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Drug Use Among the Very Old Living in Ordinary Households: Aspects on Well-being, Cognitive and Functional Ability
Sophiahemmet University.ORCID iD: 0000-0002-7573-3570
2007 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Background: In Sweden today a major proportion of the population survive to old ages. To a large extent, the oldest old are capable of living longer in their own households; some of them are very healthy while others have multiple diagnoses or ailments caused by a normal ageing process. This means that many elderly persons receive their health care needs in their own home, and in the future this will be even more common. Drug use of the elderly is a complex field, and many drugs have side effects complicating the medical treatment and decreasing the quality of life.

 

Aim: This thesis aims to explore and describe the medicine use and the medical situation of very old persons (¡Ý84 years) living in ordinary households, and to obtain knowledge of their views on the use of drugs.

Methods: This thesis combines quantitative and qualitative research methods. The quantitative studies (Study I, II and III) were based on data from the Kungsholmen Project, a population based study of elderly people living in a district of the inner city of Stockholm, Sweden. Data collection of the present studies was carried out from the third follow-up 1997-1998. The qualitative data (Study IV) was obtained 2005 through in-depth interviews with 25 elderly men and women, aged 85-97 years, living in ordinary households in Stockholm, Sweden. A pre-tested semi-structured questionnaire was used for the interviews.

Results: The findings in Study I demonstrated that cardiovascular diseases are very frequent in this population (62%). Heart failure (47%) and hypertension (37%) were the most common conditions; and diuretics (69%), nitrates (31%) and cardiac glycosides (30%) were the most commonly prescribed drugs. Multivariate regression analyses showed that while being affected by a CV disease did not affect the emotional well-being of the participants (PANAS-PA, p=0.171; PANAS-NA, p=0.209), the use of cardiac glycosides (p=0.006) and nitrates (p=0.008) was associated with increased negative feelings. Study II revealed that 88% of the population took medicines on a regular basis, and only 23% of them received help with the handling of their medicines. Using logistic regression models controlling for sociodemographic variables, cognitive and functional status, female gender (OR: 2.8; 95% CI: 1.2-6.5) was the only variable associated with regular use of medicines. The results also showed that older age and functional disability as measured by ADL, increased the risk of receiving help with medicines, while higher cognitive status decreased the odds of receiving help. Using multiple regression models, we found that the only factor related to not receiving help from a family member was that of living alone (OR:0.05; 95% CI: 0.006-0.4). Study III showed that the prevalence of pain among very old persons was 46%, and the prevalence of pain treatment was 71%. Results from logistic regression analysis using all variables in the model indicated that pain reporting was not associated with age, gender or living conditions, but decreased with decreasing cognitive status and with increasing functional disability. Furthermore, pain treatment was not associated with age, gender, living conditions, cognitive and functional status. The qualitative data in Study IV indicated that most of the participants managed their medicines by themselves and were very content with this. Those elderly who received help with their medicines were also very pleased with this help. The findings also revealed that the most important components for the elderly to be able to remain living in their homes and to handle their medicines by themselves, were to have good cognitive ability, to be independent and to get support with their medicines from a close person as a back-up.

Conclusions: This study revealed that a large proportion of very old people (¡Ý84 years) were living in ordinary households and used medicines regularly. Being a woman and living alone were associated with receiving help with medicines from the community help services. Cognitive and functional ability were revealed to be significant factors in the management of medicines, but also to affect the pain reporting, and type of received pain treatment. Most of the older participants managed to handle their medicines by themselves, and were very pleased by doing this. However, most of them were concerned about the risk of losing their memory, as they are getting older, because they knew that they would not be able to manage themselves any more and therefore would have to move to an institution.

