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  • 1. Elyn, Antoine
    et al.
    Sourdet, Sandrine
    Morin, Lucas
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Nourhashemi, Fati
    Saffon, Nicolas
    Barreto, Philipe de Souto
    Rolland, Yves
    End of life care practice and symptom management outcomes of nursing home residents with dementia: secondary analyses of IQUARE trial2019In: European Geriatric Medicine, ISSN 1878-7649, E-ISSN 1878-7657, Vol. 10, no 6, p. 947-955Article in journal (Refereed)
    Abstract [en]

    Purpose End-of-life care is a central issue in nursing homes. Poor care outcomes have been reported, especially among residents with dementia. Our aim was two-fold: to assess whether the diagnosis of dementia was associated with specific patterns of care and symptom management for residents with dementia during the last 6 months of life, and to compare these patterns of care between residents with dementia who died within 6 months and those who survived longer. Methods Secondary prospective analyses of the IQUARE trial (trial registration number NCT01703689). 175 nursing homes in South West France. Residents with and without dementia at baseline (May-June 2011), stratified according to their vital status at 6-month follow-up. Results Of 6275 residents enrolled in IQUARE study (including 2688 with dementia), 494 (7.9%) died within 6 months. Compared to residents without dementia (n = 254), those with dementia (n = 240) were less likely to be self-sufficient (OR = 0.08, 95% CI 0.01-0.64). They were more likely to have physical restraints (OR = 1.65, 95% CI 1.08-2.51) and less likely to be prescribed benzodiazepines (OR = 0.58, 95% CI 0.38-0.88). Among residents with dementia, those who died during the first 6 months of follow-up were more likely to be identified with a formal end-of-life status (OR = 5.71, 95% CI 3.48-9.37) although such identification remains low with only 15% of them. They were more likely to experience pain (OR = 1.43, 95% CI 1.04-1.97) and to be physically restrained (OR = 1.46, 95% CI 1.08-1.98). However, pain relief and psychological distress management were not improved. Conclusions Poor quality indicators such as physical restraints are associated with end-of-life care for residents with dementia. Among symptom management outcomes, pain medication remains low even if pain complaint increased at life end.

  • 2. Palmer, Katie
    et al.
    Villani, Emanuele R.
    Vetrano, Davide L.
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI). Università Cattolica del Sacro Cuore, Italy.
    Cherubini, Antonio
    Cruz-Jentoft, Alfonso J.
    Curtin, Denis
    Denkinger, Michael
    Gutierrez-Valencia, Marta
    Guðmundsson, Adalsteinn
    Knol, Wilma
    Mak, Diane V.
    O'Mahony, Denis
    Pazan, Farhad
    Petrovic, Mirko
    Rajkumar, Chakravarthi
    Topinkova, Eva
    Trevisan, Catarina
    van der Cammen, Tischa J. M.
    van Marum, Rob J.
    Wehling, Martin
    Ziere, Gijsbertus
    Bernabei, Roberto
    Onder, Graziano
    Bakken, Marit
    Baeyens, Jean-Pierre
    Benetos, Athanase
    Crome, Peter
    Fruhwald, Tomas
    Gallagher, Paul
    Jackson, Stephen
    Jansen, Paul
    Knol, Wilma
    O'Neill, Desmond
    Pilotto, Alberto
    Ronnemaa, Elina
    Rosholm, Jens-Ulrik
    Serra, Jose Antonio
    Soulis, George
    van der Velde, Nathalie
    Association of polypharmacy and hyperpolypharmacy with frailty states: a systematic review and meta-analysis2019In: European Geriatric Medicine, ISSN 1878-7649, E-ISSN 1878-7657, Vol. 10, no 1, p. 9-36Article, review/survey (Refereed)
    Abstract [en]

    Purpose: To investigate: (1) the cross-sectional association between polypharmacy, hyperpolypharmacy and presence of prefrailty or frailty; (2) the risk of incident prefrailty or frailty in persons with polypharmacy, and vice versa.

    Methods: A systematic review and meta-analysis was performed according to PRISMA guidelines. We searched PubMed, Web of Science, and Embase from 01/01/1998 to 5/2/2018. Pooled estimates were obtained through random effect models and Mantel-Haenszel weighting. Homogeneity was assessed with the I-2 statistic and publication bias with Egger's and Begg's tests.

