1
|
Matovelle P, Oliván-Blázquez B, Fraile-Peñaranda I, Turón-Lanuza A, Gallego-Royo A, Casado-Vicente V, Magallón-Botaya R. Polypharmacy in Older Patients: A Three-Year Longitudinal Analysis in Primary Care Settings of Aragón, Spain. Ann Geriatr Med Res 2024; 28:36-45. [PMID: 37994020 PMCID: PMC10982450 DOI: 10.4235/agmr.23.0137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 11/14/2023] [Accepted: 11/16/2023] [Indexed: 11/24/2023] Open
Abstract
BACKGROUND Challenges of polypharmacy and the impact of coronavirus disease 2019 (COVID-19) pandemic in older patients require further investigation. This retrospective study analyzed the progression of polypharmacy and anticholinergic burden in older patients in a primary care setting before, during, and after the COVID-19 pandemic. METHODS This 3-year cross-sectional study (2019, 2020, and 2021) comprised a dynamic cohort of individuals aged ≥75 years, who attended the Arrabal Primary Care Center in Zaragoza, Spain. Older patients with polypharmacy (≥5 medications) were identified according to their electronic health records. We collected demographic and clinical data, including medication prescriptions, diagnoses, and anticholinergic risks, and performed descriptive and statistical analyses. RESULTS This study included a total of 1,928 patients with a mean age of 83.52±0.30 years. Over the 3-year study period, the mean number of medications prescribed increased, from 9.4 in 2019 to 10.4 in 2021. The prevalence of excessive polypharmacy (≥10 medications) increased from 39% in 2019 to 45% in 2021. The most commonly prescribed drugs were anilides, proton pump inhibitors, benzodiazepine derivatives, and platelet aggregation inhibitors. Women had a higher prevalence of illnesses and anticholinergic drug prescriptions than men. CONCLUSION The results of this study highlighted an upward trend in polypharmacy and excessive polypharmacy among older patients in primary care settings. Future research should focus on optimizing medication management and deprescribing strategies and minimizing the adverse effects of polypharmacy in this population.
Collapse
Affiliation(s)
- Priscila Matovelle
- Department of Geriatrics, San Juan de Dios Hospital, Zaragoza, Spain
- Department of Medicine, Psychiatry and Dermatology, Faculty of Medicine, University of Zaragoza, Zaragoza, Spain
| | - Bárbara Oliván-Blázquez
- Group B21-20R, Health Research Institute of Aragon (IISA), Zaragoza, Spain
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS, RD21/0016/0001), Zaragoza, Spain
- Department of Psychology and Sociology, University of Zaragoza, Zaragoza, Spain
| | - Irene Fraile-Peñaranda
- Department of Preventive Medicine Unit, Lozano Blesa University Clinical Hospital, Zaragoza, Spain
| | | | - Alba Gallego-Royo
- Aragonese Healthcare Service (SALUD), Zaragoza, Spain
- Aragon Health Research Institute, Zaragoza, Spain
| | - Verónica Casado-Vicente
- Family and Community Medicine, University Health Centre Parquesol, Valladolid, Spain
- Department of Medicine, University of Valladolid, Valladolid, Spain
| | - Rosa Magallón-Botaya
- Department of Medicine, Psychiatry and Dermatology, Faculty of Medicine, University of Zaragoza, Zaragoza, Spain
- Group B21-20R, Health Research Institute of Aragon (IISA), Zaragoza, Spain
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS, RD21/0016/0001), Zaragoza, Spain
- Aragonese Healthcare Service (SALUD), Zaragoza, Spain
| |
Collapse
|
2
|
Togashi S, Ohinata H, Noguchi T, Wakabayashi H, Nakamichi M, Shimizu A, Nishioka S, Momosaki R. Polypharmacy, Potentially Inappropriate Medications, and Dysphagia in Older Inpatients: A Multi-Center Cohort Study. Ann Geriatr Med Res 2024; 28:86-94. [PMID: 38229436 PMCID: PMC10982443 DOI: 10.4235/agmr.23.0203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Revised: 01/05/2024] [Accepted: 01/10/2024] [Indexed: 01/18/2024] Open
