Sujita W. Narayan

Associations of drug burden index with falls, general practitioner visits, and mortality in older people.

On a population level in people aged ≥65 years old living in New Zealand, the aim of this study is to quantify each individuals cumulative exposure to anticholinergic and sedative medicines using the Drug Burden Index (DBI) and examine the impact of DBI on fall‐related hospitalisations, general practitioner (GP) visits, and all‐cause mortality.

Prevalence of potentially inappropriate medicine use in older New Zealanders: a population-level study using the updated 2012 Beers criteria.

RATIONAL, AIMS AND OBJECTIVES To examine the prevalence of potentially inappropriate medicines (PIMs) in older New Zealanders at a population level. METHODS De-identified prescription data for all individuals ≥65 years were obtained from the Pharmaceutical Claims Data Mart for 2011. International Classification of Diseases-10-AM (version 6) codes were used to extract diagnostic information from the National Minimum Datasets and PIMs were identified using the updated Beers 2012 criteria. RESULTS 40.9% of older people were prescribed PIMs with approximately half dispensed ≥2 PIMs in 2011. Exposure was highest in individuals aged 65-74 years (68.9 ± 2.9). The most prevalent PIMs dispensed were diclofenac (6.0%), amitriptyline (4.9%), ibuprofen (4.6%), zopiclone (3.2%) and naproxen (3.0%). 66.3% of individuals were dispensed ≥1 and 80.8% were dispensed ≥2 medicines with a potential for drug-disease/syndrome interaction. CONCLUSIONS The updated Beers 2012 criteria identified that the use of PIMs at a population level is common in older New Zealanders.

Decade-long temporal trends in the utilization of preventive medicines by centenarians

Centenarians represent a population of individuals with delayed disability and are an ideal representation of ageing well; however, studies related to medicine use in this population are scarce. Our study aimed to explore the temporal trends associated with the utilization of preventive medicines in centenarians.

Population-based study examining the utilization of preventive medicines by older people in the last year of life: Preventive medicines at end-of-life

To examine the patterns of preventive medicines (PM) use in the last year of life of older adults.

Evaluation of the National Minimum Data Set for Neurological Conditions in Older Adults

Aim: To evaluate the National Minimum Data Set (NMDS) against the International Resident Assessment Instrument–Home Care (interRAI-HC) in diagnosing dementia or Parkinson disease (PD). Method: The NMDS data were matched with interRAI-HC for all older individuals in New Zealand. Dementia or PD was compared within 90 and 180 days and 1 to 4 years preceding and subsequent to the date of diagnosis in interRAI-HC. Consistency was measured through sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), weighted kappa (κ), and McNemar test. Results: For a diagnosis within 90 days, dementia showed 60.77% sensitivity, 95.33% specificity, 68.46% PPV, and 93.58% NPV. The PD showed 65.74% sensitivity, 99.52% specificity, 80.43% PPV, and 98.98% NPV. κ for dementia (κ = 0.59), PD (κ = 0.720), and McNemar test was significant (P < .001) for all lengths of follow-up. Conclusion: Substantial agreement between multiple sources of health data can be a valuable resource for decision-making in older people with neurological conditions.

Antihypertensive medicines utilization: A decade-long nationwide study of octogenarians, nonagenarians and centenarians

Gaining an insight into the utilization of antihypertensive medicines against a background of evolving hypertension treatment guidelines that might not be relevant to the oldest old is important. The aim of the present study was to characterize the overall trends in the utilization of antihypertensive medicines in the oldest old by therapeutic class and chemical type, stratified by age and sex over a decade.

A population-level study examining discontinuation of statins in older people with dementia

The variability in functional and cognitive decline in individuals with dementia poses challenges when prescribing statins on whether the individual is likely to survive long enough to have time to benefit from treatment [1, 2]. We investigated the prevalence of discontinuation of statins in older people diagnosed with dementia in their last year of life compared to those without dementia, and evaluated statin discontinuation based on an indication for primary versus secondary prevention of cardiovascular diseases. Pharmaceutical collections were used to obtain information on sex, age, medicines, daily dose, frequency, quantity, ethnicity, and date of prescription. The date of the last statin prescription was used to evaluate statin discontinuation. Discontinuation was defined as persistently not using statins for ≥ 90 days during the therapy course. The National Minimum Dataset provided diagnosis based on the International Statistical Classification of Diseases and Related Health Problems, 10th Revision, Australian Modification, 6th edition. Date of death was extracted from the births, deaths, and marriages’ register. A total of 20,745 individuals aged ≥ 75 years old who died within the study period (2007 to 2011) and had at least one dispensing record of statin prior to death were included in the study. Of these individuals, 2145 had a documented diagnosis of dementia. If an individual had a diagnosis of acute myocardial infarction cerebrovascular accident or peripheral vascular disease, then statins were considered to be used for secondary prevention. Baseline characteristics of all individuals are provided in Electronic Supplementary Material Appendix Table S1. Survival curves (probability of continuing statins as a function of time from baseline) were calculated for individuals with and without dementia and compared using log-rank test and interpreted by visualization. Cox regression tested the relationship between the change in statin discontinuation and dementia. Age, sex, prioritized ethnicities, and the Charlson Comorbidity Index scores were identified as confounders of interest. In both analyses, the baseline date was the 365 days before the date of death, and the follow-up date is the day the individual receives the last statin prescription. At the study interval of 12 months prior to death, among individuals who were prescribed statins for primary prevention, those with a diagnosis of dementia had a higher prevalence of discontinuation than those without a diagnosis of dementia; hazard ratio 1.19, 95% CI 1.10–1.29, p < 0.05. This was the opposite for individuals on secondary prevention (Table 1). In the last 6 and 3 months of life, among those prescribed statins for primary prevention, there was no significant difference in discontinuation between those with and without dementia. Kaplan–Meier survival curves illustrate that discontinuation of statins in individuals with a diagnosis of dementia was higher in individuals prescribed statins for primary prevention compared to secondary prevention (logrank χ = 14.80, p < 0.05). Statins are of questionable benefit in individuals with advanced dementia and it has been established in some individuals that discontinuation of statins has led to improvements in cognition and quality of life [3–5]. For our study, stratification by prevention categories supplements a different perspective to previous statin discontinuation studies. There are some notable limitations in this study. Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00228-017-2390-4) contains supplementary material, which is available to authorized users.