Prevalence of Polypharmacy and Factors Associated with it Among Saudi Older Adults - Results from the Saudi National Survey for Elderly Health (SNSEH).

Background and Objectives: The percentage of Saudi older adults (SOA) is increasing over time. With advanced age, the prevalence of chronic diseases and multiple disabilities are increasing. This leads to increase utilization of multiple medications. The objectives of this study were to describe medication utilization, determine the prevalence of polypharmacy (PP) and factors associated with it among SOA. Methods: This cross-sectional study was conducted among community-dwelling SOA aged ≥ 60 years old using the Saudi National Survey for Elderly Health (SNSEH). The survey was conducted between 2006 and 2007 by the Ministry of Health on a nationally representative sample of SOA. The data included demographics, socioeconomic and health information such as diseases and medications. Polypharmacy was defined as the concurrent use of medications from ≥ 5 therapeutic classes. A modified Poisson multivariable regression was used to study factors associated with PP controlling for confounders. All analyses were done using STATA 14. Results: The study included 2,946 SOA; 50.4% were males, 60.9% were 60-70 years old, and 69.6% were illiterate. The most common medications used among SOA were: Paracetamol (67%), joint pain medications and NSAIDs (50% each), anti-diabetic and multivitamins and minerals (47% each). PP was identified in (51.5%) of participants. The most medication associated with PP were: Paracetamol (79.9%), multivitamins and minerals (71.6%), steroid and DMARDs (70.1%), NSAIDs (66.4%), anti-diabetic and anti-hypertensive (61.3%). Higher risk of PP was associated with diabetes (RR: 1.863; 95% CI: 1.686-2.059), hypertension (RR: 1.829; 95% CI: 1.624-2.060), having pain (RR: 2.282; 95% CI: 1.918-2.713), urinary incontinence (RR: 1.389; 95% CI: 1.238-1.560; ref: no urinary incontinence) or suggestive depression (RR: 1.379; 95% CI: 1.259-1.512). Similarly, compared to low income (<2500 SAR), higher incomes were more likely to have PP. On the other hand, compared to the central region, southern and northern regions were less likely to have PP (RR = 0.741; 95% CI: 0.652-0.843 and RR: 0.736; 95% CI: 0.596-0.908, respectively). Severe cognitive impairment was associated with a lower risk of PP (RR: 0.708; 95% CI: 0.501-1.000). Conclusion: The prevalence of PP among a nationally representative SOA was very high, i.e., 51.5%. Higher risk of PP was associated with many factors such as region, income, diabetes, hypertension, musculoskeletal pain, urinary incontinence, and depression. PP leads to many negative implications such as drug interactions, combined side effects, hospitalization, and death. Therefore, raising the knowledge of health care providers on the consequences of PP and providing medication therapy management services may help decrease the negative consequences of PP and improve therapy outcomes.

Quality of life in vitiligo patients in central Saudi Arabia.

OBJECTIVES: To assess the quality of life (QoL) in patients with vitiligo in central Saudi Arabia using the dermatology life quality index (DLQI). METHODS: A cross-sectional study spanning over 6 months was conducted on 253 adult patients with vitiligo at the outpatient dermatology clinics of the National Center of Vitiligo (Light Clinics) and King Khalid University Hospital, Riyadh, Saudi Arabia. The patients were asked to complete a self-administered questionnaire using an Arabic version of the DLQI to measure the impact of vitiligo on their QoL. The association between the demographic and diseases characteristic to the median DLQI scores was investigated using binary logistic regression. RESULTS: The median DLQI score was 4, the range 25, min 0 - max 25 and percentiles 2-8. The unadjusted odds ratio (95%CI) showed the median DLQI score was significantly higher in married subjects 2.29 (1.33-3.94) (p<0.01), non-segmental vitiligo 2.10 (1.16-3.79) (p<0.01), and the progressive vitiligo 1.87 (1.09-3.18) (p<0.02) than their counterparts. However, after adjustment only married status predicted the high DLQI score 2.08 (1.11-3.61) (p<0.01). CONCLUSION: The QoL in vitiligo patients in Saudi Arabia is adverse than those with lighter skin, in other countries. Therefore, in Saudi Arabia, better management modalities to improve patients' QoL and prevent subsequent mental distress are needed.

