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  • 1. Bennett, Alexander
    et al.
    Gnjidic, Danijela
    Gillett, Mark
    Carroll, Peter
    Matthews, Slade
    Johnell, Kristina
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Fastbom, Johan
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Hilmer, Sarah
    Prevalence and Impact of Fall-Risk-Increasing Drugs, Polypharmacy, and Drug-Drug Interactions in Robust Versus Frail Hospitalised Falls Patients: A Prospective Cohort Study2014In: Drugs & Aging, ISSN 1170-229X, E-ISSN 1179-1969, Vol. 31, no 3, p. 225-232Article in journal (Refereed)
    Abstract [en]

    Background Several measures of medication exposure are associated with adverse outcomes in older people. Exposure to and the clinical outcomes of these measures in robust versus frail older inpatients are not known. Objective In older robust and frail patients admitted to hospital after a fall, we investigated the prevalence and clinical impact of fall-risk-increasing drugs (FRIDs), total number of medications, and drug-drug interactions (DDIs). Methods Patients >= 60 years of age admitted with a fall to a tertiary referral teaching hospital in Sydney were recruited and frailty was assessed. Data were collected at admission, discharge, and 2 months after admission. Results A total of 204 patients were recruited (mean age 80.5 +/- 8.3 years), with 101 robust and 103 frail. On admission, compared with the robust, frail participants had significantly higher mean +/- SD number of FRIDs (frail 3.4 +/- 2.2 vs. robust 1.6 +/- 1.5, P < 0.0001), total number of medications (9.8 +/- 4.3 vs. 4.4 +/- 3.3, P < 0.0001), and DDI exposure (35 vs. 5 %, P = 0.001). Number of FRIDs on discharge was significantly associated with recurrent falls [odds ratio (OR) 1.7 (95 % confidence interval [CI] 1.3-2.1)], which were most likely to occur with 1.5 FRIDs in the frail and 2.5 FRIDs in the robust. Number of medications on discharge was also associated with recurrent falls [OR 1.2 (1.0-1.3)], but DDIs were not. Conclusion Exposure to FRIDs and other measures of high-risk medication exposures is common in older people admitted with falls, especially the frail. Number of FRIDs and to a lesser extent total number of medicines at discharge were associated with recurrent falls.

  • 2.
    Fastbom, Johan
    et al.
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Johnell, Kristina
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    National Indicators for Quality of Drug Therapy in Older Persons: the Swedish Experience from the First 10 Years2015In: Drugs & Aging, ISSN 1170-229X, E-ISSN 1179-1969, Vol. 32, no 3, p. 189-199Article, review/survey (Refereed)
    Abstract [en]

    Inappropriate drug use is an important health problem in elderly persons. Beginning with the Beers' criteria in the early 1990s, explicit criteria have been extensively used to measure and improve quality of drug use in older people. This article describes the Swedish indicators for quality of drug therapy in the elderly, introduced in 2004 and updated in 2010. These indicators were designed to be applied to people aged 75 years and over, regardless of residence and other characteristics. The indicators are divided into drug specific, covering choice, indication and dosage of drugs, polypharmacy, drug-drug interactions (DDIs), drug use in decreased renal function and in some symptoms; and diagnosis specific, covering the rational, irrational and hazardous drug use in common disorders in elderly people. During the 10 years since introduction, the Swedish indicators have several applications. They form the basis for recommendations for drug therapy in older people, are implemented in prescribing supports and drug utilisation reviews, are used in national benchmarking of the quality of Swedish healthcare and have contributed to initiatives from pensioner organisations. The indicators have also been used in several pharmacoepidemiological studies. Since 2005, there have been signs of improvement of the quality of drug prescribing to elderly persons in Sweden. For example, the prescribing of drugs that should be avoided in older persons decreased by 36 % between 2006 and 2012 in persons aged 80 years and older. Similarly, drug combinations that may cause DDIs decreased by 26 % and antipsychotics by 41 %. The indicators have likely contributed to this.

