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BACKGROUND: Dietary supplement (DS) use is common and increasing among older adults, though much data available on use frequencies are from surveys and performed cross-sectionally. This paper sought to assess the frequency and pattern of dietary supplement use among older adults over time. METHODS: A secondary analysis of data from the AAA LongROAD study, a longitudinal prospective cohort study of older adult drivers, using data from baseline and the first two years of follow up included a total of 2990 drivers aged 65-79 years recruited at five study sites across the US from July 2015 to March 2017. Participants underwent baseline and annual evaluations, which included a brown bag medication review. DS were identified and categorized according to type and key components. Prevalence and pattern of DS use over time and relationship to demographics were measured with frequency and Chi squared analyses. RESULTS: 84% of participants took at least one dietary supplement during the 2-year study period, and 55% of participants continually reported use. DS accounted for approximately 30% of the total pharmacologic-pill burden in all years. Participants who were White non-Hispanic, female, 75-79 years of age at baseline, and on more non-supplement medications took significantly more dietary supplements (P

BackgroundPrescribing cascades are important contributors to polypharmacy. Little is known about which older adults are at highest risk of experiencing prescribing cascades. We explored which older veterans are at highest risk of the gabapentinoid (including gabapentin and pregabalin)-loop diuretic (LD) cascade, given the dramatic increase in gabapentinoid prescribing in recent years.MethodsUsing Veterans Affairs and Medicare claims data (2010-2019), we performed a prescription sequence symmetry analysis (PSSA) to assess loop diuretic initiation before and after gabapentinoid initiation among older veterans (≥66 years). To identify the cascade, we calculated the adjusted sequence ratio (aSR), which assesses the temporality of LD relative to gabapentinoid initiation. To explore high-risk groups, we used multivariable logistic regression with prescribing order modeled as a binary dependent variable. We calculated adjusted odds ratios (aORs), measuring the extent to which factors are associated with one prescribing order versus another.ResultsOf 151,442 veterans who initiated a gabapentinoid, there were 1,981 patients who initiated a LD within 6 months after initiating a gabapentinoid compared to 1,599 patients who initiated a LD within 6 months before initiating a gabapentinoid. In the gabapentinoid-LD group, the mean age was 73 years, 98% were male, 13% were Black, 5% were Hispanic, and 80% were White. Patients in each group were similar across patient and health utilization factors (standardized mean difference

ImportancePolypharmacy is associated with mortality, falls, hospitalizations, and functional and cognitive decline. The study of polypharmacy-related interventions has increased substantially, prompting the need for an updated, more focused systematic overview.ObjectiveTo systematically evaluate and summarize evidence across multiple systematic reviews (SRs) examining interventions addressing polypharmacy.Evidence reviewA search was conducted of MEDLINE, the Cochrane Database of Systematic Reviews, and the Database of Abstracts of Reviews of Effects for articles published from January 2017-October 2022, as well as those identified in a previous overview (January 2004-February 2017). Systematic reviews were included regardless of study design, setting, or outcome. The evidence was summarized by 4 categories: (1) medication-related process outcomes (eg, potentially inappropriate medication [PIM] and potential prescribing omission reductions), (2) clinical and functional outcomes, (3) health care use and economic outcomes, and (4) acceptability of the intervention.FindingsFourteen SRs were identified (3 from the previous overview), 7 of which included meta-analyses, representing 179 unique published studies. Nine SRs examined medication-related process outcomes (low to very low evidence quality). Systematic reviews using pooled analyses found significant reductions in the number of PIMs, potential prescribing omissions, and total number of medications, and improvements in medication appropriateness. Twelve SRs examined clinical and functional outcomes (very low to moderate evidence quality). Five SRs examined mortality; all mortality meta-analyses were null, but studies with longer follow-up periods found greater reductions in mortality. Five SRs examined falls incidence; results were predominantly null save for a meta-analysis in which PIMs were discontinued. Of the 8 SRs examining quality of life, most (7) found predominantly null effects. Ten SRs examined hospitalizations and readmissions (very low to moderate evidence quality) and 4 examined emergency department visits (very low to low evidence quality). One SR found significant reductions in hospitalizations and readmissions among higher-intensity medication reviews with face-to-face patient components. Another meta-analysis found a null effect. Of the 7 SRs without meta-analyses for hospitalizations and readmissions, all had predominantly null results. Two of 4 SRs found reductions in emergency department visits. Two SRs examined acceptability (very low evidence quality), finding wide variation in the adoption of polypharmacy-related interventions.Conclusions and relevanceThis updated systematic overview noted little evidence of an association between polypharmacy-related interventions and reduced important clinical and health care use outcomes. More evidence is needed regarding which interventions are most useful and which populations would benefit most.

Objectives: We evaluated the impact of polypharmacy on the health of community-dwelling older adults. Methods: We prospectively analyzed 5,631 individuals from the Moli-sani study (51% men, aged ≥65 years, recruitment 2005–2010, follow-up 2005–2020). Exposure was categorized as chronic polypharmacy therapy (C-PT; ≥5 therapeutic groups and >2 defined daily doses (DDDs)) or non-chronic polypharmacy therapy (NC-PT; polypharmacy but ≤2 DDDs). Hospitalization and mortality were the main outcomes. The mediating role of potentially inappropriate prescriptions (PIP) was examined. Results: Compared to individuals not on polypharmacy, those in NC-PT and C-PT had higher hazards of mortality [21% (95% CI 7%–37%) and 30% (16%–46%), respectively] and hospitalization [39% (28%–51%) and 61% (49%–75%), respectively]. Similar results were found for cardiovascular outcomes. PIP mediated the association between polypharmacy and outcomes, with mediation effects ranging from 13.6% for mortality to 6.0% for hospitalization. Older adults without multimorbidity experienced the same harm from multiple medications as those with multimorbidity. Conclusion: Polypharmacy is associated with a higher hazard of mortality and hospitalization, with PIP playing an important role. Addressing "medication without harm" requires assessing the appropriateness of drug prescriptions and monitoring for adverse effects. [ABSTRACT FROM AUTHOR]

Background Methods Results Conclusion Exposure to central nervous system (CNS)‐active polypharmacy—overlapping exposure to three or more CNS‐active medications—is potentially harmful yet common among persons living with dementia (PLWD). The extent to which these medications are prescribed to community‐dwelling PLWD by individual clinicians versus distributed across multiple prescribers is unclear.We identified community‐dwelling Medicare beneficiaries with a dementia diagnosis and Medicare Parts A, B, and D coverage for at least one month in 2019. Using fill date and days' supply for prescriptions filled between January 1, 2019 and December 31, 2019, we identified beneficiaries exposed to CNS‐active polypharmacy (i.e., >30 days of overlapping exposure to three or more antidepressant, antipsychotic, antiseizure, benzodiazepine, opioid, nonbenzodiazepine benzodiazepine receptor agonists, or skeletal muscle relaxant medications). We examined the number and type of clinicians who contributed to polypharmacy person‐days among PLWD.The cohort included 955,074 PLWD who were primarily female (64.0%), were White (78.5%), and had a mean age of 83.4 years (standard deviation 8.0). Notably, 14.3% were exposed to CNS‐active polypharmacy. At the person level, 24.6% of PLWD experienced polypharmacy prescribed by a single clinician. Considering total days of exposure, 45.3% of polypharmacy person‐days were prescribed by a single clinician. Primary care physicians prescribed 63.0% of polypharmacy person‐days and accounted for the plurality of days for all seven medication classes, followed by psychiatrists for antipsychotics and benzodiazepines and primary care advanced practice providers (APPs) for antidepressants and antiseizure medications.In this cross‐sectional analysis of Medicare claims data, primary care clinicians (both physicians and APPs) prescribed the majority of medications that contributed to CNS‐active polypharmacy for PLWD. Future research is needed to identify strategies to support primary care clinicians in appropriate prescribing of CNS‐active medications to PLWD. [ABSTRACT FROM AUTHOR]

