Polypharmacy, Hazardous Alcohol and Illicit Substance Use, and Serious Falls Among PLWH and Uninfected Comparators

Womack, Julie A.; Murphy, Terrence E.; Rentsch, Christopher T; Tate, Janet P.; Bathulapalli, Harini; Smith, Alexandria; Bates, Jonathan; Jarad, Samah; Gibert, Cynthia L.; Rodriguez‐Barradas, Maria C.; Tien, Phyllis C.; Yin, Michael T.; Gill, Thomas M; Friedlaender, Gary E.; Brandt, Cynthia; Justice, Amy C.

doi:10.1097/qai.0000000000002130

Cited by 34 publications

(42 citation statements)

References 32 publications

(41 reference statements)

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“…Polypharmacy may increase the risk of adverse drug reactions due to the use of medications with overlapping side effects, which may convert asymptomatic side effects to a reason for hospitalization. Polypharmacy has been associated with several adverse health outcomes including physical decline, cognitive impairment, falls, hospitalization and mortality . However, it should be highlighted that the causality between polypharmacy and the aforementioned outcomes is difficult to ascertain as the outcomes could be a direct consequence of the primary conditions.…”

Section: Discussionmentioning

confidence: 99%

The challenge of HIV treatment in an era of polypharmacy

2020

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Introduction The availability of potent antiretroviral therapy has transformed HIV infection into a chronic disease such that people living with HIV (PLWH) have a near normal life expectancy. However, there are continuing challenges in managing HIV infection, particularly in older patients, who often experience age‐related comorbidities resulting in complex polypharmacy and an increased risk for drug‐drug interactions. Furthermore, age‐related physiological changes may affect the pharmacokinetics and pharmacodynamics of both antiretrovirals and comedications thereby predisposing elderly to adverse drug reactions. This review provides an overview of the therapeutic challenges when treating elderly PLWH (i.e. >65 years). Particular emphasis is placed on drug‐drug interactions and other common prescribing issues (i.e. inappropriate drug use, prescribing cascade, drug‐disease interaction) encountered in elderly PLWH. Discussion Prescribing issues are common in elderly PLWH due to the presence of age‐related comorbidities, organ dysfunction and physiological changes leading to a higher risk for drug‐drug interactions, drugs dosage errors and inappropriate drug use. Conclusions The high prevalence of prescribing issues in elderly PLWH highlights the need for ongoing education on prescribing principles and the optimal management of individual patients. The knowledge of adverse health outcomes associated with polypharmacy and inappropriate prescribing should ensure that there are interventions to prevent harm including medication reconciliation, medication review and medication prioritization according to the risks/benefits for each patient.

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Section: Discussionmentioning

confidence: 99%

The challenge of HIV treatment in an era of polypharmacy

2020

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“…PIMs were assessed using the most recent version of the classical Beers criteria and included, for instance, drugs with anticholinergic properties or benzodiazepines, which can impair cognition and consequently increase the risk of falls in elderly persons [3, 21]. Proton pump inhibitors were not considered a PIM, as our study did not capture treatment duration and only proton pump inhibitor treatment for longer than 8 weeks is considered inappropriate according to Beers criteria.…”

Section: Methodsmentioning

confidence: 99%

Polypharmacy, Drug–Drug Interactions, and Inappropriate Drugs: New Challenges in the Aging Population With HIV

