Anna Renom-Guiteras1,2,3, Petra A Thürmann4,5, Ramón Miralles2,3, Renate Klaaßen-Mielke6, Ulrich Thiem6,7, Astrid Stephan1,8, Michel H C Bleijlevens9, David Jolley10, Helena Leino-Kilpi11, Ingalill Rahm Hallberg12, Kai Saks13, Maria Soto-Martin14, Adelaida Zabalegui15,16, Gabriele Meyer1,8. 1. School of Nursing Science, University of Witten/Herdecke, Witten, Germany. 2. Geriatrics Department, University Hospital Parc de Salut Mar, Barcelona, Spain. 3. Universitat Autònoma de Barcelona, Barcelona, Spain. 4. Chair of Clinical Pharmacology, University of Witten/Herdecke, Witten, Germany. 5. Philipp Klee-Institute of Clinical Pharmacology, HELIOS University Clinic Wuppertal, Wuppertal, Germany. 6. Department of Medical Informatics, Biometry and Epidemiology, Ruhr University, Bochum, Germany. 7. Department of Geriatrics, Elisabeth Krankenhaus Essen, Essen, Germany. 8. Institute of Health and Nursing Science, Medical Faculty, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany. 9. Care and Public Health Research Institute (Caphri), Department of Health Services Research, Maastricht University, Maastricht, The Netherlands. 10. Personal Social Services Unit, University of Manchester, Manchester, UK. 11. Department of Nursing Science and Nurse Director, University of Turku, Turku University Hospital, Turku, Finland. 12. The Pufendorf Institute of Advanced Studies, Lund University, Lund, Sweden. 13. Department of Internal Medicine, University of Tartu, Tartu, Estonia. 14. Department of Geriatric Medicine, Gerontopole, Alzheimer Disease Research Center, Inserm UMR 1027, University Hospital of Toulouse, France. 15. Hospital Clinic de Barcelona, Barcelona, Spain. 16. School of Medicine, Universitat de Barcelona, Barcelona, Spain.
Abstract
Objectives: to evaluate the frequency of potentially inappropriate medication (PIM) prescription among older people with dementia (PwD) from eight countries participating in the European study 'RightTimePlaceCare', and to evaluate factors and adverse outcomes associated with PIM prescription. Methods: survey of 2,004 PwD including a baseline assessment and follow-up after 3 months. Interviewers gathered data on age, sex, prescription of medication, cognitive status, functional status, comorbidity, setting and admission to hospital, fall-related injuries and mortality in the time between baseline and follow-up. The European Union(7)-PIM list was used to evaluate PIM prescription. Multivariate regression analysis was used to investigate factors and adverse outcomes associated with PIM prescription. Results: overall, 60% of the participants had at least one PIM prescription and 26.4% at least two. The PIM therapeutic subgroups most frequently prescribed were psycholeptics (26% of all PIM prescriptions) and 'drugs for acid-related disorders' (21%). PwD who were 80 years and older, lived in institutional long-term care settings, had higher comorbidity and were more functionally impaired were at higher risk of being prescribed two PIM or more. The prescription of two or more PIM was associated with higher chance of suffering from at least one fall-related injury and at least one episode of hospitalisation in the time between baseline and follow-up. Conclusions: PIM use among PwD is frequent and is associated with institutional long-term care, age, advanced morbidity and functional impairment. It also appears to be associated with adverse outcomes. Special attention should be paid to psycholeptics and drugs for acid-related disorders.
Objectives: to evaluate the frequency of potentially inappropriate medication (PIM) prescription among older people with dementia (PwD) from eight countries participating in the European study 'RightTimePlaceCare', and to evaluate factors and adverse outcomes associated with PIM prescription. Methods: survey of 2,004 PwD including a baseline assessment and follow-up after 3 months. Interviewers gathered data on age, sex, prescription of medication, cognitive status, functional status, comorbidity, setting and admission to hospital, fall-related injuries and mortality in the time between baseline and follow-up. The European Union(7)-PIM list was used to evaluate PIM prescription. Multivariate regression analysis was used to investigate factors and adverse outcomes associated with PIM prescription. Results: overall, 60% of the participants had at least one PIM prescription and 26.4% at least two. The PIM therapeutic subgroups most frequently prescribed were psycholeptics (26% of all PIM prescriptions) and 'drugs for acid-related disorders' (21%). PwD who were 80 years and older, lived in institutional long-term care settings, had higher comorbidity and were more functionally impaired were at higher risk of being prescribed two PIM or more. The prescription of two or more PIM was associated with higher chance of suffering from at least one fall-related injury and at least one episode of hospitalisation in the time between baseline and follow-up. Conclusions: PIM use among PwD is frequent and is associated with institutional long-term care, age, advanced morbidity and functional impairment. It also appears to be associated with adverse outcomes. Special attention should be paid to psycholeptics and drugs for acid-related disorders.
Authors: Danijela Gnjidic; George O Agogo; Christine M Ramsey; Daniela C Moga; Heather Allore Journal: J Gerontol A Biol Sci Med Sci Date: 2018-09-11 Impact factor: 6.053
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