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Liu BM, Kouladjian O'Donnell L, Redston MR, Fujita K, Thillainadesan J, Gnjidic D, Hilmer SN. Association of the Drug Burden Index (DBI) exposure with outcomes: A systematic review. J Am Geriatr Soc 2024; 72:589-603. [PMID: 38006299 DOI: 10.1111/jgs.18691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 10/24/2023] [Accepted: 10/25/2023] [Indexed: 11/27/2023]
Abstract
BACKGROUND The Drug Burden Index (DBI) measures an individual's total exposure to anticholinergic and sedative medications. This systematic review aimed to investigate the association of the DBI with clinical and prescribing outcomes in observational pharmaco-epidemiological studies, and the effect of DBI exposure on functional outcomes in pre-clinical models. METHODS A systematic search of nine electronic databases, citation indexes and gray literature was performed (April 1, 2007-December 31, 2022). Studies that reported primary data on the association of the DBI with clinical or prescribing outcomes conducted in any setting in humans aged ≥18 years or animals were included. Quality assessment was performed using the Joanna Briggs Institute critical appraisal tools and the Systematic Review Centre for Laboratory animal Experimentation risk of bias tool. RESULTS Of 2382 studies screened, 70 met the inclusion criteria (65 in humans, five in animals). In humans, outcomes reported included function (n = 56), cognition (n = 20), falls (n = 14), frailty (n = 7), mortality (n = 9), quality of life (n = 8), hospitalization (n = 7), length of stay (n = 5), readmission (n = 1), other clinical outcomes (n = 15) and prescribing outcomes (n = 2). A higher DBI was significantly associated with increased falls (11/14, 71%), poorer function (31/56, 55%), and cognition (11/20, 55%) related outcomes. Narrative synthesis was used due to significant heterogeneity in the study population, setting, study type, definition of DBI, and outcome measures. Results could not be pooled due to heterogeneity. In animals, outcomes reported included function (n = 18), frailty (n = 2), and mortality (n = 1). In pre-clinical studies, a higher DBI caused poorer function and frailty. CONCLUSIONS A higher DBI may be associated with an increased risk of falls and decreased function and cognition. Higher DBI was inconsistently associated with increased mortality, length of stay, frailty, hospitalization or reduced quality of life. Human observational findings with respect to functional outcomes are supported by preclinical interventional studies. The DBI may be used as a tool to identify older adults at higher risk of harm.
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Affiliation(s)
- Bonnie M Liu
- Ageing and Pharmacology Laboratory, Kolling Institute, Faculty of Medicine and Health, The University of Sydney and the Northern Sydney Local Health District, Sydney, Australia
- Aged Care Department, Royal North Shore Hospital, Sydney, Australia
| | - Lisa Kouladjian O'Donnell
- Ageing and Pharmacology Laboratory, Kolling Institute, Faculty of Medicine and Health, The University of Sydney and the Northern Sydney Local Health District, Sydney, Australia
| | - Mitchell R Redston
- St George and Sutherland Clinical School, Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Kenji Fujita
- Ageing and Pharmacology Laboratory, Kolling Institute, Faculty of Medicine and Health, The University of Sydney and the Northern Sydney Local Health District, Sydney, Australia
| | - Janani Thillainadesan
- Department of Geriatric Medicine and Centre for Education and Research on Ageing, Concord Hospital, Sydney, Australia
- Concord Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Danijela Gnjidic
- School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Sarah N Hilmer
- Ageing and Pharmacology Laboratory, Kolling Institute, Faculty of Medicine and Health, The University of Sydney and the Northern Sydney Local Health District, Sydney, Australia
- Aged Care Department, Royal North Shore Hospital, Sydney, Australia
- Clinical Pharmacology Department, Royal North Shore Hospital, Sydney, Australia
