Older adults' medication use 6 months before and after hip fracture: a population-based cohort study

OBJECTIVES: To study changes in use of fall‐risk increasing drugs (FRIDs) and bone density–related medication in participants with hip fracture before and after the fracture and to analyze differences between five healthcare districts. DESIGN: Population‐based cohort study. SETTING: Data retrieved from two national databases PARTICIPANTS: All 2,043 people with hip fracture aged 60 and older in a Swedish county in 2006. MEASUREMENTS: Changes in FRIDs and bone‐active medications prescribed within 6 months before and 6 months after hip fracture and differences between health care districts. RESULTS: Before hip fracture, 1,308 participants (67.7%) received any FRIDs or combinations; after fracture, 97.7% were treated. Polypharmacy (≥5 drugs) increased 39.3%, excessive polypharmacy (≥10 drugs) increased 36.4%, and use of three or more psychotropic drugs increased 8.6%. After fracture, the use of all analyzed drugs including psychotropic, cardiovascular, opioid, and anticholinergic drugs increased significantly (P<.001). Treatment with calcium and vitamin D increased from 9% before to 27.7% after and with bisphosphonates from 3.5% to 7.6%. Variations in postfracture prescribing between the five health care districts were observed regarding opioids (range 85–64%), bisphosphonates (range 20–4%), and calcium and vitamin D (72–13%) (P<.001, for all comparisons). CONCLUSION: Two‐thirds of participants with hip fracture were prescribed FRIDs before fracture, and the number increased significantly after fracture. Significant variations between healthcare districts in treating osteoporosis and pain were evident; geriatric support could be a contributing factor to the greater treatment in two districts.     

Personality and reasons for not using asthma medication in young adults

Objectives

To identify young adults' stated reasons for not taking asthma medication and to determine the significance of personality, asthma control and health-related quality of life in relation to these stated reasons.

Background

Reasons for non-adherence to asthma medication treatment have previously been studied, but research on the significance of personality in relation to stated reasons for not taking asthma medication is limited.

Methods

Young adults with asthma (age 22 years; n = 216) stated their most common reasons for not taking asthma medication and completed postal questionnaires on personality, asthma control and health-related quality of life (HRQL).

Results

The most common reason for non-adherence was “No perceived need” (n = 141). Participants giving this reason for not taking asthma medication scored lower on the personality trait Negative Affectivity and reported both higher asthma control and higher mental HRQL. “Insufficient routines” was the second most common reason (n = 66), and participants stating it scored higher on Negative Affectivity and reported lower asthma control. An increase in asthma control increased the odds of stating “No perceived need” as the reason for not taking asthma medication. An increase in Negative Affectivity was associated with an increase in the odds of giving “Insufficient routines” as a reason.

Conclusions

The personality trait Negative Affectivity and perceived asthma control played a role in the young adults' stated reasons for not taking asthma medication, which indicates that these parameters are of importance to young adults' medication management.     

Long-term risk of pneumothorax in asthmatic children: A 12-year population-based cohort study

Pneumothorax is a life-threatening complication during acute asthma attack. However, long-term risk of pneumothorax in asthmatic children remains unknown.In this retrospective cohort study, 333,657 children were defined as asthma cohort and a 1:1 matched non-asthma cohort were generated from 2000 to 2011. At the end of 2012, the incidence of pneumothorax in asthma and non-asthma cohorts and asthma to non-asthma hazard ratios (HRs) with confidence intervals (CIs) of pneumothorax were analyzed.The incidence of pneumothorax was 1.35-fold higher in the asthma cohort than that in the non-asthma cohort. The asthma to non-asthma HRs of pneumothorax were higher in children younger than 6 years (1.76, 95% CI: 1.21–2.57) and in girls (2.27; 95% CI: 1.23–4.16). The HRs of pneumothorax were higher in asthmatic children with more asthma-related out-patient clinic visits/per year (>5 visits; HR: 2.81; 95% CI: 1.79–4.42), more emergency department visits/per year (>4 visits; HR: 1.68; 95% CI: 1.02–2.78), and longer hospitalization days due to asthma (>4 days; HR: 3.42; 95% CI: 1.52–6.94) (P < .0001, the trend test).Asthmatic children had greater risk for pneumothorax, particularly in young children and in those with severe and uncontrolled asthma.     

