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Tynkkynen LK, Pulkki J, Tervonen-Gonçalves L, Schön P, Burström B, Keskimäki I. Health system reforms and the needs of the ageing population—an analysis of recent policy paths and reform trends in Finland and Sweden. Eur J Ageing 2022; 19:221-232. [PMID: 35465210 PMCID: PMC9012246 DOI: 10.1007/s10433-022-00699-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/17/2022] [Indexed: 01/08/2023] Open
Abstract
AbstractPopulation ageing with an increasing number of people experiencing complex health and social care needs challenges health systems. We explore whether and how health system reforms and policy measures adopted during the past two decades in Finland and Sweden reflect and address the needs of the older people. We discuss health system characteristics that are important to meet the care needs of older people and analyse how health policy agendas have highlighted these aspects in Finland and Sweden. The analysis is based on “most similar cases”. The two countries have rather similar health systems and are facing similar challenges. However, the policy paths to address these challenges are different. The Swedish health system is better resourced, and the affordability of care better ensured, but choice and market-oriented competition reforms do not address the needs of the people with complex health and social care needs, rather it has led to increased fragmentation. In Finland, the level of public funding is lower which may have negative impacts on people who need multiple services. However, in terms of integration and care coordination, Finland seems to follow a path which may pave the way for improved coordination of care for people with multiple care needs. Intensified monitoring and analysis of patterns of health care utilization among older people are warranted in both countries to ensure that care is provided equitably.
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Affiliation(s)
| | - Jutta Pulkki
- Faculty of Social Sciences, Health Sciences, Tampere University, Tampere, Finland
| | | | - Pär Schön
- Aging Research Center, Karolinska Institutet and Stockholm University, Stockholm, Sweden
| | - Bo Burström
- Department of Global Public Health, Equity and Health Policy Research Group, Karolinska Institutet, Stockholm, Sweden
| | - Ilmo Keskimäki
- Finnish Institute for Health and Welfare, Helsinki, Finland
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Larnyo E, Dai B, Larnyo A, Nutakor JA, Ampon-Wireko S, Nkrumah ENK, Appiah R. Impact of Actual Use Behavior of Healthcare Wearable Devices on Quality of Life: A Cross-Sectional Survey of People with Dementia and Their Caregivers in Ghana. Healthcare (Basel) 2022; 10:275. [PMID: 35206890 PMCID: PMC8872618 DOI: 10.3390/healthcare10020275] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 01/17/2022] [Accepted: 01/24/2022] [Indexed: 12/17/2022] Open
Abstract
The increasing prevalence of dementia has necessitated the introduction and use of healthcare wearable devices to augment the healthcare services delivered to people with dementia (PWDs). Unfortunately, evidence on user feedback and the real impact of the actual use of these devices on the quality of life of PWDs has not been fully explored, especially in the context of developing countries. This study, therefore, seeks to evaluate the impact of actual use behavior (AUB) of healthcare wearable devices on the quality of life (QoL) of PWDs in Ghana by using constructs from the extended Unified Theory of Acceptance and Use of Technology (UTAUT2) model and the SF-36 quality of life instrument. Data were collected from people with dementia and, in some cases, caregivers (acting as proxies) in three administrative regions of Ghana using structured questionnaires. Of the 420 questionnaires distributed, 356 were returned, giving a response rate of (356/420, 84.8%). Three hundred and twenty (320) responses were used for further analysis, employing the Partial Least Squares based on Structural Equation Modeling. The results showed a significant positive relationship between AUB and QoL (p < 0.001). Other predictors such as behavioral intention, facilitating conditions, effort expectancy and social influence were also found to significantly impact the actual use behavior of healthcare wearable devices among PWDs. The study also revealed that 4% (14) of patients rated their reported health transition associated with the use of healthcare wearable devices as excellent, 42.5% (136) as very good, and 39.4% (126) as good, respectively at the time of the study compared to a year ago. This study provided empirical evidence of the positive impact of the actual use of healthcare wearable devices on the quality of life of PWDs and further highlighted the factors that drive actual use behavior among PWDs in Ghana. Based on the findings of this study, stakeholders need to create the necessary conditions that will facilitate the adoption and use of healthcare wearable devices, as this will help improve the quality of life, reduce the burden of the disease on caregivers, and enable independent living of PWDs.
