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Moon A, Jang S, Kim JH, Jang S. Risk of falls or fall-related injuries associated with potentially inappropriate medication use among older adults with dementia. BMC Geriatr 2024; 24:699. [PMID: 39179955 PMCID: PMC11342481 DOI: 10.1186/s12877-024-05300-x] [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: 10/25/2023] [Accepted: 08/13/2024] [Indexed: 08/26/2024] Open
Abstract
BACKGROUND Potentially inappropriate medications (PIMs) are prevalent in older adults with dementia and subsequent falls or fall-related injuries. The present study determined the risk of falls or fall-related injuries associated with PIM use in older adults with dementia. METHODS The National Health Insurance Service-Elderly Cohort Database 2.0 (NHIS-ECDB 2.0) was used for this self-controlled case series (SCCS) study. This study included 1430 participants who went through exposure and non-exposure periods of PIM application among patients with dementia and experienced outcome events of falls or fall-related injuries between January 2016 and December 2019. The incidence of falls or fall-related injuries during the exposure and post-exposure periods was compared with that during the non-exposure period. Beers Criteria were used to define PIMs in patients with dementia. Negative binomial regression was conducted. The incidence rate ratio (IRR) was used to determine the risk of falls or fall-related injuries. RESULTS During the exposure periods in which falls or fall-related injuries occurred, the mean number of PIMs among patients with dementia was 3.76 (SD = 2.99), and the most commonly used PIMs among patients with dementia were first-generation antihistamines (n = 283; 59.1%). Compared to the non-exposure period, the adjusted IRR during the exposure period was 1.57 (95% CI = 1.39-1.76). The risk of falls or fall-related injuries was increased when PIM use in patients with dementia was initiated (1-14 days: IRR = 2.76, 95% CI = 2.31-3.28; 15-28 days: IRR = 1.95, 95% CI = 1.48-2.56; ≥ 29 days: IRR = 1.17, 95% CI = 1.01-1.35). Especially, an increased risk of falls or fall-related injuries was associated with greater PIM use among patients with dementia. CONCLUSION Among older adults with dementia, PIMs significantly increase the risk of falls and fall-related injuries. Therefore, strategies should be developed to manage PIM prescriptions in patients with dementia to prevent falls.
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Affiliation(s)
- Arum Moon
- College of Pharmacy, Gachon University, 191 Hambakmoe‑Ro, Yeonsu‑Gu, Incheon, 21936, Republic of Korea
- Gachon Institute of Pharmaceutical Sciences, Incheon, Republic of Korea
| | - Suhyun Jang
- College of Pharmacy, Gachon University, 191 Hambakmoe‑Ro, Yeonsu‑Gu, Incheon, 21936, Republic of Korea
- Gachon Institute of Pharmaceutical Sciences, Incheon, Republic of Korea
| | - Jung-Ha Kim
- Department of Family Medicine, Chung-Ang University Medical Center, College of Medicine, Chung-Ang University, Seoul, Republic of Korea
| | - Sunmee Jang
- College of Pharmacy, Gachon University, 191 Hambakmoe‑Ro, Yeonsu‑Gu, Incheon, 21936, Republic of Korea.
- Gachon Institute of Pharmaceutical Sciences, Incheon, Republic of Korea.
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Pan S, Li S, Jiang S, Shin JI, Liu GG, Wu H, Lyu B. Trends in Number and Appropriateness of Prescription Medication Utilization Among Community-Dwelling Older Adults in the United States: 2011-2020. J Gerontol A Biol Sci Med Sci 2024; 79:glae108. [PMID: 38644631 DOI: 10.1093/gerona/glae108] [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: 11/23/2023] [Indexed: 04/23/2024] Open
Abstract
BACKGROUND Contemporary data on the quantity and quality of medication use among older adults are lacking. This study examined recent trends in the number and appropriateness of prescription medication use among older adults in the United States. METHODS Data from the National Health and Nutrition Examination Survey (NHANES) between 2011 and March 2020 were used, and 6 336 adult participants aged 65 and older were included. We examined the number of prescription medication, prevalence of polypharmacy (≥5 prescription drugs), use of potentially inappropriate medication (PIM), and use of recommended medications (angiotensin-converting enzyme inhibitor [ACEI]/angiotensin receptor blockers [ARBs] plus beta-blockers among patients with heart failure and ACEI/ARBs among patients with albuminuria). RESULTS There has been a slight increase in the prevalence of polypharmacy (39.3% in 2011-2012 to 43.8% in 2017-2020, p for trend = .32). Antihypertensive, antihyperlipidemic, antidiabetic medications, and antidepressants are the most commonly used medications. There was no substantial change in the use of PIM (17.0% to 14.7%). Less than 50% of older adults with heart failure received ACEI/ARBs plus beta-blockers (44.3% in 2017-2020) and approximately 50% of patients with albuminuria received ACEI/ARBs (54.0% in 2017-2020), with no improvement over the study period. Polypharmacy, older age, female, and lower socioeconomic status were generally associated with greater use of PIM but lower use of recommended medications. CONCLUSIONS The medication burden remained high among older adults in the United States and the appropriate utilization of medications did not improve in the recent decade. Our results underscore the need for greater attentions and interventions to the quality of medication use among older adults.
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Affiliation(s)
- Shaoxi Pan
- School of Public Health, The Key Laboratory of Environmental Pollution Monitoring and Disease Control, Ministry of Education, Guizhou Medical University, Guiyang 561113, China
- China Center for Health Economic Research, Peking University, Beijing, China
| | - Shanshan Li
- China Center for Health Economic Research, Peking University, Beijing, China
- Institute for Global Health and Development, Peking University, Beijing, China
| | - Shaoxiang Jiang
- Institute for Global Health and Development, Peking University, Beijing, China
| | - Jung-Im Shin
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, Maryland, USA
| | - Gordon G Liu
- Institute for Global Health and Development, Peking University, Beijing, China
- National School of Development, Peking University, Beijing, China
| | - Hongyan Wu
- School of Public Health, The Key Laboratory of Environmental Pollution Monitoring and Disease Control, Ministry of Education, Guizhou Medical University, Guiyang 561113, China
| | - Beini Lyu
- Institute for Global Health and Development, Peking University, Beijing, China
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3
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Yang PJ, Chen CC, Chen SC. Impact of potentially inappropriate medications on the risk of hospital admissions and emergency department visits in patients with dementia. QJM 2024; 117:473-474. [PMID: 38305471 DOI: 10.1093/qjmed/hcae022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2024] [Indexed: 02/03/2024] Open
Affiliation(s)
- Po-Jen Yang
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan
- School of Medicine, Chung Shan Medical University, Taichung, Taiwan
- Department of Family and Community Medicine, Chung Shan Medical University Hospital, Taichung, Taiwan
- Department of Geriatric Medicine, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Chun-Chieh Chen
- School of Medicine, Chung Shan Medical University, Taichung, Taiwan
- Department of Family and Community Medicine, Chung Shan Medical University Hospital, Taichung, Taiwan
- Department of Occupational Medicine, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Shiuan-Chih Chen
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan
- School of Medicine, Chung Shan Medical University, Taichung, Taiwan
- Department of Family and Community Medicine, Chung Shan Medical University Hospital, Taichung, Taiwan
- Department of Occupational Medicine, Chung Shan Medical University Hospital, Taichung, Taiwan
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Podesser F, Weninger J, Weiss EM, Marksteiner J, Canazei M. Short-Term Medication Effect on Fall Risk in Multimorbid Inpatients with Dementia. Gerontology 2024; 70:620-629. [PMID: 38626732 DOI: 10.1159/000538074] [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: 07/12/2023] [Accepted: 02/25/2024] [Indexed: 04/18/2024] Open
Abstract
INTRODUCTION Dementia increases the risk of falls and fall-related injuries, which may be caused by inappropriate medication use. To date, there is little evidence on which medications are more likely to cause falls. We therefore investigated the effects of medication use and medication changes 48 h before falls in hospitalised patients with dementia. METHODS This matched case-control study included 74 patients with a mean age of 83 years (38% women) who had been hospitalised for at least 7 days. Information on medications, diagnoses, disease severity, use of walking aids, falls, and demographics was collected from electronic medical records. The effects of the number of medications and psychotropics, equivalent daily doses of antidepressants, antipsychotics and benzodiazepines, anticholinergic burden, medication initiation, dose change, medication discontinuation, as-needed medications, opioid use and the presence of fall-increasing diseases were examined separately for the periods 0 h-24 h and 24 h-48 h before the falls using binomial logistic regression analyses. RESULTS Falls increased significantly with higher daily antipsychotic doses 24 h before the fall. In addition, the rate of falls increased with higher anticholinergic burden and prevalence of medication discontinuation 24-48 h before the fall. Notably, the total number of medications and psychotropic medications had no effect on the incidence of falls. CONCLUSION With regard to the short-term effects of medication on fall risk, particular attention should be paid to the daily dose of antipsychotics, anticholinergic burden and medication discontinuation. Further studies with larger samples are needed to confirm the results of this study.
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Affiliation(s)
| | - Johannes Weninger
- Research and Development Department, Bartenbach GmbH, Aldrans, Austria
| | - Elisabeth M Weiss
- Department of Psychology, University of Innsbruck, Innsbruck, Austria
| | - Josef Marksteiner
- Department of Psychiatry and Psychotherapy A, Hall State Hospital, Hall in Tyrol, Austria
| | - Markus Canazei
- Department of Psychology, University of Innsbruck, Innsbruck, Austria
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Sawan MJ, Clough A, Hillen J, Soulsby N, Gnjidic D. Comparison of polypharmacy and potentially inappropriate medication use in older adults with and without dementia receiving residential medication management reviews. Australas J Ageing 2024. [PMID: 38581686 DOI: 10.1111/ajag.13316] [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: 06/29/2023] [Revised: 12/19/2023] [Accepted: 03/15/2024] [Indexed: 04/08/2024]
Abstract
OBJECTIVES Among residents who had a residential medication management review (RMMR), there is a lack of studies assessing exposure to polypharmacy and potentially inappropriate medications (PIMs) in people with dementia. This study compared the exposure to polypharmacy and PIMs in residents with dementia and without dementia receiving RMMR. METHODS A retrospective analysis was performed using data of 16,261 residents living in 343 Australian residential aged care facilities who had an RMMR in 2019. Medication use was assessed as polypharmacy (defined as ≥9 medications) and use of ≥1 PIMs using the 2019 updated Beers criteria. Dementia diagnosis was determined with ICD-10 coding from medical records. Descriptive analyses reported resident demographics and patterns of medication use. Pearson's χ2 tests and logistic regression analysis were conducted to compare medication exposure between residents with and without dementia. RESULTS Among 16,261 residents, 6781 (42%) had dementia. Residents with dementia were significantly more likely to be exposed to polypharmacy and PIMs, compared to those without dementia (74% vs. 70% and 83% vs. 73%, p < .001 respectively). Residents with dementia had 1.31 times the odds of exposure to polypharmacy (adjusted OR: 1.31, 95% CI: 1.22-1.41, p < .001) and 1.88 times the odds of being prescribed ≥1 PIMs than people without dementia (adjusted OR: 1.88, 95% CI: 1.73-2.04, p < .001). CONCLUSIONS In a study of residents receiving RMMR, polypharmacy and PIMs were highly common, and those with dementia were more likely to be exposed to inappropriate polypharmacy. There is a need for targeted deprescribing strategies to immediately address inappropriate prescribing in residents, particularly those living with dementia.
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Affiliation(s)
- Mouna J Sawan
- Faculty of Medicine and Health, Sydney Pharmacy School, The University of Sydney, Sydney, New South Wales, Australia
| | - Alexander Clough
- Faculty of Medicine and Health, Sydney Pharmacy School, The University of Sydney, Sydney, New South Wales, Australia
| | - Jodie Hillen
- University of South Australia, Adelaide, South Australia, Australia
- Ward Medication Management, Melbourne, Victoria, Australia
| | | | - Danijela Gnjidic
- Faculty of Medicine and Health, Sydney Pharmacy School, The University of Sydney, Sydney, New South Wales, Australia
- Charles Perkins Centre, The University of Sydney, Sydney, New South Wales, Australia
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Singh S, Cocoros NM, Li X, Mazor KM, Antonelli MT, Parlett L, Paullin M, Harkins TP, Zhou Y, Rochon PA, Platt R, Dashevsky I, Massino C, Saphirak C, Crawford SL, Gurwitz JH. Developing a PRogram to Educate and Sensitize Caregivers to Reduce the Inappropriate Prescription Burden in the Elderly with Alzheimer's Disease (D-PRESCRIBE-AD): Trial protocol and rationale of an open-label pragmatic, prospective randomized controlled trial. PLoS One 2024; 19:e0297562. [PMID: 38346025 PMCID: PMC10861034 DOI: 10.1371/journal.pone.0297562] [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: 10/16/2023] [Accepted: 11/02/2023] [Indexed: 02/15/2024] Open
Abstract
CONTEXT Potentially inappropriate prescribing of medications in older adults, particular those with dementia, can lead to adverse drug events including falls and fractures, worsening cognitive impairment, emergency department visits, and hospitalizations. Educational mailings from health plans to patients and their providers to encourage deprescribing conversations may represent an effective, low-cost, "light touch", approach to reducing the burden of potentially inappropriate prescription use in older adults with dementia. OBJECTIVES The objective of the Developing a PRogram to Educate and Sensitize Caregivers to Reduce the Inappropriate Prescription Burden in Elderly with Alzheimer's Disease (D-PRESCRIBE-AD) trial is to evaluate the effect of a health plan based multi-faceted educational outreach intervention to community dwelling patients with dementia who are currently prescribed sedative/hypnotics, antipsychotics, or strong anticholinergics. METHODS The D-PRESCRIBE-AD is an open-label pragmatic, prospective randomized controlled trial (RCT) comparing three arms: 1) educational mailing to both the health plan patient and their prescribing physician (patient plus physician arm, n = 4814); 2) educational mailing to prescribing physician only (physician only arm, n = 4814); and 3) usual care (n = 4814) among patients with dementia enrolled in two large United States based health plans. The primary outcome is the absence of any dispensing of the targeted potentially inappropriate prescription during the 6-month study observation period after a 3-month black out period following the mailing. Secondary outcomes include dose-reduction, polypharmacy, healthcare utilization, mortality and therapeutic switching within targeted drug classes. CONCLUSION This large pragmatic RCT will contribute to the evidence base on promoting deprescribing of potentially inappropriate medications among older adults with dementia. If successful, such light touch, inexpensive and highly scalable interventions have the potential to reduce the burden of potentially inappropriate prescribing for patients with dementia. ClinicalTrials.gov Identifier: NCT05147428.
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Affiliation(s)
- Sonal Singh
- Department of Family Medicine and Community Health, Division of Health Systems Science, Umass Chan Medical School, Worcester, Massachusetts, United States of America
| | - Noelle M. Cocoros
- Department of Population Medicine, Harvard Medical School, Harvard Pilgrim Health Care Institute, Boston, Massachusetts, United States of America
| | - Xiaojuan Li
- Department of Population Medicine, Harvard Medical School, Harvard Pilgrim Health Care Institute, Boston, Massachusetts, United States of America
| | - Kathleen M. Mazor
- Division of Health Systems Science, UMass Chan Medical School, Worcester, Massachusetts, United States of America
| | - Mary T. Antonelli
- Tan Chingfen Graduate School of Nursing, UMass Chan Medical School, Worcester, Massachusetts, United States of America
| | - Lauren Parlett
- Carelon Research, Wilmington, Delaware, United States of America
| | - Mark Paullin
- Carelon Research, Wilmington, Delaware, United States of America
| | - Thomas P. Harkins
- Humana Healthcare Research, Inc., (Humana), Louisville, Kentucky, United States of America
| | - Yunping Zhou
- Humana Healthcare Research, Inc., (Humana), Louisville, Kentucky, United States of America
| | - Paula A. Rochon
- Women’s Age Lab and Women’s College Research Institute, Women’s College Hospital, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Richard Platt
- Department of Population Medicine, Harvard Medical School, Harvard Pilgrim Health Care Institute, Boston, Massachusetts, United States of America
| | - Inna Dashevsky
- Department of Population Medicine, Harvard Medical School, Harvard Pilgrim Health Care Institute, Boston, Massachusetts, United States of America
| | - Carly Massino
- Division of Health Systems Science, UMass Chan Medical School, Worcester, Massachusetts, United States of America
| | - Cassandra Saphirak
- Division of Health Systems Science, UMass Chan Medical School, Worcester, Massachusetts, United States of America
| | - Sybil L. Crawford
- Division of Health System Science, UMass Chan Medical School, Tan Chingfen Graduate School of Nursing, Worcester, Massachusetts, United States of America
| | - Jerry H. Gurwitz
- Division of Geriatric Medicine and Division of Health Systems Science, UMass Chan Medical School, Worcester, Massachusetts, United States of America
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Kumar S, Castelino R, Rao A, Gattani S, Kumar A, Pillai A, Sehgal A, Rane P, Ramaswamy A, Dhekale R, Krishnamurthy J, Banavali S, Badwe R, Prabhash K, Noronha V, Gota V. Performance of potentially inappropriate medications assessment tools in older Indian patients with cancer. Cancer Med 2024; 13:e6797. [PMID: 38183404 PMCID: PMC10807583 DOI: 10.1002/cam4.6797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Revised: 11/14/2023] [Accepted: 11/23/2023] [Indexed: 01/08/2024] Open
Abstract
BACKGROUND Polypharmacy and potentially inappropriate medication (PIM) use are common problems in older adults. Safe prescription practices are a necessity. The tools employed for the identification of PIM sometimes do not concur with each other. METHODS A retrospective analysis of patients ≥60 years who visited the Geriatric Oncology Clinic of the Tata Memorial Hospital, Mumbai, India from 2018 to 2021 was performed. Beer's-2015, STOPP/START criteria v2, PRISCUS-2010, Fit fOR The Aged (FORTA)-2018, and the EU(7)-PIM list-2015 were the tools used to assess PIM. Every patient was assigned a standardized PIM value (SPV) for each scale, which represented the ratio of the number of PIMs identified by a given scale to the total number of medications taken. The median SPV of all five tools was considered the reference standard for each patient. Bland-Altman plots were utilized to determine agreement between each scale and the reference. Association between baseline variables and PIM use was determined using multiple logistic regression analysis. RESULTS Of the 467 patients included in this analysis, there were 372 (79.66%) males and 95 (20.34%) females with an average age of 70 ± 5.91 years. The EU(7)-PIM list was found to have the highest level of agreement given by a bias estimate of 0.010, the lowest compared to any other scale. The 95% CI of the bias was in the narrow range of -0.001 to 0.022, demonstrating the precision of the estimate. In comparison, the bias (95%) CI of Beer's criteria, STOPP/START criteria, PRISCUS list, and FORTA list were -0.039 (-0.053 to -0.025), 0.076 (0.060 to 0.092), 0.035 (0.021 to 0.049), and -0.148 (-0.165 to -0.130), respectively. Patients on polypharmacy had significantly higher PIM use compared to those without (OR = 1.47 (1.33-1.63), p = <0.001). CONCLUSIONS The EU(7)-PIM list was found to have the least bias and hence can be considered the most reliable among all other tools studied.
