A narrative review of problems with medicines use in people with dementia

ABSTRACT

Introduction: People with dementia may be particularly susceptible to medication-related problems for various reasons. They include progressive cognitive decline, high sensitivity to the effect of medications on cognition and memory, and increased likelihood of comorbidities.

Areas covered: This paper aimed to review current literature on the frequency and the types of medication-related problems, and their contribution to hospital admission in people with dementia. Literature searches were conducted using key search terms of dementia and medication-related problems. Studies investigating any medication-related problems in people with dementia or cognitive impairment were included.

Expert opinion: Previous research showed a high prevalence of medication-related problems in people with dementia. However, no single category of medication-related problems was reported consistently as the most frequent type across studies. The available studies also showed that medication-related hospitalization was common among people with dementia. These findings underline the need for effective medication management services to reduce the risk of these problems in people with dementia and cognitive impairment. Further work is required to characterize medication-related problems comprehensively in this vulnerable patient group across settings of care. Future research should take a holistic approach in the identification of medication-related problems.

KEYWORDS:

• Adverse drug reactions
• dementia
• hospitalization
• medication adherence
• medication-related problems
• medication safety
• potentially inappropriate prescribing

Article highlights

• Overall, the body of literature in this area is limited to a few categories of medication-related problems (MRPs) in people with dementia and cognitive impairment in contrast to the broader scope of MRPs. However, the available studies showed that, when assessed comprehensively MRPs were more prevalent in people with dementia and cognitive impairment than those without.

• No single category of MRPs was reported consistently as the most frequent type across studies; however, unnecessary medication therapy, ADRs, and medication nonadherence were the most commonly identified MRPs. Furthermore; the use of potentially inappropriate medications was prevalent in people with dementia and cognitive impairment.

• Little research is available on the contribution of MRPs to hospital admission in people with dementia; however, a study from Sweden highlighted that MRPs were the major reason for hospitalization in people with dementia.

• Given the high prevalence of MRPs, there is a need for effective medication management services to ensure optimal therapeutic outcomes through improved medicines use in people with dementia and cognitive impairment.

• Further research is needed to fully characterize MRPs comprehensively across settings of care and should take a holistic approach to the identification of MRPs in people with dementia and cognitive impairment.

Declaration of interest

TCE is supported by an Australian Government Research Training Program Scholarship. The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was not funded.