Drug-related problems among older people with dementia: A systematic review

Qin, Qlaementine Ng Xue; Ming, Long Chiau; Wahab, Mohd Shahezwan Abd; Tan, Ching Siang; Yuda, Ana; Hermansyah, Andi

doi:10.1016/j.sapharm.2023.02.015

Cited by 5 publications

(6 citation statements)

References 19 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The high frequency of medication overuse and misuse among PWD is particularly concerning. First, PWD are at high risk for drug‐related problems 7,8,35 . PWD are more likely to be hospitalized due to adverse drug events and medication errors than persons without dementia with one study identifying that anticoagulants and opioids contributed to the majority of admissions 6 .…”

Section: Discussionmentioning

confidence: 99%

“…First, PWD are at high risk for drug-related problems. 7,8,35 PWD are more likely to be hospitalized due to adverse drug events and medication errors than persons without dementia with one study identifying that anticoagulants and opioids contributed to the majority of admissions. 6 Additionally, many of the potentially problematic medications highlighted in our study, such as strongly anticholinergic medications and sedative-hypnotics, have been linked with accelerated cognitive decline, hospitalizations, and death.…”

Section: Discussionmentioning

confidence: 99%

“…Polypharmacy is associated with several adverse health outcomes, including hospitalizations, emergency department visits, and increased mortality 4,5 . Drug‐related problems are prevalent among PWD and contribute to unwanted hospitalizations at higher rates than those without dementia 6–9 . This is especially prominent in PWD due in part to increased susceptibility to medication side effects, drug–drug interactions, and difficulty with medication management leading to unintentional non‐adherence and medication errors 7,8,10 …”

Section: Introductionmentioning

confidence: 99%

“…4,5 Drug-related problems are prevalent among PWD and contribute to unwanted hospitalizations at higher rates than those without dementia. [6][7][8][9] This is especially prominent in PWD due in part to increased susceptibility to medication side effects, drug-drug interactions, and difficulty with medication management leading to unintentional non-adherence and medication errors. 7,8,10 Many medications may be problematic among PWD.…”

Section: Introductionmentioning

confidence: 99%

“…[6][7][8][9] This is especially prominent in PWD due in part to increased susceptibility to medication side effects, drug-drug interactions, and difficulty with medication management leading to unintentional non-adherence and medication errors. 7,8,10 Many medications may be problematic among PWD. For example, guidelines for diabetes management recommend less strict glycemic control for individuals with multimorbidity and limited life expectancy as the risks associated with certain antidiabetic agents, such as insulin and sulfonylureas, may outweigh the benefits of long-term tight glycemic control.…”

Section: Introductionmentioning

confidence: 99%

See 4 more Smart Citations

Medication misuse and overuse in community‐dwelling persons with dementia

Deardorff

Jing

Growdon

et al. 2023

J American Geriatrics Society

View full text Add to dashboard Cite

BackgroundPersons with dementia (PWD) have high rates of polypharmacy. While previous studies have examined specific types of problematic medication use in PWD, we sought to characterize a broad spectrum of medication misuse and overuse among community‐dwelling PWD.MethodsWe included community‐dwelling adults aged ≥66 in the Health and Retirement Study from 2008 to 2018 linked to Medicare and classified as having dementia using a validated algorithm. Medication usage was ascertained over the 1‐year prior to an HRS interview date. Potentially problematic medications were identified by: (1) medication overuse including over‐aggressive treatment of diabetes/hypertension (e.g., insulin/sulfonylurea with hemoglobin A1c < 7.5%) and medications inappropriate near end of life based on STOPPFrail and (2) medication misuse including medications that negatively affect cognition and medications from 2019 Beers and STOPP Version 2 criteria. To contextualize, we compared medication use to people without dementia through a propensity‐matched cohort by age, sex, comorbidities, and interview year. We applied survey weights to make our results nationally representative.ResultsAmong 1441 PWD, median age was 84 (interquartile range = 78–89), 67% female, and 14% Black. Overall, 73% of PWD were prescribed ≥1 potentially problematic medication with a mean of 2.09 per individual in the prior year. This was notable across several domains, including 41% prescribed ≥1 medication that negatively affects cognition. Frequently problematic medications included proton pump inhibitors (PPIs), non‐steroidal anti‐inflammatory drugs (NSAIDs), opioids, antihypertensives, and antidiabetic agents. Problematic medication use was higher among PWD compared to those without dementia with 73% versus 67% prescribed ≥1 problematic medication (p = 0.002) and mean of 2.09 versus 1.62 (p < 0.001), respectively.ConclusionCommunity‐dwelling PWD frequently receive problematic medications across multiple domains and at higher frequencies compared to those without dementia. Deprescribing efforts for PWD should focus not only on potentially harmful central nervous system‐active medications but also on other classes such as PPIs and NSAIDs.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Medication misuse and overuse in community‐dwelling persons with dementia

Deardorff

Jing

Growdon

et al. 2023

J American Geriatrics Society

View full text Add to dashboard Cite

show abstract

Identification of novel NLRP3 inhibitors: a comprehensive approach using 2D-QSAR, molecular docking, molecular dynamics simulation and drug-likeness evaluation

Mouhsin,

Abchir,

El Otmani

et al. 2023

Chem. Pap.

View full text Add to dashboard Cite

This research, employing computational methodologies, aimed to discover potential inhibitors for the nucleotide-binding oligomerization domain-like receptor protein 3 (NLRP3), an intracellular sensor pivotal in in ammation and various disease processes. Despite NLRP3's critical role, there remains a research gap in the identi cation of novel inhibitors, making this study's objective signi cant. Through statistical techniques such as principal component analysis (PCA) and K-means clustering, data re nement and division was conducted in this research, leading to a more targeted set of potential inhibitors. By employing stepwise and subset multiple linear regression, a two-dimensional quantitative structureactivity relationship (2D-QSAR) model was developed, revealing six essential molecular descriptors for inhibitory activity. The interpretation of these descriptors led to the proposition of ve potential compounds. One of these proposed compounds demonstrated remarkable binding a nity through molecular docking studies, marking it as a promising inhibitor of NLRP3. Further veri cation of this compound's potential was conducted via molecular dynamics simulations, a rming its stability and interactions within the protein-ligand system. Compliance with lipinski's rule of ve indicated the drug-like properties of the proposed compounds and their potential for oral bioavailability. Consequently, these ndings present a comprehensive methodology for the discovery and evaluation of novel NLRP3 inhibitors, signi cantly contributing to potential therapeutic advancements.

show abstract