Medication in a cohort of older adults with a particular focus on pain medication

Einleitung: Die medizinische Versorgung in Deutschland sieht sich im Rahmen des demographischen Wandels einem zunehmend älter werdenden Patientenklientel gegenüber. Dennoch sind Studien in dieser Altersgruppe rar. Die Berliner Initiative Studie (BIS) untersucht ausschließlich Menschen, die mindestens 70 Jahre alt sind. Ziel dieser Arbeit ist es, die Epidemiologie der Medikamenten– und insbesondere der Schmerzmitteleinnahme in der älteren und hochaltrigen Bevölkerung besser zu verstehen. Methodik: Insgesamt wurden 2069 Probanden für diese populationsbasierte Kohortenstudie aus dem erweiterten Berliner Raum rekrutiert. Die aktuelle Medikation wurde im Rahmen eines Interviews erfasst. Sämtliche Medikamente wurden mit Hilfe des Anatomisch-Therapeutisch-Chemischen (ATC)-Codes kodiert und weiterführend ausgewertet. Potenziell inadäquate Medikamente wurden anhand der PRISCUS-Liste bestimmt. Die statistische Auswertung der Daten, einschließlich der logistischen Regressionsanalyse, erfolgte pseudonymisiert über SPSS und Microsoft Excel. Für diese Arbeit wurden die Daten der Baseline-Visite der BIS aus den Jahren 2009 – 2011 untersucht. Ergebnisse: Der überwiegende Teil der Probanden (97,1%) nahm Medikamente ein. Fünf Medikamente oder mehr, entsprechend einer Polypharmazie, wurden von 66,7% der Probanden eingenommen. Ein zunehmender Anstieg der Prävalenz von Polypharmazie war mit steigendem Alter zu beobachten. Niedrig dosierte Acetylsalicylsäure (ASS) war das Medikament, das in der BIS insgesamt am häufigsten eingenommen wurde. Knapp ein Drittel der Kohorte nahm Schmerzmittel ein. Nichtsteroidale Antirheumatika (NSAR) stellten die am häufigsten eingenommenen Schmerzmittel dar. Zu 43,2% wurden Schmerzmittel regelmäßig konsumiert. Analgetika wurden häufiger verschrieben als freiverkäuflich erworben. Weibliches Geschlecht, moderater Alkoholkonsum, geringe körperliche Betätigung und ein als schlecht empfundener subjektiver Gesundheitszustand waren mit einer erhöhten Schmerzmitteleinnahme assoziiert. Metamizol wurde von ≥80-Jährigen signifikant häufiger eingenommen als von 70 – 79-Jährigen. Potenziell inadäquate Analgetika wurden von 24 Probanden (3,7%) eingenommen. Probanden mit normaler Nierenfunktion, die ein Schmerzmittel benötigten, nahmen zu 69,0% ein NSAR ein, bei Probanden mit reduzierter Nierenfunktion waren es 55,2%. Zusätzlich zur regelmäßigen Einnahme von NSAR nahmen ungefähr ein Drittel der Probanden ein Magensäure-hemmendes Medikament ein. Schlussfolgerung: Die Ergebnisse aus der Baseline-Visite der BIS führen zu einem umfassenden Einblick in die Epidemiologie der Medikation und Schmerzmedikation der älteren Bevölkerung. Die hohen Prävalenzen für Polypharmazie beinhalten auch die vorhandene Selbstmedikation. Somit sollte jene Selbstmedikation beim Verschreiben von Medikamenten im hohen Alter große Aufmerksamkeit erhalten. Auch einige NSAR sind freiverkäuflich erhältlich. Trotz bekannter gastrointestinaler und nierenschädigender Komplikationen finden sich viele Vertreter der NSAR nicht auf der PRISCUS-Liste wieder. In der BIS zeigte sich, dass eine Anpassung bei reduzierter Nierenfunktion bereits zum Teil erfolgte. Eine leitliniengerechte Prävention von gastrointestinalen Komplikationen mit Magensäure-hemmenden Medikamenten bei NSAR-Einnahme fand oftmals nicht statt.Introduction: Medical Care in Germany is facing an aging patient clientele due to demographic changes. Yet, medical studies for this age group remain scarce. The Berlin Initiative Study (BIS) included individuals who were at least 70 years of age. The objective of this study was to achieve a better understanding of the epidemiology of medication and analgesic use in the elderly. Methods: A total of 2069 participants were recruited for this population-based cohort-study from the greater Berlin area. The current medication was determined through an interview. Medication was sampled through the Anatomic-Therapeutic-Chemical (ATC)-Code and further evaluated. Potentially inadequate analgesics are based on the PRISCUS-list. Statistical analysis including the logistic regression analysis of the collected pseudonymized data used SPSS and Microsoft Excel. The Data of the BIS Baseline visit from 2009 – 2011 have been analyzed in this thesis. Results: Medications were used by most participants (97,1%). 66.7% of the participants took five or more drugs. Prevalence of polypharmacy increased continually with age. Low dose acetylsalicylic acid was the most frequently used medication in the BIS. One third of participants consumed analgesic drugs. Non-steroidal anti-inflammatory drugs (NSAID) were the most widely used analgesic group. 43.2% of all analgesics were used regularly. Analgesics were more often prescribed than acquired over the counter (OTC). Female gender, moderate alcohol consumption, low physical activity and poorly rated subjective health were associated with the use of analgesic drugs. Metamizole was used significantly more often in ≥80-year-olds than in 70 – 79-year-olds. Potentially inadequate analgesics were used by 24 participants (3,7%). 69% of participants with a normal kidney function, who needed analgesic medication, took NSAID opposed to 55.2% of participants with reduced kidney function. In addition to regular use of NSAID, 35.9% of participants used medication for stomach protection. Conclusion: The results of the Baseline-visit of the BIS help to gain a more thorough view on medication and analgesic use in an elderly cohort. The high prevalence of polypharmacy also includes OTC-medication. This should require more emphasis on OTC-medication when prescribing medication for the elderly. The well-established PRISCUS-list for potentially inadequate drugs cautions only about a handful of analgesics. Despite that, gastrointestinal as well as kidney complications are well known in literature especially for NSAID. The BIS demonstrates that an adjustment for reduced kidney function was partly done. A guideline-based prevention of gastrointestinal complications with medication for stomach protection was infrequently performed

