Proton Pump Inhibitors and Risk of 1-Year Mortality and Rehospitalization in Older Patients Discharged From Acute Care Hospitals

Abstract

The use of proton pump inhibitors (PPIs) has rapidly increased during the past several years. However, concern remains about risks associated with their long-term use in older populations.Objective: To investigate the relationship between the use of PPIs and the risk of death or the combined end point of death or rehospitalization in older patients discharged from acute care hospitals. Design:We investigated the relationship between PPI use and study outcomes using time-dependent Cox proportional hazards regression in patients 65 years or older discharged from acute care medical wards from April 1 to June 30, 2007.Setting: Eleven acute care medical wards.Participants: Four hundred ninety-one patients (mean [SD] age, 80.0 [5.9] years). Main Outcome Measures:Mortality and the combined end point of death or rehospitalization.Results: The use of PPIs was independently associated with mortality (hazard ratio, 1.51 [95% CI, 1.03-2.77]) but not with the combined end point (1.49 [0.98-2.17]). An increased risk of mortality was observed among patients exposed to high-dose PPIs vs none (hazard ratio, 2.59 [95% CI, 1.22-7.16]). Conclusions and Relevance:In older patients discharged from acute care hospitals, the use of high-dose PPIs is associated with increased 1-year mortality. Randomized controlled studies including older frail patients are needed. In the meantime, physicians need to use caution and balance benefits and harms in longterm prescription of high-dose PPIs.

Non-invasive assessment of gastric secretory function in centenarians

“…Recently, Kelly et al underlined how inappropriate PPI therapy is still a problem in hospitals, though it appears to be at a lower level compared with previous studies. 16,17 The present study clearly demonstrated that in over 100 years subjects the gastric acid production is preserved in 80% of the studied population. This results is quite difBref report Table 1 fering from that previously thought, and why this occurs is unknown.…”

Analysis of medication use by elderly persons with supplemental health insurance plans

“…In the USA, the use of muscle relaxants among the elderly aged over 65 years increased 136% between 1999 and 2012 34 . Proton pump inhibitors, meanwhile, elevate gastric pH, increasing the risk of infection by Clostridium difficile, bone loss, fractures, pneumonia and malabsorption 35 , and so the Beers Criteria 2015 recommends avoiding their use for more than eight weeks 9 . The medications used by the participants of the present study differed from those seen among elderly Family Health Strategy users 20 .…”

Rapport sur l’utilisation des inhibiteurs de la pompe à protons : les recommandations françaises sont-elles respectées ?

“…Si les effets iatrogènes ont longtemps été considérés comme bénins, et le plus souvent pré-coces et transitoires, la littérature s'enrichit depuis quelques années de la description d'effets indésirables plus graves concernant majoritairement les traitements au long cours chez des personnes âgées et pouvant contribuer à réduire leur espérance de vie [5]. L'agence américaine du médicament, Food and Drug Administration (FDA), a publié en 2011 une note d'alerte sur les risques de fractures (par hypocalcémie et malabsorption de la vitamine B12) que peut engendrer un traitement trop long par IPP [6], ainsi que sur les risques engendrés par l'hypomagnésémie due à l'utilisation des IPP [7].…”