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Deprescribing Antipsychotics and Proton Pump Inhibitors in Long-Term Care: A Prescribing Portraits Approach. 在长期护理中减少抗精神病药物和质子泵抑制剂的处方:处方肖像方法。
IF 3.4 3区 医学
Drugs & Aging Pub Date : 2025-06-06 DOI: 10.1007/s40266-025-01217-1
Nooreen Haji, Aaron M Tejani, Anthony Tung, Ying Wang, Deborah Heidary, Wade Thompson, Carolyn Bubbar
{"title":"Deprescribing Antipsychotics and Proton Pump Inhibitors in Long-Term Care: A Prescribing Portraits Approach.","authors":"Nooreen Haji, Aaron M Tejani, Anthony Tung, Ying Wang, Deborah Heidary, Wade Thompson, Carolyn Bubbar","doi":"10.1007/s40266-025-01217-1","DOIUrl":"https://doi.org/10.1007/s40266-025-01217-1","url":null,"abstract":"<p><strong>Introduction: </strong>Antipsychotics (APs) and proton pump inhibitors (PPIs) are commonly prescribed in long-term care (LTC) despite potential risks with prolonged use.</p><p><strong>Objective: </strong>This study evaluates the frequency of AP and PPI prescriptions and assesses the impact of \"prescribing portraits\" on deprescribing in LTC residents at 2 LTC facilities in British Columbia.</p><p><strong>Methods: </strong>This multicenter, prospective quality improvement (QI) study was conducted at two LTC homes: Holy Family Hospital (site A) and Queen's Park Care Centre (site B). The QI approach involved collecting data on prescribing appropriateness, implementing a real-time intervention, and tracking its impact. Prescribing portraits-personalized reports detailing individual prescribing patterns, evidence-based indications, and deprescribing recommendations-were presented to prescribers by clinical pharmacists. The primary outcomes were the proportion of prescriptions eligible for deprescribing and the deprescribing rate at 3 months post-intervention.</p><p><strong>Results: </strong>At site A, 21 of 48 residents receiving AP were identified as eligible for deprescribing, with 31.6% receiving deprescribing orders within 3 months. Among 12 residents previously assessed in our earlier QI study at site A who remained on PPIs, 33% were newly deprescribed after reassessment in this study. At site B, 23 of 48 residents on antipsychotics were eligible, with a deprescribing rate of 20%. For PPIs, 31 of 38 residents were considered eligible at site B, and 36% had deprescribing orders initiated.</p><p><strong>Conclusions: </strong>Integrating prescribing portraits into multidisciplinary medication reviews promotes appropriate deprescribing of APs and PPIs in LTC, encouraging safer prescribing practices and improving medication safety.</p>","PeriodicalId":11489,"journal":{"name":"Drugs & Aging","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144233468","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}
引用次数: 0
Metformin: An Old Drug with New Tricks-Promising Role in Vascular Aging and Cardioprotection. 二甲双胍:一种新手段的老药——在血管老化和心脏保护方面的前景。
IF 3.4 3区 医学
Drugs & Aging Pub Date : 2025-06-05 DOI: 10.1007/s40266-025-01215-3
Rooban Sivakumar, K A Arul Senghor, V M Vinodhini, Janardhanan S Kumar
{"title":"Metformin: An Old Drug with New Tricks-Promising Role in Vascular Aging and Cardioprotection.","authors":"Rooban Sivakumar, K A Arul Senghor, V M Vinodhini, Janardhanan S Kumar","doi":"10.1007/s40266-025-01215-3","DOIUrl":"https://doi.org/10.1007/s40266-025-01215-3","url":null,"abstract":"<p><p>Metformin, traditionally promoted for its efficacy in diabetes, is increasingly appreciated for its geroprotective potential in the development of vascular aging, a key contributor to cardiovascular morbidity. This review aims at understanding the spectrum of mechanisms that govern the amelioration of degenerative processes associated with vascular aging by metformin. Central to this therapeutic promise is the activation of AMPK, which reduces metabolic dysregulation and hence slows vascular senescence. Oxidative stress has been identified as an important mechanism thought to be enhanced by metformin in the preservation of endothelial function and attenuation of arterial stiffening. Besides, metformin