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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
Less detail

Anticholinergic burden and dry mouth among Finnish, community-dwelling older adults.

https://arctichealth.org/en/permalink/ahliterature294919
Source
Gerodontology. 2018 Mar; 35(1):3-10
Publication Type
Journal Article
Date
Mar-2018
Author
Antti Tiisanoja
Anna-Maija Syrjälä
Kaija Komulainen
Pasi Lampela
Sirpa Hartikainen
Heidi Taipale
Matti Knuuttila
Pekka Ylöstalo
Author Affiliation
Unit of Oral Health Sciences Research, University of Oulu, Oulu, Finland.
Source
Gerodontology. 2018 Mar; 35(1):3-10
Date
Mar-2018
Language
English
Publication Type
Journal Article
Keywords
Aged
Aged, 80 and over
Cholinergic Antagonists - adverse effects - therapeutic use
Finland - epidemiology
Humans
Independent living
Male
Poisson Distribution
Saliva - secretion
Xerostomia - chemically induced - epidemiology
Abstract
The aim was to study whether the anticholinergic burden of drugs is related to xerostomia and salivary secretion among community-dwelling elderly people.
Anticholinergic drugs have been shown to be a risk factor for dry mouth, but little is known about the effects of cumulative exposure to anticholinergic drugs measured by anticholinergic burden on salivary secretion or xerostomia.
The study population consisted of 152 community-dwelling, dentate, non-smoking, older people from the Oral Health GeMS study. The data were collected by interviews and clinical examinations. Anticholinergic burden was determined using the Anticholinergic Drug Scale (ADS). A Poisson regression model with robust error variance was used to estimate relative risks (RR) with 95% confidence intervals (CI 95%).
Participants with a high-anticholinergic burden (ADS = 3) were more likely to have xerostomia (RR: 3.17; CI: 1.44-6.96), low-unstimulated salivary flow (
PubMed ID
28940566 View in PubMed
Less detail

Anticholinergic drug use, serum anticholinergic activity, and adverse drug events among older people: a population-based study.

https://arctichealth.org/en/permalink/ahliterature115704
Source
Drugs Aging. 2013 May;30(5):321-30
Publication Type
Article
Date
May-2013
Author
Pasi Lampela
Piia Lavikainen
J Arturo Garcia-Horsman
J Simon Bell
Risto Huupponen
Sirpa Hartikainen
Author Affiliation
Kuopio Research Centre of Geriatric Care, University of Eastern Finland, Kuopio Campus, P.O. Box 1627, 70211 Kuopio, Finland. Pasi.Lampela@uef.fi
Source
Drugs Aging. 2013 May;30(5):321-30
Date
May-2013
Language
English
Publication Type
Article
Keywords
Activities of Daily Living
Aged
Aged, 80 and over
Animals
Cerebral Cortex - metabolism
Cholinergic Antagonists - adverse effects - blood - therapeutic use
Depression - prevention & control
Female
Finland
Geriatric Assessment
Humans
Male
Mental Status Schedule
Pulmonary Disease, Chronic Obstructive - drug therapy
Rats
Rats, Wistar
Urinary Bladder, Overactive - drug therapy
Abstract
The serum anticholinergic activity (SAA) assay has been used to quantify patients' anticholinergic load. In addition, several ranked lists of anticholinergic drugs have been developed to assess anticholinergic drug burden.
This study investigated whether SAA assay results and scores from three ranked lists of anticholinergic drugs (Carnahan's Anticholinergic Drug Scale, Rudolph's Anticholinergic Risk Scale, and Chew's list) are associated with anticholinergic adverse drug events (ADEs) in older people.
We analyzed data from participants in the population-based Geriatric Multidisciplinary Good Care of the Elderly Study in Kuopio, Finland (n = 621). Demographic, diagnostic, and drug use data were collected during standardized interviews and verified from medical records. Vision, functional capacity, cognition, and mood were assessed using validated techniques. The SAA was measured from blood samples.
The SAA was not associated with anticholinergic ADEs. Anticholinergic drug burden computed using each of the three lists was inversely associated with short-distance vision (p 
Notes
Comment In: J Urol. 2014 Aug;192(2):49025035017
PubMed ID
23475596 View in PubMed
Less detail

