The patterns and burden of multimorbidity in geriatric patients with prolonged use of addictive medications

Abstract Background Multimorbidity and prolonged use of addictive medications are prevalent among older patients, and known to increase the risk of adverse drug events. Yet, the relationship between these two entities has remained understudied. Aims This study explored the association between multimorbidity burden and prolonged use of addictive medications in geriatric patients, adjusted for clinically important covariates. Furthermore, we identified comorbidity patterns in prolonged users. Methods We conducted a cross-sectional study on a consecutive sample of 246 patients, aged 65–90 years, admitted to a large public university hospital in Norway. We defined prolonged use of addictive medications as using benzodiazepines, opioids and/or z-hypnotics beyond the duration recommended by clinical guidelines (≥ 4 weeks). Multimorbidity was assessed with the Cumulative Illness Rating Scale for Geriatrics (CIRS-G), based on diagnoses made by independent physicians. Results Compared to non-prolonged use, prolonged use was significantly more common among patients who had psychiatric (19/27, 70%), liver (19/22, 86%), upper gastrointestinal tract (21/32, 66%), musculoskeletal (52/96, 54%), or nervous system disorders (46/92, 50%). Patients with prolonged use had a higher multimorbidity burden than those without such use (CIRS-G score, mean = 7.7, SD = 2.7 versus mean = 4.6, SD = 2.2, p < 0.001). Multivariable logistic regression indicated a significant association between multimorbidity burden and prolonged addictive medication use (OR = 1.72, 95% CI 1.42–2.08). Predictive margins postestimation showed a systematic increase in the predicted CIRS-G scores when the number of addictive drug used increases. Conclusions Multimorbidity is strongly associated with prolonged use of addictive medications. Multiple substance use may aggravate disease burden of older patients.

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Sociodemographic, clinical and pharmacological profiles of medication misuse and dependence in hospitalised older patients in Norway: a prospective cross-sectional study

BMJ Open ◽

10.1136/bmjopen-2019-031483 ◽

2019 ◽

Vol 9 (9) ◽

pp. e031483 ◽

Cited By ~ 2

Author(s):

Socheat Cheng ◽

Tahreem Ghazal Siddiqui ◽

Michael Gossop ◽

Espen Saxhaug Kristoffersen ◽

Christofer Lundqvist

Keyword(s):

Pain Intensity ◽

Older Patients ◽

Adverse Drug Events ◽

Cross Sectional Study ◽

University Hospital ◽

Sectional Study ◽

Cross Sectional ◽

Medication Misuse ◽

Factors Associated ◽

Concurrent Use

ObjectivesTimely recognition of medication misuse and dependence is crucial to avoid both adverse drug events and increasing health expenditure. Yet the detection of these disorders in older people remains challenging due to the paucity of evidence on characteristics of patients at risk. This study investigates sociodemographic, pharmacological and clinical characteristics and factors associated with prolonged medication use, misuse and dependence in hospitalised older patients, focusing on three commonly prescribed central nervous system depressants (CNSDs): opioid analgesics, benzodiazepines and z-hypnotics.DesignA prospective, cross-sectional study complying with the Strengthening the Reporting of Observational Studies in Epidemiology guidelines.SettingSomatic departments of the Akershus University Hospital, Norway.Participants246 patients aged 65–90 were included.Outcome measuresProlonged use was defined as using CNSDs for ≥4 weeks. Misuse and dependence were assessed with the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition criteria for substance abuse and dependence. We used descriptive statistics to report patients’ characteristics and logistic regression to demonstrate factors associated with prolonged use, and misuse or dependence.ResultsForty per cent of participants reported using CNSDs for ≥4 weeks. The odds of prolonged use were higher for patients aged 75–84 (OR=2.32, 95% CI 1.16 to 4.65) and ≥85 (OR=3.33, 95% CI 1.25 to 8.87) vs <75 years, for pain intensity (OR=1.02, 95% CI 1.01 to 1.04), and polypharmacy versus no polypharmacy (OR=5.16, 95% CI 2.13 to 12.55). The odds were lower for patients who completed secondary education (OR=0.33, 95% CI 0.13 to 0.83) compared with those with only basic education. Factors associated with misuse or dependence were pain intensity (OR=1.02, 95% CI 1.01 to 1.04) and concurrent use of ≥2 CNSDs (OR=3.99, 95% CI 1.34 to 11.88).ConclusionCNSD overuse is prevalent among hospitalised older patients, despite clear guidelines and recommendations. Our findings underline a need for stronger focus on responsible prescribing, timely detection and prevention of this issue, with special attention towards older patients, those with enhanced pain, polypharmacy and/or concurrent use of several CNSDs.Trial registration numberNCT03162081.

