Drugs & Aging最新文献

{"title":"Opioids to Treat Chronic Pain in the Older Adult: A Clinical Consensus to Guarantee Safety and Avoid Adverse Events.","authors":"Hugo Ribeiro, João Rocha Neves, Paulo Roberto, Catarina Cunha Sousa, Diogo Barros, Joana Brandão Silva, Andreia Fernandes, Eduardo Dourado, Adriana Pereira, João Paulo Castro, Inês Rodrigues, Leonardo Napoleão, Mariana Fragão Marques, Marília Dourado, José Paulo Andrade","doi":"10.1007/s40266-026-01329-2","DOIUrl":"10.1007/s40266-026-01329-2","url":null,"abstract":"<p><p>Pain management in older adults presents unique challenges owing to age-related physiological changes, comorbidities, polypharmacy, and heightened vulnerability to opioid-related adverse effects. This consensus review synthesizes current evidence and expert opinion on the safe and effective use of opioids in older adult patients. A multidisciplinary panel reviewed the literature, addressing the mechanisms of action of opioids, pharmacokinetic characteristics, routes of administration, pharmacology of aging, and distinctions in opioid use for cancer pain versus noncancer pain. Recommendations were developed through iterative consensus. Opioids produce analgesia primarily via μ, κ, δ opioid receptor agonism and nonclassical nociception. The receptor selectivity influences efficacy and side effect profiles. Age-related alterations, such as reduced renal and hepatic clearance, decreased lean body mass, increased body fat, and changes in protein binding, affect absorption, distribution, metabolism, and elimination, requiring dose adjustments and extended dosing intervals. The choice of route of administration (oral, transdermal, parenteral, epidural) should be based on initial needs, adherence to treatment, gastrointestinal function, and skin integrity. In older adult patients, opioid selection should be carefully considered, giving preference to agents with inactive metabolites or predictable clearance, and with conservative initial doses (\"start low, go slow\"), regular reassessment and proactive management of side effects, such as constipation, cognitive effects, and fall risk, are essential. For cancer pain, prioritizing potent opioids with transdermal administration for fixed-dose medication and ultrarapid acting fentanyl in pro re nata for the control of sudden pain is usually appropriate. Nevertheless, the target is the multimodal pharmacological treatment; for chronic noncancer pain, greater emphasis on therapy directed at the pathophysiology of pain, risk-benefit assessment, and time-limited use of opioids are strategic actions. Individualized opioid prescriptions in older adults, guided by pharmacologic principles, route-specific considerations, and differentiated approaches for cancer pain versus noncancer pain, optimize analgesia while minimizing harm. Further research should target age-specific dosing algorithms and long-term outcomes.</p>","PeriodicalId":11489,"journal":{"name":"Drugs & Aging","volume":" ","pages":"817-836"},"PeriodicalIF":4.2,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13582386/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148789566","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":"Influence of Ageing on the Pharmacology, Efficacy and Safety of Oral Targeted Therapies for Inflammatory Bowel Disease: Focus on Janus Kinase (JAK) Inhibitors and Sphingosine-1-Phosphate (S1P) Receptor Modulators.","authors":"Luc J J Derijks, Fatma Karapinar-Çarkit, Zlatan Mujagić, Rob J van Marum, Marieke J Pierik","doi":"10.1007/s40266-026-01321-w","DOIUrl":"10.1007/s40266-026-01321-w","url":null,"abstract":"<p><p>Older adults represent a rapidly expanding subgroup of patients with inflammatory bowel disease, yet they remain markedly under-represented in pivotal clinical trials, limiting age-specific estimates of drug benefit and harm. This review synthesises the available evidence on the influence of ageing on the pharmacology, efficacy and safety of orally administered targeted inflammatory bowel disease therapies, focusing on registered Janus kinase inhibitors (tofacitinib, upadacitinib, filgotinib) and sphingosine-1-phosphate receptor modulators (ozanimod, etrasimod). Because the available age-stratified evidence is sparse and heterogeneous, a narrative review methodology was