Assessing the use of medications in the elderly: Methods and initial experience in the cardiovascular health study

Psaty, Bruce M.; Marshall, Lisa; Savage, Peter J.; Rutan, Gale H.; German, Pearl S.; Lyles, Mary F.

doi:10.1016/0895-4356(92)90143-b

Cited by 292 publications

(214 citation statements)

References 27 publications

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“…After the transcription process was completed, the interviewer placed the medications in front of the participant and inquired how often each medication was taken on average during the previous 2 weeks. 35 The measure of dose reported taken was created from the available data since the interviewers independently recorded the dose and instructions, and asked participants how frequently they took a medicine. 36 For all scheduled benzodiazepine prescriptions, the dose reported taken was the calculated total daily dose taken from the patient response to the question, "How often the medication was taken on average during the previous 2 weeks?"…”

Section: Methodsmentioning

confidence: 99%

Correlates and prevalence of benzodiazepine use in community-dwelling elderly

Schulz²,

et al. 1998

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OBJECTIVE:To describe the prevalence of benzodiazepine use, sociodemographic and physical health factors associated with use, dosages taken, and directions for use among individuals aged 65 years and older. DESIGN:Cross-sectional analysis of baseline data from the community-based, prospective observational Cardiovascular Health Study. PATIENTS/PARTICIPANTS:Medicare eligibility lists from four U.S. communities were used to recruit a representative sample of 5,201 community-dwelling elderly, of which 5,181 participants met all study criteria. MEASUREMENTS AND MAIN RESULTS:Among participants, 511 (9.9%) were taking at least one benzodiazepine, primarily anxiolytics (73%). Benzodiazepines were often prescribed to be taken pro re nata (PRN "as needed"), and 36.5% of prescriptions with instructions to be taken regularly were taken at a dose lower than prescribed. Reported over-the-counter (OTC) sleep aid medication use was 39.2% in benzodiazepine users and 3.3% in nonusers. In a multivariate logistic model, the significant independent correlates of benzodiazepine use were being white (odds ratio [

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Section: Methodsmentioning

confidence: 99%

Correlates and prevalence of benzodiazepine use in community-dwelling elderly

Schulz²,

et al. 1998

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“…13 For sensitivity analysis, exposure while receiving warfarin but not aspirin was excluded by censoring exposure at the time it was ascertained that warfarin was used, providing warfarin use was recorded prior to stroke. This was done because anticoagulation with warfarin is highly (about 70%) efficacious for reducing stroke in patients with AF.…”

Section: Methodsmentioning

confidence: 99%

Stroke risk in an elderly population with atrial fibrillation

et al. 1999

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Patients with nonvalvular atrial fibrillation (AF) have an increased risk of stroke, but the absolute rate of stroke varies widely depending on coexistent vascular disease. We assessed the stroke rate and predictive value of two published schemes for stroke risk stratification in a population-derived cohort of 259 elderly people with nonvalvular AF followed for a median of 5.3 years. The rate of ischemic stroke was 2.8% per year (95% confidence interval [CI] 1.9, 3.9). Thirty-one percent were predicted to be at low risk, and their stroke rate was 1.7% per year (95% CI 0.6, 3.8). Many people with AF in this population-derived cohort had relatively low rates of stroke. Further studies to reliably stratify stroke risk in patients with AF are needed. A trial fibrillation (AF) is an independent risk factor for stroke, 1 but the absolute rate of stroke varies widely depending on coexistent vascular disease. Stroke rates range from less than 0.5% per year in patients with AF under age 60 years old without cardiopulmonary disease ("lone AF") 2,3 to 12% per year for those with prior stroke. 4,5 Risk stratification schemes for stroke in patients with AF have been derived from participants in randomized clinical trials. 3,6 However, participants with AF in these trials were, on average, younger and more often men than patients with AF in population-based cohorts. 7 The frequency and predictive value of thromboembolic risk factors in a population-derived cohort have not been examined previously.We determined the stroke rate of participants with AF in the Cardiovascular Health Study (CHS), 8,9 categorized AF participants as being at low, moderate, or high risk of stroke using two published risk stratification schemes, 10,11 and then assessed whether these schemes successfully predicted stroke during follow-up. METHODSThe CHS is a multicenter, longitudinal observational study of a population-based sample of 5,201 adults over age 65 at entry recruited from four communities. Details of study design and recruitment, which commenced in 1989, have been published. 8,9 At CHS entry, 277 participants (5.3%) were identified as having AF on the basis of entry electrocardiograms or through self-report confirmed by review of medical records. Excluding 18 people with prosthetic cardiac valves or mitral stenosis, the remaining 259 participants with nonvalvular AF are considered here. Antithrombotic therapy during follow-up was determined by their personal physicians.We assessed thromboembolic risk factors associated with stroke in two published risk stratification schemes (Table 1). 10,11 Definitions of clinical characteristics of CHS participants have been reported. 12 A history of hypertension was defined as systolic blood pressure of 160 mm Hg or higher, diastolic blood pressure of 90 mm Hg or higher, or self-reported hypertension with current use of antihypertensive medication. Prevalent myocardial infarction, angina pectoris, congestive heart failure, stroke, and transient ischemic attack (TIA) were identified by interview with subseq...

