International Journal of Preventive Medicine Research
Articles Information
International Journal of Preventive Medicine Research, Vol.4, No.2, Jun. 2018, Pub. Date: Jun. 7, 2018
Potentially Inappropriate Medication in Patients Admitted with Diagnosis of Delirium Superimposed on Dementia
Pages: 18-24 Views: 1584 Downloads: 518
[01] Gudrun Hefner, Psychiatric Hospital, Vitos Klinik Hochtaunus, Friedrichsdorf, Germany.
[02] Martina Hahn, Psychiatric Hospital, Vitos Klinik Eichberg, Eltville, Germany.
[03] Sibylle Christine Roll, Psychiatric Hospital, Vitos Klinik Eichberg, Eltville, Germany.
[04] Ansgar Klimke, Psychiatric Hospital, Vitos Klinik Hochtaunus, Friedrichsdorf, Germany.
[05] Christoph Hiemke, Department of Psychiatry and Psychotherapy, University Medical Center, Mainz, Germany.
[06] Joachim Röschke, SCIVIAS Psychiatric Hospital, Bad Soden, Germany.
Drugs may enhance the incidence of delirium in predisposed patients with dementia. This study analyzed prescription of potentially inappropriate medications (PIMs) of the Priscus list and the delirigenic burden of drugs and their role as precipitating factors for the development of delirium in patients with dementia. Patients with the diagnosis of dementia who had been hospitalized because of a delirium were screened retrospectively for number and sort of PIMs, as defined by the Priscus list. The delirogenic drug burden was assessed by a risk-scale ranging from 0 (not existing) to 4 (high) per drug and calculation of a sum score per patient. Overall, 79 patients (57.0% female) with a mean (Mean±SD) age of 81.1±6.6 years were included. They received by mean 6.0±3.3 drugs at admission and 6.9±2.8 at discharge. At admission 15 patients (19.0%) received at least one Priscus-PIM and 57 (72.9%) at least one drug with delirogenic properties. Prescription of PIMs slightly decreased by 20% at discharge. The mean delirogenic burden sum score was 2.0±2.1 (range 0-11) at admission and decreased by 40% to 1.2±1.2 (range 0-5) at discharge. Drugs were diagnosed as precipitating factors for delirium in 13 patients (16.5%). Besides amitriptyline, drugs with a strong delirogenic activity, as promethazine or levomepromazine, have not been considered as a possible reason for delirium. Although physicians try to avoid inappropriate drug-prescribing to demented patients, delirogenic drugs are frequently given to patients with dementia and in a significant number of patients they were associated with the occurrence of delirium. Preliminary evidence indicated that reduction of the delirogenic burden score of the medication is more appropriate to dimish this risk than reduction of PIM prescriptions. More cautious prescribing by the physician is indicated and future interventions may need to focus on polypharmacy to optimize pharmacological treatment in vulnerable demented patients.
Dementia, Delirium, Potentially Inappropriate Medication, Priscus-List, Adverse Drug Reactions, Risk-Scale
[01] Wittchen HU, Jacobi F, Rehm J, Gustavsson A, Svensson M, Jonsson B, Olesen J, Allgulander C, Alonso J, Faravelli C, Fratiglioni L, Jennum P, Lieb R, Maercker A, van Os J, Preisig M, Salvador-Carulla L, Simon R, Steinhausen HC (2011) The size and burden of mental disorders and other disorders of the brain in Europe 2010. Eur Neuropsychopharmacol 21: 655-679. doi: 10.1016/j.euroneuro.2011.07.018
[02] Cova I, Markova A, Campini I, Grande G, Mariani C, Pomati S (2017) Worldwide trends in the prevalence of dementia. J Neurol Sci 379: 259-260. doi: 10.1016/j.jns.2017.06.030
[03] Roden M, Simmons BB (2014) Delirium superimposed on dementia and mild cognitive impairment. Postgrad Med 126: 129-137. doi: 10.3810/pgm.2014.10.2827
[04] Hasegawa N, Hashimoto M, Yuuki S, Honda K, Yatabe Y, Araki K, Ikeda M (2013) Prevalence of delirium among outpatients with dementia. Int Psychogeriatr 25: 1877-1883. doi: 10.1017/S1041610213001191
[05] Singler K, Thomas C (2017) [HELP - Hospital Elder Life Program - multimodal delirium prevention in elderly patients]. Internist (Berl) 58: 125-131. doi: 10.1007/s00108-016-0181-0
[06] Inouye SK (1999) Predisposing and precipitating factors for delirium in hospitalized older patients. Dement Geriatr Cogn Disord 10: 393-400.
