Leppävirta, Finland
Leppävirta, Finland

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Rikala M.,University of Eastern Finland | Korhonen M.J.,University of Turku | Sulkava R.,University of Eastern Finland | Sulkava R.,Kuopio University Hospital | And 2 more authors.
International Psychogeriatrics | Year: 2011

Background: The study evaluated the effects of an annual medication assessment conducted as part of a Comprehensive Geriatric Assessment (CGA) on the prevalence of psychotropic drug use in community-dwelling elderly people. Methods: Randomly selected persons (n = 1000) aged ≥75 years living in the city of Kuopio, Finland were randomized to intervention and control groups. The intervention group underwent an annual (2004-2006) medication assessment as part of a CGA by physicians. Data on drug use were gathered by interviews at baseline (2004) and in three following years (2005-2007). Generalized estimating equations (GEE) were applied to explore whether the prevalence of psychotropic drug use differed between the community-dwelling participants of the intervention (n = 361) and control groups (n = 339) over time. Results: At baseline, nearly 40% of the participants used psychotropic drugs in each group. In the intervention group, the study physicians implemented 126 psychotropic drug-related changes, 39% of which were persistent after one year. The prevalence of use of psychotropic drugs, antipsychotics and anxiolytic/hypnotics did not differ between the groups over time. The prevalence of antidepressant use remained constant in the intervention group, but increased in the control group (p-value for interaction = 0.039). The prevalence of concomitant use of psychotropic drugs decreased non-significantly in the intervention group, but increased in the control group (p-value for interaction = 0.009). Conclusions: Conducting an annual medication assessment outside the usual primary health care system does not appear to reduce the prevalence of psychotropic drug use in community-dwelling elderly people. However, it may prevent concomitant use of psychotropic drugs. © 2010 International Psychogeriatric Association.


Rikala M.,University of Eastern Finland | Korhonen M.J.,University of Turku | Sulkava R.,University of Eastern Finland | Sulkava R.,Kuopio University Hospital | And 2 more authors.
European Journal of Clinical Pharmacology | Year: 2011

Purpose: The aim of this prospective cohort study was to analyze psychotropic drug use in community-dwelling elderly people over a 3-year period and characterize those individuals most susceptible to persistent and incident use. Methods: Data on demographics, health status, cognition, functional capacity and drug use were gathered by interviews at baseline (2004) and in three follow-ups (2005-2007) in a population-based sample of 700 community-dwelling people aged ≥75 years. Characteristics associated with persistent and incident use were identified using Cox proportional-hazards regression. Results: At baseline, 38% (n = 269) of the participants used psychotropic drugs. Of these, 60% (n = 162) reported use in all three follow-ups, whereas 22% (n = 59) discontinued use. Among the baseline users of antipsychotics (n = 40), antidepressants (n = 83) and benzodiazepines (n = 219), respectively, 43, 51 and 55% reported use in all three follow-ups. The characteristics associated with persistent use of psychotropic drugs included concomitant use of psychotropic drugs, regular use of psychotropic drugs, increasing age and good self-rated health. Among the baseline nonusers of psychotropic drugs (n = 431), 20% (n = 88) initiated use during the follow-up. Incident use of psychotropic drugs was associated with increasing Geriatric Depression Scale scores, a Mini-Mental State Examination score ≤24, number of visits to physician ≥ 6, moderate/poor self-rated health and moderate/poor life satisfaction. Conclusions: Psychotropic drugs, benzodiazepines in particular, are frequently used for extended periods in community-dwelling people aged ≥75 years. Individuals with multiple psychotropic drugs and a regular pattern of use are most susceptible to persistent use. Characteristics associated with incident use include depressive symptoms, cognitive decline and poor general health. © 2011 Springer-Verlag.


