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| 4. |
- Dahlin-Ivanoff, Synneve, 1950, et al.
(författare)
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Elderly persons in the risk zone: Design of a multidimensional, health-promoting, randomised three-armed controlled trial for "prefrail" people of 80+ years living at home
- 2010
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Ingår i: BMC geriatrics. - 1471-2318. ; 10:1
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Tidskriftsartikel (refereegranskat)abstract
- ABSTRACT: BACKGROUND: The very old (80+) are often described as a "frail" group that is particularly exposed to diseases and functional disability. They are at great risk of losing the ability to manage their activities of daily living independently. A health-promoting intervention programme might prevent or delay dependence in activities of daily life and the development of functional decline. Studies have shown that those who benefit most from a health-promoting and disease-preventive programme are persons with no, or discrete, activity restrictions. The three-armed study "Elderly in the risk zone" is designed to evaluate if multi-dimensional and multi-professional educational senior meetings are more effective than preventive home visits, and if it is possible to prevent or delay deterioration if an intervention is made when the persons are not so frail. In this paper the study design, the intervention and the outcome measures as well as the baseline characteristics of the study participants are presented. METHODS: The study is a randomised three-armed single-blind controlled trial with follow-ups 3 months, 1 and 2 years. The study group should comprise a representative sample of pre-frail 80-year old persons still living at home in two municipalities of Gothenburg. To allow for drop-outs, it was estimated that a total of about 450 persons would need to be included in the study. The participants should live in their ordinary housing and not be dependent on the municipal home help service or care. Further, they should be independent of help from another person in activities of daily living and be cognitively intact, having a score of 25 or higher as assessed with the Mini Mental State Examination (MMSE). DISCUSSION: We believe that the design of the study, the randomisation procedure, outcome measurements and the study protocol meetings should ensure the quality of the study. Furthermore, the multi-dimensionality of the intervention, the involvement of both the professionals and the senior citizens in the planning of the intervention should have the potential to effectively target the heterogeneous needs of the elderly.
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| 5. |
- Dahlin-Ivanoff, Synneve, 1950, et al.
(författare)
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For whom is a health-promoting intervention effective? : Predictive factors for performing activities of daily living independently
- 2016
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Ingår i: BMC Geriatrics. - : BioMed Central. - 1471-2318. ; 16
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Tidskriftsartikel (refereegranskat)abstract
- Background: Health-promoting interventions tailored to support older persons to remain in their homes, so-called “ageing in place” is important for supporting or improving their health. The health-promoting programme “Elderly Persons in the Risk Zone,” (EPRZ) was set up for this purpose and has shown positive results for maintaining independence in activities of daily living for older persons 80 years and above at 1- and 2 year follow-ups. The aim of this study was to explore factors for maintaining independence in the EPRZ health-promoting programme. Methods: Total of 459 participants in the original trial was included in the analysis; 345 in the programme arm and 114 in the control arm. Thirteen variables, including demographic, health, and programme-specific indicators, were chosen as predictors for independence of activities of daily living. Logistic regression was performed separately for participants in the health promotion programme and in the control arm. Results: In the programme arm, being younger, living alone and self-rated lack of tiredness in performing mobility activities predicted a positive effect of independence in activities of daily living at 1-year follow-up (odds ratio [OR] 1.18, 1.73, 3.02) and 2-year, (OR 1.13, 2.01, 2.02). In the control arm, being less frail was the only predictor at 1-year follow up (OR 1.6 1.09, 2.4); no variables predicted the outcome at the 2-year follow-up. Conclusions: Older persons living alone - as a risk of ill health - should be especially recognized and offered an opportunity to participate in health-promoting programmes such as “Elderly Persons in the Risk Zone”. Further, screening for subjective frailty could form an advantageous guiding principle to target the right population when deciding to whom health-promoting intervention should be offered. Trial registration: The original clinical trial was registered at ClinicalTrials.gov. Identifier: NCT00877058 , April 6, 2009.
