Anemia in nursing homes, proton pump inhibitors and prescribing cascade of antianemic drugs.

Key summary points: Aim: To examine the relation between drugs commonly used in NHs and diagnosis of anemia in a łarge sample of older adults resident in nursing homes (NHs). Findings: We investigated the relation between anemia and medications potentially related to anemia in nursing homes. Only the association with PPI was found. Message: Optimization of PPI prescription is needed to avoid potential adverse events and the use of drugs to treat anemia as the effect of a prescribing cascade. Purpose: Some medications can cause anemia through their effect on gastrointestinal function, such as proton pump inhibitors and H2-antagonists, and on the risk of bleeding, such as anticoagulants and antiplatelet agents. The main aim of this study is to evaluate how anemia is related with the most commonly used drugs in a large sample of NH residents. Methods: This retrospective cross-sectional multicenter study was conducted in a sample of Italian long-term care NHs distributed throughout the country. Results: In all, 2602 NH residents recruited from 27 Italian long-term NHs (mean age ± SD: 88.4 ± 8.5) and 441 (16.9%) had a diagnosis of anemia. The unadjusted model showed a significant relation with PPI (OR 1.71, 95% CI 1.39–2.11, p < 0.0001). This relation was maintained in the model adjusted for age, sex, CKD, atrophic gastritis, peptic ulcer and rheumatic disease (OR 1.61, 95% CI 1.31–1.99, p < 0.0001). PPI users were also at higher risk of being treated with antianemic drugs—iron supplements, folate, vitamin B12 and erythropoietin (OR 2.03, 95% CI 1.67–2.48, p < 0.0001)—even if they did not have anemia (OR 1.94, 95% CI 1.55–2.42, p < 0.0001). Conclusion: Proton pump inhibitors are associated with anemia in NH residents. PPIs are also related with an increased probability of receiving drugs to treat anemia, such as iron supplements, folate or cyanocobalamin and erythropoietin, as the effect of a prescribing cascade. Optimization of PPI prescription is needed to avoid adverse events and promote rational drug prescription. [ABSTRACT FROM AUTHOR]