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Qeadan F, Beaudin S, Reutrakul S, English K. Single use of psychoactive substances and its association with sleep disorders and sleep health in a large US college sample. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2024:1-15. [PMID: 38442345 DOI: 10.1080/07448481.2024.2317171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 01/30/2024] [Indexed: 03/07/2024]
Abstract
OBJECTIVE Estimate the association between single (i.e., exclusive) use of a range of substances and sleep outcomes. PARTICIPANTS College students participated in the 2015-2019 American College-Health Association-National College-Health Assessment survey. METHODS Multivariable logistic and linear regressions were used. RESULTS Single users of sedative, opioid, tobacco, and stimulant drugs were more likely to report a diagnosis of insomnia and other sleep disorder and indicated more days per week of negative sleep health outcomes compared not only to non-users of these substances but also polysubstance users. Single users of alcohol were significantly less likely to report a diagnosis of sleep disorder and indicated having had more days per week of positive sleep health outcomes compared to non-alcohol users and polysubstance users. However, those results are reversed for binge drinking. CONCLUSIONS Support of programs addressing behaviors to reduce the high prevalence of psychoactive substance use and sleep disturbances in college youth is needed.
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Affiliation(s)
- Fares Qeadan
- Parkinson School of Health Sciences and Public Health, Loyola University Chicago, Maywood, IL, USA
| | - Stephane Beaudin
- Department of Microbiology and Environmental Toxicology, University of California, Santa Cruz, CA, USA
| | | | - Kevin English
- Albuquerque Area Southwest Tribal Epidemiology Center, Albuquerque, NM, USA
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Gallagher E, Mehmood M, Lavan A, Kenny RA, Briggs R. Psychotropic medication use and future unexplained and injurious falls and fracture amongst community-dwelling older people: data from TILDA. Eur Geriatr Med 2023:10.1007/s41999-023-00786-x. [PMID: 37157012 DOI: 10.1007/s41999-023-00786-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Accepted: 04/13/2023] [Indexed: 05/10/2023]
Abstract
PURPOSE Psychotropic medications (antidepressants, anticholinergics, benzodiazepines, 'Z'-drugs and antipsychotics) are frequently identified as Falls Risk Increasing Drugs. The aim of this study is to clarify the association of psychotropic medication use with future falls/fracture amongst community-dwelling older people. METHODS Participants ≥ 65 years from TILDA were included and followed from Waves 1 to 5 (8-year follow-up). Incidence of falls (total falls/unexplained/injurious) and fracture was by self-report; unexplained falls were falls not caused by a slip/trip, with no apparent cause. Poisson regression models reporting incidence rate ratios (IRR) assessed the association between medications and future falls/fracture, adjusted for relevant covariates. RESULTS Of 2809 participants (mean age 73 years), 15% were taking ≥ 1 psychotropic medication. During follow-up, over half of participants fell, with 1/3 reporting injurious falls, over 1/5 reporting unexplained falls and almost 1/5 reporting fracture. Psychotropic medications were independently associated with falls [IRR 1.15 (95% CI 1.00-1.31)] and unexplained falls [IRR 1.46 (95% CI 1.20-1.78)]. Taking ≥ 2 psychotropic medications was further associated with future fracture (IRR 1.47 (95% CI 1.06-2.05)]. Antidepressants were independently associated with falls [IRR 1.20 (1.00-1.42)] and unexplained falls [IRR 2.12 (95% CI 1.69-2.65)]. Anticholinergics were associated with unexplained falls [IRR 1.53 (95% CI 1.14-2.05)]. 'Z'-drug and benzodiazepine use were not associated with falls or fractures. CONCLUSION Psychotropic medications, particularly antidepressants and anticholinergic medications, are independently associated with falls and fractures. Regular review of ongoing need for these medications should therefore be central to the comprehensive geriatric assessment.
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Affiliation(s)
- Eleanor Gallagher
- Mercer's Institute of Successful Ageing, St James's Hospital, Dublin, Ireland
| | - Mustafa Mehmood
- Department of Emergency Medicine, St James's Hospital, Dublin, Ireland
| | - Amanda Lavan
- Mercer's Institute of Successful Ageing, St James's Hospital, Dublin, Ireland
- Discipline of Medical Gerontology, Trinity College Dublin, Dublin, Ireland
- The Irish Longitudinal Study on Ageing, Trinity College Dublin, Dublin, Ireland
| | - Rose Anne Kenny
- Mercer's Institute of Successful Ageing, St James's Hospital, Dublin, Ireland
- Discipline of Medical Gerontology, Trinity College Dublin, Dublin, Ireland
- The Irish Longitudinal Study on Ageing, Trinity College Dublin, Dublin, Ireland
| | - Robert Briggs
- Mercer's Institute of Successful Ageing, St James's Hospital, Dublin, Ireland.
