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Yoshida Y, Ishizaki T, Masui Y, Miura Y, Matsumoto K, Nakagawa T, Inagaki H, Ito K, Arai Y, Kabayama M, Kamide K, Rakugi H, Ikebe K, Gondo Y. Effects of multimorbidity and polypharmacy on physical function in community-dwelling older adults: A 3-year prospective cohort study from the SONIC. Arch Gerontol Geriatr 2024; 126:105521. [PMID: 38878595 DOI: 10.1016/j.archger.2024.105521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Revised: 05/26/2024] [Accepted: 06/02/2024] [Indexed: 09/05/2024]
Abstract
BACKGROUND We prospectively examined the effect of baseline multimorbidity and polypharmacy on the physical function of community-dwelling older adults over a three-year period. METHODS The analysis included 1,401 older adults (51.5 % women) who participated in both wave 1 and wave 2 (3-year follow-up) of the Septuagenarians, Octogenarians, and Nonagenarians Investigation with Centenarians (SONIC) study. Grip strength and walking speed were binarized into poor/not poor physical function according to the frailty definition. The number of chronic conditions and the number of prescribed medications were categorized into 3 and 4 groups, respectively. Multivariable logistic regression was used to examine associations between the number of chronic conditions, medication use at baseline, and poor physical function over a three-year period. RESULTS After adjusting for confounding factors, hyperpolypharmacy (≥ 10 medications) demonstrated associations with weak grip strength (adjusted odds ratio [aOR] = 2.142, 95 % confidence interval [CI] = 1.100-4.171) and slow walking speed (aOR = 1.878, 95 % CI = 1.013-3.483), while co-medication (1-4 medications) was negatively associated with slow walking speed (aOR = 0.688, 95 % CI = 0.480-0.986). There was no significant association between the number of chronic conditions and physical function. CONCLUSION The findings suggest that the number of medications can serve as a simple indicator to assess the risk of physical frailty. Given that many older individuals receive multiple medications for extended durations, medical management approaches must consider not only disease-specific treatment outcomes but also prioritize drug therapy while actively avoiding the progression towards frailty and geriatric syndromes.
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Affiliation(s)
- Yuko Yoshida
- Tokyo Metropolitan Institute for Geriatrics and Gerontology, 35-2 Sakae-cho, Itabashi-ku, Tokyo 173-0015, Japan
| | - Tatsuro Ishizaki
- Tokyo Metropolitan Institute for Geriatrics and Gerontology, 35-2 Sakae-cho, Itabashi-ku, Tokyo 173-0015, Japan.
| | - Yukie Masui
- Tokyo Metropolitan Institute for Geriatrics and Gerontology, 35-2 Sakae-cho, Itabashi-ku, Tokyo 173-0015, Japan
| | - Yuri Miura
- Tokyo Metropolitan Institute for Geriatrics and Gerontology, 35-2 Sakae-cho, Itabashi-ku, Tokyo 173-0015, Japan
| | | | | | - Hiroki Inagaki
- Tokyo Metropolitan Institute for Geriatrics and Gerontology, 35-2 Sakae-cho, Itabashi-ku, Tokyo 173-0015, Japan
| | - Kae Ito
- Tokyo Metropolitan Institute for Geriatrics and Gerontology, 35-2 Sakae-cho, Itabashi-ku, Tokyo 173-0015, Japan
| | | | | | | | - Hiromi Rakugi
- Osaka University, Japan; Osaka Rosai Hospital, Japan
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Attoh-Mensah E, Pothier K, Loggia G, Morello R, Chavoix C, Marcelli C. Involvement of cognitive abilities in the occurrence of fractures in fallers aged 55 years or older: a cross-sectional study. Aging Clin Exp Res 2024; 36:180. [PMID: 39212862 PMCID: PMC11364792 DOI: 10.1007/s40520-024-02830-7] [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: 06/24/2024] [Accepted: 08/05/2024] [Indexed: 09/04/2024]
Abstract
BACKGROUND Both bone fragility and poor cognitive functions are known to contribute to fracture occurrence, but it remains unclear whether their contribution is independent of each other and which cognitive dysfunctions are most involved. This study aimed to clarify the involvement of various cognitive abilities in fall-related fractures among community-dwelling fallers aged 55 and over, and to determine whether poor cognitive abilities is a risk factor independent of bone fragility. METHODS In a cross-sectional study, we collected sociodemographic and medical data, including bone mineral density (BMD), and performed cognitive and mobility assessments in 189 individuals with a history of fall in the previous year. RESULTS Fallers with a fracture had poorer cognitive and mobility performance than non-injured fallers. Multivariate regressions revealed that cognition, BMD and other risk factors were independently associated with fracture among all participants (OR = 1.04, 95% CI = 1.01-1.08, p = 0.034 for completion time on part A of the Trail Making Test [TMT-A], and OR = 0.53, 95% CI = 0.33-0.84, p < 0.001 for BMD), particularly in women (OR = 0.77, 95% CI = 0.60-0.98, p = 0.039 for backward digit span score, and OR = 0.43, 95% CI = 0.25-0.75, p = 0.001 for BMD). CONCLUSION Thus, poor cognition, especially poor processing speed and working memory, is associated with an increased risk of fracture in fallers, particularly in women, regardless of BMD or other fracture risk factors. Hence, an in-depth cognitive evaluation should enhance the detection of fallers at risk of fracture, particularly in the absence of signs of osteoporosis, and thus ensure the best possible prevention.
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Affiliation(s)
- Elpidio Attoh-Mensah
- Normandie Univ, UNICAEN, INSERM, COMETE, CYCERON, Caen, 14000, France.
- Permanent address: Univ. Limoges, HAVAE, 123 Avenue Albert Thomas, UR, 20217, F-87000, Limoges, Limoges, France.
| | - Kristell Pothier
- Department of Psychology, PAVeA Laboratory (UR 2114), University of Tours, Tours, 37000, France
| | - Gilles Loggia
- Normandie Univ, UNICAEN, INSERM, COMETE, CYCERON, Caen, 14000, France
- Department of Geriatrics, Normandie Univ, UNICAEN, CHU de Caen, Caen, 14000, France
| | - Remy Morello
- Department of Statistics and Clinical Research, Normandie Univ, UNICAEN, CHU de Caen, Caen, 14000, France
| | - Chantal Chavoix
- Normandie Univ, UNICAEN, INSERM, COMETE, CYCERON, Caen, 14000, France
| | - Christian Marcelli
- Normandie Univ, UNICAEN, INSERM, COMETE, CYCERON, Caen, 14000, France
- Department of Rheumatology, Normandie Univ, CHU de Caen, Caen, 14000, France
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de Godoi Rezende Costa Molino C, Rübel L, Mantegazza N, Bischoff-Ferrari HA, Freystaetter G. Association of polypharmacy with cognitive impairment in older trauma patients: a cross-sectional study. Eur J Hosp Pharm 2024; 31:428-433. [PMID: 36882299 DOI: 10.1136/ejhpharm-2022-003645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Accepted: 02/21/2023] [Indexed: 03/09/2023] Open
Abstract
INTRODUCTION Few if any studies have been conducted to date on the association between polypharmacy and cognitive impairment among older trauma patients. Therefore, we investigated whether polypharmacy is associated with cognitive impairment in trauma patients aged ≥70 years. METHODS This is a cross-sectional study of patients aged ≥70 years hospitalised due to a trauma-related injury. Cognitive impairment was defined as a Mini-Mental State Examination (MMSE) score ≤24 points. Medications were coded according to the Anatomical Therapeutic Chemical classification. Three exposures were examined: polypharmacy (≥5 medications), excessive polypharmacy (≥10 medications), and number of medications. Separate logistic regression models adjusted for age, sex, body mass index (BMI), education, smoking, independent living, frailty, multimorbidity, depression, and type of trauma were used to test the association between the three exposures and cognitive impairment. RESULTS A total of 198 patients were included (mean age 80.2; 64.7% women and 35.4% men), of which 148 (74.8%) had polypharmacy and 63 (31.8%) had excessive polypharmacy. The prevalence of cognitive impairment was 34.3% overall, 37.2% in the polypharmacy group and 50.8% in the excessive polypharmacy group. More than 80% of participants were taking at least one analgesic. Overall, polypharmacy was not statistically significantly associated with cognitive impairment (odds ratio (OR) 1.20 [95% confidence interval (CI) 0.46 to 3.11]). However, patients in the excessive polypharmacy group were more than two times more likely to have cognitive impairment (OR 2.88 [95% CI 1.31 to 6.37]) even after adjustments for relevant confounders. Similarly, the number of medications was associated with greater odds of cognitive impairment (OR 1.15 [95% CI 1.04 to 1.28]) after adjustments for the same relevant confounders. CONCLUSION Cognitive impairment is common among older trauma patients, particularly among those in the excessive polypharmacy group. Polypharmacy was not associated with cognitive impairment. Excessive polypharmacy and number of medications, on the other hand, were associated with greater odds of cognitive impairment in older trauma patients.
