@article {453, title = {Impact of strategies to reduce polypharmacy on clinically relevant endpoints: a systematic review and meta-analysis.}, journal = {Br J Clin Pharmacol}, volume = {82}, year = {2016}, month = {2016 Aug}, pages = {532-48}, abstract = {

AIM: The aim of the present study was to explore the impact of strategies to reduce polypharmacy on mortality, hospitalization and change in number of drugs.

METHODS: Systematic review and meta-analysis: a systematic literature search targeting patients >=65 years with polypharmacy (>=4 drugs), focusing on patient-relevant outcome measures, was conducted. We included controlled studies aiming to reduce polypharmacy. Two reviewers independently assessed studies for eligibility, extracted data and evaluated study quality.

RESULTS: Twenty-five studies, including 10 980 participants, were included, comprising 21 randomized controlled trials and four nonrandomized controlled trials. The majority of the included studies aimed at improving quality or the appropriateness of prescribing by eliminating inappropriate and non-evidence-based drugs. These strategies to reduce polypharmacy had no effect on all-cause mortality (odds ratio 1.02; 95\% confidence interval 0.84, 1.23). Only single studies found improvements, in terms of reducing the number of hospital admissions, in favour of the intervention group. At baseline, patients were taking, on average, 7.4 drugs in both the intervention and the control groups. At follow-up, the weighted mean number of drugs was reduced (-0.2) in the intervention group but increased (+0.2) in controls.

CONCLUSIONS: There is no convincing evidence that the strategies assessed in the present review are effective in reducing polypharmacy or have an impact on clinically relevant endpoints. Interventions are complex; it is still unclear how best to organize and implement them to achieve a reduction in inappropriate polypharmacy. There is therefore a need to develop more effective strategies to reduce inappropriate polypharmacy and to test them in large, pragmatic randomized controlled trials on effectiveness and feasibility.

}, keywords = {Aged, Drug-Related Side Effects and Adverse Reactions, Hospitalization, Humans, Inappropriate Prescribing, Outcome Assessment, Health Care, Polypharmacy, Practice Patterns, Physicians{\textquoteright}, Randomized Controlled Trials as Topic}, issn = {1365-2125}, doi = {10.1111/bcp.12959}, author = {Johansson, Tim and Abuzahra, Muna E and Keller, Sophie and Mann, Eva and Faller, Barbara and Sommerauer, Christina and H{\"o}ck, Jennifer and L{\"o}ffler, Christin and K{\"o}chling, Anna and Schuler, Jochen and Flamm, Maria and S{\"o}nnichsen, Andreas} } @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 {12, title = {The impact of preoperative testing for blood glucose concentration and haemoglobin A1c on mortality, changes in management and complications in noncardiac elective surgery: a systematic review.}, journal = {Eur J Anaesthesiol}, volume = {32}, year = {2015}, month = {2015 Mar}, pages = {152-9}, abstract = {

BACKGROUND: The risks associated with surgery are elevated in patients with diabetes mellitus. For this reason, preoperative diagnostics frequently include the measurement of blood glucose and haemoglobin A1c (HbA1c), but it is unclear whether these tests contribute to improved perioperative or postoperative outcomes.

OBJECTIVES: This systematic review aimed to evaluate the evidence that preoperative testing for blood glucose and HbA1c might influence the following outcome parameters: changes in clinical management; mortality; and the incidence of perioperative and postoperative complications in patients undergoing elective, noncardiac surgery.

DESIGN: We performed a systematic search of the literature from January 2001 to March 2013, thus updating a review carried out by the National Institute for Health and Clinical Excellence (NICE) up to the year 2001.

ELIGIBILITY CRITERIA: Controlled studies including cohort and case-control studies with a population of at least 60 patients were eligible.

