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Novais T, Reallon E, Martin J, Barral M, Krolak-Salmon P, Coste MH, Zenagui H, Garnier-Crussard A, Hoegy D, Mouchoux C. Clinical impact of an individualised clinical pharmacy programme into the memory care pathway of older people: an observational study. Int J Clin Pharm 2024; 46:889-898. [PMID: 38642248 DOI: 10.1007/s11096-024-01723-z] [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: 06/12/2023] [Accepted: 03/08/2024] [Indexed: 04/22/2024]
Abstract
BACKGROUND In older patients, medication exposure [i.e. polypharmacy, potentially inappropriate medications (PIMs), medications with anticholinergic and/or sedative properties] is a modifiable risk factor associated with cognitive iatrogenic risk and dementia. AIM To assess the potential clinical impact of the implementation of an individualised clinical pharmacy programme at the initiation of the Memory care pathway in older patients with a cognitive complaint. METHOD This prospective observational study included older patients with high-risk of adverse drug event (HR) admitted in a French geriatric university hospital to explore the cognitive complaint or the cognitive disorder between January and November 2021. Drug-related problems (DRPs) were identified during a medication review performed in HR patients, and pharmaceutical interventions (PIs) notified in the patient's hospitalisation report were collected. The clinical impact of PIs was assessed by an expert panel (geriatricians and clinical pharmacists) using the Clinical, Economic, and Organisational (CLEO) tool. RESULTS Overall, 326 patients were eligible and 207 (63.5%) were considered as HR patients. Among HR patients, 88.9% (n = 184) were treated using at least 5 medications (polypharmacy), and 36.7% (n = 76) received at least one PIM with cognitive iatrogenic risk. During the medication review, 490 PIs were provided and their clinical impact was rated as minor for 57.3% (n = 281), moderate for 26.7% (n = 131), and major for 2.5% (n = 12). CONCLUSION The integration of clinical pharmacist secured the Memory care pathway of older patients with a cognitive complaint by identifying an important number of DRPs and PIMs with potential cognitive iatrogenic risk.
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Affiliation(s)
- Teddy Novais
- Pharmaceutical Unit, Lyon Institute for Aging, Charpennes Hospital, University Hospital of Lyon, 27 rue Gabriel Péri, 69100, Villeurbanne, France.
- Research on Healthcare Performance (RESHAPE), INSERM U1290, University Lyon 1, Lyon, France.
| | - Elsa Reallon
- Pharmaceutical Unit, Lyon Institute for Aging, Charpennes Hospital, University Hospital of Lyon, 27 rue Gabriel Péri, 69100, Villeurbanne, France
| | | | | | - Pierre Krolak-Salmon
- Day-Care Unit, Lyon Institute for Aging, Charpennes Hospital, University Hospital of Lyon, Lyon, France
- Clinical and Research Memory Center of Lyon, Lyon Institute for Aging, Hospices Civils de Lyon, France
- Eduwell Team, Lyon Neuroscience Research Center (CRNL), INSERM U1028, CNRS UMR5292, UCBL1, Lyon, France
| | - Marie-Hélène Coste
- Day-Care Unit, Lyon Institute for Aging, Charpennes Hospital, University Hospital of Lyon, Lyon, France
- Clinical and Research Memory Center of Lyon, Lyon Institute for Aging, Hospices Civils de Lyon, France
| | - Hanane Zenagui
- Day-Care Unit, Lyon Institute for Aging, Charpennes Hospital, University Hospital of Lyon, Lyon, France
| | - Antoine Garnier-Crussard
- Day-Care Unit, Lyon Institute for Aging, Charpennes Hospital, University Hospital of Lyon, Lyon, France
- Clinical and Research Memory Center of Lyon, Lyon Institute for Aging, Hospices Civils de Lyon, France
- Eduwell Team, Lyon Neuroscience Research Center (CRNL), INSERM U1028, CNRS UMR5292, UCBL1, Lyon, France
| | - Delphine Hoegy
- Pharmaceutical Unit, Groupement Hospitalier Est, University Hospital of Lyon, Lyon, France
- Health, Systemic, Process (P2S), Research Unit 4129, University Claude Bernard Lyon 1, University of Lyon, Lyon, France
| | - Christelle Mouchoux
- Pharmaceutical Unit, Lyon Institute for Aging, Charpennes Hospital, University Hospital of Lyon, 27 rue Gabriel Péri, 69100, Villeurbanne, France
- Research on Healthcare Performance (RESHAPE), INSERM U1290, University Lyon 1, Lyon, France
- Eduwell Team, Lyon Neuroscience Research Center (CRNL), INSERM U1028, CNRS UMR5292, UCBL1, Lyon, France
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Golenia A, Olejnik P, Grusiecka‐Stańczyk M, Żołek N, Wojtaszek E, Żebrowski P, Raszeja‐Wyszomirska J, Małyszko J. Cognitive impairment in patients awaiting kidney and liver transplantation-A clinically relevant problem? Brain Behav 2024; 14:e3647. [PMID: 39135287 PMCID: PMC11319212 DOI: 10.1002/brb3.3647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2024] [Revised: 06/19/2024] [Accepted: 07/12/2024] [Indexed: 08/16/2024] Open
Abstract
INTRODUCTION Cognitive impairment (CI) is common in both end-stage kidney disease (ESKD) and alcohol-related liver cirrhosis. The aim of this study was to assess the prevalence and patterns of CI in patients awaiting kidney and liver transplantation, and to identify its determinants. METHODS In this cross-sectional, prospective study, 31 consecutive patients with ESKD and 31 consecutive patients with alcohol-related liver cirrhosis, all currently on transplant waiting lists, were screened for cognitive decline using the Addenbrooke's Cognitive Examination. Medical history, demographics, and laboratory test results were also collected. RESULTS The prevalence of CI among patients with ESKD and alcohol-related liver cirrhosis was 26% and 90%, respectively. In both groups, memory was the most affected cognitive domain, along with verbal fluency in patients with ESKD, and visuospatial abilities in patients with alcoholic cirrhosis. The most statistically significant increase in the prevalence of CI was found in patients with lower educational attainment, in both alcohol-related liver cirrhosis and ESKD populations as well as in older patients with alcoholic cirrhosis. Furthermore, better cognitive functioning in ESKD patients was associated with higher levels of total lymphocyte count and alanine transaminase (ALT), and in alcohol-related liver cirrhosis patients with higher levels of ALT and aspartate transaminase. A nonsignificant trend toward lower memory domain scores was also observed with increasing ammonia levels and increasing severity of liver disease (higher Child-Pugh scores). Finally, suboptimal performance on the screening test was correlated with the severity of liver disease as assessed by the Model for End-Stage Liver Disease Sodium (MELD-Na), but not at the statistically significant level. CONCLUSIONS The prevalence of CI, especially in patients with alcohol-related liver cirrhosis, is high and can be a significant clinical problem, negatively affecting the transplantation process. Routine screening tests in this group would contribute to the implementation of appropriate management, such as rehabilitation program or psychosocial treatments and facilitate the provision of specialized health care.
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Affiliation(s)
| | | | | | - Norbert Żołek
- Institute of Fundamental Technological ResearchPolish Academy of SciencesWarsawPoland
| | - Ewa Wojtaszek
- Department of Nephrology, Dialysis and Internal MedicineMedical University of WarsawWarsawPoland
| | - Paweł Żebrowski
- Department of Nephrology, Dialysis and Internal MedicineMedical University of WarsawWarsawPoland
| | - Joanna Raszeja‐Wyszomirska
- Department of Hepatology, Transplantology, and Internal MedicineMedical University of WarsawWarsawPoland
| | - Jolanta Małyszko
- Department of Nephrology, Dialysis and Internal MedicineMedical University of WarsawWarsawPoland
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Wang J, Cheng Z, Li Y. Medication Management Difficulty, Medication Nonadherence, and Risk of Hospitalization Among Cognitively Impaired Older Americans: A Nationally Representative Study. J Appl Gerontol 2024:7334648241262940. [PMID: 39025781 DOI: 10.1177/07334648241262940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/20/2024] Open
Abstract
Effective disease management in older adults relies on medication adherence to prevent adverse outcomes like hospitalization, particularly among those with cognitive impairment. In this study, we examined the impact of cognitive impairment on medication management, adherence, and hospitalization risk across levels of cognitive function. Analyzing data from 28,558 community-dwelling older adults, we found that those with dementia had the most difficulty managing medications (13.12%), followed by cognitive impairment without dementia (5.80%), and intact cognition (1.96%). Only persons with dementia showed a significant association between medication management difficulty and hospitalization risk (Odds Ratio [OR] = 1.71; 95% Confidence Intervals: 1.08, 2.70; p = .02). Cost-related medication nonadherence was associated with hospitalization risk solely among those with intact cognition (OR = 1.25; 95% CI: 1.07, 1.45; p = .004). Dementia was associated with higher odds of medication management difficulty and subsequently hospitalization risk, underscoring the need for resources to support medication use for this population.
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Affiliation(s)
- Jinjiao Wang
- Elaine Hubbard Center for Nursing Research on Aging, University of Rochester School of Nursing, Rochester, NY, USA
| | - Zijing Cheng
- Department of Public Health Sciences, University of Rochester Medical Center, Rochester, NY, USA
| | - Yue Li
- Department of Public Health Sciences, University of Rochester Medical Center, Rochester, NY, USA
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O'Conor R, Russell AM, Pack A, Oladejo D, Filec S, Rogalski E, Morhardt D, Lindquist LA, Wolf MS. Managing medications among individuals with mild cognitive impairment and dementia: Patient-caregiver perspectives. J Am Geriatr Soc 2024. [PMID: 39007450 DOI: 10.1111/jgs.19065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2024] [Revised: 06/05/2024] [Accepted: 06/13/2024] [Indexed: 07/16/2024]
Abstract
BACKGROUND With changing cognitive abilities, individuals with mild cognitive impairment (MCI) and dementia face challenges in successfully managing multidrug regimens. We sought to understand how individuals with MCI or dementia and their family caregivers manage multidrug regimens and better understand patient-to-caregiver transitions in medication management responsibilities. METHODS We conducted qualitative interviews among patient-caregiver dyads. Eligibility included: patients with a diagnosis of MCI, mild or moderate dementia, managing ≥3 chronic conditions, ≥5 prescription medications, who also had a family caregiver ≥18 years old. Semi-structured interview guides, informed by the Medication Self-Management model, ascertained roles and responsibilities for medication management and patient-to-caregiver transitions in medication responsibilities. RESULTS We interviewed 32 patient-caregiver dyads. Older adults and caregivers favored older adult autonomy in medication management, and individuals with MCI and mild dementia largely managed their medications independently using multiple strategies (e.g., establishing daily routines, using pillboxes). Among individuals with moderate dementia, caregivers assumed all medication-related responsibilities except when living separately. In those scenarios, caregivers set up organizers and made reminder calls, but did not observe family members taking medications. Patient-to-caregiver transitions in medication responsibilities frequently occurred after caregivers observed older adults making errors with medications. As caregivers sought to assume greater responsibilities with family members' medicines, they faced multiple barriers. Most barriers were dyadic; they affected both the older adult and the caregiver and/or the relationship. Some barriers were specific to caregivers; these included caregivers' competing responsibilities or inaccurate perceptions of dementia, while other barriers were related to the healthcare system. CONCLUSIONS To ease medication management transitions, balance must be sought between preservation of older adult autonomy and early family caregiver involvement. Clinicians should work to initiate conversations with family caregivers and individuals living with MCI or dementia about transitioning medication responsibilities as memory loss progresses, simplify regimens, and deprescribe, as appropriate.
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Affiliation(s)
- Rachel O'Conor
- Division of General Internal Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
- Center for Applied Health Research on Aging, Institute for Public Health and Medicine, Northwestern University, Chicago, Illinois, USA
| | - Andrea M Russell
- Division of General Internal Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
- Center for Applied Health Research on Aging, Institute for Public Health and Medicine, Northwestern University, Chicago, Illinois, USA
| | - Allison Pack
- Division of General Internal Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
- Center for Applied Health Research on Aging, Institute for Public Health and Medicine, Northwestern University, Chicago, Illinois, USA
| | - Dianne Oladejo
- Division of General Internal Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
- Center for Applied Health Research on Aging, Institute for Public Health and Medicine, Northwestern University, Chicago, Illinois, USA
| | - Sarah Filec
- Division of General Internal Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
- Center for Applied Health Research on Aging, Institute for Public Health and Medicine, Northwestern University, Chicago, Illinois, USA
| | - Emily Rogalski
- Healthy Aging & Alzheimer's Research Care (HAARC) Center, The University of Chicago, Chicago, Illinois, USA
| | - Darby Morhardt
- Mesulam Center for Cognitive Neurology and Alzheimer's Disease, Northwestern University, Chicago, Illinois, USA
| | - Lee A Lindquist
- Division of Geriatrics, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Michael S Wolf
- Division of General Internal Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
- Center for Applied Health Research on Aging, Institute for Public Health and Medicine, Northwestern University, Chicago, Illinois, USA
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Pepper A, Dening KH. Dementia, comorbidity and multimorbidity. Br J Community Nurs 2024; 29:321-325. [PMID: 38963276 DOI: 10.12968/bjcn.2024.0053] [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] [Indexed: 07/05/2024]
Abstract
Many people living with dementia will also have multimorbidity comprising several other intercurrent, long-term and comorbid conditions. This article examines the relationship between such conditions in the context of dementia, giving an overview of the literature, including prevalence and some of the common conditions that can coexist with dementia. The theory and evidence-base will be tied together using a case study approach, to illustrate the complexity of managing comorbid conditions and multimorbidity alongside dementia, and explore some of the approaches that can be used by community nurses to support the overall health of people living with dementia that they work with.
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Girone N, Cocchi M, Achilli F, Grechi E, Vicentini C, Benatti B, Vismara M, Priori A, Dell'Osso B. Treatment adherence rates across different psychiatric disorders and settings: findings from a large patient cohort. Int Clin Psychopharmacol 2024:00004850-990000000-00140. [PMID: 38813934 DOI: 10.1097/yic.0000000000000557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/31/2024]
Abstract
Approximately 50% of patients with psychiatric disorders do not fully adhere to the prescribed psychopharmacological therapy, significantly impacting the progression of the disorder and the patient's quality of life. The present study aimed to assess potential differences in terms of rates and clinical features of treatment adherence in a large cohort of psychiatric patients with different diagnoses attending various psychiatric services. The study included 307 psychiatric patients diagnosed with a primary major depressive disorder, bipolar disorder, anxiety disorder, schizophrenic spectrum disorder, or personality disorder. Patient's adherence to treatment was evaluated using the Clinician Rating Scale, with a cutoff of at least five defining adherence subgroups. One-third of the sample reported poor medication adherence. A lower rate of adherence emerged among patients with schizophrenic spectrum disorder and bipolar disorder. Subjects with poor adherence were more frequently inpatients and showed higher current substance use, a greater number of previous hospitalizations, and more severe scores at psychopathological assessment compared with patients with positive adherence. Poor adherence was associated with symptom severity and increased rates of relapses and rehospitalizations. In addition, substance use appears to be an unfavorable transdiagnostic factor for treatment adherence.
