Drugs & Aging最新文献

{"title":"Medicine Optimisation and Deprescribing Intervention Outcomes for Older People with Dementia or Mild Cognitive Impairment: A Systematic Review.","authors":"Nicola Andrews, Cindy Brooks, Michele Board, Simon Fraser, Sue Latter, Kirsty Aplin, Beth McCausland, Eloise Radcliffe, Jay Amin, Rosemary Lim, Ellen van Leeuwen, Kinda Ibrahim","doi":"10.1007/s40266-025-01189-2","DOIUrl":"https://doi.org/10.1007/s40266-025-01189-2","url":null,"abstract":"<p><strong>Background: </strong>Polypharmacy is common amongst older people with dementia or mild cognitive impairment (MCI), increasing the risk of medication-related harm. Medicine optimisation and deprescribing to reduce polypharmacy is considered feasible, safe and can lead to improved health. However, for those living with dementia or MCI, this can be challenging. This systematic review aimed to summarise the evidence on the outcomes of medicine optimisation and deprescribing interventions for older people with dementia or MCI.</p><p><strong>Methods: </strong>Literature was searched using CINAHL, Embase, Medline, PsychINFO, Web of Science and the Cochrane Library from database inception to January 2024. Papers reporting data specific to people with dementia or MCI from medicine optimisation and deprescribing interventional research studies of any design and in any setting were included. A narrative synthesis was conducted owing to heterogeneity of study designs and outcomes. Quality was assessed using the Mixed Methods Appraisal Tool.</p><p><strong>Results: </strong>A total of 32 papers reporting on 28 studies were included, with samples ranging from 29 to 17,933 patients and a mean patient age ranging from 74 to 88 years. Of the studies, 60% were undertaken in long-term care settings. Involvement of patients and/or carers in interventions was limited. Papers were grouped as either incorporating a medication review component (n = 13), education component (n = 5) or both (n = 14). Studies primarily focussed on medication-related outcomes, generally showing a positive effect on decreasing the number and improving appropriateness of medications. Fewer papers reported clinical outcomes (behavioural and psychological symptoms of dementia, falls, quality of life and cognition) with mixed findings. A reduction or no change in mortality or hospital attendance demonstrated safety of the interventions in the few papers reporting these outcomes. The quality of the evidence was mixed.</p><p><strong>Conclusions: </strong>Medicine optimisation and deprescribing interventions generally reduced the number and increased the appropriateness of medications, and although less frequently reported, these interventions seemed to be safe and showed an absence of worsening of clinical outcomes. This review highlights a need for further research, particularly in people with dementia or MCI living at home, with more focus on clinical outcomes and a greater involvement of patients and informal carers.</p><p><strong>Protocol registration: </strong>The protocol was published in the International Prospective Register of Systematic Reviews (PROSPERO) [Ref: CRD42023398139].</p>","PeriodicalId":11489,"journal":{"name":"Drugs & Aging","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143604370","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":"Trazodone and Risk of Orthostatic Hypotension, Syncope and Falls in Geriatric Outpatients with Hypertension.","authors":"Giulia Rivasi, Marco Capacci, Lorenzo Maria Del Re, Ilaria Ambrosino, Ludovica Ceolin, Alessandra Liccardo, Maria Francesca Bisignano, Giuseppe D'Ambrosio, Greta Ceccarelli, Giulia Matteucci, Enrico Mossello, Andrea Ungar","doi":"10.1007/s40266-025-01196-3","DOIUrl":"https://doi.org/10.1007/s40266-025-01196-3","url":null,"abstract":"<p><strong>Introduction: </strong>In older adults, trazodone is frequently prescribed for anxiety and insomnia owing to its perceived greater tolerability in comparison with benzodiazepines. However, it may have hypotensive effects.</p><p><strong>Aim: </strong>The aim of this study is to investigate the effects of trazodone on orthostatic blood pressure (BP) response and risk of syncope and falls in hypertensive older adults.</p><p><strong>Patients and methods: </strong>A longitudinal observational study involving patients ≥ 75 years was conducted in two geriatric outpatient clinics in Florence, Italy. At baseline, participants underwent a 3-min active stand test, office BP measurement and home and ambulatory BP monitoring. At follow-up, syncope and falls were recorded.