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Vaughan RM, O'Dwyer M, Tyrrell J, Kennelly SP, McCarron M. Drug burden index of people ageing with intellectual disability and cognitive complaints attending a specialist memory service. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2024. [PMID: 39187934 DOI: 10.1111/jir.13180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 07/05/2024] [Accepted: 07/29/2024] [Indexed: 08/28/2024]
Abstract
BACKGROUND Medications with sedative or anticholinergic properties should be prescribed with caution in those with cognitive complaints. This is particularly relevant in people ageing with an intellectual disability (ID). Higher drug burden index (DBI) scores are associated with increased frailty and falls and reduced quality of life in older people and increased risk of adverse effects (daytime somnolence, constipation) in those with ID. While previous studies have shown that the ID population has higher rates of drug burden and a higher propensity to be prescribed an antipsychotic than the general population, the degree of burden has not been assessed specifically in those with ID and cognitive complaints. METHODS We assessed drug burden in a cohort of sequential referrals to a national memory service for people with ID. All patients were referred for assessment of cognitive complaints (self-reported or caregiver-reported problems with memory or cognition). DBI was calculated individually for each participant, and the impact of aetiology of ID, level of ID, age, psychiatric/neurological comorbidities and diagnostic outcome on DBI scores was assessed. RESULTS The study population was 58.6% female with a median age of 55 years and aetiology of ID was Down syndrome (DS) in 71.3%. Consensus diagnosis was Alzheimer's dementia in 40.2%, mild cognitive impairment in 29.9% and cognitively unimpaired from baseline in 25.3%. Medication use was high with 95.4% taking medications, with a median number of medications of 4 (interquartile range 4) and a rate of polypharmacy (≥5 medications) of 51.7%. Overall, 65.5% were exposed to sedative or anticholinergic medications with 39.1% exposed to a clinically significant DBI score >1. Those with psychiatric comorbidities, non-DS aetiology or epilepsy were significantly more likely to have a DBI score >1. CONCLUSIONS People with ID and incipient cognitive complaints have a high level of drug burden, which concerningly exceeds that of the general population.
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Affiliation(s)
- R M Vaughan
- National Intellectual Disability Memory Service, Tallaght University Hospital, Dublin, Ireland
| | - M O'Dwyer
- Trinity Centre for Ageing and Intellectual Disability, School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland
- School of Pharmacy and Pharmaceutical Sciences, Trinity College Dublin, Dublin, Ireland
| | - J Tyrrell
- National Intellectual Disability Memory Service, Tallaght University Hospital, Dublin, Ireland
| | - S P Kennelly
- National Intellectual Disability Memory Service, Tallaght University Hospital, Dublin, Ireland
| | - M McCarron
- National Intellectual Disability Memory Service, Tallaght University Hospital, Dublin, Ireland
- School of Pharmacy and Pharmaceutical Sciences, Trinity College Dublin, Dublin, Ireland
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Yoon DH, Kim JS, Hwang SS, Lee DW, Song W. The Effect of High-Speed Power Training on Physical Frailty in Older Adults: Effect of a Visual-Guided Exercise Program in South Korean Rural Areas. JOURNAL OF ENVIRONMENTAL AND PUBLIC HEALTH 2023; 2023:8912846. [PMID: 37305077 PMCID: PMC10256443 DOI: 10.1155/2023/8912846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 04/20/2023] [Accepted: 04/28/2023] [Indexed: 06/13/2023]
Abstract
Objective Exercise has been shown to be an effective intervention; the difficulty still lies in providing exercise programs to the older adults in rural areas. Therefore, this study aimed to examine the effects of a 12-week exercise program provided with visual guidelines (prerecorded video) on frailty among older adults in rural areas. Methods Fifty participants (71.7 ± 4.9 years) from 5 different rural areas were recruited and divided into two groups: the exercise group (EX, n = 24 (male: 8, female: 18)) and the control group (CON, n = 26 (male: 7, female: 17)). With the commencement of the exercise intervention, a prerecorded high-speed power training program for frail older adults was distributed to the EX group. A new prerecorded exercise program was delivered to the EX group every 4 weeks. Frailty status was diagnosed with Fried's criteria before and after the intervention. Muscle strength was measured in the upper and lower limb strength (hand-grip strength and leg extension and flexion), and physical function was measured using a short physical performance battery and gait speed. Fasting blood was collected before and after the intervention and analyzed for blood lipid profile. Results After 12 weeks of the intervention period, a significant difference in frailty status (P < 0.01) and score (P < 0.01) favoring the EX group was observed. Physical functions (gait speed (P=0.01) and time for sit to stand (P < 0.01)) were significantly improved in the EX group with a significant increase in knee extensor strength (P < 0.01). A significant difference in serum high-density lipoprotein levels favoring the EX group (P=0.03) was also observed. Conclusions This study confirmed the positive effect of a visual-guided exercise program on older adults' residents in rural areas and provided alternative methods to effectively provide exercise program for the older adults with limited resources.
