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Drug use in patients with dementia: a register-based study in the health region of Girona (Catalonia/Spain)

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Abstract

Purpose

To describe the pattern of drug consumption among patients with dementia in a geographically defined general population in Catalonia (Spain), and to determine its association with age, gender, type of dementia and severity indicators.

Methods

Cross-sectional study that included 1,894 cases of dementia registered by the Registry of Dementias of Girona from 2007 to 2009. Prescribed drugs were categorized according to the Anatomical Therapeutic Chemical (ATC) classification. A descriptive analysis of drug consumption was stratified according to age, gender, dementia subtypes and dementia severity. Binary logistic regression models were adjusted to detect the association of these variables with drug consumption according to the ATC groups.

Results

The most commonly prescribed drugs were for the central nervous system (CNS) (96.4 %), cardiovascular system (79.4 %) and digestive and metabolic system categories (77.7 %). No significant differences were found between the use of nervous system drugs and age, gender, dementia subtypes or dementia severity. The use of alimentary tract and metabolism related drugs, as well as cardiovascular and blood system drugs, were positively correlated with age and secondary dementia. The prevalence of use of cardiovascular and musculoskeletal drugs was higher in women than in men (OR: 1.34; OR: 1.26 respectively). A negative association was found between the severity of dementia and the use of musculoskeletal drugs (OR: 0.71), while its use was significantly higher in the youngest patients (OR: 1.71).

Conclusions

Almost all patients with dementia received a CNS drug, being at risk of inappropriate treatment. Treatment for comorbidities in patients with dementia should not be withheld on the basis of age or dementia severity, but rather on the benefit/risk ratio of its prescription. Further studies are needed to evaluate potentially inappropriate drug use and possible untreated conditions in this population.

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References

  1. Ferri CP, Prince M, Brayne C, Brodaty H, Fratiglioni L, Ganguli M et al (2005) Alzheimer’s Disease International. Global prevalence of dementia: a Delphi consensus study. Lancet 366:2112–2117. doi:10.1016/S0140-6736(05)67889-0

    Article  PubMed  Google Scholar 

  2. Alzheimer’s Association, Thies W, Bleiler L (2011) Alzheimer’s disease facts and figures. Alzheimers Dement J Alzheimers Assoc 7:208–244. doi:10.1016/j.jalz.2011.02.004

    Article  Google Scholar 

  3. Brodaty H, Breteler MB, Dekosky ST, Dorenlot P, Fratiglioni L, Hock C, Kenigsberg PA, Scheltens P, De Strooper B (2011) The World of Dementia Beyond 2020. J Am Geriatr Soc 59:923–927. doi:10.1111/j.1532-5415.2011.03365

    Article  PubMed  Google Scholar 

  4. Spanish Epidemiological Studies on Ageing Group, Virués-Ortega J, de Pedro-Cuesta J, Vega S, Seijo-Martínez M, Saz P, Rodríguez F et al (2011) Prevalence and European comparison of dementia in a ≥ 75-year-old composite population in Spain. Acta Neurol Scand 123:316–324. doi:10.1111/j.1600-0404.2010.01398

    Article  PubMed  Google Scholar 

  5. de Pedro-Cuesta J, Virués-Ortega J, Vega S, Seijo-Martínez M, Saz P, Rodríguez F et al (2009) Prevalence of dementia and major dementia subtypes in Spanish populations: a reanalysis of dementia prevalence surveys, 1990–2008. BMC Neurol 9:55. doi:10.1186/1471-2377-9-55

    Article  PubMed  Google Scholar 

  6. García García FJ, Sánchez Ayalab MI, Pérez Martín A, Martin Corre E, Marsal Alonso C, Rodríguez Ferrer G et al (2001) Prevalencia de demencia y de sus subtipos principales en sujetos mayores de 65 años: efecto de la educación y ocupación. Estudio Toledo. [The prevalence of dementia and its main subtypes in subjects older than 65 years: the effects of occupation and education. Toledo Study]. Med Clin (Barc) 116:401–407

