Measurement of accessibility is a crucial pillar in assessing equity of access to pain treatment, particularly in the context of reducing opioid prescribing in response to rising overdose deaths in the United States.

The aim of this study was to develop an instrument to measure barriers to prescription opioid access among individuals with chronic pain and test its psychometric properties.

This study used a cross-sectional online survey of a convenience sample of adults (>18 years) who reported any type of pain for at least 45 days or more in the previous 3 months. The survey captured demographic characteristics, self-reported medication use characteristics, and measures such as the Brief Pain Inventory-Short Form and the PROMIS Global Health measure, along with an item pool of potential questions that measure barriers to opioid access.

Respondents (N = 200) were 89 % women, 86 % White, averaging 45.32 years old (SD:11.79), and reported poor quality life. Two subscales, Access to Care and Patient Concerns, were identified for the Barriers to Opioid Access Scale with good internal consistency reliability (α = 0.909 and 0.835, respectively). In multivariable analyses, the Access to Care subscale was associated with the PROMIS mental health score (-2.44; 95 % CI: -3.77, -1.11), and the Patient Concerns subscale was associated with self-reported frequency of opioid use (-0.70; 95 % CI: -0.99, -0.40).

The newly developed BOAS has the potential to serve as a tool for capturing quality of pain treatment as well as measuring the impact of policy changes on the quality of treatment provided to patients with chronic pain.

The incidence of drug-related admissions in France was 8.5% in 2018, with falls being the 5 th cause of DRA. The screening of adverse drug reactions (ADRs) in old adults can be challenging. Our objective was to determine the proportion of old patients hospitalized for drug-related falls in a geriatrics department, assess their preventability and the impact of hospitalizations on the prescription of fall-risk increasing drugs (FRIDs).

A retrospective observational study, including patients aged over 75 years who were admitted to an acute geriatrics medicine department from May 10, 2022, to February 2, 2023, was conducted. We used a previously published method to detect DRA and assess their preventability.

Of the 512 patients admitted to the department during the study period, 104 patients (20%) were hospitalized due to falls, of whom 71 (14%) were considered to be drug-related. Falls associated with drugs were categorized as more severe (p = 0.01). In 41% of drug-related falls, ADRs were considered to be definitively avoidable. The most commonly implicated FRIDs classes were beta-blockers (53%, n = 38); diuretics (47%, n = 34); antidepressants (41%, n = 29); benzodiazepines (6%, n = 20); and underuse of vitamin D in patients with a documented deficiency (65%, n = 46). In patients hospitalized for drug-related falls, the FRIDs decreased between admission (n = 314) and discharge (n = 198, p < 0.01).

The proportion of hospitalizations for drug-related falls is notably high in geriatric department, and a substantial proportion can be prevented. These findings emphasize the importance of targeting high-risk patients for falls and implementing preventive measures, such as reassessing their medication as recommended in the latest international guidelines for falls prevention.

To estimate the prevalence of polypharmacy (concomitant use of ≥5 medications), hyperpolypharmacy (≥10 medications), and potentially inappropriate medication (PIM) use among older adults according to dementia and frailty status.

Cross-sectional data (2016-2017) from 3912 participants aged 71 to 94 years (mean ± SD, 79.6±4.8 years; 59.2% female; 24.5% Black race) from the community-based Atherosclerosis Risk in Communities (ARIC) study were used. Dementia and mild cognitive impairment status was based on comprehensive neurocognitive assessment, informant interviews, and adjudication by an expert panel. Participants were classified as frail, prefrail, or robust according to the Fried frailty phenotype definition. Medication containers were brought to the clinic. The PIMs were defined using a modified version of the Beers Criteria.

Polypharmacy, hyperpolypharmacy, and PIM use were prevalent in 67.1%, 18.8%, and 23.9% of participants, respectively, and 7.9% were classified as having dementia and 8.0% as frail. The demographic-adjusted relative risk ratio (95% CI) for participants with dementia vs normal cognition was 1.79 (1.27 to 2.51) for hyperpolypharmacy, and the odds ratio (95% CI) for PIM use was 1.58 (1.21 to 2.06). The relative risk ratios (95% CIs) for hyperpolypharmacy were 8.35 (5.57 to 12.54) for frail and 2.70 (2.14 to 3.41) for prefrail compared with robust.

Polypharmacy, hyperpolypharmacy, and PIM use were common in this community-based sample of adults approximately 80 years old. These patterns of use were even more common among participants with dementia and frailty, who are at elevated risk for adverse outcomes.

The use of potentially inappropriate medications (PIMs) in older adults in the emergency department (ED) is associated with increased risk of readmissions and adverse drug reactions. We sought to assess the impact of electronic health record (EHR)-based geriatric clinical decision support (CDS) on adherence to geriatric recommendations for targeted PIMs prescribed to older adults while in the ED and at ED discharge.

We performed a multicenter pre-post implementation cohort study comparing adherence to geriatric recommendations before and after implementation of ED geriatric CDS for patients 65 years or older for a targeted list of 12 PIMs. ED geriatric CDS consisted of custom order panels with clinical guidance for preferred alternative agents or preferred geriatric dosing if providers opted to proceed with ordering a targeted PIM; CDS was implemented for both medications ordered during the ED visit as well as outpatient prescriptions ordered at discharge. The primary outcomes were the proportions of ED orders and discharge prescriptions adherent to ED geriatric CDS recommendations.

A total of 6745 ED orders and 1440 discharge prescriptions were eligible for study inclusion. The proportion of targeted PIMs consistent with geriatric CDS recommendations was higher in the postimplementation group compared to preimplementation group for both ED orders (52% vs. 71%; difference 19%, 95% confidence interval [CI] 16.8%-21.3%) and discharge prescriptions (0.5% vs. 31.7%; difference 31.1%, 95% CI 27.5%-34.7%). In the postimplementation period, geriatric CDS order panel utilization for targeted PIMs was 62.1% for ED orders and 36.7% for discharge prescriptions. Among orders placed through ED geriatric CDS order panels, 90% of ED orders and 80.4% of discharge prescriptions were adherent to geriatric CDS recommendations.

EHR-based CDS for older adults in the ED increased the proportion of ED orders and discharge prescriptions adherent to geriatric drug therapy recommendations.

Patients in temporary stays are typically older individuals with frailty and multimorbidity. However, limited knowledge exists about their medication use. This study aimed to describe prescription drug use among patients in temporary stays in Denmark.

We conducted a drug utilisation study on 11,424 patients in public healthcare-operated temporary stay units across 14 Danish municipalities between 2016 and 2023 (median age 81 years; 54% women). Prescription data were sourced from the Danish National Prescription Registry.

Patients used a median of six drug classes (interquartile range [IQR] 4-10) in the four months before moving into a temporary stay facility; 68% used ≥ 5 drug classes, and 26% used ≥ 10. The most commonly used drug classes were paracetamol (49%), statins (30%), and proton pump inhibitors (29%). The monthly rate of new drug use increased from 23/100 patients six months before move-in to a peak of 262/100 patients in the first month after move-in, driven primarily by laxatives, analgesics, and antibiotics. High-risk drug use increased from 70 to 83% following move-in, with 49% of patients initiating at least one new high-risk drug, most commonly opioids (28%), potassium (17%), and anticoagulants and platelet inhibitors (15%). General practitioners initiated 60-70% of treatments and maintained 80-90%. Hospital physician prescriptions increased around move-in, peaking at 55% for initiation and 25% for maintenance in the first month after move-in.

Patients in temporary stays in Denmark demonstrate high medication use, including high-risk drugs, with a notable increase in treatment initiations around the time of move-in.

Poor data transfer and interoperability between electronic health record (EHR) systems has been a challenge hindering availability and usability of patient information in clinical practice and evidence-based decision-making. To improve data transfer and interoperability, patient information should be documented in a structured format. This also applies to medication-related patient information and results of the interventions, such as medication reviews (MRs), to individually optimize medication regimens, especially in older adults.