RESULTS: The search retrieved 1346 records (including hand-search). Twenty-two studies met all inclusion criteria and were included in the review. Fifteen cohort and two case-control studies evaluated the effectiveness of preoperative blood glucose testing and nine studies the effectiveness of testing HbA1c. Four of the included studies evaluated both tests. There were no data derived from high-quality studies supporting routine preoperative testing for blood glucose or HbA1c in otherwise healthy adult patients undergoing elective noncardiac surgery. Only in vascular and orthopaedic surgery may screening identify patients at an increased risk.

CONCLUSION: Preoperative blood glucose testing and testing for HbA1c is not required in nondiabetic patients unless there are clinical sings arousing suspicion. Patients scheduled for vascular and orthopaedic surgery carry an elevated risk justifying preoperative testing for blood glucose or HbA1c as a screening tool.

}, keywords = {Biomarkers, Blood Glucose, Diabetes Mellitus, Elective Surgical Procedures, Glycated Hemoglobin, Humans, Orthopedic Procedures, Predictive Value of Tests, Preoperative Care, Risk Assessment, Risk Factors, Time Factors, Treatment Outcome, Vascular Surgical Procedures}, issn = {1365-2346}, doi = {10.1097/EJA.0000000000000117}, author = {Bock, Matthias and Johansson, Tim and Fritsch, Gerhard and Flamm, Maria and Hansbauer, Bernhard and Mann, Eva and S{\"o}nnichsen, Andreas} } @article {14, title = {Assessment tools for determining appropriateness of admission to acute care of persons transferred from long-term care facilities: a systematic review.}, journal = {BMC Geriatr}, volume = {14}, year = {2014}, month = {2014 Jun 22}, pages = {80}, abstract = {

BACKGROUND: Residents of long-term care facilities have a high risk of acute care admission. Estimates of the frequency of inappropriate transfers vary substantially throughout the studies and various assessment tools have been used. The purpose of this study is to systematically review and describe the internationally existing assessment tools used for determining appropriateness of hospital admissions among long-term care residents.

METHOD: Systematic review of the literature of two databases (PubMed and CINAHL{\textregistered}). The search covered seven languages and the period between January 2000 and December 2012. All quantitative studies were included if any assessment tool for appropriateness of hospital and/or emergency department admission of long-term care residents was used. Two pairs of independent researchers extracted the data.

RESULTS: Twenty-nine articles were included, covering study periods between 1991 and 2009. The proportion of admissions considered as inappropriate ranged from 2\% to 77\%. Throughout the studies, 16 different assessment tools were used; all were based on expert opinion to some extent; six also took into account published literature or interpretation of patient data. Variation between tools depended on the concepts studied, format and application, and aspects evaluated. Overall, the assessment tools covered six aspects: specific medical diagnoses (assessed by n = 8 tools), acuteness/severity of symptoms (n = 7), residents{\textquoteright} characteristics prior to admission (n = 6), residents{\textquoteright} or families{\textquoteright} wishes (n = 3), existence of a care plan (n = 1), and availability or requirement of resources (n = 10). Most tools judged appropriateness based on one fulfilled item; five tools judged appropriateness based on a balance of aspects. Five tools covered only one of these aspects and only six considered four or more aspects. Little information was available on the psychometric properties of the tools.

CONCLUSIONS: Most assessment tools are not comprehensive and do not take into account residents{\textquoteright} individual aspects, such as characteristics of residents prior to admission and wishes of residents or families. The generalizability of the existing tools is unknown. Further research is needed to develop a tool that is evidence-based, comprehensive and generalizable to different regions or countries in order to assess the appropriateness of hospital admissions among long-term care residents.

}, keywords = {Emergency Service, Hospital, Humans, Long-Term Care, Patient Admission, Patient Transfer, Residential Facilities}, issn = {1471-2318}, doi = {10.1186/1471-2318-14-80}, author = {Renom-Guiteras, Anna and Uhrenfeldt, Lisbeth and Meyer, Gabriele and Mann, Eva} } @article {13, title = {Compliance with trial registration in five core journals of clinical geriatrics: a survey of original publications on randomised controlled trials from 2008 to 2012.}, journal = {Age Ageing}, volume = {43}, year = {2014}, month = {2014 Nov}, pages = {872-6}, abstract = {

OBJECTIVE: to assess the proportion of registered randomised controlled trials in five core clinical geriatric journals and to analyse whether registered study outcomes correspond with published outcomes.