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| 6. |
- Edberg, Anna-Karin, 1961-, et al.
(författare)
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Hur du använder läkemedel
- 2009. - 1
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Ingår i: Livslots för seniorer. - Stockholm : Hjälpmedelsinstitutet. ; , s. 65-75
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Bokkapitel (populärvet., debatt m.m.)
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| 7. |
- Edberg, Anna-Karin, et al.
(författare)
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Hur du använder läkemedel
- 2009
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Ingår i: Livslots för seniorer. - Stockholm : Hjälpmedelsinstitutet. ; :1, s. 65-75
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Bokkapitel (övrigt vetenskapligt/konstnärligt)
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| 8. |
- Ekerstad, Niklas, et al.
(författare)
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Acute care of severely frail elderly patients in a CGA-unit is associated with less functional decline than conventional acute care
- 2017
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Ingår i: Clinical Interventions in Aging. - : DOVE MEDICAL PRESS LTD. - 1176-9092 .- 1178-1998. ; 12, s. 1239-1248
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Tidskriftsartikel (refereegranskat)abstract
- Background: A high percentage of individuals treated in specialized acute care wards are frail and elderly. Our aim was to study whether the acute care of such patients in a comprehensive geriatric assessment (CGA) unit is superior to care in a conventional acute medical care unit when it comes to activities of daily living (ADLs), frailty, and use of municipal help services. Patients and methods: A clinical, prospective, controlled trial with two parallel groups was conducted in a large county hospital in West Sweden and included 408 frail elderly patients, age 75 or older (mean age 85.7 years; 56% female). Patients were assigned to the intervention group (n=206) or control group (n=202). Primary outcome was decline in functional activity ADLs assessed by the ADL Staircase 3 months after discharge from hospital. Secondary outcomes were degree of frailty and use of municipal help services. Results: After adjustment by regression analyses, treatment in a CGA unit was independently associated with lower risk of decline in ADLs [odds ratio (OR) 0.093; 95% confidence interval (CI) 0.052-0.164; P amp;lt; 0.0001], and with a less prevalent increase in the degree of frailty (OR 0.229; 95% CI 0.131-0.400; P amp;lt; 0.0001). When ADLs were classified into three strata (independence, instrumental ADL-dependence, and personal ADL-dependence), changes to a more dependence-associated stratum were less prevalent in the intervention group (OR 0.194; 95% CI 0.085-0.444; P=0.0001). There was no significant difference between the groups in increased use of municipal help services (OR 0.682; 95% CI 0.395-1.178; P=0.170). Conclusion: Acute care of frail elderly patients in a CGA unit was independently associated with lesser loss of functional ability and lesser increase in frailty after 3 months.
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| 9. |
- Ekerstad, Niklas, 1969-, et al.
(författare)
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Is the acute care of frail elderly patients in a comprehensive geriatric assessment unit superior to conventional acute medical care?
