scholarly journals Use of pharmacy services in community-dwelling middle-aged and older adults in Ireland

2021 ◽  
Vol 29 (Supplement_1) ◽  
pp. i4-i5
Author(s):  
F Moriarty ◽  
M Flood
Keyword(s):  
Blood Pressure ◽  
Older Adults ◽  
Health Insurance ◽  
Educational Attainment ◽  
Private Health Insurance ◽  
Service Use ◽  
Community Dwelling ◽  
Pharmacy Service ◽  
Pharmacy Services ◽  
Gp Visits

Abstract Introduction Pharmacy has a potentially significant role in meeting the escalating need for healthcare, particularly with population ageing and shifts to more community-based care under Ireland’s health reform policies. The role of community pharmacists has evolved in recent years with expansion in pharmacy services offered. This study aims to assess pharmacy services use among adults aged ≥50 years in Ireland, and determine the demographic and clinical factors associated with pharmacy services use. Methods This cross-sectional study included community-dwelling participants in wave 4 of The Irish Longitudinal Study on Ageing (TILDA), aged ≥50 years who were self-respondents (i.e. proxy respondents were omitted). TILDA is a nationally representative cohort study, and wave 4 data was collected during 2016. TILDA participants were asked if they availed of several named services when visiting the pharmacy in the last 12 months. These included: requesting advice about medication; vaccination; blood pressure (BP) or cholesterol checks; advice on smoking cessation or weight management; and diabetes, asthma, or allergy tests. We considered age, sex, educational attainment, GP utilization, medical card and private health insurance status, loneliness, polypharmacy, use of high risk medications (anticoagulants, NSAIDs, opioids, diuretics, antiplatelets, antimicrobials, insulin and hypoglycaemics) and comorbidities. Multivariate logistic regression was used to examine the association of these with reporting (i) any pharmacy service use and (ii) requesting medicines advice. Results This study included 5,782 participants, 55.5% were female with a mean age of 68 years. 96.6% of participants (5,587) reporting visiting a pharmacy in the previous 12 months, and almost one quarter of these (1,323) availed of at least one specified pharmacy service. The most common services reported were requesting advice about medications (786, 13.6%), blood pressure monitoring (184, 3.2%), and vaccination (166, 2.9%). Compared to those not using any services, service users were a similar age (mean 68 years), but were taking more medications (mean 3.6 versus 2.8), were more often female (64.1% versus 54.2%), had higher educational attainment, and had higher GP visit rates. Controlling for other factors, the following were associated with a high likelihood of availing of pharmacy services: female gender (odds ratio (OR) 1.32, 95%CI 1.14–1.52), third level education (OR 1.85, 95%CI 1.51–2.27), higher rates of GP visits, private health insurance (OR 1.29, 95%CI 1.07–1.56), higher number of medications, loneliness, and a diagnosed respiratory condition (OR 1.42, 95% CI 1.14–1.74). The relationship between these factors and requesting medicines advice were similar. Conclusion A high proportion of middle-aged and older adults visit community pharmacy and a quarter avail of specified pharmacy services. Despite advances in the services offered in pharmacies, medicines advice remains at the core of pharmacists’ practice. Those on multiple medications, who may derive greater benefit from such services, are more likely to avail of them. Number of GP visits was also associated with service use, suggesting patients may avail of pharmacy services as a complement, rather than a substitute, to visiting their GP. Services were more often used by people who are lonely, and pharmacists should consider interventions to support these people.

Impact of a Private Health Insurance Mandate on Public Sector Autism Service Use in Pennsylvania

2012 ◽  
Vol 51 (8) ◽  
pp. 771-779 ◽  
Author(s):  
Bradley D. Stein ◽  
Mark J. Sorbero ◽  
Upasna Goswami ◽  
James Schuster ◽  
Douglas L. Leslie
Keyword(s):  
Health Insurance ◽  
Public Sector ◽  
Private Health Insurance ◽  
Service Use ◽  
Insurance Mandate

Association of Systolic and Diastolic Blood Pressure With All-Cause Mortality Among Community-Dwelling Older Adults: A Prospective Observational Study

2021 ◽  
pp. 089826432110552
Author(s):  
Qian Lian ◽  
Tazeen H. Jafar ◽  
John C. Allen ◽  
Stefan Ma ◽  
Rahul Malhotra
Keyword(s):  
Blood Pressure ◽  
Older Adults ◽  
Diastolic Blood Pressure ◽  
Mortality Risk ◽  
Cox Regression ◽  
Community Dwelling ◽  
Representative Study ◽  
Hazard Ratios ◽  
Nationally Representative ◽  
Community Dwelling Older Adults

