| 1. |
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- 2019
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Tidskriftsartikel (refereegranskat)
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| 2. |
- Fresard, Laure, et al.
(författare)
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Identification of rare-disease genes using blood transcriptome sequencing and large control cohorts
- 2019
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Ingår i: Nature Medicine. - : NATURE PUBLISHING GROUP. - 1078-8956 .- 1546-170X. ; 25:6, s. 911-919
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Tidskriftsartikel (refereegranskat)abstract
- It is estimated that 350 million individuals worldwide suffer from rare diseases, which are predominantly caused by mutation in a single gene(1). The current molecular diagnostic rate is estimated at 50%, with whole-exome sequencing (WES) among the most successful approaches(2-5). For patients in whom WES is uninformative, RNA sequencing (RNA-seq) has shown diagnostic utility in specific tissues and diseases(6-8). This includes muscle biopsies from patients with undiagnosed rare muscle disorders(6,9), and cultured fibroblasts from patients with mitochondrial disorders(7). However, for many individuals, biopsies are not performed for clinical care, and tissues are difficult to access. We sought to assess the utility of RNA-seq from blood as a diagnostic tool for rare diseases of different pathophysiologies. We generated whole-blood RNA-seq from 94 individuals with undiagnosed rare diseases spanning 16 diverse disease categories. We developed a robust approach to compare data from these individuals with large sets of RNA-seq data for controls (n = 1,594 unrelated controls and n = 49 family members) and demonstrated the impacts of expression, splicing, gene and variant filtering strategies on disease gene identification. Across our cohort, we observed that RNA-seq yields a 7.5% diagnostic rate, and an additional 16.7% with improved candidate gene resolution.
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| 3. |
- Lalic, Samanta, et al.
(författare)
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Polypharmacy and Medication Regimen Complexity as Risk Factors for Hospitalization Among Residents of Long-Term Care Facilities : A Prospective Cohort Study
- 2016
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Ingår i: Journal of the American Medical Directors Association. - : Elsevier BV. - 1525-8610 .- 1538-9375. ; 17:11, s. 1067.e1-1067.e6
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: To investigate the association between polypharmacy and medication regimen complexity with time to first hospitalization, number of hospitalizations, and number of hospital days over a 12-month period. Design: A 12-month prospective cohort study. Participants and Setting: A total of 383 residents of 6 Australian long-term care facilities (LTCFs). Measurements: The primary exposures were polypharmacy (>= 9 regular medications) and the 65-item Medication Regimen Complexity Index (MRCI). Cox proportional hazards regression was used to compute hazard ratios (HRs) and 95% confidence intervals (CIs) for the association between polypharmacy and MRCI with time to first hospitalization. Poisson regression was used to compute incident rate ratios (IRR) and 95% CIs for the association between polypharmacy and MRCI with number of hospitalizations and number of hospital days. Models were adjusted for age, sex, length of stay in LTCF, comorbidities, activities of daily living, and dementia severity. Results: There were 0.56 (95% CI 0.49-0.65) hospitalizations per person-year and 4.52 (95% CI 4.31-4.76) hospital days per person-year. In adjusted analyses, polypharmacy was associated with time to first hospitalization (HR 1.84; 95% CI 1.21-2.79), number of hospitalizations (IRR 1.51; 95% CI 1.09-2.10), and hospital days per person-year (IRR 1.39; 95% CI 1.24-1.56). Similarly, in adjusted analyses a 10-unit increase in MRCI was associated with time to first hospitalization (HR 1.17; 95% CI 1.06-1.29), number of hospitalizations (IRR 1.15; 95% CI 1.06-1.24), and hospital days per person-year (IRR 1.19; 95% CI 1.16-1.23). Conclusions: Polypharmacy and medication regimen complexity are associated with hospitalizations from LTCFs. This highlights the importance of regular medication review for residents of LTCFs and the need for further research into the risk-to-benefit ratio of prescribing in this setting.
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| 4. |
- Kerry, Miriam, et al.
(författare)
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Multiple antihypertensive use and risk of mortality in residents of aged care services : a prospective cohort study
- 2020
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Ingår i: Aging Clinical and Experimental Research. - : Springer Science and Business Media LLC. - 1594-0667 .- 1720-8319. ; 32:8, s. 1541-1549
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Tidskriftsartikel (refereegranskat)abstract
- Aims The objective of this study is to investigate the association between multiple antihypertensive use and mortality in residents with diagnosed hypertension, and whether dementia and frailty modify this association.Methods This is a two-year prospective cohort study of 239 residents with diagnosed hypertension receiving antihypertensive therapy across six residential aged care services in South Australia. Data were obtained from electronic medical records, medication charts and validated assessments. The primary outcome was all-cause mortality and the secondary outcome was cardiovascular-related hospitalizations. Inverse probability weighted Cox models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for all-cause mortality. Covariates included age, sex, dementia severity, frailty status, Charlson's comorbidity index and cardiovascular comorbidities.Results The study sample (mean age of 88.1 +/- 6.3 years; 79% female) included 70 (29.3%) residents using one antihypertensive and 169 (70.7%) residents using multiple antihypertensives. The crude incidence rates for death were higher in residents using multiple antihypertensives compared with residents using monotherapy (251 and 173/1000 person-years, respectively). After weighting, residents who used multiple antihypertensives had a greater risk of mortality compared with monotherapy (HR 1.40, 95%CI 1.03-1.92). After stratifying by dementia diagnosis and frailty status, the risk only remained significant in residents with diagnosed dementia (HR 1.91, 95%CI 1.20-3.04) and who were most frail (HR 2.52, 95%CI 1.13-5.64). Rate of cardiovascular-related hospitalizations did not differ among residents using multiple compared to monotherapy (rate ratio 0.73, 95%CI 0.32-1.67).Conclusions Multiple antihypertensive use is associated with an increased risk of mortality in residents with diagnosed hypertension, particularly in residents with dementia and among those who are most frail.
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| 5. |
- Liau, Shin J., et al.
(författare)
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Medication Management in Frail Older People : Consensus Principles for Clinical Practice, Research, and Education
- 2021
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Ingår i: Journal of the American Medical Directors Association. - : Elsevier BV. - 1525-8610 .- 1538-9375. ; 22:1, s. 43-49
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Tidskriftsartikel (refereegranskat)abstract
- Frailty is a geriatric condition associated with increased vulnerability to adverse drug events and medication-related harm. Existing clinical practice guidelines rarely provide medication management recommendations specific to frail older people. This report presents international consensus principles, generated by the Optimizing Geriatric Pharmacotherapy through Pharmacoepidemiology Network, related to medication management in frail older people. This consensus comprises 7 principles for clinical practice, 6 principles for research, and 4 principles for education. Principles for clinical practice include (1) perform medication reconciliation and maintain an up-to-date medication list; (2) assess and plan based on individual's capacity to self-manage medications; (3) ensure appropriate prescribing and deprescribing; (4) simplify medication regimens when appropriate to reduce unnecessary burden; (5) be alert to the contribution of medications to geriatric syndromes; (6) regularly review medication regimens to align with changing goals of care; and (7) facilitate multidisciplinary communication among patients, caregivers, and healthcare teams. Principles for research include (1) include frail older people in randomized controlled trials; (2) consider frailty status as an effect modifier; (3) ensure collection and reporting of outcome measures important in frailty; (4) assess impact of frailty on pharmacokinetics and pharmacodynamics; (5) encourage frailty research in under-researched settings; and (6) utilize routinely collected linked health data. Principles for education include (1) provide undergraduate and post-graduate education on frailty; (2) minimize low-value care related to medication management; (3) improve health and medication literacy; and (4) incorporate evidence in relation to frailty into clinical practice guidelines. These principles for clinical practice, research and education highlight different considerations for optimizing medication management in frail older people. These principles can be used in conjunction with existing best practice guidelines to help achieve optimal health outcomes for this vulnerable population. Implementation of the principles will require multidisciplinary collaboration between healthcare professionals, researchers, educators, organizational leaders, and policymakers.
