SpringerLink
Log in

Potentially inappropriate medication among people with dementia: towards individualized decision-making

  • Review
  • Published:
European Geriatric Medicine Aims and scope Submit manuscript

Abstract

Aim

The aims of this manuscript are to report on several aspects that may deserve special consideration when individualizing decisions on the prescription appropriateness among people with dementia, and to discuss current research needs in relation to these aspects.

Methods

Review article based on selective literature.

Results

The aspects that may deserve special consideration are: the prescription of pychotropic medications, for being commonly inappropriately prescribed; the presence of advanced stage of dementia, comorbidities or multi-morbidity and/or frailty, as they can determine the prognosis and goals of care; the values and wishes of the person with dementia, as they may prioritize different goals of care; and medication adherence, as it may be poorer compared with persons without dementia. Further research on these aspects including representative participants is necessary as evidence base to guide clinical practice.

Conclusion

Individualised decisions on prescription appropriateness among people with dementia may require a comprehensive evaluation of the person in order to establish a shared care plan. Further research will probably support this process.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Subscribe and save

Springer+ Basic
EUR 32.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or Ebook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price includes VAT (Germany)

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. International D. World Alzheimer Report 2018—the state of the art of dementia research: New frontiers

  2. Nichols E, Szoeke CEI, Vollset SE, Abbasi N, Abd-Allah F, Abdela J et al (2019) Global, regional, and national burden of Alzheimer’s disease and other dementias, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet Neurol 18(1):88–106

    Google Scholar 

  3. Livingston G, Sommerlad A, Orgeta V, Costafreda SG, Huntley J, Ames D et al (2017) Dementia prevention, intervention, and care. The Lancet 390:2673–734

    Google Scholar 

  4. Livingston G, Huntley J, Sommerlad A, Ames D, Ballard C, Banerjee S et al (2020) Dementia prevention, intervention, and care: 2020 report of the Lancet Commission. The Lancet 396:413–46

    Google Scholar 

  5. Spinewine A, Schmader KE, Barber N, Hughes C, Lapane KL, Swine C et al (2007) Appropriate prescribing in elderly people: how well can it be measured and optimised? Lancet 370:173–84

    PubMed  Google Scholar 

  6. Gallagher P, Ryan C, Byrne S, Kennedy J, O’Mahony D (2008) STOPP (Screening Tool of Older Person’s Prescriptions) and START (Screening Tool to Alert doctors to Right Treatment). Consensus validation. Int J Clin Pharmacol Ther 46(2):72–83

    CAS  PubMed  Google Scholar 

  7. Laroche M-L, Charmes J-P, Merle L (2007) Potentially inappropriate medications in the elderly: a French consensus panel list. Eur J Clin Pharmacol. 63(8):725–31

    PubMed  Google Scholar 

  8. Delgado J, Bowman K, Clare L (2020) Potentially inappropriate prescribing in dementia: a state-of-the-art review since 2007, vol 10. BMJ Publishing Group, BMJ Open

    Google Scholar 

  9. Hukins D, Macleod U, Boland JW (2019) Identifying potentially inappropriate prescribing in older people with dementia: a systematic review. Eur J Clin Pharmacol 75:467–81

    PubMed  Google Scholar 

  10. Holmes HM, Sachs GA, Shega JW, Hougham GW, Cox Hayley D, Dale W (2008) Integrating palliative medicine into the care of persons with advanced dementia: identifying appropriate medication use. J Am Geriatr Soc 56(7):1306–1311

    PubMed  Google Scholar 

  11. Parsons C (2017) Polypharmacy and inappropriate medication use in patients with dementia: an underresearched problem. Ther Adv Drug Saf 8:31–46

    PubMed  Google Scholar 

  12. Disalvo D, Luckett T, Agar M, Bennett A, Davidson PM (2016) Systems to identify potentially inappropriate prescribing in people with advanced dementia: a systematic review. BMC Geriatrics 16:114

