User login
Lower Urinary Tract Symptoms Associated With Poorer Cognition in Older Adults
Lower urinary tract symptoms were significantly associated with lower scores on measures of cognitive impairment in older adults, based on data from approximately 10,000 individuals.
“We know that lower urinary tract symptoms are very common in aging men and women;” however, older adults often underreport symptoms and avoid seeking treatment, Belinda Williams, MD, of the University of Alabama, Birmingham, said in a presentation at the annual meeting of the American Geriatrics Society.
“Evidence also shows us that the incidence of lower urinary tract symptoms (LUTS) is higher in patients with dementia,” she said. However, the association between cognitive impairment and LUTS has not been well studied, she said.
To address this knowledge gap, Dr. Williams and colleagues reviewed data from older adults with and without LUTS who were enrolled in the REasons for Geographic and Racial Differences in Stroke (REGARDS) study, a cohort study including 30,239 Black or White adults aged 45 years and older who completed telephone or in-home assessments in 2003-2007 and in 2013-2017.
The study population included 6062 women and 4438 men who responded to questionnaires about LUTS and completed several cognitive tests via telephone in 2019-2010. The tests evaluated verbal fluency, executive function, and memory, and included the Six-Item Screener, Animal Naming, Letter F naming, and word list learning; lower scores indicated poorer cognitive performance.
Participants who met the criteria for LUTS were categorized as having mild, moderate, or severe symptoms.
The researchers controlled for age, race, education, income, and urban/rural setting in a multivariate analysis. The mean ages of the women and men were 69 years and 63 years, respectively; 41% and 32% were Black, 59% and 68% were White.
Overall, 70% of women and 62% of men reported LUTS; 6.2% and 8.2%, respectively, met criteria for cognitive impairment. The association between cognitive impairment and LUTS was statistically significant for all specific tests (P < .01), but not for the global cognitive domain tests.
Black men were more likely to report LUTS than White men, but LUTS reports were similar between Black and White women.
Moderate LUTS was the most common degree of severity for men and women (54% and 64%, respectively).
The most common symptom overall was pre-toilet leakage (urge urinary incontinence), reported by 94% of women and 91% of men. The next most common symptoms for men and women were nocturia and urgency.
“We found that, across the board, in all the cognitive tests, LUTS were associated with lower cognitive test scores,” Dr. Williams said in her presentation. Little differences were seen on the Six-Item Screener, she noted, but when they further analyzed the data using scores lower than 4 to indicate cognitive impairment, they found significant association with LUTS, she said.
The results showing that the presence of LUTS was consistently associated with lower cognitive test scores of verbal fluency, executive function, and memory, are applicable in clinical practice, Dr. Williams said in her presentation.
“Recognizing the subtle changes in cognition among older adults with LUTS may impact treatment decisions,” she said. “For example, we can encourage and advise our patients to be physically and cognitively active and to avoid anticholinergic medications.”
Next steps for research include analyzing longitudinal changes in cognition among participants with and without LUTS, said Dr. Williams.
During a question-and-answer session, Dr. Williams agreed with a comment that incorporating cognitive screening strategies in to LUTS clinical pathways might be helpful, such as conducting a baseline Montreal Cognitive Assessment Test (MoCA) in patients with LUTS. “Periodic repeat MoCAs thereafter can help assess decline in cognition,” she said.
The study was supported by the National Institutes of Neurological Disorders and Stroke and the National Institute on Aging. The researchers had no financial conflicts to disclose.
Lower urinary tract symptoms were significantly associated with lower scores on measures of cognitive impairment in older adults, based on data from approximately 10,000 individuals.
“We know that lower urinary tract symptoms are very common in aging men and women;” however, older adults often underreport symptoms and avoid seeking treatment, Belinda Williams, MD, of the University of Alabama, Birmingham, said in a presentation at the annual meeting of the American Geriatrics Society.
“Evidence also shows us that the incidence of lower urinary tract symptoms (LUTS) is higher in patients with dementia,” she said. However, the association between cognitive impairment and LUTS has not been well studied, she said.
To address this knowledge gap, Dr. Williams and colleagues reviewed data from older adults with and without LUTS who were enrolled in the REasons for Geographic and Racial Differences in Stroke (REGARDS) study, a cohort study including 30,239 Black or White adults aged 45 years and older who completed telephone or in-home assessments in 2003-2007 and in 2013-2017.
The study population included 6062 women and 4438 men who responded to questionnaires about LUTS and completed several cognitive tests via telephone in 2019-2010. The tests evaluated verbal fluency, executive function, and memory, and included the Six-Item Screener, Animal Naming, Letter F naming, and word list learning; lower scores indicated poorer cognitive performance.