- Discipline of Medical Gerontology, Trinity College Dublin, Dublin, Ireland.
- The Irish Longitudinal Study on Ageing, Trinity College Dublin, Dublin, Ireland.
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Bellon F, Stremler R, Rubinat-Arnaldo E, Padilla-Martínez JM, Casado-Ramirez E, Sánchez-Ortuño M, Gea-Sánchez M, Martin-Vaquero Y, Moreno-Casbas T, Abad-Corpa E. Sleep quality among inpatients of Spanish public hospitals. Sci Rep 2022; 12:21989. [PMID: 36539518 PMCID: PMC9764317 DOI: 10.1038/s41598-022-26412-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2022] [Accepted: 12/14/2022] [Indexed: 12/24/2022] Open
Abstract
Sleep is a complex process and is needed both in health and illness. Deprivation of sleep is known to have multiple negative physiological effects on people's bodies and minds. Despite the awareness of these harmful effects, previous studies have shown that sleep is poor among hospitalised patients. We utilized an observational design with 343 patients recruited from medical and surgical units in 12 hospitals located in nine Spanish regions. Sociodemographic and clinical characteristics of patients were collected. Sleep quality at admission and during hospitalisation was measured by the Pittsburgh Sleep Quality Index. Sleep quantity was self-reported by patients in hours and minutes. Mean PSQI score before and during hospitalisation were respectively 8.62 ± 4.49 and 11.31 ± 4.04. Also, inpatients slept about an hour less during their hospital stay. Lower educational level, sedative medication intake, and multi-morbidity was shown to be associated with poorer sleep quality during hospitalisation. A higher level of habitual physical activity has shown to correlate positively with sleep quality in hospital. Our study showed poor sleep quality and quantity of inpatients and a drastic deterioration of sleep in hospital versus at home. These results may be helpful in drawing attention to patients' sleep in hospitals and encouraging interventions to improve sleep.
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Affiliation(s)
- Filip Bellon
- grid.15043.330000 0001 2163 1432GESEC Group, Department of Nursing and Physiotherapy, Faculty of Nursing and Physiotherapy, University of Lleida, Montserrat Roig, 25198 Lleida, Spain ,Healthcare Research Group (GRECS), Institute of Biomedical Research Lleida (IRBLleida), Av. Alcalde Rovira Roure, 80, 25198 Lleida, Spain
| | - Robyn Stremler
- grid.17063.330000 0001 2157 2938Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON Canada ,grid.42327.300000 0004 0473 9646The Hospital for Sick Children (SickKids), Toronto, ON Canada
| | - Esther Rubinat-Arnaldo
- grid.15043.330000 0001 2163 1432GESEC Group, Department of Nursing and Physiotherapy, Faculty of Nursing and Physiotherapy, University of Lleida, Montserrat Roig, 25198 Lleida, Spain ,Healthcare Research Group (GRECS), Institute of Biomedical Research Lleida (IRBLleida), Av. Alcalde Rovira Roure, 80, 25198 Lleida, Spain ,grid.413448.e0000 0000 9314 1427Center for Biomedical Research on Diabetes and Associated Metabolic Diseases (CIBERDEM), Instituto de Salud Carlos III, Barcelona, Spain
| | - Julia M. Padilla-Martínez
- grid.10586.3a0000 0001 2287 8496University of Murcia-Murcia Health Service (IMIB-Arrixaca), Campus Universitario, 1, 30100 Murcia, Spain
| | - Elvira Casado-Ramirez
- grid.512898.f0000 0004 0593 3686Nursing and Healthcare Research Unit (Investén-Isciii), Av. Monforte de Lemos, 5. Pabellón 13, 28029 Madrid, Spain ,grid.512892.5Biomedical Research Center for Fragility and Healthy Aging (CIBERFES), Av. Monforte de Lemos, 5. Pabellón 11, 28029 Madrid, Spain
| | | | - Montserrat Gea-Sánchez
- grid.15043.330000 0001 2163 1432GESEC Group, Department of Nursing and Physiotherapy, Faculty of Nursing and Physiotherapy, University of Lleida, Montserrat Roig, 25198 Lleida, Spain ,Healthcare Research Group (GRECS), Institute of Biomedical Research Lleida (IRBLleida), Av. Alcalde Rovira Roure, 80, 25198 Lleida, Spain ,grid.512892.5Biomedical Research Center for Fragility and Healthy Aging (CIBERFES), Av. Monforte de Lemos, 5. Pabellón 11, 28029 Madrid, Spain
| | - Yolanda Martin-Vaquero
- Zamora Healthcare Complex, Zamora Health Care Management, Av. de Requejo, 35, 49022 Zamora, Spain
| | - Teresa Moreno-Casbas
