Continuity of GP care for patients with dementia: impact on prescribing and the health of patients

British Journal of General Practice, Journal Year: 2022, Volume and Issue: 72(715), P. e91 - e98

Published: Jan. 24, 2022

Background Higher continuity of GP care (CGPC), that is, consulting the same doctor consistently, can improve doctor–patient relationships and increase quality care; however, its effects on patients with dementia are mostly unknown. Aim To estimate associations between CGPC potentially inappropriate prescribing (PIP), incidence adverse health outcomes (AHOs) in dementia. Design setting A retrospective cohort study 1 year follow-up anonymised medical records from 9324 dementia, aged ≥65 years living England 2016. Method measures include Usual Provider Care (UPC), Bice–Boxerman Continuity (BB), Sequential (SECON) indices. Regression models estimated PIPs survival analysis AHOs during adjusted for age, sex, deprivation level, 14 comorbidities, frailty. Results The highest quartile (HQ) UPC (highest continuity) had 34.8% less risk delirium (odds ratio [OR] 0.65, 95% confidence interval [CI] = 0.51 to 0.84), 57.9% incontinence (OR 0.42, CI 0.31 0.58), 9.7% emergency admissions hospital 0.90, 0.82 0.99) compared lowest quartile. Polypharmacy PIP were identified 81.6% ( n 7612) 75.4% 7027) patients, respectively. HQ fewer prescribed medications (HQ: mean 8.5, (LQ): 9.7, P <0.01) 2.1, LQ: 2.5, <0.01), including loop diuretics incontinence, drugs cause constipation, benzodiazepines high fall risk. BB SECON produced similar findings. Conclusion was associated safer lower rates major events. Increasing may help treatment outcomes.

Language: Английский

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Polypharmacy among older adults with dementia compared with those without dementia in the United States

Journal of the American Geriatrics Society, Journal Year: 2021, Volume and Issue: 69(9), P. 2464 - 2475

Published: June 8, 2021

Abstract Background/objectives In older persons with dementia (PWD), extensive medication use is often unnecessary, discordant goals of care, and possibly harmful. The objective this study was to determine the prevalence constituents polypharmacy among PWD attending outpatient visits in United States. Design Cross‐sectional analysis. Setting participants without (PWOD) aged ≥65 years recorded nationally representative National Ambulatory Medical Care Survey (NAMCS), 2014–2016. Measurements were identified as those a diagnosis on NAMCS encounter form and/or receiving an anti‐dementia medication. Visits PWOD compared terms sociodemographic, practice/physician factors, comorbidities, prescribing outcomes. Regression analyses examined effect contributions by clinically relevant categories (defined being prescribed ≥5 prescription nonprescription medications). Results unweighted sample involved 918 for 26,543 PWOD, representing 29.0 780 million visits. had median age 81 average 2.8 comorbidities other than dementia; 63% female. number medications eight three ( p < 0.001). After adjustment, significantly higher odds (AOR 3.0; 95% CI: 2.1–4.3) or ≥10 2.8; 2.0–4.2) PWOD. largest sources cardiovascular central nervous system medications; usage from generally elevated at least one highly sedating anticholinergic 2.5; 1.6–3.9). Conclusion visits, extremely common PWD, driven wide array categories. Addressing will require cross‐cutting multidisciplinary approaches.

Language: Английский

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Global prevalence of polypharmacy and potentially inappropriate medication in older patients with dementia: a systematic review and meta-analysis

Frontiers in Pharmacology, Journal Year: 2023, Volume and Issue: 14

Published: Aug. 24, 2023

Background: Older patients with dementia always need multiple drugs due to comorbidities and cognitive impairment, further complicating drug treatment increasing the risk of potentially inappropriate medication. The objective our study is estimate global prevalence polypharmacy medication (PIM) explore factors PIM for older dementia. Methods: We searched PubMed, Embase (Ovid), Web Science databases identify eligible studies from inception 16 June 2023. conducted a meta-analysis observational reporting in using random-effect model. associated were meta-analyzed. Results: Overall, 62 included, which 53 reported 28 polypharmacy. pooled was 43% (95% CI 38–48) 62% 52–71), respectively. Sixteen referred use, 15 pooled. Polypharmacy (2.83, 95% 1.80–4.44), diabetes (1.31, 1.04–1.65), heart failure (1.17, 1.00–1.37), depression (1.45, 1.14–1.88), history cancer (1.20, 1.09–1.32), hypertension (1.46, 1.05–2.03), ischemic disease (1.55, 0.77–3.12), any cardiovascular (1.11, 1.06–1.17), vascular (1.09, 1.03–1.16), chronic obstructive pulmonary (1.39, 1.13–1.72), psychosis (1.91, 1.04–3.53) are positively use. Conclusion: highly prevalent Among different regions, use varied widely. Increasing closely For other such as diabetes, prescribing should be cautioned.

