Daily Archives: 1 September 2024

Enhanced Drug Management Required for Elderly Hospital Patients

Specialised medication management for elderly patients could significantly reduce their hospital stays and lower their mortality risk, according to new research conducted by Flinders University in partnership with Flinders Medical Centre. The findings, published in The Journal of the American Medical Directors Association (JAMDA), reveal that one in ten elderly patients experience ‘adverse drug reactions’ (ADRs) while hospitalised. This highlights a critical area for healthcare systems to address, particularly as the ageing population is likely to present with multiple chronic conditions and an increased medication load.

Dr Joshua Inglis, a researcher at the College of Medicine and Public Health and a Consultant Physician at the Department of Clinical Pharmacology in Flinders Medical Centre, stressed the importance of preventing medication-related harm. He noted that ADRs in patients aged 65 and older are associated with prolonged hospital stays and increased risk of death, underscoring the need for enhanced protective measures within hospitals. This growing issue calls for a strategic focus on medication safety and harm prevention as the demographic landscape shifts towards an older population.

The research team advocates for implementing multidisciplinary teams to manage specific classes of high-risk medications across hospitals. Individual doctors review patient medications during hospital stays, but a coordinated, hospital-wide approach could yield better outcomes. Dr Inglis suggested that medication stewardship programs, which have proven effective in managing antibiotic use, could be adapted to oversee the use of other high-risk medications such as opioids, anticoagulants, and psychotropics.

The study examined over 700 patients aged 65 and older admitted to Flinders Medical Centre over three years. Approximately 10% of these patients suffered from unwanted reactions to medications, which were directly linked to extended durations of hospital stay and a higher likelihood of death during their admission. This connection underscores the potential benefits of a more structured approach to medication management, aiming to reduce these adverse outcomes.

Adverse drug reactions were most commonly associated with medications used to treat high blood pressure and other cardiac conditions, as well as solid painkillers like oxycodone and antibiotics such as penicillin. The side effects from these drugs ranged from kidney and liver injuries to low blood pressure, sedation, nausea, vomiting, diarrhoea, and bleeding. Each instance of an adverse reaction not only extended the length of hospital stay but also increased the risk of death, highlighting a severe concern for patient safety.

Dr Inglis emphasised the novelty and significance of their findings, marking the first time a study has demonstrated a correlation between experiencing an ADR in a hospital and facing severe consequences such as extended hospitalisation or death. He called for healthcare organisations to develop proactive stewardship programs to prevent such adverse reactions. The research team also suggested that further studies involving different patient cohorts, such as older people living with dementia, could provide additional insights into improving health outcomes for the aged population and reducing the incidence of ADRs.

More information: Joshua M. Inglis et al, The Clinical Impact of Hospital-Acquired Adverse Drug Reactions in Older Adults: An Australian Cohort Study, The Journal of the American Medical Directors Association. DOI: 10.1016/j.jamda.2024.105083

Journal information: The Journal of the American Medical Directors Association Provided by Flinders University

Research Reveals the Significant Effects of Severe Poverty on Death Rates Amongst Ethnically Mixed, Low-Income Groups

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Over the last four decades, the wealth, health, and mortality disparity between affluent and impoverished Americans has grown consistently. Recently, a pioneering study by the Vanderbilt University Medical Center focused on a highly impoverished, predominantly Black demographic. The findings were stark: individuals earning below $15,000 annually died on average over a decade sooner than those with yearly incomes above $50,000.

This groundbreaking research highlights the urgent need to address the disparities in mortality linked to both race and income. As noted in Elsevier’s recent publication in the American Journal of Preventive Medicine, addressing these issues requires a holistic approach. The study underscores the importance of striving for income equality to diminish low-income Americans’ health and mortality disparities.

Dr Wei Zheng, MD, PhD, MPH, the director of the Vanderbilt Epidemiology Center and the study’s corresponding author, pointed out a significant finding. Although tobacco smoking is traditionally seen as the leading cause of death in the US, the study revealed that the risk of death due to poverty in this low-income group surpasses that due to smoking.

