commonly used prescribed medications were HMG-CoA reductase inhibitors (statins) (n = 52, 19.2%). The most common natural health product was vitamin D (n = 201, 74.2%). For OTC drugs, non-steroidal anti-inflammatories (n = 82, 30.3%) were the most common. Females were more likely than males to take 1+ OTC medications, as well as supplements. Those over 65 years of age were more likely to consume prescription drugs than their counterparts (p ≤ 0.05). Subjects taking more than two prescribed or OTC medications were less physically fit as determined by their VO2max. The average daily Vitamin D intake was 1896.3 IU per participant. Conclusions Medication use was common in otherwise healthy older individuals. Consumption was higher among females and those older than 65 years. Vitamin D intake was over two-fold higher than the recommended 800 IU/day for older persons, but within the tolerable upper intake of 4,000 IU/day. The appropriateness of the high rate of medication use in this generally healthy population deserves further investigation.
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Cross AJ, George J, Woodward MC, Ames D, Brodaty H, Elliott RA. Dietary Supplement Use in Older People Attending Memory Clinics in Australia. J Nutr Health Aging 2017; 21:46-50. [PMID: 27999849 DOI: 10.1007/s12603-016-0742-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Dietary supplement use is common in older adults. There has been limited research in people attending memory clinics. OBJECTIVES To explore the use of dietary supplements in older people attending Australian memory clinics. DESIGN Cross-sectional analysis of baseline data from the Prospective Research In MEmory clinics (PRIME) study. PARTICIPANTS Community-dwelling older people who attended nine memory clinics and had a diagnosis of mild cognitive impairment (MCI) or dementia. MEASUREMENTS Dietary supplement was defined as a product that contains one or more: vitamin, mineral, herb or other botanical, amino acid or other dietary substance. Non-prescribed supplement was defined as a supplement that is not usually prescribed by a medical practitioner. Polypharmacy was defined as use of five or more medications. RESULTS 964 patients, mean age 77.6 years, were included. Dietary supplements were used by 550 (57.1%) patients; 353 (36.6%) used two or more. Non-prescribed supplements were used by 364 (36.8%) patients. Supplement use was associated with older age (OR: 1.12, 95% CI: 1.03-1.21), lower education level (OR: 1.53, 95% CI: 1.01-2.32) and a diagnosis of MCI rather than dementia (OR: 1.52, 95% CI: 1.05-2.21). Potential drug-supplement interactions were identified in 107 (11.1%) patients. Supplement users had increased prevalence of polypharmacy compared to non-users (80.5% vs. 48.1%, p<0.001). CONCLUSIONS Dietary supplements, including non-prescribed supplements, were commonly used by people attending memory clinics. Supplement use increased the prevalence of polypharmacy and resulted in potential supplement-drug interactions. Further research is required to assess the clinical outcomes of supplement use.
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Affiliation(s)
- A J Cross
- Rohan A Elliott. Pharmacy Department, Austin Health, PO Box 5555, Heidelberg, VIC, 3084, Australia. Phone: +61 3 9496 2334. Fax: +61 3 9496 5900,
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Lozupone M, Panza F, Stella E, La Montagna M, Bisceglia P, Miscio G, Galizia I, Daniele A, di Mauro L, Bellomo A, Logroscino G, Greco A, Seripa D. Pharmacogenetics of neurological and psychiatric diseases at older age: has the time come? Expert Opin Drug Metab Toxicol 2016; 13:259-277. [DOI: 10.1080/17425255.2017.1246533] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Madia Lozupone
- Unit of Neurodegenerative Disease, Department of Basic Medicine Sciences, Neuroscience, and Sense Organs, University of Bari ‘Aldo Moro,’, Bari, Italy
| | - Francesco Panza
- Unit of Neurodegenerative Disease, Department of Basic Medicine Sciences, Neuroscience, and Sense Organs, University of Bari ‘Aldo Moro,’, Bari, Italy
- Unit of Neurodegenerative Disease, Department of Clinical Research in Neurology, University of Bari ‘Aldo Moro’ at ‘Pia Fondazione Card. G. Panico,’, Tricase, Lecce, Italy
- Geriatric Unit and Gerontology-Geriatrics Research Laboratory, Department of Medical Sciences, IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy
| | - Eleonora Stella
- Psychiatric Unit, Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
| | - Maddalena La Montagna
- Psychiatric Unit, Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
| | - Paola Bisceglia
- Geriatric Unit and Gerontology-Geriatrics Research Laboratory, Department of Medical Sciences, IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy
| | - Giuseppe Miscio
- Laboratory of Clinical Chemistry, Department of Clinical Pathology, IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy
| | - Ilaria Galizia
- Psychiatric Unit, Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
| | - Antonio Daniele
- Institute of Neurology, Catholic University of Sacred Heart, Rome, Italy
| | - Lazzaro di Mauro
- Laboratory of Clinical Chemistry, Department of Clinical Pathology, IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy
| | - Antonello Bellomo
- Psychiatric Unit, Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
| | - Giancarlo Logroscino
- Unit of Neurodegenerative Disease, Department of Basic Medicine Sciences, Neuroscience, and Sense Organs, University of Bari ‘Aldo Moro,’, Bari, Italy
