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Undertreatment of osteoporosis in the oldest old? A nationwide study of over 700,000 older people.

https://arctichealth.org/en/permalink/ahliterature97688
Source
Arch Osteoporos. 2009 Dec;4(1-2):17-23
Publication Type
Article
Date
Dec-2009
Author
Kristina Johnell
Johan Fastbom
Author Affiliation
Aging Research Center, Karolinska Institutet, Gävlegatan 16, 113 30 Stockholm, Sweden.
Source
Arch Osteoporos. 2009 Dec;4(1-2):17-23
Date
Dec-2009
Language
English
Publication Type
Article
Abstract
SUMMARY: We analysed data from elderly people registered in the Swedish Prescribed Drug Register to investigate whether age is associated with use of osteoporosis drugs in a nationwide population. Our results indicate an undertreatment of osteoporosis, particularly with bisphosphonates, in the oldest old in Sweden. INTRODUCTION: The aim of this study was to investigate whether age is associated with use of osteoporosis drugs in a large population of older people. METHODS: We analysed data on age, sex, type of residential area (urban/rural) and dispensed drugs for people aged >/=75 years registered in the Swedish Prescribed Drug Register from October to December 2005 (n = 731,105). Multivariate logistic regression was used to analyse whether age was associated with use of osteoporosis drugs, after adjustment for type of residential area and number of other drugs (a proxy for comorbidity). RESULTS: Osteoporosis drugs were used by 16.1% of the women and 3.4% of the men. The probability of use of bisphosphonates declined with increasing age [ORwomen = 0.36 (95% CI 0.34-0.38) and ORmen = 0.46 (95% CI 0.37-0.56) for age >/=90 years vs. 75-79 years]. Raloxifene was also negatively associated with age. Calcium + vitamin D supplements, however, showed a divergent pattern regarding age. In women, the lowest likelihood of use of calcium + vitamin D supplements occurred in the oldest old (>/=90 years). CONCLUSIONS: Our results indicate an undertreatment of osteoporosis, particularly with bisphosphonates, in the oldest old in Sweden. Future research is needed for understanding the mechanisms behind this age effect.
PubMed ID
20234854 View in PubMed
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Gender and use of hypnotics or sedatives in old age: a nationwide register-based study.

https://arctichealth.org/en/permalink/ahliterature101544
Source
Int J Clin Pharm. 2011 Jul 6;
Publication Type
Article
Date
Jul-6-2011
Author
Kristina Johnell
Johan Fastbom
Author Affiliation
Aging Research Center, Karolinska Institutet and Stockholm University, Gävlegatan 16, 113 30, Stockholm, Sweden, Kristina.Johnell@ki.se.
Source
Int J Clin Pharm. 2011 Jul 6;
Date
Jul-6-2011
Language
English
Publication Type
Article
Abstract
Objective To investigate whether gender is associated with use of hypnotics or sedatives and with different types of hypnotics or sedatives in older people after adjustment for age, socioeconomic status (i.e., education) and co-morbidity (i.e., number of other drugs). Setting Sweden Method We conducted a register-based analysis of data on gender, age, dispensed drugs, and education from people aged 75-89 years registered in the Swedish Prescribed Drug Register between July and October 2005 (n = 645,429). Main outcome measure The hypnotic or sedative drug classes were benzodiazepines, benzodiazepine related drugs (i.e., Z-drugs) and other types of hypnotics or sedatives. The individual hypnotics or sedatives were nitrazepam, flunitrazepam, triazolam, zopiclone, zolpidem, clomethiazole and propiomazine. Results In the total study population, 27.1% of the women and 18.1% of the men were dispensed at least one hypnotic or sedative drug. The logistic regression analyses of those who used hypnotics or sedatives (n = 151,700) revealed that women were more likely than men to use benzodiazepines (adjusted OR = 1.11; 95% CI 1.07-1.14) and benzodiazepine related drugs (adjusted OR = 1.14; 95% CI 1.12-1.17), whereas men were more likely to use other types of hypnotics or sedatives (adjusted OR = 0.69; 95% CI 0.67-0.71). Among the individual hypnotics or sedatives, the strongest associations with gender was found for nitrazepam (adjusted OR = 1.19; 95% CI 1.14-1.25 for women compared with men), zolpidem (adjusted OR = 1.18; 95% CI 1.16-1.21), clomethiazole (adjusted OR = 0.48; 95% CI 0.46-0.51) and propiomazine (adjusted OR = 0.77; 95% CI 0.75-0.79). Conclusion Use of hypnotics or sedatives in old age seems to be related to female gender. Also, among elderly users of hypnotics or sedatives, women appear to be more likely to use benzodiazepines and benzodiazepine related drugs than men. The explanation to these gender differences merits further investigation.
PubMed ID
21732166 View in PubMed
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Comparison of prescription drug use between community-dwelling and institutionalized elderly in Sweden.