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Affiliation(s)
- Dong Hyun Yoon
- Department of Rehabilitation Medicine, Seoul Metropolitan Government Boramae Medical Center, Seoul, Republic of Korea
- Institute on Aging, Seoul National University, Seoul 08826, Republic of Korea
| | - Jin-Soo Kim
- Exercise Medicine Research Institute, Edith Cowan University, Joondalup, WA 6027, Australia
- School of Medicine and Sciences, Edith Cowan University, Joondalup, WA 6027, Australia
| | - Su Seung Hwang
- Health and Exercise Science Laboratory, Department of Physical Education, Institute of Sports Science, Seoul National University, Seoul 08826, Republic of Korea
| | - Dong Won Lee
- Health and Exercise Science Laboratory, Department of Physical Education, Institute of Sports Science, Seoul National University, Seoul 08826, Republic of Korea
| | - Wook Song
- Institute on Aging, Seoul National University, Seoul 08826, Republic of Korea
- Health and Exercise Science Laboratory, Department of Physical Education, Institute of Sports Science, Seoul National University, Seoul 08826, Republic of Korea
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3
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Osman A, Kamkar N, Speechley M, Ali S, Montero-Odasso M. Fall risk-increasing drugs and gait performance in community-dwelling older adults: A systematic review. Ageing Res Rev 2022; 77:101599. [PMID: 35219903 DOI: 10.1016/j.arr.2022.101599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2021] [Revised: 02/12/2022] [Accepted: 02/23/2022] [Indexed: 11/01/2022]
Abstract
PURPOSE Medication use, and gait impairment are two major risk factors for falls in older adults. There are several mechanisms linking fall risk-increasing drugs (FRIDs) and increased fall risk. One pathway involves gait performance as an intermediate variable. It is plausible that FRIDs indirectly increase fall risk by causing gait impairment. The purpose of this review was to systematically review the existing evidence on the association between FRIDs and gait performance in community-dwelling older adults without neurological movement disorders. METHODS Two searches were performed using MeSH terms and keywords in the electronic databases MEDLINE, EMBASE, PsycINFO, CINAHL and grey literature. We included clinical trials and observational studies that assessed the association between a FRID class and any quantitative measure of gait performance. Quality assessment was performed using the Newcastle-Ottawa scale for observational studies and the Cochrane risk-of-bias tool for clinical trials. Study characteristics and findings were summarized in a descriptive approach for each drug class. RESULTS A total of 11,197 studies were retrieved from both searches at the first step and a total of 23 studies met the final inclusion criteria. Fourteen studies assessed the association between psychotropic FRIDs and gait performance and nine assessed cardiovascular FRIDs. Four out of five studies found that drugs with sedative properties are associated with reduced gait speed in older adults. Three out of four studies found no association between statin use and gait speed. There is insufficient evidence on the association between FRIDs and other gait performance measures. CONCLUSION Caution should be taken when prescribing drugs with sedative properties to older adults at risk of falls. Further research is required to assess the impact of the use FRIDs on gait performance measures other than gait speed.
