Johan Fastbom

Aging Research Center, Tukholma, Stockholm, Sweden

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Publications (152)

  • [Show abstract] [Hide abstract] ABSTRACT: Background: The association between mortality risk and use of antidepressants in people with dementia is unknown. Objective: To describe the use of antidepressants in people with different dementia diagnoses and to explore mortality risk associated with use of antidepressants 3 years before a dementia diagnosis. Methods: Study population included 20 050 memory clinic patients from the Swedish Dementia Registry (SveDem) diagnosed with incident dementia. Data on antidepressants dispensed at the time of dementia diagnosis and during 3-year period before dementia diagnosis were obtained from the Swedish Prescribed Drug Register. Cox regression models were used. Results: During a median follow-up of 2 years from dementia diagnosis, 25.8% of dementia patients died. A quarter (25.0%) of patients were on antidepressants at the time of dementia diagnosis, while 21.6% used antidepressants at some point during a 3-year period before a dementia diagnosis. Use of antidepressant treatment for 3 consecutive years before a dementia diagnosis was associated with a lower mortality risk for all dementia disorders and in Alzheimer's disease. Conclusion: Antidepressant treatment is common among patients with dementia. Use of antidepressants during prodromal stages may reduce mortality in dementia and specifically in Alzheimer's disease.
    Article · Sep 2016 · Acta Psychiatrica Scandinavica
  • [Show abstract] [Hide abstract] ABSTRACT: Aim: To describe variations in nurses' perceptions of using a computerised decision support system (CDSS) in drug monitoring. Background: There is an increasing focus on incorporating informatics into registered nurses' (RNs) clinical practice. Insight into RNs' perceptions of using a CDSS in drug monitoring can provide a basis for further development of safer practices in drug management. Method: A qualitative interview study of 16 RNs. Data were analysed using a phenomenographic approach. Results: The RNs perceived a variety of aspects of using a CDSS in drug monitoring. Aspects of 'time' were evident, as was giving a 'standardisation' to the clinical work. There were perceptions of effects of obtained knowledge and 'evidence' and the division of 'responsibilities' between RNs and physicians of using the CDSS. Conclusion: The RNs perceived a CDSS as supportive in drug monitoring, in terms of promoting standardised routines, team-collaboration and providing possibilities for evidence-based clinical practice. Implications: Implementing a CDSS seems to be one feasible strategy to improve RNs' preconditions for safe drug management. Nurse managers' engagement and support in this process are vital for a successful result.
    Article · Sep 2016 · Journal of Nursing Management
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    [Show abstract] [Hide abstract] ABSTRACT: We aimed to (1) study factors that determine the use of invasive procedures in the management of acute myocardial infarction (AMI) in patients with dementia and (2) determine whether the use of invasive procedures was associated with their better survival.
    Full-text Article · Sep 2016 · Journal of the American Medical Directors Association
  • Jonas W Wastesson · Johan Fastbom · Kristina Johnell
    Article · Aug 2016 · Journal of the American Medical Directors Association
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    Ylva Haasum · Johan Fastbom · Kristina Johnell
    [Show abstract] [Hide abstract] ABSTRACT: Objectives: Many drugs increase the risk of falls in old age. Although persons with Parkinson's disease (PD) are at increased risk of experiencing falls and fractures, the use of fall-risk inducing drugs (FRIDs) in this population has not previously been investigated. The objective of this study was to investigate the burden of use of FRIDs in older persons treated with anti-Parkinson drugs (APD; used as a proxy for PD), compared to persons without APD. Methods: We analyzed individual data on age, sex, type of housing and drug use in 1 346 709 persons aged ≥ 65 years in the Swedish Prescribed Drug Register on the date of 30 September 2008. Main outcome measure was the use of FRIDs. Results: FRIDs were used by 79% of persons with APD and 75% of persons without APD. Persons with APD were more likely to use ≥ 1 FRIDs compared to persons without APD (adjusted OR: 1.09; 95% CI: 1.06-1-12). The association was stronger for concomitant use of ≥ 5 FRIDS (adjusted OR: 1.49; 95% CI: 1.44-1.55). Conclusions: The high use of FRIDs among persons with APD indicates that these patients may be at increased risk of drug-induced falls. Further studies are needed to investigate how these drugs affect the risk of falling in persons with PD.
