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Reduction of suboptimal prescribing and clinical outcome for dementia patients in a senior behavioral health inpatient unit

Published online by Cambridge University Press:  20 November 2008

Virginia T. Chan ,
Benjamin K. P. Woo ,
Daniel D. Sewell ,
E. Clark Allen ,
Shahrokh Golshan ,
Valerie Rice ,
Arpi Minassian  and
John W. Daly
Virginia T. Chan
Affiliation:
Department of Psychiatry, University of California, San Diego, U.S.A.
Benjamin K. P. Woo
Affiliation:
Department of Psychiatry, University of California, Los Angeles-Kern County, Bakersfield, U.S.A.
Daniel D. Sewell*
Affiliation:
Department of Psychiatry, University of California, San Diego, U.S.A.
E. Clark Allen
Affiliation:
Department of Psychiatry, University of California, San Diego, U.S.A.
Shahrokh Golshan
Affiliation:
Department of Psychiatry, University of California, San Diego, U.S.A.
Valerie Rice
Affiliation:
Department of Psychiatry, University of California, San Diego, U.S.A.
Arpi Minassian
Affiliation:
Department of Psychiatry, University of California, San Diego, U.S.A.
John W. Daly
Affiliation:
Department of Internal Medicine, University of California, San Diego, U.S.A.
*
Correspondence should be addressed to: Daniel D. Sewell, M.D., University of California, San Diego, 200 West Arbor Drive, San Diego, CA 92103-8631, U.S.A. Phone: +1 619-543-3772; Fax: +1 619-543-3648. Email: [email protected].
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Abstract

Background: Suboptimal prescribing in older psychiatric patients causes iatrogenic morbidity. The objectives of this study were to compare the prevalence of suboptimal prescribing before and after admission to a geropsychiatry inpatient unit and to evaluate a possible correlation between optimal medication use and functional improvement in patients with dementia.

Methods: The study sample comprised 118 consecutively admitted patients to a 14-bed university hospital-based geropsychiatry inpatient unit over a period of 20 months who met the DSM-IVTR criteria for an Axis I psychiatric illness and co-morbid dementia. At admission demographic information, Mini-mental State Examination (MMSE) Score, Mattis Dementia Rating Scale Score (DRS), and number of active medical illnesses were recorded. At admission and discharge the number and type of medications, number of Revised Beers Criteria (RBC) medications (a published list of potentially inappropriate medications in older adults independent of diagnoses or conditions), Global Assessment of Functioning (GAF) scores, and Scale of Functioning (SOF) scores were tabulated. χ2 tests, paired t-tests and Pearson correlations were used to test the medication prevalence and associations between measures of clinical function and other variables.

Results: The mean age (standard deviation) of the sample was 81.5 (6.2) years. The mean scores on the MMSE and DRS were 22.1 (6.2) and 116.6 (18.7), respectively. From admission to discharge, the mean number of RBC medications per patient decreased significantly from 0.8 (1.1) to 0.4 (0.6). There was also a significant correlation between reduction in Beers criteria medications and improved SOF score from time of admission to time of discharge.

Conclusion: Suboptimal medication use is a potential source of decreased function in older patients with dementia.

Keywords

anticholinergicsbehavioral symptomsdementiaelderlypolypharmacy
Type
Research Article
Information
International Psychogeriatrics , Volume 21 , Issue 1 , February 2009 , pp. 195 - 199
Copyright
Copyright © International Psychogeriatric Association 2008