</p><p><strong>Results: </strong>Among 123 participants (mean age 81 years, 59% female), 12 (10%) reported regular trazodone use. Trazodone users showed lower office diastolic BP (71.8 versus 80.1 mmHg, p = 0.042), a greater systolic and diastolic BP reduction immediately after standing (Δsystolic_T0 23.8 versus 14.3 mmHg, p = 0.037; Δdiastolic_T0 8.9 versus 1.6 mmHg, p = 0.004) and a greater diastolic BP reduction after 1-min standing (Δdiastolic_T1 6.5 versus 0 mmHg, p = 0.029). No differences were reported for home or ambulatory BP. Incidence of syncope and falls was 25%, with a significantly higher rate in patients receiving trazodone (58.3% versus 21.2%, p = 0.001). Trazodone use predicted syncope and falls independently of age, disability and fall history. This association was not confirmed when adjusting for dementia diagnosis. BP values were not associated with the study outcome.</p><p><strong>Conclusions: </strong>In older hypertensive outpatients, trazodone is associated with a greater orthostatic BP drop and may predispose them to an increased risk of syncope and falls.</p>","PeriodicalId":11489,"journal":{"name":"Drugs & Aging","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143604333","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":"Executive Summary: Treatment of Osteoporosis and Osteoarthritis in the Oldest Old.","authors":"Nicola Veronese, Nicholas C Harvey, René Rizzoli, Nicholas R Fuggle, Jean-Yves Reginster","doi":"10.1007/s40266-025-01184-7","DOIUrl":"10.1007/s40266-025-01184-7","url":null,"abstract":"<p><p>This is the executive summary of a work by the European Society for Clinical and Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal Diseases (ESCEO) (Nicholas Fuggle et al. in Drugs, 2024).</p>","PeriodicalId":11489,"journal":{"name":"Drugs & Aging","volume":" ","pages":"179-181"},"PeriodicalIF":3.4,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143481769","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":"An Educational Intervention to Promote Central Nervous System-Active Deprescribing in Dementia: A Pilot Study.","authors":"Noah M Barnett, Sarah E Vordenberg, H Myra Kim, Molly Turnwald, Julie Strominger, Amanda N Leggett, Esther Akinyemi, Frederic C Blow, Alyssa Vanderziel, Celeste Pappas, Donovan T Maust","doi":"10.1007/s40266-024-01178-x","DOIUrl":"10.1007/s40266-024-01178-x","url":null,"abstract":"<p><strong>Background: </strong>Central nervous system (CNS)-active polypharmacy (defined as concurrent exposure to three or more antidepressant, antipsychotic, antiseizure, benzodiazepine, opioid, or nonbenzodiazepine benzodiazepine receptor agonists) is associated with significant potential harms in persons living with dementia (PLWD).We conducted a pilot trial to assess a patient nudge intervention's implementation feasibility and preliminary effectiveness to prompt deprescribing conversations between PLWD experiencing CNS-active polypharmacy and their primary care clinicians (\"clinicians\").</p><p><strong>Methods: </strong>We used the electronic health record to identify PLWD prescribed CNS-active polypharmacy in primary care clinics from two health systems. Clinics were assigned to intervention (n = 10) or control (n = 12), with PLWD in intervention clinics mailed an educational brochure to prompt discussion with clinicians about the appropriateness of their CNS-active regimen. We conducted chart reviews for evidence of documentation related to these medications and used the electronic health record (EHR) to assess preliminary effectiveness 120 days after sending the brochure (e.g., number of CNS-active medications prescribed, change in total standardized daily dose [TSDD] of CNS-active medications, and change in prevalence of CNS-active polypharmacy). We interviewed 10 clinicians from intervention clinics to assess their perceptions about the acceptability of the intervention.</p><p><strong>Results: </strong>PLWD in the intervention group (n = 61) and control group (n = 68) had an average age of 72.4 years (standard deviation [SD] 9.7), 62.8% were female, and 84.5% were white. We did not find any documented evidence of conversations related to CNS-active medications between PLWD who received the brochure and their primary care clinicians. After 120 days, there was no significant between-group difference in the mean number of CNS-active medications prescribed (- 1.0 [SD 1.3] versus - 1.0 [SD 1.3]), mean TSDD (- 1.6 [SD 6.0] versus - 1.3 [SD 5.8]), or the percentage of patients with CNS-active polypharmacy (52.6% versus 50.4%). Interviews with clinicians suggested they were aware that combinations of CNS-active medications were not ideal; however, they reported inheriting patients who were already on these medications, and they did not have sufficient clinic time or access to safer alternatives to overcome patient hesitation to deprescribe.</p><p><strong>Conclusions: </strong>A direct-to-patient mailed educational brochure did not demonstrate feasibility in provoking deprescribing conversations between PLWD and clinicians or preliminary effectiveness in decreasing CNS-active polypharmacy.