Scheper, G.J. (2015) Het effect van stoppen van medicijnen bij verpleeghuisbewoners Een interim-analyse van de DIM-NHR Studie. thesis, Medicine.
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Abstract
Background: The growth of the elderly population is a rising problem in the Netherlands. This group often has chronic illnesses and comorbidities which frequently lead to polypharmacy. As a result these patients have a higher risk of inappropriate medication use, which in turn can lead to a higher risk of adverse events, increased fall risk, decreased quality of life and cognitive decline. This is particularly the case for nursing home residents. Additionally many of these residents are suffering from dementia, which is often associated with neuropsychiatric symptoms and use of psychopharmaca. This study was part of the the DIM-NHR Study which examines the efficacy and cost-effectiveness of the multidisciplinary multistep medication review in order to optimize drug prescribing and successfully stop inappropriate medication in the nursing home setting. Aims of the study: To assess successful discontinuation of medication and its effects on clinical outcomes cognition, quality of life, neuropsychiatric symptoms and adverse events, as well as assessing whether there is a difference between residents with and without dementia. Methods: Data were collected in X nursing homes in the Netherlands. Medication use data were collected for the four month period. The Mini-Mental-State examination (MMSE), Sever impairment Battery short version(SIB-s), Dementia Quality of Life index Dementia (DQI, EuroQol-5D (EQ-5D-3L), EQ-VAS and Neuropsychiatric Inventory (NPI) were taken at baseline and follow- up. Medical record study was done at follow up to look at adverse events. Once the proportion of nursing home residents who successfully discontinued medication had been calculated, the differences in clinical outcomes were analyzed, as well as the differences between the dementia and non-dementia subgroup. Results: Overall, 199 residents were included (mean age 82,3, 67,3% female). For 84 (42,2%) residents at least one drug was successfully discontinued. There were no significant differences in clinical outcomes between residents who did an did not successfully discontinue medication. When successfully discontinued, the EQ-VAS significantly improved in the non-dementia subgroup, but not in the dementia group. In the non-dementia group the number of falls are significantly lower than in the dementia group. The number of paramedical consults and visits by a specialist in geriatric medicine were significant higher in the non-dementia group. Conclusion: In nearly half of the cases one or more medications have been stopped during the study period. Successful discontinuation of medication improves some clinical outcomes in the non-dementia subgroup.
| Item Type: | Thesis (Thesis) |
|---|---|
| Supervisor name: | Facultaire begeleider: and Boersma, dr. F. specialist ouderengeneeskunde |
| Supervisor name: | Dagelijks begeleider: and Taxis prof. dr. K. en and Wouters dr. H. Afdeling: Basiseenheid Farmacotherapie en Far |
| Faculty: | Medical Sciences |
| Date Deposited: | 25 Jun 2020 10:45 |
| Last Modified: | 25 Jun 2020 10:45 |
| URI: | https://umcg.studenttheses.ub.rug.nl/id/eprint/675 |
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