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Published on Oct 14, Health of the elderly population and population with intellectual disabilities and their use of medicines and food supplements. SlideShare Explore Search You. Successfully reported this slideshow. We use your LinkedIn profile and activity data to personalize ads and to show you more relevant ads.
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Are you sure you want to Yes No. Be the first to like this. Embeds 0 No embeds. No notes for slide. Jure Peklar PhD thesis 1. Mitja Kos, PhD and Assoc. Martin Charles Henman, PhD. All research presented in this doctoral thesis was performed at the Faculty for pharmacy, University of Ljubljana, Slovenia and Trinity College Dublin, Ireland.
Izjavljam, da sem doktorsko disertacijo izdelal samostojno pod mentorstvom izr. Raziskave, predstavljene v tej doktorski disertaciji, so bile izvedene v okviru raziskovalnega dela na Fakulteti za farmacijo, Univerze v Ljubljani, Slovenija ter Trinity College Dublin, Irska.
Jure Peklar Kolofon 4. I have been impressed with the urgency of doing. Knowing is not enough; we must apply. Being willing is not enough; we must do. Leonardo da Vinci 5. This will have implications for the planning and delivery of health and social care. Understanding how older people manage their pharmacotherapy can help to maximise the benefits of medicines and prevent potential tangible side effects as older people are more vulnerable to adverse drug events due to diminished physiological reserve associated with ageing.
This can be exacerbated further by acute or chronic disease and by the effects of the medicines used to treat them. Older people are often prescribed sedative medicines which have been associated with falls, fractures, physical and cognitive impairment, and disability. Frailty as one of more complex geriatric syndrome, develops as a consequence of age-related declines in many physiological systems, resulting in vulnerability to stressors e.
To test the hypothesis that there is an association between the use of sedative medicines and frailty we used cross-sectional data from the first wave of the Irish Longitudinal Study on Ageing TILDA. The elderly subgroup in TILDA study cohort included 3, participants representative of the community-living population living in Ireland. Frailty status was measured using two different methods: Cumulative effect of multiple sedative medicines was calculated using the sedative load model which was updated to reflect current knowledge about the sedative effects of medicines.
Sedative medicines most frequently hypnotics and antidepressants were used by one fifth Sedative load was independently associated with both phenotype frailty and FI 6. The use of medicines with sedative properties in older Irish adults was significant and more prevalent in the subpopulation with the poorest health status.
These findings could have important clinical implications with respect to prevention of adverse health outcomes in the elderly.
In the ageing population the awareness and willingness of preserving health and intensifying pharmacological treatment with food supplements FS is strong. The main purpose of food supplements use is to provide nutrients potentially missing in the food consumed due to the nature of the food intake e. In combination with medicines they may be used to augment treatment needs or to meet separate needs but both may incur risk as well as benefit. We researched the use of food supplements in the Irish community-dwelling population aged 50 years and over alone and in concurrent combination with medicines within the TILDA project, to help us understand better what are the specific factors associated with its pattern.
Overall every seventh respondent The range of combined use varied from 1 supplement with 19 medicines to 10 supplements with 2 medicines. The most prevalent supplements were calcium with or without D vitamin, omegafatty acids and glucosamine.
Combined use was highest in those taking medicines for bone diseases At least one potential medicine-supplement interaction of any kind was detected in 4.
Overall, potential major interactions were detected in 4. Independent factors for FS use in the TILDA cohort aged 50 years and over were being female, employed, non-smoker, having higher education and living alone. Furthermore, factors were having private insurance, three or more chronic conditions and polypharmacotherapy. Similarly were independent 7. The variability in FS use in the population showed evidence of unmet need and therefore unrealised benefits among some sub-groups and of exposure to avoidable and potentially serious drug interactions among others.
Both of these outcomes may increase in the future as the proportion of the over 50s with multimorbidity, polypharmacotherapy and supplements use grows. Intellectual disability ID is a disability characterised by significant limitations in both intellectual functioning and in adaptive behaviours, which covers many everyday social and practical skills.
Life expectancy is increasing in this population similarly to the non-ID population. Increasing numbers of people with ID are living in the community and are dependent upon primary health care services e. All this, however, brings new challenges which need to be addressed at the primary health care level to accommodate the special demands that this population may pose, including the differences in the medicine and food supplement utilisation pattern.
