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Article ; Online: CORR Insights®: The Rothman Index is Associated With Postdischarge Adverse Events After Hip Fracture Surgery in Geriatric Patients.

Jämsen, Esa

Clinical orthopaedics and related research

2018 Volume 476, Issue 5, Page(s) 1007–1009

MeSH term(s)	Aged ; Hip Fractures ; Humans ; Pelvic Bones
Language	English
Publishing date	2018-04-18
Publishing country	United States
Document type	Journal Article ; Comment
ZDB-ID	80301-7
ISSN	1528-1132 ; 0009-921X
ISSN (online)	1528-1132
ISSN	0009-921X
DOI	10.1097/01.blo.0000532689.78005.16
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Article ; Online: Prevalence of potentially inappropriate medication use in older population: comparison of the Finnish Meds75+ database with eight published criteria.

Paulamäki, Jasmin / Jyrkkä, Johanna / Hyttinen, Virva / Jämsen, Esa

BMC geriatrics

2023 Volume 23, Issue 1, Page(s) 139

Abstract: Background: There are several national and international criteria available for identifying potentially inappropriate medications (PIMs) for older people. The prevalence of PIM use may vary depending on the criteria used. The aim is to examine the ... ...

Abstract	Background: There are several national and international criteria available for identifying potentially inappropriate medications (PIMs) for older people. The prevalence of PIM use may vary depending on the criteria used. The aim is to examine the prevalence of potentially inappropriate medication use in Finland according to the Meds75+ database, developed to support clinical decision-making in Finland, and to compare it with eight other PIM criteria. Methods: This nationwide register study consisted of Finnish people aged 75 years or older (n = 497,663) who during 2017-2019 purchased at least one prescribed medicine considered as a PIM, based on any of the included criteria. The data on purchased prescription medicines was collected from the Prescription Centre of Finland. Results: The annual prevalence of 10.7-57.0% was observed for PIM use depending on which criteria was used. The highest prevalence was detected with the Beers and lowest with the Laroche criteria. According to the Meds75+ database, annually every third person had used PIMs. Regardless of the applied criteria, the prevalence of PIM use decreased during the follow-up. The differences in the prevalence of medicine classes of PIMs explain the variance of the overall prevalence between the criteria, but they identify the most commonly used PIMs quite similarly. Conclusion: PIM use is common among older people in Finland according to the national Meds75+ database, but the prevalence is dependent on the applied criteria. The results indicate that different PIM criteria emphasize different medicine classes, and clinicians should consider this issue when applying PIM criteria in their daily practice.
MeSH term(s)	Humans ; Aged ; Potentially Inappropriate Medication List ; Inappropriate Prescribing ; Finland/epidemiology ; Prevalence ; Cross-Sectional Studies
Language	English
Publishing date	2023-03-10
Publishing country	England
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2059865-8
ISSN	1471-2318 ; 1471-2318
ISSN (online)	1471-2318
ISSN	1471-2318
DOI	10.1186/s12877-022-03706-z
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Article: Agreement Between Self-Reported Information and Health Register Data on Chronic Diseases in the Oldest Old.

Halonen, Pauliina / Jämsen, Esa / Enroth, Linda / Jylhä, Marja

Clinical epidemiology

2023 Volume 15, Page(s) 785–794

Abstract: Purpose: To study the agreement on disease prevalence between survey data and national health register data among people aged over 90.: Patients and methods: The survey data were from the Vitality 90+ Study conducted among 1637 community dwellers and ...

