Pharmacotherapy of people screened positive for dementia in primary care: Results of the DelpHi study

People with dementia (PwD) are often multimorbid and have complex pharmacotherapy regimens associated with an increased number of drug-related problems. This can lead to a reduction in the quality of life and increased hospitalization rates for PwD, and high costs for the national health system. Therefore, it is important to take the prevention of DRP into account when planning care programs for PwD. Previous medication safety and care studies mainly concentrated on institutionalized PwD. Little is known about the situation in community-dwelling PwD. The objectives of this thesis are to determine: (a) the frequency and type of antidementia drug treatment and associated socio-demographic and clinical variables (b) the prevalence of PIM according to the Priscus list and associated sociodemographic and clinical variables associated (c) the frequency and the type of DRPs and associated socio-demographic and clinical variables in community-dwelling primary care patients who were screened positive for dementia. The analyses are based on the data from the DelpHi-MV study, a cluster-randomized, controlled intervention trial to implement and evaluate an innovative concept of collaborative dementia care management in Germany. The data of N=448 study participants (≥70 years, living at home) screened positive for dementia (DemTect<9) with a complete baseline medication assessment were included in the analysis. The results showed that 30% of community-dwelling people who were screened positive for dementia received antidementia drugs, 63% of these had a formal diagnosis of dementia. In the subgroup of study participants with a formal diagnosis of dementia 46% received antidementia medication. The prescription for antidementia drugs was significantly associated with the severity of cognitive impairment and a formal dementia diagnosis. 38% of patients without diagnosis receive antidementia drugs. 22% of study participants received at least one PIM according to the Priscus list. The cognitive impairment was not associated with PIM use. The prescription of a PIM was significantly associated with the total number of drugs taken, and with a diagnosis of a mental or behavioral disorder. Polypharmacy, defined as the chronical use of five or more medications, was identified in 67% of the study participants, 93% had at least one DRP detected by a pharmacist or a study nurse during a home visit. A total 1,077 DRPs were registered. Problems related to administration and compliance were the most common group of DRPs, followed by problems with drug interactions, problems with inappropriate drug choice, problems with the dosage, and problems with adverse drug events. Cognitive impairment was not associated with the total number of DRPs. The total number of drugs taken and the presence of a diagnosis of mental and behavioral disorders were associated with total number of DRPs. The thesis provides an overview of the complete medication and DRPs of PwD in primary care. Among others, the problems of antidementia drug treatment and intake of the PIMs were discussed. The thesis suggests that medication management based on home medication assessment is important for PwD, because such a review ensures the availability of comprehensive information on the actual complete medication, nutritional factors, and real drug administration. The thesis thus provides a basis for the improvement of medication safety and the development of innovative care concepts for PwD. The high prevalence of DRPs in this population underlines the importance of including a systematic medication management into dementia treatment and care programs. Identified risk factors for DRPs can help to allocate medication management to the patient groups that are at the highest risk.