</p>","PeriodicalId":11489,"journal":{"name":"Drugs & Aging","volume":" ","pages":"257-265"},"PeriodicalIF":3.4,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11879751/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143002234","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":"Safety and Efficacy of Sodium-Glucose Cotransporter 2 Inhibitors in Older Adults with Variable Disease States: A Meta-analysis of Large Placebo-Controlled Trials.","authors":"Syeda Ayesha Shah, Hasan Mushahid, Ali Salman, Syed Husain Farhan, Fakhar Latif, Rabbia Siddiqi, Abdulqadir J Nashwan, Dmitry Abramov, Abdul Mannan Khan Minhas","doi":"10.1007/s40266-025-01183-8","DOIUrl":"10.1007/s40266-025-01183-8","url":null,"abstract":"<p><strong>Background: </strong>Recent guidelines recommend the use of sodium-glucose cotransporter 2 (SGLT-2) inhibitors (SGLT2i) in patients suffering from cardiorenal diseases. However, the safety and efficacy of SGLT2i in older adults with atherosclerotic cardiovascular disease (ASCVD), heart failure (HF), and chronic kidney disease (CKD) remain unclear.</p><p><strong>Methods: </strong>Online databases were queried from inception to 11 July 2023 to identify primary or secondary analyses for inclusion. Efficacy outcomes included all-cause mortality, cardiovascular (CV) death, hospitalization for heart failure (HHF), major adverse cardiac events (MACE), CV death/HHF composite, and cardiorenal composite events. Safety endpoints included acute kidney injury (AKI), serious adverse events, genital infections, limb amputation, fractures, urinary tract infections (UTI), and volume depletion. Data were pooled using a random-effects model to derive risk ratios (RRs) and 95% confidence intervals (CIs).</p><p><strong>Results: </strong>Eight trials with 32,541 older adults identified in primary or secondary analyses were included. In older adults, SGLT2i reduced the risk of all-cause mortality (RR 0.88; 95% CI 0.83- 0.95), CV death (RR 0.82; 95% CI 0.74-0.92), HHF (RR 0.72; 95% CI 0.66-0.79), MACE (RR 0.87; 95% CI 0.77-0.99), CV death/HHF composite (RR 0.78; 95% CI 0.70-0.88), and cardiorenal composite events (RR 0.77; 95% CI 0.70-0.85). For safety endpoints, SGLT2i decreased the risk of serious adverse events (RR 0.92; 95% CI 0.89-0.95) and increased the risk of genital infections (RR 3.48; 95% CI 2.58-4.69).</p><p><strong>Conclusions: </strong>This analysis of randomized trials demonstrates that SGLT2i are efficacious in older adults. However, since older individuals are often underrepresented in most clinical trials, further research targeting this growing demographic is essential.</p>","PeriodicalId":11489,"journal":{"name":"Drugs & Aging","volume":" ","pages":"195-211"},"PeriodicalIF":3.4,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143476287","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":"Perioperative Anticholinergic Medication Use and Incident Dementia among Older Surgical Patients: a Retrospective Cohort Study using Real-World Data.","authors":"Emma Holler, Sanjay Mohanty, Molly Rosenberg, Corey Kalbaugh, Zina Ben Miled, Malaz Boustani, Christina Ludema","doi":"10.1007/s40266-025-01185-6","DOIUrl":"10.1007/s40266-025-01185-6","url":null,"abstract":"<p><strong>Background: </strong>Inpatient anticholinergic medications have been associated with a higher likelihood of postoperative delirium in older adults. However, it remains unclear whether administering anticholinergic medications after surgery adversely affects long-term cognitive function.</p><p><strong>Objective: </strong>We aimed to evaluate the relationship between in-hospital anticholinergic medications and time to incident dementia in a cohort of older surgical patients. We also sought to determine whether the association between in-hospital anticholinergic drugs and dementia differed by sex and prehospital anticholinergic exposure.</p><p><strong>Methods: </strong>This was a retrospective analysis of electronic health record data from a regional health information exchange. The study population included patients aged 50 years and older who underwent major surgery requiring an inpatient stay between 2014 and 2021. Orders for anticholinergic medications were identified using the anticholinergic cognitive burden (ACB) scale. A Cox proportional hazards model was used to estimate the association between inpatient orders for strong anticholinergics and incident dementia after hospital discharge. Cause-specific hazards were modeled. Stratification and relative excess risk due to interaction (RERI) were used to investigate multiplicative and additive interaction, respectively.