Abstract	Purpose: To study the agreement on disease prevalence between survey data and national health register data among people aged over 90. Patients and methods: The survey data were from the Vitality 90+ Study conducted among 1637 community dwellers and persons in long-term care aged 90 and over in Tampere, Finland. The survey was linked with two national health registers, including hospital discharge data and prescription information. The prevalence of 10 age-related chronic diseases was calculated for each data source and the agreement between the survey and the registers was estimated using Cohen's kappa statistics and positive and negative percent agreement. Results: The prevalence of most diseases was higher in the survey than in the registers. The level of agreement was highest when the survey was compared with information combined from both registers. Agreement was almost perfect for Parkinson's disease (ĸ=0.81) and substantial for diabetes (ĸ=0.75) and dementia (ĸ=0.66). For heart disease, hypertension, stroke, cancer, osteoarthritis, depression, and hip fracture, the agreement ranged from fair to moderate. Conclusion: Self-reported information on chronic diseases shows acceptable agreement with health register data to warrant the use of survey methods in population-based health studies among the oldest old. It is important to acknowledge the gaps in health registers when validating self-reported information against register data.
Language	English
Publishing date	2023-06-26
Publishing country	New Zealand
Document type	Journal Article
ZDB-ID	2494772-6
ISSN	1179-1349
ISSN	1179-1349
DOI	10.2147/CLEP.S410971
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Article ; Online: Regional variation of potentially inappropriate medication use and associated factors among older adults: A nationwide register study.

Paulamäki, Jasmin / Jyrkkä, Johanna / Hyttinen, Virva / Huhtala, Heini / Jämsen, Esa

Research in social & administrative pharmacy : RSAP

2023 Volume 19, Issue 10, Page(s) 1372–1379

Abstract: Background: Certain medications should be used with caution in older persons, which challenges rational prescribing. Potentially inappropriate medications (PIMs) are defined as medicines whose potential risk of harm typically outweighs the clinical ... ...

Abstract	Background: Certain medications should be used with caution in older persons, which challenges rational prescribing. Potentially inappropriate medications (PIMs) are defined as medicines whose potential risk of harm typically outweighs the clinical benefits in geriatric population. Earlier studies have found regional differences in PIM use, but the factors underlying this phenomenon are unclear. Objective: To compare prescription PIM prevalence among Finnish hospital districts and determine which population characteristics and factors related to social and health care are associated with regional variation. Methods: This nationwide register study was based on the Prescription Centre data on all people aged ≥75 years in 2017-2019. Hospital district (n = 20) characteristics were drawn from the Finnish Institute for Health and Welfare's, Finnish Medical Association's, and Finnish Medicines Agency's publicly open data. PIMs were defined according to the Finnish Meds75+ database. A linear mixed-effect model was used to analyze potential associations of regional characteristics with PIM prevalence. Results: Prevalence of PIMs varied between 16.4% and 24.8% across regions. The highest prevalence was observed in the southern regions, while the lowest prevalence was on the west coast. Hospital district characteristics associated with higher PIM prevalence were higher share of population living alone, with excessive polypharmacy, or assessed using the Resident Assessment Instrument, shortage of general practitioners in municipal health centers, and low share of home care personnel. Waiting time in health care or share of population with morbidities were not associated with PIM use. Of the total variance in PIM prevalence, 86% was explained by group-level factors related to hospital districts. The regional variables explained 75% of this hospital-district-level variation. Conclusions: PIM prevalence varied significantly across hospital districts. Findings suggest that higher PIM prevalence may be related to challenges in the continuity of care rather than differences in health care accessibility or share of the population with morbidities.
MeSH term(s)	Humans ; Aged ; Aged, 80 and over ; Potentially Inappropriate Medication List ; Inappropriate Prescribing ; Hospitals ; Prevalence ; Health Facilities ; Polypharmacy
Language	English
Publishing date	2023-06-17
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2192059-X
ISSN	1934-8150 ; 1551-7411
ISSN (online)	1934-8150
ISSN	1551-7411
DOI	10.1016/j.sapharm.2023.06.005
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Article ; Online: Dementia and Related Comorbidities in the Population Aged 90 and Over in the Vitality 90+ Study, Finland: Patterns and Trends From 2001 to 2018.

Halonen, Pauliina / Enroth, Linda / Jämsen, Esa / Vargese, Saritha / Jylhä, Marja

Journal of aging and health

2022 Volume 35, Issue 5-6, Page(s) 370–382

Abstract: Objectives: To examine trends in the prevalence of dementia and related comorbidities among the oldest old.: Methods: Six repeated cross-sectional surveys were conducted between 2001 and 2018, each including all inhabitants aged over 90 in Tampere, ... ...

