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Analgesic use among community-dwelling people aged 75 years and older: A population-based interview study.

https://arctichealth.org/en/permalink/ahliterature142226
Source
Am J Geriatr Pharmacother. 2010 Jun;8(3):233-44
Publication Type
Article
Date
Jun-2010
Author
Niina Pokela
J Simon Bell
Katri Lihavainen
Raimo Sulkava
Sirpa Hartikainen
Author Affiliation
Kuopio Research Centre of Geriatric Care, University of Eastern Finland, Kuopio, Finland.
Source
Am J Geriatr Pharmacother. 2010 Jun;8(3):233-44
Date
Jun-2010
Language
English
Publication Type
Article
Keywords
Activities of Daily Living
Aged
Aged, 80 and over
Analgesics - therapeutic use
Analgesics, Opioid - therapeutic use
Cross-Sectional Studies
Data Collection
Depression - complications
Female
Finland
Health status
Humans
Male
Multivariate Analysis
Pain - drug therapy
Polypharmacy
Residence Characteristics - statistics & numerical data
Sex Factors
Abstract
Pain is often underrecognized and undertreated among older people. However, older people may be particularly susceptible to adverse drug reactions linked to prescription and nonprescription analgesics.
The aims of this study were to assess the prevalence of analgesic use among a random sample of community-dwelling people aged >or=75 years, and to investigate factors associated with daily and as-needed analgesic use.
A random sample of people aged >or=75 years was drawn from the population register in Kuopio, Finland, in November 2003. Data on prescription and nonprescription analgesic use were elicited during nurse interviews conducted once for each participant in 2004. Self-reported drug utilization data were verified against medical records. The interview included items pertaining to sociodemographic factors, living conditions, social contacts, health behavior, and state of health. Physical function was assessed using the Instrumental Activities of Daily Living Scale, and the 10-item Barthel Index. Self-rated mobility was assessed by asking whether respondents could walk 400 meters (yes, yes with difficulty but without help, not without help, or no). Cognitive function was assessed using the Mini-Mental State Examination. The presence of depressive symptoms was assessed using the 15-item Geriatric Depression Scale. Respondents' self-rated health was determined using a 5-point scale (very poor, poor, moderate, good, or very good).
Of the initial random sample of participants (N = 1000), 700 provided consent to participate and were community dwelling. Among the participants, 318 (45.4%) were users of >or=1 analgesic on a daily or as-needed basis. Only 23.3% of analgesic users took an analgesic on a daily basis. Factors associated with any analgesic use included female sex (odds ratio [OR], 1.78 [95 degrees % CI, 1.17-2.71]), living alone (OR, 1.46 [95 degrees % CI, 1.02-2.11]), poor self-rated health (OR, 2.6 [95% CI, 1.22-3.84]), and use of >or=10 nonanalgesic drugs (OR, 2.21 [95% CI, 1.26-3.87]). Among users of >or=1 oral analgesic, factors associated with opioid use included moderate (OR, 2.46 [95% CI, 1.175.14]) and poor (OR, 2.57 [95% CI, 1.03-6.42]) self-rated health. Opioid use (OR, 0.19 [95% CI, 0.04-0.86]) and daily analgesic use (OR, 0.16 [95% CI, 0.34-0.74]) were inversely associated with depressive symptoms. Pain in the previous month was reported by 71.4% of analgesic users and 26.4% of nonusers of analgesics.
Analgesics were used by approximately 50% of community-dwelling people aged >or=75 years. However, age was not significantly associated with increased use of analgesics in multivariate analysis. The majority of analgesic drugs were used on an as-needed rather than a daily basis (76.7% vs 23.3%, respectively). Factors most significantly associated with analgesic use were female sex, living alone, poor self-rated health, and use of >or=10 nonanalgesic drugs.
PubMed ID
20624613 View in PubMed
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Analgesic use and frailty among community-dwelling older people: a population-based study.

