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Rankin, L., Svahn, S., Kindstedt, J. & Gustafsson, M. (2024). Differences in pharmacological treatment of heart failure among persons with or without major cognitive disorder: a cross-sectional study based on national registries in Sweden. Drugs & Aging, 41(11), 907-913
Open this publication in new window or tab >>Differences in pharmacological treatment of heart failure among persons with or without major cognitive disorder: a cross-sectional study based on national registries in Sweden
2024 (English)In: Drugs & Aging, ISSN 1170-229X, E-ISSN 1179-1969, Vol. 41, no 11, p. 907-913Article in journal (Refereed) Published
Abstract [en]

Introduction: Comorbidities are common among older people, and during the last decade, a strong association between heart failure (HF) and cognitive impairment has been found. As much as 40–50% of individuals with HF will also have some degree of cognitive impairment. Previous studies report an undertreatment for some cardiovascular diseases in patients with major neurocognitive disorder (NCD).

Objective: The aim of this present study was to explore differences in pharmacological treatment of HF in individuals diagnosed with HF with or without comorbidity of major NCD.

Methods: This study combined data from three different Swedish national registers: the Swedish National Patient Register, the Swedish registry for cognitive/dementia disorders (SveDem), and the Swedish Prescribed Drug Register. A logistic regression model including variables for age, sex, major NCD, and nursing home residency was used to analyze associations between drug use and major NCD.

Results: We found a lower prevalence of filled prescriptions of renin-angiotensin system (RAS) inhibitors, β-blockers (BBs), and mineralocorticoid receptor antagonists (MRAs) among patients with major NCD. Living in a nursing home was associated with lower prevalence of RAS inhibitors, BBs, digitalis glycosides, and sodium-glucose cotransporter-2 (SGLT2) inhibitors. Females were found to have higher odds of using BBs, loop diuretics and digitalis glycosides, and lower odds of using RAS inhibitors and SGLT2 inhibitors than males.

Conclusion: Our findings indicate that there is possible undertreatment among individuals with HF identified in specialized care with co-occurring major NCD. Major NCD was associated with less filled prescriptions of basal pharmacological treatments such as RAS inhibitors, BBs, and MRAs. Future research needs to not only investigate this relationship further but also focus on reasons for the undertreatment of HF and other comorbidities within this group.

Place, publisher, year, edition, pages
Springer Nature, 2024
National Category
Neurology
Identifiers
urn:nbn:se:umu:diva-231657 (URN)10.1007/s40266-024-01153-6 (DOI)001346657900001 ()39488814 (PubMedID)2-s2.0-85208132218 (Scopus ID)
Funder
The Dementia Association - The National Association for the Rights of the Demented
Available from: 2024-11-14 Created: 2024-11-14 Last updated: 2024-11-14Bibliographically approved
Hasselgren, L., Conradsson, M., Lampinen, J., Toots, A., Olofsson, B., Nilsson, I., . . . Littbrand, H. (2024). Feasibility of a person-centred multidimensional interdisciplinary rehabilitation programme in community-dwelling people with dementia: a randomised controlled pilot trial. BMC Geriatrics, 24(1), Article ID 794.
Open this publication in new window or tab >>Feasibility of a person-centred multidimensional interdisciplinary rehabilitation programme in community-dwelling people with dementia: a randomised controlled pilot trial
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2024 (English)In: BMC Geriatrics, E-ISSN 1471-2318, Vol. 24, no 1, article id 794Article in journal (Refereed) Published
Abstract [en]

Background: A team-based, individualised rehabilitation approach may be required to meet the complex needs of people with dementia. This randomised controlled pilot trial evaluated the feasibility of a person-centred multidimensional interdisciplinary rehabilitation programme for community-dwelling older people with dementia and their informal primary caregivers.

Methods: Participants with dementia were randomised to an intervention group (n = 31, mean age (SD) 78.4 (6.0) years) or usual care (n = 30, mean age 79.0 (7.1)). The rehabilitation programme consisted of a 20-week rehabilitation period containing assessments and interventions based on each individual’s goals, and group-based physical exercise plus social interaction twice a week for 16 weeks at a rehabilitation unit. After 5 and 14 months, the interdisciplinary team followed up participants over two four-week periods. For both groups, dates of deaths and decision to move to nursing home over three years, as well as interventions for the relevant periods, were collected. Blinded assessors measured physical functions, physical activity, activities of daily living, cognitive functions, nutritional status, and neuropsychiatric symptoms at baseline and at 5, 12, 24, and 36 months.