This study aimed to identify what information obtained from MRs should be documented in a structured form in EHRs at a national and organizational level.

The study was conducted as a 3-round Delphi consensus survey in 2020. The electronic survey was based on a comprehensive inventory of international and national MR procedures in various settings. Expert panelists (N=41) independently assessed which topics should be documented in a structured form in EHRs. The interprofessional panel (N=41) consisted of 12 physicians, 13 pharmacists, 10 nurses, and 6 information management professionals (participation rate 66%-76% in rounds 1-3; consensus limit set at 80%). The responses were analyzed quantitatively and qualitatively.

Consensus was reached on 97.3% (108/111) of predetermined topics to be documented in a structured form in EHRs. Of these, 39 concerned the MR process, 25 related to potentially drug-induced symptoms, 11 related to burden of risks for adverse drug effects, 12 related to laboratory tests and other test results, 12 related to medication adherence, and 9 related to the use of intoxicants. The patient's blood pressure (mean 4.85, SD 0.53; on a Likert scale 1-5), kidney function (mean 4.81, SD 0.56), and risk of bleeding (mean 4.81, SD 0.56) were ranked as the 3 most important topics to be documented in a structured form. The panel reached a consensus that the information obtained from MRs should be made available to all health care professionals in the national digital repository for patient data and to patients to some extent.

The interprofessional expert panel strongly agreed on the results of the MRs that should be documented in a structured form in EHRs and made available to both health professionals involved in care teams and patients themselves.

To describe the variation in the use of potentially inappropriate antipsychotic and benzodiazepine medications in residents who have received a medication review and to evaluate the extent to which this variation is associated with aged care home (ACH) and resident characteristics.

This cross-sectional, retrospective study used pharmacist-extracted data from 15,442 residents across 342 Australian ACHs who had a medication review during 2019. The proportion of residents receiving ≥1 potentially inappropriate antipsychotic and benzodiazepine medication according to Beers criteria were classified into quintiles by facility usage (Q1-Q5). Quintile characteristics were compared using descriptive analysis of facility and resident data. Logistic regression was used to compare individual usage between residents in each quintile adjusting for facility and resident characteristics.

The cohort had mean age 85 years (SD ±9), with less than 14% of residents in Q1 (n = 68), and >31% of residents in Q5 (n = 68) using an antipsychotic. For benzodiazepines, these proportions were <19% in Q1 (n = 68) and >45% in Q5 (n = 67). Facilities in major cities were significantly more likely to report antipsychotic (Q1:74% vs Q5:88%, P = .03) and benzodiazepine use (Q1:69% vs Q5:87%, P = .015). Residents in Q5 were seven times more likely to be prescribed an antipsychotic (aOR:7.22, 95% CI:5.93-8.79) than residents in Q1, and eight times more likely to be prescribed a benzodiazepine (aOR:8.57, 95% CI 7.33-10.01, P < .001) than residents in Q1.

Significant variation exists in potentially inappropriate antipsychotic and benzodiazepine use among ACH residents receiving a medication review highlighting the need for further research to reduce prescribing of these high-risk medications.

The use of potentially inappropriate medications (PIMs) in older adults can increase the risk of drug-related adverse events. We aimed to examine the associations between PIMs, frailty, and each frailty component in community-dwelling older women.

This cross-sectional study included participants aged ≥65 years from a prospective cohort of older Japanese women. Frailty was classified using the Japanese version of Fried's Frailty Criteria, comprising five components. PIMs were identified using a screening tool for Japanese among regular prescription medications collected from participants' prescription notebooks. Multivariable logistic regression models adjusted for age and comorbidities were used to examine the association between PIMs (0, 1, 2, ≥3), frailty, and each component. The possible interactions between age groups (65-74 and ≥75 years) and PIMs were investigated. Age-stratified analyses were also performed.

We analyzed 530 older women (median age [interquartile range], 71 [68, 75] years) with a frailty prevalence of 5.5%. Three or more PIMs were associated with frailty and weight loss (adjusted odds ratio [95% confidence interval], 3.80 [1.23, 11.80], 2.53 [1.15, 5.39]). In age-stratified analyses, ≥3 PIMs were associated with weight loss (8.39 [1.79, 48.98]) in women aged ≥75 years, whereas 1 or 2 PIMs were associated with frailty (4.52 [1.17, 19.08]) or weakness (3.13 [1.22, 7.78]) in those aged 65-74 years.

Our results may suggest that the number of PIM prescriptions is associated with frailty and frailty components in older women. Longitudinal studies are required to clarify the causality between the number of PIMs and frailty. Geriatr Gerontol Int 2025; 25: 686-693.

BackgroundSubjective memory complaints (SMC) are common in older adults and may indicate an increased risk of cognitive decline. Polypharmacy and anticholinergic burden have been associated with cognitive impairment, but their specific contribution to SMC remains unclear. The aim of this study was to investigate the association between polypharmacy, anticholinergic burden and SMC in community-dwelling older adults.MethodsThis cross-sectional study included 652 participants aged 65 years and older from geriatric outpatient clinics. SMC was assessed via a structured clinician-administered question, and cognitive function was evaluated using the Mini-Mental State Examination (MMSE). Polypharmacy was defined as the concomitant use of five or more medications, while anticholinergic burden was determined using the Anticholinergic Burden Classification (ABC). Logistic regression models were used to examine the independent effects of polypharmacy and anticholinergic burden on SMC, adjusting for demographic variables, comorbidities and depressive symptoms.ResultsSMC was reported by 48% of participants. Polypharmacy (OR = 2.10, 95% CI: 1.43-3.08, P < 0.001) and higher anticholinergic burden (OR = 2.39, 95% CI: 1.72-3.32, P < 0.001) were independently associated with increased SMC. Chronic obstructive pulmonary disease (COPD) was also identified as a significant predictor (OR = 2.90, 95% CI: 1.41-5.98, P = 0.004).ConclusionPolypharmacy and anticholinergic burden are significant risk factors for SMC in older adults. Reducing unnecessary medication use and minimizing anticholinergic burden may help to alleviate cognitive complaints. Future longitudinal studies are needed to determine causal relationships and possible interventions.

Older patients are more susceptible to medication use, and physiological changes resulting from aging and organic dysfunctions presented by critically ill patients may alter the pharmacokinetic or pharmacodynamic behavior. Thus, critically ill older people present greater vulnerability to the occurrence of pharmacotherapeutic problems.

To evaluate pharmacotherapy and the development of potential adverse drug reactions (ADRs) in older patients admitted to an intensive care unit (ICU).

A cohort study was conducted in an ICU for adults of a Brazilian University Hospital during a 12-month period. The patients' pharmacotherapy was evaluated daily, considering the occurrence of ADRs and drug-drug interactions (DDIs), the use of potentially inappropriate medications (PIMs) for older people, and the pharmacotherapy anticholinergic burden (ACB). A trigger tool was used for active search of ADRs, with subsequent causality evaluation. PIM use was evaluated by means of the Beers criteria and the STOPP/START criteria. The ABC scale was employed to estimate ACB. The Micromedex® and Drugs.com® medication databases were employed to evaluate the DDIs.

The sample of this study consisted of 41 patients, with a mean age of 66.8 years old (±5.2). The 22 triggers used assisted in identifying 15 potential ADRs, and 26.8% of the patients developed them. The mean estimated ACB score was 3.0 (±1.8), and the patients used 3.1 (±1.4) and 3.3 (±1.6) PIMs according to the Beers and the STOPP criteria, respectively. A total of 672 DDIs were identified, with a mean of 16.8 (±9.5) DDIs/patient during ICU hospitalization. Our findings show an association between occurrence of ADRs in the ICU and polypharmacy (p=.03) and DDIs (p=.007), corroborating efforts for rational medication use as a preventive strategy.

Using tools to evaluate the pharmacotherapy for older people in intensive care can assist in the recognition and prevention of pharmacotherapeutic problems, with emphasis on the identification of ADRs through the observation of triggers and subsequent causality analysis.

