Community-dwelling older adults' awareness of the inappropriate use of proton pump inhibitors

Proton pump inhibitors and the risk of gastric cancer: a systematic review, evidence synthesis and life course epidemiology perspective

OBJECTIVES

Since proton pump inhibitors (PPI) have been introduced, many concerns were raised regarding potential gastric carcinogenicity. We aim to summarise and weigh the epidemiological evidence and address possible causality.

DESIGN

Systematic literature review, evidence synthesis and life-course assessment.

DATA SOURCES

PubMed, Web of Science and Cochrane database (from inception up to October 2024), and back- and forward citation tracking (Web of Science).

ELIGIBILITY CRITERIA

Original studies and quantitative evidence syntheses assessing the association between PPIs and gastric cancer in humans, without language restrictions.

DATA EXTRACTION AND SYNTHESIS

Study design, definitions (and participant numbers) of PPI use and gastric cancer, study characteristics (setting, period, follow-up, lag-time), age and sex distribution presented in tables and evidence mapping.

RESULTS

We identified 33 original studies, 21 meta-analyses, three umbrella meta-analyses, one individual patient data meta-analysis and a Markov model (2006-2023). PPIs were consistently associated with an increased gastric cancer risk with 20/21 meta-analyses reporting pooled relative risks between 1.3 and 2.9. Available trials were underpowered. Reverse causation/protopathic bias, residual confounding (by indication) and lag time seem the largest methodological challenges, as well as disentangling the effects of Helicobacter pylori and its' eradication. Insufficient data are available on age and sex-specific risks, with no studies specifically addressing PPIs in young populations. We hypothesise a sensitive-period exposure model, in which PPI use during pregnancy and early life may be particularly damaging regarding long-term cancer risk. An exploration of Swedish cancer incidence data suggests potential cohort effects as overall gastric cancer risk decreased over time (1970-2022). The risk has increased in young (<40 years) men since the early 2000s, ~10 years after the introduction of Helicobacter pylori eradication and PPIs.

CONCLUSION

Although for older individuals with valid indications, the gastric cancer risk related to PPI use may be limited, we do argue for a more rational and evidence-supported use of PPIs in young populations.

Assessment of Awareness and Knowledge of Proton Pump Inhibitors Among the General Population in Lahore, Pakistan

Background

Proton pump inhibitors (PPIs) are used for various conditions and are generally considered safe drugs; however, there has been a surge in their usage over time, partially related to their safety and overprescription.

Purpose

This study is aimed to assess how much the public of Lahore knows about PPI, and how they use it, and if they follow their physician’s instructions or not.

Methods

A cross-sectional study was planned to attain the objective of the study. Respondents visiting various community pharmacies were inquired about their willingness to participate in this study. Chi-square was used to find the association between sociodemographic parameters and awareness of PPIs. p value less than 0.05 was considered statistically significant.

Results

There were mostly university students (73.7%), with 82.2% having heard of PPIs. Prevalent use (86.85%) is observed, often after a medical condition. Notably, 60.1% use PPIs as needed, but only 52.3% complete the prescribed course. PPIs were taken before meals only by 69.3% of participants. Associations exist between having heard of PPIs, and age with younger participants ( p < 0.001) exhibiting less awareness. Females also have heard lesser of PPIs ( p = 0.011). Education correlates with unawareness ( p < 0.001), and many participants are unaware of PPI side effects (51.04%).

Conclusion

The study contributes valuable insights to the understanding of PPI usage perspectives, offering implications for healthcare practices and public health awareness campaigns. Overall, the public shows signs of awareness but those are not enough to eliminate the misuse of PPIs in Lahore.

Predictors of medicine-related perceptions towards deprescribing inappropriate medications among older adult outpatients in Jordan: a cross-sectional study

OBJECTIVES

To examine the predictors of medicine-related perceptions towards deprescribing inappropriate medications among older adults in Jordan.

DESIGN

A cross-sectional, correlational study.

SETTING

Data were collected by a graduate nursing student from five outpatient clinics in a selected public hospital in Jordan via inperson interviews 5 days a week over a period of 4 months.