Language: Английский

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The Prevalence of Polypharmacy and Potentially Inappropriate Medications and Its Relationship with Cognitive Status in Portuguese Institutionalized Older Adults: A Cross-Sectional Study

International Journal of Environmental Research and Public Health, Journal Year: 2022, Volume and Issue: 19(5), P. 2637 - 2637

Published: Feb. 24, 2022

The aim of this study was to evaluate the prevalence polypharmacy and potentially inappropriate medications (PIMs) in a population older adults living nursing homes. Furthermore, we also intended assess possible association between polypharmacy, cognitive impairment institutionalized adults. A cross-sectional analyzed data from 193 home residents district Viseu, Portugal, September 2018 June 2019, with mean age 82.4 ± 6.2 years (ranging 65 95 old); 72.5% (n = 140) were female participants. Major presented 80.8% population, who took 7.6 3.3 drugs per day. Using Beers Criteria, found that 79.3% PIMs. There positive PIM (p < 0.001), showing higher medicines intake increased number Polypharmacy not associated functionality perform activities daily living, but impairment. lower scores on Mini Mental State Examination (MMSE) more 0.039) used 0.001). Moreover, patients taking five or prescription day (major polypharmacy) consuming any psychiatric, gastrointestinal oral antidiabetic agents (regardless whether they considered not) had odds displaying than those did 0.05). Older adult studied homes affected by polypharmacy. This observation reveals need adopt implement strategies make drug therapy adequate safer for

Language: Английский

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Adherence to Guideline Recommendations on Psychotropic Drug Use for Challenging Behavior in Dementia

Journal of the American Medical Directors Association, Journal Year: 2025, Volume and Issue: 26(4), P. 105474 - 105474

Published: Feb. 7, 2025

Psychotropic drugs are frequently prescribed for challenging behavior in residents with dementia nursing homes. Recommendations on psychotropic drug use described the Dutch multidisciplinary guideline "Problem dementia." This study aimed to gain insight into adherence recommendations type and timing of evaluations different types a national sentinel network Prospective observational study. Data 22 homes across Netherlands were collected during 3-month measurement period 2021. Physicians completed registration forms integrated electronic health record after reporting progress notes. Prescribed type(s), intervention (start/stop/change dosage/evaluation), indications recorded. Adherence was achieved if recommended specified indication. reported within 7 days starting. A total 1279 behaviors 599 collected. Recommended used 57% all forms. The highest rate psychotic (80%), followed by agitation (48%). lowest nighttime restlessness (22%). Of newly started prescriptions, 17% evaluated present just over half cases. Frequently, not or performed time frame. Further research is needed determine reasons non-recommended use, low evaluation rates, factors that influence adherence. may increase awareness

Language: Английский

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Multicomponent intervention to tailor prescriptions to patients with dementia in an intermediate care hospital: pre-post quasi experimental study

BMC Geriatrics, Journal Year: 2025, Volume and Issue: 25(1)

Published: Feb. 27, 2025

In persons with dementia, polypharmacy may be discordant the goals of care. It is necessary to design interventions that align treatment regimens patient's situation, prognosis and preferences. The objectives this study conducted at an intermediate care were to: i) identify inappropriate prescribing per main goal; ii) compare pharmacotherapy data pre post a medication review based on degree cognitive impairment; iii) assess implementation proposed recommendations three months after discharge. Pre-post quasi-experimental study. Patients dementia discharged from hospital between November 2021 April 2022. Demographic, clinical evaluated admission. Medication reviews interviews caregivers pharmacologic therapies overall At discharge, information was shared primary team in discharge summary. Follow up evaluate during performed months. Of 97 patients included, 94.8% had least one inappropriately prescribed medication. mean number chronic medications taken patient decreased by 29.6%, 8.05(SD 3.5) 5.67(SD 2.7) (p < 0.001); anticholinergic burden 18.6%, 1.59(SD 1.0) 1.29(SD 0.9) therapeutic complexity 28.4%, 29.23(SD 13.8) 20.94(SD 11.3) 0.001). 3 90.0%. Admission provides ideal setting for multicomponent intervention, tailoring prescriptions preferences, improving parameters related side effects, ensuring are maintained over medium term.

