@article {11, title = {Effect of person-centred care on antipsychotic drug use in nursing homes (EPCentCare): study protocol for a cluster-randomised controlled trial.}, journal = {Implement Sci}, volume = {10}, year = {2015}, month = {2015 Jun 04}, pages = {82}, abstract = {

BACKGROUND: The majority of nursing home residents with dementia experience behavioural and psychological symptoms like apathy, agitation, and anxiety. According to analyses of prescription prevalence in Germany, antipsychotic drugs are regularly prescribed as first-line treatment of neuropsychiatric symptoms in persons with dementia, although guidelines clearly prioritise non-pharmacological interventions. Frequently, antipsychotic drugs are prescribed for inappropriate reasons and for too long without regular reviewing. The use of antipsychotics is associated with adverse events like increased risk of falling, stroke, and mortality. The aim of the study is to investigate whether a person-centred care approach, successfully evaluated in nursing homes in the United Kingdom, can be implemented in German nursing homes and, in comparison with a control group, can result in a clinically relevant reduction of the proportion of residents with antipsychotic prescriptions.

METHODS/DESIGN: The study is a cluster-randomised controlled trial comparing an intervention group (two-day initial training on person-centred care and ongoing training and support programme) with a control group. Both study groups will receive, as optimised usual care, a medication review by an experienced psychiatrist/geriatrician providing feedback to the prescribing physician. Overall, 36 nursing homes in East, North, and West Germany will be randomised. The primary outcome is the proportion of residents receiving at least one antipsychotic prescription (long-term medication) after 12~months of follow-up. Secondary outcomes are residents{\textquoteright} quality of life, agitated behaviour, as well as safety parameters like falls and fall-related medical attention. A health economic evaluation and a process evaluation will be performed alongside the study.

DISCUSSION: To improve care, a reduction of the current high prescription rate of antipsychotics in nursing homes by the intervention programme is expected.

TRIAL REGISTRATION: ClinicalTrials.gov: NCT02295462.

}, keywords = {Accidental Falls, Antipsychotic Agents, Costs and Cost Analysis, Dementia, Drug Utilization, Germany, Homes for the Aged, Humans, Inservice Training, Mental Disorders, Nursing Homes, Patient-Centered Care, Psychomotor Agitation, Quality of Life, Research Design}, issn = {1748-5908}, doi = {10.1186/s13012-015-0268-3}, author = {Richter, Christin and Berg, Almuth and Fleischer, Steffen and K{\"o}pke, Sascha and Balzer, Katrin and Fick, Eva-Maria and S{\"o}nnichsen, Andreas and L{\"o}scher, Susanne and Vollmar, Horst Christian and Haastert, Burkhard and Icks, Andrea and Dintsios, Charalabos-Markos and Mann, Eva and Wolf, Ursula and Meyer, Gabriele} } @article {17, title = {Prevalence and associations of potentially inappropriate prescriptions in Austrian nursing home residents: secondary analysis of a cross-sectional study.}, journal = {Wien Klin Wochenschr}, volume = {125}, year = {2013}, month = {2013 Apr}, pages = {180-8}, abstract = {

BACKGROUND: Potentially inappropriate prescriptions (PIP) are an important cause of adverse medication-related events and increases morbidity, hospitalization, and health care costs, especially in nursing home residents. However, little is known about the associations between PIP and residents{\textquoteright} characteristics.

OBJECTIVE: The aim of our study was to analyse the prevalence and associations of PIP with residents{\textquoteright} and facilities{\textquoteright} characteristics.

METHODS: We performed a secondary analysis of a cross-sectional study with 48 out of 50 eligible nursing homes and 1,844 out of 2,005 eligible residents in a defined rural-urban area in Austria. The Austrian list of potentially inappropriate medications was applied for the evaluation of inappropriate prescribing. Cluster-adjusted multiple regression analysis was used to investigate institutional and residents{\textquoteright} characteristics associated with PIP.

