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Objectives The objectives of this study were to identify variables associated with dementia and entry into aged residential care (ARC) and derive and validate a risk prediction model for dementia and entry into ARC. Design This was an observational study of prospectively collected Home Care International Residential Assessment Instrument (interRAI-HC) assessment data. Setting and Participants Participants included all people age ≥65 years who had completed an interRAI-HC assessment between July 1, 2012 and June 30, 2018. Exclusion criteria included death or entry into ARC within 30 days of assessment and not living at home at the time of the assessment. Measures InterRAI data from 94,202 older New Zealanders were evaluated for presence or absence of dementia. A multivariable competing-risks model for entry into ARC with death as the competing event was used to estimate subdistribution hazard ratios (SHR). Results In total, there were 18,672 (19.8%) persons with dementia (PWD). PWD were almost twice as likely to enter ARC as persons without dementia [42.8% vs 25.3%; difference 17.5% (95% confidence interval 16.7%‒18.2%)]. PWD at highest risk of entering ARC were those where there was a desire to live elsewhere (SHR 1.44), depression (indicated, SHR 1.15), poor cognitive performance (Cognitive Performance Scale minimal SHR 1.32 and severe plus SHR 1.91), and wandering (SHR 1.19). Factors associated with reduced risks of PWD entering ARC were living with a child or relative, alcohol consumption, and comorbidities. Conclusions and Implications A desire to live elsewhere, social isolation, independent activities of daily living, and depression were independently associated with entry into ARC. Supporting caregivers may improve outcomes for PWD that delay entry into ARC. Future revisions of the interRAI questionnaire could provide more insight on this matter.

The study of the magnitude and variation of drug response is defined as pharmacodynamics (PDs). PD models examine plasma concentration and effect relationship. It can predict the archetypal effect ([Formula: see text]) of a drug as a function of the drug concentration ([Formula: see text]) and estimate an unknown PD parameter ([Formula: see text]). The PD models have been described as fixed, linear, log-linear, [Formula: see text], sigmoid [Formula: see text], and indirect PD response. Ligand binding model is an example of a PD model that works on the underpinning PD principle of a drug, eliciting its pharmacological effect at the receptor site. The pharmacological effect is produced by the drug binding to the receptor to either activate or antagonise the receptor. Ligand binding models describe a system of interacting components, i.e. the interaction of one or more ligands with one or more binding sites. The [Formula: see text] model is the central method that provides an empirical justification for the concentration/dose-effect relationship. However, for ligand binding models justification is provided by theory of receptor occupancy. In essence, for ligand binding models, the term [Formula: see text] is best used to describe the fraction of receptors occupied at a particular ligand concentration. It is stated that the [Formula: see text], which means the effect of a drug should depend on the fraction of receptors that are occupied. In the future, network-based systems pharmacology models using ligand binding principles could be an effective way of understanding drug-related adverse effects. This will facilitate and strengthen the development of rational drug therapy in clinical practice.

Introduction: Inappropriate prescribing in residential care is a particular health concern. This study aims to identify the prevalence of potentially inappropriate prescriptions (PIP) and potential prescribing omissions (PPO) in older people living in residential care in New Zealand. Method: The STOPP/START criteria was applied to the data collected from the medical notes of people aged >= 65 years-old living in two residential care homes in New Zealand. Prescribed medicines were classified using the World Health Organisation Anatomic Therapeutic Classification. Charlson Comorbidity Index and Katz Activities of Daily Living were computed for each resident and included in the regression analyses. Results: The mean age of residents (n = 137) was 85.4 (+/- 7.7) years. In total, 205 PIPs among 102 residents (74.5%) were identified and 66 PPOs were present among 49 residents (35.8%). Antipsychotics were the most common PIPs in residents with a medium/high falls risk (18.6%). Residents with higher comorbidity scores were less likely to be taking a PIP. Residents with a medium/high falls risk were more likely to have a PIP, than those with a low falls risk. Conclusion: Consistent with other countries, PIPs and PPOs were highly prevalent in older people in residential care in New Zealand. Antipsychotics, opiates and benzodiazepines accounted for approximately 50% of the 205 PIP exposures. Regarding PPO, the omission of aspirin and angiotensin converting enzyme inhibitors where clinically indicated was noted. The STOPP/START criteria could be used in multidisciplinary clinical reviews to help improve the medicine therapy in older people living in the residential care setting. Refereed/Peer-reviewed

Background The aim of this population-level study was to describe and characterize the utilization of AEDs in older people in New Zealand from 2005 to 2013. Methods De-identified individual level dispensing data for people aged 65 years and over for the period 2005–2013 were obtained from New Zealand Ministry of Health. AEDs were categorized using the ATC classification system of the WHOCC and Norwegian institute of public health. Utilization rates by year, age, sex, ethnicity and district health boards were measured as DDD per TOPD. Results The prevalence of AEDs utilization (DDD/TOPD) increased from 14.23 in 2005 to 14.39 in 2013. The newer AEDs increased from 0.64 in 2005 to 1.82 in 2013, but the prevalence for older AEDs decreased over the same study period from 13.59 to 12.57. AEDs utilization in males over the 9-year period was 17.18 (33.22% higher than females). Highest utilization was observed in those aged between 65 and 69 years, with average of 15.44 (28.88% higher than 85 plus age group). Sodium valproate followed by phenytoin and carbamazepine were the most common AEDs. Among the newer AEDs, gabapentin followed by lamotrigine was most frequently utilized. Conclusion Utilization of AEDs increased over the 9-year study period in older New Zealanders. The newer AEDs may have contributed to this increase. Further research is required to examine the utilization of AEDs by therapeutic indications.

Objectives The primary objective was to evaluate the risk of fractures associated with use of zopiclone, a new Z-hypnotic, in a population-based cohort of older people in New Zealand (NZ) in a real-world setting. The secondary objective was to examine a nonlinear relationship with age and risk for fractures in zopiclone users. Design Population-based cohort study with a case-crossover design. Setting A nationwide representative sample of New Zealanders aged 65 years and older sourced from the pharmaceutical collections and hospital discharges. Participants 74,787 older individuals with a first-time fracture between January 1, 2005, and December 31, 2015, were analyzed using a case-crossover design for fracture risk with zopiclone use. Measurements Prescription records (2005–2014) of zopiclone were sourced from NZ Pharmaceutical Collections (Pharms). The first-time coded diagnosis of fracture was extracted from the National Minimal Datasets. Datasets were linked by a unique patient identifier to set up case-crossover designs. Relative risks (RRs) of fracture associated with zopiclone was calculated using conditional logistic regression. A varying-coefficient conditional logistic model was employed to examine the influence of age as a risk factor for fractures. Results The risk of fracture associated with zopiclone is higher [RR = 1.45, 95% confidence interval (CI) = 1.37–1.55], compared to non-use. The increased risk of fracture associated with zopiclone [adjusted relative risk (ARR) = 1.36, 95% CI = 1.28–1.45] remained significant after adjusting for concomitant use of alpha blockers, antipsychotics, beta blockers, benzodiazepines, and tricyclic antidepressants. The varying coefficient model showed that the risk of fracture increases significantly and monotonically with age. Conclusion The results support that the magnitude of the risk of fracture is higher with use of zopiclone compared to non-use. Prescribers must be aware that the relationship between age and fracture risk is nonlinear, and the oldest old are highly vulnerable to fractures with zopiclone use.