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Affiliation(s)
- Caroline de Godoi Rezende Costa Molino
- Center on Aging and Mobility, University Hospital Zurich, City Hospital Zurich, Waid and University of Zurich, Zurich, Switzerland
- Department of Aging Medicine and Aging Research, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Lisa Rübel
- Center on Aging and Mobility, University Hospital Zurich, City Hospital Zurich, Waid and University of Zurich, Zurich, Switzerland
| | - Noemi Mantegazza
- Center on Aging and Mobility, University Hospital Zurich, City Hospital Zurich, Waid and University of Zurich, Zurich, Switzerland
- Department of Aging Medicine and Aging Research, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Heike A Bischoff-Ferrari
- Center on Aging and Mobility, University Hospital Zurich, City Hospital Zurich, Waid and University of Zurich, Zurich, Switzerland
- Department of Aging Medicine and Aging Research, University Hospital Zurich and University of Zurich, Zurich, Switzerland
- University Clinic for Aging Medicine, City Hospital, Zurich, Waid, Zurich, Switzerland
| | - Gregor Freystaetter
- Center on Aging and Mobility, University Hospital Zurich, City Hospital Zurich, Waid and University of Zurich, Zurich, Switzerland
- Department of Aging Medicine and Aging Research, University Hospital Zurich and University of Zurich, Zurich, Switzerland
- University Clinic for Aging Medicine, City Hospital, Zurich, Waid, Zurich, Switzerland
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Milot E, Rehel S, Langeard A, Bigot L, Pasquier F, Matveeff L, Gauthier A, Bessot N, Quarck G. Effectiveness of multi-modal home-based videoconference interventions on sleep in older adults: study protocol for a randomized controlled trial. Front Public Health 2024; 12:1326412. [PMID: 38686035 PMCID: PMC11057197 DOI: 10.3389/fpubh.2024.1326412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 03/19/2024] [Indexed: 05/02/2024] Open
Abstract
Aging is characterized by substantial changes in sleep architecture that negatively impact fitness, quality of life, mood, and cognitive functioning. Older adults often fail to reach the recommended level of physical activity to prevent the age-related decline in sleep function, partly because of geographical barriers. Implementing home-based interventions could surmount these obstacles, thereby encouraging older adults to stay active, with videoconference administration emerging as a promising solution. Increasing the availability of biological rhythms synchronizers, such as physical activity, light exposure, or vestibular stimulation, represents a viable non-pharmacological strategy for entraining circadian rhythms and potentially fortifying the sleep-wake cycle, thereby enhancing sleep in aging. This study aims to (1) assess the impact of remote physical exercise training and its combination with bright light exposure, and (2) investigate the specific contribution of galvanic vestibular stimulation, to sleep quality among healthy older adults with sleep complaints. One hundred healthy older adults aged 60-70 years with sleep complaints will be randomly allocated to one of four groups: a physical exercise training group (n = 25), a physical exercise training combined with bright light exposure group (n = 25), a galvanic vestibular stimulation group (n = 25) or a control group (i.e., health education) (n = 25). While physical exercise training and health education will be supervised via videoconference at home, bright light exposure (for the physical exercise training combined with bright light exposure group) and vestibular stimulation will be self-administered at home. Pre-and post-tests will be conducted to evaluate various parameters, including sleep (polysomnography, subjective questionnaires), circadian rhythms (actigraphy, temperature), fitness (physical: VO2 peak, muscular function; and motor: balance, and functional mobility), cognition (executive function, long-term memory), quality of life and mood (anxiety and depression). The findings will be anticipated to inform the development of recommendations and non-pharmaceutical preventive strategies for enhancing sleep quality in older adults, potentially leading to improvements in fitness, cognition, quality of life, and mood throughout aging.
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Affiliation(s)
- Emma Milot
- Université de Caen Normandie, INSERM, COMETE U1075, CYCERON, CHU de Caen, Normandie Université, Caen, France
| | - Stéphane Rehel
- Université de Caen Normandie, INSERM, COMETE U1075, CYCERON, CHU de Caen, Normandie Université, Caen, France
| | - Antoine Langeard
- Université de Caen Normandie, INSERM, COMETE U1075, CYCERON, CHU de Caen, Normandie Université, Caen, France
| | | | - Florane Pasquier
- Université de Caen Normandie, INSERM, COMETE U1075, CYCERON, CHU de Caen, Normandie Université, Caen, France
| | - Laura Matveeff
- Université de Caen Normandie, INSERM, COMETE U1075, CYCERON, CHU de Caen, Normandie Université, Caen, France
| | - Antoine Gauthier
- Université de Caen Normandie, INSERM, COMETE U1075, CYCERON, CHU de Caen, Normandie Université, Caen, France
| | - Nicolas Bessot
- Université de Caen Normandie, INSERM, COMETE U1075, CYCERON, CHU de Caen, Normandie Université, Caen, France
| | - Gaëlle Quarck
- Université de Caen Normandie, INSERM, COMETE U1075, CYCERON, CHU de Caen, Normandie Université, Caen, France
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Mischler B, Hilfiker R, Hund-Georgiadis M, Maguire C. Physical activity based on daily step-count in inpatient setting in stroke and traumatic brain injury patients in subacute stage: A cross-sectional observational study. NeuroRehabilitation 2023; 52:435-450. [PMID: 37005896 DOI: 10.3233/nre-220248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/30/2023]
Abstract
BACKGROUND Daily step-count is important post-insult in the subacute phase to influence neuroplasticity, functional recovery and as a predictive factor for activity level one-year post event. OBJECTIVE Measure daily step-count in subacute patients follow-ing brain injury in an inpatient neurorehabilitation setting and compare these to evi-dence-based recommendations. METHODS 30 participants measured of daily step-count over a seven-day period, throughout the day to assess when and how activity varied. Step-counts were analyzed in sub-groups based on walking ability using the Functional Ambulation Categories (FAC). Correlations between steps-count and FAC level, walking speed, light touch, joint position sense, cognition, and fear of falling were calculated. RESULTS Median (IQR) daily steps for all patients was 2512 (568.5,4070.5). Not independently walkers took 336 (5–705), the value is below the recommendation. Participants walking with assistance took 700 (31–3080), significantly below recommended value (p = 0.002), independent walkers took 4093 (2327–5868) daily steps, significantly below recommended value (p = < 0.001). Step-count showed moderate to high and statistically-significant correlations: positive for walking speed, joint position sense, negative for fear of falling, and number of medications. CONCLUSIONS Only 10% of all participants reached the recommended daily steps. Interdisciplinary team-work and strategies to increase daily activity between therapies may be crucial to achieve recommended step-levels in subacute inpatient settings.
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Affiliation(s)
- Brigitte Mischler
- Center for Neurorehabilitation and Paraplegiology, REHAB Basel, Basel, Switzerland
- Bern University of Applied Science, Department of Health, Bern, Switzerland
| | - Roger Hilfiker
- Bern University of Applied Science, Department of Health, Bern, Switzerland
- Institute of Higher Education and Research in Healthcare (IUFRS), University of Lausanne, Lausanne, Switzerland
| | | | - Clare Maguire
- Center for Neurorehabilitation and Paraplegiology, REHAB Basel, Basel, Switzerland
- Bern University of Applied Science, Department of Health, Bern, Switzerland
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Baillet M, Morello R, Vittecoq O, Chavoix C, Marcelli C. Bone, cognitive, and anthropometric profiles and their relation to fracture sites in fallers: a cross-sectional study. Osteoporos Int 2023; 34:901-913. [PMID: 36959306 DOI: 10.1007/s00198-023-06701-1] [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: 10/05/2022] [Accepted: 02/08/2023] [Indexed: 03/25/2023]
Abstract
UNLABELLED Risk factors involved in the different osteoporotic fracture locations are not well-known. The results of this study suggest that there is not one typical profile characterising a particular fracture site but that the occurrence of a fracture may result from the combination of different bone, cognitive, and anthropometrics characteristics. PURPOSE Risk factors involved in the different osteoporotic fracture locations are not well-known. The aim of this study was to identify the differences in bone, cognitive, and anthropometric characteristics between different fracture sites, and to determine whether the site of a fall-related fracture is related to a specific profile. METHODS One hundred six women aged 55 years and older with a recent fall-related fracture of the hip (n = 30), humerus (n = 28), wrist (n = 32), or ankle (n = 16) were included. Bone, cognitive, and anthropometric characteristics were first compared among the four fracture site groups. Then, a principal component analysis (PCA) was performed and a comparison was made between the four profiles identified by the first two PCA components. RESULTS The four fracture site groups differed significantly in their education level, bone mineral density (BMD), body mass index (BMI), fear of falling, and number of errors in the Trail Making Test B, an executive function test. Each of the four fracture sites was found in each four PCA profiles, albeit with a different distribution. The profiles differed mainly by bone, cognitive, and anthropometric characteristics, but also by fear of falling. CONCLUSIONS The fall-related fracture sites differ significantly in anthropometric and bone parameters, in fear of falling and in cognitive abilities. There is not one typical bone, cognitive, and anthropometric profile characterising a particular fall-related site, but rather several possible profiles for a given site. This suggests that the fracture site depends on a combination of several characteristics of the patient.
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Affiliation(s)
- Maëlle Baillet
- INSERM, UniCaen, U1075, COMETE, PFRS, Normandie University, Caen, France
- Department of Rheumatology, Caen University Hospital, Caen, France
| | - Rémy Morello
- Department of Statistics and Clinical Research, Caen University Hospital, Caen, France
| | - Olivier Vittecoq
- Department of Rheumatology, Rouen University Hospital, Rouen, France
| | - Chantal Chavoix
- INSERM, UniCaen, U1075, COMETE, PFRS, Normandie University, Caen, France
| | - Christian Marcelli
- INSERM, UniCaen, U1075, COMETE, PFRS, Normandie University, Caen, France.