Lampela P.,University of Eastern Finland | Hartikainen S.,University of Eastern Finland | Hartikainen S.,Leppavirta Health Center | Lavikainen P.,University of Eastern Finland | And 3 more authors.
Drugs and Aging | Year: 2010

Background: High drug consumption among the elderly and inappropriate prescribing practices increase the risk of adverse drug effects in this population. This risk may be decreased by conducting, for example, a medication review alone or as part of a comprehensive geriatric assessment (CGA); however, little is known about the fate of the changes in medication made as a result of the CGA or medication review. Objective: To study the performance of the CGA with regards to medication changes and to determine the persistence of these changes over a 1-year period. Methods: This study was a population-based intervention study. A random sample of 1000 elderly (age ≥75 years) was randomized either to a CGA group or to a control group. Home-dwelling patients from these groups (n = 331 and n = 313 for intervention and control groups, respectively) were analysed in this study. Study nurses collected information on medication at study entry and 1 year later in both groups; in the intervention group, study physicians assessed, and changed when appropriate, the medication at study entry. The medication changes and their persistence over 1 year were then evaluated. Results: Medication changes were more frequent in the intervention group than in the control group. Regular medication was changed during follow-up in 277 (83.7%) and in 228 (72.8%) [odds ratio (OR) 1.9; 95%CI 1.3, 2.8] patients in the intervention and control groups, respectively. In the intervention group, study physicians were responsible for 35.4% of all new prescriptions and for 15.6% of all drug terminations. Changes took place particularly in the prescription of CNS drugs. About 58% of the drugs initiated by study physicians were still in use 1 year later, and 25.5% of those terminated by study physicians had been reintroduced. Conclusion: Drug intervention as part of a CGA can be used to rationalize the drug therapy of a patient. However, its effectiveness is subsequently partly counteracted by other physicians working in the healthcare system. © 2010 Adis Data Information BV.


Rikala M.,University of Eastern Finland | Hartikainen S.,University of Eastern Finland | Hartikainen S.,Leppavirta Health Center | Sulkava R.,University of Eastern Finland | Korhonen M.J.,University of Turku
Drugs and Aging | Year: 2010

Background: Pharmacoepidemiological studies assessing the associations between psychotropic drug use and adverse events in the elderly frequently employ automated pharmacy databases as the source of exposure data. However, information on the validity of these databases for estimating psychotropic drug exposures in elderly people is scarce. Objective: This study evaluated the validity of the Finnish Prescription Register for estimating current exposures to psychotropic drugs in elderly people. Furthermore, the potential change in the validity over time was determined. Methods: This was a population-based intervention study (GeMS; Geriatric Multidisciplinary Strategy for the Good Care of the Elderly) conducted between 2004 and 2007. Initially, 1000 randomly selected persons aged ≥75 years living in the City of Kuopio, Finland, in November 2003 were invited to participate in the study. Of these, 716 agreed to participate at baseline (2004) and 570 were still available for 3-year follow-up (2007). The validity of the Prescription Register was assessed by comparing it with the self-reported information collected by interviews in 2004 and in 2007 in the GeMS study. Using the self-reported data as a reference standard, sensitivity, specificity and Cohens κ statistic (measure of inter-rater agreement for qualitative [categorical] items) with 95% confidence intervals were computed for different categories and subcategories of psychotropic drugs, applying fixed-time windows of 4, 6 and 12 months. Results: In 2007, the sensitivity varied between psychotropic categories and subcategories, being generally highest with the 12-month time window(0.57-0.96). The specificity was highest with the 4-month time window (0.94-0.99), showing a slight tendency to decrease with an extended time window. The sensitivity and specificity were highest for antidepressants and antipsychotics, followed by benzodiazepines. The agreement was almost perfect (κ = 0.81-1.00) or substantial (κ= 0.61-0.80) for all categories and subcategories of psychotropic drugs. Few differences in validity were observed between the two years. Conclusion: Using self-reported data as a reference standard, the Prescription Register provides valid information on current exposures to antidepressants and antipsychotics in elderly people if the time window is selected with adequate consideration. However, the validity is lower for benzodiazepines, suggesting that other sources of information should be considered when performing pharmacoepidemiological studies. © 2010 Adis Data Information BV. All rights reserved.


