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Kim JS, Kim E. Subjective memory complaints and medication adherence among hypertensive Korean older adults with multimorbidity: mediating effect of depression and social support. BMC Public Health 2024; 24:585. [PMID: 38395841 PMCID: PMC10885607 DOI: 10.1186/s12889-024-18061-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2023] [Accepted: 02/10/2024] [Indexed: 02/25/2024] Open
Abstract
BACKGROUND & AIM(S) Medication adherence (MA) is a key factor in maintaining adequate blood pressure and preventing complications. However, some older adults experience difficulties in taking medicine properly due to declines in cognitive function. Although subjective memory complaints (SMC) are recognized as early markers of cognitive impairment, previous studies concerning the relationship between MA and cognitive function have focused only on objective cognitive function. Furthermore, while depression has a high correlation with SMC, low MA, and social support, there is limited evidence on their relationship. This study aims to understand the effect of SMC on MA and the mediating effect of depression and social support. METHOD(S) This study is a descriptive cross-sectional investigation. A sample of 195 community-dwelling hypertensive older adults with multimorbidity from 3 community senior centers in Gwangju, South Korea were recruited through convenience sampling. Data was collected through face-to-face survey from January to March 2018. The PROCESS macro v4.2 program [Model 6] was used to analyze the mediating effect of depression and social support in the relationship between SMC and MA. Data analysis was performed using SPSS/WIN 26.0 and STATA MP 17.0. RESULTS The average MA was 6.74. There were significant differences in MA according to awareness of prescribed drugs, awareness of side effects, insomnia, and healthcare accessibility. SMC was positively correlated with depression, while social support and MA were negatively correlated. While depression was a significant mediator of the effect of SMC on MA, the mediating effect of social support was not significant. The multiple mediation effect of depression and social support was not significant. CONCLUSION The results suggest that medication management of older adults in community settings should be accompanied by a comprehensive health assessment of associated factors. Health professionals should explore strategies to improve memory as well as prevent and alleviate depression to increase MA among hypertensive older adults with multimorbidity.
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Affiliation(s)
- Jeong Sun Kim
- College of Nursing, Chonnam National University, 160, Baekseo-ro, Dong-gu, Gwangju, South Korea
| | - Eunji Kim
- Department of Public Health Science, Graduate School of Public Health, Seoul National University, 1 Gwanak-ro, Gwanak-gu, Seoul, South Korea.
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Madavanakadu Devassy S, Baby John S, Scaria L. Cognitive factors associated with hypertension and diabetes control among diagnosed and treated patients; findings from a community cohort in India. Prev Med Rep 2023; 36:102495. [PMID: 38116262 PMCID: PMC10728465 DOI: 10.1016/j.pmedr.2023.102495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 11/04/2023] [Accepted: 11/05/2023] [Indexed: 12/21/2023] Open
Abstract
Uncontrolled hypertension and diabetes are a challenge for healthcare providers worldwide. The research documenting the underlying risk factors of uncontrolled chronic illnesses in community cohorts from India is negligible. The current cross-sectional household door-knock survey conducted among 759 participants aged 30 and above from a geographically well-defined area examines the cognitive risk factors associated with hypertension and diabetes control in the Indian population. The study used an assessment tool consisting of a socio-demographic questionnaire, items to measure cognitive factors, and onsite hypertension and diabetes measurements. Results suggested that among the participants, more than 36% had hypertension, 26% had diabetes, and of those with diagnosed diabetes and hypertension, more than 22% with hypertension and 48% with diabetes had uncontrolled conditions. Univariate analysis suggests that cognitive functioning was negatively associated with uncontrolled hypertension and psychological impairments of depression and anxiety were positively associated. The associations were not significant for uncontrolled diabetes. Only if treatments integrate psychological and cognitive interventions to ensure adherence to medical and lifestyle modifications will it achieve the WHO target of 80% control of detected conditions. The findings can inform the policies and programs to optimise government spending and modify the current chronic condition management practices.
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Affiliation(s)
- Saju Madavanakadu Devassy
- Department of Social Work, Rajagiri College of Social Sciences, Kalamassery, Cochin, Kerala, India
- International Centre for Consortium Research in Social Care, Kalamassery, Cochin, Kerala, India
- University of Edinburgh, Scotland
| | | | - Lorane Scaria
- Department of Social Work, Rajagiri College of Social Sciences, Kalamassery, Cochin, Kerala, India
- International Centre for Consortium Research in Social Care, Kalamassery, Cochin, Kerala, India
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Sharma R, Mahajan N, Fadaleh SA, Patel H, Ivo J, Faisal S, Chang F, Lee L, Patel T. Medication Reviews and Clinical Outcomes in Persons with Dementia: A Scoping Review. PHARMACY 2023; 11:168. [PMID: 37888512 PMCID: PMC10609910 DOI: 10.3390/pharmacy11050168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2023] [Revised: 10/10/2023] [Accepted: 10/16/2023] [Indexed: 10/28/2023] Open
Abstract
Persons diagnosed with dementia are often faced with challenges related to polypharmacy and inappropriate medication use and could benefit from regular medication reviews. However, the benefit of such reviews has not been examined in this population. Therefore, the current scoping review was designed to identify the gaps in the current knowledge regarding the impact of medication reviews on the clinical outcomes in older adults with dementia. Relevant studies were identified by searching three databases (Ovid MEDLINE, Ovid EMBASE, and Scopus) from inception to January 2022 with a combination of keywords and medical subject headings. After the removal of duplicates and ineligible articles, 22 publications of the initial 8346 were included in this review. A total of 57 outcomes were identified, including those pertaining to the evaluation of medication use (n = 17), drug-related interventions (n = 11), drug-related problems (n = 10), dementia-related behavioral symptoms (n = 8), cost-effectiveness (n = 2), drug-related hospital admissions (n = 1), as well as outcomes classified as other (n = 7). Gaps identified through this scoping review included the paucity of studies measuring the impact of medication reviews on the medication management capacity and medication adherence, quality of life, and mortality.
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Affiliation(s)
- Rishabh Sharma
- School of Pharmacy, University of Waterloo, 10 Victoria St S A, Kitchener, ON N2G 1C5, Canada; (R.S.); (S.A.F.); (H.P.); (J.I.); (S.F.); (F.C.)
| | - Neil Mahajan
- Faculty of Health, Western University, 1151 Richmond St, London, ON N6A 5B9, Canada;
| | - Sarah Abu Fadaleh
- School of Pharmacy, University of Waterloo, 10 Victoria St S A, Kitchener, ON N2G 1C5, Canada; (R.S.); (S.A.F.); (H.P.); (J.I.); (S.F.); (F.C.)
| | - Hawa Patel
- School of Pharmacy, University of Waterloo, 10 Victoria St S A, Kitchener, ON N2G 1C5, Canada; (R.S.); (S.A.F.); (H.P.); (J.I.); (S.F.); (F.C.)
| | - Jessica Ivo
- School of Pharmacy, University of Waterloo, 10 Victoria St S A, Kitchener, ON N2G 1C5, Canada; (R.S.); (S.A.F.); (H.P.); (J.I.); (S.F.); (F.C.)
| | - Sadaf Faisal
- School of Pharmacy, University of Waterloo, 10 Victoria St S A, Kitchener, ON N2G 1C5, Canada; (R.S.); (S.A.F.); (H.P.); (J.I.); (S.F.); (F.C.)
| | - Feng Chang
- School of Pharmacy, University of Waterloo, 10 Victoria St S A, Kitchener, ON N2G 1C5, Canada; (R.S.); (S.A.F.); (H.P.); (J.I.); (S.F.); (F.C.)
| | - Linda Lee
- CFFM MINT Memory Clinic, 25 Joseph St, Kitchener, ON N2G 4X6, Canada;
- Schlegel-UW Research Institute for Aging, 250 Laurelwood Dr, Waterloo, ON N2J 0E2, Canada
- Department of Family Medicine, McMaster University, 100 Main St W 5th Floor, Hamilton, ON L8P 1H6, Canada
| | - Tejal Patel
- School of Pharmacy, University of Waterloo, 10 Victoria St S A, Kitchener, ON N2G 1C5, Canada; (R.S.); (S.A.F.); (H.P.); (J.I.); (S.F.); (F.C.)