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| 6. |
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| 7. |
- Stasinopoulos, Jacquelina, et al.
(författare)
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Frequency of and factors related to pro re nata (PRN) medication use in aged care services
- 2018
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Ingår i: Research in Social and Administrative Pharmacy. - : Elsevier BV. - 1551-7411 .- 1934-8150. ; 14:10, s. 964-967
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Tidskriftsartikel (refereegranskat)abstract
- Background: Little is known about the contribution of 'pro re nata' (PRN) medications to overall medication burden in residential aged care services (RACS). Objectives: To determine the frequency of, and factors associated with PRN medication administration in RACS. Measurements: Details of all medications charted for regular or PRN use were extracted from medication charts for 383 residents of 6 Australian RACS. Records of medications administered over a 7 day period were also extracted. Factors associated with PRN medication administration among residents charted >= 1 PRN were determined using multivariate logistic regression. Results: Of the 360 (94%) residents charted >= 1 PRN medication, 99 (28%) were administered PRN medication at least once. The most prevalent PRN medications were analgesics and laxatives. Residents with greater dependence with activities of daily living (ADL) (adjusted odds ratio (aOR) per additional point on Katz ADL scale: 0.80; 95% confidence interval (CI) 0.72-0.89; p < 0.001) and a greater number of regular medications (aOR per additional medication: 1.06; 95% CI 1.00-1.13; p = 0.042) were more likely to be administered PRN medication. Conclusions: Although most residents are charted PRN medications, rates of administration are relatively low, suggesting the contribution of PRNs to medication burden in RACS may be lower than previously thought.
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| 8. |
- Tan, Edwin C. K., et al.
(författare)
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Research Priorities for Optimizing Geriatric Pharmacotherapy : An International Consensus
- 2018
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Ingår i: Journal of the American Medical Directors Association. - : Elsevier BV. - 1525-8610 .- 1538-9375. ; 19:3, s. 193-199
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Tidskriftsartikel (refereegranskat)abstract
- Medication management is becoming increasingly challenging for older people, and there is limited evidence to guide medication prescribing and administration for people with multimorbidity, frailty, or at the end of life. Currently, there is a lack of clear research priorities in the field of geriatric pharmacotherapy. To address this issue, international experts from 5 research groups in geriatric pharmacotherapy and pharmacoepidemiology research were invited to attend the inaugural Optimizing Geriatric Pharmacotherapy through Pharmacoepidemiology Network workshop. A modified nominal group technique was used to explore and consolidate the priorities for conducting research in this field. Eight research priorities were elucidated: quality of medication use; vulnerable patient groups; polypharmacy and multimorbidity; person-centered practice and research; deprescribing; methodological development; variability in medication use; and national and international comparative research. The research priorities are discussed in detail in this article with examples of current gaps and future actions presented. These priorities highlight areas for future research in geriatric pharmacotherapy to improve medication outcomes in older people.
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| 9. |
- Aljeaidi, Muhamad, et al.
(författare)
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Dry Eyes, Ocular Lubricants, and Use of Systemic Medications Known or Suspected to Cause Dry Eyes in Residents of Aged Care Services
- 2020
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Ingår i: International Journal of Environmental Research and Public Health. - : MDPI AG. - 1661-7827 .- 1660-4601. ; 17:15
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Tidskriftsartikel (refereegranskat)abstract
- Ocular issues are common, burdensome, and under-researched among residents of aged care services. This study aims to investigate the prevalence of dry eyes or use of ocular lubricants among residents, and the possible association with systemic medications known or suspected to cause dry eyes. A cross-sectional study of 383 residents of six aged care services in South Australia was conducted. Data were extracted from participants' medical histories, medication charts, and validated assessments. The main exposure was systemic medications known to cause, contribute to, or aggravate dry eyes. The primary outcome was documented dry eyes or regular administration of ocular lubricants. Logistic regression was used to estimate odds ratios (ORs) and 95% confidence intervals (CIs) for the association between systemic medications and dry eyes/use of ocular lubricants. Dry eyes were documented for 53 (13.8%) residents and 98 (25.6%) residents were administered ocular lubricants. Overall, 116 (30.3%) residents had documented dry eyes/used ocular lubricants. Of these, half (n= 58) were taking a medication known to cause, contribute to, or aggravate dry eyes. Taking one or more medications listed as known to cause dry eyes was associated with having dry eyes/use of ocular lubricants (OR 1.83, 95% CI 1.15-2.94). In sub-analyses, no individual medication was associated with dry eyes/use of ocular lubricants. Dry eyes and use of ocular lubricants are common in residential aged care. Our hypothesis generating findings suggest the need for further research into the clinical significance of systemic medications as a possible cause of dry eyes.
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| 10. |
- Aljeaidi, Muhamad S., et al.
(författare)
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The association between polypharmacy and cognitive ability in older adults : A national cohort study
- 2022
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Ingår i: Research in Social and Administrative Pharmacy. - : Elsevier BV. - 1551-7411 .- 1934-8150. ; 18:3, s. 2505-2509
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Tidskriftsartikel (refereegranskat)abstract
- Background: Polypharmacy, the use of multiple medications by one individual, may be associated with adverse health outcomes including poor cognition. However, it remains unclear whether a longitudinal relationship exists.Objectives: To investigate the association between polypharmacy and 3-year cognitive ability in older adults.Methods: A longitudinal cohort study of older adults 65 years and older, residing in the community, who participated in waves 12 (2012), 13 (2013) and 16 (2016) of the Household Income and Labour Dynamics (HILDA) Survey was conducted. Polypharmacy was defined as the regular use of 5 or more prescription medications. Cognitive ability was assessed using backwards digit span test (BDS), 25-item version of the National Adult Reading Test (NART-25) and symbol-digit modalities test (SDM). Linear regression was used to test the longitudinal association between polypharmacy and cognitive test scores at 3 years. All analyses were adjusted for age, sex, education, comorbidities, socioeconomic and lifestyle factors, and baseline cognitive test scores.Results: A total of 2141 participants (mean age 72.9 years, 54.4% female) were included in the study sample. Polypharmacy was present in 27.3%. After adjusting for potential confounders, polypharmacy was negatively associated with cognitive ability at 3 years: BDS: −0.067 (95% CI = −0.353 to −0.051), NART-25: −0.071 (95% CI = −1.428 to −0.294), SDM: −0.073 (95% CI = −2.960 to −0.696).Conclusion: Polypharmacy was associated with poorer cognitive ability at 3 years, even after adjusting for comorbidities and other confounders. Future research should consider the long-term impact of polypharmacy on cognitive ability, and identify strategies to optimise medication use and cognition in older adults.
