Change search
Refine search result
1 - 26 of 26
CiteExportLink to result list
Permanent link
Cite
Citation style
  • apa
  • ieee
  • modern-language-association-8th-edition
  • vancouver
  • Other style
More styles
Language
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Other locale
More languages
Output format
  • html
  • text
  • asciidoc
  • rtf
Rows per page
  • 5
  • 10
  • 20
  • 50
  • 100
  • 250
Sort
  • Standard (Relevance)
  • Author A-Ö
  • Author Ö-A
  • Title A-Ö
  • Title Ö-A
  • Publication type A-Ö
  • Publication type Ö-A
  • Issued (Oldest first)
  • Issued (Newest first)
  • Created (Oldest first)
  • Created (Newest first)
  • Last updated (Oldest first)
  • Last updated (Newest first)
  • Disputation date (earliest first)
  • Disputation date (latest first)
  • Standard (Relevance)
  • Author A-Ö
  • Author Ö-A
  • Title A-Ö
  • Title Ö-A
  • Publication type A-Ö
  • Publication type Ö-A
  • Issued (Oldest first)
  • Issued (Newest first)
  • Created (Oldest first)
  • Created (Newest first)
  • Last updated (Oldest first)
  • Last updated (Newest first)
  • Disputation date (earliest first)
  • Disputation date (latest first)
Select
The maximal number of hits you can export is 250. When you want to export more records please use the Create feeds function.
  • 1. Cermakova, Pavla
    et al.
    Szummer, Karolina
    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).
    Winblad, Bengt
    Eriksdotter, Maria
    Religa, Dorota
    Management of Acute Myocardial Infarction in Patients With Dementia: Data From SveDem, the Swedish Dementia Registry2017In: Journal of the American Medical Directors Association, ISSN 1525-8610, E-ISSN 1538-9375, Vol. 18, no 1, p. 19-23Article in journal (Refereed)
    Abstract [en]

    Objectives: We aimed to (1) study factors that determine the use of invasive procedures in the management of acute myocardial infarction (AMI) in patients with dementia and (2) determine whether the use of invasive procedures was associated with their better survival. Design: Cohort study based on patients registered in the Swedish Dementia Registry (SveDem), 20072012. Median follow-up time was 228 days. Setting: Patients diagnosed with dementia in specialist memory clinics and primary care units in Sweden. Participants: A total of 525 patients with dementia who suffered AMI (mean age 89 years, 54% women). Measurements: Information on AMI and use of invasive procedures (coronary angiography and percutaneous coronary intervention) was obtained from Swedish national health registers. Binary logistic regression was applied to study associations of patients characteristics with the use of invasive procedures; odds ratios (ORs) with 95% confidence intervals (CIs) were calculated. Survival was analyzed with Kaplan-Meier curves; log-rank test was used to compare survival of patients who received an invasive procedure versus those who did not receive it. Cox regression was applied to study association of the invasive procedures with all-cause mortality; hazard ratios (HRs) with 95% CIs were calculated. Results: One hundred ten patients (21%) with dementia received an invasive procedure in the management of AMI. After multivariate adjustment, lower age and higher global cognitive status were associated with the use of invasive procedures. The invasively managed patients survived longer (P = .001). The use of invasive procedures was associated with a lower risk of all-cause mortality, adjusting for type of AMI and dementia disorder, age, gender, registration unit, history of AMI and comorbidity score (HR 0.35, 95% CI 0.21-0.59), or total number of drugs (HR 0.34, 95% CI 0.20-0.58). Conclusion: Age and cognitive status determine the use of invasive procedures in patients with dementia. This study suggests that the invasive management of AMI has a benefit for survival of patients with dementia. (C) 2016 AMDA - The Society for Post-Acute and Long-Term Care Medicine.

  • 2.
    Ek, Stina
    et al.
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Rizzuto, Debora
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Calderón-Larrañaga, Amaia
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Franzen, Erika
    Xu, Weili
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Welmer, Anna-Karin
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI). Karolinska Institutet, Sweden; Karolinska University Hospital, Sweden; Stockholm Gerontology Research Center, Sweden.
    Predicting First-Time Injurious Falls in Older Men and Women Living in the Community: Development of the First Injurious Fall Screening Tool2019In: Journal of the American Medical Directors Association, ISSN 1525-8610, E-ISSN 1538-9375, Vol. 20, no 9, p. 1163-+Article in journal (Refereed)
    Abstract [en]

    Objectives: The aim of this study was to create a screening tool to predict first-time injurious falls in community-living older men and women. Design: Longitudinal cohort study between 2001 and 2009. Setting: The Swedish National Study on Aging and Care in Kungsholmen (SNAC-K), Sweden. Participants: Community-living older adults (n = 2808; 1750 women and 1058 men) aged >= 60 years (mean age 73, standard deviation 10.3). Measurements: The outcome was injurious falls within 5 years from baseline survey. Data on the risk factors for falls were collected through interviews, clinical examinations, and tests at baseline. Several previously established fall risk factors were identified for the development of the screening tool. The tool was formulated based on the beta coefficients from sex-specific multivariate Cox proportional hazards models. The discriminative power was assessed using Harrell C statistic. Results: Old age, living alone, being dependent in instrumental activities of daily living, and impaired balance were the factors included in the final score of the First Injurious Fall (FIF) screening tool. The predictive values (Harrell C statistic) for the scores were 0.75 for women and 0.77 for men. The sensitivity and specificity at the Youden cut-off points were 0.69 and 0.70 for women, and 0.72 and 0.71 for men. Conclusions and Implications: The FIF screening tool for first injurious fall in older persons consists of 3 questions and a physical test (5-second 1-leg standing balance with eyes open). Quick and easy to administer, it could be ideal for use in primary care or public health to identify older men and women at high fall risk, who may benefit from primary preventive interventions.

  • 3. Garcia-Ptacek, Sara
    et al.
    Contreras Escamez, Beatriz
    Zupanic, Eva
    Religa, Dorota
    von Koch, Lena
    Johnell, Kristina
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    von Euler, Mia
    Kåreholt, Ingemar
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI). Jönköping University, Sweden.
    Eriksdotter, Maria
    Prestroke Mobility and Dementia as Predictors of Stroke Outcomes in Patients Over 65 Years of Age: A Cohort Study From The Swedish Dementia and Stroke Registries2018In: Journal of the American Medical Directors Association, ISSN 1525-8610, E-ISSN 1538-9375, Vol. 19, no 2, p. 154-161Article in journal (Refereed)
    Abstract [en]

    Objectives

    To explore the association between prestroke mobility dependency and dementia on functioning and mortality outcomes after stroke in patients>65 years of age.

    Design

    Longitudinal cohort study based on SveDem, the Swedish Dementia Registry and Riksstroke, the Swedish Stroke Registry.

    Participants

    A total of 1689 patients with dementia >65 years of age registered in SveDem and suffering a first stroke between 2007 and 2014 were matched with 7973 controls without dementia with stroke.

    Measurements

    Odds ratios (ORs) and 95% confidence intervals (CIs) for intrahospital mortality, and functioning and mortality outcomes at 3 months were calculated. Functioning included level of residential assistance (living at home without help, at home with help, or nursing home) and mobility dependency (independent, needing help to move outdoors, or needing help indoors and outdoors).