    Article  Google Scholar 

  7. Criado-Alvarez JJ, Barrientos R (2010) Variabilidad y tendencias en el uso de fármacos contra la demencia. Estimación de la prevalencia de la enfermedad de Alzheimer en Castilla-La Mancha [Variability and trends in dementia drug consumption in Castille-La Mancha (Spain)]. Estimated prevalence of Alzeheimer’s disease. Neurologia 25:234–238

    Article  PubMed  CAS  Google Scholar 

  8. Milton JC, Hill-Smith I, Jackson SHD (2008) Prescribing for older people. BMJ 336:606–609. doi:10.1136/bmj.39503.424653.80

    Article  PubMed  Google Scholar 

  9. Instituto Nacional de Estadística. IneBase: cifras de población. Available at: http://www.scribd.com/doc/45546624/Eurostat-YearBook-2010. Accessed 21 November 2011- Updated 4th April 2011.

  10. Instituto de Información Sanitaria (2004) Consumo farmacéutico por grupos, edad y sexo. Porcentajes. Ministerio de Sanidad y Consumo, Madrid

    Google Scholar 

  11. Instituto de Información Sanitaria (2005) Consumo farmacéutico por grupos, edad y sexo. Indicadores. Ministerio de Sanidad y Consumo, Madrid

    Google Scholar 

  12. Garrido-Garrido EM, García-Garrido I, García-López-Durán JC, García-Jiménez F, Ortega López I, Bueno-Cavanillas A (2011) Estudio de pacientes polimedicados mayores de 65 años en un centro de asistencia primaria urbano [Study of polymedicated patients over 65 years-old in an urban primary care centre]. Rev Calidad Asistencial 26:90–96

    Article  CAS  Google Scholar 

  13. Planas-Pujol X, López-Pousa S, Vilalta Franch J, Montserrat-Vila S, Garre-Olmo J (2010) Perfil de consumo farmacológico y función cognoscitiva en edad avanzada: estudio de población general no insitucionalizada [Drug consumption and cognitive function in non-institutionalized elderly: a population-based study]. Rev Neurol 25:498–506

    Article  CAS  Google Scholar 

  14. Fernández-Liz E, Modamio P, Catalán A, Lastra CF, Rodríguez T, Mariño EL (2008) Identifying how age and gender influence prescription drug use in a primary health care environment in Catalonia, Spain. Br J Clin Pharmacol 65:407–417. doi:10.1111/j.1365-2125.2007.03029.x

    Article  PubMed  Google Scholar 

  15. Gavilán Moral E, Morales Suárez-Varela MT, Hoyos Esteban JA, Pérez Suanes AM (2006) Polimedicación y prescripción de fármacos inadecuados en pacientes ancianos inmovilizados que viven en la comunidad. [Inappropriate multiple medication and prescribing of drugs in immobile elderly patients living in the community]. Aten Primaria 38:476–482

    Article  PubMed  Google Scholar 

  16. Mort JR, Aparasu RR (2002) Prescribing of psychotropics in the elderly: why is it so often inappropriate? CNS Drugs 16:99–109

    Article  PubMed  Google Scholar 

  17. van der Hooft CS, Jong GW, Dieleman JP, Verhamme KM, van der Cammen TJ, Stricker BH, Sturkenboom MC (2005) Inappropriate drug prescribing in older adults: the updated 2002 Beers criteria—a population-based cohort study. Br J Clin Pharmacol 60:137–144. doi:10.1111/j.1365-2125.2005.02391

    Article  PubMed  Google Scholar 

  18. Gallagher P, Barry P, O’Mahony D (2007) Inappropriate prescribing in the elderly. J Clin Pharm Ther 32:13–121. doi:10.1111/j.1365-2710.2007.00793.x

    Article  Google Scholar 

  19. Lövheim H, Karlsson S, Gustafson Y (2008) The use of nervous system drugs and analgesics among very old people with and without dementia. Pharmacoepidemiol Drug Saf 17:912–918. doi:10.1002/pds.1600