- CFFM MINT Memory Clinic, 25 Joseph St, Kitchener, ON N2G 4X6, Canada;
- Schlegel-UW Research Institute for Aging, 250 Laurelwood Dr, Waterloo, ON N2J 0E2, Canada
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Raghunandan R, Howard K, Ilomaki J, Hilmer SN, Gnjidic D, Bell JS. Preferences for deprescribing antihypertensive medications amongst clinicians, carers and people living with dementia: a discrete choice experiment. Age Ageing 2023; 52:afad153. [PMID: 37596920 PMCID: PMC10439526 DOI: 10.1093/ageing/afad153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Indexed: 08/21/2023] Open
Abstract
BACKGROUND Optimal management of hypertension in people with dementia may involve deprescribing antihypertensives. Understanding differing treatment priorities is important to enable patient-centred care. This study explored preferences for antihypertensive deprescribing amongst people living with dementia, carers and clinicians. METHODS Discrete choice experiments (DCEs) are a stated preference survey method, underpinned by economic theory. A DCE was conducted, and respondents completed 12 labelled choice-questions, each presenting a status quo (continuing antihypertensives) and antihypertensive deprescribing option. The questions included six attributes, including pill burden, and event risks for stroke, myocardial infarction, increased blood pressure, cognitive decline, falls. RESULTS Overall, 112 respondents (33 carers, 19 people living with dementia, and 60 clinicians) completed the survey. For people with dementia, lower pill burden increased preferences for deprescribing (odds ratio (OR) 1.95, 95% confidence interval (95% CI) 1.08-3.52). Increased stroke risk (for each additional person out of 100 having a stroke) decreased the likelihood of deprescribing for geriatricians (OR 0.71, 95% CI 0.55-0.92) and non-geriatrician clinicians (OR 0.62, 95% CI 0.45-0.86), and carers (OR 0.71, 95% CI 0.58-0.88). Increased myocardial infarction risk decreased preferences for deprescribing for non-geriatricians (OR 0.81, 95% CI 0.69-0.95) and carers (OR 0.84, 95% CI 0.73-0.98). Avoiding cognitive decline increased preferences for deprescribing for geriatricians (OR 1.17, 95% CI 1.03-1.33) and carers (OR 1.27, 95% CI 1.09-1.48). Avoiding falls increased preferences for deprescribing for clinicians (geriatricians (OR 1.20, 95% CI 1.11-1.29); non-geriatricians (OR 1.16, 95% CI 1.07-1.25)). Other attributes did not significantly influence respondent preferences. CONCLUSIONS Antihypertensive deprescribing preferences differ amongst people with dementia, carers and clinicians. The study emphasises the importance of shared decision-making within the deprescribing process.
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Affiliation(s)
- Rakhee Raghunandan
- Menzies Centre for Health Policy and Economics, School of Public Health, Faculty of Medicine and Health, University of Sydney, Camperdown, NSW, Australia
| | - Kirsten Howard
- Menzies Centre for Health Policy and Economics, School of Public Health, Faculty of Medicine and Health, University of Sydney, Camperdown, NSW, Australia
| | - Jenni Ilomaki
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Clayton, VIC, Australia
| | - Sarah N Hilmer
- Kolling Institute of Medical Research, Royal North Shore Hospital and University of Sydney, St Leonards, NSW, Australia
- Departments of Clinical Pharmacology and Aged Care, Royal North Shore Hospital, St Leonards, NSW, Australia
- Northern Clinical School, Faculty of Medicine and Health, University of Sydney, Camperdown, NSW, Australia
| | - Danijela Gnjidic
- School of Pharmacy, Faculty of Medicine and Health, and Charles Perkins Centre, University of Sydney, Camperdown, NSW, Australia
| | - J Simon Bell
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Clayton, VIC, Australia
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Depression/anxiety symptoms and self-reported difficulty managing medication regimen among community-dwelling older adults. Gen Hosp Psychiatry 2022; 78:50-57. [PMID: 35853418 DOI: 10.1016/j.genhosppsych.2022.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2022] [Revised: 06/17/2022] [Accepted: 07/07/2022] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To examine the associations between depression/anxiety severity and changes in severity and self-reported difficulty managing medications among a representative sample of community-residing US Medicare beneficiaries without a reported dementia diagnosis. METHOD We used the 2018 and 2019 National Health and Aging Trend Study (analysis sample N = 3198, 98% age 70+). Depression/anxiety was measured with the PHQ-4, and difficulty managing medication was self-reported. Following descriptive statistics, we fit a multinomial logistic regression model to examine the associations between depression/anxiety symptoms in 2018 and changes in severity between 2018 and 2019 and self-reported level of difficulty managing medication in 2019. RESULTS Of past-month prescription medication users in 2019, 85.2%, 10.7%, and 4.1% reported no difficulty, a little/some difficulty, and a lot of difficulty or partial/full reliance on other's help for health/functioning reasons, respectively. Both mild and moderate/severe levels of depression/anxiety in 2018 were associated with significantly higher risks of a little/some difficulty and a lot of difficulty/other's help in 2019. Compared to no change in depression/anxiety symptoms between 2018 and 2019, decreased symptoms were associated with lower risk (RRR = 0.47, 95% CI = 0.28-0.78) and increased symptoms were associated with higher risk (RRR = 1.73, 95% CI = 1.12-2.67) of a little/some difficulty managing one's medication. CONCLUSIONS Decrease and increase in depression/anxiety are associated with decreased and increased risk, respectively, of medication self-management difficulty among community-residing older adults. Healthcare providers should more carefully assess for medication management problems in their older adults with depression and anxiety symptoms and provide individually tailored interventions for those with great difficulty self-managing medication.
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Nanaumi Y, Yoshitani A, Onda M. Impact of interventions by a community pharmacist on care burden for people with dementia: development and randomized feasibility trial of an intervention protocol. Pilot Feasibility Stud 2022; 8:118. [PMID: 35655244 PMCID: PMC9161485 DOI: 10.1186/s40814-022-01071-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2021] [Accepted: 05/17/2022] [Indexed: 11/12/2022] Open
Abstract
Background Traditionally, the role of pharmacists has been to manage and monitor pharmacotherapy for patients with dementia. However, additional intervention by community pharmacists to collect and share patient information with other professionals may help reduce the care burden among caregivers. The aims of this study were to examine (1) the feasibility of a designed community pharmacist working procedure in dementia care and (2) the expected impact of pharmacist intervention on care burden. Methods This was a randomized, open-label, parallel-group feasibility study, involving eight Nara City pharmaceutical association member pharmacies that provided consent to participate. These pharmacies were assigned to an intervention group or a control group at a 1:1 ratio. The subjects were patients with dementia and their primary caregivers that visited the participating pharmacies and provided consent to participate. Pharmacists in the intervention group actively collected information from the patients’ family physicians and care managers and intervened to address medication-related problems, while those in the control group only performed their normal duties. The primary endpoint was a change in the caregiver’s score on the Japanese version of Zarit Caregiver Burden interview (J-ZBI) from the baseline to after 5 months of follow-up. The changes in mean J-ZBI scores from the beginning to the end of the study period of the two groups were compared. Results Obtaining consent from caregivers was certainly difficult, but possible. Pharmacists managed to fill out the survey form while practising pharmaceutical care. Totally, nine patients and nine caregivers in the intervention group and nine patients and eight caregivers in the control group completed the study. The changes in J-ZBI scores could be calculated for seven cases in the intervention group and five cases in the control group. The J-ZBI scores were found to decrease by 1.0 in the intervention group and increase by 3.0 in the control group. Conclusions The protocol presented was considered feasible, but, the intervention process needs to be simplified in order to conduct a large study. Also, improvements are needed in the various survey forms and in the explanatory documents for caregivers. Although the sample size was small, the effect sizes suggested that community pharmacist interventions for patient with dementia may reduce the care burden for caregivers. Trial registration UMIN000039949 (registration date: 1 April 2020, retrospectively registered) Supplementary Information The online version contains supplementary material available at 10.1186/s40814-022-01071-7.
