Miia Tiihonen

• University of Eastern Finland

Background Helicobacter pylori ( H. pylori ) has been inconsistently associated with risk of Alzheimer disease. The exposure assessment period has often overlapped with the prodromal time of Alzheimer disease. Cognitive disorders might increase vulnerability to infectious pathogens, complicating the ascertainment of temporal relationship between H....

Background Frailty and protein-energy malnutrition (PEM) are common in older home care clients. In this study, we evaluate the effect of individually tailored dietary counseling on frailty status among home care clients with PEM or its risk aged 75 or older with a follow-up of six months. Methods This intervention study is part of the non-randomiz...

Aims The aim of this study was to evaluate the association between living alone and mortality among older patients with and without diabetes. Methods Electronic patient records were used to identify patients at least 65 years of age with a diagnosis of diabetes and two age- and sex-matched controls without diabetes for each patient with diabetes i...

The Finnish web-based Meds75+ database supports rational, safe and appropriate prescribing to older adults in primary care. This article describes the content and updating process of Meds75+ and demonstrates its applicability in everyday clinical practice. Meds75+ contains a classification (A–D) and recommendation texts for 450–500 drug substances...

Aims Persons with diabetes may have an elevated risk of Parkinson's disease (PD). Statin use could also modify the progression of PD. The aim was to study whether there is an association between statin exposure and risk of PD in persons with diabetes. Methods A nationwide, nested case–control study restricted to people with diabetes was performed...

Background An increasing number of care‐dependent older people living at home need external support to receive regular dental care. Objectives To investigate the use of oral health care services among old home care clients who participated in an intervention study focusing on oral self‐care and nutrition. Materials and Methods This study employed...

Background. Rasagiline or pramipexole monotherapy has been suggested for the management of early Parkinson’s disease (PD). The aim of this research was to systematically review the clinical efficacy and safety of rasagiline or pramipexole in early PD (defined as disease duration ≤5 years and Hoehn and Yahr stage of ≤3). Methods. Randomized controll...

Purpose Because of the common and increasing use of antipsychotics in older adults, we aim to summarize the current knowledge on the causes of antipsychotic-related risk of falls in older adults. We also aim to provide information on the use of antipsychotics in dementia, delirium and insomnia, their adverse effects and an overview of the pharmacok...

Introduction Although β2-adrenoceptor (β2AR) agonists have been associated with a lower risk of Parkinson’s disease (PD), the findings are inconclusive and may reflect confounding by indication. We studied the association between inhaled β2AR agonists and risk of PD in persons with asthma or chronic obstructive pulmonary disease (COPD). Methods Th...

Objectives: The use of antipsychotics in persons with Parkinson's disease (PD) is common, although their use may aggravate the symptoms of PD. Clozapine and quetiapine are the only antipsychotics recommended in PD treatment guidelines. Information on factors associated with initiation of antipsychotics is needed. We investigated whether recent hos...

Background Use of pharmacological treatments is one possible modifiable risk factor for cognitive disorders. Objective To investigate if the use of muscle relaxants is associated with the risk of Alzheimer’s disease (AD). Methods The study was performed in a nested case-control design. Altogether 70,718 community-dwelling residents of Finland who...

Background People with Parkinson’s disease (PD) are more likely to be hospitalized and initiate antidepressant use compared to people without PD. It is not known if hospitalization increases the risk of antidepressant initiation. We studied whether a recent hospitalization associates with antidepressant initiation in people with PD. Methods A nest...

Objectives Antiepileptic drugs (AEDs) are frequently prescribed for persons with Alzheimer’s disease (AD), but little is known on factors associated with AED initiation in this population. We investigated whether recent hospitalization is associated with AED initiation in persons with AD. Design Nested case-control study in the nationwide register...

Background: The aim of this study was to compare the utilization of primary healthcare services by older patients with and without type 2 diabetes. Methods: Electronic patient records were used to identify persons over 65 years of age with a diagnosis of diabetes. Two age- and sex-adjusted controls without diabetes were extracted for each person...

Introduction Previous studies have assessed antipsychotic use after Parkinson's disease (PD) diagnosis, but incident antipsychotic use before PD diagnosis is unknown. The objective is to study the incidence of antipsychotic use among community-dwelling persons with and without PD 10 years before and after the PD diagnosis. Methods The study was ba...

Purpose: Tamsulosin has been associated with dementia, but the results have been inconsistent. Concerns have been raised about using exposure assessment time too close to the outcome. We investigated the association between use of α1-adrenoceptor antagonists indicated for benign prostate hyperplasia and risk of Alzheimer's disease (AD) using diffe...

