Frailty and polypharmacy in the community-dwelling elderly with multiple chronic diseases

Assessment of potential drug-drug interactions in patients with hereditary angioedema from the ITACA cohort: simulations from a real-life dataset considering danazol versus berotralstat

Background

Danazol is regularly used as a prophylactic treatment in patients with Hereditary angioedema due to C1-inhibitor deficiency (HAE-C1INH). However, this drug is characterized by a risk of drug-drug interactions (DDIs). Berotralstat, the first oral kallikrein inhibitor, has been recently approved for the prevention of HAE attacks. Here, we sought to compare the risk of potential DDIs in real-life HAE patients hypothetically given Danazol or Berotralstat.

Methods

Our clinic's database was retrospectively reviewed to identify patients diagnosed with HAE who were treated with at least one concomitant medication. The DDIs were assessed using three freely available drug interaction checkers and scored based on their severity. The agreement between the three drug checkers was evaluated using weighted Cohen's kappa coefficient.

Results

75 HAE patients (64% female, mean age 56 ± 21 years) were considered. They were mainly treated with antihypertensives (37%), hypoglycemic (19%), and hypolipemic agents (17%). Significant discrepancies among the three-drug interaction checkers were found. The first checker identified 18 potential DDIs, all involving Danazol and a statin (simvastatin). The second checker identified, respectively, 66 and 14 DDIs for Danazol (20% severe, regarding Simvastatin and Rivaroxaban) and Berotralstat (0% severe). The third checker identified 49 and 43 DDIs for Danazol (22% severe, regarding Simvastatin) and Berotralstat (0%).

Conclusion

Berotralstat was consistently associated with a reduced risk of DDIs compared with Danazol. A rational assessment of DDIs would help select the best prophylactic treatment for HAE.

Management of polypharmacy and potential drug-drug interactions in people with HIV and cancer: insights from a 4-year multidisciplinary clinic experience

BACKGROUND

People with HIV and cancer (PWHC) are often treated with different combinations of antiretroviral and oncology drugs, frequently associated with other co-medications; this significantly increases the risk of potential drug-drug interactions (DDIs).

RESEARCH DESIGN AND METHODS

A prospective observational study has been carried out from May 2020 to May 2024 to describe the management of therapies in PWHC in an outpatient clinic.

RESULTS

140 PWHC treated with 42 different antiretroviral and 59 oncology regimens were enrolled, resulting in the identification of 410 DDIs. Of these, 8% were scored as red-flag DDIs). Among antiretroviral medications, 77% of red-flag DDIs involved ritonavir or cobicistat. Paclitaxel was the oncology drug most frequently associated with red-flag-DDIs (77%). Proton pump inhibitors (PPIs) were involved in 19% of red-flag and 32 of orange-flag DDIs. The most frequent recommendations included performing an electrocardiogram (38%), conducting therapeutic drug monitoring (31%), discontinuing PPIs (29%) and/or adjusting the timing of drug intake (28%).

CONCLUSIONS

A high prevalence of polypharmacy and clinically relevant DDIs was observed in our cohort of PWHC. A multidisciplinary team could play a pivotal role in optimizing pharmacological therapies in this clinical setting, for example, by reducing the use of PPIs and booster-based antiretroviral regimens.

Deprescribing Cardiovascular Medications in Older Adults Living with Frailty

Certain medications have shown significant effectiveness in reducing the incidence of cardiovascular events and mortality, leading them to be among those that are prescribed most commonly for Canadian seniors. However, polypharmacy, which disproportionately affects older adults, is particularly concerning for frail individuals who are at higher risk for adverse medication-related events. The deprescribing process is the discontinuation, either immediate or gradual, of inappropriate medications, to address polypharmacy and improve outcomes. Nonetheless, the incorporation of deprescribing principles into clinical practice present challenges, including the limited amount of data available on the clinical benefits of deprescription, and a lack of consensus on how to deprescribe. The current narrative review explores frailty as a basis for deciding to deprescribe medication. The evidence regarding the benefits of use of medications prescribed for common cardiovascular conditions (including acetylsalicylic acid, statins, and antihypertensives) in older adults with frailty is reviewed. The review also examines the issue of who should initiate the deprescribing process, and the associated psychological implications. Although no one-size-fits-all approach to deprescription is available, patient goals should be prioritized. For older adults with frailty, healthcare professionals must consider carefully whether the benefits of use of a cardiovascular medication outweighs the potential harms. Ideally, the deprescribing process should involve shared decision-making among physicians, other health professionals, and patients and/or their substitute decision-makers, with the common goal of improving patient outcomes.

Profiles of physical frailty, social frailty, and cognitive impairment among older adults in rural areas of China: a latent profile analysis

Background

As China rapidly ages, it has now become a deeply aging society with the largest number of older individuals in the world. The issue is particularly severe in rural areas. With the aging population growing and the older population expanding, health problems are becoming more prevalent among older individuals, particularly frailty and cognitive impairments. This study aimed to identify the profiles of physical frailty, social frailty, and cognitive impairment among older adults and explore the influencing factors.

