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The appropriateness of drug use in an older nondemented and demented population.

https://arctichealth.org/en/permalink/ahliterature195054
Source
J Am Geriatr Soc. 2001 Mar;49(3):277-83
Publication Type
Article
Date
Mar-2001
Author
M S Giron
H X Wang
C. Bernsten
M. Thorslund
B. Winblad
J. Fastbom
Author Affiliation
Department of Clinical Neuroscience, Occupational Therapy and Elderly Care Research, Karolinska Institute, Stockholm, Sweden.
Source
J Am Geriatr Soc. 2001 Mar;49(3):277-83
Date
Mar-2001
Language
English
Publication Type
Article
Keywords
Age Factors
Aged
Aged, 80 and over
Chi-Square Distribution
Dementia - drug therapy - epidemiology - psychology
Dose-Response Relationship, Drug
Drug Interactions
Drug Therapy - contraindications - statistics & numerical data
Drug Utilization - statistics & numerical data
Female
Humans
Longitudinal Studies
Male
Mental Competency
Polypharmacy
Population Surveillance
Risk assessment
Safety
Sensitivity and specificity
Sweden - epidemiology
Abstract
To assess the extent of inappropriateness of drug use in an older nondemented and demented population.
Descriptive analysis based on data from a sample of older subjects age 81 years and older. Data were collected from the second follow-up conducted in 1994-1996.
A population-based study of the Kungsholmen project in Stockholm, Sweden.
Drug information was obtained from 681 subjects with a mean age of 86.9 years. The subjects were predominantly women (78%). Thirteen percent resided in institutions and 27.6% were diagnosed with dementia.
Dementia diagnosis based on DSM III-R. Criteria for inappropriateness of drug use: use of drugs with potent anticholinergic properties, drug duplication, potential drug-drug and drug-disease interactions, and inappropriate drug dosage.
The mean number of drugs used was 4.6: 4.5 drugs for nondemented and 4.8 for demented subjects. Nondemented subjects more commonly used cardiovascular-system drugs and demented subjects used nervous-system drugs. Demented subjects were more commonly exposed to drug duplication and to drugs with potent anticholinergic properties, both involving the use of psychotropic drugs. Nondemented subjects were more commonly exposed to potential drug-disease interactions, mostly with the use of cardiovascular drugs. The most common drug combination leading to a potential interaction was the use of digoxin with furosemide, occurring more frequently among nondemented subjects. The most common drug-disease interaction was the use of beta-blockers and calcium antagonists in subjects with congestive heart failure. The doses of drugs taken by both nondemented and demented subjects were mostly lower than the defined daily dose.
There was substantial exposure to presumptive inappropriateness of drug use in this very old nondemented and demented population. The exposure of demented subjects to psychotropic drugs and nondemented subjects to cardiovascular drugs reflect the high frequency of prescribing these drugs in this population.
Notes
Comment In: J Am Geriatr Soc. 2002 Mar;50(3):590; author reply 590-111943065
Comment In: J Am Geriatr Soc. 2002 Feb;50(2):400-112028234
PubMed ID
11300238 View in PubMed
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'Bed-blockers': delayed discharge of hospital patients in a nationwide perspective in Sweden.

https://arctichealth.org/en/permalink/ahliterature73275
Source
Health Policy. 1993 Dec;26(2):155-70
Publication Type
Article
Date
Dec-1993
Author
K. Styrborn
M. Thorslund
Author Affiliation
University Hospital, Uppsala, Sweden.
Source
Health Policy. 1993 Dec;26(2):155-70
Date
Dec-1993
Language
English
Publication Type
Article
Keywords
Aftercare
Aged
Bed Occupancy - legislation & jurisprudence - statistics & numerical data - trends
Comparative Study
Data Collection
Episode of Care
Female
Health Services Misuse - statistics & numerical data
Health Services for the Aged - legislation & jurisprudence - utilization
Hospitals - utilization
Humans
Length of Stay - statistics & numerical data - trends
Patient Discharge - economics - standards - statistics & numerical data
Sweden
Abstract
Between 1989 and 1992 the number of 'bed-blocking' patients in Sweden decreased from 15 to 7% according to national registers containing approx. 4000 patients. Part of this reduction can be explained by the 1992 Elderly Reform, which placed economic responsibility for bed-blockers on municipalities. However, the decrease began before the economic reform, implying that other factors are also involved, such as access to alternative institutional beds and other forms of care. An in-depth study of one district has provided a description of these often elderly patients, their heavy hospital utilization both before and after the bed-blocking period and their mortality. Nearly half the patients were dead within a year. Bed-blocking is a poorly defined concept requiring urgent discussion. Other related topics to which attention should be drawn are the administrative costs of economic control systems and efficient utilization of public resources as a whole.
PubMed ID
10131281 View in PubMed
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Care needs and sources of support in a nationwide sample of elderly in Sweden.