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Affiliation(s)
- Ebenezer Larnyo
- Department of Health Policy and Management, School of Management, Jiangsu University, 301 Xuefu Road, Zhenjiang 212013, China; (E.L.); (J.A.N.); (S.A.-W.); (R.A.)
| | - Baozhen Dai
- Department of Health Policy and Management, School of Management, Jiangsu University, 301 Xuefu Road, Zhenjiang 212013, China; (E.L.); (J.A.N.); (S.A.-W.); (R.A.)
| | - Abigail Larnyo
- School of Management, Jiangsu University, 301 Xuefu Road, Zhenjiang 212013, China; (A.L.); (E.N.K.N.)
| | - Jonathan Aseye Nutakor
- Department of Health Policy and Management, School of Management, Jiangsu University, 301 Xuefu Road, Zhenjiang 212013, China; (E.L.); (J.A.N.); (S.A.-W.); (R.A.)
| | - Sabina Ampon-Wireko
- Department of Health Policy and Management, School of Management, Jiangsu University, 301 Xuefu Road, Zhenjiang 212013, China; (E.L.); (J.A.N.); (S.A.-W.); (R.A.)
| | - Edmund Nana Kwame Nkrumah
- School of Management, Jiangsu University, 301 Xuefu Road, Zhenjiang 212013, China; (A.L.); (E.N.K.N.)
| | - Ruth Appiah
- Department of Health Policy and Management, School of Management, Jiangsu University, 301 Xuefu Road, Zhenjiang 212013, China; (E.L.); (J.A.N.); (S.A.-W.); (R.A.)
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Abstract
This paper considers ethical issues related to early diagnosis and all forms of prevention of Alzheimer disease and related conditions. It offers a critical view of the current state of scientific, clinical, and social responses to the growing number of older people with cognitive challenges, and suggests how priorities going forward should be different from those receiving most attention today. We begin with a review of global policy efforts, consider the fundamental goals of prevention, examine issues surrounding early diagnosis, explore more deeply values associated with efforts to prevent age associated cognitive decline, and conclude by considering often unexplored ethical issues that contextualize the field and should influence our approaches to the future.
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Affiliation(s)
- Peter J Whitehouse
- Case Western Reserve University, Cleveland, Ohio, USA; Baycrest Health Center, Cleveland, Ohio, USA; Institute of Life Course and Aging, University of Toronto; Intergenerational Schools International, Toronto, Ontario, Canada
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Häikiö K, Sagbakken M, Rugkåsa J. Dementia and patient safety in the community: a qualitative study of family carers' protective practices and implications for services. BMC Health Serv Res 2019; 19:635. [PMID: 31488131 PMCID: PMC6728989 DOI: 10.1186/s12913-019-4478-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Accepted: 08/28/2019] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Dementia is a cause of disability and dependency associated with high demands for health services and expected to have a significant impact on resources. Care policies worldwide increasingly rely on family caregivers to contribute to service delivery for older people, and the general direction of health care policy internationally is to provide care in the community, meaning most people will receive services there. Patient safety in primary care is therefore important for future care, but not yet investigated sufficiently when services are carried out in patients' homes. In particular, we know little about how family carers experience patient safety of older people with dementia in the community. METHODS This was an explorative study, with qualitative in-depth interviews of 23 family carers of older people with suspected or diagnosed dementia. Family carers participated after receiving information primarily through health professionals working in dementia care. A semi-structured topic guide was used in a flexible way to capture participants' experiences. A four-step inductive analysis of the transcripts was informed by hermeneutic-phenomenological analysis. RESULTS The ways our participants sought to address risk and safety issues can be understood to constitute protective practices that aimed to prevent or reduce the risk of harm and/or alleviate damage from harm that occurs. The protective practices relate to four areas: physical harm, economic harm, emotional harm, and relational harm. The protective practices are interlinked, and family carers sometimes prioritize one over another, and as they form part of family practice, they are not always visible to service providers. As a result, the practices may complicate interactions with health professionals and even inadvertently conceal symptoms or care needs. CONCLUSIONS When family caregivers prevent harm and meet needs, some needs may be concealed or invisible to health professionals. To recognize all needs and provide effective, safe and person-centered care, health professionals need to recognize these preventive practices and seek to build a solid partnership with family carers.
