Enhanced Free-Text Search for Aggregated Medication Error Report Analysis and Risk Detection

OBJECTIVES

Detecting medication errors (MEs) and learning from them are the key elements of medication safety management in health care. While the aggregation of the data and learning across the ME reports could help detect and manage organizational risks, the inconsistent and partly missing structural data complicate the analysis. The objective of this study was to examine whether an analysis of free-text data of aggregated ME reports could contribute to the detection of organizational risks.

METHODS

A retrospective, cross-sectional analysis of ME reports from a patient safety incident reporting system in a tertiary hospital 2017-2021. Clustering of characteristics and variables of ME reports with an enhanced free-text search of the 10 most frequent active substances (TOP10) related to ME reports using Microsoft Excel. Validity analysis of the four most frequent active substances of the search results (TOP4). Evaluation of the possible impact of the enhanced free-text search method on ME report analysis and risk detection.

RESULTS

The enhanced free-text search increased significantly the number of relevant ME reports of TOP10 active substances from 698 reports to 1578 reports. The validity of the enhanced free-text search results in TOP4 active substances was more than 74%. The enhanced free-text search revealed also new ME findings.

CONCLUSIONS

Enhanced free-text search can contribute to the aggregate analysis of clustered ME reports and to the improvement of ME risk detection. The enhanced free-text search method enables more comprehensive analysis of the free-text data with commonly available software and provides new insights into medication safety improvement.

Statin use and the risk of Parkinson's disease in persons with diabetes: A nested case-control study

AIMS

Persons with diabetes may have an elevated risk of Parkinson's disease (PD). Statin use could also modify the progression of PD. The aim was to study whether there is an association between statin exposure and risk of PD in persons with diabetes.

METHODS

A nationwide, nested case-control study restricted to people with diabetes was performed as part of nationwide register-based Finnish study on PD (FINPARK). Study included 2017 PD cases and their 7934 matched controls without PD. Persons with PD were diagnosed between 1999 and 2015, and statin use (1995-2015) was determined from Prescription Register. In the main analysis, exposure at least 3 years before outcome was considered. Cumulative exposure was categorized into tertiles, and associations were analysed with conditional logistic regression (adjusted with comorbidities and number of antidiabetic drugs).

RESULTS

Prevalence of statin use was similar in PD cases and controls, with 54.2% of cases and 54.4% controls exposed before the lag time (adjusted odds ratio [aOR] = 1.03; 95% confidence interval [CI]: 0.92-1.15). Those in the highest cumulative statin exposure tertile had higher risk of PD than statin nonusers (aOR = 1.22; 95% CI: 1.04-1.43), or those in the lowest cumulative statin exposure tertile (aOR = 1.29; 95% CI: 1.07-1.57).

CONCLUSION

Our nationwide study that controlled for diabetes duration and used 3-year lag between exposure and outcome to account for reverse causality does not provide support for the hypothesis that statin use decreases the risk of PD.

Use of oral health care services among older home care clients in the context of an intervention study

BACKGROUND

An increasing number of care-dependent older people living at home need external support to receive regular dental care.

OBJECTIVES

To investigate the use of oral health care services among old home care clients who participated in an intervention study focusing on oral self-care and nutrition.

MATERIALS AND METHODS

This study employed data from the multidisciplinary Nutrition, Oral Health and Medication (NutOrMed) intervention study with a population-based sample of 245 home care clients (74% female) aged 75 or more divided in intervention (n = 140) and two control groups (n = 105). The data were collected through interviews at baseline and 6-month follow-up.

RESULTS

At baseline, 43% of participants reported visits to oral health care within the previous year. At 6-month follow-up, this proportion was 51%. In the intervention group, the corresponding figures were 46% and 53%, and in the controls 39% and 48%. Adjusted regression analyses showed that this change was statistically significant (p = 0.008). In addition, higher education and toothache or other discomfort related to teeth or dentures at baseline were associated with increased use after the 6-month follow-up (OR = 1.1, 95% CI = 1.0-1.2; OR = 3.4, 95% CI = 1.5-7.9) but being edentulous indicated the opposite (OR = 0.2, 95% CI = 0.1-0.4). Belonging to the intervention group was not associated with increased use.

CONCLUSIONS

In older adults, any efforts to raise awareness of oral health are of great potential to increase use of services.

A Systematic Review and Meta-Analysis of the Efficacy and Safety of Rasagiline or Pramipexole in the Treatment of Early Parkinson's Disease

Background

Rasagiline or pramipexole monotherapy has been suggested for the management of early Parkinson's disease (PD). The aim of this research was to systematically review the clinical efficacy and safety of rasagiline or pramipexole in early PD (defined as disease duration ≤5 years and Hoehn and Yahr stage of ≤3).

Methods

Randomized controlled trials (RCTs) of rasagiline or pramipexole for early PD published up to September 2021 were retrieved. Outcomes of interest included changes in the Unified Parkinson's Disease Rating Scale (UPDRS) Parts II and III and the incidence of adverse events. Standardized mean difference (SMD), odds ratio (OR), and 95% confidence interval (CI) were calculated, and heterogeneity was measured with the I2 test.

Results

Nine rasagiline and eleven pramipexole RCTs were included. One post hoc analysis of one rasagiline study was included. Five studies for each drug were included in meta-analyses of the UPDRS scores. The rasagiline meta-analysis focused on patients receiving 1 mg/day. Rasagiline and pramipexole significantly improved UPDRS Part II and III scores when compared to placebo. Significant heterogeneity among the studies was present (I2 > 70%). Neither rasagiline nor pramipexole increased the relative risk for any adverse events, serious adverse events, or adverse events leading to withdrawal when compared with placebo.

Conclusion

Applying a Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) approach to summarize the evidence, we found moderate confidence in the body of evidence for the efficacy of rasagiline or pramipexole in early PD, suggesting further well-designed, multicenter comparative RCTs remain needed.

Prevalence of Cardiovascular Drugs and Oral Anticoagulant Use among Persons with and without Parkinson's Disease

INTRODUCTION

Cardio- and cerebrovascular diseases are common among persons with Parkinson's disease (PD), but it is unknown how the prevalence of cardiovascular drug and oral anticoagulant use changes in relation to PD diagnosis.

METHODS

We investigated the prevalence of cardiovascular drug and oral anticoagulant use among persons with and without PD among 17,541 persons who received incident PD diagnosis in 2001-2015 in Finland and their 116,829 matched comparison persons. Prevalence was calculated in 6-month time windows from 5 years before to 5 years after PD diagnosis (index date) and compared to a matched cohort without PD using generalized estimating equations.

RESULTS

Persons with PD had higher prevalence of any cardiovascular drugs (unadjusted OR = 1.15; 95% CI: 1.11-1.18) and oral anticoagulants (unadjusted OR = 1.16; 95% CI: 1.11-1.22) before index date than those without PD. After index date, persons with PD had lower prevalence of cardiovascular drugs (0.94; 95% CI: 0.91-0.96), and no difference was observed for oral anticoagulants. Prevalence of any cardiovascular drugs on the index date was 66 and 61% for persons with and without PD, respectively. β-blockers were the most common cardiovascular drugs in both cohorts. Warfarin was the most common oral anticoagulant, but the use of direct oral anticoagulants increased during the last years of follow-up.

CONCLUSION

Orthostatic hypotension and weight loss likely explain the decreased cardiovascular drug use after PD diagnosis. Results with oral anticoagulants may reflect clinical assessment of benefits being larger than risks, despite the risks associated with their use in persons with PD.