- Unit of Neurodegenerative Disease, Department of Clinical Research in Neurology, University of Bari ‘Aldo Moro’ at ‘Pia Fondazione Card. G. Panico,’, Tricase, Lecce, Italy
| | - Antonio Greco
- Geriatric Unit and Gerontology-Geriatrics Research Laboratory, Department of Medical Sciences, IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy
| | - Davide Seripa
- Geriatric Unit and Gerontology-Geriatrics Research Laboratory, Department of Medical Sciences, IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy
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Pierantozzi AM, Plath AE. New antithrombotic therapies and complementary and alternative medicine (CAM): Chartering into unknown territory. ADVANCES IN INTEGRATIVE MEDICINE 2016. [DOI: 10.1016/j.aimed.2016.07.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Thompson K, Shi S, Kiraly C. Primary Care for the Older Adult Patient: Common Geriatric Issues and Syndromes. Obstet Gynecol Clin North Am 2016; 43:367-79. [PMID: 27212097 DOI: 10.1016/j.ogc.2016.01.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Older adults are the fastest growing segment of the US population and the majority of older adults are women. Primary care for the older adult patient requires a wide variety of skills, reflecting the complexity and heterogeneity of this patient population. Individualizing care through consideration of patients' goals, medical conditions, and prognosis is paramount. Quality care for the older adult patient requires familiarity with common geriatric syndromes, such as dementia, falls, and polypharmacy. In addition, developing the knowledge and communication skills necessary for complex care and end-of-life care planning is essential.
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Affiliation(s)
- Katherine Thompson
- Department of Medicine, University of Chicago, 5841 South Maryland Avenue, MC 6098, Chicago, IL 60637, USA.
| | - Sandra Shi
- Department of Medicine, University of Chicago, 5841 South Maryland Avenue, MC 7082, Chicago, IL 60637, USA
| | - Carmela Kiraly
- Department of Medicine, University of Chicago, 5841 South Maryland Avenue, MC 7082, Chicago, IL 60637, USA
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Rayner JA, Bauer M. “I Wouldn’t Mind Trying It. I’m in Pain the Whole Time”: Barriers to the Use of Complementary Medicines by Older Australians in Residential Aged-Care Facilities. J Appl Gerontol 2016; 36:1070-1090. [DOI: 10.1177/0733464816629852] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Older people living in the community use complementary medicine (CM) to manage the symptoms of chronic illness; however, little is known about CM use by older people living in care settings. Using focus groups and individual interviews, this study explored the use of CM from the perspective of 71 residents, families, and health professionals from six residential aged-care facilities in Victoria, Australia. Residents used CM to manage pain and improve mobility, often covertly, and only with the financial assistance of their families. Facility policies and funding restrictions constrained CM use at the individual and facility level. An absence of evidence to support safety and efficacy coupled with the risk of interactions made doctors wary of CM use in older people. These findings have relevance for the large number of CM using “baby-boomers” as they move into residential aged-care.
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Cross AJ, George J, Woodward MC, Ames D, Brodaty H, Ilomäki J, Elliott RA. Potentially Inappropriate Medications and Anticholinergic Burden in Older People Attending Memory Clinics in Australia. Drugs Aging 2015; 33:37-44. [DOI: 10.1007/s40266-015-0332-3] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Knowles LM, Skeath P, Jia M, Najafi B, Thayer J, Sternberg EM. New and Future Directions in Integrative Medicine Research Methods with a Focus on Aging Populations: A Review. Gerontology 2015; 62:467-76. [DOI: 10.1159/000441494] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2015] [Accepted: 10/06/2015] [Indexed: 11/19/2022] Open
Abstract
This review discusses existing and developing state-of-the-art noninvasive methods for quantifying the effects of integrative medicine (IM) in aging populations. The medical conditions of elderly patients are often more complex than those of younger adults, making the multifaceted approach of IM particularly suitable for aging populations. However, because IM interventions are multidimensional, it has been difficult to examine their effectiveness and mechanisms of action. Optimal assessment of IM intervention effects in the elderly should include a multifaceted approach, utilizing advanced analytic methods to integrate psychological, behavioral, physiological, and biomolecular measures of a patient's response to IM treatment. Research is presented describing methods for collecting and analyzing psychological data; wearable unobtrusive devices for monitoring heart rate variability, activity and other behavioral responses in real time; immunochemical methods for noninvasive molecular biomarker analysis, and considerations and analytical approaches for the integration of these measures. The combination of methods and devices presented in this review will provide new approaches for evaluating the effects of IM interventions in real-life ambulatory settings of older adults, and will extend the concept of mobile health to the domains of IM and healthy aging.