- grid.512898.f0000 0004 0593 3686Nursing and Healthcare Research Unit (Investén-Isciii), Av. Monforte de Lemos, 5. Pabellón 13, 28029 Madrid, Spain ,grid.512892.5Biomedical Research Center for Fragility and Healthy Aging (CIBERFES), Av. Monforte de Lemos, 5. Pabellón 11, 28029 Madrid, Spain
| | - Eva Abad-Corpa
- grid.10586.3a0000 0001 2287 8496University of Murcia-Murcia Health Service (IMIB-Arrixaca), Campus Universitario, 1, 30100 Murcia, Spain ,grid.512892.5Biomedical Research Center for Fragility and Healthy Aging (CIBERFES), Av. Monforte de Lemos, 5. Pabellón 11, 28029 Madrid, Spain
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Hernández B, Scarlett S, Moriarty F, Romero-Ortuno R, Kenny RA, Reilly R. Investigation of the role of sleep and physical activity for chronic disease prevalence and incidence in older Irish adults. BMC Public Health 2022; 22:1711. [PMID: 36085044 PMCID: PMC9463855 DOI: 10.1186/s12889-022-14108-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 08/29/2022] [Indexed: 11/10/2022] Open
Abstract
Background Chronic diseases are the leading cause of death worldwide. Many of these diseases have modifiable risk factors, including physical activity and sleep, and may be preventable. This study investigated independent associations of physical activity and sleep with eight common chronic illnesses. Methods Data were from waves 1, 3 and 5 of The Irish Longitudinal Study on Ageing (n = 5,680). Inverse probability weighted general estimating equations were used to examine longitudinal lifetime prevalence and cumulative incidence of self-reported conditions. Results Sleep problems were significantly associated with increased odds of incident and prevalent arthritis and angina. Additionally sleep problems were associated with higher odds of lifetime prevalence of hypertension and diabetes. Physical activity was negatively associated incident osteoporosis and respiratory diseases and negatively associated with lifetime prevalence of hypertension, high cholesterol and diabetes. Conclusions Worse sleep quality and lower physical activity were associated with higher odds of chronic diseases. Interventions to improve sleep and physical activity may improve health outcomes. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-022-14108-6.
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da Silva LGR, da Silva Pinto AW, de Queiroz WE, Coelho CC, Blatt CR, Oliveira MG, de Lima Pimentel AC, Elseviers M, Baldoni AO. Deprescribing clonazepam in primary care older patients: a feasibility study. Int J Clin Pharm 2022; 44:489-498. [PMID: 35022954 DOI: 10.1007/s11096-021-01371-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Accepted: 12/16/2021] [Indexed: 12/23/2022]
Abstract
Background Inappropriate use of clonazepam by older adults is associated with cognitive impairment, delirium, and falls. Strategies to optimize its use are important to increase patient safety. Objective To evaluate the feasibility of a clonazepam deprescription protocol in the elderly. Methods This is a quasi-experimental study. Elderly people with chronic use of clonazepam and attended in primary care units in two Brazilian municipalities were selected. A deprescription protocol was used, which included five fortnightly meetings between the older adults and the research team, to reduce the dose by 25%. Patients received instructions on sleep hygiene behaviors and the advantages of clonazepam deprescription; family physicians followed a flowchart for gradual dose reduction. In the 1st and 5th meetings, there were medical appointments for anamnesis and discharge. The monitoring of patients and the application of tests were carried out by the research team. Results Of the 35 elderly people included in the study, 27 reached the end; 81.5% achieved deprescription: 22.2% stopped completely and 59.3% decreased the dose. At the last meeting, 20% of elderly patients reported an increase in blood pressure. Conclusion The high rate of deprescription and the little relevance of clonazepam withdrawal reactions, showed that the use of the protocol was effective. However, the increase in blood pressure and the worsening of sleep quality in the last meeting show the need for adjustment in the last stage of the deprescription process.
