Drugs & Aging最新文献

{"title":"Attitudes Toward Deprescribing Among Community-Dwelling Adults: A Cross-Sectional Study in Community Pharmacies.","authors":"Elodie Marcellaud, Tassadit Merabtine, Jérémy Couturas, Zeinab Tarhini, Hugo Célèrier, Simon Ageorges, Préscillia Alves Gomes, Achille Tchalla, Édouard Desvaux, Jérémy Jost","doi":"10.1007/s40266-026-01298-6","DOIUrl":"10.1007/s40266-026-01298-6","url":null,"abstract":"<p><strong>Purpose: </strong>The aim of this study was to identify patient-related factors associated with attitudes toward deprescribing and to explore perceived barriers and facilitators among community-dwelling adults.</p><p><strong>Methods: </strong>A cross-sectional observational study was conducted in 60 community pharmacies across the Haute-Vienne and Dordogne regions of France. Eligible participants were adults aged ≥ 55 years, with at least one chronic condition and taking five or more chronic medications. Pharmacies were selected using a random cluster sampling method stratified by geographic area. Consecutively recruited patients completed an anonymous self-administered questionnaire assessing their attitudes toward deprescribing, perceived medication burden, and potential barriers or facilitators. Sociodemographic and clinical data were also collected. Multivariate logistic regression was used to identify factors associated with acceptance of deprescribing.</p><p><strong>Results: </strong>Among the 505 included patients (mean age 71.9 ± 9.0 years), 24.6% were reluctant to deprescribe. The main reasons for reluctance were the perceived effectiveness of their treatment (56.5%) and the fear of symptom recurrence (35.5%). Sleep disorders (odds ratio [OR] 0.51, 95% confidence interval [CI] 0.33-0.78; p = 0.002) and urinary incontinence (OR 0.58, 95% CI 0.34-0.96; p = 0.048) were significantly associated with refusal of deprescription. Perceived medication overload (OR 1.82, 95% CI 1.12-2.95; p = 0.015) and restrictive treatment burden (OR 1.76, 95% CI 1.07-2.89; p = 0.026) were significantly associated with acceptance of deprescription.</p><p><strong>Conclusion: </strong>Attitudes toward deprescribing were positive among community-dwelling adults. Medication burden was associated with acceptance, whereas sleep disorders and urinary incontinence were associated with reluctance. Patient perceptions and clinical conditions should be considered when implementing deprescribing interventions.</p>","PeriodicalId":11489,"journal":{"name":"Drugs & Aging","volume":" ","pages":"517-527"},"PeriodicalIF":4.2,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13233936/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147812320","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":"Trends in Multi-dose Drug Dispensing Amongst Older Adults in Sweden: A Nationwide Repeated Cross-Sectional Register Study, 2014-2023.","authors":"Hilary Shepherd, Kristina Johnell, Jonas W Wastesson, Máté Szilcz","doi":"10.1007/s40266-026-01304-x","DOIUrl":"10.1007/s40266-026-01304-x","url":null,"abstract":"<p><strong>Introduction: </strong>Multi-dose dispensing (MDD) is a medication management system in Sweden that pre-packages regularly used prescription medicines into unit doses. Despite widespread use, there are no recent national estimates of MDD prevalence in Sweden, and little is known about how use evolved through the coronavirus disease 2019 (COVID-19) pandemic or which patient groups account for most MDD utilisation.</p><p><strong>Objective: </strong>The purpose of this study was to describe the prevalence of multi-dose dispensing in older adults in Sweden from 2014 to 2023, spanning the COVID-19 pandemic, and describe trends by patient subgroups.</p><p><strong>Methods: </strong>We conducted a repeated cross-sectional study of older adults aged ≥ 70 years old in Sweden, 2014-2023. We used nationwide data from the Swedish Prescribed Drug Register linked at the individual level with several other administrative and healthcare registers. The primary outcome was annual period prevalence of MDD, stratified by age, sex, education level, living status, civil status, health status and geography.</p><p><strong>Results: </strong>Prevalence of MDD amongst adults aged 70 years or older increased by 1.5 percentage points between 2014 and 2023, reaching 12.1% in 2023, and there was no additional increase during the COVID-19 pandemic (2020-2022). In nursing home residents, MDD use approached near-universal levels (from 84.2 to 96.1%). Uptake also increased across other subgroups, most notably amongst people with a dementia diagnosis (+ 45.3 percentage points), those receiving home help services (+ 21.4 percentage points) and those with five or more chronic conditions (+ 15.3 percentage points). Over time, the characteristics of MDD users shifted towards community-dwelling adults receiving home help services, younger older adults (70-79 years old) and individuals with higher education.