Older patients are more susceptible to medication use, and physiological changes resulting from aging and organic dysfunctions presented by critically-ill patients may alter the pharmacokinetic or pharmacodynamic behavior. Thus, critically-ill older people present greater vulnerability to the occurrence of pharmacotherapeutic problems.

To evaluate pharmacotherapy and the development of potential adverse drug reactions (ADRs) in older patients admitted to an intensive care unit (ICU).

A cohort study was conducted in an ICU for adults of a Brazilian University Hospital during a 12-month period. The patients' pharmacotherapy was evaluated daily, considering the occurrence of ADRs and drug-drug interactions (DDIs), the use of potentially inappropriate medications (PIMs) for older people, and the pharmacotherapy anticholinergic burden (ACB). A trigger tool was used for active search of ADRs, with subsequent causality evaluation. PIM use was evaluated by means of the Beers criteria and the STOPP/START criteria. The ABC scale was employed to estimate ACB. The Micromedex® and Drugs.com® medication databases were employed to evaluate the DDIs.

The sample of this study consisted of 41 patients, with a mean age of 66.8 years old (±5.2). The 22 triggers used assisted in identifying 15 potential ADRs, and 26.8% of the patients developed them. The mean estimated ACB score was 3.0 (±1.8), and the patients used 3.1 (±1.4) and 3.3 (±1.6) PIMs according to the Beers and the STOPP criteria, respectively. A total of 672 DDIs were identified, with a mean of 16.8 (±9.5) DDIs/patient during ICU hospitalization. Our findings show an association between occurrence of ADRs in the ICU and polypharmacy (p = 0.03) and DDIs (p = 0.007), corroborating efforts for rational medication use as a preventive strategy.

Using tools to evaluate the pharmacotherapy for older people in intensive care can assist in the recognition and prevention of pharmacotherapeutic problems, with emphasis on the identification of ADRs through the observation of triggers and subsequent causality analysis.

Objectives: Reducing fall risk requires older adults (age 65+) to adopt effective prevention strategies. This study has three aims: 1) understand Stage of Change (SOC) for three fall prevention strategies; 2) determine strategies older adults' use; and 3) understand which characteristics relate to readiness to take action. Methods: A survey of 1063 older adults assessed fall risk, SOC, and use of fall prevention strategies. Data analysis included descriptive statistics and regression analysis. Results: The most common SOC for older adults by strategy was action for overall fall prevention (61%), contemplation for medication management (45%), and preparation and action for strength/balance (29% each). Believing falls are preventable was most strongly related to being in a Change stage (e.g., action, maintenance) for overall fall prevention (Risk Ratio: 1.4, 95% CI: 1.1, 1.7). Discussion: Health promotion can focus on increasing knowledge of evidence-based fall prevention strategies to encourage older adults to take action.

High-risk medicines (HRMs) are medicines that have a higher risk of causing severe consequences for the patient when used in error.

This study aimed to develop a Finnish High-risk Medicine Classification (FIN-RiskMeds) to support healthcare professionals in HRM risk management.

The development of FIN-RiskMeds was coordinated by the Finnish Medicines Agency (Fimea) using the Delphi consensus method. The preliminary list of HRMs was based on an inventory of existing HRM lists, literature, and the expertise of the working group (WG). A three-round Delphi survey with 60 panelists and a public hearing were used to achieve consensus on the content of the classification. The consensus threshold was set at 70 %.

The expert panel agreed on 42 medicines or medicine classes (later 'items') to be included in the FIN-RiskMeds. A 70 % consensus was reached on 30 out of 60 items in Round 1 and on 13 out of 31 items in Round 2a. The strongest consensus was reached for warfarin, methotrexate, and opioids. The serious consequences and key risks of medicines and the medication process were described for all items after Rounds 2b and 3. Based on the WG's decision after a public hearing, the final classification consists of 38 items.

This study produced expert consensus-based classifications of HRMs and a comprehensive list of their key risks. HRMs and their risks should be identified across health and social care to prevent potential medication errors. It is necessary to develop medication processes to minimize the risks associated with HRMs.

Adults with dementia are frequently prescribed antipsychotic medications despite concerns that risks outweigh benefits. Understanding conditions where antipsychotics are initially prescribed, such as hospitalization, may offer insights into reducing inappropriate use.

Retrospective cohort study of community-dwelling veterans with dementia aged ≥68 with VA hospitalizations in 2014, using Veterans Health Administration (VA) and Medicare data.

The primary outcome was new outpatient antipsychotic prescription at hospital discharge. We used generalized estimating equations to study associations between antipsychotic initiation and patient, hospitalization, and facility characteristics. Among veterans with antipsychotic initiation, we used a cumulative incidence function to evaluate discontinuation in the year following hospitalization, accounting for competing risks.

4,719 community-dwelling veterans with dementia had VA hospitalizations in 2014; 264 (5.6%) filled new antipsychotic prescriptions at discharge. Antipsychotic initiation was associated with discharge unit (surgical vs medical, OR 0.41, 95% CI 0.19-0.87; psychiatric vs medical, OR 6.58, 95% CI 4.48-9.67), length of stay (OR 1.03/day, 95% CI 1.02-1.05), and delirium diagnosis (OR 2.61, 95% CI 1.78-3.83), but not demographic or facility characteristics. Among veterans with antipsychotic initiation, the 1-year cumulative incidence of discontinuation was 18.2% (n = 47); 15.9% (n = 42) of those who were alive and not censored remained on antipsychotics at 1 year.

Antipsychotic initiation at hospital discharge was uncommon among community-dwelling veterans with dementia; however, once initiated, antipsychotic persistence at 1 year was common among those who remained community-dwelling. Hospitalization is a contributor to potentially-inappropriate medications in the community, suggesting an opportunity for medication review after hospitalization.

Chemotherapy-induced peripheral neurotoxicity (CIPN) is a prevalent adverse effect of chemotherapy agents that is estimated to be present in 2/3 of patients who receive neurotoxic chemotherapy. In 30-40% of these patients, CIPN signs and symptoms can persist for months or years post-treatment. Recent studies have supported exercise as a feasible and possibly effective intervention for CIPN; however, more rigorous studies are needed to confirm feasibility, estimate efficacy, and clarify risk. In response, we developed an innovative virtual exercise-based rehabilitation program (EX-CIPN) for cancer survivors with persistent CIPN.

This study is a phase I study conducted at the Princess Margaret Cancer Centre in cancer survivors with persistent CIPN, with a focus on feasibility, acceptability, and safety. A total of 40 patients aged 18 or older, with persistent CIPN at least 6 months after chemotherapy completion will be recruited and receive the EX-CIPN program. The EX-CIPN program is a 10-week virtual home-based intervention that includes an individualized exercise program supported with a mobile application (Physitrack), wearable technology (FitBit), and weekly virtual check-ins with an oncology exercise specialist. The primary outcome of feasibility will be assessed by examining accrual, retention, and adherence rates. Acceptability will be assessed through qualitative interviews. Safety events will be monitored and reported based on CTCAE v5. Secondary outcomes will be collected using questionnaires and physiological assessments at baseline (T1), after the intervention (T2), and 3-months after intervention (T3).

This phase I study will determine intervention feasibility, acceptability, and safety and will inform the planning for a future Phase II RCT with the EX-CIPN intervention.

The trajectories of potentially inappropriate medications (PIMs) among older adults have not been well studied. This study aims to determine the 3-year trajectories of PIM dispensation and their determinants in older adults in Saudi Arabia.

A cohort study was carried out based on medical records from visits by 9,887 older adults (≥65 years) to outpatient clinics at King Saud University Medical City in Saudi Arabia from 2017 to 2019. PIMs were identified using the 2019 Beers Criteria, using the first category: medications that should be avoided by most older adults. Multinomial logistic regression was used to estimate the associations between clinical factors and the trajectories of PIM adjusting for sociodemographic factors.

