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Anticholinergic drug use and its association with self-reported symptoms among older persons with and without diabetes.

https://arctichealth.org/en/permalink/ahliterature298928
Source
J Clin Pharm Ther. 2019 Apr; 44(2):229-235
Publication Type
Journal Article
Date
Apr-2019
Author
Niina-Mari Inkeri
Merja Karjalainen
Maija Haanpää
Hannu Kautiainen
Juha Saltevo
Pekka Mäntyselkä
Miia Tiihonen
Author Affiliation
School of Pharmacy, University of Eastern Finland, Kuopio, Finland.
Source
J Clin Pharm Ther. 2019 Apr; 44(2):229-235
Date
Apr-2019
Language
English
Publication Type
Journal Article
Keywords
Aged
Aged, 80 and over
Cholinergic Antagonists - adverse effects - therapeutic use
Cohort Studies
Cross-Sectional Studies
Diabetes Mellitus - epidemiology
Female
Finland
Humans
Independent living
Male
Practice Patterns, Physicians' - statistics & numerical data
Primary Health Care
Self Report
Surveys and Questionnaires
Abstract
Anticholinergic drug use has been associated with a risk of central and peripheral adverse effects. There is a lack of information on anticholinergic drug use in persons with diabetes. The aim of this study is to investigate anticholinergic drug use and the association between anticholinergic drug use and self-reported symptoms in older community-dwelling persons with and without diabetes.
The basic population was comprised of Finnish community-dwelling primary care patients aged 65 and older. Persons with diabetes were identified according to the ICD-10 diagnostic codes from electronic patient records. Two controls adjusted by age and gender were selected for each person with diabetes. This cross-sectional study was based on electronic primary care patient records and a structured health questionnaire. The health questionnaire was returned by 430 (81.6%) persons with diabetes and 654 (73.5%) persons without diabetes. Data on prescribed drugs were obtained from the electronic patient records. Anticholinergic drug use was measured according to the Anticholinergic Risk Scale. The presence and strength of anticholinergic symptoms were asked in the health questionnaire.
The prevalence of anticholinergic drug use was 8.9% in the total study cohort. There were no significant differences in anticholinergic drug use between persons with and without diabetes. There was no consistent association between anticholinergic drug use and self-reported symptoms.
There is no difference in anticholinergic drug use in older community-dwelling persons with and without diabetes. Anticholinergic drug use should be considered individually and monitored carefully.
PubMed ID
30315583 View in PubMed
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Associations of instrumental activities of daily living and handgrip strength with oral self-care among home-dwelling elderly 75+.

https://arctichealth.org/en/permalink/ahliterature128053
Source
Gerodontology. 2012 Jun;29(2):e135-42
Publication Type
Article
Date
Jun-2012
Author
Kaija Komulainen
Pekka Ylöstalo
Anna-Maija Syrjälä
Piia Ruoppi
Matti Knuuttila
Raimo Sulkava
Sirpa Hartikainen
Author Affiliation
Kuopio Research Centre of Geriatric Care, Unit of Clinical Pharmacology and Geriatric Pharmacotherapy, School of Pharmacy, University of Eastern Finland, Kuopio, Finland. kaija.komulainen@uef.fi
Source
Gerodontology. 2012 Jun;29(2):e135-42
Date
Jun-2012
Language
English
Publication Type
Article
Keywords
Activities of Daily Living
Aged, 80 and over
Cognition - physiology
Cross-Sectional Studies
Dental Care - statistics & numerical data
Dental Plaque Index
Dentition
Educational Status
Female
Finland
Hand Strength - physiology
Humans
Independent living
Male
Oral Hygiene - statistics & numerical data
Population Surveillance
Toothbrushing - statistics & numerical data
Toothpastes - therapeutic use
Xerostomia - classification
Abstract
To study the associations of instrumental activities of daily living (IADL) and the handgrip strength with oral self-care among dentate home-dwelling elderly people in Finland.
