Browsing by Subject "iäkkäät"

Introduction: When people age, the composition of sleep changes and sleep becomes more sensitive to external disturbances, making insomnia also more common. Medication is not the first-line treatment option for insomnia. Benzodiazepines or benzodiazepine receptor agonists for the treatment of insomnia have been in the focus of past studies. The content of the dosing instructions for the supplied medicines has not been studied. The dosing instructions should provide clear instructions on how to dose the medicine prescribed to the patient. The aim of this study was to investigate the content and quality of dosing instructions prescribed for the treatment of insomnia for Finns aged ≥75 years in 2020 based on the prospective reimbursement register data by the Social Insurance Institution of Finland (Kela). Materials and methods: The reimbursed purchases of all medicines by persons aged ≥75 years from 1.1.2020 to 31.12.2020 were selected by ATC code from the medicines data according to the Insomnia: Current Care guidelines. The data was gathered from Kela’s dispensations reimbursed under the National Health Insurance scheme. The dataset consisted of 1,080,843 delivery lines, which were screened, and 328,285 lines were included in the analyses. Dosage instructions were reviewed according to the following predetermined five categories: frequency of use, dose, timing, warnings or remarks, and inappropriate instructions. In addition, 1000 dosing instructions were randomly derived to study the phrasing and appropriateness of the dosing instructions in more detail. Results: In 2020, an average of 3.8 reimbursed hypnotic drug deliveries were made per elderly person. Of the deliveries, 68% were for women. 52% of drug deliveries were partially made later and not by original prescription. In the hypnotic dataset, the three most administered drugs were zopiclone (41%), mirtazapine (34%) and zolpidem (12%). The dosage was prescribed in 98–99% of the dosage instructions. Dosing schedule was reported in 83% of dosing instructions and regularity of use was reported in 57% of them. Only 3-6% of the dosing instructions had comments or warnings. 1–2% of the dosing instructions were vague. The duration or regularity of use was clearly indicated in 5% of the dosing instructions. Only 0.1% of dosage instructions contained instructions for discontinuation or reduction. Discussion: The dose and timing of administration were well reported, but the frequency of use was reported in only about half of the dosing instructions. Only few dosing instructions contained remarks or warnings even though hypnotics are at risk for the elderly. Among the three most administered drugs for the treatment of insomnia were two benzodiazepine receptor agonists, zopiclone and zolpidem. However, they may not be suitable for the elderly according to Beers criteria and their use should be avoided. During 2020, an average of four drug deliveries were made per elderly person for the treatment of insomnia, which may indicate prolonged hypnotics use. In addition, more than half of the deliveries were partially made later and not by original prescription. Thus, several drug packages are prescribed for prescriptions, although the drug-based treatment of insomnia should only be short-lived. Conclusions: There are significant deficiencies in the contents and quality in the dosing instructions for drugs delivered to the elderly for insomnia. Minimum information on dose, timing and duration of use was not found in all dosing instructions in this study. Understandable dosing instructions and the reduction in the amount of medication in the prescription could have a further effect on reducing the long-term use of hypnotics, also increasing the safety of medicine use in the elderly.

The aged are the biggest age group of using psychotropics. The most used ones of these drugs are hypnotic and sedatives that consists mainly of benzodiazepines and related drugs. However, the aged are extremely sensitive for these drugs that are also noted as potentially inappropriate drugs for the aged in the national, but also in the various international recommendations and care guidelines. Despite the care guidelines, benzodiazepine compounds are usually used for years and often concomitantly. Research material of this longitudinal, observational study with two cohorts was collected from structured interviews at two similar acute wards in Pori City Hospital during one month in 2015. The research protocol of an early similar study which was conducted in 2004 was followed. Results of the two studies (2004 and 2015) were compared. Interviews were conducted among patients aged ≥ 65 years. Users of benzodiazepines or related drugs (2004: n=38, 2015: n=32) were further interviewed. The aim of this study was to compare the characteristics of the usage of benzodiazepine compounds in the aged between the years 2004 and 2015. In particular the medicines information sources and amount of information on these drugs i.e. knowledge on adverse drug reactions was studied and compared. Additionally a systematic review was conducted to explore the current evidence on interventions to rationalize the use of benzodiazepines and related drugs in the aged. In 2004, 54% of the interviewed patients (n=64) were using benzodiazepine compounds. However, in 2015 there were 34% (n=36) using. In 2015 regular usage of these drugs was decreased and irregular usage (given on an as-needed basis) was increased compared to the year 2004. None of the patients used long-acting benzodiazepines in 2015. Medicines information is provided notably more by doctors and pharmacies to 2004, but still the information focused more on benefits of drug other than adverse drug reactions. However, the patients' knowledge about the adverse drug reactions of benzodiazepine compounds has increased. The patients got presented adverse drug reactions known on mean of five in the year 2015, while the same value in 2004 was three. In the both years, the most of the patients were aware of the dependence these drugs may cause. The usage of benzodiazepine and related drugs in the aged has become better, but there is still need to improve multi-professional cooperation and applicate new interventions for rationalize the usage of benzodiazepinecompounds.

