Biomedical subjects
Kaisu Pitkälä
Publications and source records attributed to Kaisu Pitkälä.
Use of psychotropic drugs in elderly nursing home residents with and without dementia in Helsinki, Finland.
OBJECTIVE: Use of psychotropic medication is very common in nursing home residents. Our objective was to describe the use of psychotropic drugs in all long-term nursing home residents > or =65 years of age with and without dementia in Helsinki, Finland. METHOD: The study was a cross-sectional assessment of the nursing home population. The residents' health status was assessed and data on their demographic factors, health and medication use were collected from medical charts in February 2003. RESULTS: Of all nursing home residents in Helsinki, 82% (n = 1987) participated in the study. The nursing home residents' mean age was 83.7 (SD 7.7) years, 80.7% were female, and 69.5% were diagnosed with dementia. The mean number of drugs [corrected] given regularly was 7.9 (SD 3.6) per day per resident[corrected] Of the participants, 79.7% were regularly taking psychotropic medication. Conventional antipsychotics were administered to 18.9% of residents and atypical antipsychotics to 27.0%. Of the residents, 26.7% were on selective serotonin reuptake inhibitors (SSRIs), 3.1% on tricyclic antidepressants and 17.6% on other antidepressants. Altogether, 44.6% of residents were taking one or more antidepressant. More than a quarter (26.3%) were taking at least one anxiolytic drug. Hypnotics were used by 27.5%. However, only moderate dosages of psychotropic drugs were being taken. Only 10.4% of individuals with dementia were regularly taking cholinesterase inhibitors and four residents were taking memantine. CONCLUSIONS: Use of psychotropic drugs is very common in nursing homes in Helsinki, Finland, with four of five nursing home residents regularly receiving psychotropic drugs. Only one in ten residents were receiving cholinesterase inhibitors. Physicians caring for nursing home residents require further education on the benefits and adverse effects of psychotropic drugs in frail elderly people.
CYP3A5 genotype is associated with diagnosis of hypertension in elderly patients: data from the DEBATE Study.
OBJECTIVE: The aim of this study was to address the presently controversial question of whether cytochrome P450 (CYP) 3A5 polymorphism is associated with hypertension. METHOD: We studied 373 elderly (age > or =75 years) Finnish (Caucasian) patients from the ongoing DEBATE (Drugs and Evidence Based Medicine in the Elderly) trial. The patients were classified into those with a history of hypertension (n = 229) and those without a history of hypertension (n = 144) on the basis of a detailed questionnaire on each patient's medical history and an interview. The patients were genotyped for the CYP3A5 6986A/G single nucleotide polymorphism (SNP) [CYP3A5*1/*3 alleles]. RESULTS: The proportion of individuals with the CYP3A5*1/*3 genotype, i.e. CYP3A5 expressors, was significantly higher among patients with a diagnosis of hypertension than among patients without (18.3% vs 9.0%, p = 0.016). The corresponding odds ratio was 2.26 (95% CI 1.17, 4.38). The allele and genotype frequencies for the two control SNPs, ABCB1 (MDR1) 3435C/T and SLCO1B1 521T/C, did not differ between the two groups. CONCLUSION: This work lends support to the theory that the polymorphic CYP3A5 enzyme may be involved in regulation of blood pressure. The possible role of CYP3A5 as a genetic contributor to hypertension susceptibility warrants further study.
Low cholesterol, mortality, and quality of life in old age during a 39-year follow-up.
