BACKGROUND: Deprescribing of potentially inappropriate medications is recommended for older adults and may improve health outcomes and quality of life in persons living with Parkinson disease (PD). Patient attitudes, beliefs, and preferences play a crucial role in the success of deprescribing interventions. We aimed to examine the attitudes and beliefs about medication burden and deprescribing among persons living with PD.
METHODS: We administered a survey to participants of Fox Insight, a prospective longitudinal study of persons living with PD. The survey included the revised Patients\' Attitudes Towards Deprescribing (rPATD) questionnaire and additional questions about adverse drug effects. We used logistic regression models to explore potential predictors of treatment dissatisfaction and willingness to deprescribe.
RESULTS: Of the 4945 rPATD respondents, 31.6% were dissatisfied with their current medications, and 87.1% would be willing to deprescribe medications. Male sex was associated with a greater willingness to deprescribe (adjusted odds ratio [aOR] 1.62, 95% confidence interval [CI] 1.37-1.93). A greater belief that the medication burden was high or that some medications were inappropriate was associated with treatment dissatisfaction (aORs 3.74, 95% CI 3.26-4.29 and 5.61, 95% CI 4.85-6.50), and more willingness to deprescribe (aORs 1.74, 95% CI 1.47-2.06 and 2.87, 95% CI 2.41-3.42). Cognitive impairment was the adverse drug effect participants were most concerned about when prescribed new medications to treat nonmotor symptoms.
CONCLUSIONS: Persons with PD are often dissatisfied with their overall medication load and are open to deprescribing. Medications that are associated with cognitive impairment might be prioritized targets for deprescribing interventions in this population.

BACKGROUND: Potentially inappropriate medications (PIMs) are medications whereby the harms may outweigh the benefits for a given individual. Although overprescribed to older adults, their direct costs on the healthcare system are poorly described.
METHODS: This was a cross-sectional study of the cost of PIMs for Canadians aged 65 and older, using adapted criteria from the American Geriatrics Society. We examined prescription claims information from the National Prescription Drug Utilization Information System in 2021 and compared these with 2013. The overall levels of inflation-adjusted total annual expenditure on PIMs, average cost per quarterly exposure, and average quarterly exposures to PIMs were calculated in CAD$.
RESULTS: Exposure to most categories of PIMs decreased, aside from gabapentinoids, proton pump inhibitors, and antipsychotics, all of which increased. Canadians spent $1 billion on PIMs in 2021, a 33.6% reduction compared with 2013 ($1.5 billion). In 2021, the largest annual expenditures were on proton pump inhibitors ($211 million) and gabapentinoids ($126 million). The quarterly amount spent on PIMs per person exposed decreased from $95 to $57. In terms of mean cost per person, opioids and antipsychotics were highest ($138 and $118 per exposure). Some cost savings may have occurred secondary to an observed decline of 16.4% in the quarterly rate of exposure to PIMs (from 7301 per 10,000 in 2013 to 6106 per 10,000 in 2021).
CONCLUSIONS: While expenditures on PIMs have declined in Canada, the overall cost remains high. Prescribing of some seriously harmful classes of PIMs has increased and so directed, scalable interventions are needed.

BACKGROUND: Older adults requiring care often have multiple morbidities that lead to polypharmacy, including the use of potentially inappropriate medications (PIMs), leading to increased medical costs and adverse drug effects. We conducted a cross-sectional study to clarify the actual state of drug prescriptions and the background of polypharmacy and PIMs.
METHODS: Using long-term care (LTC) and medical insurance claims data in the Ibaraki Prefecture from April 2018 to March 2019, we included individuals aged ≥ 65 who used LTC services. The number of drugs prescribed for ≥ 14 days and the number of PIMs were counted. A generalized linear model was used to analyze the association between the backgrounds of individuals and the number of drugs; logistic regression analysis was used for the presence of PIMs. PIMs were defined by STOPP-J and Beers Criteria.
RESULTS: Herein, 67,531 older adults who received LTC services were included. The median number of total prescribed medications and PIMs was 7(IQR 5-9) and 1(IQR 0-1), respectively. The main PIMs were loop diuretics/aldosterone antagonists (STOPP-J), long-term use of proton pump inhibitors (Beers Criteria), benzodiazepines/similar hypnotics (STOPP-J and Beers Criteria), and nonsteroidal anti-inflammatory drugs (STOPP-J and Beers Criteria). Multivariate analysis revealed that the number of medications and presence of PIMs were significantly higher in patients with comorbidities and in those visiting multiple medical institutions. However, patients requiring care level ≥1, nursing home residents, users of short-stay service, and senior daycare were negatively associated with polypharmacy and PIMs.
CONCLUSIONS: Polypharmacy and PIMs are frequently observed in older adults who require LTC. This was prominent among individuals with comorbidities and at multiple consulting institutions. Utilization of nursing care facilities may contribute to reducing polypharmacy and PIMs.