The analysis showed that over 82% dispensed at least one PIM, with 55.9% having sustained PIMs, 17.9% having no PIMs, 14.0% starting PIMs, and 12.2% experiencing sporadic PIM dispensations. After adjustment, metabolic disorders (adjusted odds ratio [aOR]: 2.61, 95% confidence interval [95% CI]: 2.17-3.15), hypertensive diseases (aOR: 5.32, 95% CI: 4.67-6.07), diabetes mellitus (aOR: 10.22, 95% CI: 8.80-11.86), and diseases of the esophagus, stomach, or duodenum (aOR: 10.90, 95% CI: 7.39-16.09) were significantly associated with sustained PIM dispensation. With an increasing number of diagnoses we found an increasing odds for three trajectories (starting PIM (aOR range 1.56 to 5.82), sporadic PIM (aOR range 1.47 to 4.86), and sustained PIM (aOR range 3.91 to 37.3). Furthermore, an increasing number of medications was associated with higher odds for the same trajectories: starting PIM (aOR range 2.01 to 6.03), sporadic PIM (aOR range 1.50 to 7.10), and sustained PIM (aOR range 4.34 to 59.9).

This study showed a high prevalence of sustained trajectories of PIMs over time. Further, several common diagnoses and a greater total number of medications were identified as being associated with different PIM trajectories.

Remimazolam, a novel ultra-short-acting benzodiazepine, is a potential sedative for non-general anesthesia surgery in the elderly. This study aimed to investigate the appropriate sedative dosage of remimazolam and its effects on perioperative cognitive function in elderly patients undergoing non-general anesthesia surgery.

This multicenter, placebo-controlled trial enrolled 330 elderly patients undergoing non-general anesthesia procedures at eight centers in China from July 2021 to February 2022, with 238 ultimately completing the study. The primary endpoints were the dose of successful sedation with remimazolam and the changes in perioperative cognitive function. Adverse events were recorded to assess drug safety.

The induction dose of remimazolam for sedation in spinal anesthesia in elderly patients was 5.38 mg (95% confidence interval [CI], 5.20-5.56), maintained at a rate of 0.223 mg·kg-1·h-1 (95% CI, 0.201-0.237) with no serious adverse effects. Compared with the standard saline group, there was no statistical difference in the MMSE scores on Day 2 morning (P = 0.886), Day 2 afternoon (P = 0.864), and Day 7 (P = 0.613), and no statistical difference in the MoCA scores on Day 2 morning (P = 0.687), Day 2 afternoon (P = 0.827), and Day 7 (P = 0.483) in remimazolam group.

Remimazolam besylate is an effective sedative for elderly patients undergoing neuraxial anesthesia. It was successfully induced at a dose of 5.38 mg and maintained at 0.223 mg·kg-1·h-1, demonstrating a good safety profile without affecting short-term postoperative cognitive function.

http://www.chictr.org.cn (ChiCTR2100048744).

This study aimed to evaluate the impact of polypharmacy on length of hospital stay (LOS) and occurrence of postoperative complications in elderly patients undergoing neurosurgery.

This study represents a single-centre retrospective review of consecutive patients above 65 years old undergoing elective or emergency neurosurgery between June 2021 and January 2022. Patients were categorised into two groups based on the presence (five or more medications) or absence of polypharmacy. Chi-Square and/or Fisher exact test were used to compare baseline characteristics between groups and Mann-Whitney U test for continuous non-normally distributed variables. Multiple logistic regression models were constructed using significant variables affecting LOS and postoperative complications with adjusted Odds Ratios and 95% CIs reported.

In total 499 patients over the age of 65 underwent emergency or elective neurosurgery, and 218 (43%) met the criteria for polypharmacy. The polypharmacy group had a higher median LOS than the non-polypharmacy cohort (6 days vs. 5 days, p = 0.005). Polypharmacy was also associated with increased likelihood of postoperative complications (OR 1.62, CI 1.05-2.50, p = 0.02).

Our findings highlight the need for considered medication review in the perioperative period to support elderly patients undergoing neurosurgery for better postsurgical outcomes.

ChatGPT, a comprehensive language processing model, provides the opportunity for supportive and professional interactions with patients. However, its use to address patients' frequently asked questions (FAQs) and the readability of the text generated by ChatGPT remain unexplored, particularly in geriatrics. We identified the FAQs about common geriatric syndromes and assessed the accuracy and readability of the responses provided by ChatGPT.

Two geriatricians with extensive knowledge and experience in geriatric syndromes independently reviewed the 28 responses provided by ChatGPT. The accuracy of the responses generated by ChatGPT was categorized on a rating scale from 0 (harmful) to 4 (excellent) based on current guidelines and approaches. The readability of the text generated by ChatGPT was assessed by administering two tests: the Flesch-Kincaid Reading Ease (FKRE) and the Flesch-Kincaid Grade Level (FKGL).

ChatGPT-generated responses with an overall mean accuracy score of 88% (3.52/4). Responses generated for sarcopenia diagnosis and depression treatment in older adults had the lowest accuracy scores (2.0 and 2.5, respectively). The mean FKRE score of the texts was 25.2, while the mean FKGL score was 14.5.

The accuracy scores of the responses generated by ChatGPT were high in most common geriatric syndromes except for sarcopenia diagnosis and depression treatment. Moreover, the text generated by ChatGPT was very difficult to read and best understood by college graduates. ChatGPT may reduce the uncertainty many patients face. Nevertheless, it remains advisable to consult with subject matter experts when undertaking consequential decision-making.

To assess the comparative efficacy of interventions on depressive symptoms and disorders in older adults living in long-term care (LTC).

Systematic review and network meta-analysis.

Older adults living in LTC or equivalent settings.

We searched 6 electronic databases and gray literature sources to identify randomized controlled trials describing pharmacologic or nonpharmacologic interventions. Studies had to measure depression as an outcome in persons living in LTC. Study inclusion and study quality were assessed in duplicate. Population characteristics, descriptions of intervention and control treatments, and end-point depression outcomes for each treatment were extracted from included studies. A network meta-analysis using the standardized mean difference (SMD) of depression scores was completed using a random effects model.

A total of 182 studies were included in the review. The network meta-analysis was completed with 147 studies and included 31 treatment conditions. Compared with usual care, horticulture therapy (SMD, -6.85; 95% Credibility Interval, -8.49 to -5.22) and cognitive behavioral therapy (SMD, -1.98; 95% Credibility Interval, -2.91 to -1.05) were the most efficacious treatments. Animal therapy, group reminiscence therapy, multicomponent nonpharmacologic treatments, exercise, and socialization interventions also significantly improved depressive symptoms compared with usual care.

Many nonpharmacologic treatments for depression in LTC have been studied and are found to be efficacious. The low-risk and cost-effective nature of many of the nonpharmacologic treatments makes them ideal for use in LTC. More studies of pharmacologic treatments are needed to inform prescribing for depression in the LTC population. The range of treatments available for depression may help clinicians select therapies individualized to resident needs.

Despite the value of modern therapeutics, many obstacles prevent their optimal use. Overuse, underuse, and misuse are common, resulting in morbidity and mortality affecting billions of individuals across the world. Pharmacoepidemiology provides important insights into drug utilization, safety, and effectiveness in large populations, and it is an important method to identify opportunities to improve the value of therapeutics in clinical practice. However, for these opportunities to be realized, interventions to improve prescribing must be developed, evaluated, and implemented in the real world. We provide an overview of this process, focusing especially on how such interventions can be designed and deployed to maximize scalability, adoption, and impact. Prescribing represents a complex behavior with barriers and enablers, and interventions to improve prescribing will be most successful when developed, piloted and refined to maximize provider and patient acceptability. Carefully developed evaluations of interventions are also critical, and varied methods are available to empirically evaluate the intended and potential unintended consequences of interventions. With illustrative examples from the peer-reviewed literature, we provide readers with an overview of approaches to the essential and growing field of interventional pharmacoepidemiology. This article is part of a Special Collection on Pharmacoepidemiology.