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Zaidi AS, Peterson GM, Curtain CM, Salahudeen MS. Adverse clinical outcomes associated with drug-related hospitalizations in people with dementia. Expert Rev Clin Pharmacol 2024; 17:73-78. [PMID: 38078438 DOI: 10.1080/17512433.2023.2294007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 12/08/2023] [Indexed: 01/24/2024]
Abstract
BACKGROUND This study aimed to determine the clinical impact associated with adverse drug reactions (ADRs) in patients with dementia. RESEARCH DESIGN AND METHODS This case-control, propensity score-matched study utilized administrative data of people with dementia admitted to major public hospitals in Tasmania, Australia, from July 2010 to December 2019. RESULTS Acute renal failure constituted the most common ADR. The length of hospital stay was greater for people with an ADR index admission, versus non-ADR index admission (median [IQR]: 9 [4-18] versus 6 [2-12]; p < 0.001). In-hospital mortality and combined in-hospital and post-hospital mortality within 30, 60 and 90 days were higher for those whose index admission was ADR-related (in-hospital: HR 1.40, 95% CI 1.11-1.77, p-value <0.001; 30 days: HR 1.25, 95% CI 1.05-1.49, p-value <0.001; 60 days: HR 1.27, 95% CI 1.08-1.49, p-value <0.001; 90 days: HR 1.29, 95% CI 1.10-1.50, p-value <0.001). Subsequent ADR admission within 30, 60 and 90 days of index discharge was 9 to 10 times greater for people with dementia (30 days: OR 10.0, 95% CI 6.04-16.8, p-value <0.001; 60 days: OR 8.96, 95% CI 5.57-14.4, p-value <0.001; 90 days: OR 9.31, 95% CI 5.79-14.9, p-value <0.001). CONCLUSION Safe prescribing and vigilant monitoring of ADRs is pivotal to mitigate adverse outcomes in people with dementia.
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Affiliation(s)
- Anum Saqib Zaidi
- School of Pharmacy and Pharmacology, University of Tasmania, Hobart, Australia
| | - Gregory M Peterson
- School of Pharmacy and Pharmacology, University of Tasmania, Hobart, Australia
| | - Colin M Curtain
- School of Pharmacy and Pharmacology, University of Tasmania, Hobart, Australia
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Wojt IR, Lau ECY, Cairns R, Tan ECK. Poisonings in Older People with Dementia: A Systematic Scoping Review and Meta-Analysis. J Alzheimers Dis 2023; 95:1351-1370. [PMID: 37694366 DOI: 10.3233/jad-230246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/12/2023]
Abstract
BACKGROUND Older people with dementia are at a particularly high risk of poisonings and their subsequent harms. OBJECTIVE This review aimed to describe the key agents, incidence, risk factors, and disposition of poisonings in people with dementia reported in the literature. METHODS Medline, Embase, CINAHL, and PsycINFO databases were searched from 1 September 2001 to 1 September 2021. Terms for dementia, poisonings, and older adults formed the search concepts. Quantitative studies published in English, describing poisonings in older people with dementia, including Alzheimer's disease, were included. Two investigators independently assessed articles for eligibility and extracted relevant data. A meta-analysis of the incidence of poisonings in people with dementia across studies was performed. RESULTS Of 4,579 articles, 18 were included for final synthesis. Nervous system medications were implicated in over half of all medicinal poisonings, with anti-dementia agents, benzodiazepines, and opioids the most common classes. The non-medicinal agents frequently associated with poisonings were personal care and household products. The yearly incidence of poisoning varied across definitions of poisoning from 3% for International Classification of Disease-defined poisonings to 43% for adverse drug event-defined poisonings. Several risk factors were identified, including multimorbidity, psychotropic medication use, and living in residential care. Where described, up to one in five poisonings resulted in hospitalisation and in death. CONCLUSIONS Poisonings are common in people with dementia, involving commonly prescribed medications or easily accessible substances. Given the significant outcomes associated, further research is required to better understand these poisonings and improve public health strategies to reduce the occurrence of this preventable harm.