DESIGN: survey of original papers published 2008 to 2012.

METHODS: two independent reviewers retrieved the sample through search in the web-based archives of Age and Ageing, the Journal of the American Geriatric Society, the American Journal of Geriatric Psychiatry, the Journal of the American Medical Directors Association and International Psychogeriatrics. Data extraction was performed by two independent reviewers using a pre-tested 13-item checklist. Registration status was checked and information provided in registers compared with information presented in the original publication. A third reviewer was consulted if no consensus could be reached.

RESULTS: the sample comprised 220 original publications on randomised controlled trials. A total of 140 (63.6\%) were registered. Registration was in accordance with the ICMJE requirements in 54 out of 140 registered trials (38.6\%). Less than one-third of registered papers (n = 40) reported on all study outcomes listed in the study register. In 74 out of the 80 non-registered trials, the missing registration was not declared in the publication. There was no consistent upward trend towards higher registration compliance throughout journals and years.

CONCLUSION: our survey shows that prospective trial registration and compliance between outcomes declared in the registry and reported in the publication is poor. Concerted action of authors, editors and peer-reviewers is overdue aimed to irreversibly implement the imperative of registration of randomised controlled trials and complete outcome reporting.

}, keywords = {Geriatrics, Guideline Adherence, Guidelines as Topic, Humans, Periodicals as Topic, Publication Bias, Randomized Controlled Trials as Topic, Registries, Research Design}, issn = {1468-2834}, doi = {10.1093/ageing/afu086}, author = {Mann, Eva and Nguyen, Natalie and Fleischer, Steffen and Meyer, Gabriele} } @article {15, title = {Information technology interventions to improve medication safety in primary care: a systematic review.}, journal = {Int J Qual Health Care}, volume = {25}, year = {2013}, month = {2013 Oct}, pages = {590-8}, abstract = {

PURPOSE: Improving medication safety has become a major topic in all clinical settings. Information technology (IT) can play an important role to prevent adverse drug events (ADEs), but data on the effectiveness of IT interventions are controversial. The objective of this paper is to provide a systematic review about the effects of IT interventions on medication safety in primary care.

DATA SOURCES: PubMed, International Pharmaceutical Abstracts, EMBASE, Cochrane Database of Systematic Reviews, handsearching reference lists from full-text articles.

STUDY SELECTION: Randomized controlled trials (RCTs), if interventions based on IT, performed in primary care and outcomes reported on medication safety. Data extraction Study characteristics and outcome data independently extracted by two reviewers. Disagreement resolved by discussion with a third reviewer.

RESULTS OF DATA SYNTHESIS: Out of 3918 studies retrieved, 10 RCTs met the inclusion criteria. Of the six studies evaluating computerized provider order entry (CPOE) with clinical decision support (CDS) only 3 studies effectively reduced unsafe prescribing. Both pharmacist-led IT interventions decreased the prescription of potentially inappropriate medication or unsafe prescribing in pregnancy. No reduction of ADEs was achieved by a web program or a TeleWatch system intervention.

CONCLUSION: Only 5 of 10 RCTs revealed a reduction of medication errors. CPOE with CDS was effective if targeted at a limited number of potentially inappropriate medications. The positive results of pharmacist-led IT interventions indicate that IT interventions with inter-professional communication appear to be effective. The unequivocal results of the included RCTs stress the necessity of rigorous evaluation prior to large-scale implementation.

