Drugs & Aging最新文献

{"title":"Real-World Harm Reduction of Metformin Plus DPP4 Inhibitors versus Metformin Plus Sulfonylureas in Older Adults: A Target Trial Emulation Using German Claims Data.","authors":"Paula Starke, Petra Thürmann, Thomas Grobe, Tim Friede, Tim Mathes","doi":"10.1007/s40266-025-01218-0","DOIUrl":"10.1007/s40266-025-01218-0","url":null,"abstract":"<p><strong>Objective: </strong>This study complements evidence from randomized controlled trials on the harms (e.g., hypoglycemia) of sulfonylureas compared with dipeptidyl peptidase-4 inhibitors (DPP4i) in the treatment of type 2 diabetes in older adults using real-world data. Existing evidence suggests an increased risk of hypoglycemia, falls, fractures, and cardiovascular events.</p><p><strong>Methods: </strong>Using target trial emulation, we analyzed a retrospective cohort drawn from German routine claims data. We included patients older than 65 years who initiated DPP4i (sitagliptin, vildagliptin, or saxagliptin) or sulfonylureas (glibenclamid or glimepirid) as add on to metformin between 2011 and 2018. Confounding was adjusted for through overlap weighting, and the average treatment effects were estimated in the overlap population using generalized linear models.</p><p><strong>Results: </strong>Among 171,318 eligible patients, 111,865 (65%) received DPP4i and 59,453 (35%) sulfonylureas. Patients treated with DPP4i had a higher prevalence of all observed comorbidities. Applying overlap weights to adjust for confounding, patients treated with DPP4i had a higher rate of combined all-cause hospitalizations and outpatient visits compared with those treated with sulfonylureas (rate ratio = 1.03, 95% CI 1.02-1.03) in the total population. In contrast, we found a protective effect of DPP4i on the risk for severe hypoglycemia in the subgroups of new users (ratio rate (RR) = 0.51, 95% CI 0.33, 0.76) and patients with severe renal insufficiency (RR = 0.31, 95% CI 0.16, 0.61).</p><p><strong>Conclusions: </strong>Deprescribing sulfonylureas and using DPP4i instead may slightly reduce harm in some subgroups of older adults, which supports recommendations of existing lists of potentially inappropriate medications.</p>","PeriodicalId":11489,"journal":{"name":"Drugs & Aging","volume":" ","pages":"655-663"},"PeriodicalIF":3.4,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12254066/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144257579","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":"Managing Rheumatoid Arthritis in Older Adults with Cancer.","authors":"Maria A Lopez-Olivo, Aliza R Karpes Matusevich, Jean H Tayar, Huifang Lu","doi":"10.1007/s40266-025-01214-4","DOIUrl":"10.1007/s40266-025-01214-4","url":null,"abstract":"<p><p>Rheumatoid arthritis (RA) is a chronic autoimmune condition disproportionately affecting older adults (> 60 years), who often experience increased disease severity and comorbidities, including cancer. A comprehensive review of the literature was conducted, examining the prevalence of malignancy in patients with RA, associated risk factors, and treatment challenges, including management considerations such as psychological distress and lifestyle modifications. Clinical guidelines and consensus statements were summarized to provide practical insights for optimizing care. Older adults with RA are at an elevated risk for developing cancer due to chronic inflammation, immunosenescence from aging, and shared risk factors such as smoking. Patients with RA tend to have poorer cancer survival rates than individuals without RA, particularly for lung cancer and lymphoma. Immunosuppressive therapies used to treat RA may modestly increase cancer risks but are critical for disease control. Current guidelines emphasize discontinuation or adjustment of RA therapies upon cancer diagnosis, with tailored approaches based on cancer type and stage. Non-pharmacologic interventions, including lifestyle modifications and psychological support, play a vital role in improving quality of life and mitigating disease flares during cancer treatment. The management of RA in older adults with a history of cancer requires a personalized, multidisciplinary approach that balances the need for RA symptom control without affecting cancer outcomes. Shared decision-making, incorporating patient preferences and comorbidities, is critical for optimizing care. Further research is needed to strengthen evidence-based guidelines for this population and address gaps in understanding treatment safety and efficacy.</p>","PeriodicalId":11489,"journal":{"name":"Drugs & Aging","volume":" ","pages":"599-614"},"PeriodicalIF":3.4,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144093166","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":"Association Between Gabapentinoid Use and Changes in Claims-Based Frailty Among Long-Term Opioid Users.","authors":"Jordan Westra, Mukaila Raji, Jacques Baillargeon, Rajender R Aparasu, Yong-Fang Kuo","doi":"10.1007/s40266-025-01216-2","DOIUrl":"10.1007/s40266-025-01216-2","url":null,"abstract":"<p><strong>Objective: </strong>Assess the association of opioids and gabapentinoids with changes in frailty among Medicare beneficiaries who used opioids for 90 or more consecutive days.