    Article  PubMed  Google Scholar 

  20. Fialová D, Onder G (2009) Medication errors in elderly people: contributing factors and future perspectives. Br J Clin Pharmacol 67:641–645. doi:10.1111/j.1365-2125.2009.03419

    Article  PubMed  Google Scholar 

  21. Nijk RM, Zuidema SU, Koopmans RT (2009) Prevalence and correlates of psychotropic drug use in Dutch nursing-home patients with dementia. Int Psychogeriatr 21:485–493. doi:10.1017/S1041610209008916

    Article  PubMed  Google Scholar 

  22. Mann E, Köpke S, Haastert B, Pitkälä K, Meyer G (2009) Psychotropic medication use among nursing home residents in Austria: a cross-sectional study. BMC Geriatr 21:18. doi:10.1186/1471-2318-9-18

    Article  Google Scholar 

  23. Olsson J, Bergman A, Carlsten A, Oké T, Bernsten C, Schmidt IK, Fastbom J (2010) Quality of drug prescribing in elderly people in nursing homes and special care units for dementia: a cross-sectional computerized pharmacy register analysis. Clin Drug Investig 30:289–300. doi:10.2165/11534320

    Article  PubMed  CAS  Google Scholar 

  24. Fort I, Formiga F, Robles MJ, Regalado P, Rodríguez E (2010) Alta prevalencia de consumo de neurolépticos en las personas ancianas con demencia [High prevalence of neuroleptic drug use in elderly people with dementia]. Med Clin (Barc) 134:101–106

    Article  Google Scholar 

  25. Jedenius E, Johnell K, Fastbom J, Strömqvist J, Winblad B, Andreasen N (2011) Dementia management programme in a community setting and the use of psychotropic drugs in the elderly population. Scand J Primary Health Care; Early Online, 1–6.doi: 10.3109/02813432.2011.585277

  26. López-Pousa S, Garre-Olmo J, Monserrat-Vila S et al (2006) Propuesta para un registro clínico de demencias [A proposal for a clinical registry of dementias]. Rev Neurol 43:32–38

    PubMed  Google Scholar 

  27. Garre-Olmo J, López-Pousa S, Monserrat-Vila S et al (2007) Viabilidad de un registro de demencias: características clínicas y cobertura diagnóstica [The feasibility of a registry of dementias: clinical features and diagnostic coverage]. Rev Neurol 44:385–391

    PubMed  CAS  Google Scholar 

  28. Garre-Olmo J, Flaqué M, Gich J, Osuna Pulido T, Turbau J, Vallmajo N, Registry of Dementia of Girona Study Group (ReDeGi Group) (2009) A clinical registry of dementia based on the principle of epidemiological surveillance. BMC Neurol 9:5. doi:10.1186/1471-2377-9-5

    Article  PubMed  Google Scholar 

  29. German RR, Armstrong G, Birkhead GS (2001) Surveillance coordination Group. Updated guidelines for evaluating public health surveillance systems. MMWR Morb Mortal Wkly Rep 50:1–35

    CAS  Google Scholar 

  30. World Health Organisation (2007) Anatomical Therapeutical Chemical (ATC) Classification Index Including Defined Daily Doses (DDD) for Plain Substances. World Health Organisation Collaborating Centre for Drug Statistics Methodology, Oslo

    Google Scholar 

  31. Nygaard HA, Naik M, Ruths S, Straand J (2003) Nursing-home residents and their drug use: a comparison between mentally intact and mentally impaired residents. The Bergen district nursing home (BEDNURS) study. Eur J Clin Pharmacol 59:463–469. doi:10.1007/s00228-003-0646-7

    Article  PubMed  Google Scholar 

  32. Barat I, Andreasen F, Damsgaard MS (2000) The consumption of drugs by 75-year-old individuals living in their own homes. Eur J Clin Pharmacol 56:501–509

