Changes in the Prevalence of Polypharmacy in People with and without Dementia from 2000 to 2014: A Nationwide Study

Abstract

Background: Early and accurate diagnosis of dementia opens the door to appropriate treatment, support, and counseling. Despite availability of evidence-based guidelines for diagnostic evaluation of dementia, the diagnostic rate in people with dementia is low and the quality of dementia diagnoses is unknown. Objective:The overall aim of this register-based study was to analyze the quality of diagnostic evaluation of dementia by assessing nationwide geographical variations in a range of indicators. Methods:A register-based cross-sectional study of the entire Danish population aged 65 years or older in 2015 was conducted. The surrogate indicators for diagnostic quality included 1) prevalence rates of dementia diagnoses, 2) incidence rates of dementia diagnoses, 3) age at first diagnosis of dementia, 4) medical specialty responsible for diagnosis, 5) diagnostic rate of dementia subtypes, and 6) use of anti-dementia medication. The indicators were compared across the five Danish regions. Results:The national prevalence and incidence of registered dementia diagnoses was 3.0% and 0.5%, respectively. The proportion of patients diagnosed at a dementia specialist department ranged from 60.9% to 90.5% across the five regions, subtype specific diagnosis ranged from 45.3% to 75.5%, and use of anti-dementia medication ranged from 29.2% to 58.3%. Conclusion:The observed geographical variations in dementia diagnoses and treatment indicate inequality in the access to appropriate diagnostic evaluation and care for patients with dementia. Our findings call for more awareness of the benefits of timely diagnosis and for improvement in the quality of diagnostic evaluation of dementia.

Sex differences in multimorbidity and polypharmacy trends: A repeated cross-sectional study of older adults in Ontario, Canada

“…There are also notable sex differences in the prevalence of individual and cooccurring medication classes and chronic conditions [7,19] and potentially harmful drug-drug interactions [12]. Though recent studies have explored broad trends in multimorbidity [2,4,5] and/or polypharmacy [12,19,20,28], few have examined sex-and age-specific trends in both [20] among older adults or investigated variation over time in the impact of multimorbidity and age on medication use [29][30][31][32], particularly among older men and women.…”

Impact of the Goal‐directed Medication Review Electronic Decision Support System on Drug Burden Index: A cluster‐randomised clinical trial in primary care

“…Polypharmacy is increasing in older adults, in Australia and internationally, 1,2 and is associated with adverse outcomes including falls, functional decline, hospitalisation and death 3,4 . Use of medications with anticholinergic and sedative properties is of concern because they have cumulative effects on functional impairment in older adults 5 .…”

Potentially inappropriate medication in older participants of the Berlin Aging Study II (BASE-II) – Sex differences and associations with morbidity and medication use

“…A prevalence of 21.1% for polypharmacy in BASE-II in an analysis including people younger than 65 years at baseline assessment was reported before [20]. Studies involving community-dwelling adults have shown even higher prevalences of 36.1 to 39.1% (polypharmacy) and 7.7 to 8.9% (excessive polypharmacy) [44, 45]. A large Dutch study described an increase in polypharmacy over time from 1999 to 2014 [46].…”

“…A large Dutch study described an increase in polypharmacy over time from 1999 to 2014 [46]. Another Danish study described increasing polypharmacy from 2000 to 2011 but a stable prevalence from 2011 to 2014 [45]. Living longer typically results in the manifestation of chronic disease.…”