Rikala M.,University of Eastern Finland | Hartikainen S.,University of Eastern Finland | Hartikainen S.,Leppavirta Health Center | Saastamoinen L.K.,The Social Insurance Institution | Korhonen M.J.,University of Turku
International Journal of Methods in Psychiatric Research | Year: 2013

Pharmacoepidemiological studies provide valuable information on the relationships between psychotropic drug use and adverse outcomes in older people. To minimize the influence of misclassification bias in pharmacoepidemiological studies, more emphasis should be given to methodological aspects of exposure assessment. This study evaluated the validity of a dosage assumption of one unit per day for measuring legend duration of psychotropic drug exposures among older people. Using data from the Finnish Prescription Register, the study analysed 62,320 psychotropic drug prescriptions dispensed for people aged≥75 years (n = 52,729) in September 2009. The proportions of prescriptions in which the prescribed dose deviated from one unit per day were assessed for categories and subcategories of psychotropic drugs. The prescription was considered misclassified (a) if the prescribed drug was intended for "as needed" use, (b) if the prescription included a dose range, or (c) if the prescribed dose was below or above one unit per day. Among antidepressants, less than every fourth (23.7%) prescription was misclassified. The proportions of misclassification varied substantially across subcategories, being 13.1% for selective serotonin reuptake inhibitors (SSRIs), 25.3% for other antidepressants and 53.8% for tricyclic antidepressants. Of the benzodiazepine and antipsychotic prescriptions, 79.9% and 57.6%, respectively, were misclassified. In conclusion, the dosage assumption of one unit per day is valid for measuring the legend duration of SSRI and other antidepressant exposures among older people. Among other psychotropic drugs, the dosage assumption is likely to lead to severe exposure misclassification. © 2013 John Wiley & Sons, Ltd.


Pokela N.,University of Eastern Finland | Bell J.S.,University of Eastern Finland | Lihavainen K.,University of Eastern Finland | Lihavainen K.,University of Jyväskylä | And 3 more authors.
American Journal Geriatric Pharmacotherapy | Year: 2010

Background: Pain is often underrecognized and undertreated among older people. However, older people may be particularly susceptible to adverse drug reactions linked to prescription and nonprescription analgesics. Objectives: The aims of this study were to assess the prevalence of analgesic use among a random sample of community-dwelling people aged ≥75 years, and to investigate factors associated with daily and as-needed analgesic use. Methods: A random sample of people aged ≥75 years was drawn from the population register in Kuopio, Finland, in November 2003. Data on prescription and nonprescription analgesic use were elicited during nurse interviews conducted once for each participant in 2004. Self-reported drug utilization data were verified against medical records. The interview included items pertaining to sociodemographic factors, living conditions, social contacts, health behavior, and state of health. Physical function was assessed using the Instrumental Activities of Daily Living Scale, and the 10-item Barthel Index. Self-rated mobility was assessed by asking whether respondents could walk 400 meters (yes, yes with difficulty but without help, not without help, or no). Cognitive function was assessed using the Mini-Mental State Examination. The presence of depressive symptoms was assessed using the 15-item Geriatric Depression Scale. Respondents' self-rated health was determined using a 5-point scale (very poor, poor, moderate, good, or very good). Results: Of the initial random sample of participants (N = 1000), 700 provided consent to participate and were community dwelling. Among the participants, 318 (45.4%) were users of ≥1 analgesic on a daily or as-needed basis. Only 23.3% of analgesic users took an analgesic on a daily basis. Factors associated with any analgesic use included female sex (odds ratio [OR], 1.78 [95% CI, 1.17-2.71]), living alone (OR, 1.46 [95% CI, 1.02-2.11]), poor selfrated health (OR, 2.6 [95% CI, 1.22-3.84]), and use of ≥10 nonanalgesic drugs (OR, 2.21 [95% CI, 1.26-3.87]). Among users of ≥1 oral analgesic, factors associated with opioid use included moderate (OR, 2.46 [95% CI, 1.17-5.14]) and poor (OR, 2.57 [95% CI, 1.03-6.42]) self-rated health. Opioid use (OR, 0.19 [95% CI, 0.04-0.86]) and daily analgesic use (OR, 0.16 [95% CI, 0.34-0.74]) were inversely associated with depressive symptoms. Pain in the previous month was reported by 71.4% of analgesic users and 26.4% of nonusers of analgesics. Conclusions: Analgesics were used by ∼50% of community-dwelling people aged ≥75 years. However, age was not significantly associated with increased use of analgesics in multivariate analysis. The majority of analgesic drugs were used on an as-needed rather than a daily basis (76.7% vs 23.3%, respectively). Factors most significantly associated with analgesic use were female sex, living alone, poor self-rated health, and use of ≥10 nonanalgesic drugs. © 2010 Excerpta Medica Inc.


