Potentially inappropriate medications and drug–drug interactions in home-dwelling people with mild dementia
Corresponding Author
Ragnhild Oesterhus
Centre for Age-Related Medicine, Stavanger University Hospital, Stavanger, Norway
Department of Clinical Medicine, University of Bergen, Bergen, Norway
Correspondence to: R. D. Oesterhus, E-mail: [email protected]Search for more papers by this authorDag Aarsland
Centre for Age-Related Medicine, Stavanger University Hospital, Stavanger, Norway
Department of Neurobiology Caring Science and Society, Karolinska Institutet, Stockholm, Sweden
Search for more papers by this authorHogne Soennesyn
Centre for Age-Related Medicine, Stavanger University Hospital, Stavanger, Norway
Search for more papers by this authorArvid Rongve
Department of Clinical Medicine, University of Bergen, Bergen, Norway
Department of Research and Innovation, Haugesund Hospital, Haugesund, Norway
Search for more papers by this authorGeir Selbaek
Vestfold Hospital Trust, Norwegian Advisory Unit on Ageing and Health, Tønsberg, Norway
Centre for Old Age Psychiatric Research, Innlandet Hospital Trust, Ottestad, Norway
Search for more papers by this authorSvein R. Kjosavik
Centre for Age-Related Medicine, Stavanger University Hospital, Stavanger, Norway
Research Unit for General Practice, Uni Research Health, Bergen, Norway
Search for more papers by this authorCorresponding Author
Ragnhild Oesterhus
Centre for Age-Related Medicine, Stavanger University Hospital, Stavanger, Norway
Department of Clinical Medicine, University of Bergen, Bergen, Norway
Correspondence to: R. D. Oesterhus, E-mail: [email protected]Search for more papers by this authorDag Aarsland
Centre for Age-Related Medicine, Stavanger University Hospital, Stavanger, Norway
Department of Neurobiology Caring Science and Society, Karolinska Institutet, Stockholm, Sweden
Search for more papers by this authorHogne Soennesyn
Centre for Age-Related Medicine, Stavanger University Hospital, Stavanger, Norway
Search for more papers by this authorArvid Rongve
Department of Clinical Medicine, University of Bergen, Bergen, Norway
Department of Research and Innovation, Haugesund Hospital, Haugesund, Norway
Search for more papers by this authorGeir Selbaek
Vestfold Hospital Trust, Norwegian Advisory Unit on Ageing and Health, Tønsberg, Norway
Centre for Old Age Psychiatric Research, Innlandet Hospital Trust, Ottestad, Norway
Search for more papers by this authorSvein R. Kjosavik
Centre for Age-Related Medicine, Stavanger University Hospital, Stavanger, Norway
Research Unit for General Practice, Uni Research Health, Bergen, Norway
Search for more papers by this authorAbstract
Objectives
The objectives of this study were to describe the use of psychotropic drugs among home-dwelling people with mild dementia, to identify potentially inappropriate medications (PIM) and drug–drug interactions (DDI), and to analyze potential variables associated with having PIM and DDI.
Methods
Patients (n = 251) with a first-time diagnosis of mild dementia (defined as a mini-mental state examination score >20) were included from outpatient clinics. Prevalence of psychotropic drug use, polypharmacy, and psychotropic polypharmacy were investigated. The prevalence of PIM and DDI were defined using the Norwegian general practice criteria and an interactions database, respectively. Variables associated with having PIM and DDI were assessed using a multivariable logistic regression analysis adjusting for relevant demographic and clinical variables.
Results
Almost 96% of the patients used one or more medications. Polypharmacy was found in 45% of the patients, and nearly 70% of the patients were using one or more psychotropic drugs. Psychotropic polypharmacy was found in seven patients. PIM were identified in 35 patients (14%), while only four severe DDI were found. Female sex and number of medications were significantly associated with having PIM, whereas only number of medications was significantly associated with having DDI.
Conclusion
Few patients had PIM or severe DDI, indicating that the quality of prescribing was acceptable. However, psychotropic drug use was common in home-dwelling people with mild dementia despite limited evidence of benefit in dementia. More knowledge is needed about the potential risks associated with psychotropic drug use and having PIM and DDI in people with mild dementia. Copyright © 2016 John Wiley & Sons, Ltd.
References
- Aarsland D, Rongve A, Nore SP, et al. 2008. Frequency and case identification of dementia with Lewy bodies using the revised consensus criteria. Dement Geriatr Cogn Disord 26: 445–452.
- Andersen F, Viitanen M, Halvorsen DS, Straume B, Engstad TA. 2011. Co-morbidity and drug treatment in Alzheimer's disease. A cross sectional study of participants in the Dementia Study in Northern Norway. BMC Geriatr 11: 58. DOI:10.1186/1471-2318-11-58.