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Psychopathological Factors Associated With Burnout in Intensive Care Nurses: A Cross-Sectional Study

Journal of the American Psychiatric Nurses Association ◽

10.1177/1078390321999725 ◽

2021 ◽

pp. 107839032199972

Author(s):

Erman Yıldız

Keyword(s):

Intensive Care ◽

Emotional Exhaustion ◽

Cross Sectional Study ◽

Personal Accomplishment ◽

University Hospital ◽

Sectional Study ◽

Cross Sectional ◽

Factors Associated ◽

Anxiety Depression ◽

The Relationship

BACKGROUND: Although previous studies have separately revealed that parameters such as anxiety, depression, and secondary traumatic stress (STS) are associated with burnout, there is still a limited understanding of the relationship between anxiety, depression, and STS and burnout in intensive care unit (ICU) nurses. AIMS: To investigate the relationship between levels of burnout, anxiety, depression, and STS in ICU nurses. METHOD: A cross-sectional study was conducted with ICU nurses ( N = 164) from a university hospital in eastern Turkey. The participants completed the anxiety, depression, STS, and burnout scales along with the descriptive characteristics form. The data were analyzed using descriptive statistics, correlation, and logistic regression analysis. RESULTS: The mean scores for STS, anxiety, depression, and burnout were 40.60 ± 13.77, 17.14 ± 12.90, 13.28 ± 9.75 and 41.39 ± 14.87, respectively. The results showed that, in the ICU nurses, anxiety, depression, and STS components explained 61% of emotional exhaustion, 38% of depersonalization, and 13% of personal accomplishment. CONCLUSIONS: While the present findings supported the paradigm that burnout in ICU nurses is associated with STS, anxiety, and depression, they also revealed some details about the psychopathological factors associated with burnout. These details were as follows: (1) individuals who resorted to avoidance as a component of STS on a high level were more likely to experience emotional exhaustion and depersonalization, (2) individuals with severe depressive symptoms were more likely to experience a decrease in their personal accomplishment, and (3) individuals with anxiety symptoms were more likely to experience both emotional exhaustion and personal accomplishment.

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Obesity in Pregnant Adolescents: Clinical Correlates, Maternal and Fetal Outcomes

Global Journal of Medical Research ◽

10.34257/gjmrevol20is4pg17 ◽

2020 ◽

pp. 17-25

Author(s):

Cecília Ogando Alfama ◽

Amanda Vilaverde Perez ◽

Mariana Sbaraini ◽

Marianna Sperb ◽

Rafaela da Silveira Corrêa ◽

...

Keyword(s):

Gestational Hypertension ◽

Cross Sectional Study ◽

University Hospital ◽

Sectional Study ◽

Pregnant Adolescents ◽

Fetal Outcomes ◽

Cross Sectional ◽

The Relationship ◽

Weight Excess ◽

Lower Adherence

Objective: To evaluate the relationship between pregestational obesity and maternal and fetal outcomes in pregnant adolescents. Methods: Cross-sectional study conducted among puerperal teenagers of a university hospital in Southern Brazil. Structured questionnaires on sociodemographic and obstetric data were applied. Results: We evaluated 500 puerperal adolescents with a mean age of 17.77± 1.36. Of these, 31.2% (n=156) had pregestational weight excess. Pregestational weight excess was significantly associated with gestational hypertension (p=0.037) and diabetes (p=0.045), cesarean delivery (p=0.040),and lower adherence to prenatal care (24.7%, p=0.007).

