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Anemia in nursing homes, proton pump inhibitors and prescribing cascade of antianemic drugs

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Key summary points

AbstractSection Aim

To examine the relation between drugs commonly used in NHs and diagnosis of anemia in a łarge sample of older adults resident in nursing homes (NHs).

AbstractSection Findings

We investigated the relation between anemia and medications potentially related to anemia in nursing homes. Only the association with PPI was found.

AbstractSection Message

Optimization of PPI prescription is needed to avoid potential adverse events and the use of drugs to treat anemia as the effect of a prescribing cascade.

Abstract

Purpose

Some medications can cause anemia through their effect on gastrointestinal function, such as proton pump inhibitors and H2-antagonists, and on the risk of bleeding, such as anticoagulants and antiplatelet agents. The main aim of this study is to evaluate how anemia is related with the most commonly used drugs in a large sample of NH residents.

Methods

This retrospective cross-sectional multicenter study was conducted in a sample of Italian long-term care NHs distributed throughout the country.

Results

In all, 2602 NH residents recruited from 27 Italian long-term NHs (mean age ± SD: 88.4 ± 8.5) and 441 (16.9%) had a diagnosis of anemia. The unadjusted model showed a significant relation with PPI (OR 1.71, 95% CI 1.39–2.11, p < 0.0001). This relation was maintained in the model adjusted for age, sex, CKD, atrophic gastritis, peptic ulcer and rheumatic disease (OR 1.61, 95% CI 1.31–1.99, p < 0.0001). PPI users were also at higher risk of being treated with antianemic drugs—iron supplements, folate, vitamin B12 and erythropoietin (OR 2.03, 95% CI 1.67–2.48, p < 0.0001)—even if they did not have anemia (OR 1.94, 95% CI 1.55–2.42, p < 0.0001).

Conclusion

Proton pump inhibitors are associated with anemia in NH residents. PPIs are also related with an increased probability of receiving drugs to treat anemia, such as iron supplements, folate or cyanocobalamin and erythropoietin, as the effect of a prescribing cascade. Optimization of PPI prescription is needed to avoid adverse events and promote rational drug prescription.

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Acknowledgements

The authors are very grateful to Korian Italy for the possibility of conducting the study. Korian Italy had no role in the conception and design of the study, data analysis and interpretation, the preparation and writing of the report or the decision to submit the manuscript for publication. All authors critically revised the manuscript and approved its final version. We are grateful to J.D. Baggott for language editing.

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Authors and Affiliations

  1. Laboratory of Clinical Pharmacology and Appropriateness of Drug Prescription, Department of Health Policy, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Via Mario Negri, 2, 20156, Milan, Italy

    Chiara Elli, Alessio Novella, Alessandro Nobili & Luca Pasina

  2. Medical Direction, Korian Italy, Milan, Italy

    Aladar Ianes

Authors
  1. Chiara Elli
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  2. Alessio Novella
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  3. Alessandro Nobili
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  4. Aladar Ianes
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  5. Luca Pasina
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Contributions

All authors participated in drafting the manuscript or critical revision of the manuscript for important intellectual content and provided approval of the final submitted version. Individual contributions are as follows: CE and LP: designed the study, interpreted data and wrote the manuscript; AN: did and interpreted statistical analyses; AN and AI: made the final critical revision for important intellectual contents. All authors approved the final version of the manuscript.

Corresponding author

Correspondence to Luca Pasina.

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Conflict of interest

The authors have no conflicts of interest directly relevant to the content of this manuscript.

Ethical approval

The study was approved by the ethics committee of the IRCCS Carlo Besta Foundation (76_2020).

Informed consent

All data were anonymous and informed consent was not required for the purpose of this study.

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Elli, C., Novella, A., Nobili, A. et al. Anemia in nursing homes, proton pump inhibitors and prescribing cascade of antianemic drugs. Eur Geriatr Med 13, 553–558 (2022). https://doi.org/10.1007/s41999-022-00636-2

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  • DOI: https://doi.org/10.1007/s41999-022-00636-2

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