Medications with anticholinergic and sedative effects carry significant risks in older people. Adverse events arising from the use of these medications may also lead to hospitalization and contribute to length of stay. The Drug Burden Index (DBI) is a tool that measures a person's total exposure to medications with anticholinergic and sedative properties, using the principles of dose response and maximal effect. Cumulative anticholinergic and sedative drug burden measured using the DBI has been associated with clinically important outcomes in older people. The association between the DBI and hospitalization still remains relatively unknown.
The main aim of this study was to evaluate the relationship between DBI and hospitalization in a population-based sample of community-dwelling older Finns over a 1-year period.
The health status and medication use of 339 community-dwelling =75-year-old Finns were assessed in 2004. Data on hospitalizations over the following year were obtained from the national discharge register. Two different measures were used to assess hospitalizations in the study sample: (i) the proportion of hospitalized participants; and (ii) the number of hospital days per person-year. Estimates for the number of hospital days per person-year and rate ratios (RRs) with 95% confidence intervals (CIs) were calculated using Poisson or negative binomial regression analysis.
A total of 127 participants (38%) were exposed to DBI medications; 27% had a low DBI (>0 to 1); the age, gender and co-morbidity adjusted RR of hospital days per person-year between the exposed and unexposed participants was 1.26 (95% CI 1.18, 1.35). Between the low and high DBI groups, the difference in the number of hospital days per person-year was insignificant (p?=?0.42). In multivariate analyses, the number of regularly used medications (RR?=?1.12 [95% CI 1.00, 1.26] per additional medication) and the measure of basic activities of daily living Barthel Index (RR?=?0.94 [95% CI 0.88, 0.99] per increase) were independently associated with the use of hospital days.
Exposure to DBI medications was associated with a greater use of hospital days, but a cumulative dose-response relationship between DBI and hospitalization was not observed. The number of regularly used medications and functioning in the basic activities of daily living predicted hospital care utilization.
In Central Finland, the age-specific incidence of hip fractures did not change between the years 1982-1983 and 1992-1993 though the total number of hip fractures increased by 11% due to population aging. The objective of this study was to define the current hip fracture rates and the characteristics of patients with hip fracture. The population at risk consisted of 240,000 persons living in the Central Finland Health Care District. Hip fracture patients were identified by using the hospital discharge register, the operation lists, and the register of the Department of Anesthesiology. Patients' residential status, weight, and height, date and time of hip fracture, place of accident and mechanism and type of fracture were obtained from medical records. A total of 597 patients, 415 (69.5%) women and 182 (30.5%) men, were admitted to the hospital for treatment of an acute hip fracture in 2002-2003. The mean age of the patients was 79 (SD 13) years. Among patients aged > or =50 years (n = 577), 80.8% of the hip fractures had occurred indoors, 97.6% with a low-energetic mechanism, and 22.7% during the nighttime. The ratio of trochanteric to cervical fractures was 2:3. Between 1992-1993 and 2002-2003, the total number of hip fractures increased by 70%, from 351 to 597. The fracture rates per 1000 person-years in the age group > or =55 years were 2.0 and 3.9 in 1992-1993 and 2.8 and 5.6 in 2002-2003 for men and women, respectively. The corresponding age-adjusted incidence rate ratio (IRR) for men was 1.36 (95% CI: 1.06 to 1.76), P = 0.017, and for women 1.25 (95% CI: 1.07 to 1.47), P = 0.006. Among men, the IRR was highest in the age group 75-84 years, IRR = 1.67 (95% CI: 1.08 to 2.65), while among women, it was highest in the age group > or =85 years, IRR = 1.33 (95% CI: 1.02 to 1.75). The total number of hip fractures almost doubled within 10 years, and the age-adjusted incidence rate increased in both sexes. The accretion of the hip fracture incidence was more than could be explained merely by changes in population size and structure.
The elderly use more psychotropic medication than the general population, and its use has grown during recent decades. The aim of this study was to describe the use of psychotropics in the home-dwelling elderly aged 75 years or older in Finland. This Kuopio 75+ Study is a population-based health survey. A random sample of 700 subjects were drawn from the total population of people aged 75 years or more in January 1998. A geriatrician and a trained nurse carried out clinical examination and interview about the use of medicines for 523 home-dwelling elderly. At least one psychotropic medication was used by 37% of the sample, and 12% were using two or more psychotropics concomitantly. The psychotropic users were older, more often widowed and living alone compared to subjects without psychotropic medication. The probability of psychotropic use increased linearly with age for anxiolytics/hypnotics or antipsychotics, but not for antidepressants. Psychotropics are commonly used in the elderly, particularly among those aged 85 years or more, who are most vulnerable to adverse effects. Careful consideration is needed before prescribing psychotropics to the elderly.