Abstract
BACKGROUND Although the relationship between medication status, symptomatology, and outcomes has been evaluated, data on the prevalence of polypharmacy and potentially inappropriate medications (PIMs) and the association of polypharmacy and PIMs with swallowing function during follow-up are limited among hospitalized patients aged ≥65 years with dysphagia. METHODS In this 19-center cohort study, we registered 467 inpatients aged ≥65 years and evaluated those with the Food Intake LEVEL Scale (FILS) scores ≤8 between November 2019 and March 2021. Polypharmacy was defined as prescribing ≥5 medications and PIMs were identified based on the 2023 Updated Beers Criteria. We applied a generalized linear regression model to examine the association of polypharmacy and PIMs with FILS score at discharge. RESULTS We analyzed 399 participants (median age, 83.0 years; males, 49.8%). The median follow-up was 51.0 days (interquartile range, 22.0-84.0 days). Polypharmacy and PIMs were present in 67.7% of and 56.1% of patients, respectively. After adjusting for covariates, neither polypharmacy (β = 0.05; 95% confidence interval [CI], -0.04-0.13, p=0.30) nor non-steroidal anti-inflammatory medications (β = 0.09; 95% CI, -0.02-0.19; p=0.10) were significantly associated with FILS score at discharge. CONCLUSION The results of this study indicated a high proportion of polypharmacy and PIMs among inpatients aged ≥65 years with dysphagia. Although these prescribed conditions were not significantly associated with swallowing function at discharge, our findings suggest the importance of regularly reviewing medications to ensure the appropriateness of prescriptions when managing older inpatients.
Collapse
Affiliation(s)
- Shintaro Togashi
- Center for Outcomes Research and Economic Evaluation for Health, National Institute of Public Health, Wako‐shi, Japan
- Department of Nursing Care, Sendai Kosei Hospital, Sendai, Japan
| | | | - Taiji Noguchi
- Department of Social Science, Center for Gerontology and Social Science, Research Institute, National Center for Geriatrics and Gerontology, Obu, Japan
- Japan Society for the Promotion of Science, Chiyoda, Japan
| | - Hidetaka Wakabayashi
- Department of Rehabilitation Medicine, Tokyo Women's Medical University Hospital, Shinjuku, Japan
| | | | - Akio Shimizu
- Department of Food and Health, Faculty of Health and Human Development, The University of Nagano, Nagano, Japan
| | - Shinta Nishioka
- Department of Clinical Nutrition and Food Service, Nagasaki Rehabilitation Hospital, Nagasaki, Japan
| | - Ryo Momosaki
- Department of Rehabilitation Medicine, Mie University Graduate School of Medicine, Tsu, Japan
| |
Collapse
|
3
|
Lyne S. Benefits of deprescribing for older people with frailty and polypharmacy: part one. Nurs Older People 2023; 35:35-41. [PMID: 37670533 DOI: 10.7748/nop.2023.e1441] [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] [Accepted: 05/31/2023] [Indexed: 09/07/2023]
Abstract
The UK population is ageing rapidly, a trend that is likely to continue due to improvements in chronic disease management and increased life expectancy. Comorbidities, including frailty, become increasingly common with age and as a result it is likely that multiple medicines will be prescribed for older people, leading to polypharmacy. This is a concern because polypharmacy is associated with various adverse effects and an increased medicine burden in this population, as well as a financial burden for the healthcare system. This article, the first of two parts, explains the physiology of ageing and frailty, and considers the adverse effects of polypharmacy on older people with frailty, using a fictional case study to illustrate this. Part two will use the case study to explore the use of medication reviews and deprescribing benefits as part of medicines optimisation.
