Potentially inappropriate medication among people with dementia in eight European countries

Abstract

Objectives to evaluate the frequency of potentially inappropriate medication (PIM) prescription among older people with dementia (PwD) from eight countries participating in the European study ‘RightTimePlaceCare’, and to evaluate factors and adverse outcomes associated with PIM prescription. Methods survey of 2,004 PwD including a baseline assessment and follow-up after 3 months. Interviewers gathered data on age, sex, prescription of medication, cognitive status, functional status, comorbidity, setting and admission to hospital, fall-related injuries and mortality in the time between baseline and follow-up. The European Union(7)-PIM list was used to evaluate PIM prescription. Multivariate regression analysis was used to investigate factors and adverse outcomes associated with PIM prescription. Results overall, 60% of the participants had at least one PIM prescription and 26.4% at least two. The PIM therapeutic subgroups most frequently prescribed were psycholeptics (26% of all PIM prescriptions) and ‘drugs for acid-related disorders’ (21%). PwD who were 80 years and older, lived in institutional long-term care settings, had higher comorbidity and were more functionally impaired were at higher risk of being prescribed two PIM or more. The prescription of two or more PIM was associated with higher chance of suffering from at least one fall-related injury and at least one episode of hospitalisation in the time between baseline and follow-up. Conclusions PIM use among PwD is frequent and is associated with institutional long-term care, age, advanced morbidity and functional impairment. It also appears to be associated with adverse outcomes. Special attention should be paid to psycholeptics and drugs for acid-related disorders.

Determinants of prescribing potentially inappropriate medications in a nationwide cohort of community dwellers with dementia receiving a comprehensive geriatric assessment

“…Contrary to the analysis of studies conducted in individuals diagnosed with dementia in Sweden and in eight European countries, a striking result to emerge from our data is that the PIMs prevalence was higher in individuals who were functionally independent with respect to Activities of Daily Living (ADL).…”

International study reveals aged patients with dementia frequently receive ‘inappropriate prescriptions’

“…Older people suffering dementia have a range of needs and pharmacological treatments to manage the array of comorbidities associated with ageing and ill health 1. Many countries have reviewed medicine regimens which are potentially harmful in older populations.…”

Electronic assessment of cardiovascular potentially inappropriate medications in an administrative population database

“…Therefore, we created an European repository of PIM criteria by combining criteria from the last versions of three PIM lists: EU(7)‐PIM list, STOPP/START 2014 and BEERS 2015 . These criteria are suitable for use in European countries and have been applied in several studies . All the criteria of these three lists were integrated in the repository, and we created a Web‐based tool for researchers to facilitate the selection of criteria for electronic assessment in specific studies.…”

“…In this study, we used the PIM tool to focus on the cardiovascular medication use, which represents one of the most commonly used medication groups in the population over 65 years old . Additionally, other studies described the cardiovascular PIM criterion as one of the most frequently occurring PIMs …”

“…Few studies have explored the feasibility of electronic assessments of PIM criteria in field research databases or in primary care database from general practices. And a number of studies examined the association of high medication and PIM use with hospitalisation and mortality . The first aim of this study was to explore the feasibility of an electronic assessment of PIM criteria in a large administrative database enriched with clinical information in an older population in Stockholm County, Sweden.…”