Cognitive Impairment and Medication Complexity in Community-Living Older Adults: The Health, Aging and Body Composition Study

Abstract

Background Medication complexity is a large determinant of adherence. Few studies have explored the relationship between cognitive impairment and medication complexity. Objective To evaluate whether cognitive impairment is associated with medication complexity for prescription and over-the-counter (OTC) medications. Methods In this cross-sectional analysis, we studied the association between cognitive impairment and the complexity of prescription and OTC drug regimens. Baseline participants were from the Health, Aging and Body Composition study, consisting of 3075 well-functioning 70- to 79-year-old black and white men and women. Cognitive impairment was defined by having a Modified Mini-Mental State Examination score <80. The complexity of prescription and OTC (including supplements/herbals) medications was assessed using a modified version of the Medication Regimen Complexity Index (mMRCI). The mMRCI score increases with complexity of dosage forms, number of medications, pill burden, and nondaily dosing. Results The mean (SD) age was 74 (2.9) years (n = 3055; 52% female, 41% black). The median prescription mMRCI score was 6 (range 0–66). The median OTC mMRCI score was 4 (range 0–71). Adjusting for health status, demographics, and access to care, medication complexity was lower in participants with cognitive impairment for prescription (adjusted RR 0.89; 95% CI 0.80 to 0.99) and OTC medications (adjusted RR 0.76; 95% CI 0.64 to 0.93) compared to those without cognitive impairment. The number of prescription medications was not different, but the number of OTC drugs was lower for those with cognitive impairment. Conclusions In this cohort of well-functioning older adults, those with cognitive impairment had lower prescription complexity due to less-complex dosage forms, pill burden, or daily dosing. OTC complexity was also lower, primarily due to a lower number of OTC drugs. The results of this study show that further research on medication complexity and adherence and health outcomes in cognitively impaired individuals is warranted.

Factors associated with medication regimen complexity in older people: a cross-sectional population-based study

“…This was consistent with a previous study conducted in 3055 older adults that found that participants with cognitive impairment had lower regimen complexity [42]. The authors of this study suggested that prescribers might have simplified medication regimens to facilitate easier medication management in people with cognitive impairment.…”

Persistence with antihypertensives in uncomplicated treatment-naïve very elderly patients: a nationwide population-based study

“…However, our finding of higher persistence in very elderly patients with dementia contrasts with the results from several previous studies reporting a higher discontinuation rate for antihypertensive treatment among patients with dementia or cognitive impairment [ 27 , 28 ]. These contradictory findings are somewhat puzzling, and may be partially explained by the lower medication complexity in older adults with cognitive impairment, as observed in one previous study [ 29 ]. The care management by caregivers may also increase the treatment persistence in the very elderly with dementia [ 30 ], which is supported by the findings of recent studies that dementia was associated with the likelihoods of continuing statin therapy (aHR, 0.84; 95% CI, 0.73–0.98) and antiplatelet therapy in elderly patients after ischemic stroke [ 31 , 32 ].…”

<p>Medication Regimen Complexity In 8 Australian Residential Aged Care Facilities: Impact Of Age, Length Of Stay, Comorbidity, Frailty, And Dependence In Activities Of Daily Living</p>

“…Our study found an inverse association between medication regimen complexity and dementia severity in multivariate analysis. Previous studies have reported residents with cognitive impairment are less likely to have complex medication regimens,40,47,48 and are less likely to experience polypharmacy, or the concomitant use of multiple medications (commonly >8) 2,49. Recently, there has been focus in Australia on implementing a palliative approach to medication prescribing for residents with advanced dementia, and deprescribing for all older adults experiencing inappropriate polypharmacy 50,51.…”