Sule Arslan

Polypharmacy in the elderly: a multicenter study.

OBJECTIVE The aim of this study was to evaluate the polypharmacy issue and its correlations with socioeconomic variables in Turkish elderly patients. DESIGN Cross-sectional SETTING Outpatient clinics of the medical schools, departments of physical medicine and rehabilitation from 12 provinces. PARTICIPANTS A total of 1430 elderly in different geographical regions of Turkey during January 2007 to January 2008 were included. MEASUREMENTS Patients were interviewed using a questionnaire that included demographic characteristics, current medical diagnosis, and pharmaceuticals that are used by elderly. Demographical parameters were gender, age, marital status, number of children, level of education, province, and status of retirement. RESULTS The mean number of drugs was found to be higher in the females. There was a significant difference among age groups, marital status groups, and the number of children categories. The distribution of the number of drugs among education levels did not differ significantly, whereas the distribution of the number of drugs between the status of retirement and presence of chronic disease differed significantly. CONCLUSIONS Polypharmacy is correlated with various factors including age, sex, marital status, number of children, status of retirement, and presence of chronic medical conditions but not educational status in our study group.

Comparison of serum insulin-like growth factor-1 and growth hormone levels in osteoporotic and non-osteoporotic postmenopausal women

Abstract The purpose of this study was to compare the insulin-like growth factor-1 (IGF-1) levels and the growth hormone (GH) levels in osteoporotic and non-osteoporotic postmenopausal women. Eleven non-osteoporotic postmenopausal women and 9 women with untreated postmenopausal osteoporosis were included in the study. Bone mineral density (BMD) was assessed by dual energy X-ray absorbtiometry. Serum was assayed for calcium, phosphorus, alkaline phosphatase, bone-specific alkaline phosphatase, parathyroid hormone, IGF-1 and GH levels. IGF-1 levels were 98.8 ± 43.5 ng/ml for osteoporotic women and 169.8 ± 50.3 ng/ml for the women with normal BMD (p < 0.05). GH levels were 1.3 ± 1.1 ng/ml and 1.3 ± 1.0 ng/ml, respectively. When compared with normal postmenopausal women, IGF-1 levels were found to be lower in women with osteoporosis. IGF-1 seems to play an important role in the development of low bone mass and the present results suggest that IGF-1 is a useful predictor of the presence of osteoporosis.

Drug use in older people.

To the Editor: Aging, with its unique biological, physiological, and pharmacological issues, may interfere with drug therapy. The presence of multiple chronic diseases adds new dimensions to this difficult task. Approximately 80% of all seniors have at least one chronic condition, and 50% have at least two. 1 Surveys indicate that older people make up 12% of the population and consume 30% of all drugs prescribed in United States. 2 In our multicentric study, we aimed to evaluate the prevalence of chronic illnesses and the characteristics of drug use in a population of nursing home residents aged 60 and older in 23 cities in Turkey. Self-reported adverse drug reactions and their relationship to number of medications used were also evaluated. One thousand nine hundred forty-four subjects (1,196 male, 748 female) were enrolled in the study. The mean age standard deviation was 74.3 7.7 for men and 77.1 8.7 for women. A questionnaire consisting of questions regarding chronic illnesses, drug use patterns, and adverse drug reactions were filled out in face-to-face interviews. Fifteen major drug classes were targeted that included medications most commonly used in a geriatric population (Table 1). Hypertension was the most prevalent chronic disease seen in the study population (30.7%), followed by osteoarthritis, heart failure, diabetes mellitus, and coronary artery disease. The overall mean number of medications used (prescribed and nonprescribed) was 2.9 1.9 (2.7 1.9 for men, 3.0 1.9 for women); 28.2% of the participants reported using one medication, 24.3% two medications, 18.5% three medications, 11.7% four medications, and 17.3% five or more medications. Age and number of medications were not correlated. There was a correlation between polypharmacy and adverse reactions ( r .146, P .000). Subjects using nonprescribed drugs reported more adverse reactions ( P .05). Weighted distribution of drugs according to therapeutic category is given in Table 1. The usage of analgesic and nonsteroidal antiinflammatory drugs was more common in women than men (11.2% and 9.6%, respectively, P .05) The percentage of male subjects using cardiovascular system drugs was higher than the percentage of women (15.6% and 11.1%, respectively, P .05). The difference between use of antibiotics, ophthalmic drugs, genitourinary drugs, dermatological drugs, and otic drugs by gender was statistically not significant ( P .05). In the study population, 1,278 subjects (69.1%) answered the question regarding adverse drug reactions; 5.5% reported adverse reactions during the past year. The most common adverse reactions were gastrointestinal side effects (1.5%). Dizziness, sleep disorders, itching, diarrhea or constipation, dry mouth, and swelling of the legs were other side effects reported by the subjects. Hanlon et al. 3 reported that 91% of the communitydwelling older population uses some type of medication. Four therapeutic categories of drugs (cardiovascular, central nervous system, endocrine-metabolic, and analgesic) accounted for 79% of all prescription drugs used by the subjects in this study; the mean number of drugs was 3.54 2.66. Bjerrum et al. 4 reported that the prevalence of polypharmacy increases with age, at age 70 and older, but does not differ by sex. Hospitalization is also a major risk factor for polypharmacy. Hospitalized older people use more medications than older people who are independent in self-care. 5 Because polypharmacy increases side effects, the extent of polypharmacy in older people must be clearly identified to prevent morbidity related to drug use. Cardiovascular drugs and analgesics are often involved in polypharmacy in older people. Chronic conditions affect older people’s quality of life and contribute to a decline in independent living. Arthritis and hypertension are prominent conditions in older people. 1 In our study, hypertension and osteoarthritis were the most common chronic conditions in both sexes. Approximately 80% of all seniors have at least one chronic condition, and 50% have at least two. 6 Limitations of the study relate to the definition of adverse drug reaction used. In our study, it was not possible to assess the validity of adverse drug reactions. Because most of the study population used two or more medications, it was difficult to attribute adverse symptoms to a particular drug. The prevalence of minor adverse drug reactions might be underestimated. Older people should be encouraged to use the minimum number of medications possible. The prevalence of Table 1. Weighted Distribution of Drugs According to Therapeutic Category