It was discovered that ID population was exposed to higher multimorbidity and also pharmacotherapy compared to the non-ID population while food supplement use was almost double. Furthermore, more people with ID reported concomitant medicine and food supplement use and compared to the non-ID population it was more than double.
The intensity of medicine use was evaluated using the number of medicines per enrolled participants and was twice as great in the ID cohort versus in the non-ID cohort. The diversity of medicines used was substantial with the number of different preparations ATC level 5 per participants being In contrast to the greater variety of medicines per participant identified in the IDS TILDA cohort, supplement utilisation illustrated minimal diversity with only 10 types of supplements in use compared to in the non-ID cohort.
Long term use of sedative and anticholinergic medicines have been associated with cognitive impairment, increased risk of falls and hospitalisation. This evidence strongly suggests that in particular the ID population studied in this work is exposed to risks and vulnerable to harm from the high levels of medicines and supplements used. Since this population live in the community and it is most appropriate that they continue to be cared for in the community, those Primary Care providers who share responsibility for the provision of medicines and supplements, general practitioners and community pharmacists, should be supported and empowered to collaborate in the care of these diverse populations in need.
Poleg tega so Sedativno breme je bilo neodvisno povezano tako s fenotipsko krhkostjo, kot tudi z krhkostnim indeksom. Glavni namen jemanja prehranskih dopolnil je zagotoviti potrebna hranila, ki morda manjkajo v vsakodnevni prehrani.. Kombinacije so variirale od enega prehranskega dopolnila skupaj z 19 zdravili, do 10 dopolnil skupaj z dvema zdraviloma. Potencialne pomembne interakcije This process is globally facilitated by decreased fertility and increasing life expectancy.
A recent Irish study of all patients in general practice revealed Use of medicines was higher among women than men in all age groups with the exception of young children. A major contributor to this phenomenon is that despite having better access to prescription medicines and its greater utilisation than in past, there are also more medicines and food supplements available over the counter, making self-medication increasingly commonplace.
On the other hand, the use of medicines for diabetes mellitus was negatively associated with use of food supplements. For example, hip fracture has been associated with the use of barbiturates, benzodiazepines, tricyclic The use of psychotropic medicines and in particular of antipsychotics is highly prevalent in the population of people with intellectual disability ID.
Many times they are prescribed to mitigate behavioural problems. Treatment of those with ID is a clinically and ethically sensitive area due to the nature of condition and lack of evidence-based psychopharmacological treatment. All this, however, brings challenges which need to be addressed at the primary health care level to accommodate the special demands that this population may pose, including the differences in the medicine and food supplement utilisation pattern.
Factors of pattern of prescription medicines, non-prescription medicines and food supplements use in elderly population are health status, gender and age. The elderly are using non-prescription medicines and food supplement concomitantly with prescription medicines that can cause clinically important interactions. The pattern of use of medicines which pose a sedative burden indicates a significant risk to the health status of the elderly population.
The patterns of prescription medicine, non-prescription medicine and food supplement use among intellectual disabled population significantly differs from that of the intellectual non-disabled population.
Starostna struktura ni bila raziskana. Napovedni dejavniki, ki najbolj pomembno vplivajo na vzorec jemanja zdravil na recept, zdravil brez recepta in prehranskih dopolnil pri starostnikih so zdravstveno stanje, spol in starostno obdobje. Older people are a vulnerable population with increased multimorbidity and reduced physiological reserves which makes them prone to different negative outcomes due to the effects of pharmacotherapy on their cognitive and physical functions.
On the other hand, the knowledge and willingness to preserve health or intensify pharmacological treatment, are, due to different factors, also strong influences. The use of food supplements as means of preserving and intensifying treatment is very popular despite mixed evidence of their effectiveness.
The outcomes of medication use with or without FS may not always be as desired and knowing the risk factors associated with negative outcomes may be a decisive element contributing to successful treatment. One of the more complex and challenging manifestation of population ageing is the clinical condition of frailty. Frailty develops as a result of age-related declines in many physiological systems, leading to vulnerability to stressors e.
A systematic review of the global literature conducted in 25 showed the total weighted average prevalence of frailty of In studies that described frailty prevalence according to gender the weighted prevalence in women was statistically significantly higher 9. Similarly when comparing prefrailty, it was more prevalent in women In a discrete geographical area, in 10 European countries, a similar study 31 based on SHARE study showed more diverse picture: