PubMed Health⌕ Search

Biomedical subjects

H A Nygaard

Publications and source records attributed to H A Nygaard.

At least 19 recordsLinked to original sources
PubMed2006

Apolipoprotein E epsilon4 and impaired episodic memory in community-dwelling elderly people: a marked sex difference. The Hordaland Health Study.

BACKGROUND: Among elderly people without dementia, the apolipoprotein E epsilon4 allele (APOE4) has been associated with cognitive deficit, particularly in episodic memory, but few reports are available on whether this association differs by sex. METHODS: In a community-dwelling Norwegian cohort of 2181 elderly people (55% women), aged 70-74 years, episodic memory was examined in relation to sex and APOE4 zygosity, with the Kendrick Object Learning Test (KOLT). RESULTS: Possession of at least one APOE4 allele had a modest, detrimental effect on episodic memory in women, whereas in men, heterozygotes were unaffected and homozygotes had markedly lower scores across the distribution of KOLT scores. This sex difference was found consistently in all analyses: on comparing means and medians, examining trends across quintiles, and studying the distribution of scores and the risk of cognitive impairment. Results were broadly similar when adjusted for known determinants of cognition and also when severely impaired participants were excluded. The adjusted odds ratio (OR) of cognitive impairment in women was shown to be 1.8 (95% confidence interval (CI): 1.1 to 2.8) for heterozygotes and 1.1 (0.3 to 3.7) for homozygotes; the adjusted OR in men was observed to be 1.1 (0.6 to 2.1) for heterozygotes and 10.7 (4.7 to 24) for homozygotes. CONCLUSIONS: Although the harmful effect of APOE4 on episodic memory was modest in women, the risk was found to occur in about 30%. APOE4 was observed to have a dramatic effect on episodic memory in men, but only in homozygotes, who comprised about 3% of men: the whole male homozygous group showed a marked shift to lower memory scores.

Aged↗
PubMed2003

Multidisciplinary medication review in nursing home residents: what are the most significant drug-related problems? The Bergen District Nursing Home (BEDNURS) study.

AIM: Based on a multidisciplinary review of drug use in nursing home residents, this study aimed to identify the most frequent clinically relevant medication problems and to analyse them according to the drugs involved and types of problems. METHODS: Cross sectional study auditing drug use by 1354 residents in 23 nursing homes in Bergen, Norway. Data were collected in 1997. A physician/pharmacist panel performed a comprehensive medication review with regard to indications for drug use and active medical conditions. The drug related problems were subsequently classified according to the drugs involved and types of problems (indication, effectiveness, and safety issues). RESULTS: 2445 potential medication problems were identified in 1036 (76%) residents. Psychoactive drugs accounted for 38% of all problems; antipsychotics were the class most often involved. Multiple psychoactive drug use was considered particularly problematic. Potential medication problems were most frequently classified as risk of adverse drug reactions (26%), inappropriate drug choice for indication (20%), and underuse of beneficial treatment (13%). CONCLUSIONS: Three of four nursing home residents had clinically relevant medication problems, most of which were accounted for by psychoactive drugs. The most frequent concerns were related to adverse drug reactions, drug choice, and probable undertreatment.

Aged↗
PubMed2001

[Duration of drug treatment in nursing homes].

BACKGROUND: This article deals with duration of and changes in drug treatment of nursing home residents. MATERIAL AND METHODS: The duration of the drug use of 117 permanently admitted nursing home residents was studied retrospectively in five small nursing homes. All presently used drugs were registered with information on whether they were prescribed at or after admission. The drugs were recorded according to the ATC system. RESULTS: The median age of the residents was 87, the most frequent diagnoses were dementia (36%) and cardiovascular diseases (26%). There was a significant correlation between the number of drugs used and number of diagnoses (r = 0.35, p < 0.01). Drugs from ATC groups A and N were most commonly used. For all drugs except oestrogens there was a significant correlation between duration of stay and duration of treatment. Approximately three fourths of the residents taking cardiovascular drugs were treated at admittance. Two thirds or more of the use of laxatives, oestrogens, analgesics, psychotropic drugs and antihistamines were instituted during the nursing home stay. Antidepressants were prescribed relatively early after admittance, antipsychotics and anxiolytics later during the stay. INTERPRETATION: Major changes in drug use take place after admission to a nursing home. This especially applies to the use of psychotropics and diuretics which may precipitate the use of laxatives, while the increased use of analgesics and oestrogens may reveal under-treatment prior to admission. The drug use tends to be chronic.

