Prescribing Analgesics to Older People: A Challenge for GPs

Background: Due to population aging, there is an increase in the prevalence of chronic diseases, and in particular musculoskeletal diseases. These trends are associated with an increased demand for prescription analgesics and an increased risk of polypharmacy and adverse medication reactions, which constitutes a challenge, especially for general practitioners (GPs), as the providers who are most responsible for the prescription policy. Objectives: To identify patterns of analgesics prescription for older people in the study area and explore associations between a long-term analgesic prescription and comorbidity patterns, as well as the prescription of psychotropic and other common medications in a continuous use. Methods: A retrospective study was conducted in 2015 in eastern Croatia. Patients were GP attenders ≥40 years old (N = 675), who were recruited during their appointments (consecutive patients). They were divided into two groups: those who have been continuously prescribed analgesics (N = 432) and those who have not (N = 243). Data from electronic health records were used to provide information about diagnoses of musculoskeletal and other chronic diseases, as well as prescription rates for analgesics and other medications. Exploratory methods and logistic regression models were used to analyse the data. Results: Analgesics have been continuously prescribed to 64% of the patients, mostly to those in the older age groups (50–79 years) and females, and they were indicated mainly for dorsalgia symptoms and arthrosis. Non-opioid analgesics were most common, with an increasing tendency to prescribe opioid analgesics to older patient groups aged 60–79 years. The study results indicate that there is a high rate of simultaneous prescription of analgesics and psychotropic medications, despite the intention of GPs to avoid prescribing psychotropic medications to patients who use any option with opioid analgesics. In general, receiving prescription analgesics does not exceed the prescription for chronic diseases over the rates that can be found in patients who do not receive prescription analgesics. Conclusion: Based on the analysis of comorbidities and parallel prescribing, the results of this study can improve GPs’ prescription and treatment strategies for musculoskeletal diseases and chronic pain conditions.

Download Full-text

Seroprevalence of Antibodies against Diphtheria, Tetanus and Pertussis in Adult At-Risk Patients

Vaccines ◽

10.3390/vaccines9010018 ◽

2021 ◽

Vol 9 (1) ◽

pp. 18

Author(s):

Lise Boey ◽

Eline Bosmans ◽

Liane Braz Ferreira ◽

Nathalie Heyvaert ◽

Melissa Nelen ◽

...

Keyword(s):

At Risk ◽

Chronic Diseases ◽

Age Groups ◽

Chronic Obstructive ◽

Solid Organ ◽

Recent Infection ◽

Vaccination Programs ◽

Vaccine Preventable Diseases ◽

Increased Risk ◽

Risk Patients

Patients with chronic diseases are at increased risk of complications following infection. It remains, however, unknown to what extend they are protected against vaccine-preventable diseases. We assessed seroprevalence of antibodies against diphtheria, tetanus and pertussis to evaluate whether current vaccination programs in Belgium are adequate. Antibody titers were assessed with a bead-based multiplex assay in serum of 1052 adults with chronic diseases. We included patients with diabetes mellitus type 1 (DM1) (n = 172), DM2 (n = 77), chronic kidney disease (n = 130), chronic obstructive pulmonary disease (COPD) (n = 170), heart failure (n = 77), HIV (n = 196) and solid organ transplant (SOT) recipients (n = 230). Factors associated with seroprevalence were analysed with multiple logistic regression. We found seroprotective titers in 29% for diphtheria (≥0.1 IU/mL), in 83% for tetanus (≥0.1 IU/mL) and 22% had antibodies against pertussis (≥5 IU/mL). Seroprotection rates were higher (p < 0.001) when vaccinated within the last ten years. Furthermore, diphtheria seroprotection decreased with age (p < 0.001). Tetanus seroprotection was less reached in women (p < 0.001) and older age groups (p < 0.001). For pertussis, women had more often a titer suggestive of a recent infection or vaccination (≥100 IU/mL, p < 0.01). We conclude that except for tetanus, the vast majority of at-risk patients remains susceptible to vaccine-preventable diseases such as diphtheria and pertussis.

Download Full-text

Video-Based Communication and its Association with Loneliness, Mental Health and Quality of Life among Older People during the COVID-19 Outbreak

10.20944/preprints202104.0520.v1 ◽

2021 ◽

Author(s):

Tore Bonsaksen ◽

Hilde Thygesen ◽

Janni Leung ◽

Mary C. Ruffolo ◽

Mariyana Schoultz ◽

...

