Inappropriate Rx Use Among Older Adults With Cognitive Impairment, Dementia

HealthDay News — Many nursing home residents with cognitive impairment or dementia have potentially inappropriate medication (PIM) use, with PIM use more likely among frail individuals, according to a study published online in the Journal of the American Geriatrics Society.

Laura C. Maclagan, from the Institute for Clinical Evaluative Sciences in Toronto, and colleagues conducted a retrospective cohort study using data for 41,351 individuals with cognitive impairment or dementia aged 66+ years who were newly admitted to a nursing home between 2011 and 2014. Medication information was obtained at admission to nursing home and in the subsequent 180 days, and the prevalence of PIM use was estimated.

The researchers found that 44% of residents with cognitive impairment or dementia were on a PIM and there was variation in prevalence by frailty (38.7%, 42.8%, and 48.1% for non-frail, pre-frail, and frail, respectively; P <.001). Many residents discontinued PIMs following admission; however, PIMs were also introduced, with 10.9%, 10.1%, 6.6%, and 1.2% newly started on antipsychotics, benzodiazepines, anticholinergics, and H2-receptor antagonists, respectively. 

Frail residents had a similar risk of PIM discontinuation as non-frail residents for anticholinergics, but they were more likely to be newly prescribed benzodiazepines, antipsychotics, and anticholinergics, after adjustment for other characteristics.

“Interventions to support deprescribing of PIMs should be implemented targeting frail individuals during the transition to nursing home,” the authors wrote.

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Maclagan LC, Maxwell CJ, Gandhi S, et al. Frailty and potentially inappropriate medication use at nursing home transition [published online July 28, 2017]. J Am Geriatr Soc. doi:10.1111/jgs.15016