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Affiliation(s)
- Sharath Kumar
- Department of Clinical PharmacologyAdvanced Centre for Treatment, Research and Education in Cancer, Tata Memorial CentreNavi MumbaiIndia
| | - Renita Castelino
- Department of Clinical PharmacologyAdvanced Centre for Treatment, Research and Education in Cancer, Tata Memorial CentreNavi MumbaiIndia
| | - Abhijith Rao
- Department of Medical OncologyTata Memorial HospitalMumbaiIndia
| | - Shreya Gattani
- Department of Medical OncologyTata Memorial HospitalMumbaiIndia
| | - Anita Kumar
- Department of Medical OncologyTata Memorial HospitalMumbaiIndia
| | - Anupa Pillai
- Department of Medical OncologyTata Memorial HospitalMumbaiIndia
| | - Arshiya Sehgal
- Department of Clinical PharmacologyAdvanced Centre for Treatment, Research and Education in Cancer, Tata Memorial CentreNavi MumbaiIndia
| | - Pallavi Rane
- Department of StatisticsAdvanced Centre for Treatment, Research and Education in Cancer, Tata Memorial CentreNavi MumbaiIndia
| | - Anant Ramaswamy
- Department of Medical OncologyTata Memorial HospitalMumbaiIndia
- Homi Bhabha National InstituteMumbaiIndia
| | - Ratan Dhekale
- Department of Medical OncologyTata Memorial HospitalMumbaiIndia
| | | | - Shripad Banavali
- Department of Medical OncologyTata Memorial HospitalMumbaiIndia
- Homi Bhabha National InstituteMumbaiIndia
| | - Rajendra Badwe
- Homi Bhabha National InstituteMumbaiIndia
- Department of Surgical OncologyTata Memorial HospitalMumbaiMaharashtraIndia
| | - Kumar Prabhash
- Department of Medical OncologyTata Memorial HospitalMumbaiIndia
- Homi Bhabha National InstituteMumbaiIndia
| | - Vanita Noronha
- Department of Medical OncologyTata Memorial HospitalMumbaiIndia
- Homi Bhabha National InstituteMumbaiIndia
| | - Vikram Gota
- Department of Clinical PharmacologyAdvanced Centre for Treatment, Research and Education in Cancer, Tata Memorial CentreNavi MumbaiIndia
- Homi Bhabha National InstituteMumbaiIndia
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Trenaman SC, Quach J, Bowles SK, Kirkland S, Andrew MK. An investigation of psychoactive polypharmacy and related gender-differences in older adults with dementia: a retrospective cohort study. BMC Geriatr 2023; 23:683. [PMID: 37864154 PMCID: PMC10590009 DOI: 10.1186/s12877-023-04353-8] [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: 03/14/2023] [Accepted: 09/26/2023] [Indexed: 10/22/2023] Open
Abstract
BACKGROUND Older adults living with dementia may express challenging responsive behaviours. One management strategy is pharmacologic treatment though these options often have limited benefit, which may lead to multiple treatments being prescribed. METHODS The aim of the present study was to describe psychoactive medication polypharmacy and explore factors associated with psychoactive polypharmacy in a cohort of older adults living with dementia in Nova Scotia, Canada, including a gender-stratified analysis. This was a retrospective cohort study of those aged 65 years or older with a recorded diagnosis of dementia between 2005 and 2015. Medication dispensation data was collected from April 1, 2010, or dementia diagnosis (cohort entry) to either death or March 31, 2015 (cohort exit). Psychoactive medication claims were captured. Psychoactive medication polypharmacy was defined as presence of three or more psychoactive prescription medications dispensed to one subject and overlapping for more than 30 days. Psychoactive polypharmacy episodes were described in duration, quantity, and implicated medications. Regression analysis examined factors associated with experience and frequency of psychoactive polypharmacy. All analysis were stratified by gender. RESULTS The cohort included 15,819 adults living with dementia (mean age 80.7 years; 70.0% female), with 99.4% (n = 15,728) receiving at least one psychoactive medication over the period of follow-up. Psychoactive polypharmacy was present in 19.3% of the cohort. The gender specific logistic regressions demonstrated that for both men and women a younger age was associated with an increased risk of psychoactive polypharmacy (women: OR 0.97, 95%CI[0.96, 0.98], men: OR 0.96, 95%CI[0.95, 0.97]). Men were less likely to experience psychoactive polypharmacy if their location of residence was urban (OR 0.86, 95%CI[0.74, 0.99]). There was no significant association between location of residence (urban or rural) and psychoactive polypharmacy for women living with dementia. Antidepressants were the most dispensed medication class, while quetiapine was the most dispensed medication. CONCLUSIONS This study suggests that of adults living with dementia those of younger ages were more likely to experience psychoactive polypharmacy and that men living with dementia in rural locations may benefit from increased access to non-pharmacological options for dementia management.
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Affiliation(s)
- Shanna C Trenaman
- College of Pharmacy, Faculty of Health, Dalhousie University, 5968 College Street, PO Box 15000, B3H 4R2, Halifax, NS, Canada.
- Division of Geriatric Medicine, Department of Medicine, Dalhousie University, Halifax, Canada.
| | - Jack Quach
- Faculty of Health, Dalhousie University, Halifax, NS, Canada
| | - Susan K Bowles
- College of Pharmacy, Faculty of Health, Dalhousie University, 5968 College Street, PO Box 15000, B3H 4R2, Halifax, NS, Canada
- Division of Geriatric Medicine, Department of Medicine, Dalhousie University, Halifax, Canada
- Nova Scotia Health, Halifax, NS, Canada
| | - Susan Kirkland
- Division of Geriatric Medicine, Department of Medicine, Dalhousie University, Halifax, Canada
- Department of Community Health and Epidemiology, Dalhousie University, Halifax, NS, Canada
| | - Melissa K Andrew
- Division of Geriatric Medicine, Department of Medicine, Dalhousie University, Halifax, Canada
- Nova Scotia Health, Halifax, NS, Canada
- Department of Community Health and Epidemiology, Dalhousie University, Halifax, NS, Canada
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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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Gómez-Gómez C, Moya-Molina MÁ, Tey-Aguilera MJ, Flores-Azofra J, González-Caballero JL. Baseline Profiles of Drug Prescriptions Prior to Diagnosis of Mild Cognitive Impairment (MCI) Obtained by Latent Class Analysis (LCA), and Assessment of Their Association with Conversion to Dementia. Healthcare (Basel) 2023; 11:2219. [PMID: 37570459 PMCID: PMC10419237 DOI: 10.3390/healthcare11152219] [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: 06/13/2023] [Revised: 07/27/2023] [Accepted: 07/31/2023] [Indexed: 08/13/2023] Open
Abstract
Polypharmacy has been linked to cognitive decline. However, interventions targeting modifiable risk factors, some of which are targets of the most commonly used drugs, could reduce the prevalence of dementia. Our aim was to determine the drug prescription regimen at baseline, prior to the diagnosis of mild cognitive impairment (MCI), and its possible association with progression to dementia. Data were collected from the electronic medical records of 342 MCI outpatients diagnosed during 2006-2017 at their first neurology consultation. We followed the classical three-step method of statistical analysis, starting with a Latent Class Analysis (LCA) to discover subgroups of drug prescription probability. Half of the patients were under polypharmacy (≥5 drugs), 17.5% had no recorded medication, 33.3% progressed to dementia (94.7% in ≤5 years), and 84.1% of them to Alzheimer's disease (AD). According to the LCA and based on 20 therapeutic indicators obtained from 240 substances and regrouped according the Anatomical Therapeutic Chemical Classification, we identified a four-profile model: (1) low (35.7% of patients); (2) mixed (28.7%); (3) cardio-metabolic (19.3%); and (4) psychotropic (16.4%). The binomial regression logistic model showed that profiles 2 and 3 (and 4 for AD), with a higher drug prescription conditioned probability against classic risk factors, were protective than profile 1 (OR = 0.421, p = 0.004; OR = 0.278, p = 0.000; OR = 0.457, p = 0.040, respectively), despite polypharmacy being significant in profiles 2 and 3 (mean > 7 drugs) vs. profile 1 (1.4 ± 1.6) (p = 0.000). Patients in the latter group were not significantly older, although being aged 65-79 years old quadrupled (OR = 4.217, p = 000) and being >79 tripled (OR = 2.945, p = 0.010) the conversion risk compared to patients <65 years old. According to the proposed analytical model, profiling the heterogeneous association of risk factors, which were taken prior to diagnosis, could be explored as an indicator of prior care and a predictor of conversion to dementia.
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Affiliation(s)
- Carmen Gómez-Gómez
- Department of Biochemistry and Molecular Biology, School of Medicine, University of Cadiz, 11002 Cádiz, Spain; (M.J.T.-A.); (J.F.-A.)
| | - Miguel Ángel Moya-Molina
- Department of Neurology, Hospital Universitario Puerta del Mar (HUPM), University of Cadiz, 11009 Cádiz, Spain
| | - Manuel Jesús Tey-Aguilera
- Department of Biochemistry and Molecular Biology, School of Medicine, University of Cadiz, 11002 Cádiz, Spain; (M.J.T.-A.); (J.F.-A.)
| | - Jorge Flores-Azofra
- Department of Biochemistry and Molecular Biology, School of Medicine, University of Cadiz, 11002 Cádiz, Spain; (M.J.T.-A.); (J.F.-A.)
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Saito Y, Oishi S, Takizawa T, Muraoka H, Yoshimura Y, Hashimoto I, Suzuki R, Ono T, Inada K. Analysis of Concomitant Medications Prescribed with Antipsychotics to Patients with Dementia. Dement Geriatr Cogn Disord 2023; 52:222-231. [PMID: 37245511 PMCID: PMC10614247 DOI: 10.1159/000531240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Accepted: 05/22/2023] [Indexed: 05/30/2023] Open
Abstract
INTRODUCTION Antipsychotics are still commonly prescribed to patients with dementia, despite the many issues that have been identified. This study aimed to quantify antipsychotic prescription in patients with dementia and the types of concomitant medications prescribed with antipsychotics. METHODS A total of 1,512 outpatients with dementia who visited our department between April 1, 2013 and March 31, 2021, were included in this study. Demographic data, dementia subtypes, and regular medication use at the time of the first outpatient visit were investigated. The association between antipsychotic prescriptions and referral sources, dementia subtypes, antidementia drug use, polypharmacy, and prescription of potentially inappropriate medications (PIMs) was evaluated. RESULTS The antipsychotic prescription rate for patients with dementia was 11.5%. In a comparison of dementia subtypes, the antipsychotic prescription rate was significantly higher for patients with dementia with Lewy bodies (DLB) than for those with all other dementia subtypes. In terms of concomitant medications, patients taking antidementia drugs, polypharmacy, and PIMs were more likely to receive antipsychotic prescriptions than those who were not taking these medications. Multivariate logistic regression analysis showed that referrals from psychiatric institutions, DLB, N-methyl-d-aspartate (NMDA) receptor antagonists, polypharmacy, and benzodiazepine were associated with antipsychotic prescriptions. CONCLUSIONS Referrals from psychiatric institutions, DLB, NMDA receptor antagonist, polypharmacy, and benzodiazepine were associated with antipsychotic prescriptions for patients with dementia. To optimise prescription of antipsychotics, it is necessary to improve cooperation between local and specialised medical institutions for accurate diagnosis, evaluate the effects of concomitant medication administration, and solve the prescribing cascade.
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Affiliation(s)
- Yoshitaka Saito
- Department of Psychiatry, Kitasato University, School of Medicine, Sagamihara-shi, Japan
| | - Satoru Oishi
- Department of Psychiatry, Kitasato University, School of Medicine, Sagamihara-shi, Japan
| | - Takeya Takizawa
- Department of Medical Psychology, Kitasato University Graduate School of Medical Sciences, Sagamihara-shi, Japan
| | - Hiroyuki Muraoka
- Department of Psychiatry, Kitasato University, School of Medicine, Sagamihara-shi, Japan
| | - Yuki Yoshimura
- Department of Psychiatry, Kitasato University, School of Medicine, Sagamihara-shi, Japan
| | - Itsuki Hashimoto
- Department of Psychiatry, Kitasato University, School of Medicine, Sagamihara-shi, Japan
| | - Ryutaro Suzuki
- Division of Integrated Psychosocial Care in Community and Child Psychiatry, Department of Psychiatry, Kitasato University, School of Medicine, Sagamihara-shi, Japan
| | - Tsuyoshi Ono
- Department of Psychiatry, Kitasato University, School of Medicine, Sagamihara-shi, Japan
| | - Ken Inada
- Department of Psychiatry, Kitasato University, School of Medicine, Sagamihara-shi, Japan
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Xiao X, Xiang S, Xu Q, Li J, Xiao J, Si Y. Comorbidity among inpatients with dementia: a preliminary cross-sectional study in West China. Aging Clin Exp Res 2023; 35:659-667. [PMID: 36754914 PMCID: PMC9908504 DOI: 10.1007/s40520-023-02349-3] [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: 06/02/2022] [Accepted: 01/11/2023] [Indexed: 02/10/2023]
Abstract
OBJECTIVE To investigate comorbidities among hospitalized patients with dementia. METHOD Data were extracted from the discharge records in our hospital. Comorbidities based on ICD-10 were selected from the Charlson Comorbidity Index (CCI) and Elixhauser Comorbidity Index (ECI). The distributions of these comorbidities were described in dementia inpatients and age- and sex-matched nondementia controls, as well as in inpatients with Alzheimer's disease and vascular dementia. A logistic regression model was applied to identify dementia-specific morbid conditions. RESULTS A total of 3355 patients with dementia were included, with a majority of 1503 (44.8%) having Alzheimer's disease, 395 (11.8%) with vascular dementia, and 441 (13.1%) with mixed dementia. The mean number of comorbidities was 3.8 in dementia patients (vs. 2.9 in controls). The most prevalent comorbidities in inpatients with dementia compared with those without dementia were cerebral vascular disease (73.0% vs. 35.9%), hypertension (62.8% vs. 56.2%), and peripheral vascular disease (53.7% vs. 31.2%). Comorbidities associated with dementia included epilepsy (OR 4.8, 95% CI 3.5-6.8), cerebral vascular disease (OR 4.1, 95% CI 3.7-4.5), depression (OR 4.0, 95% CI 3.2-5.0), uncomplicated diabetes (OR 1.5, 95% CI 1.4-1.7), peripheral vascular disease (OR 1.8, 95% CI 1.6-2.0), rheumatoid arthritis collagen vascular disease (OR 1.7, 95% CI 1.3-2.3), and anemia (OR 1.2, 95% CI 1.04-1.3). Some comorbidities suggested a protective effect against dementia. They were hypertension (OR 0.8, 95% CI 0.7-0.9), COPD (OR 0.6, 95% CI 0.5-0.6), and solid tumor without metastasis (OR 0.4, 95% CI 0.3-0.4). Vascular dementia has more cardiovascular and cerebrovascular comorbidities than Alzheimer's disease. CONCLUSION Patients with dementia coexisted with more comorbidities than those without dementia. Comorbidities (esp. cardio-cerebral vascular risks) in patients with vascular dementia were more than those in patients with AD. Specifically, vascular and circulatory diseases, epilepsy, diabetes and depression increased the risk of dementia.
