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What is known and objective There are few studies examining both drug-drug and drug-disease interactions in older adults. Therefore, the objective of this study was to describe the prevalence of potential drug-drug and drug-disease interactions and associated factors in community-dwelling older adults. Methods This cross-sectional study included 3055 adults aged 70-79 without mobility limitations at their baseline visit in the Health Aging and Body Composition Study conducted in the communities of Pittsburgh PA and Memphis TN, USA. The outcome factors were potential drug-drug and drug-disease interactions as per the application of explicit criteria drawn from a number of sources to self-reported prescription and non-prescription medication use. Results Over one-third of participants had at least one type of interaction. Approximately one quarter (25·1%) had evidence of had one or more drug-drug interactions. Nearly 10·7% of the participants had a drug-drug interaction that involved a non-prescription medication. % The most common drug-drug interaction was non-steroidal anti-inflammatory drugs (NSAIDs) affecting antihypertensives. Additionally, 16·0% had a potential drug-disease interaction with 3·7% participants having one involving non-prescription medications. The most common drug-disease interaction was aspirin/NSAID use in those with history of peptic ulcer disease without gastroprotection. Over one-third (34·0%) had at least one type of drug interaction. Each prescription medication increased the odds of having at least one type of drug interaction by 35-40% [drug-drug interaction adjusted odds ratio (AOR) = 1·35, 95% confidence interval (CI) = 1·27-1·42; drug-disease interaction AOR = 1·30; CI = 1·21-1·40; and both AOR = 1·45; CI = 1·34-1·57]. A prior hospitalization increased the odds of having at least one type of drug interaction by 49-84% compared with those not hospitalized (drug-drug interaction AOR = 1·49, 95% CI = 1·11-2·01; drug-disease interaction AOR = 1·69, CI = 1·15-2·49; and both AOR = 1·84, CI = 1·20-2·84). What is new and conclusion Drug interactions are common among community-dwelling older adults and are associated with the number of medications and hospitalization in the previous year. Longitudinal studies are needed to evaluate the impact of drug interactions on health-related outcomes. [ABSTRACT FROM AUTHOR]

Woojung Lee,1 Shelly L Gray,1 Douglas Barthold,1 Paul K Crane,2 Eric B Larson,3 Zachary A Marcum1 1School of Pharmacy, University of Washington, Seattle, WA 98195, USA; 2School of Medicine, University of Washington, Seattle, WA 98104, USA; 3Kaiser Permanente Washington Health Research Institute, Seattle, WA 98101, USACorrespondence: Zachary A MarcumDepartment of Pharmacy, School of Pharmacy, University of Washington, 1959 NE Pacific St, Box 357630, Seattle, WA 98102, USATel +1 206-685-2559Fax +1 206-543-3835Email zmarcum@uw.edu Twitter @zacharyamarcumPurpose: Antihypertensives may have effects on the brain beyond blood pressure lowering. Ongoing clinical trials aim to evaluate the effectiveness of approved antihypertensives in preventing dementia, including patients with and without hypertension. In order for a dementia prevention strategy using antihypertensives to be effective, it is critical to understand patient concerns about this strategy in both users and non-users of antihypertensives. Thus, this study examined the association between current use of antihypertensive and having concerns about using an antihypertensive as a dementia prevention strategy, as well as sociodemographic factors associated with concerns.Patients and methods: Cross-sectional, self-administered, web-based survey was conducted among 1661 patients in a large health system in January 2018. Participants reported whether they were currently taking an antihypertensive (yes/no), and what types of hypothetical concerns they have about the idea of taking an antihypertensive to prevent dementia (yes/no, for each of 7 concerns). Associations between the two variables were assessed via logistic regression, and odds ratios with 95% confidence intervals were calculated.Results: Most respondents were female (77%), 51–70 years of age (64%), and white (89%), with 30% reporting current antihypertensive use. Compared to current users, non-users were more likely to report the five following concerns: side effects from the medication, hassle to take medications, lack of evidence, not wanting to use medications, and already having normal/low blood pressure. Non-users were also less likely to report having no concerns (adjusted OR = 0.3; 95% CI = 0.2–0.4) compared to current users. Younger age and lower income were associated with having more concerns.Conclusion: Patients not currently using an antihypertensive are more likely to have concerns about using an antihypertensive for dementia prevention, compared to current antihypertensive users. Patient perspectives are important to consider for the implementation of dementia prevention strategies.Keywords: dementia, antihypertensives, primary prevention, patient concerns, patient perspectives

Objective: To assess the impact of a national immunization training certificate program on the perceived knowledge, skills and attitudes of pharmacy students toward pharmacy-based immunizations.Methods: The study design utilized a pre- and post-survey administered to pharmacy students before and after the American Pharmacists Association’s (APhA) Pharmacy-Based Immunization Delivery program. The primary outcome explored was a change in the perceived knowledge, skills, and attitudes of the pharmacy students. A five-point Likert scale (i.e. strongly agree = 5, strongly disagree = 1) was used for measuring the main outcomes, which was summated by adding the individual item scores in each section to form a composite score for each outcome. Results: The certificate training program resulted in a significant improvement in knowledge (38.5% increase in score, p

Little is known about longitudinal patterns of pain prevalence with aging. Identifying such patterns could allow for more targeted intervention. Our objective was to identify and describe long-term trajectories of bothersome pain and activity-limiting pain in a population-based sample of older adults. We conducted a retrospective cohort study of 6,783 community-dwelling participants using six years of longitudinal data from the National Health and Aging Trends Study (NHATS). NHATS is a cohort of older adults and is representative of Medicare Beneficiaries aged 65 years and older. NHATS data collection began in 2011, and demographic and health data are collected annually through in-person interviews. Outcomes were binary variables for bothersome pain in the past month and activity-limiting pain in the past month. We used group-based trajectory models to identify longitudinal patterns of bothersome pain and activity-limiting pain. We used weighted, multinomial logistic regression to describe associations with each group. The cohort was 57% female, 68% white, and 58% were ≥75 years. We identified four distinct trajectories for the probability of having bothersome pain over 6 years: consistently high (n=1901, 35%), increasing (n=898, 17%), decreasing (n=917, 17%), and consistently low (n=1735, 32%). Similar trajectories were identified for the probability of activity-limiting pain: consistently high (n=721, 13%), increasing (n=812, 15%), decreasing (n=677, 12%), and consistently low (n=3241, 60%). Number of comorbid health conditions was strongly associated with belonging to the consistently high versus low group for both bothersome pain [relative risk (RR)=1.78 increase for every additional condition; 95% CI: 1.67, 1.90)] and activity-limiting pain (RR=1.85 increase for every additional condition; 95% CI: 1.74, 1.98). Trajectories of bothersome pain and activity-limiting pain were highly variable. Approximately half of Medicare Beneficiaries have either high or increasing probability of long-term bothersome pain, and over a quarter have a high or increasing probability of activity-limiting pain long-term. [ABSTRACT FROM AUTHOR]