Patterns of medication prescription by dementia diagnosis in Australian nursing home residents: a cross‐sectional study

Liu, Enwu; Dyer, Suzanne M; Whitehead, Craig; O’Donnell, Lisa Kouladjian; Gnanamanickam, Emmanuel; Harrison, Stephanie L; Milte, Rachel; Crotty, Maria

doi:10.1002/jppr.1457

Cited by 7 publications

(25 citation statements)

References 21 publications

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“…We found that, except for antiplatelets, people with Alzheimer's disease were less frequently dispensed medicines for cardiovascular conditions than the age‐ and gender‐matched comparison group. Our findings align with a previous Australian study involving 546 nursing home residents, which found that people with dementia were less likely to be prescribed medicines for cardiovascular and respiratory diseases than residents without dementia (adjusted odds ratio 0.45, 95% confidence interval 0.27–0.77, p=0.003) . It is unclear whether the lower prevalence of medicines used for cardiac conditions in people with Alzheimer's disease reflects appropriate treatment due to a lower prevalence of cardiovascular conditions in people with Alzheimer's disease or if it reflects a possible undertreatment of cardiovascular diseases.…”

Section: Discussionsupporting

confidence: 83%

Medication Use for Comorbidities in People with Alzheimer's Disease: An Australian Population‐Based Study

et al. 2019

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BACKGROUND People with Alzheimer's disease (AD) often have multimorbidity and take multiple medi-cines. Yet few studies have examined medicine utilization for comorbidities comparing people with and without AD. OBJECTIVE The aim was to investigate the patterns of medication use for comorbidities in people with and without AD. METHODS An Australian population-based study was conducted using the Pharmaceutical Benefits Scheme 10% sample of pharmacy claims data. People with AD were defined as those dispensed medicines for dementia (cholinesterase inhibitors, memantine, or risperidone for behavioral and psychological symptoms of dementia) between January 1, 2005, and December 31, 2015, who were aged 65 years or older and alive at the end of 2016. An age-and gender-matched comparison cohort (5:1) of people without AD were identified. Medication use for comorbidities was identified using the validated comorbidity index, Rx-Risk-V. A v 2 test was used to compare differences in the pattern of medicine use between the two groups. RESULTS A total of 8280 people with AD and 41,400 comparisons without AD were included; 63.4% were female and the median age was 82 years. The median number of comorbidities was greater in people with AD {median [interquartile range (IQR)]: 5 [3-7]} than the comparison group (median [IQR]: 4 [3-6], p<0.0001). Medications for depression, pain (treated with opioid analgesics), anxiety, diabetes, hyperthyroidism, epilepsy, Parkinson's disease, and antipsychotics were used significantly more commonly in people with AD than in those without dementia. Medications for cardiac conditions, pain (treated with anti-inflammatory medications), chronic airways disease, gout, glaucoma, renal disease, benign prostatic hyperplasia, cancer, and steroid-responsive conditions were used significantly less commonly among people with AD than the comparison group. CONCLUSIONS This study highlighted significant variations in medication use for comorbidities between people with and without AD. Future studies should evaluate the reasons for the disparity in medicine utilization for comorbidities in people with AD.

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Section: Discussionsupporting

confidence: 83%

Medication Use for Comorbidities in People with Alzheimer's Disease: An Australian Population‐Based Study

et al. 2019

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“…These are key indicators of medication use quality, given the well-documented risk of harm associated with these medicines, the high prevalence of dementia and potentially problematic psychotropic agent use in Australian RACF. 29,30 Reducing the number of prescribed medications was a similar outcome reported in a recent systematic review evaluating outcomes of medication reviews in RACF residents both with and without dementia. 36 Multi-faceted interventions, inclusive of collaborative pharmacist-led medication reviews in residents both with and without dementia, have demonstrated efficacy in reducing inappropriate psychotropic medication use.…”

Section: Discussionmentioning

confidence: 70%

“…Further, residents with dementia are often managed with complex multi‐drug regimens inclusive of several psychotropic drugs 24 . RACF residents with dementia are three‐fold more likely to be prescribed antipsychotics compared with persons with dementia residing in the community, and nine‐fold more likely to be prescribed an antipsychotic than RACF residents without dementia 28,29 . Psychotropic drug use in residents with dementia is associated with reduced quality of life and increased adverse outcomes, including stroke, falls, hospital admissions and mortality 30 …”