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Sedative Load in Community-Dwelling Older Adults with Mild-Moderate Alzheimer's Disease: Longitudinal Relationships with Adverse Events, Delirium and Falls. Drugs Aging 2020; 37:829-837. [PMID: 32924095 DOI: 10.1007/s40266-020-00800-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/02/2020] [Indexed: 12/31/2022]
Abstract
BACKGROUND Older adults are frequently prescribed medications with sedative effects, which are associated with numerous adverse consequences. However, the prevalence and longitudinal associations of sedative medication use in community-dwelling older adults with mild-moderate Alzheimer's disease (AD) has not been explored to date. OBJECTIVES Our objective was to assess the prevalence of sedative medication use in community-dwelling older adults with mild-moderate AD and examine the longitudinal association between sedative medication use and adverse events (AEs). METHODS The association between baseline sedative load (SL) and AEs, unscheduled healthcare utilisation, delirium and falls was assessed in older adults with mild-moderate AD over 18 months using secondary analysis of NILVAD trial data (collected from 2014 to 2016). Baseline medication use was assessed, and the SL model was applied to each participant's medication individually. The SL model classifies medications into one of four categories: (1) primary sedatives, (2) medications with a sedating component or prominent side effect, (3) medications with sedation as a potential adverse reaction and (4) all other medications with no known sedative side effects. Medications in group 1 were assigned an SL score of 2, those in group 2 were assigned an SL score of 1, and those in categories 3 and 4 an SL score of 0. SL scores for each medication participants were taking were summed and the total SL calculated as an arithmetic sum of individual medications score. A total SL score ≥ 3 was classed as high. Statistical analysis was conducted using Poisson regression and mixed-effects linear regression, with adjustment for important clinical covariates. We also assessed the impact of SL on dementia progression and cognitive decline. RESULTS Over half (55.7% [284/510]) of those with mild-moderate AD (age 72.8 ± 8.3 years, 61.9% female) were prescribed a regular medication with sedation as a primary effect or prominent side effect, with 22.2% (113/510) having a high SL (≥ 3). The most common medications contributing to SL were antidepressants, antipsychotics, anxiolytics and hypnotics. Over 18 months, increasing baseline SL was associated with incident AEs (incidence rate ratio [IRR] 1.15; 95% confidence interval [CI] 1.11-1.19; p < 0.001), serious AEs (IRR 1.23; 95% CI 1.11-1.36; p < 0.001) and unscheduled general practitioner visits (IRR 1.23; 95% CI 1.13-1.34; p < 0.001). Further, increasing SL was associated with a greater likelihood of incident delirium (IRR 1.30; 95% CI 1.11-1.53; p < 0.001) and falls (IRR 1.20; 95% CI 1.03-1.42; p = 0.02). Associations persisted after robust covariate adjustment. SL was not associated with accelerated cognitive decline or AD progression. CONCLUSIONS In the current study, over half of older adults with mild-moderate AD were prescribed at least one drug with a sedative effect, and a significant minority had a high SL. Increasing baseline SL was associated with a greater likelihood of incident AEs, delirium and falls, highlighting the need for optimal prescribing in this potentially vulnerable cohort.
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Ah YM, Han E, Jun K, Yu YM, Lee JY. Change in sedative burden after dementia onset using difference-in-difference estimations. PLoS One 2019; 14:e0220582. [PMID: 31374112 PMCID: PMC6677315 DOI: 10.1371/journal.pone.0220582] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Accepted: 07/18/2019] [Indexed: 12/28/2022] Open
Abstract
Background Sedative agents are avoided in older adults because of potential risks including cognitive impairment, fall, frailty, and mortality. However, no studies addressing both prediagnostic and postdiagnostic period of dementia have evaluated sedative agent usage over an extended period. Objectives To describe a longitudinal change in sedative medication use before and after the diagnosis with dementia over 10 years compared to patients without dementia. Methods We conducted a retrospective cohort study using longitudinal claims data for senior national health insurance beneficiaries. After 1:4 propensity score matching, 54,165 older patients (≥60 years) were included. Difference-in-difference (DID) of sedative burden and use of sedative agents pre- and post-dementia diagnosis were estimated, and compared to those of patients without dementia. The yearly average daily sedative load (adSL) for each individual was calculated after applying duration, dose, and sedative score of medications from the sedative load model. The medication use for each sedative category was calculated using the defined daily dose (DDD) per 1000 patient-days. Results The adSL in patients with dementia was consistently high before and after diagnosis and significantly increased after diagnosis, compared to those of patients without dementia (DID 0.123 unit/day, 95% confidence interval 0.117–0.129). DID of medication use was the highest for antidepressants (64.764 DDD/1000 patient-days) followed by Z-drugs and antipsychotics. Atypical antipsychotic and antidepressant usage steeply increased after dementia diagnosis. Conclusion Sedative burden in patients with dementia before and after dementia diagnosis was higher than that in patients without dementia, and was further increased after dementia diagnosis.
