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Pharmacist Identification of Medication Therapy Problems Involving Cognition Among Older Adults Followed by a Home-Based Care Team.

Publication ,  Journal Article
Levine, AMP; Emonds, EE; Smith, MA; Rickles, NM; Kuchel, GA; Steffens, DC; Ohlheiser, A; Fortinsky, RH
Published in: Drugs Aging
February 2021

BACKGROUND: Dementia, depression, and delirium alone or in combination (3Ds) can threaten independence among older adults, and polypharmacy may further accelerate decline. Clinical pharmacists can play an important role on multidisciplinary home-based care teams by identifying medication therapy problems (MTPs) involving cognition. Within a larger ongoing clinical trial, this paper describes cognition-related MTPs and pharmacist recommendations among older adults with 3Ds followed by a home-based care team. METHODS: We conducted a retrospective analysis of medication data among Medicare Advantage members aged ≥ 65 years living at home in Connecticut with International Statistical Classification of Diseases and Related Health Problems, 10th Revision codes related to 3Ds; analyses include the first 105 subjects randomized to the home-based care team from March 2017 to January 2019. Advanced practice registered nurses conducted in-home medication reconciliations along with medical and cognitive assessments. Clinical pharmacists then conducted medication reviews centered on agents treating or exacerbating 3Ds. After review by the study advanced practice registered nurse, geriatrician, and psychiatrist, salient recommendations were forwarded to primary care providers for consideration. Medication therapy problems related to cognition were retrospectively abstracted and classified as: (1) indication: underuse or overuse; (2) effectiveness: ineffective agent or low dose (mainly for antidepressants); and (3) safety: undesirable effect (e.g., impaired cognition, dementia treatment side effects), unsafe medication (e.g., potentially inappropriate medications that can harm cognition), drug interaction, or high dose. RESULTS: Pharmacists identified 166 cognitive MTPs, with a mean (standard deviation) of 1.58 (1.35) [range 0-6] MTPs per subject. Indication MTPs represented 34% of total MTPs, of which 79% involved underuse and 21% overuse; effectiveness represented 13% of total MTPs; and safety represented over half (52%) of all MTPs, with benzodiazepines and anticholinergics frequently implicated. Recommendations commonly included medication reduction (discontinuation 23% and dose reduction 19%). We found MTPs involving cognition among most (79%) patients. CONCLUSIONS: Our study findings support the role of pharmacists on multidisciplinary teams to identify cognitively harmful medications, dementia treatment side effects, and untreated cognitive conditions. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov NCT02945085.

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Published In

Drugs Aging

DOI

EISSN

1179-1969

Publication Date

February 2021

Volume

38

Issue

2

Start / End Page

157 / 168

Location

New Zealand

Related Subject Headings

  • United States
  • Retrospective Studies
  • Pharmacists
  • Patient Care Team
  • Medication Reconciliation
  • Medicare
  • Humans
  • Home Care Services
  • Geriatrics
  • Cognitive Dysfunction
 

Citation

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ICMJE
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Levine, A. M. P., Emonds, E. E., Smith, M. A., Rickles, N. M., Kuchel, G. A., Steffens, D. C., … Fortinsky, R. H. (2021). Pharmacist Identification of Medication Therapy Problems Involving Cognition Among Older Adults Followed by a Home-Based Care Team. Drugs Aging, 38(2), 157–168. https://doi.org/10.1007/s40266-020-00821-7
Levine, Allison M. P., Erin E. Emonds, Marie A. Smith, Nathaniel M. Rickles, George A. Kuchel, David C. Steffens, Alis Ohlheiser, and Richard H. Fortinsky. “Pharmacist Identification of Medication Therapy Problems Involving Cognition Among Older Adults Followed by a Home-Based Care Team.Drugs Aging 38, no. 2 (February 2021): 157–68. https://doi.org/10.1007/s40266-020-00821-7.
Levine AMP, Emonds EE, Smith MA, Rickles NM, Kuchel GA, Steffens DC, et al. Pharmacist Identification of Medication Therapy Problems Involving Cognition Among Older Adults Followed by a Home-Based Care Team. Drugs Aging. 2021 Feb;38(2):157–68.
Levine, Allison M. P., et al. “Pharmacist Identification of Medication Therapy Problems Involving Cognition Among Older Adults Followed by a Home-Based Care Team.Drugs Aging, vol. 38, no. 2, Feb. 2021, pp. 157–68. Pubmed, doi:10.1007/s40266-020-00821-7.
Levine AMP, Emonds EE, Smith MA, Rickles NM, Kuchel GA, Steffens DC, Ohlheiser A, Fortinsky RH. Pharmacist Identification of Medication Therapy Problems Involving Cognition Among Older Adults Followed by a Home-Based Care Team. Drugs Aging. 2021 Feb;38(2):157–168.
Journal cover image

Published In

Drugs Aging

DOI

EISSN

1179-1969

Publication Date

February 2021

Volume

38

Issue

2

Start / End Page

157 / 168

Location

New Zealand

Related Subject Headings

  • United States
  • Retrospective Studies
  • Pharmacists
  • Patient Care Team
  • Medication Reconciliation
  • Medicare
  • Humans
  • Home Care Services
  • Geriatrics
  • Cognitive Dysfunction