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  • 1.
    Kelfve, Susanne
    et al.
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Centrum för forskning om äldre och åldrande (ARC), (tills m KI). Linköping University, Sweden.
    Wastesson, Jonas
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Centrum för forskning om äldre och åldrande (ARC), (tills m KI).
    Fors, Stefan
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Centrum för forskning om äldre och åldrande (ARC), (tills m KI). Stockholms universitet, Samhällsvetenskapliga fakulteten, Centrum för forskning om ojämlikhet i hälsa (CHESS).
    Johnell, Kristina
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Centrum för forskning om äldre och åldrande (ARC), (tills m KI).
    Morin, Lucas
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Centrum för forskning om äldre och åldrande (ARC), (tills m KI).
    Is the level of education associated with transitions between care settings in older adults near the end of life? A nationwide, retrospective cohort study2018Ingår i: Palliative Medicine: A Multiprofessional Journal, ISSN 0269-2163, E-ISSN 1477-030X, Vol. 32, nr 2, s. 366-375Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: End-of-life transitions between care settings can be burdensome for older adults and their relatives. Aim: To analyze the association between the level of education of older adults and their likelihood to experience care transitions during the final months before death. Design: Nationwide, retrospective cohort study using register data. Setting/participants: Older adults (65 years) who died in Sweden in 2013 (n = 75,722). Place of death was the primary outcome. Institutionalization and multiple hospital admissions during the final months of life were defined as secondary outcomes. The decedents' level of education (primary, secondary, or tertiary education) was considered as the main exposure. Multivariable analyses were stratified by living arrangement and adjusted for sex, age at time of death, illness trajectory, and number of chronic diseases. Results: Among community-dwellers, older adults with tertiary education were more likely to die in hospitals than those with primary education (55.6% vs 49.9%; odds ratio (OR) = 1.21, 95% confidence interval (CI) = 1.14-1.28), but less likely to be institutionalized during the final month before death (OR = 0.83, 95% CI = 0.76-0.91). Decedents with higher education had greater odds of remaining hospitalized continuously during their final 2 weeks of life (OR = 1.12, 95% CI = 1.02-1.22). Among older adults living in nursing homes, we found no association between the decedents' level of education and their likelihood to be hospitalized or to die in hospitals. Conclusion: Compared with those who completed only primary education, individuals with higher educational attainment were more likely to live at home until the end of life, but also more likely to be hospitalized and die in hospitals.

  • 2. Santacroce, Adriana
    et al.
    Wastesson, Jonas W.
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Centrum för forskning om äldre och åldrande (ARC), (tills m KI).
    Höhn, Andreas
    Christensen, Kaare
    Oksuzyan, Anna
    Gender differences in the use of anti-infective medications before and after widowhood: a register-based study2018Ingår i: Journal of Epidemiology and Community Health, ISSN 0143-005X, E-ISSN 1470-2738, Vol. 72, nr 6, s. 526-531Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background Recent findings suggest that bereavement due to spousal loss is associated with a decline in general immune functions, and thus to increased susceptibility to infections among widowed individuals. The present study aims to investigate whether spousal loss weakens immune defences more among men than among women using a 5% random sample of the total Danish population, and anti-infective medication use as a proxy for immune response.

    Methods We followed 6076 Danish individuals (67% women) aged 50 from 5years before and up to 5years after widowhood to examine changes in prescriptions of anti-infectives for systemic use.

    Results Women used more anti-infective drugs both before and after spousal loss (women: OR= 1.31; 95% CI 1.21 to 1.42). The age-related changes in the use of anti-infective medications in the period before widowhood were similar to that in the period after widowhood among both men and women. Also, age-related changes in the use of anti-infective medications were similar in both genders.

    Conclusions The present study shows that individuals are more likely to use anti-infective medication after being widowed than before being widowed, but this change is likely to be related to increasing age and it is similar in both genders.

