Drugs & Aging最新文献

{"title":"Patterns of Evidence-Based Medication Use in Older Adults with Chronic Heart Failure in Slovakia: A Population-Based Study Using the National Health Information Center Database.","authors":"Martin Wawruch, Mariana Mrazova, Viktor Foltin, Peter Kisac, Zuzana Mojzesova, Simona Gasparovicova, Jan Murin, Tomas Tesar, Miriam Vulevova, Petra Matalova, Sofa D Alfian, Emma Aarnio","doi":"10.1007/s40266-026-01338-1","DOIUrl":"https://doi.org/10.1007/s40266-026-01338-1","url":null,"abstract":"<p><strong>Background: </strong>Prescribing of evidence-based heart failure (HF) medications in older adults varies across settings, and population-level data from Central and Eastern Europe are scarce. Our study aimed to (a) evaluate the use of evidence-based medications among older adults with chronic HF and (b) identify patient- and healthcare-related characteristics associated with the use of evidence-based medications.</p><p><strong>Methods: </strong>In our retrospective register-based study, all patients aged ≥ 65 years in whom at least one medication was prescribed in association with newly diagnosed HF during the period of 1 January 2016 to 31 December 2021 were included. Patients were divided into non-users, new users and prevalent users of evidence-based medications. Non-users were defined as patients who did not receive the specific medication class being analysed. New users were the patients in whom the use of such medications was initiated in association with the newly diagnosed HF without having a prescription for them during the previous 3 years. In prevalent users, these medications were used for diagnoses other than HF before inclusion in our study. Patient- and healthcare-related characteristics potentially associated with the use of evidence-based medications were evaluated with binary logistic regression models comparing the group of new users with non-users.</p><p><strong>Results: </strong>The following proportions of users (both new and prevalent) were observed in our study group of 111,774 patients: angiotensin-converting enzyme inhibitors/angiotensin-receptor blockers/angiotensin receptor-neprilysin inhibitor were prescribed in 78.5% (95% confidence interval [CI] 78.3-78.8), β-blockers in 76.2% (95% CI 75.9-76.4), mineralocorticoid receptor antagonists in 41.1% (95% CI 40.8-41.4), digoxin in 13.5% (95% CI 13.3-13.7), ivabradine in 3.8% (95% CI 3.7-3.9) and sodium-glucose cotransporter-2 (SGLT2) inhibitors in 3.7% (95% CI 3.6-3.8) of patients. Specialisation of the physicians in internal medicine/cardiology, or in diabetology in the case of SGLT2 inhibitors, showed the strongest association with the prescription of analysed medications. Comorbidities were associated with the use of evaluated medications when they constituted indications or contraindications for their administration.</p><p><strong>Conclusion: </strong>Among older adults with HF, the prescription of evidence-based medications was strongly associated with physician specialty, reflecting the importance of specialised expertise in the management of HF.</p>","PeriodicalId":11489,"journal":{"name":"Drugs & Aging","volume":" ","pages":""},"PeriodicalIF":4.2,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149105831","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Risk of Dementia With Renin-Angiotensin System Inhibitors Versus Calcium Channel Blockers in Hypertensive Adults: A Nationwide Multicenter Study.","authors":"Yinfang Sun, Zhixin Guo, Jinming Zhang, Mingzhen Pang, Ruixuan Chen, Caoxiang She, Shiyu Zhou, Hao Wang, Xian Shao, Sheng Nie","doi":"10.1007/s40266-026-01337-2","DOIUrl":"https://doi.org/10.1007/s40266-026-01337-2","url":null,"abstract":"<p><strong>Objective: </strong>The aim of this study was to evaluate whether renin-angiotensin system inhibitors (RASIs) reduce dementia risk independently of blood pressure control compared with calcium channel blockers (CCBs) in antihypertensive-naïve adults with hypertension.</p><p><strong>Methods: </strong>This multicenter, new-user active comparator study included antihypertensive-naïve adults initiating RASIs or CCBs across 28 hospitals. Participants were matched 1:1 on baseline characteristics using propensity score matching (PSM). The primary outcome was incident all-cause dementia; secondary outcomes were Alzheimer's disease and vascular dementia. Hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated using Cox proportional hazards regression.