Optimizing drug therapy in patients with advanced dementia: A patient-centered approach

• Published in: European geriatric medicine 2014-02, Vol.5 (1), p.66-71
• Main Authors: Molist Brunet, N, Sevilla-Sánchez, D, Amblàs Novellas, J, Codina Jané, C, Gómez-Batiste, X, McIntosh, J, Espaulella Panicot, J
• Format: Article
• Language: English
• Subjects: Advanced dementia; End-of-life care; Internal Medicine; Polypharmacy
• ISSN: 1878-7649; 1878-7657
• DOI: 10.1016/j.eurger.2013.10.011

Abstract Background Advanced dementia is a prevalent health problem in geriatric patients. These patients usually suffer from several chronic diseases, frequently leading to an end-of-life situation lasting months or years, generating complex and often inappropriate medication regimens. Objectives Describe the re-orientation of drug therapy in patients with advanced dementia utilizing a systematic medication review process. Methods This non-experimental pre-post analysis included all patients with advanced dementia admitted to acute geriatric unit (AGU) over one year. Medications were reviewed by a multidisciplinary team and together with the patient caregivers; new therapeutic objectives based on end-of-life care principles were established. Medications were classified as preventive, therapeutic, or symptomatic. The average number of medications per patient pre- and post-admission was compared. Results We included 73 patients (mean age 86.1 years, mean Barthel Index: 14.5/100). At admission, patients had a mean of 7.27 drugs compared to 4.82 at discharge (66.85% reduction, P < 0.05). The main drugs withdrawn were cardiovascular and hematological (35.76%). Drugs for prevention decreased by 66.85% (from 1.8 to 0.6, P < 0.05) and those for symptomatic care decreased by 17,52% (from 2.34 to 1.93, P < 0.05). Conclusion Medication therapy plans in patients with advanced dementia often do not meet their therapeutic goals. The proposed methodology is a useful tool to assess therapeutic appropriateness.