Keyword(s):

Quality Of Life ◽

Mental Health ◽

Older People ◽

Online Survey ◽

Age Groups ◽

Psychological Outcomes ◽

Age Group ◽

Communication Tools ◽

Study Results

The aim of the study was to examine the use of video-based communication and its association with loneliness, mental health and quality of life in older adults (60-69 years versus 70+ years) during the COVID-19 pandemic. A cross-sectional online survey was conducted in Norway, UK, USA and Australia during April/May 2020, and 836 participants in the relevant age groups were included in the analysis. Multiple regression analyses were conducted to examine associations between use of video-based communication tools and loneliness, mental health and quality of life within age groups, while adjusting by sociodemographic variables. Video-based communication tools were found to be more often used among participants aged 60-69 years (60.1%), compared to participants aged 70 or above (51.8%, p < 0.05). Adjusting for all variables, use of video-based communication was associated with less loneliness (β = -0.12, p < 0.01) and higher quality of life (β = 0.14, p < 0.01) among participants aged 60-69 years, while no associations occurred for participants in the oldest age group. The use of video-based communication tools was therefore associated with favorable psychological outcomes among participants in their sixties, but not among participants in the oldest age group. The study results support the notion that age may influence the association between use of video-based communication tools and psychological outcomes amongst older people.

Download Full-text

Radiofrequency exposure in young and old: different sensitivities in light of age-relevant natural differences

Reviews on Environmental Health ◽

10.1515/reveh-2015-0030 ◽

2015 ◽

Vol 30 (4) ◽

Cited By ~ 7

Author(s):

Mary Redmayne ◽

Olle Johansson

Keyword(s):

Age Groups ◽

Well Being ◽

The Elderly ◽

Ageing Population ◽

Economic Implications ◽

Population Means ◽

Increased Risk ◽

Study Results ◽

Comparative Risk

AbstractOur environment is now permeated by anthropogenic radiofrequency electromagnetic radiation, and individuals of all ages are exposed for most of each 24 h period from transmitting devices. Despite claims that children are more likely to be vulnerable than healthy adults to unwanted effects of this exposure, there has been no recent examination of this, nor of comparative risk to the elderly or ill. We sought to clarify whether research supports the claim of increased risk in specific age-groups. First, we identified the literature which has explored age-specific pathophysiological impacts of RF-EMR. Natural life-span changes relevant to these different impacts provides context for our review of the selected literature, followed by discussion of health and well-being implications. We conclude that age-dependent RF-EMR study results, when considered in the context of developmental stage, indicate increased specific vulnerabilities in the young (fetus to adolescent), the elderly, and those with cancer. There appears to be at least one mechanism other than the known thermal mechanism causing different responses to RF-EMR depending upon the exposure parameters, the cell/physiological process involved, and according to age and health status. As well as personal health and quality-of-life impacts, an ageing population means there are economic implications for public health and policy.

Download Full-text

Specialist psychiatric health care utilization among older people with intellectual disability – predictors and comparisons with the general population: a national register study

BMC Psychiatry ◽

10.1186/s12888-020-02491-6 ◽

2020 ◽

Vol 20 (1) ◽

Cited By ~ 2

Author(s):

G. Ahlström ◽

A. Axmon ◽

M. Sandberg ◽

J. Hultqvist

Keyword(s):