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“…Medication use was classified using methods developed for epidemiologic research (15). Diabetes was ascertained based on report of physician diagnosis or reported use of insulin or oral hypoglycemic medication.…”

Section: Other Covariatesmentioning

confidence: 99%

Obstructive Sleep Apnea–Hypopnea and Incident Stroke

Redline¹,

Yenokyan

Gottlieb³

et al. 2010

Am J Respir Crit Care Med

1,119

494

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Rationale: Although obstructive sleep apnea is associated with physiological perturbations that increase risk of hypertension and are proatherogenic, it is uncertain whether sleep apnea is associated with increased stroke risk in the general population. Objectives: To quantify the incidence of ischemic stroke with sleep apnea in a community-based sample of men and women across a wide range of sleep apnea. Methods: Baseline polysomnography was performed between 1995 and 1998 in a longitudinal cohort study. The primary exposure was the obstructive apnea-hypopnea index (OAHI) and outcome was incident ischemic stroke. Measurements and Main Results: A total of 5,422 participants without a history of stroke at the baseline examination and untreated for sleep apnea were followed for a median of 8.7 years. One hundred ninety-three ischemic strokes were observed. In covariate-adjusted Cox proportional hazard models, a significant positive association between ischemic stroke and OAHI was observed in men (P value for linear trend: P 5 0.016). Men in the highest OAHI quartile (.19) had an adjusted hazard ratio of 2.86 (95% confidence interval, 1.1-7.4). In the mild to moderate range (OAHI, 5-25), each one-unit increase in OAHI in men was estimated to increase stroke risk by 6% (95% confidence interval, 2-10%). In women, stroke was not significantly associated with OAHI quartiles, but increased risk was observed at an OAHI greater than 25. Conclusions: The strong adjusted association between ischemic stroke and OAHI in community-dwelling men with mild to moderate sleep apnea suggests that this is an appropriate target for future stroke prevention trials.Keywords: sleep apnea; stroke; epidemiology Approximately 15.3 million strokes occur annually worldwide, and about one-third of these are fatal (1). Stroke is not only the second leading cause of death globally, but it also accounts for significant disability, institutionalization, and health care costs (2). Because stroke rates increase exponentially with advancing age, the public health importance of strokes is likely to increase as the population ages. The risk of stroke is particularly high in African Americans, American Indians, and elderly women (2). Numerous studies have identified risk factors for stroke, including hypertension, atrial fibrillation, diabetes, and smoking (2-5). Even after considering these well-recognized risk factors, there is substantial variation in stroke rates and stroke-related outcomes.Emerging data implicate obstructive sleep apnea (OSA) in the pathogenesis of risk factors associated with ischemic stroke (i.e., hypertension, coronary heart disease, diabetes, and atrial fibrillation) (6). These associations are believed to be mediated by adverse physiological responses to recurrent periods of pharyngeal occlusion and consequent oxyhemoglobin desaturation-resaturation. These responses result in free radical generation, release of proinflammatory and prothrombotic mediators, and surges in sympathetic nervous system activity and blood pressure. Th...

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Assessing the use of medications in the elderly: Methods and initial experience in the cardiovascular health study

Cited by 292 publications

References 27 publications

Correlates and prevalence of benzodiazepine use in community-dwelling elderly

Correlates and prevalence of benzodiazepine use in community-dwelling elderly

Stroke risk in an elderly population with atrial fibrillation

Obstructive Sleep Apnea–Hypopnea and Incident Stroke

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