Clinical consequences of polypharmacy in elderly

Maher, Robert L.; Hanlon, Joseph T.; Hajjar, Emily R.

doi:10.1517/14740338.2013.827660

Cited by 1,451 publications

(1,177 citation statements)

References 58 publications

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“…38 % of all patients and thus more than a third of them took five or more drugs daily and therefore fulfilled the criterion for polypharmacy. This result agrees with the findings of Maher et al, who in their study on the clinical consequences of polypharmacy assumed that 36 % of the women in an outpatient setting regularly took more than five drugs for longer periods of time [7]. Since it must be assumed that the compliance for drug consumption among elderly patients is reduced [34], the actual incidence of polypharmacy could be lower.…”

supporting

confidence: 90%

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The Problem of Polypharmacy in Female Patients with Overactive Bladders – Cross-Sectional Study in a Specialist Outpatient Department

Schneidinger

Umek

Böhmdorfer

2016

Geburtshilfe Frauenheilkd

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Background: The consumption of certain drugs can cause urinary incontinence. The aim of this study is to determine the frequency of consumption of drugs that can favour incontinence, the incidence of polypharmacy and the incidence of potentially dangerous drug-drug interactions in female patients suffering from overactive bladder (OAB) who presented to a urogynaecological outpatient department. Methods: We undertook a retrospective case series study. The data from 100 female patients who attended the urogynaecological outpatient department of the Vienna General Hospital [VGH; Allgemeinen Krankenhauses Wien (AKH)] in the period from 20.?07.?2010 to 30.?08.?2011 were evaluated. The patients suffered either from an OAB or mixed incontinence with predominantly urge components. Among other factors, we were interested in the drugs taken for longer periods of time as well as the general and the urogynaecological case histories. 15 parameters were recorded: age, BMI, menopausal status, parity, pelvic organ prolapse, DIAPPERS criteria (delirium, infection (urinary), atrophic urethritis and vaginitis, pharmaceuticals, psychological disorders (especially depression), excessive urine output, restricted mobility, stool impaction), drug side effects and drug-drug interactions. A descriptive statistical analysis was performed. The drugs were checked with the help of a drug information system (Intranet-KH [V 6.0]). Of particular interest was the consumption of drugs that could favour urinary incontinence as an adverse side effect. In addition the frequency of polypharmacy and the frequency of potentially health-threatening drug combinations were registered. Results: 57?% of the patients consumed at least one drug that could reinforce urinary incontinence. The frequency of polypharmacy was 38?%. In 45?% of the patients the possibility for health-damaging interactions existed as a result of the consumed drugs. Conclusion: The frequencies of consumption of drugs that can favour urinary incontinence and of polypharmacy are high among the patients who attend a specialist outpatient department for urinary incontinence. This emphasises the importance of a complete drug history in the diagnostic work-up for urinary incontinence.

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confidence: 90%

“…Polypharmacy is one of the reversible causes of overactive bladder [6]. We speak of polypharmacy when five or more drugs are taken regularly [7]. Numerous drugs can favour urinary incontinence and drug-drug interactions can impact on the lower urinary tract [3,8].…”

mentioning

confidence: 99%

The Problem of Polypharmacy in Female Patients with Overactive Bladders – Cross-Sectional Study in a Specialist Outpatient Department

Schneidinger

Umek

Böhmdorfer

2016

Geburtshilfe Frauenheilkd

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“…Elderly patients often have more comorbidities and polypharmacy, which are associated with higher bleeding risk than those without 28, 29, 30, 31. Our study agreed with a meta‐analysis of 4 major clinical trials of NOAC with improved efficacy in S/SE (relative risk: 0.81; 95% CI, 0.73–0.91; P <0.0001) and all‐cause mortality (relative risk: 0.90; 95% CI, 0.85–0.95; P <0.0001) and increased gastrointestinal bleeding (relative risk: 1.25; 95% CI, 1.01–1.55; P =0.04) when NOAC prescription was compared with warfarin 32.…”

Section: Discussionmentioning

confidence: 99%

Efficacy and Safety of Non–Vitamin K Antagonist Oral Anticoagulants in Atrial Fibrillation Patients With Impaired Liver Function: A Retrospective Cohort Study