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Affiliation(s)
- Xiaoqiang Xiao
- Department of Neuropsychology, Sichuan Academy of Medical Sciences and Sichuan People's Hospital, Chengdu, Sichuan, China
- Sichuan Provincial Center for Mental Health, Chengdu, Sichuan, China
- University of Electronic Science and Technology of China, Chengdu, Sichuan, China
| | - Shunju Xiang
- Department of Anesthesiology, West China Hospital, Chengdu, China
- West China School of Nursing, Sichuan University, Chengdu, China
| | - Qingya Xu
- Department of Neuropsychology, Sichuan Academy of Medical Sciences and Sichuan People's Hospital, Chengdu, Sichuan, China
- Sichuan Provincial Center for Mental Health, Chengdu, Sichuan, China
- University of Electronic Science and Technology of China, Chengdu, Sichuan, China
| | - Jieying Li
- Department of Neuropsychology, Sichuan Academy of Medical Sciences and Sichuan People's Hospital, Chengdu, Sichuan, China
- Sichuan Provincial Center for Mental Health, Chengdu, Sichuan, China
- University of Electronic Science and Technology of China, Chengdu, Sichuan, China
| | - Jun Xiao
- Department of Neuropsychology, Sichuan Academy of Medical Sciences and Sichuan People's Hospital, Chengdu, Sichuan, China.
- Sichuan Provincial Center for Mental Health, Chengdu, Sichuan, China.
- University of Electronic Science and Technology of China, Chengdu, Sichuan, China.
| | - Yang Si
- Department of Neurology, Sichuan Academy of Medical Sciences and Sichuan People's Hospital, 32# W. Sec 2, 1St Ring Rd., Chengdu, 610072, Sichuan Province, China.
- University of Electronic Science and Technology of China, Chengdu, Sichuan, China.
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Doheny M, Schön P, Orsini N, Fastbom J, Burström B, Agerholm J. Socio-demographic differences in polypharmacy and potentially inappropriate drug use among older people with different care needs and in care settings in Stockholm, Sweden. Scand J Public Health 2023; 51:11-20. [PMID: 34190622 PMCID: PMC9903244 DOI: 10.1177/14034948211018384] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
AIMS Polypharmacy and potentially inappropriate medications (PIM) are risk factors for negative health outcomes among older people. This study aimed to investigate socio-demographic differences in polypharmacy and PIM use among older people with different care needs in a standard versus an integrated care setting. METHODS Population-based register data on residents aged ⩾65 years in Stockholm County based on socio-demographic background and social care use in 2014 was linked to prescription drug use in 2015. A logistic regression analysis was used to estimate socio-demographic differences in polypharmacy and PIM, adjusting for education, age group, sex, country of birth, living alone, morbidity and dementia by care setting based on area and by care need (i.e. independent, home help or institutionalised). RESULTS The prevalence of polypharmacy and PIM was greater among home-help users (60.4% and 11.5% respectively) and institutional residents (74.4% and 11.9%, respectively). However, there were greater socio-demographic differences among the independent, with those with lower education, older age and females having higher odds of polypharmacy and PIM. Morbidity was a driver of polypharmacy (odds ratio (OR)=1.19, confidence interval (CI) 1.16-1.22) among home-help users. Dementia diagnosis was associated with reduced odds of polypharmacy and PIM among those in institutions (OR=0.78, CI 0.71-0.87 and OR 0.52, CI 0.45-0.59, respectively) and of PIM among home-help users (OR=0.53, 95% CI 0.42-0.67). CONCLUSIONS Polypharmacy and PIM were associated with care needs, most prevalent among home-help users and institutional residents, but socio-demographic differences were most prominent among those living independently, suggesting that municipal care might reduce differences between socio-demographic groups. Care setting had little effect on inappropriate drug use, indicating that national guidelines are followed.
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Affiliation(s)
- Megan Doheny
- Department of Global Public Health, Karolinska Institutet, Sweden,Megan Doheny, Department of Global Public Health, Karolinska Institutet, Widerströmska plan 3, Stockholm, 171 71, Sweden. E-mail:
| | - Pär Schön
- Aging Research Center, Karolinska Institutet – Stockholm University, Sweden
| | - Nicola Orsini
- Department of Global Public Health, Karolinska Institutet, Sweden
| | - Johan Fastbom
- Aging Research Center, Karolinska Institutet – Stockholm University, Sweden
| | - Bo Burström
- Department of Global Public Health, Karolinska Institutet, Sweden,Center for Epidemiology and Community Medicine, Stockholm County Council, Sweden
| | - Janne Agerholm
- Aging Research Center, Karolinska Institutet – Stockholm University, Sweden
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Engvig A, Maglanoc LA, Doan NT, Westlye LT. Data-driven health deficit assessment improves a frailty index's prediction of current cognitive status and future conversion to dementia: results from ADNI. GeroScience 2023; 45:591-611. [PMID: 36260263 PMCID: PMC9886733 DOI: 10.1007/s11357-022-00669-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 10/02/2022] [Indexed: 02/03/2023] Open
Abstract
Frailty is a dementia risk factor commonly measured by a frailty index (FI). The standard procedure for creating an FI requires manually selecting health deficit items and lacks criteria for selection optimization. We hypothesized that refining the item selection using data-driven assessment improves sensitivity to cognitive status and future dementia conversion, and compared the predictive value of three FIs: a standard 93-item FI was created after selecting health deficit items according to standard criteria (FIs) from the ADNI database. A refined FI (FIr) was calculated by using a subset of items, identified using factor analysis of mixed data (FAMD)-based cluster analysis. We developed both FIs for the ADNI1 cohort (n = 819). We also calculated another standard FI (FIc) developed by Canevelli and coworkers. Results were validated in an external sample by pooling ADNI2 and ADNI-GO cohorts (n = 815). Cluster analysis yielded two clusters of subjects, which significantly (pFDR < .05) differed on 26 health items, which were used to compute FIr. The data-driven subset of items included in FIr covered a range of systems and included well-known frailty components, e.g., gait alterations and low energy. In prediction analyses, FIr outperformed FIs and FIc in terms of baseline cognition and future dementia conversion in the training and validation cohorts. In conclusion, the data show that data-driven health deficit assessment improves an FI's prediction of current cognitive status and future dementia, and suggest that the standard FI procedure needs to be refined when used for dementia risk assessment purposes.
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Affiliation(s)
- Andreas Engvig
- NORMENT, Division of Mental Health and Addiction, Oslo University Hospital & Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
- Department of Nephrology, Oslo University Hospital, Oslo, Ullevål, Norway.
| | - Luigi A Maglanoc
- NORMENT, Division of Mental Health and Addiction, Oslo University Hospital & Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- University Center for Information Technology, University of Oslo, Oslo, Norway
| | - Nhat Trung Doan
- NORMENT, Division of Mental Health and Addiction, Oslo University Hospital & Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Lars T Westlye
- NORMENT, Division of Mental Health and Addiction, Oslo University Hospital & Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Psychology, University of Oslo, Oslo, Norway
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Harrison-Dening K. Guiding family carers on medication management when a person with dementia is discharged from hospital. Evid Based Nurs 2023; 26:25. [PMID: 35953271 DOI: 10.1136/ebnurs-2022-103566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/26/2022] [Indexed: 01/17/2023]
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Cao D, Yang Q, Qi F, Gu S, Yu T, Zhu L, Liu Y, Gui J, Yang B, Zhang X. Acupuncture improves the residual urine volume of bladder of middle age patients with urinary retention post-stroke: A protocol for systematic review and meta analysis. Medicine (Baltimore) 2022; 101:e31697. [PMID: 36451433 PMCID: PMC9704891 DOI: 10.1097/md.0000000000031697] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND There are 15 million new cases of stroke every year in the world, 65% of which have dysuria in the early stage of stroke, which seriously affects the quality of life of stroke patients. The purpose of this study is to evaluate the results of randomized controlled trials to determine whether acupuncture can improve the residual urine volume of the bladder in middle age patients with urinary retention post-stroke. METHODS Eight databases, including China National Knowledge Infrastructure, Chinese Scientific Journal Database, Cochrane Central Register of Controlled Trials, Embase, MEDLINE, PubMed, Wanfang Database, and Web of Science, will be searched using English and Chinese search strategies. In addition, manual retrieval of research papers, conference papers, ongoing experiments, internal reports, etc, will supplement electronic retrieval. All eligible studies published on or before October 1, 2022 will be selected. To enhance the effectiveness of the study, only clinical randomized controlled trials related to the use of manual acupuncture for the treatment of urinary retention post-stroke will be included. CONCLUSION The residual urine volume of bladder will be the primary outcome measure, whereas the Clinical efficiency will be the secondary outcomes. Side effects and adverse events will be included as safety evaluations. To ensure the quality of the systematic evaluation, study selection, data extraction, and quality assessment will be independently performed by two authors, whereas a third author will resolve any disagreement.
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Affiliation(s)
- Di Cao
- Department of Rehabilitation, The Second Affiliated Hospital of Changchun University of Chinese Medicine (Changchun Hospital of Chinese Medicine), China
| | - Qiguang Yang
- Department of Rehabilitation, The Second Affiliated Hospital of Changchun University of Chinese Medicine (Changchun Hospital of Chinese Medicine), China
| | - Fengjun Qi
- Hubei University of Chinese Medicine, China
| | - Shuhong Gu
- Department of Rehabilitation, The Second Affiliated Hospital of Changchun University of Chinese Medicine (Changchun Hospital of Chinese Medicine), China
| | - Tao Yu
- Department of Rehabilitation, The Second Affiliated Hospital of Changchun University of Chinese Medicine (Changchun Hospital of Chinese Medicine), China
| | - Lin Zhu
- Acupuncture and Massage Center of The Third Affiliated Hospital of Changchun University of Chinese Medicine, China
| | - YiMing Liu
- Hubei University of Chinese Medicine, China
| | | | - Baoru Yang
- Hubei University of Chinese Medicine, China
| | - Xiaolin Zhang
- Hubei University of Chinese Medicine, China
- * Correspondence: Xiaolin Zhang, Huebi University of Chinese Medicine, No. 16, Huangjiahu West Road, Hongshan District, Wuhan, Hubei 430065, China (e-mail: )
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17
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Potentially inappropriate medication use and mortality in patients with cognitive impairment. Eur J Clin Pharmacol 2022; 78:2013-2020. [DOI: 10.1007/s00228-022-03410-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 10/24/2022] [Indexed: 11/05/2022]
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A Systematic Review of the Current Evidence from Randomised Controlled Trials on the Impact of Medication Optimisation or Pharmacological Interventions on Quantitative Measures of Cognitive Function in Geriatric Patients. Drugs Aging 2022; 39:863-874. [PMID: 36284081 PMCID: PMC9626423 DOI: 10.1007/s40266-022-00980-9] [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] [Accepted: 09/19/2022] [Indexed: 11/25/2022]
Abstract
Background Cognitive decline is common in older people. Numerous studies point to the detrimental impact of polypharmacy and inappropriate medication on older people’s cognitive function. Here we aim to systematically review evidence on the impact of medication optimisation and drug interventions on cognitive function in older adults. Methods A systematic review was performed using MEDLINE and Web of Science on May 2021. Only randomised controlled trials (RCTs) addressing the impact of medication optimisation or pharmacological interventions on quantitative measures of cognitive function in older adults (aged > 65 years) were included. Single-drug interventions (e.g., on drugs for dementia) were excluded. The quality of the studies was assessed by using the Jadad score. Results Thirteen studies met the inclusion criteria. In five studies a positive impact of the intervention on metric measures of cognitive function was observed. Only one study showed a significant improvement of cognitive function by medication optimisation. The remaining four positive studies tested methylphenidate, selective oestrogen receptor modulators, folic acid and antipsychotics. The mean Jadad score was low (2.7). Conclusion This systematic review identified a small number of heterogenous RCTs investigating the impact of medication optimisation or pharmacological interventions on cognitive function. Five trials showed a positive impact on at least one aspect of cognitive function, with comprehensive medication optimisation not being more successful than focused drug interventions. More prospective trials are needed to specifically assess ways of limiting the negative impact of certain medication in particular and polypharmacy in general on cognitive function in older patients. Supplementary Information The online version contains supplementary material available at 10.1007/s40266-022-00980-9.
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Gan J, Chen Z, Liu S, Shi Z, Liu Y, Wang XD, Liu C, Ji Y. The presence and co-incidence of geriatric syndromes in older patients with mild-moderate Lewy body dementia. BMC Neurol 2022; 22:355. [PMID: 36123648 PMCID: PMC9484208 DOI: 10.1186/s12883-022-02897-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 09/12/2022] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Geriatric symptoms are common in dementia cases, while few studies have focused on these symptoms in Lewy body dementia (LBD). The purpose of this study is to investigate the distributions of Apolipoprotein E (APOE) ε4 and geriatric symptoms, and explore their associaitons in Dementia with Lewy bodies (DLB) and Parkinson's disease dementia (PDD). METHODS A retrospective study with 185 mild-moderate probable DLB (n = 93) and PDD (n = 92) patients was assigned. Demographic and clinical characteristics, neuropsychological assessments, and APOE genotypes were recorded. Description, correlation and logistic regression models were used to analyze the presence of geriatric symptom complaints and their associations with APOE ε4. RESULTS DLB patients displayed more frequency of fluctuating cognition, visual hallucination, rapid eye movement sleep behavior disorder, delusion, depression, anxiety, apathy, and loss of appetite, whereas the PDD cases had constipation, fear of falling, and insomnia more frequently. The APOE ε4 allele was more common in DLB than PDD (29.9% vs. 7.0%, p < 0.001), and the patients with DLB + APOE ε4 (+) were presented more delusions (p = 0.005) and apathy (p = 0.007) than patients with PDD + APOE ε4 (+). We also found that the APOE ε4 allele was significantly associated with hyperhidrosis (OR = 3.472, 95%CI: 1.082-11.144, p = 0.036) and depression (OR = 3.002, 95%CI: 1.079-8.353, p = 0.035) in DLB patients, while there were no significant associations between APOE ε4 allele and the age at visit, the age at onset, scores of MDS-UPDRS III, H&Y stage, ADL, MMSE, MOCA and NPI, as well as the presences of fluctuating cognition, VH, parkinsonism and RBD in both groups. CONCLUSION The presence and co-incidence of geriatric symptoms are common in patients with mild-moderate LBD. The presence of APOE ε4 allele is associated with hyperhidrosis and depression, but not global cognition, activitives of daily life, motor function and other neuropsychitric symptoms in DLB. These findings improve the awareness of geriatric symptoms, and contribute to the healthcare management of mild-moderate DLB and PDD.
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Affiliation(s)
- Jinghuan Gan
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, China National Clinical Research Center for Neurological Diseases, 119 Nansihuan West Road, Fengtai District, Beijing, 100070, China
| | - Zhichao Chen
- Department of Neurology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Shuai Liu
- Department of Neurology, Tianjin Huanhu Hospital, Tianjin Key Laboratory of Cerebrovascular and of Neurodegenerative Diseases, Tianjin Dementia Institute, 6 Jizhao Road, Jinnan District, Tianjin, 300350, China
| | - Zhihong Shi
- Department of Neurology, Tianjin Huanhu Hospital, Tianjin Key Laboratory of Cerebrovascular and of Neurodegenerative Diseases, Tianjin Dementia Institute, 6 Jizhao Road, Jinnan District, Tianjin, 300350, China
| | - Yiming Liu
- Department of Neurology, Qilu hospital, Shandong University, Jinan, China
| | - Xiao-Dan Wang
- Department of Neurology, Tianjin Huanhu Hospital, Tianjin Key Laboratory of Cerebrovascular and of Neurodegenerative Diseases, Tianjin Dementia Institute, 6 Jizhao Road, Jinnan District, Tianjin, 300350, China
| | - Chunyan Liu
- Department of Neurology, Aviation General Hospital, Beijing, China
| | - Yong Ji
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, China National Clinical Research Center for Neurological Diseases, 119 Nansihuan West Road, Fengtai District, Beijing, 100070, China. .,Department of Neurology, Tianjin Huanhu Hospital, Tianjin Key Laboratory of Cerebrovascular and of Neurodegenerative Diseases, Tianjin Dementia Institute, 6 Jizhao Road, Jinnan District, Tianjin, 300350, China.
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Yoon K, Kim JT, Kwack WG, Kim D, Lee KT, Yang S, Lee S, Choi YJ, Chung EK. Potentially Inappropriate Medication Use in Patients with Dementia. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:11426. [PMID: 36141699 PMCID: PMC9517486 DOI: 10.3390/ijerph191811426] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 09/07/2022] [Accepted: 09/08/2022] [Indexed: 06/16/2023]
Abstract
The objective of this study was to characterize the epidemiology of using potentially inappropriate medications associated with dementia exacerbation (DPIMs) in elderly outpatients with dementia. Electronic medical records were retrospectively reviewed for geriatric patients with dementia who were prescribed at least one medication in 2016 at a tertiary, university-affiliated hospital. The 2015 Beers criteria were used to define DPIMs. Logistic regression was performed to identify factors associated with prescribing DPIMs in patients with dementia. Among 2100 patients included in our study, 987 (47.0%) patients were prescribed at least one DPIM. Benzodiazepines were the most frequently prescribed DPIM followed by anticholinergics, histamine H2-receptor blockers, and zolpidem. The risk of prescribing DPIMs was significantly increased in female patients (odds ratio (OR) 1.355) with polypharmacy (OR 5.146) and multiple comorbidities (OR 1.129) (p < 0.05 for all). Coexistence of Parkinson's disease (OR 1.799), mood disorder (OR 1.373), or schizophrenia (OR 4.116) in patients with dementia further increased the likelihood of receiving DPIMs. In conclusion, DPIMs were commonly used in elderly patients with dementia in Korea with benzodiazepines most frequently prescribed followed by anticholinergics. Female patients using polypharmacy with multiple comorbidities should be closely monitored to minimize unnecessary DPIM use and, ultimately, DPIM-related harms.
