Associations between the Drug Burden Index, Potentially Inappropriate Medications and Quality of Life in Residential Aged Care
Tóm tắt
Inappropriate polypharmacy may negatively impact the quality of life of residents in aged care facilities, but it remains unclear which medications may influence this reduced quality of life. The objective of this study was to examine whether the Drug Burden Index and potentially inappropriate medications were associated with quality of life in older adults living in residential care with a high prevalence of cognitive impairment and dementia. We conducted cross-sectional analyses of 541 individuals recruited from 17 residential aged care facilities in Australia in the Investigating Services Provided in the Residential Environment for Dementia (INSPIRED) study. Quality of life was measured using the EuroQol Five Dimensions Questionnaire (a measure of generic quality of life) and the Dementia Quality of Life Questionnaire completed by the participant or a proxy. In the 100 days prior to recruitment, 83.1% of the participants received at least one anticholinergic or sedative medication included in the Drug Burden Index and 73.0% received at least one potentially inappropriate medication according to the Beers Criteria. Multi-level linear models showed there was a significant association between a higher Drug Burden Index and lower quality of life according to the EuroQol Five Dimensions Questionnaire [β (standard error): − 0.034 (0.012), p = 0.006] after adjustment for potential confounding factors. Increasing numbers of potentially inappropriate medications were also associated with lower EuroQol Five Dimensions Questionnaire scores [− 0.030 (0.010), p = 0.003] and Dementia Quality of Life Questionnaire-Self-Report-Utility scores [− 0.020 (0.009), p = 0.029]. Exposure to both Drug Burden Index-associated medications and potentially inappropriate medications was associated with lower Dementia Quality of Life Questionnaire-Self-Report-Utility scores [− 0.034 (0.017), p = 0.049]. Exposure to anticholinergic and sedative medications and potentially inappropriate medications occurred in over three-quarters of a population of older adults in residential care and was associated with a lower quality of life.
Tài liệu tham khảo
Lee DTF, Yu DSF, Kwong ANL. Quality of life of older people in residential care home: a literature review. J Nurs Healthc Chronic Illn. 2009;1(2):116–25. https://doi.org/10.1111/j.1752-9824.2009.01018.x.
Franic DM, Jiang JZ. Potentially inappropriate drug use and health-related quality of life in the elderly. Pharmacotherapy. 2006;26(6):768–78. https://doi.org/10.1592/phco.26.6.768.
Department of Health and Ageing. Evaluation of the impact of accreditation on the delivery of quality of care and quality of life to residents in Australian Government subsidised residential aged care homes. 2007. http://apo.org.au/node/8564. [Accessed 15 Dec 2017].
Borowiak E, Kostka T. Predictors of quality of life in older people living at home and in institutions. Aging Clin Exp Res. 2004;16(3):212–20.
Banerjee S, Samsi K, Petrie CD, Alvir J, Treglia M, Schwam EM, et al. What do we know about quality of life in dementia? A review of the emerging evidence on the predictive and explanatory value of disease specific measures of health related quality of life in people with dementia. Int J Geriatr Psychiatry. 2009;24(1):15–24. https://doi.org/10.1002/gps.2090.
AIHW. Residential aged care and home care 2013–14. 2014. http://www.aihw.gov.au/aged-care/residential-and-home-care-2013-14/. [Accessed 15 Dec 2017].
American Geriatrics Society Beers Criteria Update Expert Panel. American Geriatrics Society 2015 Updated Beers Criteria for potentially inappropriate medication use in older adults. J Am Geriatr Soc. 2015;63(11):2227–46. https://doi.org/10.1111/jgs.13702.
Lau DT, Kasper JD, Potter DE, Lyles A, Bennett RG. Hospitalization and death associated with potentially inappropriate medication prescriptions among elderly nursing home residents. Arch Intern Med. 2005;165(1):68–74. https://doi.org/10.1001/archinte.165.1.68.
