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J Gerontol A Biol Sci Med Sci. 2018 Sep 11;73(10):1410-1417. doi: 10.1093/gerona/gly078.

The Impact of Dementia Diagnosis on Patterns of Potentially Inappropriate Medication Use Among Older Adults.

Author information

1
Faculty of Pharmacy and Charles Perkins Centre, University of Sydney, New South Wales, Australia.
2
Department of Internal Medicine, New Haven, Connecticut.
3
Yale Center for Medical Informatics, Yale School of Medicine, New Haven, Connecticut.
4
Department of Pharmacy Practice and Science, College of Pharmacy, Lexington.
5
Department of Epidemiology, College of Public Health, Lexington.
6
Sanders-Brown Center on Aging, University of Kentucky, Lexington.
7
Department of Biostatistics, Yale School of Public Health, New Haven, Connecticut.

Abstract

Background:

Use of potentially inappropriate medications (PIM) among people with dementia is common. We assessed the patterns of medication use from 1-year before dementia diagnosis, to 1-year after dementia diagnosis, compared with patterns of medication use in people without dementia.

Methods:

We conducted longitudinal study using the National Alzheimer's Coordinating Center data. Adults aged 65 years and older newly diagnosed with dementia (n = 2,418) during 2005-2015 were year, age, and sex matched 1:1 with controls. Generalized estimating equation models weighted for missingness and adjusted for 15 participant characteristics were fit.

Results:

Among participants with dementia, number of medications reported 1-year prediagnosis was 8% lower than at diagnosis year (p < .0001) and 11% higher 1-year postdiagnosis compared with year of diagnosis (p < .0001). Among participants with dementia, the odds of PIM exposure, assessed using the 2015 Beers Criteria, was 17% lower 1-year prediagnosis (p < .0001) and 17% higher 1-year postdiagnosis (p = .006) compared with year of diagnosis. Among controls, there were approximately 6% more medications reported between consecutive years (p < .0001 each comparison) and the odds of PIM exposure increased 11% between consecutive years (p = .006 and p = .047). At each annual follow-up, participants with dementia had lower odds of PIM exposure than their controls (prediagnosis p < .0001, at diagnosis p = .0007, postdiagnosis p = .03, respectively). There were no differences in exposure to anticholinergic medications.

Conclusions:

Number of medications and PIM use increased annually for participants with and without dementia. Persistent challenge of increasing PIM use in this group of older adults is of major concern and warrants interventions to minimize such prescribing.

PMID:
29684111
DOI:
10.1093/gerona/gly078

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