Drugs & Aging最新文献

{"title":"Pharmacological Pain Treatment in Older Persons.","authors":"Gisèle Pickering, Aleksandra Kotlińska-Lemieszek, Nevenka Krcevski Skvarc, Denis O'Mahony, Fiammetta Monacelli, Roger Knaggs, Véronique Morel, Magdalena Kocot-Kępska","doi":"10.1007/s40266-024-01151-8","DOIUrl":"10.1007/s40266-024-01151-8","url":null,"abstract":"<p><p>Pharmacological pain treatment in older persons is presented by a multi-disciplinary group of European pain experts. Drugs recommended for acute or chronic nociceptive pain, also for neuropathic pain and the routes of administration of choice are the same as those prescribed for younger persons but comorbidities and polypharmacy in older persons increase the risk of adverse effects and drug interactions. Not all drugs are available or authorised in all European countries. For mild-to-moderate pain, non-opioids including paracetamol and non-steroidal anti-inflammatory drugs are first-line treatments, followed by nefopam and metamizole. Codeine, dihydrocodeine and tramadol are prescribed for moderate to severe pain and 'strong' opioids, including morphine, hydromorphone, oxycodone, fentanyl, buprenorphine, methadone and tapentadol, for severe pain. Chronic neuropathic pain treatment relies on coanalgesics, including anti-epileptics (gabapentinoids) and anti-depressants with additional option of topical lidocaine and capsaicine. The choice of analgesic(s) and the route of administration should be guided by the pain characteristics, as well as by the patient's comorbidities, organ function and medications. Several directions have been highlighted to optimise pharmacological pain management in older individuals: (1) before starting pain treatment adequately detect and assess pain and always perform a full geriatric assessment, (2) consider kidney function systematically to adjust the doses of analgesics and avoid the risks of overdose, (3) start with the lowest dose of an analgesic and increase it gradually under the control of the effect, (4) involve the older persons and family in their treatment, (5) reevaluate pain regularly during treatment and (6) combine pharmacological treatment with non-pharmacological approaches.</p>","PeriodicalId":11489,"journal":{"name":"Drugs & Aging","volume":" ","pages":"959-976"},"PeriodicalIF":3.4,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11634925/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142497075","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":"Considerations for Anesthesia in Older Adults with Cannabis Use.","authors":"Elena Ahrens, Luca J Wachtendorf, Kevin P Hill, Maximilian S Schaefer","doi":"10.1007/s40266-024-01161-6","DOIUrl":"10.1007/s40266-024-01161-6","url":null,"abstract":"<p><p>Over the past decade, legislative changes occurred in the USA and the western world that were followed by a substantial increase in reported use of cannabis among the general population. Among patients undergoing anesthesia for surgery or interventional procedures, older patients-often defined as adults over 65 years-are one of the fastest-growing populations. Within this group, the prevalence of cannabis use almost tripled over the past decade. In addition to habitual cannabis use, recommendations for treatment of chronic pain with cannabinoids have become increasingly more common. The clinical relevance of cannabis use in older adults is supported by recent studies linking it to increased anesthetic requirements as well as respiratory, cardiovascular, and psychiatric complications following surgery. Still, evidence remains equivocal, as these associations may largely depend on the type, frequency, and route of cannabis administration, and current research is mostly limited to retrospective cohort studies. Multisystemic effects of cannabis can become especially relevant in patients of advanced age undergoing anesthesia, characterized by physiological and pharmacodynamic alterations as well as a higher risks of drug-to-drug interactions. Best-practice guidelines emphasize the need for detailed, systematic preoperative screening for habits of cannabis use, including the history, type, and frequency, to guide perioperative management in these patients. This review discusses considerations for anesthesia in older patients with habitual cannabis use while highlighting strategies and recommendations to ensure safe and effective anesthesia care.</p>","PeriodicalId":11489,"journal":{"name":"Drugs & Aging","volume":" ","pages":"933-943"},"PeriodicalIF":3.4,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142767416","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":"Development of a Frailty Screening Tool Using Electronic Community Pharmacy Records.","authors":"Marie Carrein, Els Mehuys, Lies Lahousse, Mirko Petrovic, Ellen Van Leeuwen, Inge Van Tongelen, Eline Tommelein, Koen Boussery","doi":"10.1007/s40266-024-01160-7","DOIUrl":"10.1007/s40266-024-01160-7","url":null,"abstract":"<p><strong>Background: </strong>Frailty is associated with increased susceptibility to medication-related harm, highlighting the importance of medication review for frail older adults. Community pharmacists are increasingly involved in the initiation of medication reviews. Yet, current frailty measurement methods are impractical in this setting. Alternative approaches, leveraging routinely collected data, are needed.