Methods: The study employed a retrospective survey of 458 older individuals with T2D residing in a Chinese community, conducted between June 2020 and May 2021, to develop a predictive model for frailty. Among the participants, 83 individuals (18.1%) were diagnosed with frailty using modified frailty phenotypic criteria. The predictors of frailty in this community‐dwelling older population with T2D were determined using least absolute shrinkage and selection operator (LASSO) regression and multivariable logistic regression. These predictors were utilized to construct a nomogram. The discrimination, calibration, and medical usefulness of the prediction model were assessed through the C‐index, calibration plot, and decision curve analysis (DCA), respectively. Additionally, internal validation of the prediction model was conducted using bootstrapping validation. Results: The developed nomogram for frailty prediction predominantly incorporated age, smoking status, regular exercise, depression, albumin (ALB) levels, sleep condition, HbA1c, and polypharmacy as significant predictors. Our prediction model demonstrated excellent discrimination and calibration, as evidenced by a C‐index of 0.768 (95% CI, 0.714–0.822) and strong calibration. Internal validation yielded a C‐index of 0.732, further confirming the reliability of the model. DCA indicated the utility of the nomogram in identifying frailty among the studied population. Conclusion: The development of a predictive model enables a valuable estimation of frailty among community‐dwelling older individuals with type 2 diabetes. This evidence‐based tool provides crucial guidance to community healthcare professionals in implementing timely preventive measures to mitigate the occurrence of frailty in high‐risk patients. By identifying established predictors of frailty, interventions and resources can be appropriately targeted, promoting better overall health outcomes and improved quality of life in this vulnerable population. [ABSTRACT FROM AUTHOR]

In most older patients with Helicobacter pylori infection, the risks of eradication therapy (ET) are outweighed by the benefits, which include decreases in the incidences of gastric cancer, ulcer-related bleeding, hospitalisation and death. ET involves proton pump inhibitors or potassium-competitive acid blockers, antibiotics and/or bismuth, with quadruple therapy as front-line therapy. Prescribing complexity is increased by age-related comorbidities and polypharmacy, but overall, ET is effective and well tolerated in older people. To ensure successful eradication and prevent the emergence of drug-resistant H. pylori, performing antibiotic-resistance testing, adhering to guideline-recommended treatment durations, switching antibiotics after treatment failure, and performing post-therapy examinations is recommended. [ABSTRACT FROM AUTHOR]

Functional neurological disorder (FND) is common among children and adolescents, results in significant impairments in quality of life, and places a substantial burden on healthcare systems. Despite this, there is minimal literature to guide prescribing for this population. The purpose of this article is to provide common sense prescribing recommendations for providers who treat pediatric FND. A narrative review was conducted by searching PubMed using keywords related to FND and pharmacology. The narrative synthesis was guided by the objective of providing evidence for generally accepted practices and highlighting contributions and gaps in the literature. There is a dearth of evidence, and unique challenges exist in prescribing for pediatric patients with FND. Efforts should be made to limit prescribing and to discontinue, or de-prescribe, medications that may contribute to polypharmacy or overmedicalization of functional symptoms. Pediatric patients with FND require a thoughtful, multidisciplinary approach. [ABSTRACT FROM AUTHOR]

Polypharmacy, defined here as the concomitant use of five or more medications, is a significant health issue, particularly affecting individuals with chronic diseases like hypertension (HTN). To compare individuals with and without HTN in term of polypharmacy, and to investigate correlates of polypharmacy and medication use patterns in individuals with HTN in southwest Iran. This cross-sectional study used the baseline data of 9270 participants of the Pars Cohort Study (PCS) with a mean age of 52.6 ± 9.7 years. Poisson multivariable modeling was applied to identify correlates of polypharmacy, and Lexicomp® was used to assess drug-drug interactions. Anatomical Therapeutic Chemical classification was used to describe the pattern of medication use. The prevalence of polypharmacy in individuals without hypertension was 4.7 % (4.2%–5.2 %) vs. 23.7 % (22.1%–25.3 %) in individuals with hypertension (P < 0.001). Individuals with hypertension from middle-high socioeconomic status (SES) had a 1.51-fold higher prevalence of polypharmacy than vs. low SES. Those with more than three comorbidities had a 5.18 times higher prevalence of polypharmacy than those with isolated hypertension. Calcium channel blockers were the most common antihypertensives (20.9 %). In terms of drug-drug interactions, type C interactions were most prevalent among participants with hypertension and polypharmacy (76.0 %). Our findings imply a fairly high prevalence of polypharmacy and drug-drug interactions among individuals with hypertension; to tackle this issue, we recommend a national pharmacovigilance system, training programs for primary care physicians, public education and awareness campaigns, drug-checking campaigns, targeted screenings to alter modifiable risk factors, and the use of safe combination pills. [ABSTRACT FROM AUTHOR]

BACKGROUND: Additional evidence is required to address the unintended consequences of medication use in older people and the required caregiver support. To inform priorities for future research efforts, different stakeholder perspectives are needed, including those of older people, caregivers, clinicians, and researchers. OBJECTIVE: To develop a co-designed medicationrelated research agenda. METHODS: A 12-member Advisory Council, half of which were older people and caregivers, designed the research. An 11-question survey to identify priorities for medication-related patient-centered outcomes research (PCOR) topics was administered to members of the Elder Care Medicine Network (ECMN) (ie, older people, caregivers, clinicians, and researchers). Respondents were categorized into two groups with hierarchical assignment to the clinician/research group over the older adult/caregiver group. Chi-square tests compared priority areas for medication-related PCOR between the two groups. RESULTS: There were 53 responses (48% response rate) from the ECMN, with 39.6% (n = 21) from the clinician/researcher group and 60.4% (n = 32) from the older adult/caregiver group. The priority areas from both groups included safe ways to simplify medicines (62.2%), communicating with pharmacists and prescribers about medications (58.5%), and information about safe supplements with prescription medications (52.8%). Statistically significant differences existed between the two groups in the proportions choosing the priority areas. CONCLUSION: Co-design of a survey to identify priority areas for PCOR demonstrated successful engagement of older people and caregivers as research partners. While older people and caregivers may have differing perspectives on the importance of specific medication-related PCOR topics, simplifying medication regimen and health care communications were germane to both groups. [ABSTRACT FROM AUTHOR]

Background: There has been significant investment in pharmacists working in UK general practice to improve the effective and safe use of medicines. However, evidence of how to optimise collaboration between GPs and pharmacists in the context of polypharmacy (multiple medication) is lacking. Aim: To explore GP and pharmacist views and experiences of in-person, interprofessional collaborative discussions (IPCDs) as part of a complex intervention to optimise medication use for patients with polypharmacy in general practice. Design and setting: A mixed-method process evaluation embedded within the Improving Medicines use in People with Polypharmacy in Primary Care (IMPPP) trial conducted in Bristol and the West Midlands, between February 2021 and September 2023. Method: Audio-recordings of IPCDs between GPs and pharmacists, along with individual semi-structured interviews to explore their reflections on these discussions, were used. All recordings were transcribed verbatim and analysed thematically. Results: A total of 14 practices took part in the process evaluation from February 2022 to September 2023; 17 IPCD meetings were audio-recorded, discussing 30 patients (range 1–6 patients per meeting). In all, six GPs and 13 pharmacists were interviewed. The IPCD was highly valued by GPs and pharmacists who described benefits, including: strengthening their working relationship; gaining in confidence to manage more complex patients; and learning from each other. It was often challenging, however, to find time for the IPCDs. Conclusion: The model of IPCD used in this study provided protected time for GPs and pharmacists to work together to deliver whole-patient care, with both professions finding this beneficial. Protected time for interprofessional liaison and collaboration, and structured interventions may facilitate improved patient care. [ABSTRACT FROM AUTHOR]

We sought to identify long-term associations of medical complications and healthcare utilization related to polypharmacy following spinal surgery for degenerative lumbar pathology. The IBM MarketScan dataset was used to select patients who underwent spinal surgery for degenerative lumbar pathology with 2-year follow-up. Regression analysis compared two matched cohorts: those with and without polypharmacy. Of 118,434 surgical patients, 68.1% met criteria for polypharmacy. In the first 30 days after discharge, surgical site infection was observed in 6% of those with polypharmacy and 4% of those without polypharmacy (p < 0.0001) and at least one complication was observed in 24% for the polypharmacy group and 17% for the non-polypharmacy group (p < 0.0001). At 24 months, patients with polypharmacy were more likely to be diagnosed with pneumonia (48% vs. 37%), urinary tract infection (26% vs. 19%), and surgical site infection (12% vs. 7%), (p < 0.0001). The most prescribed medication was hydrocodone (60% of patients) and more than 95% received opioids. Two years postoperatively, the polypharmacy group had tripled overall healthcare utilization payments ($30,288 vs. $9514), (p < 0.0001). Patients taking 5 or more medications concurrently after spinal surgery for degenerative lumbar conditions were more likely to develop medical complications, higher costs, and return to the emergency department. [ABSTRACT FROM AUTHOR]