Objectives To assess the association of systolic blood pressure (SBP) and diastolic blood pressure (DBP) with mortality among older adults in Singapore. Methods Association of SBP and DBP measured in 2009 for 4443 older adults (69.5±7.4 years; 60–97 years) participating in a nationally representative study with mortality risk through end-December 2015 was assessed using Cox regression. Results Higher mortality risk was observed at the lower and upper extremes of SBP and DBP. With SBP of 100–119 mmHg as the reference, multivariable mortality hazard ratios [HRs (95% confidence interval)] were SBP <100 mmHg: 2.41 (1.23–4.72); SBP 160–179 mmHg: 1.51 (1.02–2.22); and SBP ≥180 mmHg: 1.78 (1.12–2.81). With DBP of 70–79 mmHg as the reference, HRs were DBP <50 mmHg: 2.41 (1.28–4.54) and DBP ≥110 mmHg: 2.16 (1.09–4.31). Discussion Management of high blood pressure among older adults will likely reduce their mortality risk. However, the association of excessively low SBP and DBP values with mortality risk needs further evaluation.

Abstract 22: Visit-to-Visit Variability in Blood Pressure is Related to Late-Life Cognitive Decline

Circulation ◽  
2015 ◽  
Vol 131 (suppl_1) ◽  
Author(s):  
Bo Qin ◽  
Anthony J Viera ◽  
Linda S Adair ◽  
Brenda L Plassman ◽  
Lloyd J Edwards ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Older Adults ◽  
Cognitive Function ◽  
Cognitive Decline ◽  
Verbal Memory ◽  
Repeated Measures ◽  
Community Dwelling ◽  
Cognitive Testing ◽  
Cognitive Test ◽  
Nutrition Survey

Introduction: Recent studies suggest higher visit-to-visit variability of blood pressure (BP) is associated with worse cognitive function, but evidence based on longitudinal cognitive testing has not been reported. Hypothesis: We assessed the hypothesis that higher visit-to-visit variability in BP, but not mean BP, would be associated with faster decline in cognitive function among community-dwelling older adults. Methods: This prospective cohort study comprised 1213 adults who had two or more waves of BP measurements as part of the China Health and Nutrition Survey from 1991, up to their first cognitive tests, and completed a cognitive screening test at two or more waves in 1997, 2000 or 2004. Mean (SD) age at first cognitive test was 64 (6) y. Outcomes were repeated measures of global cognitive scores (baseline mean ± SD: 19 ± 6 points), standardized composite cognitive and verbal memory scores (standardized units [SU]). Visit-to visit BP variability was expressed as the standard deviation [SD] or as the variation independent of mean (SD/mean^x, with x derived from curve fitting) in BP measures obtained at a mean interval of 3.6 years. Multivariable-adjusted linear mixed-effects models were used to determine the association of changes in cognitive scores with visit-to visit BP variability. Results: Higher visit-to-visit variability in systolic BP, but not mean systolic BP, was associated with a faster decline of cognitive function (adjusted mean difference [95% CI] for high vs. low tertile of SD in variability (Figure): global score -0.23 points/y [-0.41 to -0.04], composite scores -0.029 SU/y [-0.056 to -0.002] and verbal memory -0.044 SU/y [-0.075 to -0.012]). Higher visit-to-visit variability in diastolic BP was associated with a faster decline of global cognitive function only among adults 55-64 years, independent of mean diastolic BP. Conclusion: Higher long-term BP visit-to-visit variability predicted a faster rate of cognitive decline among older adults.

scholarly journals Group Lifestyle Phone Maintenance for Weight, Health, and Physical Function in Adults Aged 65–80 Years: A Randomized Clinical Trial

2020 ◽  
Author(s):  
Elizabeth M Venditti ◽  
Marsha D Marcus ◽  
Rachel G Miller ◽  
Vincent C Arena ◽  
Susan L Greenspan ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Older Adults ◽  
Weight Loss ◽  
Physical Function ◽  
Community Dwelling ◽  
Lipid Lowering ◽  
Additional Risk ◽  
Management Group ◽  
Registration Number ◽  
And Function

