Darshna Goordeen

Purpose: To investigate the prevalence of type 2 diabetes (T2D) medication use in the final 3,6, 9, and 12 months of life and explore patient factors associated with discontinuation in the 6 months prior to death in people living with dementia in the UK and Australia. Methods: Linked hospital and administrative data were used from the UK and Australia. We included individuals who died between July 2013 and June 2018. Logistic regressions estimated the association between age, sex, cardiovascular disease, chronic kidney disease (CKD), and cancer with discontinuation of T2D medications. Results: 10,088 UK and 6,436 Australian individuals were identified. From those supplied insulin in the last 12 months of life, there was a 25.6% reduction in use in the UK and 43.5% in Australia in the last 3 months of life, but minimal reduction in other medication classes. CKD was associated with metformin discontinuation in the last 6 months of life in the UK (OR 1.05, 95% CI 1.03–1.07) and Australia (OR 1.60, 95% CI 1.15–2.12). Conclusion: Guideline-concordant discontinuation of metformin in the last 6 months of life was observed in those with CKD. Decreased insulin supply in those living with dementia was observed. There were lower rates of discontinuation of other glucose-lowering medications in the UK and Australia.

Glucagon‐like peptide‐1 receptor agonists (GLP‐1RAs) are increasingly prescribed for type 2 diabetes and weight management. However, conflicting evidence from preclinical, clinical, and pharmacovigilance studies suggests potential neuropsychiatric effects. This study examined associations between GLP‐1RA use and initiation of a range of neuropsychiatric medications using real‐world prescription data. A Prescription Sequence Symmetry Analysis was conducted using Australia's Pharmaceutical Benefits Scheme 10% random sample between July 1, 2013 and December 31, 2024. Individuals with an incident dispensing of both a GLP‐1RA and a neuropsychiatric medication were included. Outcomes comprised antidepressants, medication for substance use disorder (SUD), antipsychotics, psychostimulants, antidementia medications, antiparkinsonian medications, antiepileptics, and antimigraine agents. Adjusted sequence ratios (aSRs) with 95% confidence intervals (CIs) were calculated using a one‐year exposure window, with sensitivity analyses varying various time windows. Among 2,033 individuals, semaglutide was the most common GLP‐1RA (50.6%), followed by exenatide (27.5%) and dulaglutide (21.9%). GLP‐1RA initiation was inversely associated with initiation of antidepressants (aSR: 0.85; 95% CI: 0.76–0.94) and medications for SUD (aSR: 0.70; 95% CI: 0.51–0.88). No significant associations were observed for other neuropsychiatric outcomes. GLP‐1RA use was inversely associated with subsequent initiation of antidepressants and medications for SUD, while no associations were identified for other neuropsychiatric marker medications. These findings highlight the need for further studies to clarify the nature and magnitude of these potential neuropsychiatric associations with GLP‐1RAs.

Introduction: High‐risk medications are medications associated with significant patient harm or death if misused or used in error. This study aimed to develop a national consensus high‐risk medication list for use in Australian residential aged care. Methods: A 3‐round modified Delphi study involving Australian healthcare professionals was conducted. In Round 1, participants indicated their level of agreement, on a 9‐point Likert scale, whether 60 medications/medication classes were considered high‐risk and should be included in a high‐risk medication list for Australian residential aged care. Round 2 included medications/medication classes that did not reach consensus and new medications identified by participants. Consensus was defined as 70% or more of participants responding at 7 or higher on the Likert scale. In Round 3, participants were asked to prioritise medications/medication classes that reached consensus in Round 1 or 2. Results: In total, 42 participants completed Round 1, and 35 (83%) completed all three rounds. Participants included pharmacists ( n = 21), prescribers ( n = 15), nurses ( n = 5) and a paramedic ( n = 1), with representation from all Australian states and mainland territories. Overall, 26 medications reached consensus (21 in Round 1, five in Round 2) and were categorised into 15 medications/medication classes for prioritisation in Round 3. The final prioritisation list was opioids, insulin, benzodiazepines, anticoagulants, z‐drugs, antipsychotics, lithium, sulfonylureas with high risk of hypoglycaemia, chemotherapeutic agents, methotrexate, digoxin, narrow therapeutic range antiepileptics, tricyclic antidepressants, immunosuppressants for transplant and sedating antihistamines. Discussion: This is the first, national consensus list of high‐risk medications developed specifically for Australian residential aged care. It can be used to implement targeted strategies to minimise medication‐related harm.

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. This review investigated the effects of patient‐directed, non‐pharmacological interventions to support deprescribing of BZRAs used for insomnia in older adults and people living with cognitive impairment.Methods: Embase, CENTRAL, Scopus, and Medline were searched in January 2024 with no publication date restrictions. Screening, data extraction, and risk of bias assessments (ROB2 for randomized studies, ROBINS‐I for non‐randomized studies) were conducted independently by two authors. Outcomes of interest included the proportion of participants who ceased BZRAs, reduction in BZRAs, switching to another medication, sleep outcomes, and clinical outcomes. Studies were included if they investigated BZRA deprescribing in older adults (≥ 65 years) or people living with cognitive impairment.Results: Seventeen reports analyzing 16 studies in hospital, community, and aged care settings were included. BZRA cessation rates ranged between 23% to 72% for written education (n = 6); 14% to 57% for combined written and verbal education (n = 5); and 9% to 100% for multi‐component interventions (n = 6). One report investigated a BZRA deprescribing educational intervention in people with cognitive impairment and found comparable effectiveness to participants without cognitive impairment. Most studies were at a high risk of bias.Conclusions: Patient‐directed interventions led to BZRA cessation, although there was significant variability between studies. It is unknown if all interventions examined are similarly effective for people living with cognitive impairment. Further research investigating approaches to deprescribing BZRAs in older adults or people with cognitive impairment is required.

Aim: The Western Pacific region has the fastest aging population and 38% of the world's diabetes population. It is unknown to what extent medication management recommendations are included for older adults in type 2 diabetes (T2D) clinical practice guidelines (CPGs).Method: MEDLINE, Embase, Scopus, guideline‐specific registries and gray literature searches were performed in November 2024. Data were extracted on guideline characteristics and recommendations relevant to older adults, dementia, frailty, co‐morbidities associated with aging or end‐of‐life. Quality appraisal was performed using the AGREE II (Appraisal of Guidelines, Research and Evaluation) tool.Results: From the 37 countries and areas of the Western Pacific region, 16 CPGs were identified, of which 15 included 1–29 relevant recommendations. Thirteen CPGs recommended less stringent and/or individualized glycemic targets focused on reducing hypoglycemia for older adults. Five CPGs recommended individualized antihyperglycemic treatment choices. Seven CPGs included recommendations about de‐intensification/simplification of complex regimens. The quality of CPGs varied, with scope and purpose rated the highest.Conclusions: There was heterogeneity in the number of recommendations within CPGs; however, none comprehensively addressed the T2D medication management needs of older adults or those living with dementia, frailty or receiving end‐of‐life care. Collaboration between diabetes and geriatric societies as well as the assistance of higher‐income countries in helping those with less resource availability could provide a way forward to improving future CPGs. Geriatr Gerontol Int 2025; 25: 717–729.