Recomendaciones en la prevención de reacciones adversas a medicamentos en personas mayores con demencia

Gómez-Pavón, Javier; García, Paloma González; Román, Inés Francés; Astiz, Maite Vidán; Rodríguez, José Gutiérrez; Díaz, Gregorio Jiménez; Fernández, Nuria Pilar Montero; Fernández, Baldomero Álvarez; Páez, José María Jiménez

doi:10.1016/j.regg.2009.10.002

Cited by 12 publications

(7 citation statements)

References 85 publications

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“…However, medications can cause adverse health events [4]. Despite people with dementia being at particular risk of developing medication-related problems, little is known about the specific issues which relate to their medication management [5,6]. Building shared understandings is important for discovering what medication management issues may be seen as most relevant research topics for people with dementia and their carers living in the community.…”

Section: Introductionmentioning

confidence: 99%

Perspectives of carers on medication management in dementia: lessons from collaboratively developing a research proposal

Mapes²,

et al. 2014

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BackgroundThe need for carers to manage medication-related problems for people with dementia living in the community raises dilemmas, which can be identified by carers and people with dementia as key issues for developing carer-relevant research projects.A research planning Public Patient Involvement (PPI) workshop using adapted focus group methodology was held at the Alzheimer’s Society’s national office, involving carers of people with dementia who were current members of the Alzheimer’s Society Research Network (ASRN) in dialogue with health professionals aimed to identify key issues in relation to medication management in dementia from the carer viewpoint. The group was facilitated by a specialist mental health pharmacist, using a topic guide developed systematically with carers, health professionals and researchers. Audio-recordings and field notes were made at the time and were transcribed and analysed thematically. The participants included nine carers in addition to academics, clinicians, and staff from DeNDRoN (Dementias and Neurodegenerative Diseases Research Network) and the Alzheimer’s Society.FindingsSignificant themes, for carers, which emerged from the workshop were related to: (1) medication usage and administration practicalities, (2) communication barriers and facilitators, (3) bearing and sharing responsibility and (4) weighing up medication risks and benefits. These can form the basis for more in-depth qualitative research involving a broader, more diverse sample.DiscussionThe supported discussion enabled carer voices and perspectives to be expressed and to be linked to the process of identifying problems in medications management as directly experienced by carers. This was used to inform an agenda for research proposals which would be meaningful for carers and people with dementia.

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Section: Introductionmentioning

confidence: 99%

Perspectives of carers on medication management in dementia: lessons from collaboratively developing a research proposal

Mapes²,

et al. 2014

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“…This study concluded that discontinuation of antipsychotic agents can increase the probability that these symptoms will reappear. However, it is also important to note that reducing the exposure time to antipsychotic drugs can lower the probability of an adverse drug-related reaction [6]. The increase in the mean number of psychotropic drugs prescribed at 6 months following the intervention could have been due not only to reintroduction of some previous treatments, but also to the prescription of new treatments in order to control the appearance of new symptoms related to the evolution of the illness.…”

Section: Discussionmentioning

confidence: 99%

“…Study of the natural history of dementia has shown that cognitive deterioration occurs more rapidly in patients with psychotic symptoms [5]. When these are treated with medication, periodic review of the treatment may be necessary [6], as the patient’s clinical status may change quickly, and along with it, the associated BPSD.…”

Section: Introductionmentioning

confidence: 99%

Consensus and evidence-based medication review to optimize and potentially reduce psychotropic drug prescription in institutionalized dementia patients