</p><p><strong>Results: </strong>Of 164,918 eligible patients (median age 65 years [interquartile range 55-74]; 51.2% male), 54,042 PSM pairs initiating RASIs versus CCBs were included. During a median follow-up of 516 days, 344 incident dementia cases occurred. The incidence rate of all-cause dementia was lower among RASI initiators than CCB initiators (1.26 vs 1.89 per 1000 person-years). Initiation of RASIs was associated with a significantly lower risk of all-cause dementia (HR 0.68, 95% CI 0.55-0.84) and Alzheimer's disease (HR 0.59, 95% CI 0.43-0.81), but not vascular dementia (HR 0.74, 95% CI 0.50-1.11), compared with CCBs. There was no significant difference in dementia risk between initiators of angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin II receptor blockers (ARBs).</p><p><strong>Conclusions: </strong>In adults with hypertension, initiation of RASIs was associated with a significantly lower risk of dementia compared with CCBs. No significant difference was observed between ACEIs and ARBs. Further validation is warranted.</p>","PeriodicalId":11489,"journal":{"name":"Drugs & Aging","volume":" ","pages":""},"PeriodicalIF":4.2,"publicationDate":"2026-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149073916","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Medication Appropriateness and Potentially Inappropriate Medications in Older Critical Care Patients: A Scoping Review.","authors":"Jessica McCann, Jen K Jennnings, Andy Husband, Darren M Ashcroft, Richard S Bourne","doi":"10.1007/s40266-026-01333-6","DOIUrl":"https://doi.org/10.1007/s40266-026-01333-6","url":null,"abstract":"<p><strong>Background: </strong>Demand for care of older people in critical care units is increasing. During critical care, new medications are initiated. Assessment of potentially inappropriate medication is not routine within this setting, and the clinical utility of medication appropriateness tools, related interventions and their impact on outcomes in the older critical care population has not yet been reviewed.</p><p><strong>Objectives: </strong>To understand the extent and type of evidence in the assessment of medication appropriateness, intervention strategies and relationship between potentially inappropriate medication use and clinical outcomes in older people in critical care.</p><p><strong>Methods: </strong>The Preferred Reporting of Items for Systematic Reviews and Meta-Analyses extension for scoping reviews was followed. Embase, MEDLINE, CINAHL, APA PsycINFO and Web of Science were systematically searched (April 2025) for studies assessing medication use in critically ill older people (≥ 60 years). Eligible study designs included randomised and non-randomised trials, cohort studies, cross-sectional studies and case-control studies.</p><p><strong>Results: </strong>Ten studies (nine patient cohorts) were included. Most were cohort studies originating from North and South America. Benzodiazepines, opioids and antithrombotics were the most common potentially inappropriate medications reported, identified mostly by Beers Criteria and STOPP Criteria. Critical care length of stay was the most frequently associated clinical outcome. No intervention studies were identified.</p><p><strong>Conclusions: </strong>Medication appropriateness assessment tools have been used to a limited degree to assess medications in older critical care people. Further research is needed to establish their validity, clinical utility and impact on prescribing decisions and to evaluate interventions aimed at improving medication appropriateness and outcomes for older people in critical care.</p>","PeriodicalId":11489,"journal":{"name":"Drugs & Aging","volume":" ","pages":""},"PeriodicalIF":4.2,"publicationDate":"2026-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149073927","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Differences in Anticholinergic Exposure Assessment Across Burden Scales and Exposure Measures in a Population-Based Study: Implications for Targeted Deprescribing in Older Adults.","authors":"Valentina M Srikartika, David Youens, Rachael Moorin, Ninh Ha","doi":"10.1007/s40266-026-01336-3","DOIUrl":"https://doi.org/10.1007/s40266-026-01336-3","url":null,"abstract":"<p><strong>Background: </strong>Anticholinergic burden scales and exposure measures can support medication review in older adults; however, different instruments may classify different groups of individuals as exposed. Population-level comparisons of burden scales and exposure measures that are feasible for administrative dispensing data remain limited.