</p><p><strong>Methods: </strong>Using a Medicare sample between 2014 and 2020, this study included long-term opioid users who were eligible for Medicare parts A, B, and D for 3 years and had no prior gabapentinoid use. The study was broken into three 1-year periods: lookback, exposure, and outcome. The exposure of interest was gabapentinoid and opioid use measured in period 2. The primary outcome was difference in frailty between periods 1 and 3. Linear regression was used to assess the difference in frailty change by gabapentinoid and opioid use. Multinomial regression was also used to assess the odds of categorical frailty change by gabapentinoid and opioid use.</p><p><strong>Results: </strong>Overall, the changes in frailty between assessment periods were small. Those who had no continued opioid/no gabapentinoid use showed decreases in frailty (- 0.0005), while each of the other three groups increased in frailty between the assessment periods (opioids only, 0.0040; gabapentinoids only, 0.0136; opioids + gabapentinoids, 0.0142). In addition, each of the drug groups showed increased odds for large increases in frailty compared with those who had no continued opioid/no gabapentinoid use (opioids only, odds ratio (OR): 1.25, 95% confidence interval (CI) 1.04-1.49; gabapentinoids only, OR: 3.12, 95% CI 1.75-5.55; opioids + gabapentinoids, OR: 2.30, 95% CI 1.85-2.87).</p><p><strong>Conclusions: </strong>Using gabapentinoids, opioids, or a combination of the two showed greater increases in frailty compared with those who used neither drug after long-term opioid use.</p>","PeriodicalId":11489,"journal":{"name":"Drugs & Aging","volume":" ","pages":"633-642"},"PeriodicalIF":3.4,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144324737","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":"Deprescribing Antipsychotics and Proton Pump Inhibitors in Long-Term Care: A Prescribing Portraits Approach.","authors":"Nooreen Haji, Aaron M Tejani, Anthony Tung, Ying Wang, Deborah Heidary, Wade Thompson, Carolyn Bubbar","doi":"10.1007/s40266-025-01217-1","DOIUrl":"10.1007/s40266-025-01217-1","url":null,"abstract":"<p><strong>Introduction: </strong>Antipsychotics (APs) and proton pump inhibitors (PPIs) are commonly prescribed in long-term care (LTC) despite potential risks with prolonged use.</p><p><strong>Objective: </strong>This study evaluates the frequency of AP and PPI prescriptions and assesses the impact of \"prescribing portraits\" on deprescribing in LTC residents at 2 LTC facilities in British Columbia.</p><p><strong>Methods: </strong>This multicenter, prospective quality improvement (QI) study was conducted at two LTC homes: Holy Family Hospital (site A) and Queen's Park Care Centre (site B). The QI approach involved collecting data on prescribing appropriateness, implementing a real-time intervention, and tracking its impact. Prescribing portraits-personalized reports detailing individual prescribing patterns, evidence-based indications, and deprescribing recommendations-were presented to prescribers by clinical pharmacists. The primary outcomes were the proportion of prescriptions eligible for deprescribing and the deprescribing rate at 3 months post-intervention.</p><p><strong>Results: </strong>At site A, 21 of 48 residents receiving AP were identified as eligible for deprescribing, with 31.6% receiving deprescribing orders within 3 months. Among 12 residents previously assessed in our earlier QI study at site A who remained on PPIs, 33% were newly deprescribed after reassessment in this study. At site B, 23 of 48 residents on antipsychotics were eligible, with a deprescribing rate of 20%. For PPIs, 31 of 38 residents were considered eligible at site B, and 36% had deprescribing orders initiated.</p><p><strong>Conclusions: </strong>Integrating prescribing portraits into multidisciplinary medication reviews promotes appropriate deprescribing of APs and PPIs in LTC, encouraging safer prescribing practices and improving medication safety.