Abstract Background Group lifestyle sessions with phone maintenance could improve weight, health, and function in vulnerable older adults. Methods Community-dwelling adults (N = 322) with body mass index (BMI, kg/m2) ≥27 and additional risk factors received 12 one-hour in-person behavioral weight management group sessions then were randomized to 8 half-hour telephone sessions (n = 162) or newsletter control (n = 160) from 4 to 12 months with no treatment contact thereafter. Primary outcome was 0- to 12-month weight change. Cardiometabolic, short physical performance battery (SPPB), and self-reported activity changes were assessed at 12 and 24 months. Results At baseline, the mean (SD) age was 71.2 (4.3) and BMI was 33.8 (5.1). Participants were 77% women, 13% Black, 85% retired, averaging 4 medical conditions, and taking blood pressure (67.4%) and lipid-lowering (51.6%) medications. At 12 months, a greater proportion of the phone group (66.0%) achieved ≥5% weight loss compared with newsletter control (53.2%; p = .02). Mean (95% CI) weight loss was greater for phone (−6.6 kg [−7.5, −5.8]) than newsletter (−5.1 kg [−7.2, −3.0]); p = .01. Modest lipid, glucose, and blood pressure improvements were found, but did not differ significantly between groups. Small SPPB and activity improvements were maintained at 12 and 24 months in both groups. Conclusions Brief phone contacts compared to newsletters enhanced weight loss maintenance among older high-risk adults at 1 year, but not cardiometabolic outcomes. Modest functional improvements were observed in both. Lower-intensity maintenance contacts (phone or newsletter) for weight, health, and physical function in older adults warrant further study. Clinical Trials Registration Number NCT03192475

Gender differences in health service use for mental health reasons in community dwelling older adults with suicidal ideation

2012 ◽  
Vol 25 (3) ◽  
pp. 374-381 ◽  
Author(s):  
Helen-Maria Vasiliadis ◽  
Sarah Gagné ◽  
Natalia Jozwiak ◽  
Michel Préville
Keyword(s):  
Mental Health ◽  
Older Adults ◽  
Suicidal Ideation ◽  
Service Use ◽  
Community Dwelling ◽  
Symptoms Of Depression ◽  
Antidepressant Use ◽  
One Year ◽  
Promotion Campaigns ◽  
Community Dwelling Older Adults

ABSTRACTBackground: To ascertain gender-specific determinants of antidepressant and mental health (MH) service use associated with suicidal ideation.Methods: Data used in this study came from the ESA (Enquête sur la Santé des Aînés) survey carried out in 2005–2008 on a large sample of community-dwelling older adults (n = 2,004). Multivariate logistic regression analyses were carried out.Results: The two-year prevalence of suicidal ideation was 8.4% and 20.3% had persistent suicidal thoughts at one-year follow-up. In males, the prevalence of antidepressant and MH service use in respondents with suicidal ideation reached 32.2% and 48.9%, respectively. In females, the corresponding rates were 42.6% and 65.6%. Males were less likely to consult MH services than females when their MH was judged poorly. Male respondents with higher income and education were less likely to use antidepressant and MH services. However, males using benzodiazepines were more likely than females to be dispensed an antidepressant. Among respondents with suicidal ideation, gender was not associated with service use. Younger age, however, was associated with antidepressant use.Conclusions: Increased promotion campaigns sensitizing men to the prodromal symptoms of depression and the need to foster access to MH care when the disorder is manageable may be needed.

Associations between CAMCOG-R subscale performance and formal education attainment in South African older adults

2014 ◽  
Vol 27 (2) ◽  
pp. 251-260 ◽  
Author(s):  
Katharine A. James ◽  
Laurian K. Grace ◽  
Kevin G.F. Thomas ◽  
Marc I. Combrinck
Keyword(s):  
Older Adults ◽  
Educational Attainment ◽  
Formal Education ◽  
Screening Tool ◽  
Resource Constraints ◽  
Subscale Score ◽  
Community Dwelling ◽  
Middle Income ◽  
Recent Memory ◽  
The Individual