RESULTS: Mean cluster-adjusted prevalence of residents with at least one PIP was 70.3 \% (95 \% CI 67.2-73.4). The number of residents with at least one psychotropic PIP was 1.014 (55 \%). The most often prescribed PIP were Prothipendyl (25.9 \% residents), Lorazepam (14.5 \%) and Diclofenac (6.1 \%). Multiple regression analysis showed an inverse association of PIP with cognitive impairment and significant positive associations with permanent restlessness and permanent negative attitude. The associations of PIP with age and male gender were inconsistent. No significant associations were found for PIP and the ratio of staff nurses to residents.

CONCLUSIONS: Our study results confirm that PIP is highly prevalent in the nursing home population. These results urgently call for effective interventions. Initiatives and successful interventions performed in other countries could serve as examples for safer prescribing in residents in Austria.

}, keywords = {Adult, Age Distribution, Aged, Austria, Cognition Disorders, Comorbidity, Cross-Sectional Studies, Diclofenac, Female, Humans, Inappropriate Prescribing, Lorazepam, Male, Middle Aged, Nursing Care, Nursing Homes, Prescriptions, Prevalence, Psychomotor Agitation, Psychotropic Drugs, Risk Assessment}, issn = {1613-7671}, doi = {10.1007/s00508-013-0342-2}, author = {Mann, Eva and Haastert, Burkhard and B{\"o}hmdorfer, Birgit and Fr{\"u}hwald, Thomas and Iglseder, Bernhard and Roller-Wirnsberger, Regina and Meyer, Gabriele} } @article {19, title = {Potentially inappropriate medication in geriatric patients: the Austrian consensus panel list.}, journal = {Wien Klin Wochenschr}, volume = {124}, year = {2012}, month = {2012 Mar}, pages = {160-9}, abstract = {

BACKGROUND: The practice of inappropriate medication and drug prescription is a major risk factor for adverse drug reactions in geriatric patients and increases the individual, as well as overall, rates of hospital admissions, resulting in increased health care expenditures. A consensus-based list of drugs, generally to be avoided in geriatric patients, is a practical tool to possibly improve the quality of prescribing.

OBJECTIVE: The aim was to develop a consensus-based list of potentially inappropriate medications (PIM) for geriatric patients in Austria. Local market characteristics and documented prescribing regimens were considered in detail.

METHODS: A two-round Delphi process involving eight experts in the field of geriatric medicine was undertaken to create a list of potentially inappropriate medications. Using a 5-point Likert scale (from strong agreement to strong disagreement), mean ratings from the experts were evaluated for each drug selected in the first round. The participants were first asked to comment on the potential inappropriateness of a preliminary list of drugs, and to propose alternate substances missing in the previous questionnaire for a second rating process. All drugs whose upper limit of the 95\% CI was less than 3.0 were classified as potentially inappropriate. Drugs with a 95\% CI enclosing 3.0 entered a second rating by the experts, in addition to other substances suggested during the first questionnaire. Drugs in the second rating were evaluated in comparable fashion to the first one. The final list was synthesized from the results in both rounds.

RESULTS: Out of a preliminary list of 102 drugs, 61 drugs (59.2\%) were classified as potentially inappropriate for geriatric persons in the first Delphi- round. In the second rating, six drugs that were reevaluated, and six drugs proposed additionally, were rated as potentially inappropriate. The final list contains 73 drugs to be avoided in older patients because of an unfavorable benefit/risk profile and/or unproven effectiveness. The list also contains suggestions for therapeutic alternatives and information about pharmacological and pharmacokinetic characteristics of all drugs judged as potentially inappropriate.

CONCLUSION: The current Austrian list of potentially inappropriate medications may be a helpful tool for clinicians to increase the quality of prescribing in older patients. Like all explicit lists previously published, its validity needs to be proven in validation studies.