Around 86% of Switzerland's nursing home (NH) residents have polypharmacy (≥ 5 concomitant medications); almost 80% use a potentially inappropriate medication increasing their risk of medication-related problems. Medication reviews can optimize medication safety by fostering interprofessional collaboration, leading to medication therapy adjustments; they are currently being considered as a future national quality indicator of NH performance in Switzerland. The present study aimed to survey current medication-use infrastructure and processes and medication review practices in NHs in the German-speaking part of Switzerland. It also aimed to explore the barriers to, facilitators of, and prerequisites for medication review to become a national NH quality indicator.

We took a rapid appraisal approach. Between February and August 2022, we distributed a structured online questionnaire to the participating NHs assessing the infrastructure and processes surrounding medication use, analyzing them quantitatively and descriptively. We followed up with 60-minute, in-depth, interprofessional, online group interviews, using a semi-structured interview guide, focusing on interprofessional collaboration and medication reviews. Data analysis was done iteratively in a descriptive manner.

Fourteen NHs in German-speaking regions of Switzerland completed the questionnaire, with 31 professionals from eleven of these NHs participating in group interviews. Almost half of the NHs (42.9%) had a cantonal license to run an in-house pharmacy, and in two-thirds of these, the legally responsible specialist was an external pharmacist. Community pharmacies supplied 92.9% of NHs with their medicines, mostly stored on the wards and prepared by nurses (57.1%). Accordingly, pharmacists were predominantly tasked with logistics, but were also key contacts for medication information. A clinical pharmacist participated in monthly ward rounds in just one NH. Medication verification occurred predominantly in the presence of physicians and sometimes nurses, mostly in the form of discussions during ward rounds or medication checks subsequent to an adverse event, rather than as part of comprehensive, proactive, interprofessional medication reviews. Interviewees identified numerous prerequisites before medication review could be used as a national NH quality indicator.

None of our participants contested the importance of medication safety and quality in NHs; they mostly favored regular medication reviews. However, interviewees expected that the nationwide introduction of medication reviews would require a standardized guide about its content, execution, analysis, and documentation, as well as interprofessional collaboration and some form of financial incentive. Promoting the use of medication reviews in NHs will have to involve interprofessional stakeholders in developing a specific implementation approach and defining the quality assessment requirements of an indicator. Further research into these topics would be highly relevant to ensure acceptance and success.

Polypharmacy, characterized by the concurrent use of five or more medications in a prescription, potentially resulting in adverse outcomes, is frequently observed among individuals with metabolic syndrome, which encompasses a collection of conditions that co-occur, heightening the likelihood of heart disease, stroke, and type 2 diabetes. This study seeks to ascertain the prevalence of polypharmacy and the use of potentially inappropriate medications (PIMs) among Iranian patients with metabolic syndrome, while also evaluating the contributing individual and sociodemographic factors.

This was a population-based, cross-sectional national study. Two databases were used: (a) Iranians Health Insurance Service database and (b) Iran's STEPS 2016 survey. Patients with metabolic syndrome conjoint in both databases were selected. Among these patients, polypharmacy and PIM were evaluated, and their association with individual and sociodemographic factors was assessed. Univariate and multivariate logistic regression were used to analyze the associations. All statistical analyses were done using SPSS 22 and Python 3.

Out of 2075 metabolic syndrome patients, 10.3% had polypharmacy. Polypharmacy significantly increased by age (OR: 4.334, adjusted for > 80-year-olds vs. 25-39-year-olds [CI: 1.664-11.283], p < 0.001), and its prevalence was significantly higher in urban areas (OR: 2.326 [CI: 1.645-3.288], p < 0.001). Polypharmacy was 5.88% in West, 5.41% in Southeast, 5.04% in Central, and 4.83% in North-Northeast of Iran. PIM was 13.2% in ≥ 60 years and significantly higher in urban areas (OR: 2.014 [CI: 1.153-3.519], p < 0.001).

Since the area of residency affects polypharmacy and PIM more significantly than wealth status and education level, it is important to implement preventive measures in urban areas.

Antidepressants are commonly used by older people and use increases during transition to long-term care facilities (LTCFs); however, little is known regarding duration of use following LTCF entry. This study aimed to examine duration of antidepressant use among new and existing antidepressant users after LTCF entry.

Retrospective cohort study.

Non-Indigenous individuals aged 65 to 105 years who entered LTCFs in 2 Australian states between 2015 and 2018 and received an antidepressant between LTCF entry and ≤60 days after, were included.

Cumulative incidence function and Fine-Gray regression models adjusted for age, sex, and LTCF entry year, accounted for the competing risk of death, and estimated the subdistribution hazard ratio (sHR) and 95% confidence interval (95% CI) for antidepressant discontinuation for all, new, and existing users.

Overall, 28,426 individuals entering 1035 LTCFs were included, of whom 22,365 (78.7%) were existing antidepressant users and 6061 (21.3%) were new users. Selective serotonin reuptake inhibitors and mirtazapine were commonly utilized. Overall, 36.1% (95% CI 35.1-37.1) of residents discontinued antidepressants (median follow-up 614 days, interquartile range 338-1002) following entry and 50.3% (95% CI 49.4-51.2) were dispensed enough to last until death. New antidepressant users had a 36% (adjusted sHR, 1.36; 95% CI, 1.29-1.44) higher risk of discontinuation compared with existing users.

Prolonged antidepressant use is common in LTCFs, and therapy is often continued until the end-of-life. Initiating nonpharmacological alternatives, regular review of antidepressant appropriateness, and seeking discontinuation opportunities where appropriate can minimize potentially inappropriate antidepressant use and risk of harm.

Older people are at an increased risk of developing adverse drug reactions (ADR) and adverse drug events (ADE). This study aimed to develop and validate a risk prediction model (ADAPTiP) for ADR/ADE in older populations.

We used the adverse drug reactions in an Ageing PopulaTion (ADAPT) cohort (N = 798; 361 ADR-related admissions; 437 non-ADR-related admissions), a cross-sectional study designed to examine the prevalence and risk factors for ADR-related hospital admissions in patients aged ≥ 65 years. Twenty predictors (categorised as sociodemographic-related, functional ability-related, disease-related, and medication-related) were considered in the development of the model. The model was developed using multivariable logistic regression and was internally validated by fivefold cross-validation. The model was externally validated in a separate prospective cohort from the Centre for Primary Care Research (CPCR) study of ADES. The cross-validated and externally validated model performance was evaluated by discrimination and calibration.

The final prediction model, ADAPTiP, included nine predictors: age, chronic lung disease, the primary presenting complaints of respiratory, bleeding and gastrointestinal disorders and syncope on hospital admission and antithrombotics, diuretics, and renin-angiotensin-aldosterone system drug classes. ADAPTiP demonstrated good performance with cross-validated area under the curve of 0.75 [95% CI 0.72;79] and 0.83 [95% CI 0.80;0.87] in the external validation.

Using accessible information from medical records, ADAPTiP can help clinicians to identify those older people at risk of an ADR/ADE who should be monitored and/or have their medications reviewed to avoid potentially harmful prescribing.

Misuse of over-the-counter (OTC) medications by older adults (age 65+) can comprise Drug-Age, Drug-Drug, Drug-Disease, and Drug-Label types. Pharmacies in the United States are prevalent sources of OTCs and are an apt setting to address OTC misuse. Senior Safe™ is a pharmacy-system redesign for preventing older adult OTC misuse. The redesign uses signage to designate high-risk OTCs and safer products for older adult use, as well as prompting older adults to engage with pharmacy staff around medication safety issue.

This study compared misuse in pharmacies with initial Senior Safe implementation (Immediate Effects group) to pharmacies with Senior Safe after 3 months (Sustained Effects group).