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Affiliation(s)
- Kristin Häikiö
- HØKH - Health Services Research Unit, Akershus University Hospital, Postbox 1000, 1478, Lørenskog, Norway.
- Oslo Metropolitan University, Pilestredet 32, 0166, Oslo, Norway.
| | - Mette Sagbakken
- Oslo Metropolitan University, Pilestredet 32, 0166, Oslo, Norway
| | - Jorun Rugkåsa
- HØKH - Health Services Research Unit, Akershus University Hospital, Postbox 1000, 1478, Lørenskog, Norway
- Centre for Care Research, University of South-Eastern Norway, 3900, Porsgrunn, Norway
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Abstract
A growing body of epidemiologic evidence indicates a decline in the incidence or prevalence of dementia in high income countries in the past 25 years. In this commentary, I first suggest that the decline in the incidence or prevalence of dementia is not explained completely by the factors considered so far, and that a broader historical perspective may be needed. Second, I suggest that the overall declining trend may conceal trends in opposite directions for the two major subtypes of dementia, the neurovascular and the neurodegenerative type. Third, I suggest some areas of future research to further elucidate the trends. The future of dementia remains somewhat unclear. Even if the incidence continues to decline, the prevalence may remain the same or increase if survival of persons affected by dementia increases. In addition, even if the prevalence declines, the total number of persons affected by dementia may remain the same or increase if the size of the elderly population expands. Finally, we cannot be sure that the decline in incidence will continue in the coming decades. With cautious optimism, we may conclude that the burden of dementia may be modified over time by human practices, including public health and medicine.
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Xu W, Wang HF, Wan Y, Tan CC, Yu JT, Tan L. Leisure time physical activity and dementia risk: a dose-response meta-analysis of prospective studies. BMJ Open 2017; 7:e014706. [PMID: 29061599 PMCID: PMC5665289 DOI: 10.1136/bmjopen-2016-014706] [Citation(s) in RCA: 96] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND There is considerable evidence of the favourable role of more physical activity (PA) in fighting against dementia. However, the shape of the dose-response relationship is still unclear. OBJECTIVE To quantitatively investigate the relationship between dementia and PA. DESIGN PubMed, EMBASE, Ovid and the Cochrane Library were searched for prospective studies published from 1 January 1995 to 15 October 2016. Two types of meta-analyses were performed with a focus on the dose-response relationship using two stage generalised least squares regression. RESULTS The primary analysis exhibited a dose-response trend for all-cause dementia (ACD), Alzheimer's disease (AD) but not for vascular dementia (VD). In the dose-response analysis, either ACD (ptrend <0.005; pnon-linearity=0.87) or AD (p trend <0.005; pnon-linearity=0.10) exhibited a linear relationship with leisure time PA (LTPA) over the observed range (0-2000 kcal/week or 0-45 metabolic equivalent of task hours per week (MET-h/week)). Specifically, for every 500 kcal or 10 MET-h increase per week, there was, on average, 10% and 13% decrease in the risk of ACD and AD, respectively. CONCLUSIONS We have reported, for the first time, the dose-response relationship between LTPA and dementia, further supporting the international PA guideline from the standpoint of dementia prevention.