Aged↗
PubMed2001

Psychotropic drug use in nursing homes--diagnostic indications and variations between institutions.

OBJECTIVE: Psychotropic drug use among nursing home residents with regard to diagnostic indications and patient- and institution characteristics was analysed. METHODS: A cross-sectional study of medication data from 1552 residents at 23 nursing homes in Bergen, Norway, was performed. Psychotropic drug use (neuroleptics, anxiolytics, hypnotics, antidepressants, and two sedative antihistamines) was analysed with regard to prevalence, diagnostic indications, duration of use, and general patient- and institution characteristics. RESULTS: Psychotropic drugs were taken on a daily schedule by 59% of all residents, most commonly as long-term treatment. Antidepressants (in 70% selective serotonin re-uptake inhibitors) were used by 31%, neuroleptics by 23%, and benzodiazepines by 22% of all the residents. Neuroleptics were given for non-psychotic behavioural and psychological symptoms in 66% of the cases. Sleeping disorders were most commonly treated with long-acting benzodiazepine hypnotics. Psychotropic drug use decreased with increasing patient age. Drug use patterns varied greatly between the different nursing homes: the prevalence of neuroleptic use varied from 0 to 61% of the residents, and antidepressant use varied from 10 to 63%. In nursing homes providing relatively more physician staff time, the residents were more likely to use antidepressants. CONCLUSIONS: Psychotropic drugs are used by a majority of nursing home residents as long-term symptomatic treatment. The great variations between the institutions can only to a small extent be explained by quantitative differences between the institutions.

Aged↗
PubMed2000

[Mental impairment in nursing home residents].

BACKGROUND: Nursing homes are the corner stones in long-term institutional care for frail elderly people. Expansion and strengthening of community-based services during the last decade has enabled frail elderly who earlier would have moved into a nursing home to stay in their own home or in service apartments. MATERIAL AND METHODS: In a cross-sectional, anonymised study, changes in nursing homes in the city of Bergen between 1985 and 1996/97 were analysed with regard to prevalence of mentally impaired residents. The following items were assessed by nurses who were in daily contact with the residents: mental capacity by means of Clinical Dementia Rating (CDR), activities of daily living (ADL), and behaviour. The study population consisted of 1,296 residents from 21 institutions in 1985 and 1,141 residents from 16 institutions i 1996/97. RESULTS: The percentage of mentally impaired residents increased significantly, from 75 to 82, and the percentage of residents who were in need of extended nursing care rose from 87 to 91. The median duration of stay did not change significantly, but was reduced for residents with slight mental impairments (CDR 1), from 871 to 721 days. INTERPRETATION: Today, predominately mentally impaired and physically disabled elderly are cared for in general nursing homes. These are patients in need of continuous medical care and supervision, and do not fit into an ideology which "demedicalizes" severe medical conditions in old people. Both nursing homes and sheltered livings are needed.

Activities of Daily Living↗
PubMed2000

[Dementia and hypothyroidism].

BACKGROUND: The clinical presentation of hypothyroidism varies considerably and may be dominated by cognitive deficits and psychological symptoms. Hence, when diagnosing dementia it is important to rule out hypothyroidism. Hypothyroidism has also been considered a classic reversible dementia; however, the aetiological association between dementia and hypothyroidism is by no means indisputable. MATERIAL AND METHODS: A review of available literature concerning hypothyroidism, cognitive functioning and dementia. RESULTS: The importance of thyroxin for the development of the brain and for intellectual development is well known. Early reports suggested that thyroxin improved or reversed dementia in patients with hypothyroidism. Later studies have shown contradictory results; however, several prospective intervention and follow-up studies of overt and subclinical hypothyroidism do not provide for support the belief that there is an aetiological association between dementia and hypothyroidism. INTERPRETATION: The lack of association between dementia and hypothyroidism has consequences for the treatment, and for information to patients and relatives of patients with concomitant dementia symptoms and hypothyroidism. The introduction of acetylcholinesterase inhibitors in the treatment of patients with Alzheimer's disease has brought new interest to this matter. When hypothyroidism is detected in a patient with suspected dementia, thyroxin should be tried first of all. If there is no obvious improvement of symptoms and there still is evidence of dementia, one should consider whether the patient is suitable for a trial with an acetylcholine inhibitor.