</p><p><strong>Objective: </strong>To compare six anticholinergic burden scales and exposure measures feasible for application to administrative dispensing data with respect to exposure classification, agreement, medication profiles and subgroup exposure patterns in older adults.</p><p><strong>Methods: </strong>This retrospective cross-sectional study was conducted in Western Australian residents aged ≥ 65 years during 2017-2018 using linked population-level administrative data. Anticholinergic exposure was calculated using three dose-based exposure measures, with standardised dose metrics and narrower medication lists and three broad-inclusion burden scales, with wider medication lists and graded potency ratings. Outcomes were classified as exposed (score > 0 within each scale or measure) and high exposure (scale- or measure-specific thresholds). Agreement was assessed using Cohen's kappa, medication profiles were described and adjusted subgroup patterns were compared using logistic regression.</p><p><strong>Results: </strong>Amongst 330,684 older adults, the proportion classified as exposed ranged from 13.1 to 53.6%, whilst the proportion classified as having high exposure ranged from 0.7 to 6.9%. Agreement in identifying exposed individuals was highest amongst dose-based exposure measures and lower between dose-based exposure measures and broad-inclusion burden scales. High-exposure overlap was limited, particularly for the modified Drug Burden Index. Dose-based exposure measures captured narrower medication profiles, dominated by tricyclic antidepressants, antipsychotics and urological antimuscarinics. Broad-inclusion burden scales captured a wider range of therapeutic classes, including medications with mild and moderate anticholinergic effects. Higher comorbidity was associated with greater exposure across all scales and measures, with the largest differences in the proportion classified as exposed observed for broad-inclusion burden scales.</p><p><strong>Conclusions: </strong>Scale or measure selection substantially influences who is classified as exposed, medication profiles and exposure patterns across subgroups. Anticholinergic burden scales and exposure measures are therefore not interchangeable and selection should reflect whether the intended purpose is population surveillance, comprehensive medication review or targeted deprescribing.</p>","PeriodicalId":11489,"journal":{"name":"Drugs & Aging","volume":" ","pages":""},"PeriodicalIF":4.2,"publicationDate":"2026-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148975691","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical and Economic Outcomes of Korea's National Polypharmacy Management Program for Hospitalized Older Adults: 90-Day Readmission and Healthcare Costs.","authors":"Suhyun Jang, Jaeok Lim, Arum Moon, Ju-Yeun Lee, Young-Mi Ah, Hye Jun Lee, Sei Young Lee, Jung-Ha Kim, Sunmee Jang","doi":"10.1007/s40266-026-01325-6","DOIUrl":"10.1007/s40266-026-01325-6","url":null,"abstract":"<p><strong>Background: </strong>Polypharmacy is a significant health concern associated with adverse outcomes in older adults. To mitigate these risks, Korea's National Health Insurance Service implemented a hospital-based, pilot polypharmacy management program.</p><p><strong>Objective: </strong>We aimed to evaluate the clinical and economic effectiveness of the polypharmacy management program in beneficiaries aged ≥ 65 years.</p><p><strong>Methods: </strong>This retrospective cohort study evaluated the polypharmacy management program implemented across 34 hospitals (2020-21). The program targeted hospitalized patients with at least one chronic condition receiving either ten or more medications or five or more medications plus an additional high-risk factor. To address the lack of randomization, an external historical control group was established by linking pilot data with the nationwide National Health Insurance Service claims database. Propensity score matching was performed on the entire cohort with subsequent analyses restricted to those aged ≥ 65 years. The primary outcome was 90-day readmission, analyzed using Cox proportional hazards regression. A cost-benefit analysis was performed from payer and societal perspectives.</p><p><strong>Results: </strong>The final analysis included 1135 intervention and 1125 control patients. Polypharmacy management program participants showed a lower risk of readmission compared with controls (adjusted hazard ratio = 0.85; 95% confidence interval 0.75-0.96). While emergency department visits did not differ significantly, the intervention group incurred significantly lower hospitalization costs (USD$6400 vs USD$6740, P = 0.005). The program demonstrated economic viability, yielding a benefit-cost ratio of 3.8 from a payer perspective.