Leeuw, T. de (Thijs) (2018) Polyfarmacie en medicatielast bij depressieve ouderen met chronisch somatische aandoeningen. thesis, Medicine.
Full text available on request.Abstract
Introduction People struggling with depression at a later age is a common societal issue. Previous work in our line of research has already demonstrated that depression in the elderly is associated with more chronic somatic disorders, and is associated with an increased risk of polypharmacy, as well as a higher anticholinergic and sedative drug/medication burden. Polypharmacy is associated with side effects, drug interactions, and inconsistent adherence to therapy. A higher medication burden is associated with cognitive and functional deterioration in the elderly. This research closely examines which chronic somatic disorders contribute to polypharmacy and a high medication burden in the elderly. Method This cross-sectional study has used the NIVEL ‘Primary Care Database’ database which contains data concerning morbidity and general practitioner care. This database is supplemented with pharmaceutical data concerning the socioeconomic status. Patients who have been diagnosed with depression and have a minimum age of 60, are matched in age and gender with mentally healthy patients. The following chronic somatic diseases have been examined: airway diseases (COPD/asthma), osteoarthritis, cardiovascular diseases, malignancies. Stepwise multivariate regression analyses have been executed in order to examine the impact/influence of chronic somatic disorders on both polypharmacy and medication burden. Furthermore, it is examined through an interaction term (depression * disorder) whether having a depression combined with a chronic somatic disorder has a possible synergistic effect on the occurrence/presence of polypharmacy or medication burden. In order to quantify the medication burden, the Drug Burden Index (DBI) is used. Results Having airway diseases (OR 2.57; 95% BI 2.34-3.26), osteoarthritis (OR 1.23; 95% BI 1.01-1.49), DM (OR 3.56; 95% BI 2.90-4.36), and cardiovascular diseases (OR 4.92; 95% BI 4.09-5.92) are associated with polypharmacy in elderly with depression. Airway diseases, osteoarthritis, DM, and cardiovascular diseases are associated with a higher medication burden of anticholinergic and sedative medication for elderly with depression, as expressed in the DBI. Either DM or cardiovascular diseases in combination with a depression have a synergistic effect on the level of the DBI. Conclusion We have demonstrated that airway diseases, osteoarthritis, DM, and cardiovascular diseases are associated with polypharmacy in the elderly with depression. Furthermore, these diseases are associated with a higher medication burden in the depressed elderly. Either DM and cardiovascular diseases in combination with a depression have a synergistic effect on the level of the DBI. Since a high anticholinergic and sedative medication burden causes cognitive and physical deterioration in the elderly, one should be aware of the consequences of high medication burden in depressed elderly who also suffer from DM or cardiovascular diseases.
| Item Type: | Thesis (Thesis) |
|---|---|
| Supervisor name: | Verhaak, Prof. Dr. P.F.M. and Holvast, drs F. |
| Faculty: | Medical Sciences |
| Date Deposited: | 25 Jun 2020 10:45 |
| Last Modified: | 25 Jun 2020 10:45 |
| URI: | https://umcg.studenttheses.ub.rug.nl/id/eprint/668 |
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