Sex and gender differences in polypharmacy in persons with dementia: A scoping review

Trenaman, Shanna C; Rideout, Megan; Andrew, Melissa K.

doi:10.1177/2050312119845715

Cited by 24 publications

(14 citation statements)

References 64 publications

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“…We found direct comparative literature in only two indicators: absence of anticholinergic medication and assessment of functional status. Our finding that men had less frequent use of anticholinergic medication was consistent with two studies [36,37], but inconsistent with others which found no significant difference in anticholinergic use between men and women with dementia [38,39]. In terms of functional status assessments, our study was consistent with one other study [40], which found hospitalized older women had more assessments than older men (9.1% of men did not have an assessment recorded, compared to 8.0% of women).…”

Section: Resultssupporting

confidence: 66%

Sex differences in the management of persons with dementia following a subnational primary care policy intervention

Sourial

Arsenault‐Lapierre

Margo-Dermer

et al. 2020

Int J Equity Health

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Background The influence of sex and gender on the risk of dementia, its clinical presentation and progression is increasingly being recognized. However, current dementia strategies have not explicitly considered sex and gender differences in the management of dementia to ensure equitable care. The objective of this study was to examine the moderating effect of sex on the quality of care following the implementation of the Quebec Alzheimer Plan (QAP). Methods We conducted a secondary analysis of the evaluation of the QAP consisting of a retrospective chart review of 945 independent, randomly-selected patient charts of males and females 75+ years old with dementia and a visit to one of 13 participating Family Medicine Groups before (October 2011–July 2013) and after (October 2014 – July 2015). The quality of dementia care score, based on Canadian and international recommendations and consensus guidelines, consisted of documented assessments in 10 domains. We used a mixed linear regression model to measure the interaction between sex and the implementation of the QAP on the quality of dementia care score, adjusting for age and number of medications. Results We found that improvements in the quality of dementia care following the QAP were larger for men than women (mean difference = 4.97; 95%CI: 0.08, 9.85). We found that men had a larger improvement in four indicators (driving assessments, dementia medication management, Alzheimer Society referrals, and functional status evaluation), while women had a smaller improvement in three (home care needs, behavioural and psychological symptoms of dementia, and weight). Men were prescribed fewer anticholinergics post-QAP, while women were prescribed more. Cognitive testing improved in men but decreased for women following the QAP; the opposite was observed for caregiver needs. Conclusion While the overall quality of care improved after the implementation of the QAP, this study reveals differences in dementia management between men and women. While we identified areas of inequalities in the care received, it is unclear whether this represents inequities in access to care and health outcomes. Future research should focus on better understanding sex and gender-specific needs in dementia to bridge this gap and better inform dementia strategies.

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Section: Resultssupporting

confidence: 66%

Sex differences in the management of persons with dementia following a subnational primary care policy intervention

Sourial

Arsenault‐Lapierre

Margo-Dermer

et al. 2020

Int J Equity Health

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“…However, consistent with findings from some other studies,16,32,33 in our study men were more likely than women to be prescribed with APs. A recent review by Trenaman et al34 observed that men and women tend to use more antipsychotics dependent on their living environment, women in the community and men in long-term care facilities. The review concluded further research is required to obtain more solid evidence and understand how gender differences can be used to improve medication use among patients with dementia.…”

Section: Discussionmentioning

confidence: 99%

<p>Determinants Of Antipsychotic Drugs Prescription Among Community-Living Older Adults With Dementia: A Population-Based Study Using Health Information Systems In The Lazio Region, Italy</p>