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Affiliation(s)
- Kyungwon Yoon
- Department of Pharmacy, College of Pharmacy, Kyung Hee University, Seoul 02447, Korea
- Department of Pharmacy, Kyung Hee University Hospital, Seoul 02447, Korea
| | - Jung-Tae Kim
- Department of Pharmacy, Kyung Hee University Hospital at Gangdong, Seoul 05278, Korea
| | - Won-Gun Kwack
- Division of Pulmonary, Allergy and Critical Care Medicine, Kyung Hee University Hospital, Seoul 02447, Korea
| | - Donghyun Kim
- Department of Pharmacy, College of Pharmacy, Kyung Hee University, Seoul 02447, Korea
| | - Kyung-Tae Lee
- Department of Biomedical and Pharmaceutical Sciences, Graduate School, Kyung Hee University, Seoul 02447, Korea
- Department of Pharmaceutical Biochemistry, College of Pharmacy, Kyung Hee University, Seoul 02447, Korea
| | - Seungwon Yang
- Department of Pharmacy, College of Pharmacy, Kyung Hee University, Seoul 02447, Korea
- Department of Regulatory Science, College of Pharmacy, Graduate School, Kyung Hee University, Seoul 02447, Korea
| | - Sangmin Lee
- Department of Pharmacy, College of Pharmacy, Kyung Hee University, Seoul 02447, Korea
- Department of Regulatory Science, College of Pharmacy, Graduate School, Kyung Hee University, Seoul 02447, Korea
| | - Yeo-Jin Choi
- Department of Pharmacy, College of Pharmacy, Kyung Hee University, Seoul 02447, Korea
- Department of Regulatory Science, College of Pharmacy, Graduate School, Kyung Hee University, Seoul 02447, Korea
| | - Eun-Kyoung Chung
- Department of Pharmacy, College of Pharmacy, Kyung Hee University, Seoul 02447, Korea
- Department of Pharmacy, Kyung Hee University Hospital at Gangdong, Seoul 05278, Korea
- Department of Regulatory Science, College of Pharmacy, Graduate School, Kyung Hee University, Seoul 02447, Korea
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Tidmore LM, Skrepnek GH. A National Assessment of Alzheimer Disease and Antipsychotic Medication Prescribing Among Older Adults in Ambulatory Care Settings. Alzheimer Dis Assoc Disord 2022; 36:230-237. [PMID: 35700324 DOI: 10.1097/wad.0000000000000509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Accepted: 03/19/2022] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The objective of this study was to assess antipsychotic prescribing within ambulatory settings in the United States among older adults with Alzheimer disease after adjusting for demographic, provider, and clinical factors. METHODS This cross-sectional cohort study utilized Centers for Disease Control's (CDC) National Ambulatory Medical Care Survey (NAMCS) ambulatory care data from 2014 to 2016 among visits 65 years old or older with any listed diagnosis of Alzheimer. Multivariable logistic regression analyses assessed the association between the outcome of antipsychotic prescribing after controlling for numerous demographic, provider, and clinical covariates. An extension of the Oacaxa-Blinder decomposition was used to assess observed differentials. RESULTS An estimated 15,471,125 ambulatory visits involving Alzheimer disease among those 65 years old or older occurred from 2014 to 2016. Antipsychotics were prescribed in 9.3% of these visits, equating to 6.81 times higher multivariable-adjusted odds relative to non-Alzheimer visits (95% confidence interval: 2.86-16.20, P <0.001). The decomposition analysis indicated that the study's predictor variables explained 15.6% of the outcome gap between Alzheimer versus non-Alzheimer visits. CONCLUSIONS Despite potential mortality risks with antipsychotics in adults 65 years old or older with Alzheimer disease and recommendations discouraging their use, this nationally representative study observed significantly higher odds of prescribing independent of demographic, provider, and clinical characteristics. Polypharmacy may be a risk factor that warrants continued assessment regarding the appropriateness of antipsychotic prescribing in this vulnerable population.
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Affiliation(s)
- Laura M Tidmore
- Department of Clinical and Administrative Sciences, University of Oklahoma College of Pharmacy, Oklahoma City, OK
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Albertsen N, Sommer TG, Olsen TM, Prischl A, Kallerup H, Andersen S. Polypharmacy and potential drug–drug interactions among Greenland’s care home residents. Ther Adv Drug Saf 2022; 13:20420986221103918. [PMID: 35784387 PMCID: PMC9243492 DOI: 10.1177/20420986221103918] [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: 10/27/2021] [Accepted: 05/09/2022] [Indexed: 11/21/2022] Open
Abstract
Background: As lifetime expectancy in Greenland is steadily increasing, so is the
proportion of elderly Greenlanders. Old age is associated with polypharmacy,
and in this study, we aim to describe the prevalence and characteristics of
polypharmacy among the care home residents in Greenland. Methods: Eight care homes in Greenland were visited between 2010 and 2016.
Questionnaires including information on prescribed medication and
comorbidities were collected and analyzed. Drugs were categorized according
to Anatomical Therapeutic Chemical (ATC) category, and potential drug–drug
interactions (pDDIs) were assessed using the Danish Interaction Database.
Polypharmacy was defined as five or more prescribed drugs. Results: All 244 eligible residents were included in the study. The median number of
prescribed drugs per resident was six, and women were prescribed more drugs
than men (median six versus five). More than 60% of all
residents fulfilled the criteria for polypharmacy. The residents in the
polypharmacy group had a higher body mass index (26.9
versus 24.3) and more chronic diseases (median two
versus one), and more often pulmonary (14%
versus 1%) or endocrine disease (22%
versus 2%) than in the non-polypharmacy group. The most
prescribed drugs belonged to ATC category N (nervous
system, 78% of the residents). Finally, pDDIs were found among 61% of the
residents and were more common in the capital (77%), which also had the
highest proportion of residents with polypharmacy (77%). Conclusion: This is the first study to describe the patterns of polypharmacy and pDDIs
among the elderly in care homes in Greenland. Our findings indicate that
polypharmacy is as common in Greenland as elsewhere in the Western world,
but there are local differences in the prevalence. Plain Language Summary Polypharmacy among the elderly in care homes in Greenland The lifetime expectancy of the Greenlandic population is increasing, and so
is the number of elderly Greenlanders. Previous studies have shown that the
elderly have a higher risk of being treated with five drugs or more which is
called polypharmacy. Polypharmacy can cause unwanted interactions and side
effects. In this study, we examine the characteristics of the residents in
Greenlandic care homes belonging to this group. Using questionnaires, we gathered information from 244 residents from care
homes in eight different towns and settlements in Greenland. Data included
types of medication prescribed to the resident, age, gender, cause of stay,
and medical history, which allowed us to compare the results between genders
and towns. We found that among 244 residents, more than half of all residents were
prescribed five or more different drugs, and women were generally prescribed
more drugs than men. Those prescribed five or more drugs had a higher body
mass index and more diseases than those prescribed fewer drugs. We also
found that certain types of medication, mainly painkillers, were the most
prescribed. Finally, residents in the care home in Greenland’s capital Nuuk
were more often prescribed five or more drugs than elsewhere in Greenland,
indicating local differences in Greenland. Our results give an essential insight into the health and medication of the
most fragile elderly in Greenland. Polypharmacy seems to be as common here
as elsewhere in the Western world and is a point of focus.
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Affiliation(s)
- Nadja Albertsen
- Master of Anthropology of Health, Department of Geriatric Medicine, Aalborg University Hospital, Hobrovej 18-22, 9100 Aalborg, Denmark
- Arctic Health Research Centre, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Tine Gjedde Sommer
- Department of Anaesthesiology and Intensive Care Medicine, Skåne University Hospital, Lund, Sweden
| | | | - Anna Prischl
- Department of Pathology, Odense University Hospital, Odense, Denmark
| | | | - Stig Andersen
- Department of Geriatric Medicine, Aalborg University Hospital, Aalborg, Denmark
- Arctic Health Research Centre, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
- Department of Internal Medicine, Queen Ingrid’s Hospital, Nuuk, Greenland
- Greenland Centre for Health Research, Ilisimatusarfik – University of Greenland, Nuuk, Greenland
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Zhao M, Chen Z, Tian F, Xu T. Potentially Inappropriate Medication Among People With Dementia in China: A Nationwide Cross-Sectional Study. Front Pharmacol 2022; 13:929584. [PMID: 35770092 PMCID: PMC9234126 DOI: 10.3389/fphar.2022.929584] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 05/24/2022] [Indexed: 11/13/2022] Open
Abstract
Objectives: The purpose of this study was to explore the prevalence of potentially inappropriate medication (PIM) among older outpatients (age ≥ 65 years old) with dementia in eight cities in China using the AGS Beers criteria of 2019 and to identify the potential factor increasing the number of PIMs.Methods: A cross-sectional study about PIM in older outpatients with dementia from January 2020 to December 2020 was carried out in eight cities in China, Chengdu, Beijing, Guangzhou, Shanghai, Shenyang, Tianjin, Zhengzhou, and Hangzhou, distributing five major geographical regions in China (east, west, north, south, central). The diagnosis of dementia was based on the International Classification of Diseases (ICD-10) to identify. Based on the 2019 AGS Beers criteria, the PIM prescriptions were evaluated. The identification of potential factors was completed using a binary logistic regression model.Results: Of 18,624 older outpatients with dementia, 3.52% were detected with 1 PIM, and 35.91% received at least two PIMs. The antipsychotic drugs quetiapine and olanzapine were most frequently prescribed in patients with PIM, accounting for 8.01 and 7.36%, respectively. Logistic regression analyses showed that female patients with dementia aged >80 years who took more medications were exposed easily to PIM use.Conclusion: PIM use among older outpatients with dementia in China is highly prevalent, and the associated risk factors were increasing age, female sex, and number of medications. The most frequently prescribed drugs by clinicians were anpsychotropic drugs, which were much more frequent than other drugs.
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Affiliation(s)
- Mengnan Zhao
- Department of Pharmacy, West China Hospital, Sichuan University, Chengdu, China
- West China School of Medicine, Sichuan University, Chengdu, China
| | - Zhaoyan Chen
- Department of Pharmacy, West China Hospital, Sichuan University, Chengdu, China
| | - Fangyuan Tian
- Department of Pharmacy, West China Hospital, Sichuan University, Chengdu, China
| | - Ting Xu
- Department of Pharmacy, West China Hospital, Sichuan University, Chengdu, China
- West China School of Medicine, Sichuan University, Chengdu, China
- *Correspondence: Ting Xu,
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Riedl L, Kiesel E, Hartmann J, Fischer J, Roßmeier C, Haller B, Kehl V, Priller J, Trojan M, Diehl-Schmid J. A bitter pill to swallow - Polypharmacy and psychotropic treatment in people with advanced dementia. BMC Geriatr 2022; 22:214. [PMID: 35296254 PMCID: PMC8925050 DOI: 10.1186/s12877-022-02914-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Accepted: 03/08/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Polypharmacy is common in people with dementia. The use of psychotropic drugs (PDs) and other, potentially inappropriate medications is high. The aims of this cross-sectional study were 1) to investigate the use of drugs in people with advanced dementia (PWAD), living at home or in long term care (LTC); 2) to focus on PD use; and 3) to identify determinants of PD use. METHODS The study was performed in the context of EPYLOGE (IssuEs in Palliative care for people in advanced and terminal stages of YOD and LOD in Germany). 191 PWAD were included. All drugs that were administered at the date of the examination were recorded. Multiple logistic regression analysis identified determinants of PD use. RESULTS 96% of PWAD received medication with a median number of four drugs. 49.7% received five or more drugs. According to the Beers Criteria 39% of PWAD ≥ 65 years received at least one potentially inappropriate medication. 79% of PWAD were treated with PDs. Older PWAD and PWAD living in LTC facilities received significantly more drugs than younger PWAD, and PWAD living at home, respectively. Dementia etiology was significantly associated with the use of antipsychotics, antidepressants and sedative substances. Place of living was associated with the use of pain medication. Behavioral disturbances were associated with the use of antipsychotics and sedative substances. CONCLUSIONS To mitigate the dangers of polypharmacy and medication related harm, critical examination is required, whether a drug is indicated or not. Also, the deprescribing of drugs should be considered on a regular basis. TRIAL REGISTRATION Clinicaltrial.gov, NCT03364179 . Registered 6 December 2017.
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Affiliation(s)
- Lina Riedl
- School of Medicine, Department of Psychiatry and Psychotherapy, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany.
| | - Esther Kiesel
- School of Medicine, Hospital Pharmacy, Technical University of Munich, Munich, Germany
| | - Julia Hartmann
- School of Medicine, Department of Psychiatry and Psychotherapy, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Julia Fischer
- School of Medicine, Department of Psychiatry and Psychotherapy, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Carola Roßmeier
- School of Medicine, Department of Psychiatry and Psychotherapy, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Bernhard Haller
- School of Medicine, Institute of Medical Informatics, Statistics and Epidemiology, Technical University of Munich, Munich, Germany
| | - Victoria Kehl
- School of Medicine, Münchner Studienzentrum, Munich Germany, Technical University of Munich, Munich, Germany
| | - Josef Priller
- School of Medicine, Department of Psychiatry and Psychotherapy, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany.,Neuropsychiatry, Charité - Universitätsmedizin Berlin and DZNE, Berlin, Germany.,University of Edinburgh and UK DRI, Edinburgh, UK
| | - Monika Trojan
- School of Medicine, Hospital Pharmacy, Technical University of Munich, Munich, Germany
| | - Janine Diehl-Schmid
- School of Medicine, Department of Psychiatry and Psychotherapy, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
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Sönnerstam E, Gustafsson M, Lövheim H. Potentially inappropriate medications in relation to length of nursing home stay among older adults. BMC Geriatr 2022; 22:70. [PMID: 35065614 PMCID: PMC8783464 DOI: 10.1186/s12877-021-02639-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Accepted: 11/16/2021] [Indexed: 11/18/2022] Open
Abstract
Background To investigate the use of potentially inappropriate medications and their relation to the length of nursing home stay among older adults. Methods Questionnaire surveys using the Multi-Dimensional Dementia Assessment scale were sent out to all nursing homes in Västerbotten county in northern Sweden in 2007 and 2013. In total, 3186 adults (1881 from 2007 and 1305 from 2013) ≥65 years old were included and 71.8% of those had cognitive impairment. Potentially inappropriate medications were identified using drug-specific quality indicators according to Swedish National Board of Health and Welfare. Results Potentially inappropriate medications were used by 48.0% of the 2007 study sample and by 28.4% of the 2013 study sample. The prevalence of glibenclamide use 2007 and antipsychotic drug use 2013 increased linearly (β = 0.534E− 3, 95% CI: 0.040E− 3-0.103E− 2, p = 0.034 and β = 0.155E− 2, 95% CI: 0.229E− 3-0.288E− 2, p = 0.022, respectively) with the length of nursing home stay. No significant association was found between the prevalence of propiomazine, codeine, long-acting benzodiazepines, anticholinergics, NSAIDs, tramadol or the total use of potentially inappropriate medications and the length of stay in nursing homes in 2007 or 2013. Antipsychotics were the most commonly prescribed of the drug classes investigated and used by 22.6% of the residents 2007 and by 16.0% of the residents 2013. Conclusions These results indicate that treatment with potentially inappropriate medications is common among older adults living in nursing homes, but it seems to be related to the length of nursing home stay only to a smaller extent. Drug treatment should regularly be reviewed and followed-up among nursing home residents regardless of their length of nursing home stay, in order to prevent unnecessary adverse events. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-021-02639-3.
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Chen S, Chen X, Zhang H. Polypharmacy Among People Living with Dementia — Israel and 24 Countries in European Union, 2015–2019. China CDC Wkly 2022; 4:1007-1012. [PMID: 36483007 PMCID: PMC9709303 DOI: 10.46234/ccdcw2022.204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2022] [Accepted: 10/24/2022] [Indexed: 11/13/2022] Open
Abstract
What is already known about this topic? With a growing number of people living with dementia (PLWD), the practice of taking multiple medications to manage symptoms or comorbidities, i.e., polypharmacy, among PLWD has become a global health challenge. What is added by this report? In 2015-2019, polypharmacy for PLWD varied substantially among 25 studied countries, with approximately 1 in 5 Estonian PLWD and 4 in 5 Cypriot PLWD having polypharmacy. In addition, Switzerland, Poland, Austria, and the Czech Republic have experienced a significantly increasing trend in polypharmacy for PLWD. What are the implications for public health practice? Countries should pay special attention to polypharmacy and make efforts to control polypharmacy among PLWD, especially in countries where the trend of polypharmacy among PLWD has been increasing.