  • 3. Fereshtehnejad, Seyed-Mohammad
    et al.
    Johnell, Kristina
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Eriksdotter, Maria
    Anti-Dementia Drugs and Co-Medication Among Patients with Alzheimer's Disease Investigating Real-World Drug Use in Clinical Practice Using the Swedish Dementia Quality Registry (SveDem)2014In: Drugs & Aging, ISSN 1170-229X, E-ISSN 1179-1969, Vol. 31, no 3, p. 215-224Article in journal (Refereed)
    Abstract [en]

    Background There is a substantial risk of drug-interactions, adverse events, and inappropriate drug use (IDU) among frail Alzheimer's disease (AD) patients; however, there are few studies about co-medication and IDU in clinical settings. Objectives To investigate anti-dementia drugs, associated characteristics of cholinesterase inhibitors (ChEIs) and NMDA antagonists, co-medication, and IDU in a large population of outpatients with mild AD. Methods In this cross-sectional analysis of medication characteristics, we analyzed data from the Swedish Dementia Quality Registry (SveDem) on 5,907 newly diagnosed AD patients who were registered in memory clinics. SveDem is a national quality registry in Sweden, which was established in 2007 to evaluate and improve dementia healthcare. Comparisons were performed concerning co-medications, use of >= 3 psychotropic drugs (IDU) and polypharmacy (>= 5 drugs) based on anti-dementia treatment (ChEIs or NMDA antagonists). Information on baseline characteristics such as age, sex, living conditions, cognitive evaluation based on the Mini-Mental State Examination (MMSE) score, and diagnostic work-up was also evaluated. Results The majority of the AD patients were in the mild stage of the disease. Overall, 4,342 (75.4 %) patients received any ChEI, 438 (7.6 %) used an NMDA antagonist and 74 (1.3 %) patients were treated with both. However, 907 (15.7 %) patients were not treated with any anti-dementia drug. While polypharmacy was seen in 33.5 % of patients, only 2.6 % concurrently used >= 3 psychotropic medications. Patients on ChEIs were significantly younger, had a higher MMSE score and were treated with a smaller number of medications (a proxy for overall co-morbidity). Co-medication with antipsychotics [3.3 vs. 7.6 %; adjusted odds ratio (OR) 0.55 (95 % CI 0.38-0.79)] and anxiolytics [5.8 vs. 10.9 %; adjusted OR 0.62 (95 % CI 0.46-0.84)] was significantly lower in the ChEI+ group than in those with no anti-dementia treatment. Conclusion Patients taking ChEIs were treated with less antipsychotics and anxiolytics than those not taking ChEIs. More research is warranted to elucidate whether use of ChEIs in clinical practice can reduce the need for psychotropic drugs in AD patients.

  • 4. Giovannini, Silvia
    et al.
    van der Roest, Henriette G.
    Carfi, Angelo
    Finne-Soveri, Harriet
    Garms-Homolova, Vjenka
    Declercq, Anja
    Jonsson, Palmi V.
    van Hout, Hein
    Vetrano, Davide L.
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI). Catholic University of the Sacred Heart, Italy.
    Gravina, Ester Manes
    Bernabei, Roberto
    Onder, Graziano
    Polypharmacy in Home Care in Europe: Cross-Sectional Data from the IBenC Study2018In: Drugs & Aging, ISSN 1170-229X, E-ISSN 1179-1969, Vol. 35, no 2, p. 145-152Article in journal (Refereed)
    Abstract [en]

    Background Home care (HC) patients are characterized by a high level of complexity, which is reflected by the prevalence of multimorbidity and the correlated high drug consumption. This study assesses prevalence and factors associated with polypharmacy in a sample of HC patients in Europe. Methods We conducted a cross-sectional analysis on 1873 HC patients from six European countries participating in the Identifying best practices for care-dependent elderly by Benchmarking Costs and outcomes of community care (IBenC) project. Data were collected using the interResident Assessment Instrument (interRAI) instrument for HC. Polypharmacy status was categorized into three groups: non-polypharmacy (0-4 drugs), polypharmacy (5-9 drugs), and excessive polypharmacy (C10 drugs). Multinomial logistic regressions were used to identify variables associated with polypharmacy and excessive polypharmacy. Results Polypharmacy was observed in 730 (39.0%) HC patients and excessive polypharmacy in 433 (23.1%). As compared with non-polypharmacy, excessive polypharmacy was directly associated with chronic disease but also with female sex (odds ratio [OR] 1.58; 95% confidence interval [CI] 1.17-2.13), pain (OR 1.51; 95% CI 1.15-1.98), dyspnea (OR 1.37; 95% CI 1.01-1.89), and falls (OR 1.55; 95% CI 1.01-2.40). An inverse association with excessive polypharmacy was shown for age (OR 0.69; 95% CI 0.56-0.83). Conclusions Polypharmacy and excessive polypharmacy are common among HC patients in Europe. Factors associated with polypharmacy status include not only co-morbidity but also specific symptoms and age.