Hospitalization and the Risk of Initiation of Antipsychotics in Persons With Parkinson's Disease

OBJECTIVES

The use of antipsychotics in persons with Parkinson's disease (PD) is common, although their use may aggravate the symptoms of PD. Clozapine and quetiapine are the only antipsychotics recommended in PD treatment guidelines. Information on factors associated with initiation of antipsychotics is needed. We investigated whether recent hospitalization is associated with initiation of antipsychotics in persons with PD, and whether discharge diagnoses differ between those who had antipsychotics initiated and those who did not.

DESIGN

Nested case-control study in the nationwide register-based Finnish Study on Parkinson's disease (FINPARK).

SETTING AND PARTICIPANTS

The FINPARK study includes 22,189 persons who received an incident, clinically verified PD diagnosed during 1996-2015 and were community-dwelling at the time of diagnosis. The cases were 5088 persons who had antipsychotics initiated after PD diagnosis, identified with 1-year washout. The controls were 5088 age-, sex-, and time from PD diagnosis-matched persons who did not use antipsychotics on the matching date (antipsychotic purchase date). Recent hospitalization was defined as discharge in the 2-week period preceding the matching date.

METHODS

Associations were investigated with conditional logistic regression.

RESULTS

Quetiapine was the most commonly initiated antipsychotic (72.0% of cases), followed by risperidone (15.0%). Clozapine was initiated rarely (1.1%). Recent hospitalization associated strongly with antipsychotic initiation [61.2% of cases and 14.9% of controls, odds ratio (OR) 9.42, 95% CI 8.33-10.65], and longer hospitalizations were more common among cases. PD was the most common discharge diagnosis category (51.2% of hospitalized cases and 33.0% controls), followed by mental and behavioral disorders (9.3%) and dementia (9.0%) among cases. Antidementia and other psychotropic medication use were more common among cases.

CONCLUSIONS AND IMPLICATIONS

These results suggest that antipsychotics were initiated because of neuropsychiatric symptoms or aggravation of those symptoms. Antipsychotics should be prescribed after careful consideration to avoid adverse effects in persons with Parkinson's disease.

Therapeutic dilemma's: antipsychotics use for neuropsychiatric symptoms of dementia, delirium and insomnia and risk of falling in older adults, a clinical review

PURPOSE

Because of the common and increasing use of antipsychotics in older adults, we aim to summarize the current knowledge on the causes of antipsychotic-related risk of falls in older adults. We also aim to provide information on the use of antipsychotics in dementia, delirium and insomnia, their adverse effects and an overview of the pharmacokinetic and pharmacodynamic mechanisms associated with antipsychotic use and falls. Finally, we aim to provide information to clinicians for weighing the benefits and harms of (de)prescribing.

METHODS

A literature search was executed in CINAHL, PubMed and Scopus in March 2022 to identify studies focusing on fall-related adverse effects of the antipsychotic use in older adults. We focused on the antipsychotic use for neuropsychiatric symptoms of dementia, insomnia, and delirium.

RESULTS

Antipsychotics increase the risk of falls through anticholinergic, orthostatic and extrapyramidal effects, sedation, and adverse effects on cardio- and cerebrovascular system. Practical resources and algorithms are available that guide and assist clinicians in deprescribing antipsychotics without current indication.

CONCLUSIONS

Deprescribing of antipsychotics should be considered and encouraged in older people at risk of falling, especially when prescribed for neuropsychiatric symptoms of dementia, delirium or insomnia. If antipsychotics are still needed, we recommend that the benefits and harms of antipsychotic use should be reassessed within two to four weeks of prescription. If the use of antipsychotic causes more harm than benefit, the deprescribing process should be started.

β2-Adrenoceptor Agonists in Asthma or Chronic Obstructive Pulmonary Disease and Risk of Parkinson's Disease: Nested Case-Control Study

Introduction

Although β2-adrenoceptor (β2AR) agonists have been associated with a lower risk of Parkinson's disease (PD), the findings are inconclusive and may reflect confounding by indication. We studied the association between inhaled β2AR agonists and risk of PD in persons with asthma or chronic obstructive pulmonary disease (COPD).

Methods

The nested case-control study was conducted within a register-based Finnish Parkinson's disease study (FINPARK) and included 1406 clinically verified PD cases diagnosed during 1999-2015, who also had asthma/COPD >3 years before PD. PD cases were matched with up to seven controls by age, sex, duration of asthma/COPD, pulmonary diagnosis, and region (N = 8630). Cumulative and average annual exposure to short- and long-acting β2AR agonists before a 3-year lag period was assessed with quartiles of defined daily doses (DDDs). Adjusted odds ratios (aORs) were calculated with 95% confidence intervals (CIs) using conditional logistic regression.

Results

Cumulative exposure to either short- or long-acting β2AR agonists was not associated with a risk of PD. With average annual exposure, a decreased risk was observed only for the highest quartile of long-acting β2AR agonists (aOR 0.75; 95% CI 0.58-0.97). In the stratified analysis the lowest risk estimates were observed among those with both asthma and COPD diagnoses. The suggestion of an inverse association was seen for the highest quartile of long-acting β2AR agonists in asthma.

Discussion

Higher levels of exposure to β2AR agonists were not consistently associated with a reduced risk of PD. The inverse association in the highest category of average annual exposure to long-acting β2AR agonists may be explained by unmeasured confounding, such as disease severity or smoking.

Evaluation of Global trigger tool as a medication safety tool for adverse drug event detection-a cross-sectional study in a tertiary hospital

The objective of this study is to describe and analyze adverse drug events (ADE) identified using the Global trigger tool (GTT) in a Finnish tertiary hospital during a 5-year period and also to evaluate whether the medication module of the GTT is a useful tool for ADE detection and management or if modification of the medication module is needed. A cross-sectional study of retrospective record review in a 450-bed tertiary hospital in Finland. Ten randomly selected patients from electronic medical records were reviewed bimonthly from 2017 to 2021. The GTT team reviewed a total of 834 records with modified GTT method, which includes the evaluation of possible polypharmacy, National Early Warning Score (NEWS), highest nursing intensity raw score (NI), and pain triggers. The data set contained 366 records with triggers in medication module and 601 records with the polypharmacy trigger that were analyzed in this study. With the GTT, a total of 53 ADEs were detected in the 834 medical records, which corresponds to 13 ADEs/1000 patient-days and 6% of the patients. Altogether, 44% of the patients had at least one trigger found with the GTT medication module. As the number of medication module triggers increased per patient, it was more likely that the patient had also experienced an ADE. The number of triggers found with the GTT medication module in patients' records seems to correlate with the risk of ADEs. Modification of the GTT could provide even more reliable data for ADE prevention.

The Cumulative Use of Muscle Relaxants and the Risk of Alzheimer's Disease: A Nationwide Case-Control Study

BACKGROUND

Use of pharmacological treatments is one possible modifiable risk factor for cognitive disorders.

OBJECTIVE

To investigate if the use of muscle relaxants is associated with the risk of Alzheimer's disease (AD).

METHODS

The study was performed in a nested case-control design. Altogether 70,718 community-dwelling residents of Finland who received AD diagnosis in 2005-2011 were included as cases (the MEDALZ study). Each case was matched with four controls without AD by age, sex, and region of residence (N = 282,858). Data was extracted from Prescription register (1995-2012), Special Reimbursement register (1972-2012), and Hospital Discharge register (1972-2012). Drug use periods were modeled with PRE2DUP-method. Defined daily dose (DDD) was used to quantify the use. Analyses were conducted for any muscle relaxant use, and drug specific analyses were done for orphenadrine and tizanidine. A five-year lag window prior to the diagnosis was used, and results analyzed with conditional logistic regression.

