Læknablaðið - 15.01.2009, Síða 16

FRÆÐIGREINAR
RANNSÓKNIR
mikilvægar upplýsingar um tengsl lyfjanotkunar
við heilbrigði, heilbrigðisþjónustu og félagslega
þætti. Til dæmis mætti kanna tengsl lyfjanotkunar
og byltna hjá öldruðum með tengingu lyfjagagna-
grunns við slysaskráningu. Rannsókn af þessu
tagi leggur einnig grunn að hagkvæmnigreiningu
tiltekinna lyfjameðferða sem verður að teljast verð-
ugt framtíðarverkefni ekki síst í ljósi ört stækkandi
hóps aldraðra og fjölveikra.
Ályktun
Niðurstöður þessarar úttektar gefa til kyrtna að
geðlyfjanotkun eldri íslendinga sé almenn, sér-
staklega hvað varðar notkun kvíðastillandi lyfja
og svefnlyfja. Samanborið við upplýsingar úr
sambærilegum dönskum lyfjagagnagrunni virð-
ist ávísun á geðlyf umtalsvert meiri hér á landi.
Höfundar telja þörf fyrir frekari umræðu og rann-
sóknir á undirliggjandi orsökum, gagnsemi og
afleiðingum almennrar notkunar geðlyfja meðal
aldraðra Islendinga.
Þakkir
Þakkir fær Kristinn Jónsson, kerfisfræðingur,
Landlæknisembættinu.
Heimildir
1. Shah RR. Drug development and use in the elderly: Search
for the right dose and dosing regimen. Br J Clin Pharmacol
2004; 58:452-69.
2. Jyrkka J, Vartiainen L, Hartikainen S, et al. Increasing use of
medicines in elderly persons: a five-year follow-up of the
Kuopio 75+ Study. Eur J Clin Pharmacol 2006; 62:151-8.
3. Medicines consumption in the Nordic Countries 1999-2003:
Nordic Medico Statistical Committee (NOMESCO)2004.
4. Wettermark B, Hammar N, Ford CM, et al. The New
Swedish Prescribed Drug Register - Opportunities for
pharmacoepidemiological research and experience from the
first six months. Pharmacoepidemiol and Drug Saf 2007; 16:
726-35.
5. Indikatorer för utvárdering av kvaliteten I alders
lákemedelsterapi: Svenska Socialstyrelsen 2003.
6. Lernfelt B, Samuelsson O, Skoog I, Landahl S. Changes in
drug treatment in the elderly between 1971 and 2000. Eur C
Pharmacol 2003; 59: 637-3.
7. Gurwitz JH, Field TS, Harrold LR, et.al. Incidence
and Preventability of Adverse Drug Events Among
Older Persons in the Ambulatory Setting.
JAMA 2003; 289:1107-16.
8. Piette JD, Heisler M, Wagner TH. Cost-Related Medication
Underuse Among Chronically 111 Adults. Am J Public Health
2004; 94:1782-1787.
9. Solomon D. Underuse of osteoporosis medications in elderly
patients with fractures: American J Med 2003; 115: 398-400.
10. Fialová D, Topinková E, Gambassi G, et al. Potentially
Inappropriate Medication Use Among Elderly Home Care
Patients in Europe. JAMA 2005; 293:1348-58.
11. Samúelsson O, Björnsson S, Jóhannsson B, Jónsson PV.
Lyfjanotkun aldraðra á bráðasjúkrahúsi: Aukaverkanir og
gæðavísar. Læknablaðið 2000; 86:11-6.
12. Giron MS, Forsell Y, Bernsten C, et al. Sleep problems in
a very old population: drug use and clinical correlates. J
Gerontol A Biol Sci Med Sci 2002; 57: M236-40.
13. Buysse DJ. Insomnia, depression and aging. Assessing sleep
and mood interactions in older adults. Geriatrics 2004; 59:
47-51.
14. Skoog I. Psychiatric epidemiology of old age: the H70 study
- the NAPE Lecture 2003. Acta Psychiatr Scand 2004; 109: 4-
18.
15. Hanlon JT, Schmader KE, Koronkowski MJ, et al.; Adverse
drug events in high risk older outpatients. J Am Geriatr Soc
1998; 46: 252-3.
16. Moore AR, O'Keeffe ST. Drug-Induced Cognitive Impairment
in the Elderly Drugs Aging 1999; 15(1): 15-28.
