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Læknablaðið - 15.09.2013, Síða 17

Læknablaðið - 15.09.2013, Síða 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

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