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Affiliation(s)
- Ilsa R Wojt
- The University of Sydney, School of Pharmacy, Faculty of Medicine and Health, Sydney, New South Wales, Australia
| | - Edward C Y Lau
- The University of Sydney, School of Pharmacy, Faculty of Medicine and Health, Sydney, New South Wales, Australia
| | - Rose Cairns
- The University of Sydney, School of Pharmacy, Faculty of Medicine and Health, Sydney, New South Wales, Australia
- New South Wales Poisons Information Centre, The Children's Hospital at Westmead, New South Wales, Australia
| | - Edwin C K Tan
- The University of Sydney, School of Pharmacy, Faculty of Medicine and Health, Sydney, New South Wales, Australia
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Honjo Y, Ide K, Takechi H. Most families tend to realize progress of Alzheimer's disease when behavioural and psychological symptoms are obvious. Psychogeriatrics 2022; 22:317-323. [PMID: 35146847 DOI: 10.1111/psyg.12815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 11/20/2021] [Accepted: 01/17/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Alzheimer's disease (AD) is a common cognitive disease that can progress at an accelerating rate. Even with early diagnosis, the families might not recognize AD progressing unless behavioural and psychological symptoms of dementia (BPSD) develop. In many cases, discrepancies could exist between family-assessed AD stage and diagnosed AD stage. This study explored such discrepancies and potential clinical implications. METHODS Participants were 161 new outpatients with AD or mild cognitive impairment at four memory clinics whose AD stage was diagnosed using the Revised Hasegawa Dementia Scale (HDS-R) and Mini-Mental State Examination (MMSE). We classified patients into four groups according to AD severity. Family members completed the Functional Assessment Staging (FAST) scale during an interview. We then assigned patients to three groups according to discrepancies between family-assessed and diagnosed AD stage. Families also completed the Neuropsychiatric Inventory Questionnaire (NPI-Q), which assesses 12 neuropsychiatric domains, in order to examine the presence of BPSD in relation to AD stage. RESULTS Most families (74%-80%) assessed patients as having milder AD than the diagnosed stage. NPI-Q scores and duration of education significantly affected discrepancies with HDS-R and MMSE scores. The NPI-Q domains of anxiety, apathy/indifference, aberrant motor behaviours, and appetite/eating disturbance significantly affected family-assessed FAST. Families of patients with more years of education assessed the AD stage as more advanced than the diagnosed stage. Surprisingly, living together did not significantly affect the discrepancy. CONCLUSIONS Most families assessed AD as milder than the clinically diagnosed AD stage. In addition, high NPI-Q scores and more years of school education significantly affected the discrepancy. Family-assessed FAST was significantly affected by the NPI-Q domains of anxiety, apathy/indifference, aberrant motor behaviours, and appetite/eating disturbance. These results suggest that obvious BPSD are significant factors for Japanese families to recognize AD progress.
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Affiliation(s)
- Yasuyuki Honjo
- Department of Memory Clinic, Kyoto Min-iren Asukai Hospital, Kyoto, Japan.,Department of Memory Clinic, Kyoto-Kaisei Hospital, Kyoto, Japan.,Department of Memory Clinic, Seika-cho National Health Insurance Hospital, Kyoto, Japan
| | - Kazuki Ide
- Center for Infectious Disease Education and Research, Osaka University 2-8 Yamadaoka, Osaka, Japan
| | - Hajime Takechi
- Department of Geriatrics and Cognitive Disorders, Fujita Health University School of Medicine, Toyoake, Japan
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Villalba-Moreno AM, Galván-Banqueri M, Rodríguez-Pérez A, Toscano-Guzmán MD, López-Hermoso C, Sánchez-Fidalgo S, Santos-Ramos B, Alfaro-Lara ER. Chronic-pharma: New Platform for Chronic Patients Pharmacotherapy Optimization. J Med Syst 2022; 46:18. [PMID: 35226192 PMCID: PMC8885479 DOI: 10.1007/s10916-022-01808-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 02/12/2022] [Indexed: 11/25/2022]
Abstract
We describe the technological development of a web platform named CHRONIC-PHARMA that integrates three prescription support tools for patients with chronic diseases: Anticholinergic Burden Calculator (ABC), LESS-CHRON criteria and TRIGGER-CHRON. They focus on the optimization and evaluation of pharmacotherapy in patients with chronic diseases, resulting in a useful, single platform that can facilitate the review of pharmacotherapy and improve the safety of chronically ill patients. This is achieved by estimating and reducing the anticholinergic risk (ABC), detecting opportunities for deprescribing drugs and monitoring its success (LESS-CHRON criteria), as well as calculating the risk of adverse drug events (TRIGGER-CHRON). The platform is freely accessible online (https://chronic-pharma.com/) as well as through a mobile application, and therefore easily accessible among the healthcare community.
