Medication Use Among Nursing Home Residents With Severe Dementia: Identifying Categories of Appropriateness and Elements of a Successful Intervention

被引：33

作者：

Kroeger, Edeltraut ^{[1
,2
]}

Wilchesky, Machelle ^{[3
,4
]}

Marcotte, Martine ^{[1
]}

Voyer, Philippe ^{[1
,5
]}

Morin, Michele ^{[1
,6
]}

Champoux, Nathalie ^{[7
]}

Monette, Johanne ^{[4
]}

Aubin, Michele ^{[1
,8
]}

Durand, Pierre J. ^{[1
,2
,9
]}

Verreault, Rene ^{[1
,9
]}

Arcand, Marcel ^{[10
]}

机构：

[1] CHU Quebec, Ctr Excellence Vieillissement Quebec, Quebec City, PQ, Canada

[2] Univ Laval, Fac Pharm, Quebec City, PQ G1K 7P4, Canada

[3] Donald Berman Maimonides Geriatr Ctr, Montreal, PQ, Canada

[4] McGill Univ, Div Geriatr Med, Montreal, PQ, Canada

[5] Univ Laval, Fac Sci Infirm, Quebec City, PQ G1K 7P4, Canada

[6] Univ Laval, Dept Med, Fac Med, Quebec City, PQ G1K 7P4, Canada

[7] Inst Univ Geriatr Montreal, Montreal, PQ, Canada

[8] Univ Laval, Fac Med, Dept Med Familiale, Quebec City, PQ G1K 7P4, Canada

[9] Univ Laval, Fac Med, Dept Med Sociale & Prevent, Quebec City, PQ G1K 7P4, Canada

[10] Univ Sherbrooke, Ctr Rech Vieillissement, Sherbrooke, PQ J1K 2R1, Canada

来源：

JOURNAL OF THE AMERICAN MEDICAL DIRECTORS ASSOCIATION | 2015年 / 16卷 / 07期

关键词：

Nursing home resident; severe dementia; medication use; appropriateness; criteria; intervention; interdisciplinary; ADVERSE DRUG-REACTIONS; POTENTIALLY INAPPROPRIATE MEDICATIONS; RANDOMIZED CONTROLLED-TRIAL; STOPP SCREENING TOOL; ELDERLY-PATIENTS; OLDER-ADULTS; EXPLICIT CRITERIA; BEERS CRITERIA; PRESCRIBING INDICATORS; PHARMACEUTICAL CARE;

D O I：

10.1016/j.jamda.2015.04.002

中图分类号：

R592 [老年病学]; C [社会科学总论];

学科分类号：

03 ; 0303 ; 100203 ;

摘要：

Background: Seniors with severe dementia residing in nursing homes (NHs) frequently receive large numbers of medications. With disease progression, the medications' harm-benefit ratio changes and they need to be reviewed, adjusted, or discontinued. Evidence on successful interventions to optimize medication use among these residents is lacking. Objectives: The objective of the study was to identify categories of appropriateness for medications as well as successful interventions or elements thereof to improve medication use in NH residents with severe dementia, suitable for use in Canada. Methods: A scoping literature review was performed to identify criteria and categories of appropriateness of medications for these residents as well as elements of successful interventions to optimize medication use. A 15-member multidisciplinary Delphi panel was convened to evaluate the applicability of these findings for NHs in a Canadian province. Results: The scoping review identified 1 study presenting categories of appropriateness specific to residents with severe dementia and 35 interventions aimed at reducing drug-drug interactions, inappropriate use of specific drug classes, inappropriate drug use overall, or polypharmacy. Regarding appropriateness, the Delphi panel agreed on the categorization of 63 medications or medication classes as "generally," "sometimes," or "rarely appropriate." The main elements of interventions successful in improving appropriate medication use in NH residents with dementia also were approved by the Delphi panel (ie, medication reviews using criteria of appropriateness, educational and training sessions, and interdisciplinary case conferences). Conclusions: These results may be used to develop an intervention to optimize medication use in NH residents with severe dementia. (C) 2015 AMDA - The Society for Post-Acute and Long-Term Care Medicine.

引用

页码：629.e1 / 629.e17

页数：17

共 122 条

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