https://arctichealth.org/en/permalink/ahliterature120299
Source
Drugs Aging. 2012 Sep;29(9):751-8
Publication Type
Article
Date
Sep-2012
Author
Kristina Johnell
Johan Fastbom
Author Affiliation
Aging Research Center, Karolinska Institutet and Stockholm University, Stockholm, Sweden. Kristina.Johnell@ki.se
Source
Drugs Aging. 2012 Sep;29(9):751-8
Date
Sep-2012
Language
English
Publication Type
Article
Keywords
Aged
Aged, 80 and over
Comorbidity
Drug Prescriptions - statistics & numerical data
Female
Humans
Institutionalization - statistics & numerical data
Logistic Models
Male
Residence Characteristics - statistics & numerical data
Sweden - epidemiology
Abstract
Most previous studies about drug use in the elderly population have either investigated drug use in institutions or in the community-dwelling setting. Hence, very few studies have compared drug use in institutionalized and community-dwelling elderly, maybe because of a lack of sufficiently large databases.
The aim of the study was to investigate differences in drug use patterns between community-dwelling and institutionalized elderly, after adjustment for age, gender and number of other drugs (used as a proxy for overall co-morbidity).
We analysed data from individuals aged =65 years who filled at least one drug prescription between July and September 2008 and were consequently registered in the Swedish Prescribed Drug Register (n = 1,347,564; 1,260,843 community-dwelling and 86,721 institutionalized elderly). A list of current prescriptions was constructed for every individual on the arbitrarily chosen date 30 September 2008. Outcome measures were the 20 most common drug classes and the 20 most common individual drugs. Logistic regression analysis was used to investigate whether institutionalization was associated with use of these drugs, after adjustment for age, gender and number of other drugs.
Institutionalized elderly were more likely than community-dwelling elderly to use antidepressants, laxatives, minor analgesics, opioids and hypnotics/sedatives, after adjustment for age, gender and number of other drugs. On the contrary, institutionalization was negatively associated with use of lipid modifying agents, angiotensin II antagonists, selective calcium channel blockers, ß-blocking agents and ACE inhibitors, after adjustment for age, gender and number of other drugs.
Our results indicate that institutionalized elderly are more likely than community-dwelling elderly to use psychotropics, analgesics and laxatives, but less likely to receive recommended cardiovascular drug therapy, which may indicate a need for implementation of evidence-based guidelines for drug treatment in this vulnerable group of elderly patients. Further research is needed to elucidate to what extent the differences in drug use between community-dwelling and institutionalized elderly are explained by different underlying disease patterns and by different prescribing traditions in the different settings.
PubMed ID
23018611 View in PubMed
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[Shortages in the treatment of depression of the elderly in nursing homes in Stockholm. Diagnosis is based on flimsy ground, follow up performed early]

https://arctichealth.org/en/permalink/ahliterature45744
Source
Lakartidningen. 2004 Nov 11;101(46):3683-4, 3686-8
Publication Type
Article
Date
Nov-11-2004

National indicators for quality of drug therapy in older persons: the Swedish experience from the first 10 years.

https://arctichealth.org/en/permalink/ahliterature271023
Source
Drugs Aging. 2015 Mar;32(3):189-99
Publication Type
Article
Date
Mar-2015
Author
Johan Fastbom
Kristina Johnell
Source
Drugs Aging. 2015 Mar;32(3):189-99
Date
Mar-2015
Language
English
Publication Type
Article
Keywords
Aged
Drug Interactions
Drug Therapy - standards
Humans
Polypharmacy
Sweden
Abstract
Inappropriate drug use is an important health problem in elderly persons. Beginning with the Beers' criteria in the early 1990s, explicit criteria have been extensively used to measure and improve quality of drug use in older people. This article describes the Swedish indicators for quality of drug therapy in the elderly, introduced in 2004 and updated in 2010. These indicators were designed to be applied to people aged 75 years and over, regardless of residence and other characteristics. The indicators are divided into drug specific, covering choice, indication and dosage of drugs, polypharmacy, drug-drug interactions (DDIs), drug use in decreased renal function and in some symptoms; and diagnosis specific, covering the rational, irrational and hazardous drug use in common disorders in elderly people. During the 10 years since introduction, the Swedish indicators have several applications. They form the basis for recommendations for drug therapy in older people, are implemented in prescribing supports and drug utilisation reviews, are used in national benchmarking of the quality of Swedish healthcare and have contributed to initiatives from pensioner organisations. The indicators have also been used in several pharmacoepidemiological studies. Since 2005, there have been signs of improvement of the quality of drug prescribing to elderly persons in Sweden. For example, the prescribing of drugs that should be avoided in older persons decreased by 36 % between 2006 and 2012 in persons aged 80 years and older. Similarly, drug combinations that may cause DDIs decreased by 26 % and antipsychotics by 41 %. The indicators have likely contributed to this.
Notes
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PubMed ID
25673123 View in PubMed
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Institutionalization as a risk factor for inappropriate drug use in the elderly: a Swedish nationwide register-based study.