A non-equivalent group design, involving older adults recruited from matched and randomly-allocated pharmacy sites within a health system, compared the Immediate Effects (n = 83) and Sustained Effects (n = 65) groups. All participants were recruited outside the pharmacy and were given hypothetical symptom scenarios from which to choose (i.e., cough/cold/allergy, pain, or sleep). Participants were then asked to select an OTC to treat that symptom, and explain their OTC use at symptom onset and if symptoms persisted/worsened. Participants' reported OTC use was evaluated for each misuse type. Multivariate modeling estimated differences in misuse between the Immediate and Sustained Effects groups.

No significant differences emerged between Immediate and Sustained Effect groups for any misuse type for which statistical modeling was conducted. Drug-Age misuse was statistically less likely for sleep products (OR = 0.170, p = .005) and for adults aged 85+ when compared to the 65-74 and 75-84 age categories (OR = 3.979, p = .053; OR = 6.900, p = .031, respectively).

These non-significant results suggest that the intervention effect was maintained at three months. Overall, then, misuse reductions occurring immediately after intervention implementation did not significantly increase after three months. System buy-in, including assessing costs to implement and maintain Senior Safe, is critical to promote broader adoption.

Potentially inappropriate prescribing (PIP) contributes significantly to treatment burden, specifically in older people. Detecting PIP and improving prescribing practices are therefore crucial for ensuring patient safety and positive outcomes.

This study aimed to assess physicians' and pharmacists' awareness and use of tools to identify PIP, as well as their confidence in recommending medication for older people.

A national cross-sectional survey was conducted in Saudi Arabia using a 15-item questionnaire. The online questionnaire covered participants' demographics, their experience with PIP tools including awareness, frequency of use and the type of resources utilized. Both open-ended and closed-ended questions were included, with closed-ended questions formatted as multiple-choice and Likert scale. Descriptive and logistic regression analyses of the data was undertaken using Stata version 16.

A total of 271 participants completed the questionnaire, half (n = 138, 50.9%) were pharmacists. Only a third (n = 81, 29.9%) of participants were familiar with PIP tools. Providers focusing on older people were significantly more aware of PIP tools (p < 0.001). Significantly more pharmacists (n = 50, 36.2%) demonstrated an awareness of PIP tools compared to physicians (n = 31, 23.3%) (p = 0.02). Confidence in recommending appropriate medications for older people varied, with 43.9% of participants having moderate confidence.

This study highlights the lack of awareness among physicians and pharmacists in Saudi Arabia regarding the validated PIP tools to support prescribing and medication management practices. There is a need to develop, disseminate and support the use of translated, validated and culturally appropriate PIP tools in this context.

ObjectiveTo assess medication appropriateness using the medication appropriateness index (MAI) criteria, the prevalence of potentially inappropriate medication (PIM) prescribing, and factors associated with increased PIM use in elderly ambulatory patients with cirrhosis.MethodsA cross-sectional study of 70 elderly ambulatory patients with cirrhosis (≥65 years old), from January to December 2021. Two clinical pharmacists evaluated medication appropriateness using the MAI tool. Data were analyzed using SPSS version 27.0. Descriptive statistics were used to present patient demographics, clinical characteristics, and MAI responses. Regression analysis was used to identify predictive factors for PIM prescribing. The kappa statistic was used to assess interrater agreement.ResultsAll participants had at least one medication with ≥ 1 inappropriate MAI criterion, with the most common issue being incorrect treatment duration (18%). Of 610 evaluated medications, 44.1% were classified as PIMs. The mean MAI scores per patient and per medication were 15.97 (±10.48) and 1.83 (±3.18), respectively, consistent with other studies. However, the prevalence of PIMs was higher, likely due to the specific disease population studied, as this is the first study to evaluate medication appropriateness in cirrhotic patients. Good interrater agreement was observed (kappa = 0.74), indicating good interrater reliability. Increased inappropriate prescribing was associated with the number of medications, age and severe renal impairment.ConclusionsPIMs are common in elderly patients with cirrhosis, highlighting the need for better prescribing practices to ensure medication safety. Involving clinical pharmacists with geriatrics expertise and using medication appropriateness tools can reduce PIMs and drug-related problems. Further, healthcare team training is essential to improve prescribing practices. Assessing PIMs in this population could enhance clinical outcomes, reduce adverse drug reactions, and lower healthcare costs. Incorporating comprehensive medication management into routine care for elderly cirrhotic patients is a key strategy to improve patient safety and quality of life.

As the inflammatory bowel disease (IBD) patient population is aging, the prevalence of polypharmacy is rising. However, data exploring the prevalence, risk factors, and clinical outcomes associated with polypharmacy among older adults with IBD are limited. The aim of the study is to determine (i) prevalence of polypharmacy (≥5 medications) and potentially inappropriate medication (PIM) utilization in older adults with IBD, (ii) changes in medications over time, (iii) predictors of polypharmacy, and (iv) the impact of polypharmacy/PIMs on 1-year hospitalization rates.

We conducted a retrospective single-center study of older adults with IBD from September 1, 2011, to December 31, 2022. Wilcoxon-signed rank and McNemar tests were used to assess changes in polypharmacy between visits, with ordinal logistic regression and Cox proportional hazards models used to determine risk factors for polypharmacy and time to hospitalization, respectively.

Among 512 older adults with IBD, 74.0% experienced polypharmacy at the initial visit, with 42.6% receiving at least one PIM. In addition, severe polypharmacy (≥10 medications) was present among 28.6% individuals at the index visit and increased to 38.6% by the last visit ( P < 0.01). Multivariable analysis revealed that age ≥70 years, body mass index ≥30.0 kg/m 2 , previous IBD-related surgery, and the presence of comorbidities were associated with polypharmacy. Moreover, severe polypharmacy ( adj hazard ratio 1.95, 95% confidence interval 1.29-2.92), as well as PIM use ( adj hazard ratio 2.16, 95% confidence interval 1.37-3.43) among those with polypharmacy, was significantly associated with all-cause hospitalization within a year of the index visit.

Severe polypharmacy was initially present in more than 25% of older adults with IBD and increased to 34% within 4 years of the index visit. Severe polypharmacy, as well as PIM utilization among those with polypharmacy, were also associated with an increased risk of hospitalization at 1 year, highlighting the need for deprescribing efforts in this population.

Older Medicare beneficiaries are susceptible to receiving potentially inappropriate medications (PIMs), where the risks outweigh the benefits. Racial and ethnic differences in PIM use may perpetuate health disparities and disproportionately lead to costly adverse drug events for some groups.

To examine associations of race and ethnicity with PIM use among older Medicare beneficiaries.

This cross-sectional study used nationwide Medicare Part D Event files, fee-for-service claims, and Medicare Advantage (MA) encounter data among Medicare beneficiaries 65 years or older with Part D prescription drug coverage. The study population included random samples of 20% of traditional Medicare (TM) beneficiaries and 50% of MA enrollees from January 1, 2016, to December 31, 2019. Analysis was conducted from May 28 to September 16, 2024.

Race and ethnicity.

Linear probability models were estimated for outcomes of (1) high-risk medication use among older adults, (2) potentially harmful drug-disease interactions in patients with dementia, and (3) potentially harmful drug-disease interactions in patients with a history of falls.

The study sample included 21 193 170 patients with 32 199 587 beneficiary-year observations (mean [SD] age, 75.5 [7.3] years; 18 936 697 [58.8%] female; 983 513 [3.1%] Asian or Pacific Islander, 3 190 515 [9.9%] Black, 2 710 930 [8.4%] Hispanic, and 25 314 629 [78.6%] White). Compared with White beneficiaries, the rates of high-risk medication use were 1.7 [95% CI, -1.8 to -1.6] percentage points lower for Asian or Pacific Islander beneficiaries, 3.4 [95% CI, -3.4 to -3.3] percentage points lower for Black beneficiaries, and 0.6 [95% CI, -0.6 to -0.5] percentage points lower for Hispanic beneficiaries. Similarly, White beneficiaries had the highest rates of potentially harmful drug-disease interactions among those with dementia as well as those with a history of falls. The pattern of racial and ethnic differences was similar in analyses stratified by enrollment in TM or MA plans. However, the differences between White individuals and other groups were smaller in MA than in TM plans for all comparisons.