Abstract	Objectives: To examine trends in the prevalence of dementia and related comorbidities among the oldest old. Methods: Six repeated cross-sectional surveys were conducted between 2001 and 2018, each including all inhabitants aged over 90 in Tampere, Finland ( Results: The prevalence of dementia decreased from 47% in 2007 to 41% in 2018. Throughout the study period, depression was more common among people with dementia compared to those without. The prevalence of hypertension, diabetes, and osteoarthritis increased and the prevalence of depression decreased among people with dementia. The mean number of comorbidities increased from 2.0 in 2001 to 2.3 in 2018. Discussion: Dementia remains highly prevalent among the oldest old and it is accompanied by an increasing burden of comorbidities, posing a challenge to people with dementia, their caregivers, and care systems.
MeSH term(s)	Aged, 80 and over ; Humans ; Dementia/epidemiology ; Finland/epidemiology ; Cross-Sectional Studies ; Comorbidity ; Hypertension/epidemiology ; Prevalence
Language	English
Publishing date	2022-10-18
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	1045392-1
ISSN	1552-6887 ; 0898-2643
ISSN (online)	1552-6887
ISSN	0898-2643
DOI	10.1177/08982643221123451
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Article ; Online: The role of geriatric syndromes in predicting unplanned hospitalizations: a population-based study using Minimum Data Set for Home Care.

Rönneikkö, Jukka / Huhtala, Heini / Finne-Soveri, Harriet / Valvanne, Jaakko / Jämsen, Esa

BMC geriatrics

2023 Volume 23, Issue 1, Page(s) 696

Abstract: Background: The predictive accuracies of screening instruments for identifying home-dwelling old people at risk of hospitalization have ranged from poor to moderate, particularly among the oldest persons. This study aimed to identify variables that ... ...

Abstract	Background: The predictive accuracies of screening instruments for identifying home-dwelling old people at risk of hospitalization have ranged from poor to moderate, particularly among the oldest persons. This study aimed to identify variables that could improve the accuracy of a Minimum Data Set for Home Care (MDS-HC) based algorithm, the Detection of Indicators and Vulnerabilities for Emergency Room Trips (DIVERT) Scale, in classifying home care clients' risk for unplanned hospitalization. Methods: In this register-based retrospective study, factors associated with hospitalization among home care clients aged ≥ 80 years in the City of Tampere, Finland, were analyzed by linking MDS-HC assessments with hospital discharge records. MDS-HC determinants associated with hospitalization within 180 days after the assessment were analyzed for clients at low (DIVERT 1), moderate (DIVERT 2-3) and high (DIVERT 4-6) risk of hospitalization. Then, two new variables were selected to supplement the DIVERT algorithm. Finally, area under curve (AUC) values of the original and modified DIVERT scales were determined using the data of MDS-HC assessments of all home care clients in the City of Tampere to examine if addition of the variables related to the oldest age groups improved the accuracy of DIVERT. Results: Of home care clients aged ≥ 80 years, 1,291 (65.4%) were hospitalized at least once during the two-year study period. Unplanned hospitalization occurred following 15.9%, 22.8%, and 33.9% MDS-HC assessments with DIVERT group 1, 2-3 and 4-6, respectively. Infectious diseases were the most common diagnosis within each DIVERT groups. Many MDS-HC variables not included in the DIVERT algorithm were associated with hospitalization, including e.g. poor self-rated health and old fracture (other than hip fracture) (p 0.001) in DIVERT 1; impaired cognition and decision-making, urinary incontinence, unstable walking and fear of falling (p < 0.001) in DIVERT 2-3; and urinary incontinence, poor self-rated health (p < 0.001), and decreased social interaction (p 0.001) in DIVERT 4-6. Adding impaired cognition and urinary incontinence to the DIVERT algorithm improved sensitivity but not accuracy (AUC 0.64 (95% CI 0.62-0.65) vs. 0.62 (0.60-0.64) of the original DIVERT). More admissions occurred among the clients with higher scores in the modified than in the original DIVERT scale. Conclusions: Certain geriatric syndromes and diagnosis groups were associated with unplanned hospitalization among home care clients at low or moderate risk level of hospitalization. However, the predictive accuracy of the DIVERT could not be improved. In a complex clinical context of home care clients, more important than existence of a set of risk factors related to an algorithm may be the various individual combinations of risk factors.
MeSH term(s)	Aged ; Humans ; Retrospective Studies ; Accidental Falls ; Fear ; Home Care Services ; Hospitalization ; Urinary Incontinence ; Geriatric Assessment
Language	English
Publishing date	2023-10-26
Publishing country	England
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2059865-8
ISSN	1471-2318 ; 1471-2318
ISSN (online)	1471-2318
ISSN	1471-2318
DOI	10.1186/s12877-023-04408-w
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Article: Process-related predictors of readmissions and mortality following hip fracture surgery: a population-based analysis.