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Affiliation(s)
- Shanquan Chen
- Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom
- Shanquan Chen,
| | - Xi Chen
- School of Public Health, Yale University, New Haven, Connecticut, United States
| | - Huanyu Zhang
- Shenzhen Research Institute, the Chinese University of Hong Kong, Shenzhen, China
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Multicomponent Staff Training Intervention to Improve Residential Dementia Care (PROCUIDA-Demencia): A Mixed-Methods 2-Arm Cluster Randomized Controlled Pilot and Clinical Outcomes Study. J Am Med Dir Assoc 2021; 23:350-358.e5. [PMID: 34762845 DOI: 10.1016/j.jamda.2021.09.035] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 09/24/2021] [Accepted: 09/26/2021] [Indexed: 01/27/2023]
Abstract
OBJECTIVES To evaluate the feasibility outcomes of implementing a multicomponent staff training intervention (PROCUIDA-Demencia) to promote psychosocial interventions and reduce antipsychotic prescription in Mexican care homes and study its effect on staff's care experience and residents' quality of life. DESIGN A mixed-methods 2-arm cluster randomized controlled pilot study of a 2-day staff training program with baseline, 12 weeks, and 24 weeks of the PROCUIDA-Demencia intervention vs treatment as usual (TAU). SETTING AND PARTICIPANTS Eight care homes in Mexico City were selected, from which 55 residents and 126 staff were recruited. INTERVENTION In situ staff training consisting of evidence-based manualized psychosocial interventions of person-centered activities, reminiscence therapy, doll therapy, psychomotor dance therapy, and antipsychotic prescription review. Fidelity to protocol was supervised once a week. METHODS Cluster-level feasibility measures included views of staff, residents, and relatives on acceptability, satisfaction, adherence, and fidelity to the intervention. Staff outcome measures were Maslach Burnout Inventory (MBI), Approaches to Dementia Questionnaire, and Sense of Competence in Dementia Care Staff. Residents' outcome measures included Quality of Life-Alzheimer's Disease scale (QoL-AD), and Neuropsychiatric Inventory-Nursing Home Version (NPI-NH). Staff distress was measured using the NPI-NH occupational disturbance scale. Feasibility was elicited through a focus group, and hierarchical linear mixed effects models were used to assess the adjusted effects of the respective measures. RESULTS Observed medical practice showed the prescription of at least 1 antipsychotic in 41% of participants in the intervention group. Overall, 39% of residents reported discontinuation, and 15% reduction of antipsychotics, following the 12-week medical review in parallel with psychosocial interventions. Clinical outcomes contributed positively to the reduction in baseline staff burden according to the MBI after the intervention [mean difference -8.9, 95% confidence interval (CI) -17.7, -0.1, P = .049] and to the reduction in severity and frequency of behavior as per NPI-NH in residents (mean difference -9.4, 95% CI -17.5, -1.3, P = .025). CONCLUSIONS AND IMPLICATIONS PROCUIDA-Demencia is a feasible intervention for Mexican care homes. Results contribute to the Mexican Dementia Plan optimizing dementia care by supporting the need for staff training to implement psychosocial interventions prior to prescribing antipsychotic medication.
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Abstract
OBJECTIVES Nursing home (NH) residents with dementia is exposed to high rates of psychotropic prescriptions. Our objectives were to: (1) pool the prevalence estimates of psychotropic polypharmacy from the existing literature and (2) examine potentially influential factors that are related to a higher or lower prevalence. DESIGN Meta-analysis of data collected from randomized trials, quasi-experimental, prospective or retrospective cohort, and cross-sectional studies. English-language searches of PubMed and PsycINFO were completed by November 2020. Included studies reported prevalence estimates of psychotropic polypharmacy (i.e. defined as either two-or-more or three-or-more medications concurrently) in NH residents with dementia. SETTING AND PARTICIPANTS NH residents with dementia. MEASUREMENTS Random-effects models were used to pool the prevalence of psychotropic polypharmacy in NH residents with dementia across studies. Estimates were provided for both two-or-more and three-or-more concurrent medications. Heterogeneity and publication bias were measured. Meta-regression examined the influence of the percentage of the sample who were male, mean age of the sample, geographic region (continent), sample size, and study year on the prevalence of psychotropic polypharmacy. RESULTS Twenty-five unique articles were included comprising medications data from 92,370 NH residents with dementia in 12 countries. One-in-three (33%, [95% CI: 28%, 39%]) NH residents with dementia received two-or-more psychotropic medications concurrently. One-in-eight (13%, [95% CI: 10%, 17%]) received three-or-more psychotropic medications concurrently. Estimates were highly variable across both definitions of psychotropic polypharmacy (p < 0.001). Among study-level demographics, geographic region, sample size, or study year, only male sex was associated with greater use of two-or-more psychotropic medications (Unadjusted OR = 1.02, p = 0.006; Adjusted OR = 1.04, p = 0.07). CONCLUSIONS Psychotropic polypharmacy is common among NH residents with dementia. Identifying the causes of utilization and the effects on resident health and well-being should be prioritized by federal entities seeking to improve NH quality.
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Albertsen N, Olsen TM, Sommer TG, Prischl A, Kallerup H, Andersen S. Who lives in care homes in Greenland? A nationwide survey of demographics, functional level, medication use and comorbidities. BMC Geriatr 2021; 21:500. [PMID: 34536989 PMCID: PMC8449891 DOI: 10.1186/s12877-021-02442-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Accepted: 08/31/2021] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Greenland is facing an ageing population, and little is known about the characteristics of the elderly population in Greenland. This study offers both a comparison and a description of the demographics, causes of admission, comorbidities and medication of the residents in care homes in the capital, major and minor towns in four of the five administrative regions of Greenland. METHODS The study was conducted from 2010 to 2016 as a descriptive questionnaire-based cross-sectional study. Data from eligible residents from eight care homes were collected from the regular care staff. Data were categorised into three groups based on town size for analysis. RESULTS 244 (100 %) of eligible residents participated in the study. Nearly 100 % were of Greenlandic ethnicity based on parents' place of birth, and 62 % were women. The median age at admission/study was 69/71 years for men and 77/79 years for women (both p = 0.001). The median Body Mass Index was 25.6 kg/m2, more than half of the population were previous- or never-smokers and less than ten per cent consumed more than ten drinks of alcohol per week. The most common causes of admission were dementia (25.4 %), stroke (19.3 %) and social causes (11.1 %), while stroke (30.7 %), dementia (29.5 %) and musculoskeletal diseases (25.8 %) were the most common diagnoses at the time of the study. The Barthel Index was used to estimate the residents' level of independence, and residents in smaller towns were found to have a higher level of independence than residents in the capital. The median number of prescribed medications was five, and more residents in the capital were prescribed more than ten medications than elsewhere in Greenland. CONCLUSIONS This study is the first to describe care home residents in Greenland. We found a population younger than residents in comparable Danish care homes and that women were older than men at admission. In addition, care home residents in the capital had a lower level of independence and a higher number of prescribed medications, which could relate to differences in morbidity, access to health care services and differences in social circumstances influencing the threshold for care home admission.
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Affiliation(s)
- N Albertsen
- Department of Geriatric Medicine, Aalborg University Hospital, Aalborg, Denmark.
- Arctic Health Research Centre, Aalborg University Hospital, Aalborg, Denmark.
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.
| | - T M Olsen
- Department of Psychiatry, Regionalshospitalet Randers, Randers, Denmark
| | - T G Sommer
- Department of Anesthesiology and Intensive Care Medicine, Skåne University Hospital, Malmö, Sweden
| | - A Prischl
- Department of Pathology, Odense University Hospital, Odense, Denmark
| | - H Kallerup
- Upernavik Health Center, Upernavik, Greenland
| | - S Andersen
- Department of Geriatric Medicine, Aalborg University Hospital, Aalborg, Denmark
- Arctic Health Research Centre, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
- Department of Internal Medicine, Queen Ingrid's Hospital, Nuuk, Greenland
- Greenland Center for Health Research, Ilisimatusarfik, University of Greenland, Nuuk, Greenland
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Kouladjian O'Donnell L, Reeve E, Hilmer SN. Development, validation and evaluation of the Goal-directed Medication review Electronic Decision Support System (G-MEDSS)©. Res Social Adm Pharm 2021; 18:3174-3183. [PMID: 34583897 DOI: 10.1016/j.sapharm.2021.09.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 09/12/2021] [Indexed: 01/23/2023]
Abstract
OBJECTIVES 1) To understand and investigate the experiences of accredited clinical pharmacists (ACP) using computerised clinical decision support systems (CCDSS) during medication reviews for older people, including those living with dementia; 2) To design, develop, validate, and evaluate a CCDSS that incorporates pharmacological and other deprescribing tools to aid person-centred management of high-risk medications in older adults living with and without dementia. METHODS This study consisted of three phases and was designed on scenario-based methodology: a) the development phase, which included an exploratory survey and prototype building; b) the validation phase, which included qualitative data collection and usability testing with ACPs, general practitioners (GPs) and carers for people living with dementia; and c) the evaluation phase, using mixed-methods analyses. RESULTS The exploratory survey found that ACPs required a flexible, and reliable CCDSS to support them with clinical decisions regarding high-risk medication use in older adults. The Goal-directed Medication review Electronic Decision Support System (G-MEDSS)© was developed and validated using quantitative and qualitative feedback received from ACPs, GPs and carers for people with dementia. The mean (SD) System Usability Scale score was 69.0 (12.9), which indicated fair-good usability. DISCUSSION AND CONCLUSIONS Involving end-users in the design process refined and improved the design of G-MEDSS, allowing for a person-centred and goal-directed delivery of pharmaceutical care. G-MEDSS allows healthcare practitioners conducting medication reviews for older adults living with and without dementia to tailor pharmaceutical care to meet their goals and preferences. Future studies may explore integration of G-MEDSS with prescribing or dispensing software.
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Affiliation(s)
- Lisa Kouladjian O'Donnell
- Departments of Clinical Pharmacology and Aged Care, Faculty of Medicine and Health, The University of Sydney, Kolling Institute, Royal North Shore Hospital, Sydney, New South Wales, Australia.
| | - Emily Reeve
- Departments of Clinical Pharmacology and Aged Care, Faculty of Medicine and Health, The University of Sydney, Kolling Institute, Royal North Shore Hospital, Sydney, New South Wales, Australia; Geriatric Medicine Research, Faculty of Medicine, and College of Pharmacy, Dalhousie University and Nova Scotia Health Authority, Halifax, Canada; Quality Use of Medicines and Pharmacy Research Centre, UniSA: Clinical and Health Science, University of South Australia, Adelaide, South Australia, Australia.
| | - Sarah N Hilmer
- Departments of Clinical Pharmacology and Aged Care, Faculty of Medicine and Health, The University of Sydney, Kolling Institute, Royal North Shore Hospital, Sydney, New South Wales, Australia.
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Thapaliya K, Harris ML, Byles JE. Polypharmacy trajectories among older women with and without dementia: A longitudinal cohort study. EXPLORATORY RESEARCH IN CLINICAL AND SOCIAL PHARMACY 2021; 3:100053. [PMID: 35480610 PMCID: PMC9031090 DOI: 10.1016/j.rcsop.2021.100053] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Revised: 07/02/2021] [Accepted: 08/03/2021] [Indexed: 11/29/2022] Open
Abstract
Background Objective Method Results Conclusion
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Affiliation(s)
- Kailash Thapaliya
- Research Centre for Generational Health and Ageing, University of Newcastle, Newcastle, NSW, Australia
- Hunter Medical Research Institute (HMRI), Newcastle, NSW, Australia
- Corresponding author at.: Research Centre for Generational Health and Ageing, HMRI, University of Newcastle, Newcastle, NSW, Australia.
| | - Melissa L. Harris
- Research Centre for Generational Health and Ageing, University of Newcastle, Newcastle, NSW, Australia
- Hunter Medical Research Institute (HMRI), Newcastle, NSW, Australia
| | - Julie E. Byles
- Research Centre for Generational Health and Ageing, University of Newcastle, Newcastle, NSW, Australia
- Hunter Medical Research Institute (HMRI), Newcastle, NSW, Australia
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Trenaman SC, Bowles SK, Kirkland SA, Andrew MK. Potentially Inappropriate Drug Duplication in a Cohort of Older Adults with Dementia. CURRENT THERAPEUTIC RESEARCH 2021; 95:100644. [PMID: 34589160 PMCID: PMC8458971 DOI: 10.1016/j.curtheres.2021.100644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Accepted: 08/23/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Concurrent use of 2 nonsteroidal anti-inflammatory drugs, selective serotonin reuptake inhibitors, loop diuretics, angiotensin-converting enzyme inhibitors, or anticoagulants is considered potentially inappropriate by Screening Tool of Older Persons' Prescriptions and Screening Tool to Alert to Right Treatment criteria. OBJECTIVE The objective was to examine drug duplication in a cohort of older adults with dementia. METHODS Cohort entry for Nova Scotia Seniors' Pharmacare Program beneficiaries was the date an International Classification of Diseases ninth edition or 10th edition code for dementia was recorded in accessed databases between March 1, 2005, and March 31, 2015. Medication dispensation and sociodemographic data were captured from the Nova Scotia Seniors' Pharmacare Program database between April 1, 2010, and March 31, 2015. Duplication was considered when 2 drugs from the same class were dispensed such that the supply in the patient's possession could overlap for more than 30 days. We reported number of cases of duplication and duration of overlap. Sex differences in drug duplication were assessed with bivariate logistic regression. RESULTS In the cohort of 28,953 Nova Scotia Seniors' Pharmacare Program beneficiaries with dementia, we documented concurrent use in 101 (1.7%) nonsteroidal anti-inflammatory drugs users (mean duration = 75.6 days), 95 (1.0%) selective serotonin reuptake inhibitors users (mean duration = 146.6 days), 5 (0.07%) loop diuretic users (mean duration = 530.6 days), 183 (2.0%) angiotensin-converting enzyme inhibitor users (mean duration = 123.9 days), and 160 (3.5%) anticoagulant users (mean duration = 63.6 days). Nonsteroidal anti-inflammatory drug pairs were most commonly celecoxib with naproxen or diclofenac. Selective serotonin reuptake inhibitors duplication was most commonly sertraline with citalopram. No sex differences in risk for drug duplication were identified. CONCLUSIONS Drug duplication was identified in a cohort of older adults with dementia and is a feasible target for intervention. (Curr Ther Res Clin Exp. 2021; 82:XXX-XXX).
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Affiliation(s)
- Shanna C. Trenaman
- Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Susan K. Bowles
- Nova Scotia Health, Halifax, Nova Scotia, Canada
- College of Pharmacy, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Susan A. Kirkland
- Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
- Department of Community Health and Epidemiology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Melissa K. Andrew
- Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
- Nova Scotia Health, Halifax, Nova Scotia, Canada
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Frahm N, Hecker M, Zettl U. Polypharmacy in chronic neurological diseases: Multiple sclerosis, dementia and Parkinson's disease. Curr Pharm Des 2021; 27:4008-4016. [PMID: 34323180 DOI: 10.2174/1381612827666210728102832] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Accepted: 07/02/2021] [Indexed: 11/22/2022]
Abstract
Polypharmacy is an important aspect of medication management and particularly affects elderly and chronically ill people. Patients with dementia, Parkinson's disease (PD) or multiple sclerosis (MS) are at high risk for multimedication due to their complex symptomatology. Our aim was to provide an overview of different definitions of polypharmacy and to present the current state of research on polypharmacy in patients with dementia, PD or MS. The most common definition of polypharmacy in the literature is the concomitant use of ≥5 medications (quantitative definition approach). Polypharmacy rates of up to >50% have been reported for patients with dementia, PD or MS, although MS patients are on average significantly younger than those with dementia or PD. The main predictor of polypharmacy is the complex symptom profile of these neurological disorders. Potentially inappropriate medication (PIM), drug-drug interactions, poor treatment adherence, severe disease course, cognitive impairment, hospitalisation, poor quality of life, frailty and mortality have been associated with polypharmacy in patients with dementia, PD or MS. For patients with polypharmacy, either the avoidance of PIM (selective deprescribing) or the substitution of PIM with more suitable drugs (appropriate polypharmacy) is recommended to achieve a more effective therapeutic management.