Lihavainen K.,University of Jyväskylä | Sipila S.,University of Jyväskylä | Rantanen T.,University of Jyväskylä | Sihvonen S.,Jyväskylä University of Applied Sciences | And 3 more authors.
Journals of Gerontology - Series A Biological Sciences and Medical Sciences | Year: 2010

Balance is among the most important prerequisites for safe and independent mobility. Whether musculoskeletal pain is related to standing balance impairment has received limited attention. The aim of this study was to examine the association of musculoskeletal pain with the control of balance in older people.Methods. A total of 605 participants aged 75 years and older (mean age 80.4, 71 % women) were interviewed about presence and severity of musculoskeletal pain. Balance was measured by a force platform, and impaired balance was defined as a high sway velocity moment or inability to maintain semitandem standing.Results. Musculoskeletal pain was reported by 48% of the participants, of whom majority had moderate to severe pain in lower extremities or back. Participants with moderate to severe musculoskeletal pain swayed more while standing than those without pain. After controlling for age, gender, body mass, chronic diseases, muscle strength, and physical activity, the participants with moderate to severe pain had more than twice (odds ratio 2.33, 95% confidence interval 1.44-3.76) the risk for impaired balance compared with those without pain.Conclusions. The findings demonstrate a direct relationship between the moderate to severe musculoskeletal pain and impaired postural balance. Pain seems to be an important target for the prevention of balance impairment and further mobility limitation among older people. © 2010 The Author.


Tikkanen P.,University of Eastern Finland | Nykanen I.,University of Eastern Finland | Nykanen I.,Clinical Pharmacology and Geriatric Pharmacotherapy Unit | Lonnroos E.,University of Eastern Finland | And 7 more authors.
Journals of Gerontology - Series A Biological Sciences and Medical Sciences | Year: 2012

Background. Physical activity in midlife has been related to lower mortality and better health in old age. The present study evaluated whether physical activity at age of 20-64 years was associated with mobility and muscle strength in old age. Methods. A random sample of 1,000 persons was extracted from all the ≥75-year-old people living in Kuopio, Finland, and 679 community-dwelling participants were included in the present analyses. Data on health status, ability to walk outside or 400 m, and physical activity level were obtained through structured interviews. Participants' walking speed, grip strength, and knee extension strength were measured by physiotherapists. Relationship between physical activity at age of 20-64 years and old-age mobility and strength was assessed using logistic regression and covariance analyses. Results. Of the 679 participants (mean age 80.8 years), 58.8% had been physically active at age of 20-64 years. Physical activity at that age was positively associated with ability to walk 400 m independently in old age (adjusted odds ratio 2.17, 95% confidence intervals: 1.25-3.77). Men who had been physically active at age of 20-64 years had greater walking speed (adjusted p = .01) and grip strength (adjusted p = .02) compared with physically inactive men. In women, the results did not differ statistically significantly. Conclusions. Physical activity at age of 20-64 years was associated with better mobility in old age. It was also linked to better grip strength and walking speed in older men but not in women. © The Author 2012.


