Polypharmacy in older adults: a narrative review of definitions, epidemiology and consequences

European Geriatric Medicine, Год журнала: 2021, Номер 12(3), С. 443 - 452

Опубликована: Март 10, 2021

Abstract Background The number of older adults has been constantly growing around the globe. Consequently, multimorbidity and related polypharmacy have become an increasing problem. In absence accepted agreement on definition polypharmacy, data its prevalence in various studies are not easily comparable. Besides, evidence potential adverse clinical outcomes to is limited though linked numerous outcomes. This narrative review aims find summarize recent publications definitions, epidemiology consequences polypharmacy. Methods MEDLINE database was used identify definition, using their respective common terms variations. Systematic reviews original published between 2015 2020 were included. Results One hundred forty-three definitions associated found. Most them numerical definitions. Its ranges from 4% among community-dwelling people over 96.5% hospitalized patients. addition, with Conclusion term imprecise, yet subject ongoing debate. clinically oriented found this such as appropriate or necessary more useful relevant. Regardless highly prevalent adults, particularly nursing home residents Approaches increase appropriateness can improve adults.

Язык: Английский

---

Mitochondrial dysfunction in drug-induced hepatic steatosis: recent findings and current concept

Clinics and Research in Hepatology and Gastroenterology, Год журнала: 2025, Номер 49(3), С. 102529 - 102529

Опубликована: Янв. 9, 2025

Язык: Английский

---

Prevalence of Polypharmacy, Hyperpolypharmacy and Potentially Inappropriate Medication Use in Older Adults in India: A Systematic Review and Meta-Analysis

Frontiers in Pharmacology, Год журнала: 2021, Номер 12

Опубликована: Май 19, 2021

Background: Older people often receive multiple medications for chronic conditions, which result in polypharmacy (concomitant use of 5‒9 medicines) and hyperpolypharmacy ≥10 medicines). A limited number studies have been performed to evaluate the prevalence polypharmacy, hyperpolypharmacy, potentially inappropriate medication (PIM) older developing countries. The present study aimed investigate regional variations PIM (60 + years) India. Methods: Studies were identified using Medline/PubMed, Scopus, Google Scholar databases published from inception (2002) September 31, 2020. Out total 1890 articles, 27 included study. Results: Overall, pooled was 49% (95% confidence interval: 42–56; p < 0.01), 31% (21–40; 28% (24–32; 0.01) among Indian adults. Polypharmacy more prevalent North-east India (65%, 50–79), whereas south (33%, 17–48). Region-wize estimates as follows: 23% (21–25) East, 33% West (24–42), 17.8% North (11–23), 32% (26–38) South adults aged ≥70°years 35% (28–42), those taking (≥5.5/day) 27% (22–31), a high PIMs (≥3) 29% (22–36). Subgroup analysis showed that cross-sectional had higher 55% (44–65) than cohorts 45% (37–54). Hyperpolypharmacy inpatient care settings 37% (26–47), private hospitals (24–38) government 25% (19–31). Conclusion: are widely About affected by use. Thus, appropriate steps needed promote rational geriatric prescribing Systematic Review Registration : https://clinicaltrials.gov , identifier [CRD42019141037].

Язык: Английский

---

DPSP: a multimodal deep learning framework for polypharmacy side effects prediction

Bioinformatics Advances, Год журнала: 2023, Номер 3(1)

Опубликована: Янв. 1, 2023

Because unanticipated drug-drug interactions (DDIs) can result in severe bodily harm, identifying the adverse effects of polypharmacy is one most important tasks human health. Over past few decades, computational methods for predicting have been developed.This article presents DPSP, a framework side based on construction novel drug features and application deep neural network to predict DDIs. In first step, variety information evaluated, feature extraction method Jaccard similarity are used determine similarities between two drugs. By combining these similarities, vector generated each drug. second predicts DDIs specific DDI events using multimodal vectors. On three benchmark datasets, performance DPSP measured by comparing its results those several well-known methods, such as GNN-DDI, MSTE, MDF-SA-DDI, NNPS, DDIMDL, DNN, DeepDDI, KNN, LR, RF. outperforms classification metrics. The indicate that use diverse effective efficient effects.The source code datasets available at https://github.com/raziyehmasumshah/DPSP.