    Results

    Prestroke dependency in activities of daily living and mobility were worse in patients with dementia than controls without dementia. In unadjusted analyses, patients with dementia were more often discharged to nursing homes (51% vs 20%; P < .001). Mortality at 3 months was higher in patients with dementia (31% vs 23% P < .001) and fewer were living at home without help (21% vs 55%; P < .001). In adjusted analyses, prestroke dementia was associated with higher risk of 3-month mortality (OR 1.34; 95% CI 1.18–1.52), requiring a higher level of residential assistance (OR 4.07; 3.49–.75) and suffering from more dependency in relation to mobility (OR 2.57; 2.20–3.02). Patients with dementia who were independent for mobility prestroke were more likely to be discharged to a nursing home compared with patients without dementia with the same prestroke mobility (37% vs 16%; P < .001), but there were no differences in discharge to geriatric rehabilitation (19% for both; P = .976). Patients, who moved independently before stroke, were more often discharged home (60% vs 28%) and had lower mortality. In adjusted analyses, prestroke mobility limitations were associated with higher odds for poorer mobility, needing more residential assistance, and death.

    Conclusions

    Patients with mobility impairments and/or dementia present a high burden of disability after a stroke. There is a need for research on stroke interventions among these populations.

  • 4. Garcia-Ptacek, Sara
    et al.
    Kåreholt, Ingemar
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI). Jönkoping University, Sweden.
    Farahmand, Bahman
    Cuadrado, Maria Luz
    Religa, Dorota
    Eriksdotter, Maria
    Dementia and Obesity Paradox: Reply to the Letter by Dr Moga et al.2015In: Journal of the American Medical Directors Association, ISSN 1525-8610, E-ISSN 1538-9375, Vol. 16, no 1, p. 79-81Article in journal (Refereed)
  • 5. Garcia-Ptacek, Sara
    et al.
    Kåreholt, Ingemar
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI). Jönköping University, Sweden.
    Farahmand, Bahman
    Luz Cuadrado, Maria
    Religa, Dorota
    Eriksdotter, Maria
    Body-Mass Index and Mortality in Incident Dementia: A Cohort Study on 11,398 Patients From SveDem, the Swedish Dementia Registry2014In: Journal of the American Medical Directors Association, ISSN 1525-8610, E-ISSN 1538-9375, Vol. 15, no 6, p. 447.e1-Article in journal (Refereed)
    Abstract [en]

    Background: Body mass index (BMI) is used worldwide as an indirect measure of nutritional status and has been shown to be associated with mortality. Controversy exists over the cut points associated with lowest mortality, particularly in older populations. In patients suffering from dementia, information on BMI and mortality could improve decisions about patient care. Objectives: The objective was to explore the association between BMI and mortality risk in an incident dementia cohort. Design: Cohort study based on SveDem, the Swedish Quality Dementia Registry; 2008-2011. Setting: Specialist memory clinics, Sweden. Participants: A total of 11,398 patients with incident dementia with data on BMI (28,190 person-years at risk for death). Main outcome measures: Hazard ratios and 95% confidence intervals for mortality associated with BMI were calculated, controlling for age, sex, dementia type, results from Mini-Mental State Examination, and number of medications. BMI categories and linear splines were used. Results: Higher BMI was associated with decreased mortality risk, with all higher BMI categories showing reduced risk relative to patients with BMI of 18.5 to 22.9 kg/m(2), whereas underweight patients (BMI <18.5 kg/m(2)) displayed excess risk. When explored as splines, increasing BMI was associated with decreased mortality risk up to BMI of 30.0 kg/m(2). Each point increase in BMI resulted in an 11% mortality risk reduction in patients with BMI less than 22.0 kg/m(2), 5% reduction when BMI was 22.0 to 24.9 kg/m(2), and 3% risk reduction among overweight patients. Results were not significant in the obese weight range. Separate examination by sex revealed a reduction in mortality with increased BMI up to BMI 29.9 kg/m(2) for men and 24.9 kg/m(2) for women. Conclusion: Higher BMI at the time of dementia diagnosis was associated with a reduction in mortality risk up to and including the overweight category for the whole cohort and for men, and up to the normal weight category for women.

  • 6.
    Haaksma, Miriam L.
    et al.
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI). Radboud University Medical Center, the Netherlands.
    Rizzuto, Debora
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Leoutsakos, Jeannie-Marie S.
    Marengoni, Alessandra
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI). University of Brescia, Italy.
    Tan, Edwin C. K.
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI). Monash University, Australia.
    Rikkert, Marcel G. M. Olde
    Fratiglioni, Laura
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Melis, René J. F.
    Calderón-Larrañaga, Amaia
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Predicting Cognitive and Functional Trajectories in People With Late-Onset Dementia: 2 Population-Based Studies2019In: Journal of the American Medical Directors Association, ISSN 1525-8610, E-ISSN 1538-9375, Vol. 20, no 11, p. 1444-1450Article in journal (Refereed)
    Abstract [en]

    Objectives: Previous studies have shown large heterogeneity in the progression of dementia, both within and between patients. This heterogeneity offers an opportunity to limit the global and individual burden of dementia through the identification of factors associated with slow disease progression in dementia. We explored the heterogeneity in dementia progression to detect disease, patient, and social context factors related to slow progression. Design: Two longitudinal population-based cohort studies with follow-up across 12 years. Setting and Participants: 512 people with incident dementia from Stockholm (Sweden) contributed to the Kungsholmen Project and the Swedish National Study of Aging and Care in Kungsholmen. Methods: We measured cognition using the Mini-Mental State Examination and daily functioning using the Katz Activities of Daily Living Scale. Latent classes of trajectories were identified using a bivariate growth mixture model. We then used bias-corrected logistic regression to identify predictors of slower progression. Results: Two distinct groups of progression were identified; 76% (n = 394) of the people with dementia exhibited relatively slow progression on both cognition and daily functioning, whereas 24% (n = 118) demonstrated more rapid worsening on both outcomes. Predictors of slower disease progression were Alzheimer's disease (AD) dementia type [odds ratio (OR) 2.07, 95% confidence interval (CI) 1.15-3.71], lower age (OR 0.88, 95% CI 0.83-0.94), fewer comorbidities (OR 0.77, 95% CI 0.66-0.90), and a stronger social network (OR 1.72, 95% CI 1.01-2.93). Conclusions/Implications: Lower age, AD dementia type, fewer comorbidities, and a good social network appear to be associated with slow cognitive and functional decline. These factors may help to improve the counseling of patients and caregivers and to optimize the planning of care in dementia.

  • 7.
    Haaksma, Miriam L.
    et al.
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI). Radboud university medical center, The Netherlands.
    Rizzuto, Debora
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Ramakers, Inez H. G. B.
    Garcia-Ptacek, Sara
    Marengoni, Alessandra
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI). University of Brescia, Italy.
    van der Flier, Wiesje M.
    Verhey, Frans R. J.
    Rikkert, Marcel G. M. Olde
    Melis, René J. F.
    The Impact of Frailty and Comorbidity on Institutionalization and Mortality in Persons With Dementia: A Prospective Cohort Study2019In: Journal of the American Medical Directors Association, ISSN 1525-8610, E-ISSN 1538-9375, Vol. 20, no 2, p. 165-170Article in journal (Refereed)
    Abstract [en]

    Objectives: The predictive value of frailty and comorbidity, in addition to more readily available information, is not widely studied. We determined the incremental predictive value of frailty and comorbidity for mortality and institutionalization across both short and long prediction periods in persons with dementia.

