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Heinjoki M, Karjalainen M, Saltevo J, Tiihonen M, Haanpää M, Kautiainen H, Mäntyselkä P. Kidney function and nephrotoxic drug use among older home-dwelling persons with or without diabetes in Finland. BMC Nephrol 2020; 21:11. [PMID: 31924175 PMCID: PMC6954600 DOI: 10.1186/s12882-020-1684-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Accepted: 01/03/2020] [Indexed: 01/13/2023] Open
Abstract
Background Due to these changes in kidney function, aging kidneys are more prone to drug-induced impairments in renal properties. Diabetes has been associated with the declined kidney function and an elevated risk of renal failure. The aim of this study is to compare kidney function and potentially nephrotoxic drug use among home-dwelling older persons with or without diabetes. Methods A total of 259 persons with and 259 persons without diabetes and aged ≥65 years were randomly selected to participate in a health examination with complete data gathered from 363 individuals (187 with diabetes and 176 without diabetes). The estimated glomerular filtration rate (eGFR) was calculated using CKD-EPI equation. Each participant was categorized based on the nephrotoxic profile of their medications. Results There were no differences in mean eGFR values (77.5 ± 18.8 vs. 80.5 ± 14.8 ml/min/1.73m2, p = 0.089) or in the proportion of participants with eGFR < 60 ml/min/1.73m2 among persons with diabetes (16% vs. 10%, p = 0.070), compared to persons without diabetes. Potentially nephrotoxic drug use was similar between the groups. The mean number of potentially nephrotoxic drugs was 1.06 ± 0.88 in those with and 0.97 ± 1.05 in those without diabetes (p = 0.39). Conclusions The kidney function of older persons with diabetes does not differ from that of older persons without diabetes and furthermore potentially nephrotoxic drug use seem to play only a minor role in the decline in kidney function among home-dwelling persons in the Inner-Savo district.
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Tuuliainen E, Nihtilä A, Komulainen K, Nykänen I, Hartikainen S, Tiihonen M, Suominen AL. The association of frailty with oral cleaning habits and oral hygiene among elderly home care clients. Scand J Caring Sci 2019; 34:938-947. [DOI: 10.1111/scs.12801] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Accepted: 11/13/2019] [Indexed: 01/11/2023]
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Ikäheimo I, Karjalainen M, Tiihonen M, Haanpää M, Kautiainen H, Saltevo J, Mäntyselkä P. Clinically relevant drug‐drug interactions and the risk for drug adverse effects among home‐dwelling older persons with and without type 2 diabetes. J Clin Pharm Ther 2019; 44:735-741. [DOI: 10.1111/jcpt.12854] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Accepted: 04/30/2019] [Indexed: 02/06/2023]
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Nihtilä A, Tuuliainen E, Komulainen K, Nykänen I, Hartikainen S, Tiihonen M, Suominen AL. The combined effect of individually tailored xerostomia and nutritional interventions on dry mouth among nutritionally compromised old home care clients. Gerodontology 2019; 36:244-250. [PMID: 30945350 DOI: 10.1111/ger.12405] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2018] [Revised: 01/06/2019] [Accepted: 03/01/2019] [Indexed: 01/19/2023]
Abstract
OBJECTIVE To examine the effectiveness of tailored xerostomia and nutritional 6-month interventions on xerostomia among home care clients aged 75 years or over who were malnourished or at risk of malnutrition. BACKGROUND A subjective feeling of dry mouth (xerostomia) is common among older adults and affects their quality of life, nutrition and oral health. Medical conditions, polypharmacy, dehydration and malnutrition are often underlying causes of xerostomia. MATERIALS AND METHODS The data are based on the NutOrMed study with a dietary intervention group of 119 patients and control group of 97 patients. In-home interviews were carried out by home care nurses, nutritionists, dental hygienists and pharmacists and tailored interventions by nutritionist and dental hygienists. Xerostomia intervention included individual counselling on dry mouth care and was applied to all those suffering occasionally or continuously from xerostomia (57%, n = 66) in the intervention group. Nutritional intervention was applied to all participants in the intervention group, and it included instructions on increasing the number of meals, energy, protein intake and liquid intake. RESULTS Among participants who received both interventions, xerostomia decreased by 30% and malnutrition or risk of malnutrition decreased by 61%. The interventions were highly significant (OR 0.1, 95% CI: 0.06; 0.2) in reducing xerostomia. CONCLUSIONS Home care clients suffering from xerostomia profited significantly from tailored xerostomia and dietary interventions. Evaluation and treatment of xerostomia are important among older persons who are malnourished or at risk of malnutrition as a part of a comprehensive health intervention to improve their nutrition and oral health.