Brain-Derived Neurotrophic Factor and Immune Cells in Osteoarthritis, Chronic Low Back Pain, and Chronic Widespread Pain Patients: Association with Anxiety and Depression

Background and Objectives: Musculoskeletal dysfunction can induce several types of chronic pain syndromes. It is of particular interest to elucidate the pathomechanism of different forms of chronic pain. It is possible that patients who have developed chronic widespread pain (CWP) may endure different pathomechanisms as compared to those who suffer from local pain (osteoarthritis, OA) and regional pain (chronic low back pain, cLBP), especially with regard to pain regulation and its related biomediators. The aim of this study was to determine the differences in pathomechanisms among these patients by measuring pain-related biomediators, particularly brain-derived neurotrophic factor (BDNF). Additionally, subpopulations of immune cells were determined in parallel. Materials and Methods: Patients and healthy subjects (HSs) were recruited (age and gender-matched). BDNF was measured from serum samples of patients and HSs and the data of body composition parameters were recorded. Additionally, both patients and HSs were asked to fill in questionnaires related to pain intensity, anxiety, and depression. Results: Our results highlight that the levels of both free and total BDNF are significantly lower in pain patients compared to HSs, with p values of 0.041 and 0.024, respectively. The number of CD3− CD56bright natural killer (NK) cells shows significant differences between the groups. Comparing all chronic pain patients with HSs reveals a significantly lower number of CD4+ CD8+ T cells (p = 0.031), CD3− CD56bright NK cells (p = 0.049) and CD20+ CD3− cells (p = 0.007). Conclusions: To conclude, it seems that a general conformity between the pathomechanisms of different chronic pain diseases exists, although there are unique findings only in specific chronic pain patients

Upper airway stimulation in obstructive sleep apnea improves glucose metabolism and reduces hedonic drive for food

© 2018 European Sleep Research SocietyUpper airway stimulation is a new and effective second-line treatment for obstructive sleep apnea, but possible consequences on glucose metabolism and central regulation of food intake are unclear. Twenty patients were prospectively studied before and 12 months after obstructive sleep apnea treatment by upper airway stimulation. Respiratory parameters and daytime sleepiness were assessed to document effectiveness of treatment. Glucose metabolism was assessed by the oral glucose tolerance test, and hedonic versus homeostatic drive to eat was characterized. At 12 months, upper airway stimulation significantly improved measures of obstructive sleep apnea (all p < 0.01). Despite no change in body weight, fasting C-peptide insulin resistance index (p = 0.01) as well as insulin and C-peptide levels at 60 min during the oral glucose tolerance test (p < 0.02) were reduced. Hedonic drive to eat was strongly reduced (p < 0.05), while leptin and ghrelin rema

Peripheral Blood Lymphocyte Phenotype Differentiates Secondary Antibody Deficiency in Rheumatic Disease from Primary Antibody Deficiency

The phenotype of primary immunodeficiency disorders (PID), and especially common variable immunodeficiency (CVID), may be dominated by symptoms of autoimmune disorders. Furthermore, autoimmunity may be the first manifestation of PID, frequently preceding infections and the diagnosis of hypogammaglobulinemia, which occurs later on. In this case, distinguishing PID from hypogammaglobulinemia secondary to anti-inflammatory treatment of autoimmunity may become challenging. The aim of this study was to evaluate the diagnostic accuracy of peripheral blood lymphocyte phenotyping in resolving the diagnostic dilemma between primary and secondary hypogammaglobulinemia. Comparison of B and T cell subsets from patients with PID and patients with rheumatic disease, who developed hypogammaglobulinemia as a consequence of anti-inflammatory regimes, revealed significant differences in proportion of naïve B cells, class-switched memory B cells and CD21low B cells among B cells as well as in CD4+ memory T cells and CD4+ T follicular cells among CD4+ T cells. Identified differences in B cell and T cell subsets, and especially in the proportion of class-switched memory B cells and CD4+ T follicular cells, display a considerable diagnostic efficacy in distinguishing PID from secondary hypogammaglobulinemia due to anti-inflammatory regimens for rheumatic disease