et al. 2019

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BackgroundDementia patients often show neuropsychiatric symptoms, known as behavioral and psychological symptoms of dementia (BPSD). These are a common motive for medical consultations, hospitalizations, and nursing home stays. Various studies have suggested that the high prevalence of psychotropic drug use to treat BPSD in institutionalized dementia patients may lead to impaired cognitive capacity, rigidity, somnolence, and other complications during the course of the illness. The aim of this study was to design a consensus-based intervention between care levels to optimize and potentially reduce prescription of psychotropic drugs in institutionalized patients with dementia and assess the changes occurring following its implementation.MethodsDesign: Prospective, quasi-experimental, pre/post intervention, multicenter study. Scope: 7 nursing homes associated with a single primary care team. Inclusion Criteria: Institutionalized patients diagnosed with dementia and under treatment with 1 or more psychotropic drugs for at least 3 months. Sample: 240 individuals; mean age, 87 years (SD: 6.795); 75% (180) women. Intervention: Creation of evidence-based therapeutic guidelines for psychotropic drug use in the treatment of BPSD by consensus between reference professionals. Joint review (primary care and geriatric care nursing home professionals) of the medication based on the guidelines and focusing on individual patient needs. Primary variable: Number of psychotropic drugs used per patient. Assessment: Preintervention, immediate postintervention, and at 1 and 6 months.ResultsOverall, the number of psychotropic drugs prescribed was reduced by 28% (from 636 before to 458 after the intervention). The mean number of psychotropic drugs prescribed per patient decreased from 2.71 at baseline to 1.95 at 1 month postintervention and 2.01 at 6 months (p < 0.001 for both time points). Antipsychotics were the drug class showing the highest reduction rate (49.66%). Reintroduction of discontinued psychotropic drugs was 2% at 1 month following the intervention and 12% at 6 months.ConclusionsA consensus guidelines-based therapeutic intervention with a patient-centered medication review by a multidisciplinary team led to a reduction in prescription of psychotropic drugs in institutionalized dementia patients.Electronic supplementary materialThe online version of this article (10.1186/s12877-018-1015-9) contains supplementary material, which is available to authorized users.

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“…These negative consequences suggest that interventions aimed at reducing the risks associated with these drugs might be necessary. Psychotropic drugs are not the only cause for concern in institutionalized dementia patients; polypharmacy itself is another important factor that must be taken into account to prevent adverse events and potentially inappropriate prescriptions in this population (7).…”

Section: Introductionmentioning

confidence: 99%

Cost-utility Analysis of a Consensus and Evidence-based Medication Review to Optimize and Potentially Reduce Psychotropic Drug Prescription in Institutionalized Dementia Patients

Mesquida

Folkvord

Seda

et al. 2021

Preprint

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BACKGROUND: Growing evidence shows the effects of psychotropic drugs on the evolution of dementia. Until now, only a few studies have evaluated the cost‑effectiveness of psychotropic drugs in institutionalized dementia patients. This study aims to assess the cost‑utility of intervention based on consensus between specialized caregivers involved in the management of dementia patients for optimizing and potentially reducing the prescription of inappropriate psychotropic drugs in this population. This analysis was conducted using the Monitoring and Assessment Framework for the European Innovation Partnership on Active and Healthy Ageing (MAFEIP) tool.METHODS: The MAFEIP tool builds up from a variety of surrogate endpoints commonly used across different studies in order to estimate health and economic outcomes in terms of incremental changes in quality adjusted life years (QALYs), as well as health and social care utilization. Cost estimates are based on scientific literature and expert opinion; they are direct costs and include medical visits, hospital care, medical tests and exams and drugs administered, among other concepts. The healthcare costs of patients using the intervention were calculated by means of a medication review that compared patients' drug‑related costs before, during and after the use of the intervention. The cost‑utility analysis was performed from the perspective of a health care system with a time horizon of 12 months.RESULTS: The tool calculated the incremental cost‑effectiveness ratio (ICER) of the intervention, revealing it to be dominant, or rather, better (more effective) and cheaper than the current (standard) care. The ICER of the intervention was in the lower right quadrant, making it an intervention that is always accepted even with the lowest given Willingness to Pay (WTP) threshold value (€15,000). CONCLUSIONS: The results of this study show that the intervention was dominant, or rather, better (more effective) and cheaper than the current (standard) care. This dominant intervention is therefore recommended to interested investors for systematic application.

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Recomendaciones en la prevención de reacciones adversas a medicamentos en personas mayores con demencia

Cited by 12 publications

References 85 publications

Perspectives of carers on medication management in dementia: lessons from collaboratively developing a research proposal

Perspectives of carers on medication management in dementia: lessons from collaboratively developing a research proposal

Consensus and evidence-based medication review to optimize and potentially reduce psychotropic drug prescription in institutionalized dementia patients

Cost-utility Analysis of a Consensus and Evidence-based Medication Review to Optimize and Potentially Reduce Psychotropic Drug Prescription in Institutionalized Dementia Patients

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