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Lactate dehydrogenase level as an early predictor of transient tachypnea of the newborn duration and complications

10.21203/rs.3.rs-119294/v1 ◽

2020 ◽

Author(s):

Mada Osefori ◽

Leen Jamel Doya ◽

Bana Nezha ◽

Adnan Dayoub

Keyword(s):

Intensive Care ◽

Lactate Dehydrogenase ◽

Neonatal Intensive Care ◽

Lactate Dehydrogenase Level ◽

Cross Sectional Study ◽

Postnatal Period ◽

University Hospital ◽

Cross Sectional ◽

Duration Of Hospitalization ◽

The Relationship

Abstract Background: Transient tachypnea of the newborn(TTNB) is a common cause of respiratory distress in the postnatal period. It is rarely associated with serious complications that need intensive care. Prediction of the complications during the first hours of hospitalization is very difficult, so the purpose of the current study is to investigate the relationship between lactate dehydrogenase (LDH) level in blood and the course of Transient tachypnea of the newborn (the duration of hospitalization, and the incidence of complications).Material and methods: In a cross-sectional study design included 120 neonates with Transient tachypnea of the newborn who had referred to the Neonatal Intensive Care Unit (NICU) at Tishreen University Hospital over 1 year period from January 2018 to January 2019. The neonates were classified according to Lactate dehydrogenase measurement as normal or high lactate dehydrogenase level in blood.Results: The results showed that there was a significant relationship between the level of lactate dehydrogenase and the duration of hospitalization, the incidence of complications, and the frequency of complications.Conclusions: lactate dehydrogenase might be useful for clinicians to predict the duration of hospitalization and the incidence of complications in neonates with TTNB.

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Relationship Quality and Distress in Caregivers of Persons With Dementia: A Cross-Sectional Study

American Journal of Alzheimer s Disease & Other Dementias® ◽

10.1177/1533317517691121 ◽

2017 ◽

Vol 32 (3) ◽

pp. 157-165 ◽

Cited By ~ 8

Author(s):

Heidi Bjørge ◽

Kari Kvaal ◽

Milada Cvancarova Småstuen ◽

Ingun Ulstein

Keyword(s):

Leisure Time ◽

Expressed Emotion ◽

Rating Scale ◽

Cross Sectional Study ◽

Regression Analyses ◽

Sectional Study ◽

Factor Analyses ◽

Cross Sectional ◽

The Family ◽

The Relationship

This cross-sectional study aimed to investigate the relationship between caregivers and care receivers, defined as home-dwelling family members with dementia. We used a self-rating questionnaire, the Felt Expressed Emotion Rating Scale (FEERS; 6 simple questions), to measure caregiver perceptions of the care receiver’s criticisms (CCs) and emotional overinvolvement (EOI) toward the caregiver. We performed factor analyses to rank single items on the FEERS pertaining to CC and EOI. We included 208 caregiver/care receiver pairs. Logistic regression analyses tested associations between FEERS items and caregiver and care receiver variables. The main contributors to caregiver perceptions of CC were the caregiver’s own distress and the amount of time spent with the care receiver. Socially distressed caregivers perceived the care receiver as emotionally overinvolved. When offering a psychosocial intervention, a tailored program should target the caregiver’s perceived relationship with the family member and the caregiver’s distress. The program should also endeavor to give the caretaker more opportunities for leisure time.

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IS DISTRIBUTION OF PAIN RELATED WITH CENTRAL SENSITIZATION IN PATIENTS WITH LOWER LIMB OSTEOARTHRITIS?

Journal of Musculoskeletal Research ◽

10.1142/s0218957721500196 ◽

2021 ◽

pp. 2150019

Author(s):

Andriana Koufogianni ◽

Asimakis K. Kanellopoulos ◽

Konstantinos Vassis ◽

Ioannis A. Poulis

Keyword(s):

Lower Limb ◽

Central Sensitization ◽

Rating Scale ◽

Cross Sectional Study ◽

The Body ◽

Cross Sectional ◽

Numeric Pain Rating Scale ◽

The Relationship ◽

Pain Distribution

Design: Cross-sectional study. Background: Osteoarthritis is one of the most common conditions in our society. A growing number of studies suggest the existence of central sensitization (CS) in a subgroup of osteoarthritic patients. One of the criteria included for the classification of CS pain is the expanded distribution of pain. As this criterion is a well-recognized sign of CS, a digital pain drawing (DPD) analysis would be useful to easily identify possible extended areas of pain distribution (PD) in patients with OA. Objective: To study the relationship between the percentage of distribution of pain in the lower limb for both knee and hip, in patients before hip or knee arthroplasty, and the Central Sensitization Inventory Questionnaire. Methods: Twenty women (mean [Formula: see text] years) with diagnosed chronic (over 3 months) knee ([Formula: see text]) and hip ([Formula: see text]) OA participated in the study, with intensity of pain from mild to severe, meaning pain [Formula: see text]/10 using the Numeric Pain Rating Scale (NPRS). The PD was analyzed via software created for this research, called “Pain Distribution Application”. Results: A statistically significant positive correlation between CSI and PD to the lower extremity OA (hip and knee) ([Formula: see text], [Formula: see text]) was found. The distribution of pain has a linear correlation with the results in CSI, of patients who tested positive for CS, i.e. with a score of [Formula: see text]. Conclusions: As the distribution of pain on the surface of the body (diffusion) increases, so does the score of people who test positive for CSI. Our results showed that calculating the distribution of pain with our application may have a utility as a CS screening tool. The PD threshold of 10% of the body area is an index for CS for chronic pain lower limb OA patients.