Background: Older people with HIV (PWH) are at risk of polypharmacy (taking multiple medications). Most medications may be necessary and indicated to manage HIV (e.g., antiretroviral therapy [ART]) and HIV-associated comorbidities. However, some are potentially inappropriate medications (PIMs), defined as causing greater harm than benefit, which leads to medication overload. The objective of this study was to characterize polypharmacy (taking multiple medications) and medication overload (prescription of ≥ 1 PIMs) among older PWH. Methods: This retrospective study included older PWH (aged ≥ 50 years old) attending the tertiary care HIV clinic at the McGill University Health Centre (Montreal, Canada), from June 2022–June 2023. Patient characteristics, medications, and select laboratory values (e.g., CD4 count, hemoglobin A1C) were entered into the MedSafer software identifying PIMs and classifying them according to risk of adverse drug event. We measured the prevalence of polypharmacy (≥ 5 medications prescribed, both including and excluding ART) and medication overload (≥ 1 PIMs). Multivariable logistic regression identified factors associated with medication overload. Results: The study included 100 patients, with a median age of 59 years (IQR = 54–63; range 50–82); 42% female. Polypharmacy affected 89% of patients when including antiretroviral therapy (ART) and 60% when excluding ART. Medication overload was present in 58% of patients, and 37.4% of identified PIMs were classified as high-risk. Polypharmacy was the sole predictor of medication overload. Conclusion: Older PWH are at significant risk of medication overload and receiving higher risk PIMs. Deprescribing PIMs in this population could improve medication appropriateness while reducing the risk of ADEs. [ABSTRACT FROM AUTHOR]

Polypharmacy (use of ≥5 concurrent medications) is highly prevalent among older adults to manage chronic diseases and is linked to adverse geriatric outcomes, including physical and cognitive functional impairments, falls, frailty, hospitalization, and mortality. Deprescribing (withdrawal) is a potential strategy to manage polypharmacy. The broad molecular changes by which polypharmacy causes harm and deprescribing may be beneficial are unknown and unfeasible to study rigorously in tissue from geriatric patients. Therefore, in a randomized controlled trial, we administered therapeutic doses of commonly used chronic medications (oxycodone, oxybutynin, citalopram, simvastatin, or metoprolol) as monotherapy or concurrently (polypharmacy) from middle‐age (12 months) to old‐age (26 months) to male C57BL/6J (B6) mice and deprescribed (gradually withdrew) treatments in a subset from age 21 months. We compared drug‐related hepatic effects by applying proteomics along with transcriptomics and histology. We found that monotherapy effects on hepatic proteomics were limited but significant changes were seen with polypharmacy (93% unique to polypharmacy). Polypharmacy altered the hepatic expression of proteins involved in immunity, and in drug, cholesterol, and amino acid metabolism, accompanied by higher serum drug levels than monotherapies. Deprescribing not only reversed some effects but also caused irreversible and novel changes in the hepatic proteome. Furthermore, our study identified several hepatic protein co‐expressed modules that are associated with clinically relevant adverse geriatric outcomes, such as mobility, frailty, and activities of daily living. This study highlights the complex molecular changes following aging, chronic polypharmacy, and deprescribing. Further exploration of these mechanistic pathways may inform management of polypharmacy and deprescribing in older adults. [ABSTRACT FROM AUTHOR]

Objective: Previous studies suggest older patients with multiple health conditions and medications may experience adverse interactions, leading to negative outcomes. However, there's limited research on this in older adults receiving home medical care. This study assesses whether polypharmacy is linked to falls or other clinical outcomes. Methods: The study population included 217 participants, aged ≥65 years, receiving home medical care, who consented to participate in the Osaka Home Care Registry (OHCARE) study in Japan. The survey examined the association between polypharmacy and clinical outcomes. We defined "polypharmacy" as six or more medications taken regularly. Results: Of the participants, 135 (62.6%) had polypharmacy and were significantly more likely to have hypertension or diabetes. Common medications included those for hypertension, diabetes, and mental disorders. Participants with polypharmacy experienced significantly more falls. Multivariate analysis showed an association between polypharmacy and falls (odds ratio: 2.81, 95% confidence interval [1.34, 5.92]). Conclusion: Even in older patients receiving home health care, the use of six or more medications poses a risk of falls. Careful observations and life support by medical stuffs are necessary to prevent falls in older patients with polypharmacy receiving home medical care. [ABSTRACT FROM AUTHOR]

Background: Patient and Public Involvement (PPI) is increasingly recognized as an essential aspect of clinical research, particularly for ensuring relevancy and impact of research to those most affected. This study addresses the gap in involving older patients, particularly nursing home residents, in the research process by exploring motivations, expectations, and experiences of nursing home residents in Bremen, Germany, involved in PPI for developing a clinical trial on polypharmacy. Methods: Two Patient Advisory Boards (PABs) were established in nursing homes as part of the INVOLVE-Clin project. A Patient Advocate (PA) facilitated communication between nursing home residents and researchers. A qualitative case study approach was employed, involving semi-structured interviews and group discussions with nursing home residents and researchers. Data was analyzed using structured qualitative content analysis. Results: The study found varied motivations and expectations between nursing home residents and researchers. Nursing home residents valued the social interaction and the opportunity to voice their health concerns, while researchers aimed to incorporate patients' perspectives into study design. The PA was considered crucial in facilitating communication between nursing home residents and researchers. Challenges included the complexity of the study topic and the need for methodological adjustments to suit nursing home residents´ cognitive abilities. Generally, PAB participation was experienced to provide mental stimulation and increased confidence among nursing home residents in discussing their medication management. The PAB's influence led to the decision not to conduct a polypharmacy study. Discussion: The findings underscore the importance of flexible approaches to PPI, particularly when involving older nursing home residents. Methodological adjustments, such as tailoring content and structure of PABs, and the inclusion of additional boards for diverse perspectives, are vital for effective involvement. The study also highlights the need for ongoing innovation in PPI methods to ensure meaningful engagement of older patients in clinical research. Conclusion: This study contributes essential insights into the practical implementation of PPI with nursing home residents, highlighting the need for patient-centric approaches that recognize their unique challenges and contributions. These findings are critical for shaping scientifically robust but also socially relevant and impactful research, especially in an aging society. Plain English Summary: This study looked at how nursing home residents in two nursing homes in Bremen, Germany, feel about being part of health research. It focused on their reasons for joining, what they hoped to get out of it, and their experiences. The study used two groups, called Patient Advisory Boards (PABs), in these nursing homes. An important part of making this work was having someone called a Patient Advocate, who talked to the nursing home residents and communicated their perspectives to the research team. Researchers talked to the residents and other researchers through interviews and group discussions. The study found that nursing home residents and researchers had different reasons for being involved. The nursing home residents enjoyed the chance to talk with others and share their health worries, while the researchers wanted to make sure the study considered the views of older patients. There were some challenges for both, researchers and nursing home residents. The topic of the study, which was about using many different medicines (polypharmacy), was complex. Nursing home residents would need easier methods to take part. Nonetheless, being part of the PABs was experienced to be good by the nursing home residents. It helped them think more about their health and feel more confident talking about their medicines. The study shows that when including nursing home residents in health research, it's important to think about their specific needs to ensure meaningful engagement. [ABSTRACT FROM AUTHOR]

Background Objectives Methods Results Conclusions Huntington's Disease is a rare neurodegenerative disorder in which appropriate medication management is essential. While many medications are prescribed based on expert knowledge, overviews of actual medication use in HD are sparse.We provide a detailed overview of medication use and associated indications across HD disease stages, considering sex and regional differences.Data from the largest observational HD study, ENROLL‐HD, were used. We created HD‐related medication and indication classes to identify medication trends in manifest, premanifest and control subjects. We studied medication use in adult, childhood‐ and adolescent‐onset HD, incorporating disease stage (including phenoconverters), sex and regional differences.In 8546 manifest HD patients, 84.6% used medication (any type), with the average number of medications per user rising from 2.5 in premanifest HD to 5.2 in end stage disease. Antipsychotics (29.2%), SSRIs (27.5%) and painkillers (21.8%) were most often used. Medication use varied with disease progression. Several differences were observed between the sexes, and notably between Europe and Northern America as well. Medication use increased after phenoconversion (from 64.8% to 70.6%, P < 0.05), with the largest difference in antipsychotic use (4.4%–7.8%, P < 0.05). Medication patterns were different in childhood‐onset HD, with no use of painkillers, less use of anti‐chorea and antidepressant drugs, and more for aggression and irritability.Medication use in HD increases with disease progression, with varying types of medications prescribed based on disease stage, sex, and region of living. Recognizing these medication trends is vital for further personalized HD management. [ABSTRACT FROM AUTHOR]