RESULTS

The use of any muscle relaxant was associated with the risk of AD, aOR (95% CI) 1.04 (1.02-1.07). Stronger associations were observed with longer use (>366 days, aOR 1.12 (1.03-1.21)) than shorter use (1-365 days aOR, 1.04 (1.02-1.06)) compared to non-users. Dose-response was not observed. Tizanidine was not associated with AD, whereas cumulative exposure of orphenadrine (≥101 DDDs) was associated with the risk of AD, aOR 1.19 (1.07-1.32).

CONCLUSION

Muscle relaxant use was associated with the risk of AD and higher exposure to orphenadrine showed increased risk. Further studies on higher doses and longer durations of use are warranted.

Recent Hospitalization and Initiation of Antiepileptics Among Persons With Alzheimer's Disease

OBJECTIVES

Antiepileptic drugs (AEDs) are frequently prescribed for persons with Alzheimer's disease (AD), but little is known on factors associated with AED initiation in this population. We investigated whether recent hospitalization is associated with AED initiation in persons with AD.

DESIGN

Nested case-control study in the nationwide register-based Medication use and Alzheimer's disease (MEDALZ) cohort.

PARTICIPANTS AND SETTINGS

The MEDALZ cohort includes 70,718 persons diagnosed with AD during 2005-2011 in Finland. Altogether 6814 AED initiators and 6814 age-, sex-, and time since AD diagnosis-matched noninitiators were included in this study. Matching date was the date of AED initiation.

METHODS

AED purchases were identified from the Prescription Register and hospitalizations from the Care Register for Health Care. Recent hospitalization was defined as hospitalization ending within 2 weeks before the matching date. Association between recent hospitalization and AED initiation was assessed with conditional logistic regression.

RESULTS

The most frequently initiated AEDs were pregabalin (42.9%) and valproic acid (32.2%). A bigger proportion of AED initiators (36.9%) than noninitiators (5.3%) were recently hospitalized [odds ratio (OR) 10.5, 95% CI 9.22-11.9]. Dementia was the most frequent discharge diagnosis among AED initiators (29.1%) and noninitiators (27.9%). Among AED initiators, the next most frequent diagnosis was epilepsy (20.6%). Musculoskeletal diagnoses and use of analgesics including opioids was more common among gabapentinoid initiators compared with other AED initiators.

CONCLUSIONS AND IMPLICATIONS

Recent hospitalization was significantly related to AED initiation. Initiations of AED might have been related to common symptoms in persons with AD like neuropathic pain, epilepsy, and neuropsychiatric symptoms.

Recent hospitalization and risk of antidepressant initiation in people with Parkinson's disease

BACKGROUND

People with Parkinson's disease (PD) are more likely to be hospitalized and initiate antidepressant use compared to people without PD. It is not known if hospitalization increases the risk of antidepressant initiation. We studied whether a recent hospitalization associates with antidepressant initiation in people with PD.

METHODS

A nested case-control study within the nationwide register-based FINPARK cohort which includes community-dwelling Finnish residents diagnosed with PD between years 1996 and 2015 (N = 22,189) was conducted. Initiation of antidepressant use after PD diagnosis was identified from Prescription Register with 1-year washout period (cases). One matched non-initiator control for each case was identified (N = 5492 age, sex, and time since PD diagnosis-matched case-control pairs). Hospitalizations within the 14 day-period preceding the antidepressant initiation were identified from the Care Register for Health Care.

RESULTS

The mean age at antidepressant initiation was 73.5 years with median time since PD diagnosis 2.9 years. Selective serotonin reuptake inhibitors (48.1%) and mirtazapine (35.7%) were the most commonly initiated antidepressants. Recent hospitalization was more common among antidepressant initiators than non-initiators (48.3 and 14.3%, respectively) and was associated with antidepressant initiation also after adjusting for comorbidities and use of medications during the washout (adjusted OR, 95% CI 5.85, 5.20-6.59). The initiators also had longer hospitalizations than non-initiators. PD was the most common main discharge diagnosis among both initiators (54.6%) and non-initiators (28.8%). Discharge diagnoses of mental and behavioral disorders and dementia were more common among initiators.

CONCLUSIONS

Hospitalisation is an opportunity to identify and assess depressive symptoms, sleep disorders and pain, which may partially explain the association. Alternatively, the indication for antidepressant initiation may have led to hospitalisation, or hospitalisation to aggravation of, e.g., neuropsychiatric symptoms leading to antidepressant initiation.

Use of primary health care services among older patients with and without diabetes

Background

The aim of this study was to compare the utilization of primary healthcare services by older patients with and without type 2 diabetes.

Methods

Electronic patient records were used to identify persons over 65 years of age with a diagnosis of diabetes. Two age- and sex-adjusted controls without diabetes were extracted for each person with diagnosis of diabetes. A health questionnaire was sent by mail to 527 people with diabetes and 890 controls. Of the persons who answered the questionnaire, 518 persons were randomly selected to participate in a health examination. The study group in this analysis consisted of 187 persons with diabetes and 176 persons without diabetes who attended the health examination. The data on primary health care utilization were extracted from electronic patient records one year before and one after the health examination.

Results

Before the onset of the study, the patients with diabetes had more doctor’s appointments (p < 0.001), nurse’s appointments (< 0.001) and laboratory tests taken (p < 0.001) than those without diabetes After 1-year follow-up period the patients with diabetes had more doctor’s appointments (p = 0.002), nurse’s appointments (p = 0.006), laboratory tests taken (p = 0.006) and inpatient care at the community hospital (p = 0.004) than patients without a diagnosis of type 2 diabetes. The use of the community hospital increased significantly among patients with diabetes (ratio 2.50; 95% Cl 1.16–5.36) but not by patients without diabetes (ratio 0.91; 95% Cl 0.40.2.06). The number of nurse’s appointments increased for patients without diabetes (ratio 1.31; 95% Cl 1.07–1.60) but not for those with diabetes (ratio 1.04; 95% Cl 0.88–1.24).

Conclusions

Patients with diabetes visit more often physicians and nurses compared with those without diabetes. During a 1-year follow-up, the use of community hospital care increased significantly among patients with diabetes. In addition to focusing on prevention and care of diabetes, these results suggest the importance of diabetes in planning community-based health care services.

Use of α1-Adrenoceptor Antagonists Tamsulosin and Alfuzosin and The Risk of Alzheimer's Disease

Purpose

Tamsulosin has been associated with dementia, but the results have been inconsistent. Concerns have been raised about using exposure assessment time too close to the outcome. We investigated the association between use of α1‐adrenoceptor antagonists indicated for benign prostate hyperplasia and risk of Alzheimer's disease (AD) using different exposure windows.

Methods

The study (24 602 cases and 98 397 matched controls) included men from the Finnish nationwide nested case–control study on Medication and Alzheimer's disease (MEDALZ). Cases received clinically verified AD diagnosis during 2005–2011 and were community‐dwelling at the time of diagnosis. Use of tamsulosin and alfuzosin in 1995–2011 was identified from the Prescription Register and categorized based on whether it had occurred within 3 years before AD diagnosis (lag time) or before that. Dose–response analysis using defined daily doses of drug (DDDs) was conducted. Associations were investigated with conditional logistic regression, adjusted for confounders and mediators.

Results

The use of α1‐adrenoceptor antagonists before lag time associated with an increased risk of AD (OR 1.24 [1.20–1.27]). After adjustment for comorbidities and concomitant drug use throughout the assessment time (confounders) and healthcare contacts within the lag period (mediators), the association weakened (aOR 1.10 [1.06–1.14]). We found no evidence of dose–response‐relationship when comparing the users of higher than median DDDs to the users of lower than median DDDs.

Conclusion

Our findings, especially the lack of dose–response‐relationship and attenuation after mediator adjustment, do not provide strong support for the previous hypothesis on α1‐adrenoceptor antagonists as a risk factor for dementia.