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Affiliation(s)
- Wei Xu
- Department of Neurology, Qingdao Municipal Hospital, College of Medicine and Pharmaceutics, Ocean University of China, Qingdao, China
| | - Hui Fu Wang
- Department of Neurology, Qingdao Municipal Hospital, Qingdao University, Qingdao, China
| | - Yu Wan
- Department of Neurology, Qingdao Municipal Hospital, Qingdao University, Qingdao, China
| | - Chen-Chen Tan
- Department of Neurology, Qingdao Municipal Hospital, Qingdao University, Qingdao, China
| | - Jin-Tai Yu
- Department of Neurology, Qingdao Municipal Hospital, Qingdao University, Qingdao, China
| | - Lan Tan
- Department of Neurology, Qingdao Municipal Hospital, College of Medicine and Pharmaceutics, Ocean University of China, Qingdao, China
- Department of Neurology, Qingdao Municipal Hospital, Qingdao University, Qingdao, China
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Variations in dementia diagnosis in England and association with general practice characteristics. Prim Health Care Res Dev 2017; 18:235-241. [PMID: 28262084 DOI: 10.1017/s146342361700007x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES Improving dementia diagnosis rates in England has been a key strategic aim of the UK Government but the variation and low diagnosis rates are poorly understood. The aim of this study was to explore the variation in actual versus expected diagnosis of dementia across England, and how these variations were associated with general practice characteristics. METHOD A cross-sectional, ecological study design using secondary data sources and median regression modelling was used. Data from the year 2011 for 7711 of the GP practices in England (92.7%). Associations of dementia diagnosis rates (%) per practice, calculated using National Health Service England's 'Dementia Prevalence Calculator' and various practice characteristics were explored using a regression model. RESULTS The median dementia diagnosis rate was 41.6% and the interquartile range was 31.2-53.9%. Multivariable regression analysis demonstrated positive associations between dementia diagnosis rates and deprivation of the population, overall Quality and Outcomes Framework performance, type of primary care contract and size of practice list. Negative associations were found between dementia diagnosis rates and average experience of GPs in the practice and the proportion of the practice caseload over 65 years old. CONCLUSION Dementia diagnosis rates vary greatly across GP practices in England. This study has found independent associations between dementia diagnosis rates and a number of patient and practice characteristics. Consideration of these factors locally may provide targets for case-finding interventions and so facilitate timely diagnosis.
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Lo MH, Lin CL, Chuang E, Chuang TY, Kao CH. Association of dementia in patients with benign paroxysmal positional vertigo. Acta Neurol Scand 2017; 135:197-203. [PMID: 26932875 DOI: 10.1111/ane.12581] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/15/2016] [Indexed: 12/31/2022]
Abstract
OBJECTIVE We conducted a cohort study to investigate whether benign paroxysmal positional vertigo (BPPV) is correlated with an increased risk of dementia. METHODS We established a case cohort comprising 7818 patients aged over 20 years who were diagnosed with BPPV from 2000 to 2010. In addition, we formed a control cohort by randomly selecting 31,272 people without BPPV and matched them with the BPPV patients according to gender, age, and index year. Cox proportional hazard regressions were performed to compute the hazard ratio (HR) of dementia after we adjusted for demographic characteristics and comorbidity. RESULTS The prevalence of comorbidity was higher among patients with BPPV than among those without BPPV. In addition, patients with BPPV exhibited a 1.24-fold (95% confidence interval, CI 1.09-1.40; P < 0.001) higher risk of dementia than those without BPPV after we adjusted for age, gender, and comorbidity. An analysis stratified according to demographic factors revealed that women with BPPV exhibited a 1.36-fold (95% CI 1.16-1.59; P < 0.001) higher risk of dementia. Patients with BPPV aged over 65 years exhibited a significantly higher risk of dementia (adjusted HR: 1.26; 95% CI 1.10-1.43; P < 0.001) than those without BPPV. CONCLUSIONS Patients with BPPV exhibited a higher risk of dementia than those without BPPV.
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Affiliation(s)
- M.-H. Lo
- Department of Physical Medicine and Rehabilitation; Veterans General Hospital Taipei and National Yang-Ming University; Taipei Taiwan
| | - C.-L. Lin
- Management Office for Health Data; China Medical University Hospital; Taichung Taiwan
- College of Medicine; China Medical University; Taichung Taiwan
| | - E. Chuang
- Intended B.S. Molecular and Cell Biology; University of California; Berkeley CA USA
| | - T.-Y. Chuang
- Department of Physical Medicine and Rehabilitation; Veterans General Hospital Taipei and National Yang-Ming University; Taipei Taiwan
| | - C.-H. Kao
- Graduate Institute of Clinical Medicine Science and School of Medicine; College of Medicine; China Medical University; Taichung Taiwan
- Department of Nuclear Medicine and PET Center; China Medical University Hospital; Taichung Taiwan
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Parekh N, Page A, Ali K, Davies K, Rajkumar C. A practical approach to the pharmacological management of hypertension in older people. Ther Adv Drug Saf 2016; 8:117-132. [PMID: 28439398 DOI: 10.1177/2042098616682721] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Hypertension is the leading cause of cardiovascular (CV) morbidity and mortality in adults over the age of 65. The first part of this paper is an overview, summarizing the current guidelines on the pharmacological management of hypertension in older adults in Europe and the USA, and evidence from key trials that contributed to the guidelines. In the second part of the paper, we will discuss the major challenges of managing hypertension in the context of multimorbidity, including frailty, orthostatic hypotension (OH), falls and cognitive impairment that are associated with ageing. A novel 'BEGIN' algorithm is proposed for use by prescribers prior to initiating antihypertensive therapy to guide safe medication use in older adults. Practical suggestions are highlighted to aid practitioners in making rational decisions to treat and monitor hypertension, and for considering withdrawal of antihypertensive drugs in the complex older person.
