Potentially Inappropriate Medication in Community-Dwelling Primary Care Patients who were Screened Positive for Dementia

Abstract

Background: Potentially inappropriate medication (PIM) in older people is a risk factor for adverse drug effects. This risk is even higher in older people with dementia (PWD).Objective: Our study aimed to determine (1) the prevalence of PIM among primary care patients who were screened positive for dementia and (2) the sociodemographic and clinical variables associated with the use of PIM.Methods: DelpHi-MV (Dementia: life- and person-centered help in Mecklenburg–Western Pomerania) is a general practitioner-based, cluster-randomized, controlled intervention study to implement and evaluate an innovative concept of collaborative dementia care management in Germany. The comprehensive baseline assessment includes a home medication review. The present analyses are based on the data from 448 study participants (age 70+, DemTect <9). PIMs were identified using the list of Potentially Inappropriate Medications in the Elderly (Priscus).Results: (1) A total of 99 study participants (22%) received at least one PIM. The highest prevalence was found for antidepressants, benzodiazepines, and analgetics. The most frequently prescribed PIMs were amitriptyline, etoricoxib, and doxazosin. (2) Use of a PIM was significantly associated with a diagnosis of a mental or behavioral disorder.Conclusions: The prescription rate of PIMs for community-dwelling PWD was comparable with the rates found for the general population of older people in Germany (20–29%). Antidepressants with anticholinergic properties and long-acting benzodiazepines were the most prescribed PIMs, despite having an unfavorable benefit-risk ratio. This high prevalence of PIM prescriptions in a vulnerable population of PWD indicates that standard care for dementia should include careful medication review and management.

A qualitative study exploring medication management in people with dementia living in the community and the potential role of the community pharmacist

“…Other studies have identified high levels of polypharmacy with potentially inappropriate prescribing in people with dementia ranging from 22% to 81.5% of participants . We found that medication review focussing on simplifying the regimen might be helpful, particularly if delivered in the home environment.…”

“…In the UK, 800 000 people live with dementia – this figure is expected to double by 2040 reflecting global predictions . The presence of dementia potentially increases the likelihood of the presence for risk factors for adverse drug reactions such as lack of pharmacy input, drug interactions, comorbidity and polypharmacy, amongst others . The cognitive impairment characteristic of dementia may result in a lack of capacity to safely self‐administer medication .…”

Determinants of prescribing potentially inappropriate medications in a nationwide cohort of community dwellers with dementia receiving a comprehensive geriatric assessment

“…[54][55][56] The results of the logistic regression analysis showed that the likelihood of PIMs increased with the number of medications prescribed, which is akin to the findings of the research in older people with dementia in care homes in the United Kingdom. 41 The study by Wucherer et al in community-dwelling primary care patients screened positive for dementia, 57 and the research conducted in Sweden used the EU(7)-PIM list to evaluate the prevalence of PIMs in older people with cognitive impairment. 52 A study performed in the United Kingdom, utilizing the primary care database of anonymised electronic health records from general practice, witnessed that patients more than 65 years of age diagnosed with dementia, and taking multiple medications, were more likely to be prescribed antipsychotics.…”

Prescription of Benzodiazepines and Related Drugs in Patients with Mild Cognitive Deficits and Alzheimer’s Disease

“…Despite the increased risk of adverse events and limited evidence for the efficacy of BZDR, earlier studies reported a relatively high prescription rate in dementia patients [9][10][11]. Though, the majority of earlier evaluations were based on claims data of health insurance companies or considered dementia patients in certain healthcare settings (e. g., only nursing home inhabitants or community-dwelling patients) [9][10][11][12][13][14][15]. In contrast, our study includes patients with AD across all severity stages of dementia and from different residential sites.…”