https://arctichealth.org/en/permalink/ahliterature117548
Source
Drugs Aging. 2013 Feb;30(2):129-36
Publication Type
Article
Date
Feb-2013
Author
Marjaana P H Koponen
J Simon Bell
Niina M Karttunen
Irma A Nykänen
Franciska A M Desplenter
Sirpa A Hartikainen
Author Affiliation
Kuopio Research Centre of Geriatric Care, School of Pharmacy, University of Eastern Finland, 70211 Kuopio, Finland. marjaana.koponen@uef.fi
Source
Drugs Aging. 2013 Feb;30(2):129-36
Date
Feb-2013
Language
English
Publication Type
Article
Keywords
Aged
Analgesics - therapeutic use
Drug Utilization - statistics & numerical data
Female
Finland - epidemiology
Frail Elderly - statistics & numerical data
Humans
Male
Pain - drug therapy - epidemiology
Pain Measurement
Residence Characteristics
Abstract
Frail older people have a decreased ability to respond to stressors and may therefore be more susceptible to adverse events related to inadequately treated pain. Conversely, aging- and frailty-related changes in pharmacokinetics and pharmacodynamics may predispose frail older people to adverse events of analgesics.
The aim of this study was to explore whether analgesic use is associated with frailty status and whether there are differences in the types of analgesics used between frailty groups among community-dwelling older people.
The study population consisted of 605 community-dwelling people aged >75 years. Demographic, diagnostic and drug use data were collected during standardized nurse interviews. Participants were classified as frail, pre-frail or robust using the Cardiovascular Health Study frailty criteria (weight loss, weakness, exhaustion, slowness and low physical activity).
Overall, 11.4 % (n = 69) of the study participants were frail and 49.4 % (n = 299) were pre-frail. The prevalence of prescription and non-prescription analgesic use was higher among frail (68.1 %) than among pre-frail (54.5 %) and robust (40.5 %) older people (p
PubMed ID
23288603 View in PubMed
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Anticholinergic drug use and mortality among residents of long-term care facilities: a prospective cohort study.

https://arctichealth.org/en/permalink/ahliterature143410
Source
J Clin Pharmacol. 2011 Feb;51(2):256-63
Publication Type
Article
Date
Feb-2011
Author
Eeva-Katri Kumpula
J Simon Bell
Helena Soini
Kaisu H Pitkälä
Author Affiliation
Kuopio Research Centre of Geriatric Care, University of Eastern Finland, Box 1627, Kuopio 70211, Finland.
Source
J Clin Pharmacol. 2011 Feb;51(2):256-63
Date
Feb-2011
Language
English
Publication Type
Article
Keywords
Aged
Aged, 80 and over
Cause of Death
Cholinergic Antagonists - therapeutic use
Cohort Studies
Cross-Sectional Studies
Female
Finland
Humans
Long-Term Care - statistics & numerical data
Male
Proportional Hazards Models
Prospective Studies
Abstract
Few studies have investigated the possible association between use of anticholinergic drugs and mortality. The objectives of this study were to investigate the prevalence and determinants of anticholinergic drug use and the possible association between anticholinergic drug use and mortality. Data were obtained from 53 long-term care wards in Helsinki, Finland, in 2003. Medication, diagnostic, and mortality data were available for 1004 residents. Each resident's anticholinergic load was calculated using the Anticholinergic Risk Scale (ARS). Cox proportional hazards models were used to investigate the risk of death among users with a mild anticholinergic load (ARS score 1-2) and high load (ARS score =3) compared with nonusers of anticholinergic drugs. Age, sex, and nutritional status were used as covariates. Among the 1004 residents, 455 (45%) were nonusers of anticholinergic drugs, 363 (36%) had a mild anticholinergic load, and 186 (19%) had a high anticholinergic load. One-year all-cause mortality rates were 28%, 29%, and 27%, respectively. Higher ARS scores were not associated with mortality (ARS score 1-2: hazard ratio 1.08; 95% confidence interval, 0.84-1.41; ARS score =3: hazard ratio 1.05; 95% confidence interval, 0.75-1.46). Anticholinergic drug use was common; however, high ARS scores were not associated with mortality. Further research is needed using alternative models and among different resident populations.
PubMed ID
20489026 View in PubMed
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Anticholinergic drug use, serum anticholinergic activity, and adverse drug events among older people: a population-based study.

