Health of the elderly population and population with intellectual disabilities and their use of medicines and food supplementsPeklar, Jure (Avtor) Kos, Mitja (Mentor) Henman, Martin Charles (Komentor) stari ljudjeosebe z motnjami v duševnem razvojuzdravilauspavalaantidepresivipolifarmakoterapijaprehranski dodatkineželeni učinkikronične boleznistarostna oslabelostdisertacijeDue to the accelerated ageing of the worldwide population the proportion of elderly (aged 65 and over) people is growing. 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.g. infection or hospitalisation) and adverse health outcomes as falls and fractures, mobility and functional declines, hospitalisation, nursing home admissions and death. 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 3,446 participants representative of the community-living population in Ireland. Frailty status was measured using two different methods: phenotype (Fried’s) frailty and frailty index (FI). 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 (19.4%) of participants and was higher in women than in men. Frail participants (4.2%) were significantly older, had more chronic diseases, poorer education and more (ADL and IADL) disabilities but also higher polypharmacotherapy (5 or more medicines) and sedative medicine use. Sedative load was independently associated with both phenotype frailty and FI frailty. 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.g. poor quality), specific diet or because of increased need for a specific nutrient due to disease or metabolic malfunction (osteoporosis, anaemia,…), pregnancy or lifestyle activities (increased physical activity). 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 (14.0%) reported concurrent medicine-FS use. 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, omega-3-fatty acids and glucosamine. Combined use was highest in those taking medicines for bone diseases (60.0%; mostly calcium with or without D vitamin) and lowest in those taking medicines for diabetes (15.7%). At least one potential medicine-supplement interaction of any kind was detected in 4.1% respondents. Anticoagulants and NSAIDs were among the most frequently interacting medicines. Overall, potential major interactions were detected in 4.5% of those reported any medicine-FS use. 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 factors for overall combined medicine-FS use being female, employed, having private insurance and number of chronic conditions. 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.g. GP, community pharmacy). 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. Data used in our research was taken from the first wave of the ID supplement to TILDA. To make comparison between the ID population from the Intellectual disability supplement to TILDA and TILDA cohort possible, only the community dwelling subpopulation of person aged 50 years and over with ID were included in the study. 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 100 enrolled participants and was twice as great in the ID cohort (503 versus 251) as in the non-ID cohort. The diversity of medicines used was substantial with the number of different preparations (ATC level 5) per 100 participants being 95.8 (ID) vs. 7.0 (non-ID). 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 134 in the non-ID cohort). The most reported therapeutic class in the non-ID cohort were “Lipid modifying agents” (ATC C10) while in the ID cohort were “Psycholeptics” (ATC N05) with antipsychotics being most prevalent. 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. [J. Peklar]20162023-01-12 07:43:15Doktorska disertacija143776sl