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Affiliation(s)
- Yoko Nanaumi
- Advance Pharma Research Office, 3-6-2 Ukyo, Nara, 631-0805, Japan
| | - Atsushi Yoshitani
- Nara City Pharmaceutical Association, 768, Kidera-cho, Nara, 630-8306, Japan
| | - Mitsuko Onda
- Faculty of Pharmacy, Osaka Medical and Pharmaceutical University, 4-20-1, Nasahara, Takatsuki City, Osaka, Japan.
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Yamamoto K, Akasaka H, Yasunobe Y, Shimizu A, Nomoto K, Nagai K, Umegaki H, Akasaki Y, Kojima T, Kozaki K, Kuzuya M, Ohishi M, Akishita M, Takami Y, Rakugi H. Clinical characteristics of older adults with hypertension and unrecognized cognitive impairment. Hypertens Res 2022; 45:612-619. [PMID: 35210565 DOI: 10.1038/s41440-022-00861-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 01/14/2022] [Accepted: 01/18/2022] [Indexed: 11/09/2022]
Abstract
To treat older patients with hypertension, it is important to detect cognitive impairment at an early stage because of its potential influence on treatment efficacy and functional prognosis. In this study, we aimed to identify the incidence and determinants of cognitive impairment in hypertensive patients aged 65 years and above who visited our outpatient clinic and were not previously diagnosed with cognitive impairment. Among 312 patients with hypertension, we found that 35% (n = 109) and 7.7% (n = 24) had cognitive impairment and dementia, respectively, as defined by the Mini-Mental State Examination (≤27 or ≤23, respectively). Patients with cognitive impairment were older, had lower levels of education, and had lower instrumental activities of daily living (IADL) scores than those without cognitive impairment. Multiple regression analysis revealed that age and IADL were associated with cognitive impairment in patients with hypertension. Regarding the treatment of hypertension, the office and home blood pressure levels, number of antihypertensive medications prescribed, and proportion of the use of each antihypertensive drug was equivalent between patients with and without cognitive impairment. Finally, patients with unrecognized cognitive impairment showed distinct clinical characteristics, including high antihypertensive medication burden and preserved IADL, when compared to hypertensive patients in the different cohorts of definitive mild cognitive impairment of a similar age. These findings suggest that older hypertensive patients are at a high risk of masked cognitive decline, even if they are functionally independent.
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Affiliation(s)
- Koichi Yamamoto
- Department of Geriatric and General Medicine, Osaka University Graduate School of Medicine, Osaka, Japan.
| | - Hiroshi Akasaka
- Department of Geriatric and General Medicine, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Yukiko Yasunobe
- Department of Geriatric and General Medicine, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Atsuya Shimizu
- National Center for Geriatrics and Gerontology, Obu, Japan
| | | | - Kumiko Nagai
- Department of Geriatric Medicine, Graduate School of Medicine, Kyorin University School of Medicine, Tokyo, Japan
| | - Hiroyuki Umegaki
- Department of Community Healthcare & Geriatrics, Graduate School of Medicine, Nagoya University, Nagoya, Japan
| | - Yuichi Akasaki
- Department of Cardiovascular Medicine and Hypertension, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan
| | - Taro Kojima
- Department of Geriatric Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Koichi Kozaki
- Department of Geriatric Medicine, Graduate School of Medicine, Kyorin University School of Medicine, Tokyo, Japan
| | - Masafumi Kuzuya
- Department of Community Healthcare & Geriatrics, Graduate School of Medicine, Nagoya University, Nagoya, Japan
| | - Mitsuru Ohishi
- Department of Cardiovascular Medicine and Hypertension, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan
| | - Masahiro Akishita
- Department of Geriatric Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Yoichi Takami
- Department of Geriatric and General Medicine, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Hiromi Rakugi
- Department of Geriatric and General Medicine, Osaka University Graduate School of Medicine, Osaka, Japan.
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Marcum ZA, Chang CY, Barthold D, Holmes HM, Lo-Ciganic WH. Industry Payments to Physicians and Prescribing Branded Memantine and Donepezil Combination. Neurol Clin Pract 2021; 11:181-187. [PMID: 34484885 DOI: 10.1212/cpj.0000000000000870] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Accepted: 03/05/2020] [Indexed: 11/15/2022]
Abstract
Background Once-daily extended-released memantine with donepezil (hereafter memantine/donepezil) may improve medication adherence but has a 60-fold higher cost compared with combined generic components. Little is known about factors associated with prescribing memantine/donepezil. We examined the association between pharmaceutical industry payments to physicians and prescribing memantine/donepezil in Medicare. Methods A cross-sectional study was conducted. Using 2015-2016 Centers for Medicare and Medicaid Services Open Payments and Part D prescription databases, we identified unique physicians who prescribed ≥11 memantine/donepezil prescriptions from 2015 to 2016. Outcome variable was the number of memantine/donepezil prescriptions written per physician per year. The key independent variable was physician receipt of industry payments defined in 2 models: (1) number of payments and (2) amount of payment ($100 units) for memantine/donepezil received per physician per year. Multivariable Poisson regression was used, adjusting for potential confounders. Results Among 4,895 unique eligible physicians in 2015-2016, the median number of memantine/donepezil prescriptions per physician per year was 19.5 (25th percentile 13, 75th percentile 32). Physicians received between 0 and 75 payments per year (median 1, 25th percentile 0, 75th percentile 2.5) for memantine/donepezil, totaling an average of $92 per year (median $10.5, 25th percentile $0, 75th percentile $33.20). Every 1 additional payment received was associated with a 2% increase in new memantine/donepezil prescriptions prescribed per physician per year (rate ratio [RR] 1.02, 95% confidence interval [CI] 1.02-1.02). Every $100 increase in payment for memantine/donepezil was associated with a 0.3% increase in new memantine/donepezil prescriptions prescribed per physician per pear (RR 1.003, 95% CI 1.002-1.004). Conclusions Receipt of industry payments for memantine/donepezil was independently associated with increased likelihood of physician prescribing memantine/donepezil in Medicare.