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Pölönen S, Tiihonen M, Nykänen I, Taipale H, Tolppanen AM, Hartikainen S. Incidence of prescription vitamin B12 use in relation to diagnosis of Alzheimer’s disease among community-dwelling persons. J Public Health (Oxf) 2018. [DOI: 10.1007/s10389-018-0996-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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Tolppanen AM, Tiihonen M, Taipale H, Koponen M, Tanskanen A, Lavikainen P, Tiihonen J, Hartikainen S. Systemic Estrogen Use and Discontinuation After Alzheimer's Disease Diagnosis in Finland 2005-2012: A Nationwide Exposure-Matched Cohort Study. Drugs Aging 2018; 35:985-992. [PMID: 30317535 PMCID: PMC6208773 DOI: 10.1007/s40266-018-0591-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
BACKGROUND It is unknown whether cognitive status or diagnosed cognitive decline affects estrogen use. OBJECTIVES We assessed how common systemic estrogen use was among community-dwellers with Alzheimer's disease (AD) and a matched comparison cohort without AD. METHODS This study included an exposure-matched cohort of all Finnish community-dwelling women who received a clinically verified diagnosis of AD in 2005-2011 (N = 46,116; index cases) and an equally sized matched comparison cohort without AD. Follow-up began on the matching date (date of the AD diagnosis of the index case). Data on systemic estrogen use were obtained from the prescription register. Use initiation and discontinuation were assessed. RESULTS Altogether 3.1% of women with AD and 4.3% of women without AD used estrogen during the follow-up period. Only < 0.5% initiated use during the follow-up period, but 3.7% continued use until death. The prevalence of estrogen use 1 year after the AD diagnosis declined in 2005-2011. CONCLUSIONS There were no major differences in systemic estrogen use among Finnish women with AD when compared to those without AD. Although some persons initiated estrogen use after AD diagnosis and/or at an advanced age, the observed use patterns were mainly consistent with the current recommendations.
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Inkeri NM, Karjalainen M, Haanpää M, Kautiainen H, Saltevo J, Mäntyselkä P, Tiihonen M. Anticholinergic drug use and its association with self-reported symptoms among older persons with and without diabetes. J Clin Pharm Ther 2018; 44:229-235. [DOI: 10.1111/jcpt.12772] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Accepted: 09/14/2018] [Indexed: 02/06/2023]
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Karjalainen M, Saltevo J, Tiihonen M, Haanpää M, Kautiainen H, Mäntyselkä P. Frequent pain in older people with and without diabetes - Finnish community based study. BMC Geriatr 2018; 18:73. [PMID: 29544464 PMCID: PMC5856375 DOI: 10.1186/s12877-018-0762-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Accepted: 03/06/2018] [Indexed: 11/15/2022] Open
Abstract
Background The association between pain and diabetes in older people has been largely unexplored. The aim of this survey was to analyze the prevalence and characteristics of pain among Finnish men and women 65 or older with and without diabetes in primary care. Methods All home-dwelling persons 65 years or older with diabetes (N = 527) and age and gender matched controls (N = 890) were identified from electronic patient records. Frequent pain was regarded as any pain experienced more often than once a week, and it was divided into pain experienced several times a week but not daily and pain experienced daily or continuously. The Numeric Rating Scale (0–10) (NRS) was used to assess the intensity and interference of the pain. Results The number of subjects who returned the questionnaire was 1084 (76.5%). The prevalence of frequent pain in the preceding week was 50% among women without diabetes and 63% among women with diabetes (adjusted, p = 0.22). In men, the corresponding proportions were 42% without diabetes and 47% with diabetes (adjusted, p = 0.58). In both genders, depressive symptoms and the number of comorbidities were associated with pain experienced more often than once a week and with daily pain. Diabetes was not associated with pain intensity or pain interference in either women or men. Conclusions Pain in older adults is associated with depressive symptoms and the number of comorbidities more than with diabetes itself.