The Utilization of Complementary and Alternative Medicine among Saudi Older Adults: A Population-Based Study.

BACKGROUND: Complementary and alternative medicine (CAM) is an integral part of patients' therapeutic experience worldwide. Among Saudi older adults, less is known about CAM utilization. OBJECTIVES: To determine the prevalence, patterns, and factors associated with CAM utilization among SOA. METHODS: In the Saudi National Survey for Elderly Health (SNSEH), subjects were asked about CAM use during the last twelve months before the interview. CAM use was defined as any use of herbal products, acupuncture, bloodletting, cauterization, medical massage, bones manual manipulation, honey, or religious rituals. Demographic characteristics included gender, age, marital status, region, educational level, and residence area. In addition, multiple comorbidities were included as possible factors that may be associated with CAM use. Multivariable logistic regression was used to explore factors associated with CAM utilization. All statistical analyses were done using STATA v.14. RESULTS: Out of 2946 respondents, 50.4% were males, the mean age was 70.3 ± 8.3 years, and 70% were illiterate. CAM use was prevalent (62.5%). The most common CAM types were herbal products (25.4%), acupuncture (21.2%), bloodletting (12%), honey (9.5%), cauterization (7.4%), medical massage and bones manual manipulation (4%), and traditional bone setting (2.1%). In the multivariable regression, age, gender, and marital status did not have an impact on the odds of using CAM. Subjects from rural areas were 2.92 times more likely to use CAM compared with subjects in urban areas (OR = 2.92; 95%CI: 2.28-3.75). Subjects with metabolic disorders (OR = 0.50; 95% CI: 0.42-0.60) or kidney disease were less likely to use CAM (OR = 0.30; 95%CI: 0.14-0.64). About pain, CAM is used more in neck pain (OR = 1.69; 95%CI: 1.30-2.21) and also used in back pain (OR = 1.22; 95%CI: 1.03-1.46). CONCLUSIONS: CAM use was very prevalent among SOA. Clinicians and pharmacists must ask about CAM use among older adults as many of CAM may interact with patients medications.

Utilization of Colorectal Cancer Screening among Saudi Elderly Population: A Study from the Saudi National Survey for Elderly Health

Objective: The goal of this study was to measure colorectal cancer screening (CRCS) utilization in Saudi Arabia 's elderly population and to assess the factors associated with CRCS. Methods: The Saudi National Survey for Elderly Health was used to examine CRCS utilization. It is a nationally representative population-based cross-sectional survey that was conducted between 2006-2007. Utilization of CRCS was defined as any colonoscopy during the last five years or fecal occult blood test (FOBT) during the twelve months before the interview. Multivariable logistic regression was used to assess patients' demographics, co-morbidities, number of visits to primary health clinics, and hospital availability and accessibility impact on CRCS. Results: The prevalence of CRCS utilization among Saudi elderly population was 5.64%. The fecal occult blood test was done in 4.4% of subjects while scope use was performed in 0.55%. In addition, 0.69% of patients have gone through both FOBT and scope use. Having blood in stools (OR=2.80; 95%CI: 1.3-6.00), Self-drivers (OR= 2.52) private driver (OR=2.1; 95%CI: 1.15-3.7) having 4 or more visits to primary care centers 1.81 (95%CI: 1.14-2.86) were positively associated with CRCS utilization. On the other hand, being single was negatively associated with CRCS utilization. Conclusion: In this nationally representative sample CRCS prevalence was very low. According to our findings and in the context of the burden of colorectal cancer on the population, we recommend developing national evidence-based policies and programs that take in consideration easiness of transportation and the availability of primary care centers near to Saudi elderly population.

