Biomedical subjects

Timo E Strandberg

Publications and source records attributed to Timo E Strandberg.

42 records · Page 3Linked to original sources

PubMed2002

Management of nonmalignant pain in home-dwelling older people: a population-based survey.

OBJECTIVES: To investigate use of prescribed analgesic drugs in relation to experience of joint or back pain in a home-dwelling older population, to study changes in the use of analgesic drugs over 10 years, and to investigate concomitant use of protective gastrointestinal drugs with prescribed analgesic drugs in 1999. DESIGN: Cross-sectional mailed surveys 10 years apart. SETTING: Helsinki, Finland. PARTICIPANTS: Random samples of older birth cohorts born in 1904, 1909, and 1914 in 1989 (n = 644) (n=644)-->, and of three separate cohorts born in 1914, 1919, and 1924 in 1999 (n = 3,000). MEASUREMENTS: Use of various types of analgesic and protective gastrointestinal drugs, prescribed and over the counter. Experience of joint and back pain that interferes with daily functioning. RESULTS: The response rate of home-dwelling older people was 83% in 1989 and 81% in 1999. Although the use of analgesic drugs as self-treatment increased from 28.5% to 41.4% during the 10 years, in 1999, only 35.5% to 38.2% of those suffering joint or back pain that impaired daily functioning had been prescribed an analgesic drug for regular use. Of those using prescribed medication, 57.5% were on nonsteroidal antiinflammatory drugs (NSAIDs), 20.9% acetaminophen, and 18.5% weak opiates. Only one-fifth of those individuals taking NSAIDs were on a concomitant gastroprotective drug. CONCLUSIONS: Pain is markedly undertreated in community-dwelling older people, which may have serious implications for their well-being and functioning. Although we noted a tendency for safety in the use of prescribed analgesic drugs, a significant effort must sill be made to implement evidence-based practice. Self-treatment of pain has increased in 1 decade, which may reduce the overall safety of analgesic drug use among older people.

Age Factors↗

PubMed2002

Isolated diastolic hypertension, pulse pressure, and mean arterial pressure as predictors of mortality during a follow-up of up to 32 years.

OBJECTIVE: To compare mortality associated with various blood pressure components in middle-aged men during up to 32 years of follow-up. DESIGN: A prospective cohort study. SETTING: Helsinki, Finland. PARTICIPANTS: We studied 3267 initially healthy men, aged 30-45 years, who participated in health check-ups from 1964 onwards. MAIN OUTCOME MEASURES: Cox regression was used to relate baseline blood pressure components to all-cause (n = 701) and cardiovascular disease (CVD) mortality (n = 325). RESULTS: Systolic (SBP) and diastolic (DBP) blood pressures, pulse pressure and mean arterial pressure singly predicted CVD mortality. With SBP 160 mmHg and DBP 90 mmHg as cut-off values, four blood pressure subgroups were identified: normotension (n = 1919), isolated systolic hypertension (ISH, n = 17), isolated diastolic hypertension (IDH, n = 1013), and combined systolic and diastolic hypertension (SDH, n = 318). IDH was subdivided into IDH-1 with SBP 140-159 mmHg (n = 667) and IDH-2 with SBP less than 140 mmHg (n = 346). With normotension as reference, only SDH and IDH-1 predicted CVD mortality [relative risk (RR) 2.71, 95% confidence interval (CI) 2.00 to 3.66, and RR 1.39, 95% CI 1.04 to 1.87, respectively]. Risk with IDH-2 (RR 1.14, 95% CI 0.77 to 1.69) was not statistically significant. SDH and IDH-1, but not IDH-2, were also associated with increased all-cause mortality risk. Use of antihypertensive medication did not explain the results. CONCLUSION: These results demonstrate the often neglected role of SBP in predicting long-term CVD risk in middle-aged men. When SBP is less than 140 mmHg, IDH is not associated with significantly increased risk of mortality. Administrative guidelines, which affect population health, should also take due note of SBP.

Adult↗

PubMedDate not supplied

Inappropriate drug prescribing in home-dwelling, elderly patients: a population-based survey.

BACKGROUND: In 1997, a US expert panel developed explicit criteria on potentially inappropriate drugs for the general elderly population. OBJECTIVE: To investigate the proportion of inappropriate medications among home-dwelling, elderly patients in Helsinki, Finland, between November 1, 1998, and March 31, 1999. METHODS: A cross-sectional mail survey was sent to a random sample of 3921 elderly urban residents aged 75, 80, 85, 90, and 95 years. Of these, 3219 were home dwellers. MAIN OUTCOMES MEASURES: Prevalence of potentially inappropriate drugs and prevalence of drugs considered inappropriate related to 15 common medical conditions according to recommendations given by the expert panel in 1997. RESULTS: The response rate was 78%. Of the respondents, 12.5%, 1.3%, and 0.2% were taking at least 1, 2, or 3 inappropriate drugs, respectively. The most prevalent inappropriate drugs were dipyridamole (3.6%), long-acting benzodiazepines (2.6%), amitriptyline hydrochloride (1.6%), ergot mesyloids (1.6%), muscle relaxants (1.2%), and meprobamate (1.1%). Use of medications considered inappropriate with certain medical conditions was higher: 27.2% of patients with chronic obstructive pulmonary disease were taking beta-blockers and 19.3% used sedatives. Of diabetic individuals taking oral hypoglycemics or insulin, 32.5% were taking a concomitant beta-blocker. Of those with a peripheral vascular disease, 37.9% were taking beta-blockers. However, two thirds of all these patient groups had concomitant coronary heart disease. CONCLUSIONS: Compared with previous surveys, the use of inappropriate medications in our home-dwelling, elderly population is conspicuously low. In contrast, use of certain drugs considered inappropriate with different medical conditions was relatively high. However, the inappropriateness of the latter treatments may be questioned in individual patients.