https://arctichealth.org/en/permalink/ahliterature127160
Source
Ann Pharmacother. 2012 Mar;46(3):339-46
Publication Type
Article
Date
Mar-2012
Author
Ylva Haasum
Johan Fastbom
Kristina Johnell
Author Affiliation
Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm Gerontology Research Center, Stockholm, Sweden. Ylva.Haasum@ki.se
Source
Ann Pharmacother. 2012 Mar;46(3):339-46
Date
Mar-2012
Language
English
Publication Type
Article
Keywords
Aged
Aged, 80 and over
Benzodiazepines - administration & dosage
Cholinergic Antagonists - administration & dosage
Drug Interactions
Drug Utilization - statistics & numerical data
Female
Homes for the Aged - statistics & numerical data
Humans
Institutionalization - statistics & numerical data
Male
Nursing Homes - statistics & numerical data
Polypharmacy
Psychotropic Drugs - administration & dosage
Registries
Residence Characteristics - statistics & numerical data
Risk factors
Sweden
Abstract
Few studies have investigated institutionalization as a potential risk factor for potentially inappropriate drug use (PIDU). Sweden now has unique possibilities for comparisons of drug use in large populations of institutionalized and home-dwelling elderly through linkage of the Swedish Prescribed Drug Register (SPDR) with the Swedish Social Services Register.
To compare PIDU in institutionalized versus home-dwelling elderly persons in Sweden.
We conducted a cross-sectional retrospective study of 1,260,843 home-dwelling and 86,721 institutionalized elderly individuals. We analyzed data on age, sex, and dispensed drugs for individuals aged 65 years or older registered in the SPDR from July to September 2008. Data on type of housing were retrieved from the Social Services Register. The main outcome measures of PIDU were use of anticholinergic drugs, long-acting benzodiazepines, concurrent use of 3 or more psychotropics, and potentially serious drug-drug interactions (DDIs).
Thirty percent of the institutionalized and 12% of the home-dwelling elderly were exposed to PIDU. Living in an institution was strongly associated with overall PIDU (OR 2.36; 95% CI 2.29 to 2.44), use of anticholinergic drugs (OR 2.58; 95% CI 2.48 to 2.68), long-acting benzodiazepines (OR 1.50; 95% CI 1.41 to 1.60), and concurrent use of 3 or more psychotropics (OR 7.26; 95% CI 6.96 to 7.59), after controlling for age, sex, and number of drugs (used as proxy for comorbidity). However, institutionalization was associated with a lower probability of potentially serious DDIs (OR 0.60; 95% CI 0.55 to 0.65).
Our results indicate that institutionalization is a potential risk factor for PIDU. This implies that more cautious prescribing is warranted in institutions, where the frailest and most vulnerable elderly individuals reside. Research is needed to identify underlying risk factors for PIDU within these settings.
PubMed ID
22318931 View in PubMed
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The potential economic consequences of cognitive improvement with losartan.