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Affiliation(s)
| | - Amy Page
- The University of Western Australia, Crawley, Australia
| | - Khalid Ali
- Brighton and Sussex Medical School, Brighton, UK
| | - Kevin Davies
- Brighton and Sussex Medical School, Brighton, UK
| | - Chakravarthi Rajkumar
- Department of Elderly Medicine, Brighton and Sussex Medical School, Audrey Emerton Building, Eastern Road, Brighton BN2 5BE, UK
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Shrivastava SR, Shrivastava PS, Ramasamy J. Dementia in middle- and low-income nations: A public health priority. JOURNAL OF RESEARCH IN MEDICAL SCIENCES 2016; 21:5. [PMID: 27904551 PMCID: PMC5122221 DOI: 10.4103/1735-1995.175162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Saurabh RamBihariLal Shrivastava
- Department of Community Medicine, Shri Sathya Sai Medical College and Research Institute, Ammapettai, Kancheepuram, Tamil Nadu, India
| | - Prateek Saurabh Shrivastava
- Department of Community Medicine, Shri Sathya Sai Medical College and Research Institute, Ammapettai, Kancheepuram, Tamil Nadu, India
| | - Jegadeesh Ramasamy
- Department of Community Medicine, Shri Sathya Sai Medical College and Research Institute, Ammapettai, Kancheepuram, Tamil Nadu, India
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Simultaneous temporal trends in dementia incidence and prevalence, 2005-2013: a population-based retrospective cohort study in Saskatchewan, Canada. Int Psychogeriatr 2016; 28:1643-58. [PMID: 27352934 DOI: 10.1017/s1041610216000818] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND Original studies published over the last decade regarding time trends in dementia report mixed results. The aims of the present study were to use linked administrative health data for the province of Saskatchewan for the period 2005/2006 to 2012/2013 to: (1) examine simultaneous temporal trends in annual age- and sex-specific dementia incidence and prevalence among individuals aged 45 and older, and (2) stratify the changes in incidence over time by database of identification. METHODS Using a population-based retrospective cohort study design, data were extracted from seven provincial administrative health databases linked by a unique anonymized identification number. Individuals 45 years and older at first identification of dementia between April 1, 2005 and March 31, 2013 were included, based on case definition criteria met within any one of four administrative health databases (hospital, physician, prescription drug, and long-term care). RESULTS Between 2005/2006 and 2012/2013, the 12-month age-standardized incidence rate of dementia declined significantly by 11.07% and the 12-month age-standardized prevalence increased significantly by 30.54%. The number of incident cases decreased from 3,389 to 3,270 and the number of prevalent cases increased from 8,795 to 13,012. Incidence rate reductions were observed in every database of identification. CONCLUSIONS We observed a simultaneous trend of decreasing incidence and increasing prevalence of dementia over a relatively short 8-year time period from 2005/2006 to 2012/2013. These trends indicate that the average survival time of dementia is lengthening. Continued observation of these time trends is warranted given the short study period.