Язык: Английский

---

Medication adherence with fixed-dose versus free-equivalent combination therapies: Systematic review and meta-analysis

Frontiers in Pharmacology, Год журнала: 2023, Номер 14

Опубликована: Март 22, 2023

Objective: We conducted a large-scale meta-analysis and subgroup analysis to compare the effect of fixed-dose combination (FDC) therapy with that free-equivalent (FEC) on medication adherence. Methods: Studies published in Web Science, PubMed, Cochrane Library, ScienceDirect, Embase up May 2022 were identified according Preferred Reporting Items for Systematic Reviews Meta-Analyses (PRISMA) guidelines. The primary assessed outcomes possession ratio (MPR) proportion days covered (PDC). investigated probability being adherent prescribed treatment (MPR or PDC ≥80%) average estimate these two parameters. reporting such results included this meta-analysis. summary measures reported as risk (RR) weighted mean difference (MD) 95% confidence interval (CI) using random-effects model DerSimonian Laird. quality cohort studies was Newcastle-Ottawa scale. Results: Of 1,814 screened studies, 61 met predefined inclusion criteria. showed compared FEC, FDC significantly improved compliance patients by 1.29 times (95% CI:1.23-1.35, p < 0.00001). I2 99% represent high heterogeneity across studies. adherence between FEC 0.10 CI: 0.06-0.14, 0.00001) an 100%. Subgroup analyses performed disease type, period evaluation indicators. A sensitivity exclude low-quality well which there ambiguity method calculating estimator. Conclusion: Analysis parameters intention-to-treat populations suggests can improve its advantages over may increase time. Further research is needed better understand how medical conditions affect impact reduced pill burden adherence, particularly diseases other than cardiovascular type 2 diabetes mellitus.

Язык: Английский

---

Polypharmacy and Excessive Polypharmacy Among Persons Living with Chronic Pain: A Cross-Sectional Study on the Prevalence and Associated Factors

Journal of Pain Research, Год журнала: 2023, Номер Volume 16, С. 3085 - 3100

Опубликована: Сен. 1, 2023

Polypharmacy can be defined as the concomitant use of ≥5 medications and excessive polypharmacy, ≥10 medications. Objectives were to (1) assess prevalence polypharmacy among persons living with chronic pain, (2) identify sociodemographic clinical factors associated polypharmacy.This cross-sectional study used data from 1342 ChrOnic Pain trEatment (COPE) Cohort (Quebec, Canada). The self-reported number currently by participants (regardless whether they prescribed or taken over-the-counter, for treating pain other health issues) was categorized polypharmacy.Participants reported using an average 6 (median: 5). 71.4% (95% CI: 69.0-73.8) 25.9% 23.6-28.3). No significant differences found across gender identity groups. Multivariable logistic regression revealed that greater chances reporting (vs <10 medications) included being born in Canada, medications, intensity (0-10) relief treatments (0-100%). Factors lower physical psychological treatments, better general health/physical functioning, considering terrible/feeling like it will never get better, employed.Polypharmacy is rule rather than exception pain. Close monitoring evaluation different are important all persons, especially those limited access care.

Язык: Английский

---

Evaluation of potentially inappropriate medications for the elderly according to beers, STOPP, START, and Chinese criteria

Frontiers in Pharmacology, Год журнала: 2024, Номер 14

Опубликована: Янв. 3, 2024

Objective: Polypharmacy prevalence is increasing worldwide, and it becoming more popular among the elderly. This study aimed to compare of potentially inappropriate medications (PIMs) using Beers criteria (2019 edition), for older adults in China (Chinese criteria), Screening Tool Older Persons’ Prescriptions (STOPP), Alert Right Treatment (START) identify risk factors associated with PIM use. Methods: was a cross-sectional sample 276 inpatients aged ≥65 years old from January 2020 June 2020. A conducted analyze PIMs based on Chinese, STOPP, START criteria. use analysed four different logistic regression analysis used investigate independent Results: The mean number by elderly population nine (range, 0–28). total 252 patients (accounting 91.30%) took five or 120 43.48%) 10 medications. rates were 66.30% (183/276), 55.07% (152/276), 26.45% (73/276), 64.13% (177/276) determined Beers, criteria, respectively. top screened STOPP proton pump inhibitors, clopidogrel, benzodiazepines, Missed ACEI systolic heart failure and/or coronary artery disease found be most common potential prescription omission (PPOs) analyzed Logistic showed that strongest predictor PIMs, as all an increased ( p &lt; 0.001). Age another factor our 0.05). Conclusion: study, correlated polypharmacy. Application useful tool detecting

