Potentially inappropriate prescribing in people with dementia: An Australian population‐based study

Abstract

Objective To investigate the prevalence of potentially inappropriate prescribing (PIP) using the Screening Tool of Older Person's Prescriptions (STOPP) criteria in people with dementia compared with people without dementia. Methods A retrospective cohort study was conducted using the Pharmaceutical Benefits Scheme 10% sample of pharmacy claims. People with dementia were defined as those dispensed a medicine for dementia (cholinesterase inhibitors, memantine, or risperidone for behavioural and psychological symptoms of dementia) between 1 January 2005 and 31 December 2015, aged 65 years or older at 1 January 2016 and alive at the end of 2016. An age‐ and gender‐matched comparison cohort of people not dispensed medicines for dementia was identified. PIP prevalence was determined between 1 January 2016 and 31 December 2016. Results In total, 8280 people dispensed medicines for dementia and 41 400 comparisons not dispensed medicines for dementia were included: 63% were female and the median age was 82 years. PIP prevalence was 79% among people with dementia compared with 70% among the comparison group (P < .0001). Use of anticholinergics, long‐term use of high‐dose proton pump inhibitors, and use of benzodiazepines were the most common instances of PIP in people with dementia. After adjustments for age, gender, comorbidity, and number of prescribers, people with dementia were more likely to be exposed to PIP than comparisons (adjusted OR 1.44, 95% CI, 1.35‐1.53, P < .0001). Conclusions PIP was more common in people dispensed medicines for dementia than comparisons. These results highlight the need for effective interventions to optimize prescribing in people with dementia.

Drug related problems in older adults living with dementia

“…However, these PIMs could have been prevented if medication prescribing is carefully balanced between risks and benefits and is avoided for unsuitable patients. Although some dispensed medications such as antipsychotics and benzodiazepines could relieve BPSD, these medications should not be used as the first line treatment [ 114 ]. Therefore, precipitating causes should be managed and non-pharmacological treatment should be attempted before the initiation of antipsychotics [ 122 , 123 ].…”

“…These findings can explain why using of cardiac therapy, psycholeptics and psychoanaleptics are strong predictors of the occurrence of PIM. According to the 2019 Beers criteria, antipsychotics and benzodiazepines are considered common prescribed PIMs which may result in worsening of cognitive function and detrimental health consequences [71,[110][111][112][113][114][115][116]. Furthermore, antipsychotics are known as an increased risk of cardiovascular events (stroke and heart arrhythmia) and mortality [117][118][119][120] whereas benzodiazepines are labeled as the predictor of falls and fractures [121].…”

Pharmacogenomics of Cognitive Dysfunction and Neuropsychiatric Disorders in Dementia

“…The implementation of PGx procedures may help to minimize drug-drug interactions. For instance, CYP2C19 variants influence the effects of proton-pump inhibitors and the onset of infections [324]. ACE variants affect the pharmacokinetics and pharmacodynamics of ACE inhibitors which may interact with psychotropic drugs, contributing to cerebrovascular dysfunction [229].…”

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

“…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].…”