Comprehensive geriatric assessment decreases prevalence of orthostatic hypotension in older persons.

https://arctichealth.org/en/permalink/ahliterature116373
Source
Scand J Public Health. 2013 Jun;41(4):351-8
Publication Type
Article
Date
Jun-2013
Author
Pasi Lampela
Piia Lavikainen
Risto Huupponen
Esko Leskinen
Sirpa Hartikainen
Author Affiliation
Kuopio Research Centre of Geriatric Care, University of Eastern Finland, Kuopio, Finland. Pasi.Lampela@uef.fi
Source
Scand J Public Health. 2013 Jun;41(4):351-8
Date
Jun-2013
Language
English
Publication Type
Article
Keywords
Aged
Aged, 80 and over
Female
Finland - epidemiology
Follow-Up Studies
Geriatric Assessment - methods
Humans
Hypotension, Orthostatic - epidemiology - prevention & control
Male
Markov Chains
Models, Theoretical
Prevalence
Abstract
Orthostatic hypotension (OH) is associated with significant morbidity and mortality among older people. We have studied whether its prevalence can be reduced by a Comprehensive Geriatric Assessment (CGA).
1000 randomly-selected persons aged =75 years were divided into intervention (n = 500) and control groups (n = 500). We focused on those subjects in whom an orthostatic blood pressure test had been performed at least once during the study period (2004-2007) (n = 365 and 332 for intervention and control groups, respectively). A CGA, including evaluation of the adequacy of the medication, was performed annually in the intervention group but not in the control group. We conducted Markov models to study change in the OH profiles and the effect of CGA on it. Competing risk of mortality was modeled as an absorbing state to avoid attrition bias.
Over 3 years, the prevalence of OH decreased (35.0% ? 28.0%) in the intervention group, whereas its prevalence increased in the control group (32.8% ? 40.8%). By Markov models it was shown that CGA had a statistically significant effect on recovering from OH. In addition, CGA was shown to protect from developing OH.
Repeated CGA performed annually can reduce the prevalence of OH.
PubMed ID
23404180 View in PubMed
Less detail

The effect of comprehensive geriatric assessment on anticholinergic exposure assessed by four ranked anticholinergic lists.

https://arctichealth.org/en/permalink/ahliterature283602
Source
Arch Gerontol Geriatr. 2017 Jan - Feb;68:195-201
Publication Type
Article
Author
Pasi Lampela
Heidi Taipale
Piia Lavikainen
Sirpa Hartikainen
Source
Arch Gerontol Geriatr. 2017 Jan - Feb;68:195-201
Language
English
Publication Type
Article
Keywords
Aged
Aged, 80 and over
Cholinergic Antagonists
Drug Utilization - statistics & numerical data
Female
Finland
Follow-Up Studies
Geriatric Assessment - methods
Humans
Independent living
Male
Outcome Assessment (Health Care)
Abstract
Older people often use multiple drugs, and some of them have anticholinergic activity. Anticholinergic drugs may cause adverse reactions, and therefore their use should be limited. To identify anticholinergic load, several ranked lists with different drugs and scoring systems have been developed and used widely in research. We investigated, if a comprehensive geriatric assessment (CGA) decreased the anticholinergic drug score in a 4-year period. We used four different anticholinergic ranked lists to determine the anticholinergic score and to describe how the results differ depending on the list used.
We analyzed data from population-based intervention study, in which a random sample of 1000 persons aged =75 years were randomized to either an intervention group or a control group. Those in the intervention group underwent CGA including medication assessment annually between 2004 and 2007. Current medication use was assessed annually. The anticholinergic load was calculated by using four ranked lists of anticholinergic drugs (Boustani's, Carnahan's, Chew's and Rudolph's) for each person and for each year.
CGA had no statistically significant effect on anticholinergic exposure during the 4-year follow-up, but improvements towards more appropriate medication use were observed especially in the intervention group. However, age, gender and functional comorbidity index were associated to higher anticholinergic exposure, depending on the list used.
Repeated CGAs may result as more appropriate anticholinergic medication use. The selection of the list may affect the results and therefore the selection of the list is important.
PubMed ID
27837709 View in PubMed
Less detail

