T. Zimmermann

Potenziell inadäquate Medikamente bei älteren hausärztlich versorgten Patientinnen und Patienten

BACKGROUNDnElderly people are often burdened by several diseases. This accounts for a higher medication intake and increases the risk of adverse drug events. To minimize this risk, several lists (Beers, PRISCUS) have been published of drugs that elderly patients should not take. We present a longitudinal analysis of the use of potentially inappropriate medication (PIM) over a period 4.5xa0years in a cohort of patients aged 75xa0years or more.nnnMETHODSnData were collected from the prospective, multicenter, observational study German Study on Ageing, Cognition and Dementia in Primary Care Patients (AgeCoDe), initially enrolling 3,327xa0patients. We investigated the prevalence of PIM by checking medications during visits to patients homes. Furthermore, we analyzed the use of individual PIM agents over time.nnnRESULTSnAt baseline, we found a PIM prevalence of 29u2009% according to the PRISCUS list, which decreased to 25.0u2009% 4.5xa0years later (χ(2): 7.87, pu2009=u20090.004). The Beers list yielded a prevalence of 21u2009% at baseline, decreasing after 4.5xa0years to 17.1u2009% (χ(2): 10.77, pu2009=u20090.000). A time-dependent multilevel model confirmed these results. Older age, depression, and the use of numerous prescribed agents are independent risk factors for using a PRISCUS-PIM.nnnCONCLUSIONnOur results seem to support a trend toward a more rational drug therapy because fewer patients were prescribed PIM. Thus, for the individual patient, the risk of adverse effects and side effects is reduced as are the costs of these effects.ZusammenfassungHintergrundÄltere Menschen sind oftmals durch mehrere Krankheiten belastet. Mit der daraus resultierenden mehrfachen Medikamenteneinnahme steigt das Risiko für unerwünschte Arzneimittelereignisse. Mit Wirkstofflisten (Beers-Liste, PRISCUS-Liste) soll dieses Risiko für ältere Patienten reduziert werden. Wir stellen hier eine längsschnittliche Analyse (4,5xa0Jahre) zur Einnahme potenziell inadäquater Medikamente (PIM) in einer Kohorte von hausärztlichen Patienten im Alter von ≥u200975xa0Jahren vor.MethodenDie Daten wurden für die prospektive, multizentrische Beobachtungsstudie „German Study on Ageing, Cognition and Dementia in Primary Care Patients (AgeCoDe)“ bei initial 3327xa0Patienten erhoben. Über eine Medikamentenanamnese bei den Patienten zu Hause ermittelten wir die Häufigkeit der PIM-Einnahme und analysierten die Anteile einzelner PIM-Wirkstoffgruppen über die Zeit.ErgebnisseGemäß der PRISCUS-Liste betrug der Anteil von Patienten mit PIM-Einnahme zu Studienbeginn 28,7u2009% und sank 4,5xa0Jahre später auf 25,0u2009% (χ2: 7,87; pu2009=u20090,004). Gemessen an der Beers-Liste lag der Anteil zu Beginn bei 21,0u2009% und nahm 4,5xa0Jahre später auf 17,1u2009% ab (χ2: 10,77; pu2009=u20090,000). Das zeitabhängige Mehrebenenmodell bestätigt dies. Hohes Alter, Depression und die Einnahme vieler rezeptpflichtiger Medikamente sind unabhängige Risikofaktoren für eine PIM-Einnahme gemäß PRISCUS-Liste.DiskussionWir sehen in unseren Ergebnissen einen Trend zur rationaleren Arzneimitteltherapie, weil weniger älteren Patienten PIM verordnet werden. Dies senkt das Risiko für unerwünschte Wirkungen und Nebenwirkungen und die dafür aufzuwendenden Kosten.AbstractBackgroundElderly people are often burdened by several diseases. This accounts for a higher medication intake and increases the risk of adverse drug events. To minimize this risk, several lists (Beers, PRISCUS) have been published of drugs that elderly patients should not take. We present a longitudinal analysis of the use of potentially inappropriate medication (PIM) over a period 4.5xa0years in a cohort of patients aged 75xa0years or more.MethodsData were collected from the prospective, multicenter, observational study “German Study on Ageing, Cognition and Dementia in Primary Care Patients (AgeCoDe),” initially enrolling 3,327xa0patients. We investigated the prevalence of PIM by checking medications during visits to patients’ homes. Furthermore, we analyzed the use of individual PIM agents over time.ResultsAt baseline, we found a PIM prevalence of 29u2009% according to the PRISCUS list, which decreased to 25.0u2009% 4.5xa0years later (χ2: 7.87, pu2009=u20090.004). The Beers list yielded a prevalence of 21u2009% at baseline, decreasing after 4.5xa0years to 17.1u2009% (χ2: 10.77, pu2009=u20090.000). A time-dependent multilevel model confirmed these results. Older age, depression, and the use of numerous prescribed agents are independent risk factors for using a PRISCUS-PIM.ConclusionOur results seem to support a trend toward a more rational drug therapy because fewer patients were prescribed PIM. Thus, for the individual patient, the risk of adverse effects and side effects is reduced as are the costs of these effects.