Prevalence of oral anticoagulant use among people with and without Alzheimer’s disease

Background

Although cardio- and cerebrovascular diseases are common among people with Alzheimer’s disease (AD), it is unknown how the prevalence of oral anticoagulant (OAC) use changes in relation to AD diagnosis. We investigated the prevalence of OAC use in relation to AD diagnosis in comparison to a matched cohort without AD.

Methods

Register-based Medication use and Alzheimer’s disease (MEDALZ) cohort includes 70 718 Finnish people with AD diagnosed between 2005–2011. Point prevalence of OAC use (prescription register) was calculated every three months with three-month evaluation periods, from five years before to five years after clinically verified diagnosis and compared to matched cohort without AD. Longitudinal association between AD and OAC use was evaluated by generalized estimating equations (GEE).

Results

OAC use was more common among people with AD until AD diagnosis, (OR 1.17; 95% CI 1.13–1.22), and less common after AD diagnosis (OR 0.87; 95% CI 0.85–0.89), compared to people without AD. At the time of AD diagnosis, prevalence was 23% and 20% among people with and without AD, respectively. OAC use among people with AD began to decline gradually two years after AD diagnosis while continuous increase was observed in the comparison cohort. Warfarin was the most common OAC, and atrial fibrillation was the most common comorbidity in OAC users.

Conclusion

Decline in OAC use among people with AD after diagnosis may be attributed to high risk of falling and problems in monitoring. However, direct oral anticoagulants (DOACs) that are nowadays more commonly used require less monitoring and may also be safer for vulnerable people with AD.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12877-022-03144-x.

Eating problems among old home care clients

Aims

The purpose was to examine the prevalence and determinants of self‐reported eating problems in old home care clients, screened separately by a clinical nutritionist and a dental hygienist.

Methods and Results

The data came from the Nutrition, Oral Health and Medication (NutOrMed) study, the participants of which were ≥75‐year‐old home care clients living in Finland. The structured interviews were conducted at the participants' (n = 250) homes. Of the participants, 29% reported poor appetite, 20% had problems with chewing, and 14% had problems with swallowing when asked by a clinical nutritionist. Additionally, 18% reported oral health‐related eating problems when asked by a dental hygienist. Participants with continuous xerostomia (odds ratio [OR]: 3.0, 95% confidence interval [CI]: 1.0–9.0) or poor self‐reported oral health (OR: 4.3, 95% CI: 1.4–13.0) had a higher risk for problems with chewing when asked by a clinical nutritionist. Edentulous participants (OR: 3.5, 95% CI: 1.2–10.9) and participants with toothache or problems with dentures (OR: 10.3, 95% CI: 4.0–26.0) had a higher risk for oral health‐related eating problems when asked by a dental hygienist.

Conclusion

Eating problems are common in older adults, and interprofessional collaboration is required for their identification and alleviation.

Effect of individually tailored nutritional counselling on protein and energy intake among older people receiving home care at risk of or having malnutrition: a non-randomised intervention study

Background

With ageing, food intake may decrease and lead to an insufficient nutrient intake causing protein-energy malnutrition (PEM) which is associated with adverse health effects and increased mortality. The aim of this study was to investigate the effects of individually tailored dietary counseling focused on protein intake among home care clients with PEM or at risk of developing PEM. The secondary aim was to study the intake of energy and other nutrients.

Methods

This intervention study is part of the non-randomised population-based multidisciplinary Nutrition, Oral Health and Medication study (NutOrMed study). The intervention group comprised 112 and the control group 87 home care clients (≥75 years) with PEM or risk of PEM. PEM was defined by Mini Nutritional Assessment score < 24 and/or plasma albumin < 35 g/L. The nutrients intake was assessed from 24-hour dietary recall at the baseline and after the six-month intervention. The intervention consisted of an individually tailored dietary counseling; the persons were instructed to increase their food intake with protein and energy dense food items, the number of meals and consumption of protein-, energy- and nutrient-rich snacks for six months.

Results

After the six-month nutritional intervention, the mean change in protein intake increased 0.04 g/kgBW (95% CI 0.05 to 0.2), fibre 0.8 g (95% CI 0.2 to 4.3), vitamin D 8.5 μg (95% CI 0.7 to 4.4), E 0.6 mg (95% CI 0.4 to 2.2), B12 0.7 μg (95% CI 0.02 to 2.6), folate 8.7 μg (95% CI 1.5 to 46.5), iron 0.4 mg 95% CI 0.6 to 2.4), and zinc 0.5 mg (95% CI 0.6 to 2.2) in the intervention group compared with the control group. The proportion of those receiving less than 1.0 g/kg/BW protein decreased from 67 to 51% in the intervention group and from 84 to 76% in the control group. Among home care clients with a cognitive decline (MMSE< 18), protein intake increased in the intervention group by 0.2 g/kg/BW (p = 0.048) but there was no change in the control group.

Conclusion

An individual tailored nutritional intervention improves the intake of protein and other nutrients among vulnerable home care clients with PEM or its risk and in persons with cognitive decline.

Trial registration

ClinicalTrials.gov: NCT02214758. Date of trial registration: 12/08/2014.

Association between different diabetes medication classes and risk of Parkinson's disease in people with diabetes

PURPOSE

Diabetes has been associated with increased risk of Parkinson's disease (PD). Diabetes medications have been suggested as a possible explanation, but findings have been inconsistent. More information on the role of exposure in different time windows is needed because PD has long onset. We assessed the association between use of different diabetes medication categories and risk of PD in different exposure periods.

METHODS

A case-control study restricted to people with diabetes was performed as part of nationwide register-based Finnish study on PD (FINPARK). We included 2017 cases (diagnosed 1999-2015) with PD and 7934 controls without PD. Diabetes medication use was identified from Prescription Register (1995-2015) and categorised to insulins, biguanides, sulfonylureas, thiazolidinediones (TZDs), dipeptidyl peptidase 4 (DPP-4) inhibitors, glucagon-like peptide-1 (GLP-1) analogues and glinide. Exposure for each medication class was determined as none, at least three years before outcome and only within the three-year lag time before PD outcome.

RESULTS

The use of insulins, biguanides, sulfonylureas, DPP-4 inhibitors, GLP-1 analogues or glinides was not associated with PD. Use of TZDs before lag time compared to non-use of TZDs (adjusted odds ratio (OR) 0.78; 95% Confidence interval (CI) 0.64-0.95) was associated with decreased risk of PD.

CONCLUSIONS

Our nationwide case-control study of people with diabetes found no robust evidence on the association between specific diabetes medication classes and risk of PD. Consistent with earlier studies, TZD use was associated with slightly decreased risk of PD. The mechanism for this should be verified in further studies.

Opioids and Falls Risk in Older Adults: A Narrative Review

Pain treatment is important in older adults but may result in adverse events such as falls. Opioids are effective for nociceptive pain but the evidence for neuropathic pain is weak. Nevertheless, both pain and opioids may increase the risk of falls. This narrative literature review aims to summarize the existing knowledge on the opioid-related fall risk in older adults, including the pharmacokinetics and pharmacodynamics, and assist clinicians in prescribing and deprescribing opioids in older persons. We systematically searched relevant literature on opioid-related fall risk in older adults in PubMed and Scopus in December 2020. We reviewed the literature and evaluated fall-related adverse effects of opioids, explaining how to optimally approach deprescribing of opioids in older adults. Opioid use increases fall risk through drowsiness, (orthostatic) hypotension and also through hyponatremia caused by weak opioids. When prescribing, opioids should be started with low dosages if possible, keeping in mind their metabolic genetic variation. Falls are clinically significant adverse effects of all opioids, and the risk may be dose dependent and highest with strong opioids. The risk is most prominent in older adults prone to falls. To reduce the risk of falls, both pain and the need for opioids should be assessed on a regular basis, and deprescribing or changing to a lower dosage or safer alternative should be considered if the clinical condition allows. Deprescribing should be done by reducing the dosage gradually and by assessing and monitoring the pain and withdrawal symptoms at the same time. Weighing the risks and benefits is necessary before prescribing opioids, especially to older persons at high risk of falls. Clinical decision tools assist prescribers in clinical decisions regarding (de-) prescribing.