    PubMed  PubMed Central  Google Scholar 

  13. Fick DM, Semla TP, Steinman M, Beizer J, Brandt N, Dombrowski R et al (2019) American geriatrics Society 2019 updated AGS beers criteria® for potentially inappropriate medication use in older adults. J Am Geriatr Soc 67(4):674–694

    Google Scholar 

  14. O’Mahony D, O’Sullivan D, Byrne S, O’Connor MN, Ryan C, Gallagher P (2014) STOPP/START criteria for potentially inappropriate prescribing in older people: version 2. Age Ageing 44(2):213–218

    PubMed  PubMed Central  Google Scholar 

  15. Ma H, Huang Y, Cong Z, Wang Y, Jiang W, Gao S et al (2014) The efficacy and safety of atypical antipsychotics for the treatment of dementia: a meta-analysis of randomized placebo-controlled trials. J Alzheimer’s Dis 42(3):20

    Google Scholar 

  16. Bronskill SE, Campitelli MA, Iaboni A, Herrmann N, Guan J, Maclagan LC et al (2018) Low-dose trazodone, benzodiazepines, and fall-related injuries in nursing homes: a matched-cohort study. J Am Geriatr Soc. 66(10):1963–1971

    PubMed  Google Scholar 

  17. Dyer AH, Murphy C, Lawlor B, Kennelly SP, Lawlor B, Segurado R et al (2020) Cognitive outcomes of long-term benzodiazepine and related drug (bdzr) use in people living with mild to moderate alzheimer’s disease: results from NILVAD. J Am Med Dir Assoc. 21(2):194–200

    PubMed  Google Scholar 

  18. Van Leeuwen E, Petrovic M, van Driel ML, De Sutter AI, Vander Stichele R, Declercq T et al (2018) Discontinuation of long-term antipsychotic drug use for behavioral and psychological symptoms in older adults Aged 65 years and older with dementia. J Am Med Dir Assoc 19(11):1009–14

    PubMed  Google Scholar 

  19. Forester BP, Vahia I (2019) Behavioral And Psychological Symptoms—An Emerging Crisis Of The Alzheimer Dementia Epidemic. JAMA Netw Open. 2(3):e190790

    PubMed  Google Scholar 

  20. Reeve E, Ong M, Wu A, Jansen J, Petrovic M, Gnjidic D (2017) A systematic review of interventions to deprescribe benzodiazepines and other hypnotics among older people. Eur J Clin Pharmacol. 73(8):927–935

    CAS  PubMed  Google Scholar 

  21. Renn BN, Asghar-Ali AA, Thielke S, Catic A, Martini SR, Mitchell BG et al (2018) A Systematic Review of Practice Guidelines and Recommendations for Discontinuation of Cholinesterase Inhibitors in Dementia. American Journal of Geriatric Psychiatry 26(2):134–47

    Google Scholar 

  22. Colloca G, Tosato M, Vetrano DL, Topinkova E, Fialova D, Gindin J et al (2012) Inappropriate Drugs in Elderly Patients with Severe Cognitive Impairment: Results from the Shelter Study. PLoS ONE. 7(10):134–147

    Google Scholar 

  23. Thompson W, Lundby C, Graabæk T, Nielsen DS, Ryg J, Søndergaard J et al (2019) Tools for deprescribing in frail older persons and those with limited life expectancy: a systematic review. J Am Geriatr Soc 67:172–80

    PubMed  Google Scholar 

  24. Kutner JS, Blatchford PJ, Taylor DH, Ritchie CS, Bull JH, Fairclough DL et al (2015) Safety and benefit of discontinuing statin therapy in the setting of advanced, life-limiting illness a randomized clinical trial. JAMA Intern Med 175(5):691–700

    PubMed  PubMed Central  Google Scholar 

  25. Narayan SW, Hilmer SN, Nishtala PS (2018) A population-level study examining discontinuation of statins in older people with dementia. Eur J Clin Pharmacol. 74(3):379–381

    PubMed  Google Scholar 

  26. Browne J, Edwards DA, Rhodes KM, Brimicombe DJ, Payne RA (2017) Association of comorbidity and health service usage among patients with dementia in the UK: a population-based study. BMJ Open. 7(3):e012546