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Luukkonen A, Tiihonen M, Rissanen T, Hartikainen S, Nykänen I. Orthostatic Hypotension and Associated Factors among Home Care Clients Aged 75 Years or Older - A Population-Based Study. J Nutr Health Aging 2018; 22:154-158. [PMID: 29300435 DOI: 10.1007/s12603-017-0953-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVES The aim of this study was to examine orthostatic hypotension (OH) and associated factors among home care clients aged 75 years or older. DESIGN Non-randomised controlled study. SETTING AND PARTICIPANTS The study sample included 244 home care clients aged 75 years or older living in Eastern and Central Finland. MEASUREMENTS Nurses, nutritionists and pharmacists collected clinical data including orthostatic blood pressure, depressive symptoms (15-item Geriatric Depression Scale GDS-15), nutritional status (Mini Nutritional Assessment MNA), drug use, self-rated health, daily activities (Barthel ADL Index and Lawton and Brody IADL scale) and self-rated ability to walk 400 metres. Comorbidities were based on medical records. RESULTS The prevalence of OH was 35.7% (n = 87). No association between OH and the number of drugs used or causative drug use and OH was found. In univariate analysis, coronary heart disease, systolic and diastolic blood pressure in a sitting position and lower mean MNA scores were associated with a risk of OH. Multivariate analysis showed that lower mean MNA scores (OR 1.140, 95% CI: 1.014-1.283) appeared to be independently connected to a risk of OH. CONCLUSION One-third of the home clients had OH and it was associated with lower MNA scores.
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Karjalainen M, Tiihonen M, Kautiainen H, Saltevo J, Haanpää M, Mäntyselkä P. Pain and self-rated health in older people with and without type 2 diabetes. Eur Geriatr Med 2017; 9:127-131. [DOI: 10.1007/s41999-017-0017-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Accepted: 12/11/2017] [Indexed: 11/30/2022]
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Aro AK, Karjalainen M, Tiihonen M, Kautiainen H, Saltevo J, Haanpää M, Mäntyselkä P. Glycemic control and health-related quality of life among older home-dwelling primary care patients with diabetes. Prim Care Diabetes 2017; 11:577-582. [PMID: 28754430 DOI: 10.1016/j.pcd.2017.07.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Revised: 06/30/2017] [Accepted: 07/08/2017] [Indexed: 11/22/2022]
Abstract
AIMS To evaluate the health-related quality of life (HRQoL) and functional capacity in relation to glycemic control among older home-dwelling primary care patients. METHODS Electronic patient records were used to identify 527 people over 65 years with diabetes. Of these, 259 randomly selected subjects were invited to a health examination and 172 of them attended and provided complete data. The participants were divided into three groups based on the HbA1c: good (HbA1c<48mmol/mol (N=95)), intermediate (HbA1c 48-57mmol/mol (N=48)) and poor (HbA1c>57mmol/mol (N=29)) glycemic control. HRQoL was measured with the EuroQol EQ-5D questionnaire. Functional and cognitive capacity and mental well-being were assessed with the Lawton Instrumental Activities of Daily Living (IADL) scale, Mini-Mental State Examination (MMSE) and Geriatric Depression Scale (GDS-15). RESULTS EQ-5D scores for good, intermediate and poor glycemic control were 0.78; 0.74 and 0.70, p=0.037. Sub-items of mobility (p=0.002) and self-care were the most affected (p=0.031). Corresponding trend was found for IADL, p=0.008. A significant correlation was found between MMSE scores and HbA1c. CONCLUSION Older primary care home-dwelling patients with diabetes and poorer glycemic control have lower functional capacity and HRQoL, especially in regard to mobility and self-care.