Place, publisher, year, edition, pages
Stockholm: Karolinska University Press , 2007. , 56 p.
Keyword [en]
Drug use, Medicine management, Very old, Aged 84 and older, Ordinary households, Community, Well-being, Cognitive status, Functional ability, Population-based, In-depth-interviews, Quantitative and qualitative methods, Sweden
National Category
Nursing
Identifiers
URN: urn:nbn:se:shh:diva-139ISBN: 978-91-7140-979-9 (print)OAI: oai:DiVA.org:shh-139DiVA: diva2:314322
Public defence
2007-03-21, 13:00 (English)
Opponent
Supervisors
Available from: 2010-04-27 Created: 2010-03-12 Last updated: 2016-06-09Bibliographically approved
List of papers
1. A population-based study on well-being in the very old: the role of cardiovascular diseases and drugs
Open this publication in new window or tab >>A population-based study on well-being in the very old: the role of cardiovascular diseases and drugs
2005 (English)In: Archives of gerontology and geriatrics (Print), ISSN 0167-4943, E-ISSN 1872-6976, Vol. 40, no 3, 287-97 p.Article in journal (Refereed) Published
Abstract [en]

Cardiovascular diseases constitute the most common health problems in very old people. Consequently, cardiovascular drugs are the medicines that are most frequently used by elderly subjects. Although many studies have examined the physiological effect and adverse reactions of these drugs, knowledge on their effect on emotional well-being is missing. The present study aims to examine the association between cardiovascular diseases and their medical treatment on the emotional well-being of very old people. We investigated a representative group of elderly subjects gathered from a population-based study (n=235). Participants were 84 years or older and cognitively intact (mini-mental state examination (MMSE) > or =24 points). Well-being was assessed with the positive and negative affect schedule (PANAS), measuring different mood categories. Cardiovascular diseases were diagnosed following the International Classification of Diseases. In this population the prevalence of cardiovascular diseases was high (62%). Multivariate regression analysis showed that while being affected by a cardiovascular disease did not affect the emotional well-being of the subjects (PANAS-PA, p=0.171; PANAS-NA, p=0.209), the use of some cardiovascular drugs showed an association. Cardiac glycosides (p=0.006) and nitrates (p=0.008) were associated with increased negative feelings. Due to high prevalence of cardiovascular diseases and use of cardiovascular medicines, this finding has relevance on the quality of life of elderly people. However, due to the nature of this study we cannot assess cause-effect relationship of this positive association. Therefore, the present findings suggest that there is a need for clinical studies in this increasing and limited studied age group.

National Category
Nursing
Identifiers
urn:nbn:se:shh:diva-108 (URN)10.1016/j.archger.2004.09.005 (DOI)15814162 (PubMedID)
Available from: 2010-03-02 Created: 2010-02-25 Last updated: 2014-10-31Bibliographically approved
2. Factors influencing the handling of medicines among very old people living at home in an urban area
Open this publication in new window or tab >>Factors influencing the handling of medicines among very old people living at home in an urban area
2006 (English)In: Aging Clinical and Experimental Research, ISSN 1594-0667, E-ISSN 1720-8319, Vol. 18, no 6, 497-502 p.Article in journal (Refereed) Published
Abstract [en]

BACKGROUND AND AIMS: Elderly people in Sweden live longer in their own homes, some of them with good health, and others with chronic conditions that require medical treatment. Thus, the aim of this study was to investigate factors influencing elderly people's handling of their medicines. METHODS: Cross-sectional population-based study. Participants were 333, aged 84+ years, living in their own homes. Information on regular drug use was obtained from interviews. Descriptive statistics were used to describe the population, and logistic regression models were used to investigate the factors associated with receiving help in handling medicines. The Mini-Mental State Examination (MMSE) measured cognitive status, and the basic Activities of Daily Living (ADL) assessed functional status. RESULTS: Most participants were women living alone. 88% of this population took medicines on a regular basis and 23% of them received help with medicine handling. Using logistic regression models controlling for sociodemographic variables, cognitive and functional status, female (OR=2.8, 95% CI=1.2-6.5) was the only variable associated with regular use of medicines. Older age and functional disability in ADL increased the risk of receiving help with medicines, while higher cognitive status decreased the odds of receiving help. The only factor related to receiving help from a family member was living alone (OR=0.05; 95% CI=0.01-0.40). CONCLUSIONS: This study indicates that cognitive and functional problems require increased help with handling medicines. These results stress the need for ongoing vigilance of, and support for, people with this high-risk profile.