The study analysed data for 168 dentate participants (mean age 80.6 years) in the population-based Geriatric Multidisciplinary Strategy for Good Care of the Elderly (GeMS) study. Each participant received a clinical oral examination and structured interview in 2004-2005. Functional status was assessed using the IADL scale and handgrip strength was measured using handheld dynamometry.
Study participants with high IADL (scores 7-8) had odds ratios (ORs) for brushing their teeth at least twice a day of 2.7 [95% confidence intervals (CI) 1.1-6.8], for using toothpaste at least twice a day of 2.0 (CI 0.8-5.2) and for having good oral hygiene of 2.8 (CI 1.0-8.3) when compared with participants with low IADL (scores =6). Participants in the upper tertiles of the handgrip strength had ORs for brushing the teeth at least twice a day of 0.9 (CI 0.4-1.9), for using the toothpaste at least twice a day of 0.9 (CI 0.4-1.8) and for good oral hygiene of 1.1 (CI 0.5-2.4) in comparison with the study subjects in the lowest tertile of handgrip strength.
The results of this study suggest that the functional status, measured by means of the IADL scale, but not handgrip strength, is an important determinant of oral self-care among the home-dwelling elderly.
PubMed ID
22239745 View in PubMed
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Collective action for a common service platform for independent living services.

https://arctichealth.org/en/permalink/ahliterature263914
Source
Int J Med Inform. 2013 Oct;82(10):922-39
Publication Type
Article
Date
Oct-2013
Author
Fatemeh Nikayin
Mark De Reuver
Timo Itälä
Source
Int J Med Inform. 2013 Oct;82(10):922-39
Date
Oct-2013
Language
English
Publication Type
Article
Keywords
Cooperative Behavior
Delivery of Health Care - organization & administration
Finland
Home Care Services - organization & administration
Independent living
Interinstitutional Relations
Leadership
Models, organizational
Organizational Objectives
Abstract
The paper aims to explain how and why organizations, providing assistive devices and related web services for elderly independent living services, might be willing to collaborate and to share their resources and data on a common service platform.
A theoretical framework from literature on collective action theory, platform and business ecosystem concepts was developed to explain what factors influence inter-organizational collective action for a common service platform. The framework was tested in a case study of collaborative platform project for independent living services in Finland. Semi-structured interviews with the project managers and the decision makers of involved organizations were the primary source of data collection.
Strikingly, interdependency among the organizations was not found to be important for collaboration in this case. Instead, we found that a central organization can play an important role in initiating, facilitating and encouraging collaboration among different parties. Moreover, we found more willingness for collaboration when the platform is aimed to be open to third-parties to complement the platform with additional services.
Strategies of the platform leader and openness of the platform towards third parties are the most important drivers for collective action between organizations offering independent living services. Establishing common service platforms for independent living services requires explicit attention to these inter-organizational issues.
PubMed ID
23891564 View in PubMed
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Concern about falling in older women with a history of falls: associations with health, functional ability, physical activity and quality of life.

https://arctichealth.org/en/permalink/ahliterature106791
Source
Gerontology. 2014;60(1):22-30
Publication Type
Article
Date
2014
Author
Radhika Patil
Kirsti Uusi-Rasi
Pekka Kannus
Saija Karinkanta
Harri Sievänen
Author Affiliation
The UKK Institute for Health Promotion Research, Tampere University Hospital, Tampere, Finland.
Source
Gerontology. 2014;60(1):22-30
Date
2014
Language
English
Publication Type
Article
Keywords
Accidental Falls - prevention & control
Activities of Daily Living - psychology
Aged
Aged, 80 and over
Aging - physiology - psychology
Fear - psychology
Female
Finland
Health status
Humans
Independent Living - psychology
Logistic Models
Motor Activity
Quality of Life
Questionnaires
Risk factors
Abstract
Fear of falling has been linked to activity restriction, functional decline, decreased quality of life and increased risk of falling. Factors that distinguish persons with a high concern about falling from those with low concern have not been systematically studied.
This study aimed to expose potential health-related, functional and psychosocial factors that correlate with fear of falling among independently living older women who had fallen in the past year.