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Affiliation(s)
- Nicolaja Girone
- Department of Mental Health, Department of Biomedical and Clinical Sciences Luigi Sacco, University of Milan
| | - Maddalena Cocchi
- Department of Mental Health, Department of Biomedical and Clinical Sciences Luigi Sacco, University of Milan
| | - Francesco Achilli
- Department of Mental Health, Department of Biomedical and Clinical Sciences Luigi Sacco, University of Milan
| | - Edoardo Grechi
- Department of Mental Health, Department of Biomedical and Clinical Sciences Luigi Sacco, University of Milan
| | - Chiara Vicentini
- Department of Mental Health, Department of Biomedical and Clinical Sciences Luigi Sacco, University of Milan
| | - Beatrice Benatti
- Department of Mental Health, Department of Biomedical and Clinical Sciences Luigi Sacco, University of Milan
- Center for Neurotechnology and Brain Therapeutic, 'Aldo Ravelli', University of Milan
| | - Matteo Vismara
- Department of Mental Health, Department of Biomedical and Clinical Sciences Luigi Sacco, University of Milan
| | - Alberto Priori
- Center for Neurotechnology and Brain Therapeutic, 'Aldo Ravelli', University of Milan
- Neurology Department of Health Sciences, San Paolo University Hospital, ASST Santi Paolo e Carlo, University of Milan Medical School, Milan, Italy
| | - Bernardo Dell'Osso
- Department of Mental Health, Department of Biomedical and Clinical Sciences Luigi Sacco, University of Milan
- Center for Neurotechnology and Brain Therapeutic, 'Aldo Ravelli', University of Milan
- Department of Psychiatry and Behavioral Sciences, Bipolar Disorders Clinic, Stanford University, Stanford, California, USA
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Khalil M, Woldesenbet S, Munir MM, Katayama E, Mehdi Khan MM, Altaf A, Rashid Z, Endo Y, Dillhoff M, Tsai S, Pawlik TM. Surgical outcomes and healthcare expenditures among patients with dementia undergoing major surgery. World J Surg 2024; 48:1075-1083. [PMID: 38436547 DOI: 10.1002/wjs.12106] [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: 12/10/2023] [Accepted: 02/09/2024] [Indexed: 03/05/2024]
Abstract
BACKGROUND We sought to define surgical outcomes among elderly patients with Alzheimer's disease and related dementias (ADRD) following major thoracic and gastrointestinal surgery. METHODS A retrospective cohort study was used to identify patients who underwent coronary artery bypass grafting (CABG), abdominal aortic aneurysm (AAA) repair, pneumonectomy, pancreatectomy, and colectomy. Individuals were identified from the Medicare Standard Analytic Files and multivariable regression was utilized to assess the association of ADRD with textbook outcome (TO), expenditures, and discharge disposition. RESULTS Among 1,175,010 Medicare beneficiaries, 19,406 (1.7%) patients had a preoperative diagnosis of ADRD (CABG: n = 1,643, 8.5%; AAA repair: n = 5,926, 30.5%; pneumonectomy: n = 590, 3.0%; pancreatectomy: n = 181, 0.9%; and colectomy: n = 11,066, 57.0%). After propensity score matching, patients with ADRD were less likely to achieve a TO (ADRD: 31.2% vs. no ADRD: 40.1%) or be discharged to home (ADRD: 26.7% vs. no ADRD: 46.2%) versus patients who did not have ADRD (both p < 0.001). Median index surgery expenditures were higher among patients with ADRD (ADRD: $28,815 [IQR $14,333-$39,273] vs. no ADRD: $27,101 [IQR $13,433-$38,578]; p < 0.001) (p < 0.001). On multivariable analysis, patients with ADRD had higher odds of postoperative complications (OR 1.32, 95% CI 1.25-1.40), extended length-of-stay (OR 1.26, 95% CI 1.21-1.32), 90-day readmission (OR 1.37, 95% CI 1.31-1.43), and 90-day mortality (OR 1.76, 95% CI 1.66-1.86) (all p < 0.001). CONCLUSION Preoperative diagnosis of ADRD was an independent risk factor for poor postoperative outcomes, discharge to non-home settings, as well as higher healthcare expenditures. These data should serve to inform discussions and decision-making about surgery among the growing number of older patients with cognitive deficits.
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Affiliation(s)
- Mujtaba Khalil
- Department of Surgery, The Ohio State University, Wexner Medical Center and James Comprehensive Cancer Center, Columbus, Ohio, USA
| | - Selamawit Woldesenbet
- Department of Surgery, The Ohio State University, Wexner Medical Center and James Comprehensive Cancer Center, Columbus, Ohio, USA
| | - Muhammad Musaab Munir
- Department of Surgery, The Ohio State University, Wexner Medical Center and James Comprehensive Cancer Center, Columbus, Ohio, USA
| | - Erryk Katayama
- Department of Surgery, The Ohio State University, Wexner Medical Center and James Comprehensive Cancer Center, Columbus, Ohio, USA
| | - Muhammad Muntazir Mehdi Khan
- Department of Surgery, The Ohio State University, Wexner Medical Center and James Comprehensive Cancer Center, Columbus, Ohio, USA
| | - Abdullah Altaf
- Department of Surgery, The Ohio State University, Wexner Medical Center and James Comprehensive Cancer Center, Columbus, Ohio, USA
| | - Zayed Rashid
- Department of Surgery, The Ohio State University, Wexner Medical Center and James Comprehensive Cancer Center, Columbus, Ohio, USA
| | - Yutaka Endo
- Department of Surgery, The Ohio State University, Wexner Medical Center and James Comprehensive Cancer Center, Columbus, Ohio, USA
| | - Mary Dillhoff
- Department of Surgery, The Ohio State University, Wexner Medical Center and James Comprehensive Cancer Center, Columbus, Ohio, USA
| | - Susan Tsai
- Department of Surgery, The Ohio State University, Wexner Medical Center and James Comprehensive Cancer Center, Columbus, Ohio, USA
| | - Timothy M Pawlik
- Department of Surgery, The Ohio State University, Wexner Medical Center and James Comprehensive Cancer Center, Columbus, Ohio, USA
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Ergui I, Griffith N, Salama J, Ebner B, Dangl M, Vincent L, Razuk V, Marzouka G, Colombo R. In-Hospital Outcomes in Patients With Non-ST Segment Elevation Myocardial Infarction and Concomitant Neurodevelopmental Disorders in the United States: Insights From the National Inpatient Sample 2011-2020. Cureus 2024; 16:e60289. [PMID: 38746481 PMCID: PMC11093150 DOI: 10.7759/cureus.60289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/14/2024] [Indexed: 05/16/2024] Open
Abstract
Patients with neurodevelopmental disorders (NDDs) encounter significant barriers to receiving quality health care, particularly for acute conditions such as non-ST segment elevation myocardial infarction (NSTEMI). This study addresses the critical gap in knowledge regarding in-hospital outcomes and the use of invasive therapies in this demographic. By analyzing data from the National Inpatient Sample database from 2011 to 2020 using the International Classification of Diseases, Ninth Edition (ICD-9) and Tenth Edition (ICD-10) codes, we identified patients with NSTEMI, both with and without NDDs, and compared baseline characteristics, in-hospital outcomes, and the application of invasive treatments. The analysis involved a weighted sample of 7,482,216 NSTEMI hospitalizations, of which 30,168 (0.40%) patients had NDDs. There were significantly higher comorbidity-adjusted odds of in-hospital mortality, cardiac arrest, endotracheal intubation, infectious complications, ventricular arrhythmias, and restraint use among the NDD cohort. Conversely, this group exhibited lower adjusted odds of undergoing left heart catheterization, percutaneous coronary intervention, or coronary artery bypass graft surgery. These findings underscore the disparities faced by patients with NDDs in accessing invasive cardiac interventions, highlighting the need for further research to address these barriers and improve care quality for this vulnerable population.
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Affiliation(s)
- Ian Ergui
- Internal Medicine, University of Miami Miller School of Medicine/Jackson Memorial Hospital, Miami, USA
| | - Nayrana Griffith
- Cardiology, University of Miami Miller School of Medicine/Jackson Memorial Hospital, Miami, USA
| | - Joshua Salama
- Internal Medicine, University of Miami Miller School of Medicine/Jackson Memorial Hospital, Miami, USA
| | - Bertrand Ebner
- Cardiology, University of Miami Miller School of Medicine/Jackson Memorial Hospital, Miami, USA
| | - Michael Dangl
- Internal Medicine, University of Miami Miller School of Medicine/Jackson Memorial Hospital, Miami, USA
| | - Louis Vincent
- Cardiology, University of Miami Miller School of Medicine/Jackson Memorial Hospital, Miami, USA
| | - Victor Razuk
- Cardiology, University of Miami Miller School of Medicine/Jackson Memorial Hospital, Miami, USA
| | - George Marzouka
- Cardiology, Miami Department of Veterans Affairs, Miami, USA
| | - Rosario Colombo
- Cardiology, University of Miami Miller School of Medicine/Jackson Memorial Hospital, Miami, USA
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Rekk K, Arnet I, Dietrich F, Polymeris AA, Lyrer PA, Engelter ST, Schaedelin S, Allemann SS. Relationship between electronically monitored adherence to direct oral anticoagulants and ischemic or hemorrhagic events after an initial ischemic stroke-A case control study. PLoS One 2024; 19:e0301421. [PMID: 38662779 PMCID: PMC11045050 DOI: 10.1371/journal.pone.0301421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Accepted: 03/15/2024] [Indexed: 04/28/2024] Open
Abstract
BACKGROUND Patients with atrial fibrillation (AF) have a high risk for recurrent clinical events after an ischemic stroke. Direct oral anticoagulants (DOAC) are prescribed for secondary prevention. Adherence to DOAC is crucial mainly because of their short elimination half-life. Non-adherence to DOAC can negatively impact patients' outcomes. The relationship between (non-)adherence and recurrent clinical events is unknown in AF patients after initial stroke. We investigated adherence to DOAC in stroke survivors with AF who were included in the MAAESTRO study at the University Hospital Basel, Switzerland, between 2008 and 2022. METHODS This study is a secondary analysis of data from MAAESTRO with a matched nested case-control design and 1:2 ratio. DOAC intake was measured with a small electronic device (Time4MedTM). We defined two arbitrary intervals of 17 days and 95 days as the longest time spans with electronic monitoring data per patient to maximize the number of participants with adequate amount of observation time available for analysis. Taking and timing adherence were calculated retrospectively i.e., prior to the recurrent event for cases. Trendline analysis of adherence over 95 days was calculated. Linear regression analysis was performed after adjusting for the co-variables age and daily pill burden. Sensitivity analysis was performed with controls for intervals in the reverse direction (prospectively). RESULTS We analyzed 11 cases and 22 matched controls (mean age: 75.9 ± 9.2 years vs. 73.1 ± 8.4 years; n.s.) with similar stroke characteristics (NIHSS, mRS, MoCA) and 36.4% women in each group. Mean adherence values were high and similar between cases and controls (95 days taking: 87.0 ± 18.9% (cases) vs. 90.8 ± 9.8% (controls), n.s.; similar values for timing adherence). Six hemorrhagic and five ischemic events had occurred. Compared to controls, a significantly higher 95 days taking adherence was observed for hemorrhagic events (96.0 ± 5.0% (cases) vs. 88.1 ± 11.5% (controls); p<0.01) and a significantly lower 95 days taking adherence was observed for ischemic events (75.7 ± 24.8% (cases) vs. 94.2 ± 6.2% (controls), p = 0.024). Values for timing adherence were similar. A non-significant downward linear trend of adherence was observed over 95 days independently of the clinical events. The sensitivity analysis showed that the direction of the interval had negligible impact on the 95 days adherence. CONCLUSION Because recurrent ischemic events after an AF-related stroke were associated with low adherence to DOAC <76%, adherence enhancing interventions seem crucial in anticoagulated AF-patients. However, AF-patients with high adherence might benefit from a regular re-assessment of the bleeding risk as hemorrhagic complications were associated with adherence to DOAC >96%. TRIAL REGISTRATION ClinicalTrials.gov NCT03344146.
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Affiliation(s)
- Katharina Rekk
- Department of Pharmaceutical Sciences, Pharmaceutical Care Research Group, University of Basel, Basel, Switzerland
| | - Isabelle Arnet
- Department of Pharmaceutical Sciences, Pharmaceutical Care Research Group, University of Basel, Basel, Switzerland
| | - Fine Dietrich
- Department of Pharmaceutical Sciences, Pharmaceutical Care Research Group, University of Basel, Basel, Switzerland
| | - Alexandros A. Polymeris
- Department of Neurology and Stroke Centre, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Philippe A. Lyrer
- Department of Neurology and Stroke Centre, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Stefan T. Engelter
- Department of Neurology and Stroke Centre, University Hospital Basel and University of Basel, Basel, Switzerland
- Department of Geriatric Medicine, Neurology and Neurorehabilitation, Felix Platter Hospital, University of Basel, Basel, Switzerland
| | - Sabine Schaedelin
- Department of Clinical Research, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Samuel S. Allemann
- Department of Pharmaceutical Sciences, Pharmaceutical Care Research Group, University of Basel, Basel, Switzerland
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Niu X, Chang J, Corrada MM, Bullock A, Winchester B, Manson SM, O’Connell J, Jiang L. The Relationship between All-Cause Dementia and Acute Diabetes Complications among American Indian and Alaska Native Peoples. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:496. [PMID: 38673407 PMCID: PMC11049920 DOI: 10.3390/ijerph21040496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Revised: 04/02/2024] [Accepted: 04/09/2024] [Indexed: 04/28/2024]
Abstract
BACKGROUND American Indian and Alaska Native people (AI/AN) bear a disproportionate burden of diabetes. Growing evidence shows significant associations between several acute diabetes complications and dementia among diabetes patients. However, little is known about these relationships among AI/AN adults. Here, we aim to investigate these associations among AI/AN adults. METHODS This cross-sectional study extracted data from the Indian Health Service's (IHS) National Data Warehouse and related administrative databases. A total of 29,337 IHS actual users with diabetes who were 45+ years old during fiscal year 2013 were included. All-cause dementia and diabetes complications were identified using ICD-9 diagnostic codes. Negative binomial regression models were used to evaluate the associations of interest. RESULTS Nearly 3% of AI/AN diabetes patients had a dementia diagnosis. After controlling for covariates, dementia was associated with a 94% higher rate of severe hypoglycemia (Incidence Rate Ratio [IRR = 1.94, 95% CI:1.50-2.51), 52% higher rate of severe hyperglycemia (IRR = 1.52, 95% CI, 1.11-2.08), and 92% higher rate of any acute complication (IRR = 1.92, 95% CI:1.53-2.41). CONCLUSIONS AI/AN diabetes patients with dementia suffered from considerably higher rates of acute diabetes complications than their counterparts without dementia. The clinical management of patients with comorbid diabetes and dementia is particularly challenging and may require individualized treatment approaches.
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Affiliation(s)
- Xiaoyi Niu
- Department of Epidemiology & Biostatistics, University of California Irvine, Irvine, CA 92697, USA; (X.N.); (M.M.C.)
| | - Jenny Chang
- Department of Medicine, University of California Irvine, Irvine, CA 92697, USA;
| | - Maria M. Corrada
- Department of Epidemiology & Biostatistics, University of California Irvine, Irvine, CA 92697, USA; (X.N.); (M.M.C.)
