Öldrunarlækningar á Íslandi : þróun og framtíðarsýn

Neðst á síðunni er hægt að nálgast greinina í heild sinni með því að smella á hlekkinn View/OpenÖldrunarlækningar litu fyrst dagsins ljós um miðbik síðustu aldar þegar læknar í Bretlandi og í Bandaríkjunum sýndu fram á að hægt væri að koma fólki aftur til sjálfstæðrar tilveru eftir vistun á langlegustofnun á grundvelli hrumleika eða ástands sem var talið óafturkræft. Þessu dæmi var snúið við með heildrænni nálgun, bættri greiningu sjúkdóma, fjölþættri endurhæfingu en ekki síst með breytingu á hugarfari. Aldurstengdir sjúkdómar voru betur skilgreindir, meðferð þeirra bætt og komið á verklagi með matsskölum, forvörnum og þverfaglegri teymisvinnu. Með árunum hefur þörfin fyrir öldrunarlækningar aukist mikið vegna framfara í læknisfræði, mikillar fjölgunar aldraðra og einstaklinga með fötlun eða færniskerðingu af völdum langvinnra sjúkdóma. Heilbrigðisþjónustan á hinsvegar ennþá talsvert í land með að koma til móts við þessa þróun, enda býr hún við takmörkuð fjárráð, miðstýrt og flókið skipulag sem er fremur sniðið að þörfum yngri hópa með færri og samþættari vandamál

Prevention and treatment of corticosteroid induced osteoporosis : Clinical Guidelines

Neðst á síðunni er hægt að nálgast greinina í heild sinni með því að smella á hlekkinn View/OpenOsteoporosis is a common and serious side effect of long-term corticosteroid therapy. The risk of osteoporosis resulting from corticosteroid use can be reduced if appropriate preventive and therapeutic steps are taken. These guidelines are evidence based and are intended for clinicians who are responsible for the treatment of patients on long-term corticosteroid therapy. Many clinicians may have to modify their adherence to these guidelines, for example due to lack of access to bone densitometry.Beinþynning er algeng og alvarleg hjáverkun langtímameðferðar með sykursterum. Með virkri forvörn og/eða sértækri meðferð gegn beinþynningu er unnt að draga úr þeim heilsufarsvanda og samfélagskostnaði sem hlýst af beinþynningu af völdum sykursterameðferðar. Leiðbeiningar þessar eru settar fram samkvæmt góðri og skynsamlegri ákvarðanatöku (evidence based) og eru ætlaðar læknum sem bera ábyrgð á meðferð sjúklinga á langtíma sykursterameðferð. Í daglegu starfi getur verið erfitt að fylgja þessum leiðbeiningum, til dæmis eru beinþéttnimælingar eingöngu framkvæmdar í Reykjavík og á Akureyri