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Miettinen M, Tiihonen M, Hartikainen S, Nykänen I. Prevalence and risk factors of frailty among home care clients. BMC Geriatr 2017; 17:266. [PMID: 29149866 PMCID: PMC5693585 DOI: 10.1186/s12877-017-0660-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Accepted: 11/09/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Frailty is a common problem among older people and it is associated with an increased risk of death and long-term institutional care. Early identification of frailty is necessary to prevent a further decline in the health status of home care clients. The aims of the present study were to determine the prevalence of frailty and associated factors among 75-year-old or older home care clients. METHODS The study participants were 75-year-old or older home care clients living in three cities in Eastern and Central Finland. Home care clients who had completed the abbreviated Comprehensive Geriatric Assessment (aCGA) for frailty (n = 257) were included in the present study. Baseline data were obtained on functional status, cognitive status, depressive symptoms, self-rated health, ability to walk 400 m, nutritional status, drug use and comorbidities. RESULTS Most of the home care clients (90%) were screened for frailty using the aCGA. Multivariate analysis showed that the risk of malnutrition or malnutrition (OR = 4.27, 95% CI = 1.56, 11.68) and a low level of education (OR = 1.14, 95% CI = 1.07, 1.23) were associated with frailty. CONCLUSION Frailty is a prevalent problem among home care clients. The risk of malnutrition or malnourishment and a lower level of education increase the risk of frailty. Screening for frailty should be done to detect the most vulnerable older people for further intervention to prevent adverse health problems. TRIAL REGISTRATION ClinicalTrials.gov: NCT02214758 .
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Nihtilä A, Tuuliainen E, Komulainen K, Autonen-Honkonen K, Nykänen I, Hartikainen S, Ahonen R, Tiihonen M, Suominen AL. Preventive oral health intervention among old home care clients. Age Ageing 2017; 46:846-851. [PMID: 28200017 DOI: 10.1093/ageing/afx020] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2016] [Accepted: 01/17/2017] [Indexed: 11/14/2022] Open
Abstract
Background poor oral health is common among older people dependent on supportive care and it affects their quality of life. Cognitive impairment and functional dependency may increase the risk of compromised daily oral hygiene. Aim to investigate the effectiveness of a tailored preventive oral health intervention among home care clients aged 75 years or over. Patients and methods the intervention group comprised 151 patients (84.4 ± 5.6 years) and the control group 118 patients (84.7 ± 5.2 years). An interview and a clinical examination were carried out before a tailored intervention of oral and denture hygiene. The participants in both groups were re-interviewed and re-examined after 6 months. Results the intervention significantly reduced the number of plaque covered teeth and improved denture hygiene. In addition, functional ability and cognitive function were significantly associated with better oral hygiene. Conclusions the intervention had a positive effect on oral hygiene, however the number of teeth with plaque remained high, even after the intervention. Multiple approaches based on individual needs are required to improve the oral health of vulnerable older adults, including integrating dental preventive care into daily care plan carried out by home care nurses.
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Tiihonen M, Hartikainen S, Nykänen I. Chair rise capacity and associated factors in older home-care clients. Scand J Public Health 2017; 46:699-703. [PMID: 28699419 DOI: 10.1177/1403494817718072] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
AIMS The aim of this study was to investigate the ability of older home-care clients to perform the five times chair rise test and associated personal characteristics, nutritional status and functioning. METHODS The study sample included 267 home-care clients aged ≥75 years living in Eastern and Central Finland. The home-care clients were interviewed at home by home-care nurses, nutritionists and pharmacists. The collected data contained sociodemographic factors, functional ability (Barthel Index, IADL), cognitive functioning (MMSE), nutritional status (MNA), depressive symptoms (GDS-15), medical diagnoses and drug use. The primary outcome was the ability to perform the five times chair rise test. RESULTS Fifty-one per cent ( n=135) of the home-care clients were unable to complete the five times chair rise test. Twenty-three per cent ( n=64) of the home-care clients had good chair rise capacity (≤17 seconds). In a multivariate logistic regression analysis, fewer years of education (odds ratio [OR] = 1.11, 95% confidence interval [CI] 1.04-1.18), lower ADL (OR = 1.54, 95% CI 1.34-1.78) and low MNA scores (OR = 1.12, 95% CI 1.04-1.20) and a higher number of co-morbidities (OR = 1.21, 95% CI 1.02-1.43) were associated with inability to complete the five times chair rise test. CONCLUSIONS Poor functional mobility, which was associated with less education, a high number of co-morbidities and poor nutritional status, was common among older home-care clients. To maintain and to prevent further decline in functional mobility, physical training and nutritional services are needed. (NutOrMed, ClinicalTrials.gov Identifier: NCT02214758).
