Mirko Petrovic

Ghent University, Gand, Flanders, Belgium

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Publications (95)187.7 Total impact

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    ABSTRACT: Objective Chronic use of benzodiazepines and Z-drugs (BZD/Zs) has been linked to cognitive decline. In this one-year prospective cohort study, we explored the impact of chronic BZD/Z use on cognitive decline compared to nonusers.Methods In cognitively capable BZD/Z users and nonusers in 10 Belgian nursing homes, we investigated cognition with the MiniMentalStateExamination(MMSE) at baseline and one year. A decrease of ≥4 points on the MMSE (clinically relevant decrease) was used in multiple logistic regression. We collected baseline demographics, functional, psychometric and social characteristics potentially influencing cognition.ResultsIn both the 131 BZD/Z users and 95 nonusers, the cognition decreased significantly over time, but without significant difference between the groups. Clinically relevant decrease was present in 34% BZD/Z users and 27% nonusers (NS). Controlled for age, gender, education and BZD/Z use, the significant risk factors for clinically relevant cognitive decline were depression, hearing and functional impairment. Frequent reading was associated with less MMSE decrease.Our findings could not demonstrate with statistical significance that BZD/Z use was associated with fast cognitive decline. The risk factors for fast decline were depression, hearing and functional impairment, and the absence of a reading attitude. In addition, BZD/Z use and depression were associated, indicating a complex relationship. Copyright © 2015 John Wiley & Sons, Ltd.
    Human Psychopharmacology Clinical and Experimental 01/2015; · 2.10 Impact Factor
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    ABSTRACT: The identification of older patients at risk of poor hospital outcomes (e.g. longer hospital stay, in-hospital mortality, and institutionalisation) is important to provide an effective healthcare service. To identify factors related to older patients' clinical, nutritional, functional and socio-demographic profiles at admission to an acute care ward that can predict poor hospital outcomes. The CRiteria to assess appropriate Medication use among Elderly complex patients project was a multicentre, observational study performed in geriatric and internal medicine acute care wards of seven Italian hospitals. One thousand one hundred twenty-three consecutively admitted patients aged 65 years or older. Hospital outcomes were length of stay, in-hospital mortality, and institutionalisation. Mean age of participants was 81 years, 56% were women. Median length of stay was 10 (7-14) days, 41 patients died during hospital stay and 37 were newly institutionalised. Number of drugs before admission, metastasized cancer, renal failure or dialysis, infection, falls at home during the last year, pain, and walking speed were independent predictors of LoS. Total dependency in activities of daily living and inability to perform grip strength test were independent predictors of in-hospital mortality. Malnutrition and total dependency in activities of daily living were independent predictors of institutionalisation. Our results confirm that not only diseases, but also multifaceted aspects of ageing such as physical function and malnutrition are strong predictors of hospital outcomes and suggest that these variables should be systematically recorded.
    PLoS ONE 12/2014; 9(12):e115413. · 3.53 Impact Factor
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    ABSTRACT: Older patients are at an increased risk of developing adverse drug reactions (ADR). Of particular concern are the oldest old, which constitute an increasingly growing population. Having a validated clinical tool to identify those older patients at risk of developing an ADR during hospital stay would enable healthcare staff to put measures in place to reduce the risk of such an event developing. The current study aimed to (1) develop and (2) validate an ADR risk prediction model.
    PLoS ONE 10/2014; 9(10):e111254. · 3.53 Impact Factor
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    ABSTRACT: Chronic use of benzodiazepines and z-drugs (BZD/Zs), the most commonly used symptomatic treatment for sleep problems, is discouraged because of the unproven long-term effectiveness. In this study, we evaluated 1-year evolution of subjective sleep quality of chronic BZD/Z users compared with nonusers.
    Drugs & Aging 08/2014; · 2.50 Impact Factor
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    ABSTRACT: Guidelines discourage chronic benzodiazepines and related Z drugs (BZD/Zs) for sleep problems. However, prevalence among nursing home residents remains high. Discontinuing these drugs is widely recommended but seems difficult to implement. The aim of our study was to evaluate the overall feasibility in the nursing home, in terms of willingness towards discontinuation and success rate at 8 months, together with the impact on withdrawal symptoms, change in sleep quality, quality of life and medication use.