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Effoe VS, Suerken CK, Quandt SA, Bell RA, Arcury TA. The Association of Complementary Therapy Use With Prescription Medication Adherence Among Older Community-Dwelling Adults. J Appl Gerontol 2015; 36:1054-1069. [PMID: 26320147 DOI: 10.1177/0733464815602116] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Medication adherence is a major health concern, particularly among older adults who have one or more chronic conditions. We examined the association between complementary therapy use and medication adherence among older community-dwelling adults. In a bi-ethnic sample of 165 adults aged 65 years and older, anthropometric variables, data on chronic medical conditions, and medication use were assessed. Medication adherence was modeled as a score (<50%, 50%-75%, and >75%) and complementary therapy use was categorized as a binary variable. Over half of the participants (50.3%) were female, and 47.3% were African American. Complementary therapy use was prevalent (87.9%) and did not differ by sex, ethnicity, income, and educational attainment. Medication adherence score was >75% in 84.8% of complementary therapy users and 80.0% of non-users ( p = .61). Despite a high use of complementary therapy in this population, there was no apparent association with low medication adherence.
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Affiliation(s)
- Valery S Effoe
- 1 Wake Forest School of Medicine, Winston-Salem, NC, USA
| | | | - Sara A Quandt
- 1 Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Ronny A Bell
- 1 Wake Forest School of Medicine, Winston-Salem, NC, USA
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Gardiner P, Filippelli AC, Kabbara K, Lin SC, Sadikova E, Kaptchuk TJ, Kemper K. Online Education for Improving Communication and Documentation of Dietary Supplements Among Health Professionals Practicing in a Hospital Setting. J Altern Complement Med 2015; 21:638-44. [PMID: 26270001 DOI: 10.1089/acm.2015.0156] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Little is known about the feasibility of online education in improving communication and documentation of dietary supplements (DS) among clinicians. METHODS This prospective educational study included clinicians at an urban teaching hospital. The curriculum included video streams, didactics, and interactive case presentations to discuss (1) DS safety and effectiveness, (2) cultural competency, (3) managing DS in a hospital setting, and (4) DS adverse events. Participants were surveyed, at baseline and after training, about DS knowledge, confidence, communication, and documentation practices. RESULTS Thirty-nine of 61 (64%) recruited clinicians completed all four patient cases and post-tests. Most (82%) were women and 59% were physicians. The mean DS knowledge test score increased after the curriculum (p < 0.0001), and the clinician confidence score also increased (p < 0.0001). Most (82%) participants reported that curriculum changed their use of evidence-based resources (p = 0.01). There was a change in the indications for symptom management (p = 0.05) and gastrointestinal/digestive health issues (p = 0.03). There were statistically significant increases in the frequency of asking patients about DS use during discharge (p = 0.01), and 82% responded that the curriculum changed their DS documentation. CONCLUSION An online curriculum is an effective tool for presenting DS education to clinicians with the goal of improving clinicians' knowledge, confidence, and documentation practices about DS.
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Affiliation(s)
- Paula Gardiner
- 1 Department of Family Medicine, Boston University Medical Center , Boston, MA
| | - Amanda C Filippelli
- 1 Department of Family Medicine, Boston University Medical Center , Boston, MA
| | - Karim Kabbara
- 2 Information Technology-Application Service, Boston University School of Medicine , Boston, MA
| | - Steven C Lin
- 3 Department of Medicine, University of California at San Diego , San Diego, CA
| | - Ekaterina Sadikova
- 4 Department of Research and Evaluation, Kaiser Permanente , Pasadena, CA
| | - Ted J Kaptchuk
- 5 Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center , Harvard Medical School, Boston, MA
| | - Kathi Kemper
- 6 Department of Pediatrics, Ohio State University College of Medicine , Columbus, OH
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Gardiner P, Filippelli AC, Sadikova E, White LF, Jack BW. Medication and Dietary Supplement Interactions among a Low-Income, Hospitalized Patient Population Who Take Cardiac Medications. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE : ECAM 2015; 2015:429826. [PMID: 25949262 PMCID: PMC4407526 DOI: 10.1155/2015/429826] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/30/2014] [Revised: 03/07/2015] [Accepted: 03/24/2015] [Indexed: 02/06/2023]
Abstract
Purpose. To identify characteristics associated with the use of potentially harmful combinations of dietary supplements (DS) and cardiac prescription medications in an urban, underserved, inpatient population. Methods. Cardiac prescription medication users were identified to assess the prevalence and risk factors of potentially harmful dietary supplement-prescription medication interactions (PHDS-PMI). We examined sociodemographic and clinical characteristics for crude (χ (2) or t-tests) and adjusted multivariable logistic regression associations with the outcome. Results. Among 558 patients, there were 121 who also used a DS. Of the 110 participants having a PHDS-PMI, 25% were asked about their DS use at admission, 75% had documentation of DS in their chart, and 21% reported the intention to continue DS use after discharge. A multivariable logistic regression model noted that for every additional medication or DS taken the odds of having a PHDS-PMI increase and that those with a high school education are significantly less likely to have a PHDS-PMI than those with a college education. Conclusion. Inpatients at an urban safety net hospital taking a combination of cardiac prescription medications and DS are at a high risk of harmful supplement-drug interactions. Providers must ask about DS use and should consider the potential for interactions when having patient discussions about cardiac medications and DS.