Background: Inappropriate prescribing (IP) is a common problem in the older population. Despite numerous attempts to tackle this issue, it remains a public health concern. In most European countries, general practitioners (GPs) are responsible for global primary care and are thus gatekeepers for the adequacy of medicines, specifically for older people. An in-depth analysis of the situation is necessary to understand why this phenomenon is still prevalent and to identify solutions that could help avoid IP in primary practice. Method: A qualitative study based on five focus groups (FG) comprising nine to thirteen general practitioners was conducted in the French-speaking part of Belgium. Participants were recruited among the Local Medical Evaluation Groups (LMEG) and selected to guarantee heterogeneity in working organisations, years of professional experience, gender and age. All interviews were recorded with prior agreement and transcribed in verbatims. The transcripts were coded and analysed to highlight the primary themes, considering dominant and marginal discourses. Results: Fifty four GPs participated in the study, with an average experience of 30 years. IPs are perceived as a significant problem in the older population, leading to dangerous health situations. The issue is associated with polypharmacy and multimorbidity, and GPs stated to manage IP using their clinical experience. Most of the study participants faced difficulties managing IP, mostly due to the specificity and complexity of elderly care. Indeed, managing an older patient is challenging due to medical complexity, poor adherence to drug regimes, or low medical literacy. In addition, the medical environment of general practice is challenging, with multiple providers, lack of time, prescribing routine and the absence of effective communication with specialists or other care providers. Additionally, the tools and support available to help medication management in primary care are inadequate. Enhancing collaboration with pharmacists is perceived as a strong potential facilitator. Conclusion: This article addresses the complex management of IP in the old age, from the point of view of GPs. Interesting clues were highlighted, like the need to clarify roles of healthcare providers, the better fit of tools to facilitate medication's review with particularities of GPs needs and the empowerment of pharmacist collaboration. [ABSTRACT FROM AUTHOR]

Background: Multimorbidity, polypharmacy, and inappropriate prescribing are significant challenges in the geriatric population. Tools such as the Beers List, FORTA, and STOPP/START criteria have been developed to identify potentially inappropriate prescribing (PIP). STOPP/START criteria detect both potentially inappropriate medications (PIMs) and potential prescribing omissions (PPOs). The latest, third version of STOPP/START criteria expands the tool, based on the growing literature. The study aimed to evaluate the prevalence of PIP and the number of PIP per person identified by STOPP/START version 3 and to compare it to the previous version. Methods: This retrospective, cross-sectional study enrolled one hundred geriatric patients with polypharmacy from two day-care centers for partially dependent people in Poland. Collected data included demographic and medical data. STOPP/START version 3 was used to identify potentially inappropriate prescribing, whereas the previous version served as a reference. Results: STOPP version 3 detected at least one PIM in 73% of the study group, a significantly higher result than that for version 2 (56%). STOPP version 3 identified more PIMs per person than the previous version. Similarly, START version 3 had a significantly higher prevalence of PPOs (74% vs. 57%) and a higher number of PPOs per person than the previous version. The newly formed STOPP criteria with high prevalence were those regarding NSAIDs, including aspirin in cardiovascular indications. Frequent PPOs regarding newly formed START criteria were the lack of osmotic laxatives for chronic constipation, the lack of mineralocorticoid receptor antagonists, and SGLT-2 inhibitors in heart failure. Conclusions: This study showed the high effectiveness of the STOPP/START version 3 criteria in identifying potentially inappropriate prescribing, with a higher detection rate than version 2. [ABSTRACT FROM AUTHOR]

AbstractType 2 diabetes mellitus (T2DM), responsible for most diabetes cases recorded worldwide, increases the risk of chronic wounds and amputation. Patients with T2DM appear to be more susceptible to delayed wound healing due to their treatment adherence. This review explores the specifics of polypharmacy, side effects, possible drug interactions and the importance of medication adherence for therapeutic efficacy. We discuss the effects of anti-diabetes medications on wound healing as well as the role that biofilms and microbial infections play in diabetic wounds. Inconsistent use of medications can lead to poor glycaemic control, which negatively affects the healing process of diabetic foot ulcers. Managing chronic wounds represents a substantial portion of healthcare expenditures. Biofilm-associated infections are difficult for the immune system to treat and respond inconsistently to antibiotics as these infections are slow growing and persistent. Additionally, we emphasize the critical role pharmacists play in enhancing patient adherence and optimizing diabetes treatment by offering comprehensive coverage of drugs associated with problems related to pharmacological therapy in type 2 diabetes. [ABSTRACT FROM AUTHOR]

Background/Objectives: Potentially inappropriate prescribing (PIP) is a common health problem in older adults and is associated with negative health outcomes such as the occurrence of adverse drug events. Several studies have been conducted in different countries and settings to assess the prevalence of PIP, including in Home Care Services. However, data on the prevalence of PIP in home-care services in Saudi Arabia are limited. This study aimed to evaluate PIP use among older patients receiving home healthcare services in Saudi Arabia and to identify the predictors and commonly implicated medications.; Methods: A cross-sectional study was conducted over an 8-month period between January and August 2023. Data were collected from the medical records of patients older than 65 years who were currently receiving home health care services at King Faisal Hospital in Taif City, Saudi Arabia. PIPs were identified using the 2019 updated Beers Criteria.; Results: A total of 375 patients were included. Out of these, 285 PIPs were identified, of which 219 patients (58.4%) received at least one PIP. The most common therapeutic class associated with the PIPs was gastrointestinal medications (66.3%). Patient age and number of medications were significant predictors of PIP.; Conclusions: Our study found a high prevalence of PIP among elderly patients receiving home health care in Taif, Saudi Arabia. This study highlights the need for improved patient data automation and implementation of the Beers criteria to prevent PIPs in the future. [ABSTRACT FROM AUTHOR]

Background: The modifiable risk factor exerting the most substantial influence on the development and disease course of multiple sclerosis (MS) is cigarette smoking. Furthermore, smoking is associated with a higher risk of suffering from one or more comorbidities and potentially contributes to polypharmacy. We aimed to use personality tests to explore health-promoting and harmful patient characteristics. Objective: To investigate two important factors influencing the course of MS – the degree of smoking dependence and the status of polypharmacy – in association with personality traits. Design: This is a bicentric, cross-sectional study. Methods: We collected sociodemographic, clinical and medical data from patients with MS (n = 375) at two German neurological clinics. The participants were asked to complete the NEO Five-Factor Inventory (NEO-FFI) and the Temperament and Character Inventory-Revised (TCI-R). Relationships between variables were examined using correlation analyses, and differences between groups were examined using linear models. Current smokers with MS were also asked to complete the Fagerström questionnaire to categorize them into patients with mild, moderate and severe smoking dependence. Results: In our sample, 67.5% were women, and the mean age was 48.1 years. The patients had a median Expanded Disability Status Scale of 3.0 at a median disease duration of 10 years. Patients with MS with severe smoking dependence had on average a significantly higher neuroticism score in the NEO-FFI compared to those with mild or moderate smoking dependence. Patients with MS and polypharmacy had significantly higher neuroticism scores than those without. In the extraversion scale of the NEO-FFI, patients with MS and polypharmacy had significantly lower scores on average. Significant differences were also found when analysing the TCI-R in patients with MS and heavy smoking dependence, with higher scores for harm avoidance (HA) and lower scores for reward dependence, self-directedness (S-D) and cooperativeness (CO) in various subscales. Polypharmacy in patients with MS was associated with higher scores for HA and self-transcendence. Furthermore, patients with polypharmacy showed lower values than patients without polypharmacy in individual subscales of the dimensions of persistence, S-D and CO. Conclusion: Using the NEO-FFI, we were able to show that neuroticism is a detrimental trait and extraversion a protective trait in patients with MS in relation to nicotine dependence and polypharmacy. In addition, the evaluation of the TCI-R showed that high HA as well as low S-D and CO scores were more common in patients with MS and nicotine dependence or polypharmacy. With this knowledge, the risk of polypharmacy and smoking can be understood in the context of personality characteristics and targeted treatment and counselling can be provided. [ABSTRACT FROM AUTHOR]

