Catching some zzz’s with Z-drugs? You might want to reconsider

Dr Ilan Matok heads the pharmacoepidemiology research unit in the Hebrew University of Jerusalem’s School of Pharmacy, and directs research evaluating the safety of medication. Their research was recently published in Age and Ageing.

Insomnia is a very common medical complaint, and increases with age. Patients with insomnia often report increased daytime fatigue, confusion, anxiety, and depression. While insomnia can have a significant negative impact on quality of life, a recent study highlights the need for careful consideration in the use of sleeping medication to manage this condition, especially among older adults.

It is widely recognized that the use of traditional “benzodiazepine” type sleeping medication (e.g. nitrazepam), increase the risk of fractures and falls in older adults. However, less is known about the safety of “non-benzodiazepine” sleeping medication, otherwise known as “Z-drugs” (e.g zopiclone). In fact, these drugs have been marketed as safer than benzodiazepine medication, and are often perceived as such by clinicians and patients alike.

September 2017 issue of Age and Ageing journal is out now

The September 2017 issue of Age and Ageing, the journal of the British Geriatrics Society is out now.  A full table of contents is available here, with editorials, research papers, reviews, short reports, case reports book reviews and more.  

Hot topics in this issue include:

The future of Comprehensive Geriatric Assessment

Causes of unsafe primary care

Improving medication adherence after hospital discharge

Oral health in hospitals and care homes

Research methods: how to do a systematic review

The Editor’s View article gives an overview of the issue with a summary of highlights. This article is free to read and can be viewed here.

July 2017 issue of Age and Ageing journal is out now

The July 2017 issue of Age and Ageing, the journal of the British Geriatrics Society is out now.  A full table of contents is available here, with editorials, research papers, reviews, short reports, case reports book reviews and more.

Hot topics in this issue include:

Care home leadership

Physical restraint

Diet and muscle function

Prescribing for frail older
adults

Treatment of overactive
bladder

The Editor’s View article gives an overview of the issue with a summary of highlights. This article is free to read and can be viewed here.

July issue of Age and Ageing journal out now

The July 2016 issue of Age and Ageing, the journal of the British Geriatrics Society is out now.

A full table of contents is available here, with editorials, research papers, reviews, short reports, case reports book reviews and more. Hot topics this issue include:

• Frailty index based on basic laboratory and clinical measures
• Dietary protein and ageing
• Do you want to live to be 100
• Social engagement and cognitive ageing
• Selective serotonin reuptake inhibitors and progression of dementia

The Editor’s View can be read here.

This issue’s free access papers are:

• Sex differences in the risk of receiving potentially inappropriate prescriptions among older adults

• Diagnostic test accuracy of informant-based tools to diagnose dementia in older hospital patients with delirium: a prospective cohort study

• Do you want to live to be 100? Answers from older people

Better medicine reviews in care homes – a no brainer?

Wasim Baqir is a Research & Development Pharmacist at Northumbria Healthcare NHS Foundation Trust.

There are currently 405,000 care home residents in the UK aged over 65 taking an average of seven medicines, with some taking double or treble this amount. Research shows at any one time 70% of them have an error with their medication which can occur during prescribing, dispensing or administration. That’s a lot of errors.

I’m a clinical pharmacist working in Northumbria and although these figures are quite well known, they are still pretty shocking.

Medicines use in care homes is problematic: over-prescribing, lack of structured review and little or no resident involvement in decisions are common themes. Despite the evidence (think CHUMS report) and guidance (think NICE guidelines) medicines use in care homes remains generally poor. That’s why I’m backing a new campaign from the Royal Pharmaceutical Society to improve the situation.

Diabetes care in the very old. Beyond the limits of evidence?

Dr. Shota Hamada is a Visiting Research Fellow in the Department of Primary Care and Public Health Sciences, King’s College London.

Very old people have rarely been included in clinical trials in sufficient numbers and treatment recommendations for them are largely based on professional opinion informed by evidence generated from younger patients. Selecting drug treatment for very old people may be influenced by distinct concerns including co-morbidities, declining physical and cognitive functioning, and perceptions of limited life expectancy, that may be less relevant in younger people.

Our recent research, published in Age and Ageing, investigates changing prescriptions for antidiabetic and cardiovascular medications for very old patients who were newly diagnosed with type 2 diabetes over a 20 year period.