BACKGROUND: Hospitalizations are frequently disruptive for persons with dementia (PWD) in part due to the use of potentially problematic medications for complications such as delirium, pain, and insomnia. We sought to determine the impact of hospitalizations on problematic medication prescribing in the months following hospitalization.
METHODS: We included community-dwelling PWD in the Health and Retirement Study aged ≥66 with a hospitalization from 2008-2018. We characterized problematic medications as medications that negatively affect cognition (strongly anticholinergics/sedative-hypnotics), medications from 2019 Beers criteria, and medications from STOPP-V2. To capture durable changes, we compared problematic medications 4 weeks pre-hospitalization (baseline) to 4 months post-hospitalization period. We used a generalized linear mixed model with Poisson distribution adjusting for age, sex, comorbidity count, pre-hospital chronic medications, and timepoint.
RESULTS: Among 1,475 PWD, 504 had a qualifying hospitalization (median age 84 (IQR=79-90), 66% female, 17% Black). There was a small increase in problematic medications from the baseline to post-hospitalization timepoint that did not reach statistical significance (adjusted mean 1.28 vs. 1.40, difference 0.12 (95% CI -0.03, 0.26), p=0.12). Results were consistent across medication domains and certain subgroups. In one pre-specified subgroup, individuals on <5 pre-hospital chronic medications showed a greater increase in post-hospital problematic medications compared to those on ≥5 medications (p=0.04 for interaction, mean increase from baseline to post-hospitalization of 0.25 for those with <5 medications (95% CI 0.05, 0.44) vs. 0.06 (95% CI -0.12, 0.25) for those with ≥5 medications).
CONCLUSIONS: Hospitalizations had a small, non-statistically significant effect on longer-term problematic medication use among PWD.

Older adults are at risk of adverse drug events during transition of care from hospital to community, thus optimal communication about medications at discharge is essential. Standardization of medication discharge plan (MDP) is lacking. This study aimed to (1) create a standardized MDP for older adults using consensus-based principles, (2) create a short-version MDP and (3) generate a practical guide. Modified Delphi was used to establish consensus on guiding principles for the MDP. Additionally, participants were asked about guiding principles deemed most essential, patient prioritization, the format and mode of transmission of the MDP. Twenty-six guiding principles reached consensus, with 17 prioritized for a short-version MDP. The practical guide includes explanations of the guiding principles, criteria for patient selection and recommendations on the format and mode of transmission. The results of this study will assist implementation of MDPs when older adults are discharged from hospital.

