Abstract

BackgroundCompared with those without dementia, older patients with dementia admitted to acute care settings are at higher risk for triad combination of polypharmacy (PP), potentially inappropriate medication (PIM), and drug-drug interaction (DDI), which may consequently result in detrimental health. The aims of this research were to assess risk factors associated with triad combination of PP, PIM and DDI among hospitalized older patients with dementia, and to assess prevalence and characteristics of PP, PIM and DDI in this population.MethodsIn this retrospective cross-sectional study, 416 older inpatients diagnosed with dementia and referred for specialist geriatric consultation at a tertiary hospital in Brisbane, Australia during 2006–2016 were enrolled. Patients were categorized into two groups according to their exposure to the combination of PP, PIM and DDI: ‘triad combination’ and ‘non-triad combination’. Data were collected using the interRAI Acute Care (AC) assessment instrument. Independent risk factors of exposure to the triad combination were evaluated using bivariate and multivariate logistic regression analyses.ResultsOverall, 181 (43.5%) were classified as triad combination group. The majority of the population took at least 1 PIM (56%) or experienced at least one potential DDI (76%). Over 75% of the participants were exposed to polypharmacy. The most common prescribed PIMs were antipsychotics, followed by benzodiazepines. The independent risk factors of the triad combination were the presence of atrial fibrillation diagnosis and higher medications use in cardiac therapy, psycholeptics and psychoanaleptics.ConclusionsThe exposure to triad combination of PP, PIM and DDI are common among people with dementia as a result of their vulnerable conditions and the greater risks of adverse events from medications use. This study identified the use of cardiac therapy, psycholeptics and psychoanaleptics as predictors of exposure to PP, PIM and DDI. Therefore, use of these medications should be carefully considered and closely monitored. Furthermore, comprehensive medication reviews to optimize medication prescribing should be initiated and continually implemented for this vulnerable population.

Highlights

  • During the recent decades, the increasing aging population and the great gains in life expectancy have resulted in raised prevalence of neurodegenerative diseases including dementia

  • The exposure to triad combination of PP, potentially inappropriate medication (PIM) and drug-drug interaction (DDI) are common among people with dementia as a result of their vulnerable conditions and the greater risks of adverse events

  • This study identified the use of cardiac therapy, psycholeptics and psychoanaleptics as predictors of exposure to PP, PIM and DDI

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Summary

Introduction

The increasing aging population and the great gains in life expectancy have resulted in raised prevalence of neurodegenerative diseases including dementia. Due to the deterioration of cortical functions, especially in memory, people with dementia may take the medicine repeatedly or wrong medications, resulting in drug related problems (DRPs) and increased medication use. These problems have devastating effects on health outcomes, such as adverse drug events, morbidity and mortality. The estimated cost of dementia in Australia was over $15 billion in 2019 and is estimated to increase to over $36.8 billion by 2056 [6] Compared with those without dementia, older patients with dementia admitted to acute care settings are at higher risk for triad combination of polypharmacy (PP), potentially inappropriate medication (PIM), and drug-drug interaction (DDI), which may result in detrimental health. The aims of this research were to assess risk factors associated with triad combination of PP, PIM and DDI among hospitalized older patients with dementia, and to assess prevalence and characteristics of PP, PIM and DDI in this population

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