Drug Use among Seniors on Public Drug Programs in Canada, 2012

Hunt, Jordan

doi:10.12927/hcq.2015.24250

Cited by 14 publications

(4 citation statements)

References 19 publications

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“…A physician services databases provided data on clinic visits, emergency department contacts, and hospitalizations in the prior year . The Ontario Drug Benefit Program database provided data on additional cardiovascular medications, neuropsychiatric medications, and miscellaneous medications . The available databases contained no information on smoking status, daily exercise, education level, family history, genetic factors, hearing loss, social isolation, or other factors that can alter dementia risk …”

Section: Methodsmentioning

confidence: 99%

Association Between Statin Use and Risk of Dementia After a Concussion

2019

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oncussions are a common cause of brain injury occurring in more than 1 million Americans each year and disproportionately involving older adults. 1-4 The subacute consequences vary widely and include fatigue, headache, irritability, insomnia, inattention, photophobia, vertigo, and cognitive difficulties. 5-9 Most patients recover from a concussion within weeks, although some can develop lingering mood disorders or chronic neuropsychiatric disorders. 10-14 The extent of complications after a concussion is uncertain, and effective pharmacologic treatments remain elusive. 15-17 Unfortunately, many medical treatments for traumatic brain injury that showed promise in animal models have subsequently failed in human clinical trials. 18-22 Hydroxymethylglutaryl coenzyme A reductase inhibitors (statins) are a class of medications prescribed for the treatment of hyperlipidemia. 23,24 Preclinical data suggest that statin use might mitigate injury-related brain edema, oxidative stress, amyloid protein aggregation, and neuroinflammation. 25-29 The potential neuroprotective benefits from statins have also been speculated and include preserved cerebral blood flow, leading to decreased risks of Alzheimer disease, vascular dementia, and age-related cognitive decline. 30-35 Together, these findings suggest that statin use could contribute to microvascular homeostasis and immune modulation independent of systemic lipid levels. However, statins do not improve cognition for patients already diagnosed as having dementia. 36-38 IMPORTANCE Concussions are an acute injury that may lead to chronic disability, while statin use might improve neurologic recovery. OBJECTIVE To test whether statin use is associated with an increased or decreased risk of subsequent dementia after a concussion.

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Section: Methodsmentioning

confidence: 99%

Association Between Statin Use and Risk of Dementia After a Concussion

2019

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“…PPIs irreversibly inhibit hydrogen-potassium ATPase in the parietal cells of the stomach, reducing the acidity of the gastric contents, and usually alleviate GERD symptoms. PPI is one of the most commonly prescribed medications, used by an estimated 7% to 9% of all adults worldwide and by more than 20% of those aged 65 years or older . A meta-analysis found no differences in effectiveness of acid suppression when comparing equivalent doses of different types of PPIs (Table 3), indicating that these can be used interchangeably if the dose is adjusted accordingly .…”

