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Monilääkitykselle ei ole olemassa yksiselitteistä määritelmää. Useimmiten monilääkitys määritellään viiden tai useamman lääkärin määräämän lääkkeen yhtäaikaiseksi käytöksi. Tutkimusten mukaan monilääkityksellä on yhteyttä iäkkäiden terveysongelmiin, muun muassa kaatumisiin. Tämän tutkimuksen tarkoituksena oli selvittää monilääkityksen yhteyttä kotona asuvien iäkkäiden henkilöiden alaraajojen toimintakykyyn ja kaatumisiin.
Tutkimusaineistona käytettiin AGNES-hankkeen aineistoa. Tutkittavat olivat Jyväskylän seudulla asuvia 75-, 80- ja 85-vuotiaita. Otos oli 916 henkilöä. Päävastemuuttujia olivat alaraajojen toimintakyky (SPPB-testistö) ja kaatumiset viimeksi kuluneen 12 kuukauden aikana. Monilääkityksellä tarkoitettiin viittä tai useampaa reseptilääkettä ja merkittävällä monilääkityksellä 10 tai useampaa reseptilääkettä. Kaatuneiden ja ei-kaatuneiden ryhmien välisiä eroja tarkasteltiin ristiintaulukoinnilla, χ2-testillä, Fisherin tarkalla testillä ja Mann-Whitneyn U-testillä. Monilääkityksen yhteyttä alaraajojen toimintakykyyn ja kaatumisiin tutkittiin binäärisellä logistisella regressioanalyysillä vakioimalla ikä ja sukupuoli.
Tutkittavista naisia oli 57,5 % ja terveytensä vähintään keskinkertaiseksi kokevia 95,2 %. Hyvä alaraajojen toimintakyky (SPPB 10-12 pistettä) oli 69 %:lla tutkittavista. Monilääkittyjä oli 43,1 % ja merkittävästi monilääkittyjä 9,7 %. Tutkittavista 57,8 % oli kaatunut vähintään kerran viimeksi kuluneen vuoden aikana ja kaatumisen pelkoa oli kokenut vähintään joskus 74,1 %. Ei-monilääkityillä oli todennäköisemmin hyvä alaraajojen toimintakyky verrattuna merkittävästi monilääkittyihin (OR 5,48; 95 % LV 3,32−9,03). Ei-monilääkittyjen tilastollisesti merkitsevä yhteys hyvään alaraajojen toimintakykyyn säilyi, kun malliin lisättiin koettu terveys (OR 3,39; 95 % LV 1,98−5,81) ja kaatumisen pelko (OR 3,06; 95 % LV 1,74–5,37). Myös monilääkityillä oli merkittävästi monilääkittyjä todennäköisemmin hyvä alaraajojen toimintakyky (OR 1,92; 95 % LV 1,11–3,29). Ei-monilääkityillä oli pienempi todennäköisyys kaatua verrattuna sekä monilääkittyihin (OR 0,60; 95 % LV 0,39–0,99) että merkittävästi monilääkittyihin (OR 0,47; 95 % LV 0,29–0,74), kun malli vakioitiin iällä ja sukupuolella. Monilääkityksen yhteydessä kaatumisiin ei ollut eroa niiden henkilöiden välillä, joilla oli hyvä vs. huono alaraajojen toimintakyky.
Monilääkitys oli yhteydessä alaraajojen toimintakykyyn ja kaatumisiin, yhteys alaraajojen toimintakykyyn oli selvempi. Merkittävästi monilääkityillä ja monilääkityillä oli huonompi alaraajojen toimintakyky ja he kaatuivat todennäköisemmin ei-monilääkittyihin verrattuna. Lisää tutkimusta tarvitaan erottamaan tarkoituksenmukaista ja epätarkoituksenmukaista monilääkitystä. Mahdollisten lääkehaittojen ehkäisemiseksi iäkkäiden terveydentilaa ja lääkitystä olisi hyvä arvioida säännöllisin väliajoin.
There is no consensus definition for polypharmacy so far. Polypharmacy is most often defined as five or more medications an individual takes concurrently. Earlier studies have demonstrated that polypharmacy is associated with older people’s health problems such as falls. This study researched whether polypharmacy is associated with physical performance and falls in community-dwelling older adults.