    European Journal of Clinical Pharmacology 08/2014; · 2.70 Impact Factor
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    ABSTRACT: Background Malnutrition is common both after the age of 70 and in many types of cancer, being responsible for poor quality of life, poor treatment response and a shorter survival time. Patients with haematological malignancies face specific challenges regarding nutrition because of intensive treatments they endure. Early detection of nutritional problems is important to allow interventions. Objectives To assess the nutritional status of a group of older patients with aggressive haematological malignancies before the onset of systemic therapy using the MNA-SF. Setting The haematology department of a university hospital. Participants Patients ≥ 70 years, with newly diagnosed aggressive haematological malignancies. Methods Observational single centre study. Patients were screened for malnutrition before and two months after start of therapy using the Mini Nutritional Assessment Short Form (MNA-SF). Results Seventy patients were included. Mean age was 77.4 ± 4.7 years (range 70.0–91.0). At baseline, 20% (CI95 = 11–31%) were malnourished and 61% (CI95 = 49–73%) were at risk for malnutrition. Recent weight loss and declined food intake were the most recorded MNA-SF parameters. Mean Body Mass Index (BMI) was 26.3 ± 4.1 (range 19.8–41.1) and 41% (n = 29) of patients had a BMI < 25. Conclusions Using the MNA-SF, most of the older patients with an aggressive haematological malignancy are at risk for malnutrition. Therefore, nutritional assessment with individualised dietary advice and follow-up during treatment should be recommended as an integrated part of the treatment plan.
    European geriatric medicine 08/2014; · 0.55 Impact Factor
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    ABSTRACT: Incidence rates of haematological malignancies increase with age. In these older cancer patients, important information may be missed without a Comprehensive Geriatric Assessment (CGA). A validated screening instrument is needed to identify those patients for whom a CGA would be beneficial. The G8 has recently been validated as a screening tool for older cancer patients in need of a CGA.
    European journal of oncology nursing: the official journal of European Oncology Nursing Society 06/2014; · 1.13 Impact Factor
  • A Somers, M Petrovic
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    ABSTRACT: Drug related problems represent an important problem in geriatric patients, and contribute to hospitalization in 15 to 30% of the admissions. In most cases this concerns adverse drug reactions (normal dose and overdose) but also drug therapy failures (e.g. undertreatment) are common. The main pharmacological classes involved are cardiovascular drugs and drugs for the central nervous system. Drug related problems can be prevented by regular medication review to decide if all drugs have to be continued, and to check for adverse drug reactions. Clinical pharmacists in hospitals can detect drug related problems (over-, under- and misuse using a systematic approach) and recommend changes to improve pharmacotherapy. The community pharmacist can help by elaborating drug schemes, by screening for medication interactions, and by resolving practical problems.
    Journal de pharmacie de Belgique 06/2014;
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    ABSTRACT: Changes in physical performance during hospital stay have rarely been evaluated. In this study, we examined functional changes during hospital stay by assessing both physical performance and activities of daily living. Additionally, we investigated characteristics of older patients associated with meaningful in-hospital improvement in physical performance. The CRiteria to assess appropriate Medication use among Elderly complex patients project recruited 1123 patients aged ≥65 years, consecutively admitted to geriatric or internal medicine acute care wards of seven Italian hospitals. We analyzed data from 639 participating participants with a Mini Mental State Examination score ≥18/30. Physical performance was assessed by walking speed and grip strength, and functional status by activities of daily living at hospital admission and at discharge. Meaningful improvement was defined as a measured change of at least 1 standard deviation. Multivariable logistic regression models predicting meaningful improvement, included age, gender, type of admission (through emergency room or elective), and physical performance at admission. Mean age of the study participants was 79 years (range 65-98), 52% were female. Overall, mean walking speed and grip strength performance improved during hospital stay (walking speed improvement: 0.04±0.20 m/s, p<0.001; grip strength improvement: 0.43±5.66 kg, p = 0.001), no significant change was observed in activities of daily living. Patients with poor physical performance at admission had higher odds for in-hospital improvement. Overall, physical performance measurements show an improvement during hospital stay. The margin for meaningful functional improvement is larger in patients with poor physical function at admission. Nevertheless, most of these patients continue to have poor performance at discharge.