- Department of Rheumatology, Caen University Hospital, Caen, France.
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Yoshida Y, Ishizaki T, Masui Y, Arai Y, Inagaki H, Ogawa M, Yasumoto S, Iwasa H, Kamide K, Rakugi H, Ikebe K, Gondo Y. Association of personality traits with polypharmacy among community-dwelling older adults in Japan: a cross-sectional analysis of data from the SONIC study. BMC Geriatr 2022; 22:372. [PMID: 35484487 PMCID: PMC9047377 DOI: 10.1186/s12877-022-03069-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 04/13/2022] [Indexed: 11/30/2022] Open
Abstract
Background Polypharmacy is a serious concern among older adults and is frequently related to adverse outcomes, including health problems, reduced quality of life, and increased medical expenses. Although personality traits are associated with health behaviors and diseases, the effect of polypharmacy on personality traits is unclear. Therefore, we examined the association of personality traits with polypharmacy among community-dwelling older adults. Methods This cross-sectional study analysed data on 836 community-dwelling older adults aged 69–71 years who participated in the Japanese longitudinal cohort study of Septuagenarians, Octogenarians, and Nonagenarians Investigation with Centenarians. Polypharmacy was defined as the intake of ≥ 5 medications concurrently. Personality traits were assessed using the Japanese version of the NEO-Five-Factor Inventory (NEO-FFI). A five-factor model of personality traits, including “neuroticism,” “extraversion,” “openness,” “agreeableness,” and “conscientiousness,” was measured by the NEO-FFI. Results The average number of medications was about 3 in both men and women. Among the participants, polypharmacy was observed in 23.9% of men and 28.0% of women. Multivariable logistic regression analysis showed that neuroticism (adjusted odds ratio [aOR] per 1 point increase = 1.078, 95% confidence interval [CI] = 1.015–1.144) in men and extraversion (aOR = 0.932, 95% CI = 0.884–0.983) in women were associated with polypharmacy. Conclusions Higher neuroticism in men and lower extraversion in women were associated with polypharmacy. This study suggests that personality traits may be involved in the process leading to the development of polypharmacy. Information on individual personality traits may help medical professionals in decision-making regarding medication management for lifestyle-related diseases.
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Affiliation(s)
- Yuko Yoshida
- Tokyo Metropolitan Institute of Gerontology, 35-2 Sakae-cho, Itabashi-ku, Tokyo, Japan.
| | - Tatsuro Ishizaki
- Tokyo Metropolitan Institute of Gerontology, 35-2 Sakae-cho, Itabashi-ku, Tokyo, Japan
| | - Yukie Masui
- Tokyo Metropolitan Institute of Gerontology, 35-2 Sakae-cho, Itabashi-ku, Tokyo, Japan
| | - Yasumichi Arai
- Keio University, 35 Shinanomachi, Shinjuku-ku, Tokyo, Japan
| | - Hiroki Inagaki
- Tokyo Metropolitan Institute of Gerontology, 35-2 Sakae-cho, Itabashi-ku, Tokyo, Japan
| | - Madoka Ogawa
- Osaka University, 2-2 Yamadaoka, Suita, Osaka, Japan
| | | | - Hajime Iwasa
- Fukushima Medical University, 1 Hikariga-oka, Fukushima, Japan
| | - Kei Kamide
- Osaka University, 2-2 Yamadaoka, Suita, Osaka, Japan
| | - Hiromi Rakugi
- Osaka University, 2-2 Yamadaoka, Suita, Osaka, Japan
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Roughead EE, Pratt NL, Parfitt G, Rowett D, Kalisch-Ellett LM, Bereznicki L, Merlin T, Corlis M, Kang AC, Whitehouse J, Bilton R, Schubert C, Torode S, Kelly TL, Andrade AQ, Post D, Dorj G, Cousins J, Williams M, Lim R. Effect of an ongoing pharmacist service to reduce medicine-induced deterioration and adverse reactions in aged-care facilities (nursing homes): a multicentre, randomised controlled trial (the ReMInDAR trial). Age Ageing 2022; 51:6572256. [PMID: 35460410 PMCID: PMC9034696 DOI: 10.1093/ageing/afac092] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Indexed: 01/04/2023] Open
Abstract
Objective To assess the effectiveness of a pharmacist-led intervention using validated tools to reduce medicine-induced deterioration and adverse reactions. Design and setting Multicenter, open-label parallel randomised controlled trial involving 39 Australian aged-care facilities. Participants Residents on ≥4 medicines or ≥1 anticholinergic or sedative medicine. Intervention Pharmacist-led intervention using validated tools to detect signs and symptoms of medicine-induced deterioration which occurred every 8 weeks over 12 months. Comparator Usual care (Residential Medication Management Review) provided by accredited pharmacists. Outcomes Primary outcome was change in Frailty Index at 12 months. Secondary outcomes included changes in cognition, 24-hour movement behaviour by accelerometry, grip strength, weight, adverse events and quality of life. Results 248 persons (median age 87 years) completed the study; 120 in the interventionand, 128 in control arms. In total 575 pharmacist, sessions were undertaken in the intervention arm. There was no statistically significant difference for change in frailty between groups (mean difference: 0.009, 95% CI: −0.028, 0.009, P = 0.320). A significant difference for cognition was observed, with a mean difference of 1.36 point change at 12 months (95% CI: 0.01, 2.72, P = 0.048). Changes in 24-hour movement behaviour, grip strength, adverse events and quality of life were not significantly different between groups. Point estimates favoured the intervention arm at 12 months for frailty, 24-hour movement behaviour and grip strength. Conclusions The use of validated tools by pharmacists to detect signs of medicine-induced deterioration is a model of practice that requires further research, with promising results from this trial, particularly with regards to improved cognition.
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Affiliation(s)
- Elizabeth E Roughead
- Quality Use of Medicines and Pharmacy Research Centre, UniSA Clinical and Health Sciences, University of South Australia, Adelaide, SA, Australia
| | - Nicole L Pratt
- Quality Use of Medicines and Pharmacy Research Centre, UniSA Clinical and Health Sciences, University of South Australia, Adelaide, SA, Australia
| | - Gaynor Parfitt
- Alliance for Research in Exercise, Nutrition and Activity, UniSA Allied Health & Human Performance, University of South Australia, Adelaide, SA, Australia
| | - Debra Rowett
- Quality Use of Medicines and Pharmacy Research Centre, UniSA Clinical and Health Sciences, University of South Australia, Adelaide, SA, Australia
| | - Lisa M Kalisch-Ellett
- Quality Use of Medicines and Pharmacy Research Centre, UniSA Clinical and Health Sciences, University of South Australia, Adelaide, SA, Australia
| | - Luke Bereznicki
- School of Medicine, University of Tasmania, Tasmania, TAS, Australia
| | - Tracy Merlin
- Adelaide Health Technology Assessment, School of Public Health, University of Adelaide, Adelaide, SA, Australia
| | - Megan Corlis
- Australian Nursing and Midwifery Federation (SA Branch), Ridleyton, SA, Australia
| | - Ai Choo Kang
- University of South Australia, Adelaide, SA, Australia
| | | | - Rebecca Bilton
- Quality Use of Medicines and Pharmacy Research Centre, UniSA Clinical and Health Sciences, University of South Australia, Adelaide, SA, Australia
| | - Camille Schubert
- Adelaide Health Technology Assessment, School of Public Health, University of Adelaide, Adelaide, SA, Australia
| | - Stacey Torode
- University of South Australia, Adelaide, SA, Australia
| | - Thu-Lan Kelly
- Quality Use of Medicines and Pharmacy Research Centre, UniSA Clinical and Health Sciences, University of South Australia, Adelaide, SA, Australia
| | - Andre Q Andrade
- Quality Use of Medicines and Pharmacy Research Centre, UniSA Clinical and Health Sciences, University of South Australia, Adelaide, SA, Australia
| | - Dannielle Post
- Alliance for Research in Exercise, Nutrition and Activity, UniSA Allied Health & Human Performance, University of South Australia, Adelaide, SA, Australia
| | - Gereltuya Dorj
- Quality Use of Medicines and Pharmacy Research Centre, UniSA Clinical and Health Sciences, University of South Australia, Adelaide, SA, Australia
| | - Justin Cousins
- School of Medicine, University of Tasmania, Tasmania, TAS, Australia
| | | | - Renly Lim
- Quality Use of Medicines and Pharmacy Research Centre, UniSA Clinical and Health Sciences, University of South Australia, Adelaide, SA, Australia
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Langeard A, Zouabi A, Martin T, Quarck G, Gauthier A. Circadian rhythm of postural control, sleepiness and verticality perception in older adults. Age Ageing 2022; 51:6548377. [PMID: 35298587 DOI: 10.1093/ageing/afac061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Indexed: 11/14/2022] Open
Abstract
INTRODUCTION with ageing, the risk of falling increases. It has been reported that fall frequency may depend on the time of the day, suggesting a possible circadian rhythm of postural control. The objective was to test whether postural control in older adults followed a circadian rhythm. Then, in order to examine the possible functions involved in circadian variations in balance performances, circadian rhythm of sleepiness and vertical perception were also tested. METHODS eight participants (70.7 ± 4.7 years) were included. Baseline circadian rhythm profile was assessed through continuous core temperature measurement. Static and dynamic balance, subjective sleepiness and fatigue, and verticality perception were measured at 2:00, 6:00, 10:00, 14:00, 18:00 and 22:00, on separate weeks in a random order. RESULTS temperature followed a circadian rhythm, with lowest temperature occurring at 03:50. Circadian rhythm was detected for the centre of pressure displacement length and velocity, in dynamic condition eyes closed, with lowest performances occurring at 18:33 and 16:59, respectively. Subjective sleepiness and fatigue also followed circadian rhythm with lowest sleepiness occurring at 15:46 and 15:50, for the Karolinska Sleeping Scale and the Visual Analogic Scale of fatigue, respectively. Finally, the vertical perception was not significantly following a circadian rhythm. CONCLUSION older adults present a circadian rhythm of balance, in particular in more challenging conditions, and the lowest performances occurred in the late afternoon These circadian rhythms could explain some of the falls happening at this time in community-dwelling older adults.