</p><p><strong>Objective: </strong>To develop a frailty screening tool utilising routine electronic pharmacy records.</p><p><strong>Methods: </strong>Community-dwelling older adults (≥ 70 years) using ≥ 5 chronic medications were recruited in 196 Belgian community pharmacies. Frailty was assessed using SHARE-FI75+ (based on Fried's frailty phenotype). Model development was on the basis of a two-stage approach using multivariable logistic regression with split-sample internal validation. Stage 1 considered only electronic pharmacy record variables, while stage 2 also included other variables that can easily be collected in the community pharmacy. Model performance was evaluated for discrimination, calibration and predictive accuracy.</p><p><strong>Results: </strong>We recruited 875 participants [mean ± standard deviation (SD) age 79.3 ± 5.9 years], with 14.8% identified as frail. At stage 1, the frailty screening model included age, sex, reimbursement level of medical expenses, number of chronic medications and medication-derived comorbidities (anxiety, congestive heart failure, hypertension) [area under the receiver operating characteristic curve (AUC) 0.77, 95% confidence interval (CI) 0.69-0.85; sensitivity 78.0%; specificity 60.1%]. At stage 2, additional information on difficulties with basic activities of daily living or pharmacist's intuitive frailty assessment further improved the model (AUC 0.81, 95% CI 0.74-0.88 and AUC 0.82, 95% CI 0.75-0.89, respectively).</p><p><strong>Conclusions: </strong>We developed a screening tool for frailty using data from electronic pharmacy records. This tool offers the opportunity for frailty screening in community pharmacy and to identify individuals that may benefit the most from medication review. External validation is warranted.</p>","PeriodicalId":11489,"journal":{"name":"Drugs & Aging","volume":" ","pages":"989-1001"},"PeriodicalIF":3.4,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142695263","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":"Assessing Frailty-Specific Treatment Effect in Cardiovascular Disease: A Systematic Review.","authors":"Lily Zhong, Saran Thanapluetiwong, Kailin Xu, Darae Ko, Dae Hyun Kim","doi":"10.1007/s40266-024-01157-2","DOIUrl":"10.1007/s40266-024-01157-2","url":null,"abstract":"<p><strong>Background: </strong>Clinicians are increasingly considering using frailty assessments to individualize treatment for older patients. It remains uncertain whether interventions to reduce cardiovascular disease (CVD) events offer similar benefits between older adults with and without frailty.</p><p><strong>Methods: </strong>A systematic literature search was undertaken in PubMed and Embase, adhering to PRISMA guidelines. Key inclusion criteria were randomized controlled trials published between January 2007 and September 2024 with CVD outcomes as an endpoint and data on frailty-specific treatment effects. Data were collected for population characteristics, intervention, follow-up time, frailty measure, outcome rates, and frailty subgroup treatment effect. Due to heterogeneity among the studies, the results were not pooled.</p><p><strong>Results: </strong>The search identified 151 unique studies, of which 18 were included. Using Cochrane Risk of Bias 2.0, 12 out of the 18 studies have low risk of bias. The intervention was more effective in frail participants than in non-frail counterparts in two studies (e.g., aerobic exercise), less effective in frail participants in three studies (e.g., intensive lifestyle intervention), similarly effective across frailty levels in seven studies (e.g., prasugrel), and inconclusive in six studies (e.g., edoxaban). Some treatments were similarly effective across frailty level by hazard ratio but had a greater reduction in absolute risk for frail versus non-frail patients.</p><p><strong>Conclusions: </strong>Cardiovascular interventions may provide differential benefits by patients' frailty. These findings suggest the potential utility of frailty assessment for optimizing cardiovascular interventions.</p>","PeriodicalId":11489,"journal":{"name":"Drugs & Aging","volume":" ","pages":"945-958"},"PeriodicalIF":3.4,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142709491","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":"Exploring Sex, Gender, and Gender-Related Sociocultural Factors in Clinical Decision-Making for Older Adults Using a Prescribing Cascade Vignette: A Transnational Qualitative Study.","authors":"Altea Kthupi, Paula A Rochon, Sara Santini, Luca Paoletti, Robin Mason, Lisa M McCarthy, Barbara Carrieri, Kieran Dalton, Joyce Li, Kawsika Sivayoganathan, Parya Borhani, Shelley A Sternberg, Donna R Zwas, Rachel D Savage","doi":"10.1007/s40266-024-01158-1","DOIUrl":"10.1007/s40266-024-01158-1","url":null,"abstract":"<p><strong>Background: </strong>Despite growing awareness of sex differences in inappropriate prescribing among older adults, including the initiation of problematic prescribing cascades, the impact of gender bias remains largely unexplored.