Prescription and nonprescription drug use among at-risk community-dwelling seniors in Ottawa-Carleton.

BACKGROUND: The Council on Aging Ottawa-Carleton conducted an evaluation study aimed at reducing the inappropriate use of medication by community-dwelling seniors. During a 17-month period from 1990 to 1992, 278 of 415 seniors consented to participate. All were new referrals to home care, all were 65 years of age or older and all were taking a minimum of six prescription medications. OBJECTIVE: To describe the patterns of prescription and nonprescription drug use among high risk elderly people living in the Ottawa-Carleton region. ANALYSIS: Descriptive statistics and logistic regression were used to explore relationships between the numbers of drugs (prescription and nonprescription), drug classes and drug subclasses, and sex, age and number of prescribing physicians. RESULTS: The top 10 prescription or nonprescription drugs taken by study participants were consistent among diseases and health problems most commonly found among the elderly. Comparisons by rank for subclasses of drugs indicated that eye, ear, nose and throat (EENT), and respiratory drugs were considerably more prevalent among males than females, while women took more hormones and anxiolytics, sedatives and hypnotics. Age also appeared to have an effect; the proportions of respiratory drugs and hormones decreased with age. In contrast, vitamins and EENT drugs were most prevalent among the oldest seniors. These findings were supported by the results of multivariate analyses. Having three or more prescribing doctors was positively associated with the use of laxatives. Findings from multivariate analyses indicated that for prescription drugs, the youngest age group was about four times more likely than the oldest age group to be taking at least eight drugs. For nonprescription drugs, the only statistically significant finding was that those with three or more doctors were twice as likely as those with one or two doctors to take at least one nonprescription drug.

Small group estimation for public health.

We used synthetic estimation and linear regression to estimate the prevalence of selected risk factors and health status indicators in small populations. The derivation was based on the sociodemographic characteristics of the populations and the relationships between these variables and the health variables, as measured by the Ontario Health Survey (OHS). The estimates were validated by a comparison with the direct results of the OHS (gold standards). Synthetic estimates were much less dispersed than the regression estimates or the direct OHS estimates. Regression estimates performed better than synthetic estimates on most validation indicators, and combined approaches performed marginally better yet, although there were few clear patterns. Although correlation coefficients with gold standards in excess of 0.8 were obtained for some variables, the estimates rarely met pre-determined criteria for accuracy. At present these techniques have limited value for public health workers, but further work is justified, especially on approaches combining synthetic and regression estimation.

Fat-related dietary behaviour: behavioural science concepts for public health practice.

Despite being central to Canadian health objectives, reduction in fat consumption remains a difficult health target to reach. Strong epidemiological data associate high dietary fat intake with cardiovascular disease (CVD). There has been considerable interest in applying concepts from psychosocial models of behaviour change to enhance the effectiveness of CVD prevention programs. This review suggests that the determinants of fat-related dietary behaviours can be integrated within a comprehensive model useful to public health practice. The Transtheoretical Model (TTM) is suggested as an organizing framework for variables empirically related to diet. The TTM holds that dietary change occurs through successive stages, defined according to people's readiness to adopt new behaviours. Furthermore, readiness to change can be explained by variables that are amenable to public health interventions. The integration of important variables within the TTM framework may prove helpful in designing, implementing and evaluating effective dietary change intervention programs in the community.

Guidelines for measurement of blood pressure, follow-up, and lifestyle counselling. Canadian Coalition for High Blood Pressure Prevention and Control.

As part of the Coalition's mandate to promote the prevention and control of high blood pressure in Canada, an interdisciplinary Workgroup was established to review and update the existing standards (1987) for blood pressure measurement and referral guidelines. The intent was to prepare a scientifically based document which contained practical guidelines for the measurement of blood pressure and criteria for follow-up, and one which promoted the concept of cardiovascular health in the assessment and interpretation of blood pressure readings. These guidelines were primarily developed to assist primary health care providers and/or clinicians to assess, monitor, counsel, refer, and develop treatment plans for adults-at-risk for high blood pressure or those with the confirmed diagnosis of hypertension. Readers are referred to The Canadian Hypertension Society Consensus Conference series (Canadian Medical Association Journal 1993) for specific guidelines on the evaluation, diagnosis, and treatment of hypertension. The document is divided into three sections: 1. Measurement of blood pressure 2. Criteria for follow-up 3. Guidelines for lifestyle counselling Each section cites the references used in developing the guidelines and where relevant, identifies other resources which can be used in clinical practice.