</p><p><strong>Conclusions: </strong>Our nationwide study indicates that MDD has become an established standard of medication management in Swedish nursing homes and is progressively extending into community settings amongst older adults with complex health needs. Prescribing of MDD remained stable during the COVID-19 pandemic. Future studies should quantify risks and benefits of MDD use especially in vulnerable, older, and frail populations.</p>","PeriodicalId":11489,"journal":{"name":"Drugs & Aging","volume":" ","pages":"529-541"},"PeriodicalIF":4.2,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13233645/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148137084","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":"Exploring the Link Between Pharmacological Management of Orthostatic Hypotension and Cognitive Performance: A Scoping Review.","authors":"Nathan Gould, Ga Hye Jeong, Sang Ah Lee, Jaspreet Bhangu","doi":"10.1007/s40266-026-01303-y","DOIUrl":"10.1007/s40266-026-01303-y","url":null,"abstract":"<p><strong>Background: </strong>Orthostatic hypotension is recognized as a potential contributor to cognitive impairment in older adults. It is still unknown whether pharmacological treatment of orthostatic hypotension can affect cognition.</p><p><strong>Objective: </strong>The aim of this scoping review was to identify whether treatment of orthostatic hypotension with midodrine, droxidopa, and fludrocortisone had any effect on cognitive performance.</p><p><strong>Methods: </strong>We searched the databases of Embase and MEDLINE. Key eligibility criteria included observational studies or clinical trials using midodrine, droxidopa, or fludrocortisone to treat adult patients with orthostatic hypotension with cognition assessed. Key search terms used were \"orthostatic hypotension,\" \"cognition,\" \"midodrine,\" \"fludrocortisone,\" and \"droxidopa.\" Quality assessment was performed using the LEGEND (Let Evidence Guide Every New Decision) Evidence Evaluation System. A descriptive synthesis was undertaken because of heterogeneous study designs and assessments, categorizing studies by patient population, with no statistical pooling.</p><p><strong>Results: </strong>Five studies met the criteria for the scoping review. These studies investigated midodrine, droxidopa, and fludrocortisone used individually, or in combination, to treat orthostatic hypotension. Three studies found cognitive improvements with orthostatic hypotension treatment, one found negative cognitive side effects with orthostatic hypotension medications and one study found no significant change. Three patient populations were examined in these studies: patients with dementia, patients with parkinsonism, and patients with spinal cord injury. Included studies were small, observational, and interventional and cognitive outcomes ranged from symptom-based assessments to formal neuropsychological testing.</p><p><strong>Conclusions: </strong>Limited conclusions can be drawn from these five studies because of non-standardized cognitive assessments, small sample sizes, and methodological variability. However, overall, this scoping review provides evidence that treatment of orthostatic hypotension might have a cognitive benefit in certain populations. Further observational studies and clinical trials are warranted to better elucidate whether combinations of midodrine, droxidopa, and fludrocortisone will work in specific patient populations to improve clinical outcomes.</p>","PeriodicalId":11489,"journal":{"name":"Drugs & Aging","volume":" ","pages":"495-505"},"PeriodicalIF":4.2,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148028394","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":"Potentially Inappropriate Prescription and Its Association with Index Hospitalization: A Multicenter, Cross-Sectional Study Using TIME Criteria.","authors":"Gulistan Bahat, Serdar Ozkok, Tugba Erdogan, Birkan Ilhan, Meryem Merve Oren, Duygu Erbas Sacar, Busra Can, Bahar Tekin Cetin, Timur Selcuk Akpinar, Rana Tuna Dogrul, Kamile Silay, Suna Burkuk, Meltem Halil, Fatma Erol, Sumru Savas, Sevnaz Sahin, Pinar Arman, Deniz Suna Erdincler, Emine Gemci, Sevgi Aras, Murat Varli, Melike Yazici, Suna Avci, Asli Tufan, Banu Ozulu Turkmen, Betul Gulsum Yavuz Veizi, Mehmet Ilkın Naharci, Ilker Tasci, Gozde Sengul Aycicek, Zekeriya Ulger, Funda Salgur, Huseyin Doruk, Umut Karabay, Mehmet Akif Karan","doi":"10.1007/s40266-026-01282-0","DOIUrl":"10.1007/s40266-026-01282-0","url":null,"abstract":"<p><strong>Background and objective: </strong>To evaluate the prevalence and types of potentially inappropriate prescriptions (PIP) in hospitalized older adults and to study whether PIP was a causative factor for index hospitalization, using the Turkish Inappropriate Medication Use in oldEr adults (TIME) criteria.