[07] Mittal V, Muralee S, Williamson D, McEnerney N, Thomas J, Cash M, Tampi RR (2011) Review: delirium in the elderly: a comprehensive review. Am J Alzheimers Dis Other Demen 26: 97-109. doi: 10.1177/1533317510397331
[08] Meyer S, Meyer O, Kressig RW (2010) [Drug-induced delirium]. Ther Umsch 67: 79-83. doi: 10.1024/0040-5930/a000015
[09] Hofmann W (2017) [Dementia and comorbid conditions]. Internist (Berl) 58: 105-116. doi: 10.1007/s00108-016-0182-z
[10] Barry HE, Cooper JA, Ryan C, Passmore AP, Robinson AL, Molloy GJ, Darcy CM, Buchanan H, Hughes CM (2016) Potentially Inappropriate Prescribing Among People with Dementia in Primary Care: A Retrospective Cross-Sectional Study Using the Enhanced Prescribing Database. J Alzheimers Dis 52: 1503-1513. doi: 10.3233/JAD-151177
[11] Goldberg RM, Mabee J, Chan L, Wong S (1996) Drug-drug and drug-disease interactions in the ED: analysis of a high-risk population. Am J Emerg Med 14: 447-450.
[12] Mintzer J, Burns A (2000) Anticholinergic side-effects of drugs in elderly people. J R Soc Med 93: 457-462.
[13] Gray SL, Hanlon JT (2016) Anticholinergic medication use and dementia: latest evidence and clinical implications. Ther Adv Drug Saf 7: 217-224.
[14] Shinohara M, Yamada M (2016) [Drug-induced Cognitive Impairment]. Brain Nerve 68: 421-428. doi: 10.11477/mf.1416200415
[15] Klotz U (2009) Pharmacokinetics and drug metabolism in the elderly. Drug Metab Rev 41: 67-76. doi: 10.1080/03602530902722679
[16] McLean AJ, Le Couteur DG (2004) Aging biology and geriatric clinical pharmacology. Pharmacol Rev 56: 163-184.
[17] Fried LP, Tangen CM, Walston J, Newman AB, Hirsch C, Gottdiener J, Seeman T, Tracy R, Kop WJ, Burke G, McBurnie MA (2001) Cardiovascular Health Study Collaborative Research G. Frailty in older adults: evidence for a phenotype. J Gerontol A Biol Sci Med Sci 56: M146-156.
[18] Chang CB, Chen JH, Wen CJ, Kuo HK, Lu IS, Chiu LS, Wu SC, Chan DC (2011) Potentially inappropriate medications in geriatric outpatients with polypharmacy: application of six sets of published explicit criteria. Br J Clin Pharmacol 72: 482-489. doi: 10.1111/j.1365-2125.2011.04010.x
[19] Hefner G, Shams ME, Wenzel-Seifert K, Fellgiebel A, Falter T, Haen E, Hiemke C (2015) Rating the delirogenic potential of drugs for prediction of side effects in elderly psychiatric inpatients. J J Pharma Pharmacovigilance 1: 003.