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Affiliation(s)
- Niklas Frahm
- Department of Neurology, Neuroimmunology Section, Rostock University Medical Center, Rostock, Germany
| | - Michael Hecker
- Department of Neurology, Neuroimmunology Section, Rostock University Medical Center, Rostock, Germany
| | - Uwe Zettl
- Department of Neurology, Neuroimmunology Section, Rostock University Medical Center, Rostock, Germany
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The inappropriate use of proton pump inhibitors and its associated factors among community-dwelling older adults. Heliyon 2021; 7:e07595. [PMID: 34337188 PMCID: PMC8313491 DOI: 10.1016/j.heliyon.2021.e07595] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 06/13/2021] [Accepted: 07/14/2021] [Indexed: 12/12/2022] Open
Abstract
Objectives Little is known about the inappropriate use of proton pump inhibitors (PPIs) and how mild cognitive impairment (MCI) and high comorbid burden relate to the inappropriate prescribing of PPIs. Therefore, the current study aimed to examine these associations among community-dwelling older adults in Jordan. Method This cross-sectional study was conducted on 215 community-dwelling older adults from three local healthcare centers located in Irbid, Jordan. Data about PPI use, including the name of medication, dose, frequency, duration, and indication, were collected retrospectively from a review of the participating older adults’ medication cards for November and December 2019. The collected data were evaluated based on the Food and Drug Administration (FDA) guidelines. MCI was measured using the Arabic version of the Montreal Cognitive Assessment, and comorbid burden was measured using the Cumulative Illness Rating Scale for Geriatrics. Results Forty-seven percent of the participants were found to have taken a PPI, with 68 % having taken one for a longer period than recommended by the FDA. Older adults with MCI or high comorbid burden were found to be more susceptible than other older adults to the long-term use of PPIs. The logistic regression revealed that MCI is a statistically significant predictor of inappropriate PPI use (p < 0.001). Conclusion Inappropriate PPI use is common among community-dwelling older adults in Jordan, with a significantly higher prevalence of inappropriate PPI use in people with MCI than in people with normal cognitive abilities. Future intervention studies are highly recommended to encourage optimal prescribing of PPIs for community-dwelling older adults.
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Borda MG, Castellanos-Perilla N, Tovar-Rios DA, Oesterhus R, Soennesyn H, Aarsland D. Polypharmacy is associated with functional decline in Alzheimer's disease and Lewy body dementia. Arch Gerontol Geriatr 2021; 96:104459. [PMID: 34225098 DOI: 10.1016/j.archger.2021.104459] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 05/28/2021] [Accepted: 06/09/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND In dementia, a number of factors may influence functional decline in addition to cognition. In this study, we aimed to study the potential association of the number of prescribed medications with functional decline trajectories over a five-year follow-up in people diagnosed with mild Alzheimer's disease (AD) or Lewy Body dementia (LBD). METHODS This is a longitudinal analysis of a Norwegian cohort study entitled "The Dementia Study of Western Norway". We included 196 patients newly diagnosed with AD (n=111) and LBD (n=85), followed annually for 5 years. We conducted linear mixed-effects models to analyse the association of the number of medications with functional decline measured by the Rapid Disability Rating Scale - 2. RESULTS The mean prescribed medications at baseline was 4.18∓2.60, for AD 3.92∓2.51 and LBD 4.52∓2.70. The number of medications increased during the follow-up; at year five the mean for AD was 7.28∓4.42 and for LBD 8.11∓5.16. Using more medications was associated with faster functional decline in AD (Est 0.04, SE 0.01, p-value 0.003) and LBD (Est 0.08, SE 0.03, p-value 0.008) after adjusting for age, sex, comorbidity, neuropsychiatric symptoms, and cognition. For each medication added during the follow-up, functional trajectories worsened by 1% for AD and 2% for LBD. The number of medications was not associated with cognitive decline. CONCLUSION We found that higher number of medications was related to a faster functional decline, both in AD and LBD. With disease progression, there was an increase in the number of medications. Prescription in dementia should be carefully assessed, possibly improving the functional prognosis.
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Affiliation(s)
- Miguel Germán Borda
- Centre for Age-Related Medicine (SESAM), Stavanger University Hospital, Stavanger, Norway; Semillero de Neurociencias y Envejecimiento, Ageing Institute, Medical School, Pontificia Universidad Javeriana. Bogotá, Colombia; Faculty of Health Sciences, University of Stavanger, Stavanger, Norway.
| | - Nicolás Castellanos-Perilla
- Centre for Age-Related Medicine (SESAM), Stavanger University Hospital, Stavanger, Norway; Semillero de Neurociencias y Envejecimiento, Ageing Institute, Medical School, Pontificia Universidad Javeriana. Bogotá, Colombia
| | - Diego Alejandro Tovar-Rios
- Centre for Age-Related Medicine (SESAM), Stavanger University Hospital, Stavanger, Norway; Universidad Del Valle, Grupo de Investigación en Estadística Aplicada - INFERIR, Faculty of Engineering, Santiago De Cali, Valle Del Cauca, Colombia.; Universidad Del Valle, Prevención y Control de la Enfermedad Crónica - PRECEC, Faculty of Health, Santiago De Cali, Valle Del Cauca, Colombia
| | - Ragnhild Oesterhus
- Centre for Age-Related Medicine (SESAM), Stavanger University Hospital, Stavanger, Norway; The Hospital Pharmacy Enterprise of Western Norway, Bergen, Norway
| | - Hogne Soennesyn
- Centre for Age-Related Medicine (SESAM), Stavanger University Hospital, Stavanger, Norway
| | - Dag Aarsland
- Centre for Age-Related Medicine (SESAM), Stavanger University Hospital, Stavanger, Norway; Department of Old Age Psychiatry, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
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Vickers LE, Martinez AI, Wallem AM, Johnson C, Moga DC. Potentially Inappropriate Medication Use in Older Adults with Alzheimer's Disease and Related Dementias Living in the Community: A Cross-Sectional Analysis. Drugs Real World Outcomes 2021; 8:519-526. [PMID: 34114133 PMCID: PMC8605947 DOI: 10.1007/s40801-021-00265-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/22/2021] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND With the older adult population in the USA increasing, so is the population of those with Alzheimer's disease and related dementias (ADRD). Older adults are vulnerable to the effects of potentially inappropriate medications as established by the Beers Criteria; however, some medications continue to be prescribed against recommendations. OBJECTIVES Our objectives were to describe potentially inappropriate medication (PIM) use linked to cognitive impairment or decline (referred to as Cog-PIM) in older adults with and without ADRD and to investigate whether the odds of Cog-PIM report differ by ADRD status in ambulatory care (i.e., outpatient care) in the USA. METHODS A cross-sectional analysis was performed using a nationally representative sample of non-perioperative, office-based ambulatory care visits by adults aged ≥ 65 years in 2016 (n = 218,182,131). Data were collected from the National Ambulatory Medical Care Survey. Cog-PIMs were identified as defined in the 2015 Beers Criteria recommendations for medications that may be potentially inappropriate in older adults with cognitive impairment or dementia. ADRD status was determined by clinician report using free text, the ADRD flag, or the presence of a diagnosis code indicating dementia. Multivariable logistic regressions were used to estimate the odds of Cog-PIM use overall and by medication class. RESULTS In 2016, 2.1% (n = 4,651,563) of outpatient visits were made by older adults with ADRD, 33.2% of which reported at least one Cog-PIM. Anticholinergic Cog-PIMs were noted in 20.5% of ADRD visits compared with 8.1% of non-ADRD visits. Antipsychotic PIMs were noted in 15.5% of ADRD visits compared with 0.8% of non-ADRD visits. Benzodiazepine and non-benzodiazepine receptor agonist hypnotic (Z drug) Cog-PIMs were reported in 10.9% of ADRD visits and 10.7% of non-ADRD visits. ADRD status was a significant predictor of Cog-PIM report overall (adjusted odds ratio [aOR] 2.74 [95% confidence interval {CI} 1.20-6.27]) and for anticholinergics and antipsychotics specifically (aOR 3.35 [95% CI 1.24-9.03] and aOR 22.80 [95% CI 5.80-89.50], respectively). CONCLUSION This study demonstrated a high prevalence of Cog-PIM use and increased odds of Cog-PIM use in older adults with ADRD. Future work should investigate opportunities in the ambulatory care setting for safer prescribing and de-escalation of Cog-PIMs.
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Affiliation(s)
| | | | | | - Clare Johnson
- University of Kentucky College of Pharmacy, Lexington, KY, USA
| | - Daniela C Moga
- University of Kentucky College of Pharmacy, Lexington, KY, USA. .,University of Kentucky College of Public Health, Lexington, KY, USA. .,University of Kentucky Institute for Pharmaceutical Outcomes and Policy, Lexington, KY, USA. .,Sanders-Brown Center on Aging, Lexington, KY, USA.
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Growdon ME, Gan S, Yaffe K, Steinman MA. Polypharmacy among older adults with dementia compared with those without dementia in the United States. J Am Geriatr Soc 2021; 69:2464-2475. [PMID: 34101822 DOI: 10.1111/jgs.17291] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 04/27/2021] [Accepted: 05/01/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND/OBJECTIVES In older persons with dementia (PWD), extensive medication use is often unnecessary, discordant with goals of care, and possibly harmful. The objective of this study was to determine the prevalence and medication constituents of polypharmacy among older PWD attending outpatient visits in the United States. DESIGN Cross-sectional analysis. SETTING AND PARTICIPANTS PWD and persons without dementia (PWOD) aged ≥65 years attending outpatient visits recorded in the nationally representative National Ambulatory Medical Care Survey (NAMCS), 2014-2016. MEASUREMENTS PWD were identified as those with a diagnosis of dementia on the NAMCS encounter form and/or those receiving an anti-dementia medication. Visits with PWD and PWOD were compared in terms of sociodemographic, practice/physician factors, comorbidities, and prescribing outcomes. Regression analyses examined the effect of dementia diagnosis on contributions by clinically relevant medication categories to polypharmacy (defined as being prescribed ≥5 prescription and/or nonprescription medications). RESULTS The unweighted sample involved 918 visits for PWD and 26,543 visits for PWOD, representing 29.0 and 780 million outpatient visits. PWD had a median age of 81 and on average had 2.8 comorbidities other than dementia; 63% were female. The median number of medications in PWD was eight compared with three in PWOD (p < 0.001). After adjustment, PWD had significantly higher odds of being prescribed ≥5 medications (AOR 3.0; 95% CI: 2.1-4.3) or ≥10 medications (AOR 2.8; 95% CI: 2.0-4.2) compared with PWOD. The largest sources of medications among PWD were cardiovascular and central nervous system medications; usage from other categories was generally elevated in PWD compared with PWOD. PWD had higher odds of receiving at least one highly sedating or anticholinergic medication (AOR 2.5; 95% CI: 1.6-3.9). CONCLUSION In a representative sample of outpatient visits, polypharmacy was extremely common among PWD, driven by a wide array of medication categories. Addressing polypharmacy in PWD will require cross-cutting and multidisciplinary approaches.
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Affiliation(s)
- Matthew E Growdon
- Division of Geriatrics, University of California, San Francisco, California, USA.,San Francisco VA Medical Center, San Francisco, California, USA
| | - Siqi Gan
- Division of Geriatrics, University of California, San Francisco, California, USA.,San Francisco VA Medical Center, San Francisco, California, USA
| | - Kristine Yaffe
- San Francisco VA Medical Center, San Francisco, California, USA.,Departments of Neurology, Psychiatry, and Epidemiology and Biostatistics, University of California, San Francisco, California, USA
| | - Michael A Steinman
- Division of Geriatrics, University of California, San Francisco, California, USA.,San Francisco VA Medical Center, San Francisco, California, USA
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Patient- and Prescriber-Related Factors Associated with Potentially Inappropriate Medications and Drug-Drug Interactions in Older Adults. J Clin Med 2021; 10:jcm10112305. [PMID: 34070618 PMCID: PMC8198936 DOI: 10.3390/jcm10112305] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 05/15/2021] [Accepted: 05/21/2021] [Indexed: 01/25/2023] Open
Abstract
We aimed to evaluate the prevalence of potentially inappropriate medication (PIM) use and drug–drug interactions (DDIs) in older adults and their associated factors. This cross-sectional study used National Health Insurance data of older adults in South Korea. The 2015 AGS Beers Criteria were used to classify PIM use and DDIs. The associations of PIM use and DDIs with patient- and prescriber-related factors were evaluated using multiple logistic regression. Of the older adults who received at least one outpatient prescription (N = 1,277,289), 73.0% and 13.3% received one or more prescriptions associated with PIM use or DDIs, respectively. Chlorphenamine was most commonly associated with PIM, followed by diazepam. Co-prescriptions of corticosteroids and NSAIDs accounted for 82.8% of DDIs. Polypharmacy and mainly visiting surgeons or neurologists/psychiatrists were associated with a higher likelihood of prescriptions associated with PIM use or DDIs. Older age, high continuity of care (COC), and mainly visiting a hospital were associated with a lower likelihood of PIM use or DDIs. Prescriptions associated with PIM use and DDIS were more frequent for low COC patients or those who mainly visited clinics; therefore, patients with these characteristics are preferred intervention targets for reducing prescriptions associated with PIM use and DDIs.
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Sawan MJ, Wennekers D, Sakiris M, Gnjidic D. Interventions at Hospital Discharge to Guide Caregivers in Medication Management for People Living with Dementia: a Systematic Review. J Gen Intern Med 2021; 36:1371-1379. [PMID: 33537953 PMCID: PMC8131426 DOI: 10.1007/s11606-020-06442-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 12/10/2020] [Indexed: 01/17/2023]
Abstract
BACKGROUND Hospital discharge has a significant impact on the continuity of care for people living with dementia. Clear guidance on medication management should be provided to caregivers of people living with dementia to ensure appropriate use of medications post-discharge. AIM Identify and appraise the impact of interventions at hospital discharge to guide caregivers in the medication management for people living with dementia. METHOD A systematic search of original studies was performed in Medline, Embase, PsycINFO, and CINAHL. Articles published in English that reported on interventions to guide caregivers in medication management for people living with dementia were included. Two authors independently reviewed titles and abstract. Full-text articles were assessed for eligibility and quality assessment was conducted by two authors. RESULTS A total of five studies were included with a range of interventions that were typically delivered post-discharge by a multidisciplinary team and most targeted administration of medications by caregivers. Overall, three types of discharge interventions were identified including a pre-discharge caregiver educational intervention, a post-discharge multidisciplinary team intervention, and discharge summary documentation intervention at transitions of care. Of these, a pre-discharge caregiver education led to shorter hospital stay (25 days vs. 31 days, p = 0.005). A post-discharge intervention that included follow-up visits resulted in lower use of high-risk medications (19% vs. 40%), and reduction in 30-day re-hospitalization rates (11% vs. 20%). In contrast, in another post-discharge intervention study, no difference in one-month re-hospitalization rates (8.4% vs. 8.0%, p = 0.82) was demonstrated. In another study, a post-discharge hospital educational program provided to caregivers led to significantly reduced caregiver burden (31.7 ± 17.6 (SD) pre-intervention to 27.7 ± 16.9 (SD) post-intervention (p = 0.037)). DISCUSSION Current findings suggest there is a need for well-designed interventions to guide caregivers in all aspects of medication management for people living with dementia, and should include support for caregivers in care coordination.
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Affiliation(s)
- Mouna J Sawan
- School of Pharmacy School, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia.
| | - Damian Wennekers
- School of Pharmacy, Faculty of Science, University of Utrecht, Utrecht, The Netherlands
| | - Marissa Sakiris
- School of Pharmacy School, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia
| | - Danijela Gnjidic
- School of Pharmacy School, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia
- Charles Perkins Centre, The University of Sydney, Camperdown, NSW, Australia
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Sharma R, Bansal P, Sharma A, Chhabra M, Bansal N, Arora M. Clonazepam tops the list of potentially inappropriate psychotropic (PIP) medications in older adults with psychiatric illness: A cross-sectional study based on Beers criteria 2019 vs STOPP criteria 2015. Asian J Psychiatr 2021; 58:102570. [PMID: 33618072 DOI: 10.1016/j.ajp.2021.102570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 12/27/2020] [Accepted: 01/06/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND In older adults, polypharmacy and potentially inappropriate psychotropic (PIP) medication use are prominent prescription challenges. However, there is limited information available on the use of PIP medication in older adults having psychiatry illness. OBJECTIVE To find out the most commonly prescribed PIP in tertiary care hospitals of developing countries with respect to Beers criteria 2019 and Screening Tool of Older Persons' Potentially Inappropriate Prescriptions (STOPP) and predictors of PIP. METHODS A cross-sectional analysis of 456 patients of either sex with a median age of 65 years visiting the outpatient department of psychiatry was performed at the tertiary care hospital of North India with respect to Beers criteria 2019 and STOPP criteria 2015. Bivariate logistic regression was used to figure out the predictors of PIP medication. RESULTS Results of the study reflects a staggering number of older adults, (more than 91 % and 73 %) out of total 456 patients were prescribed with at least one PIP medication as per Beers criteria and STOPP criteria, respectively. Long-acting benzodiazepine like clonazepam, chlordiazepoxide were identified as one of the most commonly prescribed PIP medications with respect to the both set of criteria. Further analysis revealed that polypharmacy (≥5 medications with odds Ratio (OR) 17.33, 95% Confidence Interval (CI) 1.42-210.66, P-0.025) as the sole important predictor for PIP medication. CONCLUSION According to the Beers criterion and the STOPP criteria, the use of PIP medicine is very prevalent among older adults with psychiatric illness. The Beers criteria dramatically diagnose more PIP medication than STOPP criteria.
