Use of Medications by Persons 65 and Over: Data From the Established Populations for Epidemiologic Studies of the Elderly

Abstract

Data were analyzed from household interviews of four population-based cohorts comprising the Established Populations for Epidemiologic Studies of the Elderly to estimate the prevalence of prescription and nonprescription medication use among community-living elderly and to examine sociodemographic and health factors related to medication use. Prescription drugs were used by 60-68% of men and 68-78% of women. Nonprescription drugs were used by 52-68% of men and 64-76% of women. Use of prescription medications generally increased with age although use of nonprescription drugs was not associated with age. Men and women who smoked or used alcohol in the preceding year frequently took medications. Those who reported more depressive symptoms, impairments in physical functioning, hospitalizations, and had poorer self-perceived health status were most likely to take medications. However, 10-29% of respondents with fair or poor self-perceived health took no prescription medications, and 3-13% took neither prescription nor nonprescription medications. While further research appears warranted into potential overmedication of elders, particularly those with many depressive symptoms, these data suggest that studies of potential underuse among elders with poor health are equally important.

Composição dos gastos privados com medicamentos utilizados por aposentados e pensionistas com idade igual ou superior a 60 anos em Belo Horizonte, Minas Gerais, Brasil

“…A maioria dos estudos de utilização de medicamentos relata o uso de um número médio de quatro medicamentos por idoso 4,5,6,7,8,9 . O perfil de utilização de medicamentos por idosos acarreta em gasto elevado com a aquisição dos mesmos em comparação ao observado nas demais faixas etárias 10,11 .…”

Inhibition of Clinical Benefits of Aspirin on First Myocardial Infarction by Nonsteroidal Antiinflammatory Drugs

“…[1][2][3][4] The most plausible mechanism by which aspirin prevents ischemic events is by irreversible inhibition of the isoenzyme cyclooxygenase-1 (COX-1). 5 In the United States, nonaspirin nonsteroidal anti-inflammatory drugs (NSAIDs) are commonly used 6 for their analgesic, anti-inflammatory, and antipyretic effects. These effects result primarily from inhibition of COX-2 7 and reduced prostaglandin production.…”

The panorama of opioid‐related cognitive dysfunction in patients with cancer

“…93 Aging is associated with a decline in renal function, 94 and both polypharmacy and drug utilization in general is remarkably high in this segment of the population. 95,96 In general, it is likely that both altered pharmacokinetic and pharmacodynamic factors contribute to the risk of opioidrelated cognitive dysfunction in this patient group. 97 Several studies have documented the use of lower doses of opioids in the elderly.…”

“…• Educate family regarding recognition of potential neurotoxic features such as myoclonus 106 • Objectively monitor cognition 108,111 • Adjust dose in elderly patients 96,97 • Discontinue or minimize use of all unnecessary medications, especially other psychotropics 4 • Adjust dose for impaired renal function [93][94][95] • Maintain adequate hydration and use diuretics cautiously 4 • Perform a multidimensional assessment 127,128 • Identify poor prognosticators for pain control: neuropathic and incidental pain, somatization, tolerance, and addiction history 125 • Optimal utilization of other therapies e.g., appropriate use of adjuvant and other therapies, maximize nonpharmacologic interventions 67 • Adopt a proactive approach: early intervention with management strategies to possibly avert a full-blown delirium syndrome 17 patient group noted a decrease of approximately 60% in the chart recordings of agitated impaired mental status in association with a practice change of increased opioid rotation, hydration, and objective cognitive monitoring. 133 An open prospective study of hospice patients by Maddocks et al found a significant improvement in mental state in patients with morphine-associated delirium, who were switched to oxycodone.…”

“…• Educate family regarding nature of opioid-related cognitive dysfunction and delirium: psychomotor agitation, perceptual disturbance, delusions, and communication difficulties [107][108][109][110] • Establish goals of care, evaluate pros and cons of intervention in the context of the patient's clinical situation, previously expressed wishes, and family wishes 128 • Monitor delirium severity with an instrument that is either partly 118,119 or wholly observational 42,122,123 • Consider either opioid dose reduction or opioid switch [129][130][131][132][133] • Discontinue or minimize use of all unnecessary medications, especially other psychotropics 4 • Consider all other contributory causes, especially concurrent reversible causes 4 • Assess renal function and adjust dose of opioid or other drugs accordingly [92][93][94][95][96][97] • Assess hydration and supplement with parenteral fluids if necessary 4 • Commence symptomatic treatment of delirium with neuroleptic such as haloperidol 8,150,151 • Environmental manipulation: minimal noise, reorientation, encourage presence of family member 116 • Prevent recurrence: if delirium is reversed, address risk factors for recurrence in future (see Table 6) and emotional lability to be misinterpreted as poor pain control. 108,109 The use of psychostimulants has been advocated in the treatment of opioid-induced sedation, [157][158][159] and cognitive benefit has been demonstrated with neuropsychologic testing in a randomized, doubleblind, placebo-controlled, crossover trial of methylphenidate in patients receiving a continuous infusion of opi...…”