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  • 1
    Keywords: MORTALITY ; POPULATION ; prevention ; ELDERLY-PATIENTS ; CRITERIA ; ALL-CAUSE ; OLDER-PEOPLE ; SCREENING TOOL ; ALERT DOCTORS ; POLYPHARMACY
    Abstract: Background Cardiovascular disease is a leading cause of death in older people, and the impact of being exposed or not exposed to preventive cardiovascular medicines is accordingly high. Underutilization of beneficial drugs is common, but prevalence estimates differ across settings, knowledge on predictors is limited, and clinical consequences are rarely investigated. Methods Using data from a prospective population-based cohort study, we assessed the prevalence, determinants, and outcomes of medication underuse based on cardiovascular criteria from Screening Tool To Alert to Right Treatment (START). Results Medication underuse was present in 69.1% of 1454 included participants (mean age 71.1 +/- 6.1 years) and was significantly associated with frailty (odds ratio: 2.11 [95% confidence interval: 1.24-3.63]), body mass index (1.03 [1.01-1.07] per kg/m(2)), and inversely with the number of prescribed drugs (0.84 [0.79-0.88] per drug). Using this information for adjustment in a follow-up evaluation (mean follow-up time 2.24 years) on cardiovascular and competing outcomes, we found no association of medication underuse with cardiovascular events (fatal and non-fatal) (hazard ratio: 1.00 [0.65-1.56]), but observed a significant association of medication underuse with competing deaths from non-cardiovascular causes (2.52 [1.01-6.30]). Conclusion Medication underuse was associated with frailty and adverse non-cardiovascular clinical outcomes. This may suggest that cardiovascular drugs were withheld because of serious co-morbidity or that concurrent illness can preclude benefit from cardiovascular prevention. In the latter case, adapted prescribing criteria should be developed and evaluated in those patients.
    Type of Publication: Journal article published
    PubMed ID: 26288222
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  • 2
    Keywords: MORTALITY ; POPULATION ; HEALTH ; AGE ; VALIDITY ; OLDER-ADULTS ; prescription ; antidepressant ; SOCIAL SUPPORT ; EMERGENCY
    Abstract: Objective: The aim of this study was to evaluate the association between loneliness in elderly people with the use of psychotropic drugs. Methods: A subsample of 3111 participants (ages 55-85) of the large population-based German ESTHER study was included in the study. Loneliness was measured by using a three-item questionnaire. Two subgroups were defined according to their degrees of loneliness. Psychotropic drugs were categorized by study doctors. Logistic regression analyses were conducted to determine the association between loneliness subgroups and the use of psychotropic drugs adjusted for psychosocial variables, multimorbidity, depression, anxiety, and somatic symptom severity. Results: Of the participants 14.1% (95%-CI=[12.9; 15.4]) were estimated to have a high degree of loneliness (women 〉 men); 19% (95%-CI=[17.6; 20.4]) of the participants used psychotropic drugs, 8.4% (95%-CI=[7.5; 9.5]) antidepressants. Logistic regression analysis showed that more lonely participants had significantly higher odds for using psychotropic drugs (OR: 1.495; 95%-CI=[1.121; 1.993]). Depression severity, somatic symptom severity, and female gender were also positively associated with the use of psychotropic drugs. Conclusion: A high degree of subjective loneliness in the elderly is associated with the use of psychotropic drugs, even after adjustment for somatic and psychological comorbidities and psychosocial variables.
    Type of Publication: Journal article published
    PubMed ID: 25504324
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