Sedative load and adverse events among community-dwelling older people

Older people are frequent users of drugs with sedative properties. However, older people are susceptible to adverse drug events. Sedative drug use has been associated with impaired physical and cognitive function, an increased risk of falls and increased mortality. Sedative load refers to cumulative exposure to multiple drugs with sedative properties. This thesis aimed to investigate sedative load and adverse drug events among community-dwelling people aged ≥75 years. The thesis had focus on (I) the prevalence and factors associated with sedative load, (II) the association between the sedative load and balance and mobility, (III) the association between sedative load and muscle strength; and (IV) evolution of sedative load over time and the corresponding risk of death. The study analyzed data from Geriatric Multidisciplinary Strategy for the Good Care of the Elderly (GeMS) study which was a prospective population-based, randomized comparative study conducted from 2004–2007 in Kuopio, Finland. Participants were randomized to the intervention (n=500) and comparison groups (n=500). All participants were interviewed annually by trained nurses regarding drug use, medical conditions, and other health-related factors. Physical function tests were conducted by trained physiotherapists. Data on mortality were extracted from national registers. Communitydwelling persons (n=700 at baseline) were included in the analyses. Sedative load was calculated for each participant according to a previously published model. Unadjusted and adjusted analyses were conducted using logistic regression, analysis of covariance (ANCOVA) and Cox proportional hazards models. At the baseline of the GeMS Study, 29% of participants used one or more sedative drugs on regular basis. Factors associated with higher sedative load were female sex, poor selfrated health, impaired Instrumental Activities of Daily Living, and subjective feelings of loneliness. Sedative load was associated with poorer performance in balance and mobility tests which included 10 meter walking speed, the Timed Up and Go test and Berg Balance Scale. Sedative load was not associated with self-reported ability to walk 400 meters. Sedative load was associated with poorer performance in muscle strength tests, including hand grip strength, knee extension strength and chair stands test. Increasing sedative load was associated with poorer grip strength. Sedative load increased during the 3-year followup, and at the end of study, 36% of participants used sedative drugs. However, increasing sedative load was not associated with an increased risk of death. In conclusion, cumulative exposure to drugs with sedative properties was associated with decreased physical function. This represents a threat to independent living among older people. This thesis highlights the importance of implementing strategies to optimize sedative drug use among older people. National Library of Medical Classification: QV 85, WE 103, WE 500, WT 166 Medical Subject Headings: Hypnotics and sedatives/adverse effects; Prevalence; Drug Utilization; Postural Balance; Movement; Muscle strength; Mortality; Aged