Geriatrician interventions on medication prescribing for frail older people in residential aged care facilities Pharmacist participation in hospital ward teams and hospital readmission rates among people with dementia: a randomized controlled trial Effects of Pharmacists’ Interventions on Inappropriate Drug Use and Drug-Related Readmissions in People with Dementia—A Secondary Analysis of a Randomized Controlled Trial Drug-related problems and medication reviews among old people with dementia The Cochrane Collaboration’s tool for assessing risk of bias in randomised trials Interdisciplinary geriatric and psychiatric care reduces potentially inappropriate prescribing in the hospital: interventional study in 150 acutely ill elderly patients with mental and somatic comorbid conditions. Deprescribing in Frail Older People: A Randomised Controlled Trial Co-morbidity and drug treatment in Alzheimer's disease. A cross sectional study of participants in the Dementia Study in Northern Norway ROBINS-I: a tool for assessing risk of bias in non-randomised studies of interventions Clinical medication review by a pharmacist of elderly people living in care homes--randomised controlled trial. Nurse-Led Medicines' Monitoring for Patients with Dementia in Care Homes: A Pragmatic Cohort Stepped Wedge Cluster Randomised Trial Validation of the Minimum Data Set Cognitive Performance Scale: agreement with the Mini-Mental State Examination. Education to reduce potentially harmful medication use among residents of assisted living facilities: a randomized controlled trial. Effects of a pharmacist's medication review in nursing homes. Randomised controlled trial. An outreach geriatric medication advisory service in residential aged care: a randomised controlled trial of case conferencing. Feasibility study of a systematic approach for discontinuation of multiple medications in older adults: addressing polypharmacy.
Objective In Australian residential aged care facilities ( RACFs ) , the use of certain classes of high-risk medication such as antipsychotics , potent analgesics , and sedatives is high . Here , we examined the prescribed medications and subsequent changes recommended by geriatricians during comprehensive geriatric consultations provided to residents of RACFs via videoconference .  Design This is a prospect i ve observational study . Setting Four RACFs in Queensl and , Australia , are included . Participants A total of 153 residents referred by general practitioners for comprehensive assessment by geriatricians delivered by video-consultation .  Results Residents ’ mean ( st and ard deviation , SD ) age was 83.0 ( 8.1 ) years and 64.1 % were female . They had multiple comorbidities ( mean 6 ) , high levels of dependency , and were prescribed a mean ( SD ) of 9.6 ( 4.2 ) regular medications . Ninety-one percent of patients were taking five or more medications daily . Of total medications prescribed ( n=1,469 ) , geriatricians recommended withdrawal of 9.8 % ( n=145 ) and dose alteration of 3.5 % ( n=51 ) . New medications were initiated in 47.7 % ( n=73 ) patients . Of the 10.3 % ( n=151 ) medications considered as high risk , 17.2 % were stopped and dose altered in 2.6 % . Conclusion There was a moderate prevalence of potentially inappropriate high-risk medications . However , geriatricians made relatively few changes , suggesting either that , on balance , prescription of these medications was appropriate or , because of other factors , there was a reluctance to adjust medications . A structured medication review using an algorithm for withdrawing medications of high disutility might help optimize medications in frail patients . Further research , including a broader survey , is required to underst and these dynamics Purpose To assess whether comprehensive medication review s conducted by clinical pharmacists as part of a healthcare team reduce drug-related hospital readmission rates among people with dementia or cognitive impairment . Methods This r and omized controlled trial was carried out between January 9 , 2012 , and December 2 , 2014 . Patients aged ≥65 years with dementia or cognitive impairment admitted to three wards at two hospitals located in Northern Sweden were included . Results Of the 473 deemed eligible for participation , 230 were r and omized to intervention and 230 to control group by block r and omization . The primary outcome , risk of drug-related hospital readmissions , was assessed