Age Factors↗

PubMedDate not supplied

Detection and documentation of dementia and delirium in acute geriatric wards.

Detection of cognitive impairment among hospitalized older individuals has shown to be insufficient. A point prevalence study in two geriatric hospitals in Helsinki, Finland, was performed among 219 acutely ill individuals over 70 years to assess the detection of dementia and delirium. Documentation of dementia and delirium in medical records, and recordings of confusional symptoms in nurses' notes were compared with the researchers' diagnosis made after a detailed assessment of cognitive status. The cognitive decline was mentioned in medical records in 70/88 (79.5%) of the cases. Cognitive testing was performed on 42/88 (47.7%) of the dementia patients, and the diagnosis of dementia was recorded in 47/88 (53.4%) of them. A specific etiological diagnosis was recorded in only 4/88 (4.5%) cases. Cognitive impairment in at least one of these four means was recorded in 80/88 (90.9%) of cases (sensitivity 0.93). Eight patients had a false-positive diagnosis of dementia (specificity 0.94). Delirium was diagnosed in 77 (35.2%) patients by the researchers, but it was recorded in only 31/77 (40.3%) in medical records. In 64/77 (83.1%) cases signs of confusion were recorded in nurses' notes. Poor detection and documentation may lead to undertreatment of both disorders.

Acute Disease↗

PubMedDate not supplied

Mortality and incidence of cancer during 10-year follow-up of the Scandinavian Simvastatin Survival Study (4S).

BACKGROUND: The effects of cholesterol-lowering treatment with statins on mortality and risk of cancer beyond the usual 5-6-year trial periods are unknown. We extended post-trial follow-up of participants in the Scandinavian Simvastatin Survival Study (4S) to investigate cause-specific mortality and incidence of cancer 5 years after closure of the trial. METHODS: 4S was a randomised double-blind trial of simvastatin or placebo in patients with coronary heart disease, serum total cholesterol 5.5-8.0 mmol/L, and serum triglycerides 2.5 mmol/L or lower. The double-blind period lasted for a median of 5.4 years (range for survivors 4.9-6.3) and ended in 1994. After the trial, most patients in both groups received open-label lipid-lowering treatment. National registers were used to assess mortality and causes of death and cancer incidence in the original treatment groups for a median total follow-up time of 10.4 years (range for survivors 9.9-11.3). Analysis was by intention to treat. FINDINGS: 414 patients originally allocated simvastatin and 468 assigned placebo died during the 10.4-year follow-up (relative risk 0.85 [95% CI 0.74-0.97], p=0.02), a difference largely attributable to lower coronary mortality in the simvastatin group (238 vs 300 deaths; 0.76 [0.64-0.90], p=0.0018). 85 cancer deaths arose in the simvastatin group versus 100 in the placebo group (0.81 [0.60-1.08], p=0.14), and 227 incident cancers were reported in the simvastin group versus 248 in the placebo group (0.88 [0.73-1.05], p=0.15). Incidence of any specific type of cancer did not rise in the simvastatin group. INTERPRETATION: Simvastatin treatment for 5 years in a placebo-controlled trial, followed by open-label statin therapy, was associated with survival benefit over 10 years of follow-up compared with open-label statin therapy for the past 5 years only. No difference was noted in mortality from and incidence of cancer between the original simvastatin group and placebo group.

Adult↗

PubMedDate not supplied

Living will, resuscitation preferences, and attitudes towards life in an aged population.

BACKGROUND: The growth of life-sustaining medical technology and greater attention to medical care at the end of life have provoked interest in issues related to advance care planning. OBJECTIVE: To investigate how having a living will (LW), resuscitation preferences, health condition, and life attitudes are related in home-dwelling elderly people. METHODS: In a cross-sectional descriptive study, detailed assessments were made of 378 home-dwelling elderly individuals participating in a cardiovascular prevention study (DEBATE Study). The participants were inquired about a preexistence of a written document (LW) concerning life-sustaining care, preferences of cardiopulmonary resuscitation (CPR) in their current situation, and attitudes towards life. General health, physical and cognitive functioning, the presence of depression, and quality of life were also assessed. RESULTS: Forty-four of the 378 participants (12%) had a LW. As compared with those without one (n = 334), there were more women [82% (36/44) vs. 63% (210/334)] and widows [57% (25/44) vs. 41% (135/334)] among those with a LW. They were also more educated and considered their health to be better. Despite having a LW, 46% (20/44) of them preferred CPR in their current condition, a proportion not statistically different from the 58% (194/334) of the individuals without a LW. In the whole sample, 39% (149/378) of the individuals preferred to forgo CPR. As compared with those preferring CPR, they were older, more often women, and widowed. Participants preferring to forgo CPR had a poorer quality of life, were more lonely, and showed signs of depression more often than those preferring CPR. The preference to forgo CPR was related to attitudes towards life regardless of physical or cognitive functioning. CONCLUSIONS: Having a LW does not reduce the reported preference of CPR which is related more to current mental status and life attitudes. In-depth assessment of the patient's preferences should be performed in any comprehensive care plan.

Age Factors↗