Effectiveness and Safety of Dementia Care Management in Primary Care

JAMA Psychiatry, Год журнала: 2017, Номер 74(10), С. 996 - 996

Опубликована: Июль 26, 2017

Dementia care management (DCM) can increase the quality of for people with dementia. Methodologically rigorous clinical trials on DCM are lacking.To test effectiveness and safety in treatment dementia living at home caregiver burden (when available).This pragmatic, general practitioner-based, cluster-randomized intervention trial compared as usual baseline 12-month follow-up. Simple 1:1 randomization practices Germany was used. Analyses were intent to treat per protocol. In total, 6838 patients screened (eligibility: 70 years older home) from January 1, 2012, March 31, 2016. Overall, 1167 (17.1%) diagnosed having dementia, 634 (9.3%) provided written informed consent participate.Dementia 6 months homes is a model collaborative care, defined complex aiming provide optimal support caregivers using computer-assisted assessment determining personalized array modules subsequent success monitoring. targeted individual patient level conducted by study nurses care-specific qualifications.Quality life, burden, behavioral psychological symptoms pharmacotherapy antidementia drugs, use potentially inappropriate medication.The mean age 80 years. A total 407 received intended available primary outcome measurement. Of these patients, 248 (60.9%) women, 204 (50.1%) lived alone. significantly decreased (b = -7.45; 95% CI, -11.08 -3.81; P < .001) -0.50; -1.09 0.08; .045) usual. Patients receiving had an increased chance drug (DCM, 114 291 [39.2%] vs usual, 31 116 [26.7%]) after 12 (odds ratio, 1.97; 0.99 3.94; .03). life 0 0.17; .03) not alone but did overall. There no effect medication 1.86; 0.62 3.62; .97).Dementia specifically trained effective that improves relevant patient- caregiver-related outcomes Implementing different health systems should become active area research.clinicaltrials.gov Identifier: NCT01401582.

Язык: Английский

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A qualitative study exploring medication management in people with dementia living in the community and the potential role of the community pharmacist

Health Expectations, Год журнала: 2017, Номер 20(5), С. 929 - 942

Опубликована: Янв. 19, 2017

Abstract Background The prevalence of dementia is increasing rapidly. People with may be prescribed complex medication regimens, which challenging for them and any carers involved to safely manage. Objective To describe understand the key challenges, in relation issues, experienced by people their informal dwelling community potential role pharmacists. Design Qualitative semi‐structured interviews. Participants dementia, health social care professionals ( HSCP s). Results Thirty‐one participants (eleven carers, four sixteen s) were interviewed. Three themes identified: improving management caring commonly included responsibility created both practical problems an emotional burden. This burden was worsened difficulty obtaining support if person on a regimen. believed that process could improved coordinated on‐going from s, should focus carer. Medication reviews, particularly when conducted home environment, helpful. Conclusion living process, have role, they frequently find challenging. Community pharmacists enhanced this area, but would need work within more multidisciplinary environment outside pharmacy.

Язык: Английский

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Person-Centered Assessment and Care Planning

The Gerontologist, Год журнала: 2017, Номер 58(suppl_1), С. S32 - S47

Опубликована: Окт. 13, 2017

The quality of dementia care rendered to individuals and families is contingent upon the assessment planning, degree which those processes are person-centered. This paper provides recommendations for planning derived from a review research literature. These guidelines build previous published by Alzheimer's Association, apply all settings, types, stages dementia. target audience these includes professionals, paraprofessionals, direct workers, depending on their scope practice training.

Язык: Английский

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Polypharmacy and Potentially Inappropriate Medication in People with Dementia: A Nationwide Study

Journal of Alzheimer s Disease, Год журнала: 2018, Номер 63(1), С. 383 - 394

Опубликована: Март 23, 2018

Background:Polypharmacy (use of ≥5 different medications) and potentially inappropriate medication (PIM) are well-known risk factors for numerous negative health outcomes. However, the use polypharmacy PIM in people with dementia is not well-described. Objective:To examine prevalence older without a nationwide population. Methods:Cross-sectional study Danish population aged ≥65 2014 (n = 1,032,120) based on register data, including information diagnoses dispensed prescriptions. Polypharmacy among 35,476) 994,231) were compared, stratified by living situation adjusted age, sex, comorbidity. The red-yellow-green list from Institute Rational Pharmacotherapy German PRISCUS used to define PIM. Results:People more frequently exposed (dementia: 62.6% versus no-dementia: 35.1%, p < 0.001) likewise (red-yellow-green: 45.0% 29.7%, 0.001; PRISCUS: 24.4% 13.2%, 0.001). After adjustments comorbidity, likelihood was higher community-dwelling than (odds ratio (OR); [95% confidence interval (CI)] polypharmacy: 1.50 [1.45–1.55]; red-yellow-green: 1.27 [1.23–1.31]; 1.25 [1.20–1.30]). In contrast, slightly decreased odds nursing home residents. Conclusion:Use widespread so dementia. This could have implications patient-safety demonstrates need interventions improve drug therapy

Язык: Английский

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AgeWell.de – study protocol of a pragmatic multi-center cluster-randomized controlled prevention trial against cognitive decline in older primary care patients

BMC Geriatrics, Год журнала: 2019, Номер 19(1)

Опубликована: Авг. 1, 2019

In the absence of treatment options, WHO emphasizes identification effective prevention strategies as a key element to counteract dementia epidemic. Regarding complex nature dementia, trials simultaneously targeting multiple risk factors should be particularly for prevention. So far, however, only few such multi-component have been launched, but yielding promising results. Germany, comparable initiatives are lacking, and translation these interventions into routine care was not yet done. Therefore, AgeWell.de will conducted first trial in Germany which is closely linked primary setting.

