Health Technology Assessment, Journal Year: 2023, Volume and Issue: unknown, P. 1 - 108
Published: Oct. 1, 2023
Agitation is common and impacts negatively on people with dementia carers. Non-drug patient-centred care first-line treatment, but we need other treatment when this fails. Current evidence sparse safer effective alternatives to antipsychotics.
Language: Английский
Journal of General Internal Medicine, Journal Year: 2025, Volume and Issue: unknown
Published: March 19, 2025
Language: Английский
Citations
0
Journal of the American Geriatrics Society, Journal Year: 2022, Volume and Issue: 70(12), P. 3513 - 3525
Published: Aug. 19, 2022
Abstract Background The Centers for Medicare & Medicaid Services implemented the National Partnership to Improve Dementia Care in Nursing Homes (the Partnership) decrease antipsychotic use and improve care nursing home (NH) residents with dementia. We determined whether extent of other psychotropic medication prescribing AL dementia mirrored that long‐stay NH (LSNH) after Partnership. Methods Using a 20% sample fee‐for‐service beneficiaries Part D, we conducted retrospective cohort study including LSNH monthly prevalence (antipsychotics, antidepressants, anxiolytics/sedative‐hypnotics, anticonvulsants/mood stabilizers, benzodiazepines, antidementia medications) was examined. used an interrupted time‐series analysis compare before (July 1, 2010–March 31, 2012) (April 2012–December 2017) both settings. Results identified 107,931 ≥1 month as resident 323,766 dementia, 1,923,867 person‐months 4,984,405 person‐months, respectively. Antipsychotic declined over period After launch Partnership, rate decline slowed (slope change = 0.03 [95% CLs: 0.02, 0.04]) while increased −0.12 −0.16, −0.08]). Antidepressants were most prevalent prescribed, anticonvulsant/mood stabilizer increased, anxiolytic/sedative‐hypnotic declined. Conclusions federal reduce did not appear affect Given increase mood stabilizers/anticonvulsants occurred monitoring may be warranted all medications
Language: Английский
Citations
18
Medicina, Journal Year: 2022, Volume and Issue: 58(10), P. 1445 - 1445
Published: Oct. 13, 2022
The number of patients with Alzheimer’s disease is increasing annually. Most these are older adults comorbid physical illnesses, which means that they often treated a combination medications for the have and those disease. Thus, potentially at risk polypharmacy. In addition, drug interactions between treatment illnesses may reduce their efficacy increase side effects. This article reviews polypharmacy in elderly disease, focus on psychotropic drugs.
Language: Английский
Citations
15
Journal of Clinical Medicine, Journal Year: 2023, Volume and Issue: 12(10), P. 3389 - 3389
Published: May 10, 2023
Little research has evaluated trends in psychotropic prescribing and polypharmacy primary care patients, especially those with dementia. We sought to examine this Australia from 2011 2020 using the dataset, MedicineInsight. Ten consecutive serial cross-sectional analyses were performed evaluate proportion of patients aged 65 years or more, a recorded diagnosis dementia, who prescribed medications within first six months each year 2020. This was compared propensity score-matched control without Before matching, 24,701 (59.2% females) with, 72,105 without, dementia included. In 2011, 42% (95% confidence interval [CI] 40.5-43.5%) group had at least one prescription medication, which declined 34.2% CI 33.3-35.1%; p for trend < 0.001) by However, it remained unchanged matched controls (36% [95% 34.6-37.5%] 36.7% 35.7-37.6%] 2020). The greatest decline groups medication class antipsychotics (from 15.9% 14.8-17.0%] 8.8% 8.2-9.4%]; 0.001). During period, prevalence (use two more individual psychotropics) also decreased 21.7% 20.5-22.9%) 18.1% 17.4-18.9%) groups, slightly increased 15.2% 14.1-16.3%) 16.6% 15.9-17.3%) controls. prescribing, particularly antipsychotics, Australian is encouraging. still occurred almost five end study period. Programs focused on encouraging further reductions use multiple drugs are recommended, rural remote regions.
Language: Английский
Citations
8
Alzheimer s & Dementia, Journal Year: 2022, Volume and Issue: 19(5), P. 1865 - 1875
Published: Nov. 4, 2022
Abstract Introduction Potentially inappropriate medications (PIMs) cause adverse events and death. We evaluate the Care Ecosystem (CE) collaborative dementia care program on medication use among community‐dwelling persons living with (PLWD). Methods Secondary analysis of a randomized clinical trial (RCT) comparing CE to usual (UC) changes in PIMs, over 12 months between March 2015 May 2020. outcomes included change number medications, clinically relevant anti‐dementia medications. Results Of 804 PLWD, N = 490 had complete data. The resulted significantly fewer PIMs compared UC (−0.35; 95% CI, −0.49 −0.20; P < 0.0001). Number needed prevent an increase 1 PIM was 3. Total for or cognitive impairment, CNS‐active anticholinergics, benzodiazepines, opioids were also fewer. Anti‐dementia regimens modified more frequently. Conclusion review intervention embedded optimized PLWD. Highlights Compared (UC), prevented increases potentially (PIMs). Use reduced, trend antipsychotics. adjusted use.