The research included 79,385 participants aged between 40 and 79 from the ongoing Southern Community Cohort Study. Most of these participants were enlisted at community health centres across 12 southeastern states from 2002 to 2009. About two-thirds of the cohort members are Black, and over half reported a household income below $15,000 annually. This setup provided a unique lens to examine the severe impact of extreme poverty on mortality in a racially diverse, low-income population.

The study participants provided detailed information through questionnaires about their health and lifestyle behaviours that influence disease risk and mortality, including smoking, alcohol consumption, physical activity, and diet quality.

During the roughly 18-year follow-up period, there were 19,749 deaths among the participants. Analysis showed that low-income individuals with the poorest lifestyle scores experienced a mortality rate more than six times higher than those in the highest income bracket with the best lifestyle scores. Interestingly, low-income participants with the best lifestyle scores still had a lower cumulative mortality rate than high-income individuals with the poorest lifestyle scores. This finding reinforces the significant impact of lifestyle and behavioural factors on health and lifespan.

However, the study also noted that low-income communities often lack access to healthy food options, adequate healthcare, and safe environments conducive to physical exercise. These limitations mean that promoting healthy behaviours alone is insufficient to counteract the detrimental effects of poverty on mortality.

Among high-income participants, White individuals had a lower cumulative mortality risk compared to Black individuals. However, this trend reversed in the low-income bracket, where White participants exhibited higher mortality rates than their Black counterparts. In the high-income group, the average age at death was 82.7 years for Whites and 81.2 years for Blacks, while in the low-income group, it was 67.8 years for Whites and 70.9 years for Blacks.

Even with some participants adhering to healthier lifestyles, the life expectancy disparity between the two income groups varied from around ten years for Blacks to nearly 15 years for Whites. The findings from this study are a clarion call for the evaluation of policies and public health strategies aimed at reducing mortality and health disparities among low-income Americans. Without targeted interventions to separate the link between low income and poor health, we may continue to see the socioeconomic gaps in health not only widen but also become more entrenched.

More information: Lili Liu et al, Impacts of Poverty and Lifestyles on Mortality: A Cohort Study in Predominantly Low-Income Americans, American Journal of Preventive Medicine. DOI: 10.1016/j.amepre.2024.02.015

Journal information: American Journal of Preventive Medicine Provided by Elsevier

Researchers Determine the Impact of Exercise on Cells

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Recent research has further illuminated the widely recognized health benefits of exercise, demonstrating that the body’s response to physical activity is far more complex and extensive than previously understood. Scientists from various institutions across the United States conducted a collaborative study examining the cellular and molecular changes induced by exercise across nineteen different organs in rats subjected to intense physical training. The results were published in Nature, which adds depth to our understanding of exercise’s impact.

Historically, research on the biological effects of exercise has often been narrow in focus, typically examining a single organ, one gender, or specific time points, and limited to a few types of data. This approach has constrained a comprehensive understanding of how exercise affects the body at a molecular level. To address this, the Molecular Transducers of Physical Activity Consortium (MoTrPAC) utilized various advanced laboratory techniques to analyze these effects holistically. Their findings revealed significant changes across vital organs such as the heart, brain, and lungs, essential in regulating the immune system, stress responses, and pathways linked to several diseases.

A key discovery from the study provided insights into the reduction of liver fat content through exercise, suggesting potential strategies for treating non-alcoholic fatty liver disease. This example highlights how exercise benefits organs not directly involved in physical activity, promoting overall health improvements. The potential for these insights to lead to personalized exercise programs tailored to individual health needs or therapeutic strategies that mimic the benefits of physical activity for those unable to exercise traditionally is a beacon of hope in the field of healthcare.

This groundbreaking research is part of a broader initiative by MoTrPAC, which was established in 2016 and comprises experts from renowned institutions, including the Broad Institute of MIT and Harvard, Stanford University, and the National Institutes of Health. The consortium, initiated by prominent scientists such as Steve Carr and Robert Gerszten, aims to uncover the biological processes underlying the health benefits of exercise. The collaborative nature of this research, with a diverse group of scientists contributing to the study under the guidance of senior researchers like Carr and Clary Clish, makes you an integral part of this scientific journey.

The study required immense coordination and planning. Nearly 10,000 assays were performed, resulting in about 15 million measurements across various tissues. This extensive data collection highlights the complexity of exercise as a biological process and its capacity to positively influence health across multiple systems. The researchers have made all the animal data available in an online public repository, enabling other scientists to access detailed information about the molecular changes induced by exercise.