</p><p><strong>Objectives: </strong>We explored how a patient's sex and gender-related sociocultural factors influence physicians' prescribing decisions, potentially leading to prescribing cascades in older adults. A secondary objective was to explore whether and how physician sex affected prescribing decisions for female and male patients.</p><p><strong>Methods: </strong>Physicians in Canada and Italy were presented with a clinical vignette describing an older male or female patient on amlodipine presenting with peripheral edema. Physicians were interviewed using the 'think-aloud' method to describe their treatment considerations. Thematic multi-site analysis was used to analyze the data.</p><p><strong>Results: </strong>Of 30 physicians, only two considered prescribing a diuretic for an older female patient. Most physicians identified amlodipine as the cause of the edema and adjusted or substituted the medication, often making these treatment decisions without considering sex- and gender-related sociocultural factors. When prompted, physicians acknowledged the relevance of these factors, but their responses varied. Some adapted their treatment plans, noting the challenges of managing edema, particularly for female patients, whereas others did not incorporate these considerations. Interestingly, some physicians adjusted their plans based on gender-related factors yet still stated that gender did not influence their treatment decisions. No variations in treatment decisions based on physician sex were observed.</p><p><strong>Conclusion: </strong>The study reveals a gap between physicians' recognition of gender-related sociocultural factors and their consistent integration into clinical decision-making, highlighting the need for more nuanced approaches in prescribing practices.</p>","PeriodicalId":11489,"journal":{"name":"Drugs & Aging","volume":" ","pages":"977-988"},"PeriodicalIF":3.4,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142727085","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":"Acknowledgement to Referees.","authors":"","doi":"10.1007/s40266-024-01162-5","DOIUrl":"https://doi.org/10.1007/s40266-024-01162-5","url":null,"abstract":"","PeriodicalId":11489,"journal":{"name":"Drugs & Aging","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2024-11-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142616736","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":"Minimising Harm and Managing Pain: Deprescribing Opioids in Older Adults.","authors":"Aili V Langford, Carl R Schneider, Emily Reeve, Danijela Gnjidic","doi":"10.1007/s40266-024-01154-5","DOIUrl":"10.1007/s40266-024-01154-5","url":null,"abstract":"<p><p>Approximately one in three older adults (aged 65 years and over) experience pain, negatively impacting their quality of life. Opioid analgesics are commonly prescribed to manage pain; however, balancing the benefits and harms of these high-risk analgesics can be challenging for both healthcare professionals and patients. This is particularly true for older adults, as factors such as polypharmacy, age-related physiological changes and cognitive decline may impact upon opioid safety and efficacy. Deprescribing is the patient-centred process of reducing or discontinuing a medication that is no longer appropriate, or where the risks of continuation are deemed to outweigh the anticipated benefits. Opioid deprescribing has been proposed as a mechanism to reduce individual and societal opioid-related harm; however, to date, research has predominantly focused on the general adult population, rather than older adults. This current opinion aims to summarise the existing opioid deprescribing literature, discussing its applicability for older adults. Drawing on a non-systematic review of the literature, it identifies unique challenges and considerations for this population, highlights international initiatives to enhance opioid deprescribing in clinical practice and proposes future directions to advance the field.