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- Chermá Yeste, Maria Dolores, et al.
(författare)
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Assessment of the prescription of antidepressant drugs in elderly nursing home patients
- 2008
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Ingår i: Journal of Clinical Psychopharmacology. - 0271-0749 .- 1533-712X. ; 28:4, s. 424-431
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Tidskriftsartikel (refereegranskat)abstract
- The aim of the study was to investigate the use of antidepressant drugs among elderly people in nursing homes. Elderly residents who where found to have been prescribed at least one antidepressant drug according to the specific medication dispensing system were identified in 8 nursing homes in the county of Östergötland, Sweden. Data were collected from the medical record forms at the nursing home. Blood samples were drawn for the assessment of drug concentration, blood chemistry parameters and cytochrome P450 expression. At least one antidepressant drug was prescribed to 38% of elderly people in the nursing home studied. A total of 71 patients were evaluated, 80% women and 20% men. The median age was 84 years (range, 71-100 years). Indications for antidepressant drug treatment were found on 96% of medical record forms (depression, 60%); however, information relating to when treatment was initiated could not be found on 34% of medical record forms and a clear time schedule for how long this drug treatment was planned to continue could not be found either. A possible adverse effect of antidepressant drug treatment was retrieved in at least 77% of patients. Polypharmacotherapy was common; median number of drugs per patient was 11. Concentrations of drugs were higher than expected in 73%. Most patients were medicated with citalopram (n = 44). A clear interindividual variability of concentrations at each dose level was found for citalopram and for the metabolites desmethylcitalopram and didesmethylcitalopram. A significant correlation was found between the estimation of creatinine clearance and concentration-dose ratio of citalopram. Poor metabolizers, who had been prescribed an antidepressant drug that are substrate for the cytochrome P450 isoenzyme examined, have higher concentrations of prescribed antidepressant drug than do non-poor metabolizers in relation to dose. An increase in quality contribution to follow-up at antidepressant medications is needed. A more frequent clinical use of therapeutic drug monitoring and pharmacogenetic tests in addition to therapeutic drug monitoring may be one important tool in this process.
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- Sjöblom, Peter, et al.
(författare)
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Can diabetes medication be reduced in elderly patients? : An observational study of diabetes drug withdrawal in nursing home patients with tight glycaemic control
- 2008
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Ingår i: Diabetes Research and Clinical Practice. - : Elsevier BV. - 0168-8227 .- 1872-8227. ; 82:2, s. 197-202
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Tidskriftsartikel (refereegranskat)abstract
- Aim: To explore the feasibility of withdrawal of diabetes medication in elderly patients with HbA1c £ 6.0%.Methods: HbA1c was measured in 98 patients with known diabetes in 17 nursing homes in Sweden. 32 subjects with HbA1c £ 6.0% participated in the drug withdrawal study. After measuring plasma glucose on three consecutive days, diabetes drugs were reduced, i.e. complete withdrawal of oral anti-diabetic drugs (OADs), complete insulin withdrawal when doses were £ 20 units/day and reduced by half in patients on more than 20 units/day.Results: We identified 31 episodes of plasma glucose £ 4.4 mmol/l, most of them nocturnal (n=17). Mean HbA1c was 5.2 % ± 0.4 compared to 7.1 % ± 1.6 in the non-intervention group. Three months after the diabetes drug discontinuation, 24 patients (75%) remained in the intervention group and mean HbA1c was then 5.8 %. ± 0.9. Six months after baseline investigation mean HbA1c in the intervention group was 5.8 % ± 1.1 compared with 6.6 % ± 1.4 in the non-intervention group.Conclusions: Hypoglycaemic events are common among elderly patients with type 2 diabetes. The withdrawal of diabetes medication in elderly with tight glycaemic control is safe and may decrease the risk for hypoglycaemia.
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- Östgren, Carl Johan, et al.
(författare)
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Fördel minska diabetesbehandling hos svårt multisjuka med lågt HbA1c : Positiva resultat från utsättningsstudie bland äldre i särskilt boende
- 2009
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Ingår i: Läkartidningen. - 0023-7205 .- 1652-7518. ; 106:24-25, s. 1649-1651
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)abstract
- Hypoglykemier kan orsaka försämring av intellektuella funktioner och ge symtom som oro och agitation. Äldre multisjuka patienter torde vara särskilt känsliga för sådana bieffekter. Vi har på patienter med typ 2-diabetes i särskilt boende genomfört en öppen strukturerad utsättningsstudie av insulin och perorala diabetesläkemedel hos patienter med HbA1c ≤6,0 procent. Av de 32 patienter som fick sina diabetesläkemedel minskade eller utsatta kunde 24 fullfölja studien. I denna grupp steg HbA1c under studien från 5,2 procent till måttliga 5,8 procent efter såväl 3 som 6 månader. Resultaten bör kunna tjäna som stöd för att under kontrollerade former minska eller avveckla diabetesbehandlingen i livets slutskede hos svårt multisjuka patienter med låga HbA1c-nivåer.
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