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

Bala, Sharmin S.; Jamieson, Hamish A.; Nishtala, Prasad S.

doi:10.1002/gps.5004

Cited by 13 publications

(14 citation statements)

References 54 publications

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“…Previous findings seem contradictory as to the association between dementia and PIM use. Indeed, prior studies found that PIM use is common in older adults with Alzheimer's disease and related dementia, while other studies have observed the opposite . Finally, in our study, the risk of being persistent with PIMs at 1 year increased by 25% and 14% for individuals with diabetes and cardiovascular diseases, respectively.…”

Section: Discussionsupporting

confidence: 40%

One‐year persistence of potentially inappropriate medication use in older adults: A population‐based study

Roux

Sirois

Simard

et al. 2020

Brit J Clinical Pharma

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Aims: To assess the 1-year persistence of potentially inappropriate medication (PIM) use and identify associated factors in community-dwelling older adults in Quebec, Canada.Methods: A population-based cohort study was conducted using the Quebec Integrated Chronic Disease Surveillance System. Individuals insured by the public drug plan and aged ≥66 years who initiated a PIM between 1 April 2014 and 31 March 2015 were followed-up for 1 year. PIMs were identified using the 2015 Beers criteria. One-year persistence of PIM use was defined as continuous treatment with any PIM, without interruption for more than 60 days between prescriptions refills.Poisson regression models were performed to identify factors associated with 1-year persistence of any PIM.Results: In total, 25.1% of PIM initiators were persistent at 1 year. In non-persistent individuals, the median time to PIM discontinuation was 31 days (interquartile range 21-92). Individuals were more persistent at 1 year with antipsychotics (43.9%), longduration sulphonylureas (40.2%), antiarrhythmics/immediate-release nifedipine (36.5%) and proton pump inhibitors (36.0%). Factors significantly associated with persistence were an increased age, being a man and having a high number of medications and chronic diseases, especially dementia, diabetes and cardiovascular diseases. Conclusions:One-quarter of community-dwelling older adults are continuously exposed to PIMs. To optimize medication prescribing in the older population, further interventions are needed to limit the use of PIMs most likely to be continued, especially in individuals most at risk of being persistent and also particularly vulnerable to adverse events.

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Section: Discussionsupporting

confidence: 40%

One‐year persistence of potentially inappropriate medication use in older adults: A population‐based study

Roux

Sirois

Simard

et al. 2020

Brit J Clinical Pharma

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“…The requirement for proper discussion on limits of what treatment can achieve, and the specialist informing the GP adequately was identified as potentially leading to PIM. These findings are in line with those from previous research which emphasised the need for improved inter-professional communication, to address PIM, especially in palliative care [ 25 – 30 ].…”

Section: Discussionsupporting

confidence: 91%

Pacific meets west in addressing palliative care for Pacific populations in Aotearoa/New Zealand: a qualitative study

et al. 2020

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Background: While many Aotearoa/New Zealanders are receiving excellent palliative care the Pacific populations have limited access to available hospice and palliative care services. Little research has been conducted to identify barriers unique to Pacific populations accessing these services. The purpose of this study was to explore key stakeholders' perspectives on the determinants of low access among Pacific populations to these services. Methods: Forty-five semi-structured interviews were conducted face-to-face with hospice patients and their families, hospice/health providers and key informants from the Auckland and Wellington region of Aotearoa/New Zealand. The interviews were recorded and transcribed verbatim and a thematic analysis was carried out by identifying, coding and categorising patterns in the data. Identified themes were then discussed further to determine the relevance of the data grouped by theme. Results: Five interrelated themes affecting access emerged: perception of hospice (often negative) through lack of accurate information, but changing; families' role to look after their own and sick elderly; hospice experiences; continuity of care in the community and the need for information and communication. Conclusion: Hospice and associated palliative care services are under-utilised and commonly misunderstood among Pacific populations in Aotearoa/New Zealand. There is active support following appropriate information received, hence the need for community education and culturally appropriate hospice and palliative services. Inadequate inter-professional communication contributes to polypharmacy and inefficiency in continuity of care across all levels. The Pacific individual is one component of a collective that is critical in major decisions in end-oflife and life changing situations. The findings may guide policies and further research to improve Hospice and Palliative services in Aotearoa/New Zealand.

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“…However, whether or not prescribing anticholinergics is appropriate is something still unclear (López-Álvarez and Agüera Ortiz, 2019). In fact, a study using the Beers criteria found that 39.9% of elderly people with dementia on an outpatient basis were taking anticholinergic drugs classified as potentially inadequate (Bala et al, 2019).…”

Section: Prevalencementioning

confidence: 99%

Anticholinergic Drugs in Geriatric Psychopharmacology

López-Álvarez¹,

Sevilla‐Llewellyn‐Jones

Agüera-Ortíz³

2019

Front. Neurosci.

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Drugs with anticholinergic action are widely prescribed in the elderly population due to their potential clinical benefits. However, these benefits are limited by adverse effects which may be serious in particular circumstances. This review presents different aspects of the use of anticholinergics in old age with a focus in psychogeriatric patients. We critically review published data on benefits and disadvantages of anticholinergics, which are often controversial. Prevalence, pathophysiology and measurement methods of the anticholinergic action of drugs are discussed. We also present the most important drawbacks resulting from its use, including effects on cognition in healthy and cognitively impaired people, in aged schizophrenia patients, emergence of delirium and psychiatric symptoms, influence in functionality, hospitalization, institutionalization and mortality, and the potential benefits and limitations of their discontinuation. Finally, we suggest practical recommendations for the safe use of anticholinergics in clinical conditions affecting elderly patients, such as dementia, schizophrenia and acute hallucinatory episodes, depression, anxiety, Parkinson’s disease, cardiovascular conditions and urinary incontinence.

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

Cited by 13 publications

References 54 publications

One‐year persistence of potentially inappropriate medication use in older adults: A population‐based study

One‐year persistence of potentially inappropriate medication use in older adults: A population‐based study

Pacific meets west in addressing palliative care for Pacific populations in Aotearoa/New Zealand: a qualitative study

Anticholinergic Drugs in Geriatric Psychopharmacology

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