    Design: Longitudinal clinical cohort study with a follow-up of institutionalization and mortality occurrence across 7 years after baseline.

    Setting and Participants: 331 newly diagnosed dementia patients, originating from 3 Alzheimer centers (Amsterdam, Maastricht, and Nijmegen) in the Netherlands, contributed to the Clinical Course of Cognition and Comorbidity (4C) Study.

    Measures: We measured comorbidity burden using the Cumulative Illness Rating Scale for Geriatrics (CIRS-G) and constructed a Frailty Index (FI) based on 35 items. Time-to-death and time-to-institutionalization from dementia diagnosis onward were verified through linkage to the Dutch population registry.

    Results: After 7 years, 131 patients were institutionalized and 160 patients had died. Compared with a previously developed prediction model for survival in dementia, our Cox regression model showed a significant improvement in model concordance (U) after the addition of baseline CIRS-G or FI when examining mortality across 3 years (FI: U = 0.178, P = .005, CIRS-G: U = 0.180, P = .012), but not for mortality across 6 years (FI: U = 0.068, P = .176, CIRS-G: U = 0.084, P = .119). In a competing risk regression model for time-to-institutionalization, baseline CIRS-G and FI did not improve the prediction across any of the periods.

    Conclusions: Characteristics such as frailty and comorbidity change over time and therefore their predictive value is likely maximized in the short term. These results call for a shift in our approach to prognostic modeling for chronic diseases, focusing on yearly predictions rather than a single prediction across multiple years. Our findings underline the importance of considering possible fluctuations in predictors over time by performing regular longitudinal assessments in future studies as well as in clinical practice.

  • 8.
    Heiland, Emerald G.
    et al.
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Welmer, Anna-Karin
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI). Stockholm Gerontology Research Center, Sweden; Karolinska University Hospital, Sweden.
    Wang, Rui
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Santoni, Giola
    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). Stockholm Gerontology Research Center, Sweden.
    Qiu, Chengxuan
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Cardiovascular Risk Factors and the Risk of Disability in Older Adults: Variation by Age and Functional Status2019In: Journal of the American Medical Directors Association, ISSN 1525-8610, E-ISSN 1538-9375, Vol. 20, no 2, p. 208-212Article in journal (Refereed)
    Abstract [en]

    Objectives: We aimed to quantify the increased risk of disability associated with cardiovascular risk factors among older adults, and to verify whether this risk may vary by age and functional status.

    Design: Longitudinal population-based cohort study.

    Setting: Urban area of Stockholm, Sweden.

    Participants: Community-dwelling and institutionalized adults >= 60 years in the Swedish National study on Aging and Care in Kungsholmen free of cardiovascular diseases and disability (n = 1756) at baseline (2001-2004).

    Measures: Incident disability in activities of daily living (ADL) was ascertained over 9 years. Cardiovascular risk factors (physical inactivity, alcohol consumption, smoking, high blood pressure, diabetes, high body mass index, high levels of total cholesterol, and high C-reactive protein) and walking speed were assessed at baseline. Data were analyzed using Cox proportional hazards models, stratifying by younger-old (age 60-72 years) and older-old (>= 78 years).

    Results: During the follow-up, 23 and 148 persons developed ADL-disability among the younger-and older-old, respectively. In the younger-old, the adjusted hazard ratio (HR) of developing ADL-disability was 4.10 (95% confidence interval [CI] 1.22-13.76) for physical inactivity and 5.61 (95% CI 1.17-26.82) for diabetes. In the older-old, physical inactivity was associated with incident ADL-disability (HR 1.99, 95% CI 1.36-2.93), and there was a significant interaction between physical inactivity and walking speed limitation (<0.8 m/s), showing a 6-fold higher risk of ADL-disability in those who were both physically inactive and had walking speed limitation than being active with no limitation, accounting for a population-attributable risk of 42.7%.

    Conclusions/Implications: Interventions targeting cardiovascular risk factors may be more important for the younger-old in decreasing the risk of disability, whereas improving physical function and maintaining physical activity may be more beneficial for the older-old.

  • 9. Lalic, Samanta
    et al.
    Sluggett, Janet K.
    Ilomäki, Jenni
    Wimmer, Barbara C.
    Tan, Edwin C. K.
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI). Monash University, Australia.
    Robson, Leonie
    Emery, Tina
    Bell, J. Simon
    Polypharmacy and Medication Regimen Complexity as Risk Factors for Hospitalization Among Residents of Long-Term Care Facilities: A Prospective Cohort Study2016In: Journal of the American Medical Directors Association, ISSN 1525-8610, E-ISSN 1538-9375, Vol. 17, no 11, p. 1067.e1-1067.e6Article in journal (Refereed)
    Abstract [en]

    Objectives: To investigate the association between polypharmacy and medication regimen complexity with time to first hospitalization, number of hospitalizations, and number of hospital days over a 12-month period. Design: A 12-month prospective cohort study. Participants and Setting: A total of 383 residents of 6 Australian long-term care facilities (LTCFs). Measurements: The primary exposures were polypharmacy (>= 9 regular medications) and the 65-item Medication Regimen Complexity Index (MRCI). Cox proportional hazards regression was used to compute hazard ratios (HRs) and 95% confidence intervals (CIs) for the association between polypharmacy and MRCI with time to first hospitalization. Poisson regression was used to compute incident rate ratios (IRR) and 95% CIs for the association between polypharmacy and MRCI with number of hospitalizations and number of hospital days. Models were adjusted for age, sex, length of stay in LTCF, comorbidities, activities of daily living, and dementia severity. Results: There were 0.56 (95% CI 0.49-0.65) hospitalizations per person-year and 4.52 (95% CI 4.31-4.76) hospital days per person-year. In adjusted analyses, polypharmacy was associated with time to first hospitalization (HR 1.84; 95% CI 1.21-2.79), number of hospitalizations (IRR 1.51; 95% CI 1.09-2.10), and hospital days per person-year (IRR 1.39; 95% CI 1.24-1.56). Similarly, in adjusted analyses a 10-unit increase in MRCI was associated with time to first hospitalization (HR 1.17; 95% CI 1.06-1.29), number of hospitalizations (IRR 1.15; 95% CI 1.06-1.24), and hospital days per person-year (IRR 1.19; 95% CI 1.16-1.23). Conclusions: Polypharmacy and medication regimen complexity are associated with hospitalizations from LTCFs. This highlights the importance of regular medication review for residents of LTCFs and the need for further research into the risk-to-benefit ratio of prescribing in this setting.

  • 10. Laudisio, Alice
    et al.
    Lo Monaco, Maria Rita
    Vetrano, Davide L.
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI). Catholic University of Medicine, Italy.
    Pisciotta, Maria Stella
    Brandi, Vincenzo
    Gemma, Antonella
    Fusco, Domenico
    Bernabei, Roberto
    Incalzi, Raffaele Antonelli
    Zuccala, Giuseppe
    Association of Pisa Syndrome With Mortality in Patients With Parkinson's Disease2019In: Journal of the American Medical Directors Association, ISSN 1525-8610, E-ISSN 1538-9375, Vol. 20, no 8, p. 1037-+Article in journal (Refereed)
    Abstract [en]

    Objectives: In Parkinson's disease, Pisa syndrom (PS) has been associated with disease stage and severity, combined treatment with levodopa and dopamine agonists, gait disorders, and comorbidities. Some forms of PS are potentially reversible; nevertheless, little is known about the impact of this syndrome on survival. Design: Prospective study with a median follow-up of 2 years. Setting and participants: Patients with Parkinson's disease, age 65 years and older (N = 189), attending a geriatric day hospital. Measurements: According to established criteria, PS was diagnosed in the presence of at least 10 degrees lateral flexion of the trunk reducible by passive mobilization or supine positioning. Cox regression was adopted to assess the association of PS with all-cause mortality. Results: PS was diagnosed in 40 patients (21%); over the follow-up, 21 (11%) subjects died. In Cox regression, PS was associated with higher mortality [hazard ratio (HR) 4.10; 95% confidence interval (CI) = 1.36-12.38], after adjusting; other variables associated with mortality were age (HR = 1.19, 95% CI = 1.08-1.32), beta blockers (HR = 4.35, 95% CI = 1.23-15.39), and albumin levels (HR = 0.05, 95% CI = 0.01-0.33). The association of PS with mortality remained significant also after adjusting for variables associated with this syndrome (HR = 4.04, 95% CI = 1.33-12.25). Conclusions/Implications: PS represents a risk factor for earlier mortality in Parkinson's disease; further studies are needed to ascertain the underlying causes and whether treatment of this condition might improve survival. (C) 2019 AMDA - The Society for Post-Acute and Long-Term Care Medicine.

  • 11. Lexomboon, Duangjai
    et al.
    Tan, Edwin C. K.
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI). Monash University, Australia.
    Höijer, Jonas
    Garcia-Ptacek, Sara
    Eriksdotter, Maria
    Religa, Dorota
    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).
    Sandborgh-Englund, Gunilla
    The Effect of Xerostomic Medication on Oral Health in Persons With Dementia2018In: Journal of the American Medical Directors Association, ISSN 1525-8610, E-ISSN 1538-9375, Vol. 19, no 12, p. 1080-1085Article in journal (Refereed)
    Abstract [en]

    Objectives: Medication-induced hyposalivation can increase the risk for oral complications, including dental caries and tooth loss. This problem is particularly important in people with dementia because of their declining ability to maintain oral care. The objective of this study was to describe the association between the number of xerostomic medications used and tooth loss and restorative and dental preventive treatment in a population of persons with dementia. Design: A longitudinal population-based register study with a 3-year follow-up was conducted. Data were extracted from the Swedish Dementia Registry (SveDem), the Swedish Prescribed Drug Register (SPDR), the Swedish National Patient Register (SNPR), and the Dental Health Register (DHR). Setting and participants: Participants were persons with dementia who were registered in the SveDem at the time of their dementia diagnosis. Measures: The exposure was continuous use of xerostomic medications over the 3 years prior to dementia diagnosis (baseline). The outcomes were the incidence of tooth extractions, tooth restorations, and dental preventive procedures. Poisson regression models were used to estimate incidence rate ratios (IRRs) for the association between the exposure and outcomes, adjusting for relevant confounders. Results: A total of 34,037 persons were included in the analysis. A dose-response relationship between the exposure and tooth extractions was observed. Compared with nonusers of xerostomic medication, the rate of tooth extractions increased with increasing number of xerostomic medications used (IRR = 1.03, 1.11, and 1.40 for persons using an average > 0-1, > 1-3, and > 3 xerostomic medications, respectively). However, the risk for having new dental restorations and receiving preventive procedures did not differ between groups. Conclusion: Continuous use of xerostomic medications can increase the risk for tooth extraction in people with dementia. This study highlights the importance of careful consideration when prescribing xerostomic medications to people with dementia, and the need for regular and ongoing dental care.

  • 12.
    Marengoni, Alessandra
    et al.
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI). University of Brescia, Italy.
    Rizzuto, Debora
    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). Stockholm Gerontology Research Center, Sweden.
    Antikainen, Riitta
    Laatikainen, Tiina
    Lehtisalo, Jenni
    Peltonen, Markku
    Soininen, Hilkka
    Strandberg, Timo
    Tuomilehto, Jaakko
    Kivipelto, Miia
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI). National Institute for Health and Welfare, Finland; University of Eastern Finland, Finland; Karolinska Institutet, Sweden; Stockholms Sjukhem, Sweden.
    Ngandu, Tiia
    The Effect of a 2-Year Intervention Consisting of Diet, Physical Exercise, Cognitive Training, and Monitoring of Vascular Risk on Chronic Morbidity-the FINGER Randomized Controlled Trial2018In: Journal of the American Medical Directors Association, ISSN 1525-8610, E-ISSN 1538-9375, Vol. 19, no 4, p. 355-360Article in journal (Refereed)
    Abstract [en]

    Objective: To verify whether a multidomain intervention lowers the risk of developing new chronic diseases in older adults. Methods: Multicenter, double-blind randomized controlled trial started in October 2009, with 2-year follow-up. A total of 1260 people aged 60 to 77 years were enrolled in the Finnish Geriatric Intervention Study to Prevent Cognitive Impairment and Disability (FINGER). Participants were randomly assigned in a 1:1 ratio to a 2-year multidomain intervention (n = 631) (nutritional guidance, exercise, cognitive training, and management of metabolic and vascular risk factors) or a control group (n = 629) (general health advice). Data on most common chronic diseases were collected by a physician at baseline and 2 years later. Results: At 2-year follow-up, the average number of new chronic diseases was 0.47 [standard deviation (SD) 0.7] in the intervention group and 0.58 (SD 0.8) in the control group (P < .01). The incidence rate per 100 person-years for developing 1+ new disease(s) was 17.4 [95% confidence interval (CI) = 15.1-20.1] in the intervention group and 20.5 (95% CI = 18.0-23.4) in the control group; for developing 2+ new diseases, 4.9 (95% CI = 3.7-6.4) and 6.1 (95% CI = 4.8-7.8); and for 3+ new diseases, 0.7 (95% CI = 0.4-1.5) and 1.8 (95% CI = 1.1-2.8), respectively. After adjustment for age, sex, education, current smoking, alcohol intake, and the number of chronic diseases at baseline, the intervention group had a hazard ratio ranging from 0.80 (0.66-0.98) for developing 1+ new chronic disease(s) to 0.38 (0.16-0.88) for developing 3+ new chronic diseases compared to the control group. Conclusions: Findings from this randomized controlled trial suggest that a multidomain intervention could reduce the risk of developing new chronic diseases in older people.