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Affiliation(s)
- Zachary A Marcum
- Department of Pharmacy (ZAM, DB), University of Washington, Seattle; Department of Pharmaceutical Outcomes and Policy (C-YC, W-HL-C), Center for Drug Evaluation and Safety (C-YC, W-HL-C), College of Pharmacy, University of Florida, Gainesville; and Division of Geriatric and Palliative Medicine (HMH), The University of Texas Health Science Center at Houston, McGovern Medical School
| | - Ching-Yuan Chang
- Department of Pharmacy (ZAM, DB), University of Washington, Seattle; Department of Pharmaceutical Outcomes and Policy (C-YC, W-HL-C), Center for Drug Evaluation and Safety (C-YC, W-HL-C), College of Pharmacy, University of Florida, Gainesville; and Division of Geriatric and Palliative Medicine (HMH), The University of Texas Health Science Center at Houston, McGovern Medical School
| | - Douglas Barthold
- Department of Pharmacy (ZAM, DB), University of Washington, Seattle; Department of Pharmaceutical Outcomes and Policy (C-YC, W-HL-C), Center for Drug Evaluation and Safety (C-YC, W-HL-C), College of Pharmacy, University of Florida, Gainesville; and Division of Geriatric and Palliative Medicine (HMH), The University of Texas Health Science Center at Houston, McGovern Medical School
| | - Holly M Holmes
- Department of Pharmacy (ZAM, DB), University of Washington, Seattle; Department of Pharmaceutical Outcomes and Policy (C-YC, W-HL-C), Center for Drug Evaluation and Safety (C-YC, W-HL-C), College of Pharmacy, University of Florida, Gainesville; and Division of Geriatric and Palliative Medicine (HMH), The University of Texas Health Science Center at Houston, McGovern Medical School
| | - Wei-Hsuan Lo-Ciganic
- Department of Pharmacy (ZAM, DB), University of Washington, Seattle; Department of Pharmaceutical Outcomes and Policy (C-YC, W-HL-C), Center for Drug Evaluation and Safety (C-YC, W-HL-C), College of Pharmacy, University of Florida, Gainesville; and Division of Geriatric and Palliative Medicine (HMH), The University of Texas Health Science Center at Houston, McGovern Medical School
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Suwa S, Tsujimura M, Yumoto A, Iwata N, Shimamura A. Multidisciplinary pharmacotherapy collaboration for home-based older adults with dementia: a study focusing on physicians, pharmacists, and nursing professionals. Psychogeriatrics 2021; 21:749-762. [PMID: 34212449 DOI: 10.1111/psyg.12735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2020] [Revised: 05/22/2021] [Accepted: 06/07/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND It is imperative that a team consisting of a physician, pharmacist, and nursing professional provides pharmacotherapy support to achieve the optimal effect of pharmacotherapy for older adults with dementia. This study reviewed Japanese publications on the process of pharmacotherapy support practised by various professionals for home-based older adults with dementia and investigated healthcare professionals' perceived importance and practice of pharmacotherapy support. METHODS This study aimed to shed light on basic pharmacotherapy support for behavioural and psychological symptoms among home-based older adults with dementia using multidisciplinary collaboration, through a literature review of Japanese publications. Based on the literature review, 13 items pertaining to basic pharmacotherapy support for home-based older adults with dementia were extracted. A mail-based, self-administered, anonymous questionnaire survey was conducted with professionals including physicians, pharmacists, and nursing professionals who provide pharmacotherapy support to home-based older adults with dementia. Participants rated 13 items on their perceived importance and practice of basic pharmacotherapy support using a four-point Likert scale. RESULTS The results indicated that participants recognised the importance of all 13 items. At least 80% of all professionals indicated that they practised seven out of 13 items. Less than 80% of all professionals indicated they practised the other six items that should be provided after the commencement of pharmacotherapy. A relatively high proportion of nursing professionals (70%) indicated they practised the remaining six items. The 13 items were indeed deemed important for characterising pharmacotherapy support. However, in Japan, suboptimal support is provided following the commencement of medication. This may be because appropriate modifications to dementia care are not made as the patient's condition progresses. CONCLUSIONS It is suggested that multidisciplinary collaboration focusing on the progression of dementia and the process of pharmacotherapy, especially after the commencement of pharmacotherapy, may help provide effective, continuous pharmacotherapy.
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Affiliation(s)
- Sayuri Suwa
- Graduate School of Nursing, Chiba University, Chiba, Japan
| | - Mayuko Tsujimura
- School of Nursing, Faculty of Medicine, Shiga University of Medical Science, Shiga, Japan
| | - Akiyo Yumoto
- Graduate School of Nursing, Chiba University, Chiba, Japan
| | - Naoko Iwata
- School of Nursing, Faculty of Medicine, Tokyo Medical University, Tokyo, Japan
| | - Atsuko Shimamura
- Department of Nursing, Faculty of Health Science, Toho University, Chiba, Japan
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An investigation of new medications initiation during ambulatory care visits in patients with dementia. EXPLORATORY RESEARCH IN CLINICAL AND SOCIAL PHARMACY 2021; 3:100058. [PMID: 35480611 PMCID: PMC9030674 DOI: 10.1016/j.rcsop.2021.100058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 06/23/2021] [Accepted: 08/06/2021] [Indexed: 11/21/2022] Open
Abstract
Background Objectives Methods Results Conclusion What was already known?Dementia remains responsible for a large economic burden; research has shown that patients with dementia have increased utilization of ambulatory care visits before and after diagnosis. Prior research in patients with dementia has focused on inappropriate prescribing, adverse drug interactions, and polypharmacy, but little work has been published investigating new medications prescribed at outpatient visits. Opportunities exist for pharmacists to manage medications in the outpatient setting for patients with complex medication regimens.
What the study adds?Though fewer visits for patients with dementia provided new medications compared to visits for patients without dementia, there was no statistically significant difference in odds of a new medication being provided after adjustment for important confounders. Some of the new medications more commonly provided to dementia patients include anticoagulants and antipsychotics that often require close monitoring and dosage adjustments. Pharmacist led services would likely improve the care of the dementia population in an outpatient setting, but further investigation of new medication usage and the utility of pharmacists is needed.
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Barry HE, McGrattan M, Ryan C, Passmore AP, Robinson AL, Molloy GJ, Darcy CM, Buchanan H, Hughes CM. 'I just take them because I know the people that give them to me': A theory-informed interview study of community-dwelling people with dementia and carers' perspectives of medicines management. Int J Geriatr Psychiatry 2021; 36:883-891. [PMID: 33368704 DOI: 10.1002/gps.5488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 10/22/2020] [Accepted: 12/19/2020] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Identify facilitators and barriers to successful medicines management for people with dementia (PwD) in primary care from the perspectives of community-dwelling PwD and carers. METHODS Semi-structured interviews conducted with PwD and carers in Northern Ireland. The 14-domain Theoretical Domains Framework guided data collection and analysis. Interviews explored participants' experiences and perceptions of medicines management. PwD also completed the Beliefs about Medicines Questionnaire indicating their level of agreement with statements about medicines. Qualitative data were analysed using the framework method and content analysis. Quantitative data were analysed descriptively. RESULTS Eighteen PwD and 15 carers were interviewed. PwD believed they were competent with medicines management ('beliefs about capabilities'). Most PwD reported having strategies to prompt them to take their medicines ('memory, attention and decision processes'). Carers played an important role in supporting PwD with medicines management ('social influences') and monitoring adherence ('behavioural regulation') and anticipated having to take on a greater role as patients' cognitive impairment worsened ('beliefs about consequences'). Participants highlighted assistance provided by community pharmacies with medicines acquisition and delivery ('environmental context and resources') and placed great trust in primary healthcare professionals ('social influences'). PwD had positive attitudes towards medication and believed strongly in the necessity of their medicines. CONCLUSIONS This is the first study to use a theoretical approach to explore medicines management for community-dwelling PwD. The findings provide new insights into the critical role of carers in facilitating optimal medicines management and will inform future intervention development, in which carers' needs assessment and involvement will be key.
