Medicine Optimisation and Deprescribing Intervention Outcomes for Older People with Dementia or Mild Cognitive Impairment: A Systematic Review.

IF 3.4 3区 医学 Q2 GERIATRICS & GERONTOLOGY
Nicola Andrews, Cindy Brooks, Michele Board, Simon Fraser, Sue Latter, Kirsty Aplin, Beth McCausland, Eloise Radcliffe, Jay Amin, Rosemary Lim, Ellen van Leeuwen, Kinda Ibrahim
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引用次数: 0

Abstract

Background: Polypharmacy is common amongst older people with dementia or mild cognitive impairment (MCI), increasing the risk of medication-related harm. Medicine optimisation and deprescribing to reduce polypharmacy is considered feasible, safe and can lead to improved health. However, for those living with dementia or MCI, this can be challenging. This systematic review aimed to summarise the evidence on the outcomes of medicine optimisation and deprescribing interventions for older people with dementia or MCI.

Methods: Literature was searched using CINAHL, Embase, Medline, PsychINFO, Web of Science and the Cochrane Library from database inception to January 2024. Papers reporting data specific to people with dementia or MCI from medicine optimisation and deprescribing interventional research studies of any design and in any setting were included. A narrative synthesis was conducted owing to heterogeneity of study designs and outcomes. Quality was assessed using the Mixed Methods Appraisal Tool.

Results: A total of 32 papers reporting on 28 studies were included, with samples ranging from 29 to 17,933 patients and a mean patient age ranging from 74 to 88 years. Of the studies, 60% were undertaken in long-term care settings. Involvement of patients and/or carers in interventions was limited. Papers were grouped as either incorporating a medication review component (n = 13), education component (n = 5) or both (n = 14). Studies primarily focussed on medication-related outcomes, generally showing a positive effect on decreasing the number and improving appropriateness of medications. Fewer papers reported clinical outcomes (behavioural and psychological symptoms of dementia, falls, quality of life and cognition) with mixed findings. A reduction or no change in mortality or hospital attendance demonstrated safety of the interventions in the few papers reporting these outcomes. The quality of the evidence was mixed.

Conclusions: Medicine optimisation and deprescribing interventions generally reduced the number and increased the appropriateness of medications, and although less frequently reported, these interventions seemed to be safe and showed an absence of worsening of clinical outcomes. This review highlights a need for further research, particularly in people with dementia or MCI living at home, with more focus on clinical outcomes and a greater involvement of patients and informal carers.

Protocol registration: The protocol was published in the International Prospective Register of Systematic Reviews (PROSPERO) [Ref: CRD42023398139].

老年痴呆或轻度认知障碍患者的药物优化和处方化干预结果:一项系统综述。
背景:多重用药在老年痴呆或轻度认知障碍(MCI)患者中很常见,增加了药物相关伤害的风险。药物优化和减少处方以减少多药被认为是可行的,安全的,并可导致改善健康。然而,对于那些患有痴呆症或轻度认知障碍的人来说,这可能是一个挑战。本系统综述旨在总结针对老年痴呆或轻度认知障碍患者的药物优化和处方干预结果的证据。方法:采用CINAHL、Embase、Medline、PsychINFO、Web of Science、Cochrane Library数据库自建库至2024年1月的文献检索。从药物优化和任何设计和任何环境下的介入性研究中报告痴呆症或轻度认知障碍患者特定数据的论文被纳入。由于研究设计和结果的异质性,进行了叙事综合。使用混合方法评价工具评价质量。结果:共纳入28项研究的32篇论文,样本29 ~ 17933例患者,患者平均年龄74 ~ 88岁。在这些研究中,60%是在长期护理环境中进行的。患者和/或护理人员参与干预的情况有限。论文分为药物评价部分(n = 13)、教育部分(n = 5)或两者兼而有之(n = 14)。研究主要集中在药物相关的结果上,通常显示出减少药物数量和提高药物适当性的积极作用。很少有论文报道临床结果(痴呆的行为和心理症状、跌倒、生活质量和认知),结果好坏参半。在少数报道这些结果的论文中,死亡率或住院率的降低或没有变化证明了干预措施的安全性。证据的质量好坏参半。结论:药物优化和处方化干预通常减少了药物的数量并增加了药物的适宜性,尽管报道较少,但这些干预似乎是安全的,并且没有显示出临床结果的恶化。这篇综述强调了进一步研究的必要性,特别是对住在家里的痴呆症或轻度认知障碍患者的研究,更多地关注临床结果,并让患者和非正式护理人员更多地参与其中。方案注册:该方案发表在国际前瞻性系统评价注册(PROSPERO) [Ref: CRD42023398139]。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Drugs & Aging
Drugs & Aging 医学-老年医学
CiteScore
5.50
自引率
7.10%
发文量
68
审稿时长
6-12 weeks
期刊介绍: Drugs & Aging delivers essential information on the most important aspects of drug therapy to professionals involved in the care of the elderly. The journal addresses in a timely way the major issues relating to drug therapy in older adults including: the management of specific diseases, particularly those associated with aging, age-related physiological changes impacting drug therapy, drug utilization and prescribing in the elderly, polypharmacy and drug interactions.
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