https://arctichealth.org/en/permalink/ahliterature190767
Source
Blood Press. 2002;11(1):46-52
Publication Type
Article
Date
2002
Author
Linus Jönsson
William Gerth
Johan Fastbom
Author Affiliation
Department of Neuroscience, Occupational Therapy and Elderly Care Research (NEUROTEC), Karolinska Institutet, Stockholm, Sweden. linus.j@healtheconomics.se
Source
Blood Press. 2002;11(1):46-52
Date
2002
Language
English
Publication Type
Article
Keywords
Adult
Aged
Antihypertensive Agents - economics - pharmacology - therapeutic use
Cognition - drug effects
Cognition Disorders - drug therapy - economics - prevention & control
Cost-Benefit Analysis
Female
Humans
Hydrochlorothiazide - pharmacology
Intelligence Tests
Losartan - economics - pharmacology - therapeutic use
Male
Middle Aged
Sweden - epidemiology
Abstract
In a clinical trial, treatment of mild-moderate hypertensive patients with losartan (50 mg) increased Mini-Mental State Examination (MMSE) scores by 4 points from baseline over a 26-month period, compared with a 1-point increase in patients treated with hydrochlorothiazide (25 mg). This study explores the potential economic consequences of this improvement in cognitive function in a population of elderly hypertensive patients in Sweden. Resource use and MMSE data for 437 hypertensive, non-demented subjects aged 75 years and above, were taken from a population-based study in Sweden. MMSE scores were strongly related with costs of care due to higher utilization of home help and special living arrangements in patients with low scores. A 1-point difference in MMSE was associated with a difference in the annual cost of care of approximately 5700 Swedish kronor (SEK). Over 26 months, the potential cost savings from the 4-point improvement observed with losartan was estimated to be between 24700 and 43700 SEK. This can be compared with the acquisition cost of losartan; approximately 5700 SEK over the study period. Thus, an improvement in cognitive function of the magnitude documented in the study of losartan vs hydrochlorothiazide, may translate into economic benefits beyond those expected in terms of blood pressure control.
Notes
Comment In: Blood Press. 2002;11(1):4-511926350
PubMed ID
11926351 View in PubMed
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The association of inappropriate drug use with hospitalisation and mortality: a population-based study of the very old.

https://arctichealth.org/en/permalink/ahliterature67198
Source
Drugs Aging. 2005;22(1):69-82
Publication Type
Article
Date
2005
Author
Inga Klarin
Anders Wimo
Johan Fastbom
Author Affiliation
Division of Geriatric Epidemiology, Neurotec, Karolinska Institutet, Stockholm, Sweden. inga.klarin@neurotec.ki.se
Source
Drugs Aging. 2005;22(1):69-82
Date
2005
Language
English
Publication Type
Article
Keywords
Aged
Aged, 80 and over
Drug Utilization - statistics & numerical data
Female
Hospitalization
Humans
Logistic Models
Longitudinal Studies
Male
Medication Errors - mortality
Pharmaceutical Preparations - adverse effects - contraindications
Research Support, Non-U.S. Gov't
Sweden - epidemiology
Abstract
BACKGROUND AND OBJECTIVE: Inappropriate prescribing is an important and possibly preventable risk factor for adverse drug reactions (ADRs) in the elderly, and hospital-based studies have shown that a large proportion of admissions is a result of ADRs. However, little is known about how inappropriate drug use (IDU) affects the elderly at the population level. The aim of this study was to explore possible associations of IDU with acute hospitalisation and mortality in an elderly population during 3 years of follow-up. PATIENTS AND METHODS: Data from a rural, population-based, longitudinal cohort study within the Kungsholmen Project, Sweden, were used. 785 participants, > or=75 years of age, had complete data on drug use and selected covariates collected during baseline investigation from 1995 to 1998, and were included in the study. Hospitalisation and mortality data during 3 years after inclusion were collected. IDU was assessed at baseline using consensus-based criteria applicable to available data (derived from Beers' criteria, Canadian criteria and clinical indicators of drug-related morbidity in older adults) with the addition of potentially dangerous drug duplication and additional potentially hazardous drug-drug interactions. IDU was defined as presence of at least one inappropriate drug regimen according to the study criteria. Logistic regression and proportional hazard models were used, respectively, to study the association of IDU with hospitalisation and mortality. RESULTS: Drugs were used on a regular or 'as needed' basis by 91.6% of the study population, with a mean of 4.4 drugs per person. IDU was common, with a prevalence of 18.6% and was associated with increased risk of at least one acute hospitalisation in community-living elderly, after adjustment for age, sex, education, comorbidity, dependency in activities of daily living (ADL) and smoking. The odds ratio was 2.72 (95% CI 1.64, 4.51). No association with mortality was found, after adjustment for age, sex, housing, education, comorbidity, ADL-dependency, smoking and body mass index. CONCLUSION: Polypharmacy and IDU are common among the elderly and IDU is associated with acute hospitalisation in community-living elderly. Although causality cannot be established with this study design, the results are consistent with the high prevalence of drug-related hospital admissions found in hospital-based studies. Our results indicate that it is desirable with current knowledge, to reduce IDU through information to physicians and careful prescribing.
PubMed ID
15663350 View in PubMed
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Use of antidepressants in Parkinson's disease: A Swedish register-based study of over 1.5 million older people.