CERAD-NP-Testbatterie: Alters-, geschlechts- und bildungsspezifische Normen ausgewählter Subtests

The CERAD-NP battery represents well-established tests for the neuropsychological diagnosis of characteristic cognitive deficits in Alzheimers dementia. However, the use of neuropsychological tests requires reliable standard values for the population under consideration, taking sociodemographic characteristics like age, education and gender into account. This report presents age-, education- and gender-specific reference values for the subtests verbal fluency, word list memory, word list recall and word list recognition as well as the word list savings score of the CERAD-NP battery. The study sample consists of 2891 general practitioners patients from Germany aged 75 years and older. The study participants had a mean age of 80.2 years (SD=3.6); thus, this report provides reliable reference values for the neuropsychological diagnosis of dementia in older age groups.ZusammenfassungMit der CERAD-NP-Testbatterie liegen gut etablierte Verfahren zur neuropsychologischen Diagnostik charakteristischer kognitiver Defizite einer Demenz vom Alzheimer-Typ vor. Die Anwendbarkeit neuropsychologischer Verfahren setzt das Vorhandensein zuverlässiger Normwerte für die zugrunde liegende Population unter Berücksichtigung soziodemographischer Faktoren wie Alter, Bildung und Geschlecht voraus. In der vorliegenden Arbeit wurden alters- bildungs- und geschlechtsspezifische Normwerte (Prozentränge und T-Werte bzw. Perzentile) für die Subtests Verbale Flüssigkeit, Wortliste Gedächtnis, Wortliste Abrufen und Wortliste Wiedererkennen sowie den Wortliste-Savings-Score der CERAD-NP-Testbatterie an einer Stichprobe von 2891 älteren (75xa0Jahre und darüber) nichtdementen Hausarztpatienten aus Deutschland ermittelt. Die Probanden hatten ein Durchschnittsalter von 80,2xa0Jahren (SD=3,6); somit bietet dieser Beitrag zuverlässige Normwerte für die neuropsychologische Demenzdiagnostik in den höheren Altersgruppen an.AbstractThe CERAD-NP battery represents well-established tests for the neuropsychological diagnosis of characteristic cognitive deficits in Alzheimer’s dementia. However, the use of neuropsychological tests requires reliable standard values for the population under consideration, taking sociodemographic characteristics like age, education and gender into account. This report presents age-, education- and gender-specific reference values for the subtests verbal fluency, word list memory, word list recall and word list recognition as well as the word list savings score of the CERAD-NP battery. The study sample consists of 2891 general practitioners’ patients from Germany aged 75xa0years and older. The study participants had a mean age of 80.2xa0years (SD=3.6); thus, this report provides reliable reference values for the neuropsychological diagnosis of dementia in older age groups.

Male and female residents in postgraduate medical education - A gender comparative analysis of differences in career perspectives and their conditions in Germany

Aim: This article focuses on the gender-specific career differences of residents in their postgraduate medical education in Germany. In particular the structural obstacles female physicians have to overcome during residency are investigated. Moreover, the study examines the position preferences of male and female physicians in the hospital and in how far occupational self-efficacy corresponds to the interest in a hospital leading position. Methods: The KarMed-Study’s database consists of annual postal surveys throughout the entire residency of medical students, who were in their “Practical Year” in 2008/2009. Descriptive statistics and regression models were used in the analysis. Results: Male and female physicians differ in terms of their preferred work place (hospital, ambulatory care, others), hospital position and working hours. Female physicians prefer part-time work and rarely assume leading positions compared to male physicians. In addition, female physicians, especially those with children, need more time to complete their postgraduate training. Female physicians with children are burdened and disadvantaged more often than their female colleagues without children as well as male physicians in general (e.g. belated start and completion of residency, lower rate of doctorate titles, higher quota of part-time contracts, short-term employment contracts, and higher rates of residency interruption or termination). Besides gender and doctorate title, the occupational self-efficacy expectation has an influence on the preference of leading positions in hospitals. Respondents with a low occupational self-efficacy score are less likely to strive for leading positions with more responsibilities than those with a high score. Conclusion: The results demonstrate clear gender disparities in postgraduate training. Female physicians, especially those with children, are disadvantaged in various areas when compared with their male colleagues. In particular, the low rate of doctorate titles and the low score of self-efficacy expectation are associated negatively with the willingness to aim at leading positions in hospitals. Special measures and programmes should be developed for female physicians to counteract these differences.

