Extent and quality of drug use in community-dwelling people aged ≥75 years: A Swedish nationwide register-based study

Lagerin, Annica; Törnkvist, Lena; Nilsson, Gunnar; Johnell, Kristina; Fastbom, Johan

doi:10.1177/1403494817744101

Cited by 11 publications

(10 citation statements)

References 28 publications

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“…The contribution of gender to polypharmacy is also seldom studied in the very old [ 4 , 6 – 9 , 12 – 15 ]. Women live longer than men with more total disease and disability, along with more chronic versus life-threatening conditions, so prescribing might vary accordingly with gender [ 16 – 19 ].…”

Section: Introductionmentioning

confidence: 99%

Characterising polypharmacy in the very old: Findings from the Newcastle 85+ Study

et al. 2021

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Background Polypharmacy is potentially harmful and under-researched amongst the fastest growing subpopulation, the very old (aged ≥85). We aimed to characterise polypharmacy using data from the Newcastle 85+ Study—a prospective cohort of people born in 1921 who turned 85 in 2006 (n = 845). Methods The prevalence of polypharmacy at baseline (mean age 85.5) was examined using cut-points of 0, 1, 2–4, 5–9 and ≥10 medicines—so-called ‘no polypharmacy’, ‘monotherapy’, ‘minor polypharmacy’, ‘polypharmacy’ and ‘hyperpolypharmacy.’ Cross-tabulations and upset plots identified the most frequently prescribed medicines and medication combinations within these categories. Mixed-effects models assessed whether gender and socioeconomic position were associated with prescribing changes over time (mean age 85.5–90.5). Participant characteristics were examined through descriptive statistics. Results Complex multimorbidity (44.4%, 344/775) was widespread but hyperpolypharmacy was not (16.0%, 135/845). The median medication count was six (interquartile range 4–8). Preventative medicines were common to all polypharmacy categories, and prescribing regimens were diverse. Nitrates and oral anticoagulants were more frequently prescribed for men, whereas bisphosphonates, non-opioid analgesics and antidepressants were more common in women. Cardiovascular medicines, including loop diuretics, tended to be more frequently prescribed for socioeconomically disadvantaged people (<25th centile Index of Multiple Deprivation (IMD)), despite no difference in the prevalence of cardiovascular disease (p = 0.56) and diabetes (p = 0.92) by IMD. Conclusion Considering their complex medical conditions, prescribing is relatively conservative amongst 85-year-olds living in North East England. Prescribing shows significant gender and selected socioeconomic differences. More support for managing preventative medicines, of uncertain benefit, might be helpful in this population.

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Section: Introductionmentioning

confidence: 99%

Characterising polypharmacy in the very old: Findings from the Newcastle 85+ Study

et al. 2021

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“…In Sweden, although community health nurses play a significant role in ensuring safe medication management for older adults, this role is not sufficiently recognised (Lagerin, Törnkvist, Nilsson, Johnell, & Fastbom, 2020). In Slovenia, this is part of PHVs in relation to adherence to the medication plan but not in relation to dealing with polypharmacy and inappropriate medication use.…”

Section: Discussionmentioning

confidence: 99%

Comparison of community health nurses' preventive home visits to older adults in Sweden and Slovenia:

Kapun

Meglič²,

Hajdarević

2022

Obzor Zdrav Neg

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Introduction: Community health nurses contribute significantly to better health, well-being and independence of older adults. The aim of the study is to compare preventive services for older adults in community health care between Sweden and Slovenia.Methods: Literature review and document analysis were used to conduct a qualitative comparative analysis. Literature was retrieved from the MEDLINE, CINAHL and COBIB databases. An analysis of documents such as sectoral legal bases, guidelines and expert recommendations in Slovenia and Sweden was also conducted. The analysis included sources related to preventive services for older adults living at home published between January 2000 and December 2020 in Slovene, English or Swedish.Results: Twenty units of literature were included in the review. Four comparative factors were identified: system and legal basis, organisation and scope, providers, and content. In Slovenia, all older adults are entitled to the same range of preventive services. Compared to Sweden, the organisation of community health care in Slovenia is more centralised, all older adults are entitled to the same scope of preventive health visits, while the level of education and scope of competences of healthcare providers are lower. In both countries, the content of preventive home visits to older adults is similar.Discussion and conclusion: In Slovenia, community health nurses with additional knowledge could prescribe medical devices and medications form a limited list, as well as coordinate care. This would allow them to act more independently in patients' home environment. Further development of more personalised preventive services for older adults depends on research, resource provision and consideration of the organisational culture.

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“…During the past several decades, medication use has increased more rapidly in older people than in other groups (Hovstadius et al, 2010), mainly because of the introduction of new drugs and treatment guidelines (Morin et al, 2015;Lagerin et al, 2017). At the same time, age-related physiological changes in drug turnover and sensitivity to drugs increase the risk of adverse drug reactions (ADRs) (Bergqvist et al, 2009;Kim Jennifer, 2017), which is further augmented by the use of multiple drugs (polypharmacy).…”

Section: Introductionmentioning

confidence: 99%

District nurses’ experiences of using a clinical decision support system and an assessment tool at elderly care units in primary health care: a qualitative study

Lagerin

Törnkvist

Fastbom

et al. 2021

Prim Health Care Res Dev

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Aim: The present study aimed to describe the experience of district nurses (DNs) in using a clinical decision support system (CDSS) and the safe medication assessment (SMA) tool during patient visits to elderly care units at primary health care centres. Background: In Swedish primary health care, general practitioners (GPs) prescribe and have the responsibility to regularly review older adults’ medications, while DN (nurses specialised in primary health care) play an important role in assessing older adults’ ability to manage their medications, detecting potential drug-related problems and communicating with patients and GPs about such problems. In a previous feasibility study, we found that DNs who use a combination of a CDSS and the SMA tool identified numerous potentially harmful or dangerous factors and took a number of nursing care actions to improve the safety and quality of patients’ medication use. In telephone interviews, patients indicated that they were positive towards the assessment and interventions. Methods: Individual interviews with seven DNs who worked at six different primary health care centres in Region Stockholm were carried out in 2018. In 2019, an additional group interview was conducted with two of the seven DNs so they could discuss and comment on preliminary findings. Qualitative content analysis was used to analyse the interview transcripts. Findings: Using the tools, the DNs could have a natural conversation about medication use with older adults. They could get a clear picture of the older adults’ medication use and thus obtain information that could facilitate collaboration with GPs about this important component of health care for older adults. However, for the tools to be used in clinical practice, some barriers would have to be overcome, such as the time-consuming nature of using the tools and the lack of established routines for interprofessional collaboration regarding medication discussions.

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Extent and quality of drug use in community-dwelling people aged ≥75 years: A Swedish nationwide register-based study

Cited by 11 publications

References 28 publications

Characterising polypharmacy in the very old: Findings from the Newcastle 85+ Study

Characterising polypharmacy in the very old: Findings from the Newcastle 85+ Study

Comparison of community health nurses' preventive home visits to older adults in Sweden and Slovenia:

District nurses’ experiences of using a clinical decision support system and an assessment tool at elderly care units in primary health care: a qualitative study

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