- Department of Neurology, School of Medicine, University of California Irvine, Irvine, CA 92697, USA
| | - Ann Bullock
- Formerly with the Division of Diabetes Treatment and Prevention, Indian Health Service, Rockville, MD 20857, USA;
| | | | - Spero M. Manson
- Centers for American Indian and Alaska Native Health, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA; (S.M.M.); (J.O.)
| | - Joan O’Connell
- Centers for American Indian and Alaska Native Health, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA; (S.M.M.); (J.O.)
| | - Luohua Jiang
- Department of Epidemiology & Biostatistics, University of California Irvine, Irvine, CA 92697, USA; (X.N.); (M.M.C.)
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11
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Goldstein A, Commissariat PV, Sullivan KL, Hallowell ES, Davis JD, Margolis SA. Compensatory Strategy Intervention: What Older Patients Want and Why. Arch Clin Neuropsychol 2024:acae023. [PMID: 38520386 DOI: 10.1093/arclin/acae023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 01/30/2024] [Accepted: 03/01/2024] [Indexed: 03/25/2024] Open
Abstract
OBJECTIVE Compensatory strategies can improve performance of instrumental activities of daily living in people with cognitive impairment. This study investigated patient interest in compensatory strategy interventions and preference for various intervention formats. METHODS Semi-structured qualitative interviews with 38 older adults with cognitive impairment queried motivation to improve strategy use and interest in intervention formats/delivery methods. Two coders used thematic analysis to determine rates of interest in each intervention type and explore patient-reported barriers and facilitators to motivation and intervention models. RESULTS Most of the samples reported motivation to enhance compensatory strategy use. Degree of motivation was driven by current experiences with strategy use, perceived benefit of potential changes, intrinsic desire to improve life and self, and current perceived need. The vast majority were interested in hour-long, multi-session, instructor-led interventions. Just over half of the sample was interested in a self-directed virtual program, and just under half was interested in involving family/friends. Facilitators and barriers to interest in intervention formats and delivery methods varied based on participants' previous experiences, preferred learning style, content, and time commitment of the intervention, and perceived current need for intervention. One-fifth of the sample expressed no interest in any intervention type, though they expressed openness to assistance in the future as needed. CONCLUSIONS Older adults with cognitive impairment are generally motivated to enhance their compensatory strategy use. Clinicians/researchers designing compensatory strategy interventions should consider instructor-led formats, present individualized benefits of interventions, and demonstrate the benefits of both preventative and remedial intervention to optimize patient engagement.
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Affiliation(s)
- Allyson Goldstein
- Department of Adult Psychiatry and Behavioral Health, Rhode Island Hospital, Providence, RI, USA
| | - Persis V Commissariat
- Section on Clinical, Behavioral, and Outcomes Research, Joslin Diabetes Center, Harvard Medical School, Boston, MA, USA
| | - Kelli L Sullivan
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI, USA
- Department of Adult Psychiatry and Behavioral Health, Miriam Hospital, Providence, RI, USA
| | - Emily S Hallowell
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI, USA
- Mental Health and Behavioral Sciences, Providence Veterans Administration Medical Center, Providence, RI, USA
| | - Jennifer D Davis
- Department of Adult Psychiatry and Behavioral Health, Rhode Island Hospital, Providence, RI, USA
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Seth A Margolis
- Department of Adult Psychiatry and Behavioral Health, Rhode Island Hospital, Providence, RI, USA
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI, USA
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12
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Piechocki M, Przewłocki T, Pieniążek P, Trystuła M, Podolec J, Kabłak-Ziembicka A. A Non-Coronary, Peripheral Arterial Atherosclerotic Disease (Carotid, Renal, Lower Limb) in Elderly Patients-A Review PART II-Pharmacological Approach for Management of Elderly Patients with Peripheral Atherosclerotic Lesions outside Coronary Territory. J Clin Med 2024; 13:1508. [PMID: 38592348 PMCID: PMC10934701 DOI: 10.3390/jcm13051508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Revised: 02/23/2024] [Accepted: 03/03/2024] [Indexed: 04/10/2024] Open
Abstract
BACKGROUND Aging is a key risk factor for atherosclerosis progression that is associated with increased incidence of ischemic events in supplied organs, including stroke, coronary events, limb ischemia, or renal failure. Cardiovascular disease is the leading cause of death and major disability in adults ≥ 75 years of age. Atherosclerotic occlusive disease affects everyday activity, quality of life, and it is associated with reduced life expectancy. As most multicenter randomized trials exclude elderly and very elderly patients, particularly those with severe comorbidities, physical or cognitive dysfunctions, frailty, or residence in a nursing home, there is insufficient data on the management of older patients presenting with atherosclerotic lesions outside coronary territory. This results in serious critical gaps in knowledge and a lack of guidance on the appropriate medical treatment. In addition, due to a variety of severe comorbidities in the elderly, the average daily number of pills taken by octogenarians exceeds nine. Polypharmacy frequently results in drug therapy problems related to interactions, drug toxicity, falls with injury, delirium, and non-adherence. Therefore, we have attempted to gather data on the medical treatment in patients with extra-cardiac atherosclerotic lesions indicating where there is some evidence of the management in elderly patients and where there are gaps in evidence-based medicine. Public PubMed databases were searched to review existing evidence on the effectiveness of lipid-lowering, antithrombotic, and new glucose-lowering medications in patients with extra-cardiac atherosclerotic occlusive disease.
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Affiliation(s)
- Marcin Piechocki
- Department of Vascular and Endovascular Surgery, The St. John Paul II Hospital, Prądnicka 80, 31-202 Krakow, Poland; (M.P.); (P.P.); (M.T.)
- Department of Cardiac and Vascular Diseases, Institute of Cardiology, Jagiellonian University Medical College, św. Anny 12, 31-007 Krakow, Poland;
| | - Tadeusz Przewłocki
- Department of Cardiac and Vascular Diseases, Institute of Cardiology, Jagiellonian University Medical College, św. Anny 12, 31-007 Krakow, Poland;
- Department of Interventional Cardiology, The St. John Paul II Hospital, Prądnicka 80, 31-202 Krakow, Poland;
| | - Piotr Pieniążek
- Department of Vascular and Endovascular Surgery, The St. John Paul II Hospital, Prądnicka 80, 31-202 Krakow, Poland; (M.P.); (P.P.); (M.T.)
- Department of Cardiac and Vascular Diseases, Institute of Cardiology, Jagiellonian University Medical College, św. Anny 12, 31-007 Krakow, Poland;
| | - Mariusz Trystuła
- Department of Vascular and Endovascular Surgery, The St. John Paul II Hospital, Prądnicka 80, 31-202 Krakow, Poland; (M.P.); (P.P.); (M.T.)
| | - Jakub Podolec
- Department of Interventional Cardiology, The St. John Paul II Hospital, Prądnicka 80, 31-202 Krakow, Poland;
- Department of Interventional Cardiology, Institute of Cardiology, Jagiellonian University Medical College, św. Anny 12, 31-007 Krakow, Poland
| | - Anna Kabłak-Ziembicka
- Department of Interventional Cardiology, Institute of Cardiology, Jagiellonian University Medical College, św. Anny 12, 31-007 Krakow, Poland
- Noninvasive Cardiovascular Laboratory, The St. John Paul II Hospital, Prądnicka 80, 31-202 Krakow, Poland
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Possemis N, Verhey F, Prickaerts J, Blokland A, Ramakers I. A proof of concept phase II study with the PDE-4 inhibitor roflumilast in patients with mild cognitive impairment or mild Alzheimer's disease dementia (ROMEMA): study protocol of a double-blind, randomized, placebo-controlled, between-subjects trial. Trials 2024; 25:162. [PMID: 38438923 PMCID: PMC10910786 DOI: 10.1186/s13063-024-08001-3] [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: 12/27/2023] [Accepted: 02/21/2024] [Indexed: 03/06/2024] Open
Abstract
BACKGROUND Research into the neurobiological underpinnings of learning and memory has demonstrated the cognitive-enhancing effects associated with diverse classes of phosphodiesterase (PDE) inhibitors. Specific PDE inhibitors have been identified to improve neuronal communication through selective inhibition of PDE activity. Roflumilast, a PDE4 inhibitor, has demonstrated efficacy in enhancing episodic memory in healthy adults and elderly participants with pronounced memory impairment, indicative of amnestic mild cognitive impairment (aMCI). In alignment with these findings, the present protocol aims to provide a proof of concept phase II of the potential of roflumilast to aid patients diagnosed with (a)MCI or mild Alzheimer's disease (AD) dementia. METHODS The study will be conducted according to a double-blind, randomized placebo-controlled, between-subjects design. Participants with (a)MCI and mild AD dementia will be recruited through the Memory Clinic at the Maastricht University Medical Centre + (MUMC +) in Maastricht, the Netherlands, alongside outreach through regional hospitals, and social media. The study will have three arms: placebo, 50 μg roflumilast, and 100 μg roflumilast, with a treatment duration of 24 weeks. The primary outcome measure will focus on the assessment of episodic memory, as evaluated through participants' performance on the 15-word Verbal Learning Task (VLT). Our secondary objectives are multifaceted, including an exploration of various cognitive domains. In addition, insights into the well-being and daily functioning of participants will be investigated through interviews with both the participants and their (informal) caregivers, we are interested in the well-being and daily functioning of the participants. DISCUSSION The outcomes of the present study aim to elucidate the significance of the PDE4 inhibition mechanism as a prospective therapeutic target for enhancing cognitive function in individuals with (a)MCI and mild AD dementia. Identifying positive effects within these patient cohorts could extend the relevance of this treatment to encompass a broader spectrum of neurological disorders. TRIAL REGISTRATION The Medical Ethics Committee of MUMC + granted ethics approval for the 4th version of the protocol on September 10th, 2020. The trial was registered at the European Drug Regulatory Affairs Clinical Trials (EudraCT) registered on the 19th of December 2019 ( https://www.clinicaltrialsregister.eu/ctr-search/trial/2019-004959-36/NL ) and ClinicalTrial.gov (NCT04658654, https://clinicaltrials.gov/study/NCT04658654?intr=roflumilast&cond=mci&rank=1 ) on the 8th of December 2020. The Central Committee on Research Involving Human Subjects (CCMO) granted approval on the 30th of September 2020.
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Affiliation(s)
- Nina Possemis
- Dept. of Psychiatry and Neuropsychology, School for Mental, Health and Neuroscience, Alzheimer Centre Limburg, Maastricht University, Maastricht, The Netherlands
| | - Frans Verhey
- Department of Psychiatry & Neuropsychology, School for Mental Health and Neuroscience, Maastricht University Medical Centre+ (MUMC+), Alzheimer Centre Limburg, Maastricht University, Maastricht, The Netherlands
| | - Jos Prickaerts
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - Arjan Blokland
- Faculty of Psychology and Neuroscience, Department of Neuropsychology & Psychopharmacology, EURON, Maastricht University, Maastricht, the Netherlands
| | - Inez Ramakers
- Department of Psychiatry & Neuropsychology, School for Mental Health and Neuroscience, Maastricht University Medical Centre+ (MUMC+), Alzheimer Centre Limburg, Maastricht University, Maastricht, The Netherlands.
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Dong X, Tsang CCS, Wan JY, Chisholm-Burns MA, Finch CK, Tsao JW, Browning JA, Garuccio J, Zeng R, Wang J. Effects of Medicare Part D medication therapy management on racial/ethnic disparities in adherence to antidementia medications among patients with Alzheimer's disease and related dementias: An observational study. EXPLORATORY RESEARCH IN CLINICAL AND SOCIAL PHARMACY 2024; 13:100420. [PMID: 38420610 PMCID: PMC10900920 DOI: 10.1016/j.rcsop.2024.100420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 08/18/2023] [Accepted: 02/08/2024] [Indexed: 03/02/2024] Open
Abstract
Background Evidence is sparse on the effects of Medicare medication therapy management (MTM) on racial/ethnic disparities in medication adherence among patients with Alzheimer's disease and related dementias. Objectives This study examined the Medicare MTM program's effects on racial/ethnic disparities in the adherence to antidementia medications among patients with Alzheimer's disease and related dementias. Methods This is a retrospective analysis of 100% of 2010-2017 Medicare Parts A, B, and D data linked to Area Health Resources Files. The study outcome was nonadherence to antidementia medications, and intervention was defined as new MTM enrollment in 2017. Propensity score matching was conducted to create intervention and comparison groups with comparable characteristics. A difference-in-differences model was employed with logistic regression, including interaction terms of dummy variables for the intervention group and racial/ethnic minorities. Results Unadjusted comparisons revealed that Black, Hispanic, and Asian/Pacific Islander patients were more likely to be nonadherent than non-Hispanic White (White) patients in 2016. Differences in odds of nonadherence between Black and White patients among the intervention group were lower in 2017 than in 2016 by 27% (odds ratios [OR]: 0.73, 95% confidence interval [CI]: 0.65-0.82). A similar lowering was seen between Hispanic and White patients by 26% (OR: 0.74, 95% CI: 0.63-0.87). MTM enrollment was associated with reduced disparities in nonadherence for Black-White patients of 33% (OR: 0.67, 95% CI: 0.57-0.78) and Hispanic-White patients of 19% (OR: 0.81, 95% CI: 0.67-0.99). Discussion The Medicare MTM program was associated with lower disparities in adherence to antidementia medications between Black and White patients, and between Hispanic and White patients in the population with Alzheimer's disease and related dementias. Conclusions Expanding the MTM program may particularly benefit racial/ethnic minorities in Alzheimer's disease and related dementia care.