The prevalence of benzodiazepines utilization and its association with falls among Saudi older adults; results from the Saudi national survey for elderly Health (SNSEH).

PURPOSE: First, to determine benzodiazepines prevalence (BDZs) among Saudi older adults (SOA); Second, to quantify the association between BDZs use and falls among SOA. Third, to determine falls effect on all-cause mortality among SOA. METHODS: This is a cross-sectional study that used the Saudi National Survey for Elderly Health; a nationally-representative, population-based survey. Participants were asked about BDZs use and falls history during the 12 months prior to the interview. Demographics, medications, comorbidities and housing conditions were used as covariates. Multiple imputation was used to impute missing data. Modified poisson multivariable regression was used to study the association between BDZs and falls. Cox- proportional hazard regression was used to determine falls effect on mortality over nine years period. RESULTS: Among 2946 SOA, BDZs prevalence was 4%. Around 13% reported falls. In the multivariable regression, relative risk (RR) of falls was 2 comparing BDZs users to non-users (95CI%: 1.02-3.99). Antidepressants (RR = 1.72; 95%CI: 1.10-2.74), laxatives (RR = 1.38; 95%CI: 1.11-1.7), low body mass index (RR = 1.94; 95%CI: 1.33-2.84), mild cognitive impairment (RR = 1.56; 95%CI: 1.21-2.03), high door steps (RR = 1.54; 95%CI: 1.23-1.93) and insufficient illumination (RR = 1.38; 95%CI: 1.11-1.71) increased falls risk. Lastly, the hazard ratio of falls on death was 1.48 (95%CI: 1.17, 1.89) over nine years. CONCLUSION: Despite the recommendation against BDZs use among older adults, still there were subjects who were prescribed these drugs. falls are common among SOA. Preventive strategies such medication therapy management, nutrition improvement, elderly-friendly housing structures can reduce the prevalence of falls and consequent increase in mortality among SOA.

The health of Saudi older adults; results from the Saudi National Survey for Elderly Health (SNSEH) 2006-2015.

OBJECTIVES: To Describe the Saudi older adult (SOA) characteristics and Introduce the Saudi National Survey for Elderly Health (SNSEH). METHODS: The SNSEH, a population-based nationally-representative survey, was used. Subjects were included in 2006-2007, using random-cluster sampling utilizing probability proportional to size approach, and followed-up to determine their vital status until June 2015. In the analyses, survey weights were incorporated. Parametric, non-parametric and logistic regression were used. Cox-proportional hazard regression was used to determine gender effects on mortality. RESULTS: We included 2,946 SOA. The mean age was 70.1(SD = 0.3). Around, 70% were illiterate. Almost 50% had monthly income of 2500 (2007-Saudi-Riyals). The most reported diseases were hypertension, diabetes and joints pain. The most reported medications were over the counter, antidiabetics and antihypertensive. The nine-years age-adjusted death hazard was 42% higher in SOA males. CONCLUSION: This is an introductory paper for a series of papers that describe SOA health. These efforts will help in guiding the development of a national healthcare model for SOA, evidence-based health policies and public intervention programs that address SOA health-related issues.

Evaluation and identification of damaged single nucleotide polymorphisms in COL1A1 gene involved in osteoporosis.