  • 5.
    Grande, Giulia
    et al.
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI). University of Milan, Italy.
    Morin, Lucas
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Vetrano, Davide Liborio
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI). Catholic University of Rome, Italy.
    Fastbom, Johan
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Johnell, Kristina
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Drug Use in Older Adults with Amyotrophic Lateral Sclerosis Near the End of Life2017In: Drugs & Aging, ISSN 1170-229X, E-ISSN 1179-1969, Vol. 34, no 7, p. 529-533Article in journal (Refereed)
    Abstract [en]

    Background Amyotrophic lateral sclerosis (ALS), with its certain prognosis and swift progression, raises concerns regarding the adequacy of pharmacological treatment, including the risk-benefit profiles of prescribed drugs. Objective Our objective was to evaluate the use of prescription drugs over the course of the last year of life in older adults with ALS. Methods We conducted a nationwide retrospective cohort study of older adults who died with ALS in Sweden between 2007 and 2013. The primary outcome was the number of prescription drugs to which individuals were exposed during the last 12 months before death. Results The overall proportion of individuals receiving ten or more different prescription drugs increased from 19% at 12 months before death to 37% during the last month of life. Institutionalization was independently associated with polypharmacy near the end of life (odds ratio 1.84; 95% confidence interval 1.42-2.39). Conclusion Future research is needed to assess the time to benefit of treatments and to develop guidelines for medication discontinuation in advanced ALS.

  • 6.
    Haasum, Ylva
    et al.
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Fastbom, Johan
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Fratiglioni, Laura
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Kåreholt, Ingemar
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Johnell, Kristina
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Pain Treatment in Elderly Persons With and Without Dementia: A population-Based Study of Institutionalized and Home-Dwelling Elderly2011In: Drugs & Aging, ISSN 1170-229X, E-ISSN 1179-1969, Vol. 28, no 4, p. 283-293Article in journal (Refereed)
    Abstract [en]

    Background: Several previous studies have reported an undertreatment of pain in elderly persons with dementia. It has also been suggested that persons with dementia may be at risk for inappropriate treatment of pain with psychotropics.

    Objectives: The objective of this study was to investigate if persons with dementia are as likely as persons without dementia to receive pharmacological pain treatment, after taking into account residential setting and pain-related disorders. We also aimed to investigate whether use of psychotropics is related to pain in persons with and without dementia.

    Methods: We used baseline data from the SNAC-K (Swedish National Study of Aging and Care – Kungsholmen). We analysed use of analgesics and psychotropics, prevalence of pain-related diagnoses, self-reported pain, dementia status and residential setting in 2610 participants aged >65 years.

    Results: Of the persons with dementia, 46% used at least one analgesic drug compared with 25% of those without dementia. Although persons with dementia reported pain less frequently than persons without dementia, the prevalence of pain-related diagnoses was similar. After adjustment for individual factors and residential setting (own home/institution), persons with dementia had a higher probability of use of paracetamol (acetaminophen) and psychotropics, whereas there were no significant differences in use of any analgesic, opioids and NSAIDs. Furthermore, having a pain-related diagnosis was associated with use of psychotropics in persons with dementia.

    Conclusions: Persons with dementia had a higher probability of use of paracetamol and were about as likely as persons without dementia to use any analgesic, opioids and NSAIDs, after adjustment for confounders. This may reflect a recent increased awareness of pain and pain management in persons with dementia, compared with previous studies that have reported an underuse of analgesics in persons with dementia. However, further research is needed to analyse if persons with dementia are appropriately treated for pain with regard to type of analgesic drug, pain intensity, indication, dosage and regimen.