chosen to map the literature and identify knowledge gaps. We pragmatically report age-related findings using the age cut-offs applied in original studies and map outcomes including clinical and endoscopic response/remission, corticosteroid sparing and adverse drug events of special interest (serious/opportunistic infections, cardiovascular and thromboembolic events, malignancies and treatment discontinuation). Across the limited age-stratified datasets, efficacy appears largely maintained in older patients, but the evidence base is heterogeneous and frequently lacks dedicated analyses. Ageing-related physiological changes, comorbidity, frailty and polypharmacy are expected to modulate pharmacokinetic and pharmacodynamic variability and to amplify the clinical relevance of class-specific safety concerns, particularly infections, major adverse cardiovascular events and malignancy signals with Janus kinase inhibition and initiation-related cardiovascular/conduction considerations with sphingosine-1-phosphate modulation. There is, however, no clear consensus on how ageing-related vulnerability, including frailty and comorbidity burden, should be defined, measured, and reported across studies, which complicates the interpretation and comparison of outcomes. In the absence of robust outcome data for older adults with inflammatory bowel disease, treatment selection should be guided by biological vulnerability (frailty, organ function, comorbidity burden) and structured risk-mitigation strategies, while future research should prioritise age- and frailty-enriched prospective studies with geriatric-relevant outcomes and long-term pharmacovigilance.</p>","PeriodicalId":11489,"journal":{"name":"Drugs & Aging","volume":" ","pages":"791-815"},"PeriodicalIF":4.2,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13582079/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148905405","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":"Drug Utilisation of Fall-Risk-Increasing Drugs (FRIDs) and Risk of Hospitalisation: A Nested Case-Control Study Among Community-Dwelling Older Adults.","authors":"Lara Perrella, Elena Olmastroni, Sara Mucherino, Andrea Rossi, Valentina Orlando, Manuela Casula, Enrica Menditto","doi":"10.1007/s40266-026-01312-x","DOIUrl":"10.1007/s40266-026-01312-x","url":null,"abstract":"<p><strong>Background: </strong>Falls are a leading cause of hospitalisation among older adults, with substantial impacts on quality of life and healthcare costs. Fall-risk-increasing drugs represent an important risk factor.</p><p><strong>Objective: </strong>This study aimed to evaluate the association between fall-risk-increasing drug use and the risk of fall-related hospitalisation.</p><p><strong>Methods: </strong>A nested case-control study was conducted using administrative healthcare data from a sample of Italian community-dwelling older adults. Cases included individuals aged ≥65 years hospitalised for fall-related injuries in 2018, matched 1:1 by sex and age with controls who had no fall-related injuries. Fall-risk-increasing drug exposure was assessed by drug class, duration and recency of use. Adjusted odds ratios (aORs) were estimated using logistic regression, controlling for polypharmacy and comorbidities.</p><p><strong>Results: </strong>Among 16,118 cases and 16,118 controls (68.77% female, mean age 79.76 years), cases showed a higher prevalence of polypharmacy (five to nine drugs: 42.03 vs 37.16%; ten or more drugs: 7.02 vs 5.44%; p < 0.0001) and multimorbidity (three or more diseases: 6.42 vs 2.82%; p < 0.0001). Fall-risk-increasing drug use was higher in cases (37.70 vs 26.49%, p < 0.0001), with a 51% increased risk of fall-related hospitalisation (aOR 1.51, 95% confidence interval [CI] 1.44-1.59). Opioids (aOR 1.40, 95% CI 1.31-1.50) and antidepressants (aOR 1.45, 95% CI 1.36-1.54) were associated with the highest risk. Prolonged fall-risk-increasing drug exposure (>9 months; aOR 1.69, 95% CI 1.57-1.83) and current exposure (within 30 days before hospitalisation; aOR 1.78, 95% CI 1.68-1.89) showed higher odds.</p><p><strong>Conclusions: </strong>Fall-risk-increasing drug use was associated with a higher risk of fall-related hospitalisations in older adults. These findings support the importance of optimising prescribing and managing polypharmacy as potential strategies to improve patient safety and reduce the healthcare burden.