Use of proton-pump inhibitors and their associated risks among frail elderly nursing home residents

Figures & data

Table I. Characteristics of residents divided by the use of proton pump inhibitors (PPI).

	PPI users (n = 433)	PPI non users (n = 1554)	p-value^1
Mean age (SD^2)	83.8 (7.4)	83.7 (7.8)	0.69
Females, %	79.2	81.1	0.38
Education < 7 years, %	61.2	61.9	0.83
Unable to move independently, %	35.5	28.9	0.009
Nutritional status according to the MNA^3> 23.5 points, %	12.5	10.9
17–23 points, %	59.4	60.6
<17 points, %	28.2	28.5	0.65
Mean body mass index, kg/m^2 (SD^2)	24.0 (5.0)	23.6 (4.9)	0.15
Mean number of medications (SD^2)	10.5 (3.4)	7.2 (3.2)	< 0.001
Laxatives, %	58.9	54.3	0.09
Calcium supplements, %	40.1	24.9	< 0.001
Vitamin D supplements, %	37.7	29.5	0.001
Cholinesterase inhibitor, %	6.5	7.4	0.51
SSRIs^4, %	32.8	24.9	0.001
Low-dose aspirin^5, %	43.9	46.7	0.29
NSAIDs^5, %	5.5	5.2	0.74
Coronary heart disease, %	47.4	34.9	< 0.001
Prior stroke or transient ischemic attack, %	29.4	29.8	0.88
Dementia, %	56.8	73.0	0.001
Prior hip fracture, %	28.5	19.4	< 0.001
Diabetes, %	20.0	16.9	0.14
Cancer, %	15.1	10.3	0.008
Prior ventricular or duodenal ulcer, %	15.0	3.1	< 0.001
Mean Charlson comorbidity index^6 (SD^2)	2.3 (1.3)	2.1 (1.2)	< 0.001
Lactose intolerance, %	15.1	7.8	< 0.001
Celiac disease, %	0.5	0.5	0.98
Constipation, %	44.2	44.3	0.98
Diarrhea, %	19.7	12.9	< 0.001
Frequent vomiting, %	8.2	3.7	< 0.001

Notes: ¹Categorial variables are tested with chi-squared test or Fisher's exact test and continuous variables with t-test or Mann–Whitney U-test. ²SD = standard deviation. ³MNA = Mininutritional Assessment (Vellas et al., [19]). ⁴SSRIs = Serotonin Reuptake Inhibitors. ⁵NSAIDs = Non Steroidal Anti-inflammatory drugs. ⁶Charlson Comorbity Index (Charlson et al., [18]).

Table II. Characteristics of patients divided by having or not having diarrhea.

	Diarrhea (n = 277)	Without diarrhea (n = 1645)	p-value^1
Mean age (SD^2)	84.9 (7.2)	83.5 (7.7)	0.003
Females, %	82.3	82.3	0.41
Nutrition and gastrointestinal symptoms, %
Nutritional status according to MNA,^3 %			0.11
<17 points	33.2	27.5
17–23.5 points	57.8	60.7
> 23.5 points	9.0	11.7
Mean body mass index, kg/m^2 (SD^2)	23.6 (5.0)	23.8 (4.9)	0.43
Drinks at least 5 glasses of fluids/day, %	55.6	60.4	0.079
Eats at least two portions of fruits or vegetables/day, %	77.1	75.9	0.66
Frequent vomiting, %	9.2	3.7	< 0.001
Constipation, %	39.0	43.9	0.13
Medical conditions:
Mean Charlson Comorbidity Index^4 (SD)	2.34 (1.2)	2.09 (1.2)	0.001
Dementia, %	70.4	69.2	0.70
Prior ventricular or duodenal ulcer, %	9.0	4.8	0.007
Prior hip fracture, %	25.2	20.4	0.085
Cancer, %	12.4	10.8	0.46
Coronary heart disease, %	44.3	36.1	0.0013
Diabetes mellitus, %	21.7	16.6	0.047
Prior stroke or transient ischemic attack, %	31.2	28.9	0.45
Lactose intolerance, %	28.1	6.4	< 0.001
Celiac disease, %	1.5	0.3	0.009
Chronic inflammatory bowel disease, %	1.1	0.4	0.11
Use of drugs
Mean number of medications (SD^2)	8.6(3.6)	7.8(3.5)	< 0.001
Laxatives, %	46.2	56.6	0.001
Calcium supplements, %	32.6	27.5	0.083
Vitamin D supplements, %	31.0	31.6	0.86
Cholinesterase inhibitors, %	6.1	7.3	0.34
SSRIs, %	31.8	25.9	0.041
Iron supplements, %	9.7	9.4	0.84
Antibiotics, %	18.4	16.9	0.54
metformin, %	4.0	2.6	0.21
Non-steroidal anti-inflammatory drugs, %	46.2	49.5	0.30

Notes: ¹Categorial variables are tested with chi-squared test or Fisher's exact test and continuous variables with t-test or Mann–Whitney U-test. ²SD = standard deviation. ³MNA = Mininutritional Assessment (Vellas et al., [19]). ⁴Charlson Comorbity Index (Charlson et al., [18]).

Vellas BJ, Guigoz Y, Garry PJ. Facts, research and intervention in geriatrics: Nutrition in the elderly. The Mini Nutritional Assessment (MNA). 3rd. Paris: Serdi Publishing; 1997.

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