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Yin S, Zhu F, Li Z, Che D, Li L, Zhang L, Zhong Y, Luo B, Wu X. Research Hotspots and Trends in Music Therapy Intervention for Patients With Dementia: A Bibliometrics and Visual Analysis of Papers Published From 2010 to 2021. Front Psychiatry 2022; 13:860758. [PMID: 35573325 PMCID: PMC9098357 DOI: 10.3389/fpsyt.2022.860758] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2022] [Accepted: 04/08/2022] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND As a serious public health problem, dementia has placed a heavy burden on society and families. Evidence suggests that the use of music therapy as a non-pharmacological intervention has certain advantages with respect to reducing the behavioral and psychological symptoms of dementia (BPSD) and improving the cognition and mental status of dementia patients. However, research trends and hotspots regarding music therapy intervention for dementia analysis have not been systematically studied via bibliometric analysis. METHODS We searched the Web of Science Core Collection (WoSCC) for texts published between January 1, 2010, and October 31, 2021, and visualized country, institution, journal, keyword co-occurrence, keyword emergence and keyword clustering. RESULTS A total of 217 articles from the WoSCC database were analyzed. In this research field, the annual number of publications has generally shown a slowly increasing trend, and the United States has the most publications and the most frequent cooperation among countries. University College London (UCL) has the most extensive influence among research institutions. Among articles, those published in the JOURNAL OF ALZHEIMER'S DISEASE were the most numerous, with 20 such articles being published, accounting for 9.22% (20/217) of the total. Comprehensive analysis of five clusters via biclustering shows that the research hotspots in this field during the past 11 years have mainly focused on the autobiographical memory, cognitive function, mental state and BPSD of dementia patients. CONCLUSION This study conducted a bibliometric and visual analysis of relevant studies concerning music therapy intervention for dementia patients. Psychological problems faced by dementia patients and the topics of quality of life, individualized music therapy, the mental state of caregivers and other related topics may be important research directions in the future. Therefore, the question of how to develop standardized research protocols and identify unified efficacy evaluation indicators should be a focus of and difficulty for future research.
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Affiliation(s)
- Shao Yin
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Fengya Zhu
- Zigong First People's Hospital, Zigong, China
| | - Zhao Li
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Deya Che
- Zigong First People's Hospital, Zigong, China
| | - Liuying Li
- Zigong First People's Hospital, Zigong, China
| | - Lu Zhang
- Department of Medical Information Engineering, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Yue Zhong
- Zigong First People's Hospital, Zigong, China
| | - Biao Luo
- Zigong First People's Hospital, Zigong, China
| | - Xiaohan Wu
- Zigong First People's Hospital, Zigong, China
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Lee JW, Li M, Boyd CM, Green AR, Szanton SL. Preoperative Deprescribing for Medical Optimization of Older Adults Undergoing Surgery: A Systematic Review. J Am Med Dir Assoc 2021; 23:528-536.e2. [PMID: 34861224 DOI: 10.1016/j.jamda.2021.11.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 11/03/2021] [Accepted: 11/04/2021] [Indexed: 01/03/2023]
Abstract
OBJECTIVE To summarize the evidence for preoperative deprescribing and its effect on postoperative outcomes in older adults undergoing surgery. DESIGN Systematic review. SETTING AND PARTICIPANTS All available studies. METHODS We searched EMBASE, Cumulative Index of Nursing and Allied Health (CINAHL), and PubMed from inception to January 12, 2021. Settings included outpatient settings during the waiting period for surgery (ie, preoperative clinic) through to the preoperative period in the hospital. Participants who were older adults, aged ≥65 years, undergoing planned or emergency surgery with deprescribing or medication-related interventions were included for review. RESULTS We identified 3 different methods of deprescribing intervention delivery during the preoperative period: geriatrician-led (n = 2), interdisciplinary team-led (n = 8), and pharmacist-led (n = 6). Outcomes were related to health care utilization, patient outcomes, and medication changes; however, results were difficult to compare because of heterogeneous outcomes within the topics. Overall, results were either positive or neutral. CONCLUSIONS AND IMPLICATIONS The evidence for deprescribing during the preoperative period for older adults undergoing surgery is weak because of the heterogeneity of intervention delivery and outcomes, inclusion of nonoperative cases in some studies, and low power. This review highlights the need for future research, which may consider the following: (1) interdisciplinary approach, (2) coordination of deprescribing efforts with primary care provider from the waiting period for surgery up to after hospital discharge, and (3) validated deprescribing criteria such as STOPP/START that is easy to implement. It is important to note that results yielded positive and neutral results, not negative ones, which should reassure clinicians to implement deprescribing for older adults during the surgical period. Additionally, policy initiatives such as integrated electronic medical records or increased reimbursement of deprescribing efforts for primary care providers and/or hospitals should be pursued to prevent adverse postoperative events for this population.