PARTICIPANTS

A convenience sample of 200 older adults who regularly visited the outpatient clinics of the selected public hospital for regular check-ups during July 2023 were recruited.

OUTCOME MEASURES

Predictors of patients' perceived medication concerns, interest in stopping medications, perceived unimportance of medications, and beliefs about medication overuse were examined.

RESULTS

Increased perceived medication concerns among patients were significantly associated with older age (p=0.037), lower level of self-rated general health (p=0.002), less perceived care-provider knowledge of medications (p=0.041), higher perceived unimportance of medicines (p=0.018), less collaboration with care providers (p=0.017), being seen by a clinical pharmacist (p<0.001) and an increased number of prescribed medicines (p<0.001). Increased perceived interest in stopping medications was significantly associated with lower levels of self-rated general health (p=0.029), less perceived involvement in decision-making (p=0.013), higher perceived unimportance of medicines (p=0.002), being seen by a clinical pharmacist (p=0.024) and an increased number of prescribed medicines (p=0.001). Furthermore, increased perceived unimportance of medications among patients was significantly associated with more perceived beliefs about medication overuse (p=0.007), more perceived interest in stopping medicines (p=0.001) and greater perceived medication concerns (p=0.001). Moreover, greater perceived beliefs about medication overuse were significantly associated with older age (p=0.018), higher perceived unimportance of medicines (p=0.016), more collaboration with care providers (p=0.038), having post-traumatic disorder (p=0.018) and an increased number of prescribed medicines (p=0.038).

CONCLUSIONS

The current study examined predictors of medicine-related perceptions towards deprescribing inappropriate medications among older adults. Care providers should discuss the benefits of deprescribing inappropriate medications with their patients to prevent the side effects associated with long-term unnecessary use. Future studies on the effectiveness of an evidence-based deprescribing protocol on minimising the clinical side effects associated with the inappropriate prescription of medications among older adults are recommended.

Knowledge and Attitudes Regarding the Inappropriate Use of Proton Pump Inhibitors Among Students of Umm Al-Qura University in Saudi Arabia: A Cross-Sectional Study

Background Proton pump inhibitors (PPIs) are commonly prescribed to manage various upper gastrointestinal conditions such as dyspepsia, gastroesophageal reflux disease (GERD), and peptic ulcer disease. However, concerns are increasing regarding their excessive and inappropriate use, particularly in cases where there is no clear medical indication. Inappropriate use can lead to unnecessary side effects and complications, emphasizing the need for better awareness of appropriate PPI use. Objectives This study aimed to assess the knowledge and attitudes of Umm Al-Qura University (UQU) students in Makkah, Saudi Arabia, regarding the inappropriate use of PPIs, highlighting the necessity of targeted educational interventions to improve awareness and promote safe PPI practices. Methods A cross-sectional online survey was conducted among 534 UQU students, aged 18-30, from both health-related and non-health-related majors. Participants were selected through convenience sampling, with the questionnaire distributed via Google Forms across various channels. Data were prepared using Microsoft Excel and analyzed with IBM SPSS Statistics for Windows, V. 25.0 (IBM Corp., Armonk, NY, USA). Results The survey revealed a significant lack of awareness about the potential side effects of PPIs, with 48.1% of participants (n=247) exhibiting low awareness, 30.9% (n=165) demonstrating high awareness, and 21% (n=112) showing moderate understanding. A chi-squared test confirmed that this awareness distribution significantly differed from what was expected, χ²(2, n=534)=60.48, p<0.001. In terms of behavior, 70.4% of participants adhered to good practices regarding PPI use, following appropriate guidelines such as using PPIs only when prescribed, following the correct dosage, and avoiding self-medication. Additionally, 21.3% (n=114) displayed moderate behavior, and 8.2% demonstrated poor behavior by engaging in practices such as using PPIs without medical supervision or not adhering to the recommended dosage and duration. A chi-squared test indicated significant differences in the behavior distribution, χ²(2, n=534)=344.14, p<0.001. Conclusion While most respondents displayed good behavior regarding PPI usage, there remains a significant gap in knowledge and attitudes. Addressing these gaps through targeted educational interventions, such as workshops, e-learning modules, and awareness campaigns, could promote the safe and effective use of PPIs among students in Saudi Arabia. The next steps would involve implementing these programs in collaboration with healthcare professionals and university departments, with effectiveness measured through follow-up surveys, behavior assessments, and analysis of PPI usage trends over time.