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Affiliation(s)
| | - Amira Zouabi
- Normandie Univ, UNICAEN, INSERM, COMETE, Caen 14000, France
| | - Tristan Martin
- Normandie Univ, UNICAEN, INSERM, COMETE, Caen 14000, France
| | - GaËlle Quarck
- Normandie Univ, UNICAEN, INSERM, COMETE, Caen 14000, France
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10
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Ozkok S, Aydin CO, Sacar DE, Catikkas NM, Erdogan T, Kilic C, Karan MA, Bahat G. Associations between polypharmacy and physical performance measures in older adults. Arch Gerontol Geriatr 2021; 98:104553. [PMID: 34653922 DOI: 10.1016/j.archger.2021.104553] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 10/06/2021] [Indexed: 02/07/2023]
Abstract
OBJECTIVES A preserved ambulation is one of the keypoints for functionality and polypharmacy, a common problem in older adults, is associated with worse functional status. Our aim was to examine the associations of polypharmacy with certain physical performance measures used to evaluate ambulation. METHODS This retrospective, cross-sectional study was conducted in a geriatric outpatient clinic. Using ≥5 medications was accepted as polypharmacy. Usual gait speed (UGS), chair sit-to-stand test (CSST), timed up and go test (TUG) and short physical performance battery (SPPB) were performed to assess physical performance status. We created two models for logistic regression analyses: Model 1 was adjusted for age, sex and body mass index (BMI). We added comorbidities to Model 1 and further created Model 2. RESULTS There were 392 participants (69.1% were female, mean age: 73.9±6.2 years). Polypharmacy was seen in 62.5%. Participants with polypharmacy presented with a poor physical performance compared to the no-polypharmacy group (p<0.001, for each). In multivariate analyses, polypharmacy was independently associated with poor SPPB (Odds Ratio (OR)=2.5; 95% Confidence Interval (CI)=1.3-4.7 and OR=2.4; 95% CI=1.2-4.8 for Model 1 and 2, respectively) and long CSST (OR= 2.6; 95% CI=1.3-5.2 and OR=3.7; 95% CI=1.7-8.2 for Model 1 and 2, respectively). There was a significant association between polypharmacy and slow UGS in Model 1 (OR=1.9; 95% CI=1.0-3.5); but relationship did not persist after adding comorbidities into the first model (OR=1.6; 95% CI= 0.8-3.1). There was no significant association between long TUG and polypharmacy in any of the models. CONCLUSION Polypharmacy is well-known with its association with falls and fractures in older adults and this might be explained by its association with poor physical performance. Whether polypharmacy causes a deterioration in physical performance is an issue needs to be enlightened by further longitudinal studies.
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Affiliation(s)
- Serdar Ozkok
- Department of Internal Medicine, Division of Geriatrics, Istanbul Medical School, Istanbul University, Capa, 34390, Istanbul, Turkey.
| | - Caglar Ozer Aydin
- Department of Internal Medicine, Division of Geriatrics, Istanbul Medical School, Istanbul University, Capa, 34390, Istanbul, Turkey
| | - Duygu Erbas Sacar
- Department of Internal Medicine, Division of Geriatrics, Istanbul Medical School, Istanbul University, Capa, 34390, Istanbul, Turkey
| | - Nezahat Muge Catikkas
- Department of Internal Medicine, Division of Geriatrics, Istanbul Medical School, Istanbul University, Capa, 34390, Istanbul, Turkey
| | - Tugba Erdogan
- Department of Internal Medicine, Division of Geriatrics, Istanbul Medical School, Istanbul University, Capa, 34390, Istanbul, Turkey
| | - Cihan Kilic
- Department of Internal Medicine, Division of Geriatrics, Istanbul Medical School, Istanbul University, Capa, 34390, Istanbul, Turkey
| | - Mehmet Akif Karan
- Department of Internal Medicine, Division of Geriatrics, Istanbul Medical School, Istanbul University, Capa, 34390, Istanbul, Turkey
| | - Gulistan Bahat
- Department of Internal Medicine, Division of Geriatrics, Istanbul Medical School, Istanbul University, Capa, 34390, Istanbul, Turkey
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11
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Older Adults with Hypertension: Prevalence of Falls and Their Associated Factors. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18168257. [PMID: 34444005 PMCID: PMC8392439 DOI: 10.3390/ijerph18168257] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/03/2021] [Revised: 07/29/2021] [Accepted: 07/30/2021] [Indexed: 01/04/2023]
Abstract
Falls are prominent health issues among older adults. Among hypertensive older adults, falls may have a detrimental effect on their health and wellbeing. The purpose of this study is to determine the prevalence of falls among hypertensive older adults and to identify the associated factors that contribute to their falls. This was a cross-sectional study conducted among two hundred and sixty-nine hypertensive older adults who were selected via systematic random sampling in two primary health clinics in Kuala Terengganu, Malaysia. Data on their socio-demographic details, their history of falls, medication history and clinical characteristics were collected. Balance and gait were assessed using the Performance Oriented Mobility Assessment (POMA). It was found that 32.2% of participants reported falls within a year. Polypharmacy (adjusted OR 2.513, 95% CI 1.339, 4.718) and diuretics (adjusted OR 2.803, 95% CI 1.418, 5.544) were associated with an increased risk of falls. Meanwhile, a higher POMA score (adjusted OR 0.940, 95% CI 0.886, 0.996) and the number of antihypertensives (adjusted OR 0.473, 95% CI 0.319, 0.700) were associated with a low incidence of falling among hypertensive older adults. Falls are common among hypertensive older adults. Older adults who are taking diuretics and have a polypharmacy treatment plan have a higher incidence of falls. However, older adults taking a higher number of anti-hypertensive medications specifically were not associated with an increased prevalence of falls.
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12
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Mehta RS, Kochar BD, Kennelty K, Ernst ME, Chan AT. Emerging approaches to polypharmacy among older adults. NATURE AGING 2021; 1:347-356. [PMID: 37117591 DOI: 10.1038/s43587-021-00045-3] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 02/10/2021] [Indexed: 12/22/2022]
Abstract
Polypharmacy is a major health issue for older adults. Entangled with several geriatric syndromes, including frailty, falls and cognitive decline, research focused on polypharmacy has been challenged by heterogeneity in its definition, confounding by comorbidities and limited prospective data. In this Review, we discuss varying definitions for polypharmacy and highlight the need for a uniform definition for future studies. We critically appraise strategies for reducing medication prescriptions and implementing deprescribing as a mechanism to reduce the potential harmful effects of polypharmacy. As we look to the future, we assess the role of novel analytics and high-throughput technology, including multiomics profiling, to advance research in polypharmacy and the development of new strategies for risk stratification in the age of precision medicine.
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Affiliation(s)
- Raaj S Mehta
- Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
- Clinical and Translational Epidemiology Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Bharati D Kochar
- Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
- Clinical and Translational Epidemiology Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Korey Kennelty
- Department of Pharmacy Practice and Science, College of Pharmacy, University of Iowa, Iowa City, IA, USA
- Department of Family Medicine, Carver College of Medicine, University of Iowa, Iowa City, IA, USA
| | - Michael E Ernst
- Department of Pharmacy Practice and Science, College of Pharmacy, University of Iowa, Iowa City, IA, USA
- Department of Family Medicine, Carver College of Medicine, University of Iowa, Iowa City, IA, USA
| | - Andrew T Chan
- Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
- Clinical and Translational Epidemiology Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
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13
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Langeard A, Cloutier SO, Olmand M, Saillant K, Gagnon C, Grégoire CA, Fortier A, Lacroix M, Lalongé J, Gayda M, Besnier F, Gagnon D, Bherer L, Nigam A. High-intensity interval training vs. hydrochlorothiazide on blood pressure, cardiovascular health and cognition: Protocol of a non-inferiority trial. Contemp Clin Trials 2021; 102:106286. [PMID: 33484896 DOI: 10.1016/j.cct.2021.106286] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 01/05/2021] [Accepted: 01/15/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND While the number of people with hypertension (HBP) continues to increase, the therapeutic target for optimal blood pressure (BP) has been revised to a lower level. Studies have suggested that High-Intensity Interval Training (HIIT) could be as efficient as BP-lowering drugs, but no study has compared their efficacy in a randomized trial. The aim of this protocol is to determine if HIIT is as efficient as Hydrochlorothiazide (HCTZ) in lowering 24 h ambulatory BP in prehypertensive older adults. Moreover, the secondary aim is to determine if HIIT is associated with greater cardiovascular and cognitive benefits than HCTZ. METHODS This study is an interventional, single-center, non-inferiority trial, with two randomized parallel groups of prehypertensive participants aged 60 years or more. One group will be prescribed daily doses of 12.5 mg of HCTZ for 12 weeks, and the other group will follow thrice-weekly HIIT for 12 weeks. Each group will be composed of 30 participants. The primary outcome is 24 h ambulatory BP. Secondary outcomes are scores on neuropsychological assessments, balance and gait performances, maximal oxygen uptake, peripheral endothelial function, and arterial stiffness. Non-inferiority tests will be performed on the primary outcome, and secondary outcomes will be compared using independent t-tests. CONCLUSION This study will determine if HIIT is at least as efficient as HCTZ in lowering BP in prehypertensive older adults. This study will also determine if HIIT provides greater benefits in terms of cardiovascular and cognitive status (NCT04103411).