OBJECTIVES: We assessed the impact of serum cholesterol level in early midlife on total mortality during up to 39 years of follow-up and on the quality of life (QoL) in old age. BACKGROUND: Total effects of low serum cholesterol on health have been in dispute, especially in elderly persons, and there are few data on the long-term effects of low cholesterol on QoL. METHODS: The cohort consisted of 3,277 healthy businessmen age 30 to 45 years at baseline (1960s). In addition to baseline, serum cholesterol values were available for part of the cohort in 1974, 1986, and 2000. The QoL was assessed in 80.9% of survivors (n = 1,820, mean age 73 years) with a RAND-36 (SF-36) QoL questionnaire in 2000. Mortality up to 2002 (n = 1,173) was retrieved from national registers. RESULTS: Cholesterol was clearly reduced in survivors during follow-up, except in the lowest baseline serum cholesterol group. Baseline cholesterol predicted 39-year total mortality in a graded manner (p < 0.0001), and a value < or =5.0 mmol/l was associated with a 25% reduction in total mortality. In old age, the physical component summary score of RAND-36 was significantly (p = 0.02) higher (better) in the lowest baseline cholesterol group; no difference was found in the mental component summary score (p = 0.51). CONCLUSIONS: Low serum cholesterol level in midlife predicted not only better survival but also better physical function and QoL in old age, without adversely affecting mental QoL.
A follow-up study found that cardiovascular risk in middle age predicted mortality and quality of life in old age.
OBJECTIVE: Cardiovascular risk reduction, while saving lives, may prolong the time with disability and impair the quality of life in survivors. We compared the consequences of middle age cardiovascular risk in old age. STUDY DESIGN AND SETTING: In 1974, risk was low in 593 (low-risk group) and high in 610 men (high-risk group). At baseline, all were healthy with similar age and socioeconomic status. Lifestyle and clinical factors, including quality of life (RAND-36), were surveyed with a questionnaire in 2000, and mortality was determined up to 2002. RESULTS: During the follow-up, 303 men died, with mortality 54% higher in the high-risk group (P=.001). In the 2000 survey, high-risk men still had significantly greater BMI, higher blood glucose, higher prevalence of smoking, and more sedentary lifestyle, and they reported more both cardiovascular and noncardiovascular diseases. All the RAND-36 scales were worse in the high-risk group; of the two component summary scores, physical (PCS), but not mental (MCS) score, was significantly lower in the high-risk group. CONCLUSION: Low cardiovascular risk in middle age was associated with lower mortality, morbidity, and better quality of life in old age 26 years later. The results may support the theory of compression of morbidity.
Alcohol consumption, 29-y total mortality, and quality of life in men in old age.
BACKGROUND: The negative effects of excessive alcohol consumption are well known, but moderate alcohol consumption is advocated for health reasons. OBJECTIVE: We compared 29-y total mortality and quality of life in old age by alcohol consumption in midlife. DESIGN: Cardiovascular disease risk factors and alcohol consumption were assessed in 1974 in 1808 men (aged 40-55 y) of high socioeconomic status. At baseline, the men were without signs of chronic diseases. Baseline alcohol consumption was divided as zero (n = 116), moderate (1-349 g/wk; n = 1519), and high (>349 g/wk; n = 173). Quality of life was surveyed in 2000 with the RAND-36 (SF-36) health survey (n = 1216). Mortality was retrieved from registers during the 29-y follow-up. RESULTS: Median alcohol consumption in 1974 and in 2000 was 123 (interquartile range: 56-238) and 84 (28-168) g/wk, respectively, and was significantly correlated. Values of cardiovascular disease risk factors measured in 1974 increased with increasing alcohol consumption. During the 29-y follow-up, 499 men (27.6%) died; mortality was significantly higher among men with the highest alcohol consumption (37.6%) than in abstainers (25.0%) or in men with moderate (26.7%) consumption. Quality of life was not significantly associated with baseline alcohol consumption in responding survivors but was worst in men with high consumption when deaths during follow-up were accounted for. CONCLUSIONS: In this male cohort of high socioeconomic status, only the highest alcohol consumption (>3 drinks/d) affected mortality, and it was associated with worse quality of life in old age. Moderate alcohol consumption in middle age offered no special benefits compared with abstinence over the long term.
Lipid-lowering response to statins is affected by CYP3A5 polymorphism.