Participants who met the criteria for LUTS were categorized as having mild, moderate, or severe symptoms.
The researchers controlled for age, race, education, income, and urban/rural setting in a multivariate analysis. The mean ages of the women and men were 69 years and 63 years, respectively; 41% and 32% were Black, 59% and 68% were White.
Overall, 70% of women and 62% of men reported LUTS; 6.2% and 8.2%, respectively, met criteria for cognitive impairment. The association between cognitive impairment and LUTS was statistically significant for all specific tests (P < .01), but not for the global cognitive domain tests.
Black men were more likely to report LUTS than White men, but LUTS reports were similar between Black and White women.
Moderate LUTS was the most common degree of severity for men and women (54% and 64%, respectively).
The most common symptom overall was pre-toilet leakage (urge urinary incontinence), reported by 94% of women and 91% of men. The next most common symptoms for men and women were nocturia and urgency.
“We found that, across the board, in all the cognitive tests, LUTS were associated with lower cognitive test scores,” Dr. Williams said in her presentation. Little differences were seen on the Six-Item Screener, she noted, but when they further analyzed the data using scores lower than 4 to indicate cognitive impairment, they found significant association with LUTS, she said.
The results showing that the presence of LUTS was consistently associated with lower cognitive test scores of verbal fluency, executive function, and memory, are applicable in clinical practice, Dr. Williams said in her presentation.
“Recognizing the subtle changes in cognition among older adults with LUTS may impact treatment decisions,” she said. “For example, we can encourage and advise our patients to be physically and cognitively active and to avoid anticholinergic medications.”
Next steps for research include analyzing longitudinal changes in cognition among participants with and without LUTS, said Dr. Williams.
During a question-and-answer session, Dr. Williams agreed with a comment that incorporating cognitive screening strategies in to LUTS clinical pathways might be helpful, such as conducting a baseline Montreal Cognitive Assessment Test (MoCA) in patients with LUTS. “Periodic repeat MoCAs thereafter can help assess decline in cognition,” she said.
The study was supported by the National Institutes of Neurological Disorders and Stroke and the National Institute on Aging. The researchers had no financial conflicts to disclose.
Lower urinary tract symptoms were significantly associated with lower scores on measures of cognitive impairment in older adults, based on data from approximately 10,000 individuals.
“We know that lower urinary tract symptoms are very common in aging men and women;” however, older adults often underreport symptoms and avoid seeking treatment, Belinda Williams, MD, of the University of Alabama, Birmingham, said in a presentation at the annual meeting of the American Geriatrics Society.
“Evidence also shows us that the incidence of lower urinary tract symptoms (LUTS) is higher in patients with dementia,” she said. However, the association between cognitive impairment and LUTS has not been well studied, she said.
To address this knowledge gap, Dr. Williams and colleagues reviewed data from older adults with and without LUTS who were enrolled in the REasons for Geographic and Racial Differences in Stroke (REGARDS) study, a cohort study including 30,239 Black or White adults aged 45 years and older who completed telephone or in-home assessments in 2003-2007 and in 2013-2017.
The study population included 6062 women and 4438 men who responded to questionnaires about LUTS and completed several cognitive tests via telephone in 2019-2010. The tests evaluated verbal fluency, executive function, and memory, and included the Six-Item Screener, Animal Naming, Letter F naming, and word list learning; lower scores indicated poorer cognitive performance.
Participants who met the criteria for LUTS were categorized as having mild, moderate, or severe symptoms.
The researchers controlled for age, race, education, income, and urban/rural setting in a multivariate analysis. The mean ages of the women and men were 69 years and 63 years, respectively; 41% and 32% were Black, 59% and 68% were White.
Overall, 70% of women and 62% of men reported LUTS; 6.2% and 8.2%, respectively, met criteria for cognitive impairment. The association between cognitive impairment and LUTS was statistically significant for all specific tests (P < .01), but not for the global cognitive domain tests.
Black men were more likely to report LUTS than White men, but LUTS reports were similar between Black and White women.
Moderate LUTS was the most common degree of severity for men and women (54% and 64%, respectively).
The most common symptom overall was pre-toilet leakage (urge urinary incontinence), reported by 94% of women and 91% of men. The next most common symptoms for men and women were nocturia and urgency.
“We found that, across the board, in all the cognitive tests, LUTS were associated with lower cognitive test scores,” Dr. Williams said in her presentation. Little differences were seen on the Six-Item Screener, she noted, but when they further analyzed the data using scores lower than 4 to indicate cognitive impairment, they found significant association with LUTS, she said.
The results showing that the presence of LUTS was consistently associated with lower cognitive test scores of verbal fluency, executive function, and memory, are applicable in clinical practice, Dr. Williams said in her presentation.