</p><p><strong>Results: </strong>In total, 66,420 surgical encounters were analyzed. Approximately 90% of patients received one or more strong anticholinergics during hospitalization, and 3806 patients developed dementia during a median follow-up of 3.4 years. The median time to dementia was 2.2 years. Each one-order increase in inpatient anticholinergic medications was associated with a 0.60% increase in dementia risk (HR 1.006; 95% CI 1.003-1.008). This association was stronger among patients who were prescribed anticholinergics before hospitalization (RERI 0.10; 95% CI 0.08-1.12; p = 0.0122).</p><p><strong>Conclusions: </strong>Perioperative anticholinergics may increase the risk of dementia after major surgery. Avoiding these medications in hospitalized older adults may improve long-term cognitive outcomes.</p>","PeriodicalId":11489,"journal":{"name":"Drugs & Aging","volume":" ","pages":"235-243"},"PeriodicalIF":3.4,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11930629/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143187612","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":"Topical Medications for Chronic Itch in Older Patients: Navigating a Pressing Need.","authors":"Brooke Bartley, Christina Pierce, Chad Hivnor, Rodrigo Valdes-Rodriguez","doi":"10.1007/s40266-024-01174-1","DOIUrl":"10.1007/s40266-024-01174-1","url":null,"abstract":"<p><p>Chronic itch in older patients is a common problem, with a significant impact on quality of life. Chronic itch in the older population may be attributable to several causes, such as age-related changes, skin conditions, systemic conditions, medications, and psychological conditions. Given the complexity of itch in this population, comorbidities, and polypharmacy in most geriatric patients, treating chronic itch can be challenging for healthcare providers. Therefore, optimized topical treatment regimens are paramount to help these patients and prevent side effects.</p>","PeriodicalId":11489,"journal":{"name":"Drugs & Aging","volume":" ","pages":"213-233"},"PeriodicalIF":3.4,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143064481","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":"Regular Use of Oral Nonsteroidal Anti-inflammatory Drugs in a Population of Polish Seniors: Findings from the PolSenior2 Cross-Sectional Survey.","authors":"Karol Wierzba, Michał Chmielewski, Emilia Błeszyńska-Marunowska, Kacper Jagiełło, Łukasz Wierucki, Tomasz Zdrojewski","doi":"10.1007/s40266-025-01180-x","DOIUrl":"10.1007/s40266-025-01180-x","url":null,"abstract":"<p><strong>Introduction: </strong>Older adults represent a growing proportion of the general population. Nonsteroidal anti-inflammatory drugs (NSAIDs) constitute a group of medicines that are both necessary, owing to their anti-inflammatory, analgesic, and cardioprotective abilities, and potentially harmful, owing to their side effects.</p><p><strong>Objectives: </strong>This study provides a comprehensive analysis of NSAID usage patterns among Polish adults aged 60 years and older. It focused on the regular use (≥ three times per week) of two types of NSAIDs: acetylsalicylic acid (ASA) and non-ASA NSAIDs, examining consumption on the basis of age, sex, educational level, and place of residence.</p><p><strong>Methods: </strong>Data were collected from the PolSenior2 study, a national cross-sectional survey of 5987 Polish individuals aged 60-106 years, conducted from 2018 to 2019.</p><p><strong>Results: </strong>The study found that 30.7% [95% confidence interval (CI) 28.8-32.7)]of Polish seniors regularly used NSAIDs, with 26.2% (95% CI 24.5-28.0) regularly using ASA, 6.3% (95% CI 5.3-7.2) regularly using non-ASA NSAIDs, and 1.9% (95% CI 1.4-2.3) reporting regular use of both. An age-related increase in regular NSAID use, including ASA, was observed. Women were more likely than men to use non-ASA NSAIDs regularly, whereas men in the 70-79 age group were more likely to use ASA. A lower level of education was associated with more frequent NSAID use.</p><p><strong>Conclusions: </strong>The findings have implications for healthcare practitioners and policymakers, emphasizing the need for careful management of NSAID use. The study contributes to a more nuanced understanding of NSAID usage and underscores the necessity for tailored healthcare strategies to ensure safe and effective medication use among older adults.