Potentially Inappropriate Medication Use in Patients with Dementia

Abstract

The objective of this study was to characterize the epidemiology of using potentially inappropriate medications associated with dementia exacerbation (DPIMs) in elderly outpatients with dementia. Electronic medical records were retrospectively reviewed for geriatric patients with dementia who were prescribed at least one medication in 2016 at a tertiary, university-affiliated hospital. The 2015 Beers criteria were used to define DPIMs. Logistic regression was performed to identify factors associated with prescribing DPIMs in patients with dementia. Among 2100 patients included in our study, 987 (47.0%) patients were prescribed at least one DPIM. Benzodiazepines were the most frequently prescribed DPIM followed by anticholinergics, histamine H2-receptor blockers, and zolpidem. The risk of prescribing DPIMs was significantly increased in female patients (odds ratio (OR) 1.355) with polypharmacy (OR 5.146) and multiple comorbidities (OR 1.129) (p < 0.05 for all). Coexistence of Parkinson’s disease (OR 1.799), mood disorder (OR 1.373), or schizophrenia (OR 4.116) in patients with dementia further increased the likelihood of receiving DPIMs. In conclusion, DPIMs were commonly used in elderly patients with dementia in Korea with benzodiazepines most frequently prescribed followed by anticholinergics. Female patients using polypharmacy with multiple comorbidities should be closely monitored to minimize unnecessary DPIM use and, ultimately, DPIM-related harms.

Prevalence of Use of Potentially Inappropriate Medications Among Older Adults Worldwide

“…Following exclusion of 213 duplicate studies, 1258 studies were excluded by the titles and abstracts. Ninety-four studies with 371 224 692 older outpatients were included for analysis (Figure 1; eAppendix 2 in Supplement 1).…”

“…Forty-one studies were conducted in Asia, followed by 22 studies in Europe, 14 studies in North America, 8 studies in South America, 7 studies in Africa, and 2 studies in Oceania. Between 1999 and 2021, a total of 51 studies were performed in high-income countries, 23 studies in upper- to middle-income countries, 17 studies in lower- to middle-income countries, and 3 studies in low-income countries. Sixty-three studies of the PIM prevalence estimates were based on the Beers criteria, 26 studies…”

“…Between 1999 and 2021, a total of 51 studies were performed in high-income countries, 23 studies in upper- to middle-income countries, 17 studies in lower- to middle-income countries, and 3 studies in low-income countries. Sixty-three studies of the PIM prevalence estimates were based on the Beers criteria, 26 studies were based on the STOPP/START criteria, 13 studies on localization criteria that were developed based on the characteristics of medication for older patients in their own country, and 13 studies on other criteria. Eighty-five studies…”

“…Sixty-three studies of the PIM prevalence estimates were based on the Beers criteria, 26 studies were based on the STOPP/START criteria, 13 studies on localization criteria that were developed based on the characteristics of medication for older patients in their own country, and 13 studies on other criteria. Eighty-five studies were cross-sectional in design, and 11 studies were conducted in a national population survey. The mean age of the participants in most studies (65 studies…”

“…Eighty-five studies were cross-sectional in design, and 11 studies were conducted in a national population survey. The mean age of the participants in most studies (65 studies) was younger than 80 years and older than 65 years, and 31 studies had a mean number of drugs greater than 5. Thirty-four studies had a male ratio of more than 50%, and 34 studies included older outpatients with certain diseases.…”