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Affiliation(s)
- Xiaobei Dong
- Department of Clinical Pharmacy and Translational Science, University of Tennessee Health Science Center College of Pharmacy, 881 Madison Avenue, Memphis, TN 38163, USA
| | - Chi Chun Steve Tsang
- Department of Clinical Pharmacy and Translational Science, University of Tennessee Health Science Center College of Pharmacy, 881 Madison Avenue, Memphis, TN 38163, USA
| | - Jim Y. Wan
- Department of Preventive Medicine, University of Tennessee Health Science Center College of Medicine, 66 North Pauline St, Memphis, TN 38163, USA
| | - Marie A. Chisholm-Burns
- Department of Clinical Pharmacy and Translational Science, University of Tennessee Health Science Center College of Pharmacy, 881 Madison Avenue, Memphis, TN 38163, USA
| | - Christopher K. Finch
- Department of Clinical Pharmacy and Translational Science, University of Tennessee Health Science Center College of Pharmacy, 881 Madison Avenue, Memphis, TN 38163, USA
| | - Jack W. Tsao
- Department of Neurology, University of Tennessee Health Science Center College of Medicine, 855 Monroe Avenue, Memphis, TN 38163, USA
| | - Jamie A. Browning
- Department of Clinical Pharmacy and Translational Science, University of Tennessee Health Science Center College of Pharmacy, 881 Madison Avenue, Memphis, TN 38163, USA
| | - Joseph Garuccio
- Department of Clinical Pharmacy and Translational Science, University of Tennessee Health Science Center College of Pharmacy, 881 Madison Avenue, Memphis, TN 38163, USA
| | - Rose Zeng
- Department of Clinical Pharmacy and Translational Science, University of Tennessee Health Science Center College of Pharmacy, 881 Madison Avenue, Memphis, TN 38163, USA
| | - Junling Wang
- Department of Clinical Pharmacy and Translational Science, University of Tennessee Health Science Center College of Pharmacy, 881 Madison Avenue, Memphis, TN 38163, USA
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Elkefi S, Blecker S, Bitan Y. Health Information Technology Supporting Adherence Memory Disorder Patients: A Systematic Literature Review. Appl Clin Inform 2024; 15:85-100. [PMID: 38295858 PMCID: PMC10830240 DOI: 10.1055/s-0043-1776792] [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: 09/07/2023] [Accepted: 10/09/2023] [Indexed: 02/05/2024] Open
Abstract
BACKGROUND People with memory disorders have difficulty adhering to treatments. With technological advances, it remains important to investigate the potential of health information technology (HIT) in supporting medication adherence among them. OBJECTIVES This review investigates the role of HIT in supporting adherence to medication and therapies among patients with memory issues. It also captures the factors that impact technology adherence interventions. METHODS We searched the literature for relevant publications published until March 15, 2023, using technology to support adherence among patients with memory issues (dementia, Alzheimer's, amnesia, mild cognitive impairment, memory loss, etc.). The review was reported following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. We conducted a quality assessment of the papers following the Mixed Methods Appraisal Tool. RESULTS Fifteen studies were included after carefully reviewing the 3,773 articles in the search. Methodological quality, as appraised, ranged from 80 to 100% with eight studies rated 100%. The studies overall did not have a high risk of bias. Thus, all of the 15 studies were included. Technologies investigated were classified into four groups based on their impact: therapeutic patient education, simplifying treatment regimens, early follow-up visits and short-term treatment goals, and reminder programs. Different technologies were used (automatic drug dispensers or boxes, mobile health-based interventions, game-based interventions, e-health-based interventions, patient portals, and virtual reality). The factors impacting patients' adherence to technology-based treatment and medication were clustered into human-computer interaction and integration challenges. CONCLUSION This study contributes to the literature by classifying the technologies that supported medication adherence among patients with memory issues in four groups. It also explores and presents the possible limitations of existing solutions to drive future research in supporting care for people with memory disorders.
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Affiliation(s)
- Safa Elkefi
- School of Nursing, Columbia University Medical School, Columbia University, United States
- Langone health, New York University Medical School, New York University, New York, United States
| | - Saul Blecker
- Langone health, New York University Medical School, New York University, New York, United States
| | - Yuval Bitan
- Department of Health Policy and Management, Ben-Guiron University of the Negev, Beer Sheva, Israel
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16
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Racsa PN, Booth TA, Chung LN, Dixon SW, Poonawalla IB. Association of medication adherence quality measures for diabetes, hypertension, and hyperlipidemia with cognitive decline. J Family Med Prim Care 2023; 12:2667-2675. [PMID: 38186814 PMCID: PMC10771214 DOI: 10.4103/jfmpc.jfmpc_935_23] [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: 06/07/2023] [Revised: 07/19/2023] [Accepted: 08/09/2023] [Indexed: 01/09/2024] Open
Abstract
Background While diabetes, hypertension, and hyperlipidemia each are associated with increased risk of cognitive decline, little is known regarding how nonadherence to medications for these conditions is associated with cognitive decline risk. Methods We identified patients enrolled in a Medicare Advantage Prescription Drug plan who were eligible for inclusion in the CMS Star Medication Adherence quality measures for diabetes, hypertension, and hyperlipidemia in 2018, 2019, and 2020. To achieve an adherence quality measure, patients had to meet 80% of the proportion of days for the medication. We used propensity score with inverse probability of treatment weighting to balance outcomes for baseline characteristics and logistic regression models to compare odds of cognitive decline outcomes across patient groups. Results The study population of 99,774 individuals had a mean age of 71.0 years and was 49.1% female, 73.9% White, and 17.8% Black, with 62.0% living in an urban setting. Compared with patients who missed zero adherence measures, those who missed one measure had 23%-33% increased odds of cognitive decline (any decline OR = 1.23; dementia OR = 1.33; Alzheimer's disease OR = 1.27; all P values <0.01). Patients who missed 2-3 measures had 37%-96% increased odds of cognitive decline (any decline OR = 1.37; dementia OR = 1.58; Alzheimer's disease OR = 1.96; all P values <0.01). Patients who missed ≥4 adherence measures had the greatest odds of cognitive decline (any decline OR = 1.64; dementia OR = 2.05; Alzheimer's disease OR = 2.48; all P values <0.01). Conclusion Not achieving CMS Star Medication Adherence quality measures for diabetes, hypertension, and hyperlipidemia therapies was associated with increased risk of cognitive decline outcomes.
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Affiliation(s)
- Patrick N. Racsa
- Affiliated with Humana at the Time of the Work, Humana Healthcare Research, Inc., Humana Inc., 500 W Main Street Louisville, KY 40202 USA
| | - Tori A. Booth
- Humana Pharmacy Solutions, Humana Inc. 500 W Main Street Louisville, KY 40202, USA
| | - Linda N. Chung
- Humana Pharmacy Solutions, Humana Inc. 500 W Main Street Louisville, KY 40202, USA
| | - Suzanne W. Dixon
- Humana Healthcare Research, Inc., Humana Inc., 500 W Main Street Louisville, KY 40202, USA
| | - Insiya B. Poonawalla
- Humana Healthcare Research, Inc., Humana Inc., 500 W Main Street Louisville, KY 40202, USA
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17
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DeVettori G, Troxel WM, Duff K, Baron KG. Positive airway pressure adherence among patients with obstructive sleep apnea and cognitive impairment: A narrative review. Sleep Med 2023; 111:28-35. [PMID: 37716335 PMCID: PMC10613340 DOI: 10.1016/j.sleep.2023.08.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 08/19/2023] [Accepted: 08/29/2023] [Indexed: 09/18/2023]
Abstract
Adults with Mild Cognitive Impairment (MCI) and Alzheimer's disease (AD) have increased rates of Obstructive Sleep Apnea (OSA). Positive Airway Pressure (PAP) is the first-line treatment for OSA and may have potential benefits for slowing cognitive decline in these individuals. However, adherence is low in PAP users overall and those with cognitive impairment may have unique challenges. Furthermore, there has been little systematic study of the use of PAP or strategies to enhance PAP adherence among those with AD or MCI. The aim of this review is to examine existing observational, quasi-experimental and experimental studies of the effects of PAP on cognitive function. In addition, our goal was to gather evidence about the adherence rates, and support for PAP among adults with MCI and mild to moderate AD. Through searches of electronic databases (University of Utah Library, SAGE Publishing, PubMed, Wiley, EBSCO, Science Direct, ProQuest, and NCBI), we identified 11 articles that fit our study inclusion criteria. Synthesis of data was performed with a focus on cognitive outcomes of PAP interventions and adherence. Findings from the studies showed that multiple indices of memory improved with PAP use. Adherence in MCI and AD populations was largely comparable to adherence reported in general adult populations, but more research is needed to optimize systems for providing support for PAP users and caregivers. Results support PAP as a promising intervention in this population but more research is needed to make definitive conclusions about the relationship between PAP use and improved cognitive function. Furthermore, research is needed to determine if additional interventions are needed to support patients and caregivers.
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Affiliation(s)
- Giulia DeVettori
- Division of Public Health, Department of Family and Preventive Medicine, University of Utah, Salt Lake City, UT, USA
| | - Wendy M Troxel
- Rand Corporation, Division of Behavior and Policy Sciences, Pittsburgh, PA, USA
| | - Kevin Duff
- Department of Neurology, University of Utah, Salt Lake City, UT, USA; Department of Neurology, Oregon Health & Science University, Portland, OR, USA
| | - Kelly G Baron
- Division of Public Health, Department of Family and Preventive Medicine, University of Utah, Salt Lake City, UT, USA.
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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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19
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Zhao M, Chen Z, Xu T, Fan P, Tian F. Global prevalence of polypharmacy and potentially inappropriate medication in older patients with dementia: a systematic review and meta-analysis. Front Pharmacol 2023; 14:1221069. [PMID: 37693899 PMCID: PMC10483131 DOI: 10.3389/fphar.2023.1221069] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 08/03/2023] [Indexed: 09/12/2023] Open
Abstract
Background: Older patients with dementia always need multiple drugs due to comorbidities and cognitive impairment, further complicating drug treatment and increasing the risk of potentially inappropriate medication. The objective of our study is to estimate the global prevalence of polypharmacy and potentially inappropriate medication (PIM) and explore the factors of PIM for older patients with dementia. Methods: We searched PubMed, Embase (Ovid), and Web of Science databases to identify eligible studies from inception to 16 June 2023. We conducted a meta-analysis for observational studies reporting the prevalence of potentially inappropriate medication and polypharmacy in older patients with dementia using a random-effect model. The factors associated with PIM were meta-analyzed. Results: Overall, 62 eligible studies were included, of which 53 studies reported the prevalence of PIM and 28 studies reported the prevalence of polypharmacy. The pooled estimate of PIM and polypharmacy was 43% (95% CI 38-48) and 62% (95% CI 52-71), respectively. Sixteen studies referred to factors associated with PIM use, and 15 factors were further pooled. Polypharmacy (2.83, 95% CI 1.80-4.44), diabetes (1.31, 95% CI 1.04-1.65), heart failure (1.17, 95% CI 1.00-1.37), depression (1.45, 95% CI 1.14-1.88), history of cancer (1.20, 95% CI 1.09-1.32), hypertension (1.46, 95% CI 1.05-2.03), ischemic heart disease (1.55, 95% CI 0.77-3.12), any cardiovascular disease (1.11, 95% CI 1.06-1.17), vascular dementia (1.09, 95% CI 1.03-1.16), chronic obstructive pulmonary disease (1.39, 95% CI 1.13-1.72), and psychosis (1.91, 95% CI 1.04-3.53) are positively associated with PIM use. Conclusion: PIM and polypharmacy were highly prevalent in older patients with dementia. Among different regions, the pooled estimate of PIM use and polypharmacy varied widely. Increasing PIM in older patients with dementia was closely associated with polypharmacy. For other comorbidities such as heart failure and diabetes, prescribing should be cautioned.
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Affiliation(s)
| | | | | | - Ping Fan
- Department of Pharmacy, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Fangyuan Tian
- Department of Pharmacy, West China Hospital, Sichuan University, Chengdu, Sichuan, China
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20
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Wawruch M, Petrova M, Tesar T, Murin J, Schnorrerova P, Paduchova M, Celovska D, Havelkova B, Trnka M, Alfian SD, Aarnio E. Factors associated with non-adherence to angiotensin-converting enzyme inhibitors and angiotensin receptor blockers in older patients with peripheral arterial disease. Front Pharmacol 2023; 14:1199669. [PMID: 37637425 PMCID: PMC10448819 DOI: 10.3389/fphar.2023.1199669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 07/31/2023] [Indexed: 08/29/2023] Open
Abstract
Introduction: As in other chronic conditions, medication adherence is important in the treatment of peripheral arterial disease (PAD). Our study aimed at a) analysing non-adherence to angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) in groups of older ACEI and ARB users with PAD, and b) identifying characteristics associated with non-adherence. Methods: We focused on the implementation phase of adherence (i.e., after treatment initiation and before possible discontinuation of treatment). The study cohort included ACEI/ARB users aged ≥65 years in whom PAD was newly diagnosed during 2012. Non-adherence was defined as Proportion of Days Covered (PDC) < 80%. Results: Among 7,080 ACEI/ARB users (6,578 ACEI and 502 ARB users), there was no significant difference in the overall proportion of non-adherent patients between ACEI and ARB users (13.9% and 15.3%, respectively). There were differences in factors associated with non-adherence between the groups of persistent and non-persistent (i.e., discontinued treatment at some point during follow-up) ACEI and ARB users. Increasing age, dementia and bronchial asthma were associated with non-adherence in persistent ACEI users. General practitioner as index prescriber was associated with adherence in the groups of non-persistent ACEI users and persistent ARB users. Conclusion: Identified factors associated with non-adherence may help in determining the groups of patients who require increased attention.
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Affiliation(s)
- Martin Wawruch
- Institute of Pharmacology and Clinical Pharmacology, Faculty of Medicine, Comenius University, Bratislava, Slovakia
| | - Miriam Petrova
- Institute of Pharmacology and Clinical Pharmacology, Faculty of Medicine, Comenius University, Bratislava, Slovakia
| | - Tomas Tesar
- Department of Organisation and Management of Pharmacy, Faculty of Pharmacy, Comenius University, Bratislava, Slovakia
| | - Jan Murin
- 1st Department of Internal Medicine, Faculty of Medicine, Comenius University, Bratislava, Slovakia
| | - Patricia Schnorrerova
- Institute of Pharmacology and Clinical Pharmacology, Faculty of Medicine, Comenius University, Bratislava, Slovakia
| | | | - Denisa Celovska
- 1st Department of Internal Medicine, Faculty of Medicine, Comenius University, Bratislava, Slovakia
| | | | - Michal Trnka
- Institute of Medical Physics, Biophysics, Informatics and Telemedicine, Faculty of Medicine, Comenius University, Bratislava, Slovakia
| | - Sofa D. Alfian
- Department of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy, Universitas Padjadjaran, Bandung, Indonesia
- Center of Excellence in Higher Education for Pharmaceutical Care Innovation, Universitas Padjadjaran, Bandung, Indonesia
| | - Emma Aarnio
- School of Pharmacy, University of Eastern Finland, Kuopio, Finland
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21
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Allen DD, Jaffe L. A Survey of Medication Management in Occupational Therapy Practice. Occup Ther Health Care 2023:1-14. [PMID: 37548574 DOI: 10.1080/07380577.2023.2243516] [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: 09/16/2022] [Accepted: 07/28/2023] [Indexed: 08/08/2023]
Abstract
A descriptive study was conducted through the use of an online survey to gain understanding of the current occupational therapy practices of medication management. Although most respondents felt this topic is important, 24% of those surveyed reported not including medication management in their practice. Results suggest cognition was an important consideration when addressing medication management as well as the need to increase occupational therapy practitioners' knowledge and use of medication management.
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Affiliation(s)
- Denise D Allen
- Department of Rehabilitation Sciences, FL Gulf Coast University 10501 FGCU Boulevard South, Fort Myers, FL, USA
| | - Lynn Jaffe
- Emeritus of Department of Rehabilitation Sciences, Emeritus at Florida Gulf Coast University, Fort Myers, FL, USA
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22
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K J, Rao M, YN S, Thunga G, N R, Sudhakar C, Sanatombi Devi E. Determinants of Medication Non-Adherence Among the Elderly with Co-Existing Hypertension and Type 2 Diabetes Mellitus in Rural Areas of Udupi District in Karnataka, India. Patient Prefer Adherence 2023; 17:1641-1656. [PMID: 37465058 PMCID: PMC10351531 DOI: 10.2147/ppa.s380784] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 06/08/2023] [Indexed: 07/20/2023] Open
Abstract
Purpose Medication adherence is a crucial component in the management of elderly with co-morbid chronic conditions. Hence, this study aimed to investigate the determinants of medication non-adherence among rural elderly with co-morbid chronic conditions of hypertension (HTN) and type 2 diabetes mellitus (T2DM) in India. Patients and Methods This cross-sectional study adopted the probability proportional to size (PPS) sampling technique to find the determinants of medication non-adherence among elderly residing in rural coverage areas of five randomly selected primary health centres (PHC) in Udupi district, Karnataka, India. A total of 360 elderly (72 samples from each cluster) who met the inclusion criteria and consented were interviewed using predesigned prevalidated and standardized or reliable tools. The data were coded and entered in SPSS version 16.0 and analyzed using both descriptive and inferential statistics. Results The study found that 55.6% (n=200) of rural elderly with co-morbid conditions HTN and T2DM were non-adherent to their medications and established Spearman correlation coefficient rank (r) value between undesirable person-related factors (r=-0.444); good family support (including financial support) (r=0.185); poor accessibility to healthcare facility (r=-0.209); detrimental medication-related factors including high cost of medication (r=-0.237) were found to be significant at 0.05 level of confidence (p < 0.05). Further, the study depicted that the chi-square test (χ2) was identified to be significantly associated (p<0.05) with a variable such as education, knowledge, number of illnesses and impairments, vision, memory, and physical impairments. Conclusion Medication adherence could be improved among rural elderly with co-morbid conditions by identifying and addressing the determinants at the earliest. Further, it is vital to identify the suitable intervention program to address these avoidable problems.