The study population consisted of 916 community-dwelling adults from the AGNES study aged 75, 80 and 85 living in the Jyväskylä area. Outcome measures were lower extremity functioning measured by Short Physical Performance Battery (SPPB) and falls during the last 12 months. Polypharmacy was defined as using five or more doctor-prescribed medications and excessive polypharmacy as ten or more medications. Differences between fallers and non-fallers were analysed with cross-tabulation, χ2-test, Fisher’s exact test and Mann-Whitney’s U-test. An association between polypharmacy and lower extremity functioning, and association between polypharmacy and falls were analysed with binary logistic regression analyses adjusted for age and sex.
Of the participants, 57,5 % were female. Self-perceived health was at least moderate among 95,2 % of the participants and 69 % had good lower extremity functioning (SPPB 10−12 points). Polypharmacy was observed in 43,1 % and excessive polypharmacy in 9,7 % of the participants. Of all participants, 57,8 % had fallen at least once during the last 12 months and 74,1 % had feared falling at least sometimes. Those with no polypharmacy were more likely to have good lower extremity functioning than those with excessive polypharmacy (OR 5,48; 95 % CI 3,32−9,03). The association between polypharmacy and good lower extremity functioning remained significant after adjusting for self-perceived health (OR 3,39; 95 % CI 1,98−5,81) and fear of falling (FOF) (OR 3,06; 95 % CI 1,74–5,37). Participants with polypharmacy also had more likely better lower extremity functioning than those participants with excessive polypharmacy (OR 1,92; 95 % CI 1,11–3,29). Participants with no polypharmacy had a lower risk of falling than those with polypharmacy (OR 0,60; 95 % CI 0,39–0,99), and those with excessive polypharmacy (OR 0,47; 95 % CI 0,29–0,74) when adjusted for age and sex. There were no differences in the association between polypharmacy and falls among those with good or poor lower extremity functioning.
This study showed that polypharmacy is associated with lower extremity functioning and falls. Those with polypharmacy or excessive polypharmacy had poorer lower extremity functioning and had more likely fallen than those without polypharmacy. More studies are needed to distinguish between appropriate and inappropriate polypharmacy. The health status and medication of the older people would be necessary to evaluate on a regular basis in order to prevent the possible health problems caused by polypharmacy.
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[{"key": "dc.contributor.advisor", "value": "Eronen, Johanna", "language": "", "element": "contributor", "qualifier": "advisor", "schema": "dc"}, {"key": "dc.contributor.author", "value": "H\u00e4melehto, Sari", "language": "", "element": "contributor", "qualifier": "author", "schema": "dc"}, {"key": "dc.date.accessioned", "value": "2022-06-27T06:32:15Z", "language": null, "element": "date", "qualifier": "accessioned", "schema": "dc"}, {"key": "dc.date.available", "value": "2022-06-27T06:32:15Z", "language": null, "element": "date", "qualifier": "available", "schema": "dc"}, {"key": "dc.date.issued", "value": "2022", "language": "", "element": "date", "qualifier": "issued", "schema": "dc"}, {"key": "dc.identifier.uri", "value": "https://jyx.jyu.fi/handle/123456789/82028", "language": null, "element": "identifier", "qualifier": "uri", "schema": "dc"}, {"key": "dc.description.abstract", "value": "Monil\u00e4\u00e4kitykselle ei ole olemassa yksiselitteist\u00e4 m\u00e4\u00e4ritelm\u00e4\u00e4. Useimmiten monil\u00e4\u00e4kitys m\u00e4\u00e4ritell\u00e4\u00e4n viiden tai useamman l\u00e4\u00e4k\u00e4rin m\u00e4\u00e4r\u00e4\u00e4m\u00e4n l\u00e4\u00e4kkeen yht\u00e4aikaiseksi k\u00e4yt\u00f6ksi. Tutkimusten mukaan monil\u00e4\u00e4kityksell\u00e4 on yhteytt\u00e4 i\u00e4kk\u00e4iden terveysongelmiin, muun muassa kaatumisiin. T\u00e4m\u00e4n tutkimuksen tarkoituksena oli selvitt\u00e4\u00e4 monil\u00e4\u00e4kityksen yhteytt\u00e4 kotona asuvien i\u00e4kk\u00e4iden henkil\u00f6iden alaraajojen toimintakykyyn ja kaatumisiin.