Medication of older people admitted to acute care -

Efst á síðunni er hægt að nálgast greinina í heild sinni með því að smella á hlekkinnIntroduction: The Inter RAI Minimal Data Set for Acute Care (MDS-AC) is a geriatric assessment tool designed for use in acute medicine care. We used data from a study on the MDS-AC to evaluate the medication use of 75+ year old patients (n=730) admitted to selected acute care hospitals in five Nordic countries. Associations of medication use with: Preadmission Activities of Daily Living (ADL), Instrumental Activities of Daily Living (IADL), Cognitive Performance Scale (CPS) , walking, memory, continence, falls, chronic pain, admission delirium, length of stay in hospital (LOS) and 12 months survival after discharge, were analyzed. Special focus was on polyphamacy, inappropriate medications, psychotropic medication use and cardiovascular medications. Results: Average number of drugs was 6.2(SD+/-3.7). Polypharmacy (five or more medications) was found among 66% of patients and 16% used inappropriate medications. Women used on average more medications than men, 6.6 vs 5.7 respectively (p < .05). Polypharmacy was associated with worse IADL function and pain (p<.001) and better cognitive function and less falls (p < .05). Inappropriate medications were associated to increased length of stay (p<.05). Psychotropic medications had the most pronounced association with worse function and outcomes in a variety of variables. Cardiovascular drugs were associated with better functional outcome. Conclusion: Polypharmacy, use of inappropriate medications and psychotropic medication use were prevalent in this study. Associations were found between these factors and negative functional outcomes. Individual tailoring of pharmacotherapy of acutely ill older patients with concomitant chronic illnesses combined with functional impairment is important

Population assessment of future trajectories in coronary heart disease mortality.

Background: Coronary heart disease (CHD) mortality rates have been decreasing in Iceland since the 1980s, largely reflecting improvements in cardiovascular risk factors. The purpose of this study was to predict future CHD mortality in Iceland based on potential risk factor trends. Methods and findings: The previously validated IMPACT model was used to predict changes in CHD mortality between 2010 and 2040 among the projected population of Iceland aged 25–74. Calculations were based on combining: i) data on population numbers and projections (Statistics Iceland), ii) population risk factor levels and projections (Refine Reykjavik study), and iii) effectiveness of specific risk factor reductions (published meta-analyses). Projections for three contrasting scenarios were compared: 1) If the historical risk factor trends of past 30 years were to continue, the declining death rates of past decades would level off, reflecting population ageing. 2) If recent trends in risk factors (past 5 years) continue, this would result in a death rate increasing from 49 to 70 per 100,000. This would reflect a recent plateau in previously falling cholesterol levels and recent rapid increases in obesity and diabetes prevalence. 3) Assuming that in 2040 the entire population enjoys optimal risk factor levels observed in low risk cohorts, this would prevent almost all premature CHD deaths before 2040. Conclusions: The potential increase in CHD deaths with recent trends in risk factor levels is alarming both for Iceland and probably for comparable Western populations. However, our results show considerable room for reducing CHD mortality. Achieving the best case scenario could eradicate premature CHD deaths by 2040. Public health policy interventions based on these predictions may provide a cost effective means of reducing CHD mortality in the future

Medication of older people admitted to acute care -

Efst á síðunni er hægt að nálgast greinina í heild sinni með því að smella á hlekkinnIntroduction: The Inter RAI Minimal Data Set for Acute Care (MDS-AC) is a geriatric assessment tool designed for use in acute medicine care. We used data from a study on the MDS-AC to evaluate the medication use of 75+ year old patients (n=730) admitted to selected acute care hospitals in five Nordic countries. Associations of medication use with: Preadmission Activities of Daily Living (ADL), Instrumental Activities of Daily Living (IADL), Cognitive Performance Scale (CPS) , walking, memory, continence, falls, chronic pain, admission delirium, length of stay in hospital (LOS) and 12 months survival after discharge, were analyzed. Special focus was on polyphamacy, inappropriate medications, psychotropic medication use and cardiovascular medications. Results: Average number of drugs was 6.2(SD+/-3.7). Polypharmacy (five or more medications) was found among 66% of patients and 16% used inappropriate medications. Women used on average more medications than men, 6.6 vs 5.7 respectively (p < .05). Polypharmacy was associated with worse IADL function and pain (p<.001) and better cognitive function and less falls (p < .05). Inappropriate medications were associated to increased length of stay (p<.05). Psychotropic medications had the most pronounced association with worse function and outcomes in a variety of variables. Cardiovascular drugs were associated with better functional outcome. Conclusion: Polypharmacy, use of inappropriate medications and psychotropic medication use were prevalent in this study. Associations were found between these factors and negative functional outcomes. Individual tailoring of pharmacotherapy of acutely ill older patients with concomitant chronic illnesses combined with functional impairment is important

Estimated deaths per 100.000 prevented or added in 2040.

<p>Estimated deaths by risk factor change, under three risk factor scenarios.</p

Data on sample characteristics and risk factor values from the Reykjavik study (1981) and REFINE Reykjavik study (2006 and 2010).

<p>Data on sample characteristics and risk factor values from the Reykjavik study (1981) and REFINE Reykjavik study (2006 and 2010).</p

Future CHD mortality rate among 25–74 year old Icelanders in three different risk factor scenarios.

<p>Future CHD mortality rate among 25–74 year old Icelanders in three different risk factor scenarios.</p

CHD deaths per 100,000 prevented or added as a result of risk factor changes, under three cardiovascular risk factor scenarios.

<p>May not sum to total due to rounding.</p

Overview of three future risk factor scenarios.

<p>Overview of three future risk factor scenarios.</p

Future CHD mortality rate among 25–74 year old Icelanders.

<p>Future CHD mortality in two different risk factor scenarios and a proposal to obtainable goals.</p

Data sources.

<p>CHD mortality in 2010 was not available.</p