</p>","PeriodicalId":11489,"journal":{"name":"Drugs & Aging","volume":" ","pages":"665-673"},"PeriodicalIF":3.4,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144233468","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Drugs and Healthy Aging.","authors":"Sarah N Hilmer, Luigi Ferrucci, Antonio Cherubini","doi":"10.1007/s40266-025-01208-2","DOIUrl":"10.1007/s40266-025-01208-2","url":null,"abstract":"<p><p>Appropriate drug treatment can enhance the likelihood of experiencing healthy aging and maintaining functional ability up to very late in life. Strong evidence exists that overall drugs can help prevent and manage diseases. However, such evidence is mostly available from studies that are not representative of older people and do not include functional/well-being outcomes. Therapeutic drugs can also impair physical and cognitive function and social interactions, particularly in the context of polypharmacy, multimorbidity and frailty. Certain drugs can affect the ability to exercise and consume a healthy diet, which are key nonpharmacological interventions that promote healthy aging. Yet, exercise and nutritional interventions can help manage adverse drug reactions. In the future, drugs (gerotherapeutics) may be developed that slow the aging process, which should prevent or delay the incidence and progression of many chronic diseases, improving healthy aging.</p>","PeriodicalId":11489,"journal":{"name":"Drugs & Aging","volume":" ","pages":"591-598"},"PeriodicalIF":3.4,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12254174/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144552599","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":"Risk Factors for Vancomycin-Induced Nephrotoxicity and Kidney Prognosis in Patients Aged 75 Years and Older: A Retrospective Study.","authors":"Masaki Takigawa, Hiroyuki Tanaka, Masako Kinoshita, Toshihiro Ishii, Masayuki Masuda","doi":"10.1007/s40266-025-01203-7","DOIUrl":"10.1007/s40266-025-01203-7","url":null,"abstract":"<p><strong>Introduction: </strong>Whether risk factors for vancomycin-induced nephrotoxicity (VIN) development reported in recent years are also risk factors in the older population has not yet been fully investigated. This study aimed to investigate the risk factors for VIN development in the older population and to examine factors influencing kidney prognosis after VIN development.</p><p><strong>Methods: </strong>A total of 468 patients aged ≥ 75 years were included in this study. Factors related to VIN onset in older adults were examined through logistic regression analysis.</p><p><strong>Results: </strong>A total of 40 patients (8.5%) with VIN were identified. Univariate analysis revealed significant differences in body mass index (BMI), combined use of tazobactam/piperacillin (T/P), and intensive care unit admission between the VIN and non-VIN groups (P = 0.042, 0.005, and 0.040, respectively). Multivariate analysis identified the combined use of T/P as a factor related to VIN. In patients aged 85 years or older, the concomitant use of T/P and intensive care unit (ICU) admission were identified as factors related to VIN. Compared with the VIN recovery group, the nonrecovery group had a longer time to VIN onset and a higher proportion of patients on concomitant diuretics.</p><p><strong>Conclusions: </strong>This study revealed that the combined use of T/P and ICU admission were risk factors for VIN in older individuals. Additionally, the time until VIN onset and the concomitant use of diuretics may affect the kidney prognosis of older patients who develop VIN. When administering vancomycin to older patients, it is necessary to eliminate or be cautious of these factors in relation to VIN development and kidney prognosis.</p>","PeriodicalId":11489,"journal":{"name":"Drugs & Aging","volume":" ","pages":"547-557"},"PeriodicalIF":3.4,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144062821","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of Anticholinergic Burden Scales and Their Association with Cognitive and Functional Impairment in Older Adults: A Cross-Sectional Study Using the REPOSI Database.","authors":"Alessio Novella, Marina Azab, Luca Pasina","doi":"10.1007/s40266-025-01204-6","DOIUrl":"10.1007/s40266-025-01204-6","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;The increasing use of anticholinergic medications in older adults with multiple chronic conditions raises significant concerns regarding their cumulative anticholinergic burden, which is linked to several adverse outcomes. This study aimed to compare existing anticholinergic burden scales to identify those most effective at correlating drug-induced anticholinergic load with cognitive and functional impairment. In addition, we proposed a new classification system on the basis of published scales to optimally correlate total anticholinergic burden with observed clinical deficits.