- Aparasu RR, Mort JR. 2000. Inappropriate prescribing for the elderly: Beers criteria-based review. Ann Pharmacother 34: 338–346.
- Bakken MS, Ranhoff AH, Engeland A, Ruths S. 2012. Inappropriate prescribing for older people admitted to an intermediate-care nursing home unit and hospital wards. Scand J Prim Health Care 30: 169–175.
- Banerjee S, Hellier J, Dewey M, et al. 2011. Sertraline or mirtazapine for depression in dementia (HTA-SADD): a randomised, multicentre, double-blind, placebo-controlled trial. Lancet 378: 403–411.
- Bergh S, Selbæk G, Engedal K. 2012. Discontinuation of antidepressants in people with dementia and neuropsychiatric symptoms (DESEP study): double blind, randomised, parallel group, placebo controlled trial. BMJ 344: e1566. DOI:10.1136/bmj.e1566.
- Bjoerke-Bertheussen J, Ehrt U, Rongve A, Ballard C, Aarsland D. 2012. Neuropsychiatric symptoms in mild dementia with Lewy bodies and Alzheimer's disease. Dement Geriatr Cogn Disord 34: 1–6.
- Brekke M, Rognstad S, Straand J, et al. 2008. Pharmacologically inappropriate prescriptions for elderly patients in general practice: how common? Baseline data from The Prescription Peer Academic Detailing (Rx-PAD) study. Scand J Prim Health Care 26: 80–85.
- Chang CB, Chen JH, Wen CJ, et al. 2011. Potentially inappropriate medications in geriatric outpatients with polypharmacy: application of six sets of published explicit criteria. Br J Clin Pharmacol 72: 482–489.
- Conwell Y, Forbes NT, Cox C, Caine ED. 1993. Validation of a measure of physical illness burden at autopsy: the Cumulative Illness Rating Scale. J Am Geriatr Soc 41: 38–41.
- Coupland C, Dhiman P, Moriss R, et al. 2011. Antidepressant use and risk of adverse outcomes in older people: population based cohort study. BMJ 343: d4451.
- Cummings JL, Mega M, Gray K, et al. 1994. The neuropsychiatric inventory comprehensive assessment of psychopathology in dementia. Neurology 44: 2308–2314.
- De Groot V, Beckerman H, Lankhorst GJ, Bouter LM. 2003. How to measure comorbidity: a critical review of available methods. J Clin Epidemiol 56: 221–229.
- Defrancesco M, Marksteiner J, Fleischhacker WW, Blasko I. 2015. Use of benzodiazepines in Alzheimer's disease: a systematic review of literature. Int J Neuropsychopharmacol 18: 1–11.
- Emre M, Aarsland D, Brown R, et al. 2007. Clinical diagnostic criteria for dementia associated with Parkinson's disease. Mov Disord 22: 1689–1707.
- Enache D, Winblad B, Aarsland D. 2011. Depression in dementia: epidemiology, mechanisms, and treatment. Curr Opin Psychiatry 24: 461–472.
- Folstein MF, Folstein SE, Mchugh PR. 1975. “Mini-mental state” a practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 12: 189–198.
- Hajjar ER, Hanlon JT, Artz MB, et al. 2003. Adverse drug reaction risk factors in older outpatients. Am J Geriatr Pharmacother 1: 82–89.
- Hartikainen S, Rahkonen T, Kautiainen H, Sulkava R. 2003. Use of psychotropics among home-dwelling nondemented and demented elderly. Int J Geriatr Psychiatry 18: 1135–1141.
- Hjort PF, Waaler HT. 2010. Dementia towards 2050. Tidsskr Nor Laegeforen 130: 1356–1358.
- Kales HC, Zivin K, Kim HM, et al. 2011. Trends in antipsychotic use in dementia 1999–2007. Arch Gen Psychiatry 68: 190–197.
- Kuschel BM, Laflamme L, Möller J. 2014. The risk of fall injury in relation to commonly prescribed medications among older people—a Swedish case-control study. Eur J Public Health 25: 527–532.
- Lau DT, Mercaldo ND, Harris AT, et al. 2010. Polypharmacy and potentially inappropriate medication use among community-dwelling elders with dementia. Alzheimer Dis Assoc Disord 24: 56–63.
- Lechevallier-Michel N, Gautier-Bertrand M, Alpérovitch Aet al. 2005. Frequency and risk factors of potentially inappropriate medication use in a community-dwelling elderly population: results from the 3C study. Eur J Clin Pharmacol 60: 813–819.
- Lindblad CI, Hanlon JT, Gross CR, et al. 2006. Clinically important drug-disease interactions and their prevalence in older adults. Clin Ther 28: 1133–1143.
- Linn BS, Linn MW, Gurel L. 1968. Cumulative Illness Rating Scale. J Am Geriatr Soc 16: 622–626.
