International Journal of Preventive Medicine Research
Articles Information
International Journal of Preventive Medicine Research, Vol.4, No.2, Jun. 2018, Pub. Date: Jun. 7, 2018
Potentially Inappropriate Medication in Patients Admitted with Diagnosis of Delirium Superimposed on Dementia
Pages: 18-24 Views: 128 Downloads: 75
Authors
[01] Gudrun Hefner, Psychiatric Hospital, Vitos Klinik Hochtaunus, Friedrichsdorf, Germany.
[02] Martina Hahn, Psychiatric Hospital, Vitos Klinik Eichberg, Eltville, Germany.
[03] Sibylle Christine Roll, Psychiatric Hospital, Vitos Klinik Eichberg, Eltville, Germany.
[04] Ansgar Klimke, Psychiatric Hospital, Vitos Klinik Hochtaunus, Friedrichsdorf, Germany.
[05] Christoph Hiemke, Department of Psychiatry and Psychotherapy, University Medical Center, Mainz, Germany.
[06] Joachim Röschke, SCIVIAS Psychiatric Hospital, Bad Soden, Germany.
Abstract
Drugs may enhance the incidence of delirium in predisposed patients with dementia. This study analyzed prescription of potentially inappropriate medications (PIMs) of the Priscus list and the delirigenic burden of drugs and their role as precipitating factors for the development of delirium in patients with dementia. Patients with the diagnosis of dementia who had been hospitalized because of a delirium were screened retrospectively for number and sort of PIMs, as defined by the Priscus list. The delirogenic drug burden was assessed by a risk-scale ranging from 0 (not existing) to 4 (high) per drug and calculation of a sum score per patient. Overall, 79 patients (57.0% female) with a mean (Mean±SD) age of 81.1±6.6 years were included. They received by mean 6.0±3.3 drugs at admission and 6.9±2.8 at discharge. At admission 15 patients (19.0%) received at least one Priscus-PIM and 57 (72.9%) at least one drug with delirogenic properties. Prescription of PIMs slightly decreased by 20% at discharge. The mean delirogenic burden sum score was 2.0±2.1 (range 0-11) at admission and decreased by 40% to 1.2±1.2 (range 0-5) at discharge. Drugs were diagnosed as precipitating factors for delirium in 13 patients (16.5%). Besides amitriptyline, drugs with a strong delirogenic activity, as promethazine or levomepromazine, have not been considered as a possible reason for delirium. Although physicians try to avoid inappropriate drug-prescribing to demented patients, delirogenic drugs are frequently given to patients with dementia and in a significant number of patients they were associated with the occurrence of delirium. Preliminary evidence indicated that reduction of the delirogenic burden score of the medication is more appropriate to dimish this risk than reduction of PIM prescriptions. More cautious prescribing by the physician is indicated and future interventions may need to focus on polypharmacy to optimize pharmacological treatment in vulnerable demented patients.
Keywords
Dementia, Delirium, Potentially Inappropriate Medication, Priscus-List, Adverse Drug Reactions, Risk-Scale
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