Disease-Modifying Antirheumatic Drugs and Risk of Parkinson Disease: Nested Case-Control Study of People With Rheumatoid Arthritis

BACKGROUND

Epidemiological studies have suggested a link between rheumatoid arthritis and Parkinson's disease (PD). Disease-modifying anti-rheumatic drugs (DMARDs) might explain this association.

OBJECTIVE

To evaluate the association between DMARDs and risk of PD in persons with rheumatoid arthritis.

METHODS

Nested nationwide case-control study was conducted within the Finnish Parkinson's disease (FINPARK) cohort that includes 22,189 Finnish persons with clinically verified PD diagnosed in 1996-2015. The cases had recorded diagnosis of PD in the Special Reimbursement Register and had no exclusion diagnoses whose symptoms may be confused with PD within two years of PD diagnosis. This study included cases with PD diagnosed during 1999-2015 and rheumatoid arthritis diagnosed >3 years before PD. Rheumatoid arthritis was identified using Finnish Care Register for Health Care and Special Reimbursement Register. Cases were matched with up to seven control persons by age, sex, duration of rheumatoid arthritis and region. DMARDs were categorised into five classes and data on purchased prescriptions was identified from the Prescription Register since 1995. Associations were studied with conditional logistic regression adjusted for confounders.

RESULTS

Altogether 315 cases with PD and 1,571 matched controls were included. Majority (> 60%) were women and median duration of rheumatoid arthritis on matching date was 11.6 years for controls and 12.6 years for cases. Use of DMARDs was not associated with risk of PD with three-year lag period applied between exposure and outcome, except chloroquine/hydroxychloroquine which associated with decreased risk (adjusted odds ratio 0.74; 95% confidence interval 0.56-0.97). Other DMARDs, including sulfasalazine, methotrexate, gold preparations and immunosuppressants, were not associated with PD.

DISCUSSION

Our results suggest that the lower risk of PD in people with rheumatoid arthritis is not explained by DMARD use as these drugs in general did not modify the risk of PD among persons with rheumatoid arthritis. Association between chloroquine/hydroxychloroquine and lower risk of PD as well as the possible underlying mechanisms should be further investigated.

CLASSIFICATION OF EVIDENCE

This study provides Class II evidence that in individuals with rheumatoid arthritis using DMARDs, only chloroquine/hydroxychloroquine was associated with a potentially decreased risk of developing PD (adjusted OR 0.74, 95% CI 0.56-0.97).

Incidence of antidepressant use among community dwellers with and without Parkinson's disease - a nationwide cohort study

Background

Antidepressant use is more common in people with Parkinson’s disease (PD), but it is unknown when this difference emerges.

Methods

We studied the incidence of antidepressant use in six-month periods from 10 years before to 15 years after PD diagnosis in the nationwide register-based Finnish Study on Parkinson’s disease (FINPARK). This study included 20,456 community dwellers with clinically verified PD diagnosed during 1996–2015 and 140,291 matched comparison persons.

Results

Altogether 44.3% of people with PD initiated antidepressants, compared to 25.0% of people without PD. The difference was largest 6 months before PD diagnosis (incidence rate ratio 5.28, 95% CI 4.80–5.80; 9.02 and 1.68 initiations/100 person-years in people with and without PD, respectively). The difference emerged already 7 years before the diagnosis and remained above the comparison group for most of the study period.

Conclusions

Persons with PD may have symptoms that require antidepressant treatment years before and after diagnosis. The symptoms needing antidepressant treatment may be clinical signs of possible PD and they should be considered as a need to assess clinical status in person diagnosed with PD.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12877-021-02145-6.

Use of pain relieving drugs in community-dwelling older people with and without type 2 diabetes

AIMS

To analyze the use of pain medication among community-dwelling people aged 65 years or older with and without type 2 diabetes in primary care.

METHODS

A total of 187 patients with and 176 patients without diabetes were randomly selected from a primary care sample of 389 patients with diabetes and 604 age- and gender-matched controls. Pain status was defined as no pain, nociceptive pain or neuropathic pain. Pain medication (paracetamol, NSAID, opioids, neuropathic pain medication) use was based on electronic patient records and checked by a physician during a health examination.

RESULTS

Some pain was present in 90 (51%) patients without and in 106 (57%) patients with diabetes (p = 0.55). Of the patients without diabetes, 109 (62%) and with diabetes 123 (66%) used some pain medication (p = 0.45). The respective proportions for the regular use were 13% and 11% and for the as needed use 56% and 61%. Diabetes was not associated with any of the pain medications used. The use of pain-relieving drugs was most common for neuropathic pain.

CONCLUSIONS

The present study indicated that community-dwelling people with and without diabetes used pain medication similarly. Pain medication was used mostly as needed instead of being regular.

Interprofessional learning in social and health care-Learning experiences from large-group simulation in Finland

Aim

This study aimed to describe the learning experiences of social and healthcare students and professionals of an interprofessional large‐group simulation. A simulation on sudden infant death syndrome (SIDS) was organized in collaboration between a Finnish university, university hospital and university of applied sciences.

Design

A case study.

Methods

The research data were collected at the large‐group simulation with a questionnaire containing variables on a five‐point Likert scale and open questions. The questionnaire was filled out by 350 students and professionals participating in the simulation. The quantitative data were analysed using descriptive statistical methods and the open‐ended questions by inductive content analysis.

Results

The large‐group simulation proved to be a valid teaching and learning method for collaborating with other professionals and interacting with clients and the method can be considered as cost‐effective compared with small‐group simulations. The produced knowledge can be used in planning simulations in basic and in‐service training.

Oral Health and Hygiene and Association of Functional Ability: A Cross-Sectional Study Among Old Home Care Clients

PURPOSE

To describe oral health and hygiene in old home care clients and investigate how functional ability was associated with them.

MATERIALS AND METHODS

This study employed part of the baseline data of a multidisciplinary intervention study of 269 home care clients aged ≥75 years, living in Eastern and Central Finland. Structured interviews were used to measure ability to function in activities of daily living (ADL), instrumental activities of daily living (IADL), comorbidity (functional comorbidity index, FCI), depression (geriatric depression scale, GDS-15), cognitive function (mini-mental state examination, MMSE), nutritional status (mini nutritional assessment, MNA) and numbers of prescription drugs used. Clinical oral examination was included.

RESULTS

The majority of participants were at least moderately dependent on support for ADL. Of the examined, 46% were edentulous and average number of teeth was 8.4. Dental plaque in ≥ 20% of teeth present was detected in 74%, bleeding on probing in ≥ 25% of teeth examined in 75%, and caries in 30% of the dentate participants. In multivariate analyses, better functional ability (ADL) was statistically significantly associated with lower occurrence of dental plaque in ≥ 20% of teeth present. Better functional ability (ADL) and higher number of teeth were associated with lower occurrence of bleeding on probing in ≥ 25% of teeth examined and higher number of teeth with plaque with higher occurrence of bleeding on probing.

CONCLUSION

Impaired functional ability is an important determinant of poor oral health and hygiene among old home care clients.

Opioid Use After Hospital Care due to Hip Fracture Among Community-Dwelling Persons With and Without Alzheimer's Disease

BACKGROUND

Hip fractures are common among persons with Alzheimer's disease (AD), but problems in pain assessment may lead to insufficient analgesia after hospitalization.