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Affiliation(s)
- Paula Gardiner
- Department of Family Medicine, Boston University School of Medicine, Boston Medical Center, Boston, MA 02118, USA
| | - Amanda C. Filippelli
- Department of Family Medicine, Boston University School of Medicine, Boston Medical Center, Boston, MA 02118, USA
| | - Ekaterina Sadikova
- Department of Family Medicine, Boston University School of Medicine, Boston Medical Center, Boston, MA 02118, USA
| | - Laura F. White
- Department of Biostatistics, Boston University School of Public Health, Boston, MA 02118, USA
| | - Brian W. Jack
- Department of Family Medicine, Boston University School of Medicine, Boston Medical Center, Boston, MA 02118, USA
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Gardiner P, Sadikova E, Filippelli AC, White LF, Jack BW. Medical reconciliation of dietary supplements: don't ask, don't tell. PATIENT EDUCATION AND COUNSELING 2015; 98:512-517. [PMID: 25636694 PMCID: PMC4404157 DOI: 10.1016/j.pec.2014.12.010] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/17/2014] [Revised: 10/08/2014] [Accepted: 12/27/2014] [Indexed: 06/04/2023]
Abstract
OBJECTIVE To explore inpatient reconciliation of dietary supplement (DS) use and determine characteristics associated with DS documentation. METHODS We analyzed DS use among 558 inpatients recruited from the Re-Engineered Discharge clinical trial to identify: (1) if patients self-reported DS and (2) if DS use was documented at admission. We examined socio-demographics for association with documentation using chi squares and t-tests. Logistic regression was performed to assess adjusted associations with DS documentation. RESULTS Sixty percent reported DS use (n=333). Among users, 36% had admission DS documentation, 20% were asked about use at admission, 18% reported disclosing use to a provider, and 48% reported they would continue to use DS. Overall, 6% of participants were asked, disclosed, and had documentation of DS. Logistic regression revealed increased age associated with lower odds of DS documentation. Identifying as Hispanic or African American reduces DS documentation odds compared to those identifying as white. CONCLUSIONS There is lack of consistent DS medical reconciliation in the inpatient setting. While more than half of patients used DS prior to hospitalization, most were not asked about use on admission. PRACTICE IMPLICATIONS This study adds to literature on medical reconciliation which requires that providers inquire and document patient DS use.
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Affiliation(s)
- Paula Gardiner
- Department of Family Medicine, Boston University School of Medicine, Boston Medical Center, Boston, USA.
| | - Ekaterina Sadikova
- Department of Family Medicine, Boston University School of Medicine, Boston Medical Center, Boston, USA
| | - Amanda C Filippelli
- Department of Family Medicine, Boston University School of Medicine, Boston Medical Center, Boston, USA
| | - Laura F White
- Department of Biostatistics, Boston University School of Public Health, Boston, USA
| | - Brian W Jack
- Department of Family Medicine, Boston University School of Medicine, Boston Medical Center, Boston, USA
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Peklar J, Henman MC, Kos M, Richardson K, Kenny RA. Concurrent use of drugs and supplements in a community-dwelling population aged 50 years or more: potential benefits and risks. Drugs Aging 2015; 31:527-40. [PMID: 24890574 DOI: 10.1007/s40266-014-0180-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The use of vitamin and mineral (VMs) and non-vitamin/non-mineral supplements (non-VMs) in the general population and the older population in developed countries has increased. When combined with drugs, their use can be associated with benefit and potential risks. OBJECTIVE The aims of this study were to determine the extent and associated factors of the combined use of drugs and VM/non-VM supplements, and to examine the potential major drug-supplement interactions METHODS Cross-sectional analysis of first-wave data of TILDA, The Irish Longitudinal Study on Ageing, nationally representative a cohort including 8,081 community-dwelling persons aged ≥50 years. Prevalences including 95 % confidence intervals (CI) were weighted to the population. Group differences in drug and supplement use were assessed using Pearson's Chi-square test, and associations between concurrent drug-supplement use and covariates were assessed using logistic regression. Potential interactions between drugs and supplements were assessed using relevant sources. RESULTS Every seventh respondent (14.0 %; 95 % CI 13.1-15.0) reported regular concurrent use of drugs and supplements; 7.9 % (95 % CI 7.3-8.6) took only VMs, 3.9 % (95 % CI 3.4-4.4) took only non-VMs, and 2.2 % (95 % CI 1.8-2.6) took at least one of each concurrently with drugs. Concurrent use was more prevalent in women and in the oldest (≥75 years) group. Chronic disease, female sex, third-level education and private medical insurance were associated with an increased likelihood of use of both supplement types, whereas those classed as employed were much less likely to use any supplements. Supplements were combined with drugs in all of the commonly prescribed therapeutic groups, ranging from just under 60 % with drugs for bone diseases to 15.7 % with drugs for diabetes. Potential major drug-supplement interactions were detected in 4.5 % (95 % CI 3.4-5.8) of concurrent drug-supplement users, and were more prevalent in older respondents. CONCLUSIONS Concurrent use of drugs and supplements among those aged over 50 years in the Irish population is substantial and increases with age. There is considerable variation in usage, and the outcome of this approach is evidence of unmet need and therefore unrealised benefits among some subgroups, and of exposure to avoidable and potential serious drug interactions among others.