“Recognizing the subtle changes in cognition among older adults with LUTS may impact treatment decisions,” she said. “For example, we can encourage and advise our patients to be physically and cognitively active and to avoid anticholinergic medications.”
Next steps for research include analyzing longitudinal changes in cognition among participants with and without LUTS, said Dr. Williams.
During a question-and-answer session, Dr. Williams agreed with a comment that incorporating cognitive screening strategies in to LUTS clinical pathways might be helpful, such as conducting a baseline Montreal Cognitive Assessment Test (MoCA) in patients with LUTS. “Periodic repeat MoCAs thereafter can help assess decline in cognition,” she said.
The study was supported by the National Institutes of Neurological Disorders and Stroke and the National Institute on Aging. The researchers had no financial conflicts to disclose.
FROM AGS 2024
Lower Protein Intake In Midlife May Increase Mortality Risk
Lower intake of dietary protein in midlife was a significant independent predictor of all-cause mortality in later life, based on data from a cohort study of more than 8000 men.
The Recommended Dietary Allowance of dietary protein intake is 0.8 g/kg body weight, but previous studies of the effect of dietary protein on all-cause mortality have yielded inconsistent results, Pedro Joaquin Ayau Aguilar, MD, of the University of Hawaii, Honolulu, said in a presentation at the annual meeting of the American Geriatrics Society.
To better examine these effects, Dr. Aguilar and colleagues reviewed data from 7486 participants in the Kuakini Honolulu Heart Program (HHP), a prospective cohort study of Japanese-American men in Hawaii.
Participants underwent a baseline exam in 1965-1968 at ages 45-68 years and were followed for mortality until December 31, 2022. The researchers created quintiles of dietary protein/kg categorized as plant or animal source, trained dietitians worked with participants to complete a 24-hour diet recall, and the primary outcome was all-cause mortality.
Overall, the mean protein intake in the study population was 1.5 g/kg body weight; the mean animal protein and plant protein intakes were 1.1 g/kg and 0.4 g/kg, respectively.
In an age-adjusted analysis, mortality rates per 1,000 person-years were significantly higher with lower total protein intake, with rates of 39.7 per 1,000 person-years and 36.8 per 1,000 person-years in the first and fifth quintiles, respectively (P < .0001).
Data Show Consistency Across Protein Types
Trends were similar for animal protein and plant protein intake, with mortality rates of 39.6 and 36.5 per 1000 person-years for the first and fifth quintiles, respectively.
“All of these categories had a significant trend, with the lowest quintile showing the highest mortality rate,” Dr. Aguilar said in his presentation.
The study was limited by several factors including the homogeneous population of Japanese men, and the inability to make conclusions about cause and effect, Dr. Aguilar said. However, the results were strengthened by the large cohort, long follow-up, and complete mortality surveillance, he added.
As for the study’s clinical implications, “I believe it adds to the body of evidence on how nutrition impacts health and [the data] can help us better advise our patients on their macronutrient intake to better optimize their health,” Dr. Aguilar said in a question-and-answer session following the presentation.
Looking ahead, “More research is needed to more accurately define which type of protein and in which amounts are optimal for health,” as well as how other macronutrients in different stages of life affect health span and life span, he said.
Although a minimum Recommended Daily Allowance of dietary protein is 0.8 g/kg body weight, the relationship between dietary protein intake and all-cause mortality remains unclear, said Shelly Gray, PharmD, professor of pharmacy at the University of Washington School of Pharmacy, said in an interview.
Dr. Gray, who served as a moderator for the session in which the study was presented, agreed that more research is needed before clinical implications can be discussed.
The study was supported by the Department of Geriatric Medicine, John A. Burns School of Medicine, University of Hawaii; Kuakini Medical Center, Honolulu, Hawaii; and the National Institutes of Health. The researchers had no financial conflicts to disclose. Dr. Gray had no financial conflicts to disclose.
Lower intake of dietary protein in midlife was a significant independent predictor of all-cause mortality in later life, based on data from a cohort study of more than 8000 men.
The Recommended Dietary Allowance of dietary protein intake is 0.8 g/kg body weight, but previous studies of the effect of dietary protein on all-cause mortality have yielded inconsistent results, Pedro Joaquin Ayau Aguilar, MD, of the University of Hawaii, Honolulu, said in a presentation at the annual meeting of the American Geriatrics Society.
To better examine these effects, Dr. Aguilar and colleagues reviewed data from 7486 participants in the Kuakini Honolulu Heart Program (HHP), a prospective cohort study of Japanese-American men in Hawaii.
