Effects of a multifaceted intervention in psychogeriatric patients: one-year prospective study

Abstract

Objectives The aetiology of behavioural and psychological symptoms (BPSD) could be related to inadequate treatment in patients with dementia. The aim of this study was to determine how a multifaceted intervention based on a medication review and multidisciplinary follow-up could improve treatment and minimise risk in these patients. Methods A prospective interventional study was undertaken between July 2015 and July 2016 of patients with dementia admitted to control BPSD. Patients with previous psychiatric illness or palliative care were excluded. Prescription information was obtained from Aegerus and the Catalonia clinical record HC3. The intervention was conducted by a multidisciplinary team. The Medication Appropriateness Index (MAI) was used to assess the intervention. results 65 patients (60% women, mean age 84.9±6.7 years) with mild-moderate cognitive impairment (mean 4.5±1.8), moderate-severe functional dependence (mean 43.8±23.9) and a high prevalence of geriatric syndromes and comorbidity were included in the study. 87.7% of the patients were taking ≥5 drugs (mean 9.0±3.1) and 38.5% were taking ≥10. Patients presented with BPSD values of 1.9±0.8 at admission. Common symptoms prompting admission were agitation (47.7%) and irritability (43.1%). A total of 175 drug-related problems (DRPs) were detected (2.97 per patient). Significant differences (p<0.001) were found between the MAI score at admission (4±4.6) and post-intervention (0.5±2.6). Most prevalent MAI criteria were related to interactions (40%), dosage (38.5%) and duplication (26.2%). 55 patients (84.6%) were taking anticholinergic drugs at admission (2.6±1.2 anticholinergic drugs per patient), and the post-intervention reduction was significant (p<0.016). Conclusions The balance between effective treatment and safety is complex in these patients. Medication review in interdisciplinary teams is an essential component to optimise interventions and assessment of safety. MeThOds design, setting and inclusion/exclusion criteriaThis was a one-year prospective interventional study performed in a long-term care psychogeriatric unit (21 beds) in an intermediate care hospital (HSS Mutuam Güell, 165 beds) in Barcelona, Spain.

Anticholinergic Burden and Safety Outcomes in Older Patients with Chronic Hepatitis C: A Retrospective Cohort Study

“…We also found a relationship between comorbidity and drugs with a greater anticholinergic effect. Patients with anticholinergic drugs had more comorbidity (CRG ≥ 6/05) [39]. The presence of moderate and excessive polypharmacy (≥5 and ≥10 drugs) has been found to be a risk factor for the presence of anticholinergic medication; data in concordance with those observed by Sevilla et al [30].…”

“…Prevalence of patients taking anticholinergic drugs was statistically significantly higher (p < 0.0001) on the ACB and ADS scales (35.2% and 34.3%) than on the ARS scale (10.6%). Anticholinergic medications are considered inadequate for geriatric patients [39]. Mechanisms potentially explaining the association between anticholinergic medicines and adverse events include age-related changes in pharmacokinetics and pharmacodynamics, as well as increased permeability of blood-brain barriers [40].…”

Adverse Drug Events in Patients with Dementia and Neuropsychiatric/Behavioral, and Psychological Symptoms, a One-Year Prospective Study

“…A high proportion of the ADEs were identified at admission (50%) [1,13], so the ADEs were probably responsible for the symptoms worsening. When this medication was removed or changed for a more appropriate one, the symptoms reduced or disappeared [38]. This is a highly relevant result for patient safety and shows that a routine systematic review of the pharmacotherapy can result in a better clinical outcome, quality of life, and economic saves [10,15].…”

“…It is important to know which cardiovascular medication is most associated with falls. Loop diuretics have a well-known correlation, and between antihypertensive drugs, we found heterogeneous characteristics; therefore, we should prioritize drugs with a better correlation of safety or even a protective effect on the risk of falls [24,38].…”

“…Our study has some limitations. A specific sample size has not been established in order to provide a predetermined power to the statistical analysis, as ours is a sub-study of a cohort whose main goal was to was to determine how multifaceted pharmaceutical intervention based on a medication review and multidisciplinary follow up could improve the treatments and minimize the risk of patients in the psychogeriatric unit [38]. However, the study period was long, and this may mitigate this weakness.…”