has lipid-lowering and antiinflammatory activity, which is critical for reducing arterial rigidity and the development of atherosclerotic plaque. In recent times, both clinical and preclinical studies revealed empirical data that confirmed the effectiveness of metformin in the improvement of endothelial function and the decreasing of arterial stiffness as a part of a reduction in the rates of cardiovascular events. The therapeutic action of the drug goes beyond glycemic control, rendering it a geroprotector potentially suitable for broader application in age-related vascular decline. In light of these findings, the clinical acceptance of metformin as an intervention in vascular aging should be possible and promising. Carefully monitored follow-up studies are needed to optimize dosing, delineate the broad biological effects, and verify long-term benefits, which will underpin metformin's role in the paradigm against age-associated vascular diseases.</p>","PeriodicalId":11489,"journal":{"name":"Drugs & Aging","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144224743","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}
引用次数: 0
Burden of Disease and Treatment Gap in Patients with an Osteoporotic Hip Fracture between 2015 and 2019 in Italy. 意大利2015年至2019年骨质疏松性髋部骨折患者的疾病负担和治疗差距
IF 3.4 3区 医学
Drugs & Aging Pub Date : 2025-06-02 DOI: 10.1007/s40266-025-01211-7
Matteo Scortichini, Myriam Dilecce, Massimo Spelta, Susan Sammak, Salvatore Riegler, Fausto Bartolini, Paolo Sciattella
{"title":"Burden of Disease and Treatment Gap in Patients with an Osteoporotic Hip Fracture between 2015 and 2019 in Italy.","authors":"Matteo Scortichini, Myriam Dilecce, Massimo Spelta, Susan Sammak, Salvatore Riegler, Fausto Bartolini, Paolo Sciattella","doi":"10.1007/s40266-025-01211-7","DOIUrl":"10.1007/s40266-025-01211-7","url":null,"abstract":"<p><strong>Background: </strong>Osteoporosis (OP) represents a public health challenge, with OP fractures associated with high morbidity, mortality, and economic burden, and fracture risk increasing with age. We evaluated the treatment gap, subsequent fracture rate, and medical costs among patients with OP hip fracture in Italy.</p><p><strong>Methods: </strong>From two regional administrative databases, our retrospective cohort study included adults aged ≥ 50 years hospitalized for a first OP hip fracture (index fracture; 1 January 2015 to 31 December 2018).</p><p><strong>Study outcomes: </strong>percentage of patients not prescribed OP treatment in the 6 months following index fracture; fracture and mortality rates (mortality data only available for one region), direct medical costs, persistence and adherence to OP treatment in the 12 months following index fracture (follow-up).</p><p><strong>Results: </strong>Of 23,961 eligible patients, 87.8% (n = 21,028) were not prescribed OP treatment in the 6 months post-index fracture, with low 12-month persistence (33.7%) and adherence (9.6%) among treated patients. During follow-up, fracture and mortality rates were 36.9 and 280.9 per 1000 patient-years, respectively; higher in non-treated versus treated (39.3 versus 24.0 and 303.7 versus 126.7) patients. Mean (SD) cost per patient was €4963 (€5509); higher in non-persistent versus persistent patients (€5832 versus €4817).</p><p><strong>Conclusions: </strong>Among patients from two Italian regions experiencing a first hip fracture, we observed a large treatment gap, and high subsequent fracture rates and medical costs. Considering fracture risk increases with age and a globally aging population, these costs are likely to increase and pose a substantial burden on the Italian health service.</p>","PeriodicalId":11489,"journal":{"name":"Drugs & Aging","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144198551","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}
引用次数: 0
Risk Factors for Vancomycin-Induced Nephrotoxicity and Kidney Prognosis in Patients Aged 75 Years and Older: A Retrospective Study. 75岁及以上患者万古霉素所致肾毒性和肾脏预后的危险因素:一项回顾性研究。
IF 3.4 3区 医学