Background Although cardio- and cerebrovascular diseases are common among people with Alzheimer’s disease (AD), it is unknown how the prevalence of oral anticoagulant (OAC) use changes in relation to AD diagnosis. We investigated the prevalence of OAC use in relation to AD diagnosis in comparison to a matched cohort without AD. Methods Register-ba...

Aims: The purpose was to examine the prevalence and determinants of self-reported eating problems in old home care clients, screened separately by a clinical nutritionist and a dental hygienist. Methods and results: The data came from the Nutrition, Oral Health and Medication (NutOrMed) study, the participants of which were ≥75-year-old home car...

Abstract Background With ageing, food intake may decrease and lead to an insufficient nutrient intake causing protein-energy malnutrition (PEM) which is associated with adverse health effects and increased mortality. The aim of this study was to investigate the effects of individually tailored dietary counseling focused on protein intake among home...

Purpose: Diabetes has been associated with increased risk of Parkinson's disease (PD). Diabetes medications have been suggested as a possible explanation, but findings have been inconsistent. More information on the role of exposure in different time windows is needed because PD has long onset. We assessed the association between use of different...

Purpose We investigated the drug use before and after transition to automated multi-dose dispensing (MDD) service among persons with Alzheimer’s disease (AD) and compared whether the changes were similar in persons without AD. Methods The register-based Finnish nationwide MEDALZ cohort includes 70,718 community-dwelling persons diagnosed with AD d...

Pain treatment is important in older adults but may result in adverse events such as falls. Opioids are effective for nociceptive pain but the evidence for neuropathic pain is weak. Nevertheless, both pain and opioids may increase the risk of falls. This narrative literature review aims to summarize the existing knowledge on the opioid-related fall...

Background Epidemiological studies have suggested a link between rheumatoid arthritis and Parkinson’s disease (PD). Disease-modifying anti-rheumatic drugs (DMARDs) might explain this association. Objective To evaluate the association between DMARDs and risk of PD in persons with rheumatoid arthritis. Methods Nested nationwide case-control study w...

Background Antidepressant use is more common in people with Parkinson’s disease (PD), but it is unknown when this difference emerges. Methods We studied the incidence of antidepressant use in six-month periods from 10 years before to 15 years after PD diagnosis in the nationwide register-based Finnish Study on Parkinson’s disease (FINPARK). This s...

Objectives Antipsychotics are often prescribed to persons with cognitive impairment in the hospital, but it is not known whether recent hospital care increases the risk of antipsychotic initiation in community dwellers with Alzheimer's disease (AD). We studied whether hospital care during the previous 2 weeks is associated with antipsychotic initia...

Aims: To analyze the use of pain medication among community-dwelling people aged 65 years or older with and without type 2 diabetes in primary care. Methods: A total of 187 patients with and 176 patients without diabetes were randomly selected from a primary care sample of 389 patients with diabetes and 604 age- and gender-matched controls. Pain...

Background Parkinson’s disease is the second most common neurodegenerative disorder. Motor and non-motor symptoms seem to precede the diagnosis of Parkinson’s disease. Objective To evaluate the incidence of muscle relaxant use in community-dwelling persons with and without Parkinson’s disease from 4 years before to 4 years after the diagnosis of Pa...

Purpose: To describe oral health and hygiene in old home care clients and investigate how functional ability was associated with them. Materials and methods: This study employed part of the baseline data of a multidisciplinary intervention study of 269 home care clients aged ≥75 years, living in Eastern and Central Finland. Structured interviews...

Background: Due to these changes in kidney function, aging kidneys are more prone to drug-induced impairments in renal properties. Diabetes has been associated with the declined kidney function and an elevated risk of renal failure. The aim of this study is to compare kidney function and potentially nephrotoxic drug use among home-dwelling older p...

Aims To evaluate the incidence of described purchases of vitamin B12 in community-dwelling persons with and without Alzheimer’s disease (AD) from 9 years before to 5 years after the diagnosis. Subject and methods We utilized register-based data from the Finnish nationwide MEDALZ (Medication use and Alzheimer’s disease) cohort, including all AD cas...

Background: Increasing numbers of frail elderly people living at home but dependent on supportive care will face complex oral health challenges. Objectives: To investigate the associations of frailty status with oral cleaning habits and oral hygiene taking into account the effects of preventive oral health intervention among home care clients ag...

Background Hip fractures are common among persons with Alzheimer’s disease (AD), but problems in pain assessment may lead to insufficient analgesia after hospitalization. Objective We investigated the prevalence of opioid use in the 6 months after discharge from hospital care due to hip fracture among community-dwellers with and without AD. Setti...