Potentially Inappropriate Medications in Hospitalized Older Patients in Tabuk, Saudi Arabia Using 2023 Beers Criteria: A Retrospective Multi-Centric Study

Purpose

Older persons are frequently prescribed several medications; therefore, inappropriate medication prescriptions are common. Prescribing potentially inappropriate medications (PIMs) poses a serious risk and hence, we aimed to assess the PIMs in older patients in Tabuk, using the 2023 Beers criteria.

Patients and Methods

A retrospective cross-sectional study was carried out, including older persons ≥65 years of age admitted in two government hospitals from June 2022 to May 2023, and prescribed with five or more medications. PIMs were assessed using the 2023 Beers criteria. Descriptive analysis was performed for the categorical and continuous variables. Logistic regression was used to assess the influence of age, gender, number of medications and comorbidities on PIMs using SPSS version 27.

Results

The study included 420 patients. The mean age of the participants was 75.52 ± 8.70 years (range, 65-105 years). There was a slightly higher proportion of females (52%). The prevalence of PIMs was 81.43%, where 35.41% were prescribed one PIM, 26.48% were prescribed two PIMs, and 17.32% were prescribed three PIMs. The proportion of medications considered potentially inappropriate among older patients was 70.11%, and proton pump inhibitors were the most commonly prescribed medication (52.99%). The proportion of medications to be used with caution was 19.55%, with diuretics being the most frequently administered medication (91.43%). Gender and comorbidity did not influence PIMs, but age and number of medications significantly influenced the likelihood of PIMs.

Conclusion

PIMs are prevalent among older people and are significantly associated with age and multiple medications. Caution should be exercised while prescribing medications to older persons. Frequent audits should be performed to assess PIMs, and clinicians should be informed of the same to avoid serious outcomes associated with PIMs. Interventions designed to reduce PIM need to be initiated.

Magnitude and Determinants of Long-term Use of Proton Pump Inhibitors Among Portuguese Older Adults in Primary Health Care

PURPOSE

Proton Pump Inhibitors (PPIs) have been associated with several adverse effects of particular concern in older populations. Their use for a period longer than 8 weeks is not recommended for older adults. Strategies to discontinue PPIs have been offered; however, their use remains high. This study aims to characterize PPI use in Portuguese older people and to identify the factors associated with potentially inappropriate use.

METHODS

A cross-sectional study was conducted on 1200 randomly selected older adults (≥65 years of age), users of primary health care facilities in the Regional Health Administration (Administração Regional de Saúde of Centro [ARSC]) of Portugal between April 2021 and August 2022. Data concerning their characteristics and PPI use were provided by the Shared Services of the Health Ministry (Serviços Partilhados do Ministério da Saúde) and collected retrospectively. Associations between independent variables and PPI use were investigated by logistic regression analysis.

FINDINGS

Of the older adults, 37.92% were receiving PPIs and 78.68% of them were taking them for a longer period than recommended; 49.79% were taking PPIs without having any digestive system-related disease. Multivariate analysis showed that the prolonged use of PPIs was not associated with any specific pattern, although inappropriate PPI use is high among Portuguese older adults.

IMPLICATIONS

Long-term PPI use in older adults is widespread and does not fit any particular patient profile; therefore, cross-cutting educational interventions should be designed independently of the patient's pathologic condition or treatment.

Assessment of Awareness and Knowledge of Proton Pump Inhibitors Among the General Population in Saudi Arabia

Background

One of the most commonly used classes of medications that are known for their excessively expanded misuse is proton pump inhibitors (PPIs). Although they are profoundly useful, they also account for several adverse effects. Assessing the awareness of the general population may throw light on the problem and limit irrational use. This study aims to determine the knowledge, attitude, and behavior of the general population of Saudi Arabia regarding PPI use.

Materials and methods

This was a descriptive cross-sectional study using a structured online survey. The questionnaire comprised 1088 participants of the adult general population of Saudi Arabia to assess knowledge and awareness of proton pump inhibitors. 