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| 11. |
- Chen, Lynna, et al.
(författare)
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The association between benzodiazepine use and sleep quality in residential aged care facilities : a cross-sectional study
- 2016
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Ingår i: BMC Geriatrics. - : Springer Science and Business Media LLC. - 1471-2318. ; 16
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Tidskriftsartikel (refereegranskat)abstract
- Background: Benzodiazepines are commonly prescribed in residential aged care facilities (RACFs) for their sedative and anxiolytic effects. The objective of this study was to investigate the association between benzodiazepine use and sleep quality in residents of RACFs. Methods: A cross-sectional study involving 383 participants was conducted in six Australian RACFs. Night-time sleep quality, day-time drowsiness and day-time napping behavior were assessed using a validated questionnaire. Logistic regression was used to compute adjusted odds ratios (AORs) and 95% confidence intervals (CIs) for the association between benzodiazepine use and sleep quality. Covariates included pain, dementia severity, depression, insomnia and other sedative use. Results: Of the 383 residents (mean age 87.5 years, 77.5% female), 96(25.1%) used a benzodiazepine on a regular basis. Residents who used long-acting benzodiazepines on a regular basis had higher night-time sleep quality than non-users (AOR = 4.00, 95%CI 1.06 - 15.15). Residents who used short-acting benzodiazepines on a PRN only basis had longer daytime napping times than non-users (AOR = 1.77, 95% CI 1.01 - 3.08). No benzodiazepine category was associated with day-time drowsiness. Conclusions: The association between benzodiazepine use and sleep quality is dependent on the half-life and prescribing pattern of the benzodiazepine. Short-acting PRN benzodiazepines were associated with lower night time sleep quality and longer day-time napping compared to long-acting regular benzodiazepines. Longitudinal studies are needed to determine whether these findings reflect channeling of short-acting agents to residents at higher risk of sleep disorders.
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| 12. |
- Ding, Lijie, et al.
(författare)
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Smoking, heavy drinking, physical inactivity, and obesity among middle-aged and older adults in China : cross-sectional findings from the baseline survey of CHARLS 2011-2012.
- 2020
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Ingår i: BMC Public Health. - : BioMed Central. - 1471-2458. ; 20:1
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Prevention and control of cardiometabolic conditions and cardiovascular disease (CVD) in China may contribute to sustainable CVD reduction globally, given the fact that one-fifth of the worldwide population is in China. Knowing the distribution of behavioral risk factors (e.g., smoking and physical inactivity), especially at a national level in China, would be extremely relevant to the field of public health and CVD prevention. The objectives of this study were to investigate the nationwide prevalence of obesity, smoking, heavy drinking, and physical inactivity in Chinese adults, and further explore whether cardiometabolic conditions would modify the distribution of behavioral risk factors.METHODS: This population-based study is based on the China Health and Retirement Longitudinal Study (2011-2012), including 17,302 adults (≥45 years, mean age 59.67 years, female 51.66%) from 25 provinces in China. Data on demographics, lifestyle factors, health status and history of diseases were collected via structured interviews and laboratory tests. Smoking, heavy drinking, obesity, and physical inactivity were defined following standard guidelines. We performed descriptive analysis and logistic regressions in this study.RESULTS: The overall prevalence of heavy drinking, obesity, current smoking, and physical inactivity among middle-aged and older adults was 7.23% (95% confidence interval 6.53-7.29%), 11.53% (10.43-12.62%), 27.46% (26.30-28.62%), and 44.06% (41.19-46.92%), respectively. The prevalence varied between rural and urban areas as well as among geographic areas, with higher prevalence in the Northern and Northeastern regions. Heavy drinking and obesity were significantly associated with incident hypertension, diabetes, and high cholesterol; while current smoking was significantly associated with incident hypertension. Compared with healthy individuals, participants who self-reported a diagnosis of hypertension, high cholesterol, or diabetes were less likely to smoke currently and drink alcohol heavily, but more likely to be physically inactive and obese.CONCLUSIONS: Among Chinese middle-aged and older adults, the prevalence of behavioral risk factors varies by geographic region. Further effort is required to improve physical activity and fitness for Chinese adults, especially those with cardiometabolic conditions.
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| 13. |
- Haaksma, Miriam L., et al.
(författare)
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Predicting Cognitive and Functional Trajectories in People With Late-Onset Dementia : 2 Population-Based Studies
- 2019
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Ingår i: Journal of the American Medical Directors Association. - : Elsevier BV. - 1525-8610 .- 1538-9375. ; 20:11, s. 1444-1450
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: Previous studies have shown large heterogeneity in the progression of dementia, both within and between patients. This heterogeneity offers an opportunity to limit the global and individual burden of dementia through the identification of factors associated with slow disease progression in dementia. We explored the heterogeneity in dementia progression to detect disease, patient, and social context factors related to slow progression. Design: Two longitudinal population-based cohort studies with follow-up across 12 years. Setting and Participants: 512 people with incident dementia from Stockholm (Sweden) contributed to the Kungsholmen Project and the Swedish National Study of Aging and Care in Kungsholmen. Methods: We measured cognition using the Mini-Mental State Examination and daily functioning using the Katz Activities of Daily Living Scale. Latent classes of trajectories were identified using a bivariate growth mixture model. We then used bias-corrected logistic regression to identify predictors of slower progression. Results: Two distinct groups of progression were identified; 76% (n = 394) of the people with dementia exhibited relatively slow progression on both cognition and daily functioning, whereas 24% (n = 118) demonstrated more rapid worsening on both outcomes. Predictors of slower disease progression were Alzheimer's disease (AD) dementia type [odds ratio (OR) 2.07, 95% confidence interval (CI) 1.15-3.71], lower age (OR 0.88, 95% CI 0.83-0.94), fewer comorbidities (OR 0.77, 95% CI 0.66-0.90), and a stronger social network (OR 1.72, 95% CI 1.01-2.93). Conclusions/Implications: Lower age, AD dementia type, fewer comorbidities, and a good social network appear to be associated with slow cognitive and functional decline. These factors may help to improve the counseling of patients and caregivers and to optimize the planning of care in dementia.
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| 14. |
- Hoang, Minh Tuan, et al.
