Some well-known risk factors for AD were confirmed in this study and potential new risk factors were identified. The association of AD with a history of migraines and occupational exposure to defoliants/fumigants is of particular interest because these are biologically plausible risk factors.
An unexpected finding was that the pill count technique used in this study of elderly clients using chronic, repeat medications appeared to underestimate medication adherence. Numerous other limitations of pill count, self-report, and a province-wide prescription claims database in estimating medication adherence are presented. When using medication adherence as a process measure, the researcher and practitioner should be aware of the limitations unique to the data source they choose, and interpret data cautiously.
A survey of drug-related admissions of patients aged 50 years and older was conducted at the Health Sciences Centre, Winnipeg to determine the interrelationship of risk factors, and isolate the effect of age. All nonelective medical admissions were prospectively assessed to determine the role of drug therapy as a contributory factor. Of the 863 eligible admissions, 162 exhibited at least one drug-related adverse patient event (DRAPE) at the time of hospitalization. This accounted for 19% of the admissions (23% of 718 admissions that involved prescription drugs). Although adverse drug reactions were responsible for many DRAPEs (48%), intentional noncompliance (27%), treatment failure (19%), alcohol (14%), and medication error (10%) were also frequent contributing causes. Drugs commonly implicated in DRAPEs were systemic steroids, digoxin, nonsteroidal anti-inflammatory agents, alpha-methyldopa, calcium channel blockers, beta-blockers, theophylline, furosemide, sympathomimetics, thiazides, and benzodiazepines. The risk of a DRAPE was related to the number of diseases prior to admission (r = 0.81; P less than .026) and the number of drugs used (r = 0.77; P less than .001). Age was not correlated with the risk of a DRAPE. Females had significantly more adverse drug reactions, although sex was not a predictor for overall DRAPE risk.
Because depressive symptoms as measured by the CES-D predict the development of AD and dementia over 5 years, clinicians should monitor their older patients with these symptoms for signs of cognitive impairment.
Memory complaints predict the development of dementia over five years, and clinicians should monitor these persons closely. However, the proportion of persons developing dementia was small, and SML alone is unlikely to be a useful clinical predictor of dementia.
The impact of an aging population on the health care system is a primary speculative concern for health policy. Unique data from a large sample of 4,263 decedents aged 45 years and over in Manitoba, Canada, describe actual utilization in the four years prior to death: all hospitalizations, nursing home stays, and ambulatory physician contacts. Total expenditures associated with dying do increase with age, but even among the very elderly many deaths have few expenditure consequences. Apocalyptic scenarios for the health care system may be premature.
Objectives — To measure the impact of a community‐based geriatric pharmaceutical care model on specific process measures.
Methods — The model was evaluated using a prospective, randomised, controlled study design. Clients who self‐presented or were referred by Home Care were eligible if they were 65 years of age or older, non‐institutionalised, taking two or more prescribed or non‐prescribed medications, and willing to provide signed informed consent. A pharmacist conducted a comprehensive drug therapy review on test clients, then addressed issues with the client and/or the client's physician, with follow‐up as required. Measurements included number of drugs, drug knowledge, adherence to therapy, cost of prescribed medicines, and number of reported symptoms obtained from a home medication history conducted by trained volunteers, the provincial prescription claims database, and response to a physician survey.
Setting — The pharmaceutical care model was situated within a community‐based interdisciplinary health clinic targeting non‐institutionalised elderly.
Key findings — One hundred and thirty‐five clients were randomised to test (n=69) or control (n=66). A mean of 14.4 (SD 4.6) potential or actual issues were identified in test clients. Ninety‐four per cent of physicians agreed with at least one of the pharmacist's recommendations but only 230 of 794 recommendations by the pharmacist (29 per cent) resulted in a change. There was no difference in overall number of prescribed or over‐the‐counter medications, drug costs, symptoms reported, drug knowledge or medication adherence between test and control groups post‐intervention.
Future research — Further research is needed to identify barriers to changing drug use behaviour and facilitating acceptance of pharmaceutical care in the community.
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