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Whitehouse PJ, George DR. A tale of two reports: what recent publications from the Alzheimer's Association and Institute of Medicine say about the state of the field. J Alzheimers Dis 2016; 49:21-5. [PMID: 26444797 DOI: 10.3233/jad-150663] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Peter J Whitehouse
- Department of Neurology, Case Western Reserve University, University Hospital Systems, Cleveland, OH, USA
| | - Daniel R George
- Department of Humanities, Penn State Hershey College of Medicine, Hershey, PA, USA
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Osborne V, Davies M, Layton D, Shakir SAW. Utilisation of extended release quetiapine (Seroquel XL™): Results from an observational cohort study in England. Eur Psychiatry 2016; 33:61-67. [PMID: 26872067 DOI: 10.1016/j.eurpsy.2015.12.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2015] [Revised: 12/17/2015] [Accepted: 12/18/2015] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND A post-authorisation safety study was carried out as part of the EU Risk Management Plan to examine the long-term (up to 12 months) use of quetiapine XL as prescribed in general practice in England. AIM To present a description of the drug utilisation characteristics of quetiapine XL. METHODS An observational, population-based cohort design using the technique of Modified Prescription-Event Monitoring (M-PEM). Patients were identified from dispensed prescriptions issued by general practitioners (GPs) for quetiapine XL between September 2008 and February 2013. Questionnaires were sent to GPs 12 months following the 1st prescription for each individual patient, requesting drug utilisation information. Cohort accrual was extended to recruit additional elderly patients (special population of interest). Summary descriptive statistics were calculated. RESULTS The final M-PEM cohort consisted of 13,276 patients; median age 43 years (IQR: 33, 55) and 59.0% females. Indications for prescribing included bipolar disorder (n=3820), MDD (n=2844), schizophrenia (n=2373) and other (non-licensed) indications (n=3750). Where specified, 59.3% (7869/13,276) were reported to have used quetiapine IR (immediate release formulation) previously at any time. The median start dose was highest for patients with schizophrenia (300 mg/day [IQR 150, 450]). The final elderly cohort consisted of 3127 patients and 28.5% had indications associated with dementia. The median start dose for elderly patients was highest for patients with schizophrenia or BD (both 100mg/day [IQR 50, 300]). CONCLUSIONS The prevalence of off-label prescribing in terms of indication and high doses was common, as was use in special populations such as the very elderly. Whilst off-label use may be unavoidable in certain situations, GPs may need to re-evaluate prescribing in circumstances where there may be safety concerns. This study demonstrates the ongoing importance of observational studies such as M-PEM to gather real-world clinical data to support the post-marketing benefit:risk management of new medications, or existing medications for which license extensions have been approved.
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Affiliation(s)
- V Osborne
- Drug Safety Research Unit, Bursledon Hall, Blundell Lane, Southampton SO31 1AA, UK.
| | - M Davies
- Drug Safety Research Unit, Bursledon Hall, Blundell Lane, Southampton SO31 1AA, UK
| | - D Layton
- Drug Safety Research Unit, Bursledon Hall, Blundell Lane, Southampton SO31 1AA, UK
| | - S A W Shakir
- Drug Safety Research Unit, Bursledon Hall, Blundell Lane, Southampton SO31 1AA, UK
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Wimo A, Sjölund BM, Sköldunger A, Qiu C, Klarin I, Nordberg G, von Strauss E. Cohort Effects in the Prevalence and Survival of People with Dementia in a Rural Area in Northern Sweden. J Alzheimers Dis 2015; 50:387-96. [DOI: 10.3233/jad-150708] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Affiliation(s)
- Anders Wimo
- Aging Research Center (ARC), Karolinska Institutet and Stockholm University, Stockholm, Sweden
- Center for Alzheimer Research at Karolinska Institutet, Stockholm, Sweden
- Centre for Research & Development, Uppsala University/County Council of Gävleborg, Sjukhuset i Gävle, Sweden
| | - Britt-Marie Sjölund
- Aging Research Center (ARC), Karolinska Institutet and Stockholm University, Stockholm, Sweden
- University of Gävle, Gävle, Sweden
| | - Anders Sköldunger
- Aging Research Center (ARC), Karolinska Institutet and Stockholm University, Stockholm, Sweden
| | - Chengxuan Qiu
- Aging Research Center (ARC), Karolinska Institutet and Stockholm University, Stockholm, Sweden
| | - Inga Klarin
- Department of Geriatrics, Karolinska University Hospital, Stockholm, Sweden
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm Sweden
| | | | - Eva von Strauss
- Aging Research Center (ARC), Karolinska Institutet and Stockholm University, Stockholm, Sweden
- The Swedish Red Cross University College, Stockholm, Sweden
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Tang HD, Zhou Y, Gao X, Liang L, Hou MM, Qiao Y, Ma JF, Chen SD. Prevalence and Risk Factor of Cognitive Impairment were Different between Urban and Rural Population: A Community-Based Study. J Alzheimers Dis 2015; 49:917-25. [PMID: 26519443 DOI: 10.3233/jad-150748] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Hui-Dong Tang
- Department of Neurology and Institute of Neurology, Ruijin Hospital affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, PR China
| | - Yi Zhou
