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Drug prescription in elderly hospitalized patients with cognitive impairment in the Italian dementia‐friendly hospital project
Author(s) -
Govoni Stefano,
Rosi Alessia,
Preda Stefania,
Allegri Nicola
Publication year - 2020
Publication title -
alzheimer's and dementia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 6.713
H-Index - 118
eISSN - 1552-5279
pISSN - 1552-5260
DOI - 10.1002/alz.047619
Subject(s) - medicine , polypharmacy , medical prescription , anxiety , sedative , depression (economics) , dementia , intervention (counseling) , activities of daily living , physical therapy , anticholinergic , cognition , psychiatry , disease , economics , pharmacology , macroeconomics
Background Older patients with cognitive impairment represent a significant proportion of the patients hospitalized for various acute illnesses. The health staff is not prepared to deal with such patients which do not fit the standard of care of the hospital stay. Accordingly, we recorded a series of clinical parameters reflecting the health status and the drug prescriptions at the entry and during hospital stay before and after a brief (5 hrs. frontal teaching) intervention of staff training, focusing on improving the management of patients with cognitive impairment. Methods Participants were evaluated within 48 h of admission and at discharge with Mini Mental State Examination (MMSE), Barthel Index, Instrumental Activity of Daily Life (IADL), and Hospital Anxiety and Depression Scale (HADS). A preliminary analysis of 68 hospitalized participants aged 65 and older with cognitive impairment (MMSE ≥ 16, ≤24) allocated in the control group (n = 34, 20 females, 82.38 years) and intervention group (n = 34, 20 females, 81.97 years) was performed. For each patient, the number of prescriptions, sedative and anticholinergic load, and drug–drug interactions were evaluated. Results Participants presented a widespread polypharmacy receiving as average 6.9 (+/‐ 1.7 drugs/daily in the control group) and 5.9 (+/‐ 1.6 drugs/daily in the intervention group), the difference being not statistically significant (P = 0,068). Also, the sedative load presented a trend toward lower values in the intervention group. The results concerning the other clinical indices (submitted elsewhere) show that personnel training significantly improved the functional and anxiety parameters at discharge. Conclusions The results suggest that an intervention, focused on improving dementia care practices in health staff, having the potential to improve outcomes for hospitalized older adults with cognitive impairment, but not directly designed to manage drug polypharmacy, is not sufficient to modify drug prescription patterns.