Section: Observationsmentioning

confidence: 99%

Gastroesophageal Reflux Disease

Maret-Ouda

Markar

Lagergren

2020

JAMA

211

195

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astroesophageal reflux disease (GERD) is defined by its cardinal symptoms (recurrent and troublesome heartburn and regurgitation) or by its specific complications (esophagitis, peptic strictures, and Barrett esophagus). 1 Barrett esophagus is a columnar metaplasia replacing parts of the native squamous cell epithelium that can progress to esophageal adenocarcinoma. 2 GERD can be a serious problem and should not be confused with less severe disease such as gastritis or the very common symptoms of dyspepsia or regurgitation that occur in almost all individuals without any underlying gastrointestinal pathology. GERD is caused by gastric contents' reaching the esophagus. Except for causing esophageal symptoms or complications, gastric juices can also reach more proximally (ie, into the pharynx, mouth, larynx, and airways) and cause or worsen various extraesophageal symptoms and conditions such as hoarseness, wheezing, cough, and asthma. 1 Established risk factors for developing GERD include increased body mass index, tobacco smoking, and genetic predisposition, 3 whereas infection with the gastric bacterium Helicobacter pylori can decrease this risk. 4 The prevalence of GERD is high and increasing, with greater rates in high-income countries (15%-25%) than in most low-and middle-income countries (<10%). 2,5 GERD can result in diminished health-related quality of life, and its prevalence and need for longterm treatment can consume substantial health care resources and result in high costs to society. 6,7 This review provides an update of the current evidence regarding GERD, with an emphasis on its clinical management in adults.IMPORTANCE Gastroesophageal reflux disease (GERD) is defined by recurrent and troublesome heartburn and regurgitation or GERD-specific complications and affects approximately 20% of the adult population in high-income countries.OBSERVATIONS GERD can influence patients' health-related quality of life and is associated with an increased risk of esophagitis, esophageal strictures, Barrett esophagus, and esophageal adenocarcinoma. Obesity, tobacco smoking, and genetic predisposition increase the risk of developing GERD. Typical GERD symptoms are often sufficient to determine the diagnosis, but less common symptoms and signs, such as dysphagia and chronic cough, may occur. Patients with typical GERD symptoms can be medicated empirically with a proton pump inhibitor (PPI). Among patients who do not respond to such treatment or if the diagnosis is unclear, endoscopy, esophageal manometry, and esophageal pH monitoring are recommended. Patients with GERD symptoms combined with warning symptoms of malignancy (eg, dysphagia, weight loss, bleeding) and those with other main risk factors for esophageal adenocarcinoma, such as older age, male sex, and obesity, should undergo endoscopy. Lifestyle changes, medication, and surgery are the main treatment options for GERD. Weight loss and smoking cessation are often useful. Medication with a PPI is the most common treatment, and after initial full-dose therapy, w...

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“…With an ageing population and a rise in the prevalence of chronic diseases, the number of individuals exposed to multiple medications is rapidly growing. In Canada, two thirds of individuals aged C65 years covered by public drug programmes use at least five different classes of prescribed medication per year [1,2]. In Quebec, the mean annual number of claims for individuals aged C65 years insured by the provincial drug plan nearly doubled in the last 10 years, from 62.5 in 2003 to 111.7 in 2013 [3].…”

Section: Introductionmentioning

confidence: 99%

Monitoring polypharmacy at the population level entails complex decisions: results of a survey of experts in geriatrics and pharmacotherapy

Sirois

Tannenbaum

Gagnon

et al. 2016

Drugs Ther Perspect

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Aim The use of multiple medications is rising steadily among older individuals, but little is known about the impact of polypharmacy at a population level, both over time and across countries. Surveillance of polypharmacy is required to overcome these gaps. There currently exists no standard population indicator of polypharmacy. The objective of this survey was to query expert opinion on establishing a gold standard method for polypharmacy surveillance at the population level. Methodology We invited 71 experts in geriatrics, pharmacoepidemiology, pharmacology and surveillance to respond to an Internet-based survey. Participants were asked to rate their degree of agreement on statements related to the definition of polypharmacy, the goals of polypharmacy surveillance and knowledge transfer issues. Consensus was reached when 70 % of participants either strongly or moderately agreed with the statements. Qualitative content analysis was performed on optional comments provided by the participants.Results Thirty individuals (42 %) completed the survey. Consensus was reached on most items. However, there was no agreement on a quantitative indicator of polypharmacy. Participants resolved that the indicator include a quality component, and that levels of polypharmacy be created. Defining exposure also proved problematic: cumulative (e.g. total annual number) and/or simultaneous (concomitant) prescriptions could be considered. Conclusions A gold standard indicator of polypharmacy should include both quantity and quality. There is a need to better inform the relevant outcomes of polypharmacy, to identify the most appropriate threshold(s) and quality measure(s) of interest to decision makers.

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Drug Use among Seniors on Public Drug Programs in Canada, 2012

Cited by 14 publications

References 19 publications

Association Between Statin Use and Risk of Dementia After a Concussion

Association Between Statin Use and Risk of Dementia After a Concussion

Gastroesophageal Reflux Disease

Monitoring polypharmacy at the population level entails complex decisions: results of a survey of experts in geriatrics and pharmacotherapy

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