- 2017
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Ingår i: Clinical Interventions in Aging. - : DOVE MEDICAL PRESS LTD. - 1178-1998 .- 1176-9092. ; 12
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Tidskriftsartikel (refereegranskat)abstract
- Objective: The aim of this study was to investigate whether the acute care of frail elderly patients in a comprehensive geriatric assessment (CGA) unit is superior to the care in a conventional acute medical care unit. Design: This is a clinical, prospective, randomized, controlled, one-center intervention study. Setting: This study was conducted in a large county hospital in western Sweden. Participants: The study included 408 frail elderly patients, aged ≥75 years, in need of acute in-hospital treatment. The patients were allocated to the intervention group (n=206) or control group (n=202). Mean age of the patients was 85.7 years, and 56% were female. Intervention: This organizational form of care is characterized by a structured, systematic interdisciplinary CGA-based care at an acute elderly care unit. Measurements: The primary outcome was the change in health-related quality of life (HRQoL) 3 months after discharge from hospital, measured by the Health Utilities Index-3 (HUI-3). Secondary outcomes were all-cause mortality, rehospitalizations, and hospital care costs. Results: After adjustment by regression analysis, patients in the intervention group were less likely to present with decline in HRQoL after 3 months for the following dimensions: vision (odds ratio [OR] =0.33, 95% confidence interval [CI] =0.14–0.79), ambulation (OR =0.19, 95% CI =0.1–0.37), dexterity (OR =0.38, 95% CI =0.19–0.75), emotion (OR =0.43, 95% CI =0.22–0.84), cognition (OR = 0.076, 95% CI =0.033–0.18) and pain (OR =0.28, 95% CI =0.15–0.50). Treatment in a CGA unit was independently associated with lower 3-month mortality adjusted by Cox regression analysis (hazard ratio [HR] =0.55, 95% CI =0.32–0.96), and the two groups did not differ significantly in terms of hospital care costs (P>0.05). Conclusion: Patients in an acute CGA unit were less likely to present with decline in HRQoL after 3 months, and the care in a CGA unit was also independently associated with lower mortality, at no higher cost.
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| 10. |
- Eklund, Kajsa, 1952, et al.
(författare)
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Long term outcome of frailty and ADL following "Continuum of care for frail elderly persons"
- 2012
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Ingår i: The Gerontologist. 2012 GSA Annual Scientific Meeting Abstracts. - 0016-9013 .- 1758-5341. ; 52:S1
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- The current trend in Western societies facing a growing proportion of older people is to support frail older persons to remain in their homes as long as possible, so-called ageing in place. Older persons comprise a group whose reserve of strength is decreasing, and whose activity and participation levels will deteriorate with increasing frailty, often leading to dependence in daily activities. Frail older persons need integrated care from different caregivers at different care levels with multi-professional competences. An intervention study for frail community-dwelling older people was designed, creating a continuum of care from the hospital through and back to their own homes. Objectives were to evaluate its effects on activities of daily living (ADL) and frailty up to one year. The study design was a RCT with participants randomized to either the intervention or a control group with follow-ups at three-, six- and 12 months. The study group includes 161 older people who sought care at the emergency department at Mölndal hospital, Sweden, and discharged to their own homes. Inclusion criteria were age 80 and older or 65 to 79 with at least one chronic disease and dependent in ADL. Frailty was measured as a sum of eight core frailty indicators and ADL with the ADL staircase. The analyses were made on the basis of the intention-to-treat principle. At both three- and twelve-month follow-up the intervention group had a higher OR in improved number of ADL managed independently. There were no significant differences between the groups regarding frailty.
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| 11. |
- Eklund, Kajsa, 1952, et al.
(författare)
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One-year outcome of frailty indicators and activities of daily living following the randomised controlled trial; "Continuum of care for frail older people"
- 2013
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Ingår i: BMC Geriatrics. - : Springer Science and Business Media LLC. - 1471-2318. ; 13
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Tidskriftsartikel (refereegranskat)abstract
- Background: The intervention; "Continuum of Care for Frail Older People", was designed to create an integrated continuum of care from the hospital emergency department through the hospital and back to the older person's own home. The aim of this study is to evaluate the effects of the intervention on functional ability in terms of activities of daily living (ADL). Methods: The study is a non-blinded controlled trial with participants randomised to either the intervention group or a control group with follow-ups at three-, six- and 12 months. The intervention involved collaboration between a nurse with geriatric competence at the emergency department, the hospital wards and a multi-professional team for care and rehabilitation of the older people in the municipality with a case manager as the hub. Older people who sought care at the emergency department at Sahlgrenska University Hospital/Molndal and who were discharged to their own homes in the municipality of Molndal, Sweden were asked to participate. Inclusion criteria were age 80 and older or 65 to 79 with at least one chronic disease and dependent in at least one ADL. Analyses were made on the basis of the intention-to-treat principle. Outcome measures were ADL independence and eight frailty indicators. These were analysed, using Chi-square and odds ratio (OR). Results: A total of 161 participated in the study, 76 persons allocated to the control group and 85 to the intervention group were analysed throughout the study. There were no significant differences between the groups with regards to change in frailty compared to baseline at any follow-up. At both the three-and twelve-month follow-ups the intervention group had doubled their odds for improved ADL independence compared to the control (OR 2.37, 95% CI; 1.20 - 4.68) and (2.04, 95% CI; 1.03 - 4.06) respectively. At six months the intervention group had halved their odds for decreased ADL independence (OR 0.52, 95% CI; 0.27 - 0.98) compared to the control group. Conclusions: The intervention has the potential to reduce dependency in ADLs, a valuable benefit both for the individual and for society.
