Effects of a multifaceted intervention in psychogeriatric patients: one-year prospective study.
OBJECTIVES
The aetiology of behavioural and psychological symptoms (BPSD) could be related to inadequate treatment in patients with dementia. The aim of this study was to determine how a multifaceted intervention based on a medication review and multidisciplinary follow-up could improve treatment and minimise risk in these patients.


METHODS
A prospective interventional study was undertaken between July 2015 and July 2016 of patients with dementia admitted to control BPSD. Patients with previous psychiatric illness or palliative care were excluded. Prescription information was obtained from Aegerus and the Catalonia clinical record HC3. The intervention was conducted by a multidisciplinary team. The Medication Appropriateness Index (MAI) was used to assess the intervention.


RESULTS
65 patients (60% women, mean age 84.9±6.7 years) with mild-moderate cognitive impairment (mean 4.5±1.8), moderate-severe functional dependence (mean 43.8±23.9) and a high prevalence of geriatric syndromes and comorbidity were included in the study. 87.7% of the patients were taking ≥5 drugs (mean 9.0±3.1) and 38.5% were taking ≥10. Patients presented with BPSD values of 1.9±0.8 at admission. Common symptoms prompting admission were agitation (47.7%) and irritability (43.1%). A total of 175 drug-related problems (DRPs) were detected (2.97 per patient). Significant differences (p<0.001) were found between the MAI score at admission (4±4.6) and post-intervention (0.5±2.6). Most prevalent MAI criteria were related to interactions (40%), dosage (38.5%) and duplication (26.2%). 55 patients (84.6%) were taking anticholinergic drugs at admission (2.6±1.2 anticholinergic drugs per patient), and the post-intervention reduction was significant (p<0.016).


CONCLUSIONS
The balance between effective treatment and safety is complex in these patients. Medication review in interdisciplinary teams is an essential component to optimise interventions and assessment of safety.
['Hernandez|Marta|M|', 'Mestres|Concepción|C|0000-0002-0494-3108', 'Junyent|Jaume|J|', 'Costa-Tutusaus|Lluís|L|', 'Modamio|Pilar|P|', 'Fernandez Lastra|Cecilia|C|', 'Mariño|Eduardo L|EL|']
D000368:Aged D000369:Aged, 80 and over D060825:Cognitive Dysfunction D003704:Dementia D064420:Drug-Related Side Effects and Adverse Reactions D005260:Female D006760:Hospitalization D006801:Humans D008297:Male D010348:Patient Care Team D011446:Prospective Studies
clinical pharmacy drug safety geriatric medicine interdisciplinar phychogeriatry