ABSTRACTBackground:The Cambridge Cognitive Examination-Revised (CAMCOG-R) is a sensitive screening tool for the early diagnosis of dementia in older adults. Overall performance on the CAMCOG-R is influenced by educational attainment. Few studies have, however, examined the association between educational attainment and performance on the individual CAMCOG subscales. We aimed to address this question in a sample from a low-and middle-income country (LAMIC), where resource constraints may have compromised access to, and quality of, education for many older adults.Methods:Participants, all over 60 years of age, were 51 cognitively healthy community-dwelling volunteers and 47 individuals diagnosed with mild-moderate stage Alzheimer's disease (AD). Most participants had some high school education. They were administered the CAMCOG-R under standardized conditions.Results:Within both the control and AD patient groups, there were significant associations between years of completed education and CAMCOG-R total score, MMSE score, and CAMCOG-R Language subscale score. In both groups, level of education was not associated with scores on these subscales: in controls, recent memory, R2 = .21, p = .055, learning memory, R2 = .16, p = .398, attention/calculation, R2 = .19, p = .467, and perception, R2 = .18, p = .984; in AD patients, recent memory, R2 = .14, p = .340, learning memory, R2 = .03, p = .680, perception, R2 = .09, p = .723, and attention/calculation, R2 = .19, p = .097.Conclusions:Some CAMCOG-R subscale scores were more strongly associated with educational attainment than others. Importantly, however, performance on the recent memory and learning memory subscales was not affected by education. These subscales are sensitive indicators of amnestic mild cognitive impairment (MCI) and early AD. These subscales may therefore remain valid for use as an AD screening tool in resource-poor healthcare settings.

scholarly journals Is orthostatic hypotension and co-existing supine and seated hypertension associated with future falls in community-dwelling older adults? Results from The Irish Longitudinal Study on Ageing (TILDA)

PLoS ONE ◽  
2021 ◽  
Vol 16 (5) ◽  
pp. e0252212
Author(s):  
Orna A. Donoghue ◽  
Matthew D. L. O’Connell ◽  
Robert Bourke ◽  
Rose Anne Kenny
Keyword(s):  
Blood Pressure ◽  
Older Adults ◽  
Longitudinal Study ◽  
Orthostatic Hypotension ◽  
Community Dwelling ◽  
Effect Sizes ◽  
Important Indicator ◽  
Supine Hypertension ◽  
Risk Of Falls ◽  
Community Dwelling Older Adults

Orthostatic hypotension (OH) often co-exists with hypertension. As increasing age affects baroreflex sensitivity, it loses its ability to reduce blood pressure when lying down. Therefore, supine hypertension may be an important indicator of baroreflex function. This study examines (i) the association between OH and future falls in community-dwelling older adults and (ii) if these associations persist in those with co-existing OH and baseline hypertension, measured supine and seated. Data from 1500 community-dwelling adults aged ≥65 years from The Irish Longitudinal Study on Ageing (TILDA) were used. Continuous beat-to-beat blood pressure was measured using digital photoplethysmography during an active stand procedure with OH defined as a drop in systolic blood pressure (SBP) ≥20 mmHg and/or ≥10 mm Hg in diastolic blood pressure (DBP) within 3 minutes of standing. OH at 40 seconds (OH40) was used as a marker of impaired early stabilisation and OH sustained over the second minute (sustained OH) was used to indicate a more persistent deficit, similar to traditional OH definitions. Seated and supine hypertension were defined as SBP ≥140 mm Hg or DBP ≥90 mm Hg. Modified Poisson models were used to estimate relative risk of falls (recurrent, injurious, unexplained) and syncope occurring over four year follow-up. OH40 was independently associated with recurrent (RR = 1.30, 95% CI = 1.02,1.65), injurious (RR = 1.43, 95% CI = 1.13,1.79) and unexplained falls (RR = 1.55, 95% CI = 1.13,2.13). Sustained OH was associated with injurious (RR = 1.55, 95% CI = 1.18,2.05) and unexplained falls (RR = 1.63, 95% CI = 1.06,2.50). OH and co-existing hypertension was associated with all falls outcomes but effect sizes were consistently larger with seated versus supine hypertension. OH, particularly when co-existing with hypertension, was independently associated with increased risk of future falls. Stronger effect sizes were observed with seated versus supine hypertension. This supports previous findings and highlights the importance of assessing orthostatic blood pressure behaviour in older adults at risk of falls and with hypertension. Observed associations may reflect underlying comorbidities, reduced cerebral perfusion or presence of white matter hyperintensities.

scholarly journals Chronic Fish Oil Consumption with Resistance Training Improves Grip Strength, Physical Function, and Blood Pressure in Community-Dwelling Older Adults

Sports ◽  
2019 ◽  
Vol 7 (7) ◽  
pp. 167 ◽  
Author(s):  
Sang-Rok Lee ◽  
Edward Jo ◽  
Andy V. Khamoui
Keyword(s):  
Blood Pressure ◽  
Older Adults ◽  
Resistance Training ◽  
Fish Oil ◽  
Physical Function ◽  
Synergistic Effects ◽  
Handgrip Strength ◽  
Community Dwelling ◽  
Sit To Stand ◽  
Community Dwelling Older Adults