Baseline data of 409 women aged 70-80 years recruited to a randomised falls prevention trial (DEX) (NCT00986466) were used. Participants were classified according to their level of concern about falling using the Falls Efficacy Scale International (FES-I). Multinomial logistic regression analyses were performed to explore associations between health-related variables, functional performance tests, amount of physical activity, quality of life and FES-I scores.
68% of the participants reported a moderate to high concern (FES-I = 20) about falls. Multinomial logistic regression showed that highly concerned women were significantly more likely to have poorer health and quality of life and lower functional ability. Reported difficulties in instrumental activities of daily living, balance, outdoor mobility and poorer quality of life contributed independently to a greater concern about falling.
Concern about falling was highly prevalent in our sample of community-living older women. In particular, poor perceived general health and mobility constraints contributed independently to the difference between high and low concern of falling. Knowledge of these associations may help in developing interventions to reduce fear of falling and activity avoidance in old age.
PubMed ID
24107382 View in PubMed
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Differences between self-reported and observed physical functioning in independent older adults.

https://arctichealth.org/en/permalink/ahliterature262880
Source
Disabil Rehabil. 2014;36(17):1395-401
Publication Type
Article
Date
2014
Author
Rona Feuering
Elisha Vered
Talma Kushnir
Alan M Jette
Itshak Melzer
Source
Disabil Rehabil. 2014;36(17):1395-401
Date
2014
Language
English
Publication Type
Article
Keywords
Accidental Falls - statistics & numerical data
Aged
Aged, 80 and over
Anxiety - epidemiology
Depression - epidemiology
Disability Evaluation
Female
Finland
Geriatric Assessment - methods
Humans
Independent living
Male
Self Report
Abstract
Understanding whether there is an agreement between older persons who provide information on their functional status and clinicians who assess their function is an important step in the process of creating sound outcome instruments.
To examine whether there is agreement between self-reported and clinician assessment of similar performance items in older adults.
Fifty independent older adults aged 70-91 years (mean age 80.3?±?5.2 years) who live in the community were examined separately and blindly in two data collection sessions. Self-reported and observed lower and upper extremity physical tasks were compared. Life Function and Disability Instrument (LLFDI) was used in both sessions. We performed intra-class correlation coefficients (ICC) as indices of agreement and "mountain plots" that were based on a cumulative distribution curve. Associations between self-reported and observed function with Fear of Fall Scale (FES) and Geriatric Depression Scale (GDS) were also assessed.
ICCs were high between self-reported lower extremity function and observed lower extremity function (ICC?=?0.83), and were poorer for self-reported and observed upper extremity function (ICC?=?0.31). In both comparisons, mountain plots revealed a right shift that was larger for upper than lower extremity functions, indicating systematic differences in self-reported and observed assessments. Associations with FES and GDS were higher for self-reported than observed function.
There is a systematic bias between self-reported and clinician observation. Professionals should be aware that information provided by patients and observation of activity assessed by clinicians could differ substantially, especially for upper extremity function. Implications for Rehabilitation There is a systematic bias between self-reported and clinician assessment of similar performance items in older adults. In general, older adults overestimate their physical function or clinicians underestimate older adults function. The bias between self-reported and clinician assessment for upper extremity function is larger than that for lower extremity function. The conclusions regarding agreement across upper extremity and lower extremity function scores are not different when using mountain plots graphs versus relying solely on the value of the ICCs. However, the graphs expand our understanding of the direction and magnitude of score differences. Professionals should be aware that information provided by patients and assessment by clinicians could differ substantially, especially for upper extremity function.
PubMed ID
24001263 View in PubMed
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Duration of new antidepressant use and factors associated with discontinuation among community-dwelling persons with Alzheimer's disease.

https://arctichealth.org/en/permalink/ahliterature300475
Source
Eur J Clin Pharmacol. 2019 Mar; 75(3):417-425
Publication Type
Journal Article
Date
Mar-2019
Author
Reetta Kettunen
Heidi Taipale
Anna-Maija Tolppanen
Antti Tanskanen
Jari Tiihonen
Sirpa Hartikainen
Marjaana Koponen
Author Affiliation
School of Pharmacy, University of Eastern Finland, PO Box 1627, 70211, Kuopio, Finland.
