The trend towards polypharmacy is increasing among the elderly, and associated with this trend is an increased risk of adverse drug effects and drug-drug interactions. Our objective was to assess whether drug adverse effects reported by patients are in general agreement with those identified by a physician.
We evaluated the medication of 404 randomly selected individuals aged 75 years or older by means of interviews carried out by trained nurses and examinations conducted by a physician. The medication used by these patients was recorded prior to the physician's examination and modified thereafter if considered appropriate. Adverse effects noted by the physician were compared to those self-reported by the patients.
Almost all of the patients (98.8%) were using at least one drug, and the mean total number of drugs used was 6.5. Adverse effects were self-reported by 11.4% of the patients, whereas the physician observed apparent adverse drug effects in 24.0% of the patients. No adverse effects were reported in 53.2% of the patients. There were only seven patients that had adverse effects that were both self-reported and identified by the physician, and only four of these patients reported the same adverse effect that had been identified by the physician.
There was a great disparity between the adverse effects identified by the physician and those reported by the patients themselves. Based on our results, it would appear that elderly people tend to neglect adverse drug effects and may consider them to be an unavoidable part of normal ageing. Therefore, physicians should enquire about possible adverse effects even though elderly patients may not complain of any drug-related problems.
To assess the effect of a comprehensive geriatric assessment and individually tailored intervention on mobility in older people. In addition, the effectiveness of the geriatric intervention was evaluated among a subgroup of persons with musculoskeletal pain.
Three-year geriatric development project with randomized assignment to intervention and control group.
Research centre, community and assisted living facilities.
Seven hundred and eighty-one Finnish persons aged 75-98 years were assigned to an intervention (n = 404) or control (n = 377) group.
A comprehensive geriatric assessment with a multifactorial intervention lasting two years. The intervention included individualized referrals, recommendations, physical activity counselling and supervised resistance training.
Perceived limitation in walking 400m was gathered annually during the intervention and at the one-year post-intervention follow-up.
The proportion of persons with mobility limitation at the beginning, at the two-year intervention and at the one-year post-intervention follow-up was 16%, 15%, 12% and 14%, respectively, in the intervention group. In the control group, the corresponding proportions were 19%, 18%, 23% and 26%. The treatment effect was significant at the end of the two-year intervention (odds ratio 0.82, 95% confidence interval 0.70-0.96, P = 0.013), and at the one-year post-intervention follow-up (0.84, 0.75-0.94, P = 0.002). The parallel positive effect of the intervention on mobility was even greater among persons with musculoskeletal pain.
The comprehensive geriatric assessment and individually tailored multifactorial intervention had a positive effect on mobility, underlining their importance in health promotion and disability prevention in older people.
High drug consumption among the elderly and inappropriate prescribing practices increase the risk of adverse drug effects in this population. This risk may be decreased by conducting, for example, a medication review alone or as part of a comprehensive geriatric assessment (CGA); however, little is known about the fate of the changes in medication made as a result of the CGA or medication review. To study the performance of the CGA with regards to medication changes and to determine the persistence of these changes over a 1-year period. This study was a population-based intervention study. A random sample of 1000 elderly (age > or =75 years) was randomized either to a CGA group or to a control group. Home-dwelling patients from these groups (n = 331 and n = 313 for intervention and control groups, respectively) were analysed in this study. Study nurses collected information on medication at study entry and 1 year later in both groups; in the intervention group, study physicians assessed, and changed when appropriate, the medication at study entry. The medication changes and their persistence over 1 year were then evaluated. Medication changes were more frequent in the intervention group than in the control group. Regular medication was changed during follow-up in 277 (83.7%) and in 228 (72.8%) [odds ratio (OR) 1.9; 95% CI 1.3, 2.8] patients in the intervention and control groups, respectively. In the intervention group, study physicians were responsible for 35.4% of all new prescriptions and for 15.6% of all drug terminations. Changes took place particularly in the prescription of CNS drugs. About 58% of the drugs initiated by study physicians were still in use 1 year later, and 25.5% of those terminated by study physicians had been reintroduced. Drug intervention as part of a CGA can be used to rationalize the drug therapy of a patient. However, its effectiveness is subsequently partly counteracted by other physicians working in the healthcare system.