</p><p><strong>Conclusions: </strong>The polypharmacy management program effectively reduced readmissions and generated substantial cost savings. These findings underscore the importance of integrating data-driven medication management into national healthcare strategies to improve patient safety and financial sustainability.</p>","PeriodicalId":11489,"journal":{"name":"Drugs & Aging","volume":" ","pages":"849-860"},"PeriodicalIF":4.2,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13582313/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148697146","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Bronchiectasis in Older Adults: Distinctive Epidemiology, Etiology, Diagnosis, and Clinical Evolution Compared with Younger Populations.","authors":"Mario Cazzola, Fabio Perrotta, Raffaella Pagliaro, Vincenzo Parente, Maria Gabriella Matera","doi":"10.1007/s40266-026-01322-9","DOIUrl":"10.1007/s40266-026-01322-9","url":null,"abstract":"<p><p>Non-cystic fibrosis bronchiectasis is increasingly recognized as a major cause of chronic respiratory morbidity, particularly among older adults. Its rising prevalence is largely attributable to improved diagnostic imaging and heightened clinical awareness, with epidemiological data consistently demonstrating a marked age-related increase in disease burden. Older patients represent the majority of contemporary cases and exhibit a distinct clinical phenotype characterized by multimorbidity, frailty, and worse outcomes. Pathophysiologically, bronchiectasis is driven by a 'vicious vortex' of airway inflammation, impaired mucociliary clearance, chronic infection, and structural lung damage. In older individuals, this process is amplified by immunosenescence, inflammaging, and age-related structural and functional lung changes, which together promote persistent infection and progressive airway injury. Additional contributors, such as microaspiration, cumulative environmental exposures, and coexisting conditions, including chronic obstructive pulmonary disease and gastroesophageal reflux disease, further exacerbate disease progression. Diagnosis in older adults with bronchiectasis is frequently delayed due to atypical presentations and clinical overlap with other chronic conditions, resulting in more advanced disease at the time of recognition. Microbiologically, older patients show a shift toward more virulent and resistant pathogens, particularly Pseudomonas aeruginosa and Enterobacteriaceae, with important implications for management. Prognosis is poorer in this population, with higher mortality, increased healthcare utilization, and reduced quality of life, largely driven by frailty and comorbidities rather than by disease severity alone. These findings highlight the need for a comprehensive, geriatric-informed approach integrating respiratory care with systematic assessment of functional status, comorbidities, and patient-centered outcomes to optimize management in older patients with bronchiectasis.</p>","PeriodicalId":11489,"journal":{"name":"Drugs & Aging","volume":" ","pages":"755-772"},"PeriodicalIF":4.2,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13582172/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148520152","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Body Mass Index Category and the Association Between Polypharmacy and Functional Recovery in Stroke Patients: A Retrospective Cohort Study.","authors":"Ayaka Matsumoto, Yoshihiro Yoshimura, Fumihiko Nagano, Sayuri Shimazu, Yoshifumi Kido, Takenori Hamada, Kouki Yoneda, Takahiro Bise, Aomi Kuzuhara","doi":"10.1007/s40266-026-01326-5","DOIUrl":"10.1007/s40266-026-01326-5","url":null,"abstract":"<p><strong>Background: </strong>Polypharmacy is a known risk factor for adverse outcomes during stroke rehabilitation; however, evidence is limited on whether nutritional status modifies this association. This study investigated whether the association between polypharmacy and functional recovery in patients after stroke differed according to body mass index (BMI), an anthropometric indicator related to nutritional status.