Source
Eur J Clin Pharmacol. 2019 Mar; 75(3):417-425
Date
Mar-2019
Language
English
Publication Type
Journal Article
Keywords
Age Factors
Aged
Aged, 80 and over
Alzheimer Disease - drug therapy
Antidepressive Agents - administration & dosage - therapeutic use
Antipsychotic Agents - administration & dosage - therapeutic use
Cohort Studies
Female
Finland
Humans
Independent living
Male
Proportional Hazards Models
Registries
Sex Factors
Time Factors
Abstract
To study how long antidepressants initiated after diagnoses of Alzheimer's disease (AD) were used and factors associated with discontinuation of use among persons with Alzheimer's disease (AD). In addition, differences in duration of use between the antidepressants groups were compared.
Register-based Medication use and Alzheimer's disease (MEDALZ) cohort included 70,718 community-dwelling people with AD who were diagnosed during the years 2005-2011. For this study, the new antidepressant users were included after 1-year washout period (N?=?16,501; 68.6% females, mean age 80.9). The duration of antidepressant use was modeled with the PRE2DUP method. Factors associated with treatment discontinuation were assessed with Cox proportional hazard models and included age, gender, comorbid conditions and concomitant medications.
Median duration of the new antidepressant use period was 309 days (IQR 93-830). For selective serotonin reuptake inhibitor (SSRI) use, the median duration was 331 days (IQR 101-829), for mirtazapine 202 days (IQR 52-635), and for serotonin and norepinephrine reuptake inhibitors (SNRIs) 134 days (IQR 37-522). After 1-year follow-up, 40.8% had discontinued antidepressant use, 54.6% after 2 years and 64.1% after 3 years. Factors associated with treatment discontinuation were age over 85, male gender, diabetes, and use of memantine, opioids, and antiepileptics whereas benzodiazepines and related drugs and antipsychotic use were inversely associated with discontinuation.
Antidepressants are used for long-term among people with AD. Need and indication for antidepressant use should be assessed regularly as evidence on their efficacy for behavioral and psychological symptoms of dementia is limited.
PubMed ID
30413841 View in PubMed
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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
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Source
Pages 515-517 in G. Pétursdóttir et al., eds. Circumpolar Health 93. Proceedings of the 9th International Congress on Circumpolar Health, Reykjavík, Iceland, June 20-25, 1993. Arctic Medical Research. 1994;53(Suppl.2)
Publication Type
Article
Date
1994
  1 document  
Author
Jónsdóttir, S
Jonsdottir, S
Author Affiliation
Reykjavík Social Service Office, Reykjavík, Iceland
Source
Pages 515-517 in G. Pétursdóttir et al., eds. Circumpolar Health 93. Proceedings of the 9th International Congress on Circumpolar Health, Reykjavík, Iceland, June 20-25, 1993. Arctic Medical Research. 1994;53(Suppl.2)
Date
1994
Language
English
Geographic Location
Denmark
Finland
Iceland
Norway
Sweden
Publication Type
Article
Digital File Format
Text - PDF
Keywords
Denmark
Elderly women
Finland
Health
Iceland
Independent living
Nordic countries
Norway
Old women
Sweden
Abstract
Never before in world history have so many individuals been living alone and independently. The welfare state has made this development possible, and in the Nordic countries this is very much true for older women.
Documents
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Exercise rehabilitation on home-dwelling patients with Alzheimer's disease--a randomized, controlled trial. Study protocol.

