Factors influencing the use of potentially inappropriate medication in older patients in Slovakia.

BACKGROUND: Although increasing attention has been given to the evaluation of use of potentially inappropriate medication in the older European Union (EU) member countries, information on this topic from Central and Eastern Europe is scarce. OBJECTIVES: The aims of the present study were: to identify risk factors enhancing the probability of use of potentially inappropriate medication in hospitalized older patients under the conditions of the Slovak healthcare system and to compare our results with previously published European studies. METHODS: The evaluation was performed in 600 patients aged > or =65 years, hospitalized in a general hospital between 1 December 2003 and 31 March 2005. To identify the use of potentially inappropriate medication, the Beers 2003 criteria were applied. Particular socio-demographic and clinical characteristics, as well as comorbid medical conditions were evaluated among possible factors enhancing the probability of use of potentially inappropriate medication. RESULTS: At least one potentially inappropriate medication was prescribed to 126 (21%) of 600 patients. Multivariate analysis identified polypharmacy [odds ratio (OR) 2.38; 95% confidence interval (CI): 1.50-3.79], depression (OR 2.03; 95% CI: 1.08-3.82), immobilization (OR 1.87; 95% CI: 1.16-3.00) and heart failure (OR 1.73; 95% CI: 1.13-2.64) as factors associated with an increased risk of use of inappropriate medication. In contrast, patients aged > or =75 years had a lower risk of being prescribed potentially inappropriate medication (OR 0.58; 95% CI: 0.39-0.88). CONCLUSIONS: Polypharmacy, immobilization, heart failure and depression were documented as predictors of use of potentially inappropriate medication. In depressive patients, drugs other than antidepressants contributed to the extensive use of potentially inappropriate medication. The observed prevalence of use of potentially inappropriate medication in older hospitalized Slovak patients was lower than the prevalence previously documented in Poland and the Czech Republic, but higher than in Croatia and Turkey. The identified risk factors were consistent with previous findings from other parts of Europe.

[Comparison of the activities of the elderly in homes of seniors in 1989 and 2000]. / Porovnanie aktivít obyvatel'ov domovov dôchodcov v rokoch 1989 a 2000.

BACKGROUND: One of important factors affecting the life of the residents in seniors' homes (SHs) is their activity in leisure time. The objective of our work was to describe these activities and their development in a period of eleven years. METHODS AND RESULTS: We have examined two sets of inhabitants of SHs with our own standardized interview: all 48 residents of one SH (average age 69.3 years) in 1989, and randomly selected 59 residents of four SHs (average age 71.2 years) in 2000. In our questionnaire, seniors answered if they took part in some of the proposed activities. The two sets of inhabitants were compared with each other, in sex and age groups, and according to cognitive impairments and mobility. In statistical evaluations we used the chi-square test in contingency tables. The inhabitants reported 179 activities, on average 3.7 activities per one resident in 1989. In 2000 they presented 187 activities, and the average (3.2 activities per one resident) decreased slightly. In both years, the most frequent activities were walking outdoors, watching TV and listening to radio. In six of the compared activities we observed a decrease in the number of residents pursuing them in 2000. When comparing the activities in sexes, we observed a greater decrease in activities in women than in men. Comparisons in age groups revealed a greater decrease of activities in "old" inhabitants (75 + years). In 2000, a considerable number of residents (without regard to age) took part in activities organized by institutions. We observed a significant increase in the number of residents with cognitive impairments and mobility deficits. CONCLUSIONS: The authors point at the issue of leisure time activities of the elderly in seniors' homes. In the monitored period of eleven years, a decrease of activities was observed.

[What are the possibilities of preventing dementia?]. / Aké sú moznosti prevencie demencie?

Population ageing makes issue of dementia prevention very important. Measures used in prevention of other diseases are also effective in prevention of dementia. Incidence of vascular dementia is decreased by effective treatment of hypertension, diabetes and anticoagulatory treatment in patients with atrial fibrillation. Nonsteroidal antiinflammatory drugs and statins reduce incidence of Alzheimer's disease.

[Non-steroidal antiinflamatory drugs in the elderly]. / Nesteroidné antiflogistiká v starobe.

Significance of non-steroidal antiinflammatory drugs treatment becomes more pronounced due to population ageing because these drugs are used by the elderly very frequently. The causes of the increased adverse effects of non-steroidal antiinflammatory drugs in old age (e.g decreased production and effectivness of prostaglandins, decreased nitrogen oxide production and decreased pain sensation) are analysed. New explanation of the the action are discussed too. Some new potential indications (e.g. Alzheimer disease, tumor prevention and modification of cellular immunity impairment caused by ageing) are reviewed.

Bacteremia due to methicillin-resistant staphylococci occurs more frequently in neutropenic patients who received antimicrobial prophylaxis and is associated with higher mortality in comparison to methicillin-sensitive bacteriemia.

Bacteriemia due to coagulase-negative staphylococci (CNS) resistant to methicillin and sensitive only to glycopeptides in 220 cancer patients was prospectively analyzed for risk factors and outcome. A group of 33 cases of bacteriemia with CNS-sensitive only to glycopeptides was compared with a group of 187 cases with CNS sensitive to methicillin. All cases appeared in two affiliated major cancer institutes in Bratislava with the same antibiotic policy. Univariate analysis showed differences in recorded risk factors: acute leukemia (48 vs. 33%, P < 0.05), neutropenia (57 vs. 32%, P < 0.045), previous prophylaxis with quinolones (30 vs. 11%, P < 0.01) and penicillin-V (15 vs. 3%, P < 0.02) and previous colonisation with CNS (27 vs. 3%, P < 0.01) were more frequently associated with bacteriemia resistant to methicillin and sensitive only to glycopeptides. Attributable mortality was also higher in this subgroup in comparison to bacteriemias with CNS sensitive to methicillin (12 vs. 3%, P < 0.05) however, overall mortality was similar. Bacteriemias due to CNS caused by sensitivity only to glycopeptides occurred more frequently in neutropenic patients (1), with acute leukemia (2), receiving quinolone and penicillin prophylaxis (3), and previously colonized (4), patients and had worse prognosis in comparison to those with methicillin-sensitive staphylococcal bacteriemias.

[Treatment with nonsteroidal anti-inflammatory agents in the aged]. / Liecba nesteroidnými antiflogistikami v starobe.

Some 13--33,7% old people use non-steroid antiphlogistics. The authors mention undesirable effects, their incidence being higher in advanced age, as well as differences between effects of different non-steroid antiphlogistics.

[Cardiotonic therapy in advanced age]. / Kardiotonická liecba vo vyssom veku.

Cardiotonic drugs are taken by as many as 13.1% of old people living at home. Their effect in old age is markedly influenced by changes of old age, polymorbidity and the administration of other drugs. Therefore as much as 80% of undesirable effects of cardiotonics are recorded in old people. The author deals also with chronic administration of cardiotonics. Factors influencing cardiotonic treatment in old age are discussed.

[Diuretic therapy in the aged]. / Diuretická liecba v starobe.

Diuretics are among the most frequently used drugs in old age. Some 12.8% old people living at home use them. Renal changes caused by old age and disease as well as changes of the cardiovascular apparatus and changes in the composition of the organism associated with old age and regulation of the intake and excretion of electrolytes increase the risk of undesirable effects of diuretic treatment in old people.