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Affiliation(s)
- Rishabh Sharma
- Department of Pharmacy Practice, Indo-Soviet Friendship College of Pharmacy, Moga, Punjab, 142001, India.
| | - Parveen Bansal
- University Centre of Excellence in Research, Baba Farid University of Health Sciences, Faridkot, Punjab, 151203, India.
| | - Arvind Sharma
- Department of Psychiatry, Guru Gobind Singh Medical College and Hospital, Faridkot, Punjab, 151203, India.
| | - Manik Chhabra
- Department of Pharmacy Practice, Indo-Soviet Friendship College of Pharmacy, Moga, Punjab, 142001, India.
| | - Nahush Bansal
- University Centre of Excellence in Research, Baba Farid University of Health Sciences, Faridkot, Punjab, 151203, India.
| | - Malika Arora
- Indian Council of Medical Research Scientist-l, Multidisciplinary Research Unit (Department of Health Research, Government of India), Guru Gobind Singh Medical College, Faridkot, Punjab, 151203, India.
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Seifert J, Fay B, Strueven NT, Schiekofer S, Wenzel-Seifert K, Haen E. [Adverse Drug Reactions in Geriatric Psychiatric Patients - Influence of Potentially Inappropriate Drugs]. PSYCHIATRISCHE PRAXIS 2021; 49:37-45. [PMID: 33773503 DOI: 10.1055/a-1394-2412] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE The purpose of this study was to examine the extent to which "potentially inappropriate drugs" (PID) are associated with an increased risk for adverse drug reactions (ADR). METHODS Data from 304 geriatric psychiatric inpatients was collected. Medical documentation was used to find indications of ADRs. Causal relationship between the ADR and the prescribed drugs was assessed by experts. RESULTS Almost 30 % of patients received ≥ 1 PID before admission to hospital, in comparison to 22 % at discharge. Increasing number of total prescriptions and the diagnosis of schizophrenia resulted in an increased risk for receiving ≥ 1 PID. Higher age and dementia were protective factors. Patients receiving ≥ 1 PID had a 5-fold increased risk of experiencing ≥ 1 ADR. Risk for an ADR increased with number of PID prescriptions. Patients treated with ≥ 1 PID had a 4-fold increased risk of experiencing severe ADRs. Risk for severe ADRs was 10-fold higher in patients treated with ≥ 2 PIDs. CONCLUSION The PRISCUS list predicts significant risk factors for the occurrence of ADRs in the geriatric psychiatric setting.
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Affiliation(s)
- Johanna Seifert
- Klinik für Psychiatrie und Psychotherapie, Bezirksklinikum Regensburg, Deutschland.,Klinik für Psychiatrie, Psychotherapie und Sozialpsychiatrie, Medizinische Hochschule Hannover, Deutschland
| | - Bianca Fay
- Klinik für Psychiatrie und Psychotherapie, Bezirksklinikum Regensburg, Deutschland
| | - Nina Theresa Strueven
- Klinik für Psychiatrie und Psychotherapie, Bezirksklinikum Regensburg, Deutschland.,Klinik für Psychiatrie und Psychotherapie, kbo-Inn-Salzach-Klinikum GmbH, Wasserburg am Inn, Deutschland
| | - Stephan Schiekofer
- Klinik für Psychiatrie und Psychotherapie, Bezirksklinikum Regensburg, Deutschland
| | | | - Ekkehard Haen
- Klinik für Psychiatrie und Psychotherapie, Bezirksklinikum Regensburg, Deutschland
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Shibasaki K, Asahi T, Kuribayashi M, Tajima Y, Marubayashi M, Iwama R, Akishita M, Ogawa S. Potential prescribing omissions of anti-osteoporosis drugs is associated with rehabilitation outcomes after fragility fracture: Retrospective cohort study. Geriatr Gerontol Int 2021; 21:386-391. [PMID: 33641245 DOI: 10.1111/ggi.14145] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Revised: 01/11/2021] [Accepted: 02/14/2021] [Indexed: 12/18/2022]
Abstract
AIM We investigated the association between rehabilitation outcomes and polypharmacy, potentially inappropriate medications and potential prescribing omissions in older adults with fragility fractures. METHODS In total, we registered 217 older adults with fragility fractures (hip or vertebral) retrospectively and examined the association between rehabilitation outcome and polypharmacy, potentially inappropriate medications and potential prescribing omissions. Polypharmacy was defined as five or more drugs. Potentially inappropriate medications and potential prescribing omissions were defined by the Beers criteria (2015) and the screening tool to alert to treatment criteria version 2, respectively. The outcome was functional independence measure gain (functional independence measure at discharge - functional independence measure at admission). RESULTS Multiple regression analyses revealed no association between functional independence measure gain and polypharmacy (crude: β = 0.058, P = 0.858; adjusted model: β = 0.013, P = 0.869) or potentially inappropriate medications (crude: β = 0.100, P = 0.144; adjusted model: β = 0.084, P = 0.260). However, there was a significant association between functional independence measure gain and potential prescribing omissions (crude: β = 0.167, P = 0.014; adjusted model: β = 0.180, P = 0.016). Participants without potential prescribing omissions (in other words, participants who were prescribed anti-osteoporosis drugs) had a greater functional independence measure gain than participants with potential prescribing omissions (in other words, those that were not prescribed anti-osteoporosis drugs). CONCLUSION To the best of our knowledge, this study is the first to report that participants without potential prescribing omissions had significantly improved rehabilitation outcomes. Geriatr Gerontol Int 2021; 21: 386-391.
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Affiliation(s)
- Koji Shibasaki
- Department of Rehabilitation Medicine, Asahi Neurology and Rehabilitation Hospital, Matsudo City, Japan.,Department of Geriatric Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Toshiomi Asahi
- Department of Rehabilitation Medicine, Asahi Neurology and Rehabilitation Hospital, Matsudo City, Japan
| | - Mari Kuribayashi
- Department of Rehabilitation Medicine, Asahi Neurology and Rehabilitation Hospital, Matsudo City, Japan
| | - Yuriko Tajima
- Department of Rehabilitation Medicine, Asahi Neurology and Rehabilitation Hospital, Matsudo City, Japan
| | - Miki Marubayashi
- Department of Rehabilitation Medicine, Asahi Neurology and Rehabilitation Hospital, Matsudo City, Japan
| | - Risa Iwama
- Department of Rehabilitation Medicine, Asahi Neurology and Rehabilitation Hospital, Matsudo City, Japan
| | - Masahiro Akishita
- Department of Geriatric Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Sumito Ogawa
- Department of Geriatric Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
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Delgado J, Jones L, Bradley MC, Allan LM, Ballard C, Clare L, Fortinsky RH, Hughes CM, Melzer D. Potentially inappropriate prescribing in dementia, multi-morbidity and incidence of adverse health outcomes. Age Ageing 2021; 50:457-464. [PMID: 32946561 DOI: 10.1093/ageing/afaa147] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Indexed: 01/09/2023] Open
Abstract
IMPORTANCE treatment of dementia in individuals with comorbidities is complex, leading to potentially inappropriate prescribing (PIP). The impact of PIP in this population is unknown. OBJECTIVE to estimate the rate of PIP and its effect on adverse health outcomes (AHO). DESIGN retrospective cohort. SETTING primary care electronic health records linked to hospital discharge data from England. SUBJECTS 11,175 individuals with dementia aged over 65 years in 2016 and 43,463 age- and sex-matched controls. METHODS Screening Tool of Older Persons' Prescriptions V2 defined PIP. Logistic regression tested associations with comorbidities at baseline, and survival analyses risk of incident AHO, adjusted for age, gender, deprivation and 14 comorbidities. RESULTS the dementia group had increased risk of PIP (73% prevalence; odds ratio [OR]: 1.92; confidence interval [CI]: 83-103%; P < 0.01) after adjusting for comorbidities. Most frequent PIP criteria were related to anti-cholinergic drugs and therapeutic duplication. Risk of PIP was higher in patients also diagnosed with coronary-heart disease (odds OR: 2.17; CI: 1.91-2.46; P < 0.01), severe mental illness (OR: 2.09; CI: 1.62-2.70; P < 0.01); and depression (OR: 1.81; CI: 1.62-2.01; P < 0.01). During follow-up (1 year), PIP was associated with increased all-cause mortality (hazard ratio: 1.14; CI: 1.02-1.26; P < 0.02), skin ulcer and pressure sores (hazard ratio: 1.66; CI: 1.12-2.46; P < 0.01), falls (hazard ratio: 1.37; CI: 1.15-1.63; P < 0.01), anaemia (hazard ratio: 1.61; CI: 1.10-2.38; P < 0.02) and osteoporosis (hazard ratio: 1.62; CI: 1.02-2.57; P < 0.04). CONCLUSION patients with dementia frequently receive PIPs, and those who do are more likely to experience AHO. These results highlight the need to optimise medication in dementia patients, especially those with comorbidities.
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Affiliation(s)
- João Delgado
- Epidemiology and Public Health, College of Medicine and Health, University of Exeter, Exeter EX1 2LU, UK
| | - Lindsay Jones
- Epidemiology and Public Health, College of Medicine and Health, University of Exeter, Exeter EX1 2LU, UK
| | - Marie C Bradley
- Office of Surveillance and Epidemiology, Center for Drug Evaluation and Research, US Food and Drug Administration, Silver Spring, MD 20993, USA
| | - Louise M Allan
- Centre for Research in Ageing and Cognitive Health, College of Medicine and Health, University of Exeter, Exeter EX1 2LU, UK
| | - Clive Ballard
- Epidemiology and Public Health, College of Medicine and Health, University of Exeter, Exeter EX1 2LU, UK
| | - Linda Clare
- Centre for Research in Ageing and Cognitive Health, College of Medicine and Health, University of Exeter, Exeter EX1 2LU, UK
| | - Richard H Fortinsky
- University of Connecticut, School of Medicine, Center on Aging, Mansfield, CT 06030-5215, USA
| | - Carmel M Hughes
- School of Pharmacy, Queen’s University Belfast, Belfast, Medical Biology Centre, Belfast BT9 7BL, UK
| | - David Melzer
- Epidemiology and Public Health, College of Medicine and Health, University of Exeter, Exeter EX1 2LU, UK
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Kristensen RU, Jensen-Dahm C, Gasse C, Waldemar G. Declining Use of Potentially Inappropriate Medication in People with Dementia from 2000 to 2015: A Repeated Cross-Sectional Nationwide Register-Based Study. J Alzheimers Dis 2021; 79:1459-1470. [PMID: 33459711 PMCID: PMC7990423 DOI: 10.3233/jad-200627] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/30/2020] [Indexed: 11/16/2022]
Abstract
BACKGROUND Studies have shown declining use of potentially inappropriate medication (PIM), medication where risks associated with use outweigh potential benefits in older people. However, the trend in people with dementia remains unknown. OBJECTIVE To test the hypothesis that the use of PIM has decreased in people with dementia in line with the declining use in the general older population. METHODS Repeated cross-sectional register-based study of the entire Danish population aged ≥65 years (2000: N = 802,106; 2015: N = 1,056,476). PIM was identified using the Danish "Red-yellow-green list". Changes in the use of PIM were examined by calculating the annual prevalence of filling prescriptions for at least one PIM in older people with and without dementia. Characteristics of the study population were examined annually including comorbidity. RESULTS From 2000 to 2015, the prevalence of PIM use decreased from 54.7%to 43.5%in people with dementia and from 39.5%to 28.8%in people without dementia; the decrease was significant across all age groups and remained so in a sensitivity analysis where antipsychotics were removed. During the same period, comorbidity scores increased in people with and without dementia. CONCLUSION The declining use of PIM in people with dementia from 2000 to 2015 parallels the trend in the general older population. The use of PIM decreased despite increasing levels of comorbidity and was not solely attributable to the decreasing use of antipsychotics in people with dementia. However, PIM use remained more widespread in people with dementia who may be more vulnerable to the risks associated with PIM.
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Affiliation(s)
- Rachel Underlien Kristensen
- Danish Dementia Research Centre (DDRC), Department of Neurology, Rigshospitalet, University of Copenhagen, Copenhagen Ø, Denmark
| | - Christina Jensen-Dahm
- Danish Dementia Research Centre (DDRC), Department of Neurology, Rigshospitalet, University of Copenhagen, Copenhagen Ø, Denmark
| | - Christiane Gasse
- Department of Affective Disorders, Aarhus University Hospital, Psychiatry, Aarhus N, Denmark
- Psychosis Research Unit, Aarhus University Hospital, Psychiatry, Aarhus N, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus C, Denmark
| | - Gunhild Waldemar
- Danish Dementia Research Centre (DDRC), Department of Neurology, Rigshospitalet, University of Copenhagen, Copenhagen Ø, Denmark
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Gan J, Wang M, Liu S, Chen Z, Wang XD, Ji Y. Effect of Multiple Medicines on Dementia Initial Treatment: Experience and Thinking. Am J Alzheimers Dis Other Demen 2021; 36:15333175211053134. [PMID: 34841902 PMCID: PMC10581110 DOI: 10.1177/15333175211053134] [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] [Indexed: 01/19/2023]
Abstract
Little is known about multiple medicines and initial therapy among people with dementia. To examine the effect of multiple medicines on the initiation of anti-dementia therapy in patients diagnosed with cognitive impairment (CI), a retrospective study with 2742 CI patients was conducted based on the outpatients' medical records. The dementias receiving 1-2 drugs were more likely to be prescribed with anti-dementia (one drug: OR = 1.877; two drugs: OR = 1.770) and psychotropic (one drug: OR = 1.980) treatment, whereas had lower chances of receiving psychotropic medication with the combinations of more than three drugs (Alzheimer's disease: OR = .365; vascular dementia: OR = .940; frontotemporal lobe degeneration: OR = .957; and dementia with Lewy bodies/Parkinson's disease dementia: OR = .952). Multiple medicines can affect anti-dementia therapy initiation in dementia patients and should be paid extreme caution.
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Affiliation(s)
- Jinghuan Gan
- Department of Neurology, Beijing Tiantan Hospital Affiliated to Capital Medical University, Beijing, China
| | - Meng Wang
- First Teaching Hospital of Tianjin, University Traditional Chinese Medicine, Tianjin, China
| | - Shuai Liu
- Tianjin Key Laboratory of Cerebrovascular and of Neurodegenerative Diseases, Tianjin Dementia Institute, Department of Neurology, Tianjin Huanhu Hospital, Tianjin, China
| | - Zhichao Chen
- Department of Neurology, Beijing Tiantan Hospital Affiliated to Capital Medical University, Beijing, China
| | - Xiao-Dan Wang
- Tianjin Key Laboratory of Cerebrovascular and of Neurodegenerative Diseases, Tianjin Dementia Institute, Department of Neurology, Tianjin Huanhu Hospital, Tianjin, China
| | - Yong Ji
- Department of Neurology, Beijing Tiantan Hospital Affiliated to Capital Medical University, Beijing, China
- Tianjin Key Laboratory of Cerebrovascular and of Neurodegenerative Diseases, Tianjin Dementia Institute, Department of Neurology, Tianjin Huanhu Hospital, Tianjin, China
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46
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Eshetie TC, Roberts G, Nguyen TA, Gillam MH, Maher D, Kalisch Ellett LM. Potentially inappropriate medication use and related hospital admissions in aged care residents: The impact of dementia. Br J Clin Pharmacol 2020; 86:2414-2423. [PMID: 32374041 PMCID: PMC7688547 DOI: 10.1111/bcp.14345] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Revised: 04/10/2020] [Accepted: 04/28/2020] [Indexed: 02/06/2023] Open
Abstract
AIMS To determine the prevalence of potentially inappropriate medication (PIM) use at hospital admission and discharge, and the contribution to hospital admission among residential aged care facility residents with and without dementia. METHODS We conducted a secondary analysis using data from a multihospital prospective cohort study involving consecutively admitted older adults, aged 75 years or older, who were taking 5 or more medications prior to hospital admission and discharged to a residential aged care facility in South Australia. PIM use was identified using the 2015 Screening Tool for Older Persons' Prescription and 2019 Beers criteria. An expert panel of clinicians with geriatric medicine expertise evaluated the contribution of PIM to hospital admission. RESULTS In total, 181 participants were included, the median age was 87.5 years and 54.7% were female. Ninety-one (50.3%) had a diagnosis of dementia. Participants with dementia had fewer PIMs, according to at least 1 of the 2 screening criteria, than those without dementia, at admission (dementia: 76 [83.5%] vs no dementia: 84 [93.3%], P = .04) and discharge (78 [85.7%] vs 83 [92.2%], P = .16). PIM use was causal or contributory to the admission in 28.1% of study participants (n = 45) who were taking at least 1 PIM at admission. CONCLUSIONS Over 80% of acutely admitted older adults took PIMs at hospital admission and discharge and for over a quarter of these people the admissions were attributable to PIM use. Hospitalisation presents an opportunity for comprehensive medication reviews, and targeted interventions that enhance such a process could reduce PIM use and related harm.