What is known and objective Polypharmacy and age are known to increase the risk for potential drug interactions. Type 2 diabetes has been associated with polypharmacy and several comorbidities. Currently, there is no information on whether the frequency of clinically relevant drug‐drug interactions and the risk for drug adverse effects differ betwe...

Objective To examine the effectiveness of tailored xerostomia and nutritional 6‐month interventions on xerostomia among home care clients aged 75 years or over who were malnourished or at risk of malnutrition. Background A subjective feeling of dry mouth (xerostomia) is common among older adults and affects their quality of life, nutrition and ora...

Background It is unknown whether cognitive status or diagnosed cognitive decline affects estrogen use. Objectives We assessed how common systemic estrogen use was among community-dwellers with Alzheimer’s disease (AD) and a matched comparison cohort without AD. Methods This study included an exposure-matched cohort of all Finnish community-dwelli...

What is known and objective Anticholinergic drug use has been associated with a risk of central and peripheral adverse effects. There is a lack of information on anticholinergic drug use in persons with diabetes. The aim of this study is to investigate anticholinergic drug use and the association between anticholinergic drug use and self‐reported s...

Background: The association between pain and diabetes in older people has been largely unexplored. The aim of this survey was to analyze the prevalence and characteristics of pain among Finnish men and women 65 or older with and without diabetes in primary care. Methods: All home-dwelling persons 65 years or older with diabetes (N = 527) and age...

Background Pain and diabetes are related to the decreased self-rated health. The aim of this population-based study was to analyze how pain affects self-rated health among people aged 65 or older with and without type 2 diabetes. Design Population-based cross-sectional cohort study. Setting Inner Savo district, Finland. Participants Home-dwellin...

Background Frailty is a common problem among older people and it is associated with an increased risk of death and long-term institutional care. Early identification of frailty is necessary to prevent a further decline in the health status of home care clients. The aims of the present study were to determine the prevalence of frailty and associated...

Purpose: The aim of this study is to determine the prevalence of use and long-term use (≥180 days) of proton pump inhibitors (PPIs) and associated factors among community-dwellers with and without Alzheimer's disease (AD). Methods: MEDALZ cohort encompassed all persons who received a verified diagnosis of AD in Finland during the years 2005-2011...

Objectives: The aim of this study was to examine orthostatic hypotension (OH) and associated factors among home care clients aged 75 years or older. Design: Non-randomised controlled study. Setting and participants: The study sample included 244 home care clients aged 75 years or older living in Eastern and Central Finland. Measurements: Nur...

Objectives: The objective of the study was to investigate whether proton pump inhibitor (PPI) use is associated with an increased risk of clinically verified Alzheimer's disease (AD). Methods: A Finnish nationwide nested case-control study MEDALZ includes all community-dwelling individuals with newly diagnosed AD during 2005-2011 (N=70,718), and...

Aims: The aim of this study was to investigate the ability of older home-care clients to perform the five times chair rise test and associated personal characteristics, nutritional status and functioning. Methods: The study sample included 267 home-care clients aged ≥75 years living in Eastern and Central Finland. The home-care clients were inte...

Aims: To evaluate the health-related quality of life (HRQoL) and functional capacity in relation to glycemic control among older home-dwelling primary care patients. Methods: Electronic patient records were used to identify 527 people over 65 years with diabetes. Of these, 259 randomly selected subjects were invited to a health examination and 1...

Background: poor oral health is common among older people dependent on supportive care and it affects their quality of life. Cognitive impairment and functional dependency may increase the risk of compromised daily oral hygiene. Aim: to investigate the effectiveness of a tailored preventive oral health intervention among home care clients aged 7...

Objective: To examine the association between postmenopausal hormone therapy (HT) and Alzheimer's disease (AD). Methods: Medicine and Alzheimer's disease (MEDALZ) is a nested case-control study of the entire Finnish population with clinically verified AD from 2005 to 2011 and up to 4 matched controls per case. This study comprises 230,580 women...

their nutritional status and may help increase older peoples' independence while encouraging autonomy [2]. Using MOW services improves older people's nutritional intake [3, 4]. A previous study among community-dwelling older people showed that use of coupled with individual nutritional counselling can improve nutritional status [5]. The main ideas...

Background: The risk of malnutrition is quite common among home care clients. To aim of this study were to describe nutritional status of Meals-on-Wheels (MOW) clients and factors associated with use of MOW among home care clients. Methods: This cross-sectional study was conducted as part of the Nutrition, Oral health and Medication (NutOrMed) stu...