Participants underwent a baseline exam in 1965-1968 at ages 45-68 years and were followed for mortality until December 31, 2022. The researchers created quintiles of dietary protein/kg categorized as plant or animal source, trained dietitians worked with participants to complete a 24-hour diet recall, and the primary outcome was all-cause mortality.
Overall, the mean protein intake in the study population was 1.5 g/kg body weight; the mean animal protein and plant protein intakes were 1.1 g/kg and 0.4 g/kg, respectively.
In an age-adjusted analysis, mortality rates per 1,000 person-years were significantly higher with lower total protein intake, with rates of 39.7 per 1,000 person-years and 36.8 per 1,000 person-years in the first and fifth quintiles, respectively (P < .0001).
Data Show Consistency Across Protein Types
Trends were similar for animal protein and plant protein intake, with mortality rates of 39.6 and 36.5 per 1000 person-years for the first and fifth quintiles, respectively.
“All of these categories had a significant trend, with the lowest quintile showing the highest mortality rate,” Dr. Aguilar said in his presentation.
The study was limited by several factors including the homogeneous population of Japanese men, and the inability to make conclusions about cause and effect, Dr. Aguilar said. However, the results were strengthened by the large cohort, long follow-up, and complete mortality surveillance, he added.
As for the study’s clinical implications, “I believe it adds to the body of evidence on how nutrition impacts health and [the data] can help us better advise our patients on their macronutrient intake to better optimize their health,” Dr. Aguilar said in a question-and-answer session following the presentation.
Looking ahead, “More research is needed to more accurately define which type of protein and in which amounts are optimal for health,” as well as how other macronutrients in different stages of life affect health span and life span, he said.
Although a minimum Recommended Daily Allowance of dietary protein is 0.8 g/kg body weight, the relationship between dietary protein intake and all-cause mortality remains unclear, said Shelly Gray, PharmD, professor of pharmacy at the University of Washington School of Pharmacy, said in an interview.
Dr. Gray, who served as a moderator for the session in which the study was presented, agreed that more research is needed before clinical implications can be discussed.
The study was supported by the Department of Geriatric Medicine, John A. Burns School of Medicine, University of Hawaii; Kuakini Medical Center, Honolulu, Hawaii; and the National Institutes of Health. The researchers had no financial conflicts to disclose. Dr. Gray had no financial conflicts to disclose.
Lower intake of dietary protein in midlife was a significant independent predictor of all-cause mortality in later life, based on data from a cohort study of more than 8000 men.
The Recommended Dietary Allowance of dietary protein intake is 0.8 g/kg body weight, but previous studies of the effect of dietary protein on all-cause mortality have yielded inconsistent results, Pedro Joaquin Ayau Aguilar, MD, of the University of Hawaii, Honolulu, said in a presentation at the annual meeting of the American Geriatrics Society.
To better examine these effects, Dr. Aguilar and colleagues reviewed data from 7486 participants in the Kuakini Honolulu Heart Program (HHP), a prospective cohort study of Japanese-American men in Hawaii.
Participants underwent a baseline exam in 1965-1968 at ages 45-68 years and were followed for mortality until December 31, 2022. The researchers created quintiles of dietary protein/kg categorized as plant or animal source, trained dietitians worked with participants to complete a 24-hour diet recall, and the primary outcome was all-cause mortality.
Overall, the mean protein intake in the study population was 1.5 g/kg body weight; the mean animal protein and plant protein intakes were 1.1 g/kg and 0.4 g/kg, respectively.
In an age-adjusted analysis, mortality rates per 1,000 person-years were significantly higher with lower total protein intake, with rates of 39.7 per 1,000 person-years and 36.8 per 1,000 person-years in the first and fifth quintiles, respectively (P < .0001).
Data Show Consistency Across Protein Types
Trends were similar for animal protein and plant protein intake, with mortality rates of 39.6 and 36.5 per 1000 person-years for the first and fifth quintiles, respectively.
“All of these categories had a significant trend, with the lowest quintile showing the highest mortality rate,” Dr. Aguilar said in his presentation.
The study was limited by several factors including the homogeneous population of Japanese men, and the inability to make conclusions about cause and effect, Dr. Aguilar said. However, the results were strengthened by the large cohort, long follow-up, and complete mortality surveillance, he added.
As for the study’s clinical implications, “I believe it adds to the body of evidence on how nutrition impacts health and [the data] can help us better advise our patients on their macronutrient intake to better optimize their health,” Dr. Aguilar said in a question-and-answer session following the presentation.
Looking ahead, “More research is needed to more accurately define which type of protein and in which amounts are optimal for health,” as well as how other macronutrients in different stages of life affect health span and life span, he said.
