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Polypharmacy and potentially inappropriate medications (PIMs) in older adults referred to a memory clinic
AIMS: The older adult is more likely to be prescribed a lot of medications (polypharmacy) on account of multi-morbidity and consequently being under the care of several specialists. Adverse drug events and reactions account for significant morbidity and mortality in this population group. Common seq...
Autores principales: | , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Cambridge University Press
2021
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8771256/ http://dx.doi.org/10.1192/bjo.2021.810 |
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author | Akpan, Anietie Blaquiere, Bruno De Nellaya, Issadevi Termure, Cornelia Mukherjee, Sujoy |
author_facet | Akpan, Anietie Blaquiere, Bruno De Nellaya, Issadevi Termure, Cornelia Mukherjee, Sujoy |
author_sort | Akpan, Anietie |
collection | PubMed |
description | AIMS: The older adult is more likely to be prescribed a lot of medications (polypharmacy) on account of multi-morbidity and consequently being under the care of several specialists. Adverse drug events and reactions account for significant morbidity and mortality in this population group. Common sequelae include confusional episodes, dementia syndromes, falls, and higher rates of acute hospital admissions. Medications are not routinely reviewed in elderly care. We sought to estimate the prevalence of polypharmacy, and potentially inappropriate medications (e.g. anticholinergics or medications with central anticholinergic effects) in those referred to the Cognitive Impairment and Dementia Service (Elm Lodge), Older Persons Mental Health, West London NHS Trust. METHOD: All referrals between 01/10/2020 and 30/11/2020 were screened for medications prescribed. Polypharmacy was defined as prescription of 5 or more medications. Medications with anticholinergic properties were considered examples of Potentially Inappropriate Medications (PIMs). The Anticholinergic Effect on Cognition (AEC) Tool, ‘Medichec’, was used to identify and rate anticholinergic burden. Anticholinergic load was also compared using the Anticholinergic Burden Scale (ABS). RESULT: Total number of patients referred – 193 11 patients excluded due to unavailable/incomplete medication records. Study number: 182 79.67% (n = 145) were prescribed 5 or more medications. 44.51% (n = 81) prescribed 5–9 medications. 23.08% (n = 42) prescribed 10–14 medications. 8.79% (n = 16) prescribed 15–19 medications. 1.67% (n = 3) prescribed more than 20 medications. 37.36% (n = 68) prescribed an anticholinergic. 6.59% (n = 12) prescribed more than 1 anticholinergic. 29.67% (n = 54) prescribed an anticholinergic. 7.699% (n = 14) prescribed more than 1 anticholinergic. CONCLUSION: Polypharmacy and potentially inappropriate prescribing (e.g. anticholinergics) remain widespread within the older adult population. Anticholinergic load was broadly similar with the Anticholinergic Effect on Cognition tool and the Anticholinergic Burden Scale. Increased anticholinergic burden further compounds risks of cognitive impairment, delirium and death. Other categories of Potentially Inappropriate Medications, including those no longer needed, ought to be identified and reviewed. Over-the-counter medications also need to be screened for. Elimination or reduction of anticholinergic burden may improve quality of life for patients, as well as cost burden on services. Pharmacovigilance, collaborative working, and regular training are needed across services providing care for the older adult. |
format | Online Article Text |
id | pubmed-8771256 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | Cambridge University Press |
record_format | MEDLINE/PubMed |
spelling | pubmed-87712562022-01-31 Polypharmacy and potentially inappropriate medications (PIMs) in older adults referred to a memory clinic Akpan, Anietie Blaquiere, Bruno De Nellaya, Issadevi Termure, Cornelia Mukherjee, Sujoy BJPsych Open Service Evaluation AIMS: The older adult is more likely to be prescribed a lot of medications (polypharmacy) on account of multi-morbidity and consequently being under the care of several specialists. Adverse drug events and reactions account for significant morbidity and mortality in this population group. Common sequelae include confusional episodes, dementia syndromes, falls, and higher rates of acute hospital admissions. Medications are not routinely reviewed in elderly care. We sought to estimate the prevalence of polypharmacy, and potentially inappropriate medications (e.g. anticholinergics or medications with central anticholinergic effects) in those referred to the Cognitive Impairment and Dementia Service (Elm Lodge), Older Persons Mental Health, West London NHS Trust. METHOD: All referrals between 01/10/2020 and 30/11/2020 were screened for medications prescribed. Polypharmacy was defined as prescription of 5 or more medications. Medications with anticholinergic properties were considered examples of Potentially Inappropriate Medications (PIMs). The Anticholinergic Effect on Cognition (AEC) Tool, ‘Medichec’, was used to identify and rate anticholinergic burden. Anticholinergic load was also compared using the Anticholinergic Burden Scale (ABS). RESULT: Total number of patients referred – 193 11 patients excluded due to unavailable/incomplete medication records. Study number: 182 79.67% (n = 145) were prescribed 5 or more medications. 44.51% (n = 81) prescribed 5–9 medications. 23.08% (n = 42) prescribed 10–14 medications. 8.79% (n = 16) prescribed 15–19 medications. 1.67% (n = 3) prescribed more than 20 medications. 37.36% (n = 68) prescribed an anticholinergic. 6.59% (n = 12) prescribed more than 1 anticholinergic. 29.67% (n = 54) prescribed an anticholinergic. 7.699% (n = 14) prescribed more than 1 anticholinergic. CONCLUSION: Polypharmacy and potentially inappropriate prescribing (e.g. anticholinergics) remain widespread within the older adult population. Anticholinergic load was broadly similar with the Anticholinergic Effect on Cognition tool and the Anticholinergic Burden Scale. Increased anticholinergic burden further compounds risks of cognitive impairment, delirium and death. Other categories of Potentially Inappropriate Medications, including those no longer needed, ought to be identified and reviewed. Over-the-counter medications also need to be screened for. Elimination or reduction of anticholinergic burden may improve quality of life for patients, as well as cost burden on services. Pharmacovigilance, collaborative working, and regular training are needed across services providing care for the older adult. Cambridge University Press 2021-06-18 /pmc/articles/PMC8771256/ http://dx.doi.org/10.1192/bjo.2021.810 Text en © The Author(s) 2021 https://creativecommons.org/licenses/by/4.0/This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited. |
spellingShingle | Service Evaluation Akpan, Anietie Blaquiere, Bruno De Nellaya, Issadevi Termure, Cornelia Mukherjee, Sujoy Polypharmacy and potentially inappropriate medications (PIMs) in older adults referred to a memory clinic |
title | Polypharmacy and potentially inappropriate medications (PIMs) in older adults referred to a memory clinic |
title_full | Polypharmacy and potentially inappropriate medications (PIMs) in older adults referred to a memory clinic |
title_fullStr | Polypharmacy and potentially inappropriate medications (PIMs) in older adults referred to a memory clinic |
title_full_unstemmed | Polypharmacy and potentially inappropriate medications (PIMs) in older adults referred to a memory clinic |
title_short | Polypharmacy and potentially inappropriate medications (PIMs) in older adults referred to a memory clinic |
title_sort | polypharmacy and potentially inappropriate medications (pims) in older adults referred to a memory clinic |
topic | Service Evaluation |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8771256/ http://dx.doi.org/10.1192/bjo.2021.810 |
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