The Changes in Medication Prescribing Among the Older People with Cognitive Impairment in the Acute Care Setting
Received 5 March 2020
Accepted for publication 18 May 2020
Published 8 June 2020 Volume 2020:15 Pages 865—876
Checked for plagiarism Yes
Review by Single anonymous peer review
Peer reviewer comments 2
Editor who approved publication: Dr Richard Walker
Sirasa Ruangritchankul,1,2 Nancye M Peel,1 Leila Shafiee Hanjani,1 Leonard C Gray1
1Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia; 2Division of Geriatric Medicine, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
Correspondence: Sirasa Ruangritchankul
Division of Geriatric Medicine, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, 270 Rama VI Road, Ratchathewi, Bangkok 10400, Thailand
Purpose: Most older people with cognitive impairment usually have multiple comorbidities. In the last decade, the guidelines for the management of chronic diseases have been changed, leading to changes in the patterns of medication prescribing and in the prevalence of drug-related problems (DRPs). The main objectives were to explore the changes in medication use and in the prevalence of polypharmacy (PP), the use of potentially inappropriate medications (PIMs) and drug–drug interactions (DDIs) among older hospitalized adults with cognitive impairment in a 5-year period.
Patients and Methods: Older hospitalized patients with cognitive impairment diagnosed by cognitive performance scale (CPS) score of 2 or more at tertiary hospital in Brisbane, Australia in 2009 and 2015 to 2016 were enrolled. Prescribed medication use, and exposures to PP, PIM and/or DDI were evaluated at two time points. The associated factors with patients exposed to > 1 criteria of PP, PIM or DDI were analyzed by using logistic regression analyses.
Results: The median number of prescribed medications was not significantly different between the two periods. The number of medications use as dermatological agents and analgesics substantially increased over 5 years. In contrast, there was a decrease in prescription of drugs for acid-related disorders, drugs used in diabetes, and mineral supplements. Most of the participants were exposed to at least one of PP, PIM or DDI. In multivariate regression analysis, the presence of diabetes diagnosis was a risk factor associated with increased exposure to > 1 criteria of PP, PIM or DDI.
Conclusion: The patterns of many prescribed medications use have altered in a 5-year period. The present study confirms that the majority of older adults with cognitive impairment admitted in an acute care setting are prone to PP, PIM and DDI. Comprehensive medication reviews should be undertaken in clinical care of older patients with cognitive impairment.
Keywords: older adults, cognitive decline, hospitalization, polypharmacy, potentially inappropriate medication, drug–drug interaction
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