  • 13.
    Morin, Lucas
    et al.
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Laroche, Marie-Laure
    Texier, Geraldine
    Johnell, Kristina
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Prevalence of Potentially Inappropriate Medication Use in Older Adults Living in Nursing Homes: A Systematic Review2016In: Journal of the American Medical Directors Association, ISSN 1525-8610, E-ISSN 1538-9375, Vol. 17, no 9, p. 862.e1-862.e9Article, review/survey (Refereed)
    Abstract [en]

    Importance: As older adults living in nursing homes are at a high risk of adverse drug-related events, medications with a poor benefit/risk ratio or with a safer alternative should be avoided.

    Objectives: To systematically evaluate the prevalence of potentially inappropriate medication use in nursing home residents.

    Evidence review: We searched in PubMed and EMBASE databases (1990-2015) for studies reporting the prevalence of potentially inappropriate medication use in people >= 60 years of age living in nursing homes. The risk of bias was assessed with an adapted version of the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) checklist.

    Findings: A total of 91 articles were assessed for eligibility, and 48 met our inclusion criteria. These articles reported the findings from 43 distinct studies, of which 26 presented point prevalence estimates of potentially inappropriate medication use (227,534 nursing home residents). The overall weighted point prevalence of potentially inappropriate medication use in nursing homes was 43.2% [95% confidence interval (CI) 37.3%-49.1%], increasing from 30.3% in studies conducted during 1990-1999 to 49.8% in studies conducted after 2005 (P<.001). Point prevalence estimates reported in European countries were found to be higher (49.0%, 95% CI 42.5-55.5) than those reported in North America (26.8%, 95% CI 16.5-37.1) or in other countries (29.8%, 95% CI 19.3-40.3). In addition, 18 studies accounting for 326,562 nursing home residents presented 20 distinct period prevalence estimates ranging from 2.3% to 50.3%. The total number of prescribed medications was consistently reported as the main driving factor for potentially inappropriate medications use.

    Conclusions and relevance: This systematic review shows that almost one-half of nursing home residents are exposed to potentially inappropriate medications and suggests an increase prevalence over time. Effective interventions to optimize drug prescribing in nursing home facilities are, therefore, needed. (C) 2016 AMDA - The Society for Post-Acute and Long-Term Care Medicine. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

  • 14.
    Morin, Lucas
    et al.
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Vetrano, Davide L.
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI). Catholic University of Rome, Italy.
    Grande, Giulia
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI). University of Milan, Italy.
    Fratiglioni, Laura
    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).
    Johnell, Kristina
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Use of Medications of Questionable Benefit During the Last Year of Life of Older Adults With Dementia2017In: Journal of the American Medical Directors Association, ISSN 1525-8610, E-ISSN 1538-9375, Vol. 18, no 6, p. 551.e1-551.e7Article in journal (Refereed)
    Abstract [en]

    Objectives: To investigate the prevalence and factors associated with the use of medications of questionable benefit throughout the final year of life of older adults who died with dementia. Design: Register-based, longitudinal cohort study. Setting: Entire Sweden. Participants: All older adults (>= 75 years) who died with dementia between 2007 and 2013 (n = 120,067). Measurements: Exposure to medications of questionable benefit was calculated for each of the last 12 months before death, based on longitudinal data from the Swedish Prescribed Drug Register. Results: The proportion of older adults with dementia who received at least 1 medication of questionable benefit decreased from 38.6% 12 months before death to 34.7% during the final month before death (P < .001 for trend). Among older adults with dementia who used at least 1 medication of questionable benefit 12 months before death, 74.8% remained exposed until their last month of life. Living in an institution was independently associated with a 15% reduction of the likelihood to receive >= 1 medication of questionable benefit during the last month before death (odds ratio 0.85, 95% confidence interval 0.88-0.83). Antidementia drugs accounted for one-fifth of the total number of medications of questionable benefit. Lipid-lowering agents were used by 8.3% of individuals during their final month of life (10.2% of community-dwellers and 6.6% of institutionalized people, P < .001). Conclusion: Clinicians caring for older adults with advanced dementia should be provided with reliable tools to help them reduce the burden of medications of questionable benefit near the end of life.

  • 15. Onder, Graziano
    et al.
    Vetrano, Davide L.
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI). Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.
    Villani, Emanuele R.
    Carfi, Angelo
    Lo Monaco, Maria Rita
    Cipriani, Maria Camilla
    Gravina, Ester Manes
    Denkinger, Michael
    Pagano, Francesco
    van der Roest, Henriette G.
    Bernabei, Roberto
    Deprescribing in Nursing Home Residents on Polypharmacy: Incidence and Associated Factors2019In: Journal of the American Medical Directors Association, ISSN 1525-8610, E-ISSN 1538-9375, Vol. 20, no 9, p. 1116-1120Article in journal (Refereed)
    Abstract [en]

    Objectives: To assess 1-year incidence and factors related to deprescribing in nursing home (NH) residents in Europe. Design: Longitudinal multicenter cohort study based on data from the Services and Health for Elderly in Long TERm care (SHELTER) study. Setting: NHs in Europe and Israel. Participants: 1843 NH residents on polypharmacy. Methods: Polypharmacy was defined as the concurrent use of 5 or more medications. Deprescribing was defined as a reduction in the number of medications used over the study period. Residents were followed for 12 months. Results: Residents in the study sample were using a mean number of 8.6 (standard deviation 2.9) medications at the baseline assessment. Deprescribing was observed in 658 residents (35.7%). Cognitive impairment (mild/moderate impairment vs intact, odds ratio [OR] 1.41, 95% confidence interval [CI] 1.11-1.79; severe impairment vs intact, OR 1.60, 95% CI 1.23-2.09), presence of the geriatrician within the facility staff (OR 1.41, 95% CI 1.15-1.72), and number of medications used at baseline (OR 1.10, 95% CI 1.06-1.14) were associated with higher probabilities of deprescribing. In contrast, female gender (OR 0.76, 95% CI 0.61-0.96), heart failure (OR 0.69, 95% CI 0.53-0.89), and cancer (OR 0.64, 95% CI 0.45-0.90) were associated with a lower probability of deprescribing. Conclusions and Implications: Deprescribing is common in NH residents on polypharmacy, and it is associated with individual and organizational factors. More evidence is needed on deprescribing, and clear strategies on how to withdraw medications should be defined in the future.