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Affiliation(s)
- Jure Peklar
- Faculty of Pharmacy, University of Ljubljana, Ljubljana, Slovenia,
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Abstract
BACKGROUND Vitamins and supplements are the most commonly used form of complementary and alternative medicine in the United States. Growing research suggests that patients substitute vitamins and supplements for their prescription medications. The reasons might include cost of prescription medications and discordant patient and doctor health belief systems. OBJECTIVES To investigate the prevalence of substitution of vitamins and supplements for prescription medications among veterans who receive care in the VA health care system and whether substitution is associated with prescription rationing due to cost, treatment beliefs, or distrust of the health system. RESEARCH DESIGN Cross-sectional observational survey. SUBJECTS Primary care patients (n=275) at the Philadelphia VA Medical Center. MEASURES Medication substitution, prescription medication rationing, treatment beliefs, and health system distrust were measured with structured instruments. Multivariate logistic regression was performed with substitution as the dependent variable. RESULTS A significant number of primary care patients in the VA system use vitamins and supplements 206 (75%). The prevalence of medication substitution is high 48 (18%). Medication substitution is strongly associated with prescription rationing due to cost (adjusted odds ratio 6.3, 95% confidence interval: 2.0-19.5, P=0.001). Similarly, greater belief in complementary and alternative approaches to care positively predicts medication substitution (adjusted odds ratio 1.08, 95% confidence interval: 1.01-1.15, P=0.011). There is no significant association between health system distrust and likelihood of medication substitution. CONCLUSIONS Medication substitution is prevalent in this sample of inner city primary care patients who receive care in the VA system. Cost of prescriptions and belief in the value of complementary and alternative approaches to care appear to be associated with this patient-driven treatment decision.
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Campbell NL, Skaar TC, Perkins AJ, Gao S, Li L, Khan BA, Boustani MA. Characterization of hepatic enzyme activity in older adults with dementia: potential impact on personalizing pharmacotherapy. Clin Interv Aging 2015; 10:269-75. [PMID: 25609939 PMCID: PMC4298284 DOI: 10.2147/cia.s65980] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
Objective To determine the frequency of pharmacogenomic variants and concurrent medications that may alter the efficacy and tolerability of acetylcholinesterase inhibitors (AChEIs). Materials and methods A multisite cross-sectional study was carried out across four memory care practices in the greater Indianapolis area. Participants were adults aged 65 years and older with a diagnosis of probable or possible Alzheimer’s disease (AD) (n=105). Blood samples and self-reported medication data were collected. Since two of the three AChEIs are metabolized by cytochrome P450 (CYP)-2D6, we determined the frequency of functional genetic variants in the CYP2D6 gene and calculated their predicted CYP2D6-activity scores. Concurrent medication data were collected from self-reported medication surveys, and their predicted effect on the pharmacokinetics of AChEIs was determined based on their known effects on CYP2D6 and CYP3A4/5 enzyme activities. Results Among the 105 subjects enrolled, 72% were female and 36% were African American. Subjects had a mean age of 79.6 years. The population used a mean of eight medications per day (prescription and nonprescription). The CYP2D6 activity score frequencies were 0 (3.8%), 0.5 (4.8%), 1.0 (36.2%), 1.5–2.0 (51.4%), and >2.0 (3.8%). Nineteen subjects (18.1%) used a medication considered a strong or moderate inhibitor of CYP2D6, and eight subjects (7.6%) used a medication considered a strong or moderate inhibitor of CYP3A4/5. In total, 28.6% of the study population was predicted to have reduced activity of the CYP2D6 or CYP3A4/5 enzymes due to either genetic variants or concomitant medications. Conclusion Both pharmacogenetic variants and concurrent drug therapies that are predicted to alter the pharmacokinetics of AChEIs should be evaluated in older adults with AD. Pharmacogenetic and drug-interaction data may help personalize AD therapy and increase adherence by improving tolerability.
