Comorbidity and polypharmacy in people with dementia: insights from a large, population-based cross-sectional analysis of primary care data

Clague, Fiona; Mercer, Stewart W; McLean, Gary; Reynish, Emma; Guthrie, Bruce

doi:10.1093/ageing/afw176

Cited by 120 publications

(151 citation statements)

References 29 publications

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“…In total, 91.6% of CCP had ≥ 4 active medications, 52.4% between 4-9, and 32.9% ≥ 10. The average use of 9.0 daily medications by our study participants is consistent with the existing literature [42,43], but it is high and concerning. On the other hand, polypharmacy is not just the use of multiple medications, but also and/or the administration of more medications than are clinically indicated, representing unnecessary drug use [44,45].…”

Section: Discussionsupporting

confidence: 91%

Relationship between Hemorrhagic Stroke and Mortality in Chronic Complex Outpatients: Results from a Community Cohort of Patients

Ma¹,

Jl²,

Mll³

et al. 2017

J Aging Sci

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Question: Around 3-5% of people can be identified as chronic complex patients(CCP) and are increasingly at risk of hemorrhagic stroke.The main objective was to explore differences in risk factors and the association with outcome factors on mortality. Materials and Methods:Multicenter and prospective cohort study from January 1 2013 to September 30 2016 among patients registered as chronic complex outpatients. To predict hazard ratios, mean survival time, and survival probabilities, multivariate Cox regression was used.Results: 932 CCP were included (52.3% women). Average age was 82.5 years (95% CI 81.8-83.2). During a mean follow-up period of 2.8 years, 65 (6.98%) stroke episodes happened (37 (56.9%) ischemic; 28 (43.1%) hemorrhagic). The percentage of ICH almost doubled (21.0% to 43.1) after CCP diagnosis; 26.1% had polypharmacy (≥ 10), 57.6% VKA-treated patientsshowed TTR <60%, and had a higher incidence of falling (31.9% vs. 19.2%, p 0.002).The average survival time was significantly shorter associated with age (HR 1.03 95% CI 1.14-1.53, p 0.001), previous stroke (HR 13.54 95%, p<0.001), antiagreggant treatment (HR 1.97 95% CI 1.21-3.21, p 0.006), anticoagulant treatment (HR 1.78 95%, CI 1.22-2.60, p 0.002), and Barthel score <60 (HR 1.43 95% CI 1.04-1.97, p 0.024). Conclusions:Given the co-occurrence of hemorrhagic strokes with poor performance status, multi-morbidity, and polypharmacy, multi-dimensional interventions are needed to improve health outcomes.

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Section: Discussionsupporting

confidence: 91%

Relationship between Hemorrhagic Stroke and Mortality in Chronic Complex Outpatients: Results from a Community Cohort of Patients

Ma¹,

Jl²,

Mll³

et al. 2017

J Aging Sci

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“…An additional explanation for a longer LOS among PWD may be the functional and cognitive decline during hospitalization, which could prevent PWD from expressing their complaints to the medical staff including the occurrence of adverse drug reactions occurring in up to 11% of the hospital admissions . This is particularly relevant for PWD since they are more likely to be on 5 or more and 10 or more repeat prescriptions compared to PwoD . Furthermore, polypharmacy is a risk factor for emergency department attendance, hospitalization, and unplanned hospitalization among PWD, and among older adults, excessive polypharmacy is associated with staying more than 10 days in the hospital .…”

Section: Discussionmentioning

confidence: 99%

“…84 This is particularly relevant for PWD since they are more likely to be on 5 or more and 10 or more repeat prescriptions compared to PwoD. 85 Furthermore, polypharmacy is a risk factor for emergency department attendance, hospitalization, and unplanned hospitalization among PWD, 86 and among older adults, excessive polypharmacy is associated with staying more than 10 days in the hospital. 31 Also, the use of inadequate medication could lead to adverse events in PWD.…”

Section: Los In Hospitalizations Due To Infectious Cardiovascularmentioning

confidence: 99%

Length of hospital stay and dementia: A systematic review of observational studies

