Drug-related problems in home-dwelling older adults: a systematic review

Purpose:The complex combination of medicinesassociated with age-related physiological alterationsleads older adults to experience drug-relatedproblems (DRPs). The goal of this study was toreview the frequency and type of DRPs and DRP riskfactors in home-dwelling older adults.Methods:A MEDLINE PubMed and EMBASEscientific databases search was performed. Articlespublished from January 2000 through December2018 reporting DRPs in home-dwelling older adultswere included.Findings:From 668 articles screened, 13 met theinclusion criteria and were included in this study.Overall, the studies included 8935 home-dwellingpatients. The mean number of DRPs per patientobserved was 4.16 (1.37e10). The main causes ofDRPs were“drug selection”(51.41%),“dose selection”(11.62%), and“patient related”(10.70%) problems.The drug classes more frequently associated withDRPs were“cardiovascular system,”“alimentary tractand metabolism,”and“nervous system,”and theyrepresented 32.1%, 29.4%, and 16.5% of all drugselection problems, respectively. Respiratory systemmedicines accounted for 6.65% of all DRPs, of which“patient related”problems accounted for 97.28%.Implications:Despite the heterogeneity ofmethodology of the included studies and theheterogeneity of tools used to identify DRPs, thisanalysis clearly shows the high prevalence of DRPs inhome-dwelling older adults and highlights the needfor interventions to improve medicine use in thispopulation. This work also provides usefulinformation for the development of strategies toimprove medication use in home-dwelling olderadults.publishe

Multilevel analysis of systolic blood pressure and ACE gene I/D polymorphism in 438 Swedish families – a public health perspective

BACKGROUND: Individuals belonging to the same family share a number of genetic as well as environmental circumstances that may condition a common SBP level. Among the genetic factors, the angiotensin converting enzyme (ACE) gene I/D polymorphism appears as a possible candidate as it might influence both SBP and the pharmacological effect of ACE inhibitors. We aimed to combine genetic epidemiology with public health ideas concerning life-course and multilevel epidemiology in order to understand the role of familial factors regarding individual SBP. METHODS: We applied multilevel regression analysis on 1926 individuals nested within 438 families from South Sweden. Modelling familial SBP variance as a function of age and use of ACE inhibitors we calculates a variance partition coefficient and the proportional change in familial SBP variance attributable to differences in ACE gene I/D polymorphism RESULTS: Our results suggest the existence of genetic or environmental circumstances that produce a considerable familial clustering of SBP, especially among individuals using ACE-inhibitors. However, ACE gene I/D polymorphism seems to play a minor role in this context. In addition, familial factors – genetic, environmental or their interaction – shape SBP among non-users of ACE inhibitors but their effect is expressed later in the life-course. CONCLUSION: Strategies directed to prevent hypertension should be launched in younger rather than in older ages and both prevention of hypertension and its treatment with ACE inhibitors should be focused on families rather than on individuals