  • 3.
    Tan, Edwin C. K.
    et al.
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Centrum för forskning om äldre och åldrande (ARC), (tills m KI). Monash University, Australia.
    Sluggett, Janet K.
    Johnell, Kristina
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Centrum för forskning om äldre och åldrande (ARC), (tills m KI).
    Onder, Graziano
    Elseviers, Monique
    Morin, Lucas
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Centrum för forskning om äldre och åldrande (ARC), (tills m KI).
    Vetrano, Davide L.
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Centrum för forskning om äldre och åldrande (ARC), (tills m KI). Università Cattolica del Sacro Cuore, Italy.
    Wastesson, Jonas W.
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Centrum för forskning om äldre och åldrande (ARC), (tills m KI).
    Fastbom, Johan
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Centrum för forskning om äldre och åldrande (ARC), (tills m KI).
    Taipale, Heidi
    Tanskanen, Antti
    Bell, J. Simon
    Research Priorities for Optimizing Geriatric Pharmacotherapy: An International Consensus2018Ingår i: Journal of the American Medical Directors Association, ISSN 1525-8610, E-ISSN 1538-9375, Vol. 19, nr 3, s. 193-199Artikel i tidskrift (Refereegranskat)
    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.

  • 4.
    Wastesson, Jonas W.
    et al.
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Centrum för forskning om äldre och åldrande (ARC), (tills m KI).
    Cedazo Minguez, Angel
    Fastbom, Johan
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Centrum för forskning om äldre och åldrande (ARC), (tills m KI).
    Maioli, Silvia
    Johnell, Kristina
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Centrum för forskning om äldre och åldrande (ARC), (tills m KI).
    The composition of polypharmacy: A register-based study of Swedes aged 75 years and older2018Ingår i: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 13, nr 3, artikel-id e0194892Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background Polypharmacy is common among older adults. However, little is known about the composition of polypharmacy: which are the most frequently used drugs, and how much do these drugs contribute to the overall prevalence of polypharmacy. Methods A total of 822,619 Swedes aged >= 75 years was identified from the Total Population Register. Through record-linkage with the Swedish Prescribed Drug Register and the Social Services Register we could analyze concurrent drug use in the entire population (both individuals living in the community and institution) on the 31 December 2013. Results The prevalence of polypharmacy (>= 5 drugs) was 45%. The most frequently used drugs were cardiovascular drugs, analgesics, and psychotropics. By excluding the ten most frequently used drug classes or compounds, the prevalence of polypharmacy was reduced by 69% and 51% respectively. The majority of the users of either one of the 10 most frequently used drugs concurrently used at least 4 other drug classes (66%-85%). Conclusion Almost half of the individuals aged >= 75 years are exposed to polypharmacy in Sweden. A handful of drugs make a large contribution to the overall prevalence of polypharmacy and the majority of drugs prescribed to persons aged >= 75 years are used in combination with other drugs. This highlights the high use of drugs, and the need to consider other concurrent drug treatments when prescribing for older adults.

  • 5.
    Wastesson, Jonas W.
    et al.
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Centrum för forskning om äldre och åldrande (ARC), (tills m KI).
    Morin, Lucas
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Centrum för forskning om äldre och åldrande (ARC), (tills m KI).
    Tan, Edwin C. K.
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Centrum för forskning om äldre och åldrande (ARC), (tills m KI).
    Johnell, Kristina
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Centrum för forskning om äldre och åldrande (ARC), (tills m KI). Stockholm Univ, Stockholm, Sweden.
    An update on the clinical consequences of polypharmacy in older adults: a narrative review2018Ingår i: Expert Opinion on Drug Safety, ISSN 1474-0338, E-ISSN 1744-764X, Vol. 17, nr 12, s. 1185-1196Artikel, forskningsöversikt (Refereegranskat)
    Abstract [en]

    Introduction: Polypharmacy, the use of multiple medications by one individual, is increasingly common among older adults. Caring for the growing number of older people with complex drug regimens and multimorbidity presents an important challenge in the coming years. Areas covered: This article reviews the international trends in the prevalence of polypharmacy, summarizes the results from previous reviews on polypharmacy and negative health outcomes, and updates a previous review on the clinical consequences of polypharmacy by focusing on studies published after 2013. This narrative review, which is based on a literature search in MEDLINE and EMBASE from January 1990 to June 2018, was undertaken to identify relevant articles. Search terms included variations of polypharmacy and multiple medications. Expert opinion: The prevalence of polypharmacy is increasing worldwide. More than half of the older population is exposed to polypharmacy in some settings. Polypharmacy is associated with a broad range of clinical consequences. However, methods to assess the dangers of polypharmacy should be refined. In our opinion, the issue of 'confounding by multimorbidity' has been underestimated and should be better accounted for in future studies. Moreover, researchers should develop more clinically relevant definitions of polypharmacy, including measures of inappropriate or problematic polypharmacy.

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