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Affiliation(s)
- Antoine Langeard
- Department of Medicine, Université de Montréal, Montréal, Québec, Canada; Preventive Medicine and Physical Activity Center (centre EPIC), Canada; Research Center, Montreal Heart Institute, Montréal, Québec, Canada; Research Center, Institut Universitaire de Gériatrie de Montréal, Montréal, Québec, Canada.
| | - Simon-Olivier Cloutier
- Department of Psychology, Université de Montréal, Montréal, Québec, Canada; Preventive Medicine and Physical Activity Center (centre EPIC), Canada
| | - Miloudza Olmand
- Department of Psychology, Université de Montréal, Montréal, Québec, Canada; Preventive Medicine and Physical Activity Center (centre EPIC), Canada
| | - Kathia Saillant
- Preventive Medicine and Physical Activity Center (centre EPIC), Canada; Research Center, Institut Universitaire de Gériatrie de Montréal, Montréal, Québec, Canada; Department of Psychology, Université du Québec à Montréal, Montréal, Québec, Canada
| | - Christine Gagnon
- Preventive Medicine and Physical Activity Center (centre EPIC), Canada; Research Center, Montreal Heart Institute, Montréal, Québec, Canada
| | - Catherine-Alexandra Grégoire
- Preventive Medicine and Physical Activity Center (centre EPIC), Canada; Research Center, Montreal Heart Institute, Montréal, Québec, Canada
| | - Annick Fortier
- Montreal Health Innovations Coordinating Center (MHICC), Canada
| | - Martine Lacroix
- Research Center, Montreal Heart Institute, Montréal, Québec, Canada
| | - Julie Lalongé
- Preventive Medicine and Physical Activity Center (centre EPIC), Canada
| | - Mathieu Gayda
- Preventive Medicine and Physical Activity Center (centre EPIC), Canada
| | - Florent Besnier
- Department of Medicine, Université de Montréal, Montréal, Québec, Canada; Preventive Medicine and Physical Activity Center (centre EPIC), Canada; Research Center, Montreal Heart Institute, Montréal, Québec, Canada
| | - Daniel Gagnon
- Department of Kinesiology and Exercise Science, Université de Montréal, Québec, Canada; Preventive Medicine and Physical Activity Center (centre EPIC), Canada
| | - Louis Bherer
- Department of Medicine, Université de Montréal, Montréal, Québec, Canada; Preventive Medicine and Physical Activity Center (centre EPIC), Canada; Research Center, Montreal Heart Institute, Montréal, Québec, Canada; Research Center, Institut Universitaire de Gériatrie de Montréal, Montréal, Québec, Canada.
| | - Anil Nigam
- Preventive Medicine and Physical Activity Center (centre EPIC), Canada; Research Center, Montreal Heart Institute, Montréal, Québec, Canada
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Attoh-Mensah E, Loggia G, Schumann-Bard P, Morello R, Descatoire P, Marcelli C, Chavoix C. Adverse Effects of Anticholinergic Drugs on Cognition and Mobility: Cutoff for Impairment in a Cross-Sectional Study in Young-Old and Old-Old Adults. Drugs Aging 2020; 37:301-310. [PMID: 31930459 DOI: 10.1007/s40266-019-00743-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND Drugs with anticholinergic properties are commonly prescribed in older adults despite growing evidence of their adverse outcomes. Several issues regarding these detrimental effects remain unresolved, such as the putative existence of a threshold above which anticholinergic drug consumption impairs cognitive or mobility performance. OBJECTIVES We aimed to investigate the number of anticholinergic drugs and the anticholinergic burden that leads to mobility or cognitive impairment and compare the effects in community-dwelling older adults in two age groups ("young-old" 55-74 vs. "old-old" ≥ 75 years). METHODS In a cross-sectional study, we identified drugs with anticholinergic (antimuscarinic) properties using the Anticholinergic Drug Scale. Cognition was assessed using the Mini Mental State Examination (MMSE) and the Trail Making Test (TMT-A and TMT-B), and mobility was assessed using the Timed Up and Go (TUG) test. RESULTS The study population consisted of 177 volunteers, 114 of whom were classed as young-old and 63 were classed as old-old adults. Despite the lack of cutoff values for impaired outcomes in young-old adults, impaired MMSE were significantly more numerous in users than in nonusers of anticholinergic drugs. In old-old adults, receiver operating characteristic (ROC) curve analysis indicated that taking a single anticholinergic drug per day was associated with impaired TMT-B completion time, TMT difference score (B-A), and TUG scores. The cutoff for anticholinergic burden was also one for these same outcomes. Based on these cutoff values, multivariate logistic regressions in old-old adults showed that the increased risk of impaired cognition and mobility was independent of confounding factors, including comorbidities. They also suggested that anticholinergic drugs would affect mobility through executive functions. CONCLUSIONS Drugs with anticholinergic (antimuscarinic) properties are associated with cognitive impairment in individuals as young as 55 years, and only one such drug per day, regardless of its anticholinergic burden, is associated with both impaired cognition and impaired mobility in old-old adults. Therefore, wherever possible, clinicians should avoid prescribing drugs with anticholinergic properties.
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Affiliation(s)
- Elpidio Attoh-Mensah
- INSERM, UniCaen, U1075, COMETE, PFRS, Normandie University, 2 rue des Rochambelles, 14000, Caen Cedex, France
| | - Gilles Loggia
- INSERM, UniCaen, U1075, COMETE, PFRS, Normandie University, 2 rue des Rochambelles, 14000, Caen Cedex, France
- Department of Geriatrics, CHU Caen, 14000, Caen, France
| | - Pascale Schumann-Bard
- INSERM, UniCaen, U1075, COMETE, PFRS, Normandie University, 2 rue des Rochambelles, 14000, Caen Cedex, France
| | - Rémy Morello
- Department of Statistics and Clinical Research, CHU Caen, 14000, Caen, France
| | - Pablo Descatoire
- INSERM, UniCaen, U1075, COMETE, PFRS, Normandie University, 2 rue des Rochambelles, 14000, Caen Cedex, France
- Department of Geriatrics, CHU Caen, 14000, Caen, France
| | - Christian Marcelli
- INSERM, UniCaen, U1075, COMETE, PFRS, Normandie University, 2 rue des Rochambelles, 14000, Caen Cedex, France
- Department of Rheumatology, CHU Caen, 14000, Caen, France
| | - Chantal Chavoix
- INSERM, UniCaen, U1075, COMETE, PFRS, Normandie University, 2 rue des Rochambelles, 14000, Caen Cedex, France.
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15
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Maas S, Festen DAM, Hilgenkamp TIM, Oppewal A. The association between medication use and gait in adults with intellectual disabilities. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2020; 64:793-803. [PMID: 32885545 PMCID: PMC7540034 DOI: 10.1111/jir.12773] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/28/2020] [Revised: 07/24/2020] [Accepted: 08/18/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Adults with intellectual disabilities (ID) often have polypharmacy and often use antipsychotics. Both polypharmacy and antipsychotics have a negative effect on gait in the general population, but this has not been studied in adults with ID. These negative effects may add to pre-existing gait disturbances in adults with ID and increase the risk for adverse health outcomes in this population. Therefore, the aim of this study is to investigate the difference in gait parameters between adults with ID with and without polypharmacy and between adults with ID using and not using antipsychotics. METHOD The gait parameters of 31 participants were collected with the GAITRite walkway, a pressure sensitive walkway measuring spatial and temporal gait parameters, in addition to information about personal characteristics, prescribed medication and presence of polypharmacy. RESULTS After adjustment for sex and body mass index, participants with polypharmacy had a significantly shorter step length [polypharmacy B (SE) = -0.079 (0.034), P = 0.03], shorter stride length [polypharmacy B (SE) = -0.157 (0.069), P = 0.03] and longer double support time [polypharmacy B (SE) = 0.0004 (0.0001), P = 0.047]. Participants using antipsychotics had a significantly longer double support time [antipsychotic use B (SE) = 0.0003 (0.0002), P = 0.019]. CONCLUSION This study showed for the first time that both polypharmacy and using antipsychotics are associated with gait in adults with ID. The differences seem to resemble a more cautious gait. Further investigation with larger study samples, additional medication types and dosages are needed to acquire more insight in this important topic.
