Interventions to Improve Medicines Management for People with Dementia: A Systematic Review

Abstract

This review highlights the limited number of studies examining medicines management interventions for people with dementia. Of the work that has been conducted to date, emphasis has been placed on psychotropic drug use. Future research must target community-dwelling dementia patients and take a holistic approach to medicines management.

Improving medicines management for people with dementia in primary care: a qualitative study of healthcare professionals to develop a theory-informed intervention

“…The systematic and robust approach taken to analysis and intervention development ensures that the final intervention will be both evidence-and theory-based. The use of a theoretical framework to inform the development of behaviour change interventions is recommended [22], and there is a distinct lack of theory-based medicines management interventions for PwD in primary care [17]. As the final intervention proceeds through feasibility and pilot testing it may undergo further refinement, helping to improve the chances of successful implementation and benefits to the target population.…”

“…At the time of study planning, there had been limited work in this area, with research focusing predominantly on antipsychotic drug use in PwD particularly care home residents, and medicines use in advanced dementia. A systematic review of the effectiveness of medicines management interventions for PwD in primary care [17], highlighted the small number of studies (n = 3), concluding that future interventions must target communitydwelling PwD and take a holistic and multidisciplinary approach to medicines management.…”

“…It emphasises identifying existing evidence in the area, and developing a theoretical understanding of the likely process of change to inform intervention design [22]. Our systematic review [17] highlighted a lack of theory-based interventions. We had already undertaken a pharmacoepidemiological study of prescribing appropriateness in community-dwelling PwD in Northern Ireland (NI) to extend the evidence base.…”

The development of a Core Outcome Set for medicines management interventions for people with dementia in primary care

“…A systematic review conducted by the authors demonstrated a lack of randomised controlled trials (RCTs) examining the effectiveness of medicines management interventions for PWD and highlighted the minimal overlap in outcomes between the three included studies [5]. With the increase in community-dwelling PWD, the literature has emphasised the importance of developing primary carebased interventions to improve medicines management for PWD [6].…”

PRN Medicines Management for Psychotropic Medicines in Long-Term Care Settings: A Systematic Review

“…Further initiatives are needed to improve PRN medicines management to explore factors that affect PRN prescription and administration and to develop appropriate PRN guidelines to prevent harm and improve the safety of people living in long-term care facilities.Pharmacy 2019, 7, 157 2 of 14 and organizational routines [11,12]. Decision-making is a key skill for many healthcare professionals and is important to ensure patient safety [13].PRN prescription and administration is commonly used for psychotropic and psycholeptics medications, including antipsychotics, neuroleptics, anxiolytics, sedatives, and hypnotics [6,8,9,[14][15][16][17][18], analgesics [6,12,14,[19][20][21], gastro-intestinal preparations [12,14], and other physical and psychological symptoms [2]. Benefits of PRN administration to patients are noted [2,9], but the use of PRN psychotropic medications has been linked to an increased risk of falls [22][23][24], infection, or dehydration [24].…”