BACKGROUND: Polypharmacy and the resulting problems lead to considerable consequences for those affected. There are also considerable problems with the medication management.
OBJECTIVE: Which interventions and programs for optimizing the supply of medication are available for nursing homes and which implementation problems can be expected?
METHODS: A literature search was carried out for interventional studies in nursing homes in Germany, with a focus on improving medication safety.
RESULTS: A total of six programs were identified for which evaluation results are available. Despite a mostly multimodal approach with several pillars of intervention (e.g., medication reviews, further education and training, development of aids), the results are largely disappointing. The effects on the number of prescriptions in general, specific medication groups or outcome parameters such as hospital admissions could only be shown in one study, whereby, selection bias could also be at least partly responsible for this. Interdisciplinary collaboration and the implementation of medication recommendations formulated in reviews by the responsible physicians are the main problem areas. At the same time, too little attention is paid to the central role of nurses in the entire process and they are not actively promoted enough. This could be one of the reasons for the difficulties in implementation in practice.
CONCLUSIONS: There are nearly no significant changes as a result of the interventions implemented in the studies reviewed. In particular, interprofessional cooperation, especially the skills of nurses and the reluctance on the part of physicians, should probably be given more attention.
UNASSIGNED: HINTERGRUND: Polypharmazie und daraus resultierende Probleme führen zu erheblichen Belastungen bei den Betroffenen. Darüber hinaus lassen sich erhebliche Probleme bei der Medikamentenversorgung feststellen.
UNASSIGNED: Welche Interventionen und Programme zur Optimierung der Medikamentenversorgung liegen für die stationäre Langzeitpflege vor, und mit welchen Umsetzungsproblemen ist zu rechnen?
UNASSIGNED: Literaturrecherche zu Interventionsstudien, die in stationären Pflegeeinrichtungen in Deutschland durchgeführt wurden, mit dem Fokus auf der Optimierung der Medikamentenversorgung.
UNASSIGNED: Sechs Programme mit Evaluationsergebnissen konnten identifiziert werden. Obwohl der Ansatz meist multimodal ist und mehrere Interventionsbereiche umfasst, wie Medikamentenbewertungen, Fort- und Weiterbildung sowie die Entwicklung von Hilfsmitteln, sind die Ergebnisse größtenteils enttäuschend. Lediglich in einer Studie konnten signifikante Auswirkungen auf die Gesamtzahl der Verschreibungen, bestimmte Medikamentengruppen und Outcome-Parameter wie Krankenhauseinweisungen belegt werden, wobei hierfür ein Selektionsbias zumindest mitverantwortlich sein könnte. Die größten Schwierigkeiten bestehen in der Umsetzung interdisziplinärer Zusammenarbeit und der Anwendung der in Reviews formulierten Medikamentenempfehlungen durch die zuständigen Ärzt*innen. Gleichzeitig wird die zentrale Rolle der Pflegenden im Gesamtprozess zu wenig beachtet und aktiv gefördert, was ein weiterer Grund für die Schwierigkeiten bei der Umsetzung in der Praxis sein könnte.
UNASSIGNED: Es zeigen sich fast keine signifikanten Veränderungen als Folge der in den gesichteten Studien durchgeführten Interventionen. Vor allem die interprofessionelle Kooperation, speziell die Kompetenzen der Pflegenden und die Zurückhaltung aufseiten der Ärzt*innen, müssten hierbei vermutlich noch stärker in den Blick genommen werden.

BACKGROUND: With the aging of the population and the increase in chronic diseases, there is an inherent risk of polypharmacy and inappropriate medication use. The study aimed to determine the prevalence and incidence of potentially inappropriate medication use and its correlation with polypharmacy.
METHODS: A retrospective, population-based cohort study among patients ≥65 years hospitalized at The National University Hospital of Iceland from 2010-2020. Data on medication usage were retrieved from the National Prescription Medicine Registry. Based on the number of medications filled in in the year prior to admission and post-discharge, participants were categorized non-polypharmacy (<5), polypharmacy (5-9), and hyper-polypharmacy (≥10). The prevalence and incidence of potentially inappropriate medication use was assessed based on the 2019 Beers criteria. Regression models were used to correlate sociodemographic, clinical, and pharmacoepidemiologic variables and the odds of new potentially inappropriate medication use.
RESULTS: The cohort comprised 55,859 patients (48.5% male) with a median [IQR] age of 80 [73-86] years. The prevalence of inappropriate medication use in the year preceding admission was 34.0%, 77.7%, and 96.4% for patients with non-polypharmacy, polypharmacy, and hyper-polypharmacy. The incidence of new potentially inappropriate medication use was 46.7% (95% CI 45.6%-47.6%) among those with no potentially inappropriate medication use pre-admission. Factors associated with higher odds of new potentially inappropriate medication use after discharge were the use of multi-dose dispensing services, dementia, polypharmacy, and hyper-polypharmacy.
CONCLUSIONS: An increased emphasis is needed to review and reevaluate the appropriateness of medication use among older population in internal medicine.
BACKGROUND: https://clinicaltrials.gov/ct2/show/NCT05756400.

OBJECTIVE: Investigate the association between potentially inappropriate medication (PIM) use and the risk of death among community-dwelling older Brazilian adults.
METHODS: Participants from the Health, Well-Being, and Aging Cohort Study (SABE) in São Paulo, Brazil, between 2000 and 2016 were included. The dependent variable was all-cause mortality, measured as the time elapsed until death. The exposure of interest was the use of PIM according to the Beers Criteria 2019 version. All covariates, except for sex and education, were considered time-varying.
RESULTS: PIM use was not associated with mortality after adjusting for covariates (HR = 0.99; 95 % CI: 0.88-1.12). There was a significant interaction between PIM use and age (HR = 0.98; 95 % CI: 0.96-0.99).
CONCLUSIONS: The association between PIM use and the risk of death was moderated by age. Future studies should consider the impact of necessary medication omissions when assessing the mortality risk associated with PIM use.

