Risk Of Polypharmacy Research Articles

Effects of glucagon-like peptide 1 receptor agonists on comorbidities in older patients with diabetes mellitus

Elderly patients with diabetes are at high risk of polypharmacy because of multiple coexisting diseases and syndromes. Polypharmacy increases the risk of drug–drug and drug–disease interactions in these patients, who may already have age-related sensory and cognitive deficits; such deficits may delay timely communication of early symptoms of adverse drug events. Several glucagon-like peptide-1 receptor agonists (GLP-1 RAs) have been approved for diabetes: liraglutide, exenatide, lixisenatide, dulagluatide, semaglutide, and albiglutide. Some are also approved for treatment of obesity. The current review of literature along with clinical case discussion provides evidence supporting GLP-1 RAs as diabetes medications for polypharmacy reduction in older diabetes patients because of their multiple pleiotropic effects on comorbidities (e.g. hyperlipidemia, hypertension, and fatty liver) and syndromes (e.g. osteoporosis and sleep apnea) that commonly co-occur with diabetes. Using one medication (in this case, GLP-1 RAs) to address multiple conditions may help reduce costs, medication burden, adverse drug events, and medication nonadherence.

Influence of polypharmacy on heart rate variability in older adults at the Hiroshima Atomic Bomb Survivors Recuperation Research Center, Japan.

BackgroundMany studies have identified the risk of polypharmacy, but physiological evidence and methods of evaluation in these studies were poor. The relationship between polypharmacy and heart rate variability in older adults remains unclear. We investigated the relationship between polypharmacy in older adults, including atomic bomb survivors, and heart rate variability.MethodsWe surveyed 56 older adults who did not need nursing care assistance in the Hiroshima Atomic Bomb Survivors Recuperation Center. Chronic diseases, types of medication, and lifestyle were assessed, and heart rate variability at rest was measured. We calculated heart rate variability indices including standard deviation of normal-to-normal RR intervals (SDNN), total power (TP), and very low frequency (VLF) and analyzed the relationship between the number of daily medication types and heart rate variability indices in older adults. The differences in heart rate variability indices were analyzed using six medications as a cut-off point.ResultsParticipants included 36 atomic bomb survivors and 20 non-atomic bomb survivors. The mean number of medication types was 3.6±3.4 (mean±standard deviation). SDNN, TP, and VLF decreased with an increased number of medications in all participants (P<0.01). When the standard of polypharmacy was set to more than six types of medications, SDNN, TP, and VLF were significantly lower in older adults who took six or more medications. Additionally, the mean number of medication types among atomic bomb survivors was higher than that of non-atomic bomb survivors (P = 0.008). The SDNN was significantly lower when atomic bomb survivors took six or more medications (P<0.001).ConclusionsWe found that a lower heart rate variability in older adults, including atomic bomb survivors, is associated with polypharmacy. We showed physiological evidence of the influence of polypharmacy, which may be important for the healthy life expectancy and prognosis in older adults.

Older HIV-infected adults. Complex patients (III): Polypharmacy.

Polypharmacy is a well-described problem in the geriatric population. It is a relatively new problem for people living with HIV (PLWH), as this group now has a life expectancy approaching that of the general population. Defining polypharmacy for PLWH is difficult, since the most common traditional definition of at least five medications would encompass a large percentage of PLWH who are on antiretrovirals (ARVs) and medications for other medical comorbidities. Even when excluding ARVs, the prevalence of polypharmacy in PLWH is higher than the general population, and not just in resource-rich countries. Using a more nuanced approach with "appropriate" or "safer" polypharmacy allows for a better framework for discussing how to mitigate the associated risks. Some of the consequences of polypharmacy include adverse effects of medications including the risk of geriatric syndromes, drug-drug interactions, decreased adherence, and over- and undertreatment of medical comorbidities. Interventions to combat polypharmacy include decreasing pill burden-specifically with fixed-dose combination (FDC) tablets- and medication reconciliation/deprescription using established criteria. The goal of these interventions is to decrease drug interactions and improve quality of life and outcomes. Some special populations of interest within the community of PLWH include those with chronic pain, substance abuse, or requiring end of life care. A final look into the future of antiretroviral therapy (ART) shows the promise of possible two-drug regimens, which can help reduce the above risks of polypharmacy.