at 180 days of follow-up by intention-to-treat analysis .During the 180 days of follow-up , 18.9 % ( 40/212 ) of patients in the intervention group and 23.0 % ( 50/217 ) of those in the control group were readmitted for drug-related reasons ( HR = 0.80 , 95 % CI = 0.53–1.21 , p = 0.28 , univariable Cox regression ) . Heart failure was significantly more common in the intervention group . After adjustment for heart failure as a potential confounder and an interaction term , multiple Cox regression analysis indicated that pharmacist participation significantly reduced the risk of drug-related readmissions ( HR = 0.49 , 95 % CI = 0.27–0.90 , p = 0.02 ) . A post-hoc analysis showed a significantly reduced risk of 30-day readmissions due to drug-related problems in the total sample ( without adjustment for heart failure ) . Conclusion Participation of clinical pharmacists in healthcare team conducting comprehensive medication review s did not significantly reduce the risk of drug-related readmissions in patients with dementia or cognitive impairment ; however , post-hoc and subgroup analyses indicated significant effects favoring the intervention . More research is needed . Trial registration : Clinical trials NCT01504672 Age-associated physiological changes and extensive drug treatment including use of potentially inappropriate medications ( PIMs ) pose a significant risk of drug – drug interactions and adverse drug events among elderly people with dementia . This study aim ed at analysing the effects of clinical pharmacists ’ interventions on use of PIMs , risk of emergency department visits , and time to institutionalization . Furthermore , a descriptive analysis was conducted of circumstances associated with drug-related readmissions . This is a secondary analysis of data from a r and omized controlled intervention study conducted in two hospitals in Northern Sweden . The study included patients ( n = 460 ) 65 years or older with dementia or cognitive impairment . The intervention consisted of comprehensive medication review s conducted by clinical pharmacists as part of a healthcare team . There was a larger decrease in PIMs in the intervention group compared with the control group ( p = 0.011 ) . No significant difference was found in time to first all-cause emergency department visits ( HR = 0.994 , 95 % CI = 0.755–1.307 p = 0.963 , simple Cox regression ) or time to institutionalization ( HR = 0.761 , 95 % CI = 0.409–1.416 p = 0.389 , simple Cox regression ) within 180 days . Common reasons for drug-related readmissions were negative effects of sedatives , opioids , antidepressants , and anticholinergic agents , result ing in confusion , falling , and sedation . Drug-related readmissions were associated with living at home , heart failure , and diabetes . Pharmacist-provided interventions were able to reduce PIMs among elderly people with dementia and cognitive impairment Background Drug-related problems , including medication errors and adverse drug events , are common among old people . Due to , for example , greater susceptibility to side effects , people with dementia are even more at risk of drug-related problems . The objectives of this study were to assess the occurrence and character of drug-related problems found among old people with dementia or cognitive impairment . Methods Data from a r and omized controlled clinical trial exploring the effects of a pharmacist intervention as part of a hospital ward team in patients 65 years and older with dementia or cognitive impairment were used . The study was conducted between 2012 and 2014 in the orthopedic and medicine wards in two hospitals located in Northern Sweden . Drug-related problems identified in this patient group were classified and described , and associations with different factors were investigated . Results Clinical pharmacists identified at least one DRP in 66 % ( 140/212 ) of participants in the intervention group , for a total of 310 DRPs . Ineffective drug/inappropriate drug and unnecessary drug therapy were the most common drug-related problems . Discontinuation of drug therapy was the most common action carried out . Drug-related problems were more common among people prescribed a larger number of drugs and among people with an earlier stroke . Conclusions Drug-related problems are common among people with dementia and cognitive impairment . Comprehensive medication review s conducted by clinical pharmacists as part of