TY - JOUR
T1 - Potentially inappropriate medication use in older adults with mild-moderate Alzheimer's disease
T2 - Prevalence and associations with adverse events
AU - NILVAD Study Group
AU - Murphy, Claire
AU - Dyer, Adam H.
AU - Lawlor, Brian
AU - Kennelly, Sean P.
AU - Olde Rikkert, Marcel G.M.
AU - Segurado, Ricardo
AU - Lawlor, Brian
AU - Howard, Robert
AU - Tsolaki, Magda
AU - Börjesson-Hanson, Anne
AU - Pasquier, Florence
AU - Lucc, Ugo
AU - Kálmán, János
AU - William Molloy, D.
AU - Riepe, Matthias W.
AU - Coen, Robert
AU - Kálmán, János
AU - Pakaski, Magdolna
AU - Kenny, Rose Anne
AU - Cregg, Fiona
AU - O'Dwyer, Sarah
AU - Walsh, Cathal
AU - Sheikhi, Ali
AU - Adams, Jessica
AU - Breuilh, Laetitia
AU - Daly, Leslie
AU - Hendrix, Suzanne
AU - Aisen, Paul
AU - Gaynor, Siobhan
AU - Taekema, Diana G.
AU - Verhey, Frans R.
AU - Nemni, Raffaello
AU - Nobili, Flavio
AU - Franceschi, Massimo
AU - Frisoni, Giovanni
AU - Zanetti, Orazio
AU - Konsta, Anastasia
AU - Anastasios, Orologas
AU - Nenopoulou, Styliani
AU - Tsolaki-Tagaraki, Fani
AU - Dereeper, Olivier
AU - De La Sayette, Vincent
AU - Sénéchal, Olivier
AU - Lavenu, Isabelle
AU - Devendeville, Agnès
AU - Calais, Gauthier
AU - Crawford, Fiona
AU - Mullan, Michael
AU - Aalten, Pauline
AU - Berglund, Maria A.
N1 - Publisher Copyright:
© The Author(s) 2020. Published by Oxford University Press on behalf of the British Geriatrics Society. All rights reserved. For permissions, please email: [email protected]
PY - 2020/7/1
Y1 - 2020/7/1
N2 - Aim: Potentially inappropriate medication (PIM) use is prevalent in older adults and is associated with adverse events, hospitalisation and mortality. We assessed the patterns and associations of PIM use in older adults with mild-to-moderate Alzheimer's Disease (AD), who may represent a particularly vulnerable group. Design: Analysis of data from NILVad, an 18-month Randomised Control Trial of Nilvadapine in mild-to-moderate AD. The v2 STOPP criteria were applied in duplicate to identify PIM use. Associations between PIM use and adverse events/unscheduled healthcare visits in addition to the associations between PIM use and AD progression were evaluated. Setting and Participants: 448 older adults with mild-to-moderate AD from 23 centres in nine European countries. Results: Of 448 participants (mean age: 72.56 ± 8.19 years), over half (55.8%) were prescribed a PIM with 30.1% being prescribed 2+ PIMs. The most frequent PIMs were (i) long-term benzodiazepines (11.6% N = 52/448), (ii) selective serotonin reuptake inhibitors without appropriate indication (11.1% N = 50/448), and (iii) Proton-Pump Inhibitors (PPIs) without appropriate indication (10.7% N = 48/448). Increasing number of PIMs was associated with a greater risk of adverse events (IRR 1.17, 1.13-1.19, P < 0.001), serious adverse events (IRR 1.27; 1.17-1.37, P < 0.001), unscheduled hospitalisations (IRR 1.16, 1.03-1.30, P = 0.016) and GP visits (IRR 1.22, 1.15-1.28, P < 0.001). PIM use was not associated with dementia progression. Conclusions and Implications: PIM use is highly prevalent in mild-to-moderate AD and is associated with adverse events and unscheduled healthcare utilisation. Further attention to de-prescribing in this vulnerable group is warranted.
AB - Aim: Potentially inappropriate medication (PIM) use is prevalent in older adults and is associated with adverse events, hospitalisation and mortality. We assessed the patterns and associations of PIM use in older adults with mild-to-moderate Alzheimer's Disease (AD), who may represent a particularly vulnerable group. Design: Analysis of data from NILVad, an 18-month Randomised Control Trial of Nilvadapine in mild-to-moderate AD. The v2 STOPP criteria were applied in duplicate to identify PIM use. Associations between PIM use and adverse events/unscheduled healthcare visits in addition to the associations between PIM use and AD progression were evaluated. Setting and Participants: 448 older adults with mild-to-moderate AD from 23 centres in nine European countries. Results: Of 448 participants (mean age: 72.56 ± 8.19 years), over half (55.8%) were prescribed a PIM with 30.1% being prescribed 2+ PIMs. The most frequent PIMs were (i) long-term benzodiazepines (11.6% N = 52/448), (ii) selective serotonin reuptake inhibitors without appropriate indication (11.1% N = 50/448), and (iii) Proton-Pump Inhibitors (PPIs) without appropriate indication (10.7% N = 48/448). Increasing number of PIMs was associated with a greater risk of adverse events (IRR 1.17, 1.13-1.19, P < 0.001), serious adverse events (IRR 1.27; 1.17-1.37, P < 0.001), unscheduled hospitalisations (IRR 1.16, 1.03-1.30, P = 0.016) and GP visits (IRR 1.22, 1.15-1.28, P < 0.001). PIM use was not associated with dementia progression. Conclusions and Implications: PIM use is highly prevalent in mild-to-moderate AD and is associated with adverse events and unscheduled healthcare utilisation. Further attention to de-prescribing in this vulnerable group is warranted.
KW - Adverse events
KW - Dementia
KW - Hospitalisations
KW - Older people
KW - Potentially inappropriate prescriptions
UR - http://www.scopus.com/inward/record.url?scp=85087530833&partnerID=8YFLogxK
U2 - 10.1093/ageing/afaa067
DO - 10.1093/ageing/afaa067
M3 - Article
C2 - 32474584
AN - SCOPUS:85087530833
SN - 0002-0729
VL - 49
SP - 580
EP - 587
JO - Age and Ageing
JF - Age and Ageing
IS - 4
ER -