Potenziell inadäquate Medikamente bei älteren hausärztlich versorgten Patientinnen und Patienten@@@Potentially inappropriate medication in elderly primary care patients: Eine retrospektive Längsschnittanalyse@@@A retrospective, longitudinal analysis

BACKGROUNDnElderly people are often burdened by several diseases. This accounts for a higher medication intake and increases the risk of adverse drug events. To minimize this risk, several lists (Beers, PRISCUS) have been published of drugs that elderly patients should not take. We present a longitudinal analysis of the use of potentially inappropriate medication (PIM) over a period 4.5xa0years in a cohort of patients aged 75xa0years or more.nnnMETHODSnData were collected from the prospective, multicenter, observational study German Study on Ageing, Cognition and Dementia in Primary Care Patients (AgeCoDe), initially enrolling 3,327xa0patients. We investigated the prevalence of PIM by checking medications during visits to patients homes. Furthermore, we analyzed the use of individual PIM agents over time.nnnRESULTSnAt baseline, we found a PIM prevalence of 29u2009% according to the PRISCUS list, which decreased to 25.0u2009% 4.5xa0years later (χ(2): 7.87, pu2009=u20090.004). The Beers list yielded a prevalence of 21u2009% at baseline, decreasing after 4.5xa0years to 17.1u2009% (χ(2): 10.77, pu2009=u20090.000). A time-dependent multilevel model confirmed these results. Older age, depression, and the use of numerous prescribed agents are independent risk factors for using a PRISCUS-PIM.nnnCONCLUSIONnOur results seem to support a trend toward a more rational drug therapy because fewer patients were prescribed PIM. Thus, for the individual patient, the risk of adverse effects and side effects is reduced as are the costs of these effects.ZusammenfassungHintergrundÄltere Menschen sind oftmals durch mehrere Krankheiten belastet. Mit der daraus resultierenden mehrfachen Medikamenteneinnahme steigt das Risiko für unerwünschte Arzneimittelereignisse. Mit Wirkstofflisten (Beers-Liste, PRISCUS-Liste) soll dieses Risiko für ältere Patienten reduziert werden. Wir stellen hier eine längsschnittliche Analyse (4,5xa0Jahre) zur Einnahme potenziell inadäquater Medikamente (PIM) in einer Kohorte von hausärztlichen Patienten im Alter von ≥u200975xa0Jahren vor.MethodenDie Daten wurden für die prospektive, multizentrische Beobachtungsstudie „German Study on Ageing, Cognition and Dementia in Primary Care Patients (AgeCoDe)“ bei initial 3327xa0Patienten erhoben. Über eine Medikamentenanamnese bei den Patienten zu Hause ermittelten wir die Häufigkeit der PIM-Einnahme und analysierten die Anteile einzelner PIM-Wirkstoffgruppen über die Zeit.ErgebnisseGemäß der PRISCUS-Liste betrug der Anteil von Patienten mit PIM-Einnahme zu Studienbeginn 28,7u2009% und sank 4,5xa0Jahre später auf 25,0u2009% (χ2: 7,87; pu2009=u20090,004). Gemessen an der Beers-Liste lag der Anteil zu Beginn bei 21,0u2009% und nahm 4,5xa0Jahre später auf 17,1u2009% ab (χ2: 10,77; pu2009=u20090,000). Das zeitabhängige Mehrebenenmodell bestätigt dies. Hohes Alter, Depression und die Einnahme vieler rezeptpflichtiger Medikamente sind unabhängige Risikofaktoren für eine PIM-Einnahme gemäß PRISCUS-Liste.DiskussionWir sehen in unseren Ergebnissen einen Trend zur rationaleren Arzneimitteltherapie, weil weniger älteren Patienten PIM verordnet werden. Dies senkt das Risiko für unerwünschte Wirkungen und Nebenwirkungen und die dafür aufzuwendenden Kosten.AbstractBackgroundElderly people are often burdened by several diseases. This accounts for a higher medication intake and increases the risk of adverse drug events. To minimize this risk, several lists (Beers, PRISCUS) have been published of drugs that elderly patients should not take. We present a longitudinal analysis of the use of potentially inappropriate medication (PIM) over a period 4.5xa0years in a cohort of patients aged 75xa0years or more.MethodsData were collected from the prospective, multicenter, observational study “German Study on Ageing, Cognition and Dementia in Primary Care Patients (AgeCoDe),” initially enrolling 3,327xa0patients. We investigated the prevalence of PIM by checking medications during visits to patients’ homes. Furthermore, we analyzed the use of individual PIM agents over time.ResultsAt baseline, we found a PIM prevalence of 29u2009% according to the PRISCUS list, which decreased to 25.0u2009% 4.5xa0years later (χ2: 7.87, pu2009=u20090.004). The Beers list yielded a prevalence of 21u2009% at baseline, decreasing after 4.5xa0years to 17.1u2009% (χ2: 10.77, pu2009=u20090.000). A time-dependent multilevel model confirmed these results. Older age, depression, and the use of numerous prescribed agents are independent risk factors for using a PRISCUS-PIM.ConclusionOur results seem to support a trend toward a more rational drug therapy because fewer patients were prescribed PIM. Thus, for the individual patient, the risk of adverse effects and side effects is reduced as are the costs of these effects.