    PubMed  PubMed Central  Google Scholar 

  27. Poblador-Plou B, Calderón-Larrañaga A, Marta-Moreno J, Hancco-Saavedra J, Sicras-Mainar A, Soljak M et al (2014) Comorbidity of dementia: a cross-sectional study of primary care older patients. BMC Psychiatry. 14(1):1–8

    Google Scholar 

  28. Haaksma ML, Rizzuto D, Ramakers IHGB, Garcia-Ptacek S, Marengoni A, van der Flier WM et al (2019) The impact of frailty and comorbidity on institutionalization and mortality in persons with dementia: a prospective cohort study. J Am Med Dir Assoc. 20(2):165–170

    PubMed  Google Scholar 

  29. Maxwell CJ, Mondor L, Hogan DB, Campitelli MA, Bronskill SE, Seitz DP et al (2019) Joint impact of dementia and frailty on healthcare utilisation and outcomes: a retrospective cohort study of long-stay home care recipients. BMJ Open. 9(6):e029523

    PubMed  PubMed Central  Google Scholar 

  30. Delgado J, Jones L, Bradley MC, Allan LM, Ballard C, Clare L et al (2021) Potentially inappropriate prescribing in dementia, multi-morbidity and incidence of adverse health outcomes. Age Ageing. 50(2):457–464

    PubMed  Google Scholar 

  31. Koné Pefoyo AJ, Bronskill SE, Gruneir A, Calzavara A, Thavorn K, Petrosyan Y et al (2015) The increasing burden and complexity of multimorbidity. BMC Public Health 15(1):415

    PubMed Central  Google Scholar 

  32. Cesari M, Marzetti E, Thiem U, Pérez-Zepeda MU, Abellan Van Kan G, Landi F et al (2016) The geriatric management of frailty as paradigm of the end of the disease era. Eur J Intern Med 31:11–4

    PubMed  Google Scholar 

  33. Burt JR, Godin J, Filion J, Montero-Odasso M, Rockwood K, Andrew MK et al (2019) Frailty prevalence in the COMPASS-ND study of neurodegenerative disorders. Can Geriatr J 22(4):205–212

    PubMed  PubMed Central  Google Scholar 

  34. Kojima G, Liljas A, Iliffe S, Walters K (2017) Prevalence of frailty in mild to moderate Alzheimer’s disease: a systematic review and meta-analysis. Curr Alzheimer Res. 14(12):1256–1263

    CAS  PubMed  Google Scholar 

  35. Porter B, Arthur A, Savva GM (2019) How do potentially inappropriate medications and polypharmacy affect mortality in frail and non-frail cognitively impaired older adults? A cohort study. BMJ Open. 9(5):e026171

    PubMed  PubMed Central  Google Scholar 

  36. Bolina AF, Gomes NC, Marchiori GF, Pegorari MS, Tavares DM, Dos S (2019) Potentially inappropriate medication use and frailty phenotype among community-dwelling older adults: a population-based study. J Clin Nurs 28(2122):3914–3922

    PubMed  Google Scholar 

  37. Maclagan LC, Maxwell CJ, Gandhi S, Guan J, Bell CM, Hogan DB et al (2017) Frailty and potentially inappropriate medication use at nursing home transition. J Am Geriatr Soc. 65(10):2205–2212

    PubMed  Google Scholar 

  38. Lavan AH, Gallagher P, Parsons C, O’Mahony D (2017) STOPPFrail (Screening Tool of Older Persons Prescriptions in Frail adults with limited life expectancy): consensus validation. Age Ageing. 75(5):723–731

    Google Scholar 

  39. Fialová D, Laffon B, Marinković V, Tasić L, Doro P, Sόos GO et al (2019) Medication use in older patients and age-blind approach: narrative literature review (insufficient evidence on the efficacy and safety of drugs in older age, frequent use of PIMs and polypharmacy, and underuse of highly beneficial nonpharmacological strategies). Eur J Clin Pharmacol 75:451–66