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Affiliation(s)
- Young-Mi Ah
- College of Pharmacy, Yeungnam University, Gyeongsangbuk-do, Republic of Korea
| | - Euna Han
- College of Pharmacy, Yonsei Institute for Pharmaceutical Research, Yonsei University, Incheon, Republic of Korea
| | - Kwanghee Jun
- College of Pharmacy and Research Institute of Pharmaceutical Sciences, Seoul National University, Seoul, Republic of Korea
| | - Yun Mi Yu
- College of Pharmacy, Yonsei Institute for Pharmaceutical Research, Yonsei University, Incheon, Republic of Korea
| | - Ju-Yeun Lee
- College of Pharmacy and Research Institute of Pharmaceutical Sciences, Seoul National University, Seoul, Republic of Korea
- * E-mail:
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O'Connell J, Henman MC, Burke É, Donegan C, McCallion P, McCarron M, O'Dwyer M. Association of Drug Burden Index with grip strength, timed up and go and Barthel index activities of daily living in older adults with intellectual disabilities: an observational cross-sectional study. BMC Geriatr 2019; 19:173. [PMID: 31234775 PMCID: PMC6591943 DOI: 10.1186/s12877-019-1190-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Accepted: 06/17/2019] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Drug Burden Index (DBI), a measure of exposure to medications with anticholinergic and sedative activity, has been associated with poorer physical function in older adults in the general population. While extensive study has been conducted on associations between DBI and physical function in older adults in the general population, little is known about associations in older adults with intellectual disabilities (ID). This is the first study which aims to examine the association between DBI score and its two sub-scores, anticholinergic and sedative burden, with two objective measures of physical performance, grip strength and timed up and go, and a measure of dependency, Barthel Index activities of daily living, in older adults with ID. METHODS Data from Wave 2 (2013/2014) of the Intellectual Disability Supplement to the Irish Longitudinal Study on Ageing (IDS-TILDA) was analysed. Analysis of Covariance (ANCOVA) was used to detect associations and produce adjusted means for the physical function and dependency measures with respect to categorical DBI scores and the anticholinergic and sedative sub-scores (DBA and DBS). RESULTS After adjusting for confounders (age, level of ID, history of falls, comorbidities and number of non-DBI medications, Down syndrome (grip strength only) and gender (timed up and go and Barthel Index)), neither grip strength nor timed up and go were significantly associated with DBI, DBA or DBS score > 0 (p > 0.05). Higher dependency in Barthel Index was associated with DBS exposure (p < 0.001). CONCLUSIONS DBI, DBA or DBS scores were not significantly associated with grip strength or timed up and go. This could be as a result of established limitations in physical function in this cohort, long-term exposure to these types of medications or lifelong sedentary lifestyles. Higher dependency in Barthel Index activities of daily living was associated with sedative drug burden, which is an area which can be examined further for review.
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Affiliation(s)
- Juliette O'Connell
- School of Pharmacy and Pharmaceutical Sciences and IDS-TILDA, School of Nursing and Midwifery, Trinity College, Dublin, Ireland.
| | - Martin C Henman
- School of Pharmacy and Pharmaceutical Sciences, Trinity College, Dublin, Ireland
| | - Éilish Burke
- IDS-TILDA, School of Nursing and Midwifery, Trinity College, Dublin, Ireland
| | - Clare Donegan
- School of Pharmacy and Pharmaceutical Sciences and IDS-TILDA, School of Nursing and Midwifery, Trinity College, Dublin, Ireland
| | | | - Mary McCarron
- Dean of Faculty of Health Sciences, Trinity College, Dublin, Ireland
| | - Máire O'Dwyer
- School of Pharmacy and Pharmaceutical Sciences, Trinity College, Dublin, Ireland
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Masnoon N, Shakib S, Kalisch-Ellett L, Caughey GE. Tools for Assessment of the Appropriateness of Prescribing and Association with Patient-Related Outcomes: A Systematic Review. Drugs Aging 2018; 35:43-60. [PMID: 29350335 DOI: 10.1007/s40266-018-0516-8] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
BACKGROUND There are tools and criteria in the literature aimed at distinguishing between appropriate and inappropriate medicines use. However, many have not been externally validated with regard to patient-related outcomes, potentially limiting their use in clinical practice. OBJECTIVES The aim of the study was to conduct a systematic review to summarise (1) available prescribing appropriateness assessment tools and criteria, and (2) their associations with patient-related outcomes (external validity). METHODS A systematic review was conducted using MEDLINE, EMBASE and Informit (Health Collection) databases to screen for articles in English that examined (1) tools to assess the appropriateness of prescribing and (2) associations of tools with patient-related outcomes, published between 2000 and 2016, without any limits placed on the study design, participant age or setting. RESULTS After screening 1710 articles, removing duplicates and shortlisting relevant articles, 42 prescribing assessment tools were identified. Out of the 42 tools, 78.6% (n = 33) provided guidance around stopping inappropriate medications, 28.6% (n = 12) around starting appropriate medications, 61.9% (n = 26) were explicit (criteria based) and 31.0% (n = 13) had been externally validated, with hospitalisation being the most commonly used patient-related outcome (n = 9, 21.4%). CONCLUSION The results of this systematic review highlight the need for evidence-based and externally validated tools, which combine the different aspects of medication management to optimise patient-related outcomes. PROSPERO registration number: CRD42017067233.