    PLoS ONE 05/2014; 9(5):e96398. · 3.53 Impact Factor
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    ABSTRACT: Background Incidence rates of haematological malignancies increase with age. In these older cancer patients, important information may be missed without a Comprehensive Geriatric Assessment (CGA). A validated screening instrument is needed to identify those patients for whom a CGA would be beneficial. The G8 has recently been validated as a screening tool for older cancer patients in need of a CGA. Objectives To test the performance of the G8 screening tool in older patients with aggressive haematological malignancies to identify those who would benefit from a CGA. Methods Cross-sectional study of patients ≥70 years with a recently diagnosed haematological malignancy. G8, CGA (including six questionnaires) and Cumulative Illness Rating Scale for Geriatrics (CIRS-G) were completed in each patient. The CGA was considered abnormal when at least one questionnaire showed an impaired score. Results Fifty patients with median age of 76 years were included; 88% (N = 44) had an abnormal CGA. ROC curve analyses revealed a G8 score ≤14 obtained a sensitivity of 89% (95% CI 75–96) and a specificity of 100% (95% CI 54–100), suggesting an optimal cut-off point. AUC ± SE was 0.949 ± 0.030. Inclusion of comorbidity in the CGA did not change the performance of the G8 (0.943 ± 0.034; P = 0.895). Conclusion The G8 can be used as a valid screening tool in older patients with aggressive haematological malignancies to identify those patients who would benefit from a CGA. Comorbidity should be assessed routinely and independently of the G8.
    European Journal of Oncology Nursing. 01/2014;
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    ABSTRACT: Background: general opinion is growing that drug cessation in complex older patients is warranted in certain situations. From a clinical viewpoint, drug cessation seems most warranted in four situations, i.e., falls, delirium, cognitive impairment and end-of-life situations. To date, little information about the effects of drug cessation in these four situations is available.Objectives: to identify the effects and effectiveness of drug cessation on falls, delirium and cognitive impairment. For end-of-life situations, we reviewed cessation of inappropriate drug use.Methods: electronic databases were searched using MeSH terms and relevant keywords. Studies published in English were included if they evaluated the effects of drug cessation in older persons, aged ≥65 years, with falls, delirium or cognitive impairment; or cessation of inappropriate drug use in end-of-life situations.Results: we selected seven articles for falls, none for delirium, two for cognition and two for end-of-life situations. Withdrawal of psychotropics reduced fall rate; a prescribing modification programme for primary care physicians reduced fall risk. Withdrawal of psychotropics and a systematic reduction of polypharmacy resulted in an improvement of cognition. Very little rigorous research has been conducted on reducing inappropriate medications in patients approaching end of life.Conclusion: little research has focussed on drug cessation. Available studies showed a beneficial impact of cessation of psychotropic drugs on falls and cognitive status. More research in this field is needed. The issue of systematic drug withdrawal in end-of-life cases is controversial, but is increasingly relevant in the face of rising numbers of older people of this clinical status.
    Age and Ageing 11/2013; · 3.11 Impact Factor
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    ABSTRACT: Reduction in length of hospital stay (LOS) is considered as a potential strategy to optimize resource consumption and reduce health care costs. We analysed predictors of increased LOS among older patients admitted to acute care wards according to type of admission (through the Emergency Room [ER] or elective). We analysed data of 1123 older patients, aged 65years or older, consecutively admitted to seven acute care wards. LOS was defined as the number of days from admission to discharge (or death) and categorized according to its median value (10days). Mean age of participants was 81±7years and 56% were women. Patients admitted through ER had a shorter LOS compared with those elective (10.4±6.7 vs. 12.0±6.7days; p<0.0001). Factors associated with LOS >10days, for patients admitted through ER, were female gender (OR 0.58; 95% C.I. 0.37-0.90), erythrocyte sedimentation rate (OR 1.02; 95% C.I. 1.01-1.03), and excessive polypharmacy (use of ≥10 drugs during stay) (OR 3.60; 95% C.I. 1.40-9.25). Predictors for elective patients were chronic alcohol consumption (OR 0.54; 95% C.I. 0.32-0.93), walking speed ≥0.8m/s (OR 0.31; 95% C.I. 0.14-0.72), excessive polypharmacy (OR 4.78; 95% C.I. 1.92-11.90), pressure ulcers (OR 2.60; 95% C.I. 1.01-6.79), cerebrovascular disease (OR 0.49; 95% C.I. 0.24-0.99) and dementia (OR 0.18; 95% C.I. 0.08-0.39). LOS differed between patients admitted through emergency and through elective admission. Demographic and clinical parameters can affect LOS and polypharmacy was the strongest and the only common risk factor in both groups.
    European Journal of Internal Medicine 09/2013; · 2.30 Impact Factor
  • European geriatric medicine 09/2013; 4:S14-S15. · 0.55 Impact Factor
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    Aging Health 06/2013; 9(3):255-264.