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Affiliation(s)
| | | | - Cristín Ryan
- The School of Pharmacy and Pharmaceutical Sciences, Trinity College Dublin, Dublin, Ireland
| | - A Peter Passmore
- Centre for Public Health, Queen's University Belfast, Belfast, UK.,Belfast Health & Social Care Trust, Belfast, UK
| | - A Louise Robinson
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Gerard J Molloy
- School of Psychology, National University of Ireland, Galway, Ireland
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12
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Asiedu-Danso M, Kretchy IA, Sekyi JK, Koduah A. Adherence to Antidiabetic Medications among Women with Gestational Diabetes. J Diabetes Res 2021; 2021:9941538. [PMID: 34395632 PMCID: PMC8363457 DOI: 10.1155/2021/9941538] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 07/06/2021] [Accepted: 07/19/2021] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Optimal adherence to prescribed medications in women with gestational diabetes is relevant for perinatal outcomes. OBJECTIVE To summarize available information on the prevalence and factors contributing to medication adherence in women with gestational diabetes from the biological and psychosocial perspectives. METHODS A literature search on adherence in gestational diabetes was conducted in PubMed/MEDLINE, CINAHL, Scopus, and the Directory of Open Access Journals for studies published on the topic. The Arksey and O'Malley framework for scoping reviews was used to explore and summarize the evidence. RESULTS A total of 2395 studies were retrieved of which 13 fully met the eligibility criteria. The studies were reported in Zimbabwe (n = 5), Iran (n = 1), Mexico (n = 1), South India (n = 1), the United States of America (n = 4), and one multinational study covering Australia, Europe, North and South America. The main types of antidiabetic medications used were insulin (n = 6), metformin (n = 4), and glyburide (n = 2). The prevalence of adherence ranged from 35.6% to 97%, with the assessment tool being self-report measures (n = 8). The main factors associated with nonadherence included worsening pregnancy symptoms, side effects of medications, perceived risks, mental health symptoms, poor social support, and socioeconomic status. Recommendations that evolved from the studies to improve adherence included education, counselling, improved support networks, and social interventions, while the main reported interventional study employed continuous education on the impact of adherence on perinatal outcomes. CONCLUSION Medication nonadherence in gestational diabetes seems to be influenced by multiple factors with some educational interventions positively impacting adherence behaviours. Thus, future research in women with gestational diabetes could consider interventions from a multifactorial perspective to improve therapeutic outcomes.
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Affiliation(s)
- Michelle Asiedu-Danso
- Department of Pharmacy Practice and Clinical Pharmacy, School of Pharmacy, College of Health Sciences, University of Ghana, P. O. Box LG, 43 Legon, Ghana
| | - Irene A. Kretchy
- Department of Pharmacy Practice and Clinical Pharmacy, School of Pharmacy, College of Health Sciences, University of Ghana, P. O. Box LG, 43 Legon, Ghana
| | - Jeremiah Kobby Sekyi
- Department of Pharmacy Practice and Clinical Pharmacy, School of Pharmacy, College of Health Sciences, University of Ghana, P. O. Box LG, 43 Legon, Ghana
| | - Augustina Koduah
- Department of Pharmacy Practice and Clinical Pharmacy, School of Pharmacy, College of Health Sciences, University of Ghana, P. O. Box LG, 43 Legon, Ghana
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13
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Tran L, Jung J, Carlin C, Lee S, Zhao C, Feldman R. Use of Direct-Acting Antiviral Agents and Survival Among Medicare Beneficiaries with Dementia and Chronic Hepatitis C. J Alzheimers Dis 2021; 79:71-83. [PMID: 33216031 PMCID: PMC7855832 DOI: 10.3233/jad-200949] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Many patients with Alzheimer's disease and related dementia (ADRD) have chronic hepatitis C due to the high prevalence of both conditions among elderly populations. Direct-acting antivirals (DAAs) are effective in treating hepatitis C virus (HCV). However, the complexity of ADRD care may affect DAA use and outcomes among patients with HCV and ADRD. Little information exists on uptake of DAAs, factors associated with DAA use, and health benefits of DAAs among patients with HCV and ADRD. OBJECTIVE To examine use and survival benefits of DAAs in Medicare patients with HCV and ADRD. METHODS The study included Medicare patients with HCV between 2014 and 2017. We estimated Cox proportional hazards regressions to examine the association between having ADRD and DAA use, and the relation between DAA use and survival among patients with HCV and ADRD. RESULTS The adjusted hazard of initiating a DAA was 50% lower in patients with ADRD than those without ADRD (adjusted HR = 0.50, 95% CI: 0.46-0.54). The hazard of DAA use among ADRD patients with behavioral disturbances was 68% lower than non-ADRD patients (adjusted HR = 0.32, 95% CI: 0.28-0.37). DAA treatment was associated with a significant reduction in mortality among ADRD patients (adjusted HR = 0.52, 95% CI: 0.44-0.61). CONCLUSION The rate of DAA treatment in patients with HCV and ADRD was low, particularly among those with behavioral disturbance. The survival benefits of DAA treatment for patients with ADRD were substantial.
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Affiliation(s)
- Linh Tran
- Department of Health Policy and Administration, College of Health and Human Development, Pennsylvania State University, University Park, PA, USA
| | - Jeah Jung
- Department of Health Policy and Administration, College of Health and Human Development, Pennsylvania State University, University Park, PA, USA
| | - Caroline Carlin
- Department of Family Medicine and Community Health, School of Medicine, University of Minnesota, Minneapolis, MN, USA
| | - Sunmin Lee
- Department of Epidemiology, School of Medicine, University of California, Irvine, Irvine, CA, USA
| | - Chen Zhao
- Department of Neurology, Penn State Health Milton S. Hershey Medical Center, Hershey, PA, USA
- Department of Public Health Sciences, Pennsylvania State University College of Medicine, Hershey, PA, USA
| | - Roger Feldman
- Division of Health Policy and Management, School of Public Health, University of Minnesota, MN, USA
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14
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Nguyen TA, Gilmartin-Thomas J, Tan ECK, Kalisch-Ellett L, Eshetie T, Gillam M, Reeve E. The Impact of Pharmacist Interventions on Quality Use of Medicines, Quality of Life, and Health Outcomes in People with Dementia and/or Cognitive Impairment: A Systematic Review. J Alzheimers Dis 2020; 71:83-96. [PMID: 31356204 DOI: 10.3233/jad-190162] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Medication use in people with dementia and/or cognitive impairment (PWD/CI) is challenging. As medication experts, pharmacists have an important role in improving care of this vulnerable population. OBJECTIVE Systematically review evidence for the effectiveness of pharmacist-led interventions on quality use of medicines, quality of life, and health outcomes of PWD/CI. METHODS A systematic review was conducted using MEDLINE, EMBASE, PsycINFO, Allied and Complementary Medicine (AMED) and Cumulative index to Nursing and Allied Health Literature (CINAHL) databases from conception to 20 March 2017. Full articles published in English were included. Data were synthesized using a narrative approach. RESULTS Nine studies were eligible for inclusion. All studies were from high-income countries and assessed pharmacist-led medication management services. There was great variability in the content and focus of services described and outcomes reported. Pharmacists were found to provide a number of cognitive services including medication reconciliation, medication review, and medication adherence services. These services were generally effective with regards to improving quality use of medicines and health outcomes for PWD/CI and their caregivers, and for saving costs to the healthcare system. Pharmacist-led medication and dementia consultation services may also improve caregiver understanding of dementia and the different aspects of pharmacotherapy, thus improving medication adherence. CONCLUSION Emerging evidence suggests that pharmacist-led medication management services for PWD/CI may improve outcomes. Future research should confirm these findings using more robust study designs and explore additional roles that pharmacists could undertake in the pursuit of supporting PWD/CI.