Collapse
Affiliation(s)
- Sue Lyne
- East Sussex Healthcare NHS Trust, East Sussex, England
| |
Collapse
|
4
|
Gómez-Gómez C, Moya-Molina MÁ, Tey-Aguilera MJ, Flores-Azofra J, González-Caballero JL. Baseline Profiles of Drug Prescriptions Prior to Diagnosis of Mild Cognitive Impairment (MCI) Obtained by Latent Class Analysis (LCA), and Assessment of Their Association with Conversion to Dementia. Healthcare (Basel) 2023; 11:2219. [PMID: 37570459 PMCID: PMC10419237 DOI: 10.3390/healthcare11152219] [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: 06/13/2023] [Revised: 07/27/2023] [Accepted: 07/31/2023] [Indexed: 08/13/2023] Open
Abstract
Polypharmacy has been linked to cognitive decline. However, interventions targeting modifiable risk factors, some of which are targets of the most commonly used drugs, could reduce the prevalence of dementia. Our aim was to determine the drug prescription regimen at baseline, prior to the diagnosis of mild cognitive impairment (MCI), and its possible association with progression to dementia. Data were collected from the electronic medical records of 342 MCI outpatients diagnosed during 2006-2017 at their first neurology consultation. We followed the classical three-step method of statistical analysis, starting with a Latent Class Analysis (LCA) to discover subgroups of drug prescription probability. Half of the patients were under polypharmacy (≥5 drugs), 17.5% had no recorded medication, 33.3% progressed to dementia (94.7% in ≤5 years), and 84.1% of them to Alzheimer's disease (AD). According to the LCA and based on 20 therapeutic indicators obtained from 240 substances and regrouped according the Anatomical Therapeutic Chemical Classification, we identified a four-profile model: (1) low (35.7% of patients); (2) mixed (28.7%); (3) cardio-metabolic (19.3%); and (4) psychotropic (16.4%). The binomial regression logistic model showed that profiles 2 and 3 (and 4 for AD), with a higher drug prescription conditioned probability against classic risk factors, were protective than profile 1 (OR = 0.421, p = 0.004; OR = 0.278, p = 0.000; OR = 0.457, p = 0.040, respectively), despite polypharmacy being significant in profiles 2 and 3 (mean > 7 drugs) vs. profile 1 (1.4 ± 1.6) (p = 0.000). Patients in the latter group were not significantly older, although being aged 65-79 years old quadrupled (OR = 4.217, p = 000) and being >79 tripled (OR = 2.945, p = 0.010) the conversion risk compared to patients <65 years old. According to the proposed analytical model, profiling the heterogeneous association of risk factors, which were taken prior to diagnosis, could be explored as an indicator of prior care and a predictor of conversion to dementia.
Collapse
Affiliation(s)
- Carmen Gómez-Gómez
- Department of Biochemistry and Molecular Biology, School of Medicine, University of Cadiz, 11002 Cádiz, Spain; (M.J.T.-A.); (J.F.-A.)
| | - Miguel Ángel Moya-Molina
- Department of Neurology, Hospital Universitario Puerta del Mar (HUPM), University of Cadiz, 11009 Cádiz, Spain
| | - Manuel Jesús Tey-Aguilera
- Department of Biochemistry and Molecular Biology, School of Medicine, University of Cadiz, 11002 Cádiz, Spain; (M.J.T.-A.); (J.F.-A.)
| | - Jorge Flores-Azofra
- Department of Biochemistry and Molecular Biology, School of Medicine, University of Cadiz, 11002 Cádiz, Spain; (M.J.T.-A.); (J.F.-A.)
| | | |
Collapse
|
5
|
Salmen T, Bobirca FT, Bica IC, Mihai DA, Pop C, Stoian AP. The Safety Profile of Sodium-Glucose Cotransporter-2 Inhibitors and Glucagon-like Peptide 1 Receptor Agonists in the Standard of Care Treatment of Type 2 Diabetes Mellitus. Life (Basel) 2023; 13:life13030839. [PMID: 36983994 PMCID: PMC10051290 DOI: 10.3390/life13030839] [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: 02/26/2023] [Revised: 03/07/2023] [Accepted: 03/10/2023] [Indexed: 03/30/2023] Open
Abstract
AIM We evaluated the safety of sodium-glucose cotransporter-2 inhibitors (SGLT2i) and glucagon-like peptide 1 receptor agonists (GLP-1 RAs) for their use with other glucose-lowering drugs and drugs for the treatment of type 2 diabetes mellitus (T2DM), in a standard-of-care regimen with maximum tolerated doses, and, respectively, when compared with metformin. METHODS We conducted a retrospective, observational study on 405 patients that were seen in the outpatient clinic of the N Paulescu National Institute for Diabetes Mellitus, Bucharest, Romania, in 2019. Their demographics, metabolic parameters, and medication safety were evaluated at three follow-up visits, from baseline, six months, and twelve months. RESULTS Both SGLT-2is and GLP-1 RAs are safe regarding creatinine, eGFR, urea, GOT, and GPT upon the comparison of the data from the six- and twelve-month visits with the initial visit, and also the twelve-month visit with the six-month visit. Moreover, when comparing SGLT-2is and GLP-1 RAs with metformin, there are safety data only for urea. CONCLUSIONS In this retrospective analysis, both SGLT-2is and GLP-1 RAs, when used in conjunction with other glucose-lowering, blood-pressure-lowering, and lipid-lowering medications, appeared to be safe for the management of T2DM.