    Article  PubMed  CAS  Google Scholar 

  33. Wills P, Claesson CB, Fratiglioni L, Fastbom J, Thorslund M, Winblad B (1997) Drug use by demented and non-demented elderly people. Age Ageing 26:383–391

    Article  PubMed  CAS  Google Scholar 

  34. Elseviers MM, Vander Stichele RR, Van Bortel L (2010) Drug utilization in Belgian nursing homes: impact of residents’ and institutional characteristics. Pharmacoepidemiol Drug Saf 19:1041–1048. doi:10.1002/pds

    Article  PubMed  Google Scholar 

  35. Prieto Lozano A, Wilke Trinxant A, Soldado Ordóñez C, Moliner Molins C, Gené BJ (1997) Rational use of drugs for the aged. Aten Primaria 19:96–100

    PubMed  CAS  Google Scholar 

  36. Pedrera Zamorano JD, Canal Macías ML, Lavado García JM, Postigo Mota S, Sánchez Belda M, Durán Gómez N (1999) A health study of older persons in Extremadura: drug taking and the most frequent chronic diseases. Rev Esp Salud Publica 73:677–686

    PubMed  CAS  Google Scholar 

  37. Durant R, Boulanger-Morel M, Ferry J, Blain A, Blain H, Jeandel C (2003) Drug prescriptions for the elderly. Results of a survey on 8,809 prescriptions obtained by coding in the North-East area of France. Press Med 12:630–637

    Google Scholar 

  38. Pizzuti R, Caffari B, Binkin N, Gruppo ARGENTO (2006) Prescription drugs and the elderly: results of the Argento study. Ig Sanita Pubbl 62:11–26

    PubMed  Google Scholar 

  39. Crentsil V, Ricks MO, Xue QL, Fried LP (2010) A pharmacoepidemiologic study of community-dwelling, disabled older woman: factors associated with medication use. Am J Geriatr Pharmacother 8:215–224. doi:10.1016/j.amjopharm.2010.06.003

    Article  PubMed  Google Scholar 

  40. Valderrama E, Rodríguez F, Palacios A, Gabarre P, Pérez del Molino J (1998) Consumo de medicamentos en los ancianos: resultado de un estudio poblacional (The use of medications among the elderly: results of a population-based study). Rev Esp Salud Publica 72:209–219

    Google Scholar 

  41. Arjona Mateos CR, Criado Velasco J, Sánchez SL (2002) Enfermedades crónicas y consumo de fármacos en mayores de 65 años. (Chronic diseases and drug consumption in patients over 65 years-old). Med Gen 47:684–695

    Google Scholar 

  42. Brodaty H, Draper B, Saab D, Low LF, Richards V, Paton H, Lie (2001) Psychosis, depression and behavioural disturbances in Sydney nursing home residents: prevalence and predictors. Int J Gertiar Psychiatry 16:504–512

    Article  CAS  Google Scholar 

  43. Andersen F, Viitanen M, Halvorsen DS, Straume B, Engstad (2011) Co-morbidity and drug treatment in Alzeheimer’s disease. A cross-sectional study of participants in the Dementia Study in Northern Norway. BMC Geriatr 11:58. doi:10.1186/1471-2318-11-58

    Article  PubMed  Google Scholar 

  44. Kessing VL, Harhoff M, Andersen PK (2007) Treatment with antidepressants in patients with dementia- a nationwide register-based study. Int Psychogeriatr 19:902–913

    Article  PubMed  Google Scholar 

  45. Calvó-Perxas L, de Eugenio RM, Marquez-Daniel F, Martínez R, Serena J, Turbau J, Vilalta-Franch J, Viñas M, Turró-Garriga O, Roig AM, López-Pousa S, Garre-Olmo J (2012) Profile and variables related to antipsychotic consumption according to dementia subtypes. Int Psychogeriatr 14:1–8. doi:10.1017/S1041610212000026