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Affiliation(s)
- Tuan Anh Nguyen
- Quality Use of Medicines & Pharmacy Research Centre, School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, Australia.,Health Strategy and Policy Institute, Ministry of Health of Vietnam
| | - Julia Gilmartin-Thomas
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Parkville, Australia
| | - Edwin Chin Kang Tan
- The University of Sydney, Faculty of Medicine and Health, School of Pharmacy, NSW, Australia.,Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, Australia.,Aging Research Center, Karolinska Institutet and Stockholm University, Stockholm, Sweden
| | - Lisa Kalisch-Ellett
- Quality Use of Medicines & Pharmacy Research Centre, School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, Australia
| | - Tesfahun Eshetie
- Quality Use of Medicines & Pharmacy Research Centre, School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, Australia
| | - Marianne Gillam
- Quality Use of Medicines & Pharmacy Research Centre, School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, Australia
| | - Emily Reeve
- NHMRC Cognitive Decline Partnership Centre, Kolling Institute of Medical Research, Northern Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia.,Geriatric Medicine Research and College of Pharmacy, Dalhousie University and Nova Scotia Health Authority, NS, Canada.,College of Medicine, University of Saskatchewan, Saskatoon, SK, Canada
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15
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Polenick CA, Stanz SD, Leggett AN, Maust DT, Hodgson NA, Kales HC. Stressors and Resources Related to Medication Management: Associations With Spousal Caregivers' Role Overload. THE GERONTOLOGIST 2020; 60:165-173. [PMID: 30358854 DOI: 10.1093/geront/gny130] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Managing medications can be stressful for spousal caregivers, but little is known about particular aspects of medication management that are most consequential for caregiving outcomes. We examined care stressors and resources related to medication management, their associations with role overload among spousal caregivers, and whether these links vary by care recipients' number of chronic health conditions and dementia status. RESEARCH DESIGN AND METHODS This cross-sectional study included 377 spousal caregivers of adults aged 65 and older from the 2011 National Health and Aging Trends Study and National Study of Caregiving. Linear regressions were estimated to evaluate how medication-related stressors (ordering medication, keeping track of medications, giving injections) and resources (medication reminder systems, shared medication management within the spousal dyad) are associated with caregivers' role overload. Care recipients' number of chronic health conditions and dementia status were considered as moderators. Models controlled for caregivers' sociodemographic characteristics, chronic health conditions, and other care tasks. RESULTS Caregivers who administered injections reported more role overload, whereas those who worked with care recipients to jointly manage medications reported less role overload. Keeping track of medications was linked to caregivers' greater role overload when care recipients had 5 or more chronic health conditions. Finally, care recipients' use of medication reminder systems was linked to less role overload for caregivers of a partner with dementia. DISCUSSION AND IMPLICATIONS Devising strategies to assist spousal caregivers in the more onerous components of medication management and promote resources that mitigate medication-related stress may improve caregiver well-being.
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Affiliation(s)
- Courtney A Polenick
- Department of Psychiatry, University of Michigan, Ann Arbor.,Program for Positive Aging, University of Michigan, Ann Arbor
| | - Sarah D Stanz
- Institute for Social Research, University of Michigan, Ann Arbor
| | - Amanda N Leggett
- Department of Psychiatry, University of Michigan, Ann Arbor.,Program for Positive Aging, University of Michigan, Ann Arbor
| | - Donovan T Maust
- Department of Psychiatry, University of Michigan, Ann Arbor.,Program for Positive Aging, University of Michigan, Ann Arbor.,Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor.,HSR&D Center for Clinical Management Research (CCMR), VA Ann Arbor Healthcare System, Michigan
| | - Nancy A Hodgson
- Department of Behavioral Health Sciences, University of Pennsylvania School of Nursing, Philadelphia
| | - Helen C Kales
- Department of Psychiatry, University of Michigan, Ann Arbor.,Program for Positive Aging, University of Michigan, Ann Arbor.,Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor.,HSR&D Center for Clinical Management Research (CCMR), VA Ann Arbor Healthcare System, Michigan.,Geriatric Research, Education and Clinical Center (GRECC), VA Ann Arbor Healthcare System, Michigan
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16
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Suchy Y, Ziemnik RE, Niermeyer MA, Brothers SL. Executive functioning interacts with complexity of daily life in predicting daily medication management among older adults. Clin Neuropsychol 2019; 34:797-825. [DOI: 10.1080/13854046.2019.1694702] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Yana Suchy
- Department of Psychology, University of Utah, Salt Lake City, UT, USA
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17
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Goodman-Casanova JM, Guzmán-Parra J, Guerrero G, Vera E, Barnestein-Fonseca P, Cortellessa G, Fracasso F, Umbrico A, Cesta A, Toma D, Boghiu F, Dewarrat R, Triantafyllidou V, Tamburini E, Dionisio P, Mayoral F. TV-based assistive integrated service to support European adults living with mild dementia or mild cognitive impairment (TV-AssistDem): study protocol for a multicentre randomized controlled trial. BMC Geriatr 2019; 19:247. [PMID: 31492113 PMCID: PMC6731559 DOI: 10.1186/s12877-019-1267-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Accepted: 08/30/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Mild cognitive impairment and mild dementia progressively compromise the ability of people to live independently and can have a negative impact on their quality of life. Within the current European Active and Assisted Living programme (AAL), project TV-AssistDem has been developed to deliver a TV-based platform service to support patients with mild cognitive impairment or mild dementia and provide relief to their caregivers. The application is intended to be used daily at home, mainly by the participants themselves, with the help of their informal caregivers. The aim of this study is to evaluate the effectiveness of TV-AssistDem to improve quality of life in people with mild cognitive impairment or mild dementia. METHODS This is a 12-month European multicentre randomized controlled trial which will be performed in two countries: Spain and Romania. Two hundred and forty older adults will be recruited using identical inclusion/exclusion criteria. The primary outcome will be the change from baseline of TV-AssistDem on patient quality of life at 12 months. The secondary outcomes will be the changes from baseline of: 1) informal caregiver quality of life, 2) informal caregiver burden, 3) patient treatment adherence, 4) patient treatment compliance, 5) patient functional status, and 6) healthcare cost-effectiveness at 12 months. Patients in the intervention group will have access to an interactive platform which offers remote assistive services through a device connected to the television. The core services of the platform are: 1) Calendar and reminders, 2) Health monitoring and data transmission to a health server and 3) Videoconference; service-oriented applications are: 4) Cognitive stimulation; 5) Reminiscences; and 6) Patient and caregiver healthcare education. The analysis will be made following an intention-to-treat procedure. Linear and Generalized Mixed Model analysis will be performed. DISCUSSION We hypothesize that the regular use of TV-AssistDem will result in an improvement in patient quality of life. The uniqueness of this home TV-based intervention lies on its widespread accessibility and its integrative approach to quality of life in people with mild cognitive impairment or mild dementia and their informal caregivers. However, several anticipated challenges will need to be faced: poor engagement and connectivity problems. TRIAL REGISTRATION ClinicalTrials.gov Identifier NCT03653234 , Date of registration: 31 August 2018.