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Affiliation(s)
- S. Maas
- Intellectual Disability Medicine, Department of General PracticeErasmus MC University Medical Center RotterdamRotterdamThe Netherlands
| | - D. A. M. Festen
- Intellectual Disability Medicine, Department of General PracticeErasmus MC University Medical Center RotterdamRotterdamThe Netherlands
| | - T. I. M. Hilgenkamp
- Intellectual Disability Medicine, Department of General PracticeErasmus MC University Medical Center RotterdamRotterdamThe Netherlands
- Department of Physical TherapyUniversity of NevadaLas VegasNVUSA
| | - A. Oppewal
- Intellectual Disability Medicine, Department of General PracticeErasmus MC University Medical Center RotterdamRotterdamThe Netherlands
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16
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Ishigo T, Takada R, Kondo F, Ibe Y, Nakano K, Tateishi R, Fujii S, Katano S, Kitagawa M, Kimyo T, Nakata H, Hashimoto A, Miyamoto A. [Association Suvorexant and Ramelteon Use with the Risk of Falling: A Retrospective Case-control Study]. YAKUGAKU ZASSHI 2020; 140:1041-1049. [PMID: 32741862 DOI: 10.1248/yakushi.20-00018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Sedative hypnotics are among the classes of drugs reported to influence falls. However, the effects of the sedative hypnotic drugs, suvorexant and ramelteon, on falls are not well known. Therefore, we conducted this retrospective case-control study to examine the association of the use of these two sedative hypnotics with the risk of falls. Conducted at the Sapporo Medical University Hospital in Japan, our study included 360 patients with fall incidents and 819 randomly selected control patients. Patients in the fall group were significantly older with a lower body mass index, and had a history of falls, disabilities in activities of daily living, cognitive impairment, and delirium. Monovariate analysis revealed that patients in the fall group frequently used ramelteon [odds ratio (OR) 2.38, 95% confidence interval (CI): 1.49-3.81, p<0.001], but rarely used suvorexant (OR 0.66, 95% CI: 0.29-1.39, p=0.317), compared with control patients. Furthermore, multivariate analysis revealed that ramelteon use did not increase the risk of falls (adjusted OR 1.43, 95% CI: 0.82-2.48, p=0.207), whereas suvorexant use significantly decreased the risk of falls (adjusted OR 0.32, 95% CI: 0.13-0.76, p=0.009). Although ramelteon tends to be used in patients at a high risk of falls, it may not increase the risk of falls. In contrast, the use of suvorexant may reduce the risk of falls.
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Affiliation(s)
- Tomoyuki Ishigo
- Division of Hospital Pharmacy, Sapporo Medical University Hospital
| | - Ryo Takada
- Division of Hospital Pharmacy, Sapporo Medical University Hospital
| | - Fuki Kondo
- Division of Hospital Pharmacy, Sapporo Medical University Hospital
| | - Yuta Ibe
- Division of Hospital Pharmacy, Sapporo Medical University Hospital
| | - Keita Nakano
- Division of Hospital Pharmacy, Sapporo Medical University Hospital
| | - Riho Tateishi
- Division of Hospital Pharmacy, Sapporo Medical University Hospital
| | - Satoshi Fujii
- Division of Hospital Pharmacy, Sapporo Medical University Hospital
| | - Satoshi Katano
- Division of Rehabilitation, Sapporo Medical University Hospital
| | - Manabu Kitagawa
- Division of Hospital Pharmacy, Sapporo Medical University Hospital
| | - Tomoko Kimyo
- Division of Hospital Pharmacy, Sapporo Medical University Hospital
| | - Hiromasa Nakata
- Division of Hospital Pharmacy, Sapporo Medical University Hospital
| | - Akiyoshi Hashimoto
- Department of Cardiovascular, Renal and Metabolic Medicine, Sapporo Medical University School of Medicine.,Division of Health Care Administration and Management, Sapporo Medical University School of Medicine
| | - Atsushi Miyamoto
- Division of Hospital Pharmacy, Sapporo Medical University Hospital
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Langeard A, Saillant K, Charlebois Cloutier E, Gayda M, Lesage F, Nigam A, Bherer L, Fraser SA. Association between Statin Use and Balance in Older Adults. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17134662. [PMID: 32610434 PMCID: PMC7369856 DOI: 10.3390/ijerph17134662] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 06/23/2020] [Accepted: 06/26/2020] [Indexed: 01/03/2023]
Abstract
Background: Several medications have been associated with an increased risk of balance deficits and greater likelihood to sustain a fall, representing a large health and economic issue. Statins are regularly prescribed to prevent strokes and heart attacks, but their impact on balance is unknown. The aim of this paper was to determine whether statin use is associated with poorer balance performances in older adults. Methods: All participants, one group taking statins (n = 34), and the other group not taking statins (n = 31), completed a balance assessment with their eyes closed and their eyes opened on a MatScan Pressure Sensing Mat. Center of Pressure (CoP) velocity, peak-to-peak distance, and standard deviation were collected in both anteroposterior (AP) and mediolateral (ML) directions. Multiple linear regression analyses were performed for each balance outcome, testing the statin use status as a predictor and controlling for appropriate factors including participants characteristics, lipid profile, and cardiovascular disease. Results: After controlling for confounding factors, statin use significantly predicted both CoP ML-Amplitude (β = 0.638, p = 0.004) and ML-Velocity (β = 0.653, p = 0.002) in the eyes-opened condition. Conclusions: The present study detected a negative association between statin use and balance control in the ML direction, suggesting that caution should be taken when prescribing statins in older adults, as this could decrease ML stability and ultimately increase fall and fracture risks.
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Affiliation(s)
- Antoine Langeard
- Research Center, Institut Universitaire de Gériatrie de Montréal, Montreal, QC H3W 1W5, Canada; (K.S.); (E.C.C.); (L.B.); (S.A.F.)
- Department of Medicine, University of Montreal, Montreal, QC H3T 1J4, Canada; (M.G.); (A.N.)
- EPIC Center, Montreal Heart Institute and University of Montreal, Montreal, QC H1T 1N6, Canada
- Research Center, Montreal Heart Institute, Montreal, QC H1T 1N6, Canada;
- Correspondence:
| | - Kathia Saillant
- Research Center, Institut Universitaire de Gériatrie de Montréal, Montreal, QC H3W 1W5, Canada; (K.S.); (E.C.C.); (L.B.); (S.A.F.)
- Department of Medicine, University of Montreal, Montreal, QC H3T 1J4, Canada; (M.G.); (A.N.)
- EPIC Center, Montreal Heart Institute and University of Montreal, Montreal, QC H1T 1N6, Canada
- Research Center, Montreal Heart Institute, Montreal, QC H1T 1N6, Canada;
| | - Elisabeth Charlebois Cloutier
- Research Center, Institut Universitaire de Gériatrie de Montréal, Montreal, QC H3W 1W5, Canada; (K.S.); (E.C.C.); (L.B.); (S.A.F.)
- Department of Medicine, University of Montreal, Montreal, QC H3T 1J4, Canada; (M.G.); (A.N.)
- EPIC Center, Montreal Heart Institute and University of Montreal, Montreal, QC H1T 1N6, Canada
- Research Center, Montreal Heart Institute, Montreal, QC H1T 1N6, Canada;
| | - Mathieu Gayda
- Department of Medicine, University of Montreal, Montreal, QC H3T 1J4, Canada; (M.G.); (A.N.)
- EPIC Center, Montreal Heart Institute and University of Montreal, Montreal, QC H1T 1N6, Canada
- Research Center, Montreal Heart Institute, Montreal, QC H1T 1N6, Canada;
| | - Frédéric Lesage
- Research Center, Montreal Heart Institute, Montreal, QC H1T 1N6, Canada;
- Department of Electrical Engineering, Polytechnique Montreal, Montreal, QC H3T 1J4, Canada
| | - Anil Nigam
- Department of Medicine, University of Montreal, Montreal, QC H3T 1J4, Canada; (M.G.); (A.N.)
- EPIC Center, Montreal Heart Institute and University of Montreal, Montreal, QC H1T 1N6, Canada
- Research Center, Montreal Heart Institute, Montreal, QC H1T 1N6, Canada;
| | - Louis Bherer
- Research Center, Institut Universitaire de Gériatrie de Montréal, Montreal, QC H3W 1W5, Canada; (K.S.); (E.C.C.); (L.B.); (S.A.F.)
- Department of Medicine, University of Montreal, Montreal, QC H3T 1J4, Canada; (M.G.); (A.N.)
- EPIC Center, Montreal Heart Institute and University of Montreal, Montreal, QC H1T 1N6, Canada
- Research Center, Montreal Heart Institute, Montreal, QC H1T 1N6, Canada;
| | - Sarah A. Fraser
- Research Center, Institut Universitaire de Gériatrie de Montréal, Montreal, QC H3W 1W5, Canada; (K.S.); (E.C.C.); (L.B.); (S.A.F.)
- Interdisciplinary School of Health Sciences, University of Ottawa, Ottawa, ON K1N 6N5, Canada
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Schmidt NE, Steffen A, Meuser TM. Impairment for Medication Management in Older Adults: Validity of a Family Report Measure. Clin Gerontol 2020; 43:350-362. [PMID: 31826718 DOI: 10.1080/07317115.2019.1703064] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Objectives: Medication nonadherence can have significant consequences for the health of older adults. Difficulty managing medications is often a sign of cognitive impairment, and monitoring is an early caregiving task for family members. This study examined a screening tool for independence in medication management.Methods: Reliability and validity of the screening tool were assessed in a sample of 152 female care partners for a relative aged 65+years.Results: The tool showed sound test-retest reliability, convergent and discriminant validity, and test utility, such that medication assistance was not better predicted by a global rating of cognitive impairment.Conclusions: In context of cognitive impairment, detection of medication mismanagement could be improved in both primary care and specialty health encounters through adoption of this single-item screening tool.Clinical Implications: This single-item report can be used to quickly facilitate discussions of medication management and cognitive impairment screening in office visits. The item also shows promise for efficient measurement of impairment in medication management than typical IADL assessment language.