    Google Scholar 

  46. Schmader KE, Hanlon JT, Fillenbaum GG, Huber M, Pieper C, Horner R (1998) Medication use patterns among demented, cognitively impaired and cognitively intact community-dwelling elderly people. Age Ageing 27:493–501

    Article  PubMed  CAS  Google Scholar 

  47. Shaffer T, Simoni-Wastila L, Toler W, Stuart B, Doshi JA (2010) Changing patterns in medication use with increasing probability of death for older Medicare beneficiaries. J Am Geriatr Soc 58:1549–1555. doi:10.1111/j.1532-5415.2010.02957.x

    Article  PubMed  Google Scholar 

  48. Rochon PA, Normand SL, Gomes T, Gill SS, Anderson GM, Melo M et al (2008) Antipsychotic therapy and short-term serious events in older adults with dementia. Arch Intern Med 168:1090–1096. doi:10.1001/archinte.168.10.1090

    Article  PubMed  Google Scholar 

  49. Gallagher P, Ryan C, Byrne S, Kennedy J, O’Mahony D (2008) STOPP (Screening Tool of Older Person’s Prescriptions) and START (Screening Tool to Alert doctors to Right Treatment). Consensus validation. Int J Clin Pharmacol Ther 46:72–83

    PubMed  CAS  Google Scholar 

  50. van der Hooft CS, Jong GW, Dieleman JP, Verhamme KM, van der Cammen TJ, Stricker BH, Sturkenboom MC (2005) Inappropriate drug prescribing in older adults: the updated 2002 Beers criteria–a population-based cohort study. Br J Clin Pharmacol 60:137–144. doi:10.1111/j.1365-2125.2005.02391.x

    Article  PubMed  Google Scholar 

  51. Kaufman DW, Kelly JP, Rosenberg L, Anderson TE, Mitchel AA (2002) Recent patterns of medication use in the ambulatory adult population of the United States: the Sloan survey. JAMA 287:337–344

    Article  PubMed  Google Scholar 

  52. Bjerrum L, Søgaard J, Hallas J, Kragstrup J (1998) Polypharmacy: correlations with sex, age and drug regimen. Eur J Clin Pharmacol 54:197–202

    Article  PubMed  CAS  Google Scholar 

  53. de Craen AJM, Gussekloo J, Vrijsen B, Westendorp RGJ (2005) Meta-analysis of nonsteroidal antiinflammatory drug use and risk of dementia. Am J Epidemiol 161:114–120. doi:10.1093/aje/kwi029

    Article  PubMed  Google Scholar 

  54. Husebo BS, Ballard C, Aarsland D (2011) Pain treatment of agitation in patients with dementia: a systematic review. Int J Geriatr Psychiatry 26:1012–1018. doi:10.1002/gps.2649

    Article  PubMed  CAS  Google Scholar 

  55. Husebo BS, Ballard C, Sandvik R, Nilsen OB, Aarsland D (2011) Efficacy of treating pain to reduce behavioural disturbances in residents of nursing homes with dementia: cluster randomised clinical trial. BMJ 343:4065. doi:10.1136/bmj.d4065

    Article  Google Scholar 

  56. Hsu CC, Wahlqvist ML, Lee MS, Tsai HN (2011) Incidence of dementia is increased in type 2 diabetes and reduced by the use of sulfonylureas and metformin. J Alzheimers Dis 24:485–493. doi:10.3233/JAD-2011-101524

    PubMed  CAS  Google Scholar 

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Declaration of interest

The authors declare that they have no conflict of interest.

Study funding

The ReDeGi is founded by the Health Region of Girona (HRG) from the Department of Health of the Generalitat de Catalunya (Spain).

The funding source had no involvement in the decision to submit the paper for publication.