  • 16. Reyniers, Thijs
    et al.
    Deliens, Luc
    Pasman, H. Roeline
    Morin, Lucas
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Addington-Hall, Julia
    Frova, Luisa
    Cardenas-Turanzas, Marylou
    Onwuteaka-Philipsen, Bregje
    Naylor, Wayne
    Ruiz-Ramos, Miguel
    Wilson, Donna M.
    Loucka, Martin
    Csikos, Agnes
    Rhee, Yong Joo
    Teno, Joan
    Cohen, Joachim
    Houttekier, Dirk
    International Variation in Place of Death of Older People Who Died From Dementia in 14 European and non-European Countries2015In: Journal of the American Medical Directors Association, ISSN 1525-8610, E-ISSN 1538-9375, Vol. 16, no 2, p. 165-171Article in journal (Refereed)
    Abstract [en]

    Objectives: The objective of this study was to examine variation in place of death of older people dying from dementia in countries across 4 continents. Design: Study of death certificate data. Methods: We included deaths of older (65 + years) people whose underlying cause of death was a dementia-related disease (ICD-10: F01, F02, F03, G30) in Belgium, the Netherlands, England, Wales, France, Italy, Spain, Czech Republic, Hungary, New Zealand, United States, Canada, Mexico and South Korea. We examined associations between place of death and sociodemographic factors, social support, and residential and health care system factors. Results: Overall, 4.8% of all deaths were from a dementia-related disease, ranging from 0.4% in Mexico to 6.9% in Canada. Of those deaths, the proportion occurring in hospital varied from 1.6% in the Netherlands to 73.6% in South Korea. When controlling for potential confounders, hospital death was more likely for men, those younger than 80, and those married or living in a region with a higher availability of long-term care beds, although this could not be concluded for each country. Hospital death was least likely in the Netherlands compared with other countries. Conclusions: Place of death of older people who died from a dementia-related disease differs substantially between countries, which might point to organizational differences in end-of-life care provision.

  • 17. Santoni, Giola
    et al.
    Meinow, Bettina
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI). Stockholm Gerontology Research Center, Sweden.
    Wimo, Anders
    Marengoni, Alessandra
    Fratiglioni, Laura
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI). Stockholm Gerontology Research Center, Sweden.
    Calderon-Larranaga, Amaia
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Using an Integrated Clinical and Functional Assessment Tool to Describe the Use of Social and Medical Care in an Urban Community-Dwelling Swedish Older Population2019In: Journal of the American Medical Directors Association, ISSN 1525-8610, E-ISSN 1538-9375, Vol. 20, no 8, p. 988-+Article in journal (Refereed)
    Abstract [en]

    Objectives: To describe the use of social and medical care services in a community-dwelling older population from Stockholm, Sweden, using an integrated clinical and functional assessment tool. Design: Study based on data from the longitudinal community-based Swedish National Study on Aging and Care in Kungsholmen. Setting and Participants: Random sample of people >65 years of age living in the community in central Stockholm between March 2001 and June 2004 (N = 2368). Measures: Health status was measured with a health assessment tool (HAT), which combines 5 indicators (gait speed, cognitive function, chronic multimorbidity, mild disability, severe disability) collected during Swedish National Study on Aging and Care in Kungsholmen clinical examinations. The amount of formal and informal social care was self-reported in hours per month and recorded by trained nurses at baseline and the 3-year follow-up for those >= 78 years of age at baseline. Data on hospital admissions, 30-day readmissions, days spent in the hospital, primary care visits, and specialist visits were obtained from Stockholm County Council registers (2001-2007). Results: At baseline, 10% of the sample received formal social care and 11% received informal care. Annually between baseline and the 3-year follow-up, 15% were admitted to the hospital, 5% were readmitted, 78% visited a specialist, and 89% visited primary care. Those with the best HAT scores received 0.02 hours/month of formal care; those with the worst, 34 h/mo. The corresponding numbers for other variables were 0.02 vs 73 h/mo of informal care, 2 vs 11 hospital admissions per 10 persons/year, 44 vs 226 hospital days per 10 persons/y, 0.4 vs 2 30-day readmissions per 10 persons/y, 37 vs 78 specialist visits per 10 persons/y, and 50 vs 327 primary care visits per 10 persons/y. Conclusions/Implications: Because of its high discriminative power, the easy-to-use HAT index could help decision makers to plan medical and social care services. (C) 2018 AMDA - The Society for Post-Acute and Long-Term Care Medicine.

  • 18.
    She, Rui
    et al.
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI). The Chinese University of Hong Kong (CUHK), China.
    Yan, Zhongrui
    Jiang, Hui
    Vetrano, Davide L.
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI). Catholic University of Rome, Italy.
    Lau, Joseph T. F.
    Qiu, Chengxuan
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI). Shandong University, China.
    Multimorbidity and Health-Related Quality of Life in Old Age: Role of Functional Dependence and Depressive Symptoms2019In: Journal of the American Medical Directors Association, ISSN 1525-8610, E-ISSN 1538-9375, Vol. 20, no 9, p. 1143-1149Article in journal (Refereed)
    Abstract [en]

    Objectives: To examine the associations of multimorbidity patterns with health-related quality of life (HRQL) in rural-dwelling older adults in China, and to explore to what extent their associations were mediated by functional dependence and depressive symptoms. Design: Population-based cross-sectional study. Setting and participants: 1497 participants (age >= 60 years; 66.4% women) in the 2014-2016 examination of the Confucius Hometown Aging Project who were living in a rural community near Qufu, Shandong, China. Measures: Data on demographics, lifestyles, chronic health conditions, and use of medications were collected through interviews, clinical examinations, and laboratory tests. Multimorbidity was defined as co-occurrence of >2 chronic diseases in the same person. The 15-item Geriatric Depression Scale (GDS-15) was used to assess depressive symptoms, and EQ-5D-3L was used to assess HRQL. Results: Multimorbidity was present in 83.8% of the participants (women vs men: 85.5% vs 80.6%, P = .015). Exploratory factor analysis identified 4 patterns of multimorbidity, that is, patterns of cardiovascular-degenerative, respiratory, neurologic-thyroid, and metabolic-cognitive-cerebrovascular diseases. The neurologic-thyroid disease pattern did not show a significant association with HRQL. The 3 other patterns were associated with poor HRQL and had a diverse impact on different dimensions of HRQL. Mediation analysis suggested that functional dependence and the presence of depressive symptoms could mediate 24.8% and 21.8%, respectively, of the association between the number of chronic diseases and poor HRQL. Conclusions/Implications: Multimorbidity is associated with poor HRQL in older adults, in which functional dependence and depressive symptoms partly mediate their associations. Prevention and proper management of dependence and depressive symptoms in older people with multimorbidity may help maintain and improve quality of life.

  • 19.
    Tan, Edwin C. K.
    et al.
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI). Monash University, Australia.
    Qiu, Chengxuan
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Liang, Yajun
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI). Karolinska Institutet, Sweden.
    Wang, Rui
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Bell, J. Simon
    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).
    Johnell, Kristina
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Antihypertensive Medication Regimen Intensity and Incident Dementia in an Older Population2018In: Journal of the American Medical Directors Association, ISSN 1525-8610, E-ISSN 1538-9375, Vol. 19, no 7, p. 577-583Article in journal (Refereed)
    Abstract [en]

    Objective: To investigate the association between antihypertensive medication regimen intensity and risk of incident dementia in an older population. Design: Prospective, longitudinal cohort study. Participants/Setting: A total of 1208 participants aged >= 78 years, free of dementia, and residing in central Stockholm at baseline (2001-2004). Measurements: Participants were examined at 3- and 6-year follow-up to detect incident dementia. Data were collected through face-to-face interviews, clinical examinations, and laboratory tests. Data on antihypertensive use were obtained by a physician through patient self-report, visual inspection, or medical records. Cox proportional hazards models were used to compute hazard ratios (HRs) and 95% confidence intervals (CIs) for the association between time-varying antihypertensive regimen intensity and incident dementia after adjusting for potential confounders. Results: During the follow-up period, 125 participants were diagnosed with dementia. Participants who developed dementia were more likely to have vascular disease at baseline (66.4% vs 55.3%, P=.02). In fully adjusted analyses, the number of antihypertensive classes (HR 0.68, 95% CI 0.55-0.84) and total prescribed daily dose (HR 0.70, 95% CI 0.57-0.86) were significantly associated with reduced dementia risk. After considering all-cause mortality as a competing risk, the number (HR 0.75, 95% CI 0.62-0.91) and doses (HR 0.71, 95% CI 0.59-0.86) of antihypertensive classes, and the independent use of diuretics (HR 0.66, 95% CI 0.44-0.99), were significantly associated with lower dementia risk. Conclusions: Greater intensity of antihypertensive drug use among older people may be associated with reduced incidence of dementia.

