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

Abstract

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

What Makes Deprescription of Psychotropic Drugs in Nursing Home Residents with Dementia so Challenging? A Qualitative Systematic Review of Barriers and Facilitators

“…This could be taken into consideration when designing future studies involving pharmacists in the deprescription process. Other systematic reviews evaluating pharmacist-supported medical reviews have yielded no firm conclusions on whether potentially inappropriate medication would be reduced [53][54][55] and this review provides some of the many explanations for the modest results, highlighting the importance of mutual acknowledgment of, and collaboration between, the different professionals. We identified a perceived need among both general practitioners and nursing home staff for more educational opportunities, from which to gain the qualifications needed to ensure that residents with dementia exhibiting behavioral challenges received the best care.…”

Interventions to Enhance Medication Safety in Residential Aged‐care Settings: An Umbrella Review

“…Thirteen reviews representing 159 unique studies examined the effects of medication review interventions on medication safety in RACS 10–14,16–19,21–24 . These medication review interventions aimed to address issues related to patient use of medications and, by doing so, improve health outcomes 14 .…”

“…Eight of the 15 included reviews recommended implementing a combination of interventions (multicomponent interventions) to ensure medication safety in RACS 10–14,16,18,24 . One review 10 indicated that the combination of educational outreach, on‐site education interventions, in addition to pharmacist‐led medication review might reduce inappropriate use of medications in RACS.…”

“…McDerby et al 24 investigated multifaceted medication reviews, where multidisciplinary collaboration and education were included as supporting interventions. They concluded that multicomponent interventions, including medication review, education and the involvement of multidisciplinary care providers and family members, enhances patient‐centred approaches to medication management in RACS dementia residents 24 …”

Ethical Tenets of PRN Medicines Management in Healthcare Settings: A Clinical Perspective

“…The collaborative approach has great potential to improve medication safety if it is cohesive and is practiced based on clearly designed roles and responsibilities [ 7 ]. The best outcome of the medication process is achieved when pharmacists, physicians and nurses undertake their assigned roles and collaborate to ensure clinical medication safety [ 8 , 9 ].…”