DEPRESCRIBING IN OLDER POLY‐TREATED PATIENTS AFFECTED WITH DEMENTIA: A SHARED EXPERIENCE BETWEEN UNIVERSITY AND TERRITORY

AbstractIntroductionThe present study aimed to assess geriatric poly‐treated patients of the Center for Cognitive Disorders and Dementia of Catanzaro Lido, in collaboration with the School of Pharmacology, University of Catanzaro, Faculty of Medicine. We used the Beers, and STOPP & START criteria for assessing poly‐treatment and deprescribing in the population under investigation.Patients and MethodsIn the time range between October 2021 and September 2022, we randomly assessed 205 patients, 114 outpatients, and 91 home care patients.The primary outcomes were: 1) deprescribing inappropriate drugs through the Beers and STOPP & START criteria;2) assessing duplicate drugs, and the risk of iatrogenic damage due to drug‐drug and drug‐disease interactions.Results69 men and 136 women, mean age of 82.7±7.4 years old, were studied. Of these, 91 patients were home care patients and 114 were outpatients. The average of the drugs used in the sample was 9.4 drugs/patient; after the first visit and the consequent deprescribing process, the average dropped to 8.7 drugs/patient (p = 0.04). Potentially inappropriate drugs were overall 74(36.1%). Of these, long half‐life benzodiazepines (8.8%), non‐steroidal anti‐inflammatory drugs in chronic use (> 15 days) (3.4%), tricyclic antidepressants (3.4%), first‐generation antihistamines (1.4%), anticholinergics (11.7%), ticlopidine (1.4%), prokinetics in chronic use (1.4%), digoxin at dosage > 0.125 mg (1.4%), amiodarone (0.97), a‐lytics (1.9%). The so‐called “duplicate” drugs were overall 26 (12.7%). 10 potentially dangerous prescriptions were found for interactions (4.8%).Discussion and conclusionsApplying the Beers and STOPP&START criteria can improve the use of drugs in the poly‐treated patient. We underline the importance of checking all the drugs taken periodically, discontinuing drugs with the lowest benefit/harm ratio and the lowest probability of adverse reactions due to withdrawal. Currently, there are no guidelines to properly address the management complexities of the older patient. Computer tools and properly trained teams (doctors, nurses, pharmacists) could identify, treat and prevent possible drug interactions.