Addressing the gaps in evaluation of new drugs for older adults: Strategies from the International Union of Basic and Clinical Pharmacology (IUPHAR) Geriatric Committee

Journal of the American Geriatrics Society, Journal Year: 2024, Volume and Issue: 72(9), P. 2942 - 2950

Published: March 14, 2024

Abstract The International Union of Basic and Clinical Pharmacology (IUPHAR) Geriatric Committee aims to improve the use drugs in older adults develop new therapeutic approaches for syndromes diseases old age through advocacy, education, research. In present paper, we propose strategies relevant drug development evaluation, spanning preclinical full range clinical studies. Drugs need consider not only age, but also other characteristics common geriatric patients, such as multimorbidity, polypharmacy, falls, cognitive impairment, frailty. IUPHAR Committee's position statement on ‘Measurement Frailty Drug Development Evaluation’ is included, highlighting 12 key principles that cover spectrum translational We where are likely be major users a drug, frailty measured at baseline an outcome. Preclinical models replicate frailty, duration exposure, comorbidities, co‐medications proposed patients may translation. highlight potential application recent technologies, physiologically based pharmacokinetic–pharmacodynamic modeling informed by biology, Artificial Intelligence, inform personalized medicine patients. Considerations rapidly aging populations low‐ middle‐income countries related health‐care trials outlined. Involving adults, their caregivers providers all phases research should development, outcomes internationally.

Language: Английский

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The Impact of Deprescribing Interventions on the Drug Burden Index and Other Outcomes: A Systematic Review

Journal of the American Medical Directors Association, Journal Year: 2024, Volume and Issue: 25(7), P. 105021 - 105021

Published: May 17, 2024

Language: Английский

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Dynamic changes in medication burden leading to fall and hospital readmissions in older adults: Toward a strategy for improving risk and managing costs

Journal of Managed Care & Specialty Pharmacy, Journal Year: 2025, Volume and Issue: 31(1), P. 96 - 100

Published: Jan. 1, 2025

The majority of a health plan's performance and designated Star Rating is related to medication-related behavior, eg, medication adherence, review, reconciliation, that are intricately adverse drug events (ADEs). Altered pharmacodynamics pharmacokinetics owing aging make older adults more vulnerable ADEs like falls, fractures, hospitalizations, mortality. Prevention avoidable risk factors such as burden can help maintain quality life. Studies multiple populations have established index (DBI), dose-dependent measure anticholinergic sedative burden, be strongly associated with worsening vertigo, dizziness, balance, which all predicate falls. mean difference in DBI greater than 0.1 provides predictive power for events, falls 30-day readmission rates. Inclusion delta metric especially on an electronic medical record has the potential reduce fall incidence outcomes hospitalizations death; this presents opportunity improve Centers Medicare & Medicaid Services Ratings by using meaningful tools foster engagement among informed active beneficiaries. We believe information extremely relevant real-world decision-making care professionals, specifically when changes dynamic happen very quickly. Moreover, managed organizations now dedicated eliciting deeper understanding mitigation social inequalities use consequences. Among proposed solutions includes tailoring prescription utilization management decrease incidences complications unintended costs. Understanding relationship between exposures causing costs third-party payments remains vital because United States, approximately one-third hospital admissions occur ADEs. This achieved emphasizing equitable therapy initiatives minimize racial disparities affect financial these patients. Importantly, approach becomes even critical systems increasingly emphasize star ratings, reflect delivered By prioritizing metrics we ensure not only clinically effective but also focused improving patients' overall well-being. Lastly, future directions, timely application advanced technologies artificial intelligence machine learning analyzing could enhance our ability predict value adjustments their correlation other These process vast amounts data quickly accurately, identifying patterns risks might otherwise go unnoticed.

Language: Английский

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Assessing the prevalence of anticholinergic and sedative medications to avoid in older adults from the French Health Data System

Journal of the American Geriatrics Society, Journal Year: 2025, Volume and Issue: unknown

Published: Jan. 3, 2025

Abstract Background In older people, medications with anticholinergic or sedative properties are associated falls, frailty, and functional cognitive impairment. These often described as a subset of potentially inappropriate (PIMs). We examined the prevalence to avoid in people France 2023. Methods This cross‐sectional study used anonymized data from large electronic healthcare database, French National Health Data System (Système des Données de Santé, SNDS). All aged 65 years January 1, 2023, December 31, were included this study. Dispensations identified according PIM criteria (2023 American Geriatrics Society Beers Criteria REMEDI[e]S tool). The was assessed for population by age (65–84 85 older) living place (home institutionalized patients) subgroups terms number percentage patients. Results 16,938,152 patients (55% women). Among all patients, 79.8% between 84 20.2% older. Most lived at home (97.0%), 3.0% institutionalized. 32.8% among 32.3% 65–84 34.8% 32.1% 54.5% most commonly dispensed oxazepam (5.27%), alprazolam zopiclone (4.85%), bromazepam (4.23%), metopimazine (2.88%), paroxetine (2.70%), nefopam (2.57%), hydroxyzine (2.17%). Conclusions highlighted that still frequently prescribed despite development regular updating criteria. Future studies needed assess whether has led worsened outcomes adults who utilized these medications, new initiatives should be developed further promote deprescribing prescribers pharmacists.