https://arctichealth.org/en/permalink/ahliterature73536
Source
Z Gerontol. 1992 Jan-Feb;25(1):57-62
Publication Type
Article
Author
L. Johansson
M. Thorslund
Author Affiliation
Uppsala University.
Source
Z Gerontol. 1992 Jan-Feb;25(1):57-62
Language
English
Publication Type
Article
Keywords
Activities of Daily Living
Aged
Aged, 80 and over
Female
Health services needs and demand
Homes for the Aged
Humans
Male
Nursing Homes
Research Support, Non-U.S. Gov't
Social Support
Sweden
Abstract
In a representative, nationwide sample of non-institutionalized elderly in Sweden the bulk of help with basic and instrumental ADL came from informal sources. Formal services played a complementary role and were primarily associated with advanced age and living alone. The findings also indicated a strong preference among the elderly for informal support,with the preference for formal services being strongest among the elderly with the greatest need of care.
PubMed ID
1570738 View in PubMed
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Changes in Swedish dental health 1968-91.

https://arctichealth.org/en/permalink/ahliterature62831
Source
Swed Dent J. 1998;22(5-6):211-22
Publication Type
Article
Date
1998
Author
K. Ahacic
I. Barenthin
M. Thorslund
Author Affiliation
Department of Social Work, University of Stockholm, Sweden.
Source
Swed Dent J. 1998;22(5-6):211-22
Date
1998
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Age Factors
Aged
Crowns - statistics & numerical data
DMF Index
Dental Care for Aged - statistics & numerical data
Dental Health Surveys
Dental Restoration, Permanent - statistics & numerical data
Dentures - statistics & numerical data
Humans
Insurance, Dental
Middle Aged
Mouth, Edentulous - epidemiology
Needs Assessment
Oral Health
Questionnaires
Research Support, Non-U.S. Gov't
Sweden - epidemiology
Abstract
Studies of changes in dental health are essential in discussions of national health policy matters. In the Level of Living Survey representative samples of the population aged 18-75 were interviewed in 1968, 1974, 1981, and 1991. In the 1991 survey those aged 76+ were also interviewed. Between all the four waves of the survey edentulousness and partial edentulousness decreased and the proportion of persons with teeth with many fillings, crowns or bridges increased. After 1974 the proportion of persons with teeth in good condition with few or no fillings also increased. The fall in edentulousness indicated a greater improvement in dental health than did the rise of the proportion of people with teeth in good condition. Age-specific comparisons showed that the change affected older people most. The largest fall in edentulousness and partial edentulousness was in ages above 50. This fall led to a nearly equal increase in the same ages of persons that had teeth with many fillings, crowns or bridges. This has meant that dental care needs have risen among older people in particular. The results are discussed in connection with the national dental health insurance scheme which was introduced in 1974.
PubMed ID
9974205 View in PubMed
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[Class and morbidity among the oldest old. A study shows a general connection]

https://arctichealth.org/en/permalink/ahliterature73285
Source
Lakartidningen. 1993 Oct 13;90(41):3547-50, 3553
Publication Type
Article
Date
Oct-13-1993

The de-institutionalization of care of the elderly: some notes about implementation and outcome of a Swedish case-study.

https://arctichealth.org/en/permalink/ahliterature232785
Source
Health Policy. 1988 Aug;10(1):41-56
Publication Type
Article
Date
Aug-1988
Author
M. Thorslund
Source
Health Policy. 1988 Aug;10(1):41-56
Date
Aug-1988
Language
English
Publication Type
Article
Keywords
Aged
Data Collection
Deinstitutionalization - trends
Evaluation Studies as Topic
Health planning
Health Services Research
Health Services for the Aged - supply & distribution
Homes for the Aged - utilization
Humans
Population Dynamics
Statistics as Topic
Sweden
Abstract
During the 1980s the number of institutional beds in Sweden has decreased in relation to the number of elderly in the population. In some communities this development has been drastic. The present paper describes how the implementation of this process in one of these communities was based on action research design. Initially most people regarded the development as a success: more elderly people were able to stay in their homes and institutional places were used more effectively. The situation today is more complicated. Elderly patients finally ending up in institutions are in greater need of care than before. Over-occupation of beds is again common, making the situation more "heavy-going" for the staff. Staff outside the institutions are also experiencing a heavier workload. In view of this, the wisdom of further de-institutionalization is now questioned.
PubMed ID
10288397 View in PubMed
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Delayed discharge of elderly hospital patients--a study of bed-blockers in a health care district in Sweden.

