Objective:

The purpose of this study is to determine the impact of pharmacist recommendations on reduction of potentially inappropriate medications (PIMs) in an older adult population with dementia or mild cognitive impairment (MCI).

Background:

Older adults with dementia or MCI are particularly vulnerable to adverse effects from PIMs. Many PIMs are anticholinergic medications which have been correlated with development of cognitive impairment in older adults. Previous studies have demonstrated that pharmacist interventions may reduce PIMs in older adults, but the impact of pharmacists embedded in an outpatient memory care clinic has not been adequately studied.

Design/Methods:

This prospective interventional study within an outpatient neurology center included patients at least 65 years old and diagnosed with dementia or MCI. Pharmacists utilized the American Geriatrics Society Beers Criteria, the Screening Tool of Older Persons’ Potentially Inappropriate Prescriptions, and the Anticholinergic Burden Scale (ACB) to identify PIMs and made recommendations to prescribers when appropriate based on clinical judgement. Primary outcomes included frequency and prevalence of PIMs before vs. after pharmacist intervention and rate of acceptance of pharmacy recommendations. Additional outcomes included ACB scores before vs. after intervention. 

Results:

A total of 180 patients were included. Pharmacists made recommendations for 49% of patients. Common pharmacist recommendations included laboratory monitoring, medication discontinuations or substitutions. Out of 192 total pharmacist recommendations, 61 (32%) were accepted by providers within the neurology center’s memory clinic. After pharmacist intervention, the frequency and prevalence of PIMs as well as ACB scores were significantly reduced (p < 0.01). 

Conclusions:

Pharmacist intervention resulted in a significant reduction in PIMs and ACB scores in patients with dementia or MCI. Future studies should incorporate a prospective design to examine the clinical benefit of pharmacist intervention and explore additional methods to improve multidisciplinary collaboration between pharmacists and prescribers.