Alzheimer Disease↗
PubMed2000

Improvement in sundowning in dementia with Lewy bodies after treatment with donepezil.

Sundowning, manifested as a recurring increase in restlessness and agitation in the evening, is described in a 71-year-old man with clinically diagnosed dementia with Lewy bodies. An objective measure of activity using the activity electronic monitoring technique indicated a marked increase in activity level during the evening compared to earlier in the day. After treatment with donepezil, a cholinesterase inhibitor, ratings of behavioural symptoms improved. In addition, there was a marked reduction in evening activity and an increase in daytime activity. Cognition and parkinsonism also improved. Possible explanations for this finding are discussed.

Aged↗
PubMed2000

Drug treatment of heart failure--do nursing-home residents deserve better?

OBJECTIVE: To describe and assess drug treatment of heart failure (HF) in nursing-home residents. DESIGN: Descriptive cross-sectional study. Individual patient information was obtained from the medical records and drug-dispensing cards. SETTING: Nursing homes in Bergen, Norway. MAIN OUTCOME MEASURES: Demographic data, diagnostic data (main diagnoses, diagnostic indications for the drugs used), medications (drugs, dosage and duration of use). RESULTS: Data were gathered from 23 of 27 obtainable institutions representing 1552 residents (86% of the Bergen nursing-home population); 469 (30%) of the residents used drugs for HF, the majority of whom (293 patients) were treated with furosemide only. Supplementary angiotensin-converting enzyme (ACE) inhibitors (predominantly in sub-target doses) were provided to 17% of the HF patients. About one out of four used drug combinations which we considered to be potentially harmful for HF patients. CONCLUSIONS: ACE inhibitors are probably under-utilised for HF in nursing-home residents. Potentially harmful drug combinations commonly occur. Both diagnosis and drug treatment for HF should be challenged in the nursing-home setting.

Aged↗
PubMed1999

Drug use in homes for the aged. A comparison between mentally intact and mentally impaired residents.

The aim of this study was to analyze drug use in 347 residents in homes for the aged in Bergen, Norway. All drugs prescribed on a regular schedule were assessed, the prevalence of potentially harmful drug combinations, and inappropriately prescribed drugs were studied and related to mental capacity of the residents. Mental capacity was assessed by means of the Clinical Dementia Rating scale (CDR). The median number of drugs used was 4.0 (range 0-11, 95% CI 3.0-4.0). Mentally impaired residents consumed fewer drugs than mentally intact ones. In a logistic regression analysis the use of NSAIDS, beta-blockers and anxiolytics was significantly lower in mentally impaired residents (OR 0.37, 95% CI 0.17-0.80, OR 0.35, 95% CI 0.13-0.95, and OR 0.45, 95% CI 0.21-0.94, respectively), and the use of laxatives and vitamin B-12 higher (OR 2.19, 95% CI 1.04-4.62, and OR 5.08, 95% CI 1.11-23.25, respectively). Twenty percent of mentally intact and 21% of mentally impaired residents have potentially harmful two-by-two drug combinations, and drugs augmenting sedating properties were dominating. The prevalence of inappropriately used drugs was significantly lower in mentally impaired residents (20%) than in mentally intact ones (33%). Antidepressants with anticholinergic properties, benzodiazepines with long half-life and phenothiazines were the most frequent.

Adrenergic beta-Antagonists↗
PubMed1998

Falls and psychotropic drug consumption in long-term care residents: is there an obvious association?

Institutional long-term care is an integrated part of primary health care. People qualifying to enter a long-term care facility must exhibit a high degree of dependency, caused either by physical or/and mental impairment. It must be obvious that the problem cannot be dealt with in the community. The type of the residents in institutions largely depends on the ability to provide proper services to elderly living in the community. This also implies that fall-related risk factors may vary. Residents living permanently in a long-term care facility (n = 118) were observed during a 6-month period with respect to fall episodes. Prior to the study, gender age, mental capacity, mobility, the ability to go to the toilet, to eat, and to communicate, and all drugs prescribed on a regular schedule were recorded. Subsequently the various elements were compared for fallers and non-fallers. There were 49 fallers. There was no difference between the two groups regarding gender, age, or drug use. Mental impairment and restricted mobility were independently associated with increased risk of falling (odds ratios 3.4 and 4.8, respectively). Falling was also associated with the degree of mental impairment (linear trend p = 0.01). A stratified Mantel-Haenszel test showed a significantly higher tendency to fall among residents using antipsychotics. Residents with restricted mobility using anxiolytics/hypnotics or antidepressants had a lower tendency to fall than non-users. They were also less prone to fall repeatedly. Anxiety and depressive states may possibly contribute to falling. Negative associations between falling and drug use are commonly studied. Possible beneficial effects are by and large disregarded.