Results: Participants in the intervention group received a mean of 70.7 (20.1) interventions during the 20-week rehabilitation period, delivered by all ten team professions. The corresponding figures for the control group were 5.8 (5.9). In the intervention group, all but one participated in rehabilitation planning, including goal setting, and attendance in the exercise and social interaction groups was 74.8%. None of the adverse events (n = 19) led to any manifest injury or disease. Cox proportional hazard regression showed a non-significant lower relative risk (HR = 0.620, 95% CI 0.27–1.44) in favour of the intervention for moving to nursing home or mortality during the 36-month follow-up period. Linear mixed-effect models showed non-significant but potentially clinically meaningful between-group differences in gait, physical activity, and neuropsychological symptoms in favour of the intervention.

Conclusions: The rehabilitation programme seems feasible among community-dwelling older people with dementia. The overall results merit proceeding to a future definitive randomised controlled trial, exploring effects and cost-effectiveness. One could consider to conduct the programme earlier in the course of dementia, adding cognitive training and a control attention activity.

Trial registration: The study protocol, ISRCTN59155421, was registered online 4/11/2015.

Place, publisher, year, edition, pages
BioMed Central (BMC), 2024
Keywords
Community-dwelling, Dementia, Feasibility study, Interdisciplinary, Rehabilitation
National Category
Geriatrics
Identifiers
urn:nbn:se:umu:diva-230590 (URN)10.1186/s12877-024-05372-9 (DOI)39342131 (PubMedID)2-s2.0-85205336926 (Scopus ID)
Funder
Forte, Swedish Research Council for Health, Working Life and Welfare, 2014−0897Promobilia foundationThe Dementia Association - The National Association for the Rights of the DementedThe Janne Elgqvist Family FoundationRegion VästerbottenAlzheimerfondenFoundation for the Memory of Ragnhild and Einar LundströmStiftelsen Gamla Tjänarinnor
Available from: 2024-10-08 Created: 2024-10-08 Last updated: 2024-10-08Bibliographically approved
Sjölander, M., Gustafsson, M., Holmberg, H. & Glader, E.-L. (2024). Longitudinal changes in self-reported medication adherence and beliefs about post-stroke medicines in Sweden: a repeated cross-sectional study. BMJ Open, 14(10), Article ID e084680.
Open this publication in new window or tab >>Longitudinal changes in self-reported medication adherence and beliefs about post-stroke medicines in Sweden: a repeated cross-sectional study
2024 (English)In: BMJ Open, E-ISSN 2044-6055, Vol. 14, no 10, article id e084680Article in journal (Refereed) Published
Abstract [en]

OBJECTIVES: To explore changes in beliefs about medicines and self-reported medication non-adherence between 3 and 24 months after stroke and to investigate associations between beliefs about medicines and non-adherence at 24 months after stroke. DESIGN: Longitudinal questionnaire survey. SETTING: Patients treated for acute stroke in 25 Swedish hospitals. PARTICIPANTS: Only patients living at home were included. Of the 594 individuals who answered the 3 month questionnaire, 401 were included at 24 months; among the remainder, 34 (5.7%) had died, 149 (25,1%) did not respond or had incomplete information on adherence and 10 (1.7%) were not living at home. MEASURES: The primary outcome was self-reported medication adherence as measured with the Medication Adherence Report Scale (MARS). The Beliefs about Medicines Questionnaires (BMQ) was used to assess personal beliefs about medicines. Background and clinical data were included from the Swedish national stroke register. RESULTS: According to dichotomised MARS sum scores, more individuals were classified as non-adherent at 24 months after stroke (n=63, 15.7%) than at 3 months after stroke (n=45, 11.2%) (p=0.030). For BMQ, the only difference over time was an increase in the Necessity subscale (p=0.007). At 24 months, in comparison to adherent patients, non-adherent patients scored statistically significant higher on negative beliefs about medicines, such as Concern (OR 1.17, 95% CI: 1.09 to 1.25), Overuse (OR: 1.37, 95% CI: 1.21 to 1.54) and Harm (OR: 1.24, 95% CI: 1.11 to 1.39), and lower on positive beliefs about medicines, namely, Necessity (OR: 0.88, 95% CI: 0.80 to 0.96) and Benefit (OR: 0.85, 95% CI: 0.74 to 0.98). CONCLUSIONS: Stroke patients' beliefs about medicines were associated with adherence, and over time beliefs remained stable across all domains, except for an increased perception of medications as being necessary. Despite this, more patients became non-adherent over time. To counteract non-adherence, interventions targeted to improve intentional adherence as well as non-intentional adherence should be investigated and implemented.