}, keywords = {Humans, Medical Informatics, Medication Errors, Patient Safety, Primary Health Care, Quality Improvement}, issn = {1464-3677}, doi = {10.1093/intqhc/mzt043}, author = {Lainer, Miriam and Mann, Eva and S{\"o}nnichsen, Andreas} } @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 {18, title = {Diabetes care among older adults in primary care in Austria--a cross-sectional study.}, journal = {Swiss Med Wkly}, volume = {142}, year = {2012}, month = {2012}, pages = {w13646}, abstract = {

QUESTIONS UNDER STUDY: The prevalence of diabetes mellitus in the older population is high, but hardly any data are available on current diabetes care in the primary care setting. We aimed at investigating the diabetes management of older patients with type 2 diabetes (T2DM) in the primary care setting, including adherence to current guidelines, comparing patients aged 70-79 years to those aged 80 years and above.

METHODS: From November 2008 through March 2009 a total of 23 primary care physicians and one consultant in internal medicine consecutively enrolled 203 unselected patients with T2DM aged >=70 years.

RESULTS: From the 203 study participants 66\% were 70-79 years of age, and 34\% were 80 years or older. Mean HbA1c and LDL-cholesterol were not significantly different between the older and the younger age group (7.6 {\textpm} 1.6 vs. 7.1 {\textpm} 0.9\%; p = 0.080; and 122 {\textpm} 40 vs. 114 {\textpm} 34 mg/dl; p = 0.273), whereas BMI was lower (27.5 {\textpm} 5.0 vs. 29.6 {\textpm} 5.0 kg/m2, p = 0.010), and the prevalent rates of coronary heart disease (55.1 vs. 37.1\%, p = 0.011) and of dementia (29\% vs. 6.1\%, p = 0.001) were higher in the older age group. LDL-cholesterol (77.6\% vs. 66.7\%, p = 0.012), creatinine clearance (34.6\% vs. 30.9\%, p = 0.049) but not HbA1c (74.6\% vs.73.9; p = 0.520) were monitored significantly less often in the older than in the younger age group.

CONCLUSIONS: While glycaemic control on average appears strict, there may be ample room for improvement in reaching lipid targets and in the monitoring of lipid and renal function among older adults in primary care, in particular among individuals aged >=80 years.

}, keywords = {Age Factors, Aged, Aged, 80 and over, Austria, Body Mass Index, Chi-Square Distribution, Cholesterol, HDL, Cholesterol, LDL, Creatinine, Cross-Sectional Studies, Diabetes Mellitus, Type 2, Female, Glomerular Filtration Rate, Glycated Hemoglobin, Humans, Male, Practice Patterns, Physicians{\textquoteright}, Statistics, Nonparametric, Triglycerides}, issn = {1424-3997}, doi = {10.4414/smw.2012.13646}, author = {Mann, Eva and Vonbank, Alexander and Drexel, Heinz and Saely, Christoph H} } @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 {20, title = {Prevalence of psychotropic medication use among German and Austrian nursing home residents: a comparison of 3 cohorts.}, journal = {J Am Med Dir Assoc}, volume = {13}, year = {2012}, month = {2012 Feb}, pages = {187.e7-187.e13}, abstract = {

BACKGROUND: Despite increasing knowledge about the limited effectiveness and severe adverse effects, the prescription rate of psychotropic medications in frail elderly persons remains high. Prescriptions are mainly made to control behavioral and psychological symptoms of dementia, although factors associated with prescriptions are rarely reported. However, such information is a prerequisite to develop intervention programs aiming to safely reduce psychotropic medication in nursing home residents.

METHODS: We report the comparison of cross-sectional data of psychotropic medication prescription rates from 3 large studies including nursing home residents in Germany and Austria. We aimed to compare the prevalence of (1) psychotropic medication, (2) different classes of psychotropic medication, (3) psychotropic medication administered for bedtime use, and (4) associations between prescription of psychotropics and institutional and residents{\textquoteright} characteristics. Confidence intervals of prevalences and multiple logistic regression analyses were adjusted for cluster correlation.