Fish oil (FO) has received great attention for its health-enhancing properties. However, its potential synergistic effects with resistance training (RT) are not well established. The purpose of this study was to investigate the effects of FO supplementation during 12-weeks of RT on handgrip strength, physical function, and blood pressure (BP) in community-dwelling older adults. Twenty-eight healthy older adults (10 males, 18 females; 66.5 ± 5.0 years) were randomly assigned to three groups: Control (CON), resistance training (RT), resistance training with FO (RTFO). Handgrip strength, physical function [five times sit-to-stand (5T-STS), timed up and go (TUG), 6-m walk (6MW), 30-s sit-to-stand (30S-STS)], and BP were measured pre- and post-intervention. ANOVA was used with significance set at P ≤ 0.05. Handgrip strength significantly increased in RT (+5.3%) and RTFO (+9.4%) but decreased in CON (−3.9%). All physical function outcomes increased in RT and RTFO. CON exhibited significantly decreased TUG and 30S-STS with no change in 5T-STS and 6MW. BP substantially decreased only in RTFO, systolic blood pressure (−7.8 mmHg), diastolic blood pressure (−4.5 mmHg), mean arterial pressure (−5.6 mmHg), while no change was found in CON and RT. Chronic RT enhanced strength and physical function, while FO consumption combined with RT improved BP in community-dwelling older adults.

Abstract P094: Food Insecurity And Elevated Blood Pressure In The Eastern Caribbean

Circulation ◽  
2021 ◽  
Vol 143 (Suppl_1) ◽  
Author(s):  
Carol R Oladele ◽  
Josefa Martinez ◽  
Marcella Nunez-Smith
Keyword(s):  
Blood Pressure ◽  
Educational Attainment ◽  
Food Insecurity ◽  
Latin American ◽  
Safety Net ◽  
Community Dwelling ◽  
Elevated Blood Pressure ◽  
Research Network ◽  
Elevated Blood ◽  
Eastern Caribbean

Background: Food insecurity (FI), an economic or social condition of limited or uncertain access to adequate food, has emerged as a contributing factor in the development and poor management of chronic diseases. The Caribbean region faces serious challenges from FI that threaten the sustainability of food systems and health of populations. Increased FI has led to greater consumption of unhealthy, cheap, and calorie dense foods that are associated with elevated blood pressure. The demonstrated challenges with FI, increased prevalence of elevated blood pressure, and dearth of evidence in part of the region make it imperative to understand the relationship between FI and elevated blood pressure. Methods: We used baseline data (2013-2018) from the Eastern Caribbean Health Outcomes Research Network Cohort Study (ECS), a population-based cohort of 2,961 community-dwelling individuals 40 years or older residing in Barbados, Puerto Rico, Trinidad and Tobago, or U.S. Virgin Islands. Participants with complete FI and blood pressure data were included. Household FI within the past 90 days was measured using the 9-item Latin American and Caribbean Food Security Scale. Responses were summed for participants to create a score (0-8) and create four categories: 0 no FI, 1-6 -mild FI, and 7-8 severe FI. The outcome, elevated blood pressure, was defined as self-report of hypertension diagnosis or systolic blood =>140 mm Hg or diastolic pressure =>90 mm Hg. Chi-square tests, analysis of variance, and multivariable logistic regression was used for analyses. We hypothesized that FI was greater among women compared to men, those with lower versus higher educational attainment, and that FI was associated with elevated blood pressure. Results: A total of 2942 participants were included in analyses. Mean age of participants was 57, 65 percent were women, and 36 percent had less than a high school education. Results showed that 27 percent of participants experienced FI, women, younger persons, and those with lower educational attainment were more likely to experience low, moderate or severe FI. Forty-one percent of those with low FI had elevated blood pressure compared to 40 percent among those with moderate, and 40 percent with severe FI. Logistic model results showed that mild (OR=1.04, CI=0.74-1.47), moderate (OR=1.01, CI=0.60-1.7), and severe FI (OR=1.38, CI=0.64-2.95) was not associated with elevated blood pressure after adjusting for demographic and clinical covariates. Post-hoc analysis showed that that moderate/severe FI was associated elevated blood pressure among women (OR=1.50, CI=1.02-2.20). Conclusions: Findings for FI and elevated blood pressure among women is consistent with prior research conducted in other contexts. Findings have implications for safety net programs and targeted efforts to reduce FI overall and among women.

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