Place, publisher, year, edition, pages
BMJ Publishing Group Ltd, 2024
Keywords
Behavior, CLINICAL PHARMACOLOGY, PREVENTIVE MEDICINE, Stroke medicine
National Category
Social and Clinical Pharmacy
Identifiers
urn:nbn:se:umu:diva-232398 (URN)10.1136/bmjopen-2024-084680 (DOI)001337368000001 ()39424386 (PubMedID)2-s2.0-85206833066 (Scopus ID)
Funder
Västerbotten County Council
Available from: 2024-11-28 Created: 2024-11-28 Last updated: 2024-11-28Bibliographically approved
Rankin, L., Lindkvist, M., Backman, A. C., Sköldunger, A., Lövheim, H., Edvardsson, D. & Gustafsson, M. (2024). Pharmacological treatment of pain in Swedish nursing homes: prevalence and associations with cognitive impairment and depressive mood. Scandinavian Journal of Pain, 24(1), Article ID 20240007.
Open this publication in new window or tab >>Pharmacological treatment of pain in Swedish nursing homes: prevalence and associations with cognitive impairment and depressive mood
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2024 (English)In: Scandinavian Journal of Pain, ISSN 1877-8860, E-ISSN 1877-8879, Vol. 24, no 1, article id 20240007Article in journal (Refereed) Published
Abstract [en]

Objectives: Chronic pain is highly prevalent in nursing home residents and often occurs with depression as well as cognitive impairment, which can severely influence and limit the expression of pain.

Methods: The present cross-sectional study aimed to estimate the prevalence of pain, depressive mood, and cognitive impairment in association with pharmacological treatment against pain and depressive symptoms among Swedish nursing home residents.

Results: We found an overall pain prevalence of 52.8%, a prevalence of 63.1% for being in a depressive mood, and a prevalence of cognitive impairment of 68.3%. Among individuals assessed to have depressive mood, 60.5% were also assessed to have pain. The prevalence of pharmacological treatment for pain was 77.5 and 54.1% for antidepressants. Prescription of pharmacological treatment against pain was associated with reports of currently having pain, and paracetamol was the most prescribed drug. A higher cognitive function was associated with more filled prescriptions of drugs for neuropathic pain, paracetamol, and nonsteroidal anti-inflammatory drugs (NSAIDs), which could indicate an undertreatment of pain in those cognitively impaired.

Conclusion: It is important to further explore the relationship between pain, depressive mood, and cognitive impairment in regard to pain management in nursing home residents.

Place, publisher, year, edition, pages
Walter de Gruyter, 2024
Keywords
cross-sectional studies, depression, elderly, pain, pain management, prevalence
National Category
Nursing Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-227303 (URN)10.1515/sjpain-2024-0007 (DOI)001248888700001 ()38887790 (PubMedID)2-s2.0-85196277330 (Scopus ID)
Funder
Forte, Swedish Research Council for Health, Working Life and Welfare, 2014‐4016Swedish Research Council, 521‐2014‐2715
Available from: 2024-07-03 Created: 2024-07-03 Last updated: 2024-07-03Bibliographically approved
Svahn, S., Appelblad, L., Lövheim, H., Gustafson, Y., Olofsson, B. & Gustafsson, M. (2024). Prevalence of heart failure and trends in its pharmacological treatment between 2000 and 2017 among very old people. BMC Geriatrics, 24(1), Article ID 701.
Open this publication in new window or tab >>Prevalence of heart failure and trends in its pharmacological treatment between 2000 and 2017 among very old people
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2024 (English)In: BMC Geriatrics, E-ISSN 1471-2318, Vol. 24, no 1, article id 701Article in journal (Refereed) Published
Abstract [en]

Purpose: The aim of this study was to describe a population of very old people with heart failure (HF), to analyse the use of cardiovascular drugs over time, and to explore factors influencing cardiovascular drug treatment for this group.