</p><p><strong>Methods: </strong>This multicenter, cross-sectional study included 405 inpatients aged ≥60 years from 13 tertiary hospital departments in Turkiye between January 2020 and April 2021. PIP were assessed using TIME criteria, which include both potentially inappropriate medications, PIM (TIME-to-STOP) and potential prescribing omissions, PPO (TIME-to-START). Following the completion of medical history taking, physical examination, and comprehensive geriatric assessment (CGA), managing physicians evaluated each criterion individually. Based on clinical adjudication, they determined whether any PIM or PPO predefined in the TIME criteria could plausibly have contributed to the hospitalization.</p><p><strong>Results: </strong>The prevalence of PIP was 82.5%, with 63.2% of patients meeting at least one TIME-to-STOP and 71.6% meeting one TIME-to-START criterion. The top-three most common PIM identified via TIME-to-STOP criteria were: Long-term proton pump inhibitor (PPI) use without indication with 7.2%, PPI use for uncomplicated peptic ulcer disease, or erosive peptic esophagitis at full therapeutic dose for > 8-12 weeks with 3.0%, and diuretic use as first-line treatment of essential hypertension with concurrent urinary incontinence with 3.0%. The top-three most common PPO identified via TIME-to-START criteria were: Herpes zoster vaccination with 73.6%, Seasonal influenza vaccination annually with 59.3%, and Pneumococcal vaccination after age 65 with 57.3%. Among all participants, 34.1% had PIP causally related to hospitalization. Overtreatment of hypertension in patients with frailty was the most common PIM-related hospitalization factor (2.5%). Lack of oral nutritional supplements in patients with malnutrition was the leading PPO linked to hospitalization (11.6%).</p><p><strong>Conclusions: </strong>PIP were highly prevalent in hospitalized older adults and frequently contributed to hospital admission. TIME criteria provided a comprehensive and context-adapted tool for identifying both inappropriate medication use and missed treatment opportunities. Routine implementation of TIME criteria-guided medication reviews may represent a promising strategy to enhance medication safety and reduce avoidable hospitalizations in older populations, warranting further investigation.</p>","PeriodicalId":11489,"journal":{"name":"Drugs & Aging","volume":" ","pages":"433-444"},"PeriodicalIF":4.2,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13149604/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147282952","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":"Cardiovascular-Related Polypharmacy and Its Association with Liver and Kidney Function: A Cross-Sectional Study Using Primary Care Data.","authors":"Caroline Trin, Harvey Jia Wei Koh, Zhomart Orman, Dianna J Magliano, Ella Zomer, Zanfina Ademi, Stella Talic","doi":"10.1007/s40266-026-01297-7","DOIUrl":"10.1007/s40266-026-01297-7","url":null,"abstract":"<p><strong>Background: </strong>Individuals at high risk of cardiovascular disease (CVD) often require multiple concurrent medications, resulting in polypharmacy. Although necessary for disease management, polypharmacy may increase the risk of adverse outcomes, including kidney and liver dysfunction. This study aimed to examine the association between CVD-related polypharmacy and biochemical indicators of kidney and liver dysfunction among patients prescribed lipid-lowering therapy in Australian primary care.</p><p><strong>Methods: </strong>We conducted a retrospective cross-sectional study of electronic medical records of adults prescribed lipid lowering therapy between January 2013 and December 2022. CVD-related polypharmacy was defined as the concurrent use of more than five cardiovascular medications within a 365-day sliding window. Liver dysfunction was defined by elevated alanine aminotransferase (ALT), aspartate aminotransferase (AST), or bilirubin levels and kidney dysfunction was defined by reduced estimated glomerular filtration rate (eGFR). Multivariable logistic regression was used to assess associations, adjusting for age, sex, and comorbidities.