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Reduction of suboptimal prescribing and clinical outcome for dementia patients in a senior behavioral health inpatient unit

Published online by Cambridge University Press:  20 November 2008

Virginia T. Chan ,
Benjamin K. P. Woo ,
Daniel D. Sewell ,
E. Clark Allen ,
Shahrokh Golshan ,
Valerie Rice ,
Arpi Minassian  and
John W. Daly
Virginia T. Chan
Affiliation:
Department of Psychiatry, University of California, San Diego, U.S.A.
Benjamin K. P. Woo
Affiliation:
Department of Psychiatry, University of California, Los Angeles-Kern County, Bakersfield, U.S.A.
Daniel D. Sewell*
Affiliation:
Department of Psychiatry, University of California, San Diego, U.S.A.
E. Clark Allen
Affiliation:
Department of Psychiatry, University of California, San Diego, U.S.A.
Shahrokh Golshan
Affiliation:
Department of Psychiatry, University of California, San Diego, U.S.A.
Valerie Rice
Affiliation:
Department of Psychiatry, University of California, San Diego, U.S.A.
Arpi Minassian
Affiliation:
Department of Psychiatry, University of California, San Diego, U.S.A.
John W. Daly
Affiliation:
Department of Internal Medicine, University of California, San Diego, U.S.A.
*
Correspondence should be addressed to: Daniel D. Sewell, M.D., University of California, San Diego, 200 West Arbor Drive, San Diego, CA 92103-8631, U.S.A. Phone: +1 619-543-3772; Fax: +1 619-543-3648. Email: dsewell@ucsd.edu.
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Abstract

Background: Suboptimal prescribing in older psychiatric patients causes iatrogenic morbidity. The objectives of this study were to compare the prevalence of suboptimal prescribing before and after admission to a geropsychiatry inpatient unit and to evaluate a possible correlation between optimal medication use and functional improvement in patients with dementia.

Methods: The study sample comprised 118 consecutively admitted patients to a 14-bed university hospital-based geropsychiatry inpatient unit over a period of 20 months who met the DSM-IVTR criteria for an Axis I psychiatric illness and co-morbid dementia. At admission demographic information, Mini-mental State Examination (MMSE) Score, Mattis Dementia Rating Scale Score (DRS), and number of active medical illnesses were recorded. At admission and discharge the number and type of medications, number of Revised Beers Criteria (RBC) medications (a published list of potentially inappropriate medications in older adults independent of diagnoses or conditions), Global Assessment of Functioning (GAF) scores, and Scale of Functioning (SOF) scores were tabulated. χ2 tests, paired t-tests and Pearson correlations were used to test the medication prevalence and associations between measures of clinical function and other variables.

Results: The mean age (standard deviation) of the sample was 81.5 (6.2) years. The mean scores on the MMSE and DRS were 22.1 (6.2) and 116.6 (18.7), respectively. From admission to discharge, the mean number of RBC medications per patient decreased significantly from 0.8 (1.1) to 0.4 (0.6). There was also a significant correlation between reduction in Beers criteria medications and improved SOF score from time of admission to time of discharge.

Conclusion: Suboptimal medication use is a potential source of decreased function in older patients with dementia.

Keywords

anticholinergicsbehavioral symptomsdementiaelderlypolypharmacy
Type
Research Article
Information
International Psychogeriatrics , Volume 21 , Issue 1 , February 2009 , pp. 195 - 199
Copyright
Copyright © International Psychogeriatric Association 2008

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