Medication use to manage comorbidities for people with dementia: a systematic review

Abstract

Aim: People with dementia commonly live with multiple comorbidities. This review aimed to review medications to manage chronic conditions in people who also have a diagnosis of dementia. The secondary aim was to determine whether drug utilisation for other conditions change as a result of dementia diagnosis. Methods: Data source: We included experimental and observational studies where participants with dementia were diagnosed and treated for one or more comorbid conditions that reported health outcomes or drug utilisation. Study selection: MedLine and Embase databases were searched from inception to March 2016 (updated September 2016). Three researchers screened titles, abstracts and full-text articles, then extracted data using a data extraction sheet. Results: Six studies met inclusion criteria with 51 696 participants (mean age 81.1 AE 2.0 years, 78% female). One experimental study compared bisphosphonate use with placebo in people with mid-stage dementia and found reduced risk of non-vertebral fractures (OR = 0.27, 95% CI 0.12-0.61) in the bisphosphonate group. Five observational studies reported drug utilisation for people with dementia to treat comorbidities, namely depression, osteoporosis, diabetes and cardiovascular disease. Drug utilisation was found to be similar for depression, diabetes and cardiovascular disease for people with and without dementia, although bisphosphonate use was significantly reduced. Conclusion: Evidence on medication use for comorbidities in people with dementia is currently limited to drug utilisation patterns and treatment of one comorbidity: osteoporosis. Comorbidities for people with dementia appear to be managed pharmacologically until the late stages of disease without considering time to benefit or that it is a life-limiting condition. 1.13 (0.93-1.38) CHADS = congestive heart failure, hypertension, age >75, diabetic, history of stroke.

Potentially inappropriate prescribing in dementia: a state-of-the-art review since 2007

“…In people living with dementia comorbidities are managed pharmacologically, often resulting in patients being prescribed a large number of medications 43 44. The frequent use of medication in people living with dementia in combinations that have been known to cause adverse reactions suggests that these individuals are especially at risk of inappropriate prescribing, 4 22 45.…”

“…People living with dementia, particularly those in advanced stages, are often excluded from trials 27 28. As a result, existing evidence for the pharmacological management of chronic conditions (eg, diabetes) does not fully reflect the needs of people with dementia, nor does it provide conclusive evidence that it improves health outcomes or quality of life 44 51 52. A 2018 systematic review on management of chronic conditions in people with dementia identified only six studies, covering depression, osteoporosis, diabetes and cardiovascular disease 44.…”

“…A 2018 systematic review on management of chronic conditions in people with dementia identified only six studies, covering depression, osteoporosis, diabetes and cardiovascular disease 44. Of these, the impact of treatment in clinical outcomes was reported for only one condition 44. The reduced representation of people with more severe dementia in clinical trials is particularly problematic as treatment targets for comorbidities of dementia may need to change as dementia progresses 29.…”

Exploring the enablers and barriers to implementing the Medication Appropriateness Tool for Comorbid Health conditions during Dementia (MATCH-D) criteria in Australia: a qualitative study

“…However, the limited evidence base was the main reason that a consensus methodology was applied to develop the MATCH-D. 26 27 This paucity of research was demonstrated in our recent systematic review on the topic found only one randomised study that investigated medication use to manage comorbidities. 27 This limited evidence base means it would not be feasible to reference the MATCH-D.…”

Protocol for a non-randomised pilot and feasibility study evaluating a multicomponent intervention to simplify medication regimens for people receiving community-based home care services

“…Research nurses were contracted by the community-based home care provider organisation and therefore had good knowledge of organisational processes, policies and procedures. A training package adapted from a related study conducted in residential aged care11 was used to train the research nurses in the consent process for the present study, and to train the research nurses and project pharmacist to use the data collection tools and administer assessments.…”