Family caregiving refers to the organization of home care for an older adult, disabled or sick person with the assistance of a relative or other close person. The number of elderly carers (> 65 years) of all family garegivers is significant. There are challenges concerning family caregiving for the older adults, due to increased age is in connection with decreased physical performance and increased number of medications and polypharmacy. Despite these factors, there has been little research on the medication safety in the family caregiving among older adults. The aim of this Master's thesis was to identify factors influencing the ability of a caregiver to cope with the medication management of the older adults. These factors were divided into subgategories: factors associated a family caregiver, associated a care recipient and system-oriented factors. The research was conducted as a method triangulation, in which the data were collected through two interviews with home visits (n = 21) and related questionnaires. The questionnaire data were quantitatively analyzed by calculating the frequencies and relative frequencies. The transcribed interviews were analyzed by abductive content analysis, combining both deductive and inductive approach. James Reason's theory of human error was used as the theoretical framework. Caregiving families participating in this research were very different compared with each other. Some family caregivers and care recipients were in good physical condition while others were severely disabled. However, the situation of the families was not individually considered when considering appropriate support services for the families. The workload of family caregivers due to the pain and the absence of days off contributed to the difficulty of medication management. The foremost system-oriented challenges in the management of the medications were: 1) difficult for the families to reach the physician and 2) for those families where assisted home care helped the caregiver, the families were not satisfied with its functioning. Due to the poor availability of physicians and the lack of a family physician, there was no one in control of the medication as a whole and there was inadequate monitoring of the medication. In the assisted home care, challenges were caused by the fact that home care visits were conducted over a wide period of time, which created challenges for giving the medications. Carers do not receive sufficient support from the society for the management of the medications. The medication safety of the older adults in the family caregiving is particularly affected by the difficulty of reaching a physician, the inadequacy of support from the assisted home care, the failure to recognize the individuality of caregiving families, and the caregivers’ burden due to pain and lack of days off. Support for caregivers must be at the forefront of society in the future, so that caregivers can cope with heavy nursing care and complicated medications, even without excessive self-activity.

The amount of informal caregiving has increased in Finland, with a growing emphasis on the older adults. Although the medication management process in informal caregiving has been studied and is known to have significant risks, research data focusing on the older adults is still limited. The aim of this study was to describe the medication management process of informal carers and care recipients of at least 65 years old. The aim was to identify medication errors and medication risks in the medication management process and to find out how the caregivers manage them. In addition, the study examined the informal carers and care recipients own development proposals to improve medication management process. A total of 21 volunteer informal carers and care recipients living in the Helsinki metropolitan area were recruited to this study. The study was conducted as a qualitative interview survey in the homes of the participants. The interviews were a combination of semi-structured interviews and narrative approach. The material to this study was collected during spring and summer 2018. The study was analysed with abductive content analysis combining both deductive and inductive approach. The aim was to find repetitive elements by encoding and grouping expressions. The results of this study were compared with previous theory and the results were supplemented with a picture of the medication management process and a fishbone diagram was drawn from the risk factors and contributing factors of the medication management process. The families had medication errors in all stages of the medication management process. The most frequent medication errors were found in counselling, medication administration and in medication treatment monitoring. As a contributing factor, the healthcare professionals’ haste and the responsibility of the caregiver recurred in the background of the medication errors. Family caregivers and care recipients wish to have more counselling, more monitoring of medication and better interaction with health care. Carers often felt left alone to take care of another person's medications and felt they lack support from healthcare. By facilitating access to a physician, improving the availability of a physician, increasing the amount of counseling and support provided by healthcare, including pharmacies, could the safety of medication management at home be improved.

Suomalainen väestö vanhenee nopeasti ja ikääntymisen myötä lisääntyvät muistisairaudet. Suomalaisen ikäpolitiikan tavoitteena on hoitaa vanhuksia mahdollisimman pitkään kotona ennen pitkäaikaiseen hoivaan siirtymistä. Yhteiskunnallista keskustelua hallitsee esitykset pitkäaikaisesta hoivasta ja hoitohenkilökunnan mitoituksesta. Kotiin hoidettavat iäkkäät ihmiset eivät ole keskustelussa juurikaan mukana. Yksin kotonaan asuvat iäkkäät muistisairaat on syrjäytetty keskustelusta lähes täysin. Sosiaalityön ja gerontologisen sosiaalityön keskiössä on olla sosiaalisen asiantuntija. Tässä työssä perehdytään poliittisten asiakirjojen kautta siihen, miten kotonaan yksin asuvien muistisairaiden sosiaalisuus on otettu poliittisessa ohjauksessa huomioon. Tarkastelun viitekehyksenä on Kari Salosen (2007; 2011) muotoilema Derek Layderin (1993) tutkimuskartan pohjalta rakentama sosiaalinen olomuotoisuus -käsite. Tutkimuksessa paneudutaan sosiaalisen olomuotoisuuden käsitteeseen ja kuvataan, miten sosiaalisen olomuotoisuuden eri tasot ilmenevät iäkkäiden ihmisten palveluja ohjaavissa asiakirjoissa. Tutkimukseen valitut asiakirjat ovat: Laki ikääntyneen väestön toimintakyvyn tukemisesta sekä iäkkäiden sosiaali- ja terveyspalveluista 980/28.12.2012 (Vanhuspalvelulaki), Hallituksen esitys eduskunnalle laiksi ikääntyneen väestön toimintakyvyn tukemisesta sekä iäkkäiden sosiaali- ja terveyspalveluista annetun lain muuttamisesta 160/2012 ja sosiaali- ja terveysministeriön ja Kuntaliiton laatusuositus hyvän ikääntymisen turvaamiseksi ja palvelujen parantamiseksi 2020-2023. Tutkimusmenetelmänä on käytetty teorialähtöistä sisällön analyysia, jota on täydennetty aineistolähtöisellä analyysilla. Tutkimuksen tuloksena voidaan todeta, että sosiaalisen olomuotoisuuden eri muotoja on nähtävissä vanhuspalvelulaissa, hallituksen esityksessä vanhuspalvelulaiksi ja STM:n laatusuosituksessa vaihtelevasti. Valitut asiakirjat ohjaavat kuntien iäkkään väestön palvelutoimintaa, mikä näkyi sosiaalisen olomuotoisuuden kehikon yhteiskunnan sekä sosiaalisen ja fyysisen ympäristön tasojen painottumisena teksteissä. Kunta, kuntayhtymät, niiden yhteistyökumppanit sekä iäkkäiden ihmisten palveluasumisen yksiköt nähdään teksteissä palveluiden tarjoamiseen liittyvinä toimijoina, ei niinkään iäkkäiden ihmisten oman elämän toimintakenttänä, elinpiirinä tai kotina. Sosiaalisen olomuotoisuuden sosiaalisten ja fyysisten ympäristöjen kategoriaa hallitsivat palvelut. Iäkkään ihmisen omaiset ja sosiaalinen verkosto kuvattiin viranomaisten palvelutarpeen arviointiin ja palvelusuunnitelmien laadintaan liittyvänä toimintana. Sosiaalisen olomuotoisuuden sijainniltaan määrittyvän toiminnan kategoriassa eniten huomiota asiakirjoissa sai toimintakyky, joka liitettiin useimmiten sosiaalisen olomuotoisuuden tutkimuskehikon ulkopuolisiin käsitteisiin terveys, itsenäinen suoriutuminen ja kuntoutus. Sosiaalisen minäidentiteetin osa-alueista asiakirjoissa käsiteltiin eniten yksilöllisiä tarpeita. Iäkkään ihmisen oma elämänkulku tai elämänhistoria, merkityksellistyneet asiat ja tapahtumat, persoonallisuuspiirteet, ajattelu, tunteet ja elämänkokemukset, eivätkä myöskään hengellisyys tai uskonto ja oman olemassaolon kokemus saaneet juurikaan mainintoja. Yksin kotonaan asuvia muistisairaita iäkkäitä ihmisiä ei asiakirjoissa omana ryhmänään käsitelty lainkaan. Tutkimuksen johtopäätöksenä voidaan todeta, että tässä tutkimuksessa analysoiduissa ikäpoliittisissa asiakirjoissa painottuu viranomaisnäkökulma palveluiden järjestämisessä iäkkään ihmisen oman toimijuuden, osallisuuden ja sosiaalisen minäidentiteetin kustannuksella. Gerontologista sosiaalityötä tarvitaan tuomaan palveluihin psykososiaalista iäkkään ihmisen elämänkulun ja elämäntarinan makro- ja mikrotasoineen huomioivaa sosiaalisen olomuotoisuuden näkökulmaa ja iäkkään ihmisen sosiaalisia verkostoja aktivoivaa verkostotyöskentelyä.