Language: Английский

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Implementation of evidence-based guidance for dementia palliative care using participatory action research: examining implementation through the Consolidated Framework for Implementation Research (CFIR)

Implementation Science Communications, Journal Year: 2021, Volume and Issue: 2(1)

Published: Dec. 1, 2021

Abstract Background The importance of providing evidence-based palliative care for people with dementia is increasingly acknowledged as important patient outcomes. In Ireland, guidance has been developed in order to address key features care, including the management pain, medications and hydration nutrition. aim this study was identify explore factors affecting implementation on care. Methods Consolidated Framework Implementation (CFIR) guided a mixed-method pre-post study. One document pertaining medication or nutrition implemented three long-term facilities. Participatory action research form work-based learning groups used implement guidance, drawing situational analysis (pre-implementation). Staff questionnaires audits were conducted pre- post-implementation while champion interviews also post-implementation. Results Features inner setting components such readiness change, process most frequently identified impacting implementation. Components outer setting, external policy incentives individual characteristics, featured less commonly. Data from qualitative revealed that perceived advantageous complimentary previous provided. Within leadership support other colleagues facilitated However, limited availability healthcare professionals assist carrying out actions presented barrier some facilitators (WBLGs) experienced encouraged active participation reflection practices. Despite challenge releasing staff attend WBLGs, quantitative data demonstrated reduced de-motivation amongst those who did noted (pre- Mdn = 19.50 versus post- 22.00, U 497.00, p 0.07). Conclusions A informed by CFIR framework conjunction participatory approach helped advance guidance. progress depended extent which previously being at each site. Post-implementation using challenges future projects cover timing training facilitate attendance different working hours. Facilitators included multidisciplinary engagement intervention champions site process.

Language: Английский

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Potentially Inappropriate Medication Use in Patients with Dementia

International Journal of Environmental Research and Public Health, Journal Year: 2022, Volume and Issue: 19(18), P. 11426 - 11426

Published: Sept. 10, 2022

The objective of this study was to characterize the epidemiology using potentially inappropriate medications associated with dementia exacerbation (DPIMs) in elderly outpatients dementia. Electronic medical records were retrospectively reviewed for geriatric patients who prescribed at least one medication 2016 a tertiary, university-affiliated hospital. 2015 Beers criteria used define DPIMs. Logistic regression performed identify factors prescribing DPIMs Among 2100 included our study, 987 (47.0%) DPIM. Benzodiazepines most frequently DPIM followed by anticholinergics, histamine H2-receptor blockers, and zolpidem. risk significantly increased female (odds ratio (OR) 1.355) polypharmacy (OR 5.146) multiple comorbidities 1.129) (p < 0.05 all). Coexistence Parkinson’s disease 1.799), mood disorder 1.373), or schizophrenia 4.116) further likelihood receiving In conclusion, commonly Korea benzodiazepines anticholinergics. Female should be closely monitored minimize unnecessary use and, ultimately, DPIM-related harms.

Language: Английский

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Preliminary Evidence for Dementia Collaborative Coaching

American Journal of Speech-Language Pathology, Journal Year: 2023, Volume and Issue: 32(5), P. 2146 - 2157

Published: July 12, 2023

The primary purpose of this study was to obtain preliminary evidence for a communication coaching intervention, Dementia Collaborative Coaching. secondary aim assess the acceptability, appropriateness, and feasibility intervention according routine care providers.

Language: Английский

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Polypharmacy is associated with functional decline in Alzheimer's disease and Lewy body dementia

Archives of Gerontology and Geriatrics, Journal Year: 2021, Volume and Issue: 96, P. 104459 - 104459

Published: June 24, 2021

Language: Английский

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