[20] Simonson W (2016) The 2015 updated Beers Criteria: The evolution continues. Geriatr Nurs 37: 61-62. doi: 10.1016/j.gerinurse.2015.12.006
[21] Holt S, Schmiedl S, Thurmann PA (2010) Potentially inappropriate medications in the elderly: the PRISCUS list. Dtsch Arztebl Int 107: 543-551. doi: 10.3238/arztebl.2010.0543
[22] Wucherer D, Eichler T, Hertel J, Kilimann I, Richter S, Michalowsky B, Thyrian JR, Teipel S, Hoffmann W (2017) Potentially Inappropriate Medication in Community-Dwelling Primary Care Patients who were Screened Positive for Dementia. J Alzheimers Dis 55: 691-701.
[23] Duran CE, Azermai M, Vander Stichele RH (2013) Systematic review of anticholinergic risk scales in older adults. Eur J Clin Pharmacol 69: 1485-1496. doi: 10.1007/s00228-013-1499-3
[24] Renom-Guiteras A, Thürmann PA, Miralles R, Klaaßen-Mielke R, Thiem U, Stephan A, Bleijlevens MH, Jolley D, Leino-Kilpi H, Rahm Hallberg I, Saks K, Soto-Martin M, Zabalegui A, Meyer G (2017) RightTimePlaceCare Consortium. Potentially inappropriate medication among people with dementia in eight European countries. Age Ageing: 1-7. doi: 10.1093/ageing/afx147
[25] Cross AJ, George J, Woodward MC, Ames D, Brodaty H, Wolfe R, Connors MH, Elliott RA (2017) Potentially Inappropriate Medication, Anticholinergic Burden, and Mortality in People Attending Memory Clinics. J Alzheimers Dis 60: 349-358. doi: 10.3233/JAD-170265
[26] Fiss T, Thyrian JR, Fendrich K, van den Berg N, Hoffmann W (2013) Cognitive impairment in primary ambulatory health care: pharmacotherapy and the use of potentially inappropriate medicine. Int J Geriatr Psychiatry 28: 173-181. doi: 10.1002/gps.3806
[27] Siebert S, Elkeles B, Hempel G, Kruse J, Smollich M (2013) [The PRISCUS list in clinical routine. Practicability and comparison to international PIM lists]. Z Gerontol Geriatr 46: 35-47. doi: 10.1007/s00391-012-0324-4
[28] Johnell K (2015) Inappropriate Drug Use in People with Cognitive Impairment and Dementia: A Systematic Review. Curr Clin Pharmacol 10: 178-184.
[29] Sköldunger A, Fastbom J, Wimo A, Fratiglioni L, Johnell K (2015) Impact of Inappropriate Drug Use on Hospitalizations, Mortality, and Costs in Older Persons and Persons with Dementia: Findings from the SNAC Study. Drugs Aging 32: 671-678. doi: 10.1007/s40266-015-0287-4
[30] Hein C, Forgues A, Piau A, Sommet A, Vellas B, Nourhashémi F (2014) Impact of polypharmacy on occurrence of delirium in elderly emergency patients. J Am Med Dir Assoc 15: 850.e11-15. doi: 10.1016/j.jamda.2014.08.012
[31] Tommelein E, Mehuys E, Petrovic M, Somers A, Colin P, Boussery K (2015) Potentially inappropriate prescribing in community-dwelling older people across Europe: a systematic literature review. Eur J Clin Pharmacol 71: 1415-1427. doi: 10.1007/s00228-015-1954-4
[32] Parsons C (2017) Polypharmacy and inappropriate medication use in patients with dementia: an underresearched problem. Ther Adv Drug Saf 8: 31-46. doi: 10.1177/2042098616670798
[33] Zimmermann T, Kaduszkiewicz H, van den Bussche H, Schon G, Brettschneider C, Konig HH, Wiese B, Bickel H, Mosch E, Luppa M, Riedel-Heller S, Werle J, Weyerer S, Fuchs A, Pentzek M, Hanisch B, Maier W, Scherer M, Jessen F, AgeCoDe-Study G (2013) [Potentially inappropriate medication in elderly primary care patients: A retrospective, longitudinal analysis]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 56: 941-949. doi: 10.1007/s00103-013-1767-5
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