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Affiliation(s)
- Jessica Marian Goodman-Casanova
- Instituto de Investigación Biomédica de Málaga – Fundación Pública Andaluza para la Investigación de Málaga de Biomedicina y Salud (IBIMA-FIMABIS), Málaga, Spain
| | - José Guzmán-Parra
- Instituto de Investigación Biomédica de Málaga – Fundación Pública Andaluza para la Investigación de Málaga de Biomedicina y Salud (IBIMA-FIMABIS), Málaga, Spain
| | - Gloria Guerrero
- Instituto de Investigación Biomédica de Málaga – Fundación Pública Andaluza para la Investigación de Málaga de Biomedicina y Salud (IBIMA-FIMABIS), Málaga, Spain
| | - Elisa Vera
- Instituto de Investigación Biomédica de Málaga – Fundación Pública Andaluza para la Investigación de Málaga de Biomedicina y Salud (IBIMA-FIMABIS), Málaga, Spain
| | - Pilar Barnestein-Fonseca
- Instituto de Investigación Biomédica de Málaga – Fundación Pública Andaluza para la Investigación de Málaga de Biomedicina y Salud (IBIMA-FIMABIS), Málaga, Spain
| | | | | | | | - Amedeo Cesta
- CNR–Italian National Research Council, ISTC, Rome, Italy
| | - Diana Toma
- S.C. INGRIJIRI LA DOMICILIU S.R.L., Brasov, Romania
| | | | - Rodolphe Dewarrat
- Institut multidisciplinaire de science de donnees (IMSD), Les Reussilles, Switzerland
| | | | | | | | - Fermín Mayoral
- Instituto de Investigación Biomédica de Málaga – Fundación Pública Andaluza para la Investigación de Málaga de Biomedicina y Salud (IBIMA-FIMABIS), Málaga, Spain
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18
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Haskins CB, McDowell BD, Carnahan RM, Fiedorowicz JG, Wallace RB, Smith BJ, Chrischilles EA. Impact of preexisting mental illness on breast cancer endocrine therapy adherence. Breast Cancer Res Treat 2019; 174:197-208. [PMID: 30465157 PMCID: PMC6426454 DOI: 10.1007/s10549-018-5050-1] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2018] [Accepted: 11/13/2018] [Indexed: 01/07/2023]
Abstract
PURPOSE Patients with estrogen receptor positive (ER+) breast cancer are often non-adherent to endocrine therapies, despite clear survival benefits. We utilized a nationally representative cancer cohort to examine the role of specific mental illnesses on endocrine therapy adherence. METHODS Using the SEER-Medicare database, we included 21,894 women aged 68+ at their first surgically treated stage I-IV ER+ breast cancer during 2007-2013. All had continuous fee-for-service Medicare Parts A and B for 36+ months before, 18+ months after diagnosis, and continuous Part D for 4+ months before, 18+ after diagnosis. Mental illness was defined as occurring in the 36 months prior to cancer onset. We analyzed endocrine therapy adherence, initiation, and discontinuation using longitudinal linear and Cox regression models. RESULTS Unipolar depression (11.0%), anxiety (9.5%), non-schizophrenia psychosis (4.6%), and dementias (4.6%) were the most prevalent diagnoses. Endocrine therapies were initiated by 80.0% of women. Among those with at least one year of use, 28.0% were non-adherent (< 0.80 adherence, mean = 0.84) and 25.7% discontinued. Patients with dementia or bipolar depression/psychotic/schizophrenia disorders had lower adjusted initiation probabilities by year one of follow-up, versus those without these diagnoses [0.74 95% CI (0.73-0.74) and 0.73 (0.72-0.73), respectively, reference 0.76 (0.76-0.77)]. Patients with substance use or anxiety disorders less frequently continued endocrine therapy for at least one year, after adjustment, [0.85 95% CI (0.85-0.86) and 0.88 (0.87-0.88), respectively, reference 0.90 (0.89-0.90)]. Patients with substance use disorders had 2.3% lower adherence rates (p < 0.001). CONCLUSIONS Nearly one-quarter of female Medicare beneficiaries have diagnosed mental illness preceding invasive breast cancer. Those with certain mental illnesses have modestly reduced rates of initiation, adherence, and discontinuation and this may help define patients at higher risk of treatment abandonment. Overall, endocrine therapy adherence remains suboptimal, unnecessarily worsening recurrence and mortality risk.
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Affiliation(s)
- Cole B Haskins
- Department of Epidemiology, College of Public Health, University of Iowa, CPHB, 145 N Riverside Dr, Iowa City, IA, 52242, USA.
- Medical Scientist Training Program, University of Iowa, Iowa City, IA, USA.
| | - Bradley D McDowell
- Holden Comprehensive Cancer Center, University of Iowa, Iowa City, IA, USA
| | - Ryan M Carnahan
- Department of Epidemiology, College of Public Health, University of Iowa, CPHB, 145 N Riverside Dr, Iowa City, IA, 52242, USA
| | - Jess G Fiedorowicz
- Department of Epidemiology, College of Public Health, University of Iowa, CPHB, 145 N Riverside Dr, Iowa City, IA, 52242, USA
- University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Robert B Wallace
- Department of Epidemiology, College of Public Health, University of Iowa, CPHB, 145 N Riverside Dr, Iowa City, IA, 52242, USA
| | - Brian J Smith
- Holden Comprehensive Cancer Center, University of Iowa, Iowa City, IA, USA
- Department of Biostatistics, College of Public Health, University of Iowa, Iowa City, IA, USA
| | - Elizabeth A Chrischilles
- Department of Epidemiology, College of Public Health, University of Iowa, CPHB, 145 N Riverside Dr, Iowa City, IA, 52242, USA
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19
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Lim RH, Sharmeen T. Medicines management issues in dementia and coping strategies used by people living with dementia and family carers: A systematic review. Int J Geriatr Psychiatry 2018; 33:1562-1581. [PMID: 30270451 PMCID: PMC6282522 DOI: 10.1002/gps.4985] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Accepted: 08/06/2018] [Indexed: 12/14/2022]
Abstract
OBJECTIVES Medicines play a key role in the lives of people with dementia, primarily to manage symptoms. Managing medicines is complex for people with dementia and their family carers and can result in multiple problems leading to harm. We conducted a systematic review to identify and model medication issues experienced and coping strategies used by people with dementia and/or family carers. METHODS Eleven general databases and four systematic review databases were searched. Studies were quality assessed using an established framework and thematically analysed. RESULTS Twenty-one articles were included in this study, and four domains affecting medication use were identified: cognitive, medication, social and cultural, and knowledge/educational and communication. People with dementia reported medication issues in all four domains, but few coping strategies were developed. Family carers reported issues and coping strategies related to the medication and knowledge/educational and communication domains. Common issues with regards to knowledge and communication about medicines remain unresolved. The "voices" of people with dementia appeared largely missing from the literature so were in-depth understanding of how, whether, and in which circumstances coping strategies work in managing medicines. CONCLUSIONS Medicines management is a complex set of activities and although current coping strategies exists, these were primarily used by family carers or the person with dementia-carer dyad. Health and social care practitioners and researchers should seek to understand in-depth the "mechanisms of action" of existing coping strategies and actively involve people with dementia as co-producers of knowledge to underpin any further work on medicines management.