OBJECTIVE

We investigated the prevalence of opioid use in the 6 months after discharge from hospital care due to hip fracture among community-dwellers with and without AD.

SETTING AND METHOD

The Medication use and Alzheimer's disease (MEDALZ) cohort was used for this study, consisting of all community-dwelling persons newly diagnosed with AD during 2005-2011 in Finland and their comparison persons without AD matched on age, sex, and region of residence at the time of AD diagnosis. Data were collected from nationwide healthcare registers.

MAIN OUTCOME MEASURES

We investigated opioid use versus non-use in persons with and without AD in the 6 months after discharge from hospital care due to hip fracture.

RESULTS

Altogether 2342 persons with AD and 1615 persons without AD, discharged to community settings within ≤ 120 days after a hip fracture, were included. A higher percentage of persons with AD used opioids compared to those without AD, 39.5% [95% confidence interval (CI) 37.5-41.5] versus 31.2% (95% CI 28.9-33.5). Persons with AD used more frequently strong opioids during the first 3 months and buprenorphine during the 6-month period, and used weak opioids less frequently after the first month after discharge compared to those without AD.

CONCLUSIONS

Frequent opioid use after hospital care due to hip fracture may indicate increased attention to pain among persons with AD. Nevertheless, the benefits and harms of opioid use should be evaluated regularly in community-dwelling older persons.

Kidney function and nephrotoxic drug use among older home-dwelling persons with or without diabetes in Finland

Background

Due to these changes in kidney function, aging kidneys are more prone to drug-induced impairments in renal properties. Diabetes has been associated with the declined kidney function and an elevated risk of renal failure. The aim of this study is to compare kidney function and potentially nephrotoxic drug use among home-dwelling older persons with or without diabetes.

Methods

A total of 259 persons with and 259 persons without diabetes and aged ≥65 years were randomly selected to participate in a health examination with complete data gathered from 363 individuals (187 with diabetes and 176 without diabetes). The estimated glomerular filtration rate (eGFR) was calculated using CKD-EPI equation. Each participant was categorized based on the nephrotoxic profile of their medications.

Results

There were no differences in mean eGFR values (77.5 ± 18.8 vs. 80.5 ± 14.8 ml/min/1.73m², p = 0.089) or in the proportion of participants with eGFR < 60 ml/min/1.73m² among persons with diabetes (16% vs. 10%, p = 0.070), compared to persons without diabetes. Potentially nephrotoxic drug use was similar between the groups. The mean number of potentially nephrotoxic drugs was 1.06 ± 0.88 in those with and 0.97 ± 1.05 in those without diabetes (p = 0.39).

Conclusions

The kidney function of older persons with diabetes does not differ from that of older persons without diabetes and furthermore potentially nephrotoxic drug use seem to play only a minor role in the decline in kidney function among home-dwelling persons in the Inner-Savo district.

The combined effect of individually tailored xerostomia and nutritional interventions on dry mouth among nutritionally compromised old home care clients

OBJECTIVE

To examine the effectiveness of tailored xerostomia and nutritional 6-month interventions on xerostomia among home care clients aged 75 years or over who were malnourished or at risk of malnutrition.

BACKGROUND

A subjective feeling of dry mouth (xerostomia) is common among older adults and affects their quality of life, nutrition and oral health. Medical conditions, polypharmacy, dehydration and malnutrition are often underlying causes of xerostomia.

MATERIALS AND METHODS

The data are based on the NutOrMed study with a dietary intervention group of 119 patients and control group of 97 patients. In-home interviews were carried out by home care nurses, nutritionists, dental hygienists and pharmacists and tailored interventions by nutritionist and dental hygienists. Xerostomia intervention included individual counselling on dry mouth care and was applied to all those suffering occasionally or continuously from xerostomia (57%, n = 66) in the intervention group. Nutritional intervention was applied to all participants in the intervention group, and it included instructions on increasing the number of meals, energy, protein intake and liquid intake.

RESULTS

Among participants who received both interventions, xerostomia decreased by 30% and malnutrition or risk of malnutrition decreased by 61%. The interventions were highly significant (OR 0.1, 95% CI: 0.06; 0.2) in reducing xerostomia.

CONCLUSIONS

Home care clients suffering from xerostomia profited significantly from tailored xerostomia and dietary interventions. Evaluation and treatment of xerostomia are important among older persons who are malnourished or at risk of malnutrition as a part of a comprehensive health intervention to improve their nutrition and oral health.

Systemic Estrogen Use and Discontinuation After Alzheimer's Disease Diagnosis in Finland 2005-2012: A Nationwide Exposure-Matched Cohort Study

BACKGROUND

It is unknown whether cognitive status or diagnosed cognitive decline affects estrogen use.

OBJECTIVES

We assessed how common systemic estrogen use was among community-dwellers with Alzheimer's disease (AD) and a matched comparison cohort without AD.

METHODS

This study included an exposure-matched cohort of all Finnish community-dwelling women who received a clinically verified diagnosis of AD in 2005-2011 (N = 46,116; index cases) and an equally sized matched comparison cohort without AD. Follow-up began on the matching date (date of the AD diagnosis of the index case). Data on systemic estrogen use were obtained from the prescription register. Use initiation and discontinuation were assessed.

RESULTS

Altogether 3.1% of women with AD and 4.3% of women without AD used estrogen during the follow-up period. Only < 0.5% initiated use during the follow-up period, but 3.7% continued use until death. The prevalence of estrogen use 1 year after the AD diagnosis declined in 2005-2011.

CONCLUSIONS

There were no major differences in systemic estrogen use among Finnish women with AD when compared to those without AD. Although some persons initiated estrogen use after AD diagnosis and/or at an advanced age, the observed use patterns were mainly consistent with the current recommendations.

Frequent pain in older people with and without diabetes - Finnish community based study

Background

The association between pain and diabetes in older people has been largely unexplored. The aim of this survey was to analyze the prevalence and characteristics of pain among Finnish men and women 65 or older with and without diabetes in primary care.

Methods

All home-dwelling persons 65 years or older with diabetes (N = 527) and age and gender matched controls (N = 890) were identified from electronic patient records. Frequent pain was regarded as any pain experienced more often than once a week, and it was divided into pain experienced several times a week but not daily and pain experienced daily or continuously. The Numeric Rating Scale (0–10) (NRS) was used to assess the intensity and interference of the pain.

Results

The number of subjects who returned the questionnaire was 1084 (76.5%). The prevalence of frequent pain in the preceding week was 50% among women without diabetes and 63% among women with diabetes (adjusted, p = 0.22). In men, the corresponding proportions were 42% without diabetes and 47% with diabetes (adjusted, p = 0.58). In both genders, depressive symptoms and the number of comorbidities were associated with pain experienced more often than once a week and with daily pain. Diabetes was not associated with pain intensity or pain interference in either women or men.

Conclusions

Pain in older adults is associated with depressive symptoms and the number of comorbidities more than with diabetes itself.

Orthostatic Hypotension and Associated Factors among Home Care Clients Aged 75 Years or Older - A Population-Based Study

OBJECTIVES

The aim of this study was to examine orthostatic hypotension (OH) and associated factors among home care clients aged 75 years or older.

DESIGN

Non-randomised controlled study.

SETTING AND PARTICIPANTS

The study sample included 244 home care clients aged 75 years or older living in Eastern and Central Finland.

MEASUREMENTS

Nurses, nutritionists and pharmacists collected clinical data including orthostatic blood pressure, depressive symptoms (15-item Geriatric Depression Scale GDS-15), nutritional status (Mini Nutritional Assessment MNA), drug use, self-rated health, daily activities (Barthel ADL Index and Lawton and Brody IADL scale) and self-rated ability to walk 400 metres. Comorbidities were based on medical records.