</p>","PeriodicalId":11489,"journal":{"name":"Drugs & Aging","volume":" ","pages":"745-754"},"PeriodicalIF":4.2,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13427996/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148316321","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":"Caring for Older Adults with Acute Myeloid Leukemia: Best Practices for Aligning Patient Fitness and Preference with Available Therapies.","authors":"Stephanie Franco, Christopher Wanjiku, Daniel R Richardson","doi":"10.1007/s40266-026-01318-5","DOIUrl":"10.1007/s40266-026-01318-5","url":null,"abstract":"<p><p>Major advances in drug development and supportive care have led to a paradigm shift in the management of many of the aspects of clinical care for older adults with acute myeloid leukemia. The development of validated geriatric assessments now enable clinicians to personalize treatment recommendations based on function, frailty, and fitness. The emergence of novel theory-driven methods to capture patient preferences has further enabled clinical teams to personalize therapy recommendations to what matters most to patients. Despite increasing excitement in the field created by the introduction of these new therapies and supportive care interventions, outcomes for older adults with acute myeloid leukemia remain very poor. Even with the best available therapies, median survival for most older adults is tragically short at around 15 months. Five-year survival for adults over the age of 75 years is profoundly low, below 10%. For many patients, current therapies fail to dramatically extend life or improve the quality of life. These stark realities must inform clinical decision making and fuel further research. This review critically examines current treatment options including recently approved targeted agents in the upfront and relapsed setting including FLT3 inhibitors, isocitrate dehydrogenase 1/2 inhibitors, and the newly approved menin inhibitors. We review the use of geriatric assessments and validated screening tools to characterize patient fitness and frailty beyond clinician-graded measures. We also introduce theory-driven preference assessments that are increasingly being used to capture patient treatment outcome priorities.</p>","PeriodicalId":11489,"journal":{"name":"Drugs & Aging","volume":" ","pages":"675-691"},"PeriodicalIF":4.2,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148590968","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":"Impact of Age on Bleeding, Stroke, and Mortality in Edoxaban-Treated Patients with Atrial Fibrillation: Results from the ETAF-TR Registry.","authors":"Oğuzhan Çelik, Ozcan Basaran, Turhan Turan, Selim Kul, Ugur Onsel Turk","doi":"10.1007/s40266-026-01319-4","DOIUrl":"10.1007/s40266-026-01319-4","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Data on age-specific outcomes in patients with atrial fibrillation (AF) treated with edoxaban in real-world settings are limited; this prespecified analysis of the ETAF-TR study aimed to investigate the influence of age on prespecified clinical outcomes, including overt bleeding, major bleeding, ischemic stroke, all-cause mortality, major adverse cardiovascular events (MACE), and net clinical benefit.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;The ETAF-TR study is a prospective, multicenter, observational registry conducted at 50 cardiology clinics across Türkiye. Patients with AF receiving edoxaban (60 mg standard dose or 30 mg reduced dose) were categorized into three age groups: &lt; 65 years (n = 265), 65-74 years (n = 397), and ≥ 75 years (n = 391). Time-to-event outcomes were analyzed using the Kaplan-Meier method and unadjusted Cox proportional hazards models, with the &lt; 65-year age group as the reference.