Use of potentially inappropriate medications among ambulatory home-dwelling elderly patients with dementia: A review of the literature

Patel, Tejal; Slonim, Karen; Lee, Linda

doi:10.1177/1715163517701770

Cited by 25 publications

(25 citation statements)

References 38 publications

(139 reference statements)

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…A systematic review among older adults with cognitive impairment and dementia reported a varied prevalence of prescription of PIMs of 10.2% to 56.4% across Europe, Australia, and the United States; and the Beers criteria were applied for assessing PIMs in majority of the studies . Another recent literature review reported that among the five studies conducted in ambulatory home‐dwelling patients diagnosed with dementia that used the Beers criteria, the prevalence of PIMs use ranged from 16.2% to 33%, and PIMs were found to be associated with gender, ethnicity, number of medications prescribed, and varied medical conditions . An understanding about the prevalence and determinants of PIMs can help prevent adverse effects and improve the quality of prescribing in this vulnerable age group.…”

Section: Introductionmentioning

confidence: 99%

“…16 Another recent literature review reported that among the five studies conducted in ambulatory home-dwelling patients diagnosed with dementia that used the Beers criteria, the prevalence of PIMs use ranged from 16.2% to 33%, and PIMs were found to be associated with gender, ethnicity, number of medications prescribed, and varied medical conditions. 17 An understanding about the prevalence and determinants of PIMs can help prevent adverse effects and improve the quality of prescribing in this vulnerable age group. To our knowledge, this is the first study conducted to evaluate the predictors of prescribing PIMs in older adults with dementia, receiving comprehensive geriatric risk assessments.…”

mentioning

confidence: 99%

See 1 more Smart Citation

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

Bala

Jamieson

Nishtala

2018

Int J Geriat Psychiatry

View full text Add to dashboard Cite

Objective To identify the prevalence and predictors of prescribing potentially inappropriate medications (PIMs) in a nationwide cohort of community dwellers with dementia requiring complex care needs. Methods A cross‐matched data of the International Resident Assessment Instrument‐Home Care (9.1) (interRAI‐HC) and prescribing data obtained from the Pharmaceutical Claims Data Mart (Pharms) extract files for older adults (≥65 y) requiring complex care needs were utilized for this study. The 2015 Beers criteria were applied to identify the prevalence of PIMs in older adults with dementia. Sociodemographic and clinical predictors of PIMs were analysed using a logistic regression model. Results The study population consisted of 16 568 individuals who had their first interRAI assessment from 1 January 2015 to 31 December 2015. The estimated prevalence of dementia was 13.2% (2190/16 568). 66.9% (1465/2190) of the older adults diagnosed with dementia were prescribed PIMs, of which anticholinergic medications constituted 59.6% (873/1465). Males and individuals who were prescribed a greater number of medications were more likely to be prescribed PIMs. Individuals over 85 years of age, Māori ethnic group of individuals, older adults who were being supervised with respect to their activities of daily living, and individuals who reported good or excellent self‐reported health had a lesser likelihood of being prescribed PIMs. Conclusion We found that PIMs are prescribed frequently in older adults with dementia. Comprehensive geriatric assessments can serve as a potential tool to decrease the occurrence of PIMs in vulnerable groups with poor functional and cognitive status.

show abstract

Section: Introductionmentioning

confidence: 99%

mentioning

confidence: 99%

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

Bala

Jamieson

Nishtala

2018

Int J Geriat Psychiatry

View full text Add to dashboard Cite

show abstract

“…Polypharmacy (the use of five or more regular medications per day) is widely recognised as a potentially significant contributor to morbidity and mortality in the elderly population [1]. As the proportion of the elderly (80 years and older) population continues to rise, the community burden of medication treated conditions will also increase, along with the risk of adverse drug reactions [2,3]. The geriatric population is especially vulnerable to the effects of polypharmacy due to the age related decline in renal and liver function, which alters drug metabolism and clearance [4,5].…”