A polypharmacy risk prediction model for elderly patients based on sociodemographic and clinical factors.

Elderly people take increasing amounts of medication. The aim of our study was to determine the effects of different sociodemographic and clinical factors on polypharmacy and to develop a risk prediction model in outpatients aged 65 years and older. Cross-sectional, observational, descriptive study of outpatients aged 65 years and older scheduled for a specialist visit. Data on sociodemographic (age, sex, place of residence, and institutionalization) as well as on clinical variables (number of prescribing physicians and number of diagnoses) were collected. Polypharmacy was defined as the uninterrupted use of more than 5 medications within the last 3months. To determine the risk factors for polypharmacy among these patients, a multivariate logistic regression model was developed and subsequently validated using bootstrap resampling techniques. The model was assessed for its discrimination accuracy using the area under the curve (ROC AUC). A total of 225 outpatients were included for development of the model. Polypharmacy was found in 46.7% of patients. The determinants that best predicted polypharmacy included: age, institutionalization, number of prescribing physicians, and number of diagnoses. The ROC AUC was 0.85. The predictive model developed in this study, which consists of 4 readily obtainable variables, may be a useful tool for identifying and monitoring elderly patients at risk for polypharmacy. .

Managing Chronic Pain in the Elderly: An Overview of the Recent Therapeutic Advancements

A majority of the elderly suffer from chronic pain that significantly alters their daily activities and imposes an enormous burden on health care. Multiple comorbidities and the risk of polypharmacy in the elderly make it a challenge to determine the appropriate drug, dosage, and maintenance of therapy. Opioids are the most commonly used agents for this purpose in the elderly. The aim of this article is to discuss both the current well-established therapies used for managing chronic pain in the elderly and also the emerging newer therapies.

Oriental herbal medicine for insomnia in the elderly with hypertension: A systematic review protocol.

Background:Hypertension and insomnia are common diseases in the elderly. Oriental herbal medicine has been widely used in East Asia, and it has been considered as a promising alternative to conventional pharmacotherapy because of its efficacy in geriatrics. Moreover, since oriental herbal medicine acts on multiple targets, it may affect both hypertension and insomnia at the same time, which can reduce the risk of polypharmacy in this population. This systematic review will assess the efficacy and safety of oriental herbal medicine in the elderly with both insomnia and hypertension.Methods:Thirteen databases including English, Chinese, Korean, and Japanese databases will be searched from their inception to August 2018. We will include randomized controlled trials assessing oriental herbal medicine for insomnia in the elderly with hypertension. The methodological quality of the included studies will be evaluated using the Cochrane Collaboration's risk of bias tool, and confidence in the cumulative evidence will be evaluated using the Grading of Recommendations Assessment, Development, and Evaluation instrument.Results:This review will provide evidence to determine the efficacy and safety of oriental herbal medicine in the elderly with both insomnia and hypertension.Conclusions:Our results will help clinicians and health policy makers take informed decisions regarding the use of oriental herbal medicine in the elderly. It will also provide evidence-based oriental herbal medicine data for elderly patients suffering from multiple diseases and their families.

Prescription drug claims following a traumatic spinal cord injury for older adults: a retrospective population-based study in Ontario, Canada

Study designRetrospective cohort study.ObjectivesThe objectives for this study were to examine the prevalence of polypharmacy for people with traumatic spinal cord injury (SCI) following injury and to determine risk factors.SettingOntario, CanadaMethodsWe used provincial-level administrative health services data of publicly funded healthcare encounters housed at the Institute for Clinical Evaluative Sciences, Toronto, Ontario. We examined prescription medications dispensed over a 1 year period post injury for persons 66+ years with an index traumatic SCI between 2004 and 2014. Polypharmacy was defined as being on 10 or more drug classes. Descriptive and analytical statistics were conducted. Relative risks and 95% confidence limits for factors related to polypharmacy were calculated using a robust Poisson multivariate regression model.ResultsWe identified 418 cases of persons with traumatic SCI during the observation window. A total of 233 patients (56%) were taking at least 10 drug classes in the year following discharge from care for traumatic SCI. The mean number of drug classes taken post injury was 11 (SD = 6). Continuity of care was significantly associated with polypharmacy, with a higher continuity of care (having at least 75% of visits with the same doctor) reducing the risk of polypharmacy. The most common drugs prescribed were laxatives, opioids and cardiovascular-related drugs.ConclusionFindings suggest that polypharmacy is extensive among older adults with traumatic SCI. Persons with better continuity of care are less likely to have polypharmacy compared to those with less continuity.SponsorshipThis project was funded by a Connaught New Investigator Award (University of Toronto), and the Craig H. Neilsen Foundation Psychosocial Research Pilot Grant (Grant #441259).