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Of 1053 enrolled patients, 25.1% were aged &lt; 65 years, 37.7% were aged 65-74 years, and 37.1% were aged ≥ 75 years. Older patients had higher Congestive heart failure, Hypertension, Age ≥75, Diabetes, Stroke, Vascular disease, Age 65-74, Sex category (female) (CHA₂DS₂-VASc) and Hypertension, Abnormal renal/liver function, Stroke, Bleeding history, Labile INR, Elderly, Drugs or Alcohol (HAS-BLED) scores, lower creatinine clearance, and more frequent use of reduced-dose edoxaban. Appropriate edoxaban dosing was documented in 82.2% of patients; 8.0% received an inappropriately low dose and 9.8% an inappropriately high dose. Nonsteroidal antiinflammatory drug (NSAID) use was observed in 8.7%, 5.3%, and 10.2% of patients in the &lt; 65, 65-74, and ≥ 75 groups, respectively, and approximately 12% received concomitant antiplatelet therapy without a documented indication. Major bleeding rates were 0.94, 1.20, and 1.13 per 100 patient-years in the &lt; 65, 65-74, and ≥ 75 groups, respectively. Thromboembolic event rates were 0.38, 0.26, and 1.88 per 100 patient-years, respectively. All-cause mortality increased with age: 2.54, 4.34, and 10.84 per 100 patient-years, respectively; the unadjusted hazard ratio for ≥ 75 versus &lt; 65 years was 4.04 (95% CI 1.69-9.65). Of 56 deaths, 10 (17.9%) were attributed to coronavirus disease 2019 (COVID-19) pneumonia, whereas one death was attributed to ischemic stroke and none to major bleeding. Prespecified descriptive secondary composites, including major adverse cardiovascular events and net clinical benefit, were also higher in the ≥ 75 group.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;In this real-world cohort of patients with AF treated with edoxaban, major bleeding rates remained consistent across age groups despite an increased comorbidity burden in older patients. Thromboembolic or hemorrhagic events could not account for the excess mortality observed in the ≥ 75 age group; instead, higher comorbidity burdens and the ongoing COVID-19 pandemic may have played contribut","PeriodicalId":11489,"journal":{"name":"Drugs & Aging","volume":" ","pages":"721-732"},"PeriodicalIF":4.2,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148444332","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":"The Association Between Anticholinergic Burden and Treatment-Related Complications in Older Adults with Cancer.","authors":"Edwin J Brokaar, Stella Trompet, Johanneke E A Portielje, Loes E Visser, Simon P Mooijaart, Anna Uit den Boogaard, Joosje C Baltussen, Yara van Holstein, Frederiek van den Bos","doi":"10.1007/s40266-026-01316-7","DOIUrl":"10.1007/s40266-026-01316-7","url":null,"abstract":"<p><strong>Background: </strong>Older adults constitute more than 50% of newly diagnosed cancer cases and polypharmacy is highly prevalent in this population. The Anticholinergic Burden (ACB) score quantifies the cumulative anticholinergic effects of all medications. Few studies link high ACB to adverse health outcomes in this population, and its effect on treatment outcomes remains largely unknown.</p><p><strong>Objective: </strong>This study investigates the association between the ACB-score and treatment-related toxicity (grade ≥ 3), functional decline, and emergency room (ER) visits or hospitalization in older adults with cancer receiving chemotherapy and/or targeted therapy.</p><p><strong>Method: </strong>Data from the Triage of Elderly Needing Treatment study were used and patients aged ≥ 70 years were included before start of chemotherapy and/or targeted therapy. Medication use was used to calculate the ACB score; ACB ≥ 3 was defined as high. The primary outcome was the association between ACB score and grade ≥ 3 toxicity. Associations were analyzed using univariable and multivariable logistic regression.</p><p><strong>Results: </strong>434 patients were included with a median age of 75.4 years; 56% were male and 15% had a high ACB-score. Grade ≥ 3 toxicity occurred more frequently in the high ACB group (OR 2.04, p = 0.013). In the multivariable model, ACB score and frailty were associated with grade ≥ 3 toxicity (OR 1.99, p = 0.022 and OR 1.79, p = 0.007).</p><p><strong>Conclusions: </strong>High ACB is associated with poorer outcomes in older adults with cancer in addition to the known risk for toxicity of frailty.