Prevalence of psychotropic drug use among elderly Icelanders living at home

Neðst á síðunni er hægt að nálgast greinina í heild sinni með því að smella á hlekkinn View/OpenOBJECTIVE: To evaluate the prevalence of psychotropic drug use among home-dwelling elderly Icelanders in the year 2006. MATERIALS AND METHODS: A population-based drug utilization study using the Icelandic Medicines Registry. The study group consisted of Icelanders, seventy years and older living at home (8% of total population). Prevalence of antidepressant, neuroleptic, anxiolytic and hypnotic use (ATC-groups N06A, N05A, N05B, N05C) was defined as the dispension per 100 individuals of one or more prescriptions for these drugs within the year 2006. For cross-national comparison we used data for 70-74 year olds in the Danish Registry of Medicinal Product Statistics. RESULTS: One third of all dispensed prescriptions in Iceland in 2006 were for people aged 70 years and older, and one fourth were for psychotropics. Elderly women were more likely than men to use psychotropics (RR=1.40 95% CI: 1.37-1.43). The prevalence of psychotropic use was 65.5% for women and 46.8% for men. Anxiolytics and hypnotics (N05B or N05C) were the most frequently used psychotropics, with a prevalence of 58.5% for women and 40.3% for men. Antidepressants were used by 28.8 % of women and 18.4 % of men. Neuroleptics were used by 5%. By comparing 70-74 years old Icelanders and Danes, the Icelanders were 1.5 to 2.5 times more likely to receive any psychotropics drug in 2006. CONCLUSION: Use of psychotropics, especially anxiolytics and hypnotics, is common among elderly Icelanders. Comparing information for 70 to 74 year olds with Danes of same age, the prescribing of psychotropics is more frequent in Iceland.Markmið: Að meta algengi geðlyfjanotkunar aldraðra sem bjuggu utan stofnana árið 2006. Efniviður og aðferðir: Lýsandi áhorfsrannsókn sem byggði á gögnum úr lyfjagagnagrunni Landlæknisembættisins. Þýðið var Íslendingar 70 ára og eldri sem bjuggu utan stofnana (8,6% af heildarmannfjölda). Algengi þunglyndis-, geðrofs-, kvíðastillandi- og svefnlyfjanotkunar (ATC-flokkar N06A, N05A, N05B, N05C) var skilgreint sem fjöldi einstaklinga á hverja 100 íbúa sem leysti út eina eða fleiri lyfjaávísun á tiltekin lyf árið 2006. Niðurstöður voru bornar saman við upplýsingar úr lyfjagagnagrunni um geðlyfjanotkun Dana á aldrinum 70 til 74 ára. Niðurstöður: Einstaklingar 70 ára og eldri leystu út þriðjung allra lyfjaávísana á Íslandi árið 2006, þar af var fjórðungur á geðlyf. Eldri konur voru líklegri en karlar til að nota geðlyf (RR=1,40 95% CI: 1,37-1,43). Algengi geðlyfjanotkunar í þýðinu var 65,5% fyrir konur og 46,8% fyrir karla. Algengust var notkun kvíðastillandi lyfja og svefnlyfja (N05B eða N05C), 58,5% meðal kvenna og 40,3% meðal karla. Algengi þunglyndislyfjanotkunar var 28,8% meðal kvenna og 18,4% meðal karla. Um 5% þýðisins notaði geðrofslyf. Algengi geðlyfjanotkunar meðal 70-74 ára var 1,5 til 2,5 falt hærra á Íslandi en Danmörku. Ályktun: Geðlyfjanotkun eldri Íslendinga er almenn, einkum í flokkum kvíðastillandi- og svefnlyfja. Samanborið við upplýsingar úr dönskum lyfjagagnagrunni fyrir aldurshópinn 70-74 ára er ávísun á geðlyf algengari á Íslandi

Epidemiology and association with outcomes of polypharmacy in patients undergoing surgery: retrospective, population-based cohort study

BACKGROUND: The aim of this study was to determine the prevalence of preoperative polypharmacy and the incidence of postoperative polypharmacy/hyper-polypharmacy in surgical patients and their association with adverse outcomes. METHODS: This was a retrospective, population-based cohort study among patients older than or equal to 18 years undergoing surgery at a university hospital between 2005 and 2018. Patients were categorized based on the number of medications: non-polypharmacy (fewer than 5); polypharmacy (5-9); and hyper-polypharmacy (greater than or equal to 10). The 30-day mortality, prolonged hospitalization (greater than or equal to 10 days), and incidence of readmission were compared between medication-use categories. RESULTS: Among 55 997 patients, the prevalence of preoperative polypharmacy was 32.3 per cent (95 per cent c.i. 33.5 to 34.3) and the prevalence of hyper-polypharmacy was 25.5 per cent (95 per cent c.i. 25.2 to 25.9). Thirty-day mortality was higher for patients exposed to preoperative hyper-polypharmacy (2.3 per cent) and preoperative polypharmacy (0.8 per cent) compared with those exposed to non-polypharmacy (0.6 per cent) (P < 0.001). The hazards ratio (HR) of long-term mortality was higher for patients exposed to hyper-polypharmacy (HR 1.32 (95 per cent c.i. 1.25 to 1.40)) and polypharmacy (HR 1.07 (95 per cent c.i. 1.01 to 1.14)) after adjustment for patient and procedural variables. The incidence of longer hospitalization (greater than or equal to 10 days) was higher for hyper-polypharmacy (11.3 per cent) and polypharmacy (6.3 per cent) compared with non-polypharmacy (4.1 per cent) (P < 0.001). The 30-day incidence of readmission was higher for patients exposed to hyper-polypharmacy (10.2 per cent) compared with polypharmacy (6.1 per cent) and non-polypharmacy (4.8 per cent) (P < 0.001). Among patients not exposed to polypharmacy, the incidence of new postoperative polypharmacy/hyper-polypharmacy was 33.4 per cent (95 per cent c.i. 32.8 to 34.1), and, for patients exposed to preoperative polypharmacy, the incidence of postoperative hyper-polypharmacy was 16.3 per cent (95 per cent c.i. 16.0 to 16.7). CONCLUSION: Preoperative polypharmacy and new postoperative polypharmacy/hyper-polypharmacy are common and associated with adverse outcomes. This highlights the need for increased emphasis on optimizing medication usage throughout the perioperative interval