Although a minimum Recommended Daily Allowance of dietary protein is 0.8 g/kg body weight, the relationship between dietary protein intake and all-cause mortality remains unclear, said Shelly Gray, PharmD, professor of pharmacy at the University of Washington School of Pharmacy, said in an interview.
Dr. Gray, who served as a moderator for the session in which the study was presented, agreed that more research is needed before clinical implications can be discussed.
The study was supported by the Department of Geriatric Medicine, John A. Burns School of Medicine, University of Hawaii; Kuakini Medical Center, Honolulu, Hawaii; and the National Institutes of Health. The researchers had no financial conflicts to disclose. Dr. Gray had no financial conflicts to disclose.
FROM AGS 2024
Inappropriate Medication Use Persists in Older Adults With Dementia
Medications that could have a negative effect on cognition are often used by older adults with dementia, according to data from approximately 13 million individuals presented at the annual meeting of the American Geriatrics Society.
Classes of medications including anticholinergics, antipsychotics, benzodiazepines, and non-benzodiazepine sedatives (Z drugs) have been identified as potentially inappropriate medications (PIMs) in patients with dementia, according to The American Geriatrics Society Beers Criteria for Potentially Inappropriate Medication Use in Older Adults.
The medications that could worsen dementia or cognition are known as CogPIMs, said presenting author Caroline M. Mak, a doctor of pharmacy candidate at the University at Buffalo School of Pharmacy and Pharmaceutical Sciences, New York.
Previous research has characterized the prevalence of use of CogPIMs, but data connecting use of CogPIMs and healthcare use are lacking, Ms. Mak said.
Ms. Mak and colleagues conducted a cross-sectional analysis of data from 2011 to 2015 from the Medical Expenditure Panel Survey (MEPS), a national survey with data on medication and healthcare use. The researchers included approximately 13 million survey respondents older than 65 years with dementia.
Exposure to CogPIMs was defined as filling a prescription for one or more of the CogPIMs during the study period. Population estimates of the prevalence of use of the CogPIMs were created using survey-weighted procedures, and prevalence trends were assessed using the Cochran-Armitage test.
Overall, the prevalence was 15.9%, 11.5%, 7.5%, and 3.8% for use of benzodiazepines, anticholinergics, antipsychotics, and Z drugs, respectively, during the study period.
Of these, benzodiazepines showed a significant trend with an increase in prevalence from 8.9% in 2011 to 16.4% in 2015 (P = .02).
The odds of hospitalization were more than twice as likely in individuals who reported using Z drugs (odds ratio, 2.57; P = .02) based on logistic regression. In addition, exposure to antipsychotics was significantly associated with an increased rate of hospitalization based on a binomial model for incidence rate ratio (IRR, 1.51; P = .02).
The findings were limited by several factors including the cross-sectional design, reliance on self-reports, and the lack of more recent data.
However, the results show that CogPIMs are often used by older adults with dementia, and antipsychotics and Z drugs could be targets for interventions to prevent harm from medication interactions and side effects, the researchers concluded.
Findings Highlight Need for Drug Awareness
The current study is important because of the expansion in the aging population and an increase in the number of patients with dementia, Ms. Mak said in an interview. “In both our older population and dementia patients, there are certain medication considerations that we need to take into account, and certain drugs that should be avoided if possible,” she said. Clinicians have been trying to use the Beers criteria to reduce potential medication harm, she noted. “One group of investigators (Hilmer et al.), has proposed a narrower focus on anticholinergic and sedative/hypnotic medication in the Drug Burden Index (DBI); the CogPIMs are a subset of both approaches (Beers and DBI) and represent a collection of medications that pose potential risks to our patients,” said Ms. Mak.
Continued reassessment is needed on appropriateness of anticholinergics, Z drugs, benzodiazepines, and antipsychotics in older patients with dementia, she added.
“Even though the only group to have a significant increase in prevalence [of use] was the benzodiazepine group, we didn’t see a decrease in any of the other groups,” said Ms. Mak. The current research provides a benchmark for CogPIMs use that can be monitored in the future for increases or, ideally, decreases, she said.
Part of a Bigger Picture
The current study is part of the work of Team Alice, a national deprescribing group affiliated with the University at Buffalo that was inspired by the tragic death of Alice Brennan, triggered by preventable medication harm, Ms. Mak said in an interview. “Team Alice consists of an array of academic, primary care, health plan, and regional health information partners that have designed patient-driven interventions to reduce medication harm, especially within primary care settings,” she said. “Their mission is to save people like Alice by pursuing multiple strategies to deprescribe unsafe medication, reduce harm, and foster successful aging. By characterizing the use of CogPIMs, we can design better intervention strategies,” she said.
Although Ms. Mak was not surprised by the emergence of benzodiazepines as the most commonly used drug groups, she was surprised by the increase during the study period.
