To investigate the extent of concomitant use of analgesic and psychotropic medicines among home-dwelling elderly people aged at least 75 years in Finland.
This was a population-based study in Finland, performed as part of Kuopio 75 + study focusing on the clinical epidemiology of diseases, medication and functional capacity. A random sample of 700 persons was drawn from the total population of the city of Kuopio, eastern Finland, aged 75 years on January 1, 1998 (n = 4518). Ninety-nine persons could not be examined and 78 were living in long-term institutions, so that the number of home-dwelling elderly persons amounted to 523. A trained nurse interviewed the participants about their use of medicines, and a geriatrician examined their overall physical and mental status. Dementia and depression were diagnosed according to the DSM IV criteria. Both regular and irregular prescribed and nonprescribed drug use was recorded.
Every fourth elderly person (27.2%) used analgesics and psychotropics concomitantly, this use becoming twice as common with advancing age (19.6% in the age group 75-79 years, 38.2% among the oldest, aged 85 + years). Concomitant use of psychotropics and opioids also became more common with increasing age (2.8% in age group 75-79 years and 9.6% in the oldest group, aged 85 + years). The use of opioids was nearly twice as common among concomitant users (19.7%) than among those using only analgesics (11.3%). Concomitant users suffered from interfering daily pain and daily pain at rest more commonly than nonusers of analgesics. Depression, sleeping problems and polypharmacy were more common among the concomitant users, who had also had more hip fractures than the rest.
Concomitant use of analgesics and psychotropics becomes more common with advancing age and is a potential risk factor for adverse drug effects.
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Generic substitution (GS) is an important way to decrease medical costs. We aimed to study the opinions and attitudes of Finnish people about GS five years after it was introduced, the reasons for substituting and what people think about generic medicines.
We sent a postal survey to a random stratified population sample of 3000 Finnish people aged at least 18 years in 2008. The random sample was drawn from five mainland counties. The sampling was conducted by the Finnish Population Register Centre. The response rate was 62% (n=1844) after exclusion of unobtainable addressees (n=34).
Most of the respondents (70.9%) considered GS a good law reform. However, there were many respondents who were unsure about their opinion (26.9%). The respondents also held the opinion that cheaper medicines are effective (80.9%) and that GS does not cause any risk to drug safety (84.9%). Most of the respondents (88.4%) who had substituted their medicines had not noticed any difference between the previously used and substituted medicines. Two main reasons for substituting were a desire to save money and recommendation by pharmacists. Of the respondents, 16.3% had experience with both substituting and refusing it. The percentage of the respondents who only had experience with refusing GS was 8.6%. Female gender, older age and use of prescription drugs were associated with refusing.
Finnish people consider GS a good reform. They also have confidence in the effect of cheaper medicines. Savings are the main reason for accepting GS.
To evaluate the health-related quality of life (HRQoL) and functional capacity in relation to glycemic control among older home-dwelling primary care patients.
Electronic patient records were used to identify 527 people over 65 years with diabetes. Of these, 259 randomly selected subjects were invited to a health examination and 172 of them attended and provided complete data. The participants were divided into three groups based on the HbA1c: good (HbA1c57mmol/mol (N=29)) glycemic control. HRQoL was measured with the EuroQol EQ-5D questionnaire. Functional and cognitive capacity and mental well-being were assessed with the Lawton Instrumental Activities of Daily Living (IADL) scale, Mini-Mental State Examination (MMSE) and Geriatric Depression Scale (GDS-15).
EQ-5D scores for good, intermediate and poor glycemic control were 0.78; 0.74 and 0.70, p=0.037. Sub-items of mobility (p=0.002) and self-care were the most affected (p=0.031). Corresponding trend was found for IADL, p=0.008. A significant correlation was found between MMSE scores and HbA1c.
Older primary care home-dwelling patients with diabetes and poorer glycemic control have lower functional capacity and HRQoL, especially in regard to mobility and self-care.
The serum fatty acid composition reflects the dietary fatty acid composition from the past few days to several weeks. However, the role of serum omega-3 (from fish and fish oils) and omega-6 (from vegetable oils) polyunsaturated fatty acids (PUFAs) in the course of metabolic syndrome is poorly understood. At the Primary Health Care Unit in Pieksämäki, Finland, all subjects born in 1942, 1947, 1952, 1957, and 1962 (n = 1,294) were invited for health checkups in 1997-1998 and 2003-2004. Metabolic syndrome was defined by using the new, harmonized criteria. The serum omega-3 PUFAs, omega-6 PUFAs, and total fatty acids were analyzed by proton nuclear magnetic resonance spectroscopy. Altogether, data from both checkups were available for 665 subjects. After adjustment for age, sex, and baseline body mass index, the incidence of metabolic syndrome between the 2 checkups with a 6.4-year follow-up was inversely associated (P