a health care team might be important to prevent , identify and solve these problems Flaws in the design , conduct , analysis , and reporting of r and omised trials can cause the effect of an intervention to be underestimated or overestimated . The Cochrane Collaboration ’s tool for assessing risk of bias aims to make the process clearer and more BACKGROUND Potentially inappropriate medications and prescription omissions ( PO ) are highly prevalent in older patients with mental comorbidities . OBJECTIVE To evaluate the effect of interdisciplinary geriatric and psychiatric care on the appropriateness of prescribing . DESIGN Prospect i ve and interventional study . SETTING Medical-psychiatric unit in an academic geriatric department . PARTICIPANTS Participants were 150 consecutive acutely ill patients aged on average 80.0 ± 8.1 years suffering from mental comorbidities and hospitalized for any acute somatic condition . INTERVENTION From admission to discharge , daily collaboration provided by senior geriatrician and psychiatrist working in a usual geriatric interdisciplinary care team .  MEASUREMENTS Potentially inappropriate medications and PO were detected and recorded by a trained independent investigator using STOPP/START criteria at admission and discharge . RESULTS Compared with admission , the intervention reduced the total number of medications prescribed at discharge from 1347 to 790 ( P < .0001 ) and incidence rates for potentially inappropriate medications and PO reduced from 77 % to 19 % ( P < .0001 ) and from 65 % to 11 % ( P < .0001 ) , respectively . Independent predictive factors for PIP at discharge were being a faller ( odds ratio [ OR ] 1.85 ; 95 % confidence interval [ CI ] 1.43 - 2.09 ) and for PO , the increased number of medications ( OR 1.54 ; 95 % CI 1.13 - 1.89 ) and a Charlson comorbidity index greater than 2 ( OR 1.85 ; 95 % CI 1.38 - 2.13 ) . Dementia and /or presence of psychiatric comorbidities were predictive factors for both potentially inappropriate medications and PO at discharge . CONCLUSION These findings hold substantial promise for the prevention of IP and OP in such a comorbid and polymedicated population . Further evaluations are , however , still needed to determine if such an intervention reduces potentially inappropriate prescribing medication-related outcomes , such as incidence of adverse drug events , rehospitalization , or mortality Objectives Deprescribing has been proposed as a way to reduce polypharmacy in frail older people . We aim ed to reduce the number of medicines consumed by people living in residential aged care facilities ( RACF ) . Secondary objectives were to explore the effect of deprescribing on survival , falls , fractures , hospital admissions , cognitive , physical , and bowel function , quality of life , and sleep . Methods Ninety-five people aged over 65 years living in four RACF in rural mid-west Western Australia were r and omised in an open study . The intervention group ( n = 47 ) received a deprescribing intervention , the planned cessation of non-beneficial medicines . The control group ( n = 48 ) received usual care . Participants were monitored for twelve months from r and omisation . Primary outcome was change in the mean number of unique regular medicines . All outcomes were assessed at baseline , six , and twelve months . Results Study participants had a mean age of 84.3±6.9 years and 52 % were female . Intervention group participants consumed 9.6±5.0 and control group participants consumed 9.5±3.6 unique regular medicines at baseline . Of the 348 medicines targeted for deprescribing ( 7.4±3.8 per person , 78 % of regular medicines ) , 207 medicines ( 4.4±3.4 per person , 59 % of targeted medicines ) were successfully discontinued . The mean change in number of regular medicines at 12 months was -1.9±4.1 in intervention group participants and + 0.1±3.5 in control group participants ( estimated difference 2.0±0.9 , 95%CI 0.08 , 3.8 , p = 0.04 ) . Twelve intervention participants and 19 control participants died within 12 months of r and omisation ( 26 % versus 40 % mortality , p = 0.16 , HR 0.60 , 95%CI 0.30 to 1.22 ) There were no significant differences between groups in other secondary outcomes . The main limitations of this study were the open design and small participant numbers . Conclusions Deprescribing reduced the number of regular medicines consumed by frail older people living in residential care with no