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;This cross-sectional study analyzed data from the REPOSI registry, which collects clinical and therapeutic information on patients aged 65 years and older admitted to internal medicine and geriatric wards across Italy. Anticholinergic exposure was assessed using 20 established anticholinergic burden scales from literature. In addition, seven experimental scales were developed on the basis of published scales and various mathematical functions (maximum, mode, median, and mean) to evaluate potential differences in measuring anticholinergic load. Outcomes included cognitive impairment, assessed using the Short Blessed Test (SBT), and functional independence, measured by the Barthel Index (BI). A zero-inflated negative binomial model was applied to analyze associations between anticholinergic burden and each outcome. Given the variability in drug scoring across published scales, we developed seven experimental scales using different mathematical functions (maximum, mode, median, and mean) to standardize scoring. Three versions included a null-score adjustment to account for drugs omitted in some scales, ensuring a more comprehensive measure of anticholinergic burden.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Among 7735 patients, higher anticholinergic burden was consistently associated with increased cognitive impairment (SBT) and physical dependency (BI) across all existing and proposed scales. The modified Anticholinergic Risk Scale (mARS) scale showed the strongest associations with cognitive (rate ratio [RR] 1.10, 95% confidence interval [CI] 1.06, 1.13; P &lt; 0.0001) and physical impairment (RR 1.18, 95% CI 1.11, 1.24; P &lt; 0.0001), indicating an 18% higher risk of dependency per unit increase, while the CRIDECO Anticholinergic Load Scale (CALS) scale exhibited the best model fit. Our newly developed scales confirmed these associations, with the median with null score and the mean with null score scale showing the strongest link to cognitive impairment (RR 1.07, 95% CI 1.05, 1.09; P &lt; 0.0001) and the strongest association with physical dependency (RR 1.11, 95% CI 1.08, 1.15; P &lt; 0.0001).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Scales that identify a greater proportion of patients with at least one anticholinergic drug may provide a more comprehensive assessment of anticholinergic burden in clinical practice. While no single s","PeriodicalId":11489,"journal":{"name":"Drugs & Aging","volume":" ","pages":"559-572"},"PeriodicalIF":3.4,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143983965","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prevalence of Self-Reported Adverse Effects to Cannabis by Older Canadians: A Cross-Sectional Analysis.","authors":"Jennifer Bolt, Kristine Lin, Melanie Fenton, Jennifer M Jakobi","doi":"10.1007/s40266-025-01206-4","DOIUrl":"10.1007/s40266-025-01206-4","url":null,"abstract":"<p><strong>Background and objective: </strong>Despite the increasing use of cannabis by older Canadians, little is known about cannabis safety in this population, particularly in non-clinical settings. The purpose of this study was to describe the self-reported adverse effects experienced by community-dwelling older Canadians who use cannabis.</p><p><strong>Methods: </strong>Canadians aged 50 years and older completed an online survey regarding their knowledge, perceptions, and experiences with cannabis. Respondents who reported current cannabis use were asked to report any adverse effects experienced in the past year related to their cannabis use. Adverse effects were categorized, and multivariate logistic regressions were performed to assess predictors of adverse effects.</p><p><strong>Results: </strong>A total of 1615 older adults completed the survey, of whom 503 reported current use of cannabis and were included in this analysis. Adverse effects were reported by 308 participants (61.2%) and included dry mouth (36.2%), feeling high (25.9%), and adverse effects impacting balance (22.1%) and mental alertness (20.3%). Compared with participants aged 50-60 years, those aged 70 years and older had lower odds of reporting any adverse effects (odds ratio (OR) 0.524, 95% confidence interval (CI) 0.303-0.906) or adverse effects impacting mental alertness (OR 0.318, 95% CI 0.172-0.588). Female participants had higher odds of reporting any adverse effect (OR 1.989, 95% CI 1.332-2971) or adverse effects impacting balance (OR 1.930, 95% CI 1.198-3.109).</p><p><strong>Conclusions: </strong>Adverse effects to cannabis are common amongst community-dwelling older adults. Increased education and guidance regarding adverse effects of cannabis, including the composition and dose of cannabis products, may help increase safe use by this population.</p>","PeriodicalId":11489,"journal":{"name":"Drugs & Aging","volume":" ","pages":"573-582"},"PeriodicalIF":3.4,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144001392","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Age Does not Affect the Efficacy of Antibody Drug Conjugates, But is Associated with High-Grade Adverse Events in Patients with Cancer Enrolled in Early Phase Clinical Trials.","authors":"Ana Vaz Ferreira, Matthieu Delaye, Arnaud Pages, Antoine Hollebecque, Anas Gazzah, Rastio Bahleda, Jean-Marie Michot, Francois-Xavier Danlos, Lauren Seknazi, Vincent Goldschmidt, Clémence Hénon, Madonna Sakkal, Cristina Smolenschi, Stéphane Champiat, Aurelien Marabelle, Yohann Loriot, Céline Nagera Lazarovici, Zoé Ap-Thomas, Geoffroy Beraud Chaullet, Santiago Ponce Aix, Christophe Massard, Kaissa Ouali, Maxime Frelaut, Capucine Baldini","doi":"10.1007/s40266-025-01212-6","DOIUrl":"10.1007/s40266-025-01212-6","url":null,"abstract":"<p><strong>Background: </strong>Data on the use of antibody drug conjugates (ADCs) in older patients are scarce.