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    ABSTRACT: OBJECTIVES: We aim to describe subjective sleep quality among long-term users of benzodiazepines (BZDs) in Belgian nursing homes, to compare it to nonusers, and to investigate determinants of poor sleep quality. METHODS: All mentally competent residents from 10 nursing homes were screened and compiled in a group of long-term BZD users or in a group of nonusers based on the medication chart. We collected demographic, functional, and medication characteristics and global and specific sleep parameters using the Pittsburgh Sleep Quality Index (PSQI). Linear regression was used to investigate which parameters were associated with sleep quality. RESULTS: Of the 300 residents, 178 (59%) were long-term BZD users and 122 were nonusers. The 2 groups did not differ in demographic and functional characteristics (mean age, 85.5y; range, 57-100; 75% women). The users reported significantly more difficulties with falling asleep, had more midnight awakenings, felt less rested in the morning, and had a poorer self-perceived sleep quality compared to nonusers. Sleep duration and time to fall asleep did not differ. The self-perceived sleep quality was mainly determined by difficulties during initiation of sleep. After controlling for demographic, medication, and functional characteristics, BZD use remained strongly associated with poor sleep (r=0.173; P=.003), and a study centre effect (differences among nursing homes) was observed (r=0.229; P<.001). CONCLUSION: Our findings do not support long-term effectiveness of BZDs; long-term users slept more poorly than nonusers and were even more outspoken in users of long-acting BZDs. In future longitudinal comparative studies of sleep quality, unexplained variability needs further assessment with medical, psychologic, and institutional parameters.
    Sleep Medicine 05/2013; · 3.10 Impact Factor
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    ABSTRACT: OBJECTIVE: Increasing the quality of life (QoL) of patients with chronic fatigue is challenging because recovery is seldom achieved. Therefore, it is important to identify processes that improve QoL. This study examined the extent of improvement related to cognitive behavior group therapy (CBT), and whether improvement is affected by initial levels of acceptance and neuroticism. METHODS: Eighty CFS patients followed CBT, and self-reported (pre-post design) on mental and physical QoL (MQoL and PQoL), fatigue, acceptance, and neuroticism. The extent of improvement was analyzed using t-tests, effect sizes, and clinically significant change criteria. Whether acceptance and neuroticism at baseline predicted changes was analyzed by means of correlation and regression analyses. RESULTS: Significant improvement was found for all variables. The effect size for MQoL and PQoL was small; for acceptance and fatigue, effect size was moderate. About 20% (MQoL) to 40% (fatigue) of the participants clinically improved. Pre-treatment level of acceptance was negatively correlated with changes in MQoL, not with PQoL changes. Neuroticism pre-treatment was positively related with MQoL changes. Regression analysis showed an effect of acceptance on changes in MQoL beyond the effect of neuroticism. CONCLUSIONS: Although CBT is an evidence-based treatment, the sizes of the effects are often small regarding QoL. Our study also revealed small effect sizes. Our study showed that patient characteristics at baseline were significantly associated with MQoL outcome; indicating that CFS patients with high neuroticism or with a low acceptance show more improvement in MQoL. We propose to specifically target acceptance and neuroticism before treatment in order to maximize clinical relevance.
    Journal of psychosomatic research 05/2013; 74(5):367-372. · 2.91 Impact Factor
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    ABSTRACT: Older patients are particularly vulnerable to adverse drug reactions (ADRs) because age is associated with changes in pharmacokinetics and pharmacodynamics that may alter drug metabolism. In addition, other conditions, commonly observed in older adults, may increase the risk of ADRs in the older population (including polypharmacy, comorbidity, cognitive and functional limitations). ADRs in older adults are frequently preventable, suggesting that screening and prevention programmes aimed at reducing the rate of iatrogenic illness are necessary in this population. The present study reviews available approaches that may be used to screen and prevent the occurrence of ADRs in older adults, including medication review, avoiding the use of potentially inappropriate medications, computer-based prescribing systems and comprehensive geriatric assessment. Available evidence on these approaches is mixed and controversial, and none of them showed a clear beneficial effect on patients' health outcomes. Limitation of these interventions is the lack of standardisation, and these differences may give reason for the variability of the results documented in randomised clinical studies. Interestingly, most of the available research is focused on a single intervention targeting either clinical or pharmacological factors causing ADRs. When these approaches are combined, positive effects on patients health outcomes can be shown, suggesting that integration of skills from different health care professionals is needed to address medical complexity of the older adults. The challenge for future research is to integrate valuable information obtained by existing instruments and methodologies in a complete and global approach targeting all potential factors involved in the onset of ADRs.
