Potentially Inappropriate Prescribing in Australian Nursing Home Residents with Advanced Dementia: A Substudy of the IDEAL Study

Disalvo, Domenica; Luckett, Tim; Luscombe, Georgina; Bennett, Alexandra; Davidson, Patricia M.; Chenoweth, Lynn; Mitchell, Geoffrey; Pond, Dimity; Phillips, Jane; Beattie, Elizabeth; Goodall, Stephen; Agar, Meera

doi:10.1089/jpm.2018.0070

Cited by 7 publications

(7 citation statements)

References 41 publications

(71 reference statements)

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“…Given an average five or more medications a day taken by older people, as found in a recent review of inappropriate medication use among older patients, 26 the average number of medications used per older person in our study was fairly high (seven medications) and similar to that detected by other authors. 23,[27][28][29][30][31][32][33] As indicated in other published research, [34][35][36] these characteristics are common within the population of institutionalized older adults.…”

Section: Discussionmentioning

confidence: 92%

Drug therapy problems identified among older adults placed in a nursing home: the Croatian experience

Šola¹,

Mucalo

Brajković

et al. 2020

J Int Med Res

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Objective The aim of this study was to determine the frequency and type of drug therapy problems (DTPs) in older institutionalized adults. Method We conducted a cross-sectional observational study from February to June 2016 at a 150-bed public nursing home in Croatia, where comprehensive medication management (CMM) services were provided. A rational decision-making process, referred to as the Pharmacotherapy Workup method, was used to classify DTPs. Results Data were prospectively collected from 73 residents, among which 71% were age 75 years or older. The median number of prescribed medications per patient was 7 (2–16) and polypharmacy (> 4) was recorded for 54 (74.0%) patients. A total 313 DTPs were identified, with an average of 4.3 ± 2 DTPs per patient. The most frequent DTP was needing additional drug therapy (n = 118; 37.7%), followed by adverse drug reaction (n = 55; 17.6%). Lactulose (14.4%), tramadol (6.7%), and potassium (6.4%) were the medications most frequently related to DTPs. Conclusion The high prevalence of DTPs identified among older institutionalized adults strongly suggests the need to incorporate new pharmacist-led CMM services within existing institutional care facilities, to improve the care provided to nursing home residents.

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Section: Discussionmentioning

confidence: 92%

Drug therapy problems identified among older adults placed in a nursing home: the Croatian experience

Šola¹,

Mucalo

Brajković

et al. 2020

J Int Med Res

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“…PIM use is a common cause of adverse drug reactions in older adults [1,2]. Those with dementia have a higher incidence of polypharmacy and PIM use, with prevalence estimates of PIM use ranging from 14 to 74% in those with dementia, whom may represent a particularly vulnerable cohort [3][4][5][6][7].…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2020

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Abstract Aim 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. Design 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. Setting and Participants 448 older adults with mild-to-moderate AD from 23 centres in nine European countries. Results 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 < 0.001), serious adverse events (IRR 1.27; 1.17–1.37, P < 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 < 0.001). PIM use was not associated with dementia progression. Conclusions and Implications 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.

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“…The problem of potentially inappropriate medications (PIMs) for older people (with or without dementia) has been reported previously in studies of residents in aged care facilities [10,11] and primary health care [3,12,13] contexts. PIMS may be defined as medications that pose potential risks that outweigh potential benefits [14].…”

Section: Introductionmentioning

confidence: 99%

Comparison of Potentially Inappropriate Medications for People with Dementia at Admission and Discharge during An Unplanned Admission to Hospital: Results from the SMS Dementia Study

et al. 2019

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People with dementia (PWD) and cognitive impairment are particularly vulnerable to medication problems, and unplanned admission to hospital presents an opportunity to address polypharmacy, potentially inappropriate medications (PIMs) and anticholinergic burden. This study aimed to compare PIMS and other medication data for PWD to determine whether these changed during hospitalization. Medications documented in patient’s records at admission and discharge were evaluated for PWD recruited to phase one of a prospective quasi-experimental pre/post-controlled trial that was conducted at two regional hospitals in NSW, Australia. The study sample included PWD or cognitive impairment having an unplanned admission to hospital. Data were collected using a purpose developed audit tool for medications and PIMs, and a Modified Anticholinergic Burden Scale. Total participants were 277, and results determined that the cognitive status of PWD is not always detected during an unplanned admission. This may make them more vulnerable to medication problems and poor outcomes. Polypharmacy and PIMS for PWD were high at admission and significantly reduced at discharge. However, PWD should be routinely identified as high risk at admission; and there is potential to further reduce polypharmacy and PIMs during admission to hospital, particularly psychotropic medications at discharge. Future studies should focus on evaluating targeted interventions designed to increase medication safety for PWD.

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Potentially Inappropriate Prescribing in Australian Nursing Home Residents with Advanced Dementia: A Substudy of the IDEAL Study

Abstract: Use of potentially inappropriate medications in Australian nursing home residents with advanced dementia is common. A greater understanding of the rationale that underpins prescribing of medications is required.

Cited by 7 publications

References 41 publications

Drug therapy problems identified among older adults placed in a nursing home: the Croatian experience

Drug therapy problems identified among older adults placed in a nursing home: the Croatian experience

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

Comparison of Potentially Inappropriate Medications for People with Dementia at Admission and Discharge during An Unplanned Admission to Hospital: Results from the SMS Dementia Study

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