Potentially inappropriate prescribing in dementia: a state-of-the-art review since 2007

Abstract

ObjectivesDementia frequently occurs alongside comorbidities. Coexisting conditions are often managed with multiple medications, leading to increased risk of potentially inappropriate medication and adverse drug reactions. We aimed to estimate prevalence of, and identify factors reported to be associated with, potentially inappropriate prescribing (PIP) for older individuals diagnosed with dementia.DesignWe used a state-of-the-art review approach, selecting papers written in English and published from 2007 to January 2018. Publications were retrieved from Scopus and Web of Science databases. Inclusion criteria included a formal diagnosis of dementia, a formal classification of PIP and reported prevalence of PIP as an outcome. Random effects models were used to provide a pooled estimate of prevalence of PIP. The Appraisal tool for Cross-Sectional Studies (AXIS tool) was used to assess bias in the included studies.ResultsThe bibliographic search yielded 221 citations, with 12 studies meeting the inclusion criteria. The estimates of PIP prevalence for people living with dementia ranged from 14% to 64%. Prevalence was 31% (95% CI 9 to 52) in the community, and 42% (95% CI 30 to 55) in nursing/care homes. PIP included prescribing likely related to dementia (eg, hypnotics and sedative and cholinesterase inhibitors) and prescribing related to treatment of comorbidities (eg, cardiovascular drugs and non-steroidal anti-inflammatory medication). Higher levels of comorbidity were associated with increased risk of PIP; however, only one study investigated associations with specific comorbidities of dementia.ConclusionPIP remains a significant issue in healthcare management for people living with dementia. Higher levels of comorbidity are associated with increased prevalence of PIP, but the specific conditions driving this increase remain unknown. Further work is necessary to investigate PIP related to the presence of common comorbidities in patients living with dementia.

Healthcare Utilization in Different Stages among Patients with Dementia: A Nationwide Population-Based Study

“…It is notable that the mean number of chronic medications used in the first year after diagnosis was as high as 22.89 per person-year and increased to 30.7 in the late stage of dementia, with an overall significant increasing trend. A high symptom burden in PwD may contribute to a greater need for medications; other risks such as multiple comorbidities, advanced age, depression, and a low functional status are also related to polypharmacy and potentially inappropriate medication (PIM) [26][27][28]. The number of prescribed medications is directly correlated to the risk of PIM among elderly patients with and without dementia [26,29].…”

Use of Anti-Dementia Drugs Reduces the Risk of Potentially Inappropriate Medications: A Secondary Analysis of a Nationwide Survey of Prescribing Pharmacies

“…Moreover, some conditions are common in old age but are not sufficiently recognised by clinicians, which eventually leads to underuse of the indicated medications [5, 6]. Certain people with dementia (PWD) who are considered underdiagnosed in typical primary practice [7] despite the constant increase in prevalence may be exposed to various health risks stemming from comorbidities [8-10] as well as adverse drug reactions, which are presumably induced by potential exposures to neuropsychiatric drugs [11, 12] or poor competence in their medication management. According to a survey implemented in 6 Japanese municipalities in 2012, the number of individuals with dementia in Japan was estimated to account for 15.7% of the entire older population.…”

Declining Use of Potentially Inappropriate Medication in People with Dementia from 2000 to 2015: A Repeated Cross-Sectional Nationwide Register-Based Study

“…In a Swedish study, 41% of acute hospitalizations of people with dementia were determined to be drug-related [14]. Nonetheless, PIM is widespread in people with dementia, with a prevalence ranging from 14-64% in a recent review [15].…”

“…In a Swedish study, 41%of acute hospitalizations of people with dementia were determined to be drug-related [ 14 ]. Nonetheless, PIM is widespread in people with dementia, with a prevalence ranging from 14–64%in a recent review [ 15 ]. In our previous study in Denmark, we found that 45%of people with dementia had filled at least one prescription for PIM in 2014 compared to 30%of people without dementia [ 16 ].…”