    Age and Ageing 03/2013; · 3.11 Impact Factor
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    ABSTRACT: Orthostatic hypotension (OH) is said to be highly prevalent in older people. Drugs are often involved as causative factor. Nevertheless, few data are available about the prevalence of OH and its relationship with drugs in olders. To review data about (i) the prevalence and characteristics of OH in older patients; and (ii) the relationship between OH and drugs. Review of publications from Ovid (PubMed) from 1980 to May 2011 using the following key words: "orthostatic hypotension" combined with "elderly" or equivalent for the analysis of prevalence (first search) and "orthostatic hypotension" combined with "drugs" or equivalent to assess the relationship between OH and drugs (second search). Fifty-one publications (of which 14 with original data) were retrieved from the prevalence search, 31 for the second search (8 with original data: 7 retrospective studies and 1 prospective cohort study) and 12 reviews or experts opinions. Prevalence of OH varies according to the characteristics of the subjects, the settings of the studies, and the procedures of blood pressure measurement. In acute geriatrics units, two studies reported a prevalence of over 30% and one study mentioned that 68% of the patients presented with at least one episode during the day. OH was associated with several geriatric problems: gait disorders, balance disorders, falls, cerebral hypoperfusion, transient ischemic attacks, cognitive impairment, acute myocardial infarct and systolic hypertension. OH can also be asymptomatic or with atypical presentation: falls, gait disorders and confusion. Psychotropic agents (antipsychotics, sedatives, antidepressants), and cardiovascular drugs (antihypertensive agents, vasodilators, diuretics) were associated with OH. If the hypothesis of causality between drug treatment and OH is confirmed, the identification of the involved drugs could be of value for the prevention of OH and its complications. In this context, the Working Group Pharmacology Pharmacotherapy and Pharmaceutical Care of the Belgian Society of Gerontology and Geriatrics proposes to conduct a multicentre study to assess the prevalence of OH in Belgian acute geriatrics units and its relationship with drugs.
    Acta clinica Belgica 03/2013; 68(2):107-12. · 0.59 Impact Factor
  • European geriatric medicine 02/2013; 4(1):50–58. · 0.55 Impact Factor
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    ABSTRACT: BACKGROUND: To assess and compare the predictive value of physical function measurements (PFMs) for all-cause mortality in older men and to evaluate the Timed Up and Go test (TUG) as a predictor in subjects with underlying comorbidity. DESIGN: Observational study of a population-based sample of 352 ambulatory older men aged 71-86 at study baseline. The Rapid disability rating scale-2, 36-Item short form health survey, Grip strength, Five times sit-to-stand test, Standing balance, and TUG were determined at baseline. Associations with all-cause mortality were assessed using Cox proportional hazard analyses. Age, Body mass index (BMI), smoking status, education, physical activity and cognitive status were included as confounders. Follow-up exceeded 15 years. Comorbidity status was categorized into cardiovascular disease, chronic obstructive pulmonary disease (COPD) and diabetes mellitus. RESULTS: All examined PFMs were associated with all-cause mortality. TUG was the best predictor (adjusted HR per SD increase = 1·58, 95% CI = 1·40-1·79, P < 0·001) for global mortality and continued to be predictive in subjects with cardiovascular disease (adjusted HR per SD increase = 1·80, 95% CI = 1·40-2·33, P < 0·001). CONCLUSIONS: The assessment of physical functioning is important in the evaluation of older persons. We encourage the use of the TUG as a reliable, quick and feasible screening tool in clinical settings.
    European Journal of Clinical Investigation 01/2013; · 3.37 Impact Factor

Publication Stats

766 Citations
187.70 Total Impact Points

Institutions

  • 1999–2014
    • Ghent University
      • • Geriatrics
      • • Department of General Practice and Primary Health Care
      • • Faculty of Pharmaceutical Sciences
      • • Department of Internal Medicine
      Gand, Flanders, Belgium
  • 1997–2014
    • Universitair Ziekenhuis Ghent
      • • Department of General Internal Medicine
      • • Department of Geriatrics
      Gand, Flanders, Belgium
  • 2013
    • Erasmus Universiteit Rotterdam
      Rotterdam, South Holland, Netherlands
  • 2012
    • Cork University Hospital
      • Department of Geriatric Medicine
      Corcaigh, Munster, Ireland
  • 2010
    • University of Antwerp
      Antwerpen, Flanders, Belgium