Jyrkka J.,University of Eastern Finland | Enlund H.,Kuwait University | Lavikainen P.,University of Eastern Finland | Sulkava R.,University of Eastern Finland | And 3 more authors.
Pharmacoepidemiology and Drug Safety | Year: 2011

Purpose: To determine the association of polypharmacy with nutritional status, functional ability and cognitive capacity among elderly persons. Methods: This was a prospective cohort study of 294 survivors from the population-based Geriatric Multidisciplinary Strategy for the Good Care of the Elderly (GeMS) Study, with yearly follow-ups during 2004 to 2007. Participants were the citizens of Kuopio, Finland, aged 75 years and older at baseline. Polypharmacy status was categorized as non-polypharmacy (0-5 drugs), polypharmacy (6-9 drugs) and excessive polypharmacy (10+ drugs). A linear mixed model approach was used for analysis the impact of polypharmacy on short form of mini nutritional assessment (MNA-SF), instrumental activities of daily living (IADL) and mini-mental status examination (MMSE) scores. Results: Excessive polypharmacy was associated with declined nutritional status (p=0.001), functional ability (p<0.001) and cognitive capacity (p<0.001) when compared to non-polypharmacy group. Age, institutional living, poor self-reported health and time of measuring were also associated with the three outcome measures. In the excessive polypharmacy group, the proportion of malnourished or at risk of it increased from 31% to 50%, having difficulties in daily tasks from 48% to 74% and impaired cognition from 36% to 54% during the follow-up. The mixed model analysis revealed that polypharmacy status was not able to predict the progress of MNA-SF, IADL and MMSE scores over a three-year time. Conclusions: Excessive polypharmacy is associated with decline in nutritional status, functional ability and cognitive capacity in elderly persons. However, the changes in nutrition, physical functionality and cognition over a three-year period cannot be predicted by polypharmacy status. © 2011 John Wiley & Sons, Ltd.


Bell J.S.,University of Eastern Finland | Laitinen M.-L.,University of Eastern Finland | Lavikainen P.,University of Eastern Finland | Lonnroos E.,University of Eastern Finland | And 3 more authors.
Pain | Year: 2011

The objective of this study was to investigate the national pattern of strong opioid use among community-dwelling persons with and without Alzheimer's disease (AD) in Finland. All persons (n = 28,093) with a diagnosis of AD in 2005 were identified by the Social Insurance Institution of Finland (SII). For each person with AD, the SII identified a comparison person individually matched in terms of age (±1 year), sex, and region of residence. Records of all reimbursed drug purchases in 2005 were extracted from the Finnish National Prescription Register. Conditional logistic regression was used to calculate unadjusted and adjusted odds ratios (ORs) and 95% confidence intervals (CIs) for reimbursed opioid use. The age of the persons with and without AD ranged from 42 to 101 (mean 80.0) years, with men comprising 32.2% (n = 9048) of persons. The annual prevalence of reimbursed opioid use was 3.0% (n = 273) and 3.8% (n = 727) among men and women with AD, respectively. The use of all reimbursed opioids was lower among persons with AD compared with those without AD (adjusted OR 0.77, 95% CI 0.71 to 0.84). The use of strong opioids (adjusted OR 1.26, 95% CI 1.05 to 1.51) and fentanyl (adjusted OR 1.44, 95% CI 1.13 to 1.83) was higher among persons with AD. Our study did not assess the stage or severity of AD, nor the opioid doses prescribed. However, the results highlight the challenges associated with diagnosing and treating pain in this population, and the importance of balancing the risk of adverse drug reactions against the ease of transdermal administration. Use of opioid analgesics was lower among 28,089 persons with Alzheimer's disease (AD) compared with individually matched comparison persons without AD. However, use of strong opioids and transdermal fentanyl was more prevalent among persons with AD. © 2010 International Association for the Study of Pain. Published by Elsevier B.V. All rights reserved.

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