Methods: All participants with information regarding HF diagnosis were selected from the Umeå 85+/Gerontological Regional Database (GERDA). The people in GERDA are all ≥85 years old. Trained investigators performed structured interviews and assessments. Information regarding medications and diagnoses was obtained from the participants and from medical records. Medical diagnoses were reviewed and confirmed by an experienced geriatrician.

Results: In this very old population, the prevalence of HF was 29.6% among women and 30.7% among men. Between 2000 and 2017, there was an increase in the use of renin-angiotensin (RAS) inhibitors (odds ratio [OR] 1.107, 95% confidence interval [CI] 1.072–1.144) and beta-blockers (BBs) (OR 1.123, 95% CI 1.086–1.161) among persons with HF, whereas the prevalence of loop diuretics (OR 0.899, 95% CI 0.868–0.931) and digitalis (OR 0.864, 95% CI 0.828–0.901) decreased (p < 0.001 for all drug classes). Higher age was associated with lower use of RAS inhibitors and BBs.

Conclusion: In this HF population, the use of evidence-based medications for HF increased over time. This may be a sign of better awareness among prescribers regarding the under-prescribing of guidelines-recommended treatment to old people. Higher age associated with a lower prevalence of RAS inhibitors and BBs. This might indicate that further improvement is possible but could also represent a more cautious prescribing among frail very old individuals.

Place, publisher, year, edition, pages
Springer Nature, 2024
Keywords
Cardiovascular drugs, Drug use, Heart failure, Very old people
National Category
Geriatrics Cardiology and Cardiovascular Disease
Identifiers
urn:nbn:se:umu:diva-229385 (URN)10.1186/s12877-024-05307-4 (DOI)001297617900008 ()39182036 (PubMedID)2-s2.0-85201929935 (Scopus ID)
Funder
Swedish Research Council, K2014–99X-22610–01–6The Dementia Association - The National Association for the Rights of the DementedInterreg
Available from: 2024-09-12 Created: 2024-09-12 Last updated: 2025-02-10Bibliographically approved
Gasi, E., Gustafsson, M. & Kindstedt, J. (2024). Psychotropic drug use and associated factors among acutely admitted older people: a cross-sectional study of a clinical sample. Drugs - real world outcomes, 11(4), 627-633
Open this publication in new window or tab >>Psychotropic drug use and associated factors among acutely admitted older people: a cross-sectional study of a clinical sample
2024 (English)In: Drugs - real world outcomes, ISSN 2199-1154, E-ISSN 2198-9788, Vol. 11, no 4, p. 627-633Article in journal (Refereed) Published
Abstract [en]

Introduction: Older people are on average more susceptible to the adverse effects of psychotropic drugs, but addressing older people as a homogenous group based on age alone can be misleading when exploring psychotropic drug use. This study aimed to describe psychotropic drug use and associated factors among community-dwelling older people who had been acutely admitted to hospital.

Methods: This cross-sectional study was based on a sample of 300 community-dwelling people 75 years or older who had been admitted to the acute medical ward at Umeå University Hospital at any time from September 2018 to October 2021. Data on medication use were obtained from electronic medical charts, and psychotropic drug use was presented as user proportions, both in terms of individual substances and drug classes. Associations between psychotropic drug use and factors comprising sex, age, cohabitation, comorbidities and multi-dose dispensing (MDD) of medicines were analysed through logistic regression.

