title: Risk of death associated with use of PPIs in three cohorts of institutionalized older people in Finland.
abstract: OBJECTIVE
  To (1) explore clinical and demographic characteristics of users and nonusers of PPIs in 3 cohorts of institutionalized older people in Finland, and (2) compare the risk of death associated with use of PPIs in each setting.
  
  
  METHODS
  Cross-sectional assessment of 3 institutionalized cohorts with 1-year follow-up of all-cause mortality.
  
  
  METHODS
  A total of 1389 residents of 69 assisted living facilities (first cohort), 1004 residents of long term care hospitals (second cohort), and 425 residents in acute geriatric wards or in nursing homes (third cohort).
  
  
  METHODS
  Demographic, drug use, and diagnostic data were collected during structured assessments conducted by trained nurses or geriatricians. Cox proportional hazards models were used to compute unadjusted and adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) for the association between use of PPIs and mortality.
  
  
  RESULTS
  In the assisted living facility, the mortality was 20.2% (n = 74) and 20.4% (n = 208) among users and nonusers of PPIs, respectively (P = 0.94). PPIs were not associated with mortality in unadjusted or adjusted analyses. In the long term care hospitals, use of PPIs was associated with increased mortality (HR, 1.36; 95% CI 1.04-1.77) when adjusted for age, sex, comorbidity, use of SSRIs, and malnutrition. In the acute geriatric wards and nursing homes, use of PPIs was associated with increased mortality (HR, 1.90; 95% CI 1.23-2.94) when adjusted for age, sex, comorbidity, delirium, and use of aspirin and SSRIs.
  
  
  CONCLUSIONS
  PPIs were not associated with mortality among residents in assisted living facilities, but were associated with increased mortality in settings where residents experienced higher levels of disability and possible susceptibility to adverse drug events.
authors.affiliation: Helsinki City Health Center, Home Nursing Services, City of Helsinki, Helsinki, Finland.
authors.forename: Mariko
authors.initials: M
authors.lastname: Teramura-Grönblad
authors.forename: J Simon
authors.initials: JS
authors.lastname: Bell
authors.forename: Minna M
authors.initials: MM
authors.lastname: Pöysti
authors.forename: Timo E
authors.initials: TE
authors.lastname: Strandberg
authors.forename: Jouko V
authors.initials: JV
authors.lastname: Laurila
authors.forename: Reijo S
authors.initials: RS
authors.lastname: Tilvis
authors.forename: Helena
authors.initials: H
authors.lastname: Soini
authors.forename: Kaisu H
authors.initials: KH
authors.lastname: Pitkälä
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D003643:Death; D005260:Female; D005387:Finland; D006801:Humans; D007326:Institutionalization; D008134:Long-Term Care; D008297:Male; D054328:Proton Pump Inhibitors / Q000009:adverse effects*; D012112:Residential Facilities; D018570:Risk Assessment
chemical_list: D054328:Proton Pump Inhibitors