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| 12. |
- Eklund, Kajsa, 1952, et al.
(författare)
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Screening for frailty among older emergency department visitors: validation of the new FRESH-screening instrument: validating a short screening for frailty
- 2016
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Ingår i: BMC Emergency Medicine. - : Springer Science and Business Media LLC. - 1471-227X. ; 16:27
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Tidskriftsartikel (refereegranskat)abstract
- Background The identification of frail older persons in different health care settings is widely seen as an important step in improving the healthcare system. Screening at an emergency department (ED) should be handled in just a few minutes without the use of tests or measurements. The FRESH-screening was developed for this purpose. This study’s aim was to evaluate the FRESH-screening and its construct validity; also assessed were the sensitivity, specificity, and predictive values for frailty screening. Methods The study had a cross-sectional design. A total of 161 elderly people who sought care at the emergency department at Mölndal Hospital were included. Inclusion criteria were ages ≥80 years or ages 65–79 with at least one chronic disease and dependence in at least one daily living activity. Sensitivity, specificity, and predictive values were calculated to describe the accuracy of the FRESH-screening in identifying those with frailty, as assessed by eight frailty indicators. Sensitivity and specificity were both set at a minimum of 80%, and a percentage sum ≥150 of the sensitivity and positive prediction was considered a measure of excellent value. Result Both sensitivity and specificity were high (81% and 80%, respectively) when comparing the four questions of the FRESH-screening against the eight frailty indicators. The percentage sum of sensitivity and positive prediction was 173 (81% + 92%), thus exceeding the 150 cutoff.
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| 13. |
- Gustafsson, Susanne, et al.
(författare)
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A person-centred approach to health promotion for persons 70+ who have migrated to Sweden : Promoting aging migrants' capabilities implementation and RCT study protocol
- 2015
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Ingår i: BMC Geriatrics. - : BioMed Central. - 1471-2318. ; 15
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Tidskriftsartikel (refereegranskat)abstract
- Background: There are inequities in health status associated with ethnicity, which may limit older foreign-born persons' ability to age optimally. Health promotion for older persons who have experienced migration is thus an area of public health importance. However, since research related to this issue is very limited, the study 'Promoting Aging Migrants' Capabilities' was initiated to improve our understanding. The study aims to implement and evaluate a linguistically adapted, evidence-based, health-promoting intervention with a person-centred approach for two of the largest groups of aging persons who have migrated to Sweden: persons from Finland and persons from the Balkan Peninsula. Methods/Design: This study has a descriptive, analytical, and experimental design. It is both a randomised controlled trial and an implementation study, containing the collection and analysis of both qualitative and quantitative data. The setting is an urban district in a medium-sized Swedish city with a high proportion of persons who were born abroad and whose socio-economic status is low. The intervention comprises four group meetings ('senior meetings') and one follow-up home visit made by a multi-professional team. For the randomised controlled trial, the plan is to recruit at least 130 community-dwelling persons 70 years or older from the target group. Additional persons from involved organisations will participate in the study of the implementation. Both the intervention effects in the target group (outcome) and the results of the implementation process (output) will be evaluated. Discussion: The results of this forthcoming randomised controlled trial and implementation study may be useful for optimising implementation of person-centred, health-promoting initiatives for older persons who have experienced migration. It is also hoped that this combined study will show that the capabilities for optimal aging among older persons born in Finland and the Balkan countries can be improved in the Swedish healthcare context. Trial registration: The trial was registered at ClinicalTrials.gov April 10, 2013, identifier: NCT01841853.