Individuals expressing the polymorphic CYP3A5 enzyme might show a more than average efficiency in the metabolism of lovastatin, simvastatin and atorvastatin. We studied whether the expression of CYP3A5 is associated with an impaired lipid-lowering response to statins in 69 Caucasian patients. Lovastatin, simvastatin and atorvastatin were significantly less effective in CYP3A5 expressors than in non-expressors. The mean serum total cholesterol concentration at 1 year was 23% higher (P = 0.0014) and the mean serum low-density lipoprotein cholesterol concentration was 24% higher (P = 0.036) in subjects possessing the CYP3A5*1 allele (CYP3A5 expressors, n = 7) than in subjects homozygous for the CYP3A5*3 allele (non-expressors, n = 39). The mean percentage reduction in serum total cholesterol from baseline was significantly smaller in CYP3A5 expressors than in non-expressors (17% versus 31%, P = 0.026). No association between hypolipidemic efficacy and CYP3A5 polymorphism was observed among 23 subjects taking statins that are not dependent on CYP3A5 (fluvastatin, pravastatin). These findings suggest that CYP3A5 may be a genetic determinant of interindividual differences in response to certain statins.
[When should the medication for dementia be stopped?].
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[Support programs for family caregivers of the elderly].
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Isolated diastolic hypertension, pulse pressure, and mean arterial pressure as predictors of mortality during a follow-up of up to 32 years.
OBJECTIVE: To compare mortality associated with various blood pressure components in middle-aged men during up to 32 years of follow-up. DESIGN: A prospective cohort study. SETTING: Helsinki, Finland. PARTICIPANTS: We studied 3267 initially healthy men, aged 30-45 years, who participated in health check-ups from 1964 onwards. MAIN OUTCOME MEASURES: Cox regression was used to relate baseline blood pressure components to all-cause (n = 701) and cardiovascular disease (CVD) mortality (n = 325). RESULTS: Systolic (SBP) and diastolic (DBP) blood pressures, pulse pressure and mean arterial pressure singly predicted CVD mortality. With SBP 160 mmHg and DBP 90 mmHg as cut-off values, four blood pressure subgroups were identified: normotension (n = 1919), isolated systolic hypertension (ISH, n = 17), isolated diastolic hypertension (IDH, n = 1013), and combined systolic and diastolic hypertension (SDH, n = 318). IDH was subdivided into IDH-1 with SBP 140-159 mmHg (n = 667) and IDH-2 with SBP less than 140 mmHg (n = 346). With normotension as reference, only SDH and IDH-1 predicted CVD mortality [relative risk (RR) 2.71, 95% confidence interval (CI) 2.00 to 3.66, and RR 1.39, 95% CI 1.04 to 1.87, respectively]. Risk with IDH-2 (RR 1.14, 95% CI 0.77 to 1.69) was not statistically significant. SDH and IDH-1, but not IDH-2, were also associated with increased all-cause mortality risk. Use of antihypertensive medication did not explain the results. CONCLUSION: These results demonstrate the often neglected role of SBP in predicting long-term CVD risk in middle-aged men. When SBP is less than 140 mmHg, IDH is not associated with significantly increased risk of mortality. Administrative guidelines, which affect population health, should also take due note of SBP.
[An elderly patient as a cancer patient].
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The problem-based learning tutorial laboratory - a method for training medical teachers.
An extensive staff development program was started in 1998 in the Faculty of Medicine at the University of Helsinki. A problem-based learning method was introduced as a new style of teaching in the curriculum reform. This paper describes a teaching method 'Problem-based learning - tutorial laboratory' for training medical teachers to act as tutors and to understand their roles as facilitators of learning and the dynamics of a small group. The method was based on learning cycles: teachers had a possibility to experience tutoring, to get feedback about it from an educational expert and from a peer teacher and also they were able to reflect on their views in the group. The teachers were content with the training. Sessions improved teacher cooperation across the departments and brought new teaching ideas for shared use. It also helped to cope with the resistance related to the curriculum change process.