Methods

In this cross-sectional study, participants were recruited from six villages in four cities in Shandong Province, China from July to October 2023 through cluster random sampling. Latent profile analysis was used to determine the profiles of physical frailty, social frailty, and cognitive impairment. Chi-square tests and Mann-Whitney U tests were used for univariate analysis, while binary logistic regression was used to analyze the related factors.

Results

Seven hundred and sixty-nine older adult care in rural areas showed two profiles: the "high cognitive function and low frailty" group (73.7%, n = 567) and the "low cognitive function and high frailty" group (26.3%, n = 202). A binary logistic regression found that older people were more likely to be aged 80 or older (OR = 2.253, p = 0.029), have a low income level (OR = 1.051, p = 0.007), have one or two (OR = 2.287, p = 0.004), or more than three chronic diseases (OR = 3.092, p = 0.002), and report moderate (OR = 3.406, p = 0.024) or poor health status (OR = 9.085, p < 0.001) in the "low cognitive function and high frailty" group. Meanwhile, older adults who have completed high school (OR = 0.428, p = 0.005) or junior college and above (OR = 0.208, p = 0.009), and engage in adequate physical activity (OR = 0.319, p < 0.001) were more likely to be in the "high cognitive function and low frailty" group.

Conclusion

In the future, medical professors should increasingly prioritize promptly identifying and intervening in cognitive decline and frailty status in older individuals without delay.

The impact of falls on activities of daily living in older adults: A retrospective cohort analysis

BACKGROUND

Falls contribute to impairments in activities of daily living (ADLs), resulting in significant declines in the quality of life, safety, and functioning of older adults. Understanding the magnitude and duration of the effect of falls on ADLs, as well as identifying the characteristics of older adults more likely to have post-fall ADL impairment is critical to inform fall prevention and post-fall intervention. The purpose of this study is to 1) Quantify the association between falls and post-fall ADL impairment and 2) Model trajectories of ADL impairment pre- and post-fall to estimate the long-term impact of falls and identify characteristics of older adults most likely to have impairment.

METHOD

Study participants were from the Ginkgo Evaluation of Memory Study, a randomized controlled trial in older adults (age 75+) in the United States. Self-reported incident falls and ADL scores were ascertained every 6 months over a 7-year study period. We used Cox proportional hazards analyses (n = 2091) to quantify the association between falls and ADL impairment and latent class trajectory modeling (n = 748) to visualize trajectories of ADL impairment pre-and post-fall.

RESULTS

Falls reported in the previous 6 months were associated with impairment in ADLs (HR: 1.42; 95% CI 1.32, 1.52) in fully adjusted models. Based on trajectory modeling (n = 748), 19% (n = 139) of participants had increased, persistent ADL impairment after falling. Participants who were female, lived in a neighborhood with higher deprivation, or experienced polypharmacy were more likely to have ADL impairment post-fall.

CONCLUSIONS

Falls are associated with increased ADL impairment, and this impairment can persist over time. It is crucial that all older adults, and particularly those at higher risk of post-fall ADL impairment have access to comprehensive fall risk assessment and evidence-based fall prevention interventions, to help mitigate the negative impacts on ADL function.

Serum neurofilament light chain levels in migraine patients: a monocentric case-control study in China

PURPOSE

Serum neurofilament light chain (sNfL) can reflect nerve damage. Whether migraine can cause neurological damage remain unclear. This study assesses sNfL levels in migraine patients and explores whether there is nerve damage in migraine.

METHODS

A case-control study was conducted in Xiamen, China. A total of 138 migraine patients and 70 healthy controls were recruited. sNfL (pg/mL) was measured on the single-molecule array platform. Univariate, Pearson correlation and linear regression analysis were used to assess the relationship between migraine and sNfL levels, with further subgroup analysis by migraine characteristics.

RESULTS

Overall, 85.10% of the 208 subjects were female, with a median age of 36 years. sNfL levels were higher in the migraine group than in the control group (4.85 (3.49, 6.62) vs. 4.11 (3.22, 5.59)), but the difference was not significant (P = 0.133). The two groups showed an almost consistent trend in which sNfL levels increased significantly with age. Subgroup analysis showed a significant increase in sNfL levels in patients with a migraine course ≥ 10 years (β = 0.693 (0.168, 1.220), P = 0.010). Regression analysis results show that age and migraine course are independent risk factors for elevated sNfL levels, and there is an interaction between the two factors. Patients aged < 45 years and with a migraine course ≥ 10 years have significantly increased sNfL levels.

CONCLUSIONS

This is the first study to evaluate sNfL levels in migraine patients. The sNfL levels significantly increased in patients with a migraine course ≥ 10 years. More attention to nerve damage in young patients with a long course of migraine is required.