RESULTS

The prevalence of OH was 35.7% (n = 87). No association between OH and the number of drugs used or causative drug use and OH was found. In univariate analysis, coronary heart disease, systolic and diastolic blood pressure in a sitting position and lower mean MNA scores were associated with a risk of OH. Multivariate analysis showed that lower mean MNA scores (OR 1.140, 95% CI: 1.014-1.283) appeared to be independently connected to a risk of OH.

CONCLUSION

One-third of the home clients had OH and it was associated with lower MNA scores.

Glycemic control and health-related quality of life among older home-dwelling primary care patients with diabetes

AIMS

To evaluate the health-related quality of life (HRQoL) and functional capacity in relation to glycemic control among older home-dwelling primary care patients.

METHODS

Electronic patient records were used to identify 527 people over 65 years with diabetes. Of these, 259 randomly selected subjects were invited to a health examination and 172 of them attended and provided complete data. The participants were divided into three groups based on the HbA1c: good (HbA1c<48mmol/mol (N=95)), intermediate (HbA1c 48-57mmol/mol (N=48)) and poor (HbA1c>57mmol/mol (N=29)) glycemic control. HRQoL was measured with the EuroQol EQ-5D questionnaire. Functional and cognitive capacity and mental well-being were assessed with the Lawton Instrumental Activities of Daily Living (IADL) scale, Mini-Mental State Examination (MMSE) and Geriatric Depression Scale (GDS-15).

RESULTS

EQ-5D scores for good, intermediate and poor glycemic control were 0.78; 0.74 and 0.70, p=0.037. Sub-items of mobility (p=0.002) and self-care were the most affected (p=0.031). Corresponding trend was found for IADL, p=0.008. A significant correlation was found between MMSE scores and HbA1c.

CONCLUSION

Older primary care home-dwelling patients with diabetes and poorer glycemic control have lower functional capacity and HRQoL, especially in regard to mobility and self-care.

Prevalence and risk factors of frailty among home care clients

BACKGROUND

Frailty is a common problem among older people and it is associated with an increased risk of death and long-term institutional care. Early identification of frailty is necessary to prevent a further decline in the health status of home care clients. The aims of the present study were to determine the prevalence of frailty and associated factors among 75-year-old or older home care clients.

METHODS

The study participants were 75-year-old or older home care clients living in three cities in Eastern and Central Finland. Home care clients who had completed the abbreviated Comprehensive Geriatric Assessment (aCGA) for frailty (n = 257) were included in the present study. Baseline data were obtained on functional status, cognitive status, depressive symptoms, self-rated health, ability to walk 400 m, nutritional status, drug use and comorbidities.

RESULTS

Most of the home care clients (90%) were screened for frailty using the aCGA. Multivariate analysis showed that the risk of malnutrition or malnutrition (OR = 4.27, 95% CI = 1.56, 11.68) and a low level of education (OR = 1.14, 95% CI = 1.07, 1.23) were associated with frailty.

CONCLUSION

Frailty is a prevalent problem among home care clients. The risk of malnutrition or malnourishment and a lower level of education increase the risk of frailty. Screening for frailty should be done to detect the most vulnerable older people for further intervention to prevent adverse health problems.

TRIAL REGISTRATION

ClinicalTrials.gov: NCT02214758 .

Preventive oral health intervention among old home care clients

Background

poor oral health is common among older people dependent on supportive care and it affects their quality of life. Cognitive impairment and functional dependency may increase the risk of compromised daily oral hygiene.

Aim

to investigate the effectiveness of a tailored preventive oral health intervention among home care clients aged 75 years or over.

Patients and methods

the intervention group comprised 151 patients (84.4 ± 5.6 years) and the control group 118 patients (84.7 ± 5.2 years). An interview and a clinical examination were carried out before a tailored intervention of oral and denture hygiene. The participants in both groups were re-interviewed and re-examined after 6 months.

Results

the intervention significantly reduced the number of plaque covered teeth and improved denture hygiene. In addition, functional ability and cognitive function were significantly associated with better oral hygiene.

Conclusions

the intervention had a positive effect on oral hygiene, however the number of teeth with plaque remained high, even after the intervention. Multiple approaches based on individual needs are required to improve the oral health of vulnerable older adults, including integrating dental preventive care into daily care plan carried out by home care nurses.

Chair rise capacity and associated factors in older home-care clients

AIMS

The aim of this study was to investigate the ability of older home-care clients to perform the five times chair rise test and associated personal characteristics, nutritional status and functioning.

METHODS

The study sample included 267 home-care clients aged ≥75 years living in Eastern and Central Finland. The home-care clients were interviewed at home by home-care nurses, nutritionists and pharmacists. The collected data contained sociodemographic factors, functional ability (Barthel Index, IADL), cognitive functioning (MMSE), nutritional status (MNA), depressive symptoms (GDS-15), medical diagnoses and drug use. The primary outcome was the ability to perform the five times chair rise test.

RESULTS

Fifty-one per cent ( n=135) of the home-care clients were unable to complete the five times chair rise test. Twenty-three per cent ( n=64) of the home-care clients had good chair rise capacity (≤17 seconds). In a multivariate logistic regression analysis, fewer years of education (odds ratio [OR] = 1.11, 95% confidence interval [CI] 1.04-1.18), lower ADL (OR = 1.54, 95% CI 1.34-1.78) and low MNA scores (OR = 1.12, 95% CI 1.04-1.20) and a higher number of co-morbidities (OR = 1.21, 95% CI 1.02-1.43) were associated with inability to complete the five times chair rise test.

CONCLUSIONS

Poor functional mobility, which was associated with less education, a high number of co-morbidities and poor nutritional status, was common among older home-care clients. To maintain and to prevent further decline in functional mobility, physical training and nutritional services are needed. (NutOrMed, ClinicalTrials.gov Identifier: NCT02214758).

Incidence and Duration of Cumulative Bisphosphonate Use among Community-Dwelling Persons with or without Alzheimer's Disease

We studied the incidence and duration of cumulative bisphosphonate use among older Finnish women and men with or without Alzheimer's disease (AD). The MEDALZ-2005 cohort is a nationwide sample of all persons with clinically diagnosed AD on 31 December 2005 and their age-, gender-, and region of residence-matched control persons without AD. Information on bisphosphonate use by persons with an AD diagnosis and their controls without AD during 2002-2009 was obtained from the prescription register database containing reimbursed medications. A total of 6,041 (11.8%) persons used bisphosphonates during the 8-year follow-up. Bisphosphonates were more commonly used among persons without AD (n = 3121, 12.3%) than among persons with AD (n = 2,920, 11.2%) (p = 0.001). The median duration of bisphosphonate use was 743 days (IQR). Among persons with AD, the median duration of use was 777 days (IQR) and among persons without AD, 701 days (IQR) (p = 0.011). People without AD more often used bisphosphonate combination preparations including vitamin D than did people with AD (p <  0.0001). Bisphosphonate use was more common among people without AD who had comorbidities, asthma/COPD, or rheumatoid arthritis compared with users with AD. Short-term users were more likely to be male, at least 80 years old, and not having AD. Although the incidence of bisphosphonate use was slightly higher among persons without AD, the cumulative duration of bisphosphonate use was longer in persons with AD. Short-term use was associated with male gender, older age, and not having AD.

Risk of Alzheimer's disease among users of postmenopausal hormone therapy: A nationwide case-control study

OBJECTIVE

To examine the association between postmenopausal hormone therapy (HT) and Alzheimer's disease (AD).

METHODS

Medicine and Alzheimer's disease (MEDALZ) is a nested case-control study of the entire Finnish population with clinically verified AD from 2005 to 2011 and up to 4 matched controls per case. This study comprises 230,580 women (46,117 cases and 184,463 controls). Data on HT use from 1995 to 2011 was extracted from the national prescription register using following ATC codes: G03C (estrogen), G03D (progestogen) and G03F (estrogen and progestogen in combination). Only systemic HT (oral or transdermal) was considered.