  • 7.
    Johnell, Kristina
    et al.
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Fastbom, Johan
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Comparison of prescription drug use between community dwelling and institutionalized elderly in Sweden2012In: Drugs & Aging, ISSN 1170-229X, E-ISSN 1179-1969, Vol. 29, no 9, p. 751-758Article in journal (Refereed)
    Abstract [en]

    Background Most previous studies about drug use in the elderly population have either investigated drug use in institutions or in the community-dwelling setting. Hence, very few studies have compared drug use in institutionalized and community-dwelling elderly, maybe because of a lack of sufficiently large databases. Objective The aim of the study was to investigate differences in drug use patterns between community-dwelling and institutionalized elderly, after adjustment for age, gender and number of other drugs (used as a proxy for overall co-morbidity). Methods We analysed data from individuals aged >= 65 years who filled at least one drug prescription between July and September 2008 and were consequently registered in the Swedish Prescribed Drug Register (n = 1,347,564; 1,260,843 community-dwelling and 86,721 institutionalized elderly). A list of current prescriptions was constructed for every individual on the arbitrarily chosen date 30 September 2008. Outcome measures were the 20 most common drug classes and the 20 most common individual drugs. Logistic regression analysis was used to investigate whether institutionalization was associated with use of these drugs, after adjustment for age, gender and number of other drugs. Results Institutionalized elderly were more likely than community-dwelling elderly to use antidepressants, laxatives, minor analgesics, opioids and hypnotics/sedatives, after adjustment for age, gender and number of other drugs. On the contrary, institutionalization was negatively associated with use of lipid modifying agents, angiotensin II antagonists, selective calcium channel blockers, beta-blocking agents and ACE inhibitors, after adjustment for age, gender and number of other drugs. Conclusions Our results indicate that institutionalized elderly are more likely than community-dwelling elderly to use psychotropics, analgesics and laxatives, but less likely to receive recommended cardiovascular drug therapy, which may indicate a need for implementation of evidencebased guidelines for drug treatment in this vulnerable group of elderly patients. Further research is needed to elucidate to what extent the differences in drug use between community-dwelling and institutionalized elderly are explained by different underlying disease patterns and by different prescribing traditions in the different settings.

  • 8. Jokanovic, Natali
    et al.
    Kautiainen, Hannu
    Bell, J. Simon
    Tan, Edwin C. K.
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI). Monash University, Australia; The University of Sydney, Australia.
    Pitkala, Kaisu H.
    Change in Prescribing forSecondary Prevention of Stroke and Coronary Heart Disease in Finnish Nursing Homes and Assisted Living Facilities2019In: Drugs & Aging, ISSN 1170-229X, E-ISSN 1179-1969, Vol. 36, no 6, p. 571-579Article in journal (Refereed)
    Abstract [en]

    Background

    One quarter of residents in long-term care facilities (LTCFs) have a diagnosis of CHD or stroke and over half use at least one preventative cardiovascular medication. There have been no studies that have investigated the longitudinal change in secondary preventative cardiovascular medication use in residents in LTCFs over time.

    Objective

    The aim of this study was to investigate the change in cardiovascular medication use among residents with coronary heart disease (CHD) and prior stroke in nursing homes (NHs) and assisted living facilities (ALFs) in Finland over time, and whether this change differs according to dementia status.

    Methods

    Three comparable cross-sectional audits of cardiovascular medication use among residents aged 65years and over with CHD or prior stroke in NHs in 2003 and 2011 and ALFs in 2007 and 2011 were compared. Logistic regression analyses adjusted for gender, age, mobility, cancer and length of stay were performed to examine the effect of study year, dementia and their interaction on medication use.

    Results

    Cardiovascular medication use among residents with CHD (NHs: 89% vs 70%; ALFs: 89% vs 84%) and antithrombotic medication use among residents with stroke (NHs: 72% vs 63%; ALFs: 78% vs 69%) declined between 2003 and 2011 in NHs and 2007 and 2011 in ALFs. Decline in the use of diuretics, nitrates and digoxin were found in both groups and settings. Cardiovascular medication use among residents with CHD and dementia declined in NHs (88% [95% CI 85-91] in 2003 vs 70% [95% CI 64-75] in 2011) whereas there was no change among people without dementia. There was no change in cardiovascular medication use among residents with CHD in ALFs with or without dementia over time. Antithrombotic use was lower in residents with dementia compared with residents without dementia in NHs (p<0.001) and ALFs (p=0.026); however, the interaction between dementia diagnosis and time was non-significant.

    Conclusions

    The decline in cardiovascular medication use in residents with CHD and dementia suggests Finnish physicians are adopting a more conservative approach to the management of cardiovascular disease in the NH population.