Drugs & Aging Pub Date : 2025-06-01 Epub Date: 2025-04-30 DOI: 10.1007/s40266-025-01203-7
Masaki Takigawa, Hiroyuki Tanaka, Masako Kinoshita, Toshihiro Ishii, Masayuki Masuda
{"title":"Risk Factors for Vancomycin-Induced Nephrotoxicity and Kidney Prognosis in Patients Aged 75 Years and Older: A Retrospective Study.","authors":"Masaki Takigawa, Hiroyuki Tanaka, Masako Kinoshita, Toshihiro Ishii, Masayuki Masuda","doi":"10.1007/s40266-025-01203-7","DOIUrl":"10.1007/s40266-025-01203-7","url":null,"abstract":"<p><strong>Introduction: </strong>Whether risk factors for vancomycin-induced nephrotoxicity (VIN) development reported in recent years are also risk factors in the older population has not yet been fully investigated. This study aimed to investigate the risk factors for VIN development in the older population and to examine factors influencing kidney prognosis after VIN development.</p><p><strong>Methods: </strong>A total of 468 patients aged ≥ 75 years were included in this study. Factors related to VIN onset in older adults were examined through logistic regression analysis.</p><p><strong>Results: </strong>A total of 40 patients (8.5%) with VIN were identified. Univariate analysis revealed significant differences in body mass index (BMI), combined use of tazobactam/piperacillin (T/P), and intensive care unit admission between the VIN and non-VIN groups (P = 0.042, 0.005, and 0.040, respectively). Multivariate analysis identified the combined use of T/P as a factor related to VIN. In patients aged 85 years or older, the concomitant use of T/P and intensive care unit (ICU) admission were identified as factors related to VIN. Compared with the VIN recovery group, the nonrecovery group had a longer time to VIN onset and a higher proportion of patients on concomitant diuretics.</p><p><strong>Conclusions: </strong>This study revealed that the combined use of T/P and ICU admission were risk factors for VIN in older individuals. Additionally, the time until VIN onset and the concomitant use of diuretics may affect the kidney prognosis of older patients who develop VIN. When administering vancomycin to older patients, it is necessary to eliminate or be cautious of these factors in relation to VIN development and kidney prognosis.</p>","PeriodicalId":11489,"journal":{"name":"Drugs & Aging","volume":" ","pages":"547-557"},"PeriodicalIF":3.4,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144062821","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}
引用次数: 0
Comparison of Anticholinergic Burden Scales and Their Association with Cognitive and Functional Impairment in Older Adults: A Cross-Sectional Study Using the REPOSI Database. 老年人抗胆碱能负荷量表的比较及其与认知和功能障碍的关系:使用REPOSI数据库的横断面研究
IF 3.4 3区 医学
Drugs & Aging Pub Date : 2025-06-01 Epub Date: 2025-04-15 DOI: 10.1007/s40266-025-01204-6
Alessio Novella, Marina Azab, Luca Pasina
{"title":"Comparison of Anticholinergic Burden Scales and Their Association with Cognitive and Functional Impairment in Older Adults: A Cross-Sectional Study Using the REPOSI Database.","authors":"Alessio Novella, Marina Azab, Luca Pasina","doi":"10.1007/s40266-025-01204-6","DOIUrl":"10.1007/s40266-025-01204-6","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;The increasing use of anticholinergic medications in older adults with multiple chronic conditions raises significant concerns regarding their cumulative anticholinergic burden, which is linked to several adverse outcomes. This study aimed to compare existing anticholinergic burden scales to identify those most effective at correlating drug-induced anticholinergic load with cognitive and functional impairment. In addition, we proposed a new classification system on the basis of published scales to optimally correlate total anticholinergic burden with observed clinical deficits.