- Department of Neurology and Institute of Neurology, Ruijin Hospital affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, PR China
| | - Xiang Gao
- Department of Nutritional Sciences, The Pennsylvania State University, University Park, PA, USA
| | - Liang Liang
- Department of Neurology and Institute of Neurology, Ruijin Hospital affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, PR China
| | - Miao-Miao Hou
- Department of Neurology and Institute of Neurology, Ruijin Hospital affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, PR China
| | - Yuan Qiao
- Department of Neurology and Institute of Neurology, Ruijin Hospital affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, PR China
| | - Jian-Fang Ma
- Department of Neurology and Institute of Neurology, Ruijin Hospital affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, PR China
| | - Sheng-Di Chen
- Department of Neurology and Institute of Neurology, Ruijin Hospital affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, PR China
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Stacpoole M, Hockley J, Thompsell A, Simard J, Volicer L. The Namaste Care programme can reduce behavioural symptoms in care home residents with advanced dementia. Int J Geriatr Psychiatry 2015; 30:702-9. [PMID: 25338971 DOI: 10.1002/gps.4211] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2014] [Accepted: 08/12/2014] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The objective of the study was to evaluate the effects of the Namaste Care programme on the behavioural symptoms of residents with advanced dementia in care homes and their pain management. METHODS Six dementia care homes collaborated in an action research study-one withdrew. Inclusion criteria were a dementia diagnosis and a Bedford Alzheimer's Nursing Severity Scale score of >16. Primary research measures were the Neuropsychiatric Inventory-Nursing Homes (NPI-NH) and Doloplus-2 behavioural pain assessment scale for the elderly. Measures were recorded at baseline and at three 1-2 monthly intervals after Namaste Care started. RESULTS Management disruption occurred across all care homes. The severity of behavioural symptoms, pain and occupational disruptiveness (NPI-NH) decreased in four care homes. Increased severity of behavioural symptoms in one care home was probably related to poor pain management, reflected in increased pain scores, and disrupted leadership. Comparison of NPI-NH scores showed that severity of behavioural symptoms and occupational disruptiveness were significantly lower after initiation of Namaste Care (n = 34, p < 0.001) and after the second interval (n = 32, p < 0.001 and p = 0.003). However, comparison of these measures in the second and third intervals revealed that both were slightly increased in the third interval (n = 24, p < 0.001 and p = 0.001). CONCLUSIONS Where there are strong leadership, adequate staffing, and good nursing and medical care, the Namaste Care programme can improve quality of life for people with advanced dementia in care homes by decreasing behavioural symptoms. Namaste is not a substitute for good clinical care.
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Affiliation(s)
| | - Jo Hockley
- Care Home Project Team, St Christopher's Hospice, London, UK
| | | | - Joyce Simard
- School of Nursing and Midwifery, University of Western Sydney, Sydney, Australia
| | - Ladislav Volicer
- School of Ageing Studies, University of South Florida, Tampa, Florida, USA
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Porteri C, Petrini C. Research involving subjects with Alzheimer's disease in Italy: the possible role of family members. BMC Med Ethics 2015; 16:12. [PMID: 25888878 PMCID: PMC4357192 DOI: 10.1186/s12910-015-0009-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2014] [Accepted: 02/19/2015] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Alzheimer's disease is a very common, progressive and still incurable disease. Future possibilities for its cure lie in the promotion of research that will increase our knowledge of the disorder's causes and lead to the discovery of effective remedies. Such research will necessarily involve individuals suffering from Alzheimer's disease. This raises the controversial issue of whether patients with Alzheimer's disease are competent to give their consent for research participation. DISCUSSION We discuss the case of subjects with Alzheimer's disease who may have impaired decision-making capacity and who could be involved in research protocols, taking into consideration aspects of the Italian normative framework, which requires a court-appointed legal representative for patients who are not able to give consent and does not recognise the legal value of advance directives. We show that this normative framework risks preventing individuals with Alzheimer's disease from taking part in research and that a new policy that favours research while promoting respect for patients' well-being and rights needs to be implemented. SUMMARY We believe that concerns about the difficulty of obtaining fully valid consent of patients with Alzheimer's disease should not prevent them from participating in clinical trials and benefiting from scientific progress. Therefore, we argue that the requirement for patients to have a legal representative may not be the best solution in all countries and clinical situations, and suggest promoting the role of patients' family members in the decision-making process. In addition, we outline the possible role of advance directives and ethics committees.