CERAD-NP-Testbatterie: Alters-, geschlechts- und bildungsspezifische Normen ausgewählter Subtests@@@CERAD-NP battery: Age-, gender- and education-specific reference values for selected subtests: Ergebnisse der German Study on Ageing, Cognition and Dementia in Primary Care Patients (AgeCoDe)@@@Results of the German Study on Ageing, Cognition and Dementia in Primary Care Patients (AgeCoDe)

The CERAD-NP battery represents well-established tests for the neuropsychological diagnosis of characteristic cognitive deficits in Alzheimers dementia. However, the use of neuropsychological tests requires reliable standard values for the population under consideration, taking sociodemographic characteristics like age, education and gender into account. This report presents age-, education- and gender-specific reference values for the subtests verbal fluency, word list memory, word list recall and word list recognition as well as the word list savings score of the CERAD-NP battery. The study sample consists of 2891 general practitioners patients from Germany aged 75 years and older. The study participants had a mean age of 80.2 years (SD=3.6); thus, this report provides reliable reference values for the neuropsychological diagnosis of dementia in older age groups.ZusammenfassungMit der CERAD-NP-Testbatterie liegen gut etablierte Verfahren zur neuropsychologischen Diagnostik charakteristischer kognitiver Defizite einer Demenz vom Alzheimer-Typ vor. Die Anwendbarkeit neuropsychologischer Verfahren setzt das Vorhandensein zuverlässiger Normwerte für die zugrunde liegende Population unter Berücksichtigung soziodemographischer Faktoren wie Alter, Bildung und Geschlecht voraus. In der vorliegenden Arbeit wurden alters- bildungs- und geschlechtsspezifische Normwerte (Prozentränge und T-Werte bzw. Perzentile) für die Subtests Verbale Flüssigkeit, Wortliste Gedächtnis, Wortliste Abrufen und Wortliste Wiedererkennen sowie den Wortliste-Savings-Score der CERAD-NP-Testbatterie an einer Stichprobe von 2891 älteren (75xa0Jahre und darüber) nichtdementen Hausarztpatienten aus Deutschland ermittelt. Die Probanden hatten ein Durchschnittsalter von 80,2xa0Jahren (SD=3,6); somit bietet dieser Beitrag zuverlässige Normwerte für die neuropsychologische Demenzdiagnostik in den höheren Altersgruppen an.AbstractThe CERAD-NP battery represents well-established tests for the neuropsychological diagnosis of characteristic cognitive deficits in Alzheimer’s dementia. However, the use of neuropsychological tests requires reliable standard values for the population under consideration, taking sociodemographic characteristics like age, education and gender into account. This report presents age-, education- and gender-specific reference values for the subtests verbal fluency, word list memory, word list recall and word list recognition as well as the word list savings score of the CERAD-NP battery. The study sample consists of 2891 general practitioners’ patients from Germany aged 75xa0years and older. The study participants had a mean age of 80.2xa0years (SD=3.6); thus, this report provides reliable reference values for the neuropsychological diagnosis of dementia in older age groups.