Bargagli¹,

Cascini²,

Agabiti³

et al. 2019

CIA

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IntroductionDespite recommendations from associations of geriatric and psychiatry societies and warnings from drug agencies, antipsychotic (AP) drugs are frequently used to control behavioral and psychological symptoms of dementia. APs are associated with a range of potential adverse events, including increased risk of cerebrovascular events and mortality. Evidence suggests limited efficacy of APs for aggression and psychosis. Our objectives were to investigate patterns and predictors for prescription of APs among older adults with dementia residing in a large region of central Italy, and to identify patient characteristics related to typical or atypical APs prescribing.MethodsThis is a retrospective population-based cohort study using data from regional health information systems (HIS). We included dementia patients aged ≥65 years residing in the Lazio region. The exposure was defined as new use vs non-use of APs. Dementia patients with incident use of APs during 2015 were followed-up from the date of first prescription to the earliest among discontinuation of use, death, or end of study (December 31, 2016).ResultsWe enrolled 24,735 dementia patients, 1727 (6.7%) new users and 23,008 non-users of APs. Forty-four percent of AP users were treated for more than 3 months, and among these about 60% received APs continuously for at least 12 months. Individuals using antidepressant or anti-dementia drugs had higher odds of being prescribed with APs (OR: 1.67 and OR: 1.86, respectively). Patients exposed to polypharmacy were less likely to receive APs (OR: 0.82). Cardiovascular risk factors and comorbidities were not associated with APs use. Low socio-economic position was associated with lower odds of atypical AP prescribing (OR: 0.57).ConclusionThe study showed that a not negligible proportion of patients had a period of AP use longer than recommended by guidelines. We identified socio-demographic and clinical factors associated with first use of APs, providing insight into prescribing practices in a community setting and useful information to address areas of potential inappropriateness.

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“…To test the independent association between polypharmacy and mental health, there is a need to control for a wide range of third varibles that can potentially confound such an association. The first group of potential confounders are demographic factors such as age and gender [7][8][9][10]. It has been demonstrated that polypharmacy is more common in women, and older individuals, who have a higher number of chronic diseases and frequent contact with the health care system [7][8][9][10].…”

Section: Introductionmentioning

confidence: 99%

“…The first group of potential confounders are demographic factors such as age and gender [7][8][9][10]. It has been demonstrated that polypharmacy is more common in women, and older individuals, who have a higher number of chronic diseases and frequent contact with the health care system [7][8][9][10]. At the same time, depressive symptoms are also more common in women than men [11][12][13][14][15].…”

Section: Introductionmentioning

confidence: 99%

Polypharmacy and Depressive Symptoms in U.S.-Born Mexican American Older Adults

Assari

Wisseh

Saqib

et al. 2019

Psych

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Background: Although some studies have suggested a link between polypharmacy and poor mental health, less is known about the association between polypharmacy and depressive symptomology among U.S.-born older Mexican Americans. Aim: This study aimed to test the association between polypharmacy and depressive symptoms in U.S.-born older Latino Americans. Materials and methods: Data came from the Sacramento Area Latino Study on Aging (SALSA 2008). A total of 691 U.S.-born older (age >= 65) Mexican Americans entered this analysis. Polypharmacy was the independent variable. Level of depressive symptoms was the outcome. Age, gender, socioeconomic status (education, income, and employment), retirement status, health (chronic medical conditions, self-rated health, and activities of daily living), language, acculturation, and smoking were the covariates. A linear regression model was used to analyze the data. Results: We found a positive association between polypharmacy and depressive symptoms, which was above and beyond demographic factors, socioeconomic status, physical health, health behaviors, language, acculturation, and health insurance. Conclusion: Polypharmacy is linked to depressive symptoms in U.S.-born older Mexican Americans. More research is needed to test the effects of reducing inappropriate polypharmacy on mental well-being of first and second generation older Mexican Americans. There is also a need to study the role of drug-drug interaction in explaining the observed link between polypharmacy and depressive symptoms.

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Sex and gender differences in polypharmacy in persons with dementia: A scoping review

Cited by 24 publications

References 64 publications

Sex differences in the management of persons with dementia following a subnational primary care policy intervention

Sex differences in the management of persons with dementia following a subnational primary care policy intervention

<p>Determinants Of Antipsychotic Drugs Prescription Among Community-Living Older Adults With Dementia: A Population-Based Study Using Health Information Systems In The Lazio Region, Italy</p>

Polypharmacy and Depressive Symptoms in U.S.-Born Mexican American Older Adults

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