  • 20.
    Tan, Edwin C. K.
    et al.
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI). Monash University, Australia.
    Sluggett, Janet K.
    Johnell, Kristina
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Onder, Graziano
    Elseviers, Monique
    Morin, Lucas
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Vetrano, Davide L.
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI). Università Cattolica del Sacro Cuore, Italy.
    Wastesson, Jonas W.
    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).
    Taipale, Heidi
    Tanskanen, Antti
    Bell, J. Simon
    Research Priorities for Optimizing Geriatric Pharmacotherapy: An International Consensus2018In: Journal of the American Medical Directors Association, ISSN 1525-8610, E-ISSN 1538-9375, Vol. 19, no 3, p. 193-199Article in journal (Refereed)
    Abstract [en]

    Medication management is becoming increasingly challenging for older people, and there is limited evidence to guide medication prescribing and administration for people with multimorbidity, frailty, or at the end of life. Currently, there is a lack of clear research priorities in the field of geriatric pharmacotherapy. To address this issue, international experts from 5 research groups in geriatric pharmacotherapy and pharmacoepidemiology research were invited to attend the inaugural Optimizing Geriatric Pharmacotherapy through Pharmacoepidemiology Network workshop. A modified nominal group technique was used to explore and consolidate the priorities for conducting research in this field. Eight research priorities were elucidated: quality of medication use; vulnerable patient groups; polypharmacy and multimorbidity; person-centered practice and research; deprescribing; methodological development; variability in medication use; and national and international comparative research. The research priorities are discussed in detail in this article with examples of current gaps and future actions presented. These priorities highlight areas for future research in geriatric pharmacotherapy to improve medication outcomes in older people.

  • 21. Trevisan, Caterina
    et al.
    Crippa, Alessio
    Ek, Stina
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Welmer, Anna-Karin
    Stockholm Gerontology Research Center, Sweden; Karolinska University Hospital, Sweden.
    Sergi, Giuseppe
    Maggi, Stefania
    Manzato, Enzo
    Bea, Jennifer W.
    Cauley, Jane A.
    Decullier, Evelyne
    Hirani, Vasant
    LaMonte, Michael J.
    Lewis, Cora E.
    Schott, Anne-Marie
    Orsini, Nicola
    Rizzuto, Debora
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Nutritional Status, Body Mass Index, and the Risk of Falls in Community-Dwelling Older Adults: A Systematic Review and Meta-Analysis2019In: Journal of the American Medical Directors Association, ISSN 1525-8610, E-ISSN 1538-9375, Vol. 20, no 5, p. 569-582Article, review/survey (Refereed)
    Abstract [en]

    Objectives: To evaluate the association between nutritional status, defined on the basis of a multidimensional evaluation, and body mass index (BMI) with the risk of falls and recurrent falls in communitydwelling older people.

    Design: Systematic literature review and meta-analysis.

    Setting and Participants: Community-dwelling older adults.

    Measures: A systematic literature review was conducted on prospective studies identified through electronic and hand searches until October 2017. A random effects meta-analysis was used to evaluate the relative risk (RR) of experiencing falls and recurrent falls (>= 2 falls within at least 6 months) on the basis of nutritional status, defined by multidimensional scores. A random effects dose-response metaanalysis was used to evaluate the association between BMI and the risk of falls and recurrent falls.

    Results: People who were malnourished or those at risk for malnutrition had a pooled 45% higher risk of experiencing at least 1 fall than were those well-nourished (9510 subjects). Increased falls risk was observed in subjects malnourished versus well-nourished [RR 1.64, 95% confidence interval (CI) 1.182.28; 3 studies, 8379 subjects], whereas no substantial results were observed for risk of recurrent falls. A U-shaped association was detected between BMI and the risk for falls (P <. 001), with the nadir between 24.5 and 30 (144,934 subjects). Taking a BMI of 23.5 as reference, the pooled RR of falling ranged between 1.09 (95% CI 1.04-1.15) for a BMI of 17, to 1.07 (95% CI 0.92-1.24) for a BMI of 37.5. No associations were observed between BMI and recurrent falls (120,185 subjects).

    Conclusions/Implications: The results of our work suggest therefore that nutritional status and BMI should be evaluated when assessing the risk for falls in older age.

  • 22.
    Vetrano, Davide L.
    et al.
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI). Catholic University of Rome, Italy.
    La Carpia, Domenico
    Grande, Giulia
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI). University of Milan, Italy.
    Casucci, Paola
    Bacelli, Tiziana
    Bernabei, Roberto
    Onder, Graziano
    Anticholinergic Medication Burden and 5-Year Risk of Hospitalization and Death in Nursing Home Elderly Residents With Coronary Artery Disease2016In: Journal of the American Medical Directors Association, ISSN 1525-8610, E-ISSN 1538-9375, Vol. 17, no 11, p. 1056-1059Article in journal (Refereed)
    Abstract [en]

    Objectives: To assess the association of the anticholinergic medication burden with hospitalization and mortality in nursing home elderly patients and to investigate the role of coronary artery disease (CAD). Design: Longitudinal (5-year) retrospective observational study. Setting: Nursing homes in Italy. Participants: A total of 3761 nursing home older residents. Measurements: A comprehensive clinical and functional assessment was carried out through the interRAI long-term care facility instrument. The anticholinergic burden was assessed through the anticholinergic cognitive burden (ACB) scale. Occurrence of hospitalization/all-cause mortality was the primary composite outcome. First hospitalization and all-cause mortality were the secondary outcomes of the study. Hazard ratios (HRs) and subdistribution HRs were obtained through Cox and competing risk (death as competing event for hospitalization) models. Results: Within the sample (mean age 83 +/- 7 years; 72% females) the incidence rate of the primary outcome was 10/100 person-year. After adjusting for potential confounders and compared with participants with an ACB of 0, those with an ACB of 1 [HR 1.46; 95% confidence interval (CI) 1.12-1.90] and ABC of 2+ (HR 1.41; 95% CI 1.11-1.79) presented an increased risk of developing the primary outcome. After stratification, the risk for the primary outcome increased along with the anticholinergic burden, only for participants affected by CAD (HR 1.53; 95% CI 0.94-2.50 and HR 1.71; 95% CI 1.09-2.68 for the ACB of 1 and ACB of 2+ groups). An ACB score of 2+ was marginally associated with first hospitalization, considering death as a competing risk, only for those with CAD (subdistribution HR 3.47; 95% CI 0.99-12.3). Conclusions: Anticholinergic medication burden is associated to hospitalization and all-cause mortality in institutionalized older adults. CAD increases such risk. The effectiveness and safety profile of complex drug regimens should be reconsidered in this population.