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;This cross-sectional study analyzed data from the REPOSI registry, which collects clinical and therapeutic information on patients aged 65 years and older admitted to internal medicine and geriatric wards across Italy. Anticholinergic exposure was assessed using 20 established anticholinergic burden scales from literature. In addition, seven experimental scales were developed on the basis of published scales and various mathematical functions (maximum, mode, median, and mean) to evaluate potential differences in measuring anticholinergic load. Outcomes included cognitive impairment, assessed using the Short Blessed Test (SBT), and functional independence, measured by the Barthel Index (BI). A zero-inflated negative binomial model was applied to analyze associations between anticholinergic burden and each outcome. Given the variability in drug scoring across published scales, we developed seven experimental scales using different mathematical functions (maximum, mode, median, and mean) to standardize scoring. Three versions included a null-score adjustment to account for drugs omitted in some scales, ensuring a more comprehensive measure of anticholinergic burden.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Among 7735 patients, higher anticholinergic burden was consistently associated with increased cognitive impairment (SBT) and physical dependency (BI) across all existing and proposed scales. The modified Anticholinergic Risk Scale (mARS) scale showed the strongest associations with cognitive (rate ratio [RR] 1.10, 95% confidence interval [CI] 1.06, 1.13; P &lt; 0.0001) and physical impairment (RR 1.18, 95% CI 1.11, 1.24; P &lt; 0.0001), indicating an 18% higher risk of dependency per unit increase, while the CRIDECO Anticholinergic Load Scale (CALS) scale exhibited the best model fit. Our newly developed scales confirmed these associations, with the median with null score and the mean with null score scale showing the strongest link to cognitive impairment (RR 1.07, 95% CI 1.05, 1.09; P &lt; 0.0001) and the strongest association with physical dependency (RR 1.11, 95% CI 1.08, 1.15; P &lt; 0.0001).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Scales that identify a greater proportion of patients with at least one anticholinergic drug may provide a more comprehensive assessment of anticholinergic burden in clinical practice. While no single s","PeriodicalId":11489,"journal":{"name":"Drugs & Aging","volume":" ","pages":"559-572"},"PeriodicalIF":3.4,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143983965","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}
引用次数: 0
Prevalence of Self-Reported Adverse Effects to Cannabis by Older Canadians: A Cross-Sectional Analysis. 加拿大老年人自我报告的大麻不良反应患病率:一项横断面分析。
IF 3.4 3区 医学
Drugs & Aging Pub Date : 2025-06-01 Epub Date: 2025-04-23 DOI: 10.1007/s40266-025-01206-4
Jennifer Bolt, Kristine Lin, Melanie Fenton, Jennifer M Jakobi
{"title":"Prevalence of Self-Reported Adverse Effects to Cannabis by Older Canadians: A Cross-Sectional Analysis.","authors":"Jennifer Bolt, Kristine Lin, Melanie Fenton, Jennifer M Jakobi","doi":"10.1007/s40266-025-01206-4","DOIUrl":"10.1007/s40266-025-01206-4","url":null,"abstract":"<p><strong>Background and objective: </strong>Despite the increasing use of cannabis by older Canadians, little is known about cannabis safety in this population, particularly in non-clinical settings. The purpose of this study was to describe the self-reported adverse effects experienced by community-dwelling older Canadians who use cannabis.</p><p><strong>Methods: </strong>Canadians aged 50 years and older completed an online survey regarding their knowledge, perceptions, and experiences with cannabis. Respondents who reported current cannabis use were asked to report any adverse effects experienced in the past year related to their cannabis use. Adverse effects were categorized, and multivariate logistic regressions were performed to assess predictors of adverse effects.