Language: Английский
Citations
13
Drugs & Aging, Journal Year: 2023, Volume and Issue: 40(10), P. 941 - 951
Published: Sept. 11, 2023
Language: Английский
Citations
7
Current Opinion in Psychiatry, Journal Year: 2022, Volume and Issue: 35(5), P. 332 - 337
Published: July 5, 2022
Elderly patients with schizophrenia (SCH) are treated antipsychotics and often on different comedications, including polypharmacy (five or more medications). Evidence-based guidelines randomized controlled trials do not include polypharmacy, something that represents a 'gap' between evidence-based recommendations clinical prescribing patterns. In this context, narrative reviews needed to help clinicians in daily practice.Antipsychotic treatment efficacies meta-analyses similar the elderly SCH compared general population (medium effect size). Long-term cohort studies show antipsychotic reduces overall mortality, hospitalizations, cardiovascular death. These limited because was studied. The prevalence of use as potentially inappropriate medications very high nursing homes (25%). 40%. Different strategies manage these problems available, collaboration pharmacists, leading reduced better adherence guidelines.Elderly less frequently studied, although they represent many SCH. medication lists pharmacists effective for optimization. More topic (e.g., prospective nonrandomized studies).
Language: Английский
Citations
12
International Journal of Molecular Sciences, Journal Year: 2023, Volume and Issue: 24(8), P. 6921 - 6921
Published: April 7, 2023
Cholinergic antagonists interfere with synaptic transmission in the central nervous system and are involved pathological processes patients neurocognitive disorders (NCD), such as behavioral psychological symptoms of dementia (BPSD). In this commentary, we will briefly review current knowledge on impact cholinergic burden BPSD persons NCD, including main pathophysiological mechanisms. Given lack clear consensus regarding symptomatic management BPSD, special attention must be paid to preventable, iatrogenic condition de-prescription should considered BPSD.
Language: Английский
Citations
6
Health Science Reports, Journal Year: 2023, Volume and Issue: 6(5)
Published: May 1, 2023
Abstract Background and Aims Potentially inappropriate medications (PIMs) carry risks that outweigh any potential benefits when compared to safer or more effective alternative treatments. Adverse drug events are likely occur in older adults with psychiatric diseases due multimorbidity, polypharmacy, age‐related changes pharmacokinetics pharmacodynamics. The aim of this study was assess the prevalence risk factors PIM use an aged care hospital's psychogeriatric division, using American Geriatrics Society Beers criteria 2019. Methods This cross‐sectional conducted on all current inpatients, having a mental disorder ≥65 years, one elderly hospital Beirut, from March May 2022. Medications, sociodemographic clinical characteristics were collected patients' medical records. PIMs evaluated based Independent variables described descriptive statistics. Factors associated identified by bivariate analysis followed binary logistic regression. A two‐sided p value <0.05 considered statistically significant. Results included 147 patients, mean age 76.3 46.9% them schizophrenia, 68.7% 5 drugs 90.5% taking at least 1 PIM. most prescribed antipsychotics (40.2%), anticholinergics (16%), antidepressants (7.8%). significantly polypharmacy (AOR = 20.88, 95% CI: 1.22−357.87, 0.04) anticholinergic cognitive burden (ACB) score 7.25, 1.13−46.52, 0.04). Conclusion highly prevalent among hospitalized Lebanese elderly. Polypharmacy ACB determinants use. multidisciplinary medication review led pharmacist could reduce
Language: Английский
Citations
6
Journal of the American Geriatrics Society, Journal Year: 2023, Volume and Issue: 71(10), P. 3086 - 3098
Published: June 5, 2023
Abstract Background Persons with dementia (PWD) have high rates of polypharmacy. While previous studies examined specific types problematic medication use in PWD, we sought to characterize a broad spectrum misuse and overuse among community‐dwelling PWD. Methods We included adults aged ≥66 the Health Retirement Study from 2008 2018 linked Medicare classified as having using validated algorithm. Medication usage was ascertained over 1‐year prior an HRS interview date. Potentially medications were identified by: (1) including over‐aggressive treatment diabetes/hypertension (e.g., insulin/sulfonylurea hemoglobin A1c < 7.5%) inappropriate near end life based on STOPPFrail (2) that negatively affect cognition 2019 Beers STOPP Version 2 criteria. To contextualize, compared people without through propensity‐matched cohort by age, sex, comorbidities, year. applied survey weights make our results nationally representative. Results Among 1441 median age 84 (interquartile range = 78–89), 67% female, 14% Black. Overall, 73% PWD prescribed ≥1 potentially mean 2.09 per individual This notable across several domains, 41% affects cognition. Frequently proton pump inhibitors (PPIs), non‐steroidal anti‐inflammatory drugs (NSAIDs), opioids, antihypertensives, antidiabetic agents. Problematic higher those versus ( p 0.002) 1.62 0.001), respectively. Conclusion Community‐dwelling frequently receive multiple domains at frequencies dementia. Deprescribing efforts for should focus not only harmful central nervous system‐active but also other classes such PPIs NSAIDs.
Language: Английский
Citations
6