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Affiliation(s)
- Luanna Gabriella Resende da Silva
- Center for Teaching and Research in Clinical Pharmacy, Federal University of São João del-Rei, Campus Centro-Oeste Dona Lindu, Sebastião Gonçalves Coelho Street, 400, Chanadour, Divinópolis City, Minas Gerais, 35501-296, Brazil.
| | - Athos Wellington da Silva Pinto
- Center for Teaching and Research in Clinical Pharmacy, Federal University of São João del-Rei, Campus Centro-Oeste Dona Lindu, Sebastião Gonçalves Coelho Street, 400, Chanadour, Divinópolis City, Minas Gerais, 35501-296, Brazil
| | | | | | - Carine Raquel Blatt
- Department of Pharmacosciences, Federal University of Health Sciences of Porto Alegre, Porto Alegre City, Rio Grande do Sul, Brazil
| | - Marcio Galvão Oliveira
- Master's Program in Collective Health, Multidisciplinary Institute for Health, Federal University of Bahia, Vitória da Conquista City, Bahia, Brazil
| | | | - Monique Elseviers
- Clinical Pharmacology Research Unit, Heymans Institute of Pharmacology, Ghent University, Ghent, Belgium
- Centre for Research and Innovation in Care (CRIC), University of Antwerp, Antwerp, Belgium
| | - André Oliveira Baldoni
- Center for Teaching and Research in Clinical Pharmacy, Federal University of São João del-Rei, Campus Centro-Oeste Dona Lindu, Sebastião Gonçalves Coelho Street, 400, Chanadour, Divinópolis City, Minas Gerais, 35501-296, Brazil
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Kakazu VA, Morelhão PK, Dokkedal-Silva V, Tufik S, Andersen ML. Increasing health professional awareness about the link between sleep and falls in older adults. Geriatr Gerontol Int 2022; 22:178-179. [PMID: 34981611 DOI: 10.1111/ggi.14338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 12/10/2021] [Accepted: 12/16/2021] [Indexed: 11/29/2022]
Affiliation(s)
- Viviane A Kakazu
- Physical Therapy Department, Sao Paulo State University (UNESP), Presidente Prudente, Brazil
| | - Priscila K Morelhão
- Psychobiology Department, Federal University of São Paulo (UNIFESP), São Paulo, Brazil
| | | | - Sergio Tufik
- Psychobiology Department, Federal University of São Paulo (UNIFESP), São Paulo, Brazil
| | - Monica L Andersen
- Psychobiology Department, Federal University of São Paulo (UNIFESP), São Paulo, Brazil
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Turner JP, Sanyal C, Martin P, Tannenbaum C. Economic Evaluation of Sedative Deprescribing in Older Adults by Community Pharmacists. J Gerontol A Biol Sci Med Sci 2020; 76:1061-1067. [DOI: 10.1093/gerona/glaa180] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Indexed: 01/30/2023] Open
Abstract
Abstract
Background
Sedative use in older adults increases the risk of falls, fractures, and hospitalizations. The D-PRESCRIBE (Developing Pharmacist-Led Research to Educate and Sensitize Community Residents to the Inappropriate Prescriptions Burden in the Elderly), pragmatic randomized clinical trial demonstrated that community-based, pharmacist-led education delivered simultaneously to older adults and their primary care providers reduce the use of sedatives by 43% over 6 months. However, the associated health benefits and cost savings have yet to be described. This study evaluates the cost-effectiveness of the D-PRESCRIBE intervention compared to usual care for reducing the use of potentially inappropriate sedatives among older adults.
Methods
A cost-utility analysis from the public health care perspective of Canada estimated the costs and quality-adjusted life-years (QALYs) associated with the D-PRESCRIBE intervention compared to usual care over a 1-year time horizon. Transition probabilities, intervention effectiveness, utility, and costs were derived from the literature. Probabilistic analyses were performed using a decision tree and Markov model to estimate the incremental cost-effectiveness ratio.
Results
Compared to usual care, pharmacist-led deprescribing is less costly (−$1392.05 CAD) and more effective (0.0769 QALYs). Using common willingness-to-pay (WTP) thresholds of $50 000 and $100 000, D-PRESCRIBE was the optimal strategy. Scenario analysis indicated the cost-effectiveness of D-PRESCRIBE is sensitive to the rate of deprescribing.
Conclusions
Community pharmacist-led deprescribing of sedatives is cost-effective, leading to greater quality-of-life and harm reduction among older adults. As the pharmacist’s scope of practice expands, consideration should be given to interprofessional models of remuneration for quality prescribing and deprescribing services.
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Affiliation(s)
- Justin P Turner
- Faculty of Pharmacy, Université de Montréal, Québec, Canada
- Centre de Recherche, Institut Universitaire de Gériatrie de Montréal, Québec, Canada
| | | | - Philippe Martin
- Faculty of Pharmacy, Université de Montréal, Québec, Canada
- Centre de Recherche, Institut Universitaire de Gériatrie de Montréal, Québec, Canada
| | - Cara Tannenbaum
- Faculty of Pharmacy, Université de Montréal, Québec, Canada
- Faculty of Medicine, Université de Montréal, Québec, Canada
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