“Unfortunately, our dataset was not rich enough to include reasons for this increase,” she said. In practice, “I have seen patients getting short-term, as needed, prescriptions for a benzodiazepine to address the anxiety and/or insomnia after the loss of a loved one; this may account for a small proportion of benzodiazepine use that appears to be inappropriate because of a lack of associated appropriate diagnosis,” she noted.
Also, the findings of increased hospitalization associated with Z drugs raises concerns, Ms. Mak said. Although the findings are consistent with other research, they illustrate the need for further investigation to identify strategies to prevent this harm, she said. “Not finding associations with hospitalization related to benzodiazepine or anticholinergics was a mild surprise,” Ms. Mak said in an interview. “However, while we know that these drugs can have a negative effect on older people, the effects may not have been severe enough to result in hospitalizations,” she said.
Looking ahead, Ms. Mak said she would like to see the study rerun with a more current data set, especially with regard to benzodiazepines and antipsychotics.
Seek Strategies to Reduce Medication Use
The current study was notable for its community-based population and attention to hospitalizations, Shelly Gray, PharmD, a professor of pharmacy at the University of Washington School of Pharmacy, said in an interview.
“Most studies examining potentially inappropriate medications that may impair cognition have been conducted in nursing homes, while this study focuses on community dwelling older adults where most people with dementia live,” said Dr. Gray, who served as a moderator for the session in which the study was presented.
In addition, “A unique aspect of this study was to examine how these medications are related to hospitalizations,” she said.
Given recent efforts to reduce use of potentially inappropriate medications in people with dementia, the increase in prevalence of use over the study period was surprising, especially for benzodiazepines, said Dr. Gray.
In clinical practice, “health care providers should continue to look for opportunities to deprescribe medications that may worsen cognition in people with dementia,” she said. However, more research is needed to examine trends in the years beyond 2015 for a more contemporary picture of medication use in this population, she noted.
The study received no outside funding. The researchers and Dr. Gray had no financial conflicts to disclose.
Medications that could have a negative effect on cognition are often used by older adults with dementia, according to data from approximately 13 million individuals presented at the annual meeting of the American Geriatrics Society.
Classes of medications including anticholinergics, antipsychotics, benzodiazepines, and non-benzodiazepine sedatives (Z drugs) have been identified as potentially inappropriate medications (PIMs) in patients with dementia, according to The American Geriatrics Society Beers Criteria for Potentially Inappropriate Medication Use in Older Adults.
The medications that could worsen dementia or cognition are known as CogPIMs, said presenting author Caroline M. Mak, a doctor of pharmacy candidate at the University at Buffalo School of Pharmacy and Pharmaceutical Sciences, New York.
Previous research has characterized the prevalence of use of CogPIMs, but data connecting use of CogPIMs and healthcare use are lacking, Ms. Mak said.
Ms. Mak and colleagues conducted a cross-sectional analysis of data from 2011 to 2015 from the Medical Expenditure Panel Survey (MEPS), a national survey with data on medication and healthcare use. The researchers included approximately 13 million survey respondents older than 65 years with dementia.
Exposure to CogPIMs was defined as filling a prescription for one or more of the CogPIMs during the study period. Population estimates of the prevalence of use of the CogPIMs were created using survey-weighted procedures, and prevalence trends were assessed using the Cochran-Armitage test.
Overall, the prevalence was 15.9%, 11.5%, 7.5%, and 3.8% for use of benzodiazepines, anticholinergics, antipsychotics, and Z drugs, respectively, during the study period.
Of these, benzodiazepines showed a significant trend with an increase in prevalence from 8.9% in 2011 to 16.4% in 2015 (P = .02).
The odds of hospitalization were more than twice as likely in individuals who reported using Z drugs (odds ratio, 2.57; P = .02) based on logistic regression. In addition, exposure to antipsychotics was significantly associated with an increased rate of hospitalization based on a binomial model for incidence rate ratio (IRR, 1.51; P = .02).
The findings were limited by several factors including the cross-sectional design, reliance on self-reports, and the lack of more recent data.
However, the results show that CogPIMs are often used by older adults with dementia, and antipsychotics and Z drugs could be targets for interventions to prevent harm from medication interactions and side effects, the researchers concluded.
Findings Highlight Need for Drug Awareness
The current study is important because of the expansion in the aging population and an increase in the number of patients with dementia, Ms. Mak said in an interview. “In both our older population and dementia patients, there are certain medication considerations that we need to take into account, and certain drugs that should be avoided if possible,” she said. Clinicians have been trying to use the Beers criteria to reduce potential medication harm, she noted. “One group of investigators (Hilmer et al.), has proposed a narrower focus on anticholinergic and sedative/hypnotic medication in the Drug Burden Index (DBI); the CogPIMs are a subset of both approaches (Beers and DBI) and represent a collection of medications that pose potential risks to our patients,” said Ms. Mak.