Association between osteoarthritis and urinary tract infection in older adults: A nationwide population-based cohort study

Osteoarthritis (OA) may increase urinary tract infection (UTI) in older adults. However, this issue remains unclear. We identified 8599 older patients (≥65 years) with OA, and an equal number of older patients without OA, matched by age, sex, and index date from the Taiwan National Health Insurance Research Database between 2001 and 2005. Past histories, including UTI and underlying comorbidities, were included in the analyses. Comparisons for any UTI, ≥1 hospitalization for UTI, and ≥3 hospitalizations for UTI between the 2 cohorts by following up until 2015 were performed. In both cohorts, the percentages of age subgroups were 65–74 years (65.7%), 75–84 years (30.1%), and ≥85 years (4.2%). The male sex was 42.4%. Patients with OA had an increased risk of any UTI compared with those without OA after adjusting for all past histories (adjusted hazard ratio [AHR]: 1.72; 95% confidence interval [CI]: 1.64–1.80). Compared with patients without OA, patients with OA also had an increased risk of ≥1 hospitalization for UTI and ≥3 hospitalizations for UTI (AHR: 1.13; 95% CI: 1.06–1.19 and AHR: 1.25; 95% CI: 1.13−1.38, respectively). In addition to OA, age 75–84 years, female sex, history of UTI, benign prostatic hyperplasia, indwelling urinary catheter, cerebrovascular disease, dementia, and urolithiasis were independent predictors for any UTI. This study showed that OA was associated with UTI in older adults. We suggest appropriately managing OA and controlling underlying comorbidities to prevent subsequent UTI.     

Drug adherence and the incidence of coronary heart disease- and stroke-specific mortality among 218,047 patients newly prescribed an antihypertensive medication: A five-year cohort study

Background

Randomized trials have shown that optimal adherence to antihypertensive agents could protect against cardiovascular diseases, but whether adherence reduces cardiovascular deaths in community settings has not been explored so fully. This study evaluates the association between antihypertensive adherence and cardiovascular (coronary heart disease and stroke) mortality in the primary care settings.

Methods

From a territory-wide database in Hong Kong, we included all patients who were prescribed their first-ever antihypertensive agents in the years between 2001 and 2005 from the public healthcare sector. All patients were followed up for five years, and assigned as having poor (Proportion of Days Covered [PDC] < 40%), intermediate (40–79%), and high (≥ 80%) adherence to antihypertensive agents. The association between antihypertensive adherence and cardiovascular mortality was evaluated by using the Cox proportional hazard models.

Results

From a total of 218,047 eligible patients, 3825 patients (1.75%) died of cardiovascular disease within five years after having received their first-ever antihypertensive agents. The proportions of patients having poor, intermediate, and high medication adherence were 32.9%, 12.1%, and 55.0%, respectively. Higher adherence levels at PDC 40%–79% (HR = 0.46, 95% C.I. 0.41–0.52, p < 0.001) and ≥ 80% (HR = 0.91, 95% C.I. 0.85–0.98, p = 0.012) were significantly less likely to be associated with mortality than the poor adherence (PDC0.040) group.

Conclusions

Better antihypertensive adherence was associated with lower cardiovascular mortality. This highlights the need to promote adherence through strategies which have been proved to be effective in clinical settings.     

Alcohol use trajectories among adults in an urban area after a disaster: evidence from a population-based cohort study

Alcohol use increased in the New York City (NYC) metropolitan area in the first months after the 11 September 2001 terrorist attacks. AIMS: To investigate alcohol use trajectories in the NYC metropolitan area in the 3 years after 11 September and examine the relative contributions of acute exposure to the attacks and ongoing stressors to these trajectories. DESIGN: We used a population-based cohort of adults recruited through a random-digit-dial telephone survey in 2002; participants completed three follow-up interviews over 30 months. SETTING: The NYC metropolitan area. PARTICIPANTS: A total of 2752 non-institutionalized adult residents of NYC. MEASUREMENTS: We used growth mixture models to assess trajectories in levels of total alcohol consumption and bingeing in the past 30 days, and predictors of these trajectories. FINDINGS: We identified five trajectories of alcohol consumption levels and three bingeing trajectories. Predictors of higher levels of use over time included ongoing stressors, traumatic events and lower income. Ongoing exposure to stressors and low income also play a central role in bingeing trajectories. CONCLUSIONS: While point-in-time mass traumatic events may matter in the short term, their contribution subsides over time. Accumulated stressors and traumatic events, in contrast, lead to higher levels of consumption among respondents already vulnerable to high alcohol use. Interventions to mitigate post-disaster stressors may have substantial benefit in reducing alcohol abuse in the medium- to long term.     