https://arctichealth.org/en/permalink/ahliterature140239
Source
Trials. 2010;11:92
Publication Type
Article
Date
2010
Author
Kaisu H Pitkala
Minna M Raivio
Marja-Liisa Laakkonen
Reijo S Tilvis
Hannu Kautiainen
Timo E Strandberg
Author Affiliation
Unit of General Practice, Helsinki University Central Hospital, University of Helsinki, PO Box 20, 00014 University of Helsinki, Finland. kaisu.pitkala@kolumbus.fi
Source
Trials. 2010;11:92
Date
2010
Language
English
Publication Type
Article
Keywords
Aged
Alzheimer Disease - economics - physiopathology - psychology - rehabilitation
Caregivers
Clinical Protocols
Cognition
Cost of Illness
Cost-Benefit Analysis
Day Care - economics
Depression - etiology
Disability Evaluation
Exercise Therapy - economics
Finland
Frail Elderly
Health Care Costs
Humans
Independent living
Mobility Limitation
Neuropsychological Tests
Postural Balance
Quality of Life
Research Design
Time Factors
Treatment Outcome
Walking
Abstract
Besides cognitive decline, Alzheimer's disease (AD) leads to physical disability, need for help and permanent institutional care. The trials investigating effects of exercise rehabilitation on physical functioning of home-dwelling older dementia patients are still scarce. The aim of this study is to investigate the effectiveness of intensive exercise rehabilitation lasting for one year on mobility and physical functioning of home-dwelling patients with AD.
During years 2008-2010, patients with AD (n = 210) living with their spousal caregiver in community are recruited using central AD registers in Finland, and they are offered exercise rehabilitation lasting for one year. The patients are randomized into three arms: 1) tailored home-based exercise twice weekly 2) group-based exercise twice weekly in rehabilitation center 3) control group with usual care and information of exercise and nutrition. Main outcome measures will be Guralnik's mobility and balance tests and FIM-test to assess physical functioning. Secondary measures will be cognition, neuropsychiatric symptoms according to the Neuropsychiatric Inventory, caregivers' burden, depression and health-related quality of life (RAND-36). Data concerning admissions to institutional care and the use and costs of health and social services will be collected during a two year follow-up.
To our knowledge this is the first large scale trial exploring whether home-dwelling patients with AD will benefit from intense and long-lasting exercise rehabilitation in respect to their mobility and physical functioning. It will also provide data on cost-effectiveness of the intervention.
ACTRN12608000037303.
Notes
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PubMed ID
20925948 View in PubMed
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Forgotten resources of older home care clients: focus group study in Finland.

https://arctichealth.org/en/permalink/ahliterature115670
Source
Nurs Health Sci. 2013 Sep;15(3):333-9
Publication Type
Article
Date
Sep-2013
Author
Riitta Turjamaa
Sirpa Hartikainen
Anna-Maija Pietilä
Author Affiliation
Department of Nursing Science, University of Eastern Finland, Kuopio, Finland.
Source
Nurs Health Sci. 2013 Sep;15(3):333-9
Date
Sep-2013
Language
English
Publication Type
Article
Keywords
Activities of Daily Living
Aged
Aged, 80 and over
Evaluation Studies as Topic
Female
Finland
Focus Groups
Frail Elderly - psychology
Geriatric Assessment
Health Resources - organization & administration
Home Care Services - organization & administration
Humans
Independent Living - psychology
Interpersonal Relations
Male
Nurses, Community Health - organization & administration
Quality of Life
Self-Help Groups
Abstract
In this qualitative focus group study, the resources available to older home-dwelling people, particularly incoming and existing home care clients, are described from the viewpoint of home care professionals (n?=?32). The data were analyzed using inductive content analysis. There were three categories of older people requiring resources from the viewpoint of interviewers: home-dwelling people, incoming home care clients, and existing home care clients. Based on the analysis, the resources of older home-dwelling people were categorized in terms of support, meaningful life, everyday activities, and environment. Incoming home care client resources were support, out-of-home activities, in-home activities, and environment. Existing client resources were described in terms of support, everyday activities, and environment. Home care professionals described the resources of the older home-dwelling people in diverse ways, but those of the perspective of existing clients were reduced. The biggest difference was in everyday activities. Psychological and social resources, including meaningful life and social relationships, seemed to be forgotten. All available resources must be taken into account, especially in the everyday home care services for existing home care clients.
PubMed ID
23480058 View in PubMed
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31 records – page 1 of 4.