INCREASE‐DEPTH: MTM and DEPrescribing THerapy recommendations for medication‐related problems among elderly adults in the INCREASE trial

Abstract

AbstractBackgroundA growing body of literature supports the hypothesis that cognitive reserve (CR) may offset the characteristic progression of dementia symptomatology. The cognitive function of polypharmacy‐prone populations, such as older adults, can be negatively impacted by various factors, including medication‐related exposures. The INCREASE trial prospectively measures the effect of targeted medication management therapy (MTM) services for medication‐related problem (MRP) reduction, maintaining CR, and delaying AD manifestations.MethodCommunity‐dwelling individuals aged ≥65 years, routinely exposed to ≥1 potentially inappropriate medication (PIM), and without baseline dementia were recruited for the INCREASE trial. Pharmacists board certified in geriatrics provided blinded comprehensive medication review (CMR) to identify MRPs (e.g., per 2015 Beers Criteria, drug‐drug/drug‐disease interaction, etc.) for all patient‐reported prescriptions, over‐the‐counter (OTC) drugs, vitamins, and supplements. Individualized risk‐benefit assessments and plans were discussed collaboratively between pharmacists, clinicians, and participants. Recommendations were categorized by medication type and recommendation type (e.g., adjusting medication exposure, non‐pharmacologic intervention, etc.) and identifying potential drug‐drug or drug‐disease interactions.ResultOf 104 participants recruited for the study, 90 were randomized; mean (SD) age at enrollment was 75.3 (8.5), with 64% female, and 89% Caucasian. Baseline CMRs identified 6.8 (SD 3.6) MRPs per participant, 2.4 (SD 1.3) of which were PIMs per 2015 Beers Criteria (Table 1). Almost half of MRPs involved medications available without a prescription (e.g., acid suppressants, diphenhydramine, vitamins, etc.). CMRs also identified 0.94 (SD 1.35) drug‐drug and 0.98 (SD 1.07) drug‐disease interactions of concern per patient. Recommendations to optimize treatment included switching therapy (27%) or stopping/reducing medication exposure (22%) (Table 2).ConclusionCMR and MTM prompts nuanced discussion between healthcare providers and patients, highlighting many drug‐related safety concerns. Certain implicated medications may be potentially associated with CR and/or dementia (e.g., anticholinergics). This analysis describes the baseline MTM recommendations provided by blinded pharmacy specialists in the INCREASE trial before randomization and participant intervention. Final recommendations for those randomized to the intervention were made after the pharmacists‐clinician team met with the participant. Evaluation of CR preservation and delay of AD onset post‐randomization are pending completion of the data collection (anticipated data collection completion by March 31, 2021).