- Llorente MD, David D, Golden AG, Silverman MA. 2000. Defining patterns of benzodiazepine use in older adults. J Geriatr Psychiatry Neurol 13: 150–160.
- Luppa M, Luck T, Weyerer S, et al. 2010. Prediction of institutionalization in the elderly. A systematic review. Age Ageing 39: 31–38.
- McKeith IG, Dickson DW, Lowe J, et al. 2005. Diagnosis and management of dementia with Lewy bodies: Third report of the DLB consortium. Neurology 65: 1863–1872.
- McKhann G, Drachman D, Folstein M, et al. 1984. Clinical diagnosis of Alzheimer's disease report of the NINCDS-ADRDA work group* under the auspices of Department of Health and Human Services Task Force on Alzheimer's Disease. Neurology 34: 939–944.
- Montastruc F, Gardette V, Cantet C, et al. 2013. Potentially inappropriate medication use among patients with Alzheimer disease in the REAL. FR cohort: be aware of atropinic and benzodiazepine drugs!. Eur J Clin Pharmacol 69: 1589–1597.
- Morris JC. 1997. Clinical dementia rating: a reliable and valid diagnostic and staging measure for dementia of the Alzheimer type. Int Psychogeriatr 9: 173–176.
- National Alzheimer's Coordinating Center. 2014. Calculation of Global Clinical Dementia Rating Score (Form B4: CDRGLOB). National Alzheimer's Coordinating Center: Seattle Available at www.alz.washington.edu/cdrnacc.html.
- Norwegian Institute of Public Health. 2014. The Norwegian Prescription Database (NorPD). Norwegian Institute of Public Health: Oslo Available at http://www.legemiddelverket.no/Legemiddelsoek/Sider/Interaksjoner.aspx.
- Norwegian Medicines Agency. 2014. Interaction Database for Norwegian Clinicians. Oslo: Norwegian Medicines Agency Available at www.interaksjoner.no.
- Nyborg G, Straand J, Brekke M. 2012. Inappropriate prescribing for the elderly—a modern epidemic? Eur J Clin Pharmacol 68: 1085–1094.
- O'Mahony D, O'Sullivan D, Byrne S, et al. 2015. STOPP/START criteria for potentially inappropriate prescribing in older people: version 2. Age Ageing 44: 213–218.
- O'Brien JT, Burns A. 2011. Clinical practice with anti-dementia drugs: a revised (second) consensus statement from the British Association for Psychopharmacology. J Psychopharmacol 25: 997–1019.
- Opondo D, Eslami S, Visscher S, et al. 2012. Inappropriateness of medication prescriptions to elderly patients in the primary care setting: a systematic review. PLoS One 7(8): e43617. DOI:10.1371/journal.pone.0043617
- Parsons C, Johnston S, Mathie E, et al. 2012. Potentially inappropriate prescribing in older people with dementia in care homes. Drugs Aging 29: 143–155.
- Porsteinsson AP, Drye LT, Pollock BG, et al. 2014. Effect of citalopram on agitation in Alzheimer disease: the CitAD randomized clinical trial. JAMA 311: 682–691.
- Rognstad S, Brekke M, Fetveit A, et al. 2009. The Norwegian general practice (NORGEP) criteria for assessing potentially inappropriate prescriptions to elderly patients. Scand J Prim Health Care 27: 153–159.
- Schneider LS, Dagerman KS, Insel P. 2005. Risk of death with atypical antipsychotic drug treatment for dementia: meta-analysis of randomized placebo-controlled trials. JAMA 294: 1934–1943.
- Selbæk G, Kirkevold Ø, Sommer OH, Engedal K. 2008. The reliability and validity of the Norwegian version of the neuropsychiatric inventory, nursing home version (NPI-NH). Int Psychogeriatr 20: 375–382.
- Søraas IA, Staurset HB, Slørdal L, Spigset O. 2014. Drug–drug interaction in nursing home patients. Tidsskr Nor Laegeforen 134: 1041–1046.
- The American Geriatrics Society. 2012. American geriatrics society updated Beers criteria for potentially inappropriate medication use in older adults. J Am Geriatr Soc 60: 616–631.
- Wergeland JN, Selbæk G, Høgset LD, Söderhamn U, Kirkevold Ø. 2014. Dementia, neuropsychiatric symptoms, and the use of psychotropic drugs among older people who receive domiciliary care: a cross-sectional study. Int Psychogeriatr 26: 383–391.
- WHO Collaborating Centre for Drug Statistics Methodology. 2014. Guidelines for ATC Classification and DDD Assignment 2015. WHO Collaborating Centre for Drug Statistics Methodology: Oslo Available at www.whocc.no.
- Zhong G, Wang Y, Zhang Y, Zhao Y. 2014. Association between benzodiazepine use and dementia: a meta-analysis. PLoS One 10(5): e0127836. DOI:10.1371/journal.pone.0127836