RESULTS

Use of systemic estrogen and progestogen was associated with an increased risk of AD, with ORs (95% CI) of 1.10 (1.06-1.12) and 1.13 (1.10-1.17) respectively, but use of systemic estrogen HT for >10years (OR, 95% CI: 0.91, 0.84-0.99) was protective against AD. Long-term (>10years) use of progestogen and combination HT was not related to AD risk (OR, 95% CI: 1.0, 0.90-1.2).

CONCLUSION

Our findings do not suggest HT is an important determinant of AD risk.

Individually Tailored Dietary Counseling among Old Home Care Clients - Effects on Nutritional Status

OBJECTIVE

To evaluate the effect of individually tailored dietary counseling on nutritional status among home care clients aged 75 years or older.

DESIGN

Non-randomised controlled study.

SETTING AND PARTICIPANTS

The study sample consisted of 224 home care clients (≥ 75 years) (intervention group, n = 127; control group, n = 100) who were at protein-energy malnutrition (PEM) or risk of PEM (MNA score <24 and plasma albumin <35 g/L).

INTERVENTION

Individually tailored dietary counseling; the persons were instructed to increase their food intake with energy-dense food items, the number of meals they ate and their consumption of energy-, protein- and nutrient-rich snacks for six months.

MEASUREMENTS

The Mini Nutritional Assessment (MNA), Body Mass Index (BMI) and plasma albumin were used to determine nutritional status at the baseline and after the six-month intervention.

RESULTS

The mean age of the home care clients was 84.3 (SD 5.5) in the intervention group and 84.4 (SD 5.3) in the control group, and 70 percent were women in both groups. After the six-month nutritional intervention, the MNA score increased 2.3 points and plasma albumin 1.6 g/L in the intervention group, against MNA score decreased -0.2 points and plasma albumin -0.1 g/L in the control group.

CONCLUSIONS

Individually tailored dietary counseling may improve nutritional status among older home care clients.

Month and Season of Birth as a Risk Factor for Alzheimer's Disease: A Nationwide Nested Case-control Study

Objectives:

Season of birth, an exogenous indicator of early life environment, has been related to higher risk of adverse psychiatric outcomes but the findings for Alzheimer’s disease (AD) have been inconsistent. We investigated whether the month or season of birth are associated with AD.

Methods:

A nationwide nested case-control study including all community-dwellers with clinically verified AD diagnosed in 2005 to 2012 (n=70 719) and up to four age- sex- and region of residence-matched controls (n=282 862) residing in Finland. Associations between month and season of birth and AD were studied with conditional logistic regression.

Results:

Month of birth was not associated with AD (p=0.09). No strong associations were observed with season (p=0.13), although in comparison to winter births (December-February) summer births (June-August) were associated with higher odds of AD (odds ratio, 1.03; 95% confidence interval, 1.00 to 1.05). However, the absolute difference in prevalence in winter births was only 0.5% (prevalence of those born in winter were 31.7% and 32.2% for cases and controls, respectively).

Conclusions:

Although our findings do not support the hypothesis that season of birth is related to AD/dementia risk, they do not invalidate the developmental origins of health and disease hypothesis in late-life cognition. It is possible that season does not adequately capture the early life circumstances, or that other (postnatal) risk factors such as lifestyle or socioeconomic factors overrule the impact of prenatal and perinatal factors.

Xerostomia among older home care clients

OBJECTIVES

The purpose of this study was to examine drug use and other factors associated with xerostomia in home care clients aged 75 years or older.

METHODS

The study sample included 270 home care clients aged ≥75 years living in Eastern and Central Finland. The home care clients underwent in-home interviews carried out by trained home care nurses, nutritionists, dental hygienists and pharmacists. The collected data contained information on sociodemographic factors, health and oral health status, drug use, depressive symptoms (GDS-15), cognitive functioning (MMSE), functional ability (Barthel Index, IADL) and nutrition (MNA). The primary outcome was xerostomia status (never, occasionally or continuously).

RESULTS

Among the home care clients, 56% (n = 150) suffered from xerostomia. Persons with continuous xerostomia used more drugs and had more depressive symptoms and a higher number of comorbidities than other home care clients. In multivariate analyses, excessive polypharmacy (OR = 1.83, 95% Cl 1.08-3.10) and depressive symptoms (OR = 1.12, 95% Cl 1.03-1.22) were associated with xerostomia.

CONCLUSIONS

Xerostomia is a common problem among old home care clients. Excessive polypharmacy, use of particular drug groups and depressive symptoms were associated with xerostomia. The findings support the importance of a multidisciplinary approach in the care of older home care clients.

Discrepancies between in-home interviews and electronic medical records on regularly used drugs among home care clients

PURPOSE

To compare discrepancies between in-home interviews and electronic medical records (EMRs) on regularly used prescription drugs among older home care clients.

METHODS

The participants were home care clients aged 75 years or older living in three Finnish municipalities. In-home interview data on regular prescription drug use from 276 home care clients were compared with EMRs. Agreement between the in-home interview data and EMRs was assessed using Cohen's kappa.

RESULTS

A majority (83%, n = 229) of the home care clients had discrepancies between in-home interview data and EMRs, and 40% had discrepancies that could clinically compromise their treatment. Living with a spouse or other family member, use of private health care services, diagnosed asthma/COPD or excessive polypharmacy was associated with having discrepancies. Discrepancies were more common among clients with better functioning and ability to self-manage drug use. Agreement between in-home interview data and EMRs was very good or good for other drug groups, but moderate for opioids, paracetamol, benzodiazepines and benzodiazepine-related drugs and lubricant eye drops, and poor for selective beta-2-adrenoceptor agonists. The most common clinically important discrepancies were psychotropics, opioids and agents acting on the renin-angiotensin system and beta-blocking agents.

CONCLUSIONS

Eight out of ten home care clients had discrepancies between in-home interview data and EMRs. Of these discrepancies, 40% were clinically important.

Hormonal contraceptive users' self-reported benefits, adverse reactions, and fears in 2001 and 2007

BACKGROUND

Hormonal contraceptives (HCs) are the most common contraceptive method in western countries. The fears and problems experienced by users of HCs can have an impact on their quality of life, and lead to abortions and unwanted pregnancies.

OBJECTIVE

To investigate whether experiences and perceptions of HC users in Finland have changed from 2001 to 2007.

METHODS

Data were collected using questionnaire surveys of women using HCs in 2001 and 2007. In Finland, HCs are available with a physician's prescription, and are only supplied in community and university pharmacies. University pharmacies in 12 large cities across Finland were selected to distribute the questionnaires. The response rate was 53% (n = 264) in 2001 and 55% (n = 436) in 2007. The average age of the respondents was 26 years in both surveys. The surveys measured self-reported benefits and adverse reactions, preconceptions, fears, knowledge, and opinions.

RESULTS

The number of HC users reporting fears increased from 2001 to 2007 (p = 0.002), whereas the number of HC users reporting adverse reactions decreased (p = 0.013). In both surveys, the most common fear was infertility after HC use (17% vs 26% for 2001 and 2007, respectively). In both surveys, the most common benefits were efficacy and regular menstrual cycle, and the most common adverse reactions were mood swings, lowered libido, and weight gain.

CONCLUSIONS

Our study suggests that, although women using HCs were convinced about their benefits, and the number of users reporting adverse reactions had decreased from 2001 to 2007, the number of users reporting fears had increased. Healthcare professionals need to provide counseling in order to alleviate women's fears and to correct false perceptions of HCs.