significant adverse effects on survival or other clinical outcomes . Trial Registration Australian New Zeal and Clinical Trials Registry Background Inappropriate medical treatment of co-morbidities in Alzheimer 's disease ( AD ) is an increasing concern in geriatric medicine . The objective of this study was to compare current drug use related to co-morbidity between individuals with a recent diagnosis of AD and a cognitively healthy control group in a population based clinical trial in Northern Norway . Methods Setting : Nine rural municipalities with 70 000 inhabitants in Northern Norway . Participants : Participants with and without AD recruited in general practice and by population based screening.187 participants with a recent diagnosis of AD were recruited among community dwellers . Of 791 respondents without cognitive symptoms , 500 were r and omly selected and invited to further clinical and cognitive testing . The final control group consisted of 200 cognitively healthy individuals from the same municipalities . Demographic characteristics , data on medical history and current medication were included , and a physical and cognitive examination was performed . The statistical analyses were carried out by independent sample t-test , chi-square , ANCOVA and logistic regression . Results A co-morbidity score was significantly higher in AD participants compared to controls . The mean number of drugs was higher for AD participants compared to controls ( 5.1 ± 3.6 and 2.9 ± 2.4 respectively , p < 0.001 age and gender adjusted ) , also when adjusted for co-morbidity . AD participants used significantly more  anticholinergic , sedative and antidepressant drugs . For nursing home residents with AD  the mean number of drugs was significantly higher compared to AD participants living at home ( 6.9 ± 3.9 and 4.5 ± 3.3 , respectively , p < 0.001 ) . Conclusions AD participants were treated with a significantly higher number of drugs as compared to cognitively healthy controls , even after adjustment for co-morbidity . An inappropriate use of anticholinergic and sedative drugs was identified , especially among nursing home residents with AD . The drug burden and the increased risk of adverse reactions among individuals suffering from AD need more attention from prescribing doctors Non-r and omised studies of the effects of interventions are critical to many areas of healthcare evaluation , but their results may be biased . It is therefore important to underst and and appraise their strengths and weaknesses . We developed ROBINS-I ( “ Risk Of Bias In Non-r and omised Studies - of Interventions ” ) , a new tool for evaluating risk of bias in estimates of the comparative effectiveness ( harm or benefit ) of interventions from studies that did not use r and omisation  to allocate units ( individuals or clusters of individuals ) to comparison groups . The tool will be particularly useful to those undertaking systematic review s that include non-r and omised studies OBJECTIVE to measure the impact of pharmacist-conducted clinical medication review with elderly care home residents . DESIGN r and omised controlled trial of clinical medication review by a pharmacist against usual care . SETTING sixty-five care homes for the elderly in Leeds , UK . PARTICIPANTS a total of 661 residents aged 65 + years on one or more medicines . INTERVENTION clinical medication review by a pharmacist with patient and clinical records . Recommendations to general practitioner for approval and implementation . Control patients received usual general practitioner care . MAIN OUTCOME MEASURES primary : number of changes in medication per participant . Secondary : number and cost of repeat medicines per participant ; medication review rate ; mortality , falls , hospital admissions , general practitioner consultations , Barthel index , St and ardised Mini-Mental State Examination ( SMMSE ) . RESULTS the pharmacist review ed 315/331 ( 95.2 % ) patients in 6 months . A total of 62/330 ( 18.8 % ) control patients were review ed by their general practitioner . The mean number of drug changes per patient were 3.1 for intervention and 2.4 for control group ( P < 0.0001 ) . There were respectively 0.8 and 1.3 falls per patient ( P < 0.0001 ) . There was no significant difference for GP consultations per patient ( means 2.9 and 2.8 in 6 months , P = 0.5 ) , hospitalisations ( means 0.2 and 0.3 , P = 0.11 ) , deaths ( 51/331 and 48/330 , P = 0.81 ) , Barthel score ( 9.8 and 9.3 , P = 0.06 ) , SMMSE score ( 13.9 and 13.8 , P = 0.62 ) , number and cost of drugs per patient ( 6.7 and 6.9 , P = 0.5 ) ( pounds sterling 42.24 and pounds sterling 42.94 per 28 days ) . A total of 75.6 % ( 565/747 ) of pharmacist recommendations were accepted by the general practitioner ; and 76.6 % ( 433/565 ) of accepted recommendations were implemented . CONCLUSIONS general practitioners do not review most care home patients ' medication . A clinical pharmacist can review them and make recommendations that are usually accepted . This leads to substantial change in patients ' medication regimens without change in drug costs . There is a reduction in the number of falls . There is no significant change in consultations , hospitalisation , mortality , SMMSE or Barthel scores Background People with dementia are susceptible to adverse drug reactions ( ADRs ) . However , they are not always closely monitored for potential problems relating to their medicines : structured nurse-led ADR Profiles have the potential to address this care gap . We aim ed to assess the number and nature of clinical problems identified and addressed and changes in prescribing following introduction of nurse-led medicines ’ monitoring . Design Pragmatic cohort stepped-wedge cluster R and omised Controlled Trial ( RCT ) of structured nurse-led medicines ’ monitoring versus usual care . Setting Five UK private sector care homes Participants 41 service users , taking at least one antipsychotic , antidepressant or anti-epileptic medicine . Intervention Nurses completed the West Wales ADR ( WWADR ) Profile for Mental Health Medicines with each participant according to trial step . Outcomes Problems addressed and changes in medicines prescribed . Data Collection and Analysis Information was collected from participants ’ notes before r and omisation and after each of five monthly trial steps . The impact of the Profile on problems found , actions taken and reduction in mental health medicines was explored in multivariate analyses , accounting for data collection step and site . Results Five of 10 sites and 43 of 49 service users approached participated . Profile administration increased the number of problems addressed from a mean of 6.02 [ SD 2.92 ] to 9.86 [ 4.48 ] , effect size 3.84 , 95 % CI 2.57–4.11 , P < 0.001 . For example , pain was more likely to be treated ( adjusted Odds Ratio [ aOR ] 3.84 , 1.78–8.30 ) , and more patients attended dentists and opticians ( aOR 52.76 [ 11.80–235.90 ] and 5.12 [ 1.45–18.03 ] respectively ) . Profile use was associated with reduction in mental health medicines ( aOR 4.45 , 1.15–17.22 ) . Conclusion The WWADR Profile for Mental Health Medicines can improve the quality and safety of care , and warrants further investigation as a strategy to mitigate the known adverse effects of prescribed medicines . Trial Registration IS RCT N BACKGROUND Almost all nursing homes in the United States are required by the 1987 Omnibus Budget Reconciliation Act to assess each resident 's functional , medical , psychosocial , and cognitive status using a st and ard instrument known as the Minimum Data Set ( MDS ) . We report a validation study to show that the MDS Cognitive Performance Scale ( CPS ) , a cognitive measure generated from 5 MDS items ( comatose status , decision making , short-term memory , making self understood , and eating ) can be used to detect cognitive impairment as defined by the Mini-Mental State Examination ( MMSE ) . METHODS Two hundred subjects were r and omly recruited from 8 nursing home facilities in North Carolina . Two medical students administered the MMSE , while a geriatric research nurse was responsible for collecting MDS cognitive items , which included the 5 items required for generating CPS scores . Cognitive impairment was defined by MMSE scores adjusted for education . Agreement between the  CPS  and the MMSE  in identifying cognitively impaired subjects was then evaluated . RESULTS The CPS showed substantial agreement with the MMSE  in the identification of cognitive impairment ; the sensitivity was .94 ( 95 % confidence interval [ CI ] : .90 , .98 ) , the specificity was .94 ( 95 % CI : .87 , .96 ) , and the diagnostic accuracy as measured by the area under the receiver operating characteristics ( ROC ) curve was .96 ( 95 % CI : .88 , 1.0 ) . CONCLUSIONS The MDS Cognitive Performance Scale , when performed by a trained research nurse