Health Care ◽

Intellectual Disability ◽

General Population ◽

Health Care Utilization ◽

Older People ◽

Age Groups ◽

Care Utilization ◽

Increased Risk ◽

National Cohort ◽

Specialist Health Care

Abstract Background People with intellectual disability (ID) face considerable barriers to accessing psychiatric health care, thus there is a risk for health disparity. The aims of the present study were 1) to compare specialist psychiatric health care utilization among older people with ID to that with their age peers in the general population, taking into account demographic factors and co-morbidities associated with specialist psychiatric health care utilization and 2) to determine a model for prediction of specialist psychiatric health care utilization among older people with ID. Material and methods We identified a national cohort of people with ID (ID cohort), aged 55+ years and alive at the end of 2012 (n = 7936), and a referent cohort from the general population (gPop cohort) one-to-one matched by year of birth and sex. Data on utilization of inpatient and outpatient specialist psychiatric health care, as well as on co-morbidities identified in either psychiatric or somatic specialist health care, were collected from the National Patient Register for the time period 2002–2012. Results After adjusting for sex, age, specialist psychiatric health care utilization the previous year, and co-morbidities, people in the ID cohort still had an increased risk of visits to unplanned inpatient (relative risk [RR] 1.95), unplanned outpatient (RR 1.59), planned inpatient (RR 2.02), and planned outpatient (RR 1.93) specialist psychiatric health care compared with the general population. Within the ID cohort, increasing age was a predictor for less health care, whereas psychiatric health care the previous year predicted increased risk of health care utilization the current year. As expected, mental and behavioral disorders predicted increased risk for psychiatric health care. Furthermore, episodic and paroxysmal disorders increased the risk of planned psychiatric health care. Conclusions Older people with ID have a high need for psychiatric specialist health care due to a complex pattern of diagnoses. Further research needs to investigate the conditions that can explain the lesser psychiatric care in higher age groups. There is also a need of research on health care utilization among people with ID in the primary health care context. This knowledge is critical for policymakers’ plans of resources to meet the needs of these people.

Download Full-text

Elder Suicide: What Senior Care Pharmacists Need to Know

The Senior Care Pharmacist ◽

10.4140/tcp.n.2021.568 ◽

2021 ◽

Vol 36 (11) ◽

pp. 568-572

Author(s):

Keith Burechson ◽

Tony Salvatore

Keyword(s):

Older People ◽

Suicide Prevention ◽

Older Patients ◽

Suicide Risk ◽

Age Groups ◽

The United States ◽

High Rate ◽

Suicide Mortality ◽

High Exposure ◽

Danger Signs

Older individual suicide is a growing community health problem in the United States. It is also preventable, and senior care pharmacists can increase awareness of the prevalence of suicide risk in older patients. Despite high exposure to many serious suicide risk factors and a high rate of suicide mortality, older people tend to be overlooked in suicide prevention efforts that lean mostly toward younger age groups. Senior care pharmacists can help remedy this situation by monitoring reports on older patients for possible signs of suicidality, alerting the care team if signs of potential suicide risk are present, and adding suicide prevention information to their education and counseling roles. An understanding of the nature of older individual suicide, the warning and danger signs of suicidality in older people and how and when to respond is needed. Providing this background would assure that senior care pharmacists have the skills and confidence necessary to embed suicide prevention in their practice.

Download Full-text

Factors Associated With Low Handgrip Strength In Older People: Data Of The Study Of Chronic Diseases (EDOC-I)

10.21203/rs.2.15731/v3 ◽

2020 ◽

Author(s):

Cledir de Araújo Amaral ◽

Thatiana Lameira Maciel Amaral ◽

Gina Torres Rego Monteiro ◽

Mauricio Teixeira Leite de Vasconcellos ◽

Margareth Crisostomo Portela

Keyword(s):