National Category
Nursing
Identifiers
urn:nbn:se:shh:diva-107 (URN)17255639 (PubMedID)
Available from: 2010-03-02 Created: 2010-02-25 Last updated: 2014-10-31Bibliographically approved
3. Pain reporting by very old Swedish community dwellers: the role of cognition and function
Open this publication in new window or tab >>Pain reporting by very old Swedish community dwellers: the role of cognition and function
2008 (English)In: Aging Clinical and Experimental Research, ISSN 1594-0667, E-ISSN 1720-8319, Vol. 20, no 1, 40-6 p.Article in journal (Refereed) Published
Abstract [en]

BACKGROUND AND AIMS: Pain is a common and unpleasant problem among elderly people and affects the possibility for them to remain living in their own homes. The aims of this study were therefore to report the prevalence of pain reporting and pain treatment, and their association with functional and cognitive status in a very old population. METHODS: Cross-sectional population-based study. Participants were 333, aged 84 years or older, living at home alone or with someone in Kungsholmen, in central Stockholm, Sweden. Information on pain was obtained from interviews. The Mini- Mental State Examination (MMSE) measured cognitive status and the index of basic Activities of Daily Living (ADL) functional status. Descriptive statistics were used to describe the population and logistic regression models to investigate factors associated with pain reporting and pain treatment. RESULTS: The prevalence of pain was 46%, and the prevalence of pain treatment 71%. Results from logistic regression analysis including all variables in the model showed that pain reporting was not associated with age, gender or living conditions. However, pain reporting was correlated with cognitive and functional status. There was no association between pain treatment and age, gender, living conditions, cognitive or functional status. CONCLUSIONS: Pain is common among the oldest old. Our results indicate that cognitive and functional status affect pain reporting. Poor cognitive status was associated with less pain reporting, whereas poor functional status was associated with more pain reporting.

National Category
Nursing
Identifiers
urn:nbn:se:shh:diva-106 (URN)18283227 (PubMedID)
Available from: 2010-03-02 Created: 2010-02-25 Last updated: 2014-10-31Bibliographically approved
4. How do older people experience their management of medicines?
Open this publication in new window or tab >>How do older people experience their management of medicines?
Show others...
2008 (English)In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 17, no 5A, 106-15 p.Article in journal (Refereed) Published
Abstract [en]

AIM: The aim of this study was to describe how older people living at home in Stockholm, Sweden, experienced the management of their own medication regimen from their own perspective. BACKGROUND: Very old people tend to use more medicines, and without proper medication, many of them would not function well and would not be able to remain in their own homes. METHODS: This qualitative study involved audiotaped interviews with 25 very old persons. Inclusion criteria: aged >or=85 years, mini-mental state examination >or=24, living at home, taking medicines regularly. Data collected May-June 2005, analysed using content analysis. DESIGN: Descriptive study. RESULTS: Findings revealed that most participants managed their medicines by themselves and were very content with this. Older people who received some help with their medicines were also very pleased with that help. The most important components for older people were to have good cognitive ability, to be independent and to get support with their medicines from a close person as a back up. CONCLUSION: Our results indicate that most of the participants were very pleased with their medicine management, either on their own or they were able to get some help. There was, however, a need for assistance in delivering the medicines to their homes. RELEVANCE TO CLINICAL PRACTICE: Understanding how older people experience their management of medicines and to reveal the components which may affect them in this situation is important to improve nursing care. To observe the life of an older person as a whole is important in nursing care, so that the person's behaviour can be understood, as how older people manage to handle their medicines may have an impact on their autonomy and on health-care resource use.

National Category
Nursing
Identifiers
urn:nbn:se:shh:diva-105 (URN)10.1111/j.1365-2702.2007.02151.x (DOI)18298761 (PubMedID)
Available from: 2010-03-02 Created: 2010-02-25 Last updated: 2014-10-31Bibliographically approved

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