Potentially inappropriate prescribing in dementia: a state-of-the-art review since 2007

Delgado, João; Bowman, Kirsty; Clare, Linda

doi:10.1136/bmjopen-2019-029172

Cited by 41 publications

(41 citation statements)

References 59 publications

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“…It is notable that the mean number of chronic medications used in the first year after diagnosis was as high as 22.89 per person-year and increased to 30.7 in the late stage of dementia, with an overall significant increasing trend. A high symptom burden in PwD may contribute to a greater need for medications; other risks such as multiple comorbidities, advanced age, depression, and a low functional status are also related to polypharmacy and potentially inappropriate medication (PIM) [26][27][28]. The number of prescribed medications is directly correlated to the risk of PIM among elderly patients with and without dementia [26,29].…”

Section: Discussionmentioning

confidence: 99%

Healthcare Utilization in Different Stages among Patients with Dementia: A Nationwide Population-Based Study

Chen

Lai

et al. 2021

IJERPH

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To evaluate the trend of healthcare utilization among patients with dementia (PwD) in different post-diagnosis periods, Taiwan’s nationwide population database was used in this study. PwD were identified on the basis of dementia diagnoses during 2002–2011. We further subdivided the cases into 10 groups from the index year to the 10th year after diagnosis. The frequency of emergency department visits and hospitalizations, the length of stay, outpatient and department visits, and the number of medications used were retrieved. The Joinpoint regression approach was used to estimate the annual percent change (APC) of healthcare utilization. The overall trend of healthcare utilization increased with the progression of dementia, with a significant APC during the first to second year after diagnosis (p < 0.01), except that the frequency of outpatient visits showed a decreasing trend with a significant APC from the first to fifth year. All sex- and age-stratified analyses revealed that male gender and old age contributed to greater use of healthcare services but did not change the overall trend. This study provides a better understanding of medical resource utilization across the full spectrum of dementia, which can allow policymakers, physicians, and caregivers to devise better care plans for PwD.

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Section: Discussionmentioning

confidence: 99%

Healthcare Utilization in Different Stages among Patients with Dementia: A Nationwide Population-Based Study

Chen

Lai

et al. 2021

IJERPH

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“…Moreover, some conditions are common in old age but are not sufficiently recognised by clinicians, which eventually leads to underuse of the indicated medications [5, 6]. Certain people with dementia (PWD) who are considered underdiagnosed in typical primary practice [7] despite the constant increase in prevalence may be exposed to various health risks stemming from comorbidities [8-10] as well as adverse drug reactions, which are presumably induced by potential exposures to neuropsychiatric drugs [11, 12] or poor competence in their medication management. According to a survey implemented in 6 Japanese municipalities in 2012, the number of individuals with dementia in Japan was estimated to account for 15.7% of the entire older population.…”

Section: Introductionmentioning

confidence: 99%

Use of Anti-Dementia Drugs Reduces the Risk of Potentially Inappropriate Medications: A Secondary Analysis of a Nationwide Survey of Prescribing Pharmacies

Suzuki

Sakakibara²,

Shiraishi

et al. 2020

Dement Geriatr Cogn Disord

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Aims: As the number of older people with dementia increases, safe pharmacotherapy in this population has attracted attention in recent years. The aims of this study were to clarify the prescribing patterns in older patients who were prescribed anti-dementia drugs and to investigate the association of potentially inappropriate medications (PIMs) with the use of anti-dementia drugs. Methods: Adults aged ≥65 years, who were prescribed anti-dementia drugs at 585 pharmacies across Japan (N = 7,953), were surveyed. The percentage of prescriptions of anti-dementia drugs and the effect of those prescriptions on PIMs were investigated. Results: Prescriptions of anti-dementia drugs were found in 4.4% of the entire study population. A multiple logistic regression analysis revealed that the use of anti-dementia drugs reduced the risk of prescribing psychotropic drugs, which represented PIMs, and that a combination of anti-dementia drugs (e.g., cholineesterase inhibitor with memantine) may reduce the risk of prescribing PIMs compared with monotherapy. Conclusion: The use of anti-dementia drugs was associated with fewer prescriptions of drugs considered as PIMs.

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Section: Introductionmentioning

confidence: 99%

“…In a Swedish study, 41%of acute hospitalizations of people with dementia were determined to be drug-related [ 14 ]. Nonetheless, PIM is widespread in people with dementia, with a prevalence ranging from 14–64%in a recent review [ 15 ]. In our previous study in Denmark, we found that 45%of people with dementia had filled at least one prescription for PIM in 2014 compared to 30%of people without dementia [ 16 ].…”

Section: Introductionmentioning

confidence: 99%

Declining Use of Potentially Inappropriate Medication in People with Dementia from 2000 to 2015: A Repeated Cross-Sectional Nationwide Register-Based Study

Kristensen

Jensen‐Dahm

Gasse

et al. 2021

JAD

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Background: Studies have shown declining use of potentially inappropriate medication (PIM), medication where risks associated with use outweigh potential benefits in older people. However, the trend in people with dementia remains unknown. Objective: To test the hypothesis that the use of PIM has decreased in people with dementia in line with the declining use in the general older population. Methods: Repeated cross-sectional register-based study of the entire Danish population aged ≥65 years (2000: N = 802,106; 2015: N = 1,056,476). PIM was identified using the Danish “Red-yellow-green list”. Changes in the use of PIM were examined by calculating the annual prevalence of filling prescriptions for at least one PIM in older people with and without dementia. Characteristics of the study population were examined annually including comorbidity. Results: From 2000 to 2015, the prevalence of PIM use decreased from 54.7%to 43.5%in people with dementia and from 39.5%to 28.8%in people without dementia; the decrease was significant across all age groups and remained so in a sensitivity analysis where antipsychotics were removed. During the same period, comorbidity scores increased in people with and without dementia. Conclusion: The declining use of PIM in people with dementia from 2000 to 2015 parallels the trend in the general older population. The use of PIM decreased despite increasing levels of comorbidity and was not solely attributable to the decreasing use of antipsychotics in people with dementia. However, PIM use remained more widespread in people with dementia who may be more vulnerable to the risks associated with PIM.

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Potentially inappropriate prescribing in dementia: a state-of-the-art review since 2007

Cited by 41 publications

References 59 publications

Healthcare Utilization in Different Stages among Patients with Dementia: A Nationwide Population-Based Study

Healthcare Utilization in Different Stages among Patients with Dementia: A Nationwide Population-Based Study

Use of Anti-Dementia Drugs Reduces the Risk of Potentially Inappropriate Medications: A Secondary Analysis of a Nationwide Survey of Prescribing Pharmacies

Declining Use of Potentially Inappropriate Medication in People with Dementia from 2000 to 2015: A Repeated Cross-Sectional Nationwide Register-Based Study

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