</p>","PeriodicalId":11489,"journal":{"name":"Drugs & Aging","volume":" ","pages":"733-743"},"PeriodicalIF":4.2,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13427958/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148560847","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":"Gabapentinoid Use and Risk of Alzheimer's Disease-Related Dementias: A Systematic Review and Meta-analysis of Observational Studies.","authors":"Anderson Matheus Pereira da Silva, Marianna Leite, Giovana Menegucci, Maria Fernanda Liphaus Almeida Negreli, Maria Eduarda Scheffer Valverde, Isabelle Rodrigues Menezes, Ocilio Ribeiro Gonçalves, Jorge Dornellys da Silva Lapa, Gustavo Noleto, Diogo Haddad Santos, Filipe Silveira Duarte, George Perry, Eryvelton de Souza Franco, Maria Bernadete de Sousa Maia","doi":"10.1007/s40266-026-01310-z","DOIUrl":"10.1007/s40266-026-01310-z","url":null,"abstract":"<p><strong>Background and objective: </strong>Gabapentinoids, particularly gabapentin and pregabalin, are widely prescribed for neuropathic pain and other chronic conditions, including in populations at risk for cognitive decline. Their long-term cognitive safety and potential association with Alzheimer's disease and related dementias (ADRD) remain uncertain. We examined whether gabapentinoid use is associated with ADRD risk and assessed between-study heterogeneity and potential study-level modifiers.</p><p><strong>Methods: </strong>PubMed, Embase, and the Cochrane Library were searched from inception through November 2025. We included observational studies comparing gabapentinoid users with non-users or non-gabapentinoid comparators and reporting incident ADRD. Risk of bias was assessed using ROBINS-E. A random-effects meta-analysis was performed using odds ratios. Subgroup and meta-regression analyses explored study-level modifiers. Certainty of evidence was assessed using GRADE (Grading of Recommendations Assessment, Development and Evaluation). The protocol was registered in PROSPERO (CRD420251240055).</p><p><strong>Results: </strong>Five observational studies (325,245 participants) were included. Gabapentinoid use was associated with modestly higher estimated odds of ADRD (odds ratio, 1.28; 95% confidence interval 1.10-1.50; P = 0.002), with high heterogeneity (I² = 90.3%). This association was attenuated when restricted to studies with a low risk of bias (odds ratio, 1.23; 95% confidence interval 0.83-1.84). Studies enrolling younger populations yielded larger estimates than those with older cohorts, though the subgroup difference was not statistically significant. Meta-regression identified mean age as a study-level moderator, accounting for 60.2% of between-study variance. Certainty of evidence was low overall.</p><p><strong>Conclusions: </strong>Gabapentinoid use was associated with modestly higher estimated odds of ADRD in pooled observational data. High heterogeneity, residual confounding, and confounding by indication preclude causal inference. These findings support cautious prescribing, particularly for off-label and long-term use, and underscore the need for prospective studies.</p><p><strong>Clinical trial registration: </strong>PROSPERO protocol number: CRD420251240055.</p>","PeriodicalId":11489,"journal":{"name":"Drugs & Aging","volume":" ","pages":"661-673"},"PeriodicalIF":4.2,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148293974","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":"Pharmacologic Treatment for Obstructive Sleep Apnea in Older Adults.","authors":"Nikhil Jaganathan, David Brower, William J Healy","doi":"10.1007/s40266-026-01311-y","DOIUrl":"10.1007/s40266-026-01311-y","url":null,"abstract":"<p><p>Older individuals frequently suffer from obstructive sleep apnea yet present with less severe symptoms than younger counterparts. Diagnosing obstructive sleep apnea in older adults poses unexpected challenges owing to poor specificity of screening tools and difficulty attending polysomnography. Continuous positive air pressure remains recommended, although its benefits in this population are not clear and many patients refuse to even attempt the therapy. Emerging research regarding the pathophysiology of obstructive sleep apnea has facilitated greater understanding of potential pharmacologic targets. Pharmacotherapy for obstructive sleep apnea is multifaceted with unique mechanisms, varying efficacy, and considerations for safety and tolerability. Glucagon-like peptide-1 receptor agonists have yielded well-tolerated positive results in obstructive sleep apnea by facilitating reduced upper airway adiposity, with tirzepatide demonstrating improvements in hypoxic