Objective To evaluate the effect of individually tailored dietary counseling on nutritional status among home care clients aged 75 years or older. DesignNon-randomised controlled study. Setting and participantsThe study sample consisted of 224 home care clients (≥ 75 years) (intervention group, n = 127; control group, n = 100) who were at protein-e...

Objectives: Season of birth, an exogenous indicator of early life environment, has been related to higher risk of adverse psychiatric outcomes but the findings for Alzheimer’s disease (AD) have been inconsistent. We investigated whether the month or season of birth are associated with AD. Methods: A nationwide nested case-control study including a...

We studied the incidence and duration of cumulative bisphosphonate use among older Finnish women and men with or without Alzheimer’s disease (AD). The MEDALZ-2005 cohort is a nationwide sample of all persons with clinically diagnosed AD on 31 December 2005 and their age-, gender-, and region of residence-matched control persons without AD. Informat...

Objectives: The purpose of this study was to examine drug use and other factors associated with xerostomia in home care clients aged 75 years or older. Methods: The study sample included 270 home care clients aged ≥75 years living in Eastern and Central Finland. The home care clients underwent in-home interviews carried out by trained home care...

Background: Malnutrition, polypharmacy and poor oral health are major concerns among older people living at home, and they contribute to disability and care dependency. This article describes the study protocol of the Nutrition, Oral Health and Medication (NutOrMed) intervention study. Methods/design: This study was a population-based multidiscipli...

Purpose: To compare discrepancies between in-home interviews and electronic medical records (EMRs) on regularly used prescription drugs among older home care clients. Methods: The participants were home care clients aged 75 years or older living in three Finnish municipalities. In-home interview data on regular prescription drug use from 276 hom...

Objectives: To describe nutritional status and to detect factors associated with it in home care clients aged 75 years or older. Design: A cross-sectional study with a population-based sample. Setting: Home care.Participants: The study included 267 home care clients in three cities in Finland. Measurements: The outcomes were nutritional status (Min...

Objectives: To describe nutritional status and to detect factors associated with it in home care clients aged 75 years or older. Design: A cross-sectional study with a population-based sample. Setting: Home care.Participants: The study included 267 home care clients in three cities in Finland. Measurements: The outcomes were nutritional status (Min...

Objectives To assess the patterns of use of reimbursed systemic hormone therapy (HT) and vaginal estrogen preparations among women aged 45 and older in Finland. Study design: Reimbursed purchases of prescribed systemic HT and vaginal estrogen preparations for the years 2003-2012 were obtained from a nationwide prescription registry. Systemic prepar...

Background Association between oophorectomy and/or hysterectomy and dementia in context of hormone therapy (HT) use is ambiguous. Objective To assess whether oophorectomy, hysterectomy, and hysterectomy with bilateral oophorectomy are related to risk of Alzheimer’s disease (AD), whether the possible indication for surgery plays a role, and if the...

Introduction: In Finland, there are more than one million people who are over 65 years old. The proportion of older people – as well as the proportion of oldest-old people (85+) – will increase in the future. Chronic diseases, which entail increased medicine consumption, are common among older people. The need for social and health services will in...

Background: Hormonal contraceptives are a common form of contraception among young women. Hormonal contraceptives are both highly effective and have positive benefits, but they can cause adverse reactions and other unwanted effects. The Internet has become an increasingly important source of information, also for health information. In addition to...

The aim of this study was to examine hormone therapy (HT) users' experiences, perceptions and information sources in 2009. Questionnaire survey was conducted in 2009 among women using HT. The questionnaire (n=500) was distributed from pharmacies across Finland. The response rate was 58% (n=281). The survey measured self-reported benefits and advers...

The aim of this study was to examine information sources used by women who use hormonal contraceptives (HCs), and how information source affected women's attitudes and perceptions in 2001 and 2007. The questionnaires were distributed from university pharmacies in 12 large cities across Finland. The data were collected with two questionnaire surveys...

Background: Hormonal contraceptives (HCs) are the most common contraceptive method in western countries. The fears and problems experienced by users of HCs can have an impact on their quality of life, and lead to abortions and unwanted pregnancies. Objective: To investigate whether experiences and perceptions of HC users in Finland have changed fro...

In 1998, the Women's Health Initiative (WHI) in 2002 and the Million Women Study (MWS) in 2003 have shown a need for re-evaluation of the benefits and adverse reactions of hormone replacement therapy (HRT). Consequently the authorities in Europe and USA have issued new recommendations against the use of HRT. The aim of this study was to examine wom...