Medication can affect the gut microbiota composition and function. The aim of this study was to investigate connections between use of common non-antibiotic medicines and the gut microbiota composition and function in a large Swedish cohort (N = 2223). Use of 67 medications and polypharmacy (≥ 5 medications), based on self-reported and prescription registry data, were associated with the relative abundance of 881 gut metagenomic species (> 5% prevalence) and 103 gut metabolic modules (GMMs). Altogether, 97 associations of 26 medications with 40 species and of four medications with five GMMs were observed (false discovery rate < 5%). Several earlier findings were replicated like the positive associations of proton pump inhibitors (PPIs) with numerous oral species, and those of metformin with Escherichia species and with lactate consumption I and arginine degradation II. Several new associations were observed between, among others, use of antidepressants, beta-blockers, nonsteroidal anti-inflammatory drugs and calcium channel blockers, and specific species. Polypharmacy was positively associated with Enterococcus faecalis, Bacteroides uniformis, Rothia mucilaginosa, Escherichia coli and Limosilactobacillus vaginalis, and with 13 GMMs. We confirmed several previous findings and identified numerous new associations between use of medications/polypharmacy and the gut microbiota composition and functional potential. Further studies are needed to confirm the new findings. [ABSTRACT FROM AUTHOR]

Background: Drug-drug interactions (DDIs) between antiretroviral therapy (ART) and commonly used co-medications in HIV patients, especially women, impact treatment efficacy and patient safety. Objective: This study aimed to study the prevalence and types of drug-drug interactions (DDIs) between antiretroviral therapy drugs (ARTs) and comedications among a female population with HIV. Additionally, the study investigates the association of these DDIs with ART medication changes and treatment adherence. Methods: This cross-sectional study included 632 adult women living with HIV (WLHIV). Data was retrospectively extracted from patient files. Drug.com interaction checker website was used to assess DDIs between ART and non-ART medications. Changes to the ART regimen previously attributed to ART side effects or patient non-adherence were considered drug changes. Results: A total of 429 WLHIV (mean age: 44.05 ± 9.50) were eligible. The prevalence of DDIs between ART and non-ART medications was 21.4%, with 4.7% minor, 18.4% moderate, and 8.9% major interactions. The highest prevalence of DDI was among cardiovascular medication users (71.7%), followed by central nervous system drugs (69.2%). Changing medications resulted in a decrease in DDIs, with significant reductions in total and minor interactions. Participants without DDIs had better adherence to ART. DDI between ART and non-ART medications was significantly associated with ART drug change, even after accounting for side effects attributed to ARTs, indicating an independent twofold association (OR = 1.99, CI 1.04–3.77). Moreover, further adjustments for HIV viral load and CD4 + cell count did not change the significance of the association (OR = 2.01, CI 1.03–3.92). Conclusion: DDIs in WLHIV impact adherence to ART. Altering ART may not be directly related to ART side effects, but rather primarily due to interactions with non-ART medications. Modifying non-ART drug regimens can reduce the likelihood of DDIs. [ABSTRACT FROM AUTHOR]

Background: Māori are over-represented in Aotearoa New Zealand morbidity and mortality statistics. Other populations with high health needs include Pacific peoples and those living with material deprivation. General practice has evolved into seven models of primary care: Traditional, Corporate, Health Care Home, Māori, Pacific, Trusts / Non-governmental organisations (Trust/NGOs) and District Health Board / Primary Care Organisations (DHB/PHO). We describe nurse work in relation to these models of care, populations with high health need and patient health outcomes. Methods: We conducted a cross-sectional study (at 30 September 2018) of data from national datasets and practices at patient level. Six primary outcome measures were selected because they could be improved by primary care: polypharmacy (≥ 65 years), glucose control testing in adults with diabetes, immunisations (at 6 months), ambulatory sensitive hospitalisations (0–14, 45–64 years) and emergency department attendances. Analysis adjusted for patient and practice characteristics. Results: Nurse clinical time, and combined nurse, nurse practitioner and general practitioner clinical time, were substantially higher in Trust/NGO, Māori, and Pacific practices than in other models. Increased patient clinical complexity was associated with more clinical input and higher scores on all outcome measures. The highest rates of preventative care by nurses (cervical screening, cardiovascular risk assessment, depression screening, glucose control testing) were in Māori, Trust/NGO and Pacific practices. There was an eightfold difference, across models of care, in percentage of depression screening undertaken by nurses and a fivefold difference in cervical screening and glucose control testing. The highest rates of nurse consultations afterhours and with unenrolled patients, improving access, were in PHO/DHB, Pacific, Trust/NGO and Māori practices. Work not attributed to nurses in the practice records meant nurse work was underestimated to an unknown degree. Conclusions: Transferring work to nurses in Traditional, Health Care Home, and Corporate practices, would release general practitioner clinical time for other work. Worse patient health outcomes were associated with higher patient need and higher clinical input. It is plausible that there is insufficient clinical input to meet the degree of patient need. More practitioner clinical time is required, especially in practices with high volumes of complex patients. [ABSTRACT FROM AUTHOR]

Purpose: Polypharmacy presents many challenges to patient medication selfmanagement. This study aims to explore the self-management processes of medication in polypharmacy from the perspectives of both patients and healthcare providers, which can help identify barriers and facilitators to effective management. Methods: A systematic review of qualitative studies was performed by searching seven databases: PubMed, Web of Science, Cochrane Library, Embase, CINAHL, PsycINFO, and MEDLINE, from their establishment until August 2024. The Critical Appraisal Skills Programme (CASP) tool was employed to evaluate the quality of the studies included. The extracted data were then analysed thematically and integrated into The Taxonomy of Everyday Self-management Strategies (TEDSS) framework. Results: A total of 16 studies were included, involving 403 patients and 119 healthcare providers. Patient management measures were mapped into TEDSS framework, including categories such as medical management, support-oriented domains, and emotional and role management. Conclusion: Enhancing patients' proactive health awareness, improving medication literacy, balancing lifestyle adjustments with medication therapy, dynamically reviewing and optimizing medications, strengthening patients' social support networks, and helping patients integrate medication management into their daily life are the key elements that can effectively assist patients in self-managing their medications. Future interventions to improve patient medication self-management ability should be designed for these issues. [ABSTRACT FROM AUTHOR]

With the acceleration of society’s aging process, the widespread phenomenon of polypharmacy among the elderly has become a significant concern. This research aimed to analyze potential inappropriate medication among 178 inpatients in the geriatric general department of our hospital from January 2022 to September 2022. The participants were randomly assigned to an observation group and a control group. The observation group received pharmaceutical intervention, whereas the control group did not. The objective was to explore the impact of pharmaceutical intervention on polypharmacy in this population. The results revealed that after pharmaceutical intervention, there were no significant differences in medication adherence, medication appropriateness index (MAI), quantity of medicine, and potentially inappropriate medication (PIM) in the control group compared to before the intervention (P > 0.05). However, the observation group showed significant improvement (P < 0.05). The proportion of patients with good adherence increased from 57% to 78%, and the percentage of patients with MAI scores over 10 decreased from 60% to 40%. Moreover, there was a reduction in the number of medications prescribed, with only 47% of patients receiving more than five different types compared to the initial rate of 64%. Additionally, the occurrence of PIM declined from an initial rate of 64% to just 44%, surpassing that observed in the control group. Therefore, the implementation of pharmaceutical intervention can effectively enhance medication adherence and appropriateness among elderly patients, mitigate the risk of PIM, and promote rational medicine utilization. [ABSTRACT FROM AUTHOR]

Background Automated frailty screening tools like the Hospital Frailty Risk Score (HFRS) are primarily validated for care consumption outcomes. We assessed the predictive ability of the HFRS regarding care consumption outcomes, frailty domain impairments and mortality among older adults with cancer, using the Geriatric 8 (G8) screening tool as a clinical benchmark. Methods This retrospective, linkage-based study included patients aged ≥70 years with solid tumor, enrolled in the Elderly Cancer Patients (ELCAPA) multicentre cohort study (2016–2020) and hospitalized in acute care within the Greater Paris University Hospitals. HFRS scores, which encompass hospital-acquired problems and frailty-related syndromes, were calculated using data from the index admission and the preceding 6 months. A multidomain geriatric assessment (GA), including cognition, nutrition, mood, functional status, mobility, comorbidities, polypharmacy, incontinence, and social environment, was conducted at ELCAPA inclusion, with computation of the G8 score. Logistic and Cox regressions measured associations between the G8, HFRS, altered GA domains, length of stay exceeding 10 days, 30-day readmission, and mortality. Results Among 587 patients included (median age 82 years, metastatic cancer 47.0%), 237 (40.4%) were at increased frailty risk by the HFRS (HFRS>5) and 261 (47.5%) by the G8 (G8≤10). Both HFRS and G8 were significantly associated with cognitive and functional impairments, incontinence, comorbidities, prolonged length of stay, and 30-day mortality. The G8 was associated with polypharmacy, nutritional and mood impairment. Discussion Although showing significant associations with short-term care consumption, the HFRS could not identify polypharmacy, nutritional, mood and social environment impairments and showed low discriminatory ability across all GA domains. [ABSTRACT FROM AUTHOR]