burden, apnea-hypopnea index and sleep outcomes. Noradrenergic-antimuscarinic combinations have demonstrated significant reductions in the apnea-hypopnea index and improved oxygen saturations through increased pharyngeal dilator tone, although these agents present high-risk anticholinergic side effects in older patients. Serotonergic and cholinergic agents may promote increased pharyngeal muscle tone, but studies are limited by small samples, methodology, and conflicting results. Sedative-hypnotics may improve sleep quality or arousal threshold but present risks of central nervous system depression in older adults. The carbonic anhydrase inhibitor sulthiame has demonstrated dose-dependent improvements in obstructive sleep apnea severity with well-tolerated outcomes. Ultimately, older patients have unique diagnostic and management considerations, warranting further study of obstructive sleep apnea pharmacotherapy to assess age-specific efficacy and outcomes.</p>","PeriodicalId":11489,"journal":{"name":"Drugs & Aging","volume":" ","pages":"693-706"},"PeriodicalIF":4.2,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148419718","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":"Bipolar Disorder in Older Adults: A Comprehensive Overview of Pharmacotherapy Patterns and Clinical Considerations.","authors":"Bashar Asir, Majd Al-Soleiti, Balwinder Singh","doi":"10.1007/s40266-026-01315-8","DOIUrl":"10.1007/s40266-026-01315-8","url":null,"abstract":"<p><p>In older adults, bipolar disorder (BD) frequently presents atypically, with manic symptoms manifesting as irritability or confusion rather than euphoria. Cognitive impairments, including mild cognitive impairment and dementia, can obscure or mimic bipolar symptoms, complicating accurate diagnosis. Depressive episodes tend to be more frequent and prolonged, increasing misdiagnosis risk as unipolar depression. Pharmacological management requires careful consideration of age-related pharmacokinetic and pharmacodynamic alterations. Mood stabilizers including lithium, valproate, and lamotrigine are commonly employed but necessitate vigilant monitoring for adverse effects and drug interactions. Atypical antipsychotics such as quetiapine and aripiprazole are generally preferred for their tolerability profiles, though comorbidity burden and polypharmacy substantially elevate risks of adverse drug reactions and interactions. Late-onset and early onset bipolar disorder in older adults (LOBD and EOBD) represent clinically relevant subgroups with differing diagnostic considerations. However, current evidence does not clearly support major differences in pharmacologic management. The purpose of this narrative review is to address this gap by comprehensively exploring the clinical presentations and diagnostic challenges in older-age BD (OABD) as well as the pharmacological treatment patterns worldwide. We also outlined clinically focused synthesis of special considerations and tailored approaches, and finally critically appraise the literature to determine future directions and research needs. Addressing the multifaceted diagnostic and pharmacotherapeutic challenges of OABD through dedicated age-specific clinical trials, comparative effectiveness studies, systematic evaluation of deprescribing strategies, and enhanced clinician awareness will be fundamental to improve outcomes for this understudied and expanding population.</p>","PeriodicalId":11489,"journal":{"name":"Drugs & Aging","volume":" ","pages":"707-720"},"PeriodicalIF":4.2,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148469591","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":"Correction: Guideline-Directed Heart Failure Pharmacotherapy in Adults Aged ≥75 Years: Evidence Gaps, Tolerability, and Implications for Clinical Practice.","authors":"Rémi Esser, Olivier Maurou, Marine Larbaneix, Alejandro Mondragon, Marlène Esteban, Christine Farges, Vincenzo Palermo, Nicolas Pages, Sophie Nisse Durgeat, Marc Harboun","doi":"10.1007/s40266-026-01308-7","DOIUrl":"10.1007/s40266-026-01308-7","url":null,"abstract":"","PeriodicalId":11489,"journal":{"name":"Drugs & Aging","volume":" ","pages":"657-659"},"PeriodicalIF":4.2,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148390210","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}