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| 16. |
- Gustafsson, Susanne, 1963, et al.
(författare)
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Health-Promoting Interventions for Persons 80 Years and Over are Successful in the Short Term – Results from the Randomized and Three-Armed Study Elderly Persons in the Risk Zone
- 2012
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Ingår i: Journal of the American Geriatrics Society. - : Wiley. - 0002-8614 .- 1532-5415. ; 60:3, s. 447-454
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES: The study Elderly Persons in the Risk Zone was designed to evaluate if it is possible to delay deterioration if a health-promoting intervention is made when the older adults (80+) are at risk of becoming frail, and if a multi-professional group intervention is more effective in delaying deterioration than a single preventive home visit. This paper examined the outcome with regard to frailty, self-rated health, and Activities of Daily Living (ADL) at the three-month follow-up. DESIGN: A randomized, three-armed, single-blind, and controlled trial performed between November 2007 and May 2011. SETTING: Two municipalities of Gothenburg, Sweden. PARTICIPANTS: A total of 459 older adults were included. They were 80 years or older, living in their ordinary housing, and not dependent on the municipal home help service. INTERVENTION: A preventive home visit or four weekly multi-professional senior group meetings with one follow-up home visit. MEASUREMENTS: The change in frailty, self-rated health, and ADL between baseline and the three-month follow-up. RESULTS: Both interventions delayed deterioration of self-rated health (OR=1.99, 95% CI=1.12 to 3.54). As regards postponing dependence in ADL, senior meetings were found to be the most beneficial intervention (OR=1.95, 95% CI=1.14 to 3.33). No effect on frailty could be demonstrated. CONCLUSION: Health-promoting interventions, made when older adults are at risk of becoming frail, can delay deterioration of self-rated health and ADL in the short term. Also, a multi-professional group intervention such as the senior meetings described seems to have a greater impact on delaying deterioration in ADL than a single preventive home visit. Further research is needed to examine the outcome in the long term, and in different contexts.
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| 17. |
- Gustafsson, Susanne, et al.
(författare)
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Health-promoting interventions for persons aged 80 and older are successful in the short term : results from the randomized and three-armed Elderly Persons in the Risk Zone study
- 2012
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Ingår i: Journal of The American Geriatrics Society. - 0002-8614 .- 1532-5415. ; 60:3, s. 447-454
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES: To examine the outcomes of the Elderly Persons in the Risk Zone study, which was designed to evaluate whether it is possible to delay deterioration if a health-promoting intervention is made when an older adult (≥80) is at risk of becoming frail and whether a multiprofessional group intervention is more effective in delaying deterioration than a single preventive home visit with regard to frailty, self-rated health, and activities of daily living (ADLs) at 3-month follow-up.DESIGN: Randomized, three-armed, single-blind, controlled trial performed between November 2007 and May 2011.SETTING: Two urban districts of Gothenburg, Sweden.PARTICIPANTS: Four hundred fifty-nine community-living adults aged 80 and older not dependent on the municipal home help service.INTERVENTION: A preventive home visit or four weekly multiprofessional senior group meetings with one follow-up home visit.MEASUREMENTS: Change in frailty, self-rated health, and ADLs between baseline and 3-month follow-up.RESULTS: Both interventions delayed deterioration of self-rated health (odds ratio (OR) = 1.99, 95% confidence interval (CI) = 1.12-3.54). Senior meetings were the most beneficial intervention for postponing dependence in ADLs (OR = 1.95, 95% CI = 1.14-3.33). No effect on frailty could be demonstrated.CONCLUSION: Health-promoting interventions made when older adults are at risk of becoming frail can delay deterioration in self-rated health and ADLs in the short term. A multiprofessional group intervention such as the senior meetings described seems to have a greater effect on delaying deterioration in ADLs than a single preventive home visit. Further research is needed to examine the outcome in the long term and in different contexts.