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Affiliation(s)
- Nicholas E Schmidt
- Department of Psychological Sciences, University of Missouri-St. Louis, St. Louis, MO, USA
| | - Ann Steffen
- Department of Psychological Sciences, University of Missouri-St. Louis, St. Louis, MO, USA
| | - Thomas M Meuser
- Center for Excellence in Aging, University of New England, Biddeford, ME, USA
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Loggia G, Attoh-Mensah E, Pothier K, Morello R, Lescure P, Bocca ML, Marcelli C, Chavoix C. Psychotropic Polypharmacy in Adults 55 Years or Older: A Risk for Impaired Global Cognition, Executive Function, and Mobility. Front Pharmacol 2020; 10:1659. [PMID: 32082159 PMCID: PMC7002919 DOI: 10.3389/fphar.2019.01659] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Accepted: 12/17/2019] [Indexed: 01/05/2023] Open
Abstract
Objectives With their broad spectrum of action, psychotropic drugs are among the most common medications prescribed to the elderly. Consequently, the number of older adults taking multiple psychotropic drugs has more than doubled over the last decade. To improve knowledge about the deleterious effects of psychotropic polypharmacy, we investigated whether there is a threshold number of psychotropic molecules that could lead to impairment of global cognition, executive function, or mobility. Furthermore, relationships between the number of psychotropic molecules and cognitive and mobility impairment were examined. Design Cross-sectional study Setting University Hospital of Caen (France) and advertisements in medical offices Participants Community-dwelling older adults 55 years and older (n = 177; 69.8 ± 9.3 years; 81% women) Measurements Number of psychotropic molecules taken daily, global cognition assessed with the Mini Mental State Examination (MMSE) and the Montreal Cognitive Assessment (MoCA), processing speed with the Trail Making Test (TMT) A, executive function with the TMT B and TMT B-A, and mobility with the Time Up and Go (TUG). The threshold numbers of psychotropic molecules were determined by ROC curves analysis. Based on these threshold values, multinomial logistic regression adjusting for covariates was then performed. Results Logistic regressions showed that the threshold of two daily psychotropic molecules, identified by the ROC curves analysis, increases the risk of impaired executive function (p = .05 and.005 for the TMT B and TMT B-A, respectively), global cognition (p = .006 and.001 for the MMSE and MoCA, respectively), and mobility (p = .005 for the TUG), independent of confounding factors, including comorbidities. Furthermore, psychotropic polypharmacy would affect mobility through executive functions. Conclusion Impairment of global cognition, executive function, and mobility when as few as two psychotropic molecules are consumed in relatively healthy young older adults should alert physicians when prescribing combinations of psychotropic medications.
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Affiliation(s)
- Gilles Loggia
- Normandie Univ, UNICAEN, INSERM, COMETE, Caen, France.,Department of Geriatrics, Normandie Univ, UNICAEN, CHU de Caen Normandie, Caen, France
| | | | | | - Rémy Morello
- Department of Statistics and Clinical Research, Normandie Univ, UNICAEN, CHU de Caen Normandie, Caen, France
| | - Pascale Lescure
- Normandie Univ, UNICAEN, INSERM, COMETE, Caen, France.,Department of Geriatrics, Normandie Univ, UNICAEN, CHU de Caen Normandie, Caen, France
| | | | - Christian Marcelli
- Normandie Univ, UNICAEN, INSERM, COMETE, Caen, France.,Department of Rheumatology, Normandie Univ, UNICAEN, CHU de Caen Normandie, Caen, France
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20
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Murphy TE, McAvay GJ, Agogo GO, Allore HG. Personalized and typical concurrent risk of limitations in social activity and mobility in older persons with multiple chronic conditions and polypharmacy. Ann Epidemiol 2019; 37:24-30. [PMID: 31473124 PMCID: PMC6755051 DOI: 10.1016/j.annepidem.2019.08.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Revised: 07/17/2019] [Accepted: 08/05/2019] [Indexed: 12/13/2022]
Abstract
PURPOSE We define personalized concurrent risk (PCR) as the subject-specific probability of an index outcome within a defined interval of time, while currently at risk for a separate outcome, where the outcomes are not mutually exclusive and can be jointly modeled with a shared random intercept. We further define typical concurrent risk as the risk obtained by setting the random intercept to null. METHODS Drawing data from the Medical Expenditure Panel Survey (cohorts 2008-2013), we jointly model limitations in social activity and mobility over two years among older community-dwelling persons with both hypertension and chronic obstructive pulmonary disease. The joint model uses inverse probability of treatment weighting based on each participant's baseline propensity of polypharmacy (≥5 classes of medication). RESULTS Even among participants with the same covariates, older persons with multiple chronic conditions exhibit wide-ranging heterogeneity of the treatment effect from polypharmacy, a risk factor for negative health outcomes among older persons. The magnitude of the PCRs is dominated by the value of the subject-specific random effect. CONCLUSIONS Estimates of PCR and typical concurrent risk can be calculated from national or institutional data sets and may facilitate the practice of personalized care for older patients with multiple chronic conditions.
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Affiliation(s)
- Terrence E Murphy
- Department of Internal Medicine, Section of Geriatrics, Yale School of Medicine, New Haven, CT; Department of Biostatistics, Yale School of Public Health, New Haven, CT
| | - Gail J McAvay
- Department of Internal Medicine, Section of Geriatrics, Yale School of Medicine, New Haven, CT
| | - George O Agogo
- Department of Internal Medicine, Section of Geriatrics, Yale School of Medicine, New Haven, CT
| | - Heather G Allore
- Department of Internal Medicine, Section of Geriatrics, Yale School of Medicine, New Haven, CT; Department of Biostatistics, Yale School of Public Health, New Haven, CT.
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21
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Sirois C, Simard M, Gosselin E, Gagnon ME, Roux B, Laroche ML. Mixed Bag “Polypharmacy”: Methodological Pitfalls and Challenges of This Exposure Definition. CURR EPIDEMIOL REP 2019. [DOI: 10.1007/s40471-019-00214-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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Morin L, Calderon Larrañaga A, Welmer AK, Rizzuto D, Wastesson JW, Johnell K. Polypharmacy and injurious falls in older adults: a nationwide nested case-control study. Clin Epidemiol 2019; 11:483-493. [PMID: 31296999 PMCID: PMC6598933 DOI: 10.2147/clep.s201614] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Accepted: 04/24/2019] [Indexed: 12/13/2022] Open
Abstract
Objective To determine whether or not the exposure to multiple drugs (polypharmacy) increases the risk of fall-related injury among older adults, beyond the effect of fall-risk increasing drugs and chronic multimorbidity. Methods Nested case-control study using linked register data with national coverage in Sweden. We defined cases as older adults (≥70 years) who had an incident non-elective admission due to a fall between 1 January and 31 December 2013. Cases were matched 1:1 on sex, age and index date to randomly selected controls from the general population. The number of prescription drugs during the 7 days preceding the index date was the main exposure. Results A total of 49,609 cases were included and matched to an equal number of controls. The number of prescription drugs was higher among cases than among controls (mean difference 1.2, 95% CI 1.16–1.26). While adjusting for potential confounders, we found that the risk of injurious falls increased in a nearly linear fashion for each additional drug (OR, 1.02; 95% CI, 1.01–1.03). When using a cut-off value of ≥4 drugs to define polypharmacy, the population attributable fraction for injurious falls was 5.2% (95% CI 2.8–7.6). Conclusion This study shows a monotonic dose-response relationship between the number of drugs and the risk of injurious falls. However, after comprehensive adjustment for known confounders (including fall-risk increasing drugs and chronic multimorbidity), this association is substantially weaker than previously reported. Moreover, even if the relationship between polypharmacy and injurious falls is really causal, the population attributable risk fraction is low.
