| 1. |
- Cornelius, C, et al.
(författare)
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Self-reported symptoms in the elderly and association with drug use
- 1997
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Ingår i: Clinical drug investigation. - 1173-2563 .- 1179-1918. ; 13:2, s. 105-117
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Tidskriftsartikel (refereegranskat)abstract
- Summary: In a cross-sectional study, we have investigated the prevalence of self-reported symptoms and their association with medicinal drug use in elderly people. Data from the Kungsholmen Project were used, a population-based study of elderly people aged 75 years and over in Stockholm, Sweden. The study sample comprised 1800 persons. Information on the occurrence of 22 different symptoms and the actual drug use was obtained at interviews with the participants. The relation of symptoms to age, gender and housing, and their association with drug use was analysed using logistic regression. The most commonly reported symptoms were pain and tiredness. In general, symptoms were more common in women and at higher ages. Many of the associations between symptoms and drug use reflected established treatments. However, some were suggestive of inappropriate treatment or dosage; for example, the association between tiredness and the use of anxiolytics and hypnotics-sedatives.
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| 2. |
- Schmidt, IK, et al.
(författare)
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Physician and staff assessments of drug interventions and outcomes in Swedish nursing homes
- 1998
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Ingår i: The Annals of Pharmacotherapy. - 1060-0280 .- 1542-6270. ; 32:1, s. 27-32
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: To describe the type and frequency of drug-related problems discussed in regular team meetings conducted in 15 Swedish nursing homes and report physician and staff assessments of these interventions and residents' outcomes. DATA SOURCES AND METHODS: The data were collected within the context of a controlled trial with the primary aim of exploring the effects of regular team interventions on drug prescribing practices in Swedish nursing homes. In 15 experimental nursing homes, the residents' drug therapy was discussed regularly by a team consisting of a pharmacist, a physician, nurses, undernurses (similar to licensed practical nurses), and nurse's aides. The pharmacist documented problems, made changes, and observed outcomes. Following the intervention period, a questionnaire was sent to the medical staff that contained items regarding perceived outcomes, the intervention's impact on knowledge of drug therapy in the elderly, and attitudes toward the pharmacist's role. RESULTS: Unclear indication and problematic choice of drugs were the most common drug-related problems discussed. In 19% of the situations, therapy changes were reported to have had a beneficial effect on the residents' clinical status; in 47% of the situations, staff reported no observable outcome from changes, suggesting that the changes had been appropriate. Finally, medical staff claimed in the follow-up survey that their knowledge about drug therapy had increased; they expressed an overall positive attitude toward this interactive collaboration. CONCLUSIONS: Regular intervention conducted by a multidisciplinary team incorporating a pharmacist can effectively improve prescribing practices, increase staff knowledge about appropriate drug therapy in the elderly, and result in improved quality of care for nursing home residents.
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| 3. |
- Schmidt, IK, et al.
(författare)
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Resident characteristics and organizational factors influencing the quality of drug use in Swedish nursing homes
- 1998
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Ingår i: Social Science and Medicine. - 0277-9536 .- 1873-5347. ; 47:7, s. 961-971
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Tidskriftsartikel (refereegranskat)abstract
- Appropriateness of drug use is an important indicator of the quality of care in nursing homes. In this study, we analyzed the influence of resident characteristics and selected organizational factors on the appropriateness of psychotropic drug use in 33 Swedish nursing homes. Specific criteria based on published guidelines and recommendations were developed to measure appropriateness. Residents diagnosed with a psychiatric disorder and younger residents had more deviations from the criteria; however, resident mix did not explain variations in appropriateness of drug use at the facility level. Facilities with better nurse staffing and drug intervention teams had fewer deviations from the criteria, but only 15–20% of the variation in drug prescribing was explained by these predictors.
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| 4. |
- Schmidt, IK, et al.
(författare)
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The impact of regular multidisciplinary team interventions on psychotropic prescribing in Swedish nursing homes
- 1998
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Ingår i: Journal of The American Geriatrics Society. - 0002-8614 .- 1532-5415. ; 46:1, s. 77-82
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: To evaluate the impact of regular multidisciplinary team interventions on the quantity and quality of psychotropic drug prescribing in Swedish nursing homes. DESIGN: A randomized controlled trial. SETTING: A sample of 33 nursing homes: 15 experimental homes and 18 control homes representing 5% of all Swedish nursing homes. PARTICIPANTS: The sample consisted of 1854 long-term care residents with an average age of 83 years. Seventy percent of the residents were women, and 42% had a documented diagnosis of dementia. An additional 5% had a psychotic disorder, and 7% had a diagnosis of depression. INTERVENTION: Experimental homes participated in an outreach program that was designed to influence drug use through improved teamwork among physicians, pharmacists, nurses, and nurses' assistants. Multidisciplinary team meetings were held on a regular basis throughout the 12-month study period. MEASUREMENTS: Lists of each resident's prescriptions were collected 1 month before and 1 month after the 12-month intervention. Measures included the proportion of residents with any psychotropic drug, polymedicine, and therapeutic duplication and proportion of residents with nonrecommended and acceptable drugs in each psychotropic drug class, as defined by current Swedish guidelines. RESULTS: Baseline results show extensive psychotropic drug prescribing, with the most commonly prescribed drugs being hypnotics (40%), anxiolytics (40%), and antipsychotics (38%). After 12 months of team meetings in the experimental homes, there was a significant decrease in the prescribing of psychotics (-19%), benzodiazepine hypnotics (-37%), and antidepressants (-59%). Orders for more acceptable antidepressants also increased in the experimental homes. In the control homes there was increased use of acceptable antidepressants, but there were no significant reductions in other drug classes. CONCLUSIONS: There is excessive prescription of psychotropic drugs in Swedish nursing homes. Improved teamwork among caregivers can improve prescribing as defined by clinical guidelines.