Sarimo, Simo / Pajulammi, Hanna / Jämsen, Esa

European geriatric medicine

2020 Volume 11, Issue 4, Page(s) 613–622

Abstract: Purpose: Readmissions are common and complicate recovery after hip fracture. The objective of this study was to study readmission rates, factors associated with readmissions and effects of orthogeriatric liaison service in a setting where patients are ... ...

Abstract	Purpose: Readmissions are common and complicate recovery after hip fracture. The objective of this study was to study readmission rates, factors associated with readmissions and effects of orthogeriatric liaison service in a setting where patients are discharged typically on the first postoperative day from the operating tertiary care hospital to lower-level health care units. Methods: A regionally representative cohort of 763 surgically treated hip fracture patients aged ≥ 50 years was included in this retrospective study, based on hospital discharge records. Primary outcome was a 30-day readmission, while the secondary outcome was a composite outcome, defined as readmission or death with a follow-up of 1 year at maximum. Results: The 30-day readmission rate was 8.3% and 1-year mortality was 22.1%. Short length of stay did not lead to poorer outcomes. Delay from admission to surgery of ≥ 4 days and discharge to primary health care wards were associated with an increased 30-day readmission rate. Age ≥ 90 years, delay to surgery, postoperative length of stay of ≥ 2 days and discharge on a Saturday were associated with higher risk for the composite outcome. Use of orthogeriatric liaison service at the operating hospital was associated with a lower risk of 30-day readmissions (11.8% vs. 6.2%, P = 0.012) whereas in longer follow-up readmissions seemed to cumulate similarly independent of orthogeriatric contribution. Patients living in the largest community in the area were discharged to a secondary care orthogeriatric ward and had a lower risk of 30-day readmissions than other patients (4.8% vs. 10.2%, P = 0.009). Conclusion: Use of orthogeriatric liaison service and later care at secondary care orthogeriatric ward seem to be beneficial for hip fracture patients in terms of reducing readmissions and mortality. Of the other care-related factors, short delay from admission to surgery and short total length of stay in the operating hospital was also associated with these outcomes, which, however, may relate to the effects of patient characteristics rather than the care process.
MeSH term(s)	Aged ; Hip Fractures/surgery ; Hospitalization ; Humans ; Infant, Newborn ; Patient Readmission ; Retrospective Studies ; Treatment Outcome
Language	English
Publishing date	2020-03-26
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2556794-9
ISSN	1878-7657 ; 1878-7649
ISSN (online)	1878-7657
ISSN	1878-7649
DOI	10.1007/s41999-020-00307-0
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Article ; Online: Does chronic kidney disease affect implant survival after primary hip and knee arthroplasty?

Jämsä, Pyry / Reito, Aleksi / Oksala, Niku / Eskelinen, Antti / Jämsen, Esa

The bone & joint journal

2021 Volume 103-B, Issue 4, Page(s) 689–695

Abstract: Aims: To investigate whether chronic kidney disease (CKD) is associated with the risk of all-cause revision or revision due to a periprosthetic joint infection (PJI) after primary hip or knee arthroplasty.: Methods: This retrospective cohort study ... ...