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Affiliation(s)
- Nashwa Masnoon
- Quality Use of Medicines and Pharmacy Research Centre, School of Pharmacy and Medical Sciences, University of South Australia, Frome Road, Adelaide, SA, Australia.
- Department of Pharmacy, Royal Adelaide Hospital, North Terrace, Adelaide, SA, Australia.
| | - Sepehr Shakib
- Department of Clinical Pharmacology, Royal Adelaide Hospital, North Terrace, Adelaide, SA, Australia
- Discipline of Pharmacology, School of Medicine, University of Adelaide, North Terrace, Adelaide, SA, Australia
| | - Lisa Kalisch-Ellett
- Quality Use of Medicines and Pharmacy Research Centre, School of Pharmacy and Medical Sciences, University of South Australia, Frome Road, Adelaide, SA, Australia
| | - Gillian E Caughey
- Quality Use of Medicines and Pharmacy Research Centre, School of Pharmacy and Medical Sciences, University of South Australia, Frome Road, Adelaide, SA, Australia
- Department of Clinical Pharmacology, Royal Adelaide Hospital, North Terrace, Adelaide, SA, Australia
- Discipline of Pharmacology, School of Medicine, University of Adelaide, North Terrace, Adelaide, SA, Australia
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O'Connell J, Burke É, Mulryan N, O'Dwyer C, Donegan C, McCallion P, McCarron M, Henman MC, O'Dwyer M. Drug burden index to define the burden of medicines in older adults with intellectual disabilities: An observational cross-sectional study. Br J Clin Pharmacol 2018; 84:553-567. [PMID: 29193284 DOI: 10.1111/bcp.13479] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Revised: 10/27/2017] [Accepted: 11/12/2017] [Indexed: 12/15/2022] Open
Abstract
AIMS The drug burden index (DBI) is a dose-related measure of anticholinergic and sedative drug exposure. This cross-sectional study described DBI in older adults with intellectual disabilities (ID) and the most frequently reported therapeutic classes contributing to DBI and examined associations between higher DBI scores and potential adverse effects as well as physical function. METHODS This study analysed data from Wave 2 (2013/2014) of the Intellectual Disability Supplement to the Irish Longitudinal Study on Ageing (IDS-TILDA), a representative study on the ageing of people with ID in Ireland. Self- and objectively-reported data were collected on medication use and physical health, including health conditions. The Barthel index was the physical function measure. RESULTS The study examined 677 individuals with ID, of whom 644 (95.1%) reported taking medication and 78.6% (n = 532) were exposed to medication with anticholinergic and/or sedative activity. 54.2% (n = 367) were exposed to high DBI score (≥1). Adjusted multivariate regression analysis revealed no significant association between DBI score and daytime dozing, constipation or falls. After adjusting for confounders (sex, age, level of ID, comorbidities, behaviours that challenge, history of falls), DBI was associated with significantly higher dependence in the Barthel index (P = 0.002). CONCLUSIONS This is the first time DBI has been described in older adults with ID. Scores were much higher than those observed in the general population and higher scores were associated with higher dependence in Barthel index activities of daily living.