Adults with symptoms of pneumonia : a prospective comparison of patients with and without infiltrates on chest radiography

Funding Information: The authors thank the staff at the emergency wards of Landspitali–The National University Hospital of Iceland for assistance with patient recruitment and Salvör Rafnsdóttir for her contribution in terms of patient recruitment. Funding Information: This work was supported by The Icelandic Centre for Research (Rannís) (grant number 217716-051), The Doctoral Grants of The University of Iceland Research Fund, The Scientific fund of Landspitali- The National University Hospital of Iceland, The Scandinavian Society for Antimicrobial Chemotherapy Foundation, and the Foundation of St. Josef's Hospital. The funding sources had no role in the study's design, conduct or reporting. Publisher Copyright: © 2022 The Author(s)OBJECTIVE: Most studies on patients hospitalized with community-acquired pneumonia (CAP) require confirmation of an infiltrate by chest radiography, but in practice admissions are common among patients with symptoms of pneumonia without an infiltrate (SPWI). The aim of this research was to compare clinical characteristics, microbial etiology, and outcomes among patients with CAP and SPWI. METHODS: Adults suspected of CAP were prospectively recruited at Landspitali University Hospital over a 1-year period, 2018 to 2019. The study was population based. Those admitted with two or more of the following symptoms were invited to participate: temperature ≥38°C or ≤36°C, sweating, shaking/chills, chest pain, a new cough, or new onset of dyspnea. Primary outcome was mortality at 30 days and one year. RESULTS: Six hundred twenty-five cases were included, 409 with CAP and 216 with SPWI; median age was 75 (interquartile range [IQR] 64-84) and 315 (50.4%) were females. Patients with CAP were more likely to have fever (≥38.0°C) (66.9% [273/408]) vs. 49.3% (106/215), p < 0.001), a higher CRP (median 103 [IQR 34-205] vs. 55 (IQR 17-103), p < 0.001), identification of Streptococcus pneumoniae (18.0% [64/355]) vs. 6.3% (10/159) of tested, p = 0.002) and to receive antibacterial treatment (99.5% [407/409]) vs. 87.5% (189/216), p < 0.001) but less likely to have a respiratory virus detected (25.4% [33/130]) vs. 51.2% (43/84) of tested, p < 0.001). The adjusted odds ratios for 30-day and 1 year mortality of SPWI compared to CAP were 0.86 (95% CI 0.40-1.86) and 1.46 (95% CI 0.92-2.32), respectively. DISCUSSION: SPWI is a common cause of hospitalization and despite having fever less frequently, lower inflammatory markers, and lower detection rate of pneumococci than patients with CAP, mortality is not significantly different.Peer reviewe

Epidemiology and association with outcomes of polypharmacy in patients undergoing surgery : retrospective, population-based cohort study

© The Author(s) 2023. Published by Oxford University Press on behalf of BJS Society Ltd. Funding Information: This work was supported by the Foundation of St Josef’s Hospital in cooperation with the Icelandic Gerontological Research Centre, the National University Hospital of Iceland (to F.J.), the Landspitali University Hospital Science Fund (to M.I.S.), and the University of Iceland Research Fund (to F.J.). Publisher Copyright: © The Author(s) 2023. Published by Oxford University Press on behalf of BJS Society Ltd.Background: The aim of this study was to determine the prevalence of preoperative polypharmacy and the incidence of postoperative polypharmacy/hyper-polypharmacy in surgical patients and their association with adverse outcomes. Methods: This was a retrospective, population-based cohort study among patients older than or equal to 18 years undergoing surgery at a university hospital between 2005 and 2018. Patients were categorized based on the number of medications: non-polypharmacy (fewer than 5); polypharmacy (5–9); and hyper-polypharmacy (greater than or equal to 10). The 30-day mortality, prolonged hospitalization (greater than or equal to 10 days), and incidence of readmission were compared between medication-use categories. Results: Among 55 997 patients, the prevalence of preoperative polypharmacy was 32.3 per cent (95 per cent c.i. 33.5 to 34.3) and the prevalence of hyper-polypharmacy was 25.5 per cent (95 per cent c.i. 25.2 to 25.9). Thirty-day mortality was higher for patients exposed to preoperative hyper-polypharmacy (2.3 per cent) and preoperative polypharmacy (0.8 per cent) compared with those exposed to non-polypharmacy (0.6 per cent) (P < 0.001). The hazards ratio (HR) of long-term mortality was higher for patients exposed to hyper-polypharmacy (HR 1.32 (95 per cent c.i. 1.25 to 1.40)) and polypharmacy (HR 1.07 (95 per cent c.i. 1.01 to 1.14)) after adjustment for patient and procedural variables. The incidence of longer hospitalization (greater than or equal to 10 days) was higher for hyper-polypharmacy (11.3 per cent) and polypharmacy (6.3 per cent) compared with non-polypharmacy (4.1 per cent) (P < 0.001). The 30-day incidence of readmission was higher for patients exposed to hyper-polypharmacy (10.2 per cent) compared with polypharmacy (6.1 per cent) and non-polypharmacy (4.8 per cent) (P < 0.001). Among patients not exposed to polypharmacy, the incidence of new postoperative polypharmacy/hyper-polypharmacy was 33.4 per cent (95 per cent c.i. 32.8 to 34.1), and, for patients exposed to preoperative polypharmacy, the incidence of postoperative hyper-polypharmacy was 16.3 per cent (95 per cent c.i. 16.0 to 16.7). Conclusion: Preoperative polypharmacy and new postoperative polypharmacy/hyper-polypharmacy are common and associated with adverse outcomes. This highlights the need for increased emphasis on optimizing medication usage throughout the perioperative interval.Peer reviewe