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Affiliation(s)
- Jeyalakshmi K
- Department of Community Health Nursing, Manipal College of Nursing, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Mahadev Rao
- Department of Pharmacy Practice, Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Shashidhara YN
- Department of Community Health Nursing, Manipal College of Nursing, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Girish Thunga
- Department of Pharmacy Practice, Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Ravishankar N
- Department of Biostatistics, Vallabhbhai Patel Chest Institute, University of Delhi, Delhi, India
| | - Christopher Sudhakar
- Department of Mental Health Nursing & Director - Quality, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Elsa Sanatombi Devi
- Department of Medical Surgical Nursing, Manipal College of Nursing, Manipal Academy of Higher Education, Manipal, Karnataka, India
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23
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van de Vijver I, Brinkhof LP, de Wit S. Age differences in routine formation: the role of automatization, motivation, and executive functions. Front Psychol 2023; 14:1140366. [PMID: 37484115 PMCID: PMC10357511 DOI: 10.3389/fpsyg.2023.1140366] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2023] [Accepted: 06/16/2023] [Indexed: 07/25/2023] Open
Abstract
Medication adherence can be vital for one's health, especially in older adults. However, previous research has demonstrated that medication adherence is negatively affected by age-related cognitive decline. In the current study we investigated whether older adults are able to compensate for this decline by relying more on the formation of efficient, automatized routines. To this end, we directly compared daily (placebo) medication adherence in a healthy sample of 68 younger (18-29 years) and 63 older adults (65-86 years) over a period of 4 weeks. We show that despite an age-related decline in cognitive functions (i.e., poorer working memory, prospective memory, task switching, and goal-directed control), older adults adhered better to a daily pill intake routine than younger adults did and, in line with our hypothesis about increased routine formation, reported higher subjective automaticity of pill intake. Across age groups, automatization of pill intake was related to intake regularity and conscientiousness, but not to individual differences in habit tendency as measured in the lab nor to explicit strategic planning. Crucially, the age-related increase in pill intake adherence was mediated by experienced automatization as well as motivation. These findings demonstrate that intact habitual processes and high motivation aid older adults in successfully forming daily routines.
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Affiliation(s)
- Irene van de Vijver
- Habit Lab, Department of Clinical Psychology, University of Amsterdam, Amsterdam, Netherlands
- Amsterdam Brain and Cognition, University of Amsterdam, Amsterdam, Netherlands
- Department of Experimental Psychology, Helmholtz Institute, Utrecht University, Utrecht, Netherlands
| | - Lotte P. Brinkhof
- Habit Lab, Department of Clinical Psychology, University of Amsterdam, Amsterdam, Netherlands
- Amsterdam Brain and Cognition, University of Amsterdam, Amsterdam, Netherlands
| | - Sanne de Wit
- Habit Lab, Department of Clinical Psychology, University of Amsterdam, Amsterdam, Netherlands
- Amsterdam Brain and Cognition, University of Amsterdam, Amsterdam, Netherlands
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24
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Tsang CCS, Zhang X, Barenie RE, Cernasev A, Miller NA, Wan JY, Tsao JW, Wang J. Disparities associated with Medicare Part D Star Ratings measures among patients with Alzheimer's disease and related dementias. Medicine (Baltimore) 2023; 102:e33641. [PMID: 37144996 PMCID: PMC10158876 DOI: 10.1097/md.0000000000033641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 04/06/2023] [Indexed: 05/06/2023] Open
Abstract
The Medicare Parts C and D Star Ratings system was established to improve care quality in Medicare. Previous studies reported racial/ethnic disparities in the calculation of medication adherence measures of Star Ratings in patients with diabetes, hypertension, and hyperlipidemia. This study aimed to identify possible racial/ethnic disparities in the calculation of adherence measures of Medicare Part D Star Ratings among patients with Alzheimer's disease and related dementias (ADRD) and diabetes, hypertension, or hyperlipidemia. This retrospective study analyzed the 2017 Medicare data and Area Health Resources Files. Non-Hispanic White (White) patients were compared to Black, Hispanic, Asian/Pacific Islander (Asian), and other patients on their likelihood of being included in the calculation of adherence measures for diabetes, hypertension, and/or hyperlipidemia. To adjust for the individual/community characteristics, logistic regression was used when the outcome is the inclusion in the calculation of one adherence measure; multinomial regression was used when examining the inclusion in the calculation of multiple adherence measures. Analyzing the data of 1438,076 Medicare beneficiaries with ADRD, this study found that Black (adjusted odds ratio, or OR = 0.79, 95% confidence interval, or 95% CI = 0.73-0.84) and Hispanic (OR = 0.82, 95% CI = 0.75-0.89) patients were less likely than White patients to be included in the calculation of adherence measure for diabetes medications. Further, Black patients were less likely to be included in the calculation of the adherence measure for hypertension medications than White patients (OR = 0.81, 95% CI = 0.78-0.84). All minorities were less likely to be included in calculating the adherence measure for hyperlipidemia medications than Whites. The ORs for Black, Hispanic, and Asian patients were 0.57 (95% CI = 0.55-0.58), 0.69 (95% CI = 0.64-0.74), and 0.83 (95% CI = 0.76-0.91), respectively. Minority patients were generally likely to be included in the measure calculation of fewer measures than White patients. Racial/ethnic disparities were observed in the calculation of Star Ratings measures among patients with ADRD and diabetes, hypertension, and/or hyperlipidemia. Future studies should explore possible causes of and solutions to these disparities.
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Affiliation(s)
- Chi Chun Steve Tsang
- Department of Clinical Pharmacy and Translational Science, University of Tennessee Health Science Center College of Pharmacy, Memphis, TN
| | - Xiangjun Zhang
- Department of Clinical Pharmacy and Translational Science, University of Tennessee Health Science Center College of Pharmacy, Memphis, TN
| | - Rachel Elizabeth Barenie
- Department of Clinical Pharmacy and Translational Science, University of Tennessee Health Science Center College of Pharmacy, Memphis, TN
| | - Alina Cernasev
- Department of Clinical Pharmacy and Translational Science, University of Tennessee Health Science Center College of Pharmacy, Memphis, TN
| | - Nancy A. Miller
- School of Public Policy, University of Maryland, Baltimore County, Baltimore, MD
| | - Jim Y. Wan
- Department of Preventive Medicine, University of Tennessee Health Science Center College of Medicine, Memphis, TN
| | - Jack W. Tsao
- Edwin H. Kolodny, MD, Department of Neurology, New York University Grossman School of Medicine, New York, NY
| | - Junling Wang
- Department of Clinical Pharmacy and Translational Science, University of Tennessee Health Science Center College of Pharmacy, Memphis, TN
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25
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Huang CY, Hu CJ, Huang LK, Chang EH. Effects of caregiver counselling on medication persistence and adherence in patients with dementia at a pharmacist-managed clinic: A pilot study. J Clin Pharm Ther 2022; 47:2074-2082. [PMID: 36543253 DOI: 10.1111/jcpt.13752] [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: 03/30/2022] [Revised: 06/30/2022] [Accepted: 07/17/2022] [Indexed: 12/24/2022]
Abstract
WHAT IS KNOWN AND OBJECTIVE Low treatment persistence and adherence in patients with dementia results in a rapid loss of disease control. This pilot study evaluated the impact of pharmacist-provided caregiver counselling on treatment persistence, adherence, quality of life (QoL) in patients with dementia, as well as caregiver's knowledge of dementia, and caregiver burden. METHODS This prospective, randomized controlled study was performed at a hospital-based pharmacist-managed clinic from December 2017 to December 2019. Patients with mild-to-moderate Alzheimer's disease (AD), initiating cholinesterase inhibitors within 3 months, and coming with their caregivers were included and randomized 1:1 to intervention or control group. The intervention group received pharmacist counselling and education sheets about AD, whereas the control group only received standard of care. Patients' treatment persistence and adherence were assessed at months 3, 6, 9, and 12; QoL, and caregiver burden were assessed at baseline and month 12. Caregiver's knowledge of dementia was assessed at baseline and 2 weeks after counselling in the intervention group. Nonparametric statistics and generalized estimating equation models were used for statistical analysis. RESULTS AND DISCUSSION A total of 40 patients and 40 caregivers were included, with 20 pairs for each group. One-year medication persistence (16/20 vs. 16/20) and adherence rates (87%-99%) were high in both groups without significant differences. Dementia knowledge scores improved significantly after counselling in the intervention group (77.5 vs. 95.8, p < 0.01). Although the change of caregiver burden was non-significant between groups, the score decreased in the intervention group (-0.89; p = 0.78) but increased in the control group (+6.01; p = 0.07). WHAT IS NEW AND CONCLUSION In this pilot study, pharmacist's counselling for patients with dementia and their caregivers is feasible and can enhance caregiver knowledge of dementia. Further study with larger scale is needed to confirm the impact on these outcomes.
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Affiliation(s)
- Chu-Yun Huang
- Department of Clinical Pharmacy, School of Pharmacy, College of Pharmacy, Taipei Medical University, Taipei, Taiwan.,Department of Pharmacy, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
| | - Chaur-Jong Hu
- Dementia Center, Department of Neurology, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan.,Department of Neurology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.,Taipei Neuroscience Institute, Taipei Medical University, Taipei, Taiwan
| | - Li-Kai Huang
- Dementia Center, Department of Neurology, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan.,Department of Neurology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.,Taipei Neuroscience Institute, Taipei Medical University, Taipei, Taiwan
| | - Elizabeth H Chang
- Department of Clinical Pharmacy, School of Pharmacy, College of Pharmacy, Taipei Medical University, Taipei, Taiwan.,Department of Pharmacy, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan.,Research Center for Pharmacoeconomics, College of Pharmacy, Taipei Medical University, Taipei, Taiwan
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26
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Troshina DV, Andreev DA, Fomicheva AV, Volovchenko AN, Volel BA. Social and psychological risk factors for decreased adherence among patients with atrial fibrillation. TERAPEVT ARKH 2022; 94:1197-1203. [DOI: 10.26442/00403660.2022.10.201905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Indexed: 11/23/2022]
Abstract
Adherence has a direct impact on reducing the effectiveness of atrial fibrillation therapy and increasing the risk of thromboembolic events. Among the factors involved in the decrease of adherence, the social and psychological characteristics of patients remain insufficiently studied. At the same time, the available publications allow us to conclude that there are markers of the risk of reduced adherence in patients with atrial fibrillation, which include age, cognitive impairment, psychoemotional disorders (including depression and anxiety) and specific behavioral patterns.
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27
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A Study on Types of Medication Adherence in Hypertension among Older Patients and Influencing Factors. Healthcare (Basel) 2022; 10:healthcare10112322. [DOI: 10.3390/healthcare10112322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 11/15/2022] [Accepted: 11/16/2022] [Indexed: 11/22/2022] Open
Abstract
Background: Hypertension has the characteristic that the risk of complications can be reduced through appropriate medication in daily life. Hence, it is important to consider practical measures to increase medication adherence, particularly among older patients. Methods: This study used the Korea Health Panel 2020 data (Version 2.0.1), jointly conducted by Korea Institute for Health and Social Affairs and National Health Insurance. A total of 2300 patients with high blood pressure over 65 years of age were selected. In order to identify types of medication adherence in older hypertensive patients, and examine factors that influence the types, the Latent Profile Analysis (LPA) and logistic regression were performed. Results: The types of adherence groups were classified into two groups: an ‘adherence group’ (87.1%) and a ‘non-adherence group’ (12.9%). Furthermore, age, living alone, and depressive symptoms were identified as determinants of medication adherence type among older hypertensive patients. Conclusion: The significant impact of sociodemographic status (age, living alone, and depressive symptoms) on medication adherence among older hypertensive patients indicates the need to establish more specific empirical interventions based on each type’s characteristics. It is expected that this study will provide an in-depth understanding of factors associated with medication adherence among older patients with hypertension, which can support interventions tailored to the specific needs of those who are non-adherent.
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28
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Chapman KR, Tremont G. Dysexecutive Behaviors Mediate the Relationship Between Functional Impairment and Caregiver Burden in Mild Cognitive Impairment. J Geriatr Psychiatry Neurol 2022; 35:823-831. [PMID: 35088611 DOI: 10.1177/08919887211070261] [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] [Indexed: 11/15/2022]
Abstract
Mild cognitive impairment (MCI) is often accompanied by executive dysfunction (ED), dysexecutive behaviors (DB), and functional impairment (FI). The respective contributions of ED, DB, and FI to caregiver burden in MCI are not well understood. The present study hypothesized that while all factors would predict caregiver burden in MCI, ED and family-reported DB would account for greater variance in caregiver burden and mediate the relationship between FI and caregiver burden. In our sample (n = 94), linear regression revealed that FI and DB predicted caregiver burden, but that DB predicted caregiver burden above and beyond the contribution of FI. DB mediated the relationship between FI and caregiver burden. These results add to a body of work demonstrating that presence of DB and FI are distressing to family members, even in mild disease stages. Because DB may account for the relationship between FI and caregiver burden, early identification of family members reporting DB in the person with MCI is imperative so that supports can be made available.
