Comparison of Potentially Inappropriate Medications for People with Dementia at Admission and Discharge during An Unplanned Admission to Hospital: Results from the SMS Dementia Study

Abstract

People with dementia (PWD) and cognitive impairment are particularly vulnerable to medication problems, and unplanned admission to hospital presents an opportunity to address polypharmacy, potentially inappropriate medications (PIMs) and anticholinergic burden. This study aimed to compare PIMS and other medication data for PWD to determine whether these changed during hospitalization. Medications documented in patient’s records at admission and discharge were evaluated for PWD recruited to phase one of a prospective quasi-experimental pre/post-controlled trial that was conducted at two regional hospitals in NSW, Australia. The study sample included PWD or cognitive impairment having an unplanned admission to hospital. Data were collected using a purpose developed audit tool for medications and PIMs, and a Modified Anticholinergic Burden Scale. Total participants were 277, and results determined that the cognitive status of PWD is not always detected during an unplanned admission. This may make them more vulnerable to medication problems and poor outcomes. Polypharmacy and PIMS for PWD were high at admission and significantly reduced at discharge. However, PWD should be routinely identified as high risk at admission; and there is potential to further reduce polypharmacy and PIMs during admission to hospital, particularly psychotropic medications at discharge. Future studies should focus on evaluating targeted interventions designed to increase medication safety for PWD.

Evaluation of the Effect of an Intervention on Potentially Inappropriate Medications (PIMS), Polypharmacy and Anticholinergic Burden Scores for People with Dementia; Results from the SMS Dementia Study†: A Quasi-Experimental Study

“…Polypharmacy was de ned as ≥ 5 medications. Medication recommendation severity scores were dichotomised as "Signi cant (severity)" Yes (1,2,3) and No (4,5), and also as due to Error (1,2,3,4) and Not due to Error (5); impact scores were dichotomised as "Relevant (impact)" Yes (1,2,3) and No (4,5,6) [16].…”

“…The number of medications at discharge reduced by 30% across study sites and phases and this was sustained at three months, suggesting that medication reconciliation and deprescribing is practiced to some extent in the delivery of usual care and may explain why the study was not able to report a treatment effect. Nonetheless reduced prescribing reduces medication related risk for PWD [1,19,20].…”

“…Proxy consent was provided by their carer or person responsible. Additional detail about participant eligibility is provided in a previous publication [1].…”

“…These reviews provide evidence to con rm that PIMs are an important clinical issue that requires further attention. Two previous studies have compared PIMs between admission and discharge and reported that PIMs for PWD were signi cantly reduced at discharge (Mean 4.0 reduced to 3.3, difference 0.7, p < 0.0001) in a study of 277 admissions [1], and (Mean reduced from 0.8 to 0.4, difference 0.4, p = 0.01) in a study of 118 admissions [11]. When PWD are admitted to hospital, there is an opportunity to undertake medication reconciliation and to identify PIMs and other medications that may no longer be required.…”

“…People with dementia (PWD) have a high risk for adverse health outcomes associated with medications due to being cognitively impaired [1]. This manifests as missing medications due to confusion or memory problems, or taking incorrect medications or dosages.…”