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Affiliation(s)
- Juliette O'Connell
- School of Pharmacy and Pharmaceutical Sciences, Trinity College, Dublin, Ireland.,IDS-TILDA, School of Nursing and Midwifery, Trinity College, Dublin, Ireland
| | - Éilish Burke
- IDS-TILDA, School of Nursing and Midwifery, Trinity College, Dublin, Ireland
| | - Niamh Mulryan
- IDS-TILDA, School of Nursing and Midwifery, Trinity College, Dublin, Ireland
| | - Claire O'Dwyer
- IDS-TILDA, School of Nursing and Midwifery, Trinity College, Dublin, Ireland
| | - Clare Donegan
- School of Pharmacy and Pharmaceutical Sciences, Trinity College, Dublin, Ireland.,IDS-TILDA, School of Nursing and Midwifery, Trinity College, Dublin, Ireland
| | | | - Mary McCarron
- Dean of Health Sciences, Trinity College, Dublin, Ireland
| | - Martin C Henman
- School of Pharmacy and Pharmaceutical Sciences, Trinity College, Dublin, Ireland
| | - Máire O'Dwyer
- School of Pharmacy and Pharmaceutical Sciences, Trinity College, Dublin, Ireland
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Tiisanoja A, Syrjälä AM, Komulainen K, Hartikainen S, Taipale H, Knuuttila M, Ylöstalo P. The association of medications with sedative properties with oral health behaviour in community-dwelling older people. Int J Dent Hyg 2017; 16:e17-e22. [PMID: 28467020 DOI: 10.1111/idh.12285] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/05/2017] [Indexed: 11/28/2022]
Abstract
OBJECTIVES The objective of this study was to determine whether drugs with sedative properties are related to oral health behaviour-such as frequency of toothbrushing, using toothpaste and dental visits-and oral hygiene, measured by the number of teeth with dental plaque, among community-dwelling older people. METHODS The study population consisted of 159 community-dwelling, dentate, non-smoking, older people from the Oral Health GeMS study (Geriatric Multidisciplinary Strategy for the Good Care of Older People study). The data were collected by interviews and clinical examinations during 2004-2005. Sedative properties of drugs were assessed using the sedative load (SL) model. Logistic and Poisson regression models were used to estimate odds ratios/relative risks (OR/RR) and 95% confidence intervals (CI). RESULTS After adjusting for confounding factors, SL associated with infrequent toothbrushing (OR 1.72, CI: 0.61-4.89), toothpaste use less than twice a day (OR 3.34, CI: 1.39-8.12), non-regular dental visits (OR 2.28 CI: 0.91-5.30) and the number of teeth with dental plaque (RR 1.20 CI: 1.04-1.39) compared to participants without a SL. CONCLUSIONS The results of this study suggest that use of drugs with sedative properties indicates poor oral health behaviour among older people.
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Affiliation(s)
- A Tiisanoja
- Unit of Oral Health Sciences Research, University of Oulu, Oulu, Finland.,Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - A-M Syrjälä
- Unit of Oral Health Sciences Research, University of Oulu, Oulu, Finland.,Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland.,Dental Training Clinic, Social and Health services, Oulu, Finland
| | - K Komulainen
- Social and Health Centre of Kuopio, Kuopio, Finland.,Institute of Dentistry, University of Eastern Finland, Kuopio, Finland
| | - S Hartikainen
- Kuopio Research Center of Geriatric Care, University of Eastern Finland, Kuopio, Finland
| | - H Taipale
- Kuopio Research Center of Geriatric Care, University of Eastern Finland, Kuopio, Finland
| | - M Knuuttila
- Unit of Oral Health Sciences Research, University of Oulu, Oulu, Finland.,Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - P Ylöstalo
- Unit of Oral Health Sciences Research, University of Oulu, Oulu, Finland.,Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland.,Institute of Dentistry, University of Eastern Finland, Kuopio, Finland.,Department of Oral and Maxillofacial Diseases, Kuopio University Hospital, Kuopio, Finland
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Jamsen KM, Bell JS, Hilmer SN, Kirkpatrick CMJ, Ilomäki J, Le Couteur D, Blyth FM, Handelsman DJ, Waite L, Naganathan V, Cumming RG, Gnjidic D. Effects of Changes in Number of Medications and Drug Burden Index Exposure on Transitions Between Frailty States and Death: The Concord Health and Ageing in Men Project Cohort Study. J Am Geriatr Soc 2016; 64:89-95. [PMID: 26782856 DOI: 10.1111/jgs.13877] [Citation(s) in RCA: 85] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVES To investigate the effects of number of medications and Drug Burden Index (DBI) on transitions between frailty stages and death in community-dwelling older men. DESIGN Cohort study. SETTING Sydney, Australia. PARTICIPANTS Community-dwelling men aged 70 and older (N=1,705). MEASUREMENTS Self-reported questionnaires and clinic visits were conducted at baseline and 2 and 5 years. Frailty was assessed at all three waves according to the modified Fried frailty phenotype. The total number of regular prescription medications and DBI (a measure of exposure to sedative and anticholinergic medications) were calculated over the three waves. Data on mortality over 9 years were obtained. Multistate modeling was used to characterize the transitions across three frailty states (robust, prefrail, frail) and death. RESULTS Each additional medication was associated with a 22% greater risk of transitioning from the robust state to death (adjusted 95% confidence interval (CI)=1.06-1.41). Every unit increase in DBI was associated with a 73% greater risk of transitioning from the robust state to the prefrail state (adjusted 95% CI=1.30-2.31) and a 2.75 times greater risk of transitioning from the robust state to death (adjusted 95% CI=1.60-4.75). There was no evidence of an adjusted association between total number of medications or DBI and the other transitions. CONCLUSION Although the possibility of confounding by indication cannot be excluded, additional medications were associated with greater risk of mortality in robust community-dwelling older men. Greater DBI was also associated with greater risk of death and transitioning from the robust state to the prefrail state.
