Polypharmacy and Potentially Inappropriate Medication in People with Dementia: A Nationwide Study

Kristensen, Rachel Underlien; Nørgaard, Aage; Jensen‐Dahm, Christina; Gasse, Christiane; Wimberley, Theresa; Waldemar, Gunhild

doi:10.3233/jad-170905

Cited by 72 publications

(85 citation statements)

References 35 publications

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“…15 The finding of our study is also supported by an Australian study involving 547 participants in residential aged care facilities that showed that people exposed to PIMs (defined by 2015 Beers criteria) were more likely to be older and have a diagnosis of dementia (P = .002). In addition, STOPP-listed PIP involving nonsteroidal anti-inflammatory drugs (NSAIDs) were more frequent in people not dispensed medicines for dementia than people dispensed medicines for dementia, including long-term use of NSAIDs (11.3% vs 7.2%, P < .0001) ( green list) higher than that of participants without dementia.…”

Section: Prevalence Of Individual Stopp Criteriasupporting

confidence: 81%

“…In addition, STOPP-listed PIP involving nonsteroidal anti-inflammatory drugs (NSAIDs) were more frequent in people not dispensed medicines for dementia than people dispensed medicines for dementia, including long-term use of NSAIDs (11.3% vs 7.2%, P < .0001) ( green list) higher than that of participants without dementia. 15 The finding of our study is also supported by an Australian study involving 547 participants in residential aged care facilities that showed that people exposed to PIMs (defined by 2015 Beers criteria) were more likely to be older and have a diagnosis of dementia (P = .002). 25 In contrast, a systematic review looking at PIP in people with dementia found that dementia was associated with a decrease in the likelihood of PIMs.…”

Section: Prevalence Of Individual Stopp Criteriasupporting

confidence: 81%

“…14 By contrast, study conducted in Denmark, which assessed PIP prevalence using the German PRISCUS and Danish red-yellow-green list, found that the prevalence of PIP in people with dementia was higher than that in people without dementia. 15 However, there have been no studies that assessed the prevalence of PIP among Australians with dementia compared with those without dementia.…”

Section: Introductionmentioning

confidence: 99%

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Potentially inappropriate prescribing in people with dementia: An Australian population‐based study

Eshetie

Nguyen

Gillam

et al. 2019

Int J Geriat Psychiatry

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Objective To investigate the prevalence of potentially inappropriate prescribing (PIP) using the Screening Tool of Older Person's Prescriptions (STOPP) criteria in people with dementia compared with people without dementia. Methods A retrospective cohort study was conducted using the Pharmaceutical Benefits Scheme 10% sample of pharmacy claims. People with dementia were defined as those dispensed a medicine for dementia (cholinesterase inhibitors, memantine, or risperidone for behavioural and psychological symptoms of dementia) between 1 January 2005 and 31 December 2015, aged 65 years or older at 1 January 2016 and alive at the end of 2016. An age‐ and gender‐matched comparison cohort of people not dispensed medicines for dementia was identified. PIP prevalence was determined between 1 January 2016 and 31 December 2016. Results In total, 8280 people dispensed medicines for dementia and 41 400 comparisons not dispensed medicines for dementia were included: 63% were female and the median age was 82 years. PIP prevalence was 79% among people with dementia compared with 70% among the comparison group (P < .0001). Use of anticholinergics, long‐term use of high‐dose proton pump inhibitors, and use of benzodiazepines were the most common instances of PIP in people with dementia. After adjustments for age, gender, comorbidity, and number of prescribers, people with dementia were more likely to be exposed to PIP than comparisons (adjusted OR 1.44, 95% CI, 1.35‐1.53, P < .0001). Conclusions PIP was more common in people dispensed medicines for dementia than comparisons. These results highlight the need for effective interventions to optimize prescribing in people with dementia.

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Section: Prevalence Of Individual Stopp Criteriasupporting

confidence: 81%

Section: Prevalence Of Individual Stopp Criteriasupporting

confidence: 81%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Potentially inappropriate prescribing in people with dementia: An Australian population‐based study

Eshetie

Nguyen

Gillam

et al. 2019

Int J Geriat Psychiatry

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“…Old age is associated with a decrease of oxidative metabolism, causing an extension on drug half-life due to changes in pharmacokinetics and pharmacodynamics (Taipale et al, 2015;Hessmann et al, 2018). In fact, the prolonged use of these drugs (over 2 months) in advanced age has shown to produce serious side effects, causing tolerance and dependence, increased risk of falls and fractures as well as an impairment of cognitive processes (Pharmd et al, 2003;Obradovi et al, 2005;Stewart, 2005;Rissman et al, 2007;Savić et al, 2010;Rosenberg et al, 2012;Makaron et al, 2013;Biétry et al, 2017;Nørgaard et al, 2017;Duke et al, 2018;Picton and Pharm, 2018;Underlien et al, 2018;Scott and Aricescu, 2019).…”

Section: Introductionmentioning

confidence: 99%

Benzodiazepines and Related Drugs as a Risk Factor in Alzheimer's Disease Dementia

Ettcheto

Olloquequi

Busquets

et al. 2020

Front. Aging Neurosci.