Pharmacotherapy is a front-line intervention used to address complex health concerns among forensic system consumers. Many are prescribed a polypharmacy pharmacotherapy regimen, though this may pose significant risks to physical health and well-being. Forensic consumers also have evidence of behavioral health concerns that may impact preferred treatment and prescribing practices. We examined the relationship between ACEs, suicide, self-harm, and inpatient aggression with psychotropic polypharmacy using retrospective data extracted from medical records from a US forensic mental health facility (N = 182). Nearly all participants (98.5%) prescribed any medication (72%) received a psychotropic polypharmacy regimen. ACEs were common, impacting 75.8% of the sample. ACEs, self-harm, and inpatient aggression, though not suicide attempts, were positively predictive of psychotropic polypharmacy in a series of regression analyses. Mediation analyses explored the interplay between ACEs, specific behavioral concerns, and psychotropic polypharmacy, though only models involving self-harm were significant. Implications for trauma-informed practice include an emphasis on consumer choice, empowerment, collaboration, and autonomy. Future research should investigate implementation of trauma-informed practices in forensic mental health settings and the effectiveness of nonpharmacological interventions that can be used to reduce dependence on psychotropic medications when managing forensic consumers' health concerns. [ABSTRACT FROM AUTHOR]

Aim: Given that metformin is often recommended for the management of type 2 diabetes mellitus, it is clinically significant to consider the potential interactions between metformin and other medications. In this study, we aimed to identify potential drug-drug interactions associated with metformin by retrospectively analyzing the prescriptions of patients taking metformin. Materials and Methods: Metformin-containing prescription data of five independent community pharmacies in Konya province for the year 2023 were analyzed retrospectively. Medscape®, Drugs® and LexiComp® software programs were used to detect potential drug-drug interactions. As a result of power analysis with the G Power program, 400 patients were included in the study with an effect size of 0.25, type 1 error of 0.05 and confidence interval of 0.95. Results: Kendall's W value indicating the agreement between Medscape®, Drugs®and LexiComp® software programs was calculated as 0.061. In terms of potential drug-drug interactions of metformin, the agreement between the software programs was observed to be slight. The highest agreement between the programs was observed between Medscape® and LexiComp® (Kappa coefficient=0.44). Conclusion: Since potential drug-drug interactions are common in prescriptions for patients taking metformin, these interactions should be carefully monitored. Clinicians should use multiple interaction programs to identify potential drug-drug interactions of metformin. [ABSTRACT FROM AUTHOR]

Background: Observational studies reported worse COVID-19 evolution in relation to polypharmacy and reductions in COVID-19 hospital admissions and death in patients receiving chronic antihistamine treatment. The current profile of hospitalized patients with regard to different variants was analyzed to identify specific targets for future prospective trials. Methods: COVID-19 admissions to the Hospital of Terrassa (11 March 2020–28 August 2024 (n = 1457), from the integral Consorci Sanitari de Terrassa population (n = 167,386 people) were studied. Age, gender, the number of chronic treatments (nT), and immunization status were analyzed. Results: After 5 May 2023, 291 patients (54% females) required COVID hospitalization. Of these, 39% received >8 nT (23% receiving 5–7 nT), 70.2% were >70 years, and 93.4% survived. In total, 12% of patients admitted after 5 May 2024 were not vaccinated, while 59% received ≥4 vaccines (43% within the last 12 months). In total, 49% of admitted patients presented no previous infection (while 3% presented infection during the last year). Delta or Omicron variants would have accounted for ≥80% of admissions > 60 years compared to the first pandemic wave if no vaccines existed. Conclusions: Patients > 70 years who receive ≥5 nT, without prior COVID-19 infections, should be the priority for prevention, with updated vaccination and early treatments to reduce hospitalizations. [ABSTRACT FROM AUTHOR]

Ageing is associated with an increased risk of adverse drug reactions. This calls for great care and diligent follow up when prescribing medication to older patients. Yet, this is seldom the case and the proportion of older people taking five or more medications has quadrupled from 12% to 49% in the last 20 years. Certain medications are riskier than others. Those with anticholinergic effects are of particular concern. Adverse effects of anticholinergics include dry mouth, nausea, dizziness, fatigue, vomiting, constipation, abdominal pain, urinary retention, blurred vision, tachycardia and neurologic impairment, such as confusion and agitation. Anticholinergic medication can cause daytime drowsiness and cognitive decline, while increasing the risk of fall and can lead to increased mortality. Although anticholinergic medication should be avoided in older people whenever possible, their use has almost doubled in the last 20 years, and those who are most vulnerable to its adverse effects had the greatest increase in use. This article examines why older people are at increased risk of adverse drug reactions and how medication review can enable older persons to take medications regularly, improve quality of life and minimise medication waste. [ABSTRACT FROM AUTHOR]

We aimed to map tasks related to medication management and time consumption in Danish home health care. Nursing staff (n = 30) from five municipalities were followed during a 10‐week period and tasks related to medication management, time consumption and information on citizens' medication were registered. A total of 269 courses were registered, including 163 (61%) home visits, 76 (28%) in‐office courses, 29 (11%) in‐clinic courses and 1 (0.4%) acute visit. Of defined categories related to medication management, 'record‐keeping and communication' (62%, n = 167), 'dispensing' (48%, n = 129) and 'identification' (30%, n = 81) were most often performed. During half of courses (55%, n = 147), the nursing staff was interrupted at least one time. The median time spent on medication management was less than the time allocated in most of allocated time slots (82%), with a median excess time of 5.1 min (range 0.02–24 min). Citizens (n = 32) used a median of 11 (interquartile range [IQR] 9–13) regular medications and 2 (IQR 1–4) as‐needed, and 69% (n = 22) used high‐risk situation medications. In conclusion, employees in Danish home health care perform diverse medication‐related tasks and are frequently interrupted in their work. Employees spend less time than allocated but do not fully solve all tasks according to best practice guidance. [ABSTRACT FROM AUTHOR]

It has become increasingly common for patients to rely on the use of multiple prescription medications. The management of polypharmacy requires careful consideration for how drugs are metabolized and their potential for interaction with other drugs. Drug–drug interaction (DDI) assessments are typically performed in a stepwise manner during drug development, though knowledge gaps can exist at the time of approval. The US Food and Drug Administration can establish postmarketing requirements (PMRs) or postmarketing commitments (PMCs) to address these knowledge gaps. In this study, we systematically evaluated PMRs and PMCs established to new molecular entities (NMEs) at the time of initial approval between 2009 and 2023, for the assessment of pharmacokinetics‐based DDIs (i.e., drug metabolizing enzyme‐ and transporter‐related DDIs). We found that 22% of NMEs had at least one DDI‐related PMR or PMC, with a total of 263 that were pharmacokinetic based. Of these, 67% were for the assessment of drug metabolizing enzymes, which were established most frequently for their evaluation as a substrate, and 28% for transporters, which were established most frequently for their evaluation as an inhibitor. The 89% of PMRs and PMCs that were considered fulfilled had a revision to the United States prescribing information, the majority of which resulted in updated new instructions for use. This study highlights the value in conducting PMRs and PMCs early in the drug development process allowing broad patient inclusion at the time of initial drug approval. [ABSTRACT FROM AUTHOR]

Background: Polypharmacy is a primary risk factor for the prescription of potentially inappropriate medications (PIMs), drug–drug interactions (DDIs), and ultimately, adverse drug reactions (ADRs). Medication review and deprescribing represent effective strategies to simplify therapeutic regimens, minimize risks, and reduce PIM prescriptions. This systematic review and meta‐analysis of experimental and observational studies aimed to evaluate the impact of different medication review and deprescribing interventions in hospitalized older patients. Methods: Experimental and observational prospective cohort studies evaluating the clinical effects of medication review and deprescribing strategies in older hospitalized patients were searched in the bibliographic databases, PubMed, Embase, and Scopus, from inception until January 8, 2024. A narrative synthesis of the results was provided, along with a meta‐analysis of dichotomous data (i.e., re‐hospitalizations and mortality). Results: Overall, 21 randomized controlled trials, 7 non‐randomized interventional studies, and 2 prospective cohort studies were included in the systematic review. Of these, 14 (46.7%) assessed medication appropriateness as the primary outcome, while the remaining evaluated clinical outcomes (e.g., length of hospital stay, hospital readmissions, emergency department visits, and incidence of ADRs) and/or quality of life. The meta‐analysis revealed a slight but statistically significant 8% reduction in hospital readmissions (HR: 0.92; 95% CI: 0.85–0.99) following medication review and deprescribing, but no significant impact on mortality (HR: 0.98; 95% CI: 0.96–1.00). Of the 30 included studies, 21 were considered at high risk of bias, mostly due to potential deviations from intended interventions and randomization processes. The remaining nine studies had "some concerns" (eight studies) or were considered at "low" risk of bias (one study). Conclusion: Medication review and deprescribing are associated with potential benefits in reducing hospital readmission rates among hospitalized older patients, particularly through the reduction of PIM prescriptions. The integration of thorough medication review and deprescribing protocols in hospital settings may improve post‐discharge outcomes and reduce overall healthcare costs. [ABSTRACT FROM AUTHOR]