https://arctichealth.org/en/permalink/ahliterature115704
Source
Drugs Aging. 2013 May;30(5):321-30
Publication Type
Article
Date
May-2013
Author
Pasi Lampela
Piia Lavikainen
J Arturo Garcia-Horsman
J Simon Bell
Risto Huupponen
Sirpa Hartikainen
Author Affiliation
Kuopio Research Centre of Geriatric Care, University of Eastern Finland, Kuopio Campus, P.O. Box 1627, 70211 Kuopio, Finland. Pasi.Lampela@uef.fi
Source
Drugs Aging. 2013 May;30(5):321-30
Date
May-2013
Language
English
Publication Type
Article
Keywords
Activities of Daily Living
Aged
Aged, 80 and over
Animals
Cerebral Cortex - metabolism
Cholinergic Antagonists - adverse effects - blood - therapeutic use
Depression - prevention & control
Female
Finland
Geriatric Assessment
Humans
Male
Mental Status Schedule
Pulmonary Disease, Chronic Obstructive - drug therapy
Rats
Rats, Wistar
Urinary Bladder, Overactive - drug therapy
Abstract
The serum anticholinergic activity (SAA) assay has been used to quantify patients' anticholinergic load. In addition, several ranked lists of anticholinergic drugs have been developed to assess anticholinergic drug burden.
This study investigated whether SAA assay results and scores from three ranked lists of anticholinergic drugs (Carnahan's Anticholinergic Drug Scale, Rudolph's Anticholinergic Risk Scale, and Chew's list) are associated with anticholinergic adverse drug events (ADEs) in older people.
We analyzed data from participants in the population-based Geriatric Multidisciplinary Good Care of the Elderly Study in Kuopio, Finland (n = 621). Demographic, diagnostic, and drug use data were collected during standardized interviews and verified from medical records. Vision, functional capacity, cognition, and mood were assessed using validated techniques. The SAA was measured from blood samples.
The SAA was not associated with anticholinergic ADEs. Anticholinergic drug burden computed using each of the three lists was inversely associated with short-distance vision (p 
Notes
Comment In: J Urol. 2014 Aug;192(2):49025035017
PubMed ID
23475596 View in PubMed
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Benzodiazepine discontinuation among community-dwelling older people: a population-based cohort study.

https://arctichealth.org/en/permalink/ahliterature140795
Source
Eur J Clin Pharmacol. 2011 Jan;67(1):105-6
Publication Type
Article
Date
Jan-2011

Change in psychotropic drug use among community-dwelling people aged 75 years and older in Finland: repeated cross-sectional population studies.

https://arctichealth.org/en/permalink/ahliterature134674
Source
Int Psychogeriatr. 2011 Oct;23(8):1278-84
Publication Type
Article
Date
Oct-2011
Author
Franciska Desplenter
Charlotte Caenen
Jolein Meelberghs
Sirpa Hartikainen
Raimo Sulkava
J Simon Bell
Author Affiliation
Kuopio Research Centre of Geriatric Care, University of Eastern Finland, Kuopio, Finland.
Source
Int Psychogeriatr. 2011 Oct;23(8):1278-84
Date
Oct-2011
Language
English
Publication Type
Article
Keywords
Aged
Aged, 80 and over
Anti-Anxiety Agents - therapeutic use
Antidepressive Agents - therapeutic use
Antipsychotic Agents - therapeutic use
Chi-Square Distribution
Cross-Sectional Studies
Female
Finland - epidemiology
Health status
Humans
Hypnotics and Sedatives - therapeutic use
Independent Living - psychology - statistics & numerical data
Logistic Models
Male
Odds Ratio
Physician's Practice Patterns - statistics & numerical data
Psychotropic Drugs - therapeutic use
Socioeconomic Factors
Statistics, nonparametric
Abstract
Older people are at high risk of experiencing psychotropic-related adverse drug events. The objective of this study was to compare and contrast the use of psychotropic drugs among community-dwelling people aged = 75 years in 1998 and 2004.
Comparable random samples of people aged = 75 years were extracted from the population register in Kuopio, Finland, in 1998 (n = 700) and 2003 (n = 1000). In 1998 and 2004, 523 and 700 community-dwelling people respectively participated in nurse interviews, during which demographic, diagnostic and drug use data were elicited. Logistic regression was used to compute unadjusted and adjusted odds ratios (ORs) and 95% confidence intervals (CIs) for the prevalence of psychotropic drug use in 2004 compared to 1998.
The unadjusted prevalence of total psychotropic (37.3% and 38.4%, OR 1.05; 95% CI 0.83-1.33), anxiolytic, hypnotic and sedative (29.6% and 31.3%, OR 1.08, 95% CI 0.85-1.38), and antidepressant (10.7% and 11.9%, OR 1.12, 95% CI 0.78-1.61) use were similar in 1998 and 2004. There was a decrease in the unadjusted prevalence of antipsychotic use (9.2% and 5.7%, OR 0.60; 95% CI 0.39-0.93). After adjusting for socioeconomic and health status differences, there was an increase in the prevalence of total psychotropic (adjusted OR 1.31, 95% CI 1.01-1.70) and antidepressant (OR 1.59, 95% CI 1.06-2.40) use.
The unadjusted prevalence of psychotropic drug use remained stable between 1998 and 2004. However, in adjusted analyses there was a small increase in the prevalence of any psychotropic drug use and antidepressant use specifically.
PubMed ID
21554797 View in PubMed
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Coexisting social conditions and health problems among clients seeking treatment for illicit drug use in Finland: the HUUTI study.