2163 Polypharmacy and patterns of prescription medication use among cancer survivors

OBJECTIVES/SPECIFIC AIMS: The population of cancer survivors is rapidly growing in the United States. Long term and late effects of cancer, combined with ongoing management of other chronic conditions, make cancer survivors particularly vulnerable to polypharmacy and its adverse effects. We examined patterns of prescription medication use and polypharmacy in a population-based sample of cancer survivors. METHODS/STUDY POPULATION: Using data from the Medical Expenditure Panel Survey (MEPS), we matched cancer survivors (n=5216) to noncancer controls (n=19,588) by age, sex, and survey year. We defined polypharmacy as using 5 or more unique medications. We also estimated proportion of respondents prescribed specific medications within therapeutic classes and total prescription expenditures. RESULTS/ANTICIPATED RESULTS: A higher proportion of cancer survivors were prescribed 5 or more unique medications (64.0%, 95% CI 62.3%–65.8%) compared with noncancer controls (51.5%, 95% CI 50.4%–52.6%), including drugs with abuse potential. Across all therapeutic classes, a higher proportion of newly (≤1 year since diagnosis) and previously (&gt;1 years since diagnosis) diagnosed survivors were prescribed medications compared to controls, with large differences in central nervous system agents (65.8% vs. 57.4% vs. 46.2%), psychotherapeutic agents (25.4% vs. 26.8% vs. 18.3%), and gastrointestinal agents (31.9% vs. 29.6% vs. 22.0%). Specifically, nearly 10% of cancer survivors were prescribed benzodiazepines and/or opioids compared to about 5% of controls. Survivors had more than double prescription expenditures (median $1633 vs. $784 among noncancer controls). Findings persisted similarly across categories of age and comorbidity. DISCUSSION/SIGNIFICANCE OF IMPACT: Cancer survivors were frequently prescribed a higher number of unique medications and inappropriate medications or drugs with abuse potential, increasing risk of adverse drug events, financial toxicity, poor adherence, and drug-drug interactions. Adolescent and young adult survivors appear at increased risk of polypharmacy.

Polimedication: applicability of a computer tool to reduce polypharmacy in nursing homes.

In order to minimize the expenditure of time, our group devised a pilot computer tool (Polimedication) that automatically processes lists of medication providing the corresponding Screening Tool of Older Persons' potentially inappropriate Prescriptions alerts and facilitating standardized reports. The drug lists for 115 residents in Santa Marta Nursing Home (Fundación San Rosendo, Ourense, Spain) were processed. The program detected 10.04 alerts/patient, of which 74.29% were not repeated. After reviewing these alerts, 12.12% of the total (1.30 alerts/patient) were considered relevant. The largest number of alerts (41.48%) involved neuroleptic drugs. Finally, the patient's family physician or psychiatrist accepted the alert and made medication changes in 62.86% of the relevant alerts. The largest number of changes (38.64%) also involved neuroleptic drugs. The mean time spent in the generation and review of the warnings was 6.26 minute/patient. Total changes represented a saving of 32.77 € per resident/year in medication. The application of Polimedication tool detected a high proportion of potentially inappropriate prescriptions in institutionalized elderly patients. The use of the computerized tool achieved significant savings in pharmaceutical expenditure, as well as a reduction in the time taken for medication review.