(författare)
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The Impact of Educational Attainment and Income on Long-Term Care for Persons with Alzheimer's Disease and Other Dementias : A Swedish Nationwide Study
- 2023
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Ingår i: Journal of Alzheimer's Disease. - : IOS Press. - 1387-2877 .- 1875-8908. ; 96:2, s. 789-800
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Tidskriftsartikel (refereegranskat)abstract
- Background: Long-term care improves independence and quality of life of persons with dementia (PWD). The influence of socioeconomic status on access to long-term care was understudied.Objective: To explore the socioeconomic disparity in long-term care for PWD.Methods: This registry-based study included 14,786 PWD, registered in the Swedish registry for cognitive and dementia disorders (2014-2016). Education and income, two traditional socioeconomic indicators, were the main exposure. Outcomes were any kind of long-term care, specific types of long-term care (home care, institutional care), and the monthly average hours of home care. The association between outcomes and socioeconomic status was examined with zero-inflated negative binomial regression and binary logistic regression.Results: PWD with compulsory education had lower likelihood of receiving any kind of long-term care (OR 0.80, 95% CI 0.68-0.93), or home care (OR 0.83, 95% CI 0.70-0.97), compared to individuals with university degrees. Their monthly average hours of home care were 0.70 times (95% CI 0.59-0.82) lower than those of persons with university degrees. There was no significant association between education and the receipt of institutional care. Stratifying on persons with Alzheimer's disease showed significant association between lower education and any kind of long-term care, and between income and the hours of home care.Conclusions: Socioeconomic inequalities in long-term care existed in this study population. Lower-educated PWD were less likely to acquire general long-term care, home care and had lower hours of home care, compared to their higher-educated counterparts. Income was not significantly associated with the receipt of long-term care.
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| 15. |
- Jokanovic, Natali, et al.
(författare)
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Change in Prescribing forSecondary Prevention of Stroke and Coronary Heart Disease in Finnish Nursing Homes and Assisted Living Facilities
- 2019
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Ingår i: Drugs & Aging. - : Springer Science and Business Media LLC. - 1170-229X .- 1179-1969. ; 36:6, s. 571-579
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Tidskriftsartikel (refereegranskat)abstract
- BackgroundOne quarter of residents in long-term care facilities (LTCFs) have a diagnosis of CHD or stroke and over half use at least one preventative cardiovascular medication. There have been no studies that have investigated the longitudinal change in secondary preventative cardiovascular medication use in residents in LTCFs over time.ObjectiveThe aim of this study was to investigate the change in cardiovascular medication use among residents with coronary heart disease (CHD) and prior stroke in nursing homes (NHs) and assisted living facilities (ALFs) in Finland over time, and whether this change differs according to dementia status.MethodsThree comparable cross-sectional audits of cardiovascular medication use among residents aged 65years and over with CHD or prior stroke in NHs in 2003 and 2011 and ALFs in 2007 and 2011 were compared. Logistic regression analyses adjusted for gender, age, mobility, cancer and length of stay were performed to examine the effect of study year, dementia and their interaction on medication use.ResultsCardiovascular medication use among residents with CHD (NHs: 89% vs 70%; ALFs: 89% vs 84%) and antithrombotic medication use among residents with stroke (NHs: 72% vs 63%; ALFs: 78% vs 69%) declined between 2003 and 2011 in NHs and 2007 and 2011 in ALFs. Decline in the use of diuretics, nitrates and digoxin were found in both groups and settings. Cardiovascular medication use among residents with CHD and dementia declined in NHs (88% [95% CI 85-91] in 2003 vs 70% [95% CI 64-75] in 2011) whereas there was no change among people without dementia. There was no change in cardiovascular medication use among residents with CHD in ALFs with or without dementia over time. Antithrombotic use was lower in residents with dementia compared with residents without dementia in NHs (p<0.001) and ALFs (p=0.026); however, the interaction between dementia diagnosis and time was non-significant.ConclusionsThe decline in cardiovascular medication use in residents with CHD and dementia suggests Finnish physicians are adopting a more conservative approach to the management of cardiovascular disease in the NH population.
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| 16. |
- Tan, Edwin C. K., et al.
(författare)
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Acetylcholinesterase inhibitors and risk of stroke and death in people with dementia
- 2018
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Ingår i: Alzheimer's & Dementia. - : Wiley. - 1552-5260 .- 1552-5279. ; 14:7, s. 944-951
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Tidskriftsartikel (refereegranskat)abstract
- Introduction: The aim of this study was to investigate the association between acetylcholinesterase inhibitor (AChEI) use and risk of ischemic stroke and death in people with dementia.Methods: A cohort study of 44,288 people with dementia registered in the Swedish Dementia Registry from 2007 to 2014. Propensity score-matched competing risk regression models were used to compute hazard ratios and 95% confidence intervals for the association between time-dependent AChEI use and risk of stroke and death.Results: Compared with matched controls, AChEI users had a lower risk of stroke (hazard ratio: 0.85, 95% confidence interval: 0.75-0.95) and all-cause death (hazard ratio: 0.76, 95% confidence interval: 0.72-0.80). After considering competing risk of death, high doses (>= 1.33 defined daily doses) of AChEI remained significantly associated with reduced stroke risk.Discussion: The use of AChEIs in people with dementia may be associated with reduced risk of ischemic stroke and death. These results call for a closer examination of the cardiovascular effects of AChEIs.
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| 17. |
- Tan, Edwin C. K., et al.
(författare)
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Anticholinergic Burden and Risk of Stroke and Death in People with Different Types of Dementia
- 2018
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Ingår i: Journal of Alzheimer's Disease. - Stockholm : Karolinska Institutet, Dept of Neurobiology, Care Sciences and Society. - 1387-2877 .- 1875-8908. ; 65:2, s. 589-596
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Tidskriftsartikel (refereegranskat)abstract
- Background: Anticholinergic burden is associated with poorer cognitive and functional outcomes in people with dementia. However, the impact of anticholinergics on significant adverse outcomes such as stroke has not been studied previously.Objective: To investigate the association between total anticholinergic cognitive burden (ACB) and risk of stroke and death in people with different dementia subtypes.Methods: This was a cohort study of 39,107 people with dementia and no prior history of stroke registered in the Swedish Dementia Registry (SveDem) from 2008-2014. Data were extracted from the Swedish Prescribed Drug Register, the Swedish National Patient Register, and the Swedish Total Population Register. Competing risk regression models were used to compute hazard ratios (HRs) and 95% confidence intervals (CIs) for the association between time-varying ACB score and risk of stroke and all-cause mortality.Results: During a mean follow-up period of 2.31 (standard deviation 1.66) years, 11,224 (28.7%) individuals had a stroke or died. Compared with non-users of anticholinergic medications, ACB score of 1 (HR 1.09, 95% CI 1.04-1.14) and ACB score of >= 2 (HR 1.20, 95% CI 1.14-1.26) increased the risk of developing the composite outcome of stroke and death. When stratifying by dementia disorder, the association remained significant in Alzheimer's disease, mixed dementia, and vascular dementia.Conclusions: The use of anticholinergic medicines may be associated with an increased risk of stroke and death in people with dementia. A dose-response relationship was observed. Careful consideration should be made when prescribing medications with anticholinergic properties to people with dementia.
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| 18. |
- Tan, Edwin C. K., et al.