Older People ◽

Chronic Diseases ◽

Handgrip Strength ◽

Age Groups ◽

Health Assessment ◽

Sample Survey ◽

Older Individuals ◽

Cross Sectional ◽

Factors Associated ◽

Important Health

Abstract Background Handgrip strength (HGS) is an important health biomarker, whose low scores have been shown to be associated with morbimortality. This study aimed to analyze the factors associated with low HGS in older persons in Rio Branco, Acre, Brazil. Methods The study was carried out with data from the Study of Chronic Diseases (EDOC-I) – Older People, a cross-sectional household PAPI probability sample survey performed with 1,016 people aged over 60 residing in Rio Branco in 2014. The low HGS was defined by the 20th percentile of the maximum HGS by sex and age group. Associations between variables of health status (psychological and physical) and low HGS, by sex, were estimated using logistic regression, expressed by adjusted ORs (aOR). Results Older individuals had lower median HGS than younger individuals (-6.0 kg among men and -2.6 kg among women). Women aged over 80 years had, on average, the lower quintile of HGS compared to women of the previous age groups. Factors independently associated with low HGS in men and women, respectively, were low weigh in body mass index [(aOR = 2.80; 95%CI: 1.19, 6.61) and (aOR = 2.61; 95%CI: 1.46, 4.66)], anemia [(aOR= 4.15; 95%CI: 2.09, 8.21) and (aOR = 1.80; 95%CI: 1.06, 3.06)] and diabetes as a risk factor in men (aOR 1.95; 95%CI: 1.00, 3.81). There was a higher chance of low HGS in men with partners (aOR = 2.44; 95%CI: 1.32, 4.51), smokers or former smokers (aOR = 3.25; 95%CI: 1.25, 8.44), with current self-assessment of health worse than the 12 previous months (aOR = 2.21; 95%CI: 1.14, 4.30) and dependence in activities of daily living (aOR = 2.92; 95%CI: 1.35, 6.30). Only among women, there was an increased chance of low HGS associated with altered waist-to-hip ratio (aOR = 1.79; 95%CI: 1.02, 3.12), insomnia (aOR = 1.83; 95%CI: 1.10, 3.03) and physical activity from displacement/occupation (aOR = 1.75; 95%CI: 1.08, 2.84). Conclusion Factors associated with low HGS are not common to sex and the inclusion of HGS as a component of health assessment seems to be a promising strategy for disease prevention and health promotion.

Download Full-text

Metabolic syndrome and associated factors in Iranian children and adolescents: the CASPIAN-V study

Journal of Cardiovascular and Thoracic Research ◽

10.15171/jcvtr.2018.37 ◽

2018 ◽

Vol 10 (4) ◽

pp. 214-220 ◽

Cited By ~ 2

Author(s):

Ramin Heshmat ◽

Zeinab Hemati ◽

Mostafa Qorbani ◽

Laleh Nabizadeh Asl ◽

Mohammad Esmaeil Motlagh ◽

...

Keyword(s):

Metabolic Syndrome ◽

Children And Adolescents ◽

Rural Areas ◽

Associated Factors ◽

Age Groups ◽

High Rate ◽

P Value ◽

Surveillance Program ◽

Pediatric Age ◽

Increased Risk

Introduction: Metabolic syndrome (MetS) is one of the common metabolic disorders seen in children and adolescents. This study aims to assess the rate of the MetS and its associated factors in a nationally-representative sample of Iranian pediatric age groups. Methods: This nationwide cross- sectional study was designed in 2015 in 30 provinces of Iran. Participants consisted of 4,200 school students, aged 7-18 years, studied in a national school-based surveillance program (CASPIAN-V). Physical examination and laboratory tests were performed using standard protocols. Blood samples were drawn from 3834 students for biochemical tests. Results: The participation rate for blood sampling was 91.5%. MetS was significantly more prevalent among students in urban than in rural areas (5.7% vs. 4.8%, P value < 0.01). MetS was more prevalent in students with obese parents than in those with non-obese parents (6.4% vs. 4.5%, P value < 0.05). Significant association existed between moderate level of healthy nutritional behaviors and MetS after controlling for potential confounders (odds ratio [OR]: 0.62, 95% CI: 0.40-0.98). Students with high unhealthy nutritional behaviors showed an increased risk of MetS in crude (OR: 1.6, 95% CI: 1.05-2.44) and adjusted model (OR: 1.65, 95% CI: 1.05-2.63). Conclusion: High rate of MetS and associated risk factors was observed in Iranian pediatric age groups, with higher rates among boys. These findings provide useful information for effective preventive strategies based on diet, exercise, and lifestyle modification rather than therapeutic modalities.

Download Full-text

A81 POST COLONOSCOPY COLORECTAL CANCERS IN MANITOBA: A POPULATION-BASED ANALYSIS

Journal of the Canadian Association of Gastroenterology ◽

10.1093/jcag/gwz047.080 ◽

2020 ◽

Vol 3 (Supplement_1) ◽

pp. 95-96

Author(s):

H Singh ◽

S Derksen ◽

M Sirski ◽

S McCulloch ◽

L M Lix

Keyword(s):