</p><p><strong>Objective: </strong>The objective was to study the safety and efficacy of ADCs used in early phase clinical trials in patients aged ≥ 65 years compared with younger patients.</p><p><strong>Patients and methods: </strong>All patients enrolled in early phase clinical trials (phase I or II) of ADCs for solid tumors in our institution between November 2014 and May 2023 were included in this retrospective monocentric study. Safety and efficacy were compared between patients ≥ 65 and < 65 years old (y.o).</p><p><strong>Results: </strong>A total of 136 patients were included in our study, with 43 (31.6%) patients aged ≥ 65 y.o. In comparison with the younger population, patients aged 65 years or older had similar demographic characteristics. Older patients experienced the same rate of all-grade adverse events (95.3 versus 97.8%) and all-grade related adverse events (65.1 versus 66.7%) but more high-grade adverse events (41.9 versus 30.1%) than younger patients. In the univariate analysis, we identified age, taken as a continuous variable, as associated with high-grade adverse event (p = 0.047). No statistically significant difference was found between older and younger patients in terms of disease control rate (65 versus 54%), median progression-free survival (2.76 months [95% confidence interval, 95% CI 1.64-3.75] compared with 2.56 [95% CI 1.81-2.79], p = 0.34), or median overall survival (6.57 months [95% CI 4.01-13.01] compared to 7.89 [95% CI 6.83-9.36], p = 0.65).</p><p><strong>Conclusions: </strong>In our cohort, ADC therapy provided comparable survival benefits for the older patients but with a higher risk of high-grade adverse event.</p>","PeriodicalId":11489,"journal":{"name":"Drugs & Aging","volume":" ","pages":"583-589"},"PeriodicalIF":3.4,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144076716","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Detection of Potential Prescribing Cascades in Multimorbid Older Patients Hospitalised with Acute Illness-An Observational Prospective Prevalence Study.","authors":"Ruth Daunt, Siobhán McGettigan, Lorna Kelly, Denis Curtin, Denis O'Mahony","doi":"10.1007/s40266-025-01201-9","DOIUrl":"10.1007/s40266-025-01201-9","url":null,"abstract":"<p><strong>Background: </strong>Prescribing cascades occur when a new drug is prescribed to treat an adverse drug event caused by an existing medication, resulting in unnecessary, or potentially hazardous additional drugs. To date, there are no published studies assessing the prevalence of prescribing cascades in older hospitalised adults.</p><p><strong>Objective: </strong>To investigate the prevalence of prescribing cascades in hospitalised older adults.</p><p><strong>Methods: </strong>We conducted a prospective observational study of adults aged ≥ 65 years with multimorbidity and polypharmacy presenting to hospital with acute unselected medical or surgical illness. Prescribing cascades were identified using two predefined validated explicit cascade lists, i.e. ThinkCascades, and a list derived from a recently published systematic review of prescribing cascades in community-dwelling adults, referred to here as the 'Doherty list'. Potential prescribing cascades were classified as 'definite', 'probable', 'possible', 'uncertain' or 'indeterminate' according to pre-specified criteria.</p><p><strong>Results: </strong>The study included 385 consecutive patients (55.1% female, mean age 80.2 years, standard deviation 7.3 years). A total of 281 potential prescribing cascades (drug A → drug B) were identified in 152 patients (39.4%). Probable or possible prescribing cascades were identified in 48 patients (12.4%) using the Doherty list and in 44 patients (11.4%) using ThinkCascades. Patients exposed to potential prescribing cascades experienced greater levels of polypharmacy than patients not exposed to prescribing cascades (median interquartile range [IQR] of 12 [9-14] daily drugs versus 9 [IQR 7-11], p < 0.001).</p><p><strong>Conclusions: </strong>Potential prescribing cascades were highly prevalent in older hospitalised adults. Practical tools are needed to assist prescribers in prevention, recognition and management of inappropriate prescribing cascades.</p>","PeriodicalId":11489,"journal":{"name":"Drugs & Aging","volume":" ","pages":"535-546"},"PeriodicalIF":3.4,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12149247/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143779432","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}