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Benzodiazepines (BZDs) and Z-drugs are compounds widely prescribed in medical practice due to their anxiolytic, hypnotic, and muscle relaxant properties. Yet, their chronic use is associated with cases of abuse, dependence, and relapse in many patients. Furthermore, elderly people are susceptible to alterations in pharmacodynamics, pharmacokinetics as well as to drug interaction due to polypharmacy. These situations increase the risk for the appearance of cognitive affectations and the development of pathologies like Alzheimer's disease (AD). In the present work, there is a summary of some clinical studies that have evaluated the effect of BZDs and Z-drugs in the adult population with and without AD, focusing on the relationship between their use and the loss of cognitive function. Additionally, there is an assessment of preclinical studies focused on finding molecular proof on the pathways by which these drugs could be involved in AD pathogenesis. Moreover, available data (1990-2019) on BZD and Z-drug use among elderly patients, with and without AD, was compiled in this work. Finally, the relationship between the use of BZD and Z-drugs for the treatment of insomnia and the appearance of AD biomarkers was analyzed. Results pointed to a vicious circle that would worsen the condition of patients over time. Likewise, it put into relevance the need for close monitoring of those patients using BZDs that also suffer from AD. Consequently, future studies should focus on optimizing strategies for insomnia treatment in the elderly by using other substances like melatonin agonists, which is described to have a much more significant safety profile.

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“…Inequality in access to physicians means that not all patients with dementia are offered systematic medical follow-up, and therefore treatable conditions may be overlooked or mismanaged, leading to accelerated functional decline, hospitalizations and increased mortality, and thus increased healthcare costs. Polypharmacy with adverse interactions and an unfavorable risk-benefit ratio is another frequent occurrence in this population, which requires systematic medical follow-up [3,4]. Moreover, for patients with dementia, treatment practices for associated medical conditions may vary due to uncertainty with regard to the balance between benefits and adverse effects, and due to a lack of scientific certainty.…”

Section: Introductionmentioning

confidence: 99%

A European Academy of Neurology guideline on medical management issues in dementia

Frederiksen

Cooper

Frisoni

et al. 2020

Euro J of Neurology

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Background and purpose Dementia is one of the most common disorders and is associated with increased morbidity, mortality and decreased quality of life. The present guideline addresses important medical management issues including systematic medical follow‐up, vascular risk factors in dementia, pain in dementia, use of antipsychotics in dementia and epilepsy in dementia. Methods A systematic review of the literature was carried out. Based on the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) framework, we developed a guideline. Where recommendations based on GRADE were not possible, a good practice statement was formulated. Results Systematic management of vascular risk factors should be performed in patients with mild to moderate dementia as prevention of cerebrovascular pathology may impact on the progression of dementia (Good Practice statement). Individuals with dementia (without previous stroke) and atrial fibrillation should be treated with anticoagulants (weak recommendation). Discontinuation of opioids should be considered in certain individuals with dementia (e.g. for whom there are no signs or symptoms of pain or no clear indication, or suspicion of side effects; Good Practice statement). Behavioral symptoms in persons with dementia should not be treated with mild analgesics (weak recommendation). In all patients with dementia treated with opioids, assessment of the individual risk–benefit ratio should be performed at regular intervals. Regular, preplanned medical follow‐up should be offered to all patients with dementia. The setting will depend on the organization of local health services and should, as a minimum, include general practitioners with easy access to dementia specialists (Good Practice statement). Individuals with dementia and agitation and/or aggression should be treated with atypical antipsychotics only after all non‐pharmacological measures have been proven to be without benefit or in the case of severe self‐harm or harm to others (weak recommendation). Antipsychotics should be discontinued after cessation of behavioral disturbances and in patients in whom there are side effects (Good Practice statement). For treatment of epilepsy in individuals with dementia, newer anticonvulsants should be considered as first‐line therapy (Good Practice statement). Conclusion This GRADE‐based guideline offers recommendations on several important medical issues in patients with dementia, and thus adds important guidance for clinicians. For some issues, very little or no evidence was identified, highlighting the importance of further studies within these areas.

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Polypharmacy and Potentially Inappropriate Medication in People with Dementia: A Nationwide Study

Abstract: Use of polypharmacy and PIM were widespread in the older population and more so in people with dementia. This could have negative implications for patient-safety and demonstrates the need for interventions to improve drug therapy in people with dementia.

Cited by 72 publications

References 35 publications

Potentially inappropriate prescribing in people with dementia: An Australian population‐based study

Potentially inappropriate prescribing in people with dementia: An Australian population‐based study

Benzodiazepines and Related Drugs as a Risk Factor in Alzheimer's Disease Dementia

A European Academy of Neurology guideline on medical management issues in dementia

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