Læknablaðið - 15.09.2013, Page 17

RANNSÓKN
Heimildir
1. Gurwitz JH. Polypharmacy. A new paradigm or quality
drug therapy in the elderly. Arch Intem Med 2004:164:
1957-9.
2. Field TS, Gurwitz JH, Avom J, McCormick D, Jain S,
Eckler M, et al. Risk factors for adverse drug events
among nursing home residents. Arch Intem Med 2001:
161:1629-34.
3. Chutka DS, Evans JM, Fleming KC, Mikkelson KG.
Dmg prescribing for elderly patients. Mayo Clin Proc
1995; 70: 685-93.
4. Sloane PD, Gruber-Baldini AL, Zimmerman S, Roth M,
Watson L, Boustani M, et al. Medication undertreatment
in assisted living settings. Arch Intem Med 2004; 164:
2031-7.
5. Kjartansson H. Jónsson PV. Geðlyfjanotkun á elli- og
hjúkrunarheimilum á Stór-Reykjavíkursvæðinu árið
1996. Læknablaðið 1999; 85: 681-90.
6. Gill SS, Bronskill SE, Normand SL, Anderson GM,
Sykora K, Lam K, et al. Antpsychotic use and mortality
in older adults with dementia. Ann Intem Med 2007;
146: 775-86.
7. Reglugerð um mat á heilsufari og aðbúnaði á hjúkrunar-
heimilum nr 544/2008. Landlæknir 2008.
8. Clew CM, Rentier RJ. Use of proton pump inhibitors
and other acid suppressive medication in newly
admitted nursing facility patients. J Am Med Dir Assoc
2008; 9: 280-1.
9. SPSS for Windows, version 11.0.
10. Rothman KJ. Controlling for confounding by stratifying
data. Kafli 8 í Epidemiology: An introduction. Oxford
University Press 2002.
11. Dwyer LL, Han B, Woodwell DA, Rechsteiner EA.
Polypharmacy in nursing home residents in the United
States: results of the 2004 National Nursing Home
Survey. Am J Geriatr Pharmacotherapy 2010; 8: 63-72.
12. Onder G, Liperoti R, Fialova D, Topinkova E, Tosato
M, Danese P, et al. Polypharmacy in nursing homes in
Europe: results from the SHELTER study. J Gerontol A
Biol Sci Med Sci 2012; 67: 698-704.
13. Olsson J, Bergman A, Carlsten A, Oké T, Bemsten C,
Schmidt IK, et al. Quality of dmg prescribing in elderly
people in nursing homes and special care units for
dementia: a cross-sectional computerized pharmacy
register analysis. J Clin Drug Investig 2010; 30:289-300.
14. Hjaltadóttir I. Gæðaviðmið fyrir íslensk hjúkmnar-
heimili. Efri og neðri mörk fyrir RAI gæðavísa.
Landlæknir 2009.
15. Woolcott JC, Richardson KJ, Wiens MO, Patel B, Marin
J, Kahn KM, et al. Meta-analysis of the impact of 9
medication classes on falls in elderly persons. Arch
Intem Med 2009; 169:1952-60.
16. Richards JB, Papaioannou A, Adachi JD, Joseph L,
Whitson HE, Prior JC, et al. Effect of selective serotonin
reuptake inhibitors on the risk of fracture. Arch Intem
Med 2007; 167; 188-94.
17. Weiner DK, Hanlon JT. Pain in nursing home residents:
management strategies. Drugs Aging 2001; 18:13-29.
18. Heilbrigðis- og tryggingamálaráðuneytið. (2004). RAI
upplýsingar um hjúkrunarheimili á íslandi. Sótt 2006,
úr RAI-gagnagmnninum.
19. Jones RJ, Marcantonio, Rabinowitz. Prevalence and cor-
relates of recognized depression in US nursing homes.
JAGS 2003; 51:1404-9.
