Geographic and socioeconomic differences in potentially inappropriate medication among older adults - applying a simplified analysis of individual heterogeneity and discriminatory accuracy (AIHDA) for basic comparisons of healthcare quality.

Background: Monitoring of healthcare quality is typically focused on differences between group averages in relation to a desirable benchmark. However, we need to consider (i) the existence of interconnected socioeconomic axes of inequality like age, sex, income, and country of birth and (ii) individual heterogeneity around group averages. Additionally, (iii) we need clear criteria to quantify group differences.

Trajectory of Cardiometabolic Disease-Related Hospitalizations Before and After Dementia Diagnosis: A Matched Cohort Study.

Objectives: Dementia is associated with increased health care use; however, the timing of hospitalizations in relation to the development of dementia remains unclear. Cardiometabolic diseases (CMDs) including type 2 diabetes, heart disease, and stroke often co-occur with dementia, but the impact of dementia on hospitalizations related to CMDs remains unknown. We aimed to map the trajectory of CMD-related hospitalization before and after dementia diagnosis and to further identify factors of CMD-related hospitalization.

Cholinesterase inhibitors and reduced risk of hospitalization and mortality in patients with Alzheimer's dementia and heart failure.

Aims: Cholinesterase inhibitors (ChEIs) have beneficial effects on the heart. Associations between ChEI-use and reduced mortality and cardiovascular events in Alzheimer's disease (AD) have been shown. Whether these associations exist in those with both heart failure (HF) and AD is unknown.

Use of drugs for hypertension or heart failure and the risk of death in COVID-19: association with loop-diuretics.

Purpose: To study the association between the use of drugs for hypertension or heart failure, particularly diuretics, and risk of death in COVID-19.

Methods: We conducted a cohort study, based on record linked individual-based data from national registers, of all Swedish inhabitants 50 years and older (n = 3,909,321) at the start of the first SARS-CoV-2 wave in Sweden. The association between use of angiotensin-converting enzyme inhibitors (ACEI), angiotensin II receptor blockers (ARB), thiazides, loop diuretics, aldosterone antagonists, beta blocking agents and calcium channel blockers at the index date 6 March 2020, and death in COVID-19 during 7 March to 31 July 2020, was analysed using Cox-proportional hazards regression, adjusted for a wide range of possible confounders.

Feasibility study of a clinical decision support system for polymedicated patients in primary care.

Age-related changes in pharmacokinetics and pharmacodynamics, multimorbidity, frailty, and cognitive impairment represent challenges for drug treatments. Moreover, older adults are commonly exposed to polypharmacy, leading to increased risk of drug interactions and related adverse events, and higher costs for the healthcare systems. Thus, the complex task of prescribing medications to older polymedicated patients encourages the use of Clinical Decision Support Systems (CDSS).

Few geriatric heart failure patients investigated according to clinical guidelines: a retrospective review of patient records.

Background: Research on heart failure (HF) has often focused on younger patients. The aim of this study was to analyze extent of investigation and treatment among older patients prior to referral to inpatient geriatric care for worsening of HF.

Methods: Data on etiology, ejection fraction (EF) by echocardiography (ECHO), level of functioning according to New York Heart Association (NYHA), analysis of N-terminal-pro-brain natriuretic peptide (NT-Pro-BNP), ongoing treatment, adherence to guidelines, and information from previous caregiver were collected from patient records prior to admission from a sample of 134 patients.

Regional variations in excessive polypharmacy and potentially inappropriate drug use among older adults in Sweden: Trends from 2006 to 2020.

Potentially inappropriate drug use (PID) is common among older adults. Cross-sectional data suggest that there are marked regional variations in PID in Sweden. There is, however, a lack of knowledge about how the regional variations have changed over time.

Cardiometabolic multimorbidity and incident dementia: the Swedish twin registry.

Aims: Cardiometabolic diseases (CMDs), including diabetes, heart disease, and stroke, are established risk factors for dementia, but their combined impact has been investigated only recently. This study aimed to examine the association between mid- and late-life cardiometabolic multimorbidity and dementia and explore the role of genetic background in this association.

Methods And Results: Within the Swedish Twin Registry, 17 913 dementia-free individuals aged ≥60 were followed for 18 years.

Performance of 3 Sets of Criteria for Potentially Inappropriate Prescribing in Older People to Identify Inadequate Drug Treatment.

Importance: Potentially inappropriate medications (PIMs) and potential prescribing omissions (PPOs) are used in research to reflect the quality of drug treatment in older people and have been suggested for inclusion in core outcome sets for evaluation of interventions for improved prescribing. Their validation so far, however, is primarily restricted to expert opinion-based processes.

Objective: To evaluate the performance of 3 explicit PIM/PPO criteria sets as diagnostic tools to identify inadequate drug treatment in older patients.