INTRODUCTION: Single-nucleotide polymorphisms (SNPs) are biomarkers for exploring the genetic basis of many complex human diseases. The prediction of SNPs is promising in modern genetic analysis but it is still a great challenge to identify the functional SNPs in a disease-related gene. The computational approach has overcome this challenge and an increase in the successful rate of genetic association studies and reduced cost of genotyping have been achieved. The objective of this study is to identify deleterious non-synonymous SNPs (nsSNPs) associated with the COL1A1 gene. MATERIAL AND METHODS: The SNPs were retrieved from the Single Nucleotide Polymorphism Database (dbSNP). Using I-Mutant, protein stability change was calculated. The potentially functional nsSNPs and their effect on proteins were predicted by PolyPhen and SIFT respectively. FASTSNP was used for estimation of risk score. RESULTS: Our analysis revealed 247 SNPs as non-synonymous, out of which 5 nsSNPs were found to be least stable by I-Mutant 2.0 with a DDG value of > -1.0. Four nsSNPs, namely rs17853657, rs17857117, rs57377812 and rs1059454, showed a highly deleterious tolerance index score of 0.00 with a change in their physicochemical properties by the SIFT server. Seven nsSNPs, namely rs1059454, rs8179178, rs17853657, rs17857117, rs72656340, rs72656344 and rs72656351, were found to be probably damaging with a PSIC score difference between 2.0 and 3.5 by the PolyPhen server. Three nsSNPs, namely rs1059454, rs17853657 and rs17857117, were found to be highly polymorphic with a risk score of 3-4 with a possible effect of non-conservative change and splicing regulation by FASTSNP. CONCLUSIONS: Three nsSNPs, namely rs1059454, rs17853657 and rs17857117, are potential functional polymorphisms that are likely to have a functional impact on the COL1A1 gene.

Exploration of deleterious single nucleotide polymorphisms in late-onset Alzheimer disease susceptibility genes.

Non-synonymous single nucleotide polymorphisms (nsSNPs) are considered as biomarkers to disease susceptibility. In the present study, nsSNPs in CLU, PICALM and BIN1 genes were screened for their functional impact on concerned proteins and their plausible role in Alzheimer disease (AD) susceptibility. Initially, SNPs were retrieved from dbSNP database, followed by identification of potentially deleterious nsSNPs and prediction of their effect on proteins by PolyPhen and SIFT. Protein stability and the probability of mutation occurrence were predicted using I-Mutant and PANTHER respectively. SNPs3D and FASTSNP were used for the functional analysis of nsSNPs. The functional impact on the 3D structure of proteins was evaluated by SWISSPDB viewer and NOMAD-Ref server. On analysis, 3 nsSNPs with IDs rs12800974 (T158P) of PICALM and rs11554585 (R397C) and rs11554585 (N106D) of BIN1 were predicted to be functionally significant with higher scores of I-Mutant, SIFT, PolyPhen, PANTHER, FASTSNP and SNPs3D. The mutant models of these nsSNPs also showed very high energies and RMSD values compared to their native structures. Current study proposes that the three nsSNPs identified in this study constitute a unique resource of potential genetic factors for AD susceptibility.

Screening and Evaluation of Deleterious SNPs in APOE Gene of Alzheimer's Disease.

Introduction. Apolipoprotein E (APOE) is an important risk factor for Alzheimer's disease (AD) and is present in 30-50% of patients who develop late-onset AD. Several single-nucleotide polymorphisms (SNPs) are present in APOE gene which act as the biomarkers for exploring the genetic basis of this disease. The objective of this study is to identify deleterious nsSNPs associated with APOE gene. Methods. The SNPs were retrieved from dbSNP. Using I-Mutant, protein stability change was calculated. The potentially functional nonsynonymous (ns) SNPs and their effect on protein was predicted by PolyPhen and SIFT, respectively. FASTSNP was used for functional analysis and estimation of risk score. The functional impact on the APOE protein was evaluated by using Swiss PDB viewer and NOMAD-Ref server. Results. Six nsSNPs were found to be least stable by I-Mutant 2.0 with DDG value of >-1.0. Four nsSNPs showed a highly deleterious tolerance index score of 0.00. Nine nsSNPs were found to be probably damaging with position-specific independent counts (PSICs) score of ≥2.0. Seven nsSNPs were found to be highly polymorphic with a risk score of 3-4. The total energies and root-mean-square deviation (RMSD) values were higher for three mutant-type structures compared to the native modeled structure. Conclusion. We concluded that three nsSNPs, namely, rs11542041, rs11542040, and rs11542034, to be potentially functional polymorphic.