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Affiliation(s)
- Kimberly R Chapman
- Department of Psychiatry, 23325Rhode Island Hospital, Providence, RI, USA.,Brown University Department of Psychiatry and Human Behavior, Providence, RI, USA
| | - Geoffrey Tremont
- Department of Psychiatry, 23325Rhode Island Hospital, Providence, RI, USA.,Brown University Department of Psychiatry and Human Behavior, Providence, RI, USA
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29
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Muñoz-Contreras MC, Segarra I, López-Román FJ, Galera RN, Cerdá B. Role of caregivers on medication adherence management in polymedicated patients with Alzheimer's disease or other types of dementia. Front Public Health 2022; 10:987936. [PMID: 36353281 PMCID: PMC9638151 DOI: 10.3389/fpubh.2022.987936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Accepted: 10/07/2022] [Indexed: 01/26/2023] Open
Abstract
Background Alzheimer's disease (AD) and other dementia patients may have severe difficulties to ensure medication adherence due to their generally advanced age, polymedicated and multi-pathological situations as well as certain degree of cognitive impairment. Thus, the role of patient caregivers becomes crucial to warrantee treatment compliance. Purpose To assess the factors associated to patients and caregivers on medication adherence of patients with AD and other types of dementia as well as the degree of caregiver satisfaction with respect to treatment. Methods An observational, descriptive, cross-sectional study among the caregivers of 100 patients with AD and other types of dementia of the "Cartagena and Region Association of Relatives of Patients with Alzheimer's Disease and other Neurodegenerative Diseases" was conducted to assess patient and caregiver factors that influence medication adherence evaluated with the Morisky-Green-Levine test. Results Overall, adherence to treatment was 71%, with similar proportions between male and female patients. Greater adherence was found in married or widowed patients (49.3%), first degree (85.9%) or female (81.7%) caregivers but lower in AD patients (75.9%). Multivariate analysis showed a statistically significant positive association between non-adherence and male sex of the caregiver (OR 3.512 [95%IC 1.124-10.973]), dementia (OR 3.065 [95%IC 1.019-9.219]), type of caregiver (non-first-degree relative) (OR 0.325 [95%IC 0.054-0.672]) and civil status of the patient (OR 2.011 [95%IC 1.155-3.501]) favorable for married or widowed patients. No or week association was found with gender, age, education level, number of drugs used or polymedicated status of the patient. Caregivers considered the use (90%) and administration (91%) of the treatment easy or very easy and rarely interfered with their daily life, especially for female caregivers (p = 0.016). Finally, 71% indicated that they were satisfied or very satisfied with the treatment received by the patient. Conclusions Caregivers influence therapeutic management with predictors for improved adherence including female gender and first-degree kinship, together with patient's marital status. Thus, training caregivers about the disease and the importance of medication adherence in AD patients may ensure optimal treatment.
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Affiliation(s)
- María Cristina Muñoz-Contreras
- Hospital Pharmacy, Hospital La Vega, Murcia, Spain,‘Pharmacokinetics, Patient Care and Translational Bioethics' Research Group, UCAM – Catholic University of Murcia, Murcia, Spain
| | - Ignacio Segarra
- ‘Pharmacokinetics, Patient Care and Translational Bioethics' Research Group, UCAM – Catholic University of Murcia, Murcia, Spain,Department of Pharmacy, Faculty of Pharmacy, UCAM – Catholic University of Murcia, Guadalupe, Spain,*Correspondence: Ignacio Segarra
| | - Francisco Javier López-Román
- Health Sciences Department, UCAM – Catholic University of Murcia, Guadalupe, Spain,Biomedical Research Institute of Murcia (IMIB-Arrixaca), Murcia, Spain
| | | | - Begoña Cerdá
- Department of Pharmacy, Faculty of Pharmacy, UCAM – Catholic University of Murcia, Guadalupe, Spain,‘Nutrition, Oxidative Stress and Bioavailability' Research Group, UCAM – Catholic University of Murcia, Murcia, Spain
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30
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Li B, Liu D, Wan Q, Sheng C, Wang X, Leng F, Peng Q, Wang T, Du A, Zhu F, Mima D, Wang H, Xie H, Wang Z, Jin H, Sun Y. Differences in treatment for Alzheimer's disease between urban and rural areas in China. Front Neurol 2022; 13:996093. [PMID: 36247753 PMCID: PMC9556779 DOI: 10.3389/fneur.2022.996093] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Accepted: 09/12/2022] [Indexed: 11/18/2022] Open
Abstract
Introduction In China, the increasing number of people with Alzheimer's disease (AD) poses a great challenge to families and the country. Economic and cultural differences cause a urban-rural gap in medical resources. This multicenter survey aimed to investigate the real-world practice of disease treatment among people with AD. Methods People with AD and their caregivers from 30 provincial regions in mainland China were enrolled from October 2020 to December 2020 to be surveyed for their treatment experience. Logistic regression was used to explore the factors that influence medication adherence in all areas, urban areas, and rural areas. Results In this survey, 1,427 participants came from urban areas, and 539 participants came from rural areas. Patients in urban areas were older (mean age 74 vs. 70, p = 0.001), less frequently had mild AD (36.0 vs. 52.1%, p < 0.001), and more often were cared for at professional institutions (8.8 vs. 3.2%, p < 0.001). In terms of pharmacotherapy, 77.8% of people accepted taking lifelong medication, whereas 61.3% of patients insisted on taking medications. Although 72.0% of rural people believed in taking lifelong medication, only 30.0% adhered to drug use. The major factors that influenced medication adherence for all patients with AD were regional distribution (p < 0.001, OR = 6.18, 95% CI: 4.93–7.74) and family earnings (p = 0.003, OR = 1.22, 95% CI: 1.07–1.38). In rural areas, family earnings (p = 0.008, OR = 1.44, 95% CI: 1.10–1.89) and severity of AD (p = 0.033, OR = 1.31, 95% CI: 1.02–1.68) were the main factors. Family earnings (p = 0.038, OR = 1.16, 95% CI: 1.01–1.34) was the only factor among urban areas. Among all non-pharmaceutical activities except for cognitive intervention, the participation rates of rural patients were significantly higher than those of urban patients (p < 0.05). Conclusion Although national progress has been made in the public awareness of disease treatment, adequate diagnosis and medication adherence need to be prompted, especially in rural areas. Furthermore, lifelong treatment should be improved based on regional characteristics through the joint efforts of the government, health workers, and social volunteers.
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Affiliation(s)
- Bei Li
- Department of Neurology, Peking University First Hospital, Peking University, Beijing, China
| | - Dejun Liu
- Health Division of Guard Bureau, General Office of CPC Central Committee, Beijing, China
| | - Qiaoqin Wan
- School of Nursing, Peking University, Beijing, China
| | - Can Sheng
- Department of Geriatrics, Peking University First Hospital, Beijing, China
| | - Xiting Wang
- Department of Geriatrics, Peking University First Hospital, Beijing, China
| | - Fangda Leng
- Department of Neurology, Peking University First Hospital, Peking University, Beijing, China
| | - Qing Peng
- Department of Neurology, Peking University First Hospital, Peking University, Beijing, China
| | - Ting Wang
- Department of Neurology, Peking University First Hospital, Peking University, Beijing, China
| | - Ailian Du
- Department of Neurology, Shanghai Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Feiqi Zhu
- Department of Neurology, Shenzhen Luohu People's Hospital, Shenzhen, China
| | - Dunzhu Mima
- Department of Neurology, People's Hospital of Tibet Autonomous Region, Lhasa, China
| | - Huali Wang
- Department of Psychiatry, Peking University Sixth Hospital, Peking University, Beijing, China
| | - Hengge Xie
- Department of Neurology, Second Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Zhaoxia Wang
- Department of Neurology, Peking University First Hospital, Peking University, Beijing, China
- *Correspondence: Yongan Sun
| | - Haiqiang Jin
- Department of Neurology, Peking University First Hospital, Peking University, Beijing, China
- Haiqiang Jin
| | - Yongan Sun
- Department of Neurology, Peking University First Hospital, Peking University, Beijing, China
- Zhaoxia Wang
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Neuroticism and Conscientiousness Moderate the Effect of Oral Medication Beliefs on Adherence of People with Mental Illness during the Pandemic. Brain Sci 2022; 12:brainsci12101315. [PMID: 36291250 PMCID: PMC9599797 DOI: 10.3390/brainsci12101315] [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: 08/03/2022] [Revised: 09/15/2022] [Accepted: 09/22/2022] [Indexed: 11/28/2022] Open
Abstract
Background. After the declaration of the pandemic status in several countries, the continuity of face-to-face visits in psychiatric facilities has been delayed or even interrupted to reduce viral spread. Little is known about the personality factors associated with medication beliefs and adherence amongst individuals with mental illness during the COVID-19 pandemic. This brief report describes a preliminary naturalistic longitudinal study that explored whether the Big Five personality traits prospectively moderate the effects of medication beliefs on changes in adherence during the pandemic for a group of outpatients with psychosis or bipolar disorder. Methods. Thirteen outpatients undergoing routine face-to-face follow-up assessments during the pandemic were included (41 observations overall) and completed the Revised Italian Version of the Ten-Item Personality Inventory, the Beliefs about Medicines Questionnaire, the Morisky Medication Adherence Scale—8-item and the Beck Depression Inventory—II. Results. Participants had stronger concerns about their psychiatric medications rather than beliefs about their necessity, and adherence to medications was generally low. Participants who had more necessity beliefs than concerns had better adherence to medications. People scoring higher in Conscientiousness and Neuroticism traits and more concerned about the medication side effects had poorer adherence. Conclusions. These preliminary data suggest the importance of a careful assessment of the adherence to medications amongst people with psychosis/bipolar disorder during the pandemic. Interventions aimed to improve adherence might focus on patients’ medication beliefs and their Conscientiousness and Neuroticism personality traits.
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Gil-Guillen VF, Balsa A, Bernárdez B, Valdés y Llorca C, Márquez-Contreras E, de la Haba-Rodríguez J, Castellano JM, Gómez-Martínez J. Medication Non-Adherence in Rheumatology, Oncology and Cardiology: A Review of the Literature of Risk Factors and Potential Interventions. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:12036. [PMID: 36231341 PMCID: PMC9564665 DOI: 10.3390/ijerph191912036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/18/2022] [Revised: 09/12/2022] [Accepted: 09/13/2022] [Indexed: 06/16/2023]
Abstract
Medication adherence is directly associated with health outcomes. Adherence has been reviewed extensively; however, most studies provide a narrow scope of the problem, covering a specific disease or treatment. This project's objective was to identify risk factors for non-adherence in the fields of rheumatology, oncology, and cardiology as well as potential interventions to improve adherence and their association with the risk factors. The project was developed in three phases and carried out by a Steering Committee made up of experts from the fields of rheumatology, oncology, cardiology, general medicine, and hospital and community pharmacy. In phase 1, a bibliographic review was performed, and the articles/reviews were classified according to the authors' level of confidence in the results and their clinical relevance. In phase 2, 20 risk factors for non-adherence were identified from these articles/reviews and agreed upon in Steering Committee meetings. In phase 3, potential interventions for improving adherence were also identified and agreed upon. The results obtained show that adherence is a dynamic concept that can change throughout the course of the disease, the treatments, and other factors. Educational interventions are the most studied ones and have the highest level of confidence in the authors' opinion. Information and education are essential to improve adherence in all patients.
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Affiliation(s)
- Vicente F. Gil-Guillen
- Department of Clinical Medicine, Miguel Hernandez University, 03550 San Juan, Spain
- Research Unit, Hospital General Universitario de Elda, 30600 Elda, Spain
| | - Alejandro Balsa
- Rheumatology Department, La Paz University Hospital, 28046 Madrid, Spain
- Institute for Health Research Hospital La Paz (IdiPaz), 28046 Madrid, Spain
| | - Beatriz Bernárdez
- Department of Oncologic Pharmacy, Santiago de Compostela University Hospital, 15706 Santiago de Compostela, Spain
- Medicine Department, Santiago de Compostela University, 15706 Santiago de Compostela, Spain
- Pharmacology Group, Health Research Institute of Santiago de Compostela (IDIS), 15782 Santiago de Compostela, Spain
- Adherence Group of the Sociedad Española de Farmacia Hospitalaria (ADHEFAR-SEFH), 28001 Madrid, Spain
| | - Carmen Valdés y Llorca
- Fuencarral Health Center, 28034 Madrid, Spain
- Observatorio de Adherencia al Tratamiento (OAT), 28231 Madrid, Spain
- Treatment Adherence Chair, San Juan de Alicante University, 03550 Alicante, Spain
| | | | | | - Jose M. Castellano
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), 28029 Madrid, Spain
- Centro Integral de Enfermedades Cardiovasculares, Monteprincipe University Hospital, 28660 Madrid, Spain
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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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Sheets KM, Davey CS, St. Peter WL, Reule SA, Murray AM. Cognitive impairment, perceived medication adherence, and high-risk medication use in patients with reduced kidney function: A cross-sectional analysis. Health Sci Rep 2022; 5:e697. [PMID: 35782299 PMCID: PMC9243633 DOI: 10.1002/hsr2.697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 05/06/2022] [Accepted: 05/31/2022] [Indexed: 11/18/2022] Open
Abstract
Background and Aims Reduced estimated glomerular filtration rate (eGFR < 60 ml/min/1.73 m2) is a risk factor for cognitive impairment (CI) and medication nonadherence. However, the association between CI and medication adherence in adults with reduced eGFR has not been adequately examined. Our pragmatic objectives were to assess the cross-sectional relationship between CI and self-reported medication adherence, medication number, and use of potentially high-risk medications among adults with reduced eGFR. Methods An observational cohort study of the epidemiology of CI in community-dwelling adults aged 45 years or older with reduced eGFR. Results Our analytic cohort consisted of 420 participants (202 with CI; mean age: 69.7 years) with reduced eGFR, at least one prescription medication, and nonmissing medication adherence data. Participants with CI had four times greater unadjusted odds of reporting good medication adherence than participants without CI (self-report of missing medications <4 days/month; odds ratio [OR]: 4.04, 95% confidence interval [CI]: 1.62-10.10). This difference persisted following adjustment for demographic factors and comorbidities (OR: 5.50, 95% CI: 1.86-16.28). Participants with CI were no more likely than participants without CI to report forgetfulness as a reason for missing medication doses. Participants with CI were, on average, taking more total (mean: 13.3 vs. 11.5, median: 12 vs. 11) and more high-risk (mean: 5.0 vs. 4.2, median: 5 vs. 4) medications than those without CI; these differences were attenuated and no longer significant following adjustment for demographics and comorbidities. Conclusion Given the well-documented association between CI and medication nonadherence, better self-reported medication adherence among those with CI may represent perceptions of adherence rather than actual adherence. Participants with CI were, on average, taking more total and more high-risk medications than those without CI, suggesting a possible increased risk for adverse drug events. Our results highlight the potential risks of relying on self-reported medication adherence in reduced eGFR patients with CI.
