We mainly perform register-based research and clinical intervention studies. Currently, the annual number of publications is 20-30 and number of PhD thesis varies between one and three.
We have expertise in:
- Register-based research including
- Modelling of drug exposure from prescription register data
- Pre-processing and linkage of register data
- pharmacoepidemiology and drug utilization
- adverse outcomes associated with drug use
- healthcare service use and costs, including drug costs
- epidemiology of diseases related to older age
- conducting intervention studies in the aged population, special focus on
- oral health
Our research is funded by grants from foundations (such as Finnish Cultural Fund), Social Insurance Institution of Finland and Kuopio University Hospital.
Current Research Projects
MEDALZ (MEDication use and ALZheimer's disease) is a nationwide cohort study, including all community-dwelling persons diagnosed with Alzheimer's disease (AD) in Finland during 2005-2011 (n=70,718). Comparison persons matched with age, gender and region of residence have been identified for each case. The data has been linked to multiple Finnish registers:
- Prescription register (1995-2012) from Social Insurance Institution
- Special reimbursement register (1972-2012) from Social Insurance Institution
- Hospital discharge register (1972-2012) from National Institute of Health and Welfare
- Causes of death register (2005-2012) from Statistics Finland
- Socioeconomic data (1970-2012) from Statistics Finland
The database will be updated with follow-up data from these registers.
Effectiveness-related themes in the MEDALZ data include:
1) Appropriateness of drug use compared with clinical care guidelines among persons with Alzheimer's disease
2) Drug use, socioeconomic factors and diseases as risk factors for Alzheimer's disease
3) Adverse outcomes associated with drug use (including hip fractures, stroke, mortality, brain injuries, hospital days)
4) Health care service use and costs associated with adverse drug events
5) Health care service use and costs in relation to AD diagnosis, including accurate time of AD diagnosis and appropriateness of care
6) Mortality related to Alzheimer's disease, and to adverse outcomes
7) Methodological development of register-based research, including modelling of drug exposure from Prescription register data
The MEDALZ is the largest cohort of persons with clinically verified diagnoses of Alzheimer's disease in the world. As persons with Alzheimer's disease are frequent users of health care services evaluation of appropriateness of their care is crucial in optimizing the service use in future as the population with Alzheimer's disease increases rapidly. Our research aims to provide important information on risk factors of Alzheimer's disease, improve the quality of life of AD patients, decrease healthcare expenses that are due to adverse drug events in this vulnerable population, and aid in efficient planning and targeting of healthcare resources.
NutOrMed - Optimal care for elderly - nutrition, oral health and medication
NutOrMed intervention study began in 2013. The aim of the study is to evaluate the impact of six month long nutritional and oral health intervention on nutritional status, oral health, functional performance and hospital admission/costs on older persons using home care services. Additionally, participants were interviewed at home regarding their medication use and this information will be compared with medication information in electronic patient records. The participants are randomly selected home care clients aged 75 years, living in Eastern and Central Finland. The intervention group included 131 persons and the control group included 169 persons.
At first, all participants were interviewed by home care nurses. The nurse interview examined cognition and depression, mobility and functional capacity. Dental hygienist and nutritionist then interviewed participants at home: dental hygienist examines the mouth and teeth or denture and self-care of the oral health and nutritionist examined weighs of the participants and daily eating routines with the 24-hour diary. The nutritional status were evaluated with Mini Nutritional Assessment (MNA) –test and height, weight and results from laboratory tests. Pharmacist interviewed participants concerning their medication use.
In nutrition intervention, participants who were malnourished or at risk of malnutrition had individually tailored intervention for six months. The oral health intervention included individualised counselling concerning oral and dental health. Intervention group was re-examined after six months.
The control group participants had the same examinations than intervention group but without any interventions.
Incidence of falls requiring primary care contacts – a population based study in Finland
The incidence of falls leading to hospital visits has been addressed in several studies but there are few data on falls that require primary care contact. The aim of this study was to investigate the incidence of falls leading to primary care contacts. This population based study of falls requiring contact to primary care was conducted in Leppävirta municipality during 12 months in years 2010 -2011. Demographic data were obtained from Statistics Finland, and the detailed information on health data from the computerized primary care medical records.
Previous Research Projects
MEDALZ-2005 is a nationwide cohort study, including all community-dwelling persons with verified Alzheimer's disease (AD) diagnosis residing in Finland on December 31, 2005 (n=28 093) and a single age-, gender and region of residence-matched comparison person without AD for each AD case. The data has been linked to prescription register, as well as hospital and social institution discharge registers (years 2002-2009). The database has been updated with data from prescription register (since 1994), and hospital and social institution discharge registers (since 1972 and 1995 respectively).
The data was used to assess:
1) persistence and changes in medication use after AD diagnosis
2) health status before and after AD diagnosis
3) medication use and its associations with adverse outcomes (mortality, hip fractures, cardio- and cerebrovascular events) in AD patients
4) use of social and healthcare services
MEDALZ-2005 was in many ways a pilot study for the ongoing MEDALZ-study. Findings from the MEDALZ-2005 study have been published in international peer-reviewed journals. In addition, PhD theses utilising this data are under preparation. MEDALZ-2005 is funded by the strategic funding provided by the Faculty of Health Sciences of University of Eastern Finland.
The Geriatric Multidisciplinary Strategy for the Good Care of the Elderly (GeMS) Study
The GEMS study is a randomised controlled intervention study which evaluated effects of annual geriatric assessment and optimisation of care on for example medication and functional performance. The study sample (n=1000) was randomly selected from all persons aged ≥75 years living in Kuopio in 2003. Participant were randomized in to the intervention (n=500) and control group (n=500). Of these 1000 persons, 781 persons provided consent to participate. The participants were interviewed and tested by a study nurse and physiotherapist. Those participants randomised to the intervention arm of the study received a comprehensive geriatric assessment including clinical examination by a study physician annually in 2004-2006. Individual tailored interventions included nutrition, oral health, medication assessment, and strength and mobility training. Control group was interviewed by study nurse and tested by study physiotherapist and otherwise they received services of standard care. Final measures were conducted in 2007.
There are several completed PhD projects based on GeMS data. Until now, results have been reported in about 60 publications in leading international medical and scientific journals. The study was supported by the Social Insurance Institution of Finland and the City of Kuopio.