Continued reassessment is needed on appropriateness of anticholinergics, Z drugs, benzodiazepines, and antipsychotics in older patients with dementia, she added.
“Even though the only group to have a significant increase in prevalence [of use] was the benzodiazepine group, we didn’t see a decrease in any of the other groups,” said Ms. Mak. The current research provides a benchmark for CogPIMs use that can be monitored in the future for increases or, ideally, decreases, she said.
Part of a Bigger Picture
The current study is part of the work of Team Alice, a national deprescribing group affiliated with the University at Buffalo that was inspired by the tragic death of Alice Brennan, triggered by preventable medication harm, Ms. Mak said in an interview. “Team Alice consists of an array of academic, primary care, health plan, and regional health information partners that have designed patient-driven interventions to reduce medication harm, especially within primary care settings,” she said. “Their mission is to save people like Alice by pursuing multiple strategies to deprescribe unsafe medication, reduce harm, and foster successful aging. By characterizing the use of CogPIMs, we can design better intervention strategies,” she said.
Although Ms. Mak was not surprised by the emergence of benzodiazepines as the most commonly used drug groups, she was surprised by the increase during the study period.
“Unfortunately, our dataset was not rich enough to include reasons for this increase,” she said. In practice, “I have seen patients getting short-term, as needed, prescriptions for a benzodiazepine to address the anxiety and/or insomnia after the loss of a loved one; this may account for a small proportion of benzodiazepine use that appears to be inappropriate because of a lack of associated appropriate diagnosis,” she noted.
Also, the findings of increased hospitalization associated with Z drugs raises concerns, Ms. Mak said. Although the findings are consistent with other research, they illustrate the need for further investigation to identify strategies to prevent this harm, she said. “Not finding associations with hospitalization related to benzodiazepine or anticholinergics was a mild surprise,” Ms. Mak said in an interview. “However, while we know that these drugs can have a negative effect on older people, the effects may not have been severe enough to result in hospitalizations,” she said.
Looking ahead, Ms. Mak said she would like to see the study rerun with a more current data set, especially with regard to benzodiazepines and antipsychotics.
Seek Strategies to Reduce Medication Use
The current study was notable for its community-based population and attention to hospitalizations, Shelly Gray, PharmD, a professor of pharmacy at the University of Washington School of Pharmacy, said in an interview.
“Most studies examining potentially inappropriate medications that may impair cognition have been conducted in nursing homes, while this study focuses on community dwelling older adults where most people with dementia live,” said Dr. Gray, who served as a moderator for the session in which the study was presented.
In addition, “A unique aspect of this study was to examine how these medications are related to hospitalizations,” she said.
Given recent efforts to reduce use of potentially inappropriate medications in people with dementia, the increase in prevalence of use over the study period was surprising, especially for benzodiazepines, said Dr. Gray.
In clinical practice, “health care providers should continue to look for opportunities to deprescribe medications that may worsen cognition in people with dementia,” she said. However, more research is needed to examine trends in the years beyond 2015 for a more contemporary picture of medication use in this population, she noted.
The study received no outside funding. The researchers and Dr. Gray had no financial conflicts to disclose.
Medications that could have a negative effect on cognition are often used by older adults with dementia, according to data from approximately 13 million individuals presented at the annual meeting of the American Geriatrics Society.
Classes of medications including anticholinergics, antipsychotics, benzodiazepines, and non-benzodiazepine sedatives (Z drugs) have been identified as potentially inappropriate medications (PIMs) in patients with dementia, according to The American Geriatrics Society Beers Criteria for Potentially Inappropriate Medication Use in Older Adults.
The medications that could worsen dementia or cognition are known as CogPIMs, said presenting author Caroline M. Mak, a doctor of pharmacy candidate at the University at Buffalo School of Pharmacy and Pharmaceutical Sciences, New York.
Previous research has characterized the prevalence of use of CogPIMs, but data connecting use of CogPIMs and healthcare use are lacking, Ms. Mak said.
Ms. Mak and colleagues conducted a cross-sectional analysis of data from 2011 to 2015 from the Medical Expenditure Panel Survey (MEPS), a national survey with data on medication and healthcare use. The researchers included approximately 13 million survey respondents older than 65 years with dementia.
Exposure to CogPIMs was defined as filling a prescription for one or more of the CogPIMs during the study period. Population estimates of the prevalence of use of the CogPIMs were created using survey-weighted procedures, and prevalence trends were assessed using the Cochran-Armitage test.