The oral health status and treatment needs of adults aged 65+ living independently in Ottawa-Carleton.

We report the findings from a dental survey of a random sample of 299 senior citizens living in Ottawa-Carleton. Those examined were younger, less likely to have a regular dentist, and more likely to have oro-facial pain, difficulty chewing, and to perceive a need to visit a dentist compared with those responding to the enrollment phone interview. Among the 65% of seniors who were dentate, 37% had dental decay; men and seniors with low incomes had more decay (p less than 0.05). Periodontal disease was worse among older seniors, men and poor seniors (p less than 0.05). One third of all seniors reported recent oro-facial pain, 50% had difficulty chewing foods and 30% reported some social impact resulting from their oral health. The resources required to treat the prevalent disorders were considerable and differences between dentate and edentulous people were negligible. Senior citizens expressed attitudes which indicate that they value dental health and would like help to achieve it.

Attitudes and practices of primary care physicians in the management of elevated serum cholesterol levels.

We conducted a telephone survey of 102 randomly selected Ottawa family physicians to determine their attitudes and practices regarding the treatment of hypercholesterolemia. Of the 102, 56% routinely measured serum cholesterol levels in all their patients over the age of 30 years, and 24% did so for patients in more restricted age ranges. The level at which they started dietary therapy averaged 6.95 mmol/L (270 mg/dl); for 25% it was less than 6.22 mmol/L (240 mg/dl). The level at which they started drug therapy averaged 8.9 mmol/L (345 mg/dl); for only 15% was it 7.23 mmol/L (280 mg/dl) or less. Two-thirds were unable to give numerical values to the serum cholesterol levels at which they started diet therapy, and 38% used the upper limits of laboratory normal values as an indication to start therapy. Our findings contrast markedly with results reported for US family physicians, who treat hypercholesterolemia much more aggressively. The variability in practices must be addressed if public campaigns to lower serum cholesterol levels are to be undertaken.

Weight control in the workplace: a needs assessment for men.

This investigation was designed to assess the needs and interests of overweight men in a worksite weight control program. Employees of 2 high-tech companies were surveyed; 373 men and 238 women responded. 56% of respondents were interested in a worksite program. 44% of male respondents had a Body Mass Index (BMI) of 25 or greater and of those, 75% indicated an interest in participating. Among women, 21% had a BMI of 25 or greater and 92% were interested in the program. Also 68% of women who were not overweight would participate in a weight control program. There was a strong preference for a self-help teaching format over group activities, and particular interest in an evaluation of their present food habits, behaviour modification techniques for weight control and the health consequences of overweight. These findings give clear direction for the development of an effective worksite intervention.

Use of the hospital postpartum period for population-based research.

A survey method was developed to conduct population-based research on behaviour in pregnancy by contacting women during the postpartum period in hospital. 85.8% of the eligible women completed the questionnaire in hospital, and follow-up measures increased the response rate to the full questionnaire to 90.8%. A shorter version of the questionnaire was completed by another 3.7% of the women for an overall response rate of 94.5%. The test-retest reliability of the questionnaire was high. This method was very acceptable to women. Non-response was due mainly to women who were missed or to lost questionnaires rather than refusal. It is important to have a high response rate on similar surveys since responders did differ from non-responders on important characteristics. This method should prove useful to other health care planners.

Smoking and health care patterns among pregnant women.

A population-based hospital survey of 3628 women in the postpartum period was conducted in the Ottawa-Carleton region in 1983 to determine the prevalence of smoking before and during pregnancy, the demographic and socioeconomic characteristics of women who smoke during pregnancy and the use of health care services by these women. Of the 3628 women 91% completed a full-length questionnaire and 4% completed a shorter questionnaire. Before pregnancy 37.4% of the women smoked cigarettes. Overall, 61.1% of the smokers changed their smoking habit: 31.1% stopped, 28.1% decreased the amount smoked and 2.0% increased the amount smoked. Two thirds of the women who stopped smoking did so as soon as they realized they were pregnant. Over 50% of teenagers, single women, women living common-law and women with less than a grade 11 education smoked after the 3rd month of pregnancy. The physician is in an ideal position to identify as soon as possible pregnant women who smoke and to initiate a health education program. Only a few women who smoked during pregnancy attended early prenatal classes. Physicians and class organizers must work to improve this situation if such classes are to have an impact on smoking during pregnancy.