RESULTS: Data from 5336 residents in 136 long term care facilities were included. In Austria, 74.6\% (95\% CI 72.0-77.2\%) of all residents had a prescription of at least one psychotropic medication compared to Germany with about 51.8\% (95\% CI 48.3-55.2\%) and 52.4\% (95\% CI 48.7-56.1\%). Of all antipsychotics, 66\% (Austria) and 47\% (Germany) were prescribed for bedtime use. Most prescriptions were conventional, low-potency antipsychotics. In all 3 studies, there was no statistically significant association between psychotropic medication prescription and nursing home characteristics. On the level of residents, consistent positive associations were found for higher level of care dependency and permanent restlessness. Consistent negative associations were found for older age and male gender.

CONCLUSION: Frequency of psychotropic and especially antipsychotic medication is substantial in nursing home residents in Germany and Austria. The high number of prescriptions is likely to be an indicator for a perceived or actual lack of strategies to handle behavioral and psychological symptoms of dementia.

}, keywords = {Age Distribution, Aged, Aged, 80 and over, Austria, Cluster Analysis, Cross-Sectional Studies, Dementia, Dose-Response Relationship, Drug, Drug Administration Schedule, Drug Utilization, Female, Geriatric Assessment, Germany, Homes for the Aged, Humans, Logistic Models, Long-Term Care, Male, Nursing Homes, Prevalence, Psychotropic Drugs, Risk Assessment, Sex Distribution}, issn = {1538-9375}, doi = {10.1016/j.jamda.2011.03.007}, author = {Richter, Tanja and Mann, Eva and Meyer, Gabriele and Haastert, Burkhard and K{\"o}pke, Sascha} } @article {21, title = {Reporting quality of conference abstracts on randomised controlled trials in gerontology and geriatrics: a cross-sectional investigation.}, journal = {Z Evid Fortbild Qual Gesundhwes}, volume = {105}, year = {2011}, month = {2011}, pages = {459-62}, abstract = {

Without transparent reporting of how a randomised controlled trial was designed and conducted and of the methods used, its internal validity cannot be assessed by the reader. A congress abstract is often the only source providing information about a trial. In January 2008, an extended CONSORT statement on abstract reporting was published. Its impact has yet to be evaluated. Using a slightly modified CONSORT checklist comprising 17 items, we thus investigated the reporting quality of randomised controlled trials published in the book of abstracts presented at the World Congress of Geriatrics and Gerontology in Paris in July 2009. A total of n=4,416 abstracts was screened for inclusion; n=129 met the inclusion criteria. The overall quality of the abstracts was remarkably poor. The primary outcome was mentioned in 34/129 abstracts (26\%), none of the abstracts reported on the procedure of random allocation of participants or clusters, 21/129 abstracts (16\%) reported some kind of blinding, and the attrition rate was mentioned in only 12/129 abstracts (9\%). The majority of abstracts fulfilled two items: description of intended intervention for each group (102/129; 79\%) and general interpretation of results (107/129; 83\%). Trial status was reported in all abstracts. Both journal editors and committees organising congresses are requested to define the use of the CONSORT statement as a prerequisite in their guidelines for authors and to instruct reviewers to conduct compliance checks. Medical associations should finally endorse the indispensability of the CONSORT statement and publish it in their journals. Otherwise the intended benefits cannot be fully generated.

}, keywords = {Abstracting and Indexing, Checklist, Congresses as Topic, Cross-Sectional Studies, Geriatrics, Germany, Guidelines as Topic, Humans, Quality Assurance, Health Care, Randomized Controlled Trials as Topic, Research Design, Writing}, issn = {1865-9217}, doi = {10.1016/j.zefq.2010.07.011}, author = {Mann, Eva and Meyer, Gabriele} } @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 {25, title = {Psychotropic medication use among nursing home residents in Austria: a cross-sectional study.}, journal = {BMC Geriatr}, volume = {9}, year = {2009}, month = {2009 May 21}, pages = {18}, abstract = {

BACKGROUND: The use of psychotropic medications and their adverse effects in frail elderly has been debated extensively. However, recent data from European studies show that these drugs are still frequently prescribed in nursing home residents. In Austria, prevalence data are lacking. We aimed to determine the prevalence of psychotropic medication prescription in Austrian nursing homes and to explore characteristics associated with their prescription.