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Tiihonen M, Taipale H, Tanskanen A, Tiihonen J, Hartikainen S. Incidence and Duration of Cumulative Bisphosphonate Use among Community-Dwelling Persons with or without Alzheimer's Disease. J Alzheimers Dis 2017; 52:127-32. [PMID: 26967224 PMCID: PMC4927880 DOI: 10.3233/jad-151181] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
We studied the incidence and duration of cumulative bisphosphonate use among older Finnish women and men with or without Alzheimer's disease (AD). The MEDALZ-2005 cohort is a nationwide sample of all persons with clinically diagnosed AD on 31 December 2005 and their age-, gender-, and region of residence-matched control persons without AD. Information on bisphosphonate use by persons with an AD diagnosis and their controls without AD during 2002-2009 was obtained from the prescription register database containing reimbursed medications. A total of 6,041 (11.8%) persons used bisphosphonates during the 8-year follow-up. Bisphosphonates were more commonly used among persons without AD (n = 3121, 12.3%) than among persons with AD (n = 2,920, 11.2%) (p = 0.001). The median duration of bisphosphonate use was 743 days (IQR). Among persons with AD, the median duration of use was 777 days (IQR) and among persons without AD, 701 days (IQR) (p = 0.011). People without AD more often used bisphosphonate combination preparations including vitamin D than did people with AD (p < 0.0001). Bisphosphonate use was more common among people without AD who had comorbidities, asthma/COPD, or rheumatoid arthritis compared with users with AD. Short-term users were more likely to be male, at least 80 years old, and not having AD. Although the incidence of bisphosphonate use was slightly higher among persons without AD, the cumulative duration of bisphosphonate use was longer in persons with AD. Short-term use was associated with male gender, older age, and not having AD.
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Imtiaz B, Taipale H, Tanskanen A, Tiihonen M, Kivipelto M, Heikkinen AM, Tiihonen J, Soininen H, Hartikainen S, Tolppanen AM. Risk of Alzheimer's disease among users of postmenopausal hormone therapy: A nationwide case-control study. Maturitas 2017; 98:7-13. [PMID: 28274328 DOI: 10.1016/j.maturitas.2017.01.002] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2016] [Revised: 12/23/2016] [Accepted: 01/05/2017] [Indexed: 12/19/2022]
Abstract
OBJECTIVE To examine the association between postmenopausal hormone therapy (HT) and Alzheimer's disease (AD). METHODS Medicine and Alzheimer's disease (MEDALZ) is a nested case-control study of the entire Finnish population with clinically verified AD from 2005 to 2011 and up to 4 matched controls per case. This study comprises 230,580 women (46,117 cases and 184,463 controls). Data on HT use from 1995 to 2011 was extracted from the national prescription register using following ATC codes: G03C (estrogen), G03D (progestogen) and G03F (estrogen and progestogen in combination). Only systemic HT (oral or transdermal) was considered. RESULTS Use of systemic estrogen and progestogen was associated with an increased risk of AD, with ORs (95% CI) of 1.10 (1.06-1.12) and 1.13 (1.10-1.17) respectively, but use of systemic estrogen HT for >10years (OR, 95% CI: 0.91, 0.84-0.99) was protective against AD. Long-term (>10years) use of progestogen and combination HT was not related to AD risk (OR, 95% CI: 1.0, 0.90-1.2). CONCLUSION Our findings do not suggest HT is an important determinant of AD risk.
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Pölönen S, Tiihonen M, Hartikainen S, Nykänen I. Individually Tailored Dietary Counseling among Old Home Care Clients - Effects on Nutritional Status. J Nutr Health Aging 2017; 21:567-572. [PMID: 28448088 DOI: 10.1007/s12603-016-0815-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
OBJECTIVE To evaluate the effect of individually tailored dietary counseling on nutritional status among home care clients aged 75 years or older. DESIGN Non-randomised controlled study. SETTING AND PARTICIPANTS The study sample consisted of 224 home care clients (≥ 75 years) (intervention group, n = 127; control group, n = 100) who were at protein-energy malnutrition (PEM) or risk of PEM (MNA score <24 and plasma albumin <35 g/L). INTERVENTION Individually tailored dietary counseling; the persons were instructed to increase their food intake with energy-dense food items, the number of meals they ate and their consumption of energy-, protein- and nutrient-rich snacks for six months. MEASUREMENTS The Mini Nutritional Assessment (MNA), Body Mass Index (BMI) and plasma albumin were used to determine nutritional status at the baseline and after the six-month intervention. RESULTS The mean age of the home care clients was 84.3 (SD 5.5) in the intervention group and 84.4 (SD 5.3) in the control group, and 70 percent were women in both groups. After the six-month nutritional intervention, the MNA score increased 2.3 points and plasma albumin 1.6 g/L in the intervention group, against MNA score decreased -0.2 points and plasma albumin -0.1 g/L in the control group. CONCLUSIONS Individually tailored dietary counseling may improve nutritional status among older home care clients.
