The risk of polypharmacy and potentially inappropriate drugs in residential care dementia patients: tips from the PharE
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ORIGINAL ARTICLE
The risk of polypharmacy and potentially inappropriate drugs in residential care dementia patients: tips from the PharE study Pietro Gareri1 · Antonino Maria Cotroneo2 · Maria Teresa Pontieri3 · Caterina Palleria4 · Giovambattista De Sarro4 Received: 21 August 2020 / Accepted: 16 September 2020 © Springer Nature Switzerland AG 2020
Abstract Aims The aims of the present study, conducted in two regions of Italy, Calabria and Piedmont, were to assess the use of inappropriate drugs according to the Beers Criteria and to study the possible drug–drug interactions. Methods Data were obtained retrospectively from 972 residential care patients between 2016 and 2018. Mean age was 82.4 ± 8.4 years, with a prevalence of women (64.8%). Activities of daily living, instrumental activities of daily living, Mini-Mental State Examination, Cumulative Illness Rating Scale, Neuropsychiatric Inventory Scale and number and kind of drugs were recorded. A classification of potential inappropriate drugs was made according to the Beers criteria. Data were collected through an Excel file able to gather the main information. In the case of suspected adverse event, Naranjo Scale was applied. The study of possible drug–drug interactions was made by Micromedex 2.0. Results Functional and cognitive impairments, comorbidities and number of drugs were assessed. The bivariate relationship between number of drugs and glomerular filtration rate assessed by CKD-EPI showed that the higher was the number of drugs used, the worst was kidney function assessment (p = 0.0001). The most frequent inappropriate drugs were anticholinergic drugs, tricyclics antidepressants, long-half-life benzodiazepines, antipsychotics and proton pump inhibitors. Conclusions These data are very interesting and show the need for an accurate choice of drugs in elderly people and for starting a wise deprescribing procedure. Keywords Elderly · Potentially inappropriate drugs · Drug–drug interactions · Polypharmacy · Deprescribing · Beers criteria
Introduction The increase in life expectancy is a global phenomenon and it is estimated that by 2050, 16% of the world will be 65 years or over, compared to 9% in 2019 [1, 2]. One of the main characteristics of older people is the presence of multiple diseases. As a consequence of this fact, they take several drugs; therefore, pharmacological treatments * Pietro Gareri [email protected] 1
Center for Cognitive Disorders and Dementia (CDCD), Catanzaro Lido, ASP Catanzaro, Viale Crotone, Catanzaro, Italy
2
Geriatric Unit, Hospital Maria Vittoria and Territorial Facility, Turin, Italy
3
RSA S. Francesco Hospital, Catanzaro, Italy
4
Chair of Pharmacology, School of Medicine, University Magna Graecia, Catanzaro, Italy
play a crucial role in elderly care management [3, 4]. Safe, effective and judicious prescribing in the elderly is challenging; drug–drug interactions (DDI), as well as drug–disease interactions and the possible role of herbal products and/or over-the-counter drugs are a remarkable con
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