Factors associated with the use of dietary supplements and over-the-counter medications in Japanese elderly patients.

BACKGROUND: The use of dietary supplements and over-the-counter (OTC) drugs is increasing, and there is adequate concern about potential harmful effects. However, there are limited reports on the concurrent use of nonprescription medications with prescription medications in elderly patients. Therefore, this study was conducted to describe the use of dietary supplements and OTC drugs, and to identify predictors for their use in elderly patients using medications prescribed for chronic diseases. METHODS: This was a cross-sectional study that enrolled 729 patients aged ≥65 years with chronic diseases, between January and March 2016. Data regarding socio-demographic status, medical condition, number of prescriptions, use of nonprescription medications, and psychological status were collected using a self-administered questionnaire and by review of medical records. Data regarding use of dietary supplements and OTC drugs were analyzed using descriptive statistics. Logistic regression analysis was applied to investigate factors associated with the use of dietary supplements and OTC drugs. RESULTS: The regular use of nonprescription drugs was reported by 32.5% of patients. Vitamins were the most commonly used dietary supplements in elderly patients. Female sex, higher educational qualifications, and good economic status were identified as predictors for the use of nonprescription medications. Concurrent use of nonprescription medications with more than 5 prescription medications was detected in 12.2% of participants. The disclosure rate of the use of nonprescription medications by patients to the physician was 30.3%. CONCLUSION: The use of dietary supplements and OTC drugs was common in elderly patients with chronic diseases, and its use is associated with sex, education, and economic status. General practitioners (GPs) need to recognize the potential use of nonprescription medications, considering that polypharmacy was common and disclosure rate was low in this study.

Factors facilitating home death in non-cancer older patients receiving home medical care.

AIM: To assess factors associated with home deaths in non-cancer elderly patients receiving home medical care by general practitioners. METHODS: A retrospective observational study was carried out in a primary care clinic in Tokyo. Patients who received home medical care and died between January 2010 and September 2017 were included in the analysis. Data from 119 non-cancer patients aged ≥65 years were collected between September and December 2017 using medical records. Patient characteristics, comorbidities, cognitive impairment, duration of home medical care, number of household members, patient's relationship with their primary caregiver, use of home care nursing services, and patient and family preference on place of death were obtained as independent variables. The main outcome was the place of death. RESULTS: Among the analyzed patients, 59.7% had impaired cognition and 47.1% expressed a preference for place of death. Patient-family congruence on the preferred place of death was 57.1% (kappa coefficient 0.39). Multivariate analysis showed that family preference for home death (adjusted odds ratio [aOR] 137.0, 95% CI 13.0-1443.8), cognitive impairment (aOR 4.26, 95% CI 1.12-16.2), death by non-infectious diseases (aOR 13.7, 95% CI 2.50-74.7) and living with more than two family members (aOR 4.79, 95%CI 1.38-16.7) were significantly associated with home deaths. CONCLUSIONS: Family preference, rather than patient preference, was a facilitating factor for home death among non-cancer older patients receiving home medical care. As many patients receiving home medical care have impaired cognition, early end-of-life discussions with patients and decision-making support for caregivers should be promoted to realize their preferences on place of death. Geriatr Gerontol Int 2019; 19: 1231-1235.

Potentially inappropriate medications with polypharmacy increase the risk of falls in older Japanese patients: 1-year prospective cohort study.

AIM: We aimed to evaluate whether potentially inappropriate medications (PIMs) increase the risk for adverse clinical outcomes including falls, emergency department (ED) visits and unplanned hospitalizations in older Japanese patients with chronic diseases, comparing the difference between patients with and without polypharmacy. METHODS: A prospective observational cohort study was carried out in a Japanese outpatient primary care clinic. Baseline data was collected from January to March 2016. A total of 740 patients aged ≥65 years with chronic diseases were enrolled and were followed up at 1 year; falls, ED visits and unplanned hospitalizations were recorded. A questionnaire and review of the patients' medical records were used to collect information regarding sociodemographic status, comorbidities and medication prescriptions. PIMs were defined using the Screening Tool of Older Person's Prescriptions criteria version 2. Using logistic regression analysis, the incidence of falls, and ED visits and hospitalizations were compared between patients with and without PIMs, stratifying by number of prescriptions: those with five or more prescriptions and those with fewer than five prescriptions. RESULTS: PIMs were identified in 32.3% of enrolled patients. After stratification by number of prescriptions, PIMs were significantly associated with falls in the group with polypharmacy (OR 2.03, 95% CI 1.11-3.69). This association was not seen in the group without polypharmacy. PIMs were not associated with ED visits or hospitalizations at the 1-year follow up upon multivariate analysis. CONCLUSIONS: The combination of PIMs and polypharmacy might increase the risk of falls, therefore clinicians need to pay attention to both PIMs and polypharmacy. Geriatr Gerontol Int 2018; 18: 1064-1070.

Association between potentially inappropriate medications and anxiety in Japanese older patients.

AIM: The use of potentially inappropriate medications (PIMs) for older patients is a major public health problem. However, there is little information regarding PIMs in Japanese primary care settings, and the association between psychological problems and PIMs is unknown. The present study was carried out to explore the prevalence of PIMs among older patients in a primary care setting in Tokyo, and to assess the association between PIMs and depression and anxiety. METHODS: A cross-sectional study in a Japanese outpatient clinic providing primary care was carried out. Data were collected from January 2016 to March 2016. A total of 740 patients aged ≥65 years with chronic diseases were enrolled. Information regarding sociodemographic status, comorbidities, and prescription and psychological status was collected using a questionnaire that patients were required to complete, and by reviewing the patients' medical records. RESULTS: The Screening Tool of Older Person's Prescriptions criteria version 2 revealed PIM prescription for 32.3% of patients. Benzodiazepines, hypnotic Z-drugs and proton pump inhibitors accounted for a majority of PIMs. After adjusting for age, sex, comorbidities, estimated glomerular filtration rate and the number of medications, anxiety was identified as a predictor for PIMs. CONCLUSIONS: PIMs among older patients are common in Japanese primary care settings, and prescription of benzodiazepines or hypnotic Z-drugs and proton pump inhibitors was frequent as PIMs. PIMs might be associated with anxiety; therefore, their association should be focused on and addressed to reduce PIMs. Geriatr Gerontol Int 2017; 17: 2520-2526.