Contraindicated medication use among patients in a memory disorders clinic

Barton, Cynthia; Sklenicka, Julie; Sayegh, Philip; Yaffe, Kristine

doi:10.1016/j.amjopharm.2008.08.002

Cited by 30 publications

(24 citation statements)

References 21 publications

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“…A possible field of research should be the treatment of OAB in these patients with mirabegron, a beta‐3‐receptor‐agonist, which does not interfere with M1 receptors. Table shows the main results of studies on the concomitant use of antimuscarinics and AChEIn …”

Section: Resultsmentioning

confidence: 99%

Management of LUTS in patients with dementia and associated disorders

Averbeck

Altaweel

Manu-Marin

et al. 2015

Neurourology and Urodynamics

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Section: Resultsmentioning

confidence: 99%

Management of LUTS in patients with dementia and associated disorders

Averbeck

Altaweel

Manu-Marin

et al. 2015

Neurourology and Urodynamics

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“…2,4,38 Prior research in dementia patients has either limited PIMs to those medications known to exacerbate cognitive impairment, 37,39 or relied exclusively on prescription medication data to calculate PIM rates in dementia patients. 35,36 However, older adults are the largest group of purchasers of OTC medications, 40 and a number of medications on the Beers list are available OTC without a prescription.…”

Section: Discussionmentioning

confidence: 99%

The Impact of Family Caregivers on Potentially Inappropriate Medication Use in Noninstitutionalized Older Adults With Dementia

Thorpe

Kennelty

et al. 2012

The American Journal of Geriatric Pharmacotherapy

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Background The risk of potentially inappropriate prescription and over-the-counter medication (PIM) use in dementia patients is high. Informal caregivers often facilitate patients’ use of medications, but the effect of caregiver factors on PIM use has not been a focus of prior research. Objective To examine PIM use in dementia patients and caregivers, and identify caregiver risk factors for PIM use in dementia patients. Methods We conducted a secondary data analysis of the baseline wave of the Resources for Enhancing Alzheimer's Caregiver's Health study. The sample was comprised of 566 persons with dementia aged 65 and older and their co-residing family caregiver. PIM was defined using the 2003 Beers criteria and was examined in both dementia patients and their caregivers. Caregiver and patient risk factors included a range of socio-demographic and health variables. Results In dementia patients, 33% were taking at least 1 PIM, and 39% of their caregivers were also taking a PIM. In fully adjusted models, the following caregiver factors were associated with an increased risk of dementia patient PIM use: caregiver's own PIM use; spouse caregivers; Hispanic caregivers; and greater number of years the caregiver has lived in the United States. Increased caregiver age was associated with a decreased risk of PIM use in patients. Conclusions PIM use may be higher in dementia patients and their informal caregivers compared to the general older adult population. Further, patterns of medication use in one member of the dyad may influence PIM risk in the other dyad member. These results suggest that interventions to increase appropriate medication use in dementia patients and their caregivers should target both members of the dyad and target over-the-counter agents along with prescription medications.

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“…Randomized clinical trials have shown that guidelines on PIM use, when implemented by physicians or pharmacists, can significantly reduce the number of prescribed PIMs 4, 5 . Regardless, studies consistently show that a significant proportion of elderly patients with or without cognitive impairment are prescribed PIMs 6, 7 .…”

Section: Introductionmentioning

confidence: 99%

Ten‐Year Trajectory of Potentially Inappropriate Medications in Very Old Women: Importance of Cognitive Status

Koyama

Steinman

Ensrud

et al. 2013

J American Geriatrics Society

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Background/ Objectives Older populations are particularly susceptible to adverse effects from potentially inappropriate medications (PIMs), which can be associated with cognitive impairment. Additionally, many older adults have existing cognitive impairment which can be exacerbated by PIMs. It is not clear which older adults tend to receive PIMs, how this may differ by cognitive status, or how the trajectories of PIM use change over time. Design Longitudinal cohort study Setting Three clinical sites in the United States. Participants We followed 1,484 community-dwelling women ≥ 75 years of age over 10 years. Measurements At follow-up, we ascertained cognitive status, which was classified as normal, mild cognitive impairment (MCI) or dementia. Beers 2003 criteria and other literature were used to identify PIMs from detailed medication inventory performed at three time points. We also measured anticholinergic load using the Anticholinergic Cognitive Burden scale (ACB), which assigns medications a value from 0 to 3 depending on anticholinergic properties. Results At baseline, 23.9% of women were taking at least one PIM and the mean(± SD) ACB score was 1.41(± 1.69). The most frequently reported PIMs were anticholinergics (15.2%), benzodiazepines (8.6%), and antispasmodics (8.0%). Over 10 years, PIM use increased for women with dementia (24.9% to 33.1%; p=0.02), yet remained fairly constant for women with MCI (23.9% to 23.0%; p=0.84) and normal cognitive status (22.2% to 19.8%; p=0.17). Mean ACB score significantly increased (p<0.001) over time for all groups (dementia: 1.28 to 2.05; MCI: 0.98 to 1.66; normal: 0.99 to 1.48). Conclusion PIM use and anticholinergic load in a community-dwelling population of older women is high, especially among women who later develop dementia. Future guidelines should limit PIM use and seek safer alternatives.

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Contraindicated medication use among patients in a memory disorders clinic

Cited by 30 publications

References 21 publications

Management of LUTS in patients with dementia and associated disorders

Management of LUTS in patients with dementia and associated disorders

The Impact of Family Caregivers on Potentially Inappropriate Medication Use in Noninstitutionalized Older Adults With Dementia

Ten‐Year Trajectory of Potentially Inappropriate Medications in Very Old Women: Importance of Cognitive Status

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