Courlet

Livio

Guidi

et al. 2019

Open Forum Infectious Diseases

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Background Antiretroviral therapy has transformed HIV infection from a deadly into a chronic condition. Aging people with HIV (PWH) are at higher risk of polypharmacy, potential drug–drug interactions (DDIs), and potentially inappropriate medications (PIMs). This study aims to compare prescribed drugs, polypharmacy, and potential DDIs between young (<65 years old) and elderly (≥65 years old) PWH. The prevalence of PIMs was assessed in elderly. Methods PWH from 2 centers within the Swiss HIV Cohort Study were asked to fill in a form with all their current medications. Polypharmacy was defined as being on ≥5 non-HIV drugs. PIMs were evaluated using Beers criteria. Potential DDIs for the most prescribed therapeutic classes were screened with the Liverpool interaction database. Results Among the 996 PWH included, 122 were ≥65 years old. Polypharmacy was more frequent in the elderly group (44% vs 12%). Medications and potential DDIs differed according to the age group: cardiovascular drugs and related potential DDIs were more common in the elderly group (73% of forms included ≥1 cardiovascular drug; 11% of cardiovascular drugs involved potential DDIs), whereas central nervous system drugs were more prescribed and involved in potential DDIs in younger PWH (26%, 11%). Potential DDIs were mostly managed through dosage adjustments. PIMs were found in 31% of the elderly group. Conclusions Potential DDIs remain common, and PIMs constitute an additional burden for the elderly. It is important that prescribers develop and maintain a proactive approach for the recognition and management of DDIs and other prescribing issues frequently encountered in geriatric medicine.

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“…We selected risk factors for consideration in a multivariable risk prediction model of serious falls among middle-aged Veterans. 4,7,16 These included sex, race/ethnicity, and age. We also included body mass index (BMI) as a categorical variable (<25 or ≥25 kg/m 2 ) and any history of a serious fall within the past 12 months.…”

Section: Primary Predictorsmentioning

confidence: 99%

Serious Falls in Middle‐Aged Veterans: Development and Validation of a Predictive Risk Model

Womack

Murphy

Bathulapalli

et al. 2020

J American Geriatrics Society

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BACKGROUND/OBJECTIVES Due to high rates of multimorbidity, polypharmacy, and hazardous alcohol and opioid use, middle‐aged Veterans are at risk for serious falls (those prompting a visit with a healthcare provider), posing significant risk to their forthcoming geriatric health and quality of life. We developed and validated a predictive model of the 6‐month risk of serious falls among middle‐aged Veterans. DESIGN Cohort study. SETTING Veterans Health Administration (VA). PARTICIPANTS Veterans, aged 45 to 65 years, who presented for care within the VA between 2012 and 2015 (N = 275,940). EXPOSURES The exposures of primary interest were substance use (including alcohol and prescription opioid use), multimorbidity, and polypharmacy. Hazardous alcohol use was defined as an Alcohol Use Disorders Identification Test ‐ Consumption (AUDIT‐C) score of 3 or greater for women and 4 or greater for men. We used International Classification of Diseases, Ninth Revision (ICD‐9), codes to identify alcohol and illicit substance use disorders and identified prescription opioid use from pharmacy fill‐refill data. We included counts of chronic medications and of physical and mental health comorbidities. MEASUREMENTS We identified serious falls using external cause of injury codes and a machine‐learning algorithm that identified serious falls in radiology reports. We used multivariable logistic regression with general estimating equations to calculate risk. We used an integrated predictiveness curve to identify intervention thresholds. RESULTS Most of our sample (54%) was aged 60 years or younger. Duration of follow‐up was up to 4 years. Veterans who fell were more likely to be female (11% vs 7%) and White (72% vs 68%). They experienced 43,641 serious falls during follow‐up. We identified 16 key predictors of serious falls and five interaction terms. Model performance was enhanced by addition of opioid use, as evidenced by overall category‐free net reclassification improvement of 0.32 (P < .001). Discrimination (C‐statistic = 0.76) and calibration were excellent for both development and validation data sets. CONCLUSION We developed and internally validated a model to predict 6‐month risk of serious falls among middle‐aged Veterans with excellent discrimination and calibration.

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Polypharmacy, Hazardous Alcohol and Illicit Substance Use, and Serious Falls Among PLWH and Uninfected Comparators

Cited by 34 publications

References 32 publications

The challenge of HIV treatment in an era of polypharmacy

The challenge of HIV treatment in an era of polypharmacy

Polypharmacy, Drug–Drug Interactions, and Inappropriate Drugs: New Challenges in the Aging Population With HIV

Serious Falls in Middle‐Aged Veterans: Development and Validation of a Predictive Risk Model

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