gms | German Medical Science

Introduction: There is insufficient knowledge about prevalence and determinants for the intake of potentially inappropriate medication (PIM) by patients with cognitive impairment (suspicion of dementia). We aimed to analyse the pharmacotherapy as well as associated drug related problems in patients with cognitive impairment using data from the AGnES-studies (GP-supporting, community-based, e-health-assisted, systemic intervention).

Methods: IT-supported home medication review (HMR) was conducted with 779 home visit patients. Out of these patients 342 received standardized dementia screening using the DemTect (suspicion of dementia / cognitive impairment: < 9 of 18 points). For retrospective identification of PIM in cognitive impairment the PRISCUS-list (Holt et al., Dt. Aerzteblatt Int. 2010) was used. The median age of the analysed patients was 82 years and the proportion of women was 78.4% (n=268).

Results: A cognitive impairment was identified with 111 patients (32.4%). Thereof 72.1% (n=87) patients with cognitive impairment received support in drug administration. The median number of treatment diagnosis was 6 and the median number of taken drugs was 7. Out of these patients we have identified the intake of PIM with 19.8% (n=22). Patient’s characteristics and drug administrative aspects were included in multiple logistic regression analysis. We found female sex (OR=10.36; 95%-CI: 1.18-83.87) and a disease of the musculoskeletal system (OR=4.2; 95%-CI: 1.1-16.01) as positive determinants for the intake of PIM. Factors which protected from the intake of PIM were support in drug administration (OR=0.13; 95%-CI: 0.02-0.63) and intake of less than 5 drugs regularly (OR=0.06; 95%-CI: 0.006-0.055; Reference: > 9 drugs).

Discussion: In a retrospective analysis we have identified a high prevalence of PIM intake by patients with cognitive impairment. We found that receiving support in drug administration prevents the intake of PIM. There are significant sex differences. Hence the analysis provides an informative basis about this relevant drug related problem. Nevertheless there are some limitations due to selected patients cohort. Further research is needed to develop and evaluate instruments to prevent intake of PIM. Both detection and prevention of the intake of PIM is a part of the medication management in the study DelpHi-MV (dementia: community based and patient centred support in Mecklenburg Western Pommerania).