Wang

Kuo

et al. 2018

JAHA

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BackgroundPatients with impaired liver function (ILF) were excluded from clinical trials that investigated non–vitamin K antagonist oral anticoagulants (NOACs) for stroke prevention in patients with atrial fibrillation. The aim of this study was to evaluate the efficacy and safety of NOACs in atrial fibrillation patients with ILF.Methods and ResultsA cohort study based on electronic medical records was conducted from 2009 to 2016 at a multicenter healthcare provider in Taiwan and included 6451 anticoagulated atrial fibrillation patients (aged 76.7±7.0 years, 52.5% male). Patients were classified into 2 subgroups: patients with normal liver function (n=5818) and patients with ILF (n=633, 9.8%). Cox regression analysis was performed to investigate the risks of thromboembolism, bleeding, and death associated with use of NOACs and warfarin in patients with normal liver function and ILF, respectively. In patients with normal liver function, compared with warfarin therapy (n=2928), NOAC therapy (n=4048) was associated with significantly lower risks of stroke or systemic embolism (adjusted hazard ratio: 0.75; 95% confidence interval, 0.65–0.88; P<0.001) and death (adjusted hazard ratio: 0.69; 95% confidence interval, 0.60–0.80; P<0.001) with no difference in major bleeding or gastrointestinal bleeding. In patients with ILF, compared with warfarin therapy (n=394), NOAC therapy (n=342) was associated with significantly lower risk of death (adjusted hazard ratio: 0.64; 95% confidence interval, 0.49–0.83; P<0.001), but no difference in stroke or systemic embolism, major bleeding, or gastrointestinal bleeding.ConclusionsIn atrial fibrillation patients with ILF, NOAC therapy and warfarin therapy were associated with similar risks of stroke or systemic embolism, major bleeding, and gastrointestinal bleeding.

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“…This means that the fundamental mechanisms of ageing as targets for the treatment or prevention of several age-related conditions are being missed. What's more, patients with multimorbidity are being exposed to many drugs at once, often with adverse effects 5 .…”

Section: Maturing Fieldmentioning

confidence: 99%

Find drugs that delay many diseases of old age

Bellantuono

2018

Nature

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COMMENT Studies of ageing have tended to focus on lifespan rather than on years of good health.© 2 0 1 8 M a c m i l l a n P u b l i s h e r s L i m i t e d , p a r t o f S p r i n g e r N a t u r e . A l l r i g h t s r e s e r v e d . a network of academic and industry scientists, clinicians and regulators called COST Action BM1402: MouseAGE. The network, which is funded by the European Union, has worked with other experts in these domains worldwide. MATURING FIELDOver the past decade, understanding of the physiological changes that occur as people age has improved a great deal.Common mechanisms seem to underpin several age-related diseases, including diabetes, Parkinson's disease and Alzheimer's. A review of more than 400 studies of people and animal models indicates that similar mechanisms underlie six conditions 2 . These can involve DNA damage, such as that caused by free radicals; cellular senescence (in which cells stop dividing and start secreting inflammatory factors); or inflammation and autophagy (the degradation of organelles, misfolded proteins and so on) 2 .This may explain why people over 65 are at a higher risk than younger people of developing more than one disease at the same time. In the United States, 7 out of 10 people over 65 with diabetes will die of heart disease, for instance.It is also becoming clear that one agerelated disease can accelerate the onset of others. A 2014 study 3 showed that people older than 75 who already had diabetes, say, were more than twice as likely to develop another disease over the next three years than those who were healthy at the beginning of the study.Also, between one-quarter and half of people over the age of 80 become frail. The accumulation of deficits makes it harder for them to recover from an infection, fall or other minor stressor 4 . It is unclear whether multimorbidity leads to frailty or vice versa, or whether they are independent.Until now, ageing research has focused mainly on single diseases, or on delaying death. This means that the fundamental mechanisms of ageing as targets for the treatment or prevention of several age-related conditions are being missed. What's more, patients with multimorbidity are being exposed to many drugs at once, often with adverse effects 5 . THREE STEPS TO TRANSLATIONResearch in mice over the past few years suggests that it might be possible to delay the decline of many tissues and the onset of disease. Drugs such as rapamycin, metformin or senolytics (which remove senescent cells), can slow the development of cataracts, osteoarthritis, osteoporosis, the loss of muscle mass and can improve cardiac function 2,6-8 .If these are to become useful in people, three advances must be made. There is no standardized definition of multimorbidity. Some researchers use the term to describe the co-occurrence of 2 diseases, some 5, others 13 and so on. This makes it hard to compare studies and to establish which diseases have a higher chance of occurring together.Agreeing to a definition will require:working out which of the 5 o...

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Clinical consequences of polypharmacy in elderly

Cited by 1,451 publications

References 58 publications

The Problem of Polypharmacy in Female Patients with Overactive Bladders – Cross-Sectional Study in a Specialist Outpatient Department

The Problem of Polypharmacy in Female Patients with Overactive Bladders – Cross-Sectional Study in a Specialist Outpatient Department

Efficacy and Safety of Non–Vitamin K Antagonist Oral Anticoagulants in Atrial Fibrillation Patients With Impaired Liver Function: A Retrospective Cohort Study

Find drugs that delay many diseases of old age

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