(författare)
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Antihypertensive Medication Regimen Intensity and Incident Dementia in an Older Population
- 2018
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Ingår i: Journal of the American Medical Directors Association. - : Elsevier BV. - 1525-8610 .- 1538-9375. ; 19:7, s. 577-583
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To investigate the association between antihypertensive medication regimen intensity and risk of incident dementia in an older population. Design: Prospective, longitudinal cohort study. Participants/Setting: A total of 1208 participants aged >= 78 years, free of dementia, and residing in central Stockholm at baseline (2001-2004). Measurements: Participants were examined at 3- and 6-year follow-up to detect incident dementia. Data were collected through face-to-face interviews, clinical examinations, and laboratory tests. Data on antihypertensive use were obtained by a physician through patient self-report, visual inspection, or medical records. Cox proportional hazards models were used to compute hazard ratios (HRs) and 95% confidence intervals (CIs) for the association between time-varying antihypertensive regimen intensity and incident dementia after adjusting for potential confounders. Results: During the follow-up period, 125 participants were diagnosed with dementia. Participants who developed dementia were more likely to have vascular disease at baseline (66.4% vs 55.3%, P=.02). In fully adjusted analyses, the number of antihypertensive classes (HR 0.68, 95% CI 0.55-0.84) and total prescribed daily dose (HR 0.70, 95% CI 0.57-0.86) were significantly associated with reduced dementia risk. After considering all-cause mortality as a competing risk, the number (HR 0.75, 95% CI 0.62-0.91) and doses (HR 0.71, 95% CI 0.59-0.86) of antihypertensive classes, and the independent use of diuretics (HR 0.66, 95% CI 0.44-0.99), were significantly associated with lower dementia risk. Conclusions: Greater intensity of antihypertensive drug use among older people may be associated with reduced incidence of dementia.
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| 19. |
- Tan, Edwin C. K., et al.
(författare)
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Do Acetylcholinesterase Inhibitors Prevent or Delay Psychotropic Prescribing in People With Dementia? Analyses of the Swedish Dementia Registry
- 2020
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Ingår i: The American journal of geriatric psychiatry. - : Elsevier BV. - 1064-7481 .- 1545-7214. ; 28:1, s. 108-117
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: To investigate whether acetylcholinesterase inhibitor (AChEI) use prevents or delays subsequent initiation of psychotropic medications in people with Alzheimer's disease (AD) and Lewy body dementia (LBD). Methods: Cohort study of 17,763 people with AD and LBD, without prior psychotropic use at time of dementia diagnosis, registered in the Swedish Dementia Registry from 2007 to 2015. Propensity score-matched regression models were used to compute hazard ratios (HRs) and 95% confidence intervals (CIs) for the association between time-dependent AChEI use and risk of psychotropic initiation. Results: Compared with matched comparators, AChEI users had a lower risk of antipsychotic ( HR: 0.85, 95%CI: 0.75-0.95) and anxiolytic (HR: 0.76, 95%CI: 0.72-0.80) initiation. In subanalyses, this association remained significant at higher AChEI doses, and in AD but not LBD. There were no associations between AChEI use and initiation of antidepressants or hypnotics. Conclusion: AChEI use may be associated with lower risk of antipsychotic and anxiolytic initiation in AD, particularly at higher doses. Further investigation into aceytylcholinesterase inhibitors in behavioral and psychological symptoms of dementia management in LBD is warranted.
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| 20. |
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| 21. |
- Tan, Edwin C. K., et al.
(författare)
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Medications That Cause Dry Mouth As an Adverse Effect in Older People : A Systematic Review and Metaanalysis
- 2018
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Ingår i: Journal of The American Geriatrics Society. - : Wiley. - 0002-8614 .- 1532-5415. ; 66:1, s. 76-84
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Forskningsöversikt (refereegranskat)abstract
- OBJECTIVES: To assess and quantify the risk of drug-induced dry mouth as a side effect in older people.DESIGN: Systematic review and metaanalysis.SETTING: A search of the literature was undertaken using Medline, Embase, Cochrane, Web of Science, and PubMed from 1990 to 2016.PARTICIPANTS: Older people (aged 60) who participated in intervention or observational studies investigating drug use as an exposure and xerostomia or salivary gland hypofunction as adverse drug outcomes.MEASUREMENTS: Two pairs of authors screened titles and abstracts of studies for relevance. Two authors independently extracted data, including study characteristics, definitions of exposure and outcome, and methodological quality. For the metaanalyses, random-effects models were used for pooling the data and I-2 statistics for exploring heterogeneity.RESULTS: Of 1,544 potentially relevant studies, 52 were deemed eligible for inclusion in the final review and 26 in metaanalyses. The majority of studies were of moderate methodological quality. In the intervention studies, urological medications (odds ratio (OR)=5.91, 95% confidence interval (CI)=4.04-8.63; I-2=62%), antidepressants (OR=4.74, 95% CI=2.69-8.32, I-2=21%), and psycholeptics (OR=2.59, 95% CI=1.79-3.95, I-2=0%) were significantly associated with dry mouth. In the observational studies, numbers of medications and several medication classes were significantly associated with xerostomia and salivary gland hypofunction.CONCLUSION: Medication use was significantly associated with xerostomia and salivary gland hypofunction in older adults. The risk of dry mouth was greatest for drugs used for urinary incontinence. Future research should develop a risk score for medication-induced dry mouth to assist with prescribing and medication management.
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| 22. |
- Tan, Edwin C. K., et al.
(författare)
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National Trends in Outpatient Antihypertensive Prescribing in People with Dementia in the United States
- 2016
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Ingår i: Journal of Alzheimer's Disease. - 1387-2877 .- 1875-8908. ; 54:4, s. 1425-1435
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Tidskriftsartikel (refereegranskat)abstract
- Objective: The objectives were to investigate national trends in outpatient antihypertensive prescribing in people with dementia in the United States between 2006 and 2012, and to investigate clinical and demographic factors associated with different antihypertensive prescribing patterns. Methods: This was an analysis of the National Ambulatory Medical Care Survey (NAMCS) and the outpatient department component of the National Hospital Ambulatory Medical Care Survey (NHAMCS). Outpatient visits by people aged >= 65 years with documented dementia were analyzed. Complex samples multivariate logistic regression was conducted to estimate temporal trends and adjusted odds ratios (AORs) with 95% confidence intervals (CIs) for factors associated with prescribing of antihypertensives, multiple antihypertensives and different antihypertensive classes. Results: There was a statistically significant increase in the proportion of physician visits by older people with dementia with a documented diagnosis of hypertension from 49.3% (95% CI: 41.3%-57.4%) in 2006 to 55.7% (95% CI: 50.2%-61.2%) in 2012. There were non-significant increases in overall antihypertensive use and the use of multiple antihypertensive classes. Male sex was associated with any antihypertensive use (AOR 1.37, 95% CI 1.02-1.84) and multiple antihypertensive class use (AOR 1.52, 95% CI 1.14-2.04). Black race (AOR 2.04, 95% CI 1.12-3.71) and Midwest residence (AOR 2.03, 95% CI 1.46-2.82) were associated with multiple antihypertensive use. Conclusion: There was an increase in documented hypertension in physician visits by older people with dementia from 2006 to 2012, but minimal increases in overall antihypertensive use. Various demographic and clinical factors were associated with the prescribing of antihypertensives in people with dementia.
