Comparisons in polypharmacy over a decade in community-dwelling older adults-findings from Israel national health and nutrition surveys.

BACKGROUND: Polypharmacy increases with age and is associated with serious health and economic costs. This study reports changes over a decade in medication-use patterns and polypharmacy, in Israeli community-dwelling older adults aged ≥ 65 years. METHODS: Demographic and health data from two representative national health cross-sectional surveys - MABAT ZAHAV 1 (MZ1) in 2005-2006, and MZ2 in 2014-2015 were analyzed. Polypharmacy was defined as use of ≥ 5 medications. Risk factors for polypharmacy were estimated by multivariable logistic regression with adjusted odds ratios (aOR) and their 95% confidence intervals (CI). RESULTS: Self-reported data on medications taken were available for 1647 participants (91.5%) in MZ1, and for 833 participants (80.2%) in MZ2, 55% women, and about 20% aged ≥ 80, in both surveys. The prevalence of polypharmacy was significantly lower in MZ2 than in MZ1: 64.2% versus 56.3%, p = .0001; with an aOR (95%CI) of 0.64 (0.52, 0.80). The most commonly taken drugs were for hypertension (27.0%, 25.3%), dyslipidemia (9.7%, 12.4%) and anticoagulation (9.2%, 9.8%). For approximately 10% of drugs, indications were either unknown or incorrect. Polypharmacy was significantly associated with poor self-health assessment 2.47 (1.99, 3.06), ≥ 4 versus 1-3 chronic illnesses 6.36 (3.85, 10.50), and age ≥ 80 versus younger 1.72 (1.32, 2.24). Similar associations were observed with major polypharmacy of ≥ 8 medications. CONCLUSION: Polypharmacy, although reduced in the last decade, requires constant attention, especially concerning lack of knowledge of indications which leads to poor adherence and adverse side effects. Health-care teams should carry out regular medicine reconciliation in at-risk elderly patients.

[Paid sickness absence during pregnancy--a justifiable social right for pregnant women or an unneeded social right leading to misuse?].

It is commonly accepted that pregnancy incurs an extra burden on the pregnant woman--both physically and mentally. Therefore, many Western countries have adopted social plans to enable pregnant women to leave their workplace without losing their income. This social right is only approved if there is a medical reason to believe that continued work might have an adverse effect on the mother or the fetus. In Israel, such a social benefit also exists. Data shows that the annual demand for this allowance is constantly increasing, while no improvement is found in preterm deliveries, or infant and maternal mortality. These facts raise the question of whether there is a justification to go on with the current policy regarding paid sickness absence during pregnancy. Furthermore, population analysis of pregnant women who require this social right in Israel may lead to a conclusion regarding its misuse. Misuse of social rights by pregnant women may, in turn, lead potential employers to refrain from hiring women in their reproductive age.

Physicians' practice and familiarity with treatment for agitation associated with dementia in Israeli nursing homes.

BACKGROUND: To clarify physicians' actual practice in treating agitation in the nursing home and to elucidate the relationship between background factors, familiarity with interventions, and practice. METHODS: A survey of actual practice for agitation in persons with dementia was administered to 67 physicians aged 31-70+ working in nursing homes in Israel. Questionnaires were administered by personal interview, self-completed, or a combination of the two. RESULTS: Psychotropic medications are prescribed by 92.5% of physicians for treating agitation, most notably, Haloperidol (39%). Non-pharmacological treatment was also reported to be common, though to a lesser extent, with environmental change being the most prevalent non-pharmacological intervention. Generally, physicians showed low familiarity levels with non-pharmacological interventions, with higher levels noted for physicians with a specialty in geriatrics compared to those who were non-specialized. Physicians who were non-Israeli and younger also reported higher familiarity levels compared to their respective counterparts (i.e. Israeli and older) but this difference did not reach significance. CONCLUSION: The findings indicate that, despite current guidelines, psychotropic medications are the treatment of choice among nursing home physicians in Israel. While rates of use of non-pharmacological interventions are substantial, their in-practice application may be hindered by lack of familiarity as well as system barriers. The results have implications for system and education changes.

Falls and fear of falling among Israeli community-dwelling older people: a cross-sectional national survey.