    Full-text Article · Aug 2016 · PLoS ONE
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    Lucas Morin · Yvan Beaussant · Régis Aubry · [...] · Kristina Johnell
    [Show abstract] [Hide abstract] ABSTRACT: Objectives To compare the aggressiveness of end-of-life care in hospitalized individuals with cancer with and without dementia in France. Design Nationwide register-based matched-cohort study. Setting Hospital facilities in France. Participants All individuals with cancer aged 65 and older with a diagnosis of dementia who died between January 1, 2010 and December 31, 2013, matched one-to-one with individuals with cancer without dementia (n = 26,782 matched pairs). Results Older individuals with cancer with dementia were less likely to receive aggressive treatment in their last month of life than those who were not diagnosed with dementia. Dementia was associated with a significant decrease in the receipt of chemotherapy (2.8% vs 8.5%, P < .001, adjusted odds ratio (aOR) = 0.33, 95% confidence interval (CI) = 0.31–0.36) in the month before death. Individuals with dementia were also less likely to receive radiation therapy (aOR = 0.49, 95% CI = 0.43–0.56), blood transfusions (aOR = 0.67, 95% CI = 0.64–0.70), artificial nutrition (aOR = 0.79, 95% CI = 0.73–0.85), and invasive ventilation (aOR = 0.62, 95% CI = 0.57–0.68), although they were more likely to remain hospitalized over their entire last month of life (aOR = 1.42, 95% CI = 1.37–1.48) and to have more than one emergency department visit (aOR = 1.22, 95% CI = 1.12–1.34). Conclusion Older hospitalized adults with cancer with dementia are less likely to receive aggressive cancer treatment near the end of life than those without dementia. This discrepancy raises important ethical questions for clinicians and healthcare policy-makers.
    Full-text Article · Jul 2016 · Journal of the American Geriatrics Society
  • Danijela Gnjidic · Johan Fastbom · Kristina Johnell
    Article · Jul 2016 · Journal of the American Geriatrics Society
  • Dataset · Jun 2016
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    Lucas Morin · Yvan Beaussant · Régis Aubry · [...] · Kristina Johnell
    [Show abstract] [Hide abstract] ABSTRACT: Aims To compare the aggressiveness of end-of-life care in hospitalized cancer patients with and without dementia in France. Methods Nationwide, retrospective study using data from the French national hospital registry, which systematically collects administrative and medical information about every inpatient admission and outpatient visit in France. Cancer patients aged ≥ 65 years with a diagnosis of dementia were matched 1:1 with cancer patients who were not diagnosed with dementia, using sex, age and primary malignancy as matching variables. Results Overall, cancer patients with dementia (n=26,782) were less likely to receive aggressive treatments in their last month of life than patients who were not diagnosed with dementia (n=26,782 matched controls). Hence, dementia was associated with a significant decrease in the receipt of chemotherapy (2.8% vs. 8.5%, P<0.001). In addition, patients with dementia were less likely to receive radiation therapy (OR= 0.49, 95%CI= 0.43-0.56), blood transfusion (OR= 0.67, 95%CI= 0.64-0.70), artificial nutrition (OR=0.79, 95%CI= 0.73-0.85), or invasive ventilation (OR= 0.62, 95%CI= 0.57-0.68) during the last month before death. However, cancer patients in the ‘dementia’ group were found to be more likely to remain hospitalized over their entire last month of life (adjusted OR= 1.42, 95%CI= 1.37-1.48) and to have more than one emergency department visit during their last month of life (adjusted OR= 1.18, 95%CI= 1.07-1.29). Conclusion Hospitalized older cancer patients with dementia are less likely to receive aggressive treatments near the end of life than patients without dementia. Such discrepancies raise an important question for clinicians and healthcare policy makers: is the propensity of cancer patients with dementia to receive less aggressive treatments the sign of a form of under-treatment, or is this – on the contrary – an indication that patients without dementia were over-treated near the end of life?
    Full-text Conference Paper · Jun 2016
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    Lucas Morin · Johan Fastbom · Kristina Johnell
    Full-text Conference Paper · Jun 2016
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    [Show abstract] [Hide abstract] ABSTRACT: Objective: Previous studies on cognitive deficits in acute and remitted states of old-age depression have shown mixed findings. The episodic nature of depression makes repeated assessment of cognitive performance important in order to address reversibility and stability of cognitive deficits. Methods: Dementia-free older participants (≥60 years) from the population-based Swedish National Study on Aging and Care in Kungsholmen who completed neuropsychological testing at baseline (T1) and follow-up (T2) formed the basis of the study sample. Participants were grouped according to depression status at T1 and T2: depressed-remitted (n = 32), remitted-depressed (n = 45), and nondepressed-depressed (n = 29). These groups were compared with a group of randomly selected and matched (age, gender, education, and follow-up time) healthy controls (n = 106) over a period of maximum 6 years. Results: Mixed ANCOVAs, controlling for age and gender, revealed depression-related deficits for processing speed, attention, executive function, and category fluency. In remitted states, only processing speed and attention were affected. However, these deficits were attenuated after exclusion of persons using benzodiazepine medications. A general pattern of cognitive decline was observed across all groups for processing speed, executive function, category fluency, and episodic and semantic memory; persons transitioning from a nondepressed to depressed state tended to show exacerbated cognitive decline. Conclusions: The results support the notion that cognitive deficits in depression may be more transient than stable. Consequently, cognitive deficits in depression might be regarded as potential treatment targets rather than stable vulnerabilities. As such, repeated assessment of cognitive functioning may provide an additional marker of treatment response.