</p><p><strong>Methods: </strong>This retrospective cohort study included patients with stroke admitted to a convalescent rehabilitation ward in Japan between January 2015 and December 2024. Patients with cerebral infarction, intracerebral hemorrhage, or subarachnoid hemorrhage were eligible. Polypharmacy was defined as the prescription of five or more medications at admission. Patients were classified by BMI according to the criteria of the Japan Society for the Study of Obesity: underweight (< 18.5 kg/m²), normal weight (18.5 to < 25.0 kg/m²), and obese (≥ 25.0 kg/m²). The primary outcome was the functional independence measure (FIM)-motor score at discharge, and secondary outcomes were the FIM-cognitive score at discharge and home discharge. Multivariable regression analyses were used to evaluate whether BMI category modified the association between polypharmacy and each outcome.</p><p><strong>Results: </strong>Among 1245 patients (median age, 75 years; 54.3% men), a significant negative interaction between polypharmacy and underweight status was observed for the FIM-motor score at discharge (B = - 4.396, 95% CI - 8.693 to - 0.100). In the underweight group, patients with polypharmacy had significantly lower adjusted FIM-motor scores than those without (65.3 versus 69.8; p = 0.020). No significant association between polypharmacy and functional recovery was found in the normal-weight or obese groups. Polypharmacy was not associated with FIM-cognitive scores or home discharge rates in any BMI category.</p><p><strong>Conclusions: </strong>Polypharmacy was associated with modestly poorer activities of daily living at discharge primarily among underweight patients after stroke. These findings suggest that BMI category may help identify patients who could benefit from closer medication assessment, although the clinical magnitude of the association was limited.</p>","PeriodicalId":11489,"journal":{"name":"Drugs & Aging","volume":" ","pages":"873-883"},"PeriodicalIF":4.2,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148668515","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Associations of Polypharmacy, Diuretics and Antipsychotics with Injurious Falls: A Population-Based Cohort Study.","authors":"Tewodros Yosef, Julie A Pasco, Monica C Tembo, Kara B Anderson, Lana J Williams, Kara L Holloway-Kew","doi":"10.1007/s40266-026-01320-x","DOIUrl":"10.1007/s40266-026-01320-x","url":null,"abstract":"<p><strong>Objective: </strong>Population ageing increases multimorbidity, which in turn contributes to polypharmacy, elevating fall risk through drug interactions and adverse effects on cognition or balance. Although polypharmacy is recognised as a risk factor, specific fall-risk-increasing drugs (FRIDs) may pose greater hazards. This study aimed to examine the associations of polypharmacy, diuretic and antipsychotic use with injurious falls among older adults.</p><p><strong>Methods: </strong>Data from 952 participants (590 men and 362 women) aged ≥ 65 years in the Geelong Osteoporosis Study were linked with the Victorian Emergency Minimum Dataset. The outcome variable was time to first fall-related emergency presentation or injurious falls, with polypharmacy, diuretics and antipsychotics as exposure variables. The associations were examined using competing risk regression, with results presented as adjusted subdistribution hazard ratios (aSHR) and 95% confidence intervals. The population attributable fraction (PAF) was calculated to assess the population-level burden of polypharmacy, diuretics and antipsychotics on injurious falls. PAF indicates the proportion of cases in a population attributable to a specific risk factor.</p><p><strong>Results: </strong>The median time to the first injurious fall was 8.0 years (IQR: 4.0-12.2). The overall incidence rate of injurious falls was 19.3 per 1000 person-years (95% CI: 16.9-22.0). Polypharmacy (aSHR = 2.62, 95% CI: 1.23-5.59), diuretic use (aSHR = 2.98, 95% CI: 1.81-4.92) and antipsychotic use (aSHR = 2.23, 95% CI: 1.23-4.07) increased the risk of injurious falls, with PAF of 17.1%, 23.0% and 4.6%, respectively.</p><p><strong>Conclusions: </strong>Polypharmacy, diuretic and antipsychotic use were associated with an increased risk of injurious falls, with diuretics accounting for the greatest population-level burden. These findings highlight the potential importance of routine medication review in identifying medications that may contribute to injurious falls among older adults. However, given the observational nature of this study, interventional studies are needed to determine whether medication review and deprescribing strategies can effectively reduce injurious falls and improve safety outcomes.