Dementia In Older Adults: Examining Gaps in Medication Reviews and Clinical Outcomes
According to the World Health Organization dementia impacts more than 55 million people worldwide. As the global population ages this number is expected to increase to 150 million by 2050.[2-3] Dementia is an umbrella term that encompasses several neurodegenerative disorders that result in cognitive decline. The likelihood of developing dementia increases with age and older adults aged 65+ face the highest risk.[1-3] Cognitive impairment results in behavioural, memory, reasoning, focus, understanding, judgment and language issues, and these outcomes impact the everyday lives of persons living with dementia.[1-3] Because of this it is imperative that dementia is properly treated through appropriate medication regimens and management. In doing so, the symptoms of dementia can be managed.
Older adults with dementia are often prescribed five or more medications per day due to comorbid conditions. Polypharmacy significantly increases the risk of drug-related problems (DRPs). As illness advances, prescribing medications and changing treatment goals becomes increasingly complex. The optimization of medication use in older adults with dementia is central to this topic, and frequent medication reviews could potentially address this concern. The Patel Research Lab conducted a scoping review to explore the research conducted in this area.
The purpose of our scoping review was to identify gaps in the current knowledge about the impact of medication reviews on clinical outcomes of older individuals with dementia. To do this we used a 5-stage framework. We identified the research question, selected relevant studies for review, abstracted and analyzed the data. We found gaps in the assessment of medication adherence, cost-effectiveness, and dementia-specific outcomes. Seven areas which require greater assessment include:
More randomized control trials (RCTs) are needed to assess the impact of medication reviews in persons with dementia in the community setting, especially in Canada.
More studies that report DRPs in persons with dementia residing in long-term care (LTC) settings.
Increase in research studies examining the impact of medication reviews on medication management and adherence.
More research examining the cost-effectiveness of conducting medication reviews.
More data about patient and caregiver satisfaction following medication reviews.
More research on the impact of medication reviews on the quality of life in persons with dementia.
Greater application of a dementia-specific core outcome set.
The importance of addressing these gaps cannot be overlooked. Medication management and adherence are vital to the well-being of older adults with dementia, and researching these knowledge gaps can significantly improve the quality of life of these individuals. At Patel Research Lab we are committed to further exploring these limitations in order to provide quality care for patients.
Dementia. World Health Organization. 2015 March. https://www.who.int/news-room/fact-sheets/detail/dementia
World Health Organization. n. Available online: https://www.who.int/news/item/07-12-2017-dementia-number-of-peopleaffected-to-triple-in-next-30-years(accessed on 20 March 2023).
Dementia in Canada, including Alzheimer’s disease. Available online: https://www.canada.ca/en/public-health/services/ publications/diseases-conditions/dementia-highlights-canadian-chronic-disease-surveillance.html (accessed on 20 March 2023).
Hanjani, L.S.; Long, D.; Peel, N.M.; Peeters, G.; Freeman, C.R.; Hubbard, R.E. Interventions to optimise prescribing in older people with dementia: A systematic review. Drugs Aging 2019, 36, 247–267
Sharma R, Mahajan N, Fadaleh SA, Patel H, Ivo J, Faisal S, Chang F, Lee L, Patel T. Medication Reviews and Clinical Outcomes in Persons with Dementia: A Scoping Review. Pharmacy. 2023; 11(5):168. https://doi.org/10.3390/pharmacy11050168
Arksey, H.; O’Malley, L. Scoping studies: Towards a methodological framework. Int. J. Soc. Res. Methodol. 2005, 8, 19–32