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Reduction in the use of potentially inappropriate drugs among old people living in geriatric care units between 2007 and 2013
Umeå University, Faculty of Medicine, Department of Pharmacology and Clinical Neuroscience, Pharmacology. Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.
Department of Neurobiology, Care Sciences and Society, Division of Nursing, Karolinska Institutet, 171 77 Stockholm, Sweden.
Umeå University, Faculty of Medicine, Department of Nursing.
Umeå University, Faculty of Medicine, Department of Nursing. Umeå University, Arctic Research Centre at Umeå University. (Arcum)
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2015 (English)In: European Journal of Clinical Pharmacology, ISSN 0031-6970, E-ISSN 1432-1041, Vol. 71, no 4, 507-515 p.Article in journal (Refereed) Published
Abstract [en]

PURPOSE: The aims of this study were to investigate trends in the prevalence of potentially inappropriate drug use among old people living in geriatric care units in the county of Västerbotten between 2007 and 2013 using six national quality indicators and to assess the impact of medication reviews on those quality indicators.

METHODS: Data were collected concerning potentially inappropriate drug use, function in the activities of daily living (ADL) and cognitive function, using the Multi-Dimensional Dementia Assessment Scale (MDDAS). A comparison was made between the years 2007 and 2013, comprising 2772 and 1902 people, respectively, living in geriatric care in the county of Västerbotten, Sweden. We conducted a parallel investigation of a separate corresponding population in Västerbotten County from 2012, where potentially inappropriate drug use was measured before and after 895 medication reviews which involved a clinical pharmacist.

RESULTS: After controlling for age, sex, ADL and cognitive impairment, there was a significant improvement in five out of six quality indicators between 2007 and 2013. While 44 % of the people were exposed to one or more potentially inappropriate medications in 2007, this number had declined to 26 % by 2013. In the separate population from 2012, the frequency of potentially inappropriate drug use was significantly reduced amongst the people who had a medication review performed.

CONCLUSION: The extent of potentially inappropriate drug use declined between 2007 and 2013 according to the quality indicators used. Medication reviews involving clinical pharmacists might be an important factor in reducing potentially inappropriate drug use and improving drug treatment among old people.

Place, publisher, year, edition, pages
2015. Vol. 71, no 4, 507-515 p.
Keyword [en]
Potentially inappropriate drug use, Medication reviews, Clinical pharmacist, Nursing home, Dementia
National Category
Nursing Pharmacology and Toxicology
Identifiers
URN: urn:nbn:se:umu:diva-100807DOI: 10.1007/s00228-015-1825-zISI: 000351224600013PubMedID: 25716889OAI: oai:DiVA.org:umu-100807DiVA: diva2:794087
Available from: 2015-03-10 Created: 2015-03-10 Last updated: 2017-05-23Bibliographically approved
In thesis
1. Optimizing drug therapy among people with dementia: the role of clinical pharmacists
Open this publication in new window or tab >>Optimizing drug therapy among people with dementia: the role of clinical pharmacists
2016 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Background: Drugs are one of the cornerstones in the management of many diseases. In general, drugs are used for diagnosis, prevention, mitigation of symptoms, and, sometimes, to cure disease. However, drug treatment in elderly people, especially those with dementia and cognitive impairments, may involve significant risk of adverse drug events.  The aim of this thesis was to identify the extent of potentially inappropriate drug treatment among people with dementia and cognitive impairment and to assess the occurrence and character of drug-related problems that lead to acute hospital admissions. Another aim was to assess the potential impact of a comprehensive medication review conducted by clinical pharmacists as part of a health care team on quality of patients’ drug therapy and drug-related hospital readmission rates.

Method: Long-term use of antipsychotic/psychotropic drugs and associated factors were investigated among 344 and 278 people respectively with dementia living in specialized care units. Trends in the prescribing of potentially inappropriate drugs between 2007 and 2013, comprising 2772 and 1902 people, living in nursing homes in the county of Västerbotten, were assessed using six national quality indicators. Data on drug use, function in the activities of daily living, cognitive function and behavioral and psychological symptoms were collected using the Multi-Dimensional Dementia Assessment Scale. Further, an investigation of a separate corresponding population from 2012 was done, where potentially inappropriate drug use was measured before and after a total of 895 medication reviews. Finally, a randomized, controlled trial was carried out among people 65 years or older with dementia or cognitive impairment in internal medicine and orthopedic wards at two hospitals in northern Sweden. The proportion of hospital admissions that were drug-related were estimated, and also whether comprehensive medication reviews conducted by clinical pharmacists as part of a health care team could affect the risk of drug-related hospital readmissions.

Results: Antipsychotic and other psychotropic drugs were frequently prescribed to people with dementia living in specialized care units for prolonged periods. Associations were found between behavioral and psychological symptoms and different psychotropic drugs. The extent of potentially inappropriate drug use declined between 2007 and 2013. In the separate corresponding population from 2012, the frequency of potentially inappropriate drug use was significantly reduced among people who underwent medication reviews. Hospitalizations due to drug-related problems among old people with dementia or cognitive impairment were prevalent. We found that inclusion of a clinical pharmacist in the health care team significantly reduced the risk of drug-related 30-day and 180-day readmissions. However, in a subset of patients with concomitant heart failure no effect was seen.

Conclusion: Among patients with dementia or cognitive impairment long-term treatment with antipsychotic and other psychotropic drugs is common. The results indicate that these drugs are prescribed to treat behavioral and psychological symptoms among cognitively impaired individuals, despite limited evidence of their efficacy and the high risk of adverse effects. Drug-related problems, such as adverse drug reactions, constituted a major cause of hospital admissions. By reducing potentially inappropriate drug use and optimizing overall drug therapy, inclusion of clinical pharmacists in a health care team might improve the quality of patient care and reduce the risk of hospital readmissions among people with dementia.

Place, publisher, year, edition, pages
Umeå: Umeå universitet, 2016. 104 p.
Series
Umeå University medical dissertations, ISSN 0346-6612 ; 1789
Keyword
Psychotropic drugs, potentially inappropriate drugs, drug-related problems, old people, dementia, nursing homes, drug-related hospitalizations, medication reviews, clinical pharmacists
National Category
Geriatrics
Research subject
Geriatrics
Identifiers
urn:nbn:se:umu:diva-118309 (URN)978-91-7601-436-3 (ISBN)
Public defence
2016-04-08, Hörsal B, byggnad 1A, Tandläkarhögskolan våning 9, Umeå universitetssjukhus, Umeå, 13:00 (Swedish)
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Available from: 2016-03-18 Created: 2016-03-15 Last updated: 2016-05-10Bibliographically approved

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Gustafsson, MariaSandman, Per-OlofKarlsson, StigIsaksson, UlfSchneede, JörnSjölander, MariaLövheim, Hugo

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Gustafsson, MariaSandman, Per-OlofKarlsson, StigIsaksson, UlfSchneede, JörnSjölander, MariaLövheim, Hugo
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PharmacologyGeriatric MedicineDepartment of NursingArctic Research Centre at Umeå University
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European Journal of Clinical Pharmacology
NursingPharmacology and Toxicology

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