Section: Introductionmentioning

confidence: 99%

“…Certain drug classes, such as benzodiazepines, antipsychotics and anticholinergics have been well described in the literature to be associated with harm in the elderly population due to age-related increased sensitivity to adverse effects [3,6]. Furthermore, these drug classes are frequently prescribed for elderly patients despite evidence of limited therapeutic benefit [2,3,7,8,9]. While other medications are continued in the elderly beyond the treatment duration required for the primary indication, such as proton pump inhibitors for reflux symptoms and antidepressants for depression [2,3].…”

Section: Introductionmentioning

confidence: 99%

“…Furthermore, these drug classes are frequently prescribed for elderly patients despite evidence of limited therapeutic benefit [2,3,7,8,9]. While other medications are continued in the elderly beyond the treatment duration required for the primary indication, such as proton pump inhibitors for reflux symptoms and antidepressants for depression [2,3]. These drugs may be described as "potentially inappropriate medications" or PIMs [3].…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Polypharmacy in very elderly hospitalised patients: a single centre study

Banakh

2018

JPT

View full text Add to dashboard Cite

Objectives: To quantify the extent of polypharmacy and potentially inappropriate medications (PIMS) in very elderly hospitalised patients. Method: A retrospective audit of prescribed medications among hospitalised medical patients (?80 years). The number of regular medications was categorised as: non-polypharmacy (0-4 drugs), polypharmacy (5-9 drugs) and hyper-polypharmacy (? 10 drugs). Results: 318 patient records were reviewed with a mean age of 86.3 years, Polypharmacy was identified in 50.6% of patients and hyper-polypharmacy in 31.2%, while only 18.2% of patients had non-polypharmacy. 62.3% of patients received at least one psychotropic agent, most commonly anti-depressants (26.1%) followed by sedatives (19.5%). Antidepressant use correlated significantly with a history of falls, P=0.005. Other commonly prescribed medications were proton-pump inhibitors (53.5%), diuretics (48.1%), statins (45.6%), beta-blockers (34.3%) and anti-coagulation agents (21.7%). Conclusion: Our study showed that over 80% of hospitalised very elderly patients were exposed to polypharmacy, and many patients were prescribed PIMS.

show abstract

Effect of collaborative dementia care on potentially inappropriate medication use: Outcomes from the Care Ecosystem randomized clinical trial

Liu

Possin

Cook

et al. 2022

Alzheimer's & Dementia

View full text Add to dashboard Cite

Introduction Potentially inappropriate medications (PIMs) cause adverse events and death. We evaluate the Care Ecosystem (CE) collaborative dementia care program on medication use among community‐dwelling persons living with dementia (PLWD). Methods Secondary analysis of a randomized clinical trial (RCT) comparing CE to usual care (UC) on changes in PIMs, over 12 months between March 2015 and May 2020. Secondary outcomes included change in number of medications, clinically relevant PIMs, and anti‐dementia medications. Results Of 804 PLWD, N = 490 had complete medication data. The CE resulted in significantly fewer PIMs compared to UC (−0.35; 95% CI, −0.49 to −0.20; P < 0.0001). Number needed to prevent an increase in 1 PIM was 3. Total medications, PIMs for dementia or cognitive impairment, CNS‐active PIMs, anticholinergics, benzodiazepines, and opioids were also fewer. Anti‐dementia medication regimens were modified more frequently. Conclusion The CE medication review intervention embedded in collaborative dementia care optimized medication use among PLWD. Highlights Compared to usual care (UC), the Care Ecosystem (CE) medication review intervention prevented increases in potentially inappropriate medications (PIMs). Use of anticholinergics, benzodiazepines, and opioids were significantly reduced, with a trend for antipsychotics. Anti‐dementia medications were adjusted more frequently. The CE medication review intervention embedded in collaborative dementia care optimized medication use.

show abstract

Use of potentially inappropriate medications among ambulatory home-dwelling elderly patients with dementia: A review of the literature

Cited by 25 publications

References 38 publications

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

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

Polypharmacy in very elderly hospitalised patients: a single centre study

Effect of collaborative dementia care on potentially inappropriate medication use: Outcomes from the Care Ecosystem randomized clinical trial

Contact Info

Product

Resources

About