Collapse
Affiliation(s)
- Teodor Salmen
- Doctoral School of Carol Davila, University of Medicine and Pharmacy, 050474 Bucharest, Romania
| | - Florin-Teodor Bobirca
- Department of General Surgery, Carol Davila, University of Medicine and Pharmacy, 050474 Bucharest, Romania
| | - Ioana-Cristina Bica
- Doctoral School of Carol Davila, University of Medicine and Pharmacy, 050474 Bucharest, Romania
| | - Doina-Andrada Mihai
- Department of Diabetes, Nutrition and Metabolic Diseases, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania
| | - Corina Pop
- Department of Gastroenterology and Internal Medicine, Carol Davila, University of Medicine and Pharmacy, 050474 Bucharest, Romania
| | - Anca Pantea Stoian
- Department of Diabetes, Nutrition and Metabolic Diseases, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania
| |
Collapse
|
6
|
Kojima T, Hamaya H, Ishii S, Hattori Y, Akishita M. Association of disability level with polypharmacy and potentially inappropriate medication in community dwelling older people. Arch Gerontol Geriatr 2023; 106:104873. [PMID: 36446253 DOI: 10.1016/j.archger.2022.104873] [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: 09/18/2022] [Revised: 11/07/2022] [Accepted: 11/21/2022] [Indexed: 11/25/2022]
Abstract
AIMS To investigate the influence of disability severity level on polypharmacy and the prescription of potentially inappropriate medication (PIM) using health insurance and long-term care (LTC) insurance claim data. METHODS Data were obtained from a health-care insurance and long-term care insurance claims database of citizens of Kure city, Japan, in April 2017. Data including age, sex, and drug profile were obtained, and the level of LTC needs was used to measure disability level. Factors associated with polypharmacy (≥5 prescribed drugs) and PIM prescription (≥1 PIM) defined by STOPP-J were analyzed statistically. RESULTS Among 67,169 people aged ≥65 (mean age 77.2 ± 7.9, male 40.7%), the frequency of polypharmacy increased with age until 85-89 (male 58.3%, female 57.6%) in both genders, and polypharmacy was most prevalent in those at the mildest LTC level (support level: male 68.9%, female 73.7%). PIM prescriptions was also frequent in those with LTC needs. On multiple logistic regression analysis, polypharmacy was significantly associated with older age and LTC needs, and PIM prescription was associated with older age and higher LTC level, suggesting that there is a large difference in prescription according to the person's age and disability level. CONCLUSION Polypharmacy was prevalent especially in older persons which peaked at the age of 85-89 or at mild disability level, and PIM prescription was prevalent in those with older age and higher care levels. When optimizing polypharmacy or PIM prescription in older patients, healthcare providers should focus on not only age but also disability level.
Collapse
Affiliation(s)
- Taro Kojima
- Department of Geriatric Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
| | - Hironobu Hamaya
- Department of Geriatric Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Shinya Ishii
- Department of Medicine for Integrated Approach to Social Inclusion, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Yukari Hattori
- Department of Geriatric Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Masahiro Akishita
- Department of Geriatric Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| |
Collapse
|
7
|
Tao A, Ho KHM, Yang C, Chan HYL. Effects of non-pharmacological interventions on psychological outcomes among older people with frailty: A systematic review and meta-analysis. Int J Nurs Stud 2023; 140:104437. [PMID: 36764033 DOI: 10.1016/j.ijnurstu.2023.104437] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2022] [Revised: 01/08/2023] [Accepted: 01/10/2023] [Indexed: 01/15/2023]
Abstract
BACKGROUND Older people with frailty are more likely to experience negative psychological well-being, depressive symptoms, anxiety, and stress. Deterioration of psychological outcomes, in turn, further aggravates the frailty status among this vulnerable population. Considering the undesirable effects of polypharmacy on older people, the use of non-pharmacological intervention has attracted increasing attention. However, the effects of non-pharmacological interventions on psychological outcomes are not clear. AIMS This review aims to systematically identify and synthesise evidence to examine the effectiveness of non-pharmacological interventions on psychological outcomes among older people with frailty. METHODS Eight electronic databases, including PubMed, MEDLINE, EMBASE, CINAHL, APA PsycInfo, Cochrane Library, CNKI and WANFANG were searched from inception to 14 November 2022. Randomised controlled trials and clinical controlled trials of non-pharmacological interventions on psychological outcomes in older people with frailty were included. The quality of the included studies was assessed using The Cochrane Risk of Bias Tool v2. Meta-analysis was performed using the RevMan5.3. The certainty of the evidence was evaluated by GRADE approach. RESULTS