</p><p><strong>Results: </strong>Among 13,568 participants (median age 63 years, interquartile range [IQR] 54-72; 54% male), 33.7% had CVD-related polypharmacy. Diabetes (odds ratio [OR] 5.40, 95% confidence interval [CI] 4.96-5.93), chronic kidney disease (OR 2.39, 95% CI 2.00-2.86), and hypertension (OR 1.91, 95% CI 1.75-2.07) were significant predictors. Older adults (≥80 years) had higher odds of CVD-related polypharmacy (OR 8.17, 95% CI 5.47-12.21). CVD-related polypharmacy was significantly associated with kidney dysfunction (OR 1.45, 95% CI 1.30-1.62), but not statistically significantly associated with liver dysfunction (OR 1.19, 95% CI 0.59-2.37).</p><p><strong>Conclusion: </strong>CVD-related polypharmacy is common among individuals receiving lipid-lowering therapy and is strongly linked to ageing and multimorbidity. Its association with kidney dysfunction suggests an interplay between cardiovascular risk, physiological decline, and treatment burden, highlighting the need for integrated, patient-centred prescribing in high-risk populations.</p>","PeriodicalId":11489,"journal":{"name":"Drugs & Aging","volume":" ","pages":"457-467"},"PeriodicalIF":4.2,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13149621/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147765897","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":"Propofol Use and Delirium in Patients Aged 80 Years and Over: A Retrospective Cohort Study of 9850 ICU Admissions.","authors":"Shengnan Kong, Xinya Li, Weisheng Chen, Bo Chen, Han Shi, Jun Lyu, Yu Wang","doi":"10.1007/s40266-026-01296-8","DOIUrl":"10.1007/s40266-026-01296-8","url":null,"abstract":"<p><strong>Objectives: </strong>There is inconsistent evidence regarding the relationship between propofol and delirium, and this evidence is predominantly drawn from mixed-age adult cohorts. In this study, we examined the link between propofol exposure and the onset of delirium in patients aged 80 years and over-a rapidly growing and physiologically distinct intensive care unit (ICU) patient group.</p><p><strong>Design: </strong>We conducted a retrospective analysis of older adults (aged 80 years or over) included in the Medical Information Mart for Intensive Care (MIMIC-IV) database. We used multivariate logistic regression to examine the relationship between propofol use and the occurrence of delirium. To strengthen the reliability of our results, we performed sensitivity analyses using propensity score matching and inverse probability of treatment weighting, as well as subgroup analyses.</p><p><strong>Results: </strong>Among 9850 ICU patients aged > 80 years, delirium was observed in 3474 cases (35.3%). Propofol showed an independent association with delirium after covariate adjustment (OR 1.22, 95% CI 1.09-1.38). This significant link was confirmed by sensitivity analyses using inverse probability of treatment weighting (OR 1.22; 95% CI 1.09-1.38) and propensity score matching (OR 1.24; 95% CI 1.08-1.43). This finding remained consistent across most of the subgroup analyses.</p><p><strong>Conclusions: </strong>These findings highlight the importance of careful sedation planning and increased monitoring when administering propofol to critically ill adults aged 80 years and over, who may be particularly susceptible to its neurocognitive effects.</p>","PeriodicalId":11489,"journal":{"name":"Drugs & Aging","volume":" ","pages":"445-455"},"PeriodicalIF":4.2,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147716495","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":"Prescribing Cascades: An Umbrella Review and Updated Systematic Review.","authors":"Massimo Carollo, Salvatore Crisafulli, Marta Zerio, Francesco Maccarrone, Anna Paladin, Margherita Selleri, Anna Forti, Francesco U S Mattace-Raso, Gianluca Trifirò","doi":"10.1007/s40266-026-01295-9","DOIUrl":"10.1007/s40266-026-01295-9","url":null,"abstract":"<p><strong>Background: </strong>Prescribing cascades (PCs) often remain underrecognized, contributing to inappropriate prescribing and increased healthcare burden.</p><p><strong>Objective: </strong>This study aimed to synthesize existing knowledge on reported PCs and identify the medications and adverse drug reactions (ADRs) involved.