Results: Approximately 50% of the individuals used at least one psychotropic drug, and 18% used two or more such medicines. Zopiclone displayed the highest user proportion of all psychotropics (18.3%), followed by mirtazapine (11.3%) and zolpidem (9.7%). Of note, zolpidem was more prevalent among the females than among the males (p = 0.006). Regarding other sex differences, 55 and 38% of the females and males, respectively, used at least one psychotropic drug (p = 0.004). A similar pattern was observed regarding sedatives and hypnotic drugs exclusively (p = 0.048). In the regression analysis, female sex (adjusted odds ratio [OR] 2.05 [95% confidence interval {CI} 1.22–3.42]) and MDD (adjusted OR 2.20 [95% CI 1.23–3.93]) were positively associated with psychotropic drug use.

Conclusion: The most common psychotropic drugs used by community-dwelling older people admitted to the acute medical ward were hypnotic drugs and antidepressants. Regarding patient factors, female sex and MDD system were positively associated with psychotropic drug use. Further studies concerning those two factors in relation to potential overprescribing could provide a better picture on how to optimize psychotropic drug use among acutely admitted vulnerable older people.

Place, publisher, year, edition, pages
Springer Nature, 2024
National Category
Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
urn:nbn:se:umu:diva-230127 (URN)10.1007/s40801-024-00455-w (DOI)001320912700001 ()39316319 (PubMedID)2-s2.0-85204689899 (Scopus ID)
Funder
Region VästerbottenUmeå UniversityForte, Swedish Research Council for Health, Working Life and Welfare, 2017-01438Swedish Research Council, 2019-01078
Available from: 2024-10-14 Created: 2024-10-14 Last updated: 2025-01-13Bibliographically approved
Kindstedt, J., Andersson, P., Westberg, A., Glader, E.-L., Lövheim, H. & Gustafsson, M. (2023). Exploring medication-related hospital admissions and their association with cognitive impairment among acutely admitted older people. Research in Social and Administrative Pharmacy, 19(7), 1048-1053
Open this publication in new window or tab >>Exploring medication-related hospital admissions and their association with cognitive impairment among acutely admitted older people
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2023 (English)In: Research in Social and Administrative Pharmacy, ISSN 1551-7411, E-ISSN 1934-8150, Vol. 19, no 7, p. 1048-1053Article in journal (Refereed) Published
Abstract [en]

Introduction: Medication-related hospital admissions (MRAs) are common among older people. Persons with cognitive impairment are especially vulnerable to adverse drug effects. At the same time, increased home health care and social support could theoretically prevent medication-related problems. This study aims to estimate the proportion of MRAs and explore their relationship with cognitive impairment in a population of acutely admitted older people.

Methods: This cross-sectional study comprised 300 individuals aged 75 years or older admitted to an acute medical ward. Two assessors identified possibly MRAs using the Assessment Tool for Hospital Admissions Related to Medications 10 (AT-HARM10). Screening for cognitive impairment was performed during ward stay using a 4-item test related to time orientation. Prevalence odds ratios between cognitive test scores and MRAs were analysed through logistic regression.

Results: Using AT-HARM10, 108 out of 300 admissions (36%) were classified as possibly MRAs by both assessors. Moreover, MRAs were least common among patients with the lowest cognitive test scores. There was an association regarding MRAs when the lowest test score was treated as a cut-off and compared against a reference category comprising all other scores (OR, 0.31 [95% CI 0.10–0.93]; p = 0.037) in a logistic regression model adjusted for cohabitation and home health care.

Conclusion: Approximately one-third of the hospital admissions among acutely admitted older people were considered at least possibly medication-related. Hence, there is still a great need to manage medication-related problems and reduce MRAs in this vulnerable population. Using a 4-item instrument to screen for cognitive impairment, there was a negative association between MRA and lowest cognitive test score. Further exploration of the relationship between MRAs and cognitive impairment may indicate appropriate components and target populations for interventions that aims to reduce the risk of MRA.