Effects of medication assessment as part of a comprehensive geriatric assessment on drug use over a 1-year period: a population-based intervention study.

https://arctichealth.org/en/permalink/ahliterature143062
Source
Drugs Aging. 2010 Jun 1;27(6):507-21
Publication Type
Article
Date
Jun-1-2010
Author
Pasi Lampela
Sirpa Hartikainen
Piia Lavikainen
Raimo Sulkava
Risto Huupponen
Author Affiliation
Department of Pharmacology and Toxicology, University of Kuopio, Kuopio, Finland. Pasi.Lampela@uku.fi
Source
Drugs Aging. 2010 Jun 1;27(6):507-21
Date
Jun-1-2010
Language
English
Publication Type
Article
Keywords
Aged
Aged, 80 and over
Drug Interactions
Drug Prescriptions
Drug Therapy
Drug Utilization Review - methods
Drug-Related Side Effects and Adverse Reactions
Finland
Geriatric Assessment - methods
Humans
Intervention Studies
Interviews as Topic
Medical Records
Outpatients
Polypharmacy
Abstract
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.
PubMed ID
20524710 View in PubMed
Less detail

Use of antidementia drugs and risk of pneumonia in older persons with Alzheimer's disease.

https://arctichealth.org/en/permalink/ahliterature287330
Source
Ann Med. 2017 May;49(3):230-239
Publication Type
Article
Date
May-2017
Author
Pasi Lampela
Anna-Maija Tolppanen
Antti Tanskanen
Jari Tiihonen
Piia Lavikainen
Sirpa Hartikainen
Heidi Taipale
Source
Ann Med. 2017 May;49(3):230-239
Date
May-2017
Language
English
Publication Type
Article
Keywords
Aged, 80 and over
Alzheimer Disease - complications - diagnosis - drug therapy
Cholinesterase Inhibitors - adverse effects - therapeutic use
Female
Finland - epidemiology
Galantamine - adverse effects - therapeutic use
Hospitalization
Humans
Indans - adverse effects - therapeutic use
Male
Memantine - adverse effects - therapeutic use
Middle Aged
Piperidines - adverse effects - therapeutic use
Pneumonia - chemically induced - complications - epidemiology - mortality
Risk
Rivastigmine - adverse effects - therapeutic use
Abstract
Persons with Alzheimer's disease are at an increased risk of pneumonia, but the comparative risks during specific antidementia treatments are not known. We compared the risk of pneumonia in the use of donepezil, rivastigmine (oral, transdermal), galantamine and memantine.
We used data from a nationwide cohort of community-dwelling individuals diagnosed with Alzheimer's disease during 2005-2011 in Finland, who initiated monotherapy with acetylcholinesterase inhibitor or memantine (n?=?65,481). The risk of hospitalization or death due to pneumonia was investigated with Cox proportional hazard models.
The risk of pneumonia was higher in persons using rivastigmine patch (n?=?9709) (adjusted hazard ratio (HR) 1.15, 95% confidence interval (CI) 1.04-1.27) and memantine (n?=?11,024) (HR 1.59, 95% CI 1.48-1.71) compared with donepezil users (n?=?26,416) whereas oral rivastigmine (n?=?7384) (HR 1.08, 95% CI 0.98-1.19) and galantamine (n?=?10,948) (HR 0.91, 95% CI 0.83-1.00) were not associated with an increased risk. These results did not change when adjusting for comorbid conditions, use of psychotropic drugs or with inverse probability of treatment weighting.
The increased risk of pneumonia in this fragile group of aged persons should be taken into account. Memantine is associated with the highest risk in the comparison of antidementia drugs. KEY Message Pneumonia risk is increased in persons with Alzheimer's disease who use memantine or rivastigmine patches.
PubMed ID
27786552 View in PubMed
Less detail

Use of Cholinesterase Inhibitors Increases Initiation of Urinary Anticholinergics in Persons with Alzheimer's Disease.

https://arctichealth.org/en/permalink/ahliterature294598
Source
J Am Geriatr Soc. 2016 07; 64(7):1510-2
Publication Type
Letter
Date
07-2016

9 records – page 1 of 1.