https://arctichealth.org/en/permalink/ahliterature281009
Source
Parkinsonism Relat Disord. 2016 06;27:85-8
Publication Type
Article
Date
06-2016
Author
Ylva Haasum
Johan Fastbom
Kristina Johnell
Source
Parkinsonism Relat Disord. 2016 06;27:85-8
Date
06-2016
Language
English
Publication Type
Article
Keywords
Aged
Aged, 80 and over
Antidepressive Agents - therapeutic use
Cross-Sectional Studies
Female
Humans
Male
Parkinson Disease - diagnosis - drug therapy - epidemiology
Registries
Sweden - epidemiology
Abstract
It has been suggested that depression in Parkinson's Disease (PD) is often unrecognized and undertreated. However, few previous studies have studied the use of antidepressants in a large sample of both home-dwelling and institutionalized elderly persons with PD. We aimed to study the use of antidepressants in older persons using anti-parkinson drugs (APD, used as a proxy for PD), stratified by residential setting.
We analyzed individual data on age, sex, residential setting and drug use in over 1.5 million older persons in the Swedish Prescribed Drug Register on 31th of December 2013.
Twenty-two percent of the home-dwellers and 50% of the institutionalized elderly persons with APD used antidepressants. Persons with APD had a higher probability of use of any antidepressant compared to persons without APD. A selective serotonin reuptake inhibitor (SSRI) was the most commonly used antidepressants in both settings followed by mirtazapin.
The high use of antidepressants among older persons with APD warrants further studies on the quality of treatment of depression in PD.
PubMed ID
27117031 View in PubMed
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Different patterns in use of antibiotics for lower urinary tract infection in institutionalized and home-dwelling elderly: a register-based study.

https://arctichealth.org/en/permalink/ahliterature121293
Source
Eur J Clin Pharmacol. 2013 Mar;69(3):665-71
Publication Type
Article
Date
Mar-2013
Author
Ylva Haasum
Johan Fastbom
Kristina Johnell
Author Affiliation
Aging Research Center, Department of Neurobiology, Care Sciences and Society (NVS), Karolinska Institutet and Stockholm University, Gävlegatan 16, 113 30 Stockholm, Sweden. Ylva.Haasum@ki.se
Source
Eur J Clin Pharmacol. 2013 Mar;69(3):665-71
Date
Mar-2013
Language
English
Publication Type
Article
Keywords
Age Factors
Aged
Anti-Bacterial Agents - adverse effects - therapeutic use
Drug Prescriptions
Drug Utilization - trends
Drug Utilization Review
Female
Guideline Adherence
Homes for the Aged
Humans
Independent living
Institutionalization
Logistic Models
Lower Urinary Tract Symptoms - diagnosis - drug therapy - microbiology
Male
Multivariate Analysis
Odds Ratio
Physician's Practice Patterns - trends
Polypharmacy
Practice Guidelines as Topic
Registries
Sex Factors
Sweden
Urinary Tract Infections - diagnosis - drug therapy - microbiology
Abstract
We compared the quality and pattern of use of antibiotics to treat urinary tract infection (UTI) between institutionalized and home-dwelling elderly.
We analyzed the quality of use of UTI antibiotics in Swedish people aged = 65 years at 30 September 2008 (1,260,843 home-dwelling and 86,721 institutionalized elderly). Data regarding drug use, age and sex were retrieved from the Swedish Prescribed Drug Register and information about type of housing from the Social Services Register. In women, we assessed: (1) the proportion who use quinolones (should be as low as possible); (2) the proportion treated with the recommended drugs (pivmecillinam, nitrofurantoin, or trimethoprim) (proportions should be about 40 %, 40 % and 15-20 %, respectively); In men, we assessed: (1) the proportion who used quinolones or trimethoprim (should be as high as possible).
The 1-day point prevalence for antibiotic use for UTI was 1.6 % among institutionalized and 0.9 % among home-dwelling elderly. Of these, about 15 % of institutionalized and 19 % of home-dwelling women used quinolones. The proportion of women treated with the recommended drugs pivmecillinam, nitrofurantoin or trimethoprim was 29 %, 27 % and 45 % in institutions and 40 %, 28 % and 34 % for home-dwellers. In men treated with antibiotics for UTI, quinolones or trimethoprim were used by about 76 % in institutions and 85 % in home-dwellers.
Our results indicate that recommendations for UTI treatment with antibiotics are not adequately followed. The high use of trimethoprim amongst institutionalized women and the low use of quinolones or trimethoprim among institutionalized men need further investigation.
PubMed ID
22922683 View in PubMed
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50 records – page 1 of 5.