Polypharmacy among patients with diabetes: a cross-sectional retrospective study in a tertiary hospital in Saudi Arabia

ObjectivesPatients with diabetes are at high risk for polypharmacy (ie, use of multiple medications) for treatment of diabetes, associated comorbidities and other coexisting conditions. This study aims to estimate the...

PDB20 - Polypharmacy Use Among Patients with Diabetes: A Cross-Sectional Retrospective Study

Patients with diabetes are at high risk for polypharmacy (i.e. use of multiple classes of medications) for treatment of diabetes, associated comorbidities, and other co-existing conditions. This study aims to estimate the prevalence of polypharmacy and factors associated with polypharmacy among adult patients with diabetes. A cross-sectional retrospective observational study of adults with diabetes, who visited the outpatient clinic of a tertiary teaching hospital in Saudi Arabia, was conducted. Data were extracted from the Electronic Health Record (EHR) database for a period of twelve-month (January to December 2016). Polypharmacy was defined as the cumulative use of five or more medication classes. Polypharmacy among adults with diabetes was measured by calculating the average number of medication classes prescribed per patient. A multivariable logistic regression model was used to examine the factors associated with polypharmacy after adjusting for age, sex, marital status, nationality, and co-existing chronic conditions. A total of 8,932 adults with diabetes were included in this study. Of these, nearly 78 % had polypharmacy, which was more likely among women as compared to men and more likely among the elderly (age > 60 years) as compared to the adults. Also, polypharmacy was two times as likely among patients with coexisting cardiovascular disease (AOR=2.89; 95% CI: 2.54-3.29), respiratory disease (AOR=2.42; 95% CI: 1.92-3.03), and mental health conditions (AOR=2.19; 95% CI: 1.74-2.76), and three times as likely among patients with co-existing musculoskeletal disease as compared to those without these co-existing chronic conditions categories. Polypharmacy is common among patients with diabetes, with an even higher rate in the elderly patients. Health care providers can help in detecting polypharmacy and in providing recommendations for simplifying medication regimens and minimizing tablet-counts to enhance the outcome of diabetes care.

Prevalence and Risk of Polypharmacy Among Elderly Cancer Patients Receiving Chemotherapy in Ambulatory Oncology Setting.

This was a single center, retrospective cross-sectional study looking into the incidence and types of drug-related problems (DRPs) detected among elderly cancer patients receiving at least three long-term medications concurrent with IV chemotherapy, and the types of intervention taken to address these DRPs. This paper serves to elucidate the prevalence and risk of polypharmacy in our geriatric oncology population in an ambulatory care setting, to raise awareness on this growing issue and to encourage more resource allocation to address this healthcare phenomenon. DRP was detected in 77.6% of elderly cancer patients receiving at least three long-term medications concurrent with IV chemotherapy, with an average incidence of three DRPs per patient. Approximately half of DRPs were related to long-term medications. Forty percent of DRPs required interventions at the prescriber level. The use of five or more medications was shown to almost double the risk of DRP occurrence (OR 1.862, P = 0.039). Out of the eight predefined categories of DRPs, underprescribing was the most common (26.7%), followed by adverse drug reaction (25.0%) and drug non-adherence (16.2%). Polypharmacy leading to DRPs is a common occurrence in elderly cancer patients receiving outpatient IV chemotherapy. There should be systematic measures in place to identify patients who are at greater risk of inappropriate polypharmacy and DRPs, and hence more frequent drug therapy optimization and monitoring. The identification of DRPs is an important step to circumvent serious drug-related harm. Future healthcare interventions directed at reducing DRPs should aim to assess the clinical and economic impact of such interventions.

Association of pre-operative medication use with post-surgery mortality and morbidity in oncology patients receiving comprehensive geriatric assessment.