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Affiliation(s)
- Kerry M. Sheets
- Department of Medicine, Division of Geriatrics and Palliative CareHennepin HealthcareMinneapolisMinnesotaUSA
| | - Cynthia S. Davey
- Biostatistical Design and Analysis CenterUniversity of Minnesota Clinical and Translational Science InstituteMinneapolisMinnesotaUSA
| | | | - Scott A. Reule
- Department of MedicineUniversity of MinnesotaMinneapolisMinnesotaUSA
- Department of MedicineNephrology Division, Minneapolis Veterans Affairs Health Care SystemMinneapolisMinnesotaUSA
| | - Anne M. Murray
- Department of Medicine, Division of Geriatrics and Palliative CareHennepin HealthcareMinneapolisMinnesotaUSA
- Department of MedicineUniversity of MinnesotaMinneapolisMinnesotaUSA
- The Berman Center for Outcomes and Clinical Research, Hennepin Healthcare Research InstituteMinneapolisMinnesotaUSA
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Allen DD, Jaffe L, Pfleghaar A. Medication Management, Mild Cognitive Impairment and Occupational Therapy: A Scoping Review. PHYSICAL & OCCUPATIONAL THERAPY IN GERIATRICS 2022. [DOI: 10.1080/02703181.2022.2079800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Denise D. Allen
- Rehabilitation Sciences, Florida Gulf Coast University, Fort Myers, FL, USA
| | - Lynn Jaffe
- Rehabilitation Sciences, Florida Gulf Coast University, Fort Myers, FL, USA
| | - Allison Pfleghaar
- Rehabilitation Sciences, Florida Gulf Coast University, Fort Myers, FL, USA
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Du Vall M, Weffald L, Delate T, Shetterly S, Bayliss EA. Clinical Factors Associated With Nonadherence to Chronic Medications in People With Cognitive Impairment. Sr Care Pharm 2022; 37:191-199. [PMID: 35450561 DOI: 10.4140/tcp.n.2022.191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Objective To study assessed adherence to 11 chronic medications and one medication class with high medical necessity in people with cognitive impairment (CIM) and identified clinical characteristics associated with nonadherence. Design This was a retrospective cohort study. 180-day adherence was calculated as the percent of days covered (PDC). Multi-variable logistic regression modeling was used to identify clinical factors associated with a PDC less than 80% (ie, nonadherence) to one or more studied chronic medication(s). Setting Primary care in an integrated health care delivery system. Patients People with CIM 65 years of age or older who were dispensed five or more chronic medications in one month between March 1, 2019, and October 31, 2019. Results Overall, the 1,109 patients included were older (mean age = 79.8 years of age), female (54.1%), White (78.6%), had a high burden of chronic disease, and 396 (35.7%) were nonadherent to one or more study medication(s). Two medications (tiotropium and venlafaxine) and one medication class (direct oral anticoagulants) had a mean PDC less than 80%. Alzheimer's disease and related dementias (ADRD), chronic pain, chronic obstructive pulmonary disease (COPD), male, nonwhite race, and one or more mental health visits were associated independently with nonadherence. Conclusions Chronic pain, COPD, ADRD, male sex, nonwhite race, and mental health care use were associated with nonadherence. These findings can help guide clinicians as they navigate medication therapy in people with CIM.
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Iki M, Fujimori K, Nakatoh S, Tamaki J, Ishii S, Okimoto N, Kamiya K, Ogawa S. Guideline adherence by physicians for management of glucocorticoid-induced osteoporosis in Japan: a nationwide health insurance claims database study. Osteoporos Int 2022; 33:1097-1108. [PMID: 35022812 DOI: 10.1007/s00198-021-06265-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Accepted: 12/06/2021] [Indexed: 12/12/2022]
Abstract
UNLABELLED Risk of fracture due to glucocorticoid-induced osteoporosis (GIO) can be reduced by anti-osteoporosis (OP) medications. The proportion of patients on long-term glucocorticoid therapy who received anti-OP medications according to the GIO management guidelines has increased in recent years, but is still suboptimal. INTRODUCTION Adherence of physicians to guidelines for glucocorticoid (GC)-induced osteoporosis (GIO) management is currently unclear. This study aimed to clarify the state of guideline adherence by physicians in Japan and identify factors associated with guideline adherence using a nationwide health insurance claims database (NDBJ). METHODS Patients aged ≥ 50 years who were prescribed GC for ≥ 90 days after 180 days without a GC prescription and who were followed up for osteoporosis (OP) management for the subsequent 360 days during the period spanning 2012-2018 were selected from the NDBJ. Guideline adherence was evaluated with the proportion of patients who received OP management as recommended by the Japanese guidelines. Information on previous vertebral and hip fractures, dementia, and polypharmacy was obtained. Factors associated with OP management were evaluated by logistic regression analysis. RESULTS A total of 512,296 patients were considered to be at high risk of fracture according to the guidelines. Proportions of patients receiving OP management (BMD testing or anti-OP medications) have increased in recent years. In 2017, 33.7% of men and 55.3% of women received OP management in the initial 90 days of GC therapy. Female sex, previous anti-OP medications, polypharmacy, and higher GC dose were significantly associated with receiving OP management, while dementia showed an inverse association. A prior history of hip fracture, a strong risk factor for future fracture, was not significantly associated with receiving OP management. CONCLUSIONS Although guideline adherence by physicians has increased in recent years, it remains suboptimal. Further efforts to improve guideline adherence are necessary. TRIAL REGISTRATION NUMBER The present study is not registered.
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Affiliation(s)
- M Iki
- Department of Public Health, Kindai University Faculty of Medicine, 377-2 Oono-higashi, Osaka, 589-8511, Osaka-Sayama, Japan.
- National Database Japan-Osteoporosis Management (NDBJ-OS) Study Group, Department of Public Health, Kindai University Faculty of Medicine, 377-2 Oono-higashi, Osaka, 589-8511, Osaka-Sayama, Japan.
| | - K Fujimori
- National Database Japan-Osteoporosis Management (NDBJ-OS) Study Group, Department of Public Health, Kindai University Faculty of Medicine, 377-2 Oono-higashi, Osaka, 589-8511, Osaka-Sayama, Japan
- Department of Health Administration and Policy, Tohoku University School of Medicine, 2-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8575, Japan
| | - S Nakatoh
- National Database Japan-Osteoporosis Management (NDBJ-OS) Study Group, Department of Public Health, Kindai University Faculty of Medicine, 377-2 Oono-higashi, Osaka, 589-8511, Osaka-Sayama, Japan
- Department of Orthopedic Surgery, Asahi General Hospital, 477 Tomari, Asaimachi, Shimo-Nikawa-gun, Toyama, 939-0798, Japan
| | - J Tamaki
- National Database Japan-Osteoporosis Management (NDBJ-OS) Study Group, Department of Public Health, Kindai University Faculty of Medicine, 377-2 Oono-higashi, Osaka, 589-8511, Osaka-Sayama, Japan
- Department of Hygiene and Public Health, Osaka Medical and Pharmaceutical University, 2-7 Daigakumachi, Takatsuki, Osaka, 569-8686, Japan
| | - S Ishii
- National Database Japan-Osteoporosis Management (NDBJ-OS) Study Group, Department of Public Health, Kindai University Faculty of Medicine, 377-2 Oono-higashi, Osaka, 589-8511, Osaka-Sayama, Japan
- Department of Regulatory Science, School of Pharmacy, Tokyo University of Pharmacy and Life Sciences, 1432-1 Horinouchi, Hachiouji, Tokyo, 193-0392, Japan
| | - N Okimoto
- National Database Japan-Osteoporosis Management (NDBJ-OS) Study Group, Department of Public Health, Kindai University Faculty of Medicine, 377-2 Oono-higashi, Osaka, 589-8511, Osaka-Sayama, Japan
- Okimoto Clinic, 185-4 Kubi, Yutaka-machi, Kure, Hiroshima, 734-0304, Japan
| | - K Kamiya
- National Database Japan-Osteoporosis Management (NDBJ-OS) Study Group, Department of Public Health, Kindai University Faculty of Medicine, 377-2 Oono-higashi, Osaka, 589-8511, Osaka-Sayama, Japan
- Department of Hygiene and Public Health, Osaka Medical and Pharmaceutical University, 2-7 Daigakumachi, Takatsuki, Osaka, 569-8686, Japan
| | - S Ogawa
- National Database Japan-Osteoporosis Management (NDBJ-OS) Study Group, Department of Public Health, Kindai University Faculty of Medicine, 377-2 Oono-higashi, Osaka, 589-8511, Osaka-Sayama, Japan
- Department of Geriatric Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8511, Japan
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Zipprich HM, Mendorf S, Schönenberg A, Prell T. The impact of poor medication knowledge on health-related quality of life in people with Parkinson's disease: a mediation analysis. Qual Life Res 2022; 31:1473-1482. [PMID: 34797508 PMCID: PMC9023397 DOI: 10.1007/s11136-021-03024-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/18/2021] [Indexed: 01/01/2023]
Abstract
PURPOSE This study aimed to determine how limited medication knowledge as one aspect of health literacy contributes to poorer health-related quality of life (HRQoL) in people with Parkinson's disease (PD). METHODS Demographical data, PD-specific data (MDS-Unified Parkinson's Disease-Rating Scale, Nonmotor symptom scale), and data about depressive symptoms (Beck's depression inventory), cognition (Montreal cognitive assessment), HRQoL (Short-Form Health Questionnaire-36, SF-36), and medication knowledge (names, time of taking, indication, dosage) were assessed in 193 patients with PD. Multivariate analysis of variance (MANOVA), multivariate analysis of covariance, and mediation analyses were used to study the relationship between medication knowledge and HRQoL in combination with different mediators and covariates. RESULTS Overall, 43.5% patients showed deficits in at least one of the 4 knowledge items, which was associated with higher age, number of medications per day and depression level, and poorer cognitive function, motor function, and lower education level. Using one-way MANOVA, we identified that medication knowledge significantly impacts physical functioning, social functioning, role limitations due to physical problems, and role limitations due to emotional problems. Mediation models using age, education level, and gender as covariates showed that the relationship between knowledge and SF-36 domains was fully mediated by Beck's Depression Inventory but not by Montreal Cognitive Assessment. CONCLUSIONS Patients who expressed unawareness of their medication did not necessarily have cognitive deficits; however, depressive symptoms may instead be present. This concomitant depressive symptomatology is crucial in explaining the contribution of nonadherence and decreased medication knowledge to poor quality of life.
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Affiliation(s)
- Hannah M Zipprich
- Department of Neurology, Jena University Hospital, Am Klinikum 1, 07747, Jena, Germany.
| | - Sarah Mendorf
- Department of Neurology, Jena University Hospital, Am Klinikum 1, 07747, Jena, Germany.
| | - Aline Schönenberg
- Department of Neurology, Jena University Hospital, Am Klinikum 1, 07747, Jena, Germany
| | - Tino Prell
- Department of Neurology, Jena University Hospital, Am Klinikum 1, 07747, Jena, Germany
- Center for Healthy Ageing, Jena University Hospital, Jena, Germany
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Kleinke F, Michalowsky B, Rädke A, Platen M, Mühlichen F, Scharf A, Mohr W, Penndorf P, Bahls T, van den Berg N, Hoffmann W. Advanced nursing practice and interprofessional dementia care (InDePendent): study protocol for a multi-center, cluster-randomized, controlled, interventional trial. Trials 2022; 23:290. [PMID: 35410437 PMCID: PMC8996202 DOI: 10.1186/s13063-022-06249-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Accepted: 03/28/2022] [Indexed: 11/16/2022] Open
Abstract
Background A redistribution of tasks between specialized nurses and primary care physicians, i.e., models of advanced nursing practice, has the potential to improve the treatment and care of the growing number of people with dementia (PwD). Especially in rural areas with limited access to primary care physicians and specialists, these models might improve PwD’s quality of life and well-being. However, such care models are not available in Germany in regular healthcare. This study examines the acceptance, safety, efficacy, and health economic efficiency of an advanced nursing practice model for PwD in the primary care setting in Germany. Methods InDePendent is a two-arm, multi-center, cluster-randomized controlled intervention study. Inclusion criteria are age ≥70 years, cognitively impaired (DemTect ≤8) or formally diagnosed with dementia, and living in the own home. Patients will be recruited by general practitioners or specialists. Randomization is carried out at the physicians’ level in a ratio of 1:2 (intervention vs. waiting-control group). After study inclusion, all participants will receive a baseline assessment and a follow-up assessment after 6 months. Patients of the intervention group will receive advanced dementia care management for 6 months, carried out by specialized nurses, who will conduct certain tasks, usually carried out by primary care physicians. This includes a standardized assessment of the patients’ unmet needs, the generation and implementation of an individualized care plan to address the patients’ needs in close coordination with the GP. PwD in the waiting-control group will receive routine care for 6 months and subsequently become part of the intervention group. The primary outcome is the number of unmet needs after 6 months measured by the Camberwell Assessment of Need for the Elderly (CANE). The primary analysis after 6 months is carried out using multilevel models and will be based on the intention-to-treat principle. Secondary outcomes are quality of life, caregiver burden, acceptance, and cost-effectiveness. In total, n=465 participants are needed to assess significant differences in the number of unmet needs between the intervention and control groups. Discussion The study will provide evidence about the acceptance, efficacy, and cost-effectiveness of an innovative interprofessional concept based on advanced nursing care. Results will contribute to the implementation of such models in the German healthcare system. The goal is to improve the current treatment and care situation for PwD and their caregivers and to expand nursing roles. Trial registration ClinicalTrials.gov NCT04741932. Registered on 2 February 2021.
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Levit LA, Arora S, Kluetz PG, Magnuson A, Rahman A, Harvey RD. Call to Action for Improving Oral Anticancer Agent Adherence. J Clin Oncol 2022; 40:1036-1040. [PMID: 34990218 DOI: 10.1200/jco.21.02529] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Affiliation(s)
- Laura A Levit
- American Society of Clinical Oncology, Alexandria, VA
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Lau CYE, Wojt I, Jeon YH, Hilmer SN, Tan ECK. Prevalence and Risk Factors for Drug-Related Problems in People With Dementia Living in the Community: A Systematic Review and Meta-Analysis. J Am Med Dir Assoc 2022; 23:980-991.e10. [PMID: 35276086 DOI: 10.1016/j.jamda.2022.01.083] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 01/18/2022] [Accepted: 01/29/2022] [Indexed: 10/18/2022]
Abstract
OBJECTIVES The aims of this systematic review were to identify the prevalence and risk factors associated with of drug-related problems (DRPs) in people living with dementia in the community. DESIGN A systematic review and meta-analysis. SETTING AND PARTICIPANTS People with dementia living in the community. METHODS Six databases (Embase, Medline, PsycINFO, International Pharmaceutical Abstracts, Scopus, and CINAHL) were searched using a combination of keywords and Medical Subject Heading (MeSH) terms with 4 concepts: dementia, older adults, DRPs, and community-dwelling. Primary outcomes were adverse drug reactions (ADRs), adverse drug events (ADEs), and medication errors (MEs). RESULTS There were 22 studies included: 4 cross-sectional studies and 18 cohort studies. The number of participants in these studies ranged from 81 to 21,795. The pooled prevalence for any ADEs, including ADRs, in people living with dementia was 19.0% (95% CI 11.6%-27.7%), whereas the pooled prevalence for specific types of ADEs ranged from 2.6% to 10.2%. Furthermore, the prevalence of MEs ranged from 0.9% to 41.3%. Psychotropic medications, polypharmacy, and inappropriate medications contributed to an increased risk of experiencing DRPs, whereas support with medication management was a protective factor. CONCLUSIONS AND IMPLICATIONS The prevalence of overall DRPs experienced by people with dementia was highly variable in included studies. Awareness that certain medication, patient, and medication management factors are associated with the risk of people with dementia experiencing DRPs may guide clinicians to identify high-risk situations and implement suitable mitigation strategies.
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Affiliation(s)
- Chun Y E Lau
- The University of Sydney, Faculty of Medicine and Health, Sydney, New South Wales, Australia
| | - Ilsa Wojt
- The University of Sydney, Faculty of Medicine and Health, Sydney, New South Wales, Australia
| | - Yun-Hee Jeon
- The University of Sydney, Faculty of Medicine and Health, Sydney, New South Wales, Australia
| | - Sarah N Hilmer
- The University of Sydney, Faculty of Medicine and Health, Sydney, New South Wales, Australia; Kolling Institute, Royal North Shore Hospital, St Leonards, New South Wales, Australia
| | - Edwin C K Tan
- The University of Sydney, Faculty of Medicine and Health, Sydney, New South Wales, Australia; Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, Victoria, Australia.