Author information

Authors and Affiliations

  1. Research Unit, Institut d’Assistència Sanitària, Girona, Spain

    Pilar Àvila-Castells, Josep Garre-Olmo, Laia Calvó-Perxas, Oriol Turró-Garriga & Secundino López-Pousa

  2. Clinical Pharmacology Section, Nursing Faculty, Universiy of Girona, Girona, Spain

    Pilar Àvila-Castells

  3. Department of Psychology, University of Girona, Girona, Spain

    Josep Garre-Olmo

  4. Dementia Unit, Hospital de Palamós, Palamós, Spain

    Elisabet Alsina

  5. Neurology Department, Hospital de Figueres, Figueres, Spain

    Olga Carmona

  6. Neurology and Geriatrics Departments, Hospital de Blanes, Blanes, Spain

    Héctor Perkal

  7. Pharmacy Unit, Health Region of Girona, Girona, Spain

    Anna Maria Roig

  8. Neurology Department, Hospital de Campdevànol, Campdevànol, Spain

    Josep Ma Cuy

  9. Dementia Unit, Hospital Santa Caterina, Salt, Spain

    Manuela Lozano & Secundino López-Pousa

  10. Department of Neurology, Hospital Universitari Josep Trueta, Girona, Spain

    Albert Molins

  11. Neurology and Geriatrics Departments, Hospital d’Olot, Olot, Spain

    Natàlia Vallmajó

  12. C/Dr Castany s/n, 17190, Salt, Girona, Spain

    Josep Garre-Olmo

Authors
  1. Pilar Àvila-Castells
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  2. Josep Garre-Olmo
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  3. Laia Calvó-Perxas
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  4. Oriol Turró-Garriga
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  6. Olga Carmona
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  8. Anna Maria Roig
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  9. Josep Ma Cuy
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  10. Manuela Lozano
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  11. Albert Molins
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  12. Natàlia Vallmajó
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  13. Secundino López-Pousa
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on behalf of the Registry Dementia of Girona Study Group

Corresponding author

Correspondence to Josep Garre-Olmo.

Additional information

The ReDeGi Group consists of the following co-investigators

1- Department of Neurology, Hospital Universitari Josep Trueta: Mar Castellanos, PhD; David Genís Batlle, MD; Jordi Gich, BPsych; Rosa Meléndez, MD; Albert Molins, MD; Lluís Ramió, MD; Joaquín Serena, PhD; Yolanda Silva, PhD.

2- Dementia Unit, Hospital Santa Caterina: Marta Hernández, BPsych; Saioa Lejarreta, MD; Manuela Lozano, BPsych; Immaculada Pericot, PhD; Joan Vilalta-Franch, PhD; Antoni Turon Estrada, PhD; Josefa Turbau, MD; Jordi Llinàs, BPsych; Secundino López-Pousa, PhD.

3- Dementia Unit, Hospital de Palamós: Elisabet Alsina, BSw; Rosa de Eugenio, MD; Erélido Hernández, MD; Margarita Flaqué, BPsych.

4- Neurology Department, Hospital de Figueres: Olga Carmona, MD; Marta Cullell, BPsych; Teresa Osuna, MD; Maria Aguirregomozcorta, MD; Mª del Mar Fernández, MD.

5- Neurology and Geriatrics Departments, Hospital d’Olot: Josep Bisbe, MD; Marta Linares, BPsych; Fabian Marquez Daniel, MD; Natalia Vallmajó, MD.

6- Neurology and Geriatrics Departments, Hospital de Blanes: Fernando Espada, MD; Teresa Casadevall, MD; Héctor Perkal, MD; Marta Viñas, MD.

7- Neurology Department; Hospital de Campdevànol: Isabel Casas, BPsych; Josefa Turbau, MD; Josep Ma Cuy, MD; Anna Manzano, MD.

8- Pharmacy Unit, Healh Region of Girona: Anna Maria Roig, BPharm; Joan Coromina, BPharm; Mònica Palacios Soto, BPharm.

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Àvila-Castells, P., Garre-Olmo, J., Calvó-Perxas, L. et al. Drug use in patients with dementia: a register-based study in the health region of Girona (Catalonia/Spain). Eur J Clin Pharmacol 69, 1047–1056 (2013). https://doi.org/10.1007/s00228-012-1451-y

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