Abstract	Aims: To investigate whether chronic kidney disease (CKD) is associated with the risk of all-cause revision or revision due to a periprosthetic joint infection (PJI) after primary hip or knee arthroplasty. Methods: This retrospective cohort study comprised 18,979 consecutive hip and knee arthroplasties from a single high-volume academic hospital. At a median of 5.6 years (interquartile range (IQR) 3.5 to 8.1), all deaths and revisions were counted. To overcome the competing risk of death, competing risk analysis using the cumulative incidence function (CIF) was applied to analyze the association between different stages of CKD and revisions. Confounding factors such as diabetes and BMI were considered using either a stratified CIF or the Fine and Gray model. Results: There were 2,111 deaths (11.1%) and 677 revisions (3.6%) during the follow-up period. PJI was the reason for revision in 162 cases (0.9%). For hip arthroplasty, 3.5% of patients with CKD stage 1 (i.e. normal kidney function, NKF), 3.8% with CKD stage 2, 4.2% with CKD stage 3, and 0% with CKD stage 4 to 5 had undergone revision within eight years. For knee arthroplasty, 4.7% with NKF, 2.7% with CKD stage 2, 2.4% with CKD stage 3, and 7% of CKD stage 4 to 5 had had undergone revision. With the exception of knee arthroplasty patients in whom normal kidney function was associated with a greater probability of all-cause revision, there were no major differences in the rates of all-cause revisions or revisions due to PJIs between different CKD stages. The results remained unchanged when diabetes and BMI were considered. Conclusion: We found no strong evidence that CKD was associated with an increased risk of all-cause or PJI-related revision. Selection bias probably explains the increased amount of all-cause revision operations in knee arthroplasty patients with normal kidney function. The effect of stage 4 to 5 CKD was difficult to evaluate because of the small number of patients. Cite this article:
MeSH term(s)	Aged ; Arthroplasty, Replacement, Hip ; Arthroplasty, Replacement, Knee ; Female ; Humans ; Male ; Middle Aged ; Prosthesis Failure ; Prosthesis-Related Infections/epidemiology ; Renal Insufficiency, Chronic/complications ; Reoperation/statistics & numerical data ; Retrospective Studies ; Risk Factors
Language	English
Publishing date	2021-04-01
Publishing country	England
Document type	Journal Article
ZDB-ID	2697156-2
ISSN	2049-4408 ; 2049-4394
ISSN (online)	2049-4408
ISSN	2049-4394
DOI	10.1302/0301-620X.103B4.BJJ-2020-0715.R2
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Article: Classifying home care clients' risk of unplanned hospitalization with the resident assessment instrument.

Rönneikkö, Jukka K / Huhtala, Heini / Finne-Soveri, Harriet / Valvanne, Jaakko N / Jämsen, Esa R

European geriatric medicine

2022 Volume 13, Issue 5, Page(s) 1129–1136

Abstract: Purpose: To identify predictive case finding tools for classifying the risk of unplanned hospitalization among home care clients utilizing the Resident Assessment Instrument-Home Care (RAI-HC), with special interest in the Detection of Indicators and ... ...