Background: Dietary supplements are commonly used by older adults, but their inappropriate use may lead to adverse events. To optimise medication use, general practitioners (GPs) ideally are aware of all substances that patients use, including supplements. This cross-sectional study explored the use of dietary supplements by older patients with polypharmacy, the rate at which they disclosed this use to their GPs, and compared patients' and GPs' attitudes towards discontinuing dietary supplements. Methods: Ten GPs in Swiss primary care recruited five to ten of their older patients taking ≥ 5 regular medications. Both GPs and their patients completed a survey on patients' use of dietary supplements and attitudes towards deprescribing those. We described and compared their responses. We assessed the association of supplement disclosure with patient characteristics using multilevel logistic regression analysis. Results: Three out of ten GPs (30%) were female, and GPs' average age was 52 years (SD = 8). 45% of patients were female (29/65). Most patients (n = 45, 70%) were taking ≥ 1 supplement. On average, patients reported to be using three supplements (SD = 2). In 60% (n = 39) of patients, GPs were unaware of ≥ 1 supplement used. We did not find evidence for an association between supplement disclosure to GPs and patient characteristics. Only 8% (n = 5) of patients and 60% (n = 6) of GPs reported ≥ 1 supplement they would be willing to deprescribe and none of the supplements reported by GPs and patients to deprescribe matched. Conclusion: Swiss GPs were unaware of many dietary supplements used by their older patients, which may affect medication optimisation efforts. [ABSTRACT FROM AUTHOR]

Background and Aims: Potentially harmful polypharmacy is a growing public health concern. This article aims to evaluate the effectiveness of a structured Team Approach to Polypharmacy Evaluation and Reduction (AusTAPER) framework. Methods: We recruited patients at metropolitan hospitals for a randomised controlled trial with 12 months of follow‐up. The intervention included a comprehensive medicines history, multidisciplinary meeting and medicines review prior to discharge, with engagement with the participants' general practitioner extending after discharge. The primary outcome was the change in the number of regular medicines used at 12 months from baseline. A cost consequence was performed to estimate costs per participant during the study period. Results: There were 98 participants enrolled in the study. The number of regular medicines was significantly reduced from baseline in both groups (−1.7 ± 4.3, t = 2.38, P = 0.02 in the control group vs −2.7 ± 3.6, t = 4.48, P = 0.0001 in the intervention group), although there was no statistical difference detected between the two groups (1.0 (SE 0.9), t = 1.03, P = 0.31). The intervention was estimated to cost AU$644.17 and was associated with cost savings of AU$552.53 per participant in sustained reduced medicines cost. Health outcomes and healthcare costs were similar in both groups. Discussion: Medicines were significantly reduced in both groups, with a trend to a larger reduction in medicines at 12 months in the intervention group. The intervention cost was approximately offset by sustained reduced medicines cost, although these results should be regarded cautiously because of the absence of significance in the differences in outcomes between groups. [ABSTRACT FROM AUTHOR]

In this pilot study, we explored current attitudes and deprescribing practices of clinicians in a large regional health service through a mixed methods approach. Respondents included doctors, pharmacists and nurse practitioners, who outlined three themes including professional and organisational contexts, disconnect between goals and practices and factors influencing deprescribing. [ABSTRACT FROM AUTHOR]

Advances in diabetes medication and population aging are lengthening the lifespans of people with diabetes mellitus (DM). Older patients with diabetes mellitus often have multimorbidity and tend to have polypharmacy. In addition, diabetes mellitus is associated with frailty, functional decline, cognitive impairment, and geriatric syndrome. Although the numbers of patients with frailty, dementia, disability, and/or multimorbidity are increasing worldwide, the accumulated evidence on the safe and effective treatment of these populations remains insufficient. Older patients, especially those older than 75 years old, are often underrepresented in randomized controlled trials of various treatment effects, resulting in limited clinical evidence for this population. Therefore, a deeper understanding of the characteristics of older patients is essential to tailor management strategies to their needs. The clinical guidelines of several academic societies have begun to recognize the importance of relaxing glycemic control targets to prevent severe hypoglycemia and to maintain quality of life. However, glycemic control levels are thus far based on expert consensus rather than on robust clinical evidence. There is an urgent need for the personalized management of older adults with diabetes mellitus that considers their multimorbidity and function and strives to maintain a high quality of life through safe and effective medical treatment. Older adults with diabetes mellitus accompanied by frailty, functional decline, cognitive impairment, and multimorbidity require special management considerations and liaison with both carers and social resources. [ABSTRACT FROM AUTHOR]

Background: Hemodialysis (HD) patients often have multiple comorbidities, leading to care from various prescribers and a complex medication regimen. Patients on HD are particularly vulnerable to treatment-related problems (TRPs). This study aimed to evaluate the impact of the lack of clinical pharmacy services on HD care by assessing the types and frequencies of TRPs encountered in HD units. Patients and methods: This was a prospective observational study. Data were collected from medical records and medication reconciliation of HD patients attending to a large Hospital specialized in Nephrology and Urology at the Minia region in Egypt. The frequencies and percentages of demographic data were calculated. Standard multiple regression analysis was conducted to assess predictors of TRPs. Results: A total of 103 patients were included. The mean age was 47.6 ± 15.1 years; patients had been on HD for 5.95 ± 5.04 years, had 2.47 ± 0.57 comorbidities and took 7.02 ± 1.35 different medications. Within the included patients, 121 TRPs were identified. The most common TRPs were the need for more frequent monitoring, followed by inappropriate dose/dosing frequency and the need for additional therapy (33.9%, 26.2%, and 15.5%, respectively). We did not identify any predictors of TRP in this study. Conclusion: In the Minia HD population of Egypt, TRPs affected 75% of the patients. Therefore, involving clinical pharmacy services to tailor the optimal management plan for each patient is crucial to reduce the frequency of TRPs in this vulnerable patient population. [ABSTRACT FROM AUTHOR]

This study aimed to describe the use of recommendations as a guide for healthcare providers to support patients experiencing medication self‐management problems and to evaluate their feasibility, user‐friendliness and usefulness. Between March and August 2023, 58 hospitalized patients completed a self‐assessment on medication self‐management problems. The problems addressed in this self‐assessment were based on a list of frequently encountered medication self‐management problems from previous research. Consequently, 18 nurses responded to the reported problems using the recommendations. Nurses evaluated the feasibility, user‐friendliness and usefulness of these recommendations through a survey. A total of 217 medication self‐management problems were reported by 58 patients. Nurses intervened in 52% of the problems using the recommendations. According to nurses, the recommendations were user‐friendly and feasible but required a substantial time investment. Considering these pilot‐based results, the recommendations have the potential to be a valuable resource for nurses in practice, though this potential requires further exploration. [ABSTRACT FROM AUTHOR]

BACKGROUND: The use of herbal products, one component of the growing field of integrative cancer care, is a common yet controversial practice. OBJECTIVES: This article distinguishes nursing issues specific to patient safety when herbal products are used during cancer treatment and identifies available evidence-based resources to enhance patient and professional comprehension. METHODS: PubMed®, CINAHL®, and Google Scholar™ databases were searched for literature published between 2018 and 2024 specific to the clinical sequelae of the use of herbal products and their interactions with antineoplastic drugs, as well as patient and healthcare providers' perceptions of efficacy and safety. METHODS: PubMed®, CINAHL®, and Google Scholar™ databases were searched for literature published between 2018 and 2024 specific to the clinical sequelae of the use of herbal products and their interactions with antineoplastic drugs, as well as patient and healthcare providers' perceptions of efficacy and safety. [ABSTRACT FROM AUTHOR]