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Araújo N, Costa A, Lopes C, Lopes-Conceição L, Ferreira A, Carneiro F, Oliveira J, Morais S, Pacheco-Figueiredo L, Ruano L, Tedim Cruz V, Pereira S, Lunet N. Prevalence of Cognitive Impairment before Prostate Cancer Treatment. Cancers (Basel) 2022; 14:cancers14051355. [PMID: 35267663 PMCID: PMC8909497 DOI: 10.3390/cancers14051355] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 02/17/2022] [Accepted: 03/03/2022] [Indexed: 11/16/2022] Open
Abstract
Cognitive impairment is common among patients with different types of cancer, even before cancer treatment, but no data were reported among patients with prostate cancer (PCa), who may be at high risk due to advanced age. This study aims to estimate the prevalence of cognitive impairment before PCa treatment. Between February 2018 and April 2021, the NEON-PC cohort recruited 605 patients with PCa proposed for treatment at the Portuguese Institute of Oncology of Porto. The Montreal Cognitive Assessment (MoCA) was used to assess cognitive performance. Participants with a MoCA < 1.5 standard deviations (SD) of age- and education-specific normative values were considered to have probable cognitive impairment (PCI) and were referred for a comprehensive neuropsychological assessment. Data from the population-based cohort EPIPorto (n = 351 men aged ≥40 years, evaluated in 2013−2015) were used for comparison. The prevalence of PCI was 17.4% in EPIPorto and 14.7% in NEON-PC (age- and education-adjusted odds ratio: 0.82, 95%CI: 0.58,1.18). Neuropsychological assessment was performed in 63 patients with PCa: 54.0% had cognitive impairment. These results suggest that the impact of PCa on cognitive performance could be negligible in the short term, contrary to what other studies have reported regarding other types of cancer.
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Affiliation(s)
- Natália Araújo
- EPIUnit-Instituto de Saúde Pública, Universidade do Porto, Rua das Taipas 135, 4050-600 Porto, Portugal; (N.A.); (A.C.); (C.L.); (L.L.-C.); (S.M.); (L.R.); (V.T.C.); (S.P.)
- Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Rua das Taipas 135, 4050-600 Porto, Portugal
| | - Adriana Costa
- EPIUnit-Instituto de Saúde Pública, Universidade do Porto, Rua das Taipas 135, 4050-600 Porto, Portugal; (N.A.); (A.C.); (C.L.); (L.L.-C.); (S.M.); (L.R.); (V.T.C.); (S.P.)
- Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Rua das Taipas 135, 4050-600 Porto, Portugal
| | - Catarina Lopes
- EPIUnit-Instituto de Saúde Pública, Universidade do Porto, Rua das Taipas 135, 4050-600 Porto, Portugal; (N.A.); (A.C.); (C.L.); (L.L.-C.); (S.M.); (L.R.); (V.T.C.); (S.P.)
- Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Rua das Taipas 135, 4050-600 Porto, Portugal
| | - Luisa Lopes-Conceição
- EPIUnit-Instituto de Saúde Pública, Universidade do Porto, Rua das Taipas 135, 4050-600 Porto, Portugal; (N.A.); (A.C.); (C.L.); (L.L.-C.); (S.M.); (L.R.); (V.T.C.); (S.P.)
| | - Augusto Ferreira
- Instituto Português de Oncologia do Porto, Rua Dr. António Bernardino de Almeida, 4200-072 Porto, Portugal; (A.F.); (F.C.); (J.O.)
| | - Filipa Carneiro
- Instituto Português de Oncologia do Porto, Rua Dr. António Bernardino de Almeida, 4200-072 Porto, Portugal; (A.F.); (F.C.); (J.O.)
| | - Jorge Oliveira
- Instituto Português de Oncologia do Porto, Rua Dr. António Bernardino de Almeida, 4200-072 Porto, Portugal; (A.F.); (F.C.); (J.O.)
| | - Samantha Morais
- EPIUnit-Instituto de Saúde Pública, Universidade do Porto, Rua das Taipas 135, 4050-600 Porto, Portugal; (N.A.); (A.C.); (C.L.); (L.L.-C.); (S.M.); (L.R.); (V.T.C.); (S.P.)
- Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Rua das Taipas 135, 4050-600 Porto, Portugal
| | - Luís Pacheco-Figueiredo
- Instituto de Investigação em Ciências da Vida e Saúde, Escola de Medicina da Universidade do Minho, 4710-057 Braga, Portugal;
| | - Luis Ruano
- EPIUnit-Instituto de Saúde Pública, Universidade do Porto, Rua das Taipas 135, 4050-600 Porto, Portugal; (N.A.); (A.C.); (C.L.); (L.L.-C.); (S.M.); (L.R.); (V.T.C.); (S.P.)
- Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Rua das Taipas 135, 4050-600 Porto, Portugal
| | - Vítor Tedim Cruz
- EPIUnit-Instituto de Saúde Pública, Universidade do Porto, Rua das Taipas 135, 4050-600 Porto, Portugal; (N.A.); (A.C.); (C.L.); (L.L.-C.); (S.M.); (L.R.); (V.T.C.); (S.P.)
- Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Rua das Taipas 135, 4050-600 Porto, Portugal
| | - Susana Pereira
- EPIUnit-Instituto de Saúde Pública, Universidade do Porto, Rua das Taipas 135, 4050-600 Porto, Portugal; (N.A.); (A.C.); (C.L.); (L.L.-C.); (S.M.); (L.R.); (V.T.C.); (S.P.)
- Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Rua das Taipas 135, 4050-600 Porto, Portugal
- Instituto Português de Oncologia do Porto, Rua Dr. António Bernardino de Almeida, 4200-072 Porto, Portugal; (A.F.); (F.C.); (J.O.)
| | - Nuno Lunet
- EPIUnit-Instituto de Saúde Pública, Universidade do Porto, Rua das Taipas 135, 4050-600 Porto, Portugal; (N.A.); (A.C.); (C.L.); (L.L.-C.); (S.M.); (L.R.); (V.T.C.); (S.P.)
- Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Rua das Taipas 135, 4050-600 Porto, Portugal
- Departamento de Ciências da Saúde Pública e Forenses e Educação Médica, Faculdade de Medicina da Universidade do Porto, Alameda Professor Hernâni Monteiro, 4200-319 Porto, Portugal
- Correspondence: ; Tel.: +351-225-513-652
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Becker JH, Feldman JM, Arora A, Busse PJ, Wisnivesky JP, Federman AD. Cognition, symptom perception, and medication non-adherence in older adults with asthma. J Asthma 2022; 59:607-615. [PMID: 33249956 PMCID: PMC8180526 DOI: 10.1080/02770903.2020.1856867] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND Cognitive impairment (CI) is highly prevalent in elderly asthmatics and is associated with worse asthma self-management (SM) and outcomes. CI may also explain why older adults may under-perceive asthma symptoms. We hypothesized that CI would be associated with low medication adherence and asthma symptom under-perception (ASP). We also hypothesized that ASP would mediate the relationship between CI and medication adherence. METHODS Participants of this longitudinal cohort study were asthmatics (N = 334) ≥60 years (51% Hispanic, 25% Black). Cognitive measures assessed general cognition, attention, processing speed, executive functioning, memory, and language. Measures of SM were self-reported and electronically measured adherence to controller medications. ASP was assessed for 6 weeks by participants entering estimates of peak expiratory flow (PEF) into a programmable peak flow meter, followed by PEF blows. Participants were blinded to actual PEF values. Percentage of time that participants were in the over-perception zone was calculated as an average. RESULTS In regression analyses, those with impairments in memory and general cognition had lower odds ratios (OR) for self-reported non-adherence (OR: 0.96, 95% CI 0.93 - 0.98 & OR: 0.90, 95% CI 0.83 - 0.96, respectively). CI was not associated with electronically measured non-adherence or ASP. In structural equation modeling, while CI was associated with adherence (β = 0.04, SE = 0.021, p = 0.04), ASP did not mediate this relationship. CONCLUSIONS While results confirmed the importance of cognition in asthma SM, these findings were not linked to ASP. Future analyses are needed to understand the role of confounding factors.
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Affiliation(s)
- Jacqueline H. Becker
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Jonathan M. Feldman
- Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, NY, USA;,Department of Pediatrics, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Arushi Arora
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Paula J. Busse
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Juan P. Wisnivesky
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Alex D. Federman
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA;,Division of Pulmonary, Critical Care and Sleep Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Ashtarieh B, Grabkowski M, Bartfay E, Sun W. Examining the barriers of influenza vaccine hesitancy in persons with dementia: a literature review. Aging Clin Exp Res 2022; 34:309-324. [PMID: 34319511 PMCID: PMC8316106 DOI: 10.1007/s40520-021-01936-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 07/09/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND/AIMS Despite the proven benefits of vaccine prevention and the continuous development of this important public health measure, vaccine hesitancy is among the top ten threats to global health according to the World Health Organization in 2019. Those who contract the influenza virus will typically develop a mild illness. However, for populations at a higher risk, including those diagnosed with dementia, influenza is proven to be more detrimental. Persons with dementia (PWD) face a serious threat to influenza on an annual basis, and vaccine hesitancy may further potentiate this risk. The purpose of this paper is to explore and understand the barriers PWD face in receiving the influenza vaccine. METHODS A literature review was conducted to examine the barriers that prevent PWD from seeking out the annual influenza vaccine. A thematic analysis provided an understanding of the overarching relationships found among the influences between the identified themes. RESULTS Three main influences were identified: (1) intra-personal, (2) inter-personal, and (3) extra-personal, with each influence containing several subsequent sub-themes. DISCUSSION/CONCLUSION The literature review found that there is a lack of research involving this high-risk population and the barriers they face, especially within the extra-personal influences. Further research is required to understand how each barrier relates and connects with each other. Understanding this connection will aid public health organizations in decreasing the threat of vaccine hesitancy, thus decreasing the incidents of preventable deaths.
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Affiliation(s)
- Bahar Ashtarieh
- Faculty of Health Sciences, Ontario Tech University, 2000 Simcoe Street North, Oshawa, ON, L1G 0C5, Canada
| | - Magda Grabkowski
- Faculty of Health Sciences, Ontario Tech University, 2000 Simcoe Street North, Oshawa, ON, L1G 0C5, Canada
| | - Emma Bartfay
- Faculty of Health Sciences, Ontario Tech University, 2000 Simcoe Street North, Oshawa, ON, L1G 0C5, Canada
| | - Winnie Sun
- Faculty of Health Sciences, Ontario Tech University, 2000 Simcoe Street North, Oshawa, ON, L1G 0C5, Canada.
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Lim RHM, Sharmeen T, Donyai P. How do people with dementia make sense of their medications? An Interpretative Phenomenological Analysis study. Int J Geriatr Psychiatry 2022; 37. [PMID: 35020232 DOI: 10.1002/gps.5673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 12/21/2021] [Indexed: 11/06/2022]
Abstract
BACKGROUND Managing medication is complex and multifaceted for people with dementia and their family carers. Despite efforts to support medication management, medication errors and medication-related hospital admissions still occur. This study investigated how people with dementia viewed and talked about their different medications and their medication taking. METHODS An interpretative phenomenological analysis (IPA) qualitative research design combining photo elicitation and in-depth interviews was used. People with a diagnosis of mild or moderate dementia took photographs of anything they viewed to be related to medication, with or without the help of family carers, over any two-day period. The photographs were then used as cues for subsequent in-depth interviews, which were analysed using IPA. RESULTS Twelve people with dementia were interviewed. Four themes encapsulated the experiences: (1) Medication as a lifeline, (2) Managing medications dominates daily lives and plans, (3) Struggling with uncertainty about the effectiveness of dementia medication and (4) Sense of 'being' and being in control. People with dementia viewed medication as a lifeline, especially donepezil, giving it preference over other daily medication they were using. Managing medications dominated the daily lives and plans of people with dementia and changed the way they viewed themselves and their life. People with dementia continually struggled with the imperceptible benefits of donepezil on their dementia, but despite such uncertainties, continued to take donepezil. CONCLUSIONS This study provided unique insights into how people with dementia made sense of their medication. Healthcare professionals can use these insights to shape their practice around medication prescribing and advice in dementia. The findings are also useful to researchers looking to develop interventions to support medication management within the home setting.
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Affiliation(s)
- Rosemary H M Lim
- Reading School of Pharmacy, University of Reading, Reading, Berkshire, UK
| | - Taniya Sharmeen
- Reading School of Pharmacy, University of Reading, Reading, Berkshire, UK
| | - Parastou Donyai
- Reading School of Pharmacy, University of Reading, Reading, Berkshire, UK
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Vasenina E, Veryugina N, Levin O. Capabilities of combined therapy of Alzheimer’s disease. Zh Nevrol Psikhiatr Im S S Korsakova 2022; 122:45-50. [DOI: 10.17116/jnevro202212211245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Forgerini M, Lucchetta RC, Oliveira FM, Herdeiro MT, Capela MV, Mastroianni PDC. Impact of pharmacist intervention in patients with Alzheimer's disease. BRAZ J PHARM SCI 2022. [DOI: 10.1590/s2175-97902022e19876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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OUP accepted manuscript. Arch Clin Neuropsychol 2022; 37:1091-1102. [DOI: 10.1093/arclin/acac015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/21/2022] [Indexed: 11/13/2022] Open
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Castillo AF, Davis AL, Fischhoff B, Krishnamurti T. Digital medicines for adherence support: A conceptual framework and qualitative study of adherence among chronically ill patients. Health Informatics J 2021; 27:14604582211059463. [PMID: 34825829 DOI: 10.1177/14604582211059463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Digital medicine programs (DMPs) are emerging technologies that use sensor-enabled medicine to detect when patients have taken their medication and then provide feedback about adherence. We use qualitative methods to understand how patients change their behavioral patterns while participating in a DMP intervention. An influence diagram outlining the factors hypothesized to affect adherence in DMPs constructed from prior scientific research and expert input was created. Subsequently, we conducted semi-structured interviews with 10 patients to see if their experience supported the relationships outlined in the model. We identified three pathways by which DMPs are likely to change behavior around medication adherence: (1) providing patients and providers with accurate, personalized information about adherence; (2) improving patient-provider interactions by structuring them around this information; and (3) facilitating routines and habits for medication use. Chronically ill patients often fail to adhere to drug regimens. Patients in a DMP intervention used the DMP-provided information to better understand drug efficacy and collaborated with their physician to develop adherence strategies. DMPs can promote medication adherence among patients who are willing to use them and may be most effective if physicians are active partners in the DMP.
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Affiliation(s)
| | - Alexander L Davis
- Department of Engineering and Public Policy, 6612Carnegie Mellon University, Pittsburgh, PA, USA
| | - Baruch Fischhoff
- Department of Engineering and Public Policy, 6612Carnegie Mellon University, Pittsburgh, PA, USA
| | - Tamar Krishnamurti
- Division of General Internal Medicine, 6614University of Pittsburgh, Pittsburgh, PA, USA
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Factors related to self-care drug treatment and medication adherence of elderly people in Japan. PUBLIC HEALTH IN PRACTICE 2021; 2:100106. [PMID: 36101625 PMCID: PMC9461522 DOI: 10.1016/j.puhip.2021.100106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Revised: 03/01/2021] [Accepted: 03/12/2021] [Indexed: 11/21/2022] Open
Abstract
Objectives Study design Methods Results Conclusions Medication adherence was significantly positively associated with health literacy. Good communication with doctors was closely related to medication adherence. Promoting health literacy and communication when supporting self-care drug treatment for elderly people.
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