{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T12:33:07Z","timestamp":1792067587146,"version":"4.4.0"},"reference-count":26,"publisher":"Wiley","issue":"9","license":[{"start":{"date-parts":[[2017,5,3]],"date-time":"2017-05-03T00:00:00Z","timestamp":1493769600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/100000049","name":"National Institute on Aging","doi-asserted-by":"publisher","award":["K08AG048321"],"award-info":[{"award-number":["K08AG048321"]}],"id":[{"id":"10.13039\/100000049","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000965","name":"American Federation for Aging Research","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000965","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000909","name":"John A. Hartford Foundation","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000909","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100004426","name":"Atlantic Philanthropies","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100004426","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J American Geriatrics Society"],"published-print":{"date-parts":[[2017,9]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>\n                      To determine patterns of and trends in contributions to central nervous system (\n                      <jats:styled-content style=\"fixed-case\">CNS<\/jats:styled-content>\n                      ) polypharmacy, defined by the Beers Criteria as three or more\n                      <jats:styled-content style=\"fixed-case\">CNS<\/jats:styled-content>\n                      \u2010active medications of each medication class, of adults aged 65 and older seen in U.S. outpatient medical practices.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>National Ambulatory Medical Care Survey (2004\u20132013).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>U.S. outpatient medical care.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants<\/jats:title>\n                    <jats:p>Visits by older adults to outpatient physicians (N = 97,910).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Measurements<\/jats:title>\n                    <jats:p>\n                      Visits including three or more\n                      <jats:styled-content style=\"fixed-case\">CNS<\/jats:styled-content>\n                      medications including antipsychotics, benzodiazepines, nonbenzodiazepine benzodiazepine receptor agonist hypnotics (\n                      <jats:styled-content style=\"fixed-case\">NBRA<\/jats:styled-content>\n                      s), tricyclic antidepressants (\n                      <jats:styled-content style=\"fixed-case\">TCA<\/jats:styled-content>\n                      s), selective serotonin reuptake inhibitors (\n                      <jats:styled-content style=\"fixed-case\">SSRI<\/jats:styled-content>\n                      s), and opioids. The proportion of\n                      <jats:styled-content style=\"fixed-case\">CNS<\/jats:styled-content>\n                      polypharmacy that each medication class contributed during 2011 to 2013 was determined, and then logistic regression was used to determine trends from 2004 to 2013 in the contribution of individual medication classes to such polypharmacy.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Of recent\n                      <jats:styled-content style=\"fixed-case\">CNS<\/jats:styled-content>\n                      polypharmacy visits, 76.2% included an opioid, and 61.8% included a benzodiazepine; 66.0% of the polypharmacy visits with benzodiazepines included opioids, and 53.3% of the polypharmacy visits with opioids included benzodiazepines. Between 2011 and 2013, opioid and benzodiazepine co\u2010prescribing occurred at approximately 1.50 million visits (95% confidence interval (\n                      <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content>\n                      ) = 1.23\u20131.78 million) annually. From 2004 (reference) to 2013, the proportion of polypharmacy visits with opioids rose from 69.6% to 76.2% (adjusted odds ratio = 2.15, 95%\n                      <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content>\n                      = 1.19\u20133.91,\n                      <jats:italic>P<\/jats:italic>\n                      = .01), and the corresponding proportion that included benzodiazepines fell. Of the polypharmacy visits, the odds of\n                      <jats:styled-content style=\"fixed-case\">SSRI<\/jats:styled-content>\n                      ,\n                      <jats:styled-content style=\"fixed-case\">NBRA<\/jats:styled-content>\n                      , and antipsychotic use were unchanged, and that of\n                      <jats:styled-content style=\"fixed-case\">TCA<\/jats:styled-content>\n                      s decreased.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>\n                      In older adults, opioid use appears to be largely driving the recent national increase in\n                      <jats:styled-content style=\"fixed-case\">CNS<\/jats:styled-content>\n                      polypharmacy. Although concomitant use of opioids and benzodiazepines is associated with greater mortality, they are the most common contributors to\n                      <jats:styled-content style=\"fixed-case\">CNS<\/jats:styled-content>\n                      polypharmacy in older adults.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/jgs.14930","type":"journal-article","created":{"date-parts":[[2017,5,3]],"date-time":"2017-05-03T09:23:02Z","timestamp":1493803382000},"page":"2052-2056","source":"Crossref","is-referenced-by-count":73,"title":["Opioids and Other Central Nervous System\u2013Active Polypharmacy in Older Adults in the United States"],"prefix":"10.1111","volume":"65","author":[{"given":"Lauren B.","family":"Gerlach","sequence":"first","affiliation":[{"name":"Department of Psychiatry University of Michigan Ann Arbor Michigan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark","family":"Olfson","sequence":"additional","affiliation":[{"name":"Department of Psychiatry College of Physicians and Surgeons Columbia University New York New York"},{"name":"New York State Psychiatric Institute New York New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Helen C.","family":"Kales","sequence":"additional","affiliation":[{"name":"Department of Psychiatry University of Michigan Ann Arbor Michigan"},{"name":"Center for Clinical Management Research VA Ann Arbor Healthcare System Ann Arbor Michigan"},{"name":"Institute for Healthcare Policy and Innovation University of Michigan Ann Arbor Michigan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Donovan T.","family":"Maust","sequence":"additional","affiliation":[{"name":"Department of Psychiatry University of Michigan Ann Arbor Michigan"},{"name":"Center for Clinical Management Research VA Ann Arbor Healthcare System Ann Arbor Michigan"},{"name":"Institute for Healthcare Policy and Innovation University of Michigan Ann Arbor Michigan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2017,5,3]]},"reference":[{"key":"e_1_2_6_2_1","doi-asserted-by":"publisher","DOI":"10.1001\/archinte.1997.00440350031003"},{"key":"e_1_2_6_3_1","doi-asserted-by":"publisher","DOI":"10.1001\/archinternmed.2009.357"},{"key":"e_1_2_6_4_1","doi-asserted-by":"publisher","DOI":"10.1176\/appi.ajp.158.6.892"},{"key":"e_1_2_6_5_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.38623.768588.47"},{"key":"e_1_2_6_6_1","doi-asserted-by":"publisher","DOI":"10.1093\/gerona\/gln043"},{"key":"e_1_2_6_7_1","doi-asserted-by":"publisher","DOI":"10.1111\/jgs.13702"},{"key":"e_1_2_6_8_1","doi-asserted-by":"publisher","DOI":"10.1097\/JGP.0b013e318202c1dc"},{"key":"e_1_2_6_9_1","doi-asserted-by":"publisher","DOI":"10.1377\/hlthaff.2010.1024"},{"key":"e_1_2_6_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jagp.2013.10.007"},{"key":"e_1_2_6_11_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1532-5415.2008.02127.x"},{"key":"e_1_2_6_12_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.h2698"},{"key":"e_1_2_6_13_1","unstructured":"FDA Drug Safety Communication: FDA Warns About Serious Risks and Death When Combining Opioid Pain and Cough Medicines with Benzodiazepines; Requires Its Strongest Warning. 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