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Affiliation(s)
- Tesfahun C. Eshetie
- Quality Use of Medicines and Pharmacy Research CentreSchool of Pharmacy and Medical Sciences, University of South AustraliaAdelaideSouth AustraliaAustralia
| | - Greg Roberts
- Pharmacy Department, Flinders Medical CentreBedford ParkSouth AustraliaAustralia
| | - Tuan A. Nguyen
- Quality Use of Medicines and Pharmacy Research CentreSchool of Pharmacy and Medical Sciences, University of South AustraliaAdelaideSouth AustraliaAustralia
| | - Marianne H. Gillam
- Quality Use of Medicines and Pharmacy Research CentreSchool of Pharmacy and Medical Sciences, University of South AustraliaAdelaideSouth AustraliaAustralia
| | - Dorsa Maher
- Pharmacy Department, Flinders Medical CentreBedford ParkSouth AustraliaAustralia
- School of Pharmacy and Medical Science, University of South AustraliasAdelaideSouth AustraliaAustralia
| | - Lisa M. Kalisch Ellett
- Quality Use of Medicines and Pharmacy Research CentreSchool of Pharmacy and Medical Sciences, University of South AustraliaAdelaideSouth AustraliaAustralia
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47
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Kouladjian O'Donnell L, Gnjidic D, Sawan M, Reeve E, Kelly PJ, Chen TF, Bell JS, Hilmer SN. Impact of the Goal-directed Medication Review Electronic Decision Support System on Drug Burden Index: A cluster-randomised clinical trial in primary care. Br J Clin Pharmacol 2020; 87:1499-1511. [PMID: 32960464 DOI: 10.1111/bcp.14557] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 08/06/2020] [Accepted: 08/21/2020] [Indexed: 01/14/2023] Open
Abstract
AIMS The Goal-directed Medication Review Electronic Decision Support System (G-MEDSS) assesses and reports a patient's goals, attitudes to deprescribing and Drug Burden Index (DBI) score, a measure of cumulative exposure to anticholinergic and sedative medications. This study evaluated the effect of implementing G-MEDSS in home medicines reviews (HMRs) on DBI exposure and clinical outcomes. METHODS A cluster-randomised clinical trial was performed across Australia. Accredited clinical pharmacists were randomised into intervention (G-MEDSS with usual care HMR) or comparison groups (usual care HMR alone). Patients were recruited by pharmacists from those routinely referred by general practitioners for HMR. The primary outcome was the proportion of patients with any reduction in DBI at 3-months follow-up. Secondary outcomes included change in DBI continuous score at 3-months, HMR recommendations to change DBI and clinical outcomes. RESULTS There were 201 patient participants at baseline (n = 88 intervention, n = 113 comparison), with 159 followed-up at 3-months (n = 63 intervention, n = 96 comparison). The proportion of patients with a reduction in DBI was not significantly different at 3-months (intervention 17%, comparison 11%; adjusted odds ratio 1.44, 95% confidence interval 0.56-3.80). Regarding secondary outcomes, there was no difference in change in DBI score at 3-months. However, the HMR report made recommendations to reduce DBI for a significantly greater proportion of patients in the intervention than in the comparison group (intervention 37%, comparison 14%; adjusted odds ratio 3.20, 95% confidence interval 1.50-6.90). No changes were observed in clinical outcomes. CONCLUSION Implementation of G-MEDSS within HMR did not reduce patients' DBI at 3 months compared with usual care HMR.
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Affiliation(s)
- Lisa Kouladjian O'Donnell
- NHMRC Cognitive Decline Partnership Centre, Northern Clinical School, Faculty of Medicine and Health, The University of Sydney, St Leonards, New South Wales, Australia.,Departments of Clinical Pharmacology and Aged Care, Kolling Institute of Medical Research, Royal North Shore Hospital, St Leonards, New South Wales, Australia
| | - Danijela Gnjidic
- Sydney Pharmacy School, Faculty of Medicine and Health, The University of Sydney, New South Wales, Australia.,Charles Perkins Centre, The University of Sydney, Sydney, New South Wales, Australia
| | - Mouna Sawan
- NHMRC Cognitive Decline Partnership Centre, Northern Clinical School, Faculty of Medicine and Health, The University of Sydney, St Leonards, New South Wales, Australia.,Departments of Clinical Pharmacology and Aged Care, Kolling Institute of Medical Research, Royal North Shore Hospital, St Leonards, New South Wales, Australia
| | - Emily Reeve
- NHMRC Cognitive Decline Partnership Centre, Northern Clinical School, Faculty of Medicine and Health, The University of Sydney, St Leonards, New South Wales, Australia.,Departments of Clinical Pharmacology and Aged Care, Kolling Institute of Medical Research, Royal North Shore Hospital, St Leonards, New South Wales, Australia.,Geriatric Medicine Research, Faculty of Medicine, and College of Pharmacy, Dalhousie University and Nova Scotia Health Authority, Halifax, Nova Scotia, Canada.,Quality Use of Medicines and Pharmacy Research Centre, UniSA: Clinical and Health Sciences, University of South Australia, Adelaide, South Australia, Australia
| | - Patrick J Kelly
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Timothy F Chen
- Sydney Pharmacy School, Faculty of Medicine and Health, The University of Sydney, New South Wales, Australia
| | - J Simon Bell
- NHMRC Cognitive Decline Partnership Centre, Northern Clinical School, Faculty of Medicine and Health, The University of Sydney, St Leonards, New South Wales, Australia.,Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, Victoria, Australia.,School of Public Health and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
| | - Sarah N Hilmer
- NHMRC Cognitive Decline Partnership Centre, Northern Clinical School, Faculty of Medicine and Health, The University of Sydney, St Leonards, New South Wales, Australia.,Departments of Clinical Pharmacology and Aged Care, Kolling Institute of Medical Research, Royal North Shore Hospital, St Leonards, New South Wales, Australia
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48
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Frederiksen KS, Cooper C, Frisoni GB, Frölich L, Georges J, Kramberger MG, Nilsson C, Passmore P, Mantoan Ritter L, Religa D, Schmidt R, Stefanova E, Verdelho A, Vandenbulcke M, Winblad B, Waldemar G. A European Academy of Neurology guideline on medical management issues in dementia. Eur J Neurol 2020; 27:1805-1820. [PMID: 32713125 PMCID: PMC7540303 DOI: 10.1111/ene.14412] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 06/12/2020] [Accepted: 06/13/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND AND PURPOSE Dementia is one of the most common disorders and is associated with increased morbidity, mortality and decreased quality of life. The present guideline addresses important medical management issues including systematic medical follow-up, vascular risk factors in dementia, pain in dementia, use of antipsychotics in dementia and epilepsy in dementia. METHODS A systematic review of the literature was carried out. Based on the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) framework, we developed a guideline. Where recommendations based on GRADE were not possible, a good practice statement was formulated. RESULTS Systematic management of vascular risk factors should be performed in patients with mild to moderate dementia as prevention of cerebrovascular pathology may impact on the progression of dementia (Good Practice statement). Individuals with dementia (without previous stroke) and atrial fibrillation should be treated with anticoagulants (weak recommendation). Discontinuation of opioids should be considered in certain individuals with dementia (e.g. for whom there are no signs or symptoms of pain or no clear indication, or suspicion of side effects; Good Practice statement). Behavioral symptoms in persons with dementia should not be treated with mild analgesics (weak recommendation). In all patients with dementia treated with opioids, assessment of the individual risk-benefit ratio should be performed at regular intervals. Regular, preplanned medical follow-up should be offered to all patients with dementia. The setting will depend on the organization of local health services and should, as a minimum, include general practitioners with easy access to dementia specialists (Good Practice statement). Individuals with dementia and agitation and/or aggression should be treated with atypical antipsychotics only after all non-pharmacological measures have been proven to be without benefit or in the case of severe self-harm or harm to others (weak recommendation). Antipsychotics should be discontinued after cessation of behavioral disturbances and in patients in whom there are side effects (Good Practice statement). For treatment of epilepsy in individuals with dementia, newer anticonvulsants should be considered as first-line therapy (Good Practice statement). CONCLUSION This GRADE-based guideline offers recommendations on several important medical issues in patients with dementia, and thus adds important guidance for clinicians. For some issues, very little or no evidence was identified, highlighting the importance of further studies within these areas.
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Affiliation(s)
- K. S. Frederiksen
- Department of NeurologyDanish Dementia Research CenterRigshospitaletUniversity of CopenhagenCopenhagenDenmark
| | - C. Cooper
- Department of Clinical Educational and Health PsychologyUniversity College LondonLondonUK
| | - G. B. Frisoni
- Memory ClinicUniversity Hospital of GenevaUniversity of GenevaGenevaSwitzerland
| | - L. Frölich
- Department of Geriatric PsychiatryZentralinstitut für Seelische Gesundheit MannheimMedical Faculty MannheimUniversity of HeidelbergMannheimGermany
| | | | - M. G. Kramberger
- Department of NeurologyCenter for Cognitive ImpairmentsUniversity Medical Center Ljubljana, and Medical facultyUniversity of LjubljanaLjubljanaSlovenia
| | - C. Nilsson
- Department of Neurology and Rehabilitation MedicineSkåne University HospitalLundSweden
- Clinical Memory Research UnitDepartment of Clinical SciencesLund UniversityMalmöSweden
| | | | - L. Mantoan Ritter
- Epilepsy CentreKing's College NHS Foundation TrustKing´s College LondonLondonUK
| | - D. Religa
- Division of Clinical GeriatricsDepartment of Neurobiology, Care Sciences and SocietyKarolinska InstitutetNeo, StockholmSweden
- Karolinska University HospitalTheme AgingHuddingeSweden
| | - R. Schmidt
- University Clinic for NeurologyMedical University of GrazGrazAustria
| | - E. Stefanova
- Medical FacultyNeurology clinic CCSUniversity of BelgradeBelgradeSerbia
| | - A. Verdelho
- Department of Neurosciences and Mental HealthCHLNorte‐Hospital de Santa MariaIMMISAMBFaculty of MedicineUniversity of LisbonLisbonPortugal
| | - M. Vandenbulcke
- Department of NeurosciencesKU LeuvenGeriatric PsychiatryUniversity Hospitals LeuvenLeuvenBelgium
| | - B. Winblad
- Karolinska University HospitalTheme AgingHuddingeSweden
- Division of NeurogeriatricsDepartment of Neurobiology, Care Sciences and SocietyKarolinska InstitutetBioClinicumSolnaSweden
| | - G. Waldemar
- Department of NeurologyDanish Dementia Research CenterRigshospitaletUniversity of CopenhagenCopenhagenDenmark
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49
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Bondi S, Yang D, Croll L, Torres J. Patient Characteristics Associated With Readmission to 3 Neurology Services at an Urban Academic Center. Neurohospitalist 2020; 11:25-32. [PMID: 33868553 DOI: 10.1177/1941874420953320] [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] Open
Abstract
Background and Purpose Hospital 30-day readmissions in patients with primary neurological problems are not well characterized. We sought to determine patient characteristics associated with readmission across 3 different inpatient neurology services at New York University Langone Hospital. Methods We retrospectively reviewed all 30-day readmissions from the General Neurology, Epilepsy, and Stroke services at NYULH Brooklyn and Manhattan campuses from 2016-2017 and compared them to a random sample of non-readmitted neurology patients. We used univariate analyses to compare demographics, clinical characteristics, disease specific metrics, and discharge factors of non-readmitted and readmitted groups and binomial logistic regression to examine specific variables with adjustment for confounders. Results We included 284 patients with 30-day readmissions and 306 control patients without readmissions matched by discharge location and service. After adjusting for confounders, we found that the following factors were associated with increased readmission risk: a recent hospital encounter increased risk for all services, increased number of medications at discharge, intensive care unit stay, higher length of stay, and prior history of seizure for the General Neurology Service, increased number of medications at discharge for the Epilepsy Service, and active malignancy and higher discharge modified Rankin Scale score for the Stroke Service. Conclusion This study identifies potential risk factors for readmission in patients across multiple neurology services. Further research is needed to establish whether these risk factors hold across multiple institutions.
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Affiliation(s)
- Steven Bondi
- Department of Neurology, New York University Langone Health, New York, NY, USA
| | - Dixon Yang
- Department of Neurology, New York University Langone Health, New York, NY, USA
| | - Leah Croll
- Department of Neurology, New York University Langone Health, New York, NY, USA
| | - Jose Torres
- Department of Neurology, New York University Langone Health, New York, NY, USA
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50
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Ilomäki J, Bell JS, Chan AYL, Tolppanen AM, Luo H, Wei L, Lai ECC, Shin JY, De Paoli G, Pajouheshnia R, Ho FK, Reynolds L, Lau KK, Crystal S, Lau WCY, Man KKC, Brauer R, Chan EW, Shen CY, Kim JH, Lum TYS, Hartikainen S, Koponen M, Rooke E, Bazelier M, Klungel O, Setoguchi S, Pell JP, Cook S, Wong ICK. Application of Healthcare 'Big Data' in CNS Drug Research: The Example of the Neurological and mental health Global Epidemiology Network (NeuroGEN). CNS Drugs 2020; 34:897-913. [PMID: 32572794 PMCID: PMC7306570 DOI: 10.1007/s40263-020-00742-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Neurological and psychiatric (mental health) disorders have a large impact on health burden globally. Cognitive disorders (including dementia) and stroke are leading causes of disability. Mental health disorders, including depression, contribute up to one-third of total years lived with disability. The Neurological and mental health Global Epidemiology Network (NeuroGEN) is an international multi-database network that harnesses administrative and electronic medical records from Australia, Asia, Europe and North America. Using these databases NeuroGEN will investigate medication use and health outcomes in neurological and mental health disorders. A key objective of NeuroGEN is to facilitate high-quality observational studies to address evidence-practice gaps where randomized controlled trials do not provide sufficient information on medication benefits and risks that is specific to vulnerable population groups. International multi-database research facilitates comparisons across geographical areas and jurisdictions, increases statistical power to investigate small subpopulations or rare outcomes, permits early post-approval assessment of safety and effectiveness, and increases generalisability of results. Through bringing together international researchers in pharmacoepidemiology, NeuroGEN has the potential to be paradigm-changing for observational research to inform evidence-based prescribing. The first focus of NeuroGEN will be to address evidence-gaps in the treatment of chronic comorbidities in people with dementia.
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Affiliation(s)
- Jenni Ilomäki
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, VIC, Australia.
| | - J Simon Bell
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, VIC, Australia
- School of Pharmacy, University of Eastern Finland, Kuopio, Finland
| | - Adrienne Y L Chan
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, The University of Hong Kong, Pokfulam, Hong Kong SAR
| | | | - Hao Luo
- Department of Social Work and Social Administration and Sau Po Centre on Ageing, The University of Hong Kong, Pokfulam, Hong Kong SAR
| | - Li Wei
- Research Department of Practice and Policy, University College London School of Pharmacy, London, UK
| | - Edward Chia-Cheng Lai
- School of Pharmacy, Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Ju-Young Shin
- School of Pharmacy, Sungkyunkwan University, Suwon, Gyeong gi-do, South Korea
| | - Giorgia De Paoli
- Medicines Monitoring Unit, Ninewells Hospital, School of Medicine, University of Dundee, Dundee, UK
| | - Romin Pajouheshnia
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute of Pharmaceutical Sciences (UIPS), Utrecht University, Utrecht, The Netherlands
| | - Frederick K Ho
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Lorenna Reynolds
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, VIC, Australia
| | - Kui Kai Lau
- Department of Medicine, The University of Hong Kong, Pokfulam, Hong Kong SAR
| | - Stephen Crystal
- Center for Health Services Research, Institute for Health, Health Care Policy, and Aging Research, Rutgers University, New Brunswick, NJ, USA
| | - Wallis C Y Lau
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, The University of Hong Kong, Pokfulam, Hong Kong SAR
- Research Department of Practice and Policy, University College London School of Pharmacy, London, UK
| | - Kenneth K C Man
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, The University of Hong Kong, Pokfulam, Hong Kong SAR
- Research Department of Practice and Policy, University College London School of Pharmacy, London, UK
| | - Ruth Brauer
- Research Department of Practice and Policy, University College London School of Pharmacy, London, UK
| | - Esther W Chan
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, The University of Hong Kong, Pokfulam, Hong Kong SAR
| | - Chin-Yao Shen
- School of Pharmacy, Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Ju Hwan Kim
- School of Pharmacy, Sungkyunkwan University, Suwon, Gyeong gi-do, South Korea
| | - Terry Y S Lum
- Department of Social Work and Social Administration and Sau Po Centre on Ageing, The University of Hong Kong, Pokfulam, Hong Kong SAR
| | | | - Marjaana Koponen
- School of Pharmacy, University of Eastern Finland, Kuopio, Finland
| | - Evelien Rooke
- Medicines Monitoring Unit, Ninewells Hospital, School of Medicine, University of Dundee, Dundee, UK
| | - Marloes Bazelier
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute of Pharmaceutical Sciences (UIPS), Utrecht University, Utrecht, The Netherlands
| | - Olaf Klungel
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute of Pharmaceutical Sciences (UIPS), Utrecht University, Utrecht, The Netherlands
| | - Soko Setoguchi
- Rutgers Robert Wood Johnson Medical School and School of Public Health and Center for Pharmacoepidemiology and Treatment Sciences, Institute for Health, Rutgers University, New Brunswick, NJ, USA
| | - Jill P Pell
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Sharon Cook
- Center for Health Services Research, Institute for Health, Health Care Policy, and Aging Research, Rutgers University, New Brunswick, NJ, USA
| | - Ian C K Wong
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, The University of Hong Kong, Pokfulam, Hong Kong SAR.
- Research Department of Practice and Policy, University College London School of Pharmacy, London, UK.
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