Pharmacoepidemiology in older people : purposes and future directions

Knowledge of the benefit/risk ratio of drugs in older adults is essential to optimise medication use. While randomised controlled trials are fundamental to the process of drug development and bringing new drugs to the market, they often exclude older adults, especially those suffering from frailty, multimorbidity and/or receiving polypharmacy. Therefore, it is generally unknown whether the benefits and harms of drugs established through pre-marketing clinical trials are translatable to the real-word population of older adults. Pharmacoepidemiology can provide real-world data on drug utilisation and drug effects in older people with multiple comorbidities and polypharmacy and can greatly contribute towards the goal of high quality use of drugs and well-being in older adults. A wide variety of pharmacoepidemiology studies can be used and exciting progress is being made with the use of novel and advanced statistical methods to improve the robustness of data. Coordinated and strategic initiatives are required internationally in order for this field to reach its full potential of optimising drug use in older adults so as to improve health care outcomes

How chronic is polypharmacy in old age? A longitudinal nationwide cohort study

OBJECTIVE: To evaluate the chronicity of polypharmacy among older adults, and to identify factors associated with chronic polypharmacy. DESIGN: Longitudinal cohort study using register data. SETTING: Nationwide, Sweden. PARTICIPANTS: All 711,432 older adults (≥65 years) living in Sweden with 5 or more prescription drugs in October 2010 were included and followed-up until December 2013. Mean age at baseline was 77 (SD, 7.8) years, 59% were women, and 7% lived in nursing homes. MEASUREMENT: Monthly changes in the exposure to polypharmacy. Data regarding prescription drug use were extracted from the Swedish Prescribed Drugs Register. RESULTS: Overall, 82% were continuously exposed to polypharmacy during ≥6 months, and 74% during ≥12 months. The proportion of individuals who remained exposed until the end of the study was 55%. Among the 21,361 individuals who had not been exposed to polypharmacy during the 6-month period before baseline (i.e. with a new episode of polypharmacy), only 30% remained exposed for ≥6 months. The proportion of older adults who spent at least 80% of their follow-up time with polypharmacy was substantially higher among prevalent polypharmacy users at baseline than among those with a new polypharmacy episode (80% vs 24%, p<0.01). Factors associated with chronic polypharmacy included higher age, female gender, living in an institution, chronic multimorbidity, and multi-dose dispensing. CONCLUSION: Polypharmacy is most often chronic, although a substantial share of older adults experience short, recurring episodes of polypharmacy and are thus exposed to its potential harms in a transient rather than persistent manner.Swedish Research Council (2015-03618)Accepte

Polypharmacy Definitions for Multimorbid Older Adults Need Stronger Foundations to Guide Research, Clinical Practice and Public Health

There are numerous definitions of polypharmacy to describe the use of many medications among older adults, but there is a need to clarify if they are purposive and meaningful. By means of a systematic review, we identified definitions of polypharmacy used in multimorbid older adults (≥65 years). We evaluated if the definitions align among the domains of research, clinical practice, and public health and appraised whether concepts of polypharmacy are based on strong foundations. More than 46 definitions of polypharmacy were retrieved from 348 publications (research: n = 243; clinical practice: n = 88; public health: n = 17). Several thresholds based on the number of medications were mentioned. The majority of the publications (n = 202, 58%) used a minimal threshold of five medications. Heterogeneous qualitative definitions were identified, mostly stating that polypharmacy is "more drugs than needed". There was no significant divergence between domains as to the type of definitions used, although qualitative definitions were more common in clinical practice. Nearly half (n = 156, 47%) of the publications provided no justification for the polypharmacy definition used. The wide variety of definitions for polypharmacy precludes comparisons, appropriate identification and management of polypharmacy in multimorbid older adults. Standardized definitions would allow more coherent judgments regarding the individual and collective stakes of polypharmacy

Statines et troubles musculaires : comparaison des notifications par les patients et les professionnels de santé

Contexte et méthodes : Nous avons comparé les signalements d'effets indésirables musculaires des statines (seules ou associées à un fibrate) effectués par des patients et des médecins au centre de pharmacovigilance de Limoges durant 2000 et 2001. Résultats : Pour 28 déclarations provenant de malades (dont 21 pour la cérivastatine), il s'agissait de myalgies (diffuses dans 80 % des cas). La dose était normale. La créatine-phospokinase (CPK) [six cas] était à 1,7 ± 0,9 N (valeur supérieure de la normale) [1–3,2 N]. Il y avait 13 notifications par les médecins : huit myalgies, cinq augmentations des CPK sans douleur (9 ± 9 N [1–20 N]). Il n'y avait aucun cas commun entre les déclarations des malades et des médecins. Les médecins déclaraient des effets plus graves et n'ayant pas nécessairement un retentissement clinique ; les malades déclaraient des effets moins précis. Conclusion : Avant d'intégrer les déclarations des malades dans la base de données actuelle, une réflexion de fond devrait être menée

La substitution en Limousin à travers l'opinion des malades, des médecins et de pharmaciens (cas de l'allopurinol et motifs d'un non maintien de la substitution)

LIMOGES-BU Médecine pharmacie (870852108) / SudocLYON1-BU Santé (693882101) / SudocSudocFranceF

Evolution de la consommation des médicaments potentiellement inappropriés après une hospitalisation, dans une population âgée de 70 ans et plus

LIMOGES-BU Médecine pharmacie (870852108) / SudocLYON1-BU Santé (693882101) / SudocSudocFranceF

Le risque iatrogène chez la personne âgée (à propos des médicaments potentiellement inappropriés)

LIMOGES-BU Médecine pharmacie (870852108) / SudocSudocFranceF

Consommation de médicaments potentiellement inappropriés dans une population âgée de 70 ans et plus (influence de l'hospitalisation et effets indésirables)

LIMOGES-BU Médecine pharmacie (870852108) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF