Analgesic use and frailty among community-dwelling older people: a population-based study.

BACKGROUND: Frail older people have a decreased ability to respond to stressors and may therefore be more susceptible to adverse events related to inadequately treated pain. Conversely, aging- and frailty-related changes in pharmacokinetics and pharmacodynamics may predispose frail older people to adverse events of analgesics. OBJECTIVE: The aim of this study was to explore whether analgesic use is associated with frailty status and whether there are differences in the types of analgesics used between frailty groups among community-dwelling older people. METHODS: The study population consisted of 605 community-dwelling people aged >75 years. Demographic, diagnostic and drug use data were collected during standardized nurse interviews. Participants were classified as frail, pre-frail or robust using the Cardiovascular Health Study frailty criteria (weight loss, weakness, exhaustion, slowness and low physical activity). RESULTS: Overall, 11.4 % (n = 69) of the study participants were frail and 49.4 % (n = 299) were pre-frail. The prevalence of prescription and non-prescription analgesic use was higher among frail (68.1 %) than among pre-frail (54.5 %) and robust (40.5 %) older people (p < 0.001). In multivariate analyses, frailty was positively associated with analgesic use (odds ratio 2.96; 95 % CI 1.38-6.36). However, frail analgesic users (46.7 %) were more likely to want their physicians to pay greater attention to pain management than robust (23.2 %) analgesic users. The most prevalent analgesic was acetaminophen (paracetamol) among frail (78.7 %) and pre-frail (63.2 %), and NSAIDs among robust (60.4 %) analgesic users. Frail (60.3 %) and pre-frail (58.1 %) participants were more likely to report musculoskeletal pain than robust (44.7 %) participants. Of robust, pre-frail and frail older people 33.0 %, 23.1 % and 4.9 % (respectively) did not use any analgesics to treat their pain. CONCLUSIONS: Frailty was associated with a higher prevalence of analgesic use. As frail older people may be more susceptible to adverse events, careful selection of analgesics is warranted. Clinicians should pay more attention to pain management to ensure adequate pain relief.

The impact of informing psychiatric patients about their medication: a systematic review.

AIM: This literature study explores the impact of educational interventions about medicines for psychiatric patients on adherence, knowledge and economic, clinical and humanistic outcomes. METHOD: A systematic review of eight electronic databases was carried out. Reference lists of primary studies were searched. Studies measuring the impact of medication information for adult psychiatric patients in an individual way on adherence, knowledge, economic, clinical and humanistic outcomes were included. Data analysis and assessment of methodological quality were executed according to the Cochrane Collaboration guidelines. A meta-analysis of primary studies was not suitable due to the heterogeneity of the primary studies. RESULTS: Literature search generated 17 studies. Thirteen studies measured adherence, seven of which reported an increase. Generally, adherence was 11-30% higher in the intervention groups than in the control group. A combination of oral and written information seemed to have an added value as compared with supplying exclusively oral or written information. The provision of easily readable written information improved adherence by 11%. Seven of the eight studies measuring knowledge reported an overall improvement. Knowledge was increased with 14-28% in interventions groups in comparison with control group. One study reported an increased satisfaction. No significant differences were seen for frequency of side-effects, relapse or admission rates, symptoms and quality of life. Not one of the 17 studies explored the economic impact of the educational intervention. The methodological quality of the included studies was variable. Individual studies suffered from a variety of biases and other methodological limitations. CONCLUSION: The included studies suggested a positive impact on adherence and knowledge. As only one study assessed patient's satisfaction, no definitive conclusions can be made. No significant differences were observed for frequency of side-effects, relapse or admission rates, symptoms and quality of life. Studies on the cost-effectiveness of such interventions need to be performed. In general, more well-designed studies with good methodological quality in this research domain are needed.