Impact of a Nurse-Based Intervention on Medication Outcomes in Older Adults: The Cc-Map Study

Abstract

Delirium is often misdiagnosed in dementia and mistreated with medications that may be continued even after hospital discharge. This paper will present results from the Early Nurse Detection of Delirium Superimposed on Dementia (END-DSD) NIH funded cluster randomized trial. We hypothesized that subjects on the END-DSD units would receive fewer psychoactive medications compared to subjects on control units. Participants (n = 391; M age = 84; 71% female; 95% Caucasian) were enrolled at the time of admission. The intervention group had significantly lower number of medications given PRN than the control group. The number of unique Beers medications given PRN was lower in the intervention group. And the number of PRN medications with an anticholinergic burden score of 3 was significantly lower. These drugs negatively impact older adults and should be avoided. Nurses play an integral role in decreasing the use of PRN and psychoactive medications in older adults. IMPROVING MEDICATION SAFETY AND TRAINING FOR OLDER ADULTS WITH DEMENTIA N. Brandt, University of Maryland at Baltimore, Baltimore, MarylandThe intent of this session is to highlight the work of an interprofessional team and tactics to improve medication safety for older adults and their caregivers. Interprofessional health care providers at the Baltimore Veterans Affairs Medical Clinic, namely medicine, pharmacy, nursing, neuropsychology & social work, have been actively involved in various clinical and educational initiatives. One of these initiatives is the "DEMO: Dementia Evaluation, Management and Outreach" program. This program aims to extend dementia evaluations to regional community-based outpatient clinics, which serve people in more rural regions, and to improve management and follow-up of these patients, including medication coordination and adherence monitoring. Additionally, the team has created and evaluated online interprofessional training focusing on medications and other needs of older adults with dementia, looking at knowledge, skills and attitudes. Results and resources will be shared with conference attendees that can be useful for their clinical care settings. Medication-related problems are common in older adults with multiple chronic conditions. Holistic, patient-centered approaches may be particularly well-suited to addressing the complex and disease-crossing nature of these problems. In this presentation, we will present results of a cluster-controlled clinical trial that evaluated the impact of a nursebased primary care intervention on medication outcomes in 1,218 high-risk older Israeli adults. Our primary outcome was the number of changes to patients' medication regimens, a marker of attention to patient-centered prescribing. After 9 months of follow-up, intervention subjects had more changes to their medication regimen than control subjects (mean 4.04 vs. 3.62 medication changes; adjusted difference 0.55, P=0.001). Similarly, intervention subjects had more changes to their symptomatic medications (mean 1.38 vs. 1.26 changes, adjus...