Using a retrospective cohort study design, British researchers have recently investigated the nature of drug treatment amongst people with dementia, specifically looking at evidence for potentially inappropriate prescribing (PIP). Data were derived primary care electronic health records linked to hospital discharge data, and compared information from 11,175 people with dementia (aged over 65 years in 2016) and 43,463 age- and sex-matched controls. PIP was identified with the Screening Tool of Older Persons’ Prescriptions V2 defined PIP. Logistic regression tested associations with comorbidities at baseline, and survival analyses risk of incident adverse health outcomes, adjusted for age, gender, deprivation and range of comorbidities.
Those with dementia had increased risk of PIP (73% prevalence; odds ratio [OR]: 1.92; confidence interval [CI]: 83–103%; P < 0.01) after adjusting for comorbidities. Most frequently encountered PIP criteria concerned anticholinergic drugs and therapeutic duplication. Risk of PIP was higher amongst those patients with comorbid coronary-heart disease (odds OR: 2.17; CI: 1.91–2.46; P < 0.01), severe mental illness (OR: 2.09; CI: 1.62–2.70; P < 0.01); and depression (OR: 1.81; CI: 1.62–2.01; P < 0.01). Followed up 12 months later, PIP was associated with increased all-cause mortality (hazard ratio: 1.14; CI: 1.02–1.26; P < 0.02), skin ulcer and pressure sores (hazard ratio: 1.66; CI: 1.12–2.46; P < 0.01), falls (hazard ratio: 1.37; CI: 1.15–1.63; P < 0.01), anaemia (hazard ratio: 1.61; CI: 1.10–2.38; P < 0.02) and osteoporosis (hazard ratio: 1.62; CI: 1.02–2.57; P < 0.04).
Naturally, the researcher suggest that more effort needs to be invested to reduce inappropriate prescribing for older people with dementia. See the details here.