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References

American Psychiatric Association. (2000). Diagnostic and Statistical Manual of Mental Disorders, 4th edn, text revision. Washington, DC: American Psychiatric Association.Google Scholar
Ancoli-Israel, S. et al. (2003). Increased light exposure consolidates sleep and strengthens circadian rhythms in severe Alzheimer's disease patients. Behavioral Sleep Medicine, 1, 22–36.CrossRefGoogle ScholarPubMed
Beers, M. H. (1997). Explicit criteria for determining potentially inappropriate medication use by the elderly. Archives of Internal Medicine, 45, 2716–2724.Google Scholar
Bruno, J. J. and Ellis, J. J. (2005). Herbal use among US elderly 2002 National Health Interview Survey. The Annals of Pharmacotherapy, 39, 643–648.CrossRefGoogle ScholarPubMed
Col, N., Fanale, J. E. and Kronholm, P. (1990). The role of medication noncompliance and adverse drug reactions in hospitalizations of the elderly. Archives of Internal Medicine, 150, 841–845.CrossRefGoogle ScholarPubMed
Egger, S. S., Bachmann, A., Hubmann, N., Schlienger, R. G. and Krähenbühl, S. (2006). Prevalence of potentially inappropriate medication use in elderly patients. Drugs & Aging, 23, 823–837.CrossRefGoogle ScholarPubMed
Fick, D. M., Cooper, J. W., Wade, W. E., Waller, J. L., Maclean, J. R. and Beers, M. H. (2003). Updating the Beers criteria for potentially inappropriate medication use in older adults. Archives of Internal Medicine, 163, 2716–2724.CrossRefGoogle ScholarPubMed
Folstein, M. F., Folstein, S. E. and McHugh, P. R. (1975). “Mini-mental state”: a practical method for grading the cognitive state of patients for the clinician. Journal of Psychiatric Research, 12, 189–198.CrossRefGoogle ScholarPubMed
Gosney, M. and Tallis, R. (1984). Prescription of contraindicated and interacting drugs in elderly patients admitted to hospital. Lancet, 2, 564–567.CrossRefGoogle ScholarPubMed
Grymonpre, R. E., Mitenko, P. A., Sitar, D. S., Aoki, F. Y. and Montgomery, P. R. (1988). Drug-associated hospital admissions in older medical patients. Journal of the American Geriatrics Society, 36, 1092–1098.CrossRefGoogle ScholarPubMed
Hohl, C. M., Dankoff, J., Colacone, A. and Afilalo, M. (2001). Polypharmacy, adverse drug-related events, and potential adverse drug interactions in elderly patients presenting to an emergency department. Annals of Emergency Medicine, 38, 666–671.CrossRefGoogle ScholarPubMed
Larson, E. B., Kukull, W. A., Buchner, D. M. and Reifler, B. V. (1987). Adverse drug reaction associated with global cognitive impairment in elderly persons. Annals of Internal Medicine, 107, 169–173.CrossRefGoogle ScholarPubMed
Mattis, S. (1976). Mental status examination for organic mental syndrome in the elderly patient. In Bellak, L. and Karasu, T.B. (eds.), Geriatric Psychiatry: A Handbook for Psychiatrists and Primary Care Physicians (pp. 77–122). New York: Grune & Stratton.Google Scholar
Passarelli, M. C., Jacob-Filho, W. and Figueras, A. (2005). Adverse drug reactions in an elderly hospitalized population: inappropriate prescription is a leading cause. Drugs & Aging, 22, 767–777.CrossRefGoogle Scholar
Rapaport, M. H., Bazzetta, J., McAdams, L. A., Patterson, T. and Jeste, D. V. (1996). Validation of the Scale of Functioning in older outpatients with schizophrenia. American Journal of Geriatric Psychiatry, 4, 218–228.CrossRefGoogle ScholarPubMed
Shelton, P. S., Fritsch, M. A. and Scott, M. A. (2000). Assessing medication appropriateness in the elderly: a review of available measures. Drugs & Aging, 16, 437–450.CrossRefGoogle ScholarPubMed
Woo, B. K., Daly, J. W., Allen, E. C., Jeste, D. V. and Sewell, D. D. (2003). Unrecognized medical disorders in older inpatients in a senior behavioral health unit in a university hospital. Journal of Geriatric Psychiatry and Neurology, 16, 121–125.CrossRefGoogle Scholar
Yoon, S. J. and Schaffer, S. D. (2006). Herbal, prescribed, and over-the-counter drug use in older women: prevalence of drug interactions. Geriatric Nursing, 27, 118–129.CrossRefGoogle ScholarPubMed