17. Sigfússon E. Notkun svefnlyfja og róandi lyfja síðustu 26
árin. Heilbrigðis- og tryggingaráðuneytið 2004.
18. Helgason T, Tómasson K, Zoéga T. Algengi og dreifing
notkunar geðdeyfðar-, kvíða- og svefnlyfja. Læknablaðið
2003; 89:15-22.
19. SigurðssonJÁ. Notkunróandilyfjaogsvefnlyfja: upplýsingar
frá apóteki og úr sjúkraskrám í Egilsstaðalæknishéraði 1986-
1989. Læknablaðið 1994; 80: 99-103.
20. Kamel NS. Gammack JK. Insomnia in the elderly: cause,
approach, and treatment. Am J Med 2006; 119(6): 463-9.
21. Evans ME, Mottram P. Diagnosis of depression in elderly
patients. Advances in Psychiatric Treatment 2000; 6: 49-56.
22. Sorock GS and Shimkin EE. Benzodiazepine sedatives and
the risk of falling in a community-dwelling elderly cohort.
Arch Int Med 1988; 148: 2441-4.
23. Ray A, Griffin MR, Downey W. Benzodiazepines of long and
short elimination half-life and the risk of hip fracture. JAMA
1989; 262: 3303-7.
24. Swift C. Falls in late life and their consequences—
implementing effective services. BMJ 2001; 322 : 855-7.
25. Campbell AJ, Robertson MC, Gardner MM, et al. Psychotropic
medication withdrawal and a home-based exercise program
to prevent falls: a randomised, controlled trial. J Am Geriatr
Soc 1999; 47 : 850-3.
26. Paulose-Ram R, Jonas BC, Orwig D, et al. Prescription
psychotropic medication use among the U.S. adult
population: results from the third National Health and
Nutrition Examination Survey, 1988-1994. J Clin Epidemiol
2003; 57: 309-17.
27. Simoni-Wastila L. Gender and Psychotropic Drug Use. Med
Care 1998; 36: 88-94.
28. Roe CM, McNamara AM, and Motheral BR. Gender- and age-
related prescription drug use pattems. Anna Pharmacother
2002: 36: 30-9.
29. Öppna jámförelser av hálso- och sjukvárdens kvalitet och
effektivitet. Jámförelser mellan landsting 2007. Sveriges
kommuner och landsting. Stockholm 2007.
30. Hayes B, Klein-Schwartz W , Barrueto F. Polypharmacy and
the Geriatric Patient. Clin Geriatr Med 2007; 23: 371-90.
31. Johnell K, Klarin I. The Relationship between Number of
Drugs and Potential Drug-Drug Interactions in the Elderly:
A Study of Over 600.000 Elderly Patients from the Swedish
Prescribed Drug Register. Drug Saf 2007; 30: 911-8.
32. Beers MH. Explicit criteria for determining potentially
inappropriate medication use by the elderly. Arch Int Med
1997; 157:1531-6.
33. Fick DM, Cooper JW, Wade WE, et al. Updating the Beers
criteria for potentially inappropriate medication use in older
adults: results of a US consensus panel of experts. Arch Intern
Med 2003; 163: 2716-24.
34. Fastbom J, Claesson CB, Comelius C, Thorslund M, Winblad
B. The use of medicines with anticholinergic effects in oider
people. J Am Geriatr Soc 1995; 43:1135-40.
35. Salzman C. Medication compliance in the elderly. J Clin
Psychiatryl995; Suppl 1:18-22.
36. MacLaughlin EJ, Raehl CL, Treadway AK, et al. Assessing
medication use in the elderly: Which tools to use in clinical
practice. Drugs and Aging 2005; 22: 231-55.
37. Ásgeirsson ÁG, Almarsdóttir AB. Umfang og ástæður sóunar
lyfja á íslandi - skil almennings. Rannsóknarstofnun um
lyfjamál við Háskóla íslands, Reykjavík: 2008.
38. Tybjerg J, Gulmann NC. Use of psychopharmaceuticals in
municipal nursing homes. A nationwide survey. Ugeskr
Laeger 1992; 154: 3126-9.
39. Hughes CM, Lapane KL, Mor V, et al. The Impact of
Legislation on Psychotropic Dmg Use in Nursing Homes: A
Cross-National Perspective. J Am Geriatr Soc 2000; 48: 931-7.
16 LÆKNAblaðið 2009/95