  • 9. Rea, Federico
    et al.
    Calusi, Giulia
    Franchi, Matteo
    Vetrano, Davide Liborio
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI). Catholic University of Rome, Italy.
    Roberto, Giuseppe
    Bonassi, Stefano
    Kirchmayer, Ursula
    Chinellato, Alessandro
    Bettiol, Alessandra
    Sultana, Janet
    Mugelli, Alessandro
    Corrao, Giovanni
    Adherence of Elderly Patients with Cardiovascular Disease to Statins and the Risk of Exacerbation of Chronic Obstructive Pulmonary Disease: Evidence from an Italian Real-World Investigation2018In: Drugs & Aging, ISSN 1170-229X, E-ISSN 1179-1969, Vol. 35, no 12, p. 1099-1108Article in journal (Refereed)
    Abstract [en]

    Objective The objective of this study was to investigate the relationship between adherence to statin therapy and the risk of exacerbation among elderly individuals affected by chronic obstructive pulmonary disease and cardiovascular disease.

    Methods Using the healthcare utilisation databases of five Italian territorial units accounting for nearly 35% of the Italian population, we recruited a cohort of 6263 elderly persons (i.e. aged 65 years or older) with co-existing chronic obstructive pulmonary disease and cardiovascular disease who initiated statin therapy. Exposure was adherence to statins measured by the proportion of days of follow-up covered. Outcome was the first hospital admission for chronic obstructive pulmonary disease occurring in the period of observation. A proportional hazards model was used to estimate the hazard ratio and 95% confidence intervals for the exposure-outcome association, after adjusting for several covariates. A set of sensitivity analyses was performed to account for sources of systematic uncertainty.

    Results During an average follow-up of about 4 years, 1307 cohort members experienced the outcome. Compared with patients with low adherence (proportion of days of follow-up covered <= 40%), those with intermediate (proportion of days of follow-up covered 41-80%) and high (proportion of days of follow-up covered >80%) adherence exhibited a lower risk of exacerbation of 16% (95% confidence interval 3-27) and 23% (95% confidence interval 10-34).

    Conclusions In a real-world setting, we observed evidence that adherence to statin therapy markedly reduced the risk of chronic obstructive pulmonary disease exacerbations in elderly patients with co-existing chronic obstructive pulmonary disease and cardiovascular disease. Given the limited and controversial evidence from trials, more randomised controlled trials are urgently needed to better examine the potential benefits of statins as adjunct therapy in chronic obstructive pulmonary disease.

  • 10.
    Sköldunger, Anders
    et al.
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Fastbom, Johan
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI). Stockholm Gerontology Research Center, Sweden.
    Wimo, Anders
    Fratiglioni, Laura
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI). Stockholm Gerontology Research Center, Sweden.
    Johnell, Kristina
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI). Stockholm Gerontology Research Center, Sweden.
    Impact of Inappropriate Drug Use on Hospitalizations, Mortality, and Costs in Older Persons and Persons with Dementia: Findings from the SNAC Study2015In: Drugs & Aging, ISSN 1170-229X, E-ISSN 1179-1969, Vol. 32, no 8, p. 671-678Article in journal (Refereed)
    Abstract [en]

    Background: Inappropriate drug use (IDU) is an important risk factor for adverse outcomes in older persons. We aimed to investigate IDU and the risk of hospitalizations and mortality in older persons and in persons with dementia and to estimate the costs of IDU-related hospitalizations.

    Methods: We analyzed 4108 individuals aged a parts per thousand yen60 years from the Swedish National Study on Aging and Care (SNAC) data from Kungsholmen and Nordanstig (2001-2004). IDU was assessed by indicators developed by the Swedish National Board of Health and Welfare. Hospitalizations and mortality data were collected from Swedish registers. Regression models were used to investigate associations between IDU, hospitalizations, and mortality in the whole population and in the subpopulation of persons with dementia (n = 319), after adjustment for sociodemographics, physical functioning, and co-morbidity. Costs for hospitalizations were derived from the Nord-Diagnose Related Group cost database. Results IDU was associated with a higher risk of hospitalization [adjusted odds ratio (OR) = 1.46; 95 % confidence interval (CI) 1.18-1.81] and mortality [adjusted hazard ratio (HR) = 1.15; 95 % CI 1.01-1.31] within 1 year in the whole study population and with hospitalization (adjusted OR = 1.88; 95 % CI 1.03-3.43) in the subpopulation of persons with dementia, after adjustment for confounding factors. There was also a tendency for higher costs for hospitalizations with IDU than without IDU, although this was not statistically significant.