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Affiliation(s)
- Ji Won Lee
- Johns Hopkins University School of Nursing, Baltimore, MD, USA.
| | - Mengchi Li
- Johns Hopkins University School of Nursing, Baltimore, MD, USA
| | | | - Ariel R Green
- Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Sarah L Szanton
- Johns Hopkins University School of Nursing, Baltimore, MD, USA; Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Tran L, Jung J, Carlin C, Lee S, Zhao C, Feldman R. Use of Direct-Acting Antiviral Agents and Survival Among Medicare Beneficiaries with Dementia and Chronic Hepatitis C. J Alzheimers Dis 2021; 79:71-83. [PMID: 33216031 PMCID: PMC7855832 DOI: 10.3233/jad-200949] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Many patients with Alzheimer's disease and related dementia (ADRD) have chronic hepatitis C due to the high prevalence of both conditions among elderly populations. Direct-acting antivirals (DAAs) are effective in treating hepatitis C virus (HCV). However, the complexity of ADRD care may affect DAA use and outcomes among patients with HCV and ADRD. Little information exists on uptake of DAAs, factors associated with DAA use, and health benefits of DAAs among patients with HCV and ADRD. OBJECTIVE To examine use and survival benefits of DAAs in Medicare patients with HCV and ADRD. METHODS The study included Medicare patients with HCV between 2014 and 2017. We estimated Cox proportional hazards regressions to examine the association between having ADRD and DAA use, and the relation between DAA use and survival among patients with HCV and ADRD. RESULTS The adjusted hazard of initiating a DAA was 50% lower in patients with ADRD than those without ADRD (adjusted HR = 0.50, 95% CI: 0.46-0.54). The hazard of DAA use among ADRD patients with behavioral disturbances was 68% lower than non-ADRD patients (adjusted HR = 0.32, 95% CI: 0.28-0.37). DAA treatment was associated with a significant reduction in mortality among ADRD patients (adjusted HR = 0.52, 95% CI: 0.44-0.61). CONCLUSION The rate of DAA treatment in patients with HCV and ADRD was low, particularly among those with behavioral disturbance. The survival benefits of DAA treatment for patients with ADRD were substantial.
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Affiliation(s)
- Linh Tran
- Department of Health Policy and Administration, College of Health and Human Development, Pennsylvania State University, University Park, PA, USA
| | - Jeah Jung
- Department of Health Policy and Administration, College of Health and Human Development, Pennsylvania State University, University Park, PA, USA
| | - Caroline Carlin
- Department of Family Medicine and Community Health, School of Medicine, University of Minnesota, Minneapolis, MN, USA
| | - Sunmin Lee
- Department of Epidemiology, School of Medicine, University of California, Irvine, Irvine, CA, USA
| | - Chen Zhao
- Department of Neurology, Penn State Health Milton S. Hershey Medical Center, Hershey, PA, USA
- Department of Public Health Sciences, Pennsylvania State University College of Medicine, Hershey, PA, USA
| | - Roger Feldman
- Division of Health Policy and Management, School of Public Health, University of Minnesota, MN, USA
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Sakiris MA, Sawan M, Hilmer SN, Awadalla R, Gnjidic D. Prevalence of adverse drug events and adverse drug reactions in hospital among older patients with dementia: A systematic review. Br J Clin Pharmacol 2020; 87:375-385. [PMID: 32520427 DOI: 10.1111/bcp.14417] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Revised: 05/28/2020] [Accepted: 06/01/2020] [Indexed: 12/18/2022] Open
Abstract
AIMS This systematic review aimed to quantify the prevalence of adverse drug events (ADEs) and adverse drug reactions (ADRs) in older inpatients with dementia. METHODS A systematic search of observational studies was performed in Embase, Medline, PsycINFO, International Pharmaceutical Abstracts, Scopus and Informit. Articles published in English that reported the prevalence of ADEs or ADRs in hospital patients aged 65 years or older with dementia were included. Two authors reviewed titles and abstracts and all eligible full-text articles. Relevant information relating to ADEs, ADRs and dementia was obtained from each article. RESULTS In total, 5 articles were included. One study reported the prevalence of ADEs to be 81.5%, defined using the Naranjo algorithm. Four studies assessed the prevalence of ADRs, ranging from 12.7 to 24.0%, assessed using various methods. One study defined ADRs according to the World Health Organization-Uppsala Monitoring Centre criteria, 2 studies employed the World Health Organization definition and 1 study did not explicitly define ADRs. The most frequently reported drug classes implicated in ADEs and ADRs were psychotropic, antihypertensive and analgesic drugs. CONCLUSION Our findings suggest a high prevalence of ADEs and ADRs in older inpatients with dementia. However, only 1 study documented ADEs and there was variability in approaches to ADR assessment. A greater understanding of ADEs and ADRs, as well as tailored assessment tools, will promote prevention of ADEs and ADRs in people with dementia.