</p><p><strong>Results: </strong>A total of 1615 older adults completed the survey, of whom 503 reported current use of cannabis and were included in this analysis. Adverse effects were reported by 308 participants (61.2%) and included dry mouth (36.2%), feeling high (25.9%), and adverse effects impacting balance (22.1%) and mental alertness (20.3%). Compared with participants aged 50-60 years, those aged 70 years and older had lower odds of reporting any adverse effects (odds ratio (OR) 0.524, 95% confidence interval (CI) 0.303-0.906) or adverse effects impacting mental alertness (OR 0.318, 95% CI 0.172-0.588). Female participants had higher odds of reporting any adverse effect (OR 1.989, 95% CI 1.332-2971) or adverse effects impacting balance (OR 1.930, 95% CI 1.198-3.109).</p><p><strong>Conclusions: </strong>Adverse effects to cannabis are common amongst community-dwelling older adults. Increased education and guidance regarding adverse effects of cannabis, including the composition and dose of cannabis products, may help increase safe use by this population.</p>","PeriodicalId":11489,"journal":{"name":"Drugs & Aging","volume":" ","pages":"573-582"},"PeriodicalIF":3.4,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144001392","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}
引用次数: 0
Age Does not Affect the Efficacy of Antibody Drug Conjugates, But is Associated with High-Grade Adverse Events in Patients with Cancer Enrolled in Early Phase Clinical Trials. 年龄不影响抗体药物偶联物的疗效,但与早期临床试验中癌症患者的高度不良事件相关。
IF 3.4 3区 医学
Drugs & Aging Pub Date : 2025-06-01 Epub Date: 2025-05-16 DOI: 10.1007/s40266-025-01212-6
Ana Vaz Ferreira, Matthieu Delaye, Arnaud Pages, Antoine Hollebecque, Anas Gazzah, Rastio Bahleda, Jean-Marie Michot, Francois-Xavier Danlos, Lauren Seknazi, Vincent Goldschmidt, Clémence Hénon, Madonna Sakkal, Cristina Smolenschi, Stéphane Champiat, Aurelien Marabelle, Yohann Loriot, Céline Nagera Lazarovici, Zoé Ap-Thomas, Geoffroy Beraud Chaullet, Santiago Ponce Aix, Christophe Massard, Kaissa Ouali, Maxime Frelaut, Capucine Baldini
{"title":"Age Does not Affect the Efficacy of Antibody Drug Conjugates, But is Associated with High-Grade Adverse Events in Patients with Cancer Enrolled in Early Phase Clinical Trials.","authors":"Ana Vaz Ferreira, Matthieu Delaye, Arnaud Pages, Antoine Hollebecque, Anas Gazzah, Rastio Bahleda, Jean-Marie Michot, Francois-Xavier Danlos, Lauren Seknazi, Vincent Goldschmidt, Clémence Hénon, Madonna Sakkal, Cristina Smolenschi, Stéphane Champiat, Aurelien Marabelle, Yohann Loriot, Céline Nagera Lazarovici, Zoé Ap-Thomas, Geoffroy Beraud Chaullet, Santiago Ponce Aix, Christophe Massard, Kaissa Ouali, Maxime Frelaut, Capucine Baldini","doi":"10.1007/s40266-025-01212-6","DOIUrl":"10.1007/s40266-025-01212-6","url":null,"abstract":"<p><strong>Background: </strong>Data on the use of antibody drug conjugates (ADCs) in older patients are scarce.</p><p><strong>Objective: </strong>The objective was to study the safety and efficacy of ADCs used in early phase clinical trials in patients aged ≥ 65 years compared with younger patients.</p><p><strong>Patients and methods: </strong>All patients enrolled in early phase clinical trials (phase I or II) of ADCs for solid tumors in our institution between November 2014 and May 2023 were included in this retrospective monocentric study. Safety and efficacy were compared between patients ≥ 65 and < 65 years old (y.o).</p><p><strong>Results: </strong>A total of 136 patients were included in our study, with 43 (31.6%) patients aged ≥ 65 y.o. In comparison with the younger population, patients aged 65 years or older had similar demographic characteristics. Older patients experienced the same rate of all-grade adverse events (95.3 versus 97.8%) and all-grade related adverse events (65.1 versus 66.7%) but more high-grade adverse events (41.9 versus 30.1%) than younger patients. In the univariate analysis, we identified age, taken as a continuous variable, as associated with high-grade adverse event (p = 0.047). No statistically significant difference was found between older and younger patients in terms of disease control rate (65 versus 54%), median progression-free survival (2.76 months [95% confidence interval, 95% CI 1.64-3.75] compared with 2.56 [95% CI 1.81-2.79], p = 0.34), or median overall survival (6.57 months [95% CI 4.01-13.01] compared to 7.89 [95% CI 6.83-9.36], p = 0.65).</p><p><strong>Conclusions: </strong>In our cohort, ADC therapy provided comparable survival benefits for the older patients but with a higher risk of high-grade adverse event.</p>","PeriodicalId":11489,"journal":{"name":"Drugs & Aging","volume":" ","pages":"583-589"},"PeriodicalIF":3.4,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144076716","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}