Section: Introductionmentioning

confidence: 99%

Pharmacist‐led medication reviews in aged care residents with dementia: A systematic review

et al. 2020

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Harm relating to medicines is an ongoing concern in residential aged care facilities (RACF). 1,2 Ageing itself is associated with pharmacokinetic and pharmacodynamic changes, multiple comorbid diseases and polypharmacy. 3-6 Polypharmacy is prevalent in RACF, and 74% of residents take nine or more medications on a regular basis. 7,8 Polypharmacy is also common in dementia, and over half of RACF residents with dementia are prescribed more than five regular medications. 9,10 Additionally, factors often complicating prescribing in the RACF population and further increasing the risk of adverse medication events include frailty, disability, cognitive impairment, inadequate monitoring, involvement of multiple care providers, and variable resident autonomy and family involvement in decision-making. 3,11-15 RACF also often has high employment turnover and casualised workforces. 16-18 RACF residents with dementia are particularly vulnerable to adverse outcomes associated with medication. 19-21 Reasons include poor representation in clinical trials for medicines to manage other comorbid conditions, and exaggeration of age-related pathophysiological changes including increased blood-brain barrier permeability to drugs and reduced drug-transporter activity. 19,22,23 This may result in unpredictable or adverse and unintended responses to drug treatment. 23 Given that dementia and the associated pharmacokinetic and

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“…Residents of care facilities frequently have low serum vitamin D which has been associated with depression, so increased time spent outdoors may improve mood by increasing vitamin D [23,27]. In this study 31% of participants were receiving vitamin D supplementation so adjustments were made in analyses for vitamin D prescription [28]. Given existing recommendations for prescription of vitamin D in adults residing in aged care homes, this rate appears low [29,30].…”

Section: Discussionmentioning

confidence: 97%

People living in residential aged care need to BE outside not just SEE outside: associations between quality of life and outdoor access: a cross-sectional study

Dyer¹,

Liu²,

Gnanamanickam³

et al. 2019

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Background The value of providing access to outdoor areas for people living in residential aged care, including those living with dementia, in terms of mood, behaviour and well-being is increasingly acknowledged. This study examines associations between provision of independent access to outdoor areas and frequency of residents going outdoors with the quality of life (QoL) of nursing home residents and compares use of outdoor areas between alternative models of residential aged care. Methods A cross-sectional study was conducted including 541 participants from 17 residential aged care homes in four states in Australia, mean age 85 years, 84% with cognitive impairment. Associations between having independent access to outdoors and the frequency of going outdoors and QoL (EQ-5D-5L) were examined using multi-level models. The odds of going outdoors in a small-scale home-like model of care compared to standard Australian models of care were examined. Results After adjustment for potential confounders (including comorbidities and facility level variables), living in an aged care home with independent access to the outdoors was not significantly associated with QoL (β=-0.01, 95% Confidence Interval (CI) -0.09 to 0.07, P=0.80). However, going outdoors daily (β=0.13 95%CI 0.06 to 0.21), but not multiple times a week (β=0.03, 95%CI -0.03 to 0.09), was associated with a better QoL. Residents living in a home-like model of care had greater odds of going outdoors daily (odds ratio 15.1, 95%CI 6.3 to 36.2). Conclusions Going outdoors frequently is associated with higher QoL for residents of aged care homes and residents are more likely to get outside daily if they live in a small-scale home-like model of care. However, provision of independent access to outdoor areas alone may be insufficient to achieve these benefits. Increased availability of models of residential aged care with staffing structures, training and design which increases support for residents to venture outdoors frequently is needed to maximise resident quality of life.

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Patterns of medication prescription by dementia diagnosis in Australian nursing home residents: a cross‐sectional study

Cited by 7 publications

References 21 publications

Medication Use for Comorbidities in People with Alzheimer's Disease: An Australian Population‐Based Study

Medication Use for Comorbidities in People with Alzheimer's Disease: An Australian Population‐Based Study

Pharmacist‐led medication reviews in aged care residents with dementia: A systematic review

People living in residential aged care need to BE outside not just SEE outside: associations between quality of life and outdoor access: a cross-sectional study

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