    PubMed  Google Scholar 

  40. Geshell L, Kwak J, Radhakrishnan K (2019) Perspectives and experiences of persons with dementia with advance care planning: an integrative literature review. J Geriatr Psychiatry Neurol 32(5):231–245

    PubMed  Google Scholar 

  41. Robben SHM, Perry M, Olde Rikkert MGM, Heinen MM, Melis RJF (2011) Care-related goals of community-dwelling frail older adults. J Am Geriatr Soc 59(8):1552–4

    PubMed  Google Scholar 

  42. Charles C, Gafni A, Whelan T (1999) Decision-making in the physician–patient encounter: revisiting the shared treatment decision-making model. Soc Sci Med 49(5):651–61

    CAS  PubMed  Google Scholar 

  43. Arlt S, Lindner R, Rösler A, von Renteln-Kruse W (2008) Adherence to medication in patients with dementia. Drugs Aging 25(12):1033–47

    PubMed  Google Scholar 

  44. Geddis-Regan A, Errington L, Abley C, Wassall R, Exley C, Thomson R (2020) Enhancing shared and surrogate decision making for people living with dementia: a systematic review of the effectiveness of interventions. Heal Expect 24(1):19–32

    Google Scholar 

  45. Giguere AMC, Lawani MA, Fortier-Brochu É, Carmichael PH, Légaré F, Kröger E et al (2018) Tailoring and evaluating an intervention to improve shared decision-making among seniors with dementia, their caregivers, and healthcare providers: Study protocol for a randomized controlled trial. Trials. 19(1):e186

    Google Scholar 

  46. El-Saifi N, Moyle W, Jones C, Tuffaha H (2018) Medication adherence in older patients with dementia: a systematic literature review. J Pharm Pract. 31(3):322–334

    PubMed  Google Scholar 

  47. Kröger E, Tatar O, Vedel I, Giguère AMC, Voyer P, Guillaumie L et al (2017) Improving medication adherence among community-dwelling seniors with cognitive impairment: a systematic review of interventions. Int J Clin Pharm. 39(4):641–656

    PubMed  Google Scholar 

  48. Ellis G, Gardner M, Tsiachristas A, Langhorne P, Burke O, Harwood RH et al (2017) Comprehensive geriatric assessment for older adults admitted to hospital. Cochrane Database Syst Rev. https://doi.org/10.1002/14651858.CD006211.pub3/full

    Article  PubMed  PubMed Central  Google Scholar 

  49. Baronner A, MacKenzie A (2017) Using geriatric assessment strategies to lead end-of-life care discussions. Curr Oncol Rep 19(11):75

    PubMed  Google Scholar 

  50. Molist Brunet N, Sevilla-Sánchez D, Amblàs Novellas J, Codina Jané C, Gómez-Batiste X, McIntosh J et al (2014) Optimizing drug therapy in patients with advanced dementia: a patient-centered approach. Eur Geriatr Med 5(1):66–71

    Google Scholar 

  51. González-Bueno J, Calvo-Cidoncha E, Sevilla-Sánchez D, Molist-Brunet N, Espaulella-Panicot J, Codina-Jané C (2018) Patient-centered prescription model to improve therapeutic adherence in patients with multimorbidity. Farm Hosp 42(3):128–134

    PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Geriatric Medicine. Parc de Salut Mar, Barcelona, Spain

    Anna Renom-Guiteras

  2. Health Services Research on Chronic Patients Network (REDISSEC), Madrid, Spain

    Anna Renom-Guiteras

Authors
  1. Anna Renom-Guiteras
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Anna Renom-Guiteras.

Ethics declarations

Conflict of interest

None declared.

Ethical approval

Not required.

Informed consent

The author gave consent for publication.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Renom-Guiteras, A. Potentially inappropriate medication among people with dementia: towards individualized decision-making. Eur Geriatr Med 12, 569–575 (2021). https://doi.org/10.1007/s41999-021-00502-7

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s41999-021-00502-7

Keywords

Search

Navigation