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| 20. |
- Jönsson, Radoslava, 1959, et al.
(författare)
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Prevalence of dizziness and vertigo in an urban elderly population.
- 2004
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Ingår i: Journal of vestibular research : equilibrium & orientation. - 0957-4271. ; 14:1, s. 47-52
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Tidskriftsartikel (refereegranskat)abstract
- The prevalence of balance symptoms (vertigo, dizziness, and dysequilibrium) was investigated in an epidemiological study of elderly people, the longitudinal and cross-sectional gerontological and geriatric population study from Göteborg, Sweden (H70). Three different age cohorts were studied, one at age 70, one at age 75 and one at ages 79, 82, 85, 88 and 90 years. Altogether 2011 participants answered the questionnaire at 3197 occasions. The overall prevalence of balance problems at age 70 was 36% (women) and 29% (men). Balance symptoms were more common among women than men, and increased with increasing age. At ages 88-90 years the corresponding values were 51-45%. The most common symptom was poor balance/general unsteadiness (11-41%). Rotatory symptoms occurred in 2-17%. Other types of symptoms were less common. Precipitating factors were rising from supine to sitting position in 17-40%. Balance symptoms in a side position were uncommon, but occurred more often when tilting the head backwards (up to 14%). Signs that possibly could indicate neurological involvement were uncommon. Falls in conjuncture to dizziness, vertigo and similar symptoms occurred in 7-15%, in about equal proportions indoors as outdoors.
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| 21. |
- Nordin Olsson, Inger, 1955-
(författare)
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Rational drug treatment in the elderly : "To treat or not to treat"
- 2012
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The general aim of this thesis was to examine the effect of interventions on the usage of inappropriate and hazardous multi-medication in the elderly ≥75 years with ≥5 drugs.Methods: Paper I describes a cluster randomization of nursing homes, the outcomes were; number of drugs, health status and evaluations. A randomized controlled trial concerning elderly in ordinary homes was performed in paper II and the outcomes were; EQ-5D index, EQ VAS and prescription quality. In paper III a cohort study was carried out and the outcomes were; medication appropriateness index, EQ-5D index and EQ VAS. In paper IV, registered nurses from the nursing homes study were interviewed in a descriptive study with a qualitative approach.Results:There was a significant reduction of number of drugs used per patient at the intervention nursing homes (p<0.05). Monitoring and evaluation of medications were significantly more frequent at the intervention homes (p<0.01). The registered nurses at the nursing homes described a self-made role in their profession and the leadership was not at sight. Drug treatment seems to be a passive process without own reflection. Extreme polypharmacy was persistent in all three groups of elderly living in ordinary homes and there was an unchanged frequency of drug-risk indicators. In the cohort study a lower medication quality was shown to be associated with a lower quality of life. EQ-5D index was statistically significantly different among the groups as was EQ VAS.Conclusion: The nursing home study showed an extreme shortage of monitoring of health status and surveillance of the effects of drugs in the elderly. More attention must be focused on the complexity of the nursing process; medication management must be promoted in teamwork with the physician. The resistance to change prescriptions in accordance with the intervention underlines the need of new strategies for improving prescription quality. Since medication quality is related to the patients’ quality of life, there is immense reason to continuously evaluate every prescription and treatment in shared decision with the patient.
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| 22. |
- Sjöberg, Christina, 1963, et al.
(författare)
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Association between multi-dose drug dispensing and quality of drug treatment--a register-based study.
