Inappropriate Drugs in Elderly Patients with Severe Cognitive Impairment: Results from the Shelter Study

Colloca, Giuseppe; Tosato, Matteo; Vetrano, Davide Liborio; Topinková, Eva; Fialová, Daniela; Gindin, Jacob; Roest, Henriëtte van der; Landi, Francesco; Liperoti, Rosa; Bernabei, Roberto; Onder, Graziano

doi:10.1371/journal.pone.0046669

Cited by 46 publications

(62 citation statements)

References 27 publications

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“…These drugs were lipid-lowering agents, antiplatelet agents (excluding acetylsalicylic acid), acetyl-cholinesterase-inhibitors and antispasmodics. 15 Even in this study, the presence of a geriatrician in the facility was associated with a lower prevalence of inappropriate prescription.…”

Section: Holmes Criteria (Advanced Dementia)contrasting

confidence: 50%

Appropriateness of pharmacological treatment in older people with dementia

et al. 2015

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Dementia is a syndrome characterized by progressive impairment in memory, cognitive functions and behavior, caused by progressive and irreversible damage of cerebral structures and functions. Among the different types of dementia, Alzheimer's disease is generally considered the most common, accounting for 60% to 80% of all cases. Dementia could be considered a typical and paradigmatic geriatric syndrome, in fact, its prevalence increases exponentially with age, rising from 3% among those 65-74 years to almost 50% among those 85 years or older 1 and this condition is associated with negative health outcomes including impaired physical function, institutionalization and hospital admission, leading to increased resources consumption and health care costs. The global population aging makes dementia an emergent disease worldwide: it was estimated that 35.6 million people were living with dementia in 2010 and the number of cases was estimated to nearly double every 20 years, to 65.7 million in 2030, and 115.4 million in 2050. 2 This outbreak of dementia has deep economic, political and social consequences. The total estimated worldwide costs of dementia were US$ 604 billion in 2010, equal to costs of cancer, heart disease, and stroke combined.3 Incalculable are, instead, the social costs of a person with dementia, for his or her family and caregivers, often shaping the life of all relatives. Treatment of comorbidities in dementiaThe management of patients with dementia is often challenging, in particular in the advanced stages of disease, when the presence of cognitive deficits is further complicated by comorbidities, geriatric syndromes (delirium, falls, malnutrition, etc.) and functional deficits. Dementia is a condition with a long clinical history so that people with this condition are likely to Appropriateness of pharmacological treatment in older people with dementiaEleonora Meloni, Davide Liborio Vetrano, Roberto Bernabei, Graziano Onder Department of Geriatrics, Neurosciences and Orthopedics, Catholic University of Sacred Heart, Rome, Italy ABSTRACTDementia is associated with a number of comorbidities often observed in older people, including hypertension, cardiovascular disease, stroke and diabetes. Treating these comorbidities in older adults with dementia results challenging for many reasons. First, older adults with dementia are generally excluded from clinical trials, so application of clinical guidelines for treatment of chronic diseases in this population might lead to polypharmacy and adverse drugs effects. Second, memory, intellectual function, judgment and language are commonly impaired in patients with cognitive deficits, compromising the compliance to complex pharmacological regimens, increasing the risk of adverse drug reactions. Third, cognitive impairment is associated with limited life expectancy and therefore limits the efficacy of pharmacological treatments and questions the appropriateness of treatment. In the present study we examine most relevant concerns related to the treatment of c...

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Section: Holmes Criteria (Advanced Dementia)contrasting

confidence: 50%

Appropriateness of pharmacological treatment in older people with dementia

et al. 2015

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“…Anticholinergic burden of medications and polypharmacy are both associated with increased cognitive dysfunction [41][42][43][44][45][46]: Inappropriate drug use was found to be common in heart failure in European Union nursing home residents [47]. Non-centrally active angiotensin-converting enzyme inhibitors are associated with a greater risk of dementia and functional disability [48].…”

Section: Associations With Heart Failure and Cognitive Declinementioning

confidence: 99%

Heart failure and cognitive dysfunction

Ampadu

Morley

2015

International Journal of Cardiology

149

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“…This study is among the first to examine this problem in such a large representative sample (N = 5,406). The only prior study, which included 1,449 Italian nursing home residents with dementia and used the same explicit criteria, found a lower rate of potentially unnecessary drugs (26.8%). The most common potentially unnecessary medications were the same as in the study being reviewed herein, with the exception of a slightly higher rate for antiplatelets (9.9% vs 7.2%, respectively).…”

Section: Resultsmentioning

confidence: 97%

Recent Literature on Medication Errors and Adverse Drug Events in Older Adults

Naples

Hanlon

Schmader

et al. 2016

J American Geriatrics Society

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Medication errors and adverse drug events are common in older adults, but locating literature addressing these issues is often challenging. The objective of this article was to summarize recent studies addressing medication errors and adverse drug events in a single location to improve accessibility for individuals working with older adults. The authors conducted a comprehensive literature search for studies published in 2014 and identified 51 potential articles. After critical review, 17 studies were selected for inclusion based on innovation, rigorous observational or experimental study designs, and use of reliable, valid measures. Four articles characterizing potentially inappropriate prescribing and interventions to optimize medication regimens were annotated and critiqued in detail. We hope that health policy makers and clinicians find this information helpful in improving the quality of care for older adults.

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Inappropriate Drugs in Elderly Patients with Severe Cognitive Impairment: Results from the Shelter Study

Cited by 46 publications

References 27 publications

Appropriateness of pharmacological treatment in older people with dementia

Appropriateness of pharmacological treatment in older people with dementia

Heart failure and cognitive dysfunction

Recent Literature on Medication Errors and Adverse Drug Events in Older Adults

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