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Affiliation(s)
- Kris M Jamsen
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, Victoria, Australia.,Cognitive Decline Partnership Centre, Hornsby Ku-ring-gai Hospital, Hornsby, New South Wales, Australia
| | - J Simon Bell
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, Victoria, Australia.,Cognitive Decline Partnership Centre, Hornsby Ku-ring-gai Hospital, Hornsby, New South Wales, Australia.,Sansom Institute, School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, South Australia, Australia
| | - Sarah N Hilmer
- Cognitive Decline Partnership Centre, Hornsby Ku-ring-gai Hospital, Hornsby, New South Wales, Australia.,Kolling Institute of Medical Research, University of Sydney, Sydney, New South Wales, Australia
| | - Carl M J Kirkpatrick
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, Victoria, Australia
| | - Jenni Ilomäki
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, Victoria, Australia
| | - David Le Couteur
- Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia.,Centre for Education and Research on Ageing, Concord, New South Wales, Australia.,ANZAC Institute, Concord Hospital, Concord, New South Wales, Australia
| | - Fiona M Blyth
- Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia.,Centre for Education and Research on Ageing, Concord, New South Wales, Australia
| | - David J Handelsman
- Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia.,ANZAC Institute, Concord Hospital, Concord, New South Wales, Australia
| | - Louise Waite
- ANZAC Institute, Concord Hospital, Concord, New South Wales, Australia
| | - Vasi Naganathan
- Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia.,Centre for Education and Research on Ageing, Concord, New South Wales, Australia
| | - Robert G Cumming
- Centre for Education and Research on Ageing, Concord, New South Wales, Australia.,Sydney School of Public Health, University of Sydney, Sydney, New South Wales, Australia
| | - Danijela Gnjidic
- Centre for Education and Research on Ageing, Concord, New South Wales, Australia.,Faculty of Pharmacy, University of Sydney, Sydney, New South Wales, Australia
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11
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Peklar J, O'Halloran AM, Maidment ID, Henman MC, Kenny RA, Kos M. Sedative Load and Frailty Among Community-Dwelling Population Aged ≥65 Years. J Am Med Dir Assoc 2015; 16:282-9. [DOI: 10.1016/j.jamda.2014.10.010] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2014] [Revised: 10/08/2014] [Accepted: 10/13/2014] [Indexed: 01/22/2023]
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12
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Liang Y, Johnell K, Yan Z, Cai C, Jiang H, Welmer AK, Qiu C. Use of medications and functional dependence among Chinese older adults in a rural community: A population-based study. Geriatr Gerontol Int 2015; 15:1242-8. [PMID: 25598446 DOI: 10.1111/ggi.12433] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/30/2014] [Indexed: 12/23/2022]
Abstract
AIM To investigate the associations between medication use and functional dependence in Chinese older people living in a rural community. METHODS The cross-sectional study included 1538 participants (age ≥60 years, 59.1% women) in the Confucius Hometown Aging Project in Shandong, China. In June 2010 to July 2011, data on demographics, lifestyle factors, health history, basic activities of daily living (ADL), instrumental ADL, and use of medications were collected through interviews and clinical examinations. Functional status was categorized into no dependence, dependence only in instrumental ADL and dependence in basic ADL. Data were analyzed with multinomial logistic models controlling for potential confounders. RESULTS Dependence in instrumental or basic ADL was significantly associated with use of antihypertensives and hypolipidemic agents, and basic ADL dependence was also associated with use of sedatives or tranquilizers and cardiac glycosides. An increased number of concurrently used medications was significantly associated with an increased likelihood of dependence in basic ADL (P for trend = 0.016). Compared with non-users of any medication, individuals who concurrently used three or more classes of medications had a multi-adjusted odds ratio of 2.91 (95% confidence interval 1.02-8.28) for dependence in basic ADL. CONCLUSIONS Use of antihypertensives, hypolipidemic drugs, cardiac glycosides and sedatives or tranquilizers, especially use of multiple classes of medications, is correlated with functional dependence among older people in rural China. Geriatr Gerontol Int 2015; 15: 1242-1248.