</p><p><strong>Methods: </strong>An umbrella review was conducted using PubMed, Embase, Cochrane Library, Web of Science, and Scopus (inception-16 July 2025). Systematic and scoping reviews on potential PCs were included. An updated systematic review, using the same databases, was conducted to cover the period from 16 February 2022 (the end date of the search period in the most recent included review) to 16 July 2025 to identify more recent studies.</p><p><strong>Results: </strong>Two systematic and two scoping reviews were included in the umbrella review, for a total of 156 primary studies, and 34 more studies met the inclusion criteria of the updated systematic review. Overall, 84 different ADRs potentially leading to PCs were described. Medications mostly involved in the onset of ADRs leading to PCs were antidepressants, antidementia drugs, antipsychotics, anxiolytics, hypnotics/sedatives, lipid-modifying agents, and antihypertensives. The most frequently reported ADRs belonged to the \"psychiatric disorders,\" \"nervous system,\" and \"gastrointestinal disorders\" system organ classes. Prescription sequence symmetry analysis (PSSA) emerged as the most used method for PC identification.</p><p><strong>Conclusions: </strong>PCs are an underrecognized driver of inappropriate polypharmacy, especially in older adults, yet current evidence is largely retrospective and heterogeneous. By consolidating available data, our work provides a valuable reference tool for clinicians and researchers. Future efforts should focus on establishing standardized definitions and developing clinical strategies to prevent inappropriate PC use.</p>","PeriodicalId":11489,"journal":{"name":"Drugs & Aging","volume":" ","pages":"397-424"},"PeriodicalIF":4.2,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13149699/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147632949","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":"Pharmacological Management of ADHD in Women Across Perimenopause, Menopause and Post-Menopause.","authors":"Dora Wynchank, Sandra Kooij","doi":"10.1007/s40266-026-01291-z","DOIUrl":"10.1007/s40266-026-01291-z","url":null,"abstract":"<p><p>Attention-deficit/hyperactivity disorder (ADHD) in women is frequently underdiagnosed and undertreated, particularly during midlife when the neuroendocrine changes of perimenopause, menopause and post-menopause can exacerbate or unmask underlying symptoms. Clinical presentations of ADHD in the (peri)menopause often include worsening inattention, emotional dysregulation, and heightened anxiety or depressive symptoms, accompanied by vasomotor disturbances, sleep disruption and subjective cognitive complaints such as brain fog and memory impairment. This narrative review integrates current evidence concerning the pharmacological management of ADHD in women across the final reproductive hormonal transition. We outline diagnostic complexities arising from a symptomatic overlap between ADHD and (peri)menopausal symptoms. Evidence for the efficacy and safety of stimulant and non-stimulant medications in this population is limited, with no randomised controlled trials specific to (peri)menopausal women. Current practice relies on expert consensus, extrapolation from younger cohorts and small observational studies. Practical clinical guidance is provided for initiating and adjusting ADHD pharmacotherapy during hormonal transitions, incorporating individualised dosing, cardiovascular monitoring and consideration of comorbidities. The potential role of menopausal hormone therapy as an adjunctive strategy for mood, sleep and cognitive symptoms is discussed and practical guidance is provided for clinicians initiating pharmacotherapy in (peri)menopausal and post-menopausal women with ADHD, with an emphasis on interdisciplinary and collaborative patient-centred care. Research priorities include controlled trials evaluating stimulant-menopausal hormone therapy combinations and optimal dose adjustment protocols.</p>","PeriodicalId":11489,"journal":{"name":"Drugs & Aging","volume":" ","pages":"385-395"},"PeriodicalIF":4.2,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13149623/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147766021","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":"Harms of Continued Antihypertensives: An Overview of Reviews.","authors":"Carmen Floriani, Angela Edith Schulthess-Lisibach, Martina Zangger, Marc von Gernler, Maja Josephine Lundberg Andersen, Sven Streit","doi":"10.1007/s40266-026-01285-x","DOIUrl":"10.1007/s40266-026-01285-x","url":null,"abstract":"<p><strong>Background: </strong>Antihypertensives are effective drugs for treatment of hypertension, which is one of the most important risk factors for cardiovascular morbidity. Intensive hypertension treatment significantly reduces cardiovascular risk among older people. Based on these findings, guidelines recommend stricter blood pressure management nowadays. Reasoning on benefit and harms of antihypertensive treatment can be challenging in daily practice because little evidence is available on specific harm outcomes.