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Frailty and Medication Use in New NH Residents With Dementia

August 02, 2017

Findings from a study published in the Journal of the American Geriatrics Society found a high prevalence of older adults with cognitive impairment taking inappropriate medications upon admission to nursing facilities. They also found that frail individuals were started on these kinds of medications more often than nonfrail older adults.

Authors conducted a retrospective cohort study of using health administrative data of older adults living in Ontario, Canada, in order to estimate the prevalence of potentially inappropriate medications (PIMs) use in older adults with dementia or cognitive impairment before and after transitioning to a nursing home (NH) and how PIMs may relate to frailty.
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Data analyzed included 41,351 individuals diagnosed with dementia or cognitive impairment, aged 66 years or older, and newly admitted to a NH between 2011 and 2014. Medication information was collected upon new resident admission and tracked during the following 180 days (2017; doi:10.1111/jgs.15016).

The 2015 Beers Criteria were used to define PIMs and included antipsychotics, H2-receptor antagonists, benzodiazepines, and drugs with strong anticholinergic properties. A 72-item frailty index and multivariable Cox proportional-hazards models were used to investigate the relationship between frailty and starting or discontinuing PIMs.

Results showed that, at NH admission, 44% of residents with cognitive impairment or dementia were on a PIM, and prevalence varied depending upon frailty (38.7% nonfrail, 42.8% pre-frail, and 48.1% frail, P < .001). During the observed period following admission, some residents discontinued PIMs (23.5% for antipsychotics, 49.3% benzodiazepines, 32.2% anticholinergics, and 30.9% H2-receptor antagonists). But some residents were started on new PIMs: 10.9% on antipsychotics, 10.1% on benzodiazepines, 6.6% on anticholinergics, and 1.2% on H2-receptor antagonists.

Frail and nonfrail residents showed to have similar risk of PIM discontinuation except for anticholinergics (hazard ratio [HR] = 1.21; 95% CI 1.06-1.39), but frail residents were more likely to be started on benzodiazepines (HR = 1.32; 95% CI 1.20-1.44), antipsychotics (HR = 1.36; 1.23-1.49), and anticholinergics (HR = 1.34; 95% CI 1.20-1.50).

Based on these data, researchers concluded that many older adults with cognitive impairment or dementia transition to NHs taking PIMs, but frail individuals are more likely to be started on PIMs after admission. Authors feel that interventions aimed at deprescribing PIMs in frail older adults are needed during transitions to NHs.—Amanda Del Signore

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