Linear Models ◽

Adult Population ◽

Age Groups ◽

Population Based ◽

Colorectal Cancers ◽

Root Cause ◽

Funding Agencies ◽

Increased Risk ◽

Study Results ◽

Manitoba Health

Abstract Background Recent consensus guidelines from the World Endoscopy Organization (WEO) recommend all jurisdictions report unadjusted rates of post colonoscopy (PC) colorectal cancers (CRC). Until recently, prior reports have mostly focused on PC-CRC in the CRC screening age groups. Aims We evaluated the rate and predictors of PC-CRC in the adult population for the province of Manitoba from 1990 to 2016. Methods Individuals 18+ years at CRC diagnosis were identified from the Manitoba Cancer Registry. Colonoscopies in the 3 years preceding CRC diagnosis were identified via linkage to Manitoba Health (MH) physicians billing claims. CRCs were classified, based on WEO recommendations, as: (1) detected CRC (colonoscopy up to 6 months before CRC diagnosis) and (2) PC-CRC-3y (colonoscopy 6–36 months before CRC diagnosis). Generalized linear models with generalized estimating equations (to adjust for clustering within endoscopy physicians) were used to test for differences in rates over 3-time intervals (1990/91 – 1999/00; 2000/01 - 2009/10; 2010/11 – Dec 31 2016), provincial region of performance of colonoscopy and identify other associations from the MH data. Results Overall, 10.5% of the 16,639 CRCs diagnosed in the study period and with colonoscopy in the preceding 3 years were PC-CRC-3y. CRCs diagnosed between April 2000 and March 2010 were more likely to be PC-CRC-3y than those diagnosed between April 2010 and December 2016 (odds ratio [OR] 1.18; 95% confidence interval [CI]: 1.03–1.37). Female sex (OR for male: 0.86; 95% CI: 0.77–0.94), IBD diagnosis (OR 3.04; 95% CI: 2.56–4.52), prior CRC (OR 5.41; 95% CI: 4.61–6.34), prior colonoscopy (OR 2.10; 95% CI 1.88–2.36), diverticulosis (OR 2.39; 95% CI: 2.16–2.6), colonoscopy by GP (OR: 1.62; 95% CI 1.16–2.26 vs. surgeons) were associated with increased odds of PC-CRC-3y. There were no regional differences, and no effect of colonoscopy volume or age greater than 75 (or lower than 50). Conclusions In Manitoba, the PC-CRC-3y rate decreased slightly in recent years. The study results of large number of PC-CRC-3y along with only a slight decrease in rates over the years, support calls for root cause analysis to evaluate individual cases of PC-CRC. An initial focus could be the groups with increased risk of PC-CRC. Funding Agencies Manitoba Health

Download Full-text

Should we redifine Hypertensive response in stress test to better predict cardiovascular risk?

European Journal of Preventive Cardiology ◽

10.1093/eurjpc/zwab061.145 ◽

2021 ◽

Vol 28 (Supplement_1) ◽

Author(s):

P Silverio Antonio ◽

P Alves Da Silva ◽

J Valente Silva ◽

J Brito ◽

T Rodrigues ◽

...

Keyword(s):

