Potentially inappropriate medication use in older adults with mild-moderate Alzheimer’s disease: prevalence and associations with adverse events

Abstract

<jats:title>Abstract</jats:title> <jats:sec> <jats:title>Aim</jats:title> <jats:p>Potentially inappropriate medication (PIM) use is prevalent in older adults and is associated with adverse events, hospitalisation and mortality. We assessed the patterns and associations of PIM use in older adults with mild-to-moderate Alzheimer’s Disease (AD), who may represent a particularly vulnerable group.</jats:p> </jats:sec> <jats:sec> <jats:title>Design</jats:title> <jats:p>Analysis of data from NILVad, an 18-month Randomised Control Trial of Nilvadapine in mild-to-moderate AD. The v2 STOPP criteria were applied in duplicate to identify PIM use. Associations between PIM use and adverse events/unscheduled healthcare visits in addition to the associations between PIM use and AD progression were evaluated.</jats:p> </jats:sec> <jats:sec> <jats:title>Setting and Participants</jats:title> <jats:p>448 older adults with mild-to-moderate AD from 23 centres in nine European countries.</jats:p> </jats:sec> <jats:sec> <jats:title>Results</jats:title> <jats:p>Of 448 participants (mean age: 72.56 ± 8.19 years), over half (55.8%) were prescribed a PIM with 30.1% being prescribed 2+ PIMs. The most frequent PIMs were (i) long-term benzodiazepines (11.6% N = 52/448), (ii) selective serotonin reuptake inhibitors without appropriate indication (11.1% N = 50/448), and (iii) Proton-Pump Inhibitors (PPIs) without appropriate indication (10.7% N = 48/448). Increasing number of PIMs was associated with a greater risk of adverse events (IRR 1.17, 1.13–1.19, P &amp;lt; 0.001), serious adverse events (IRR 1.27; 1.17–1.37, P &amp;lt; 0.001), unscheduled hospitalisations (IRR 1.16, 1.03–1.30, P = 0.016) and GP visits (IRR 1.22, 1.15–1.28, P &amp;lt; 0.001). PIM use was not associated with dementia progression.</jats:p> </jats:sec> <jats:sec> <jats:title>Conclusions and Implications</jats:title> <jats:p>PIM use is highly prevalent in mild-to-moderate AD and is associated with adverse events and unscheduled healthcare utilisation. Further attention to de-prescribing in this vulnerable group is warranted.</jats:p> </jats:sec>

Analysis of potentially inappropriate medication based on drug-drug interactions in older adults with psychiatric disorders: a retrospective study

“…For aged patients with cancer, the PIM rate ranged from 47.3% to 73% 33,34 . Murphy 35 found that 55.8% older adults with mild-to-moderate Alzheimer disease were prescribed a PIM with 30.1% being prescribed 2 and more PIMs in nine European countries. For older adults with diabetes, from 56% to 66.2% cases had at least 1 PIM 36, 37 .…”

“…Murphy 35 found that benzodiazepines, SSRIs and Proton Pump Inhibitors (PPIs) were the most frequent PIMs. Roux 31 found that benzodiazepines, PPIs, antipsychotics, antidepressants were the most prevalent PIMs.…”

Potentially Inappropriate Medication Among People With Dementia in China: A Nationwide Cross-Sectional Study

“…According to systematic analyses of global disease burden in 2017, dementia is the fifth leading cause of death in China ( Zhou et al, 2019 ). Potentially inappropriate medication (PIM) may be one of the reasons leading to death in older people with dementia, and extensive studies have also shown that the occurrence of PIM leads to an increased risk of adverse events and hospitalizations, even death ( Cross et al, 2017 ; Wallace et al, 2017 ; Murphy et al, 2020 ). Thus, it is necessary to determine PIM use and risk factors among older patients with dementia.…”

Prevalent medication-related harm identified in patients admitted to geriatric ward: cross-sectional and survival-based contributors

“…All types of medication-related harm (MRH) have been recognized by the WHO as a global public health issue [4,5]. The importance of MRH is rising and has become one of the main causes of hospital admission [6][7][8], even after a recent discharge [9,10]. Special strategies and criteria for avoiding MRH were developed and regularly updated to mitigate druginduced problems, polypharmacy, and age-related alterations in drug handling [11,12,13].…”