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.
Cites: Int J Geriatr Psychiatry. 2002 Sep;17(9):874-8312221663
Cites: J Korean Med Sci. 2002 Feb;17(1):65-7011850591
Cites: J Am Geriatr Soc. 2002 Nov;50(11):1861-512410908
Cites: Ageing Res Rev. 2003 Jan;2(1):57-9312437996
Cites: Epidemiology. 2003 Mar;14(2):240-612606892
Cites: Drugs. 2003;63(6):525-3412656651
Cites: Int Clin Psychopharmacol. 2003 May;18(3):163-712702896
Cites: Int J Geriatr Psychiatry. 2003 Dec;18(12):1135-4114677146
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.
Increased ferritin concentrations are associated with metabolic syndrome (MetS). The association between ferritin as well as hemoglobin level and individual MetS components is unclear. Erythropoietin levels in subjects with MetS have not been determined previously. The aim of this study was to compare serum erythropoietin, ferritin, haptoglobin, hemoglobin, and transferrin receptor (sTFR) levels between subjects with and without MetS and subjects with individual MetS components.
A population based cross-sectional study of 766 Caucasian, middle-aged subjects (341 men and 425 women) from five age groups born in Pieksämäki, Finland who were invited to a health check-up in 2004 with no exclusion criteria. Laboratory analyzes of blood samples collected in 2004 were done during year 2010. MetS was defined by National Cholesterol Education Program criteria.
159 (53%) men and 170 (40%) women of study population met MetS criteria. Hemoglobin and ferritin levels as well as erythropoietin and haptoglobin levels were higher in subjects with MetS (p?
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.
Anti-inflammatory substances have previously been suggested to show compensatory elevations in depressed individuals with pronounced inflammatory changes. In order to further clarify these observations, we examined depression-related alterations in the serum levels of anti-inflammatory markers interleukin (IL)-1 receptor antagonist (RA) and IL-10 and the pro-inflammatory marker IL-6 in 416 general population participants. Depression was evaluated with the Beck Depression Inventory (BDI). Participants with elevated depressive symptoms (BDI>14, n=44) had increased levels of IL-1 RA and IL-6. No changes were observed in their IL-10 levels. In multivariate modeling with adjustments for age, gender, obesity, regular smoking, alcohol use, metabolic syndrome, physical exercise, sleep disturbance, and the use of non-steroidal anti-inflammatory drugs, a high level of IL-1 RA was associated with an increased likelihood of belonging to the group with elevated depressive symptoms (OR for each 1 SD increase in the serum level of IL-1 RA: 2.17, 95% CI 1.35-3.48, p=0.001). The significance of IL-6 alterations did not persist in the same model. The pronounced secretion of anti-inflammatory marker IL-1 RA may reflect the presence of compensatory mechanisms during a depression-related inflammatory state.
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
Obesity and overweight are related to unfavourable lipoprotein subclass profiles. Here we studied the relation between weight change and lipoprotein particle concentrations and sizes in a general population cohort in a longitudinal setting.
The cohort included 683 adults with a 6.5-year follow-up. Lipoprotein particle subclasses and mean particle sizes of VLDL, LDL, and HDL were measured by nuclear magnetic resonance spectroscopy.
During the follow-up period, a weight loss of at least 5% was associated with decreased particle concentrations of all apoB-containing subclasses and increased concentrations of large HDL particles. Coherently, weight gain (=5%) was associated with increases in all apoB-containing subclasses and decreases in total and medium HDL particle concentrations. The relatively largest increase occurred for large HDL particle concentration (24.1%, 95% CI 15.8-32.5) in weight loss and for large VLDL particle concentration (33.0%, 19.6-46.4) in weight gain. Weight change correlated positively with changes in apoB-containing lipoprotein particle concentrations and also with the change in average VLDL particle size. Negative correlations were found between weight change and the change in average LDL (r = -0.10) and HDL (r = -0.32) particle size, but not between weight change and total HDL particle concentration.
Moderate weight loss is related to favourable and weight gain to unfavourable changes in lipoprotein subclass profiles. These population level findings underline the importance of weight control as a modifier of cardiovascular risk factors.