Gnjidic D, Le Couteur DG, Abernethy DR, Hilmer SN. Drug burden index and beers criteria: impact on functional outcomes in older people living in self-care retirement villages. J Clin Pharmacol. 2012;52(2):258–65. https://doi.org/10.1177/0091270010395591.
Hilmer SN, Mager DE, Simonsick EM, Cao Y, Ling SM, Windham BG, et al. A drug burden index to define the functional burden of medications in older people. Arch Intern Med. 2007;167(8):781–7. https://doi.org/10.1001/archinte.167.8.781.
Kouladjian L, Gnjidic D, Chen TF, Mangoni AA, Hilmer SN. Drug Burden Index in older adults: theoretical and practical issues. Clin Interv Aging. 2014;9:1503–15. https://doi.org/10.2147/CIA.S66660.
Wouters H, van der Meer H, Taxis K. Quantification of anticholinergic and sedative drug load with the Drug Burden Index: a review of outcomes and methodological quality of studies. Eur J Clin Pharmacol. 2017;73(3):257–66. https://doi.org/10.1007/s00228-016-2162-6.
Nishtala PS, Narayan SW, Wang T, Hilmer SN. Associations of drug burden index with falls, general practitioner visits, and mortality in older people. Pharmacoepidemiol Drug Saf. 2014;23(7):753–8. https://doi.org/10.1002/pds.3624.
Wilson NM, Hilmer SN, March LM, Chen JS, Gnjidic D, Mason RS, et al. Associations between drug burden index and mortality in older people in residential aged care facilities. Drugs Aging. 2012;29(2):157–65. https://doi.org/10.2165/11598570-000000000-00000.
Wilson NM, Hilmer SN, March LM, Cameron ID, Lord SR, Seibel MJ, et al. Associations between drug burden index and physical function in older people in residential aged care facilities. Age Ageing. 2010;39(4):503–7. https://doi.org/10.1093/ageing/afq053.
Herdman M, Gudex C, Lloyd A, Janssen M, Kind P, Parkin D, et al. Development and preliminary testing of the new five-level version of EQ-5D (EQ-5D-5L). Qual Life Res. 2011;20(10):1727–36. https://doi.org/10.1007/s11136-011-9903-x.
Mulhern B, Rowen D, Brazier J, Smith S, Romeo R, Tait R, et al. Development of DEMQOL-U and DEMQOL-PROXY-U: generation of preference-based indices from DEMQOL and DEMQOL-PROXY for use in economic evaluation. Health Technol Assess. 2013;17(5):v–xv–1–140. https://doi.org/10.3310/hta17050.
Devlin N, Shah KK, Feng Y, Mulhern B, Van Hout B. Valuing health-related quality of life: an EQ-5D-5L value set for England. HEDS Discussion Paper Series (1602). Sheffield: University of Sheffield: Health Economics and Decision Science, School of Health and Related Research (ScHARR); 2016.
Cohen-Mansfield J, Marx MS, Regier NG, Dakheel-Ali M. The impact of personal characteristics on engagement in nursing home residents with dementia. Int J Geriatr Psychiatry. 2009;24(7):755–63. https://doi.org/10.1002/gps.2192.
Palm R, Kohler K, Schwab CG, Bartholomeyczik S, Holle B. Longitudinal evaluation of dementia care in German nursing homes: the “DemenzMonitor” study protocol. BMC Geriatr. 2013;13:123. https://doi.org/10.1186/1471-2318-13-123.
Bosboom PR, Alfonso H, Almeida OP, Beer C. Use of potentially harmful medications and health-related quality of life among people with dementia living in residential aged care facilities. Dement Geriatr Cogn Dis Extra. 2012;2(1):361–71. https://doi.org/10.1159/000342172.
Kaplan RM. The minimally clinically important difference in generic utility-based measures. COPD. 2005;2(1):91–7.
Chen P, Lin KC, Liing RJ, Wu CY, Chen CL, Chang KC. Validity, responsiveness, and minimal clinically important difference of EQ-5D-5L in stroke patients undergoing rehabilitation. Qual Life Res. 2016;25(6):1585–96. https://doi.org/10.1007/s11136-015-1196-z.
