Incidence of hip fractures in persons with and without Parkinson's disease in Finland: a 15-year longitudinal study.

Unlabelled: Despite growing evidence on prodromal symptoms of Parkinson's disease, it remains unknown whether they culminated in clinically significant events. We found elevated risks of hip fractures from 3 years before until up to 10 years after diagnosis of Parkinson's disease, underscoring the need for early and continuous fracture risk management.

Purpose: Parkinson's disease (PD) is associated with a higher risk of hip fracture.

Deprescribing Benzodiazepine Receptor Agonists in Older Adults and People With Cognitive Impairment: A Systematic Review.

Background: Benzodiazepine receptor agonists (BZRAs) (benzodiazepines and z-drugs) may provide limited benefits in the management of insomnia when used short-term. However, they increase the risk of harms including falls, fractures, hospitalizations, and cognitive impairment. Deprescribing (cessation) of BZRAs may be beneficial for older adults and people living with cognitive impairment as they are at heightened risk of adverse events.

Association between number of medications and indicators of potentially inappropriate polypharmacy: a population-based cohort of older adults in Quebec, Canada.

Background: As the number of medications increases, the appropriateness of polypharmacy may become questionable due to the heightened risk of medication-related harm.

Objectives: (1) To investigate the relationship between the number of current medications used by older adults and three indicators of potentially inappropriate polypharmacy: (a) the mean number of potentially inappropriate medications (PIMs), (b) the average count of drug-drug interactions, and (c) the anticholinergic burden; (2) To characterize the population-based burden of potentially inappropriate polypharmacy by calculating the proportion of individuals with these indicators.

Design: We conducted a population-based observational study using the Quebec Integrated Chronic Disease Surveillance System.

Gabapentinoids and Risk of Hip Fracture.

Importance: The increased use of gabapentinoids has been most pronounced in older people who are also susceptible to hip fractures.

Objective: To investigate the overall association between gabapentinoids and the risk of hip fractures and the stratified association across age groups, frailty status, and history of chronic kidney disease.

Design, Setting, And Participants: This was a case-case-time-control study in patients hospitalized for hip fracture in Victoria, Australia, between March 1, 2013, and June 30, 2018, with at least 1 prescription for a gabapentinoid before fracture.

The cost of potentially inappropriate medications for older adults in Canada: A comparative cross-sectional study.

Background: Potentially inappropriate medications (PIMs) are medications whereby the harms may outweigh the benefits for a given individual. Although overprescribed to older adults, their direct costs on the healthcare system are poorly described.

Methods: This was a cross-sectional study of the cost of PIMs for Canadians aged 65 and older, using adapted criteria from the American Geriatrics Society.

Promoting medication safety for older adults upon hospital discharge: Guiding principles for a medication discharge plan.

Older adults are at risk of adverse drug events during transition of care from hospital to community, thus optimal communication about medications at discharge is essential. Standardization of medication discharge plan (MDP) is lacking. This study aimed to (1) create a standardized MDP for older adults using consensus-based principles, (2) create a short-version MDP and (3) generate a practical guide.

Reducing Central Nervous System-Active Medications to Prevent Falls and Injuries Among Older Adults: A Cluster Randomized Clinical Trial.

Importance: High-risk medications that contribute to adverse health outcomes are frequently prescribed to older adults. Deprescribing interventions reduce their use, but studies are often not designed to examine effects on patient-relevant health outcomes.

Objective: To test the effect of a health system-embedded deprescribing intervention targeting older adults and their primary care clinicians for reducing the use of central nervous system-active drugs and preventing medically treated falls.

Government Direct-to-Consumer Education to Reduce Prescription Opioid Use: A Cluster Randomized Clinical Trial.

Importance: Direct-to-consumer education reduces chronic sedative use. The effectiveness of this approach for prescription opioids among patients with chronic noncancer pain remains untested.

Objectives: To evaluate the effectiveness of a government-led educational information brochure mailed to community-dwelling, long-term opioid consumers to reduce prescription opioid use compared with usual care.

What do clinical practice guidelines say about deprescribing? A scoping review.

Introduction: Deprescribing () is an integral component of appropriate prescribing. The extent to which deprescribing recommendations are included in clinical practice guidelines is unclear. This scoping review aimed to identify guidelines that contain deprescribing recommendations, qualitatively explore the content and format of deprescribing recommendations and estimate the proportion of guidelines that contain deprescribing recommendations.