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Affiliation(s)
- Yajun Liang
- School of Public Health, Jining Medical University, Jining, China.,Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet-Stockholm University
| | - Kristina Johnell
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet-Stockholm University
| | - Zhongrui Yan
- Department of Neurology, Jining no. 1 People's Hospital, Jining, China
| | - Chuanzhu Cai
- Xing Long Zhuang Coal Mine Hospital, Yankuang Group, Jining, China
| | - Hui Jiang
- Xing Long Zhuang Coal Mine Hospital, Yankuang Group, Jining, China
| | - Anna-Karin Welmer
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet-Stockholm University.,Karolinska University Hospital, Stockholm, Sweden
| | - Chengxuan Qiu
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet-Stockholm University
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13
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Gnjidic D, Hilmer SN, Hartikainen S, Tolppanen AM, Taipale H, Koponen M, Bell JS. Impact of high risk drug use on hospitalization and mortality in older people with and without Alzheimer's disease: a national population cohort study. PLoS One 2014; 9:e83224. [PMID: 24454696 PMCID: PMC3890276 DOI: 10.1371/journal.pone.0083224] [Citation(s) in RCA: 72] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2013] [Accepted: 11/11/2013] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Evidence is lacking about outcomes associated with the cumulative use of anticholinergic and sedative drugs in people with Alzheimer's disease (AD). This retrospective cohort study investigated the relationship between cumulative exposure to anticholinergic and sedative drugs and hospitalization and mortality in people with and without AD in Finland. METHODS Community-dwelling people aged 65 years and over, with AD on December 31(st) 2005 (n = 16,603) and individually matched (n = 16,603) comparison persons (age, sex, region of residence) were identified by the Social Insurance Institution of Finland. Drug utilization data were extracted from the Finnish National Prescription Register. Exposure to anticholinergic and sedative drugs was defined using the Drug Burden Index (DBI). Hospitalization and mortality data were extracted from national registers. Cox and zero-inflated negative binomial analyses were used to investigate the relationship between DBI and hospitalization and mortality over a one-year follow-up. RESULTS In total, 5.8% of people with AD and 3.7% without AD died during 2006. For every unit increase in DBI, the adjusted hazard ratio for mortality was 1.21 (95% confidence intervals [CI]: 1.09-1.33) among people with AD, and 1.37 (95%CI: 1.20-1.56) among people without AD. Overall, 44.3% of people with AD and 33.4% without AD were hospitalized. When using no DBI exposure as the reference group, the adjusted incidence rate ratio for length of hospital stay among high DBI group (≥1) in people with AD was 1.15 (95%CI: 1.05-1.26) and 1.63 (95%CI: 1.41-1.88) in people without AD. CONCLUSION There is a dose-response relationship between cumulative anticholinergic and sedative drug use and hospitalization and mortality in people with and without AD.
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Affiliation(s)
- Danijela Gnjidic
- Faculty of Pharmacy, University of Sydney, Sydney, New South Wales, Australia
- Departments of Clinical Pharmacology and Aged Care, and Kolling Institute of Medical Research, Royal North Shore Hospital, Sydney, New South Wales, Australia
- Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
- Centre for Education and Research on Ageing and Concord RG Hospital, Sydney, New South Wales, Australia
| | - Sarah N. Hilmer
- Departments of Clinical Pharmacology and Aged Care, and Kolling Institute of Medical Research, Royal North Shore Hospital, Sydney, New South Wales, Australia
- Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
| | - Sirpa Hartikainen
- Kuopio Research Centre of Geriatric Care, School of Pharmacy, University of Eastern Finland, Kuopio, Finland
| | | | - Heidi Taipale
- Kuopio Research Centre of Geriatric Care, School of Pharmacy, University of Eastern Finland, Kuopio, Finland
| | - Marjaana Koponen
- Kuopio Research Centre of Geriatric Care, School of Pharmacy, University of Eastern Finland, Kuopio, Finland
| | - J. Simon Bell
- Kuopio Research Centre of Geriatric Care, School of Pharmacy, University of Eastern Finland, Kuopio, Finland
- Sansom Institute, School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, South Australia, Australia
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, Victoria, Australia
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