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| 23. |
- Tan, Edwin C. K., et al.
(författare)
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Psychosocial job strain and polypharmacy : a national cohort study
- 2020
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Ingår i: Scandinavian Journal of Work, Environment and Health. - : Scandinavian Journal of Work, Environment and Health. - 0355-3140 .- 1795-990X. ; 46:6, s. 589-598
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: Psychosocial job strain has been associated with a range of adverse health outcomes. The aim of this study was to examine the association between psychosocial job strain and prospective risk of polypharmacy (the prescription of ≥5 medications) and to evaluate whether coping strategies can modify this risk.Methods: Cohort study of 9703 working adults [mean age 47.5 (SD 10.8) years; 54% female] who participated in the Swedish Longitudinal Occupational Survey of Health (SLOSH) at baseline in 2006 or 2008. Psychosocial job strain was represented by job demands and control, and measured by the Swedish version of the demand–control questionnaire. The outcome was incidence of polypharmacy over an eight-year follow-up period. Information on dispensed drugs were extracted from the Swedish Prescribed Drug Register. Logistic regression was used to estimate the association of job strain status with polypharmacy, adjusted for a range of confounders.Results: During the follow-up, 1409 people developed polypharmacy (incident rate: 20.6/1000 person-years). In comparison to workers with low-strain jobs (high control/low demands), those with high-strain jobs (low control/high demands) had a significantly higher risk of incident polypharmacy (OR 1.40, 95% CI 1.04–1.89). The impact of high-strain jobs on developing polypharmacy remained among those with covert coping strategies (ie, directed inwards or towards others) but not among those with open coping strategies (ie, primarily directed toward the stressor).Conclusions: Workers in high-strain jobs may be at an increased risk of polypharmacy. Open coping strategies may reduce the negative impact of psychosocial job strain on risk of polypharmacy.
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| 24. |
- Tan, Edwin C. K., et al.
(författare)
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Validating a model for medication-related dental outcomes in older people
- 2022
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Ingår i: Oral Diseases. - : Wiley. - 1354-523X .- 1601-0825. ; 28:6, s. 1697-1704
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: To externally validate a model for medication-related dental outcomes in (a) a general older population with dementia and (b) a matched population without dementia.Subjects and Methods: This validation study used population-based data from seven Swedish national registers (2008–2017). Individuals aged 60+ with dementia were matched to those without dementia on age, gender, and county of residence at the date of diagnosis (index date). The exposure was continuous use of xerogenic medications during the 3-year period before index date. The primary outcome was the number of tooth extraction and restorative procedures within 3 years after index date.Results: A total of 334,220 individuals were included in the final sample. In the dementia cohort, the use of urological drugs (incidence rate ratio [IRR] 1.08, 95% CI 1.03–1.13), respiratory medicines (IRR 1.10, 95% CI 1.04–1.17), and proton-pump inhibitors (IRR 1.09, 95% CI 1.05–1.13) was associated with the primary outcome. In the non-dementia cohort, respiratory medicines (IRR 1.03, CI 1.00–1.05), proton-pump inhibitors (IRR 1.06, CI 1.04–1.08), opioids (IRR 1.05, CI 1.03–1.07), and antidepressants (IRR 1.06, CI 1.04–1.08) were associated with the primary outcome.Conclusions: Although there were differences in prescription patterns, the model performed similarly in both those with and without dementia.
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| 25. |
- Tan, Edwin C. K., et al.
(författare)
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Xerogenic Medications as a Predictor for Dental Health Intervention in People with Dementia
- 2020
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Ingår i: Journal of Alzheimer's Disease. - 1387-2877 .- 1875-8908. ; 75:4, s. 1263-1271
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Tidskriftsartikel (refereegranskat)abstract
- Background: Older adults with dementia often have poor oral health. Chronic use of xerogenic medications may contribute to adverse dental outcomes.Objective: To investigate the impact of xerogenic medication classes on the predicted risk for dental interventions in people with dementia.Methods: Thiswas a population-based cohort study involving 30,955 individuals registered in the Swedish Dementia Registry (SveDem) from 2008 to 2015. Data were linked with other national registers. The exposure was xerogenic medication classes used in the three years prior to dementia diagnosis (baseline). The primary outcome was the composite of number of tooth extractions and dental restorations over the three-year follow-up period. Secondary outcomes included the number of tooth extractions and number of dental restorations. Poisson regression models were used to estimate the association between the exposure and outcomes. Analyses were adjusted for age, gender, Mini-Mental State Examination, living arrangement, dementia disorder, average number of medications, Charlson’s comorbidity index, number of dental visits, and number of teeth.Results: After adjusting for potential covariates, the use of urological drugs (incidence rate ratio [IRR] 1.16, 95% CI 1.04–1.28), proton pump inhibitors (IRR 1.13, 95% CI 1.04–1.23), and opioids (IRR 1.19, 95% CI 1.06–1.34) were significantly associated with the primary composite outcome.Conclusion: The use of specific classes of xerogenic medications was associated with an increased risk for tooth extractions and restorations in people with dementia. The risks and benefits of xerogenic medications, in the context of oral health, should be carefully assessed in this vulnerable population.
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| 26. |
- Tuan Hoang, Minh, et al.
(författare)
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Influence of Education and Income on Receipt of Dementia Care in Sweden
- 2021
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Ingår i: Journal of the American Medical Directors Association. - : Elsevier BV. - 1525-8610 .- 1538-9375. ; 22:10, s. 2100-2107
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To explore the dementia diagnostic process and drug prescription for persons with dementia (PWD) with different socioeconomic status (SES). Design: Register-based cohort study. Setting and Participants: This study included 74,414 PWD aged >65 years from the Swedish Dementia Register (2007-2018). Their data were linked with the Swedish Longitudinal Integrated Database for Health Insurance and Labor Market Studies (2006-2017) to acquire the SES information 1 year before dementia diagnosis. Methods: Education and incomed2 traditional SES indicatorsdwere divided into 5 levels. Outcomes comprised the dementia diagnostic examinations, types of dementia diagnosis, diagnostic unit, and prescription of antidementia drugs. Binary logistic regression was performed to evaluate socioeconomic inequalities. Results: Compared to PWD with the lowest educational level, PWD with the highest educational level had a higher probability of receiving the basic diagnostic workup [odds ratio (OR) 1.19, 95% confidence in-terval (CI) 1.10-1.29], clock test (OR 1.12, 95% CI 1.02-1.24) and neuroimaging (OR 1.23, 95% CI 1.09-1.39). Compared with PWD in the lowest income quintile, PWD in the highest income quintile presented a higher chance of receiving the basic diagnostic workup (OR 1.35, 95% CI 1.26-1.46), clock test (OR 1.40, 95% CI 1.28-1.52), blood analysis (OR 1.21, 95% CI 1.06-1.39), Mini-Mental State Examination (OR 1.47, 95% CI 1.26-1.70), and neuroimaging (OR 1.30, 95% CI 1.18-1.4 4). PWD with higher education or income had a higher likelihood of obtaining a specified dementia diagnosis or being diagnosed at a memory clinic. SES presented no association with prescription of antidementia medication, except for the association be-tween education and the use of memantine. Conclusions and Implications: Higher education or income was significantly associated with higher chance of receiving dementia diagnostic examinations, a specified dementia diagnosis, being diagnosed at a memory clinic, and using memantine. Socioeconomic inequalities in dementia diagnostic process and prescription of memantine occurred among PWD with different education or income levels.