Oremus M, Tarride JE, Clayton N, Raina P, Canadian Willingness-to-Pay Study Group. Health utility scores in Alzheimer’s disease: differences based on calculation with American and Canadian preference weights. Value Health. 2014;17(1):77–83. https://doi.org/10.1016/j.jval.2013.10.009.
Basger BJ, Chen TF, Moles RJ. Inappropriate medication use and prescribing indicators in elderly Australians: development of a prescribing indicators tool. Drugs Aging. 2008;25(9):777–93.
Scott IA, Hilmer SN, Reeve E, Potter K, Le Couteur D, Rigby D, et al. Reducing inappropriate polypharmacy: the process of deprescribing. JAMA Intern Med. 2015;175(5):827–34. https://doi.org/10.1001/jamainternmed.2015.0324.
Reeve E, Gnjidic D, Long J, Hilmer S. A systematic review of the emerging definition of ‘deprescribing’ with network analysis: implications for future research and clinical practice. Br J Clin Pharmacol. 2015;80(6):1254–68. https://doi.org/10.1111/bcp.12732.
Garcia-Gollarte F, Baleriola-Julvez J, Ferrero-Lopez I, Cuenllas-Diaz A, Cruz-Jentoft AJ. An educational intervention on drug use in nursing homes improves health outcomes resource utilization and reduces inappropriate drug prescription. J Am Med Dir Assoc. 2014;15(12):885–91. https://doi.org/10.1016/j.jamda.2014.04.010.
Gallagher PF, O’Connor MN, O’Mahony D. Prevention of potentially inappropriate prescribing for elderly patients: a randomized controlled trial using STOPP/START criteria. Clin Pharmacol Ther. 2011;89(6):845–54. https://doi.org/10.1038/clpt.2011.44.
Dalleur O, Boland B, Losseau C, Henrard S, Wouters D, Speybroeck N, et al. Reduction of potentially inappropriate medications using the STOPP criteria in frail older inpatients: a randomised controlled study. Drugs Aging. 2014;31(4):291–8. https://doi.org/10.1007/s40266-014-0157-5.
Pitkala KH, Juola AL, Kautiainen H, Soini H, Finne-Soveri UH, Bell JS, et al. Education to reduce potentially harmful medication use among residents of assisted living facilities: a randomized controlled trial. J Am Med Dir Assoc. 2014;15(12):892–8. https://doi.org/10.1016/j.jamda.2014.04.002.
Potter K, Flicker L, Page A, Etherton-Beer C. Deprescribing in frail older people: a randomised controlled trial. PLoS One. 2016;11(3):e0149984. https://doi.org/10.1371/journal.pone.0149984.
Crotty M, Whitehead C, Rowett D, Halbert J, Weller D, Finucane P, et al. An outreach intervention to implement evidence based practice in residential care: a randomized controlled trial [ISRCTN67855475]. BMC Health Serv Res. 2004;4(1):6. https://doi.org/10.1186/1472-6963-4-6.
Price SD, Holman CD, Sanfilippo FM, Emery JD. Association between potentially inappropriate medications from the Beers criteria and the risk of unplanned hospitalization in elderly patients. Ann Pharmacother. 2014;48(1):6–16. https://doi.org/10.1177/1060028013504904.
Skoldunger A, Fastbom J, Wimo A, Fratiglioni L, Johnell K. Impact of inappropriate drug use on hospitalizations, mortality, and costs in older persons and persons with dementia: findings from the SNAC study. Drugs Aging. 2015;32(8):671–8. https://doi.org/10.1007/s40266-015-0287-4.
Diaz-Redondo A, Rodriguez-Blazquez C, Ayala A, Martinez-Martin P, Forjaz MJ, Spanish Research Group on Quality of Life. EQ-5D rated by proxy in institutionalized older adults with dementia: psychometric pros and cons. Geriatr Gerontol Int. 2014;14(2):346–53. https://doi.org/10.1111/ggi.12108.