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Interventions to Optimise Prescribing in Older People with Dementia: A Systematic Review

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Abstract

Background

Older adults living with dementia may have a higher risk of medication toxicity than those without dementia. Optimising prescribing in this group of people is a critically important yet challenging process.

Objective

Our aim was to systematically review the evidence for the effectiveness of interventions for optimising prescribing in older people with dementia.

Methods

This systematic review searched the Pubmed, Embase, CINAHL, PsycINFO and Cochrane Library electronic databases for studies that evaluated relevant interventions. Experimental, quasi-experimental and observational studies published in English prior to August 2018 were included. Data were synthesised at a narrative level.

Results

The 18 studies accepted for review included seven randomised, two nonrandomised controlled, five quasi-experimental and four observational studies. Half the studies were conducted in nursing homes and the other half in hospital and community settings. There was great variability in the interventions and outcomes reported and a meta-analysis was not feasible. The three randomised and four nonrandomised studies examining medication appropriateness all reported improvements on at least one measure of the outcome. Six studies reported on interventions that identified and resolved drug-related problems. The results for other outcomes, including the number of medications (10 studies), healthcare utilisation (7 studies), mortality (7 studies), quality of life (3 studies) and falls (3 studies), were mixed and difficult to synthesise because of variability in the study design and measures used.

Conclusion

Emerging evidence suggests that interventions in older people with dementia may have positive effects on medication appropriateness and resolution of drug-related problems; however, whether optimisation of medication results in clinically meaningful outcomes remains uncertain.

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Acknowledgements

The authors would like to thank Ms. Christine Dalais (The University of Queensland Library) for her help with the development of the search strategy.

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Authors and Affiliations

  1. Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia

    Leila Shafiee Hanjani, Nancye M. Peel & Ruth E. Hubbard

  2. Department of Pharmacy, Princess Alexandra Hospital, Woolloongabba, QLD, Australia

    Duncan Long

  3. Global Brain Health Institute, Trinity College, Dublin, Ireland

    Geeske Peeters

  4. Centre for Optimising Pharmacy Practice-based Excellence in Research, The University of Queensland, Brisbane, QLD, Australia

    Christopher R. Freeman

  5. PA-Southside Clinical Unit, Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia

    Ruth E. Hubbard

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  1. Leila Shafiee Hanjani
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Correspondence to Leila Shafiee Hanjani.

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Conflict of interest

Leila Shafiee Hanjani, Duncan Long, Nancye M. Peel, Geeske Peeters, Christopher R. Freeman and Ruth E. Hubbard declare that they have no conflicts of interest.

Funding

Leila Shafiee Hanjani is supported by an Australian Government Research Training Program (RTP), and Geeske Peeters is supported by a fellowship from the Global Brain Health Institute. This work was supported by the National Health and Medical Research Council (NHMRC) Partnership Centre for Dealing with Cognitive and Related Functional Decline in Older People (Grant no. GNT9100000). No other sources of funding were used to assist in the preparation of this article.

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Shafiee Hanjani, L., Long, D., Peel, N.M. et al. Interventions to Optimise Prescribing in Older People with Dementia: A Systematic Review. Drugs Aging 36, 247–267 (2019). https://doi.org/10.1007/s40266-018-0620-9

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  • DOI: https://doi.org/10.1007/s40266-018-0620-9

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