Comprehensive geriatric assessment (CGA) has become a predictor for elderly cancer patients in post-surgical complications, including post-discharge institutionalization and mortality. To determine whether pre-operative medication use is associated with post-operative morbidity and mortality in oncology patients receiving CGA. Patients aged 65years or older who were scheduled for cancer surgery and presented for CGA were included in the present study. Baseline characteristics of patients were collected from electrical medical records, and pre-operative medication review was performed. The primary outcome was death within 30days after surgery and post-discharge institutionalization. A total of 475 cancer patients were included. Among them, three patients died within 30days after surgery and 14 patients were discharged to another institution. All patients who died within 30days after surgery had polypharmacy with marginal significance (P = 0.087). Multivariate analysis models were constructed using significant factors for post-surgery institutionalization from univariate analysis: Model I (polypharmacy and transfusion), Model II (polypharmacy and infection), and Model III (polypharmacy, transfusion, and infection). Infection was the most significant factor. Its adjusted odds ratio was as large as 11.1 and attributable risk was almost 91%. In pre-surgery medication use, only polypharmacy showed significant association with post-discharge institutionalization. Attributable risk of polypharmacy was around 75%. It is possible that pre-operative medication use has impact on death and post-discharge institutionalization in geriatric oncology patients, further highlighting the importance of medication optimization for elderly patients with cancer surgery.

2018: Targeting the Pusher: Beyond Going Beyond Senna and Colace for the Management of Constipation in Hospice (SA502)

•Understand the pathophysiology of functional bowel disorders vs opioid induced bowel dysfunction.•Learn how to classify bowel disorders and tailor therapies according to disorder.•Learn mechanisms of action of new drugs for constipation. Constipation occurs in the majority of patients who are in hospice and palliative care patients. Frequencies range from 70% to 87% according to studies. Surprisingly research suggests that opioid are responsible for constipation in only 25% of cases and that there is a significant large populations of patients, who we are likely to encounter in hospice with functional disorders that may not respond to the mantra of “Senna and Colace.” Add the growing number of elderly in the population who have a high prevalence of functional bowel disorders one has to consider better approaches to evaluating constipation. Complicating the management of constipation are the ever growing list of medications which may work for functional bowel disorders but not for opioid induced bowel dysfunction. Sorting out proper evaluation and proper application of therapies enhances therapeutic success and avoids inappropriate use of laxatives and lowers the risk for polypharmacy. This session will be presented by a panel of hospice/ palliative care specialists, and experts in palliative pharmacotherapeutics. Attendees will walk away with a new perspective on constipation. They will understand the proper applications of the new therapies for constipation. The session will by way of didactics, case presentation and audience participation help attendees: 1.) Recognize and classify types of constipation likely to occur in the hospice setting. 2.) Refine and improve methods of constipation evaluation. 3.) Understand differences in the pathophysiology of functional disorders versus opioid bowel dysfunction. 4.) Get a detailed overview of new drugs and where they fit therapeutically in the spectrum of constipation disorders. 5.) Get a perspective on the cost of new and old medications for constipation.

Polypharmacy among the Elderly.

Introduction:Older people are at risk for polypharmacy due to multiple chronic diseases. Considering the lack of information in this regard, the aim of this study was to investigate the state of polypharmacy among the elderly in the city of Amirkola in northern part of Iran.Materials and Methods:This descriptive/analytical cross-sectional study is a part of Amirkola Health and Aging Project that was conducted on 1616 individuals aged 60 years and over. The data about medications were gathered through interviews and observation of prescriptions and medications consumed by patients. The data were analyzed by SPSS software version 18, and P ≤ 0.05 was regarded significant.Results:In this study, 1616 individuals including 883 men (54.6%) and 733 women (45.3%) were investigated. The average age of individuals was 69.37 ± 7.42. Among the investigated individuals, 526 including 368 men (41.7%) and 158 women (21.6%) consumed no medications. The prevalence of polypharmacy in this study was 23.1%, which was 32.7% in women and 15.2% in men (odds ratio = 1.51, 95% confidence interval: 1.10–1.93). The most prevalent group of medications used in both genders was cardiovascular drugs.Conclusions:Regarding the considerable prevalence of polypharmacy among the elderly, especially in aged women, serious efforts are required to manage polypharmacy. Provision of educational programs for physicians, personnel of pharmacies, and the staff of health-care centers in order for appropriate and safe consumption of medications in aged people is absolutely necessary.

A Province-wide, Cross-sectional Study of Demographics and Medication Use of Patients in Hemodialysis Units Across Ontario.