BACKGROUND: Falls and fear of falling are a major problem for older people and a leading cause of functional decline and institutionalization. There is limited data on the prevalence of falls in a 12-month period among Israeli older adults. Our main objective was to evaluate the prevalence of falls among Israeli community-dwelling older people aged ≥65 years and to identify factors associated with falls and fear of falling. METHODS: A national cross-sectional interview survey was conducted between February 2018 and April 2019 by the Israeli Center for Disease Control. The prevalence of falls was assessed by asking participants about falling within the 12 months prior to the survey. Fear of falling was assessed by asking participants about the fear of future falls. Multivariate analysis was used to identify factors associated with falls and with fear of falling. RESULTS: From 5281 households that were eligible for inclusion in this study, 3242 participants (61.4%) completed the survey. Falling at least once in the past year was reported by 23.8% of the respondents and fear of falling by 48.2%. The majority of the participants (91.1%) reported that they had never received any instruction about fall prevention from their medical care provider. In the multivariate analysis, falls and fear of falling were each a risk factor for the other; and were also significantly associated with female gender, major functional difficulties, the use of walking aids, cardiac disease, diabetes mellitus and psychotropic medications. CONCLUSION: The prevalence of falls and fear of falling among Israeli community-dwelling older people is comparable to the rates published in other countries. Efforts should be made to increase awareness about falls and their health consequences among older people. The development of specific interventions to target those at higher risk for falls and fear of falling is strongly recommended.

Health behaviors and their determinants in multiethnic, active Israeli seniors.

To assess factors that affect the adoption of healthy lifestyles among a variety of active Israeli seniors, a survey was conducted in 2002 at the Peiluyada, a physical activity-oriented health fair for seniors held annually in Israel from 1995 to 2002. A multi-language, self-administered questionnaire, assessing predisposing factors, barriers and health-protective behaviors, was fielded to potential participants. Response rate at the event was 51%. Hebrew and Arabic speakers generally characterized their health as good to very good, while Russian speakers' health was rated only poor to fair. Over 80% engaged in regular physical activity, were satisfied with their diet, and conformed to international nutritional recommendations. Vaccination coverage against influenza (81%) and pneumocccocus (58%) was highest among Arabic speakers, and lowest among Russian speakers (33.5% and 12%, respectively). Higher age (> or =75 years) was significantly associated with receiving a vaccination against influenza. Major barriers to exercise included low motivation and poor physical health or disability. Health-related dietary restrictions were the leading nutritional barrier. Prominent barriers to vaccination included concerns about vaccine effectiveness (39%) and side effects (29%). Leading cues to action were a recommendation from one's doctor (67%) and from a healthcare worker (51%).

A cost-utility analysis of a comprehensive orthogeriatric care for hip fracture patients, compared with standard of care treatment.

BACKGROUND: The economic burden associated with hip fractures calls for the investigation of innovative new cost-utility forms of organisation and integration of services for these patients. OBJECTIVE: To carry out a cost-utility analysis integrating epidemiological and economic aspects for hip fracture patients treated within a comprehensive orthogeriatric model (COGM) of care, as compared with standard of care model (SOCM). DESIGN: A demonstration study conducted in a major tertiary medical centre, operating both a COGM ward and standard orthopaedic and rehabilitation wards. METHODS: Data was collected on the clinical outcomes and health care costs of the two different treatment modalities, in order to calculate the absolute cost and disability-adjusted life years (DALY) ratio. RESULTS: The COGM model used 23% fewer resources per patient ($14,919 vs. $19,363) than the SOCM model and to avert 0.226 additional DALY per patient, mainly as a result of lower 1-year mortality rates among COGM patients (14.8% vs. 17.3%). CONCLUSION: A comprehensive ortho-geriatric care modality is more cost-effective, providing additional quality-adjusted life years (QALY) while using fewer resources compared with standard of care approach. The results should assist health policy-makers in optimising healthcare use and healthcare planning.

For-profit and not-for-profit nursing homes in Israel: do they differ with respect to quality of care?

There has long been concern whether care is better in for-profit (FP) or not-for-profit (NFP) nursing homes (NHs). In order to answer this question in the Israeli context, a cross-sectional study of quality was undertaken, as measured by the Ministry of Health (MoH) assessment teams. We examined a convenience sample of 127 NHs (48 NFP, 79 FP), comprising approximately three quarters of Israel's 193 such institutions at the time of the study (1998-2001). A 100-point composite scale was designed derived from the detailed assessments of seven different professions. The quality of care on average was better in NFP (67/100 points) compared to FP (55/100 points) institutions (p<0.01). This differential was maintained even after adjusting for potential confounders such as the daily rate paid, institutional size and staffing levels. While homes belonging to both sectors were to be found among those receiving good to excellent grades, only FPs received lower quality scores. We conclude that in Israel, as in many other jurisdictions studied, FP NHs provide poorer care than NFPs, possibly due to a conflict between the demands of patient care and the desire to maximize profits in the FP institutions.