  • 23.
    Vetrano, Davide L.
    et al.
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI). Catholic University of Rome, Italy.
    Pisciotta, Maria S.
    Laudisio, Alice
    Lo Monaco, Maria R.
    Onder, Graziano
    Brandi, Vincenzo
    Fusco, Domenico
    Di Capua, Beatrice
    Ricciardi, Diego
    Bernabei, Roberto
    Zuccala, Giuseppe
    Sarcopenia in Parkinson Disease: Comparison of Different Criteria and Association With Disease Severity2018In: Journal of the American Medical Directors Association, ISSN 1525-8610, E-ISSN 1538-9375, Vol. 19, no 6, p. 523-527Article in journal (Refereed)
    Abstract [en]

    Objectives: In Parkinson disease (PD), sarcopenia may represent the common downstream pathway that from motor and nonmotor symptoms leads to the progressive loss of resilience, frailty, and disability. Here we (1) assessed the prevalence of sarcopenia in older adults with PD using 3 different criteria, testing their agreement, and (2) evaluated the association between PD severity and sarcopenia.

    Design: Cross-sectional, observation study.

    Setting: Geriatric day hospital.

    Participants: Older adults with idiopathic PD.

    Measurements: Body composition was evaluated through dual energy x-ray absorptiometry. Handgrip strength and walking speed were measured. Sarcopenia was operationalized according to the Foundation for the National Institutes of Health, the European Working Group on Sarcopenia in Older Persons, and the International Working Group. Cohen k statistics was used to test the agreement among criteria.

    Results: Among the 210 participants (mean age 73 years; 38% women), the prevalence of sarcopenia was 28.5%-40.7% in men and 17.5%-32.5% in women. The prevalence of severe sarcopenia was 16.8%-20.0% in men and 11.3%-18.8% in women. The agreement among criteria was poor. The highest agreement was obtained between the European Working Group on Sarcopenia in Older Persons (severe sarcopenia) and International Working Group criteria (k = 0.52 in men; k = 0.65 in women; P < .01 for both). Finally, severe sarcopenia was associated with PD severity (odds ratio 2.30; 95% confidence interval 1.15-4.58).

    Conclusions: Sarcopenia is common in PD, with severe sarcopenia being diagnosed in 1 in every 5 patients with PD. We found a significant disagreement among the 3 criteria evaluated, in detecting sarcopenia more than in ruling it out. Finally, sarcopenia is associated with PD severity. Considering its massive prevalence, further studies should address the prognosis of sarcopenia in PD.

  • 24.
    Vetrano, Davide Liborio
    et al.
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI). Catholic University of Rome, Italy.
    Villani, Emanuele Rocco
    Grande, Giulia
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Giovannini, Silvia
    Cipriani, Maria Camilla
    Manes-Gravina, Ester
    Bernabei, Roberto
    Onder, Graziano
    EAssociation of Polypharmacy With 1-Year Trajectories of Cognitive and Physical Function in Nursing Home Residents: Results From a Multicenter European Study2018In: Journal of the American Medical Directors Association, ISSN 1525-8610, E-ISSN 1538-9375, Vol. 19, no 8, p. 710-713Article in journal (Refereed)
    Abstract [en]

    Objectives: To test the association between polypharmacy and 1-year change in physical and cognitive function among nursing home (NH) residents. Design: Longitudinal multicenter cohort study based on data from the Services and Health for Elderly in Long TERm care (SHELTER) study. Setting: NH in Europe (n 1/4 50) and Israel (n 1/4 7). Participants: 3234 NH older residents. Measurements: Participants were assessed through the interRAI long-term care facility instrument. Polypharmacy was defined as the concurrent use of 5 to 9 drugs and excessive polypharmacy as the use of >= 10 drugs. Cognitive function was assessed through the Cognitive Performance Scale (CPS). Functional status was evaluated through the Activities of Daily Living (ADL) Hierarchy scale. The change in CPS and ADL score, based on repeated assessments, was the outcome, and their association with polypharmacy was modeled via linear mixed models. The interaction between polypharmacy and time was reported [ beta and 95% confidence intervals (95% CIs)]. Results: A total of 1630 (50%) residents presented with polypharmacy and 781 (24%) excessive polypharmacy. After adjusting for potential confounders, residents on polypharmacy (beta 0.10, 95% CI 0.010.20) and those on excessive polypharmacy (beta 0.13, 95% CI 0.01-0.24) had a significantly higher decline in CPS score compared to those using < 5 drugs. No statistically (P >.05) significant change according to polypharmacy status was shown for ADL score. Conclusions: Polypharmacy is highly prevalent among older NH residents and, over 1 year, it is associated with worsening cognitive function but not functional decline.

  • 25.
    Wastesson, Jonas W.
    et al.
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI). University of Southern Denmark, Denmark.
    Canudas-Romo, Vladimir
    Lindahl-Jacobsen, Rune
    Johnell, Kristina
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Remaining Life Expectancy With and Without Polypharmacy: A Register-Based Study of Swedes Aged 65 Years and Older2016In: Journal of the American Medical Directors Association, ISSN 1525-8610, E-ISSN 1538-9375, Vol. 17, no 1, p. 31-35Article in journal (Refereed)
    Abstract [en]

    Objectives: To investigate the remaining life expectancy with and without polypharmacy for Swedish women and men aged 65 years and older. Design: Age-specific prevalence of polypharmacy from the nationwide Swedish Prescribed Drug Register (SPDR) combined with life tables from Statistics Sweden was used to calculate the survival function and remaining life expectancy with and without polypharmacy according to the Sullivan method. Setting: Nationwide register-based study. Participants: A total of 1,347,564 individuals aged 65 years and older who had been prescribed and dispensed a drug from July 1 to September 30, 2008. Measurements: Polypharmacy was defined as the concurrent use of 5 or more drugs. Results: At age 65 years, approximately 8 years of the 20 remaining years of life (41%) can be expected to be lived with polypharmacy. More than half of the remaining life expectancy will be spent with polypharmacy after the age of 75 years. Women had a longer life expectancy, but also lived more years with polypharmacy than men. Discussion: Older women and men spend a considerable proportion of their lives with polypharmacy. Conclusion: Given the negative health outcomes associated with polypharmacy, efforts should be made to reduce the number of years older adults spend with polypharmacy to minimize the risk of unwanted consequences.

  • 26.
    Wastesson, Jonas W.
    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).
    Johnell, Kristina
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Expanding the Proportion of Life With Polypharmacy in Sweden: 2006-20132016In: Journal of the American Medical Directors Association, ISSN 1525-8610, E-ISSN 1538-9375, Vol. 17, no 10, p. 957-958Article in journal (Refereed)
1 - 26 of 26
CiteExportLink to result list
Permanent link
Cite
Citation style
  • apa
  • ieee
  • modern-language-association-8th-edition
  • vancouver
  • Other style
More styles
Language
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Other locale
More languages
Output format
  • html
  • text
  • asciidoc
  • rtf