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| 27. |
- Wang, Kate N., et al.
(författare)
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Proton Pump Inhibitors and Infection-Related Hospitalizations Among Residents of Long-Term Care Facilities : A Case-Control Study
- 2019
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Ingår i: Drugs & Aging. - : Springer Science and Business Media LLC. - 1170-229X .- 1179-1969. ; 36:11, s. 1027-1034
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Tidskriftsartikel (refereegranskat)abstract
- Objective Our objective was to investigate associations between proton pump inhibitor (PPIs) use and infection- related hospitalizations among residents of long-term care facilities ( LTCFs).Methods This was a case-control study of residents aged = 65 years admitted to hospital between July 2013 and June 2015. Residents admitted for infections (cases) and falls or fall-related injuries (controls) were matched for age (+/- 2 years), sex, and index date of admission (+/- 6 months). Conditional logistic regression was used to estimate crude and adjusted odds ratios (aORs) and 95% confidence intervals (CIs) for associations between PPI use and infection-related hospitalizations. Analyses were adjusted for age, sex, polypharmacy, diabetes, heart failure, chronic obstructive pulmonary disease, myocardial infarction, cerebrovascular accident, and concomitant use of cancer and immunosuppressant medications. Subgroup analyses were performed for high- and low/moderate-intensity PPIs and for respiratory and non-respiratory infections. Logistic regression was used to compare the odds of infection- related hospitalizations among users of high- and low/moderate-intensity PPIs.Results Overall, 181 cases were matched to 354 controls. Preadmission PPI use was associated with infection-related hospitalizations (aOR 1.66; 95% CI 1.11-2.48). In subgroup analyses, the association was apparent only for respiratory infections (aOR 2.26; 95% CI 1.37-3.73) and high-intensity PPIs (aOR 1.93; 95% CI 1.23-3.04). However, the risk of infection-related hospitalization was not significantly higher among users of high- versus low/moderate-intensity PPIs (aOR 1.25; 95% CI 0.74-2.13).Conclusion Residents who use PPIs may be at increased risk of infection-related hospitalizations, particularly respiratory infections. Study findings provide further support for initiatives to minimize unnecessary PPI use in the LTCF setting.
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| 28. |
- Wang, Kate N., et al.
(författare)
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Statin use and fall-related hospitalizations among residents of long-term care facilities : A case-control study
- 2020
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Ingår i: Journal of Clinical Lipidology. - : Elsevier BV. - 1933-2874 .- 1876-4789. ; 14:4, s. 507-514
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Statins are associated with muscle-related adverse events, but few studies have investigated the association with fall-related hospitalizations among residents of long-term care facilities (LTCFs).OBJECTIVE: The objective of the study is to investigate whether statin use is associated with fall-related hospitalizations from LTCFs.METHODS: A case-control study was conducted among residents aged >= 65 years admitted to hospital from 2013 to 2015. Cases (n = 332) were residents admitted for falls and fall-related injuries. Controls (n = 332) were selected from patients admitted for reasons other than cardiovascular and diabetes. Cases and controls were matched 1:1 by age (+/- 2 years), index date of admission (+/- 6 months), and sex. Adjusted odds ratios (aORs) and 95% confidence intervals (CIs) were estimated using conditional logistic regression, after considering for history of falls, hypertension, dementia, functional comorbidity index, polypharmacy (>= 9 regular preadmission medications), and fall-risk medications. Subanalyses were performed for individual statins, dementia, and statin intensity.RESULTS: Overall, 43.1% of cases and 27.1% of controls used statins. Statins were associated with fall-related hospitalizations (aOR = 2.24, 95% CI 1.56-3.23), in particular simvastatin (aOR = 2.26, 95% CI 1.22-4.20) and atorvastatin (aOR = 2.08, 95% CI 1.33-3.24). Statins were associated with fall-related hospitalizations in residents with (aOR = 2.34, 95% CI 1.33-4.11) and without dementia (aOR = 2.30, 95% CI 1.46-3.63). There was no association between statin intensity and fall-related hospitalizations (aOR = 0.78, 95% CI 0.43-1.40).CONCLUSION: This study suggests a possible association between statin use and fall-related hospitalizations among residents living in LTCFs. However, there was minimal evidence for a relationship between statin intensity and fall-related hospitalizations. Further research is required to substantiate these hypothesis-generating findings.
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| 29. |
- Wang, Kate N., et al.
(författare)
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Use of Falls Risk Increasing Drugs in Residents at High and Low Falls Risk in Aged Care Services
- 2021
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Ingår i: Journal of Applied Gerontology. - : SAGE Publications. - 0733-4648 .- 1552-4523. ; 40:1, s. 77-86
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Tidskriftsartikel (refereegranskat)abstract
- Falls are associated with considerable morbidity and mortality in aged care services and falls risk increasing drugs (FRIDs) are often overlooked as a contributor to falls. This study aims to investigate the association between the risk of falling and use of FRIDs from aged care services. Inverse-probability-weighted multinomial logistic regression was used to estimate the association between falls risk and regular FRIDs in 383 residents from six Australian aged care services. Overall, residents at high and low falls risk had similar prevalence of FRIDs. Prevalence of antipsychotics and sedative-hypnotics was low. Residents at high falls risk had higher adjusted odds of using >= 2 psychotropic medications (odds ratio [OR] = 1.75, 95% confidence interval [CI] = 1.17-2.61) and >= 2 medications that cause/worsen orthostatic hypotension (OR = 3.59, 95% CI = 2.27-5.69). High prevalence of FRIDs was mainly attributable to medications for which residents had clinical indications. Clinicians appeared to have largely avoided FRIDs that explicit criteria deem potentially inappropriate for high falls risk.
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| 30. |
- Wang, Rui, et al.