}, keywords = {Aged, Aged, 80 and over, Austria, Female, Humans, Inappropriate Prescribing, Male}, issn = {1613-7671}, doi = {10.1007/s00508-011-0061-5}, author = {Mann, Eva and B{\"o}hmdorfer, Birgit and Fr{\"u}hwald, Thomas and Roller-Wirnsberger, Regina E and Dovjak, Peter and D{\"u}ckelmann-Hofer, Christine and Fischer, Peter and Rabady, Susanne and Iglseder, Bernhard} } @article {24, title = {Comparison of hip fracture incidence and trends between Germany and Austria 1995-2004: an epidemiological study.}, journal = {BMC Public Health}, volume = {10}, year = {2010}, month = {2010 Jan 29}, pages = {46}, abstract = {

BACKGROUND: Several studies evaluated variations in hip fracture incidences, as well as trends of the hip fracture incidences. Comparisons of trends are lacking so far. We compared the incidence rates and, in particular, its trends between Austria and Germany 1995 to 2004 analysing national hospital discharge diagnosis register data.

METHODS: Annual frequencies of hip fractures and corresponding incidences per 100,000 person years were estimated, overall and stratified for sex and age, assuming Poisson distribution. Multiple Poisson regression models including country and calendar year, age and sex were used to analyse differences in incidence and trend. The difference of annual changes between the two countries was explored using an interaction term (calender year * country).

RESULTS: Overall, the increase of hip fracture risk was 1.31 fold higher (95\% CI 1.29-1.34) in Austria compared to Germany, adjusted for age, sex, and calendar year. The risk increase was comparable for both sexes (males: RR 1.35 (1.32-1.37), females: RR 1.31 (1.29-1.33)). Hip fracture trend from 1995 to 2004 indicates an increase in both countries without a statistically significant difference between Austria and Germany (interaction term: p = 0.67).

CONCLUSION: In this study comparing hip fracture incidences and its trend using pooled data, the incidence in Austria was 30\% higher compared to its neighbouring country Germany. For both countries a similar increasing trend of hip fracture incidence over the 10-year study period was calculated. The results need confirmation by other studies.

}, keywords = {Adult, Aged, Aged, 80 and over, Austria, Female, Germany, Hip Fractures, Humans, Incidence, Male, Middle Aged, Poisson Distribution, Young Adult}, issn = {1471-2458}, doi = {10.1186/1471-2458-10-46}, author = {Mann, Eva and Meyer, Gabriele and Haastert, Burkhart and Icks, Andrea} } @article {23, title = {Discrepancies in national incidence trends for hip fracture: why does Austria have such a high incidence?}, journal = {Wien Klin Wochenschr}, volume = {122}, year = {2010}, month = {2010 Mar}, pages = {126-8}, keywords = {Accidental Falls, Age Factors, Aged, Austria, Causality, Cross-Cultural Comparison, Cross-Sectional Studies, Female, Germany, Hip Fractures, Humans, Incidence, Male, Middle Aged, Risk Factors, Sex Factors, Switzerland}, issn = {1613-7671}, doi = {10.1007/s00508-010-1321-5}, author = {Mann, Eva and Icks, Andrea and Meyer, Gabriele} } @article {22, title = {Is it really a true reversal?}, journal = {Wien Klin Wochenschr}, volume = {122}, year = {2010}, month = {2010 Sep}, pages = {545}, keywords = {Age Factors, Aged, Aged, 80 and over, Austria, Cross-Cultural Comparison, Cross-Sectional Studies, Female, Hip Fractures, Humans, Incidence, Male, Middle Aged, Sex Factors}, issn = {1613-7671}, doi = {10.1007/s00508-010-1454-6}, author = {Mann, Eva and Icks, Andrea and Haastert, Bernhard and Meyer, Gabriele} } @article {26, title = {Frailty: an emerging concept for general practice.}, journal = {Br J Gen Pract}, volume = {59}, year = {2009}, month = {2009 May}, pages = {e177-82}, abstract = {

