A bitter pill to swallow - Polypharmacy and psychotropic treatment in people with advanced dementia

BMC Geriatrics, Journal Year: 2022, Volume and Issue: 22(1)

Published: March 16, 2022

Abstract Background Polypharmacy is common in people with dementia. The use of psychotropic drugs (PDs) and other, potentially inappropriate medications high. aims this cross-sectional study were 1) to investigate the advanced dementia (PWAD), living at home or long term care (LTC); 2) focus on PD use; 3) identify determinants use. Methods was performed context EPYLOGE (Issu E s P alliative for terminal stages Y OD LO D Ge rmany). 191 PWAD included. All that administered date examination recorded. Multiple logistic regression analysis identified Results 96% received medication a median number four drugs. 49.7% five more According Beers Criteria 39% ≥ 65 years least one medication. 79% treated PDs. Older LTC facilities significantly than younger PWAD, home, respectively. Dementia etiology associated antipsychotics, antidepressants sedative substances. Place pain Behavioral disturbances antipsychotics Conclusions To mitigate dangers polypharmacy related harm, critical required, whether drug indicated not. Also, deprescribing should be considered regular basis. Trial registration Clinicaltrial.gov, NCT03364179 . Registered 6 December 2017.

Language: Английский

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Use of Central Nervous System (CNS) Medicines in Aged Care Homes: A Systematic Review and Meta-Analysis

Journal of Clinical Medicine, Journal Year: 2019, Volume and Issue: 8(9), P. 1292 - 1292

Published: Aug. 23, 2019

Background: Both old age and institutionalization in aged care homes come with a significant risk of developing several long-term mental neurological disorders, but there has been no definitive meta-analysis data from studies to determine the pooled estimate central nervous system (CNS) medicines use homes. We conducted this systematic review summarize CNS drugs among home residents. Methods: MEDLINE, EMBASE, CINAHL, Scopus, International Pharmaceutical Abstracts (IPA) databases were searched (between 1 January 2000 31 December 2018) identify population-based that reported Pooled proportions (with 95% confidence interval), according study location calculated. Results: A total 89 care. The drug varied country (from 20.3% Ireland 49.0% Belgium) region 31.7% North America 42.5% Scandinavia). overall psychotropic was highest Europe (72.2%, CI, 67.1–77.1%) lowest ANZ (56.9%, 52.2–61.4%). benzodiazepines widely, 18.9% 44.8% Europe. antidepressant 47 38.3% (95% CI 35.1% 41.6%), proportion (44.9%, 35.3–54.5%). Conclusion: countries, Australia New Zealand reporting drugs. criteria for prescribing clinical practice should be evidence-based. used not prohibit listed medications support judgement as well patient safety.

Language: Английский

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

Age and Ageing, Journal Year: 2020, Volume and Issue: 49(4), P. 580 - 587

Published: March 25, 2020

Potentially inappropriate medication (PIM) use is prevalent in older adults and associated with adverse events, hospitalisation mortality. We assessed the patterns associations of PIM mild-to-moderate Alzheimer's Disease (AD), who may represent a particularly vulnerable group.Analysis data from NILVad, an 18-month Randomised Control Trial Nilvadapine AD. The v2 STOPP criteria were applied duplicate to identify use. Associations between events/unscheduled healthcare visits addition AD progression evaluated.448 23 centres nine European countries.Of 448 participants (mean age: 72.56 ± 8.19 years), over half (55.8%) prescribed 30.1% being 2+ PIMs. most frequent PIMs (i) long-term benzodiazepines (11.6% N = 52/448), (ii) selective serotonin reuptake inhibitors without appropriate indication (11.1% 50/448), (iii) Proton-Pump Inhibitors (PPIs) (10.7% 48/448). Increasing number was greater risk events (IRR 1.17, 1.13-1.19, P < 0.001), serious 1.27; 1.17-1.37, unscheduled hospitalisations 1.16, 1.03-1.30, 0.016) GP 1.22, 1.15-1.28, 0.001). not dementia progression.PIM highly utilisation. Further attention de-prescribing this group warranted.

Language: Английский

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Potentially inappropriate prescriptions to Brazilian older people with Alzheimer disease

Medicine, Journal Year: 2021, Volume and Issue: 100(12), P. e25015 - e25015

Published: March 23, 2021

Older adults are the leading users of medications, where this can be associated with a high number potentially inappropriate medications (PIMs) and prescribing (PIP) consequent harm to health. No Brazilian study evaluating in older patients Alzheimer's disease (AD) was found. This determined analyzed prevalence PIP PIM prescribed for people AD.A cross-sectional carried out at Specialty Drugs Pharmacy city Sorocaba, São Paulo State, Brazil. The MEDEX system provided register AD data were collected during interviews and/or caregivers between June September 2017. PIMs identified according 2019 Beers Criteria. association independent variables by Poisson regression.This included 234 AD. 66.7% (n = 156). Of 1073 prescribed, 30.5% 327) most affecting central nervous or cardiovascular, particularly quetiapine (12.8%) acetylsalicylic acid (11.6%), respectively. Around 45.2% should avoided people, especially sertraline (14.2%) clonazepam (7.4%). After adjusted analysis, diagnosis depression (P 0.010) comorbidities 0.005).There among substantial which have been population. Health care professionals apply these findings improve safety use treating

Language: Английский

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Anticholinergic medicines use among older adults before and after initiating dementia medicines

British Journal of Clinical Pharmacology, Journal Year: 2019, Volume and Issue: 85(9), P. 1957 - 1963

Published: May 2, 2019

Aims We investigated anticholinergic medicines use among older adults initiating dementia medicines. Methods used Pharmaceutical Benefits Scheme dispensing claims to identify patients who initiated donepezil, rivastigmine, galantamine or memantine between 1 January 2013 and 30 June 2017 (after a period of ≥180 days with no these medicines) remained on therapy for ( n = 4393), dispensed in the 180 before after further examined prescribed by prescriber other than one Results One‐third study cohort (1439/4393) was exposed up Among medicines, 46% (659/1439) had same medicine The proportion increased 2.5% (95% confidence interval [CI]: 1.3–3.7) Antipsychotics 10.1% CI: 7.6–12.7) medicines; driven risperidone (7.3%, 95% 5.3–9.3). Nearly half (537/1133), were Conclusion Use is common this occurs against backdrop widespread campaigns reduce irrational combinations vulnerable population. Decisions about deprescribing questionable benefit may be complicated conflicting recommendations prescribing guidelines.

Language: Английский

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