Background:Hemodialysis patients are at an increased risk of polypharmacy as they have the highest pill burden of all chronically ill patient populations, with an estimated average of 12 medications per day.Objectives:The aim of this study was to evaluate prescribing patterns of outpatient medications in patients receiving in-center hemodialysis. This was done to identify potential candidate medications for future quality improvement initiations to optimize prescribing.Design:We conducted a descriptive retrospective cross-sectional study in the province of Ontario, Canada, using several linked health care databases housed at the Institute for Clinical Evaluative Sciences (ICES).Setting:We considered outpatient medications dispensed to patients eligible for the Ontario Drug Benefit program.Patients:Patients were receiving chronic in-center hemodialysis at one of the 69 facilities in the province of Ontario, Canada as of October 1, 2013.Measurements:We assessed whether any of our 28 study medications of interest were recently dispensed (within the prior 120 days), the type of prescribing physician, and the associated medication costs. The 28 included medications of interest (ie, proton pump inhibitors, benzodiazepines) were selected because they may not have a true indication for dialysis patients and/or there are safety concerns with their use in this population. Results are presented as median (25th, 75th percentile).Methods:We conducted this study at ICES according to a prespecified protocol approved by the Research Ethics Board at Sunnybrook Health Sciences Centre (Toronto, Ontario).Results:A total of 3094 patients on chronic in-center hemodialysis received a study drug of interest (age: 76.5 years [SD: 7.3]), 44% women). Patients were dispensed 11 (8, 14) unique medication products with more than two-thirds of patients dispensed 9 or more different medications. The median number of annual health care visits was 7 (3-15) with more than half the cohort receiving prescriptions from 3 or more specialists. The 10 most commonly dispensed study medications cost more than 3 million dollars in direct costs in 1 year.Limitations:Our study was also subjected to some limitations of health care databases.Conclusions:Polypharmacy is frequent in in-center hemodialysis patients. To decrease polypharmacy and its associated negative outcomes, health care providers need to implement tools to optimize medication use and deprescribe medications that lack evidence for efficacy and safety in hemodialysis patients. Therefore, strategies to improve prescribing and discontinue ineffective medications warrant testing for better patient outcomes and reduced health care costs.

Analysis of polypharmacy effects in older patients using Japanese Adverse Drug Event Report database.

Population aging is a global phenomenon, and choosing appropriate medical care for the elderly is critical. Polypharmacy is suspected to increase the risk of adverse events (AEs) in older patients. We examined the AE profiles associated with polypharmacy and aging using the Japanese Adverse Drug Event Report (JADER) database. We attempted to mitigate the effect of patient-related factors using a multiple-logistic regression technique and data subsetting. We selected case reports for AEs as specified in the Medical Dictionary for Regulatory Activities (MedDRA). The association between polypharmacy and “renal disorder” or “hepatic disorder” was evaluated using reporting odds ratio (ROR) and adjusted for covariates using multiple-logistic regression. For renal disorder, advanced polypharmacy showed higher adjusted RORs, because the value of administered drugs group [1.82 (1.76–1.88), ≥ 10] was higher than that of the number of administered drugs group [1.27 (1.24–1.31), 5–9]. The lower limit of the 95% confidence interval (CI) of adjusted ROR for age (≥ 60 years) was > 1 for renal disorder. For hepatic disorder, the adjusted RORs were as follows: 1.17 (1.14–1.20) for the number of administered drugs group (5–9) and 1.14 (1.11–1.18) for the number of administered drugs group (≥ 10). The adjusted RORs of hepatic disorder compared to those of renal disorder had lower adjusted RORs related to the increase in the number of administered drugs. Therefore, elderly individuals should be closely monitored for the occurrence of renal disorder when they are subjected to polypharmacy. This approach might apply to the simultaneous evaluation of the AE risk of polypharmacy and aging.