The openness of sharing data underscores the collaborative spirit of the scientific community and the commitment to advancing our understanding of exercise physiology. This study sets a new precedent for exercise research, potentially guiding public health strategies and clinical practices aimed at harnessing the inherent benefits of physical activity to combat various health conditions.

This comprehensive study not only illuminates the broad and profound impacts of exercise on the body but also serves as a model for future research in the field. It opens up new avenues for exploring how targeted exercise interventions can be developed and applied to improve health outcomes for individuals around the world.

More information: MoTrPAC Study Group et al, Temporal dynamics of the multi-omic response to endurance exercise training, Nature. DOI: 10.1038/s41586-023-06877-w

Journal information: Nature Provided by Broad Institute of MIT and Harvard

Routine Use of Fish Oil Supplements May Increase Risk of Initial Heart Disease and Stroke Events

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Regular consumption of fish oil supplements may increase, rather than decrease, the risk of first-time heart disease and stroke in individuals with good cardiovascular health while potentially slowing the progression of existing cardiovascular conditions and reducing mortality risk, suggests a comprehensive long-term study published in BMJ Medicine. Fish oil is renowned for its high omega-3 fatty acids content and is commonly recommended as a dietary preventive measure against cardiovascular disease. However, the extent of protection it provides is still debated among experts. The research aimed to consolidate the evidence by estimating the relationship between the use of fish oil supplements and the emergence of new cardiovascular issues such as atrial fibrillation, heart attacks, strokes, and heart failure, as well as overall mortality in individuals without prior cardiovascular diseases.

To further explore the potential benefits of these supplements, the study examined their impact on the progression from good cardiac health to more severe conditions, including atrial fibrillation, major cardiovascular events, and death. The analysis drew on data from 415,737 participants of the UK Biobank study, primarily composed of women (55%) aged 40 to 69, who had their initial health and dietary habits surveyed between 2006 and 2010. The follow-up period was extended until the end of March 2021 or the participants’ death, during which their health outcomes were meticulously tracked using medical records.

About one-third of the participants (31.5% or 130,365 individuals) reported consistent use of fish oil supplements. This group notably included a higher proportion of older White individuals and women, who generally consumed more alcohol and preferred oily fish to non-oily variants, with fewer smokers and residents from deprived areas among them. During the nearly 12-year monitoring period, 18,367 participants developed atrial fibrillation, 22,636 experienced heart attacks, strokes, or heart failures, and 22,140 passed away—14,902 of whom had not previously suffered from atrial fibrillation or severe cardiovascular diseases.

The study findings revealed that regular use of fish oil supplements was associated with a 13% increased risk of developing atrial fibrillation and a 5% increased risk of stroke in individuals without cardiovascular diseases at the start. Conversely, for those already suffering from cardiovascular conditions, regular intake of these supplements was linked to a 15% reduced risk of advancing from atrial fibrillation to a heart attack and a 9% lower risk of progressing from heart failure to death. These observations were further influenced by factors such as age, gender, smoking habits, consumption of non-oily fish, high blood pressure, and the use of statins and blood pressure-lowering medications.

The protective effects of fish oil supplements varied: 6% higher in women and non-smokers for transitioning from good health to severe cardiovascular events, 7% lower in men, and 11% lower in older individuals for transitioning from good health to death. Since this study is observational, the researchers caution against drawing causal conclusions. They also note the absence of data on the dosage or formulation of the fish oil supplements used, and the predominantly White demographic of the participants suggests that these findings might not apply universally.

In conclusion, the researchers emphasize the need for further studies to determine the precise mechanisms by which regular use of fish oil supplements influences the development and prognosis of cardiovascular diseases. These supplements’ nuanced roles in different stages of cardiovascular health suggest a complex interaction with individual health profiles and dietary habits, warranting a deeper investigation into their benefits and risks.

More information: Ge Chen et al, Regular use of fish oil supplements and course of cardiovascular diseases: prospective cohort study, BMJ Medicine. DOI: 10.1136/bmjmed-2022-000451

Journal information: BMJ Medicine Provided by BMJ Group