Accidental Falls↗
PubMed1997

[Project geriatric outpatient clinic. A study on geriatric outpatient clinics and patient basis].

In 1996 PROJECT: geriatric outpatient clinic was initiated by the Ministry of Health and Social Affairs. The purpose was to collect more extensive information about geriatric outpatient clinics in Norway with regard to organization of the clinics, the types of activities and the clinics and the patients attending them. Information on the activities in 1995 was collected, and a summary prepared. Detailed records were made of the activities at 15 geriatric outpatient clinics during March 1996: 288 initial contacts and 239 repeat contacts were recorded. Assessment for mental impairment and multimorbidity constituted 41% of the referrals. The average number og patients per opening hour was rather low: 0.7 (range 0.08-2.5). The pay-back for the hospital was low and there was little incentive to operate the clinics.

Aged↗
PubMed1997

[Changes among residents in homes for the aged in Bergen between 1985-96].

Homes for the aged are intended for elderly people who, by and large, are able to perform basic activities of daily living (ADL) on their own, but who, in spite of this, need or wish to live in an institutional setting, where only minor nursing facilities are available. The present study focuses on the changes in mental capacity and in the altered need for nursing assistance with ADL functions which developed among residents at 13 homes for the aged in the city of Bergen, between 1985 and 1996. In 1985, the average age for residents was 84 years; and in 1996 it was 87 years. The average duration of stay was 30 and 38 months, respectively. There was a significant increase in the proportion of mentally impaired residents (28% and 35%). There was also an increase in the percentage in need of intensive nursing care (34% and 41%). The changes in residents living in the homes were not caused by dementia. It is concluded that homes for the aged are used increasingly for elderly in need of nursing care. There is an obvious mismatch between tasks and resources.

Activities of Daily Living↗
PubMed1997

[Adverse effects of local use of beta-blockaders in glaucoma. A literature review and a survey of reports to the adverse drug reaction authority 1986-95].

The review is based on a survey of studies on adverse reactions related to topical administration of beta-blockers for glaucoma. Locally applied beta-blocking agents are partially resorbed from the nasal mucosa. Concentrations which give rise to systemic effects occur invariably. Several reports exist of congestive heart failure, arrhythmias, severe respiratory symptoms, depression, hallucinations and confusion provoked by topical use of beta-blockers, especially timolol. It is impossible to estimate from the literature how often the various adverse effects occur. One has the impression, however, that adverse effects in the pulmonary and central nervous systems have not been fully considered. Between 1986 and 1995 the Norwegian Medicines Control Authority received reports on adverse reactions related to topical use of beta-blockers in 17 patients. Six of these patients had cardiovascular and four of them severe respiratory symptoms. The latter group also included three fatal cases. The adverse effects seem to occur most frequently in the elderly, and it has been suggested that timolol should not be used in elderly people. Adverse effects related to treatment with topical beta-blockers are probably underreported in Norway.

Adrenergic beta-Antagonists↗
PubMed1995

[Drug consumption among residents of nursing homes. Changes during the first 3 months].

Five nursing homes in Bergen participated in a study of drug consumption by patients admitted for a long-term stay. The investigation was performed on admission and again after three months. During the first six months of 1991, 83 patients were admitted for a long term stay. The median drug consumption was 3.0 drugs on both occasions. On admission 8%, and after three months 3%, did not use any drug. 27%, respectively 24%, used five different drugs or more. Laxatives, diuretics, vitamins, analgetics and antipsychotic drugs were the most frequently used drugs. During the period of the study there was no change in total drug consumption. However, after three months, demented patients were treated significantly more frequently with antipsychotic drugs. Furthermore, the probability of being treated with an antipsychotic was five times higher in institutions where the physician was not engaged full time in geriatric medicine.

Aged↗