A total of 4726 articles were initially identified and screened for title and abstract. Eventually, 13 articles from 11 studies were included in this review. The results of the overall risk of bias indicated that four studies had low risk; five studies had some concerns, and two studies had high risk. Four types of intervention were identified, including physical exercise (n = 3), complementary and alternative medicine (music therapy = 1, acupressure = 1), case management (n = 5), and advance care planning (n = 1). The pooled analysis showed that group-based physical exercise had significant beneficial effects on depressive symptoms (SMD: -0.46, 95% CI: -0.81 to -0.10, p = .01; low certainty). There is no difference between the effects of case management and usual care on depressive symptoms (SMD: 0.02, 95% CI: -0.14 to 0.19, p = .79; high certainty). Narrative synthesis of evidence suggested the effects of complementary and alternative medicine on improving depressive symptoms and general mental status. CONCLUSIONS Psychological outcomes in older people with frailty are understudied. Group-based physical exercise could be a strategy to reduce depressive symptoms among older people with frailty. There is limited evidence showing the effects of complementary and alternative medicine on improving psychological outcomes. More rigorous trials are needed to examine the effects of non-pharmacological interventions on psychological outcomes among older people with frailty. REGISTRATION (PROSPERO): CRD42022303370.
Collapse
Affiliation(s)
- An Tao
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, N.T., Hong Kong
| | - Ken Hok Man Ho
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, N.T., Hong Kong
| | - Chen Yang
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, N.T., Hong Kong
| | - Helen Yue Lai Chan
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, N.T., Hong Kong.
| |
Collapse
|
8
|
Geetha J, Sakthivadivel V, Gaur A. Assessment of Fall Risk in Elderly Rural Population. MAEDICA 2021; 16:609-614. [PMID: 35261662 PMCID: PMC8897804 DOI: 10.26574/maedica.2021.16.4.609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Background: Fall risk assessment is an essential component of a comprehensive fall reduction and prevention program. Fall risk assessment is done to identify patients' risk for falls and ultimately prevent falls from occurring. The aim of the study was to identify the risk factors for fall in the elderly population. Methods:This study included 250 elderly patients > 60 years (105 males, 145 females) attending Medicine OPD in a tertiary care hospital. Detailed history including the previous h/o falls, medication history elicited and divided study subjects into two groups: fallers and non-fallers. Cardiovascular, neurological, and musculoskeletal system examinations were done. Handgrip, 30 seconds chair standing test (CST), "timed up and go" test (TUG), and performance-oriented mobility assessment (POMA) were performed. Results:The prevalence of falls in our study was 27.6%. The mean age of fallers was 72.22±6.219 years (P 0.002). Females had significant falls compared to males (p < 0.001). In binary logistic regression, age >80 [OR-3.8, CI (1.8-8.1); p 0.016], female gender [OR-19.2, CI (3.03-122.2); p 0.002], visual impairment [OR-8.9, CI (1.4-55.4); p 0.019], postural hypotension [OR-59.8, CI (3.3-1.07); p 0.006] and presence of more than three risk factors [OR-9.6, CI (4.6-2.01); p 0.000] were significantly associated with fall in our study. Conclusion:Falls among older people were common, especially among individuals aged over 80. Females were more prone to fall. The number of risk factors, visual impairment, and postural hypotension increased the fall risk. Simple clinical assessment can identify high-risk patients.
Collapse
Affiliation(s)
- Jeganathan Geetha
- Department of General Medicine, Karpaga Vinayaga Institute of Medical Sciences and Research Center, Maduranthgam, Tamilnadu, India
| | - Varatharajan Sakthivadivel
- Department of General Medicine, All India Institute of Medical Sciences, Bibinagar, Hyderabad, Telangana, India
| | - Archana Gaur
- Department of Physiology, All India Institute of Medical Sciences, Bibinagar, Hyderabad, Telangana, India
| |
Collapse
|
9
|
Young S, Chung E, Chen MA. Cardiovascular Complications of Acetylcholinesterase Inhibitors in Patients with Alzheimer's Disease: A Narrative Review. Ann Geriatr Med Res 2021; 25:170-177. [PMID: 34610666 PMCID: PMC8497945 DOI: 10.4235/agmr.21.0079] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 09/11/2021] [Accepted: 09/16/2021] [Indexed: 12/06/2022] Open
Abstract
While acetylcholinesterase inhibitors are used to treat a wide range of patients with Alzheimer's disease, acetylcholinesterase inhibitor use has also been associated with a variety of cardiovascular complications, including bradycardia and syncope. Herein, we review the pathophysiology and clinical evidence for cardiovascular complications caused by acetylcholinesterase inhibitors in patients being treated for dementia and discuss options for their management.