In this cross-sectional study of 32 199 587 Medicare beneficiary-years from 2016 to 2019, White Medicare beneficiaries had consistently higher rates of PIM use compared with other racial and ethnic groups. The observed differences may be partially explained by racial and ethnic differences in overall prescription drug use and suggest the need to reduce PIM use in all racial and ethnic groups.

Older adults with frailty have high risk for poor postoperative outcomes.

To evaluate the feasibility of a multimodal prehabilitation program in older adults with frailty awaiting hip or knee replacement.

Parallel two-arm randomized controlled pilot trial.

Community-dwelling older adults with frailty awaiting joint replacement aged ≥60 years recruited from the Musculoskeletal Central Intake and Assessment Centre (MSK CIAC), Ontario.

Exercise, protein and vitamin D supplements, and medication review.

Feasibility was assessed based on predefined progression criteria for recruitment, retention, data completion and adherence to intervention components. Clinical outcomes including Oxford Knee and Hip Scores, frailty index, Short Physical Performance Battery and health-related quality of life were collected at baseline, 1-week preoperative, 6-weeks and 6-months postoperative and were evaluated using generalized linear mixed models for repeated measures.

A total of 69 participants were enrolled. Recruitment rate was 35 %. Participants' mean age was 74 (standard deviation (SD): 7.5); 51 % were prefrail and 36 % were frail. Participant retention was 81 %, and data completion was ≥80 %. Mean adherence to strength exercises was 4 days (95 % confidence interval (CI): 3-5 days/week), balance 3 days (95 % CI: 2-4 days/week), and flexibility 3 days (95 % CI: 3-4 days/week). Adherence to vitamin D intake was 82 % (95 % CI: 73-92 %), and medication review consultation completion was 86 % (95 % CI: 68-95 %). These outcomes met the target values for feasibility success. The Oxford Knee Score at 6-months postoperative 8.78 (95 % CI: 0.40-17.16) showed a clinically meaningful and statistically significant difference between treatment groups. There were also indications of clinically relevant changes for frailty and quality of life post-surgery.

This trial provides strong evidence of feasibility and indications of improvements in postoperative clinical outcomes. Challenges to implementation and adherence were identified that can inform modifications to study design for future trials.

ClinicalTrials.gov NCT02885337. Registered August 31, 2016. https://classic.

gov/ct2/show/NCT02885337.

After a slight decline in suicide rates during the COVID-19 pandemic, suicide rates and suicide attempts in the U.S. have been increasing again in 2022 and 2023. Compared to younger age groups, the 50+ age group has significantly higher rates of serious medical outcomes from suicide attempts. In this study, we examined the medical outcome severities associated with different classes of substances involved in suicide attempt cases age 50 and older who were reported to poison centers.

We used the America's Poison Center's National Poison Data System from 2016 to 2023 (N = 335,171 cases age >50). Following descriptive statistics on the characteristics of suicide attempters and involved substances by medical outcomes (no/minimal effects, moderate effects, major effects, death, and unable to follow), we fitted multinomial and binary logistic regression models to examine the associations of medical outcomes with involved substances.

Of all cases, 22.5% used antidepressants, 21.1% benzodiazepines, 16.4% cardiovascular drugs, and 12.5% prescription opioids; 44.1% had no/minimal effect, 37.9% had a moderate effect, 12.5% had a major effect, 1.2% resulted in death, and 4.4% were unable to follow, but the proportions of major effects and death were higher in 2022-2023 than in 2016-2017. Tricyclic antidepressants were associated with the highest risks of major effects [relative risk ratios (RRR) = 5.57, 95% CI = 5.26-5.90] and death (RRR = 4.26, 95% CI = 3.67-4.94). Large RRRs were also shown for bupropion and serotonin-norepinephrine reuptake inhibitors for major outcomes and death. Cardiovascular drugs, opioids, and muscle relaxants were also associated with consistently higher risks of moderate and major effects and death. Our results also show that older ages were associated with higher death rates and that female sex was associated with higher odds of moderate/major effects compared to minimal effects but lower odds of major effects/death.

Healthcare providers, including pharmacists, can play an important role in promoting medication safety for older adults. Healthcare workers need training in assessing and recognizing signs of suicide risk in older adults who are prescribed antidepressants and sedatives. Our findings also point to the importance of better non-pharmacological chronic pain management than reliance on opioids.

Care partners are critical for making treatment decisions in persons living with dementia. However, identifying them is challenging, hindering the broader use of interventions, such as those using digital technologies. We aimed to (i) assess the feasibility of identifying and contacting care partners using electronic health record (EHR) systems, and (ii) elicit their perspectives on electronic interventions for deprescribing.

We systematically identified care partners of persons living with dementia ≥65 years of age via structured EHR data in a large health care system. Eligible care partners were contacted by patient portal (if they were an established proxy), mail, and phone to complete a survey.

Of 4,138 eligible persons living with dementia identified, 1,084 (26%) had a care partner name recorded in the EHR. Out of 259 (6%) with sufficient care partner contact information for outreach, 74 (29%) completed the survey. Among care partners, 62 (84%) reported being confident in managing dementia medications, 59 (80%) were willing to stop ≥1 medications, and 43 (58%) were very/extremely interested in using digital tools for decision-making.

Despite the low percentage of care partners with sufficient contact information, reach rates were high for contacted care partners, suggesting feasibility for pragmatic system-level interventions. Most care partners showed great interest in using digital health tools for decision-making and managing medications. Therefore, electronic tools could help with identifying care partners and engaging them. However, scaling up interventions requires better care partner documentation or extracting information from free text.

Background/Objectives: Polymorbidity and polypharmacy are major challenges in geriatric care, resulting in a reduced quality of life and increased health care costs. Methods: We evaluated the proactive medication management of nursing home residents through personal visits and the use of a clinical decision support system (CDSS) with an integrated Beers Criteria list. Results: Among 56 nursing home residents, we observed a high prevalence of polypharmacy with an average of 7.9 regular and 5.1 on-demand prescriptions. Proactive medication management led to persistent medication changes in 87.5% of patients. Regular prescriptions were reduced in 21 residents and increased in 18 residents, resulting in a reduced use of cardiovascular drugs and antacids (p < 0.05), but no significant overall reduction in polypharmacy. CDSS alerts based on Beers Criteria made no clinically relevant contribution to medication reduction. Conclusions: Proactive geriatric medication management led to persistent medication changes and no reduction in overall polypharmacy but reduced the use of selected drug classes that are associated with an increased risk of adverse reactions and costs. The clinical relevance and implementability of Beers Criteria were low, revealing major limitations of algorithm-based alerts for older patients, who require additional personalized evaluations of their individual complex healthcare needs.

Background: Hiking is a physical activity recommended for people of all ages. In an era of increased incidence of cardiovascular and psychiatric diseases, directing individuals to hiking can be very important from both public health and socioeconomic perspectives. Since the health status of recreational hikers and the general population in the Republic of Serbia has not been compared yet, our objectives are to compare the health-related characteristics of those two groups, including the prevalence of comorbidities, pharmacotherapy, and drug consumption. Methods: A descriptive epidemiological study was conducted. Research questions were asked via two specially prepared questionnaires distributed through the Google Forms platform. The means of the two groups were tested by a two-sample Student t-test for independent variables. Results: The sample consisted of 259 hikers and 292 people from the general population. A total of 199 hikers (76.8%) and 218 people from the general population group (74.7%) were declared as healthy. The statistically significant differences between the groups included age, sex, education level, and body mass index. In both groups, the majority of those with pre-existing medical conditions had at least one cardiovascular disease (23.5% of the hikers and 19.5% of the individuals in the general group). Pre-existing psychiatric diseases were noted in 6% of the hikers and in 12% of those in the general group. The average durations of the disease in the hiker and general population were 11.9 and 8.4 years, respectively (p < 0.05), whereas, there were no differences in drug consumption. Conclusions: This pilot study represents the comparison of the cardiovascular and mental health among hikers and the general population in the Republic of Serbia. Although psychiatric diseases were clearly less prevalent among hikers, the prevalence and burden of cardiovascular diseases must be interpreted with caution, due to big age difference between the respondents from both groups. However, our future studies will employ objective measurements and clinical parameters rather than self-reported surveys, so that the health benefits of hiking appear more clearly.

