Optimizing drug therapy in patients with advanced dementia: A patient-centered approach - 12/02/14
Abstract |
Background |
Advanced dementia is a prevalent health problem in geriatric patients. These patients usually suffer from several chronic diseases, frequently leading to an end-of-life situation lasting months or years, generating complex and often inappropriate medication regimens.
Objectives |
Describe the re-orientation of drug therapy in patients with advanced dementia utilizing a systematic medication review process.
Methods |
This non-experimental pre-post analysis included all patients with advanced dementia admitted to acute geriatric unit (AGU) over one year. Medications were reviewed by a multidisciplinary team and together with the patient caregivers; new therapeutic objectives based on end-of-life care principles were established. Medications were classified as preventive, therapeutic, or symptomatic. The average number of medications per patient pre- and post-admission was compared.
Results |
We included 73 patients (mean age 86.1years, mean Barthel Index: 14.5/100). At admission, patients had a mean of 7.27 drugs compared to 4.82 at discharge (66.85% reduction, P<0.05). The main drugs withdrawn were cardiovascular and hematological (35.76%). Drugs for prevention decreased by 66.85% (from 1.8 to 0.6, P<0.05) and those for symptomatic care decreased by 17,52% (from 2.34 to 1.93, P<0.05).
Conclusion |
Medication therapy plans in patients with advanced dementia often do not meet their therapeutic goals. The proposed methodology is a useful tool to assess therapeutic appropriateness.
Le texte complet de cet article est disponible en PDF.Keywords : Polypharmacy, Advanced dementia, End-of-life care
Plan
Vol 5 - N° 1
P. 66-71 - février 2014 Retour au numéroBienvenue sur EM-consulte, la référence des professionnels de santé.
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