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Affiliation(s)
- Noll L Campbell
- College of Pharmacy, Purdue University, West Lafayette, IN, USA ; Indiana University Center for Aging Research, Indiana University School of Medicine, Indianapolis, IN, USA ; Regenstrief Institute, Indiana University School of Medicine, Indianapolis, IN, USA ; Department of Pharmacy, Eskenazi Health Services, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Todd C Skaar
- Division of Clinical Pharmacology, Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Anthony J Perkins
- Indiana University Center for Aging Research, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Sujuan Gao
- Indiana University Center for Aging Research, Indiana University School of Medicine, Indianapolis, IN, USA ; Regenstrief Institute, Indiana University School of Medicine, Indianapolis, IN, USA ; Department of Biostatistics, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Lang Li
- Department of Medical and Molecular Genetics, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Babar A Khan
- Indiana University Center for Aging Research, Indiana University School of Medicine, Indianapolis, IN, USA ; Regenstrief Institute, Indiana University School of Medicine, Indianapolis, IN, USA ; Division of Clinical Pharmacology, Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Malaz A Boustani
- Indiana University Center for Aging Research, Indiana University School of Medicine, Indianapolis, IN, USA ; Regenstrief Institute, Indiana University School of Medicine, Indianapolis, IN, USA ; Center for Innovation and Implementation Science, Indiana University, Indianapolis, IN, USA
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Schnabel K, Binting S, Witt CM, Teut M. Use of complementary and alternative medicine by older adults--a cross-sectional survey. BMC Geriatr 2014; 14:38. [PMID: 24669824 PMCID: PMC3974184 DOI: 10.1186/1471-2318-14-38] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2013] [Accepted: 03/20/2014] [Indexed: 11/23/2022] Open
Abstract
Background Very little is known about complementary and alternative medicine (CAM) use by older adults in Germany. The aim of this study was to investigate the use of CAM and other health promoting substances (e.g., herbal teas) by older adults of at least 70 years of age. Methods A cross-sectional questionnaire study was conducted among persons of ≥70 years from metropolitan Berlin and rural parts of Brandenburg, Germany. Recorded were: demographics, current use of CAM, medical diagnoses, users’ opinions and preferences. Results A total of 400 older adults, living as ‘self-reliant’ (n = 154), ‘home care service user’ (n = 97), or ‘in nursing home’ (n = 149), and with the legal status ‘without guardian’ (n = 355) or ‘with guardian’ (n = 45) were included (mean age 81.8 ± 7.4 years, 78.5% female). Any type of CAM used 61.3% of respondents (dietary supplements 35.5%, herbal medicines 33.3%, and external preparations 26.8%); 3.0% used drug-interaction causing preparations. Usage was based on recommendations (total 30.3%; in 20.0% by friends or family and 10.4% by pharmacists), own initiative (27.3%), and doctors’ prescription (25.8%). Participants with legal guardian took almost solely prescribed dietary supplements. Of the others, only half (58.7%) informed their general practitioner (GP) of their CAM use. Participants expected significant (44.9%) or moderate (37.1%) improvement; half of them perceived a good effect (58.7%) and two-thirds (64.9%) generally preferred a combination of CAM and conventional medicine. More than half (57.9%) stated that they could neither assess whether their CAM preparations have side effects, nor assess what the side effects might be. Strongest predictors for CAM use were two treatment preferences (vs. ‘conventional only’: ‘CAM only’, OR = 3.98, p = 0.0042 and ‘CAM + conventional’, 3.02, 0.0028) and the type of health insurance (‘statutory’ vs. ‘private’, 3.57, 0.0356); against CAM use two subjective assessments predicted (vs. ‘CAM causes no harm’: ‘CAM causes harmful drug interactions’, 0.25, 0.0536 and ‘I cannot assess side effects’, 0.28, 0.0010). Conclusion Older German adults frequently use CAM. They perceived it as an effective complement to conventional medicine, but are not sufficiently informed about risks and benefits.
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Affiliation(s)
| | | | | | - Michael Teut
- Institute for Social Medicine, Epidemiology and Health Economics, Charité Universitätsmedizin, D-10098 Berlin, Germany.
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Campbell NL, Unverzagt F, LaMantia MA, Khan BA, Boustani MA. Risk factors for the progression of mild cognitive impairment to dementia. Clin Geriatr Med 2013; 29:873-93. [PMID: 24094301 PMCID: PMC5915285 DOI: 10.1016/j.cger.2013.07.009] [Citation(s) in RCA: 118] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The increasing prevalence of cognitive impairment among the older adult population warrants attention to the identification of practices that may minimize the progression of early forms of cognitive impairment, including the transitional stage of mild cognitive impairment (MCI), to permanent stages of dementia. This article identifies both markers of disease progress and risk factors linked to the progression of MCI to dementia. Potentially modifiable risk factors may offer researchers a point of intervention to modify the effect of the risk factor and to minimize the future burden of dementia.
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Affiliation(s)
- Noll L Campbell
- College of Pharmacy, Purdue University, 575 Stadium Mall Drive, West Lafayette, IN 47907, USA; Indiana University Center for Aging Research, 410 West 10th Street, Indianapolis, IN 46202, USA; Regenstrief Institute, Inc, 410 West 10th Street, Indianapolis, IN 46202, USA; Department of Pharmacy, Wishard/Eskenazi Health Services, 1001 West 10th Street, Indianapolis, IN 46202, USA.