</p>","PeriodicalId":11489,"journal":{"name":"Drugs & Aging","volume":" ","pages":"861-871"},"PeriodicalIF":4.2,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13582059/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148560925","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Age-Specific Considerations in Bronchiectasis Management: Focus on Older Adults with Emphasis on Anti-inflammatory Treatment.","authors":"Maria Gabriella Matera, Vito De Novellis, Raffaella Pagliaro, Vincenzo Parente, Fabio Perrotta, Mario Cazzola","doi":"10.1007/s40266-026-01317-6","DOIUrl":"10.1007/s40266-026-01317-6","url":null,"abstract":"<p><p>Bronchiectasis is increasingly recognized as a chronic inflammatory airway disease involving persistent immune dysregulation, recurrent infection, and progressive lung tissue damage. Older adults bear a particularly high burden of bronchiectasis, as age-related changes such as immunosenescence, multimorbidity, and polypharmacy complicate disease management in this population. Anti-inflammatory therapies are emerging as a central component of treatment strategies, reflecting the growing understanding of inflammation as a key driver of disease progression. However, applying these therapies to older populations requires considering altered pharmacokinetics and pharmacodynamics, increased susceptibility to adverse effects, and comorbid conditions. This review examines current and emerging anti-inflammatory treatments for bronchiectasis, focusing on their relevance, safety, and limitations in older patients. Attention is given to the roles of neutrophilic and type 2 inflammatory pathways, as well as the challenges of implementing precision medicine approaches for older people.</p>","PeriodicalId":11489,"journal":{"name":"Drugs & Aging","volume":" ","pages":"773-790"},"PeriodicalIF":4.2,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13582046/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148535590","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Loneliness and Initiation of Potentially Inappropriate Pain and Psychotropic Medications: A Retrospective Cohort Study.","authors":"Rachel D Savage, Susan E Bronskill, Andrea Gruneir, Alexa Boblitz, Jun Guan, Azmina Altaf, Rachel Strauss, Claudia Sanmartin, Laura C Rosella, Nathan M Stall, Stephanie A Chamberlain, Lisa M McCarthy, Xuesong Wang, Christina Yu, Tomi Odugbemi, Paula A Rochon","doi":"10.1007/s40266-026-01324-7","DOIUrl":"10.1007/s40266-026-01324-7","url":null,"abstract":"<p><strong>Background: </strong>Loneliness is associated with high-risk medication use in older adults in cross-sectional studies, but the direction of this relationship is unclear.</p><p><strong>Objective: </strong>The aim of this study was to examine the association between loneliness and initiation of potentially inappropriate pain and psychotropic medications, and test for sex interactions.</p><p><strong>Methods: </strong>We conducted a retrospective cohort study of community-dwelling respondents to the Canadian Community Health Survey-Healthy Aging who were interviewed between December 1, 2008, and November 30, 2009, aged ≥66 years, and Ontario residents. Self-reported loneliness was defined at baseline as a score of ≥6 on the Three-Item Loneliness Scale. Survey responses were linked to health records; respondents were followed for 3 years to assess initiation of a potentially inappropriate pain or psychotropic medication, defined using the 2019 American Geriatrics Society's Beers Criteria. We used weighted Cox proportional hazards regression models to estimate adjusted hazard ratios (HRs) and tested for sex interactions.</p><p><strong>Results: </strong>Of 2348 respondents (female 54.6%, mean age 75.4 years), 383 (12.3%) were lonely. Compared with those who were not lonely, lonely female respondents had higher rates of initiating potentially inappropriate pain medications (HR at 90 days: 1.57, 95% CI 0.96-2.27; 630 days: 1.52, 95% CI 1.05-2.12; 1080 days: 3.22, 95% CI 1.22-7.78) and potentially inappropriate psychotropic medications, but the latter estimates were imprecise. No association was found in males.</p><p><strong>Conclusion: </strong>Lonely older females initiate potentially inappropriate pain and psychotropic medications at higher rates than those who are not lonely. Screening for loneliness could prioritize patients for medication reviews, possible deprescribing, and interventions that address root causes.</p>","PeriodicalId":11489,"journal":{"name":"Drugs & Aging","volume":" ","pages":"837-848"},"PeriodicalIF":4.2,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148629531","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}