引用次数: 0
Detection of Potential Prescribing Cascades in Multimorbid Older Patients Hospitalised with Acute Illness-An Observational Prospective Prevalence Study. 多病老年急性疾病住院患者潜在处方级联的检测——一项观察性前瞻性患病率研究
IF 3.4 3区 医学
Drugs & Aging Pub Date : 2025-06-01 Epub Date: 2025-04-04 DOI: 10.1007/s40266-025-01201-9
Ruth Daunt, Siobhán McGettigan, Lorna Kelly, Denis Curtin, Denis O'Mahony
{"title":"Detection of Potential Prescribing Cascades in Multimorbid Older Patients Hospitalised with Acute Illness-An Observational Prospective Prevalence Study.","authors":"Ruth Daunt, Siobhán McGettigan, Lorna Kelly, Denis Curtin, Denis O'Mahony","doi":"10.1007/s40266-025-01201-9","DOIUrl":"10.1007/s40266-025-01201-9","url":null,"abstract":"<p><strong>Background: </strong>Prescribing cascades occur when a new drug is prescribed to treat an adverse drug event caused by an existing medication, resulting in unnecessary, or potentially hazardous additional drugs. To date, there are no published studies assessing the prevalence of prescribing cascades in older hospitalised adults.</p><p><strong>Objective: </strong>To investigate the prevalence of prescribing cascades in hospitalised older adults.</p><p><strong>Methods: </strong>We conducted a prospective observational study of adults aged ≥ 65 years with multimorbidity and polypharmacy presenting to hospital with acute unselected medical or surgical illness. Prescribing cascades were identified using two predefined validated explicit cascade lists, i.e. ThinkCascades, and a list derived from a recently published systematic review of prescribing cascades in community-dwelling adults, referred to here as the 'Doherty list'. Potential prescribing cascades were classified as 'definite', 'probable', 'possible', 'uncertain' or 'indeterminate' according to pre-specified criteria.</p><p><strong>Results: </strong>The study included 385 consecutive patients (55.1% female, mean age 80.2 years, standard deviation 7.3 years). A total of 281 potential prescribing cascades (drug A → drug B) were identified in 152 patients (39.4%). Probable or possible prescribing cascades were identified in 48 patients (12.4%) using the Doherty list and in 44 patients (11.4%) using ThinkCascades. Patients exposed to potential prescribing cascades experienced greater levels of polypharmacy than patients not exposed to prescribing cascades (median interquartile range [IQR] of 12 [9-14] daily drugs versus 9 [IQR 7-11], p < 0.001).</p><p><strong>Conclusions: </strong>Potential prescribing cascades were highly prevalent in older hospitalised adults. Practical tools are needed to assist prescribers in prevention, recognition and management of inappropriate prescribing cascades.</p>","PeriodicalId":11489,"journal":{"name":"Drugs & Aging","volume":" ","pages":"535-546"},"PeriodicalIF":3.4,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12149247/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143779432","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}
引用次数: 0
Testosterone Therapy in Older Men: Present and Future Considerations. 老年男性睾酮治疗:现在和未来的考虑。
IF 3.4 3区 医学
Drugs & Aging Pub Date : 2025-06-01 Epub Date: 2025-04-27 DOI: 10.1007/s40266-025-01209-1
Bu B Yeap, Cammie Tran, Catherine M Douglass, John J McNeil
{"title":"Testosterone Therapy in Older Men: Present and Future Considerations.","authors":"Bu B Yeap, Cammie Tran, Catherine M Douglass, John J McNeil","doi":"10.1007/s40266-025-01209-1","DOIUrl":"10.1007/s40266-025-01209-1","url":null,"abstract":"<p><p>Testosterone is the classical male anabolic hormone, involved in sexual development, virilisation and regulation of body composition in adult men. Organic disease involving the hypothalamus, pituitary or testes may interfere with endogenous testosterone production. In such men, testosterone treatment effectively ameliorates symptoms and signs of androgen deficiency. However, non-gonadal factors including age, body mass index and medical comorbidities influence circulating testosterone, and older men have on average lower testosterone concentrations compared with younger men. In these men, testosterone treatment would be a pharmacological intervention requiring stringent justification via high-quality evidence from randomised controlled trials (RCTs). Recent RCTs show benefits of testosterone treatment to improve sexual function, anaemia and bone mineral density in older men, and to prevent or revert type 2 diabetes mellitus in men at high risk. Results from a large cardiovascular safety trial in men with or at risk of cardiovascular disease provide important reassurance as to cardiovascular and prostate safety of testosterone treatment. Key questions remain as to whether testosterone's anabolic and other effects can be used safely to counter reductions in lean mass associated with incretin-based weight loss medications in men with obesity, and whether it might prevent disabilities including frailty, osteoporotic fractures and dementia in older men generally. This last question could be answered by a new testosterone RCT, targeting men in the 65-80 years age bracket, which would necessarily be large and of extended duration. A composite endpoint could be used which integrates potential benefits and risks, such as disability-free survival.</p>","PeriodicalId":11489,"journal":{"name":"Drugs & Aging","volume":" ","pages":"501-512"},"PeriodicalIF":3.4,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12148964/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143971884","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}
引用次数: 0
The Aging Patient with Cystic Fibrosis. 老年囊性纤维化患者。
IF 3.4 3区 医学
Drugs & Aging Pub Date : 2025-06-01 Epub Date: 2025-04-24 DOI: 10.1007/s40266-025-01207-3
Lauren J Sullivan, Christina M Mingora, Patrick A Flume
{"title":"The Aging Patient with Cystic Fibrosis.","authors":"Lauren J Sullivan, Christina M Mingora, Patrick A Flume","doi":"10.1007/s40266-025-01207-3","DOIUrl":"10.1007/s40266-025-01207-3","url":null,"abstract":"<p><p>Cystic fibrosis (CF) is an inherited condition that leads to multiorgan dysfunction, especially in the respiratory, gastrointestinal, and reproductive tracts, with associated conditions including persistent pulmonary infection, liver disease, pancreatic insufficiency, and infertility. Historically, people with CF (pwCF) suffered a shortened lifespan due to complications of the condition, namely respiratory. The emphasis on center-based, multidisciplinary care and the widespread introduction of cystic fibrosis transmembrane conductance regulator (CFTR) modulator therapy has resulted in pwCF living longer and healthier lives. Now they may encounter some of the health and social issues associated with growing older, which previously were not a typical experience for this population. In this article, we review relevant health issues for the aging CF population, including complications that arise from the condition itself, issues encountered due to treatment, and general conditions associated with aging that may manifest earlier or differently in pwCF. We discuss the recommendations for screening and treatment of relevant conditions, and considerations for the integration of healthcare professionals across disciplines into the care of this population.</p>","PeriodicalId":11489,"journal":{"name":"Drugs & Aging","volume":" ","pages":"513-525"},"PeriodicalIF":3.4,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12148974/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143982578","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}
引用次数: 0
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