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Tiihonen M, Taipale H, Tolppanen AM, Hartikainen S. Incidence of Bisphosphonate Use in Relation to Diagnosis of Alzheimer's Disease in Community-Dwelling Persons. J Am Geriatr Soc 2016; 64:e48-9. [PMID: 27561211 DOI: 10.1111/jgs.14356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Tolppanen AM, Ahonen R, Koponen M, Lavikainen P, Purhonen M, Taipale H, Tanskanen A, Tiihonen J, Tiihonen M, Hartikainen S. Month and Season of Birth as a Risk Factor for Alzheimer's Disease: A Nationwide Nested Case-control Study. J Prev Med Public Health 2016; 49:134-8. [PMID: 27055550 PMCID: PMC4829371 DOI: 10.3961/jpmph.16.018] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Accepted: 03/19/2016] [Indexed: 01/21/2023] Open
Abstract
Objectives: Season of birth, an exogenous indicator of early life environment, has been related to higher risk of adverse psychiatric outcomes but the findings for Alzheimer’s disease (AD) have been inconsistent. We investigated whether the month or season of birth are associated with AD. Methods: A nationwide nested case-control study including all community-dwellers with clinically verified AD diagnosed in 2005 to 2012 (n=70 719) and up to four age- sex- and region of residence-matched controls (n=282 862) residing in Finland. Associations between month and season of birth and AD were studied with conditional logistic regression. Results: Month of birth was not associated with AD (p=0.09). No strong associations were observed with season (p=0.13), although in comparison to winter births (December-February) summer births (June-August) were associated with higher odds of AD (odds ratio, 1.03; 95% confidence interval, 1.00 to 1.05). However, the absolute difference in prevalence in winter births was only 0.5% (prevalence of those born in winter were 31.7% and 32.2% for cases and controls, respectively). Conclusions: Although our findings do not support the hypothesis that season of birth is related to AD/dementia risk, they do not invalidate the developmental origins of health and disease hypothesis in late-life cognition. It is possible that season does not adequately capture the early life circumstances, or that other (postnatal) risk factors such as lifestyle or socioeconomic factors overrule the impact of prenatal and perinatal factors.
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Viljakainen S, Nykänen I, Ahonen R, Komulainen K, Suominen AL, Hartikainen S, Tiihonen M. Xerostomia among older home care clients. Community Dent Oral Epidemiol 2016; 44:232-8. [PMID: 26739925 DOI: 10.1111/cdoe.12210] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2015] [Accepted: 12/03/2015] [Indexed: 11/26/2022]
Abstract
OBJECTIVES The purpose of this study was to examine drug use and other factors associated with xerostomia in home care clients aged 75 years or older. METHODS The study sample included 270 home care clients aged ≥75 years living in Eastern and Central Finland. The home care clients underwent in-home interviews carried out by trained home care nurses, nutritionists, dental hygienists and pharmacists. The collected data contained information on sociodemographic factors, health and oral health status, drug use, depressive symptoms (GDS-15), cognitive functioning (MMSE), functional ability (Barthel Index, IADL) and nutrition (MNA). The primary outcome was xerostomia status (never, occasionally or continuously). RESULTS Among the home care clients, 56% (n = 150) suffered from xerostomia. Persons with continuous xerostomia used more drugs and had more depressive symptoms and a higher number of comorbidities than other home care clients. In multivariate analyses, excessive polypharmacy (OR = 1.83, 95% Cl 1.08-3.10) and depressive symptoms (OR = 1.12, 95% Cl 1.03-1.22) were associated with xerostomia. CONCLUSIONS Xerostomia is a common problem among old home care clients. Excessive polypharmacy, use of particular drug groups and depressive symptoms were associated with xerostomia. The findings support the importance of a multidisciplinary approach in the care of older home care clients.
