A Benefit–Risk Assessment of the Use of Proton Pump Inhibitors in the Elderly

Abstract

Proton pump inhibitors (PPIs) are among the most commonly used drugs worldwide, and their intake increases with age. Despite a relatively safe profile, a range of studies have reported associations between use of PPIs and various adverse events. The most important adverse events, such as pneumonia, bone fractures, bacterial enteric infections, and diminished vitamin absorption are critically discussed in this review in view of the body of evidence, including underlying biological mechanisms, evidence of causality, and consistency. Most of the reported risks are relatively small and sometimes based on inconsistent evidence. For an individual patient, and particularly the elderly, it is relevant to question the indication of use and balance the benefit and potential harm of PPI therapy. This approach can minimize morbidity and reduce healthcare costs. In this review, the use and safety of PPIs among the elderly is described.

PRO‐OSTEO Extend I study (improving osteoporosis management in the acute and rehabilitation settings): multicentre audit

“…There was also limited or no medication risk factor assessment during hospitalisation or mention of this in the discharge letters for primary care doctors to review, despite the well-known association of osteoporosis with the use of benzodiazepines, antidepressants, PPIs and alcohol. [18][19][20][21] The lack of appropriate communication is likely to be due to the poor recognition of osteoporosis as the underlying cause for such fractures, and this finding is consistent with that of other primary care research. 3,9,22 Given the low level of appropriate osteoporosis management in tertiary and primary care, and the high rate of mortality associated with this issue, 23,24 there appears to be an urgent need to implement a fracture liaison service, but the likelihood of this appears low in the current fiscal environment.…”

“…Discharge summaries rarely identified the fracture as being an osteoporotic or a minimal‐trauma fracture, despite identification of osteopaenia on bone scans and the minimal‐trauma descriptions of fractures in the ambulance and emergency department medical notes. There was also limited or no medication risk factor assessment during hospitalisation or mention of this in the discharge letters for primary care doctors to review, despite the well‐known association of osteoporosis with the use of benzodiazepines, antidepressants, PPIs and alcohol . The lack of appropriate communication is likely to be due to the poor recognition of osteoporosis as the underlying cause for such fractures, and this finding is consistent with that of other primary care research .…”

Medications That Older Adults in Hospice Care in the United States Take, 2007

“…Although antacids and proton pump inhibitors may help relieve dyspepsia, they can increase the risk of pneumonia in elderly adults, particularly when treatment is first initiated; contribute to electrolyte disturbances; and interfere with the absorption of other pharmacological therapies. [17][18][19][20][21][22] A recent randomized controlled trial demonstrating that cessation of statin therapy in individuals at the end of life with stable vascular disease did not alter quality of life and possibly prolonged survival highlighted the clinical relevance of preventative therapies in end-of-life care. 9 How the cessation of these other commonly used therapies affects quality of life and life expectancy remains an area of inquiry.…”

“…Subject characteristics included sex, age at death (65-74, 75-84, ≥85), race (white, other), number of days in hospice care (≤7, ≥8), and location at death (private residence; nursing home or skilled nursing facility; hospital, inpatient hospice facility, residential care facility, or other place). The number of comorbidities (0-3, ≥4) and of medications (0-5, 6-10, [11][12][13][14][15][16][17][18][19][20][21][22][23][24][25] were calculated based on the sum of recorded diagnoses and of medications. The counts were categorized based on their frequency distribution.…”

Causes, Consequences and Public Health Implications of Low B-Vitamin Status in Ageing

“…There is evidence to suggest that these medications have been associated with up to 4.5 times higher risk of vitamin B12 deficiency in case control studies [43,44]. Recently in the USA, a large community survey (25,956 cases and 184,199 controls) found that the long term use (>2 years) of H 2 RAs and PPIs was associated with a 25%–65% greater risk of a subsequent diagnosis of vitamin B12 deficiency [45].…”