    Full-text Article · Jun 2016 · International Journal of Geriatric Psychiatry
  • Kristina Johnell · Gudrun Jonasdottir Bergman · Johan Fastbom · [...] · Peter Salmi
    [Show abstract] [Hide abstract] ABSTRACT: Objective: To investigate whether psychotropics are associated with an increased risk of fall injuries, hospitalizations, and mortality in a large general population of older adults. Methods: We performed a nationwide matched (age, sex, and case event day) case-control study between 1 January and 31 December 2011 based on several Swedish registers (n = 1,288,875 persons aged ≥65 years). We used multivariate conditional logistic regression adjusted for education, number of inpatient days, Charlson co-morbidity index, dementia and number of other drugs. Results: Antidepressants were the psychotropic most strongly related to fall injuries (ORadjusted : 1.42; 95% CI: 1.38-1.45) and antipsychotics to hospitalizations (ORadjusted : 1.22; 95% CI: 1.19-1.24) and death (ORadjusted : 2.10; 95% CI: 2.02-2.17). Number of psychotropics was associated with increased the risk of fall injuries, (4 psychotropics vs 0: ORadjusted : 1.53; 95% CI: 1.39-1.68), hospitalization (4 psychotropics vs 0: ORadjusted : 1.27; 95% CI: 1.22-1.33) and death (4 psychotropics vs 0: ORadjusted : 2.50; 95% CI: 2.33-2.69) in a dose-response manner. Among persons with dementia (n = 58,984), a dose-response relationship was found between number of psychotropics and mortality risk (4 psychotropics vs 0: ORadjusted : 1.99; 95% CI: 1.76-2.25). Conclusions: Our findings support a cautious prescribing of multiple psychotropic drugs to older patients.
    Article · Apr 2016 · International Journal of Geriatric Psychiatry
  • Ylva Haasum · Johan Fastbom · Kristina Johnell
    [Show abstract] [Hide abstract] ABSTRACT: Introduction: It has been suggested that depression in Parkinson's Disease (PD) is often unrecognized and undertreated. However, few previous studies have studied the use of antidepressants in a large sample of both home-dwelling and institutionalized elderly persons with PD. We aimed to study the use of antidepressants in older persons using anti-parkinson drugs (APD, used as a proxy for PD), stratified by residential setting. Methods: We analyzed individual data on age, sex, residential setting and drug use in over 1.5 million older persons in the Swedish Prescribed Drug Register on 31th of December 2013. Results: Twenty-two percent of the home-dwellers and 50% of the institutionalized elderly persons with APD used antidepressants. Persons with APD had a higher probability of use of any antidepressant compared to persons without APD. A selective serotonin reuptake inhibitor (SSRI) was the most commonly used antidepressants in both settings followed by mirtazapin. Conclusions: The high use of antidepressants among older persons with APD warrants further studies on the quality of treatment of depression in PD.
    Article · Apr 2016 · Parkinsonism & Related Disorders
  • Clément Pimouguet · Debora Rizzuto · Johan Fastbom · [...] · Weili Xu
    [Show abstract] [Hide abstract] ABSTRACT: Background: Studies have reported that moderate/severe stages of dementia are linked to increased hospitalization rates, but little is known about the influence of incipient dementia on hospitalizations for primary care sensitive conditions (PCSCs). Objective: To examine the associations between incipient dementia and hospitalization outcomes, including all-cause and PCSC hospitalization. Methods: A total of 2,268 dementia-free participants in the Swedish National study on Aging and Care-Kungsholmen were interviewed and clinically examined at baseline. Participants aged ≥78 years were followed for 3 years, and those aged 60-72 years, for 6 years. Number of hospitalizations was retrieved from the National Patient Register. Dementia was diagnosed in accordance with Diagnostic and Statistical Manual of Mental Disorders-IV criteria. Hospitalization outcomes were compared in participants who did and did not develop dementia. Zero-inflated Poisson regressions and logistic regressions were used in data analysis. Results: During the follow-up, 175 participants developed dementia. The unadjusted PCSC admission rate was 88.2 per 1000 person-years in those who developed dementia and 25.6 per 1000 person-years in those who did not. In the fully adjusted logistic regression model, incipient dementia was associated with an increased risk of hospitalization for PCSCs (OR = 2.3, 95% CI 1.3-3.9) but not with the number of hospitalizations or with all-cause hospitalization. Risks for hospitalization for diabetes, congestive heart failure, and pyelonephritis were higher in those who developed dementia than those who did not. About 10% participants had a PCSC hospitalization attributable to incipient dementia. Conclusion: People with incipient dementia are more prone to hospitalization for PCSCs but not to all-cause hospitalization.