Psychosocial function, clinical status, and radiographic findings in a group of chronic low back pain patients

Abstract. Low back pain is considered a problem with multiple facets for which the underlying causative factors should be determined. The aim of this study was to evaluate the relationships between depression, clinical status, and radiographic findings in a group of fifty patients with low back pain for more than 6 months. The patients underwent clinical examination and they completed Beck depression inventory (BDI), Aberdeen back pain scale (ABPS) and research questionnaire. Radiographic evaluations were performed. Clinical score and duration of symptoms were found to be positively correlated. The BDI scores were not found to be correlated with the existing variables. The ABPS scores were positively correlated with clinical scores and number of medications used.

Pain and musculoskeletal impairments in patients with high body mass index

AbstractThe impact of obesity on pain has been addressed in few studies. Pain is influenced by several factors so we aimed to investigate patients with a high body mass index (BMI) from various aspects including pain, depressive symptoms, degenerative findings and bone mineral density (BMD) in order to explore possible correlations. Seventy-four consecutive female patients seeking treatment for various pain problems from the outpatient clinics of the Department of Physical Medicine and Rehabilitation (Hacettepe University) were included in the study. A questionnaire evaluating sociodemographic factors and medical history was completed by the researchers. Anthropometric measurements of the patients were gathered. A body map, a visual analogue scale and a numeric scale were used to measure pain. Beck Depression Inventory (BDI) was used for depressive symptoms. Radiographic evaluation included anteroposterior and lateral knee, anteroposterior pelvis, anteroposterior and lateral lumbar spine, and lateral feet...

AB0179 Bone mineral density measurements in obese patients

Background Obese patients are prone to develop many medical conditions, including musculoskeletal problems. Obesity seems to have a protective effect on bone explained by metabolic mechanisms. Further studies will lead to better understanding of the impact of the weight on bone mineral density (BMD) measurements. Objectives The aim of this study was to evaluate the relationship between obesity and lumbar and femoral BMD measurements. Methods The study population consisted of 71 female patients from our outpatient clinics. Clinical assessment and anthropometric measurements (height, weight, abdominal circumference, waist circumference, triceps skinfold thickness) were performed by the same physician. Body mass index (BMI) was calculated as kg/m2 and cut-off points defined by World Health Organisation (WHO) were used to identify obesity. Cut-off values are as follows: 18.5–24.99: normal, 25.0–29.99 grade1 overweight, 30.0–39.99 grade 2 overweight, > = 40.0 grade 3 overweight. Lumbar and femoral BMD measurements were obtained using dual energy X-ray absorptiometry (DEXA) (Hologic QDR 4500A). Subjects were divided into two groups: subjects with BMI < = 29.9 and subjects > 29.9, and statistical analysis were carried out accordingly. p < 0.05 was considered to be statistically significant. Results The mean age of the subjects was 52.96 ± 10.87 years (range:25–78 years) and mean BMI was 31.40 ± 5.62 (range: 21.91–47.27). According to WHO criteria: 12 subjects (16.9%) were within the normal range, 16 subjects (22.5%) were grade 1 obese, 39 subjects (54.9%) grade 2 obese and 4 subjects (5.6%) grade 3 obese. BMD measurements in all areas examined (lumbar total, L1, L2, L3, L4, intertrochanteric, neck, trochanteric and femoral total) were correlated with anthropometric measurements. BMI was positively correlated with lumbar and femoral bone mineral density measurements in all regions evaluated. BMD measurements in all areas examined (lumbar total, L1, L2, L3, L4, intertrochanteric, neck, trochanteric and femoral total) were compared according to two groups (BMI < = 29.9, BMI > 29.9). In all areas there was a significant difference between the two groups in favour of the obese group. Conclusion In accordance with the previous studies, our study indicates the positive relationship between obesity and bone mineral density measurements. Reference World Health Organization. Physical status: The use and interpretation of anthropometry. Report of a WHO expert committee. Geneva: World Health Organization, 1995