- 2011
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Ingår i: PloS one. - : Public Library of Science (PLoS). - 1932-6203. ; 6:10
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Tidskriftsartikel (refereegranskat)abstract
- In the elderly in Scandinavia, multi-dose drug dispensing (MDD) is a common alternative to ordinary prescriptions (OP). MDD patients receive their drugs in unit bags, one for each dose occasion. The prescribing procedure differs between MDD and OP. The aim of the present study was to investigate the association between MDD and quality of drug treatment (QDT).
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| 23. |
- Skoog, Ingmar, 1954, et al.
(författare)
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Suicidal feelings in a population sample of nondemented 85-year-olds.
- 1996
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Ingår i: The American journal of psychiatry. - 0002-953X. ; 153:8, s. 1015-20
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: The authors studied the 1-month frequency of suicidal feelings among very old people. METHOD: A population sample (N = 345) of nondemented 85-year-olds in Gothenburg, Sweden, were examined by a psychiatrist. Suicidal feelings were rated by the system of Paykel et al. Mental disorders were diagnosed according to DSM-III-R. RESULTS: Of the mentally healthy subjects (N = 225), 4.0% had thought during the last month that life was not worth living, 4.0% had had death wishes, and 0.9% had thought of taking their own lives. None had seriously considered suicide. The figures were higher among subjects with mental disorders (N = 120); 29.2% had thought that life was not worth living, 27.5% had had death wishes, 9.2% had thought about taking their lives, and 1.7% had seriously considered suicide. Among the subjects with mental disorders, including depression, suicidal feelings were associated with greater use of anxiolytics but not of antidepressants. Women who felt that life was not worth living had a higher 3-year mortality rate than did women without these feelings (43.2% versus 14.2%). This finding was independent of concomitant physical and mental disorders. CONCLUSIONS: Mild suicidal feelings are common in elderly subjects with metal disorders but infrequent in the mentally healthy. The substantially higher mortality rate in women who felt that life was not worth living, compared to women who did not, suggests these feelings must be taken seriously. Because of the high suicide rate in the elderly, there is a need for better diagnosis and treatment of mental disorders in this age group.
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| 24. |
- Wallerstedt, Susanna M., et al.
(författare)
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Drug Treatment in Older People before and after the Transition to a Multi-Dose Drug Dispensing System-A Longitudinal Analysis
- 2013
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Ingår i: PLOS ONE. - : Public Library of Science (PLoS). - 1932-6203. ; 8:6
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Tidskriftsartikel (refereegranskat)abstract
- BackgroundAn association has been found between multi-dose drug dispensing (MDD) and use of many drugs. The aim of this study was to investigate the nature of this association, by performing a longitudinal analysis of the drug treatment before and after the transition to MDD.MethodsInclusion critera in this register-based study were inhabitants in Region Vastra Gotaland, Sweden, who, at >= 65 years of age and between 1st July 2006 and 30th June 2010, filled their first MDD prescription. For each individual, prescribed drugs were estimated at three month intervals before and after (maximum 3 years, respectively) the first date of filling an MDD prescription (index date).ResultsA total of 30,922 individuals matched the inclusion criteria (mean age: 83.2 years; 59.9% female). There was a temporal association between the transition to MDD and an increased number of drugs: 5.4 +/- 3.9 and 7.5 +/- 3.8 unique drugs three months before and after the index date, respectively, as well as worse outcomes on several indicators of prescribing quality. When either data before or after the index date were used, a multi-level regression analysis predicted the number of drugs at the index date at 5.76 (95% confidence limits: 5.71; 5.80) and 7.15 (7.10; 7.19), respectively, for an average female individual (83.2 years, 10.8 unique diagnoses, 2.4 healthcare contacts/three months). The predicted change in the number of drugs, from three months before the index date to the index date, was greater when data before this date was used as compared with data after this date: 0.12 (0.09; 0.14) versus 0.02 (-0.01; 0.05).ConclusionsAfter the patients entered the MDD system, they had an increased number of drugs, more often potentially harmful drug treatment, and fewer changes in drug treatment. These findings support a causal relationship between such a system and safety concerns as regards prescribing practices.