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Tiihonen M, Nykänen I, Ahonen R, Hartikainen S. Discrepancies between in-home interviews and electronic medical records on regularly used drugs among home care clients. Pharmacoepidemiol Drug Saf 2015; 25:100-5. [PMID: 26541247 DOI: 10.1002/pds.3909] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2015] [Revised: 09/03/2015] [Accepted: 10/12/2015] [Indexed: 12/31/2022]
Abstract
PURPOSE To compare discrepancies between in-home interviews and electronic medical records (EMRs) on regularly used prescription drugs among older home care clients. METHODS The participants were home care clients aged 75 years or older living in three Finnish municipalities. In-home interview data on regular prescription drug use from 276 home care clients were compared with EMRs. Agreement between the in-home interview data and EMRs was assessed using Cohen's kappa. RESULTS A majority (83%, n = 229) of the home care clients had discrepancies between in-home interview data and EMRs, and 40% had discrepancies that could clinically compromise their treatment. Living with a spouse or other family member, use of private health care services, diagnosed asthma/COPD or excessive polypharmacy was associated with having discrepancies. Discrepancies were more common among clients with better functioning and ability to self-manage drug use. Agreement between in-home interview data and EMRs was very good or good for other drug groups, but moderate for opioids, paracetamol, benzodiazepines and benzodiazepine-related drugs and lubricant eye drops, and poor for selective beta-2-adrenoceptor agonists. The most common clinically important discrepancies were psychotropics, opioids and agents acting on the renin-angiotensin system and beta-blocking agents. CONCLUSIONS Eight out of ten home care clients had discrepancies between in-home interview data and EMRs. Of these discrepancies, 40% were clinically important.
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Tiihonen M, Autonen-Honkonen K, Ahonen R, Komulainen K, Suominen L, Hartikainen S, Nykänen I. NutOrMed—optimising nutrition, oral health and medication for older home care clients—study protocol. BMC Nutr 2015. [DOI: 10.1186/s40795-015-0009-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
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Imtiaz B, Tuppurainen M, Tiihonen M, Kivipelto M, Soininen H, Hartikainen S, Tolppanen AM. Oophorectomy, Hysterectomy, and Risk of Alzheimer's Disease: A Nationwide Case-Control Study. ACTA ACUST UNITED AC 2014; 42:575-81. [DOI: 10.3233/jad-140336] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Holm E, Aaltonen K, Heikkinen AM, Tiihonen M. From systemic hormone therapy to vaginal estrogen – A nationwide register study in Finland, 2003–2012. Maturitas 2014; 78:293-7. [DOI: 10.1016/j.maturitas.2014.05.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2014] [Revised: 05/08/2014] [Accepted: 05/13/2014] [Indexed: 11/27/2022]
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Tiihonen M, Leppänen HM, Heikkinen AM, Ahonen R. Hormonal contraceptive users' self-reported benefits, adverse reactions, and fears in 2001 and 2007. PATIENT-PATIENT CENTERED OUTCOMES RESEARCH 2012; 1:173-80. [PMID: 22272924 DOI: 10.2165/1312067-200801030-00004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
BACKGROUND Hormonal contraceptives (HCs) are the most common contraceptive method in western countries. The fears and problems experienced by users of HCs can have an impact on their quality of life, and lead to abortions and unwanted pregnancies. OBJECTIVE To investigate whether experiences and perceptions of HC users in Finland have changed from 2001 to 2007. METHODS Data were collected using questionnaire surveys of women using HCs in 2001 and 2007. In Finland, HCs are available with a physician's prescription, and are only supplied in community and university pharmacies. University pharmacies in 12 large cities across Finland were selected to distribute the questionnaires. The response rate was 53% (n = 264) in 2001 and 55% (n = 436) in 2007. The average age of the respondents was 26 years in both surveys. The surveys measured self-reported benefits and adverse reactions, preconceptions, fears, knowledge, and opinions. RESULTS The number of HC users reporting fears increased from 2001 to 2007 (p = 0.002), whereas the number of HC users reporting adverse reactions decreased (p = 0.013). In both surveys, the most common fear was infertility after HC use (17% vs 26% for 2001 and 2007, respectively). In both surveys, the most common benefits were efficacy and regular menstrual cycle, and the most common adverse reactions were mood swings, lowered libido, and weight gain. CONCLUSIONS Our study suggests that, although women using HCs were convinced about their benefits, and the number of users reporting adverse reactions had decreased from 2001 to 2007, the number of users reporting fears had increased. Healthcare professionals need to provide counseling in order to alleviate women's fears and to correct false perceptions of HCs.
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