Reduction of suboptimal prescribing and clinical outcome for dementia patients in a senior behavioral health inpatient unit.
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. chi2 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.


CONCLUSIONS
Suboptimal medication use is a potential source of decreased function in older patients with dementia.
Chan
Virginia T
VT
Department of Psychiatry, University of California, San Diego, CA 92103-8631, USA.
Woo
Benjamin K P
BK
Sewell
Daniel D
DD
Allen
E Clark
EC
Golshan
Shahrokh
S
Rice
Valerie
V
Minassian
Arpi
A
Daly
John W
JW
D000203:Activities of Daily Living / Q000145:classification; D002140:California; D002908:Chronic Disease / Q000453:epidemiology; D015897:Comorbidity; D003704:Dementia / Q000188:drug therapy* / Q000453:epidemiology; D004185:Disability Evaluation; D004359:Drug Therapy, Combination; D004363:Drug Utilization / Q000706:statistics & numerical data; D006760:Hospitalization / Q000706:statistics & numerical data*; D006785:Hospitals, University; D006801:Humans; D007049:Iatrogenic Disease; D001523:Mental Disorders / Q000188:drug therapy* / Q000453:epidemiology; D008609:Mental Status Schedule; D055656:Prescriptions / Q000706:statistics & numerical data*; D011567:Psychiatric Department, Hospital / Q000706:statistics & numerical data; D011619:Psychotropic Drugs / Q000009:adverse effects / Q000627:therapeutic use*; D011785:Quality Assurance, Health Care / Q000592:standards; D014600:Utilization Review / Q000706:statistics & numerical data
D011619:Psychotropic Drugs