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Bernstein M, Munoz N. Position of the Academy of Nutrition and Dietetics: food and nutrition for older adults: promoting health and wellness. J Acad Nutr Diet 2012; 112:1255-77. [PMID: 22818734 DOI: 10.1016/j.jand.2012.06.015] [Citation(s) in RCA: 150] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2012] [Indexed: 02/07/2023]
Abstract
It is the position of the Academy of Nutrition and Dietetics that all Americans aged 60 years and older receive appropriate nutrition care; have access to coordinated, comprehensive food and nutrition services; and receive the benefits of ongoing research to identify the most effective food and nutrition programs, interventions, and therapies. Health, physiologic, and functional changes associated with the aging process can influence nutrition needs and nutrient intake. The practice of nutrition for older adults is no longer limited to those who are frail, malnourished, and ill. The population of adults older than age 60 years includes many individuals who are living healthy, vital lives with a variety of nutrition-related circumstances and environments. Access and availability of wholesome, nutritious food is essential to ensure successful aging and well-being for the rapidly growing, heterogeneous, multiracial, and ethnic population of older adults. To ensure successful aging and minimize the effects of disease and disability, a wide range of flexible dietary recommendations, culturally sensitive food and nutrition services, physical activities, and supportive care tailored to older adults are necessary. National, state, and local strategies that promote access to coordinated food and nutrition services are essential to maintain independence, functional ability, disease management, and quality of life. Those working with older adults must be proactive in demonstrating the value of comprehensive food and nutrition services. To meet the needs of all older adults, registered dietitians and dietetic technicians, registered, must widen their scope of practice to include prevention, treatment, and maintenance of health and quality of life into old age.
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Affiliation(s)
- Melissa Bernstein
- Rosalind Franklin University of Medicine and Science, North Chicago, IL, USA
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Campbell NL, Boustani MA, Skopelja EN, Gao S, Unverzagt FW, Murray MD. Medication Adherence in Older Adults With Cognitive Impairment: A Systematic Evidence-Based Review. ACTA ACUST UNITED AC 2012; 10:165-77. [DOI: 10.1016/j.amjopharm.2012.04.004] [Citation(s) in RCA: 125] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2012] [Revised: 04/10/2012] [Accepted: 04/19/2012] [Indexed: 12/15/2022]
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Kanji S, Seely D, Yazdi F, Tetzlaff J, Singh K, Tsertsvadze A, Tricco AC, Sears ME, Ooi TC, Turek MA, Skidmore B, Ansari MT. Interactions of commonly used dietary supplements with cardiovascular drugs: a systematic review. Syst Rev 2012; 1:26. [PMID: 22651380 PMCID: PMC3534595 DOI: 10.1186/2046-4053-1-26] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2011] [Accepted: 04/18/2012] [Indexed: 11/10/2022] Open
Abstract
UNLABELLED BACKGROUND The objective of this systematic review was to examine the benefits, harms and pharmacokinetic interactions arising from the co-administration of commonly used dietary supplements with cardiovascular drugs. Many patients on cardiovascular drugs take dietary supplements for presumed benefits and may be at risk for adverse supplement-drug interactions. METHODS The Allied and Complementary Medicine Database, the Cochrane Library, EMBASE, International Bibliographic Information on Dietary Supplements and MEDLINE were searched from the inception of the review to October 2011. Grey literature was also reviewed.Two reviewers independently screened records to identify studies comparing a supplement plus cardiovascular drug(s) with the drug(s) alone. Reviewers extracted data using standardized forms, assessed the study risk of bias, graded the strength of evidence and reported applicability. RESULTS Evidence was obtained from 65 randomized clinical trials, 2 controlled clinical trials and 1 observational study. With only a few small studies available per supplement, evidence was insufficient for all predefined gradable clinical efficacy and harms outcomes, such as mortality and serious adverse events. One long-term pragmatic trial showed no benefit from co-administering vitamin E with aspirin on a composite cardiovascular outcome. Evidence for most intermediate outcomes was insufficient or of low strength, suggesting no effect. Incremental benefits were noted for triglyceridemia with omega-3 fatty acid added to statins; and there was an improvement in levels of high-density lipoprotein cholesterol with garlic supplementation when people also consumed nitrates CONCLUSIONS Evidence of low-strength indicates benefits of omega-3 fatty acids (plus statin, or calcium channel blockers and antiplatelets) and garlic (plus nitrates or warfarin) on triglycerides and HDL-C, respectively. Safety concerns, however, persist.