Language: Английский

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Deprescribing in cognitively vulnerable older people: development and validation of STOPPCog criteria

Age and Ageing, Journal Year: 2025, Volume and Issue: 54(2)

Published: Feb. 1, 2025

Abstract Objective To validate STOPPCog, a list of explicit criteria for potentially inappropriate medication use in cognitively vulnerable older adults. Design A Delphi consensus survey an expert panel comprising academic geriatricians, old age psychiatrists, general practitioners, and clinical pharmacists. Setting Ireland. Subjects Nine panellists. Methods STOPPCog were initially created by the authors based on experience literature appraisal. Criteria organised according to drug/drug class. Using methodology, panellists ranked their agreement with each criterion 5-point Likert scale provided written feedback. median value 1 or 2 (strongly agree/agree) 25th centile ≤2 included final list. Results All completed two validation rounds. Twenty-five proposed initially, twenty accepted. One was rejected (multi-vitamin supplements), four rephrased (two these combined one greater clarity). The comprised 23 that are arranged six subgroups i.e. (i) drugs anticholinergic properties taken daily; (ii) sedative (iii) may exacerbate psychotic symptoms patients alpha-synuclein pathology; (iv) used chronic pain; (v) without proven efficacy dementia (vi) no benefit advanced stage rating 3.0 where palliation be appropriate. Conclusion comprises relating medications assist physicians deprescribing this patient population.

Language: Английский

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Polypharmacy and Mild Cognitive Impairment in Older Adults: A 3-year Study of DO-HEALTH

Journal of the American Medical Directors Association, Journal Year: 2025, Volume and Issue: 26(6), P. 105586 - 105586

Published: April 19, 2025

Language: Английский

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The Medication-Related Burden Quality of Life (MRB-QoL) Arabic tool: Exploratory factor analysis and psychometric evaluation

Research in Social and Administrative Pharmacy, Journal Year: 2025, Volume and Issue: unknown

Published: April 1, 2025

Language: Английский

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Frailty, multimorbidity, and polypharmacy: Proposal of the new concept of the geriatric triangle

Geriatrics and gerontology international/Geriatrics & gerontology international, Journal Year: 2025, Volume and Issue: unknown

Published: April 14, 2025

As people age, the prevalence of frailty, multimorbidity, and polypharmacy increases, presenting significant challenges in geriatric medicine. These three elements are interrelated a bidirectional manner, forming what can be termed “geriatric triangle.” The complexity their interconnections means that addressing each issue isolation is insufficient for achieving an effective resolution. Thus, comprehensive understanding this triangle essential appropriate management. This review aims to illuminate relationships within offer insights into potential strategies managing these interconnected challenges. Geriatr Gerontol Int 2025; ••: ••–•• .

Language: Английский

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Emergency department visits and hospital readmissions after a deprescribing intervention among hospitalized older adults

Journal of the American Geriatrics Society, Journal Year: 2024, Volume and Issue: 72(7), P. 2038 - 2047

Published: May 9, 2024

Abstract Background Deprescribing is the planned/supervised method of dose reduction or cessation medications that might be harmful, no longer beneficial. Though benefits deprescribing are debatable in improving clinical outcomes, it has been associated with decreased number potentially inappropriate medications, which may reduce risk adverse events among hospitalized older adults. With unclear evidence for this population, study aimed to examine time‐to‐first unplanned healthcare utilization, included 90‐day emergency department (ED) visits hospital readmission and predictors, during a intervention. Methods A secondary data analysis trial (Shed‐MEDS NCT02979353) was performed. Cox regression used compare ED visit/readmission/death from discharge intervention control groups. Additionally, we performed exploratory predictors (comorbidities, functional health status, drug burden index (DBI), length stay, literacy, food insecurity, financial burden) visit/readmission/death. Results The hazard first visits/readmissions/death 15% lower versus group (95% CI: 0.61–1.19, p = 0.352, respectively); however, difference not statistically significant. For every additional comorbidities (Hazard ratio (HR): 1.12, 95% 1.04–1.21) each day stay (HR: 1.04, 1.01–1.07) were significantly higher group; whereas unit increase pre‐hospital DBI score 1.08 HR 1.16, respectively) group. Conclusions groups had comparable This finding suggests did result period following discharge.

Language: Английский

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Chronic polypharmacy, monotherapy, and deprescribing: Understanding complex effects on the hepatic proteome of aging mice

Aging Cell, Journal Year: 2024, Volume and Issue: unknown

Published: Oct. 27, 2024

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

Language: Английский

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