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Affiliation(s)
- Lucas Morin
- Aging Research Center, Karolinska Institutet and Stockholm University, Stockholm, Sweden
| | | | - Anna-Karin Welmer
- Aging Research Center, Karolinska Institutet and Stockholm University, Stockholm, Sweden.,Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.,Allied Health Professionals, Function Area Occupational Therapy & Physiotherapy, Karolinska University Hospital, Stockholm, Sweden.,Stockholm Gerontology Research Center , Stockholm, Sweden
| | - Debora Rizzuto
- Aging Research Center, Karolinska Institutet and Stockholm University, Stockholm, Sweden
| | - Jonas W Wastesson
- Aging Research Center, Karolinska Institutet and Stockholm University, Stockholm, Sweden
| | - Kristina Johnell
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
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Fernández-Huerta L, Aravena-Arriagada J, Bernales-Montero M, Córdova-León K. Relationship between sleep quality and postural balance in community-dwelling older persons: studio transversal. Medwave 2019; 19:e7651. [DOI: 10.5867/medwave.2019.05.7652] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Accepted: 04/25/2019] [Indexed: 11/27/2022] Open
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Pazan F, Burkhardt H, Frohnhofen H, Weiss C, Throm C, Kuhn-Thiel A, Wehling M. Higher Fit-fOR-The-Aged (FORTA) Scores Comprising Medication Errors are Associated with Impaired Cognitive and Physical Function Tests in the VALFORTA Trial. Drugs Aging 2019; 36:269-277. [PMID: 30578459 DOI: 10.1007/s40266-018-0626-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND The Fit fOR The Aged (FORTA) list, a drug classification combining positive and negative labelling of drugs, has been clinically (VALFORTA-trial) validated to improve medication quality and clinical endpoints. OBJECTIVE The objective of this study was to determine the association of medication quality with functional abilities tested in cognitive and physical function tests. PATIENTS AND METHODS Data from the prospective, randomized controlled VALFORTA trial on 409 geriatric (mean age 81.53 years) in-hospital patients were tested for associations between the FORTA score (sum of over- and under-treatment errors) on admission and cognitive and physical function tests. Univariate and multivariate linear correlations corrected for age, sex, number of medications, number of chronic conditions, and body mass index as well as comparisons between high and low FORTA-score (cut-off 3) patients were performed. RESULTS The FORTA score was significantly correlated with Instrumental Activities of Daily Living (p < 0.0001), the Tinetti test (p < 0.002), Essen Questionnaire on Age and Sleepiness (p < 0.0001), Mini-Mental State Examination (p < 0.0001), and handgrip strength (p < 0.04) in the univariate analysis, and with Instrumental Activities of Daily Living (p < 0.003), the Tinetti test (p < 0.003), and the Essen Questionnaire on Age and Sleepiness (p < 0.0001) in the multivariate analysis. Effect size was weak for Instrumental Activities of Daily Living (R-squared = 0.12) and the Tinetti test (R-squared = 0.03) and medium for the Essen Questionnaire on Age and Sleepiness (R-squared = 0.22). Significant differences between patients with high and low FORTA scores were found for Instrumental Activities of Daily Living, the Tinetti test, mini-nutritional assessments, Mini-Mental State Examination, Essen Questionnaire on Age and Sleepiness, and the Geriatric Depression Scale. All significant tests revealed that higher FORTA scores (lower medication quality) were associated with less favorable test outcomes. CONCLUSIONS The FORTA score is associated with relevant aspects of comprehensive geriatric assessment, underlining the importance of medication quality for the functional and cognitive well-being of older patients. TRIAL REGISTRATION NUMBER DRKS00000531.
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Affiliation(s)
- Farhad Pazan
- Medical Faculty Mannheim, Institute for Clinical Pharmacology, Ruprecht-Karls-University Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Heinrich Burkhardt
- IV. Medical Department, Geriatrics, University Hospital Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Helmut Frohnhofen
- Department of Medicine, Faculty of Health, University Witten-Herdecke, Alfred-Herrhausen-Str. 50, 58448, Witten, Germany
| | - Christel Weiss
- Department of Medical Statistics, Biomathematics and Information Processing, Medical Faculty Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Christina Throm
- Department of Cardiology and Angiology, Agaplesion Markus Hospital, Wilhelm-Epstein-Str. 4, 60431, Frankfurt, Germany
| | | | - Martin Wehling
- Medical Faculty Mannheim, Institute for Clinical Pharmacology, Ruprecht-Karls-University Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany.
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Wastesson JW, Morin L, Laroche ML, Johnell K. How Chronic Is Polypharmacy in Old Age? A Longitudinal Nationwide Cohort Study. J Am Geriatr Soc 2018; 67:455-462. [PMID: 30575952 DOI: 10.1111/jgs.15717] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Revised: 10/04/2018] [Accepted: 11/04/2018] [Indexed: 01/03/2023]
Abstract
OBJECTIVE To evaluate the chronicity of polypharmacy among older adults and to identify factors associated with chronic polypharmacy. DESIGN Longitudinal cohort study using register data. SETTING Nationwide, Sweden. PARTICIPANTS All 711,432 older adults (aged 65 years and older) living in Sweden with five or more prescription drugs in October 2010 were included and followed up until December 2013. Mean age at baseline was 77 (SD = 7.8) years, 59% were women, and 7% lived in nursing homes. MEASUREMENT Monthly changes in the exposure to polypharmacy. Data regarding prescription drug use were extracted from the Swedish Prescribed Drugs Register. RESULTS Overall, 82% were continuously exposed to polypharmacy for 6 months or longer, and 74% for 12 months or longer. The proportion of individuals who remained exposed until the end of the study was 55%. Among the 21,361 individuals who had not been exposed to polypharmacy during the 6-month period before baseline (ie, with a new episode of polypharmacy), only 30% remained exposed for 6 months or longer. The proportion of older adults who spent at least 80% of their follow-up time with polypharmacy was substantially higher among prevalent polypharmacy users at baseline than among those with a new polypharmacy episode (80% vs 24%; P < .01). Factors associated with chronic polypharmacy included higher age, female sex, living in an institution, chronic multimorbidity, and multidose dispensing. CONCLUSION Polypharmacy is most often chronic, although a substantial share of older adults experience short, recurring episodes of polypharmacy and are thus exposed to its potential harms in a transient rather than persistent manner. J Am Geriatr Soc 67:455-462, 2019.
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Affiliation(s)
- Jonas W Wastesson
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden
| | - Lucas Morin
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden
| | - Marie-Laure Laroche
- Service de Pharmacologie, Toxicologie et Pharmacovigilance, Centre Hospitalier Universitaire de Limoges, Limoges, France.,INSERM 1248, Faculté de Médecine, Université de Limoges, Limoges, France
| | - Kristina Johnell
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden
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Wastesson JW, Morin L, Tan ECK, Johnell K. An update on the clinical consequences of polypharmacy in older adults: a narrative review. Expert Opin Drug Saf 2018; 17:1185-1196. [PMID: 30540223 DOI: 10.1080/14740338.2018.1546841] [Citation(s) in RCA: 285] [Impact Index Per Article: 47.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
INTRODUCTION Polypharmacy, the use of multiple medications by one individual, is increasingly common among older adults. Caring for the growing number of older people with complex drug regimens and multimorbidity presents an important challenge in the coming years. AREAS COVERED This article reviews the international trends in the prevalence of polypharmacy, summarizes the results from previous reviews on polypharmacy and negative health outcomes, and updates a previous review on the clinical consequences of polypharmacy by focusing on studies published after 2013. This narrative review, which is based on a literature search in MEDLINE and EMBASE from January 1990 to June 2018, was undertaken to identify relevant articles. Search terms included variations of polypharmacy and multiple medications. EXPERT OPINION The prevalence of polypharmacy is increasing worldwide. More than half of the older population is exposed to polypharmacy in some settings. Polypharmacy is associated with a broad range of clinical consequences. However, methods to assess the dangers of polypharmacy should be refined. In our opinion, the issue of 'confounding by multimorbidity' has been underestimated and should be better accounted for in future studies. Moreover, researchers should develop more clinically relevant definitions of polypharmacy, including measures of inappropriate or problematic polypharmacy.
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Affiliation(s)
- Jonas W Wastesson
- a Aging Research Center, Department of Neurobiology , Care Sciences and Society, Karolinska Institutet & Stockholm University , Stockholm , Sweden
| | - Lucas Morin
- a Aging Research Center, Department of Neurobiology , Care Sciences and Society, Karolinska Institutet & Stockholm University , Stockholm , Sweden
| | - Edwin C K Tan
- a Aging Research Center, Department of Neurobiology , Care Sciences and Society, Karolinska Institutet & Stockholm University , Stockholm , Sweden.,b Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences , Monash University , Parkville , Australia
| | - Kristina Johnell
- a Aging Research Center, Department of Neurobiology , Care Sciences and Society, Karolinska Institutet & Stockholm University , Stockholm , Sweden
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Benbow J, Wand AP, Simpson B. A pilot study examining the profile of older people on clozapine. Australas Psychiatry 2018; 26:619-623. [PMID: 30226106 DOI: 10.1177/1039856218797435] [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] [Indexed: 11/17/2022]
Abstract
OBJECTIVE: The primary aim was to comprehensively describe the characteristics of a cohort of older people taking clozapine. METHOD: Participants aged ⩾ 60 had a geriatric assessment including full medical, medication and social history. Standardized screening tools for cognition, function, comorbidity and antipsychotic side effects were administered and descriptive statistics utilized. RESULTS: Thirteen patients were eligible to participate and 10 were assessed. The mean age was 69 years. The mean clozapine dose was 309 mg/day and mean duration of use was 10 years. All participants had executive dysfunction, and half had cognitive impairment. The mean number of co-morbid conditions was five. Seven people met the criteria for polypharmacy. Eight people experienced moderate-severe antipsychotic-related side-effects. The majority demonstrated impaired physical functioning. CONCLUSIONS: This cohort of older people taking clozapine experienced considerable morbidity, functional and cognitive impairment. We suggest routine screening of cognition and function in clozapine patients aged ⩾ 60 years. Those screening positive should be considered for further assessment by Older Person's Mental Health Services and/or a Geriatric Medicine service.
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Affiliation(s)
- Jen Benbow
- Staff Specialist Geriatrician, Department of Geriatric Medicine, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Anne Pf Wand
- Staff Specialist Psychiatrist, Persons' Mental Health Service, St George Hospital, Eastern Suburbs Mental Health Service, Sydney, NSW, and; Conjoint Senior Lecturer, School of Psychiatry, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Brett Simpson
- Senior Staff Specialist Psychiatrist, Older Persons' Mental Health Service, St George Hospital, Eastern Suburbs Mental Health Service, Sydney, NSW, and; Conjoint Lecturer, School of Psychiatry, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
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Association of Parkinsonism or Parkinson Disease with Polypharmacy in the Year Preceding Diagnosis: A Nested Case–Control Study in South Korea. Drug Saf 2017. [DOI: 10.1007/s40264-017-0559-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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