(författare)
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Prevalence and Patterns of Chronic Disease Pairs and Multimorbidity among Older Chinese Adults Living in a Rural Area
- 2015
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Ingår i: PLOS ONE. - : Public Library of Science (PLoS). - 1932-6203. ; 10:9
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Tidskriftsartikel (refereegranskat)abstract
- Background The burden of chronic diseases in China is substantial now. Data on patterns of chronic diseases and multimorbidity among older adults, especially among those living in rural areas, are sparse. Objective We aim to investigate the prevalence and patterns of chronic disease pairs and multimorbidity in elderly people living in rural China. Methods This population-based study included 1480 adults aged 60 years and over (mean age 68.5 years, 59.4% women) living in a rural community. Data were derived from the Confucius Hometown Aging Project in Shandong, China (June 2010-July 2011). Chronic diseases were diagnosed through face-to-face interviews, clinical examinations, and laboratory tests. Patterns of chronic disease pairs and multimorbidity were explored using logistic regression and exploratory factor analyses. Results The prevalence of individual chronic diseases ranged from 3.0% for tumor to 76.4% for hypertension, and each disease was often accompanied with three or more other chronic diseases. The observed prevalence of pairs of chronic conditions exceeded the expected prevalence for several conditions, such as cardiovascular diseases and metabolic disorders, as well as pulmonary diseases and degenerative disorders. Chronic multimorbidity (>= 2 chronic diseases) affected more than 90% of subjects, and two patterns of chronic multimorbidity were identified: cardiopulmonary-mental-degenerative disorder pattern (overall prevalence, 58.2%), and cerebrovascular-metabolic disorder pattern (62.6%). Prevalence of the cardiopulmonary-mental-degenerative disorder pattern increased with age, and was higher in men than women; whereas prevalence of the cerebrovascular-metabolic disorder pattern was higher in women than in men but did not vary by age. Conclusion Chronic multimorbidity was highly prevalent among older Chinese adults living in rural areas, and there were specific patterns of the co-occurrence of chronic diseases. Effort is needed to identify possible preventative strategies based on the potential clustering of chronic diseases.
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| 31. |
- Wastesson, Jonas W., et al.
(författare)
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An update on the clinical consequences of polypharmacy in older adults : a narrative review
- 2018
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Ingår i: Expert Opinion on Drug Safety. - : Informa UK Limited. - 1474-0338 .- 1744-764X. ; 17:12, s. 1185-1196
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Forskningsöversikt (refereegranskat)abstract
- Introduction: Polypharmacy, the use of multiple medications by one individual, is increasingly common among older adults. Caring for the growing number of older people with complex drug regimens and multimorbidity presents an important challenge in the coming years. Areas covered: This article reviews the international trends in the prevalence of polypharmacy, summarizes the results from previous reviews on polypharmacy and negative health outcomes, and updates a previous review on the clinical consequences of polypharmacy by focusing on studies published after 2013. This narrative review, which is based on a literature search in MEDLINE and EMBASE from January 1990 to June 2018, was undertaken to identify relevant articles. Search terms included variations of polypharmacy and multiple medications. Expert opinion: The prevalence of polypharmacy is increasing worldwide. More than half of the older population is exposed to polypharmacy in some settings. Polypharmacy is associated with a broad range of clinical consequences. However, methods to assess the dangers of polypharmacy should be refined. In our opinion, the issue of 'confounding by multimorbidity' has been underestimated and should be better accounted for in future studies. Moreover, researchers should develop more clinically relevant definitions of polypharmacy, including measures of inappropriate or problematic polypharmacy.
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| 32. |
- Wojt, Ilsa R., et al.
(författare)
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Clinical factors associated with increased length of stay and readmission in patients with medication-related hospital admissions : a retrospective study
- 2022
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Ingår i: Research in Social and Administrative Pharmacy. - : Elsevier BV. - 1551-7411 .- 1934-8150. ; 18:7, s. 3184-3190
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Tidskriftsartikel (refereegranskat)abstract
- Background: Adverse drug events (ADEs) remain a key contributor to hospitalisations, resulting in long hospital stays and readmissions. Information pertaining to the specific medications and clinical factors associated with these outcomes is limited. Hence, a better understanding of these factors and their relationship to ADEs is required.Objectives: To investigate medications involved, clinical manifestations of ADE-related hospitalisations, and their association with length of stay and readmission.Methods: A retrospective medical record review of patients admitted to a major, tertiary referral hospital in NSW, Australia, from January 2019 to August 2020 was conducted. ADEs were identified using Australian Refined Diagnosis Related Group (AR-DRG) codes: X40, X61, X62 and X64. Medications were classified per the Anatomical Therapeutic Chemical (ATC) classification system and clinical symptoms were classified per the International Classification of Disease (ICD) 9-CM. Logistic regression was performed to assess the relationship between medication and presentation classes with length of stay (≥2 days vs <2 days) and readmission.Results: There were 125 patients who met inclusion criteria (median age = 64 [interquartile range, 45–75] years; 53.6% male). Anti-thrombotic agents, opioids, antidepressants, antipsychotics, insulins and NSAIDs were the most implicated pharmacological classes. Neurological medications and falls were associated with a length of stay ≥2 days (adjusted odds ratio [aOR] 3.92, 95% confidence interval [CI] 1.48–10.33 and aOR 3.24, 95% CI 1.05–10.06, respectively). Neurological medications and neurological and cognitive disorders were associated with an increased likelihood of 90-day readmission (aOR 2.63, 95% CI 1.05–6.57 and aOR 3.20, 95% CI 1.17–8.75, respectively).Conclusion: This study identified neurological medications as high-risk for increased length of stay and readmission in those hospitalised due to ADEs. This highlights the need for judicious prescribing and monitoring of these medications.
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| 33. |
- Wojt, Ilsa R., et al.
(författare)
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The Prevalence and Characteristics of Psychotropic-Related Hospitalizations in Older People : A Systematic Review and Meta-Analysis
- 2021
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Ingår i: Journal of the American Medical Directors Association. - : Elsevier BV. - 1525-8610 .- 1538-9375. ; 22:6, s. 1206-1214
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Forskningsöversikt (refereegranskat)abstract
- Objectives: To assess the prevalence and characteristics of psychotropic medication-related hospitalizations in older people.Design: Systematic review with meta-analysis.Setting and Participants: Older adults (> 65 years of age) with psychotropic-related hospitalizations.Methods: A search of published literature was performed in Medline, Embase, CINAHL, and Scopus from 2010 to March 2020. Three authors independently screened titles, abstracts, and full texts of relevant studies for relevance. Two authors independently extracted full text data, including characteristics, measures of causality, prevalence data, and performed quality assessment. A meta-analysis was conducted to estimate pooled prevalence and 95% confidence intervals (CIs) of psychotropic-related hospitalizations using random effects models. Heterogeneity was explored using subgroup analyses.Results: Of 815 potentially relevant studies, 11 were included in the final analysis. Five studies were crosssectional studies, 5 were cohort studies, and 1 was a case control study. The majority of studies were rated as good quality. Psychotropic medications contributed to 2.1% (95% CI 1.2%-3.3%) of total hospitalizations and 11.3% (95% CI 8.2%-14.8%) of adverse drug event-related hospitalizations. The main psychotropic medications attributable to hospitalizations were antidepressants, hypnotics, sedatives, and antipsychotics.Conclusions and Implications: Psychotropic medications are a significant contributor to hospitalizations in older adults. The risk of hospitalization was greatest for those taking antidepressants, antipsychotics, hypnotics, and sedatives. Future studies should aim to address specific medication subgroups and implement uniform adverse drug event-related classification systems to improve comparability across studies.
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