BACKGROUND: Long-term exposure to anticholinergic and sedative drugs could be a modifiable risk factor for cognitive decline. The objective of this study was to measure the association between previous cumulative anticholinergic and sedative drug exposure (Drug Burden Index) and cognitive decline.
METHODS: A cohort study (MEMORA cohort) was conducted in a French memory clinic for patients attending a consultation between November 2014 and December 2020, with at least 2 Mini-Mental State Examination (MMSE) measurements (≥ 6 months apart) and available medication data from the local Primary Health Insurance Fund database (n = 1,970). Drug Burden Index was linearly cumulated until each MMSE measurement and was used to categorise patients according to their level of exposure (no exposure, moderate, or high). The longitudinal association between Drug Burden Index and MMSE was assessed using a multivariate linear mixed model, adjusted for age, education level, anxiety disorders, depressive disorders, functional autonomy, and behavioural disorders.
RESULTS: Overall, 1,970 patients were included with a mean follow-up duration of 2.78 years (± 1.54) and 2.99 visits per patients (5,900 MMSE + Drug Burden Index measurements collected). At baseline, 68.0% of patients had moderate cumulative anticholinergic and sedative drug exposure and a mean MMSE of 21.1. MMSE decrease was steeper in patients with moderate and high Drug Burden Index ( -1.74 and -1.70/year, respectively) than in patients with no exposure (-1.26/year) after adjusting for age, education, anxiety and depressive disorders, functional autonomy, and behavioural disorders (p < 0.01).
CONCLUSIONS: Long-term exposure to anticholinergic and sedative drugs is associated with steeper cognitive decline. Medication review focusing on de-prescribing these drugs could be implemented early to reduce cognitive impairment.

BACKGROUND: Potentially inappropriate medication remains a significant concern in general practices, particularly in the context of overactive bladder (OAB) treatment for individuals aged 65 years and older. This study focuses on the exploration of alternative options for treating OAB and the deprescribing of anticholinergic drugs commonly used in OAB. The research aims to comprehensively evaluate the efficiency of deprescribing through a mixed methods approach, combining quantitative assessment and qualitative exploration of perceptions, experiences, and potential barriers among patients and health care personnel.
OBJECTIVE: This study aims to evaluate the efficiency and safety of the intervention in which health care staff in primary care encourage patients to participate in deprescribing their drugs for OAB. In addition, we aim to identify factors contributing to or obstructing the deprescribing process that will drive more informed decisions in the field of deprescribing and support effective and safe treatment of patients.
METHODS: The drugs for overactive bladder in primary care (DROP) study uses a rigorous research design, using a randomized controlled trial (RCT) with an embedded sequential explanatory mixed methods approach. All general practices within the North Denmark Region will be paired based on the number of general practitioners (GPs) and urban or rural locations. The matched pairs will be randomized into intervention and control groups. The intervention group will receive an algorithm designed to guide the deprescribing of drugs for OAB, promoting appropriate medication use. Quantitative data will be collected from the RCT including data from Danish registries for prescription analysis. Qualitative data will be obtained through interviews and focus groups with GPs, staff members, and patients. Finally, the quantitative and qualitative findings are merged to understand deprescribing for OAB comprehensively. This integrated approach enhances insights and supports future intervention improvement.
RESULTS: The DROP study is currently in progress, with randomization of general practices underway. While they have not been invited to participate yet, they will be. The inclusion of GP practices is scheduled from December 2023 to April 2024. The follow-up period for each patient is 6 months. Results will be analyzed through an intention-to-treat analysis for the RCT and a thematic analysis for the qualitative component. Quantitative outcomes will focus on changes in prescriptions and symptoms, while the qualitative analysis will explore experiences and perceptions.
CONCLUSIONS: The DROP study aims to provide an evidence-based intervention in primary care that ensures the deprescription of drugs for OAB when there is an unfavorable risk-benefit profile. The DROP study\'s contribution lies in generating evidence for deprescribing practices and influencing best practices in health care.
BACKGROUND: ClinicalTrials.gov NCT06110975; https://clinicaltrials.gov/study/NCT06110975.
UNASSIGNED: DERR1-10.2196/56277.