\n\nTutkimusaineistona k\u00e4ytettiin AGNES-hankkeen aineistoa. Tutkittavat olivat Jyv\u00e4skyl\u00e4n seudulla asuvia 75-, 80- ja 85-vuotiaita. Otos oli 916 henkil\u00f6\u00e4. P\u00e4\u00e4vastemuuttujia olivat alaraajojen toimintakyky (SPPB-testist\u00f6) ja kaatumiset viimeksi kuluneen 12 kuukauden aikana. Monil\u00e4\u00e4kityksell\u00e4 tarkoitettiin viitt\u00e4 tai useampaa reseptil\u00e4\u00e4kett\u00e4 ja merkitt\u00e4v\u00e4ll\u00e4 monil\u00e4\u00e4kityksell\u00e4 10 tai useampaa reseptil\u00e4\u00e4kett\u00e4. Kaatuneiden ja ei-kaatuneiden ryhmien v\u00e4lisi\u00e4 eroja tarkasteltiin ristiintaulukoinnilla, \u03c72-testill\u00e4, Fisherin tarkalla testill\u00e4 ja Mann-Whitneyn U-testill\u00e4. Monil\u00e4\u00e4kityksen yhteytt\u00e4 alaraajojen toimintakykyyn ja kaatumisiin tutkittiin bin\u00e4\u00e4risell\u00e4 logistisella regressioanalyysill\u00e4 vakioimalla ik\u00e4 ja sukupuoli. \n\nTutkittavista naisia oli 57,5 % ja terveytens\u00e4 v\u00e4hint\u00e4\u00e4n keskinkertaiseksi kokevia 95,2 %. Hyv\u00e4 alaraajojen toimintakyky (SPPB 10-12 pistett\u00e4) oli 69 %:lla tutkittavista. Monil\u00e4\u00e4kittyj\u00e4 oli 43,1 % ja merkitt\u00e4v\u00e4sti monil\u00e4\u00e4kittyj\u00e4 9,7 %. Tutkittavista 57,8 % oli kaatunut v\u00e4hint\u00e4\u00e4n kerran viimeksi kuluneen vuoden aikana ja kaatumisen pelkoa oli kokenut v\u00e4hint\u00e4\u00e4n joskus 74,1 %. Ei-monil\u00e4\u00e4kityill\u00e4 oli todenn\u00e4k\u00f6isemmin hyv\u00e4 alaraajojen toimintakyky verrattuna merkitt\u00e4v\u00e4sti monil\u00e4\u00e4kittyihin (OR 5,48; 95 % LV 3,32\u22129,03). Ei-monil\u00e4\u00e4kittyjen tilastollisesti merkitsev\u00e4 yhteys hyv\u00e4\u00e4n alaraajojen toimintakykyyn s\u00e4ilyi, kun malliin lis\u00e4ttiin koettu terveys (OR 3,39; 95 % LV 1,98\u22125,81) ja kaatumisen pelko (OR 3,06; 95 % LV 1,74\u20135,37). My\u00f6s monil\u00e4\u00e4kityill\u00e4 oli merkitt\u00e4v\u00e4sti monil\u00e4\u00e4kittyj\u00e4 todenn\u00e4k\u00f6isemmin hyv\u00e4 alaraajojen toimintakyky (OR 1,92; 95 % LV 1,11\u20133,29). Ei-monil\u00e4\u00e4kityill\u00e4 oli pienempi todenn\u00e4k\u00f6isyys kaatua verrattuna sek\u00e4 monil\u00e4\u00e4kittyihin (OR 0,60; 95 % LV 0,39\u20130,99) ett\u00e4 merkitt\u00e4v\u00e4sti monil\u00e4\u00e4kittyihin (OR 0,47; 95 % LV 0,29\u20130,74), kun malli vakioitiin i\u00e4ll\u00e4 ja sukupuolella. Monil\u00e4\u00e4kityksen yhteydess\u00e4 kaatumisiin ei ollut eroa niiden henkil\u00f6iden v\u00e4lill\u00e4, joilla oli hyv\u00e4 vs. huono alaraajojen toimintakyky.\n\nMonil\u00e4\u00e4kitys oli yhteydess\u00e4 alaraajojen toimintakykyyn ja kaatumisiin, yhteys alaraajojen toimintakykyyn oli selvempi. Merkitt\u00e4v\u00e4sti monil\u00e4\u00e4kityill\u00e4 ja monil\u00e4\u00e4kityill\u00e4 oli huonompi alaraajojen toimintakyky ja he kaatuivat todenn\u00e4k\u00f6isemmin ei-monil\u00e4\u00e4kittyihin verrattuna. Lis\u00e4\u00e4 tutkimusta tarvitaan erottamaan tarkoituksenmukaista ja ep\u00e4tarkoituksenmukaista monil\u00e4\u00e4kityst\u00e4. Mahdollisten l\u00e4\u00e4kehaittojen ehk\u00e4isemiseksi i\u00e4kk\u00e4iden terveydentilaa ja l\u00e4\u00e4kityst\u00e4 olisi hyv\u00e4 arvioida s\u00e4\u00e4nn\u00f6llisin