</p>","PeriodicalId":11489,"journal":{"name":"Drugs & Aging","volume":" ","pages":"245-255"},"PeriodicalIF":3.4,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143052064","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":"Antidepressants to Manage Osteoarthritic Pain: The Value of Pain Phenotyping.","authors":"Di Zhang, Leticia A Deveza, Bryan Yijia Tan, Blake Dear, David J Hunter","doi":"10.1007/s40266-025-01182-9","DOIUrl":"10.1007/s40266-025-01182-9","url":null,"abstract":"<p><p>Osteoarthritis (OA) is a chronic condition in which pain significantly affects quality of life, often leading to reduced physical activity and disability. Globally, an estimated 595 million people are affected, with the numbers likely to increase owing to an aging population and rising obesity rates. Effective pain management is crucial, yet current treatments, such as nonsteroidal anti-inflammatory drugs (NSAIDs) and opioids, often provide limited relief and come with risks. One reason for this limited success is the insufficient recognition of the importance of psychosocial factors and heterogeneity of patients with OA (such as anxiety and depression), which can exacerbate pain and its impacts. The variability in patient pain experiences highlights the potential value of pain phenotyping, which involves a comprehensive assessment of pain characteristics to tailor treatments to individual needs. Antidepressants, particularly serotonin-norepinephrine reuptake inhibitors (SNRIs), show promise in alleviating both psychological symptoms and OA-related pain, but their effectiveness varies among individuals. Therefore, further research into standardized pain phenotyping methods and their integration into antidepressant treatment is needed to improve efficacy and minimize side effects through more personalized approaches.</p>","PeriodicalId":11489,"journal":{"name":"Drugs & Aging","volume":" ","pages":"183-193"},"PeriodicalIF":3.4,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11880052/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143457160","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":"Dementia Medications and Their Association with Pain Medication Use in Medicare Beneficiaries with Alzheimer's Disease/Alzheimer's Disease-Related Dementias and Chronic Pain.","authors":"Sadaf Arefi Milani, Jordan Westra, Yong-Fang Kuo, Brian Downer, Mukaila A Raji","doi":"10.1007/s40266-025-01181-w","DOIUrl":"10.1007/s40266-025-01181-w","url":null,"abstract":"<p><strong>Introduction: </strong>Chronic pain is prevalent among older adults with Alzheimer's disease (AD) and Alzheimer's disease-related dementias (ADRD). Memantine and acetylcholinesterase inhibitors (ACHEI; donepezil, rivastigmine, and galantamine) are approved for the treatment of dementia symptoms and may also have analgesic properties. However, findings on the clinical utility of these dementia medications for chronic pain treatment are mixed, and little is known about differences in the use of pain medication according to whether an older adult with AD/ADRD is using dementia medications.</p><p><strong>Methods: </strong>We selected a 20% national sample of Medicare enrollees with a diagnosis of AD/ADRD and chronic pain in 2020. We calculated the odds of having any pain management prescription (opioids, serotonin and norepinephrine reuptake, gapapentinoids, or non-steroidal anti-inflammatory drugs), having an opioid prescription, and having a long-term (≥ 90 days) opioid prescription, by dementia medication (none, memantine, ACHEI, or memantine and ACHEI).</p><p><strong>Results: </strong>Among 103,564 patients, 5.5% received a memantine prescription, 14.4% received an ACHEI prescription, and 8.6% received a prescription for both. Over 70% of all patients had a pain management prescription. The percentage of patients who had an opioid prescription ranged from 54.5% for those without a dementia medication prescription to 44.0% for those with a prescription for both memantine and ACHEI. Similarly, the percentage of patients who had a long-term opioid prescription was highest for those without a dementia medication prescription (12.2%) and lowest for those with a prescription for both memantine and ACHEI (8.8%). Having a prescription for memantine only was associated with lower odds of any pain management prescription (odds ratio [OR]: 0.94; 95% confidence interval [CI]: 0.88-1.00; p < 0.05). Having a prescription for either memantine (OR: 0.79; 95% CI 0.75-0.84), ACHEI (OR: 0.85; 95% CI 0.82-0.89), or both (OR: 0.75; 95% CI 0.72-0.79) was associated with lower odds of having an opioid prescription (p < 0.05). Lastly, having a prescription for either memantine (OR: 0.85; 95% CI 0.77-0.94), ACHEI (OR: 0.92; 95% CI 0.86-0.98), or both (OR: 0.83; 95% CI 0.77-0.90) was associated with lower odds of having a long-term opioid prescription.</p><p><strong>Discussion: </strong>Older adults with co-occurring AD/ADRD and chronic pain who were on dementia medications had lower odds of being prescribed opioid analgesics. Memantine and ACHEIs should be explored as potential opioid-sparing medications for older adults with AD/ADRD, given their relatively safe profiles. Future studies are needed to examine repurposing dementia medications for pain treatment.</p>","PeriodicalId":11489,"journal":{"name":"Drugs & Aging","volume":" ","pages":"267-274"},"PeriodicalIF":3.4,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11880075/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143499834","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}