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| 5. |
- Wills, P, et al.
(författare)
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Drug use by demented and non-demented elderly people
- 1997
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Ingår i: Age and Ageing. - 0002-0729 .- 1468-2834. ; 26, s. 383-91
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Tidskriftsartikel (refereegranskat)abstract
- Aim: to determine the use of drugs by demented and non-demented elderly people in a population, by dementiastatus and type, age, sex and accommodation type. Method: data were obtained from the Kungsholmen project, a longitudinal community study of people over 75 inStockholm, Sweden. Results: 85% used at least one medicinal drug, and of these 12% were demented. Mean numbers of drugs used were2.8 for demented and 3-2 for non-demented people. 45% of demented people and 38% of non-demented peopleused psychotropic agents. Psychotropic use was higher in women and increased with institutionalization.Antipsychotic agents were used more by demented (22%) than by non-demented (35%) people: this was largelyexplained by differences in accommodation type. The odds ratio (OR) for use of antipsychotics by those ininstitutions compared with those living in their own homes was 9-32. Opioids were commonly prescribed fordemented people. The proportions taking opioids in those using analgesics were 42% in demented and 23% in nondementedpeople (OR 2.07). Laxatives were used by 18% of the demented people in institutions compared with39% of non-demented people in institutions. Conclusion: 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 antipsychoticsand opioids, but fewer laxatives and minor analgesics. Prescribers and institutional staff should be aware of thesefactors so they can optimize patient treatment.
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| 6. |
- Wills, P, et al.
(författare)
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Use of cardiovascular drugs in an elderly Swedish population
- 1996
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Ingår i: Journal of The American Geriatrics Society. - 0002-8614 .- 1532-5415. ; 44, s. 54-60
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: To describe the use of cardiovascular drugs in an older population with respect to age, sex, housing type, and creatinine clearance. DESIGN: A cross-sectional survey. PARTICIPANTS: All residents of a district of Stockholm (Kungsholmen), Sweden, aged 75 and older, living in institutions or at home. MEASUREMENTS: Cardiovascular drug use, serum creatinine, electrolytes, height, weight, and symptoms. RESULTS: A total of 43 cardiovascular (CV) drugs were used. The most common drugs were digoxin (used by 18.2%), furosemide (16.4%), and glyceryl trinitrate (12.4%). Drugs with an antihypertensive effect accounted for 61% of all CV drugs. CV drug use increased with age for cardiac glycosides and diuretics, but decreased with age for calcium antagonists and beta-blockers. Drug doses tended to be less than the recommended daily dose except for a few drugs, e.g., furosemide. There was a trend toward decreasing dose with increasing age, but this was not significant. Diuretics were the only CV drugs used more often in women. People living in institutional care used the least amount of CV drugs. The dose of drugs taken did not appear to be related to estimated creatinine clearance. Comparisons between drug use and complaint of symptoms showed a strong correlation between the use of cardiac glycosides and anorexia, calcium antagonists and constipation, and nitrates and vertigo. There were weaker correlations with cardiac glycosides and visual disturbances and with potassium sparing diuretics and a high potassium. CONCLUSIONS: CV drugs are used commonly in older people. We suggest that the symptoms correlating with cardiac glycoside use may be signs of unrecognized toxicity, and this may relate to our finding that drug use is often not tailored to renal function as measured by creatinine clearance.
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| 7. |
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| 8. |
- Bond, C. A., et al.
(författare)
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International pharmacy
- 1995
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Ingår i: Pharmacotherapy. - 0277-0008 .- 1875-9114. ; 15:5, s. 586-591
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Tidskriftsartikel (refereegranskat)
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| 9. |
- Claesson, Cecilia B., et al.
(författare)
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Drug use in Swedish nursing homes
- 1998
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Ingår i: Clinical drug investigation. - 1173-2563 .- 1179-1918. ; 16:6, s. 441-52
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Tidskriftsartikel (refereegranskat)
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| 10. |
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