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Monitoring adverse events in older hospitalized patients: A retrospective cross-sectional study using validated screening criteria with administrative data

Journal of Hospital Administration ◽

10.5430/jha.v7n6p7 ◽

2018 ◽

Vol 7 (5) ◽

pp. 7

Author(s):

Stacy A. Ackroyd-Stolarz ◽

Susan K. Bowles ◽

Lorri Giffin

Keyword(s):

Administrative Data ◽

Older Patients ◽

Adverse Drug Events ◽

Pressure Ulcers ◽

Cross Sectional Study ◽

System Level ◽

Drug Event ◽

Sectional Study ◽

Cross Sectional ◽

Screening Criteria

Objective: Older patients are at higher risk of experiencing an adverse event (AE) during an acute hospitalization. The objective of the current study was to use routinely collected administrative data to characterize AEs and their system-level impact for older patients hospitalized in one Canadian health authority.Methods: This retrospective cross-sectional study occurred in the Capital District Health Authority in Nova Scotia, Canada between April 1, 2012 and March 31, 2013. The primary outcome was identification of pressure ulcers, fall-related injuries and adverse drug events in patients 65 years of age and older admitted to an acute inpatient service. AEs were identified using validated screening criteria. Data were analyzed using standard descriptive statistics.Results: There were 11,747 hospitalizations during the study period. A total of 330 (2.8%) AEs in 325 patients were identified using the screening criteria. This included 55 (16.7% of 330) pressure ulcers, 25 (7.6%) fall-related injuries and 250 (75.8%) adverse drug events. The average length of stay was significantly higher in patients with a pressure ulcer (35.8 ± 47.3 vs. 9.0 ± 14.8 days, p < .0001), fall-related injury (30.3 ± 23.2 vs. 9.0 ± 15.2 days, p < .0001), or adverse drug event (14.6 ± 14.4 vs. 9.0 ± 15.2 days, p < .0001) during their acute hospitalization.Conclusions:Use of validated screening criteria with administrative hospitalization data provides important information for monitoring the system-level impact of common AEs in older patients. Significant and clinically important differences in healthcare utilization underscore the value in monitoring these AEs in this growing patient population.

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The Correlation Between Arterial Lactate and Venous Lactate in Patients With Sepsis and Septic Shock

Journal of Intensive Care Medicine ◽

10.1177/0885066616663169 ◽

2016 ◽

Vol 33 (2) ◽

pp. 116-120 ◽

Cited By ~ 14

Author(s):

Pongdhep Theerawit ◽

Chalermpon Na Petvicharn ◽

Viratch Tangsujaritvijit ◽

Yuda Sutherasan

Keyword(s):

Characteristic Curve ◽

Cross Sectional Study ◽

University Hospital ◽

Strongly Correlated ◽

Cross Sectional ◽

Arterial Lactate ◽

Paired Samples ◽

The Mean ◽

Sepsis And Septic Shock ◽

The Relationship

Background: Applying peripheral venous lactate instead of arterial lactate in clinical practice is questionable because of deviation between both values. We aimed to find the relationship between the arterial lactate and the peripheral venous lactate before reasoned that the venous lactate could be used in substitution to the arterial lactate in sepsis. Methods: We conducted a prospective, cross-sectional study at a university hospital. The patients with sepsis in ICU who required lactate level monitoring were enrolled in this research. The correlation and agreement between arterial lactate (A-LACT) and peripheral venous lactate (V-LACT) were the primary outcomes. Results: A total of 63 paired samples were collected. The A-LACT and V-LACT were strongly correlated ( r = .934, P < .0001, r2 = .873). The regression equation was A-LACT = (0.934 × V-LACT) − 0.236. The mean difference between V-LACT and A-LACT was 0.66 ± 1.53 mmol/L. The 95% limits of agreement were between −3.66 and 2.33 mmol/L. The V-LACT ≥ 4 mmol/L can predict A-LACT level ≥ 4 mmol/L with 87.5% sensitivity and 91.5% specificity, and the area under receiver operating characteristic curve was 0.948. Conclusion: The present study demonstrated a strong correlation between A-LACT and V-LACT, but an agreement between both parameters was poor. We suggest not to use the V-LACT in substitution to the A-LACT in sepsis regarding the absolute value and clearance rate, but the V-LACT ≥ 4.5 mmol/L may be used for predicting the A-LACT ≥ 4 mmol/L.