v\u00e4liajoin.", "language": "fi", "element": "description", "qualifier": "abstract", "schema": "dc"}, {"key": "dc.description.abstract", "value": "There is no consensus definition for polypharmacy so far. Polypharmacy is most often defined as five or more medications an individual takes concurrently. Earlier studies have demonstrated that polypharmacy is associated with older people\u2019s health problems such as falls. This study researched whether polypharmacy is associated with physical performance and falls in community-dwelling older adults.\n\nThe study population consisted of 916 community-dwelling adults from the AGNES study aged 75, 80 and 85 living in the Jyv\u00e4skyl\u00e4 area. Outcome measures were lower extremity functioning measured by Short Physical Performance Battery (SPPB) and falls during the last 12 months. Polypharmacy was defined as using five or more doctor-prescribed medications and excessive polypharmacy as ten or more medications. Differences between fallers and non-fallers were analysed with cross-tabulation, \u03c72-test, Fisher\u2019s exact test and Mann-Whitney\u2019s U-test. An association between polypharmacy and lower extremity functioning, and association between polypharmacy and falls were analysed with binary logistic regression analyses adjusted for age and sex. \n\nOf the participants, 57,5 % were female. Self-perceived health was at least moderate among 95,2 % of the participants and 69 % had good lower extremity functioning (SPPB 10\u221212 points). Polypharmacy was observed in 43,1 % and excessive polypharmacy in 9,7 % of the participants. Of all participants, 57,8 % had fallen at least once during the last 12 months and 74,1 % had feared falling at least sometimes. Those with no polypharmacy were more likely to have good lower extremity functioning than those with excessive polypharmacy (OR 5,48; 95 % CI 3,32\u22129,03). The association between polypharmacy and good lower extremity functioning remained significant after adjusting for self-perceived health (OR 3,39; 95 % CI 1,98\u22125,81) and fear of falling (FOF) (OR 3,06; 95 % CI 1,74\u20135,37). Participants with polypharmacy also had more likely better lower extremity functioning than those participants with excessive polypharmacy (OR 1,92; 95 % CI 1,11\u20133,29). Participants with no polypharmacy had a lower risk of falling than those with polypharmacy (OR 0,60; 95 % CI 0,39\u20130,99), and those with excessive polypharmacy (OR 0,47; 95 % CI 0,29\u20130,74) when adjusted for age and sex. There were no differences in the association between polypharmacy and falls among those with good or poor lower extremity functioning.\n\nThis study showed that polypharmacy is associated with lower extremity functioning and falls. Those with polypharmacy or excessive polypharmacy had poorer lower extremity functioning and had more likely fallen than those without polypharmacy. More studies are needed to distinguish between appropriate and inappropriate polypharmacy. The health status and medication of the older people would be necessary to evaluate on a regular basis in order to prevent the possible health problems caused by polypharmacy.", "language": "en", "element": "description", "qualifier": "abstract", "schema": "dc"}, {"key": "dc.description.provenance", "value": "Submitted by Miia Hakanen (mihakane@jyu.fi) on 2022-06-27T06:32:14Z\nNo. of bitstreams: 0", "language": "en", "element": "description", "qualifier": "provenance", "schema": "dc"}, {"key": "dc.description.provenance", "value": "Made available in DSpace on 2022-06-27T06:32:15Z (GMT). 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