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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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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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Drug Burden Index and hospitalization among community-dwelling older people.

https://arctichealth.org/en/permalink/ahliterature124962
Source
Drugs Aging. 2012 May 1;29(5):395-404
Publication Type
Article
Date
May-1-2012
Author
Eija Lönnroos
Danijela Gnjidic
Sarah N Hilmer
J Simon Bell
Hannu Kautiainen
Raimo Sulkava
Sirpa Hartikainen
Author Affiliation
Kuopio Research Centre of Geriatric Care, University of Eastern Finland, Kuopio, Finland.
Source
Drugs Aging. 2012 May 1;29(5):395-404
Date
May-1-2012
Language
English
Publication Type
Article
Keywords
Aged
Aged, 80 and over
Cholinergic Antagonists - administration & dosage - adverse effects
Dose-Response Relationship, Drug
Female
Finland
Health status
Hospitalization - statistics & numerical data
Humans
Hypnotics and Sedatives - administration & dosage - adverse effects
Length of Stay - statistics & numerical data
Male
Multivariate Analysis
Poisson Distribution
Registries
Regression Analysis
Abstract
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.
PubMed ID
22530705 View in PubMed
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Drug Burden Index associated with function in community-dwelling older people in Finland: a cross-sectional study.

https://arctichealth.org/en/permalink/ahliterature135253
Source
Ann Med. 2012 Aug;44(5):458-67
Publication Type
Article
Date
Aug-2012
Author
Danijela Gnjidic
J Simon Bell
Sarah N Hilmer
Eija Lönnroos
Raimo Sulkava
Sirpa Hartikainen
Author Affiliation
Departments of Clinical Pharmacology and Aged Care, Royal North Shore Hospital, St Leonards, New South Wales, Australia. dgnjidic@med.usyd.edu.au
Source
Ann Med. 2012 Aug;44(5):458-67
Date
Aug-2012
Language
English
Publication Type
Article
Keywords
Activities of Daily Living
Aged, 80 and over
Cholinergic Antagonists - adverse effects
Cross-Sectional Studies
Female
Finland
Geriatric Assessment
Humans
Hypnotics and Sedatives - adverse effects
Male
Residence Characteristics
Abstract
This cross-sectional study aimed to investigate the relationship between exposure to anticholinergic and sedative medications, measured with the Drug Burden Index (DBI), and functional outcomes in community-dwelling older people living in Finland.
The study population consisted of community-dwelling older people (n = 700) enrolled in the Geriatric Multidisciplinary Strategy for the Good Care of the Elderly (GeMS) study. Outcomes included walking speed, chair stands test, grip strength, timed up and go (TUG) test, instrumental activities of daily living (IADL), and Barthel Index.
Exposure to DBI drugs was identified in 37% of participants: 24% had a DBI range between >0
PubMed ID
21495785 View in PubMed
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Muscle strength and sedative load in community-dwelling people aged 75 years and older: a population-based study.

https://arctichealth.org/en/permalink/ahliterature131140
Source
J Gerontol A Biol Sci Med Sci. 2011 Dec;66(12):1384-92
Publication Type
Article
Date
Dec-2011
Author
Heidi T Taipale
J Simon Bell
Danijela Gnjidic
Raimo Sulkava
Sirpa Hartikainen
Author Affiliation
Kuopio Research Centre of Geriatric Care, University of Eastern Finland, Kuopio, Finland. heidi.taipale@uef.fi
Source
J Gerontol A Biol Sci Med Sci. 2011 Dec;66(12):1384-92
Date
Dec-2011
Language
English
Publication Type
Article
Keywords
Aged
Aged, 80 and over
Aging - physiology
Female
Finland
Humans
Hypnotics and Sedatives - administration & dosage - adverse effects
Male
Muscle Strength - drug effects - physiology
Muscle Weakness - etiology - physiopathology
Residence Characteristics
Sampling Studies
Socioeconomic Factors
Abstract
Use of psychotropic and sedative drugs has been associated with impaired muscle strength. Muscle weakness predicts important outcomes for older people including functional disability and mortality. The objective of this study was to investigate if the use of drugs with sedative properties is associated with poorer muscle strength.
Seven-hundred community-dwelling participants, aged 75 years and older, enrolled in the population-based Geriatric Multidisciplinary Strategy for the Good Care of the Elderly (GeMS) study in 2004 were included in the present analyses. Data on demographics, diagnostics, and drug use were collected during standardized interviews, conducted by trained nurses and verified through medical records. Physiotherapists conducted objective tests of handgrip strength, knee extension strength, and the five repeated chair stands test. Sedative load was calculated using a previously published model for each participant.
Twenty-one percent of the participants (n = 147) had a sedative load of 1-2 and 8% (n = 58) had a sedative load 3 or more. After adjusting for covariates, participants with sedative load more than 0 had poorer performance on grip strength (p = .009), knee extension strength (p = .02), and five chair stands (p = .003) than nonusers of drugs with sedative properties. Increasing sedative load was associated with poorer grip strength.
Use of drugs with sedative properties was associated with impaired muscle strength. Although we adjusted for diagnoses affecting physical function, the possibility of confounding by indication cannot be entirely excluded. Given that muscle strength is predictive of functional disability and mortality, further attention should be directed toward conducting regular reviews of drug therapy and reducing use of sedative drugs.
PubMed ID
21934126 View in PubMed
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Nationwide study of antipsychotic use among community-dwelling persons with Alzheimer's disease in Finland.

https://arctichealth.org/en/permalink/ahliterature131871
Source
Int Psychogeriatr. 2011 Dec;23(10):1623-31
Publication Type
Article
Date
Dec-2011
Author
Marja-Liisa Laitinen
J Simon Bell
Piia Lavikainen
Eija Lönnroos
Raimo Sulkava
Sirpa Hartikainen
Author Affiliation
Kuopio Research Centre of Geriatric Care, University of Eastern Finland, Kuopio, Finland. marja-liisa.laitinen@uef.fi
Source
Int Psychogeriatr. 2011 Dec;23(10):1623-31
Date
Dec-2011
Language
English
Publication Type
Article
Keywords
Aged
Aged, 80 and over
Aging - drug effects - psychology
Alzheimer Disease - drug therapy - epidemiology - psychology
Antipsychotic Agents - administration & dosage - therapeutic use
Case-Control Studies
Female
Finland - epidemiology
Humans
Male
Social Environment
Abstract
Antipsychotics continue to be widely used in the treatment of behavioral and psychological symptoms of dementia despite their limited effectiveness and well-known risks, including increased mortality. Our aim was to investigate the national pattern of antipsychotic use among community-dwelling persons with and without Alzheimer's disease (AD) in Finland.
The Social Insurance Institution of Finland (SII) identified all persons with a verified diagnosis of AD in Finland on 31 December 2005. A control for each person with AD, matched in terms of age, sex and region of residence, was also identified. Data on reimbursed drug purchases in 2005 were extracted from the Finnish National Prescription Register. Conditional logistic regression analysis was used to calculate odds ratios (ORs) and 95% confidence intervals (CIs) for the use of antipsychotics.
The study population comprised 28,089 matched pairs of persons with and without AD (mean age 80.0 years, SD 6.8, 32.2% men). The annual prevalence of antipsychotic use was higher among persons with than without AD (22.1% vs. 4.4%, adjusted OR = 5.91; 95% CI 5.91-6.31). Among persons with AD, the prevalence of antipsychotic use was similar across all age groups. Of the antipsychotic users, 85.2% with AD and 51.3% without AD purchased second generation antipsychotics. Most antipsychotic prescriptions - 67.8% in the AD and 62.9% in the non-AD group - were generated in primary care situations.
One-fifth of persons with AD used antipsychotic drugs. Antipsychotic use was six times more prevalent among persons with AD than without AD. Most antipsychotics were prescribed by primary care physicians.
PubMed ID
21867581 View in PubMed
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Use of antidepressants among community-dwelling persons with Alzheimer's disease: a nationwide register-based study.

https://arctichealth.org/en/permalink/ahliterature268450
Source
Int Psychogeriatr. 2015 Apr;27(4):669-72
Publication Type
Article
Date
Apr-2015
Author
Marja-Liisa Laitinen
Eija Lönnroos
J Simon Bell
Piia Lavikainen
Raimo Sulkava
Sirpa Hartikainen
Source
Int Psychogeriatr. 2015 Apr;27(4):669-72
Date
Apr-2015
Language
English
Publication Type
Article
Keywords
Age Factors
Aged
Aged, 80 and over
Alzheimer Disease - complications - drug therapy - psychology
Antidepressive Agents - therapeutic use
Case-Control Studies
Depression - drug therapy - etiology
Female
Finland - epidemiology
Humans
Independent Living - psychology - statistics & numerical data
Male
Middle Aged
Practice Patterns, Physicians' - statistics & numerical data
Registries
Sex Factors
Abstract
Antidepressants are used to treat depression and behavioral symptoms in Alzheimer's disease (AD), although their effectiveness has been questioned and evidence about the risks is accumulating. The objective of this study was to compare antidepressant use among persons with and without AD in Finland.
The Social Insurance Institution of Finland (SII) identified all persons with a verified diagnosis of AD in Finland on December 31, 2005. For each person with AD a comparison person matched for age, sex and region of residence was also identified. Data on reimbursed drug purchases in 2005 were extracted from the Finnish National Prescription Register (FNPR). Conditional logistic regression was used to calculate odds ratios (ORs) and 95% confidence intervals (CIs) for antidepressant use.
The study sample comprised of 28,089 matched pairs of persons with and without AD (mean age 80.0 SD 6.8, 32.2% men).The prevalence of antidepressant use was higher among persons with AD than without AD (29.4% vs. 10.7%, OR = 3.54; 95% CI: 3.38, 3.70). Among the persons with AD, the prevalence of antidepressant use increased with time since AD diagnosis but not with age. Overall, 90.4% of antidepressant users with AD were co-dispensed anti-dementia drugs.
The antidepressant use was three times more prevalent among persons with AD compared to those without. Though the antidepressant selection was largely consistent with clinical practice guidelines, the high prevalence of use warrants further investigation given the uncertain effectiveness and adverse events related to these drugs.
PubMed ID
25412711 View in PubMed
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7 records – page 1 of 1.