Polypharmacy and risk of falls and fractures for patients with HIV infection and substance dependence

ABSTRACTAlthough people with HIV infection (PLWH) are at higher risk of polypharmacy and substance use, there is limited knowledge about potential harms associated with polypharmacy such as falls and fractures in this population. The study objective was to determine whether polypharmacy, as measured by the number and type of medication, is associated with falls and fractures among PLWH and DSM-IV substance dependence in the past year or ever injection drug use (IDU). We identified the number of medications by electronic medical record review in the following categories: (i) systemically active, (ii) non-antiretroviral (non-ARV), (iii) sedating, (iv) non-sedating as well as any opioid medication and any non-opioid sedating medication. Outcomes were self-reported (1) fall/accident requiring medical attention and (2) fracture in the previous year. Separate logistic regression models were fitted for medications in each category and each outcome. Among 250 participants, the odds of a fall requiring medical attention were higher with each additional medication overall (odds ratio [OR] 1.12, 95% Confidence Interval [CI] = 1.05, 1.18), each additional non-ARV medication (OR 1.13, 95%CI = 1.06, 1.20), each additional sedating medication (OR 1.36, 95%CI = 1.14, 1.62), and a non-opioid sedating medication (OR 2.89, 95%CI = 1.06, 7.85) but not with an additional non-sedating medication or opioid medication. In receiver operating characteristic (ROC) curve analyses, optimal cutoffs for predicting falls were: ≥8 overall and ≥2 sedating medications. Odds ratios for fracture in the previous year were OR 1.05, 95%CI = 0.97, 1.13 for each additional medication overall and OR 1.11, 95%CI = 0.89, 1.38 for each additional sedating medication. In PLWH and substance dependence or ever IDU, a higher number of medications was associated with greater odds of having a fall requiring medical attention. The association appeared to be driven largely by sedating medications. Future studies should determine if reducing such polypharmacy, particularly sedating medications, lowers the risk of falls.

Acetylcholinesterase Inhibitors: Beneficial Effects on Comorbidities in Patients With Alzheimer's Disease.

Elderly patients with Alzheimer's disease (AD) and other dementias are at high risk of polypharmacy and excessive polypharmacy for common coexisting medical conditions. Polypharmacy increases the risk of drug-drug and drug-disease interactions in these patients who may not be able to communicate early symptoms of adverse drug events. Three acetylcholinesterase inhibitors (ACHEIs) have been approved for AD: donepezil (Aricept), rivastigmine (Exelon), and galantamine (Razadyne). They are also used off-label for other causes of dementia such as Lewy body and vascular dementia. We here report evidence from the literature that ACHEI treatment, prescribed for cognitive impairment, can reduce the load of medications in patients with AD by also addressing cardiovascular, gastrointestinal, and other comorbidities. Using one drug to address multiple symptoms can reduce costs and improve medication compliance.

Combined Healthy Behaviors and Healthcare Services Use in Older Adults

Data on the combined impact of healthy behaviors on healthcare use in older adults are limited. Study with community-dwelling individuals aged ≥60 years from the Spanish Seniors-ENRICA cohort, recruited in 2008-2010, followed through 2012-2013, and analyzed in 2016 (N=2,021). At baseline, the following healthy behaviors were self-reported: three traditional (never smoking, being physically active, having a healthy diet) and three emerging (sleeping 7-8 hours/day, sitting <8 hours/day, not living alone). Outcomes were self-reported polypharmacy (five or more drugs per day), primary care physician visits (one or more per month), medical specialist visits (more than one per year), and hospitalization (one or more in the last year). The associations between baseline healthy behaviors and healthcare services used in 2012-2013 were summarized with ORs and 95% CIs from multiple logistic regression, adjusting for demographics, lifestyles, comorbidities, and baseline health services used. Most single healthy behaviors were associated with lower use of most health services. Compared with participants with zero or one healthy behavior, those with five or six healthy behaviors showed lower risk of polypharmacy (OR=0.46, 95% CI=0.24, 0.85, p-trend=0.001), visits to the primary care physician (OR=0.50, 95% CI=0.26, 0.96, p-trend=0.013), and hospitalization (OR=0.50, 95% CI=0.24, 1.01, p-trend=0.016). No association was found with visits to the medical specialist. The combination of five to six healthy behaviors in older adults is associated with half the risk of polypharmacy and using several healthcare services. In an era of constrained resources in most countries, this information may help inform health policy to control healthcare spending in the future.