https://arctichealth.org/en/permalink/ahliterature114452
Source
BMC Public Health. 2013;13:380
Publication Type
Article
Date
2013
Author
Ifeoma N Onyeka
Caryl M Beynon
Hanna Uosukainen
Maarit Jaana Korhonen
Jenni Ilomäki
J Simon Bell
Mika Paasolainen
Niko Tasa
Jari Tiihonen
Jussi Kauhanen
Author Affiliation
Institute of Public Health and Clinical Nutrition, Faculty of Health Sciences, University of Eastern Finland, P,O,Box 1627, Kuopio, FI, 70211, Finland. Ifeoma.onyeka@uef.fi
Source
BMC Public Health. 2013;13:380
Date
2013
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Communicable Diseases - epidemiology
Comorbidity
Cross-Sectional Studies
Depression - epidemiology
Female
Finland - epidemiology
Humans
Male
Patient Acceptance of Health Care
Questionnaires
Social Problems - statistics & numerical data
Street Drugs
Substance Abuse Treatment Centers - utilization
Substance-Related Disorders - epidemiology - rehabilitation
Abstract
Illicit drug use is an important public health problem. Identifying conditions that coexist with illicit drug use is necessary for planning health services. This study described the prevalence and factors associated with social and health problems among clients seeking treatment for illicit drug use.
We carried out cross-sectional analyses of baseline data of 2526 clients who sought treatment for illicit drug use at Helsinki Deaconess Institute between 2001 and 2008. At the clients' first visit, trained clinicians conducted face-to-face interviews using a structured questionnaire. Logistic regression was used to compute adjusted odds ratios (AORs) and 95% confidence intervals (CIs) for factors associated with social and health problems.
The mean age of the clients was 25 years, 21% (n?=?519) were homeless, 54% (n?=?1363) were unemployed and 7% (n?=?183) had experienced threats of violence. Half of the clients (50%, n?=?1258) were self-referred and 31% (n?=?788) used opiates as their primary drugs of abuse. Hepatitis C (25%, n?=?630) was more prevalent than other infectious diseases and depressive symptoms (59%, n?=?1490) were the most prevalent psychological problems. Clients who were self-referred to treatment were most likely than others to report social problems (AOR?=?1.86; 95% CI?=?1.50-2.30) and psychological problems (AOR?=?1.51; 95% CI?=?1.23-1.85). Using opiates as primary drugs of abuse was the strongest factor associated with infectious diseases (AOR?=?3.89; 95% CI?=?1.32-11.46) and for reporting a combination of social and health problems (AOR?=?3.24; 95% CI?=?1.58-6.65).
The existence of illicit drug use with other social and health problems could lead to increased utilisation and cost of healthcare services. Coexisting social and health problems may interfere with clients' treatment response. Our findings support the call for integration of relevant social, medical and mental health support services within drug treatment programmes.
Notes
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PubMed ID
23617549 View in PubMed
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Community pharmacy services for drug misuse: attitudes and practices of Finnish pharmacists.

https://arctichealth.org/en/permalink/ahliterature265962
Source
Int J Drug Policy. 2014 Nov;25(6):1139-42
Publication Type
Article
Date
Nov-2014

Concomitant use of SSRIs, NSAIDs/aspirin and gastroprotective drugs among residents of long-term care facilities: a medical record review.