Diabetes mellitus increases risk of adverse drug reactions and death in hospitalised older people : the SENATOR trial

Purpose: Adverse drug reactions (ADRs) are a major cause of morbidity and mortality, especially in older people. Older people with diabetes mellitus may be at especially high risk of ADRs but this risk has not been well studied. This study aimed to compare severity and type of ADRs in hospitalised, multimorbid older people with and without diabetes and secondly to assess the impact of ADRs on mortality, rehospitalisation and length of stay. Methods: Participants in the SENATOR (Software Engine for the Assessment and optimization of drug and non-drug Therapy in Older peRsons) trial were assessed for 12 common and ‘other’ prevalent and incident adverse drug reactions using a blinded end-point adjudication process. Descriptive analyses, logistic regression and mediation analyses were undertaken. Results: Of 1537 people in the SENATOR trial, 540 (35.1%) had diabetes mellitus (mean age 77.4 ± 7.3 years, 58.5% male). In the total population, 773 prevalent and 828 incident ADRs were reported. Both prevalent and incident symptomatic hypoglycaemia and incident acute kidney injury (AKI) were significantly more common in people with diabetes (p < 0.05). Patients with diabetes had higher all-cause mortality at 12 weeks than those without (9.1% vs 6.3%, p = 0.04). Mediation analysis revealed that mortality was significantly higher (OR = 1.43, Sobel test p = 0.048) in people with diabetes and ADRs causing AKI. Conclusions: Older multimorbid people with diabetes presenting to hospital with acute illness have significantly more ADRs than those without, and a significantly higher mortality that is mediated by medication-associated AKI and poorer renal function.Peer reviewe

A Systematic Review of the Current Evidence from Randomised Controlled Trials on the Impact of Medication Optimisation or Pharmacological Interventions on Quantitative Measures of Cognitive Function in Geriatric Patients

Publisher Copyright: © 2022, The Author(s).Background: Cognitive decline is common in older people. Numerous studies point to the detrimental impact of polypharmacy and inappropriate medication on older people’s cognitive function. Here we aim to systematically review evidence on the impact of medication optimisation and drug interventions on cognitive function in older adults. Methods: A systematic review was performed using MEDLINE and Web of Science on May 2021. Only randomised controlled trials (RCTs) addressing the impact of medication optimisation or pharmacological interventions on quantitative measures of cognitive function in older adults (aged > 65 years) were included. Single-drug interventions (e.g., on drugs for dementia) were excluded. The quality of the studies was assessed by using the Jadad score. Results: Thirteen studies met the inclusion criteria. In five studies a positive impact of the intervention on metric measures of cognitive function was observed. Only one study showed a significant improvement of cognitive function by medication optimisation. The remaining four positive studies tested methylphenidate, selective oestrogen receptor modulators, folic acid and antipsychotics. The mean Jadad score was low (2.7). Conclusion: This systematic review identified a small number of heterogenous RCTs investigating the impact of medication optimisation or pharmacological interventions on cognitive function. Five trials showed a positive impact on at least one aspect of cognitive function, with comprehensive medication optimisation not being more successful than focused drug interventions. More prospective trials are needed to specifically assess ways of limiting the negative impact of certain medication in particular and polypharmacy in general on cognitive function in older patients.Peer reviewe

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