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Adverse drug effects in elderly people -- a disparity between clinical examination and adverse effects self-reported by the patient.

https://arctichealth.org/en/permalink/ahliterature164731
Source
Eur J Clin Pharmacol. 2007 May;63(5):509-15
Publication Type
Article
Date
May-2007
Author
Pasi Lampela
Sirpa Hartikainen
Raimo Sulkava
Risto Huupponen
Author Affiliation
Department of Pharmacology and Toxicology, University of Kuopio, P.O. Box 1627, 70211, Kuopio, Finland. Pasi.Lampela@uku.fi
Source
Eur J Clin Pharmacol. 2007 May;63(5):509-15
Date
May-2007
Language
English
Publication Type
Article
Keywords
Adverse Drug Reaction Reporting Systems - statistics & numerical data
Aged
Aged, 80 and over
Data Collection - methods
Drug-Related Side Effects and Adverse Reactions
Female
Finland
Geriatric Assessment - methods
Humans
Male
Physicians - statistics & numerical data
Polypharmacy
Reproducibility of Results
Abstract
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.
Notes
Comment In: Eur J Clin Pharmacol. 2007 Oct;63(10):979-80; author reply 98117618426
PubMed ID
17351768 View in PubMed
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Self-reported sleep duration and cognitive functioning in the general population.

https://arctichealth.org/en/permalink/ahliterature148705
Source
J Sleep Res. 2009 Dec;18(4):436-46
Publication Type
Article
Date
Dec-2009
Author
Erkki Kronholm
Mikael Sallinen
Timo Suutama
Raimo Sulkava
Pertti Era
Timo Partonen
Author Affiliation
Department of Chronic Disease Prevention, National Institute for Health and Welfare, Turku, Finland. erkki.kronholm@thl.fi
Source
J Sleep Res. 2009 Dec;18(4):436-46
Date
Dec-2009
Language
English
Publication Type
Article
Keywords
Adult
Age Factors
Aged
Cognition Disorders - diagnosis - epidemiology - psychology
Cross-Sectional Studies
Disorders of Excessive Somnolence - diagnosis - epidemiology - psychology
Fatigue - epidemiology - psychology
Female
Finland
Geriatric Assessment
Health Status Indicators
Health Surveys
Humans
Judgment
Male
Memory Disorders - diagnosis - epidemiology - psychology
Middle Aged
Neuropsychological Tests - statistics & numerical data
Psychometrics - statistics & numerical data
Questionnaires
Reproducibility of Results
Self Disclosure
Sleep Apnea, Obstructive - diagnosis - epidemiology - psychology
Sleep Deprivation - diagnosis - epidemiology - psychology
Socioeconomic Factors
Statistics as Topic
Abstract
This study investigated the relationship between self-reported sleep factors (sleep duration, insomnia, use of sleeping medicine, probable sleep apnoea and feelings of fatigue and tiredness) with cognitive functioning in 5177 people aged 30 years or older from a cross-sectional representative sample of the adult population in Finland (The Finnish Health 2000 Survey). Previous studies have indicated a U-shaped association between increased health risks and sleep duration; we hypothesized a U-shaped association between sleep duration and cognitive functioning. Objective cognitive functioning was assessed with tasks derived from the Consortium to Establish a Registry for Alzheimer's Disease test battery (verbal fluency, encoding and retaining verbal material). Subjective cognitive functioning and sleep-related factors were assessed with questionnaires. Health status was assessed during a health interview. Depressive and alcohol use disorders were assessed with the Composite International Diagnostic Interview. Medication was recorded during the health examination. Short and long sleep duration, tiredness and fatigue were found to be associated with both objectively assessed and self-reported decreased cognitive functioning. The association was stronger between sleep factors and subjective cognitive function than with objective cognitive tests. These data suggest that self-reported habitual short and long sleep duration reflect both realization of homeostatic sleep need and symptom formation in the context of the individual's health status.
Notes
Comment In: J Sleep Res. 2009 Dec;18(4):385-619941591
PubMed ID
19732318 View in PubMed
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Validity of the Finnish Prescription Register for measuring psychotropic drug exposures among elderly finns: a population-based intervention study.

https://arctichealth.org/en/permalink/ahliterature144539
Source
Drugs Aging. 2010 Apr 1;27(4):337-49
Publication Type
Article
Date
Apr-1-2010
Author
Maria Rikala
Sirpa Hartikainen
Raimo Sulkava
Maarit Jaana Korhonen
Author Affiliation
Kuopio Research Centre of Geriatric Care, School of Pharmacy, University of Eastern Finland, Kuopio, Finland. maria.rikala@uef.fi
Source
Drugs Aging. 2010 Apr 1;27(4):337-49
Date
Apr-1-2010
Language
English
Publication Type
Article
Keywords
Aged
Aged, 80 and over
Antidepressive Agents - administration & dosage - pharmacology
Antipsychotic Agents - administration & dosage - pharmacology
Benzodiazepines - administration & dosage - pharmacology
Data Collection
Databases, Factual
Drug Prescriptions - statistics & numerical data
Drug Utilization - statistics & numerical data
Finland - epidemiology
Humans
Polypharmacy
Reproducibility of Results
Self Disclosure
Abstract
Pharmacoepidemiological studies assessing the associations between psychotropic drug use and adverse events in the elderly frequently employ automated pharmacy databases as the source of exposure data. However, information on the validity of these databases for estimating psychotropic drug exposures in elderly people is scarce.
This study evaluated the validity of the Finnish Prescription Register for estimating current exposures to psychotropic drugs in elderly people. Furthermore, the potential change in the validity over time was determined.
This was a population-based intervention study (GeMS; Geriatric Multidisciplinary Strategy for the Good Care of the Elderly) conducted between 2004 and 2007. Initially, 1000 randomly selected persons aged >or=75 years living in the City of Kuopio, Finland, in November 2003 were invited to participate in the study. Of these, 716 agreed to participate at baseline (2004) and 570 were still available for 3-year follow-up (2007). The validity of the Prescription Register was assessed by comparing it with the self-reported information collected by interviews in 2004 and in 2007 in the GeMS study. Using the self-reported data as a reference standard, sensitivity, specificity and Cohen's kappa statistic (measure of inter-rater agreement for qualitative [categorical] items) with 95% confidence intervals were computed for different categories and subcategories of psychotropic drugs, applying fixed-time windows of 4, 6 and 12 months.
In 2007, the sensitivity varied between psychotropic categories and subcategories, being generally highest with the 12-month time window (0.57-0.96). The specificity was highest with the 4-month time window (0.94-0.99), showing a slight tendency to decrease with an extended time window. The sensitivity and specificity were highest for antidepressants and antipsychotics, followed by benzodiazepines. The agreement was almost perfect (kappa = 0.81-1.00) or substantial (kappa = 0.61-0.80) for all categories and subcategories of psychotropic drugs. Few differences in validity were observed between the two years.
Using self-reported data as a reference standard, the Prescription Register provides valid information on current exposures to antidepressants and antipsychotics in elderly people if the time window is selected with adequate consideration. However, the validity is lower for benzodiazepines, suggesting that other sources of information should be considered when performing pharmacoepidemiological studies.
PubMed ID
20359263 View in PubMed
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