Язык: Английский

---

Prevalence and Associated Factors of Urinary Incontinence Among Chilean Community-Dwelling Older Adults: A Cross-Sectional Study

Cureus, Год журнала: 2025, Номер unknown

Опубликована: Янв. 22, 2025

Background: Systematic reviews of the global prevalence urinary incontinence (UI) have shown an underrepresentation South American population. The objective this study was (i) to determine and associated factors UI among older Chilean community-dwelling adults (ii) analyze differences between with without UI. Methods: This is analytical cross-sectional study. A total 144 aged 60 years above were eligible participate in Participants asked provide a range data, including demographic data anthropometric self-reported measures. estimated using International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF). analyzed included age, sex, weight, height, residence comorbidities, polypharmacy, cognitive function, activity daily living (ADL) functionality. Results: One hundred eight median age participants 69.0 ± 8.0 years, 84 (77.8%) women, 71 (65.7%) lived urban residence. sample 48.1% (n = 52). Stress, urge, mixed types present 75 (69.4%), 15 (14.3%), 18 (16.3%) participants, respectively. Female rheumatoid arthritis, hypothyroidism significantly more frequent (P < 0.05). Correlations ranging from negligible weak observed presence female sex (r 0.25; P 0.05), arthritis 0.23; 0.35; 0.01). Conclusions: In adults, participants. correlated hypothyroidism.

Язык: Английский

---

Operational Definitions of Polypharmacy and Their Association with All-Cause Hospitalization Risk: A Conceptual Framework Using Administrative Databases

Pharmacy, Год журнала: 2025, Номер 13(1), С. 15 - 15

Опубликована: Фев. 2, 2025

Polypharmacy, defined as the concurrent use of multiple medications, increases risk various adverse outcomes. However, variability in definitions across literature contributes to substantial heterogeneity. Building on published literature, this study aimed identify a set operational polypharmacy applicable administrative databases and assess their association with all-cause hospitalization. Data from pharmacy refill hospitalization Local Health Unit (LHU) Bergamo, Lombardy, were analyzed. Patients aged ≥40 at least one reimbursed drug prescription 2017 included. Prescription coverage was evaluated using total daily doses (DDDs), hospitalizations January June 2018 considered. Definitions explored included (i) WHO’s criterion ≥5 medications by ATC fourth-level code; (ii) exclusion prescriptions usually for short-term treatments; (iii) drugs cumulative annual DDD ≥ 60. Approaches assessed annually, quarterly, monthly, logistic regression used estimate odds ratios (ORs) risk. Among 431,620 patients, 60 definition showed (20.47–21.16%) identified an older more complex cohort. All dose-dependent Different result varying prevalence, being most consistent. A patient-centric approach is crucial appropriateness polypharmacy.

Язык: Английский

---

Therapeutic and Structural Dimensions in Psychiatric Prescribing: Bridging Psychedelics and Antidepressants

Harvard Review of Psychiatry, Год журнала: 2025, Номер unknown

Опубликована: Март 17, 2025

Abstract As practitioners seek more personalized approaches, exploring how patients’ environments, relationship templates, and mindsets factor into symptom burden can help broaden understanding of psychotropic medications facilitate recovery. Despite increasing focus on to provide relief, there is an important undeniable influence the therapeutic environment has shaping outcomes, particularly for patient-clinician alliance. While environmental dimensions are relevant informing possible placebo or nocebo responses, they also build upon pharmacodynamic neurobiological effects medications. By heightening neuroplasticity, some antidepressants may amplify nonmedication factors in lives, including patient-prescriber relationship. There parallels between psychedelics emerging literature. For instance, preparatory integrative work with a provider be crucial determining outcomes. This paper will draw from extant literature discuss psychiatric practice, acute care settings instances which prescribing key aspect treatment.

Язык: Английский

---