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Affiliation(s)
- Marissa Anne Sakiris
- School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Mouna Sawan
- School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Sarah Nicole Hilmer
- Northern Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.,Departments of Aged Care and Clinical Pharmacology, Kolling Institute of Medical Research, Royal North Shore Hospital, Sydney, NSW, Australia
| | - Rebecca Awadalla
- School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Danijela Gnjidic
- School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.,Charles Perkins Centre, The University of Sydney, Sydney, NSW, Australia
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McDerby N, Kosari S, Bail K, Shield A, Peterson G, Naunton M. Residential Aged Care Pharmacist: An Australian Pilot Trial Exploring the Impact on Quality Use of Medicines Indicators. MEDICINES 2020; 7:medicines7040020. [PMID: 32326013 PMCID: PMC7235891 DOI: 10.3390/medicines7040020] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Revised: 04/15/2020] [Accepted: 04/15/2020] [Indexed: 12/20/2022]
Abstract
Background: This pilot study aimed to assess whether an on-site pharmacist could influence indicators of quality use of medicines in residential aged care. Methods: A pharmacist was embedded in a residential aged care home for six months. A similar control site received usual care. Polypharmacy, drug burden index, antipsychotic and benzodiazepine use, hospital admission rates and length of stay, and emergency department presentation rates were outcomes used to indicate medication use quality. Data were extracted from participating resident health records. Results: Fifty-eight residents at the study site and 39 residents at the control site were included in the analysis. There was a reduction in the proportion of residents at the study site who had at least one hospital admission at follow-up (28% to 12%, p < 0.01), but no significant difference in other outcomes. Conclusions: This pilot study suggests that a residential care pharmacist may positively influence indicators of medication use quality in aged care; however, further research is needed to expand on these findings.
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Affiliation(s)
- Nicole McDerby
- Discipline of Pharmacy, Faculty of Health, University of Canberra, Bruce ACT 2617, Australia; (S.K.); (A.S.); (G.P.); (M.N.)
- Correspondence:
| | - Sam Kosari
- Discipline of Pharmacy, Faculty of Health, University of Canberra, Bruce ACT 2617, Australia; (S.K.); (A.S.); (G.P.); (M.N.)
| | - Kasia Bail
- Discipline of Nursing, Faculty of Health, University of Canberra, Bruce ACT 2617, Australia;
| | - Alison Shield
- Discipline of Pharmacy, Faculty of Health, University of Canberra, Bruce ACT 2617, Australia; (S.K.); (A.S.); (G.P.); (M.N.)
| | - Gregory Peterson
- Discipline of Pharmacy, Faculty of Health, University of Canberra, Bruce ACT 2617, Australia; (S.K.); (A.S.); (G.P.); (M.N.)
- Discipline of Pharmacy, Faculty of Health, University of Tasmania, Hobart TAS 7000, Australia
| | - Mark Naunton
- Discipline of Pharmacy, Faculty of Health, University of Canberra, Bruce ACT 2617, Australia; (S.K.); (A.S.); (G.P.); (M.N.)
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