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Affiliation(s)
- Salmaan Kanji
- Clinical Epidemiology, The Ottawa Hospital Research Institute and the Department of Pharmacy, The Ottawa Hospital, Ottawa, ON, Canada
| | - Dugald Seely
- Clinical Epidemiology, The Ottawa Hospital Research Institute and the Department of Pharmacy, The Ottawa Hospital, Ottawa, ON, Canada
- Department of Research & Clinical Epidemiology, The Canadian College of Naturopathic Medicine, Toronto, ON, Canada
| | - Fatemeh Yazdi
- Ottawa Methods Centre, Clinical Epidemiology Program, Ottawa Hospital Research Institute, University of Ottawa Evidence-based Practice Center, Ottawa, ON, Canada
| | - Jennifer Tetzlaff
- Ottawa Methods Centre, Clinical Epidemiology Program, Ottawa Hospital Research Institute, University of Ottawa Evidence-based Practice Center, Ottawa, ON, Canada
| | - Kavita Singh
- Ottawa Methods Centre, Clinical Epidemiology Program, Ottawa Hospital Research Institute, University of Ottawa Evidence-based Practice Center, Ottawa, ON, Canada
| | - Alexander Tsertsvadze
- Ottawa Methods Centre, Clinical Epidemiology Program, Ottawa Hospital Research Institute, University of Ottawa Evidence-based Practice Center, Ottawa, ON, Canada
| | - Andrea C Tricco
- Li Ka Shing Knowledge Institute, St Michael’s Hospital, Toronto, ON, Canada
| | - Margaret E Sears
- Ottawa Methods Centre, Clinical Epidemiology Program, Ottawa Hospital Research Institute, University of Ottawa Evidence-based Practice Center, Ottawa, ON, Canada
- Children’s Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada
| | - Teik C Ooi
- Division of Endocrinology and Metabolism, The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada
| | - Michele A Turek
- Division of Cardiology, The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada
| | - Becky Skidmore
- Division of Cardiology, The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada
| | - Mohammed T Ansari
- Ottawa Methods Centre, Clinical Epidemiology Program, Ottawa Hospital Research Institute, University of Ottawa Evidence-based Practice Center, Ottawa, ON, Canada
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Abstract
Advancing age is a major risk factor for cognitive impairment and dementia. Currently, there are no effective preventive strategies for cognitive decline. Since physicians have no drug therapies to offer, patients and families may turn to complementary and alternative medicine to preserve cognition. Dietary supplements are one of the most common forms of complementary and alternative medicine that patients use and although limited, evidence for their potential interactions with other treatments has been documented. Considering the insufficient evidence for their efficacy, potential for interaction with other therapies and costs to patients, physicians should be aware of the use of dietary supplements among their patients so that they can advise their patients on the potential benefits and harms.
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Affiliation(s)
- MK Gestuvo
- Department of Geriatrics and Palliative Medicine, Mount Sinai School of Medicine, New York, NY, USA
| | - WW Hung
- Department of Geriatrics and Palliative Medicine, Mount Sinai School of Medicine, New York, NY, USA
- Geriatric Research, Education and Clinical Center, James J Peters VA Medical Center, Bronx, NY, USA
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Viveky N, Toffelmire L, Thorpe L, Billinsky J, Alcorn J, Hadjistavropoulos T, Whiting SJ. Use of vitamin and mineral supplements in long-term care home residents. Appl Physiol Nutr Metab 2012; 37:100-5. [DOI: 10.1139/h11-141] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Vitamin–mineral supplementation may offer older adults health and cognition-related benefits but overuse may contribute to polypharmacy. We examined the prevalence of supplement usage in long-term care facility (LTC) residents (≥65 years of age). As cognition may be affected by nutrition, we also examined use in those with diagnosis of dementia and those with no dementia diagnosis. The prevalence of supplement usage and overall “pill count” from pharmaceutical use was assessed in 189 LTC residents and a subsample of 56 older adults with dementia diagnosis, respectively. Participants were residing in an LTC facility of a mid-size metropolitan area during 2009. The average use of supplements was 1.0 per day for all residents, with 35% taking vitamin D supplements, 20% multivitamins, and 26% calcium. Supplement use was similar (p ≥ 0.05) for those with dementia diagnosis (53%, average 2.0 per day) and for those without such diagnosis (45%, average 2.2 per day). Usage ranged between 1–6 supplements per day. In both of these groups, ∼73% of users were taking vitamin D. The number of prescribed medications ranged from 4 to 24 (average 10.2) in a subsample of residents whose supplement intake was 0 to 6 (average 2). These findings suggest an overall low rate of supplement use, with no significant differences (p ≥ 0.05) in use between residents with and without dementia diagnosis. However, some residents were at risk for supplement overuse.
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Affiliation(s)
- Navita Viveky
- College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, SK S7N 5C9, Canada
| | - Lynda Toffelmire
- College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, SK S7N 5C9, Canada
| | - Lilian Thorpe
- College of Medicine, University of Saskatchewan, Saskatoon, SK S7N 5E5, Canada
| | - Jennifer Billinsky
- College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, SK S7N 5C9, Canada
| | - Jane Alcorn
- College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, SK S7N 5C9, Canada
| | | | - Susan J. Whiting
- College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, SK S7N 5C9, Canada
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Abstract
Polypharmacy is generally defined as the use of 5 or more prescription medications on a regular basis. The average number of prescribed and over-the-counter medications used by community-dwelling older adults per day in the United States is 6 medications, and the number used by institutionalized older persons is 9 medications. Almost all medications affect nutriture, either directly or indirectly, and nutriture affects drug disposition and effect. This review will highlight the issues surrounding polypharmacy, food-drug interactions, and the consequences of these interactions for the older adult.
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Affiliation(s)
- Roschelle Heuberger
- Department of Human Environmental Studies, Central Michigan University, Mt Pleasant, Michigan 48859, USA.
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Prescribing Botanicals. Integr Med (Encinitas) 2012. [DOI: 10.1016/b978-1-4377-1793-8.00087-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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