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Medication quality and quality of life in the elderly, a cohort study
Örebro University, School of Health and Medical Sciences.
Örebro University, School of Health and Medical Sciences.
Örebro University, School of Health and Medical Sciences.ORCID iD: 0000-0001-8828-9299
2011 (English)In: Health and Quality of Life Outcomes, ISSN 1477-7525, E-ISSN 1477-7525, Vol. 9, article id 95Article in journal (Refereed) Published
Abstract [en]

Background: Modern drugs have made large contributions to better health and quality of life. Increasing proportions of negative side effects due to extensive pharmacological treatment are however observed especially among elderly patients who have multiple health problems. The aim of our study was to see if there is an association between medication quality and quality of life.

Methods: 150 patients discharged from hospital. Inclusion criteria were: living in ordinary homes, ≥ 75 years and ≥ 5 drugs. Home visits were performed to all, including prescription reviews and calculation of medication appropriateness index. The patients were divided into three groups depending on index score and followed for 12 months. The validated and recognized EQ-5D and EQ VAS instruments were used to assess quality of life.

Results: A lower medication quality was associated with a lower quality of life. EQ-5D index was statistically significantly different (declining for each group) among the groups (p = 0.001 at study start, p = 0.001 at 6 months and p = 0.013 at 12 months) as was EQ VAS (p = 0.026 at study start, p = 0.003 at 6 months and p = 0.007 at 12 months).

Conclusions: This study has shown the validity of the basic principle in prescribing: the more appropriate medication the better quality of life. Since drug quality is related to the patients’ quality of life, there is immense reason to continuously evaluate every prescription and treatment. The evaluation and if possible deprescribing should be done as a process where both the patient and physician are involved.

Place, publisher, year, edition, pages
BioMed Central, 2011. Vol. 9, article id 95
National Category
Medical and Health Sciences Nursing
Research subject
Nursing Science
Identifiers
URN: urn:nbn:se:oru:diva-20724DOI: 10.1186/1477-7525-9-95ISI: 000297062800001PubMedID: 22054205Scopus ID: 2-s2.0-80155201276OAI: oai:DiVA.org:oru-20724DiVA, id: diva2:474093
Note

Inger Nordin Olsson is also affiliated to The National Board of Health and Welfare Regional Supervisory Unit Central P.O. Box 423,SE-701 48 Örebro, Sweden; Rebecka Runnamo is also affiliated to Faculty of Health Sciences, Linköping University, SE- 581 83 Linköping, Sweden;

Available from: 2012-01-09 Created: 2012-01-09 Last updated: 2019-04-12Bibliographically approved
In thesis
1. Rational drug treatment in the elderly: "To treat or not to treat"
Open this publication in new window or tab >>Rational drug treatment in the elderly: "To treat or not to treat"
2012 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The general aim of this thesis was to examine the effect of interventions on the usage of inappropriate and hazardous multi-medication in the elderly ≥75 years with ≥5 drugs.

Methods: Paper I describes a cluster randomization of nursing homes, the outcomes were; number of drugs, health status and evaluations. A randomized controlled trial concerning elderly in ordinary homes was performed in paper II and the outcomes were; EQ-5D index, EQ VAS and prescription quality. In paper III a cohort study was carried out and the outcomes were; medication appropriateness index, EQ-5D index and EQ VAS. In paper IV, registered nurses from the nursing homes study were interviewed in a descriptive study with a qualitative approach.

Results:There was a significant reduction of number of drugs used per patient at the intervention nursing homes (p<0.05). Monitoring and evaluation of medications were significantly more frequent at the intervention homes (p<0.01). The registered nurses at the nursing homes described a self-made role in their profession and the leadership was not at sight. Drug treatment seems to be a passive process without own reflection. Extreme polypharmacy was persistent in all three groups of elderly living in ordinary homes and there was an unchanged frequency of drug-risk indicators. In the cohort study a lower medication quality was shown to be associated with a lower quality of life. EQ-5D index was statistically significantly different among the groups as was EQ VAS.

Conclusion: The nursing home study showed an extreme shortage of monitoring of health status and surveillance of the effects of drugs in the elderly. More attention must be focused on the complexity of the nursing process; medication management must be promoted in teamwork with the physician. The resistance to change prescriptions in accordance with the intervention underlines the need of new strategies for improving prescription quality. Since medication quality is related to the patients’ quality of life, there is immense reason to continuously evaluate every prescription and treatment in shared decision with the patient.

Place, publisher, year, edition, pages
Örebro: Örebro universitet, 2012. p. 84
Series
Örebro Studies in Medicine, ISSN 1652-4063 ; 64
Keywords
Elderly, polypharmacy, drug evaluation, nursing process, monitoring, inappropriate prescribing, quality of life, patient participation
National Category
Medical and Health Sciences Nursing
Research subject
Nursing Science
Identifiers
urn:nbn:se:oru:diva-20618 (URN)978-91-7668-843-4 (ISBN)
Public defence
2012-02-03, Wilandersalen, Universitetssjukhuset, Örebro, 09:00 (Swedish)
Opponent
Supervisors
Available from: 2011-12-22 Created: 2011-12-22 Last updated: 2017-10-17Bibliographically approved

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Nordin Olsson, IngerEngfeldt, Peter

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