Place, publisher, year, edition, pages
Elsevier, 2023
Keywords
Cognitive impairment, Hospital admissions, Medication-related problems, Older people
National Category
Public Health, Global Health, Social Medicine and Epidemiology Geriatrics
Identifiers
urn:nbn:se:umu:diva-207881 (URN)10.1016/j.sapharm.2023.04.117 (DOI)001001988900001 ()37105774 (PubMedID)2-s2.0-85153801441 (Scopus ID)
Funder
Swedish Research Council, 2019-01078Forte, Swedish Research Council for Health, Working Life and Welfare, 2017-01438Region Västerbotten
Available from: 2023-05-09 Created: 2023-05-09 Last updated: 2023-09-24Bibliographically approved
Norberg, H., Lindqvist, M. H. & Gustafsson, M. (2023). Older individuals’ experiences of medication management and care after discharge from hospital: an interview study. Patient Preference and Adherence, 17, 781-792
Open this publication in new window or tab >>Older individuals’ experiences of medication management and care after discharge from hospital: an interview study
2023 (English)In: Patient Preference and Adherence, E-ISSN 1177-889X, Vol. 17, p. 781-792Article in journal (Refereed) Published
Abstract [en]

Purpose: To develop an in-depth understanding of older individuals’ attitudes and perceptions of medication management and care after discharge from hospital-to-home.

Patients and Methods: A qualitative study using semi-structured interviews with selected individuals 75 years and older, discharged from hospital within the last 6–12 months, living at home, and managing their own medications. Face-to-face interviews were audio-recorded, transcribed and analyzed with thematic analysis.

Results: Among the 15 respondents, mean age was 83.5 years (range 75–95 years), 67% were women, and 60% lived alone. The majority (80%) managed their medications with a pill organizer or directly from the pill boxes, while 20% used dose dispensed medications. The analysis of the data led to six themes: Medication adherence, Personal responsibility, Transitions of care, Beliefs about medications, Participation (experience of participation, willingness to participate) and Accessibility (easier to reach hospital than primary care, navigating in the care system, continuity, personal chemistry).

Conclusion: The included respondents who were older individuals, living at home and managing their own medications, expressed that they were medical adherent and self-managing. Two important aspects which were seen were difficulties to reach primary care on their own initiative and the lack of continuity with the same physician over a longer period of time.

Place, publisher, year, edition, pages
Dove Medical Press Ltd, 2023
Keywords
medication adherence, qualitative research, self management, shared decision making, transitional care
National Category
Nursing Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
urn:nbn:se:umu:diva-206799 (URN)10.2147/PPA.S400039 (DOI)000957252200001 ()36987497 (PubMedID)2-s2.0-85152054648 (Scopus ID)
Funder
Region VästerbottenForte, Swedish Research Council for Health, Working Life and Welfare, 2017-01438Swedish Research Council, 2019-01078
Available from: 2023-04-17 Created: 2023-04-17 Last updated: 2024-01-17Bibliographically approved
Sönnerstam, E., Harlin, F. & Gustafsson, M. (2023). Potentially inappropriate medications among elderly people with neurocognitive disorders – A nationwide register-based study using 3 different explicit criteria. Research in Social and Administrative Pharmacy, 19(5), 758-763
Open this publication in new window or tab >>Potentially inappropriate medications among elderly people with neurocognitive disorders – A nationwide register-based study using 3 different explicit criteria
2023 (English)In: Research in Social and Administrative Pharmacy, ISSN 1551-7411, E-ISSN 1934-8150, Vol. 19, no 5, p. 758-763Article in journal (Refereed) Published
Abstract [en]

Background: The use of potentially inappropriate medications (PIMs) is a problem since it might contribute significantly to adverse drug reactions and hospital admissions among elderly with major neurocognitive disorder (NCD). To assess the appropriateness of drug treatment, different explicit criteria have been developed.

Objectives: To investigate and compare the prevalence of PIM users among elderly with major NCD on a nationwide basis using 3 different explicit criteria. Furthermore, the study aimed to investigate factors associated with the use of PIMs.

Methods: This nationwide register-based study included 35,212 people, 65 years or older, diagnosed with major NCD and registered in the Swedish registry for cognitive/dementia disorders up to June 30, 2017 and alive December 31, 2017. PIMs were identified using 3 different explicit criteria; the Swedish quality indicators, the EU(7)-PIM list and the AGS Beers Criteria. PIM use was defined as having collected a minimum of one PIM at least once between July 01 – December 31, 2017.