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Affiliation(s)
- Corinna Porteri
- Bioethics Unit, IRCCS Centro San Giovanni di Dio Fatebenefratelli, Via Pilastroni 4, 25125, Brescia, Italy.
| | - Carlo Petrini
- Bioethics Unit, Istituto Superiore di Sanità, Viale Regina Elena 299, 00161, Rome, Italy.
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Melzer D, Tavakoly B, Winder RE, Masoli JAH, Henley WE, Ble A, Richards SH. Much more medicine for the oldest old: trends in UK electronic clinical records. Age Ageing 2015; 44:46-53. [PMID: 25103030 PMCID: PMC4255615 DOI: 10.1093/ageing/afu113] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND the oldest old (85+) pose complex medical challenges. Both underdiagnosis and overdiagnosis are claimed in this group. OBJECTIVE to estimate diagnosis, prescribing and hospital admission prevalence from 2003/4 to 2011/12, to monitor trends in medicalisation. DESIGN AND SETTING observational study of Clinical Practice Research Datalink (CPRD) electronic medical records from general practice populations (eligible; n = 27,109) with oversampling of the oldest old. METHODS we identified 18 common diseases and five geriatric syndromes (dizziness, incontinence, skin ulcers, falls and fractures) from Read codes. We counted medications prescribed ≥1 time in all quarters of studied years. RESULTS there were major increases in recorded prevalence of most conditions in the 85+ group, especially chronic kidney disease (stages 3-5: prevalence <1% rising to 36.4%). The proportions of the 85+ group with ≥3 conditions rose from 32.2 to 55.1% (27.1 to 35.1% in the 65-84 year group). Geriatric syndrome trends were less marked. In the 85+ age group the proportion receiving no chronically prescribed medications fell from 29.6 to 13.6%, while the proportion on ≥3 rose from 44.6 to 66.2%. The proportion of 85+ year olds with ≥1 hospital admissions per year rose from 27.6 to 35.4%. CONCLUSIONS there has been a dramatic increase in the medicalisation of the oldest old, evident in increased diagnosis (likely partly due to better record keeping) but also increased prescribing and hospitalisation. Diagnostic trends especially for chronic kidney disease may raise concerns about overdiagnosis. These findings provide new urgency to questions about the appropriateness of multiple diagnostic labelling.
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Affiliation(s)
- David Melzer
- Epidemiology and Public Health, University of Exeter Medical School, Barrack Road, Exeter EX2 5DW, UK
| | - Behrooz Tavakoly
- Epidemiology and Public Health, University of Exeter Medical School, Barrack Road, Exeter EX2 5DW, UK
| | - Rachel E Winder
- Epidemiology and Public Health, University of Exeter Medical School, Smeall Building, St Luke's Campus, Exeter EX1 2LU, UK
| | - Jane A H Masoli
- Epidemiology and Public Health, University of Exeter Medical School, Barrack Road, Exeter EX2 5DW, UK
| | - William E Henley
- Health Statistics Group, University of Exeter Medical School, St Luke's Campus, Exeter EX1 2LU, UK
| | - Alessandro Ble
- Epidemiology and Public Health, University of Exeter Medical School, Barrack Road, Exeter EX2 5DW, UK
| | - Suzanne H Richards
- Primary Care Research Group, University of Exeter Medical School, Smeall Building, St Luke's Campus, Exeter EX1 2LU, UK
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Woo J, Wong M. Targeting mid-life risk factors to reduce late-life dementia. Public Health 2014; 128:952-4. [PMID: 25369360 DOI: 10.1016/j.puhe.2014.08.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2014] [Revised: 07/23/2014] [Accepted: 08/07/2014] [Indexed: 11/25/2022]
Affiliation(s)
- J Woo
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Shatin, N.T., Hong Kong.
| | - M Wong
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Shatin, N.T., Hong Kong
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