Harmful drug effects are common among older medicine users. Potentially harmful drugs for older people have been defined by different criteria. Potentially inappropriate medications (PIMs) defined by Beers criteria have been associated with adverse effects, increased costs, need of hospital care and disabilities. Drugs with anticholinergic properties (DAPs) are associated with anticholinergic side effects, cognitive decline and delirium. Psychotropic drugs have been associated with increased risk of falls and mortality. Concurrent use (≥3) of psychotropic drugs has been considered harmful for older people by the Swedish National Board of Health and Welfare. The aim of this study was to examine the prevalence of potentially harmful drug (PHD) use (DAPs, PIMs, or concurrent use of ≥3 psychotropic drugs) and the accumulation of PHDs in aged people living in nursing homes and assisted living facilities. The objective was also to investigate which patient characteristics are associated with PHD use or accumulation of these drugs. The cross-sectional data was collected in 2011-2012 as a part of a larger study "Reducing inappropriate, anticholinergic and psychotropic drug use among older residents in institutional care". The study population (N=326) consisted of ≥ 65-aged residents living in nursing homes or assisted living facilities in Helsinki (n=227) and Kouvola (n=99). The mean age was 83.5 years, 70.0 % were women and mean Charlson comorbidity index was 2.6. Residents were divided into four groups: aged using 1) DAPs, 2) PIMs defined by Beers criteria, 3) concurrent use of ≥3 psychotropic drugs and 4) no PHDs in use. Both those fulfilling any of these criteria and those fulfilling all the three criteria (accumulation of PHD) are described. Users in these groups were compared to the non-users. A majority of the residents, 78,8 % (95 % CI: 74,4 - 83,3) used ≥1 PHDs: 67,8 % (95 % CI: 62,7- 72,9) used ≥1 DAPs, 32,2 % (95 % CI: 27,1- 37,3) ≥1 PIMs and 32,2 % (95 % CI: 27,1-37,3) used ≥3 psychotropics concurrently. Of the residents, 41 (12.6 %) had a medication treatment that fulfilled all the three criteria of PHD use. These residents used significantly more PHDs than others (average mean 4,8 [range 3-7] vs. 1,6 [range 0-6]). The residents having the PHD accumulation were more often males and used more drugs than others. There were no statistical differences among the other characteristics of these groups. The most common PHDs were mirtazapine (n=66), lorazepam (n=64), oxazepam (n=62), ketiapine (n=58) and stimulant laxatives without opioids (n=58). Use of DAPs was associated with multimorbidity, use of PIMs with weaker health related quality of life, and use of psychotropics with younger age. High number of drugs was associated with all these criteria. Use and accumulation of potentially harmful drugs is common among the aged living in nursing homes and assisted living facilities. New means are needed to optimize drug treatments and to educate professionals taking care of these patients. Special attention should be paid on the use of antipsychotics, benzodiazepines, mirtazapine and stimulant laxatives.

Atypical antipsychotics (AAPs) can be used to treat severe behavioural symptoms of dementia when certain conditions are fulfilled. They are not considered as primary treatment for these symptoms due to their possible serious side effects that are found to be more common in elderly dementia patients. Package leaflets (PLs) are one of the most important sources of medicine information for elderly patients. Evidence-based medicines information is the prerequisite for decision-making and success of pharmacotherapy. The aim of this study was to evaluate the usability and informational content of atypical antipsychotic PLs from the perspective of the elderly. Additionally, the content of medicines information for the elderly found in PLs was compared to similar medicines information targeted to health care professionals (HCPs). Medication Information Design Assessment Scale (MIDAS) was used to evaluate the usability of the most commonly used AAPs (olanzapine, quetiapine and risperidone) among the elderly in Finland. To evaluate the informational content of the PLs and summaries of product characteristics (SmPCs) all the references for the elderly were identified using certain keywords. The informational content concerning elderly from the PLs was compared to information targeted to HCPs in Beer's criteria, Current Care Guideline for memory disorders, Database of medication for the elderly, Martindale and SmPCs. The usability of the PLs in this study was found to be insufficient. The mean MIDAS-credit was 6,4 (n=61; range 5,0-8,0), the maximum credit being 13. Sufficient line spacing and limiting the length of line were among the poorly represented features in the PLs in this study. The occurrence of sufficient font-size varied. Good contrast, headings, usage of upper and lower case in text and bullet points were among the well-represented features. All the PLs included in the content-analysis (n=106) contained at least three references to the elderly. The way the information was presented and how well it stood out from the leaflet varied. The SmPCs contained useful information targeted to elderly that was not found in corresponding PLs. Actions need to be taken to improve the usability and content of product specific medicines information from the perspective of the elderly. Medicine authorities and the pharmaceutical industry have the authority to make these improvements possible. Scientific data and concrete tools are needed to facilitate the change.