Predictors of decline in medication adherence: results from the cohort study of medication adherence among older adults

Few data are available on the predictors of decline in antihypertensive medication adherence and the association of decline in adherence with subsequent blood pressure (BP) control. The current analysis included 1965 adults from the Cohort Study of Medication Adherence Among Older Adults recruited between August 2006 and September 2007. Decline in antihypertensive medication adherence was defined as a ≥2-point decrease on the 8-item Morisky Medication Adherence Scale assessed during telephone surveys 1 and 2 years after baseline. Risk factors for decline in adherence were collected using telephone surveys and administrative databases. BP was abstracted from outpatient records. The annual rate for a decline in adherence was 4.3% (159 participants experienced a decline). After multivariable adjustment, a decline in adherence was associated with an odds ratio (OR) for uncontrolled BP (≥140/90 mm Hg) at follow-up of 1.68 (95% CI: 1.01-2.80). Depressive symptoms (OR: 1.84 [95% CI: 1.20-2.82]) and a high stressful life events score (OR: 1.68 [95% CI: 1.19-2.38]) were associated with higher ORs for a decline in adherence. Female sex (OR: 0.61 [95% CI: 0.42-0.88]), being married (OR: 0.68 [95% CI: 0.47-0.98]), and calcium channel blocker use (OR: 0.68 [95% CI: 0.48-0.97]) were associated with lower ORs for decline. In summary, a decline in antihypertensive medication adherence was associated with uncontrolled BP. Modifiable factors associated with decline were identified. Further research is warranted to determine whether interventions can prevent the decline in antihypertensive medication adherence and improve BP control.     

Myocardial disease mortality in children and young adults. A population-based observational study

INTRODUCTION AND OBJECTIVES. Few studies have investigated death due to myocardial disease in children and young adults. The aim of this study was to analyze the epidemiological, clinical, and pathologic characteristics of death in these cases. PATIENTS AND METHOD. Population-based observational study of all deaths in individuals aged 1-35 years in the Spanish province of Biscay over a period of 12 years. RESULTS. Forty deaths from myocardial disease occurred in 29 males and 11 females (mean age 25.3 years): 30 sudden and 10 non-sudden deaths. The mortality rate was 0.64 per 100,000 persons-year. The relative risk of sudden death was significantly greater than that of non-sudden death, particularly in adolescents and young males. The cause of death was myocarditis in 12 cases (83.3% sudden death), dilated cardiomyopathy in 10 (80% non-sudden death), arrhythmogenic cardiomyopathy in seven, hypertrophic cardiomyopathy in six, and idiopathic concentric left ventricular hypertrophy in five (100% sudden death). Myocardial disease was diagnosed before sudden death in only three cases. Ten subjects had symptoms and electrocardiogram abnormalities but their cardiomyopathy had not been diagnosed. Six individuals had a comorbid condition (morbid obesity in four), six had prodromal symptoms, and 11 had arrhythmic triggering factors (sporting activity in seven). Ventricular fibrillation was frequently observed during cardiopulmonary resuscitation. CONCLUSIONS. Mortality due to myocardial disease in children and young adults is uncommon. Most deaths are sudden. However, some may be preventable. Preventative measures should be aimed at sudden death in adolescents and young males. There was a noticeable association between arrhythmogenic cardiomyopathy and sporting activity.     