    Conclusions: Our findings suggest that IDU is associated with an increased risk of hospitalization in older persons and in persons with dementia. IDU is also associated with mortality among older persons. These findings highlight the need for cautious prescribing of long-acting benzodiazepines, anticholinergic drugs, concurrent use of three or more psychotropic drugs and drug combinations that may lead to serious drug-drug interactions to older patients. Further studies are needed to investigate the association between IDU and costs for hospitalizations.

  • 11. Tannenbaum, Cara
    et al.
    Johnell, Kristina
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Managing Therapeutic Competition in Patients with Heart Failure, Lower Urinary Tract Symptoms and Incontinence2014In: Drugs & Aging, ISSN 1170-229X, E-ISSN 1179-1969, Vol. 31, no 2, p. 93-101Article in journal (Refereed)
    Abstract [en]

    Up to 50 % of heart failure patients suffer from lower urinary tract symptoms. Urinary incontinence has been associated with worse functional status in patients with heart failure, occurring three times more frequently in patients with New York Heart Association Class III and IV symptoms compared with those with milder disease. The association between heart failure and urinary symptoms may be directly attributable to worsening heart failure pathophysiology; however, medications used to treat heart failure may also indirectly provoke or exacerbate urinary symptoms. This type of drug-disease interaction, in which the treatment for heart failure precipitates incontinence, and removal of medications to relieve incontinence worsens heart failure, can be termed therapeutic competition. The mechanisms by which heart failure medication such as diuretics, angiotensin-converting enzyme (ACE) inhibitors and beta-blockers aggravate lower urinary tract symptoms are discussed. Initiation of a prescribing cascade, whereby antimuscarinic agents or beta 3-agonists are added to treat symptoms of urinary urgency and incontinence, is best avoided. Recommendations and practical tips are provided that outline more judicious management of heart failure patients with lower urinary tract symptoms. Compelling strategies to improve urinary outcomes include titrating diuretics, switching ACE inhibitors, treating lower urinary tract infections, appropriate fluid management, daily weighing, and uptake of pelvic floor muscle exercises.

  • 12. Wimmer, Barbara Caecilia
    et al.
    Dent, Elsa
    Visvanathan, Renuka
    Wiese, Michael David
    Johnell, Kristina
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Chapman, Ian
    Bell, J. Simon
    Polypharmacy and Medication Regimen Complexity as Factors Associated with Hospital Discharge Destination Among Older People: A Prospective Cohort Study2014In: Drugs & Aging, ISSN 1170-229X, E-ISSN 1179-1969, Vol. 31, no 8, p. 623-630Article in journal (Refereed)
    Abstract [en]

    Background Older people often take multiple medications. It is a policy priority to facilitate older people to stay at home longer. Three-quarters of nursing home placements in the US are preceded by a hospitalization. Objective To investigate the association between polypharmacy and medication regimen complexity with hospital discharge destination among older people. Methods This prospective cohort study comprised patients aged >= 70 years consecutively admitted to the Geriatric Evaluation and Management unit at a tertiary hospital in Adelaide, Australia, between October 2010 and December 2011. Medication regimen complexity at discharge was calculated using the 65-item validated Medication Regimen Complexity Index (MRCI). Unadjusted and adjusted relative risks (RRs) with 95 % confidence intervals (CIs) were calculated for medication-related factors associated with discharge directly to home versus non-community settings (rehabilitation, transition care, and residential aged care). Results From 163 eligible patients, 87 were discharged directly to home (mean age 84.6 years, standard deviation [SD] 6.9; mean MRCI 26.1, SD 9.7), while 76 were discharged to non-community settings (mean age 85.8 years, SD 5.8; mean MRCI 29.9, SD 13.2). After adjusting for age, sex, comorbidity, and activities of daily living, having a high medication regimen complexity (MRCI > 35) was inversely associated with discharge directly to home (RR 0.39; 95 % CI 0.20-0.73), whereas polypharmacy (>= 9 medications) was not significantly associated with discharge directly to home (RR 0.97; 95 % CI 0.53-1.58). Conclusion Having high medication regimen complexity was inversely associated with discharge directly to home, while polypharmacy was not associated with discharge destination.

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