    Article · Mar 2016 · Journal of Alzheimer's disease: JAD
  • [Show abstract] [Hide abstract] ABSTRACT: Background: This study analyzes the prevalence and patterns of coexisting chronic conditions in older adults. Design: Cross-sectional. Participant and setting: A sample of 3363 people ≥60years living in Stockholm were examined from March 2001 through August 2004. Measurements: Chronic conditions were measured with: 1) multimorbidity (≥2 concurrent chronic diseases); 2) the Cumulative Illness Rating Scale, 3) polypharmacy (≥5 prescribed drugs), and 4) complex health problems (chronic diseases and/or symptoms along with cognitive and/or functional limitations). Results: A total of 55.6% of 60-74year olds and 13.4% of those ≥85years did not have chronic conditions according to the four indicators. Multimorbidity and polypharmacy were the most prevalent indicators: 38% aged 60-74 and 76% aged ≥85 had multimorbidity; 24.3% aged 60-74 and 59% aged ≥85 had polypharmacy. Prevalence of chronic conditions as indicated by the comorbidity index and complex health problems ranged from 16.5% and 1.5% in the 60-74year olds to 38% and 36% in the 85+ year olds, respectively. Prevalence of participants with 4 indicators was low, varying from 1.6% in those aged 60-74 to 14.9% in those aged ≥85years. Older age was associated with higher odds of each of the 4 indicators; being a woman, with all indicators but multimorbidity; and lower educational level, only with complex health problems. Conclusions: Prevalence of coexisting chronic conditions varies greatly by health indicator used. Variation increases when age, sex, and educational level are taken into account. These findings underscore the need of different indicators to capture health complexity in older adults.
    Article · Mar 2016 · European Journal of Internal Medicine
  • Edwin Tan · Chengxuan Qiu · Johan Fastbom · [...] · Kristina Johnell
    Article · Mar 2016
  • Article · Mar 2016
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    Anders Sköldunger · Johan Fastbom · Anders Wimo · [...] · Kristina Johnell
    [Show abstract] [Hide abstract] ABSTRACT: Background: We aimed to investigate the impact of dementia on drug costs in older people, after adjustment for socio-demographic factors, residential setting and co-morbidities. Methods: We included 4 129 individuals aged ≥ 60 years from The Swedish National Study on Aging and Care (SNAC) in Kungsholmen and Nordanstig 2001-2004. A generalized linear model (GLM) was used to investigate how much dementia was associated with drug costs. Results: Overall drug costs for persons with and without dementia were 6147 SEK (816 USD) and 3810 SEK (506 USD), respectively. The highest drug cost was observed for nervous system drugs among persons with dementia. The adjusted GLM showed that dementia was not associated with higher overall drug costs (β = 1.119; ns). Comorbidities and residential setting were the most important factors for overall drug costs. Conclusion: We found that the observed higher overall drug costs for persons with dementia were due to comorbidities and residential setting.
    Full-text Article · Feb 2016 · BMC Neurology
  • [Show abstract] [Hide abstract] ABSTRACT: Objective: To explore registered nurses' experience of medication management in municipal care of the elderly in Sweden, with a focus on their pharmacovigilant activities. Design: A qualitative approach using focus-group discussions was chosen in order to provide in-depth information. Data were analysed by qualitative content analysis. Setting: Five focus groups in five different long-term care settings in two regions in Sweden. Subject: A total of 21 registered nurses (RNs), four men and 17 women, aged 27-65 years, with 4-34 years of nursing experience. Results: The findings reveal that RNs in municipal long-term care settings can be regarded as vigilant intermediaries in the patients' drug treatments. They continuously control the work of staff and physicians and mediate between them, and also compensate for existing shortcomings, both organizational and in the work of health care professionals. RNs depend on other health care professionals to be able to monitor drug treatments and ensure medication safety. They assume expanded responsibilities, sometimes exceeding their formal competence, and try to cover for deficiencies in competence, experience, accessibility, and responsibility-taking. Conclusion: The RNs play a central but also complex role as vigilant intermediaries in the medication monitoring process, including the issue of responsibility. Improving RNs' possibility to monitor their patients' drug treatments would enable them to prevent adverse drug events in their daily practice. New strategies are justified to facilitate RNs' pharmacovigilant activities.
    Article · Feb 2016 · Scandinavian Journal of Primary Health Care
  • Danijela Gnjidic · Johan Fastbom · Laura Fratiglioni · [...] · Kristina Johnell
    Article · Jan 2016 · Journal of the American Geriatrics Society