Respiratory resistance among adults in a population-based cohort study in Northern Japan

BackgroundForced oscillation technique (FOT) is a noninvasive method used to measure respiratory system resistance (Rrs) and reactance (Xrs) during quiet breathing, which has been extensively studied in clinical settings. The distribution of measured FOT values was previously assessed in a community-based cohort study. In this study, we aimed to confirm the distribution of measured FOT values in a different cohort in order to investigate the relationship between these values and patient clinical and biological data.MethodsWe reviewed FOT data and relevant patient clinical and biological information collected from the Community-Based Cohort Study (CommCohort Study), carried out between 2013 to 2016 as a part of the Tohoku Medical Megabank project (TMM). In total, 16,231 adults were enrolled in the study (Male/Female: 4886/11,345).ResultsSignificant gender differences were observed in distributions of Rrs and Xrs values at 5 Hz (termed R5 and X5, respectively). R5 values in males were lower than those in females, while X5 values in males were slightly less negative. High R5 values were strongly associated with high BMI, short height, smoking status in males, high serum IgE level, and high peripheral blood eosinophil count.ConclusionThe present distribution values and their relation to clinical and biological data should provide useful insights for clinical settings and serve as a helpful guide in implementing FOT.Forced oscillation technique, respiratory system resistance, respiratory system reactance, gender difference, obesity.     

Inappropriate medication use in older adults undergoing surgery: a national study

OBJECTIVES: To determine the prevalence and factors associated with use of potentially inappropriate medications (PIMs) in older adults undergoing surgery. DESIGN: Retrospective cohort study. SETTING: Three hundred seventy‐nine acute care hospitals participating in the nationally representative Perspective database (2006–2008). PARTICIPANTS: Individuals aged 65 and older undergoing major inpatient gastrointestinal, gynecological, urological, and orthopedic surgery (N=272,351). MEASUREMENTS: Medications were classified as PIMs using previously published criteria defining 33 medications deemed potentially inappropriate in people aged 65 and older. Information about participant and provider characteristics and administration of PIMs was obtained from hospital discharge file data. Logistic regression techniques were used to examine factors associated with use of PIMs in the perioperative period. RESULTS: One‐quarter of participants received at least one PIM during their surgical admission. Meperidine was the most frequently prescribed PIM (37,855, 14% of participants). In adjusted analysis, PIM use was less likely as age advanced (adjusted odds ratio (AOR)=0.98 per year of age, 95% confidence interval (CI)=0.97–0.98) and in men (AOR=0.83, 95% CI=0.81–0.85). PIMs were more likely to be prescribed to participants cared for by orthopedic surgeons than for those cared for by general surgeons (AOR=1.22, 95% CI=1.08–1.40). Participants undergoing surgery in the West (AOR=1.79, 95% CI=1.02–3.16) and South (AOR=2.24, 95% CI=1.38–3.64) were more likely to receive a PIM than those in the Northeast. CONCLUSION: Receipt of PIMs in older adults undergoing surgery is common and varies widely between providers and geographic regions and according to participant characteristics. Interventions aimed at reducing the use of PIMs in the perioperative period should be considered in quality improvement efforts.     

Computer use and cognitive decline among Japanese older adults: A prospective cohort study

IntroductionThis study aimed to examine the prospective association between computer use and cognitive decline among community-dwelling Japanese older adults, considering the characteristics of computer users.MethodsThis four-year prospective cohort study was conducted in Obu, Japan. Participants who were cognitive intact at Wave 1 (2011-2012) were followed through the study period. Cognitive decline was defined as scoring below the standard threshold in at least one of four neuropsychological tests at Wave 2 (2015-2016). The association between computer use at Wave 1 and cognitive decline was examined using logistic regression for complete samples (n = 2010, 52.5% female, mean 71.0 ± 4.7 years) and imputed samples (n = 3435, 51.8% female, mean 71.5 ± 5.3 years).ResultsThe computer use group had a reduced adjusted odds ratio (aOR) of cognitive decline, after adjustment for covariates, in both the complete and imputed samples (complete samples: aOR 0.71, 95% confidence interval [CI] 0.52-0.97, p = 0.030; imputed samples: aOR 0.67, 95% CI 0.51-0.88, p < 0.003). Stratified analysis of both samples showed that computer users with ≥ 10 years’ education, a GDS score of < 6, or a walking speed of ≥ 1.0m/s, showed reduced aOR for cognitive decline (aOR 0.61 to 0.69, p < 0.05). Those with < 10 years of education years, GDS scores ≥ 6 of GDS, or walking speed < 1.0m/s did not show significant association.ConclusionComputer use is longitudinally associated with protected cognitive function, based on computer user characteristics.