The study included a representative sample of nearly 13,000 patients from primary care in the UK. From 1990 to 2013, use of sulphonylureas declined rapidly from 94% of patients to 29%, while metformin became the mainstay among antidiabetic drugs, increasing from 22% to 86%. Prescribing of antihypertensive (46% to 77%), lipid-lowering (1% to 64%), and antiplatelet drugs (34% to 47%) also increased substantially in this period.

These changes in prescribing seem to be motivated by evidence generated from clinical trials in younger people. From the 1990s onward, the results of several large clinical trials have been available, such as UKPDS, ACCORD and 4S, which promoted implementation of intensive multifactorial interventions for patients with diabetes to reduce mortality, cardiovascular diseases and other complications.

Do these major increases in the intensity of pharmacological management really improve survival or well-being in very old people? We do not have a clear answer to this question. Our present study is surely an initial step to evaluate drug therapy in very old people with diabetes. One of the challenges in making treatment decisions may be so-called “lag time to benefit” or “payoff time”.

For example, initiation or continuation of antidiabetic drugs should be determined carefully given that it requires several years to obtain benefits from antidiabetic drugs. Further research is needed to justify or adjust prescribing practices in terms of both effectiveness and safety outcomes. We should now prepare to develop evidence-informed strategies for diabetes management in very old people.

 

March issue of Age & Ageing journal out now

The March 2015 issue of Age and Ageing, the journal of the British Geriatrics Society is out now.

A full table of contents is available here, with editorials, research papers, reviews, short reports, case reports book reviews and more. Hot topics this issue include:

• New horizons in testosterone
• Preventing delirium
• Admissions for osteoporotic pelvic fractures and predictors of mortality
• Cognitive motor interference

The Editor’s View can be read here.

This issue’s free access papers are:

• The challenges of human population ageing
• STOPP/START criteria for potentially inappropriate prescribing in older people: version 2
• Optimal screening for increased risk for adverse outcomes in hospitalised older adults
• Objectively assessed physical activity and lower limb function and prospective associations with mortality and newly diagnosed disease in UK older adults: an OPAL four-year follow-up study

Inappropriate drug use among older persons: is it time for action?

Andreas Schoenenberger works with the Division of Geriatrics, Department of General Internal Medicine at Bern University Hospital, and with the University of Bern, Switzerland. Here he describes his recent editorial in Age and Ageing journal, written with Andreas Stuck.

Despite recent efforts to improve drug management for older people, we have not yet arrived at an optimal strategy for reducing inappropriate drug use. Drugs are considered inappropriate, if the risk outweighs the potential benefit of the drug. Along with pathophysiological changes during the ageing process, and the increasing number of co-morbidities/-medications, the potential risks of drugs increase with age and adverse drug reactions (ADRs) are encountered more frequently in older persons.

Do pharmacists have a role in reducing emergency admissions?

Alyson Huntley is a Research Fellow at the University of Bristol’s Centre of Academic Primary Care. She has recently published a systematic review of pharmacist-led interventions to reduce unplanned admissions for older people.

The expansion of the pharmacist’s role as a contributor to patient’s health has been championed over the last couple of decades.  In addition to their traditional role, pharmacists contribute to the care of people with long term conditions by carrying out medication reviews, promoting healthy lifestyles, and supporting self-care.

The older people become, the more medications they are likely to be taking (both prescribed drugs and self-medication) leading to an increased risk of adverse reactions, interaction between drugs and poor adherence.

Medicines management of polypharmacy – Making it Safe and Sound

Stephen Jackson is Professor of Clinical Gerontology at King’s Health Partners

This is a recent King’s Fund Report which takes another look at polypharmacy. It is unclear why as there has been a rather better report published by NHS Scotland. One would assume the King’s fund would check who is doing what before commissioning such a report. Interestingly there is no mention of the G (geriatrician) word anywhere in the report although the terms “older care clinician”, “clinicians who specialise in care of older people” and orthogeriatrician do appear. I thought there was insufficient recognition of the fact that multiple pathology and hence polypharmacy is essentially a problem associated with ageing.  The authors rightly differentiate between appropriate polypharmacy and what they call problematic polypharmacy known to many as inappropriate polypharmacy. Polypharmacy merely means “many medicines” as opposed to “too many medicines”.  The report could be criticised for giving the impression that appropriate prescribing is only necessary when polypharmacy is present.