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Background: Older adults have historically been excluded from clinical trials, limiting evidence‐based data. An updated picture of the situation with newly marketed medications is needed. We aimed to describe (1) the recommendations specific to older adults in monographs of newly marketed medications; (2) the representation of older adults in clinical trials of those medications. Methods: In November 2020, we listed all medications that received a notice of compliance from Health Canada between January 2006 and September 2020, excluding those with indications irrelevant to community‐dwelling older adults and locally acting medications. We assessed the availability and clarity of recommendations in monographs regarding older adults. Using Clinicaltrials.gov, we identified randomized controlled double‐blind Phase III–IV trials led in Canada/United States of a sample of 30 commonly used medications among those previously listed. We extracted information on study design, participants, and efficacy/safety analysis specific to older patients. We used simple linear regression and Chi‐square/Fisher's exact tests to analyze time trends in the representation of older adults over different periods. Results: A total of 195 monographs were included. Of the 130 monographs reporting a dosing recommendation in older adults, 53 (41%) also reported limited/insufficient data in this population or its subgroups. Of the 373 trials included, 217 (58%) did not integrate a maximum age as an inclusion criterion. However, only 113 (30%) reported including a proportion of older adults representative (or over‐representative) of the Canadian older population. Most trials (n = 289; 78%) did not provide efficacy or safety data specific to older adults. In our sample, the number/proportion of older adults in trials seemed to be increasingly reported over time, either explicitly or implicitly (e.g., inclusion criterion specifies <65 years old). Conclusions: Newly marketed medications still appear to under‐represent older adults. The resulting lack of clear recommendations in monographs compromises evidence‐based practice, thereby perpetuating the risk to older adults' health. [ABSTRACT FROM AUTHOR]

Background: Fractures have serious health consequences in older adults. While some medications are individually associated with increased risk of falls and fractures, it is not clear if this holds true for the use of many medications (polypharmacy). We aimed to identify what is known about the association between polypharmacy and the risk of fractures in adults aged ≥65 and to examine the methods used to study this association. Methods: We conducted a systematic review with narrative synthesis of studies published up to October 2023 in PubMed, Embase, CINAHL, PsychINFO, Cochrane Library, Web of Science, and the grey literature. Two independent reviewers screened titles, abstracts, and full texts, then performed data extraction and quality assessment. Results: Among the 31 studies included, 11 different definitions of polypharmacy were used and were based on three medication counting methods (concurrent use 15/31, cumulative use over a period 6/31, daily average 3/31, and indeterminate 7/31). Overall, polypharmacy was frequent and associated with higher fracture risk. A dose–response relationship between increasing number of medications and increased risk of fractures was observed. However, only seven studies adjusted for major confounders (age, sex, and chronic disease). The quality of the studies ranged from poor to high. Conclusions: Polypharmacy appears to be a relevant modifiable risk factor for fractures in older individuals that can easily be used to identify those at risk. The diversity of medication calculation methods and definitions of polypharmacy highlights the importance of a detailed methodology to understand and compare results. [ABSTRACT FROM AUTHOR]

Some meta‐analyses suggest that deprescribing may reduce mortality. Our aim was to determine the underlying factors contributing to this observed reduction. We analysed data from 12 randomized controlled trials included in the latest meta‐analysis on deprescribing in community‐dwelling older adults. Our analysis focused on deprescribed medications and potential methodological concerns. Only a third (4/12) of the trials aimed to study mortality, and that too as a secondary outcome. Five trials reported a reduction in total medications, potentially inappropriate medications or drug‐related problems. Information on specific classes of deprescribed medications was limited, although a wide array was concerned (e.g., antihypertensive, sedative, gastro‐intestinal medications and vitamins). Follow‐up periods were ≤1 year in 11 trials, and five trials included ≤150 participants. Small sample sizes often resulted in imbalanced groups (e.g., comorbidities, number of potentially inappropriate medications), yet no trials presented multivariable analyses. In the two trials with the most weight in the meta‐analysis, several deaths occurred before the intervention, making it difficult to draw conclusions about the impact of the deprescribing intervention on mortality. These methodological issues cast significant uncertainty on the benefits of deprescribing on mortality outcomes. Large‐scale, well‐designed trials are needed to address this issue effectively. [ABSTRACT FROM AUTHOR]

Background: Non-optimal medication use among older adults is a public health concern. A concrete picture of potentially inappropriate medication (PIM) use is imperative to ensure optimal medication use.Objective: To assess the prevalence of PIMs in community-dwelling older adults and identify associated factors.Methods: A retrospective population-based cohort study was conducted using the Quebec Integrated Chronic Disease Surveillance System (QICDSS). The QICDSS includes data on drug claims for community-dwelling older adults with chronic diseases or at risk of developing chronic diseases aged ≥65 years who are insured by the public drug insurance plan. Individuals aged ≥66 years who were continuously insured with the public drug plan between 1 April 2014 and 31 March 2016 were included. PIMs were defined using the 2015 Beers criteria. We conducted multivariate robust Poisson regression analyses to explore factors associated with PIM use.Results: A total of 1 105 295 individuals were included. Of these, 48.3% were prescribed at least one PIM. The most prevalent PIMs were benzodiazepines (25.7%), proton-pump inhibitors (21.3%), antipsychotics (5.6%), antidepressants (5.0%) and long-duration sulfonylureas (3.3%). Factors associated with PIM exposure included being a woman [rate ratio (RR): 1.20; 95% confidence interval (CI): 1.20-1.21], increased number of medications and having a high number of chronic diseases, especially mental disorders (RR: 1.50; 95% CI: 1.49-1.51).Conclusion: Almost one out of two community-dwelling older adults use a PIM. It is imperative to reduce the use of PIMs, by limiting their prescription and by promoting their deprescribing, which necessitates not only the active involvement of prescribers but also patients. [ABSTRACT FROM AUTHOR]

However, we submit that it is more appropriate to underestimate PIM use, knowing which medications were not considered, than to introduce potential information bias by identifying clinical conditions without a validation process, which could lead to mischaracterization of PIM use. Thus, as described in our study, we did not include all PIMs since the QICDSS does not contain all validated clinical data necessary for the inclusion of these drugs. Declaration Funding: CS reports grants from the Fonds de recherche du Québec-Santé and from the Centre de recherche sur les soins et les service de première ligne de l'Université Laval. [Extracted from the article]