Collapse
Affiliation(s)
- Sara Young
- Boston University School of Medicine, Boston, MA, USA
| | - Enoch Chung
- Boston University School of Medicine, Boston, MA, USA
| | - Michael A. Chen
- Division of Cardiology, Harborview Medical Center, University of Washington School of Medicine, Seattle, WA, USA
| |
Collapse
|
10
|
Lee H, Chong J, Jung HW, Baek JY, Lee E, Jang IY. Association of the FRAIL Scale with Geriatric Syndromes and Health-Related Outcomes in Korean Older Adults. Ann Geriatr Med Res 2021; 25:79-85. [PMID: 33975422 PMCID: PMC8273001 DOI: 10.4235/agmr.20.0095] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Accepted: 05/05/2021] [Indexed: 01/03/2023] Open
Abstract
Background Owing to the growing older population, appropriate tools are needed for frailty screening in community-dwelling older people. We investigated the association between geriatric conditions and health-related outcomes using the five-item Fatigue, Resistance, Ambulation, Illnesses, & Loss of Weight (FRAIL) scale in a Korean rural community setting. Methods We performed comprehensive geriatric assessments, including the FRAIL scale, in 1,292 community-dwelling people (mean age, 74.6 years) in the Aging Study of Pyeongchang Rural Area. These populations were prospectively followed up for 3 years to analyze the outcomes of death, institutionalization, disability, and quality of life. We investigated the association between frailty status and outcomes using the FRAIL scale. Results According to the FRAIL scale, 524 (36.5%) participants were prefrail and 297 (23.0%) were frail. According to the adjusted model, the degree of frailty status was significantly associated with concurrent geriatric syndromes and 3-year incidences of mortality, institutionalization, and disability; Kaplan–Meier analysis showed significant differences in 3-year survival based on frailty status (92.6% for robust, 85.7% for prefrail, and 74.2% for frail; log-rank p<0.001). Conclusion The five-item FRAIL scale can be used to screen for accompanying geriatric syndromes and is associated with the 3-year health-related outcomes in community-dwelling Korean older adults. From the public health perspective, this simple screening tool for frailty assessment might be applicable to older populations in Korea.
Collapse
Affiliation(s)
- Heayon Lee
- Division of Geriatrics, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.,Division of Pulmonary, Critical Care and Sleep Medicine, Department of Internal Medicine, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Junyong Chong
- Division of Gastroenterology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hee-Won Jung
- Division of Geriatrics, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Ji Yeon Baek
- Division of Geriatrics, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Eunju Lee
- Division of Geriatrics, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Il-Young Jang
- Division of Geriatrics, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.,Pyeongchang Health Center & Country Hospital, Gangwon-do, Korea
| |
Collapse
|
11
|
Park CM, Oh G, Lee H, Jung HW, Lee E, Jang IY, Kim DH. Multicomponent Intervention and Long-Term Disability in Older Adults: A Nonrandomized Prospective Study. J Am Geriatr Soc 2020; 69:669-677. [PMID: 33155305 DOI: 10.1111/jgs.16926] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 10/19/2020] [Accepted: 10/20/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND/OBJECTIVES To evaluate the long-term association between a multicomponent intervention program and disability in socioeconomically vulnerable older adults. DESIGN This was a nonrandomized prospective intervention trial. SETTING The setting was a community. PARTICIPANTS Participants included older Koreans living alone or receiving government assistance from a low-income program. INTERVENTION The intervention was a 24-week multicomponent program compromising group exercise, nutritional supplementation, management of depression, deprescribing, and home hazard reduction (n = 187) versus usual care (n = 196). MEASUREMENTS The number of dependencies in 17 basic and instrumental activities of daily living was measured every 3 months for 30 months (range: 0-17; greater values indicated worse disability). Inverse probability weighting Poisson regression was used to model the number of dependencies to adjust for confounding bias and higher dropout rates of those with greater disability. RESULTS The study population had a mean age of 76 years, and 26% were men. During the 30-month follow up, 17 died (n = 8, intervention; n = 9, control), 62 (n = 16, intervention; n = 46, control) were institutionalized or received nursing home care, and 34 (n = 15, intervention; n = 19, control) were lost to follow up. After inverse probability weighting, the mean number of dependencies at baseline was 1.21 and 1.29 for the intervention group and the control group, respectively (P = .80). The intervention group had fewer dependencies than the control group, but the difference was attenuated over time: 1.08 versus 1.60 at 6 months (P = .04), 1.29 versus 1.87 at 12 months (P = .03), 1.62 versus 2.17 at 18 months (P = .06), 2.08 versus 2.51 at 24 months (P = .18), and 2.73 versus 2.90 at 30 months (P = .67). CONCLUSION A 24-week multicomponent intervention was associated with a slower progression of disability; however, the diminishing association from 24 months and beyond suggests that reassessment and intervention may be necessary. Due to a lack of randomization, our findings should be interpreted with caution.