Hypothyroidism, a condition characterized by an underactive thyroid gland, affects millions worldwide, leading to cognitive and metabolic slowdowns. It is most prevalent in women and older adults, with causes including autoimmune thyroiditis, surgical thyroidectomy, and certain medications.

The standard treatment involves synthetic levothyroxine (LT4) monotherapy, which alleviates symptoms by converting to the active hormone, T3. However, some patients continue to experience symptoms such as fatigue, mood disturbances, and poor quality of life despite normalized TSH levels. This persistence of symptoms may stem from misdiagnosis, inadequate dosing, or incomplete normalization of thyroid hormone signaling.

Research suggests that LT4 monotherapy may not fully restore T3 levels, leading to suboptimal symptom control. Consequently, combination therapy with LT4 and liothyronine (LT3) has been proposed as an alternative, aiming to balance T4 and T3 levels more effectively. Although randomized controlled trials have not identified significant differences in patient-reported outcomes between LT4 monotherapy and combination therapy, they indicate that patients may prefer the latter.

Guidelines from leading endocrinology organizations now recommend considering combination therapy for patients with persistent symptoms despite adequate LT4 dosing. A patient-centered approach, emphasizing shared decision-making and individualized treatment plans, is essential for optimizing outcomes in hypothyroidism management. Further research is needed to refine dosing strategies and identify the patients who would benefit most from combination therapy.

The global increase in the older adult population necessitates a comprehensive understanding of medication management to mitigate the risks associated with potentially inappropriate medications (PIMs). These medications are of particular concern due to their association with adverse drug reactions, increased hospitalization, and increased healthcare costs. This study aimed to determine the prevalence and risk factors associated with PIM use among older adult patients attending primary health care centers in Bahrain.

This cross-sectional study was conducted in 2022 in 27 primary healthcare centers across Bahrain. The study included patients aged 65 years or older. A computer based simple random sample was obtained, and the Beers criteria 2023 was utilized to assess medication appropriateness. Anonymous data was retrieved from electronic medical records and analyzed via univariate, and logistic regression analyses.

Among the 595 older adult patients studied, the average age was 71.7 years, with 54.5% (n = 324) being female. Most of the patients were married (70.8%, n = 421). More than half of the patients (51.3%, n = 305) received at least one PIM, with gliclazide (37%, n = 113), pantoprazole (29.8%, n = 91), and rabeprazole (27.9%, n = 85) being the most prevalent prescribed PIM. Univariate analyses revealed that PIM rates were significantly higher among females (p = 0.001) and patients with comorbidities such as diabetes mellitus (p < 0.001), essential hypertension (p < 0.001), and hyperlipidaemia (p < 0.001). Logistic regression analysis revealed that age (OR = 1.09, p < 0.001), female sex (OR = 1.645, p = 0.012), and diabetes mellitus (OR = 1.696, p = 0.029) were significant predictors of PIM use.

This study highlights the significant burden of PIM use among older adult patients in Bahrain, with more than half of the participants receiving at least one PIM. These findings underscore the urgent need for targeted interventions, particularly among female patients, those with chronic conditions such as diabetes mellitus, and patients taking five or more medications. These insights contribute to the broader understanding of geriatric pharmacotherapy and offer a foundation for policy development aimed at optimizing medication safety in aging populations.

This review aims to present the current state of the art in measuring frailty in patients with heart failure (HF), covering the entire spectrum from diagnosis to advanced stages of the disease. Frailty is a critical factor that significantly impacts outcomes in heart failure, and accurate assessment is essential for guiding treatment and improving prognosis.

Frailty is increasingly recognized as a key determinant of morbidity and mortality in HF patients. Various tools are available for assessing frailty, but there is no consensus on the optimal method. The assessment of frailty needs to be multidimensional, incorporating physical, cognitive, and social domains. Early detection of frailty, coupled with personalized interventions, has the potential to improve patient outcomes. Integrating routine frailty assessments into the clinical care of heart failure patients is essential for optimizing treatment. Future research should focus on standardizing frailty assessment tools and integrating innovative technologies, such as artificial intelligence, to enhance the precision and applicability of these assessments in clinical practice.

To examine the prevalence of potentially inappropriate medications (PIMs) prescribed among older patients diagnosed with psychiatric diseases and to identify associated factors.

This cross-sectional study was conducted among older patients who visited outpatient clinics in Saudi Arabia between June 1st, 2019, and May 31st, 2023. PIMs use was estimated using the updated 2019 American Geriatric Society (AGS) Beers criteria. Data were analyzed using chi-square or Fisher's exact test for categorical variables and t-test for continuous variables to compare patients with and without PIMs. In addition, the Pearson correlation test was performed between the total number of prescriptions and the number of PIMs. Multivariable logistic regression analysis was used to explore PIMs. Statistical significance was set at p < 0.05.

Our study included 306 patients with psychiatric diseases, with 156 (50.98%) in the PIMs group and 150 (49.02%) in the non-PIMs group. There was a considerable positive correlation between the total number of prescriptions and the number of PIMs (r = 0.76; p < 0.0001). The adjusted logistic regression analysis revealed a significantly higher risk of PIMs use in individuals with psychiatric diseases and comorbid neurological diseases compared to those without [adjusted odds ratio (AOR) = 2.48, 95% CI [1.15-5.32]]. In contrast, the risk of PIMs use was not significantly greater for older individuals with psychiatric diseases and comorbid hypertension {AOR = 1.67, 95% CI [(0.79-3.54)]}, diabetes mellitus {AOR = 1.25, 95% CI [(0.66-2.34)]}, or pulmonary disease {AOR = 2.34, 95% CI [(0.69-7.96)]}.

This study highlighted the elevated number of PIMs in older adults with psychiatric diseases in the outpatient setting, particularly those with comorbid neurological diseases. Therefore, clinical pharmacists may play a crucial role in improving the outcomes of patients diagnosed with psychiatric illnesses. Finally, future studies should examine additional strategies to reduce the use of PIMs in this population.

Anti-seizure medications (ASMs) are specific types of anticonvulsants used to treat epileptic seizures. However, several studies have shown an association between ASMs and an increased risk of hematological disorders, such as thrombocytopenia, aplastic anemia, and platelet function disorders leading to prolonged bleeding times. This review explores the existing literature on this topic, investigating a wide variety of ASMs, ranging from first-generation medications to newer ones. A comprehensive search was conducted on all the currently approved ASMs using PubMed and Google Scholar: review articles, clinical trials, meta-analysis, observational studies, case reports, and relevant animal studies were identified. We extracted 15 ASMs including valproic acid (VPA), carbamazepine, phenytoin, phenobarbital, diazepam, clonazepam, lamotrigine, levetiracetam, oxcarbazepine, felbamate, topiramate, pregabalin, lacosamide, cannabidiol (CBD), and perampanel that contain considerable literature regarding different coagulopathies. An in-depth review of over 140 studies revealed a robust association between ASM-induced changes and the onset of bleeding disorders via several different mechanisms. Polytherapy, the use of multiple ASMs, also emerged as a significant risk factor for the development of coagulopathies. This review highlights the potential link between ASMs and bleeding disorders, emphasizing the importance of considering this risk during treatment planning. By understanding these associations, healthcare providers can optimize patient outcomes and minimize bleeding risks. Additionally, this review identifies the need for further research to bridge current knowledge gaps in clinical pharmacology related to ASMs and bleeding disorders.