Reducing potentially inappropriate polypharmacy at a national and international level: the impact of deprescribing networks.

Introduction: Over the past decade, polypharmacy has increased dramatically. Measurable harms include falls, fractures, cognitive impairment, and death. The associated costs are massive and contribute substantially to low-value health care.

Strategies to guide the successful implementation of deprescribing in community practice: Lessons learned from the front line.

Background: Sustainable implementation of new professional services into clinical practice can be difficult. In 2019, a population-wide initiative called SaferMedsNL was implemented across the province of Newfoundland and Labrador (NL), to promote appropriate medication use. Two evidence-based interventions were adapted to the context of NL to promote deprescribing of proton pump inhibitors and sedatives.

Effect of Oral Bisphosphonate Drug Holiday on Mortality Following Hip Fracture.

Context: Current clinical guidelines recommend a drug holiday after extended use of oral bisphosphonates. However, no studies have investigated the effect of drug holidays before hip fractures on postfracture mortality.

Objective: This work aimed to investigate the effect of a drug holiday on postfracture mortality in patients with extended use of oral bisphosphonates.

Prescriber Acceptability of a Direct-to-Patient Intervention for Benzodiazepine Receptor Agonist Deprescribing and Behavioural Management of Insomnia in Older Adults.

Behavioural treatments are recommended first-line for insomnia, but long-term benzodiazepine receptor agonist (BZRA) use remains common and engaging patients in a deprescribing consultation is challenging. Few deprescribing interventions directly target patients. Prescribers' support of patient-targeted interventions may facilitate their uptake.

Factors influencing the effects of policies and interventions to promote the appropriate use of medicines in high-income countries: A rapid realist review.

Background: The appropriate use of medicines has long been recognized as a fundamental component of medicine policies. We aimed to extract lessons from published research on how policy contexts and mechanisms can affect the outcomes of national- or health-system level interventions to promote appropriate medicine use (defined as an increase in underutilized medications or decrease in inappropriate medication use).

Methods: We conducted a rapid realist review of published evidence concerning system-level policies to promote the appropriate use of medicines in high-income countries with universal prescription drug coverage.

Trajectories of oral bisphosphonate use after hip fractures: a population-based cohort study.

Unlabelled: Bisphosphonates prevent future hip fractures. However, we found that one in six patients with hip fractures had a delay in bisphosphonate initiation and another one-sixth discontinued treatment within 12 months after discharge. Our results highlight the need to address hesitancy in treatment initiation and continuous monitoring.

Central Nervous System-Active Prescriptions in Older Veterans: Trends in Prevalence, Prescribers, and High-risk Populations.

Background: Little is known about the prevalence or chronicity of prescriptions of central nervous system-active (CNS-active) medications in older Veterans.

Objective: We sought to describe (1) the prevalence and trends in prescription of CNS-active medications in older Veterans over time; (2) variation in prescriptions across high-risk groups; and (3) where the prescription originated (VA or Medicare Part D).

Design: Retrospective cohort study from 2015 to 2019.

Hip fracture incidence and post-fracture mortality in Victoria, Australia: a state-wide cohort study.

Unlabelled: Hip fractures are a major public health concern. Number of hip fractures cases increased by 20% from 2012 to 2018. Factors associated with post-fracture mortality included men, those who are frail, living in a non-metropolitan region, or residing in a residential aged care facility.

Systematic Review of Psychotropic Adverse Drug Event Monitoring Tools for Use in Long-Term Care Facilities.

Objectives: To evaluate properties of psychotropic adverse drug event (ADE) monitoring tools intended for use in long-term care facilities.

Design: Systematic review.

Setting And Participants: Adults aged 18 years and older in nursing homes and other long-term care facilities.

Effectiveness and cost analysis of methods used to recruit older adult sedative users to a deprescribing randomized controlled trial during the COVID-19 pandemic.

Background: Recruitment to clinical trials is a challenge for researchers that became more pronounced because of COVID-19 public health protective measures, especially with respect to studies enrolling older adults. We completed an effectiveness and cost analysis of the recruitment methods used in The Your Answers When Needing Sleep in New Brunswick (YAWNS NB) study, a randomized controlled trial of a deprescribing intervention that recruited older adults with chronic use of sedatives during the pandemic.

Methods: Study recruitment began during the COVID-19 pandemic.