Pharmacists may improve care for patients with dementia, reduce medication-related readmissions

Clinical pharmacists who work with healthcare teams may help improve the quality of care and safety of patients with dementia and reduce the risk of medication-related hospital readmissions, according to a new study.

Previous research has found that in any given year, between one-third and half of older adults with dementia visited the emergency room, returned to the ER more frequently than those without dementia and their treatment cost more. Furthermore, a 2016 report found a high number of "near misses" involving dementia patients in hospital settings, and the number is likely underreported.

The latest study, conducted as a randomized controlled trial in Sweden, involved 460 patients aged 65 years old or older who suffered from dementia or cognitive impairment. All of the participants had been admitted to internal medicine and orthopedic wards at hospitals at some point between 2012 and 2015.

Maria Gustafsson, a doctoral student and clinical pharmacist at the Department of Community Medicine and Rehabilitation at Umeå University, said that prior to the study, she analyzed all patient causes of the original admissions and found 41 percent were related to medication effects. The most common problems were adverse drug reactions, high dosage and noncompliance.

The study involved clinical pharmacists on care teams. The pharmacists worked to make sure the individual patients' drug lists were correct and complete. They also conducted comprehensive analyses of all the drugs prescribed to the patient, initiated discussions with the healthcare team and made suggestions to the physician in charge.

"The results after the intervention showed that clinical pharmacists' participation in healthcare teams reduced the risk of drug-related hospital readmissions by half during the follow-up time of 180 days," Gustafsson said in a study announcement. She said the intervention also reduced the risk of early drug-related hospital readmissions within 30 days.

Other findings from the study:

  • The use of antipsychotic and other psychotropic drugs are common among people with dementia in specialized care units. The drugs were also used for long periods of time, which is inconsistent with prevailing treatment guidelines.
  • There is a link between several behavioral and psychological symptoms of dementia, such as aggressive behavior, and widespread prescribing of antipsychotics and other psychotropic substances. Gustafsson said this indicates that psychotropics are sometimes used to treat symptoms among people with dementia, despite known risks of adverse effects and limited research evidence supporting the treatment's efficacy.

"Drug treatment-related problems in elderly people with dementia are very common and more work is needed in order to prevent, identify and treat these problems in this part of the population," she said.

To learn more:
- here's the study abstract
- read the study announcement

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