Results: The numbers of people using one or more PIMs were 7629 (21.7%) according to the Swedish quality indicators, 11,838 (33.6%) according to the EU(7)-PIM list, and 12,002 (34.1%) according to AGS Beers Criteria. Antipsychotics, antithrombotic agents and anxiolytics were the most frequently used PIM class according to the different assessment tools, respectively. The use of PIMs was positively associated with vascular dementia and Lewy body dementia/Parkinson's disease dementia, regardless of the assessment tool used. However, the association between using at least one PIM and age, sex, MMT-value and frontotemporal dementia, differed depending on the criteria used.

Conclusions: The different results and included PIMs indicate the different perspectives on PIMs between criteria, which make it difficult to compare the results. However, psychotropic drug use requires further highlighting, as well as the association between PIM use and different types of major NCD.

Place, publisher, year, edition, pages
Elsevier, 2023
Keywords
AGS Beers criteria, Elderly, EU(7)-PIM list, Major neurocognitive disorder, Potentially inappropriate medication, Swedish indicator
National Category
Geriatrics
Identifiers
urn:nbn:se:umu:diva-205506 (URN)10.1016/j.sapharm.2023.01.010 (DOI)000955276700001 ()36717339 (PubMedID)2-s2.0-85148753060 (Scopus ID)
Funder
The Dementia Association - The National Association for the Rights of the Demented
Available from: 2023-03-14 Created: 2023-03-14 Last updated: 2023-11-07Bibliographically approved
Gustafsson, M., Altufaili, M. & Sjölander, M. (2023). Prevalence of Drugs and Drug Combinations that Increase Risk of Prolonged QT Time Among People with Major Neurocognitive Disorder Living in Sweden: A Cross-Sectional Registry Study. Drugs - real world outcomes, 10, 61-68
Open this publication in new window or tab >>Prevalence of Drugs and Drug Combinations that Increase Risk of Prolonged QT Time Among People with Major Neurocognitive Disorder Living in Sweden: A Cross-Sectional Registry Study
2023 (English)In: Drugs - real world outcomes, ISSN 2199-1154, E-ISSN 2198-9788, Vol. 10, p. 61-68Article in journal (Refereed) Published
Abstract [en]

Background: People with major neurocognitive disorder might be susceptible to drug-induced QT interval prolongation due to the presence of a number of concomitant risk factors.

Objective: The aim of this study was to investigate the prevalence of QT-prolonging drugs and QT-prolonging drug–drug interactions and associated factors among older people with major neurocognitive disorder.

Methods: In this register-based study, we obtained information regarding QT-prolonging drug use in a large population of older people with major neurocognitive disorder, through record linkage between the Swedish registry for cognitive/dementia disorders, and the Swedish Prescribed Drug Register. QT-prolonging drugs were identified according to the CredibleMeds online database and interactions using the Janusmed interaction database. Drug use was defined as one or more filled prescriptions during a 6-month timeframe, July 01 to December 31, 2017. Associations between people with a QT-prolonging drug and the factors of age and gender were analysed through multiple logistic regression.

Results: Of 35,212 people included in the study, 41.6% had one or more QT-prolonging drug prescribed. The most commonly prescribed drug was donepezil, with a prevalence of 25.0%, followed by citalopram and escitalopram, representing 14.5% and 3.9% of prescriptions in the study population, respectively. Significant associations were found between QT-prolonging drug use and the factors of younger age and female gender. The most prevalent interaction was between citalopram and donepezil (2.7%), followed by the combination of escitalopram and donepezil (0.7%).

Conclusions: In this population of older people with major neurocognitive disorder, QT-prolonging drugs and interactions that increase the risk of torsade de pointes were prevalent. Due to the presence of many risk factors in this population, it is important to continuously evaluate current QT-prolonging drugs and concomitant drug treatment in each individual.

Place, publisher, year, edition, pages
Springer Nature, 2023
National Category
Pharmaceutical Sciences
Identifiers
urn:nbn:se:umu:diva-201195 (URN)10.1007/s40801-022-00341-3 (DOI)000880534600001 ()36352305 (PubMedID)2-s2.0-85141560927 (Scopus ID)
Available from: 2023-01-05 Created: 2023-01-05 Last updated: 2023-07-13Bibliographically approved
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0003-3615-4880

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