https://arctichealth.org/en/permalink/ahliterature136585
Source
Clin Drug Investig. 2011;31(5):337-44
Publication Type
Article
Date
2011
Author
J Simon Bell
Heidi T Taipale
Helena Soini
Kaisu H Pitkälä
Author Affiliation
Kuopio Research Centre of Geriatric Care, University of Eastern Finland, Kuopio, Finland. simon.bell@uef.fi
Source
Clin Drug Investig. 2011;31(5):337-44
Date
2011
Language
English
Publication Type
Article
Keywords
Aged
Aged, 80 and over
Anti-Inflammatory Agents, Non-Steroidal - administration & dosage - adverse effects
Aspirin - administration & dosage - adverse effects
Drug Interactions
Female
Finland - epidemiology
Gastrointestinal Agents - therapeutic use
Gastrointestinal Hemorrhage - chemically induced - epidemiology - prevention & control
Humans
Long-Term Care - statistics & numerical data
Male
Medical Records
Serotonin Uptake Inhibitors - administration & dosage - adverse effects
Abstract
Concomitant use of selective serotonin reuptake inhibitors (SSRIs) and nonsteroidal anti-inflammatory drugs (NSAIDs) [including aspirin (acetylsalicylic acid)] may potentiate the likelihood of upper gastrointestinal haemorrhage (UGIH). The objectives of this study were to determine the prevalence and factors associated with concomitant SSRI/NSAID use among residents of long-term care facilities, and to investigate the use of gastroprotective drugs among concomitant SSRI/NSAID users.
The study sample comprised 1087 out of 1444 residents of all 53 long-term care wards in Helsinki, Finland, in September 2003. Data were extracted from residents' medication charts and medical records by trained nurses. Medication, diagnostic and mortality data were available for 1004 residents.
Among the 1004 residents (mean?±?SD age 81.3?±?10.9 years), 28% used an SSRI, 38% used an NSAID and 24% used a gastroprotective drug. Thirteen percent of residents were concomitant users of SSRIs/NSAIDs. Concomitant use was associated with diabetes mellitus (p?
PubMed ID
21366362 View in PubMed
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Cost-related barriers to use of health services and prescription medicines in Finland: a cross-sectional survey.

https://arctichealth.org/en/permalink/ahliterature270537
Source
Eur J Public Health. 2015 Jun;25(3):368-72
Publication Type
Article
Date
Jun-2015
Author
Katri Aaltonen
Jani Miettinen
Ilpo Airio
Jaana E Martikainen
Leena K Saastamoinen
J Simon Bell
Sirpa Hartikainen
Pauline Norris
Source
Eur J Public Health. 2015 Jun;25(3):368-72
Date
Jun-2015
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Age Factors
Aged
Cross-Sectional Studies
Family Characteristics
Female
Finland
Health Care Surveys - methods - statistics & numerical data
Health Services Accessibility - economics
Humans
Male
Middle Aged
Prescription Drugs - economics
Socioeconomic Factors
Young Adult
Abstract
The objective was to examine cost-related barriers to using health services and prescription medicines in Finland.
A survey that examined adults' experiences of and opinions about the social security system was mailed to a random population-based sample of 5000 Finns aged 18-74 years. The survey assessed households' cost-related barriers to use of health services, prescription medicines and social assistance in the past year. The responses were adjusted for sociodemographic and health predictors by weighting and logistic regression.
Responses were received from 1770 households. In total, 18% had experienced at least one cost-related barrier; 11% did not fill a prescription, 8% did not go to hospital and 13% went without another form of treatment. Of respondents diagnosed with a disabling illness or impairment, 32% reported at least one cost-related barrier. Households with below-average income reported barriers twice as often as above-average income households, after adjusting for age and health. Lower income [lowest tertile, odds ratio (OR) 5.0 compared with highest tertile], fair/poor self-assessed health (fair/poor OR 7.1 compared with very good/good), younger age (18-34 years OR 3.8 compared with 65-74 years), lower education (primary OR 1.6 compared with tertiary) and female gender (OR 1.4) were significantly associated with more frequent cost-related barriers. Overall, 34% of households who encountered cost-related barriers had applied for and 17% had received social assistance.
Cost-related barriers were common among respondents with low income and/or poor health. These barriers may thus have a role in creating inequities in access to health care in Finland.
PubMed ID
25395397 View in PubMed
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46 records – page 1 of 5.