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Affiliation(s)
- Rosemary H. Lim
- Reading School of PharmacyUniversity of ReadingReadingBerkshireUK
| | - Taniya Sharmeen
- Reading School of PharmacyUniversity of ReadingReadingBerkshireUK
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20
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Calhoun A, King C, Khoury R, Grossberg GT. An evaluation of memantine ER + donepezil for the treatment of Alzheimer’s disease. Expert Opin Pharmacother 2018; 19:1711-1717. [DOI: 10.1080/14656566.2018.1519022] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
- Amanda Calhoun
- Department of Psychiatry and Behavioral Neuroscience, Saint Louis University School of Medicine, St. Louis, MO, USA
| | - Christian King
- Department of Psychiatry and Behavioral Neuroscience, Saint Louis University School of Medicine, St. Louis, MO, USA
| | - Rita Khoury
- Department of Psychiatry and Behavioral Neuroscience, Saint Louis University School of Medicine, St. Louis, MO, USA
| | - George T. Grossberg
- Department of Psychiatry and Behavioral Neuroscience, Saint Louis University School of Medicine, St. Louis, MO, USA
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21
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Eshetie TC, Nguyen TA, Gillam MH, Kalisch Ellett LM. A narrative review of problems with medicines use in people with dementia. Expert Opin Drug Saf 2018; 17:825-836. [DOI: 10.1080/14740338.2018.1497156] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- Tesfahun C. Eshetie
- Quality Use of Medicines and Pharmacy Research Centre, School of Pharmacy and Medical Sciences, Sansom Institute for Health Research, University of South Australia, Adelaide, South Australia, Australia
| | - Tuan A. Nguyen
- Quality Use of Medicines and Pharmacy Research Centre, School of Pharmacy and Medical Sciences, Sansom Institute for Health Research, University of South Australia, Adelaide, South Australia, Australia
| | - Marianne H. Gillam
- Quality Use of Medicines and Pharmacy Research Centre, School of Pharmacy and Medical Sciences, Sansom Institute for Health Research, University of South Australia, Adelaide, South Australia, Australia
| | - Lisa M. Kalisch Ellett
- Quality Use of Medicines and Pharmacy Research Centre, School of Pharmacy and Medical Sciences, Sansom Institute for Health Research, University of South Australia, Adelaide, South Australia, Australia
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22
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Leng X, Espeland MA, Manson JE, Stefanick ML, Gower EW, Hayden KM, Limacher MC, Vaughan L, Robinson J, Wallace R, Wassertheil-Smoller S, Yaffe K, Shumaker SA. Cognitive Function and Changes in Cognitive Function as Predictors of Incident Cardiovascular Disease: The Women's Health Initiative Memory Study. J Gerontol A Biol Sci Med Sci 2018; 73:779-785. [PMID: 28977360 PMCID: PMC5946937 DOI: 10.1093/gerona/glx138] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Indexed: 01/08/2023] Open
Abstract
Background Cognitive impairment and decline may signal the increased risk of incident cardiovascular disease (CVD). We examined associations of global cognitive function, as measured by the Modified Mini-Mental State Examination (3MS) and changes in 3MS over time, with incident CVD, individual CVD outcomes, CVD death, and all-cause mortality. Methods A total of 5,596 women (≥ 60) from the Women's Health Initiative Memory Study free of CVD at baseline were followed for an average of 7.1 years. The 3MS was measured at baseline and annually thereafter. Cox proportional hazards regressions were used to model associations between baseline 3MS and changes in 3MS and time to events. Results In the fully-adjusted models for every 5-point lower baseline 3MS score, the risk was 12% greater for incident CVD, 37% for HF, 35% for CVD death, and 24% for all-cause mortality. No significant relationships were found for coronary heart disease (CHD), angina, stroke/transient ischemic attack (TIA), or coronary revascularization. When change in 3MS was added as a time-varying covariate in the fully-adjusted models, for every 1-point/year greater decline in 3MS, the risk was 4% greater for incident CVD, 10% for CHD, 9% for Stroke/TIA, 17% for CVD death, and 13% for all-cause mortality. Conclusions In older women free of prevalent CVD at baseline, lower baseline global cognitive function or decline in global cognitive function over time, increased risk of incident CVD, CVD death, and all-cause mortality.
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Affiliation(s)
- Xiaoyan Leng
- Division of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Mark A Espeland
- Division of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - JoAnn E Manson
- Division of Preventive Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Marcia L Stefanick
- Center for Disease Prevention Research, Stanford University, Palo Alto, California
| | - Emily W Gower
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill
| | - Kathleen M Hayden
- Division of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Marian C Limacher
- Division of Cardiovascular Medicine, Department of Medicine, University of Florida, Gainesville
| | - Leslie Vaughan
- Division of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Jennifer Robinson
- Department of Epidemiology, University of Iowa College of Medicine
- Department of Internal Medicine, University of Iowa College of Medicine
| | - Robert Wallace
- Department of Epidemiology, University of Iowa College of Medicine
- Department of Internal Medicine, University of Iowa College of Medicine
| | | | - Kristine Yaffe
- Departments of Epidemiology and Biostatistics and Psychiatry and Neurology, University of California, San Francisco
| | - Sally A Shumaker
- Division of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, North Carolina
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23
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Abstract
PURPOSE OF REVIEW To provide an overview of a selection of largely neglected psychological risk factors for nonadherence, and to offer new approaches to improve medication adherence. RECENT FINDINGS Current adherence research and intervention programs focus on a few risk factors for nonadherence, such as complexity of the drug regimen. In addition, other important risk factors of nonadherence are neglected or insufficiently addressed. There is good evidence for the significant role of the quality of the patient-healthcare provider relationship. Other risk factors like the individual history of nonadherence, the lack of acceptance of having a treatable disorder, fear of side-effects, comorbid depression, and cognitive impairment have been broadly neglected in adherence programs, although they offer a powerful key to improve adherence-oriented interventions. SUMMARY Current research on determinants of nonadherence has focused on a few risk factors, while neglecting crucial psychological predictors of nonadherence. The personalized consideration of a multiplicity of risk factors offers a new basis for the development and evaluation of interventions to better promote adherence.
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24
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Subic A, Cermakova P, Norrving B, Winblad B, von Euler M, Kramberger MG, Eriksdotter M, Garcia-Ptacek S. Management of acute ischaemic stroke in patients with dementia. J Intern Med 2017; 281:348-364. [PMID: 28150348 DOI: 10.1111/joim.12588] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
An estimated 10% of stroke patients have an underlying dementia. As a consequence, health professionals often face the challenge of managing patients with dementia presenting with an acute stroke. Patients with dementia are less likely to receive thrombolysis (0.56-10% vs. 1-16% thrombolysis rates in the general population), be admitted to a stroke unit or receive some types of care. Anticoagulation for secondary stroke prevention is sometimes withheld, despite dementia not being listed as an exclusion criterion in current guidelines. Studies in this population are scarce, and results have been contradictory. Three observational studies have examined intravenous thrombolysis for treatment of acute ischaemic stroke in patients with dementia. In the two largest matched case-control studies, there were no significant differences between patients with and without dementia in the risks of intracerebral haemorrhage or mortality. The risk of intracerebral haemorrhage ranged between 14% and 19% for patients with dementia. Studies of other interventions for stroke are lacking for this population. Patients with dementia are less likely to be discharged home compared with controls (19% vs. 41%) and more likely to be disabled (64% vs. 59%) or die during hospitalization (22% vs. 11%). The aim of this review was to summarize current knowledge about the management of ischaemic stroke in patients with pre-existing dementia, including organizational aspects of stroke care, intravenous thrombolysis, access to stroke unit care and use of supportive treatment. Evidence to support anticoagulation for secondary prevention of stroke in patients with atrial fibrillation and antiplatelet therapy in nonembolic stroke will be discussed, as well as rehabilitation and how these factors influence patient outcomes. Finally, ethical issues, knowledge gaps and pathways for future research will be considered.
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Affiliation(s)
- A Subic
- Division of Neurogeriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Stockholm, Sweden.,Department of Neurology, University Medical Center, Ljubljana, Slovenia
| | - P Cermakova
- Division of Neurogeriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Stockholm, Sweden.,International Clinical Research Center, St. Anne's University Hospital, Brno, Czech Republic
| | - B Norrving
- Department of Clinical Sciences Lund, Neurology, Lund University, Skane University Hospital, Lund, Sweden
| | - B Winblad
- Division of Neurogeriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Stockholm, Sweden
| | - M von Euler
- Department of Clinical Science and Education, Södersjukhuset, Stockholm, Sweden.,Karolinska University Hospital, Department of Clinical Pharmacology, Stockholm, Sweden
| | - M G Kramberger
- Department of Neurology, University Medical Center, Ljubljana, Slovenia
| | - M Eriksdotter
- Department of Geriatric Medicine, Karolinska University Hospital, Huddinge, Stockholm, Sweden.,Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Stockholm, Sweden
| | - S Garcia-Ptacek
- Department of Geriatric Medicine, Karolinska University Hospital, Huddinge, Stockholm, Sweden.,Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Stockholm, Sweden
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