    Results: Thirty-seven studies were included. The pooled proportion of polypharmacy in persons with prefrailty and frailty was 47% (95% CI 33-61) and 59% (95% CI 42-76), respectively. Increased odds ratio of polypharmacy were seen for prefrail (pooled OR=1.52; 95% CI 1.32-1.79) and frail persons (pooled OR=2.62, 95% CI 1.81-3.79). Hyperpolypharmacy was also increased in prefrail (OR=1.95; 95% CI 1.41-2.70) and frail (OR=6.57; 95% CI 9.57-10.48) persons compared to robust persons. Only seven longitudinal studies reported data on the risk of either incident prefrailty or frailty in persons with baseline polypharmacy. A significant higher odds of developing prefrailty was found in robust persons with polypharmacy (pooled OR=1.30; 95% CI 1.12-1.51). We found no papers investigating polypharmacy incidence in persons with prefrailty/frailty.

    Conclusions: Polypharmacy is common in prefrail and frail persons, and these individuals are also more likely to be on extreme drug regimens, i.e. hyperpolypharmacy, than robust older persons. More research is needed to investigate the causal relationship between polypharmacy and frailty syndromes, thereby identifying ways to jointly reduce drug burden and prefrailty/frailty in these individuals.

  • 3. Pentikäinen, H.
    et al.
    Savonen, K.
    Komulainen, P.
    Kiviniemi, V.
    Paajanen, T.
    Kivipelto, M.
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI). Karolinska Institutet, Sweden; University of Eastern Finland, Finland; National institute for health and welfare, Finland.
    Soininen, H.
    Rauramaa, R.
    Muscle strength and cognition in ageing men and women: The DR's EXTRA study2017In: European Geriatric Medicine, ISSN 1878-7649, E-ISSN 1878-7657, Vol. 8, no 3, p. 275-277Article in journal (Refereed)
  • 4. Roux, Barbara
    et al.
    Morin, Lucas
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Papon, Arnaud
    Laroche, Marie-Laure
    Prescription and deprescription of medications for older adults receiving palliative care during the last 3months of life: a single-center retrospective cohort study2019In: European Geriatric Medicine, ISSN 1878-7649, E-ISSN 1878-7657, Vol. 10, no 3, p. 463-471Article in journal (Refereed)
    Abstract [en]

    Purpose

    Near the end of life, drugs to ensure comfort and improve quality of life should be prioritized, and unnecessary drugs should be avoided. The aim was to assess the evolution and quality of drug therapy throughout the last 3 months of life of older adults in need of palliative care.

    Methods

    A single-center retrospective cohort study included older adults (65years) who died in a teaching hospital between 1 January 2014 and 30 June 2014 and had been identified as patients in need of palliative care in their last 3 months of life. Drugs were collected from electronic medical records and defined as unnecessary' or essential' based on a review of the literature.

    Results

    A total of 149 patients were included [age: 82.1 (SD 8.6)years, women: 46.3%]. The mean number of medications varied from 6.7 (SD 3.3) drugs 90 days before death, to 7.5 (SD 4.1) 7 days before death, to 5.6 (SD 3.6) on the day of death. During the final week of life, one additional prescription of essential drugs was observed for 75.2% of patients and 79.3% of patients had at least one unnecessary drug deprescribed. The most prescribed and deprescribed drug classes were, respectively, analgesics (56.4%) and antithrombotic agents (38.2%) during the last week of life.

    Conclusions

    Near the end of life, medication therapy is adapted to the goals of palliative care. However, this only occurs during the last week of life. Earlier transition to palliative care is necessary to avoid exposure to unnecessary drugs.

  • 5. Strandberg, T. E.
    et al.
    Levälahti, E.
    Ngandu, T.
    Solomon, A.
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI). Karolinska Institutet, Sweden; University of Eastern Finland, Finland.
    Kivipelto, M.
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI). Karolinska Institutet, Sweden; National Institute for Health and Welfare, Finland; University of Eastern Finland, Finland.
    Health-related quality of life in a multidomain intervention trial to prevent cognitive decline (FINGER)2017In: European Geriatric Medicine, ISSN 1878-7649, E-ISSN 1878-7657, Vol. 8, no 2, p. 164-167Article in journal (Refereed)
    Abstract [en]

    Introduction: The Finnish Geriatric Intervention Study to Prevent Cognitive Impairment and Disability (FINGER) successfully demonstrated that multidomain lifestyle intervention can improve or maintain cognitive functioning in at-risk individuals. Health-related quality of life (HRQoL) was a secondary endpoint. Methods: The intervention (n = 631) aimed at healthy diet, increased physical activity, cognitive training, and vascular risk management. The control group (n = 629) was given general health advice. HRQoL was assessed at baseline, 12, and 24 months using validated RAND-36 (SF-36) instrument with 8 scales. Results: During the 2-year intervention period, mean scores in all scales decreased in the control group, but increased in the intervention group for vitality (12 months), social function (12 months), and especially general health at both 12 and 24 months. There was a statistically significant beneficial effect of intervention on the change in general health and physical function at 12 and 24 months. Conclusion: Multidomain lifestyle intervention improved also important dimensions of HRQoL.

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