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| 25. |
- Wilhelmson, Katarina, 1958, et al.
(författare)
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Design of a randomized controlled study of a multi-professional and multidimensional intervention targeting frail elderly people.
- 2011
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Ingår i: BMC geriatrics. - : Springer Science and Business Media LLC. - 1471-2318. ; 11:1
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Tidskriftsartikel (refereegranskat)abstract
- ABSTRACT: BACKGROUND: Frail elderly people need an integrated and coordinated care. The two-armed study "Continuum of care for frail elderly people" is a multi-professional and multidimensional intervention for frail community-dwelling elderly people. It was designed to evaluate whether the intervention programme for frail elderly people can reduce the number of visits to hospital, increase satisfaction with health and social care and maintain functional abilities. The implementation process is explored and analysed along with the intervention. In this paper we present the study design, the intervention and the outcome measures as well as the baseline characteristics of the study participants. Methods/design: The study is a randomised two-armed controlled trial with follow ups at 3, 6 and 12 months. The study group includes elderly people who sought care at the emergency ward and discharged to their own homes in the community. Inclusion criteria were 80 years and older or 65 to 79 years with at least one chronic disease and dependent in at least one activity of daily living. Exclusion criteria were acute severely illness with an immediate need of the assessment and treatment by a physician, severe cognitive impairment and palliative care. The intention was that the study group should comprise a representative sample of frail elderly people at a high risk of future health care consumption. The intervention includes an early geriatric assessment, early family support, a case manager in the community with a multi-professional team and the involvement of the elderly people and their relatives in the planning process. DISCUSSION: The design of the study, the randomisation procedure and the protocol meetings were intended to ensure the quality of the study. The implementation of the intervention programme is followed and analysed throughout the whole study, which enables us to generate knowledge on the process of implementing complex interventions. The intervention contributes to early recognition of both the elderly peoples' needs of information, care and rehabilitation and of informal caregivers' need of support and information. This study is expected to show positive effects on frail elderly peoples' health care consumption, functional abilities and satisfaction with health and social care. Trial registration: ClinicalTrials.gov, NCT01260493.
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- Wilhelmson, Katarina, 1958, et al.
(författare)
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Health care use in the randomized controlled trial “Continuum of Care for Frail Elderly People”
- 2017
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Ingår i: Open Access Journal of Gerontology and Geriatric Medicine. ; 2:3
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Tidskriftsartikel (refereegranskat)abstract
- Dependence in the Activities of Daily Living (ADL) is associated with increased health care consumption. This study aimed to determine if an intervention involving a continuum of care for frail elderly people reduced the use of in-hospital and outpatient care; and if healthcare use differed by subgroups based on ADL dependence. This was a non-blinded randomized controlled trial. Participants (n=161) were aged 65-79 years with at least one chronic disease, and dependent in at least one activity of daily living (ADL); or aged 80+ years; and sought care at the emergency department. Exclusion criteria were immediate need of assessment and treatment by a physician, severe cognitive impairment, and palliative care. The intervention involved collaboration between a nurse with geriatric competence based in the emergency department, hospital wards, and a municipality-based multi- professional team with a case manager that provided care for the elderly people, care planning in the home, and active follow-up. Participants were divided into subgroups based on ADL dependence during the analysis. In the intervention group, participants classified as independent in ADL had fewer visits to a physician compared with the control group. The intervention group received more home visits by occupational therapists/physiotherapists, probably attributed to the rehabilitation inherent to the intervention. Time to first readmission was almost twice as long for independent participants in the intervention group compared with the control group (not statistically significant). Further research with a larger sample size and longer follow-up is needed to confirm if the intervention also reduces in-hospital care.
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