Collapse
Affiliation(s)
- Chan Mi Park
- Department of Family Medicine, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Gahee Oh
- Hebrew SeniorLife, Marcus Institute for Aging Research, Boston, Massachusetts, USA
| | - Heayon Lee
- Division of Geriatrics, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.,Division of Pulmonary, Critical Care and Sleep Medicine, Department of Internal Medicine, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Hee-Won Jung
- Division of Geriatrics, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Eunju Lee
- Division of Geriatrics, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Il-Young Jang
- Division of Geriatrics, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.,PyeongChang Health Center and County Hospital, PyeongChang, Republic of Korea
| | - Dae Hyun Kim
- Hebrew SeniorLife, Marcus Institute for Aging Research, Boston, Massachusetts, USA.,Division of Gerontology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| |
Collapse
|
12
|
Hattori Y, Abe T, Kojima T, Hamada S, Ogawa S, Ura N, Akishita M. Potential prescribing omissions may have no influence on cause of death in care‐dependent older adults with percutaneous endoscopic gastrostomy tube. Geriatr Gerontol Int 2020; 20:961-966. [DOI: 10.1111/ggi.14009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 07/02/2020] [Accepted: 07/20/2020] [Indexed: 01/21/2023]
Affiliation(s)
- Yukari Hattori
- Department of Geriatric Medicine, Graduate School of Medicine The University of Tokyo Bunkyo‐ku Japan
| | | | - Taro Kojima
- Department of Geriatric Medicine, Graduate School of Medicine The University of Tokyo Bunkyo‐ku Japan
| | - Shota Hamada
- Research Department, Institute for Health and Policy Association for Health Economics Research and Social Insurance and Welfare Tokyo Japan
- Department of Home Care Medicine, Graduate School of Medicine The University of Tokyo Bunkyo‐ku Japan
| | - Sumito Ogawa
- Department of Geriatric Medicine, Graduate School of Medicine The University of Tokyo Bunkyo‐ku Japan
| | | | - Masahiro Akishita
- Department of Geriatric Medicine, Graduate School of Medicine The University of Tokyo Bunkyo‐ku Japan
| |
Collapse
|
13
|
Lee JH, Jung HW, Jang IY, do Moon S, Lee S, Han SJ. Anticholinergic Cognitive Burden as a Predictive Factor for In-hospital Mortality in Older Patients in Korea. Ann Geriatr Med Res 2020; 24:20-26. [PMID: 32743318 PMCID: PMC7370777 DOI: 10.4235/agmr.19.0050] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Revised: 01/31/2020] [Accepted: 02/07/2020] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND With the increasing prevalence of chronic disease due to aging, many older adults experience multimorbidity and polypharmacy. Medications with anticholinergic properties are particularly associated with adverse cognitive outcomes, including functional decline and mortality. We assessed the clinical impact of anticholinergic cognitive burden (ACB) on clinical outcomes of older patients acutely admitted to a single, hospitalist-operated medical unit of a tertiary hospital in Korea. METHODS This retrospective study reviewed electronic medical records of 318 patients aged 65 years or older admitted to the hospitalist-operated medical unit through the emergency department of Seoul National University Hospital. The analyzed clinical outcomes were the length of hospital stay, in-hospital mortality, unplanned intensive care unit admission, and unexpected readmission within 30 days. RESULTS The clinical outcomes did not differ between patients who took five or more drugs and those who did not. Patients with an ACB score of 3 or higher had a higher in-hospital mortality rate and longer hospital stay than those who did not. After adjusting for confounding factors, an ACB score of 3 or higher was an independent predictive factor for in-hospital mortality (odds ratio=3.09; 95% confidence interval, 1.18-8.06). CONCLUSION ACB rather than the number of medications was associated with in-hospital mortality in acutely ill older patients. Further analytic and interventional studies are required to assess potentially inappropriate medication use and ACB in older inpatients.