20. Pollock BG, Mulsart BH, Magundar S, Rosen J,
Blakely RE. A double-blind comparison of citalop-
ram and risperidone for the treatment of behav-
ioral and psychotic symptoms. associated with
dementia. Am J Geriatric Psychiatry 2007; 15: 942-52.
21. Schwartz AV, Kelsey JL, Maggi S, Tuttleman M, Ho SC,
Jónsson PV, et al. International variation in the incidence
of hip fractures: cross-national project on osteopo-
rosis for the World Health Organization Program for
Research on Aging. Osteoporos Int 1999; 9: 242-53.
22. Klínískar leiðbeiningar. Beinþynning. Landlæknir 2004.
23. Dánartíðni á 100.000 íbúa. Sjúkdómar í blóðrásarkerfi
2009. Hagstofan október 2011.
24. Pilotto A, Francheschi M, Leandro G, Scarcelli C,
D'Ambrosio LP. Clincal features of reflux esophagitis in
older people: A study of 840 consecutive patients. JAGS
2006: 54:1537-42.
25. Yang YX, Lewis JD, Epstein S, Metz DC. Long-term
proton pump inhibitor therapy and risk of hip fracture.
JAMA 2006; 296: 294-53
26. Dial S, Alrasadi K, Manukian C, Huang A, Menzies D.
Risk of Clostridium difficile diarrhea among hospital
inpatients prescribed proton pump inhibitors; Cohort
and case-control studies. CMAJ 2004:171:33-8.
27. Goode PS, Burgio KL, Richter HE, Markland AD.
Incontinence in older women. JAMA 2010; 303: 2172-81.
28. Birks J. Cholinesterase inhibitors and Alzheimars
disease. Cochrane Database Syst Rev. Janúar 2006.
29. Roe MC, McNamara AM, Mothrel BR. Gender -
and age-related prescription dmg use pattems. Ann
Pharmacother 2002; 36: 30-9.
ENGLISH SUMMARY
Medication use in nursing homes in lceland 2002-2004. A descriptive study
Hansdottir H, Gudmannsson GP
Purpose: To describe medication use in nursing homes in lceland
during the years 2002-2004.
Methods: In nursing homes using automated medication delivery, the
number of medications used were calculated, from the beginning of
2002 to the end of 2004. Information was obtained from 10 nursing
homes; a total of 1409 individuals or approximately 60% of the inhabit-
ants of all nursing homes in lceland. 65% of the population were women,
mean age was 83 years and 43% died during the study periond. The
total number of prescribed medications was collected as well as their
use for common chronic conditions and symptoms was analysed.
Result: There were on average 8.9 (±4,0) medications used at the
beginning of the study period, increasing to 9.9 (±4,3) by its end. On
average, women got one more medication than men (p<0,001). 56.2%
of women and 47% of men received >10 kinds of medication by the
end of the study. Women got more psychiatric medications than men,
but men got more medications for cardiovascular diseases. 82% of the
Key words: nursing home, medication, polypharmacy, elderly.
Correspondence: Helga Hansdóttir, helgah@landspitali.is
population used psychiatric medications regularly, 65% used sedatives/
hypnotics, 50% antidepressants and 20 % antipsychotics. Approxima-
tely additional 15% used psychiatric medication temporarily overthe
study period. The majority of medications were used constantly during
the study period, especially cardiovascular medications. Medication
for urinary incontinence, non steroidal antiinflammatory medications,
medications for osteoporosis and medications against Alzheimers
disease were used more often temporarily than constantly. Medications
that were in constant use by >40% of the population were sedative/
hypnotics, antidepressants, paracetamol, diuretics and vitamin D.
Conclusion: There is a high number of medications used in nursing
homes in lceland. Most medications were already in use at the start of
the study and continued throughout the study period indicating that
medication review might be lacking. There are no indications of under-
treated of pain or depression. Vitamin D is frequently used but should be
used more often not least among men.
LÆKNAblaðið 2013/99 389