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Aim: This matched case–control study investigated potentially inappropriate medication (PIM) use, polypharmacy, and other potential risk factors for falls among hospitalized older adults in Taiwan. Methods: During an 18‐month study period, 131 case patients who experienced a fall during hospitalization in an acute‐care hospital were identified and matched by the time of day, hospital ward, and age to controls (five for each case) who were selected through random systematic sampling. Data on demographics, medical characteristics, and all orally and intravascularly administered medications during hospitalization prior to a fall were collected. PIMs were assessed using the 2019 Beers criteria. Results: A conditional logistic regression analysis revealed that admission to the departments of internal medicine (odds ratio [OR] = 2.33; 95% confidence interval [CI] = 1.09–4.91) and neurology and rehabilitation (OR = 4.67; 95% CI = 2.08–10.5), diabetes with end‐organ damage (OR = 2.07; 95% CI = 1.11–3.86), PIM use of central nervous system drugs (OR = 1.81; 95% CI = 1.15–2.86), use of colchicine (OR = 5.49; 95% CI = 1.34–22.5) and spironolactone (OR = 4.54; 95% CI = 1.31–15.8) for renal function impairment, and polypharmacy (≥5 medications; OR = 1.81; 95% CI = 1.05–3.10) significantly increased the risk of falls. By contrast, being overweight or obese (OR = 0.47; 95% CI = 0.29–0.78) was associated with a significantly lower risk of falls. Conclusions: PIM use may increase the risk of falls in hospitalized older patients, and PIM identification and evaluation can reduce this risk. Geriatr Gerontol Int 2022; 22: 857–864. [ABSTRACT FROM AUTHOR]

Aim To examine medication use among patients with dementia towards the end of their life and to evaluate the appropriateness of medication use by using a nationwide database. Methods Using Taiwan's National Health Insurance Research Database, we identified 6532 people with dementia that died between 2008 and 2012. For each person with dementia, data of medication use in the last month of outpatient setting ( vs -12th month [baseline]) and last hospitalization ( vs -3rd hospitalization [baseline]) before death were retrieved for study. The medications of interest were selected according to a consensus recommendation, which included five categories defining their appropriateness (i.e. always, sometimes, rarely and never appropriate, as well as no consensus). Multivariable logistic regression was carried out to analyze the determinants for use of 'never appropriate' medications. Results Approximately 10% of the study participants were prescribed medications categorized as 'never appropriate' in the last month of life in the outpatient settings, which was significantly lower than their baseline (−12th month: 17.5%; P < 0.0001). A similar pattern was identified in the last hospitalization before death. Older age was associated with a lower likelihood of being prescribed 'never appropriate' medications (age 75-84: aOR 0.34 [0.29-0.41], P < 0.0001; age ≥85: aOR 0.34 [0.28-0.40], P < 0.0001). In contrast, patients with a history of diabetes mellitus (aOR 1.31 [1.10-1.55], P = 0.0018) were associated with a higher likelihood of being prescribed 'never appropriate' medications. Conclusions This is the first study to sophisticatedly describe medications use, particularly according to their appropriateness for palliative care, in Asian people with dementia at the end of their life. Approximately 10% of all patients were prescribed 'never appropriate' medications at the end of their life, which deserves further study to evaluate the clinical impact of the quality of care. Geriatr Gerontol Int 2017: 17 (Suppl. 1): 65-74.. [ABSTRACT FROM AUTHOR]

Rationale, aim and objective The beneficial effects of granulocyte colony-stimulating factor (G-CSF) prophylaxis on reducing the risk of chemotherapy-induced febrile neutropenia (CIFN) were well documented throughout the literature. However, existing data regarding its cost-effectiveness were conflicting. We estimated the cost-effectiveness of G-CSF prophylaxis in CIFN under Taiwan's National Health Insurance (NHI) system. Methods Data on clinical outcomes and direct medical costs were derived for 5179 newly diagnosed breast cancer and 629 non-Hodgkin's lymphoma (NHL) patients from the NHI claims database. Patients were further categorized into three subgroups as "primary-", "secondary-" and "no -" prophylaxis based on their patterns of G-CSF use. Generalized estimating equations were applied to estimate the impact of G-CSF use on the incidence of CIFN. The incremental cost-effectiveness ratios of primary and secondary prophylactic G-CSF use were calculated and sensitivity analyses were performed. Results Primary prophylaxis of G-CSF decreased the incidence of CIFN by 27% and 83%, while secondary prophylaxis by 34% and 22% in breast cancer and NHL patients, respectively. Compared with those with no prophylaxis, the incremental cost per CIFN reduced in primary prophylaxis is $931 and $52 among patients with breast cancer and NHL, respectively. In contrast, secondary prophylaxis is dominated by no prophylaxis and primary prophylaxis in both cancer patients. Conclusion Primary but not secondary prophylactic use of G-CSF was cost-effective in CIFN in breast cancer and NHL patients under Taiwan's NHI system. [ABSTRACT FROM AUTHOR]

Aims Influenza vaccination (InVa) is an effective measure for preventing influenza infection, which is a major cause of morbidity and mortality in older adults. However, the determinants of InVa remain unclear. Methods The present study included 4756 adults aged 55 years and older who completed the baseline examination of the Healthy Aging Longitudinal Study in Taiwan. During the examination, each participant received assessments of InVa status. Comprehensive assessments of sociodemographic (age, sex, education level, marital status, living alone and occupation) and health-related factors (chronic diseases, smoking status, alcohol intake, physical activities, cognitive status and physical performance) were also carried out. The InVa rate was defined as the number of participants who reported receiving free InVa divided by the total number of candidates for free InVa. Multinomial logistic regression analysis was applied to investigate the sociodemographic and health-related determinants of InVa status. Results The coverage rate of InVa was 44.8% (2130/4756). Older age (adjusted odds ratio [OR; >75 years vs <65 years] 7.72, 95% CI 6.26-9.52), multiple chronic diseases (OR [≥2 vs 0)] 1.31, 95% CI 1.10-1.65) and physical activity (OR [yes vs no] 1.43, 95% CI 1.23-1.64) were positively associated with receiving InVa. A current smoking status (OR 0.67, 95% CI 0.55-0.82) was negatively associated with receiving InVa. Conclusions Older adults who received InVa differed from non-receivers in multiple sociodemographic and health-related characteristics. These findings support continual efforts to improve the InVa coverage rate in vulnerable populations. Geriatr Gerontol Int 2017; 17: 2396-2402. [ABSTRACT FROM AUTHOR]