Prevalence and initiation of statin therapy in the oldest old-a longitudinal population-based study.

Purpose: To investigate the prevalence and initiation of statins as well as treatment intensity in the oldest old, with younger olds as a reference.

Methods: A population-based cohort was used, including record-linked data from the Total Population Register, the Swedish Prescribed Drug Register, and the Swedish Patient Register. In each year over the study period (2009-2015), statin use was described in individuals 85 years or older and 65-84 years of age, and initiation rates were calculated among individuals with no statin treatment during a preceding 3-year period.

District nurses' experiences of using a clinical decision support system and an assessment tool at elderly care units in primary health care: a qualitative study.

Aim: The present study aimed to describe the experience of district nurses (DNs) in using a clinical decision support system (CDSS) and the safe medication assessment (SMA) tool during patient visits to elderly care units at primary health care centres.

Background: In Swedish primary health care, general practitioners (GPs) prescribe and have the responsibility to regularly review older adults' medications, while DN (nurses specialised in primary health care) play an important role in assessing older adults' ability to manage their medications, detecting potential drug-related problems and communicating with patients and GPs about such problems. In a previous feasibility study, we found that DNs who use a combination of a CDSS and the SMA tool identified numerous potentially harmful or dangerous factors and took a number of nursing care actions to improve the safety and quality of patients' medication use.

Socio-demographic differences in polypharmacy and potentially inappropriate drug use among older people with different care needs and in care settings in Stockholm, Sweden.

Aims: Polypharmacy and potentially inappropriate medications (PIM) are risk factors for negative health outcomes among older people. This study aimed to investigate socio-demographic differences in polypharmacy and PIM use among older people with different care needs in a standard versus an integrated care setting.

Methods: Population-based register data on residents aged ⩾65 years in Stockholm County based on socio-demographic background and social care use in 2014 was linked to prescription drug use in 2015.

Validating a model for medication-related dental outcomes in older people.

Objectives: To externally validate a model for medication-related dental outcomes in (a) a general older population with dementia and (b) a matched population without dementia.

Subjects And Methods: This validation study used population-based data from seven Swedish national registers (2008-2017). Individuals aged 60+ with dementia were matched to those without dementia on age, gender, and county of residence at the date of diagnosis (index date).

Psychosocial job strain and polypharmacy: a national cohort study.

Objectives Psychosocial job strain has been associated with a range of adverse health outcomes. The aim of this study was to examine the association between psychosocial job strain and prospective risk of polypharmacy (the prescription of ≥5 medications) and to evaluate whether coping strategies can modify this risk. Methods Cohort study of 9703 working adults [mean age 47.

What are the sociodemographic and gender determinants of non-fatal self-harm in older adult users and non-users of antidepressants? A national population-based study.

Background: Late-life self-harm (SH) is often linked to depression. However, very few studies have explored the role of other factors and their interaction with depression in the occurrence of late-life SH. The objective of this research was to examine sociodemographic and gender factors associated with non-fatal SH, in older adults with and without antidepressant therapy.

District nurses' use of a decision support and assessment tool to improve the quality and safety of medication use in older adults: a feasibility study.

Aim: To investigate whether district nurses (DNs) can identify factors related to the quality and safety of medication use among older patients via a clinical decision support system (CDSS) for medication and an instrument for assessing the safety of drug use [the Safe Medication Assessment tool (SMA)]. A secondary aim was to describe patients' experiences of the assessment.

Background: DNs in Stockholm County have the opportunity to establish special units at primary health care centers (PHCCs) for patients aged 75 years and older.

Xerogenic Medications as a Predictor for Dental Health Intervention in People with Dementia.

Background: Older adults with dementia often have poor oral health. Chronic use of xerogenic medications may contribute to adverse dental outcomes.

Objective: To investigate the impact of xerogenic medication classes on the predicted risk for dental interventions in people with dementia.

Drug use and torsades de pointes cardiac arrhythmias in Sweden: a nationwide register-based cohort study.

Objective: To study the occurrence of torsades de pointes (TdP) ventricular tachycardia in relation to use of drugs labelled with TdP risk, using two nationwide Swedish registers.

Design: Prospective register-based cohort study.

Setting: Entire Sweden.

Cholinesterase inhibitors in patients with diabetes mellitus and dementia: an open-cohort study of ~23 000 patients from the Swedish Dementia Registry.

Objective: Cholinesterase inhibitors (ChEIs) and memantine are the only approved pharmacological treatments for Alzheimer's disease (AD). Recent literature suggests reductions in cardiovascular burden and risk of stroke in ChEI users. However, the clinical effectiveness of these drugs in patients with diabetes mellitus (DM) and dementia has not been evaluated.