Introduction: The elderly correspond to the most medicalized group in society. Therefore, studies related to the use of medicines are important to improve policies that guarantee comprehensive care. The objective of this study was to investigate the polypharmacy among elderly individuals attending an educational program in the Federal District of Brazil and estimate the prevalence and associated variables. Method: This is a cross-sectional study with 150 elderly individuals whose data were collected in the period from December 2022 to April 2023 by means of telephone calls. Results: The prevalence of polypharmacy was estimated in 18.7%. The variables showing a positive association with polypharmacy were the following: health self-perceived as bad or very bad (PR = 8.9; 95 % CI 4.78 – 16.70), smoking (PR = 2.50; 95 % CI 1.06 – 5.89), systemic arterial hypertension (PR = 3.55; 95 % CI 1.40 – 9.00), diabetes mellitus (PR = 3.46; 95 % CI 1.67 – 7.18), depression (PR = 3.32; 95 %CI 1.58 – 6.75), multi-morbidity (PR = 8.97; 95 % CI 1.26 – 64.10) and Charlson Comorbidity Index equal to or greater than 3 (PR = 7.21; 95 % CI 1.14 – 26.17). Conclusions: The prevalence of polypharmacy and associated variables are corroborated by other Brazilian studies. Therefore, it is pointed out that healthcare teams should pay attention to this aspect of geriatric pharmacotherapy to favour the responsible use of medications and yield positive clinical outcomes. [ABSTRACT FROM AUTHOR]

Background: Polypharmacy and potentially inappropriate medications (PIM) are common among older adults with advanced cancer, but their association with physical functional outcomes is understudied. This study aimed to estimate the risk of physical functional decline associated with medication measures in older adults with advanced cancer starting a new line of systemic treatment. Methods: This secondary analysis of GAP 70+ Trial (PI: Mohile) enrolled patients aged 70+ with advanced cancer, had ≥ 1 geriatric assessment domain impairment and planned to start a new antineoplastic regimen with a high risk of toxicity. Polypharmacy (concurrent use of ≥ 8 medications (meds)) was assessed before initiation of treatment. PIM were categorized using Screening Tool of Older Person’s Prescriptions (STOPP) criteria and 2019 Beers criteria. Physical functional outcomes were assessed within 3 months of treatment initiation: (1) Activity of Daily Living (ADL) decline: 1-point decrease in ADL score between baseline and 3 months; (2) Instrumental ADL (IADL) decline: 1-point decrease in IADL score between baseline and 3 months; (3) Short physical performance battery (SPPB) decline, defined as 1-point decrease on SPPB; (4) ≥ 1 falls within 3 months of treatment. Separate multivariable, cluster-weighted Generalized Estimating Equations models adjusted for relevant covariates (e.g., age, baseline function/comorbidities). Results: Among 616 participants, mean number of meds was 6 (range 0–24); 28% received ≥ 8 meds. Polypharmacy was associated with increased risk of ADL decline (adjusted risk ratio [aRR], 1.31; 95% CI, 1.00–1.71). Taking ≥ 1 PIM per STOPP was associated with increased risk of IADL decline (aRR, 1.21; 95% CI, 1.04–1.40) and falls (aRR, 1.93; 95% CI, 1.49–2.51). Conclusions: In a large cohort of vulnerable older adults with advanced cancer receiving systemic treatment, polypharmacy and PIM were independently associated with an increased risk of physical functional decline. This emphasizes the need to develop interventions to optimize medication use, intending to improve outcomes in these patients. Trial registration: ClinicalTrials.gov Identifier: NCT02054741. Registered 01–31-2014. [ABSTRACT FROM AUTHOR]

Antipsychotic polypharmacy (APP) is frequently prescribed for schizophrenia-spectrum disorders. Despite the inconsistent findings on efficacy, APP may be beneficial for subgroups of psychotic patients. This meta-analysis of individual patient data investigated moderators of efficacy and tolerability of APP in adult patients with schizophrenia-spectrum disorders. We searched PubMed, EMBASE, and the Cochrane Central Register of Randomized Trials until September 1, 2022, for randomized controlled trials comparing APP with antipsychotic monotherapy. We estimated the effects with a one-stage approach for patient-level moderators and a two-stage approach for study-level moderators, using (generalized) linear mixed-effects models. Primary outcome was treatment response, defined as a reduction of 25 % or more in the Positive and Negative Syndrome Scale (PANSS) score. Secondary outcomes were study discontinuation, and changes from baseline on the PANSS total score, its positive and negative symptom subscale scores, the Clinical Global Impressions Scale (CGI), and adverse effects. We obtained individual patient data from 10 studies (602 patients; 31 % of all possible patients) and included 599 patients in our analysis. A higher baseline PANSS total score increased the chance of a response to APP (OR = 1.41, 95 % CI 1.02; 1.94, p = 0.037 per 10-point increase in baseline PANSS total), mainly driven by baseline positive symptoms. The same applied to changes on the PANSS positive symptom subscale and the CGI severity scale. Extrapyramidal side effects increased significantly where first and second-generation antipsychotics were co-prescribed. Study discontinuation was comparable between both treatment arms. APP was effective in severely psychotic patients with high baseline PANSS total scores and predominantly positive symptoms. This effect must be weighed against potential adverse effects. [ABSTRACT FROM AUTHOR]

Insomnia disorder is a global public health issue, commonly treated with hypnotics. However, long-term use of benzodiazepine derivatives (BZDs), especially polypharmacy with this kind of drug, carries risks for dependence and abuse. This study using large-scale medical insurance records investigated the causes of polypharmacy through the treatment of insomnia disorder. A cross-sectional study analyzed anonymized medical record data from July 2014 to March 2018 provided by a nationwide Japanese health insurance association covering 405,952 individuals. Outpatients prescribed at least one sleep medication were included. Demographic data, pharmacological classification of the drugs, and comorbidities were assessed using hierarchical logistic regression analysis to explore their associations with polypharmacy. Of the 33,212 outpatients who were prescribed sleep medications, 32.5 % were prescribed multiple types. After adjusting for demographics and type of sleep medications as covariates, hypnotic polypharmacy was significantly associated with younger age, the presence of certain kinds of comorbidities, and using BZD anxiolytics before bedtime with the highest adjusted odds ratios (8.01–9.39) when referenced with BZD hypnotics. On the other hand, usage of orexin receptor antagonists, melatonin receptor agonists, and Z-drugs indicated lower odds ratios (0.74–0.87). Hypnotic polypharmacy is relatively common in the Japanese general population. With the introduction of non-pharmacological therapy in mind, assessing patients' comorbidities and avoiding the use of benzodiazepines, especially BZD anxiolytics, before bedtime would be recommended to prevent polypharmacy. • Among hypnotic users, 32.5 % received hypnotic polypharmacy. • Younger age and presence of certain comorbidities increased the odds of polypharmacy. • Using benzodiazepines was significantly associated with hypnotic polypharmacy. • Using benzodiazepine anxiolytics before bedtime showed the highest polypharmacy odds. • Orexin antagonists and melatonin agonists showed lower odds for polypharmacy. [ABSTRACT FROM AUTHOR]

The impact of ageing on the body and its association with skin harm and frailty in relation to multimorbidity, comorbidity and polypharmacy is clearly described in the literature. The ageing population globally brings with it the challenge for healthcare professionals of managing individuals with increasingly complex and inter-related needs. This article considers ageing skin and skin tears within the context of frailty as a syndrome. It discusses what frailty is understood to be, how to recognise and assess for it, and how to consider risk and prevention of harm to the skin of the ageing person with frailty. [ABSTRACT FROM AUTHOR]

Objectives: The aim of this study is to analyze the association between the degree of frailty and inappropriate prescribing patterns at admission to an Acute Care of the Elderly Unit (ACE Unit). Methods: Prospective observational study conducted in the ACE Unit of an acute hospital in Barcelona city between June and August 2021. Epidemiological and demographic data were collected during hospitalization. Comprehensive geriatric assessment was performed on admitted patients. We recorded frailty (FRAIL scale), extreme polypharmacy (10 or more drugs), central nervous system potentially inappropriate medications‐PIMs (STOPP‐CNS or group D), cardiovascular potential prescribing omissions‐PPOs (START‐CV or group A), and anticholinergic burden using the drug burden index (DBI). Results: Ninety‐three patients were included, of whom 48 (51.6%) were male, with a mean age of 82.83 (SD 7.53) years. The main diagnosis upon admission was heart failure in 34 patients (36.6%). Frail patients were older, with more dependence of activities of daily living and more comorbidity than non‐frail patients. Additionally, frail patients demonstrated more omissions according to the START‐A criteria. No statistically significant differences were observed in term of extreme polypharmacy, PIMs, or anticholinergic burden. Conclusions: In the current study we found an association between frailty and inappropriate prescribing, specifically with regard to omissions using the START criteria for the cardiovascular system (group A). Notably, frail patients exhibited more omissions compared to their non‐frail counterparts, and this difference was statistically significant. [ABSTRACT FROM AUTHOR]