</p>","PeriodicalId":11489,"journal":{"name":"Drugs & Aging","volume":" ","pages":"863-871"},"PeriodicalIF":3.4,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11554919/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142521366","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":"Pilocarpine in the Treatment of Presbyopia: Progress, Issues, and Future Prospects.","authors":"Xiuwen Zhang, Xiaomei Xiong, Haixin Zhang, Taomin Huang, Xingtao Zhou","doi":"10.1007/s40266-024-01155-4","DOIUrl":"10.1007/s40266-024-01155-4","url":null,"abstract":"<p><p>Presbyopia is a common age-related visual impairment. With the aging of the population, the incidence of presbyopia is increasing globally, becoming a worldwide public health concern. Treatment options for presbyopia include optical lens correction, surgical intervention, and pharmacological therapy. Pharmacological treatments for presbyopia are non-invasive, reversible, and have emerged over the past decade. Following the US Food and Drug Administration's approval of 1.25% pilocarpine for presbyopia, the use of pilocarpine and its compound formulations has gained increased attention, with some drugs entering clinical phase II/III trials ( www.clinicaltrials.gov ). Therefore, this article primarily describes and analyzes the progress of research on the use of pilocarpine and its compound formulations for presbyopia, as well as the challenges that remain to be addressed. The optimal dosage form, the optimal concentration, the long-term safety, and patient compliance should be further explored, and there is a lack of multi-center evidence-based medicine research to support it. The aim of this article is to provide a reference for researchers to conduct further in-depth investigations in this area.</p>","PeriodicalId":11489,"journal":{"name":"Drugs & Aging","volume":" ","pages":"897-906"},"PeriodicalIF":3.4,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142497076","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":"Efficacy and Safety of Fixed-Dose Combinations for Pain in Older Adults.","authors":"Qianpian Zhang, Diana Xin Hui Chan, Kok-Yuen Ho","doi":"10.1007/s40266-024-01156-3","DOIUrl":"10.1007/s40266-024-01156-3","url":null,"abstract":"<p><p>Pain is common in older adults and managing pain in this population can be challenging owing to altered pharmacokinetics, multimorbidity, polypharmacy, cognitive impairment, and physical frailty. A fixed-dose combination (FDC) analgesic contains two or more pharmaceutical ingredients in a single pill and may offer more benefits when compared with loose-dose formulations. The benefits include reduced pill burden and better adherence, a broader analgesic spectrum well-suited to multimechanistic pain conditions and more predictable pharmacokinetic and pharmacodynamic properties. These advantages may outweigh disadvantages such as reduced flexibility in dose adjustment. Most of the commonly used FDC analgesics are made up of a combination of paracetamol, muscle relaxant, nonsteroidal anti-inflammatory drug or opioid. They have been shown to have better efficacy and similar safety profiles compared with individual drugs. Adverse effects from the use of FDC analgesics in older patients were comparable with that observed in younger populations. With proper patient selection and continuous surveillance, FDC analgesics will likely benefit older adults by simplifying dosing regimen and improving compliance.</p>","PeriodicalId":11489,"journal":{"name":"Drugs & Aging","volume":" ","pages":"873-879"},"PeriodicalIF":3.4,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142497074","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":"Pharmacological Treatment of Obesity in Older Adults.","authors":"Ondřej Žižka, Martin Haluzík, Edward B Jude","doi":"10.1007/s40266-024-01150-9","DOIUrl":"10.1007/s40266-024-01150-9","url":null,"abstract":"<p><p>Obesity is a complex health issue with growing prevalence worldwide. It is also becoming more prevalent in the population of older adults (i.e., 65 years of age and older), affecting frequency and severity as well as other comorbidities, quality of life and consequently, life expectancy. In this article we review currently available data on pharmacotherapy of obesity in the population of older adults and its role in obesity management. Even though there is growing evidence, in particular in the general population, of favourable efficacy and safety profiles of glucagon-like peptide-1 (GLP-1) receptor agonists liraglutide and semaglutide, and recently dual GLP-1 and glucose-dependent insulinotropic polypeptide (GIP) agonist tirzepatide, concise guidelines for older adults are not available to this day. We further discuss specific approaches to frequently represented phenotype of obesity in older adults, in particular sarcopenic obesity and rationale when to treat and how. In older adults with obesity there is a need for more drug trials focusing not only on weight loss, but also on geriatric endpoints including muscle mass preservation, bone quality and favourable fat distribution changes to get enough data for evidence-based recommendation on obesity treatment in this growing sub-population.</p>","PeriodicalId":11489,"journal":{"name":"Drugs & Aging","volume":"41 11","pages":"881-896"},"PeriodicalIF":3.4,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11554829/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142603842","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}