https://arctichealth.org/en/permalink/ahliterature73257
Source
Scand J Soc Med. 1993 Dec;21(4):272-80
Publication Type
Article
Date
Dec-1993
Author
K. Styrborn
M. Thorslund
Author Affiliation
Department of Social Medicine, University Hospital, Uppsala, Sweden.
Source
Scand J Soc Med. 1993 Dec;21(4):272-80
Date
Dec-1993
Language
English
Publication Type
Article
Keywords
Activities of Daily Living
Aged
Aged, 80 and over
Bed Occupancy - statistics & numerical data
Comorbidity
Female
Frail Elderly - statistics & numerical data
Geriatric Assessment
Health services needs and demand
Health Services Research
Hospitals - utilization
Humans
Inpatients - classification - statistics & numerical data
Long-Term Care
Male
Patient Discharge - statistics & numerical data
Research Support, Non-U.S. Gov't
Retrospective Studies
Sweden
Utilization Review
Abstract
With an ageing population an increased pressure on health care resources will be seen in most countries. Patients with delayed discharge from short-term hospitals, sometimes called "bed-blockers", are of special interest in Sweden, especially as liability for payments for these patients has been placed on the municipal authorities by a new reform in 1992. A retrospective study was made of 428 bed-blockers above the age of 64 years from one health district in Uppsala during the two-year period 1987-1988. The median age was 81.6 years, and the majority were women. The patients had a median number of diagnoses of 4.1. Additional medical events/symptoms were noted in half of the patients after they had been classified as medically ready for discharge. Even though they were classified "medically ready" for discharge, they still needed care. One-third needed further rehabilitation and another 1/3 further medical attention. Only 1/10 were independent in daily activities of living. At the final discharge 1/3 actually returned home and 16% died on the acute ward. The results clearly demonstrate that these patients often still had further medical needs after the application for transfer. One crucial question, that needs discussion, is the vague definition of a "bed-blocker". Related questions are when and where should these patients be transferred, as well as the relevance of the term "bed-blocker" from ethical perspectives.
PubMed ID
8310280 View in PubMed
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Drug use by demented and non-demented elderly people.

https://arctichealth.org/en/permalink/ahliterature207406
Source
Age Ageing. 1997 Sep;26(5):383-91
Publication Type
Article
Date
Sep-1997
Author
P. Wills
C B Claesson
L. Fratiglioni
J. Fastbom
M. Thorslund
B. Winblad
Author Affiliation
Stockholm Gerontology Research Centre and Department of Geriatric Medicine, Karolinska Institute, Sweden.
Source
Age Ageing. 1997 Sep;26(5):383-91
Date
Sep-1997
Language
English
Publication Type
Article
Keywords
Aged
Aged, 80 and over
Alzheimer Disease - drug therapy - epidemiology
Antipsychotic Agents - therapeutic use
Dementia - drug therapy - epidemiology
Drug Therapy, Combination
Drug Utilization
Female
Geriatric Assessment - statistics & numerical data
Humans
Institutionalization - statistics & numerical data
Male
Psychotropic Drugs - therapeutic use
Sex Factors
Sweden - epidemiology
Abstract
to determine the use of drugs by demented and non-demented elderly people in a population, by dementia status and type, age, sex and accommodation type.
data were obtained from the Kungsholmen project, a longitudinal community study of people over 75 in Stockholm, Sweden.
85% used at least one medicinal drug, and of these 12% were demented. Mean numbers of drugs used were 2.8 for demented and 3.2 for non-demented people. 45% of demented people and 38% of non-demented people used psychotropic agents. Psychotropic use was higher in women and increased with institutionalization. Antipsychotic agents were used more by demented (22%) than by non-demented (3.5%) people: this was largely explained by differences in accommodation type. The odds ratio (OR) for use of antipsychotics by those in institutions compared with those living in their own homes was 9.32. Opioids were commonly prescribed for demented people. The proportions taking opioids in those using analgesics were 42% in demented and 23% in non-demented people (OR 2.07). Laxatives were used by 18% of the demented people in institutions compared with 39% of non-demented people in institutions.
being in an institution had a stronger association with the use of certain drugs (e.g. psychotropics) than did dementia status. Demented people, especially those in institutions, used a large number of antipsychotics and opioids, but fewer laxatives and minor analgesics. Prescribers and institutional staff should be aware of these factors so they can optimize patient treatment.
PubMed ID
9351483 View in PubMed
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Evaluation research in care of the elderly. Some Swedish experiences.

https://arctichealth.org/en/permalink/ahliterature237423
Source
Scand J Prim Health Care. 1986 Feb;4(1):33-8
Publication Type
Article
Date
Feb-1986
Author
M. Thorslund
Source
Scand J Prim Health Care. 1986 Feb;4(1):33-8
Date
Feb-1986
Language
English
Publication Type
Article
Keywords
Aged
Facility Design and Construction - trends
Health planning - trends
Health Services for the Aged - trends
Homes for the Aged - trends
Humans
Nursing Homes - trends
Outcome and Process Assessment (Health Care) - trends
Patient Admission - trends
Research
Social Environment
Sweden
Abstract
Research projects in order to evaluate social and health care programmes are unusual in Sweden. Evaluation studies have had little or no discernible effect on the planning of services for the elderly which is largely the product of convention rather than rational thinking. It is difficult to carry out evaluation studies in a field that is rapidly changing. The variations in elderly care between different areas, between institutions and over time makes it difficult to devise general methods of evaluation. Of five recent and current Swedish studies two are treating innovations inside institutions, two deal with innovations outside institutions and one is a relocation study. One thing common to these studies is that they are administered by university departments. However, evaluation is too important to be a matter just for university disciplines. We should also encourage local initiatives to start more evaluation of 'their' interventions. It will then be a task for more centrally placed researchers to educate and guide the administrators and representatives from other areas in what respects the result of a local study can be generalized.
PubMed ID
3961307 View in PubMed
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39 records – page 1 of 4.