Blood Pressure ◽

Systolic Blood Pressure ◽

Protective Factor ◽

Antihypertensive Drugs ◽

Stress Test ◽

Treatment Strategies ◽

High Rate ◽

Coronary Syndrome ◽

Increased Risk

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Systolic blood pressure (SBP) rise during exercise is normal, but some patients present with hypertensive response to exercise (HRE). The clinical implication of such phenomenon is not fully elucidated, and treatment strategies are still uncertain. Purpose To evaluate the relationship between HRE and the development of major cardiovascular events (MACE) - death, acute coronary syndrome (ACS) and stroke. Methods Single-center retrospective study of consecutive patients submitted to exercise test (ET) from 2012 to 2015. Patient’s demographics, baseline clinical characteristics, vital signs during ET and MACE occurrence during follow-up were analysed. HRE was defined as a peak systolic blood pressure (PSBP) >210 mmHg in men and >190 mmHg in women, or a rise of the SBP of 60 mmHg in men or 50 mmHg in women or as a diastolic blood pressure >90 mmHg or a rise of 10 mmHg. Results We included 458 patients with HRE (76% men, 57.5 ± 10.83 years). The most frequent comorbidities were hypertension (83%) and dyslipidaemia (61%). During a mean follow-up of 60 ± 2 months, the incidence of MACE was 9.2% with ACS being the most frequent (4.2%), followed by mortality (3.8%) and stroke (2.1%). Patients with inconclusive ET had a fourfold higher risk of acute coronary events (OR 4.1, CI 95% 1.55-11.14, p = 0.005). Baseline SBP and PSBP were predictors of MACE occurrence (OR 1.022, CI 95% 1.004-1.04, p = 0.016, OR 1.031 CI 95% 1.012-1.051, p = 0.001, respectively) and were both associated with cardiovascular hospitalization (p = 0.006; p < 0.001, respectively). PSBP had moderate ability to predict hospitalization of cardiovascular (CV) cause (AUC 0.71, p < 0.001) with a cut-off of 193 mmHg (sensibility 91%, specify 40%) and had moderate ability to predict MACE (AUC 0.67, p < 0.001) with a cut-off of 198 mmHg (sensibility 78.6%, specify 46.1%). Regarding mortality, antihypertensive therapy prior to ET was protective (p = 0.042), with no difference between different classes of drugs. Conclusion Our data reveal a high rate of MACE occurrence between patients with HRE. The finding of diagnosed hypertension as a protective factor of stroke may be explained by the cardioprotective effect of antihypertensive drugs. An increased risk of ACS between patients with an inconclusive ET should lead to consider then for further investigation. HRE should be considered as part of CV risk assessment and adjusted lower HRE cut-off values should be considered in order to better predict MACE occurrence, particularly in high risk patients. Abstract Figure.

Download Full-text

Factors Associated With Low Handgrip Strength in Older People: Data of the Study of Chronic Diseases (EDOC-I)

10.21203/rs.2.15731/v4 ◽

2020 ◽

Author(s):

Cledir de Araújo Amaral ◽

Thatiana Lameira Maciel Amaral ◽

Gina Torres Rego Monteiro ◽

Mauricio Teixeira Leite de Vasconcellos ◽

Margareth Crisostomo Portela

Keyword(s):

Older People ◽

Chronic Diseases ◽

Handgrip Strength ◽

Age Groups ◽

Health Assessment ◽

Sample Survey ◽

Older Individuals ◽

Cross Sectional ◽

Factors Associated ◽

Important Health

Abstract Background Handgrip strength (HGS) is an important health biomarker whose low scores have been shown to be associated with the morbimortality. This study aimed to analyze the factors associated with low HGS in older people in Rio Branco, Acre, Brazil. Methods The study was carried out with data from the Study of Chronic Diseases (EDOC-I) – Older People, a cross-sectional household PAPI probability sample survey performed with 1,016 people aged over 60 residing in Rio Branco in 2014. The low HGS was defined by the 20 th percentile of the maximum HGS by sex and age group. Associations between variables of health status (psychological and physical) and low HGS, by sex, were estimated using logistic regression, expressed by adjusted ORs (aOR). Results Older individuals had lower median HGS than younger individuals (-6.0 kg among men and -2.6 kg among women). Women aged over 80 had, on average, the lower quintile of HGS compared to women of the previous age groups. Factors independently associated with low HGS in men and women, respectively, were low weigh in body mass index [(aOR = 2.80; 95%CI: 1.19, 6.61) and (aOR = 2.61; 95%CI: 1.46, 4.66)], anemia [(aOR= 4.15; 95%CI: 2.09, 8.21) and (aOR = 1.80; 95%CI: 1.06, 3.06)] and diabetes as a risk factor in men (aOR 1.95; 95%CI: 1.00, 3.81). There was a higher chance of low HGS in men with partners (aOR = 2.44; 95%CI: 1.32, 4.51), smokers or former smokers (aOR = 3.25; 95%CI: 1.25, 8.44), with current self-assessment of health worse than the 12 previous months (aOR = 2.21; 95%CI: 1.14, 4.30) and dependence in activities of daily living (aOR = 2.92; 95%CI: 1.35, 6.30). Only among women, there was an increased chance of low HGS associated with altered waist-to-hip ratio (aOR = 1.79; 95%CI: 1.02, 3.12), insomnia (aOR = 1.83; 95%CI: 1.10, 3.03) and physical activity from displacement/occupation (aOR = 1.75; 95%CI: 1.08, 2.84). Conclusion Factors associated with low HGS are not the same between sexes, and the inclusion of HGS as a component of health assessment seems to be a promising strategy for disease prevention and health promotion.

Download Full-text