Potentially Inappropriate Medication in Community-Dwelling Primary Care Patients who were Screened Positive for Dementia

Diana Wucherer, Tilly Eichler, Johannes Hertel, Ingo Kilimann, Steffen Richter, Bernhard Michalowsky, Jochen René Thyrian, Stefan Teipel, Wolfgang Hoffmann, Diana Wucherer, Tilly Eichler, Johannes Hertel, Ingo Kilimann, Steffen Richter, Bernhard Michalowsky, Jochen René Thyrian, Stefan Teipel, Wolfgang Hoffmann

Abstract

Background: Potentially inappropriate medication (PIM) in older people is a risk factor for adverse drug effects. This risk is even higher in older people with dementia (PWD).

Objective: Our study aimed to determine (1) the prevalence of PIM among primary care patients who were screened positive for dementia and (2) the sociodemographic and clinical variables associated with the use of PIM.

Methods: DelpHi-MV (Dementia: life- and person-centered help in Mecklenburg-Western Pomerania) is a general practitioner-based, cluster-randomized, controlled intervention study to implement and evaluate an innovative concept of collaborative dementia care management in Germany. The comprehensive baseline assessment includes a home medication review. The present analyses are based on the data from 448 study participants (age 70+, DemTect <9). PIMs were identified using the list of Potentially Inappropriate Medications in the Elderly (Priscus).

Results: (1) A total of 99 study participants (22%) received at least one PIM. The highest prevalence was found for antidepressants, benzodiazepines, and analgetics. The most frequently prescribed PIMs were amitriptyline, etoricoxib, and doxazosin. (2) Use of a PIM was significantly associated with a diagnosis of a mental or behavioral disorder.

Conclusions: The prescription rate of PIMs for community-dwelling PWD was comparable with the rates found for the general population of older people in Germany (20-29%). Antidepressants with anticholinergic properties and long-acting benzodiazepines were the most prescribed PIMs, despite having an unfavorable benefit-risk ratio. This high prevalence of PIM prescriptions in a vulnerable population of PWD indicates that standard care for dementia should include careful medication review and management.

Keywords: Dementia; PIM List; potentially inappropriate medications; primary health care.

Figures

Fig.1
Fig.1
CONSORT flow chart of DelpHi-MV study.

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