Collapse
Affiliation(s)
- Jae Hyun Lee
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Hee-Won Jung
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Il-Young Jang
- Division of Geriatrics, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sung do Moon
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Sunhye Lee
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Seung Jun Han
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| |
Collapse
|
14
|
Lee H, Lee E, Jang IY. Air Pollutants and Frailty in Older Adults: A Geriatrician's Perspective. Ann Geriatr Med Res 2019; 23:212-213. [PMID: 32743314 PMCID: PMC7370762 DOI: 10.4235/agmr.19.0049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2019] [Revised: 12/17/2019] [Accepted: 12/17/2019] [Indexed: 11/29/2022] Open
Affiliation(s)
- Heayon Lee
- Division of Geriatrics, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Eunju Lee
- Division of Geriatrics, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Il-Young Jang
- Division of Geriatrics, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| |
Collapse
|
15
|
Moon JH, Huh JS, Won CW, Kim HJ. Is Polypharmacy Associated with Cognitive Frailty in the Elderly? Results from the Korean Frailty and Aging Cohort Study. J Nutr Health Aging 2019; 23:958-965. [PMID: 31781725 DOI: 10.1007/s12603-019-1274-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVES Cognitive frailty-the coexistence of physical frailty and cognitive impairment-is a phenotype of frailty in the elderly. The coexistence of physical frailty and cognitive impairment, known as cognitive frailty, is one of the phenotypes of frailty in the elderly. Cognitive frailty predicts adverse health outcome more accurately than does physical frailty. In this study, we aim to determine whether the polypharmacy common among the elderly is linked with cognitive frailty. DESIGN, SETTING, AND PARTICIPANTS The elderly, aged between 70 and 84 years, who participated in the cross-sectional Korean Frailty and Aging Cohort Study were included in the present study. MEASUREMENTS Polypharmacy and hyperpolypharmacy were defined as the use of at least five and ten medications, respectively. Physical frailty was assessed by the Korean version of the FRAIL scale, and cognitive status was measured by the Trail Making Test part A, word list recall test, the Korean version of the Frontal Assessment Battery, and the Digit Span Backward test. RESULTS Among the 2,392 participants, 26.8% and 4.1% took more than five and ten prescribed medications, respectively. Polypharmacy and hyperpolypharmacy participants tend to have more cognitive impairment and physical frailty. Participants with cognitive frailty had the highest polypharmacy rate regardless of medication type. After controlling for the potential confounders including severity of comorbidities, frailty was found to be significantly related to polypharmacy, as defined by prescribed as well as total medications, including non-prescribed medications. However, cognitive impairment only showed a linkage to polypharmacy of prescribed medications, which-according to the results of multivariable analysis- could increase cognitive frailty, with an odds ratio of 2.70. CONCLUSION Although the elderly tend to depend on various medications, they should seriously consider the risk of polypharmacy for better health outcomes.
Collapse
Affiliation(s)
- J H Moon
- Chang Won Won and Hyeon Ju Kim, Department of Family Medicine, Jeju National University School of Medicine, Jeju, Republic of Korea, ; Tel.: +82-64-754-8153 (H.J.K.), ; Tel.:+82-2-958-8700 (C.W.W.)
| | | | | | | |
Collapse
|
16
|
Jung HW, Lim JY. Geriatric Medicine, an Underrecognized Solution of Precision Medicine for Older Adults in Korea. Ann Geriatr Med Res 2018; 22:157-158. [PMID: 32743267 PMCID: PMC7387626 DOI: 10.4235/agmr.18.0048] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Affiliation(s)
- Hee-Won Jung
- Graduate School of Medical Science and Engineering, Korea Advanced Institute of Science and Technology (KAIST), Daejeon, Korea
| | - Jae-Young Lim
- Department of Rehabilitation Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| |
Collapse
|