Язык: 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, Год журнала: 2023, Номер 14

Опубликована: Авг. 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.

Язык: Английский

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Factors associated with the use of potentially inappropriate medications by older adults in primary health care: An analysis comparing AGS Beers, EU(7)-PIM List , and Brazilian Consensus PIM criteria

Research in Social and Administrative Pharmacy, Год журнала: 2018, Номер 15(4), С. 370 - 377

Опубликована: Июнь 15, 2018

Язык: Английский

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Potentially inappropriate medication use among hypertensive older African-American adults

BMC Geriatrics, Год журнала: 2018, Номер 18(1)

Опубликована: Окт. 5, 2018

Inappropriate use of medications, particularly among minority older adults with co-morbidity, remains a major public health concern. The American Geriatrics Society (AGS) reports that Potentially Medication (PIM) continues to be prescribed for adults, despite evidence poor outcomes. main objective this study was examine the prevalence PIM underserved non-institutionalized hypertensive African-American adults. Furthermore, examines potential correlations between and number type chronic conditions. This cross-sectional is comprised convenience sample 193 aged 65 years recruited from several senior housing units located in areas South Los Angeles. updated 2015 AGS Beers Criteria used identify participants using PIMs. Almost one out two had inappropriate medication use. While average PIMs taken 0.87 drugs, range seven medications. 23% were due drugs drug-drug interactions. most common proton pump inhibitors (PPI) Central Nervous System (CNS) active agents. Nearly 56% potentially increased risk falls fall-associated bone fractures. significantly higher who reported 70% suffering pain. reason high levels polypharmacy, PIMs, drug interactions patients suffer multiple But it may not possible or necessary treat all Therefore, goals care should explicitly reviewed patient order determine which many conditions has greatest impact on life and/or functional priorities patient. Those have limited patient's cause harmful can reduced eliminated, while remaining medications focus important

Язык: Английский

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Alzheimer Disease: Standard of Diagnosis, Treatment, Care, and Prevention

Journal of Nuclear Medicine, Год журнала: 2022, Номер 63(7), С. 981 - 985

Опубликована: Фев. 10, 2022

Alzheimer disease (AD) is the most frequent cause of dementia in people 60 y old or older. This white paper summarizes current standards AD diagnosis, treatment, care, and prevention. Cerebrospinal fluid PET measures cerebral amyloidosis tauopathy allow diagnosis even before (prodromal stage) provide endpoints for treatments aimed at slowing course. Licensed pharmacologic symptomatic drugs enhance cholinergic pathways moderate excess glutamatergic transmission to stabilize cognition. Disease-modifying experimental remove brain amyloidosis, but so far with modest clinical effects. Nonpharmacologic interventions a healthy lifestyle (diet, socioaffective inclusion, cognitive stimulation, physical exercise, others) some beneficial Prevention targets mainly modifiable risk factors such as unhealthy lifestyle, cardiovascular-metabolic sleep-wake cycle abnormalities, mental disorders. A major challenge future telemonitoring real world these factors.

Язык: Английский

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Dementia and comorbidities in primary care: a scoping review

BMC Primary Care, Год журнала: 2023, Номер 24(1)

Опубликована: Дек. 14, 2023

Abstract Background People with dementia (PwD) are known to have more chronic conditions compared those without dementia, which can impact the clinical presentation of complicate management and reduce overall quality life. While primary care providers (PCPs) integral care, it is currently unclear how PCPs adapt practices account for comorbidities. This scoping review maps recent literature that describes role in prevention, detection/diagnosis context comorbidities, identifies critical knowledge gaps proposes potential avenues future research. Methods We searched peer-reviewed published between 2017–2022 MEDLINE, Cochrane Library, Scopus using key terms related comorbidity. The was screened relevance by title-abstract screening subsequent full-text screening. prioritized papers were categorized as either ‘Risk Assessment Prevention’, ‘Screening, Detection, Diagnosis’ or ‘Management’ further labelled ‘Tools Technologies’, ‘Recommendations Clinical Practice’ ‘Programs Initiatives’. Results identified 1,058 unique records our search respectively excluded 800 230 publications during Twenty-eight articles included review, where ~ 50% describe development testing tools technologies use pre-existing assess risk. Only one publication provides official guidelines people conditions. About 30% discuss managing PwD, most anchored around models multidisciplinary mitigating potentially inappropriate prescribing. Conclusion To knowledge, this first examines Given findings, we recommend studies: 1) validate risk assessment, timely detection diagnosis incorporate other health conditions; 2) provide additional guidance into comorbidities could (including prescribing medication) settings; 3) indicators dementia; 4) explore best models/frameworks holistic, person-centred care.

Язык: Английский

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