Möllers

Stocker

Wei

et al. 2018

Int J Geriat Psychiatry

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Objective Hospitalizations of people with dementia (PWD) are often accompanied by complications or functional loss and can lead to adverse outcomes. Unsystematic findings suggest an influence of comorbidities on the extent of differences in the length of hospital stay (LOS). This systematic review aimed to identify and evaluate all studies reporting LOS in PWD as compared to PwoD in general hospitals. Methods A systematic review of observational studies using PubMed and ISI Web of Knowledge. Inclusion criteria comprised original studies written in English or German, assessment of diagnosis of dementia, measurement of LOS, and comparison of people with and without dementia. Results Fifty‐two of 60 studies reported a longer hospitalization time for PWD compared to PwoD. The extent of the difference in LOS varied between and within countries as well as by type of primary morbidity (eg, injuries, cardiovascular diseases). The range of the LOS difference for studies without restriction to a primary morbidity was −2 to +22 days after matching or adjustment for a variable number and selection of potentially relevant covariates. For studies with injuries/fractures/medical procedures and infectious/vascular disease as the primary morbidity, the range was −2.9 to +12.4 and −11.2 to +21.8 days, respectively. Conclusions The majority of studies reported a longer hospitalization of PWD compared to PwoD. Length of hospital stay seems to be influenced by a variety of medical, social, organizational factors, including reasons for hospital admission, whose role should be explored in detail in further research.

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“…These highly stressful non‐cognitive symptoms are closely related to adverse outcomes, increased caregiving burden and healthcare costs . Furthermore, there is an increasing challenge of dementia overlapping with other geriatric syndromes, including polypharmacy, urinary incontinence, depression, falls and malnutrition . Screening and early intervention also play important roles in dementia care.…”

Section: Introductionmentioning

confidence: 99%

Delaying cognitive and physical decline through multidomain interventions for residents with mild‐to‐moderate dementia in dementia care units in Taiwan: A prospective cohort study

Liang

Chou²,

Chen

et al. 2017

Geriatrics Gerontology Int

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Aim: To develop experimental multi-domain interventions for older people with mild-to-moderate dementia, and to evaluate the effect of delaying cognitive and physical decline, and improvement or prevention of geriatric syndromes during 1-year follow up.Methods: Participants aged 65 years and older with mild-to-moderate dementia (clinical dementia rating [CDR] 1 or 2) were grouped as intervention in Jia-Li Veterans Home and usual care model in the community (Memory clinic). All residents in Jia-Li Veterans Home received comprehensive intervention, including Multi-disciplinary team consultation and intervention, Multi-component non-pharmacological management, geriatric syndromes survey and intervention by CGA, and a dementia friendly medical Green channel Approach (2MCGA). The decline of cognitive and physical function are determined by the change of Mini-Mental State Examination score, CDR and the sum of CDR box, as well as activities of daily living based on the Barthel Index. We also screened geriatric syndromes at baseline and 1 year later.Results: Participants in the intervention group were older and had a lower educational level, lower body mass index, poor baseline activities of daily living function, lower visual impairment, and higher rates of hearing impairment, polypharmacy and risk of malnutrition. The residents receiving 2MCGA had lower baseline Mini-Mental State Examination scores, and higher CDR. For residents in Jia-Li Veterans Home, all cognitive measurements except Mini-Mental State Examination were significantly associated with delaying the decline of cognition after analyzing by multiple linear regression, and multivariate logistic regression also showed that patients living in the community was independently associated with a higher odds ratio for activities of daily living decline (3.180, 95% CI 1.384-7.308, P = 0.006). There are also more improvement in their baseline geriatric syndromes and suffered less from new geriatric syndromes, including falls, urinary incontinence, and risk of malnutrition.Conclusions: The 2MCGA intervention shows strong delays in the decline of cognition and physical function for older residents with mild-to-moderate dementia. Furthermore, this strategy can also improve or prevent the onset of new geriatric syndromes, especially fall episodes, urinary incontinence and risk of malnutrition.

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Comorbidity and polypharmacy in people with dementia: insights from a large, population-based cross-sectional analysis of primary care data

Cited by 120 publications

References 29 publications

Relationship between Hemorrhagic Stroke and Mortality in Chronic Complex Outpatients: Results from a Community Cohort of Patients

Relationship between Hemorrhagic Stroke and Mortality in Chronic Complex Outpatients: Results from a Community Cohort of Patients

Length of hospital stay and dementia: A systematic review of observational studies

Delaying cognitive and physical decline through multidomain interventions for residents with mild‐to‐moderate dementia in dementia care units in Taiwan: A prospective cohort study

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