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Potentially inappropriate medications use and its associated factors among geriatric patients: a cross-sectional study based on 2019 Beers Criteria

Pharmacia ◽

10.3897/pharmacia.68.e73597 ◽

2021 ◽

Vol 68 (4) ◽

pp. 789-795

Author(s):

Heba Khader ◽

Luai Z. Hasoun ◽

Ahmad Alsayed ◽

Mahmoud Abu-Samak

Keyword(s):

Geriatric Patients ◽

Adverse Drug Events ◽

Cross Sectional Study ◽

Community Dwelling ◽

Sample Population ◽

Beers Criteria ◽

Potentially Inappropriate Medications ◽

Sectional Study ◽

Cross Sectional ◽

Inappropriate Medications

The aims of this study were to estimate the prevalence of potentially inappropriate medications (PIMs) in a community-dwelling Jordanian population of geriatrics according to the 2019 American Geriatrics Society Beers Criteria, to identify the most used PIMs and factors independently associated with PIMs use. This was an observational, descriptive, cross-sectional study. The sample population included 386 participants. Data were collected by face-to-face interviews. A total of 2894 medications were evaluated. The prevalence of patients using at least one PIM was 49.2%. The most used PIMs were proton pump inhibitors (24.6%) and long-acting sulfonylurea (20.5%). Participants who had diabetes mellitus, peptic ulcer, or irritable bowel syndrome had significantly higher numbers of PIMs. The use of PIMs was high in Jordanian geriatric patients. The results of this study might help healthcare providers to detect high-risk patients and reconsider the necessity of using PIMs to decrease the risk of adverse drug events.

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The Relationship betweenH. pyloriInfection and Osteoporosis in Japan

Gastroenterology Research and Practice ◽

10.1155/2014/340765 ◽

2014 ◽

Vol 2014 ◽

pp. 1-9 ◽

Cited By ~ 14

Author(s):

Daisuke Asaoka ◽

Akihito Nagahara ◽

Mariko Hojo ◽

Hitoshi Sasaki ◽

Yuji Shimada ◽

...

Keyword(s):

Bone Turnover Marker ◽

Cross Sectional Study ◽

University Hospital ◽

Bivariate Analysis ◽

Upper Gastrointestinal Endoscopy ◽

Cross Sectional ◽

Ulcer Disease ◽

Patient Profile ◽

H Pylori ◽

The Relationship

Background and Objective.H. pyloriinfection causes a chronic inflammation in the gastric mucosa. However, this local inflammation may result in extra-digestive conditions. Our aim is to investigate the relationship betweenH. pyloriinfection and osteoporosis in Japan.Methods. This cross-sectional study was conducted among outpatients at the Juntendo University Hospital between 2008 and 2014. Participants for patient profile,H. pyloriinfection status, comorbidity, internal medical therapies, lumbar dual-energy X-ray absorptiometry (DXA), and bone turnover marker were collected and upper gastrointestinal endoscopy for reflux esophagitis, hiatal hernia, peptic ulcer disease (PUD), and endoscopic gastric mucosal atrophy (EGA) was performed. The diagnosis of osteoporosis was performed in accordance with the Japanese criteria. We investigated risk factors of osteoporosis.Results. Of the eligible 200 study subjects, 41 cases were of osteoporosis. Bivariate analysis showed that age, being female, BMI, alcohol, smoking,H. pylori, bone-specific ALP, PUD, and EGA were related to osteoporosis. Multivariate analysis showed that age (OR 1.13; 95%CI 1.07–1.20), being female (OR 4.77; 95%CI 1.78–12.77), BMI (OR 0.79; 95%CI 0.68–0.92),H. pylori(OR 5.33; 95%CI 1.73–16.42), and PUD (OR 4.98; 95%CI 1.51–16.45) were related to osteoporosis.Conclusions.H. pyloriinfection may be a risk factor of osteoporosis in Japan.

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