Results

Of the 1088 participants, 59% were men and 41% were women, 44.6% were aged 20-30 years, 25.4% were 31-40 years, and 16% were 41-50 years. Only 54% of the participants had previous knowledge of PPIs. Regarding PPI use, 25.7% of participants previously used PPIs with medical consultation and 10.3% without medical consultation, while 64% had never used PPIs. Reasons for PPI use included: heartburn (56.4%), gastroesophageal reflux disease (51.1%), gastritis (21.8%), as part of Helicobacter pylori infection therapy (20%), peptic ulcer (15.7%), esophagitis (7.1%), sore throat (6.1%), gastroenteritis (5.4%), hiatal hernia (5%), hoarseness (3.2%), asthma (2.1%), and bariatric surgery (2.1%). Of all the participants, 61.2% completed the treatment course while 38.8% did not.

Conclusion

Generally, our population had moderate knowledge of PPI. However, it is not enough to eliminate this irrational use of PPIs.This study emphasizes the importance of effective provider-led patient education to raise awareness of potential risks and reduce inappropriate long-term use of PPIs. This is significant due to growing concern about the possibility of medication overuse and non-compliance due to a lack of awareness about PPIs. In addition, more research assessing the awareness of over-the-counter (OTC) medications should be taken into consideration.

Potentially Inappropriate Prescribing among Elderly Outpatients: Evaluation of Temporal Trends 2012-2018 in Piedmont, Italy

Pharmacological intervention is one of the cornerstones in the treatment and prevention of disease in modern healthcare. However, a large number of drugs are often prescribed and used inappropriately, especially in elderly patients. We aimed at investigating the annual prevalence of potentially inappropriate prescriptions (PIPs) among older outpatients using administrative healthcare databases of the Piedmont Region (Italy) over a seven-year period (2012–2018). We included all Piedmont outpatients aged 65 years or older with at least one drug prescription per year. Polypharmacy and the prevalence of PIPs according to the ERD list explicit tool were measured on an annual basis. A range between 976,398 (in 2012) and 1,066,389 (in 2018) elderly were evaluated. Among them, the number of subjects with at least one PIP decreased from 418,537 in 2012 to 339,764 in 2018; the prevalence significantly reduced by ~25% over the study period. The stratified analyses by age groups and sex also confirmed the downward trend and identified several differences in the most prevalent inappropriately prescribed drugs. Overall, despite a reduction in PIP prevalence, one out of three older outpatients was still exposed to inappropriateness, highlighting the extensive need for intervention to improve prescribing.

The use of analgesics and associated factors among nursing home residents

Aim: This study examined the use of analgesics and associated factors among nursing home residents (NHRs). Materials & methods: A descriptive correlational design and a convenience sample of 209 NHRs receiving analgesics was used in this study. Results: Higher use of analgesics was noted among NHRs without cognitive impairment (p < 0.001), those with higher anticholinergic burden scores (p = 0.002) and those with a higher average number of oral pills taken daily (p = 0.045). Conclusion: These findings contribute to a better understanding of the prevalence and associated factors of analgesic use, which will inform the development and application of evidence-based pain practice and guidelines in nursing homes in Jordan and beyond.

Potentially inappropriate medications use and its associated factors among geriatric patients: a cross-sectional study based on 2019 Beers Criteria

The aims of this study were to estimate the prevalence of potentially inappropriate medications (PIMs) in a community-dwelling Jordanian population of geriatrics according to the 2019 American Geriatrics Society Beers Criteria, to identify the most used PIMs and factors independently associated with PIMs use.

This was an observational, descriptive, cross-sectional study. The sample population included 386 participants. Data were collected by face-to-face interviews. A total of 2894 medications were evaluated. The prevalence of patients using at least one PIM was 49.2%. The most used PIMs were proton pump inhibitors (24.6%) and long-acting sulfonylurea (20.5%). Participants who had diabetes mellitus, peptic ulcer, or irritable bowel syndrome had significantly higher numbers of PIMs.

The use of PIMs was high in Jordanian geriatric patients. The results of this study might help healthcare providers to detect high-risk patients and reconsider the necessity of using PIMs to decrease the risk of adverse drug events.