METHODS: Cross-sectional study and association analysis in forty-eight out of 50 nursing homes with 1844 out of a total of 2005 residents in a defined urban-rural region in Austria. Prescribed medication was retrieved from residents{\textquoteright} charts. Psychotropic medications were coded according to the Anatomical Therapeutic Chemical Classification 2005. Cluster-adjusted multiple logistic regression analysis was performed to investigate institutional and residents{\textquoteright} characteristics associated with prescription.

RESULTS: Residents{\textquoteright} mean age was 81; 73\% of residents were female. Mean cluster-adjusted prevalence of residents with at least one psychotropic medication was 74.6\% (95\% confidence interval, CI, 72.0-77.2). A total of 45.9\% (95\% CI 42.7-49.1) had at least one prescription of an antipsychotic medication. Two third of all antipsychotic medications were prescribed for bedtime use only. Anxiolytics were prescribed in 22.2\% (95\% CI 20.0-24.5), hypnotics in 13.3\% (95\% CI 11.3-15.4), and antidepressants in 36.8\% (95\% CI 34.1-39.6) of residents. None of the institutional characteristics and only few residents{\textquoteright} characteristics were significantly associated with psychotropic medication prescription. Permanent restlessness was positively associated with psychotropic medication prescription (AOR 1.54, 95\% CI 1.32-1.79) whereas cognitive impairment was inversely associated (AOR 0.70, 95\% CI 0.56-0.88).

CONCLUSION: Frequency of psychotropic medication prescription is high in Austrian nursing homes compared to recent published data from other countries. Interventions should aim at reduction and optimisation of prescriptions.

}, keywords = {Adult, Aged, Aged, 80 and over, Austria, Cross-Sectional Studies, Female, Homes for the Aged, Humans, Male, Middle Aged, Nursing Homes, Psychotropic Drugs}, issn = {1471-2318}, doi = {10.1186/1471-2318-9-18}, author = {Mann, Eva and K{\"o}pke, Sascha and Haastert, Burkhard and Pitk{\"a}l{\"a}, Kaisu and Meyer, Gabriele} } @article {29, title = {[Chemical restraints in nursing homes in the federal state Vorarlberg, Austria--an analysis of nursing home documentation according to legal obligation and suggestions for future improvement].}, journal = {Wien Med Wochenschr}, volume = {158}, year = {2008}, month = {2008}, pages = {489-92}, abstract = {

High prevalence of chemical restraints in nursing homes is being criticised as suboptimal care. According to a new legal act, the Austrian "Heimaufenthaltsgesetz" 2005, nursing homes are obliged to report not only physical restraints but also chemical restraints. Using the Beers criteria we analysed all 78 notifications of chemical restraints registered during 18 months. Pronounced deficits concerning the selection of reporting criteria and the quality of doctors{\textquoteright} documentation of prescription were observed. National guidelines defining chemical restraints and providing valid assessment instruments are urgently warranted.

}, keywords = {Austria, Behavior Control, Diazepam, Documentation, Drug Prescriptions, Forecasting, Humans, Hypnotics and Sedatives, Nursing Homes, Tranquilizing Agents}, issn = {0043-5341}, doi = {10.1007/s10354-008-0549-4}, author = {Mann, Eva and Meyer, Gabriele} } @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} } @article {30, title = {Preventive health risk appraisal for older people and impact on GPs{\textquoteright} patient management: a prospective study.}, journal = {Fam Pract}, volume = {24}, year = {2007}, month = {2007 Dec}, pages = {604-9}, abstract = {

BACKGROUND: Health risk appraisals (HRAs) are recommended for detection of potentially modifiable risk factors for health status decline of older people. Little is known how family physicians manage detected risk factors.

OBJECTIVE: We evaluated (i) if risk factors in one or more of five predefined domains were detected in a primary care-based HRA and (ii) how often these findings had an impact on the further management of patients.