</p><p><strong>Objective: </strong>With this overview of reviews, we aim to summarize evidence from systematic reviews on harms associated with continued antihypertensive treatment.</p><p><strong>Methods: </strong>We searched Ovid MEDLINE, Ovid Embase and the Cochrane Library for systematic reviews with or without meta-analysis. Included were all systematic reviews of randomized and non-randomized controlled trials on harms of antihypertensive drugs in English. Any other type of article was excluded. Change in focused on the older population.</p><p><strong>Results: </strong>The search resulted in 6353 items. A total of 105 articles were eligible for full-text screening, and 47 articles fulfilled eligible criteria and were included. Most common side effects included respiratory symptoms like dry cough (particularly under angiotensin-converting enzyme inhibitors), hypotensive symptoms, renal failure and electrolyte misbalances.</p><p><strong>Conclusion: </strong>Antihypertensives have a broad spectrum of side effects, but they are effective drugs against hypertension and reduce cardiovascular disease burden.</p>","PeriodicalId":11489,"journal":{"name":"Drugs & Aging","volume":" ","pages":"425-432"},"PeriodicalIF":4.2,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147442915","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":"Managing Bone Fragility in Older Adults with Diabetes: Pathophysiology, Assessment, and Therapeutic Considerations.","authors":"Gulistan Bahat, Tugba Erdogan, Savas Ozturk, Ozlem Soyluk Selcukbiricik, Serdar Ozkok, Dilek Gogas Yavuz, Mehmet Akif Karan, Jean-Yves Reginster","doi":"10.1007/s40266-026-01290-0","DOIUrl":"10.1007/s40266-026-01290-0","url":null,"abstract":"<p><p>Older adults with diabetes mellitus, encompassing both type 1 diabetes (T1D) and type 2 diabetes (T2D), face a substantially elevated risk of fragility fractures, contributing significantly to morbidity and mortality in this vulnerable population. The underlying pathophysiology differs between the two types: T1D is typically characterized by reduced bone mineral density (BMD) stemming from insulinopenia, whereas T2D often presents with normal or even high BMD but compromised bone quality due to factors, including altered microarchitecture, accumulation of advanced glycation end products (AGEs), and low bone turnover. These distinct mechanisms create challenges for accurate fracture risk assessment, as standard tools such as dual-energy X-ray absorptiometry (DXA)-measured BMD and the Fracture Risk Assessment Tool (FRAX) often underestimate the true risk, particularly in T2D. Effective management necessitates a comprehensive, individualized approach. This includes optimizing glycemic control while minimizing hypoglycemia, implementing lifestyle modifications such as adequate nutrition (calcium, vitamin D, protein) and appropriate exercise, and crucially, proactive fall prevention strategies. Careful consideration must be given to the selection of antidiabetic medications, avoiding agents known to harm bone (e.g., thiazolidinediones) and preferring those with neutral or potentially beneficial skeletal effects (e.g., metformin, dipeptidyl peptidase-4 inhibitors [DPP-4i], glucagon-like peptide-1 receptor agonists [GLP-1 RAs]). Osteoporosis pharmacotherapies, including antiresorptive (bisphosphonates, denosumab) and anabolic agents (teriparatide, abaloparatide, romosozumab), appear effective in patients with diabetes largely on the basis of post hoc analyses and observational data, although evidence specific to this population remains limited. Integrating geriatric principles, such as assessing frailty and polypharmacy, is essential for optimizing care and improving outcomes for older adults with diabetes and bone fragility.</p>","PeriodicalId":11489,"journal":{"name":"Drugs & Aging","volume":" ","pages":"341-360"},"PeriodicalIF":4.2,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13038465/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147485050","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}