Ageing of the population in western societies and the rising costs of health and social care are refocusing health policy on health promotion and disability prevention among older people. However, efforts to identify at-risk groups of older people and to alter the trajectory of avoidable problems associated with ageing by early intervention or multidisciplinary case management have been largely unsuccessful. This paper argues that this failure arises from the dominance in primary care of a managerial perspective on health care for older people, and proposes instead the adoption of a clinical paradigm based on the concept of frailty. Frailty, in its simplest definition, is vulnerability to adverse outcomes. It is a dynamic concept that is different from disability and easy to overlook, but also easy to identify using heuristics (rules of thumb) and to measure using simple scales. Conceptually, frailty fits well with the biopsychosocial model of general practice, offers practitioners useful tools for patient care, and provides commissioners of health care with a clinical focus for targeting resources at an ageing population.

}, keywords = {Aged, Aged, 80 and over, Aging, Family Practice, Frail Elderly, Geriatric Assessment, Health Services for the Aged, Humans}, issn = {1478-5242}, doi = {10.3399/bjgp09X420653}, author = {De Lepeleire, Jan and Iliffe, Steve and Mann, Eva and Degryse, Jean Marie} } @article {28, title = {Family physicians need easy instruments for frailty.}, journal = {Age Ageing}, volume = {37}, year = {2008}, month = {2008 Jul}, pages = {484; author reply 484-5}, keywords = {Activities of Daily Living, Aged, Family Practice, Frail Elderly, Geriatric Assessment, Humans}, issn = {1468-2834}, doi = {10.1093/ageing/afn116}, author = {De Lepeleire, Jan and Degryse, Jan and Illiffe, Steve and Mann, Eva and Buntinx, Frank} } @article {27, title = {Hip fracture incidence in the elderly in Austria: an epidemiological study covering the years 1994 to 2006.}, journal = {BMC Geriatr}, volume = {8}, year = {2008}, month = {2008 Dec 23}, pages = {35}, abstract = {

BACKGROUND: Hip fractures in the elderly are a major public health burden. Data concerning secular trends of hip fracture incidence show divergent results for age, sex and regions. In Austria, the hip fracture incidence in the elderly population and trends have not been analysed yet.

METHODS: Hip fractures in the population of 50 years and above were identified from 1994 to 2006 using the national hospital discharge register. Crude incidences (IR) per 100,000 person years and standardised incidences related to the European population 2006 were analysed. Estimate of age-sex-adjusted changes was determined using Poisson regression (incidence rate ratios, IRRs).

RESULTS: The number of hospital admissions due to hip fracture increased from a total number of 11,694 in 1994 to 15,987 in 2006. Crude incidences rates (IR) per 100.000 for men increased from 244.3 (95\% confidence interval (CI) 234.8 to 253.7) in 1994 to IR 330.8 (95\% CI 320.8 to 340.9) in 2006 and for women from 637.3 (95\% CI 624.2 to 650.4) in 1994 to IR 758.7 (95\% CI 745.0 to 772.4) in 2006. After adjustment for age and sex the annual hip fracture incidence increase was only small but statistically significant (IRR per year 1.01, 95\% CI 1.01 to 1.01, p < 0.01). Change of IRR over the 12 years study period was 13\%. It was significantly higher for men (IRR over 12 years 1.21, 95\% CI 1.16 to 1.27) than for women (IRR over 12 years 1.10, 95\% CI 1.06 to 1.14) (interaction: p = 0.03).

CONCLUSION: In contrast to findings in other countries there is no levelling-off or downward trend of hip fracture incidence from 1994 to 2006 in the Austrian elderly population. Further investigations should aim to evaluate the underlying causes in order to plan effective hip fracture reduction programmes.

}, keywords = {Aged, Aged, 80 and over, Austria, Female, Hip Fractures, Humans, Incidence, Male, Middle Aged}, issn = {1471-2318}, doi = {10.1186/1471-2318-8-35}, author = {Mann, Eva and Icks, Andrea and Haastert, Burkhard and Meyer, Gabriele} }