Overall, the prevalence was 15.9%, 11.5%, 7.5%, and 3.8% for use of benzodiazepines, anticholinergics, antipsychotics, and Z drugs, respectively, during the study period.
Of these, benzodiazepines showed a significant trend with an increase in prevalence from 8.9% in 2011 to 16.4% in 2015 (P = .02).
The odds of hospitalization were more than twice as likely in individuals who reported using Z drugs (odds ratio, 2.57; P = .02) based on logistic regression. In addition, exposure to antipsychotics was significantly associated with an increased rate of hospitalization based on a binomial model for incidence rate ratio (IRR, 1.51; P = .02).
The findings were limited by several factors including the cross-sectional design, reliance on self-reports, and the lack of more recent data.
However, the results show that CogPIMs are often used by older adults with dementia, and antipsychotics and Z drugs could be targets for interventions to prevent harm from medication interactions and side effects, the researchers concluded.
Findings Highlight Need for Drug Awareness
The current study is important because of the expansion in the aging population and an increase in the number of patients with dementia, Ms. Mak said in an interview. “In both our older population and dementia patients, there are certain medication considerations that we need to take into account, and certain drugs that should be avoided if possible,” she said. Clinicians have been trying to use the Beers criteria to reduce potential medication harm, she noted. “One group of investigators (Hilmer et al.), has proposed a narrower focus on anticholinergic and sedative/hypnotic medication in the Drug Burden Index (DBI); the CogPIMs are a subset of both approaches (Beers and DBI) and represent a collection of medications that pose potential risks to our patients,” said Ms. Mak.
Continued reassessment is needed on appropriateness of anticholinergics, Z drugs, benzodiazepines, and antipsychotics in older patients with dementia, she added.
“Even though the only group to have a significant increase in prevalence [of use] was the benzodiazepine group, we didn’t see a decrease in any of the other groups,” said Ms. Mak. The current research provides a benchmark for CogPIMs use that can be monitored in the future for increases or, ideally, decreases, she said.
Part of a Bigger Picture
The current study is part of the work of Team Alice, a national deprescribing group affiliated with the University at Buffalo that was inspired by the tragic death of Alice Brennan, triggered by preventable medication harm, Ms. Mak said in an interview. “Team Alice consists of an array of academic, primary care, health plan, and regional health information partners that have designed patient-driven interventions to reduce medication harm, especially within primary care settings,” she said. “Their mission is to save people like Alice by pursuing multiple strategies to deprescribe unsafe medication, reduce harm, and foster successful aging. By characterizing the use of CogPIMs, we can design better intervention strategies,” she said.
Although Ms. Mak was not surprised by the emergence of benzodiazepines as the most commonly used drug groups, she was surprised by the increase during the study period.
“Unfortunately, our dataset was not rich enough to include reasons for this increase,” she said. In practice, “I have seen patients getting short-term, as needed, prescriptions for a benzodiazepine to address the anxiety and/or insomnia after the loss of a loved one; this may account for a small proportion of benzodiazepine use that appears to be inappropriate because of a lack of associated appropriate diagnosis,” she noted.
Also, the findings of increased hospitalization associated with Z drugs raises concerns, Ms. Mak said. Although the findings are consistent with other research, they illustrate the need for further investigation to identify strategies to prevent this harm, she said. “Not finding associations with hospitalization related to benzodiazepine or anticholinergics was a mild surprise,” Ms. Mak said in an interview. “However, while we know that these drugs can have a negative effect on older people, the effects may not have been severe enough to result in hospitalizations,” she said.
Looking ahead, Ms. Mak said she would like to see the study rerun with a more current data set, especially with regard to benzodiazepines and antipsychotics.
Seek Strategies to Reduce Medication Use
The current study was notable for its community-based population and attention to hospitalizations, Shelly Gray, PharmD, a professor of pharmacy at the University of Washington School of Pharmacy, said in an interview.
“Most studies examining potentially inappropriate medications that may impair cognition have been conducted in nursing homes, while this study focuses on community dwelling older adults where most people with dementia live,” said Dr. Gray, who served as a moderator for the session in which the study was presented.
In addition, “A unique aspect of this study was to examine how these medications are related to hospitalizations,” she said.
Given recent efforts to reduce use of potentially inappropriate medications in people with dementia, the increase in prevalence of use over the study period was surprising, especially for benzodiazepines, said Dr. Gray.
In clinical practice, “health care providers should continue to look for opportunities to deprescribe medications that may worsen cognition in people with dementia,” she said. However, more research is needed to examine trends in the years beyond 2015 for a more contemporary picture of medication use in this population, she noted.
The study received no outside funding. The researchers and Dr. Gray had no financial conflicts to disclose.
FROM AGS 2024