Abstract	Purpose: To identify predictive case finding tools for classifying the risk of unplanned hospitalization among home care clients utilizing the Resident Assessment Instrument-Home Care (RAI-HC), with special interest in the Detection of Indicators and Vulnerabilities for Emergency Room Trips (DIVERT) Scale. Methods: A register-based, retrospective study based on the RAI-HC assessments of 3,091 home care clients (mean age 80.9 years) in the City of Tampere, Finland, linked with hospital discharge records. The outcome was an unplanned hospitalization within 180 days after RAI-HC assessment. The Area Under the Curve (AUC) and the sensitivity and specificity were determined for the RAI-HC scales: DIVERT, Activities of Daily Living Hierarchy (ADLh), Cognitive Performance Scale (CPS), Changes in Health, End-Stage Diseases, Signs, and Symptoms Scale (CHESS), and Method for Assigning Priority Levels (MAPLe). Results: Altogether 3091 home care clients had a total of 7744 RAI-HC assessments, of which 1658 (21.4%) were followed by an unplanned hospitalization. The DIVERT Scale had an AUC of 0.62 (95% confidence interval 0.61-0.64) when all assessments were taken into account, but its value was poorer in the older age groups (< 70 years: 0.71 (0.65-0.77), 70-79 years: 0.66 (0.62-0.69), 80-89 years: 0.60 (0.58-0.62), ≥ 90 years: 0.59 (0.56-0.63)). AUCs for the other scales were poorer than those of DIVERT, with CHESS nearest to DIVERT. Time to hospitalization after assessment was shorter in higher DIVERT classes. Conclusion: The DIVERT Scale offers an approach to predicting unplanned hospitalization, especially among younger home care clients. Clients scoring high in the DIVERT algorithm were at the greatest risk of unplanned hospitalization and more likely to experience the outcome earlier than others.
MeSH term(s)	Activities of Daily Living ; Aged ; Aged, 80 and over ; Emergency Service, Hospital ; Home Care Services ; Hospitalization ; Humans ; Retrospective Studies
Language	English
Publishing date	2022-06-27
Publishing country	Switzerland
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2556794-9
ISSN	1878-7657 ; 1878-7649
ISSN (online)	1878-7657
ISSN	1878-7649
DOI	10.1007/s41999-022-00665-x
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Article ; Online: The Association of Long-Term Opioid Use With Health Care and Home Care Service Use Among Aged Home Care Clients.

Mörttinen-Vallius, Heidi P / Huhtala, Heini S A / Hartikainen, Sirpa A / Jämsen, Esa R K

Journal of the American Medical Directors Association

2022 Volume 24, Issue 6, Page(s) 798–803.e1

Abstract: Objectives: To compare health care and home care service utilization, mortality, and long-term care admissions between long-term opioid users and nonusers among aged home care clients.: Design: A retrospective cohort study based on the Resident ... ...

Abstract	Objectives: To compare health care and home care service utilization, mortality, and long-term care admissions between long-term opioid users and nonusers among aged home care clients. Design: A retrospective cohort study based on the Resident Assessment Instrument-Home Care (RAI-HC) assessments and electronic medical records. Setting and participants: The study sample included all regular home care clients aged ≥65 years (n = 2475), of whom 220 were long-term opioid users, in one city in Finland (population base 222,000 inhabitants). Methods: Health care utilization, mortality, and long-term care admissions over a 1-year follow-up were recorded from electronic medical records, and home care service use from the RAI-HC. Negative binomial and multivariable logistic regression, adjusted for several socioeconomic and health characteristics, were used to analyze the associations between opioid use and health and home care service use. Results: Compared with nonusers, long-term opioid users had more outpatient consultations (incidence rate ratio 1.26; 95% CI 1.08-1.48), home visits (1.23; 1.01-1.49), phone contacts (1.38; 1.13-1.68), and consultations without a patient attending a practice (1.22; 1.04-1.43) after adjustments. A greater proportion of long-term opioid users than nonusers had at least 1 hospitalization (49% vs 41%) but the number of inpatient days did not differ after adjustments. The home care nurses' median work hours per week were 4.3 (Q Conclusions and implications: Long-term opioid use in home care clients is associated with increased health care utilization regardless of the severity of pain and other sociodemographic and health characteristics. This may indicate the inability of health care organizations to produce alternative treatment strategies for pain management when opioids do not meet patients' needs. The exact reasons for opioid users' greater health care utilization should be examined in future.
MeSH term(s)	Aged ; Humans ; Analgesics, Opioid/therapeutic use ; Retrospective Studies ; Home Care Services ; Delivery of Health Care ; Pain
Chemical Substances	Analgesics, Opioid
Language	English
Publishing date	2022-12-26
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2171030-2
ISSN	1538-9375 ; 1525-8610
ISSN (online)	1538-9375
ISSN	1525-8610
DOI	10.1016/j.jamda.2022.11.023
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