METHODS: We performed a prospective observational study in a rural community in Austria and included persons (age >or= 70 years) living at home. We applied the standardized assessment for elderly people in primary care (STEP) instrument and evaluated risk factors for status decline assessing five domains (cognitive function, depression, urinary incontinence, hearing impairment and mobility/falls).

RESULTS: Two hundred and sixty-four persons participated and the HRA revealed a wide range of risk factors for health status decline [from 4.5\% (12/264) in the depression domain up to 31\% (81/264) for mobility/falls and 41\% (107/264) in the cognitive domain]. The findings had an impact on the further management in four domains: hearing impairment (100\% of findings with impact), mobility/falls (93\%), depression (83\%) and urinary incontinence (65\%). In contrast, abnormal cognitive findings lead to action only in every fifth participant (18\%; 19/107).

CONCLUSION: In contrast to other domains, family physicians are hesitant to act upon abnormal findings of cognitive testing. Additional knowledge is needed to clarify the value of abnormal cognitive findings for management of patients and support of their carers.

}, keywords = {Aged, Aged, 80 and over, Austria, Female, Health Status Indicators, Humans, Male, Observation, Patient Care Management, Physicians, Family, Prospective Studies, Risk Factors}, issn = {0263-2136}, doi = {10.1093/fampra/cmm063}, author = {Eichler, Klaus and Scrabal, Clemens and Steurer, Johann and Mann, Eva} } @article {31, title = {Comprehensive Geriatric Assessment (CGA) in general practice: results from a pilot study in Vorarlberg, Austria.}, journal = {BMC Geriatr}, volume = {4}, year = {2004}, month = {2004 May 19}, pages = {4}, abstract = {

BACKGROUND: Most comprehensive geriatric assessment (CGA) programs refer to hospital-based settings. However the body of geriatric healthcare is provided by general practitioners in their office. Structured geriatric problem detection by means of assessment instruments is crucial for efficient geriatric care giving in the community.

METHODS: We developed and pilot tested a German language geriatric assessment instrument adapted for general practice. Nine general practices in a rural region of Austria participated in this cross-sectional study and consecutively enrolled 115 persons aged over 75 years. The prevalence of specific geriatric problems was assessed, as well as the frequency of initiated procedures following positive and negative tests. Whether findings were new to the physician was studied exemplarily for the items visual and hearing impairment and depression. The acceptability was recorded by means of self-administered questionnaires.

RESULTS: On average, each patient reported 6.4 of 14 possible geriatric problems and further consequences resulted in 43.7\% (27.5\% to 59.8\%) of each problem. The items with either the highest prevalence and/or the highest number of initiated actions by the GPs were osteoporosis risk, urinary incontinence, decreased hearing acuity, missing pneumococcal vaccination and fall risk. Visual impairment was newly detected in only 18\% whereas hearing impairment and depression was new to the physician in 74.1\% and 76.5\%, respectively.A substantial number of interventions were initiated not only following positive tests (43.7\% per item; 95\% CI 27.5\% to 59.8\%), but also as a consequence of negative test results (11.3\% per item; 95\% CI 1.7\% to 20.9\%). The mean time expenditure to accomplish the assessment was 31 minutes (SD 10 min). Patients (89\%) and all physicians confirmed the CGA to provide new information in general on the patient{\textquoteright}s health status. All physicians judged the CGA to be feasible in everyday practice.

CONCLUSION: This adapted CGA was feasible and well accepted in the general practice sample. High frequencies of geriatric problems were detected prompting high numbers of problem-solving initiatives. But a substantial number of actions of the physicians following negative tests point to the risks of too aggressive treatment of elderly patients with possibly subsequent negative effects.

}, issn = {1471-2318}, doi = {10.1186/1471-2318-4-4}, author = {Mann, Eva and Koller, Michael and Mann, Christian and van der Cammen, Tischa and Steurer, Johann} }