using recommended protocol s , provides a valid measure of cognitive status in nursing home residents OBJECTIVES The objectives of this study were ( 1 ) to investigate the effect of  nurse training  on the use of potentially harmful medications ; and ( 2 ) to explore the effect of  nurse training on residents ' health-related quality of life ( HRQoL ) , health service utilization , and mortality . DESIGN A r and omized controlled trial . SETTING AND PARTICIPANTS In total , 227 residents in 20 wards of assisted living facilities in Helsinki were recruited . The 20 wards were r and omized into those in which ( 1 ) staff received two 4-hour training sessions on appropriate medication treatment ( intervention group ) , and ( 2 ) staff received no additional training and continued to provide routine care ( control group ) . INTERVENTION Two 4-hour interactive training sessions for nursing staff based on constructive learning theory to recognize potentially harmful medications and corresponding adverse drug events . MEASUREMENTS Use of potentially harmful medications , HRQoL assessed using the 15 dimensional instrument of health-related quality of life , health service utilization , and mortality assessed at baseline , and 6 and 12 months . RESULTS During the 12-month follow-up , the mean number of potentially harmful medications decreased in the intervention wards [ -0.43 , 95 % confidence interval ( CI ) -0.71 to -0.15 ] but remained constant in the control wards ( + 0.11 , 95 % CI -0.09 to + 0.31 ) ( P = .004 , adjusted for age , sex , and comorbidities ) . HRQoL declined more slowly in the intervention wards ( -0.038 ( 95 % CI -0.054 to -0.022 ) than in the control wards ( -0.072 ( 95 % CI -0.089 to -0.055 ) ( P = .005 , adjusted for age , sex , and comorbidities ) . Residents of the intervention wards had significantly less hospital days ( 1.4 days/person/year , 95 % CI 1.2 - 1.6 ) than in the control wards ( 2.3 days/person/year ; 95 % CI 2.1 - 2.7 ) ( relative risk 0.60 , 95 % CI 0.49 - 0.75 , P < .001 , adjusted for age , sex , and comorbidities ) . CONCLUSIONS Activating learning methods directed at nurses in charge of comprehensive care can reduce the use of harmful medications , maintain HRQoL , and reduce hospitalization in residents of assisted living facilities BACKGROUND Older people in nursing and residential homes often have complex disabilities and behavioural disturbances . Recent publicity has highlighted the dangers of medication in this group , and controls over prescribing have been suggested . AIMS To investigate the effect of a review of medication by a pharmacist . METHOD An 8-month prospect i ve trial of an active medication review by a pharmacist was carried out on 330 residents in nursing homes in Manchester . RESULTS The intervention group experienced greater deterioration in cognitive function and behavioural disturbance than the control group , but the changes in depression and quality of life were similar for both groups . The number of drugs prescribed fell in the intervention group , but not in the control group , with a corresponding saving in drug costs . The number of deaths was significantly smaller in the intervention homes during the intervention period ( 4 v. 14 ) but not overall during the study period as a whole ( 26 v. 28 ) . CONCLUSION This clinical intervention reduced the number of medicines prescribed to elderly people in nursing homes , with minimal impact on their morbidity and mortality BACKGROUND efficient strategies are needed to provide specialist advice in nursing homes to ensure quality medical care . We describe a case conference intervention involving a multidisciplinary team of health professionals . OBJECTIVES to evaluate the impact of multidisciplinary case conferences on the appropriateness of medications and on patient behaviours in high-level residential aged care facilities . DESIGN cluster-r and omised controlled trial . SETTING ten high-level aged care facilities . PARTICIPANTS 154 residents with medication problems and /or challenging behaviours were selected for case conference by residential care staff . INTERVENTION two multidisciplinary case conferences involving the resident 's general practitioner , a geriatrician , a pharmacist and residential care staff were held at the nursing home for each resident . MEASUREMENTS outcomes were assessed at baseline and 3 months . The primary outcome was the Medication Appropriateness Index ( MAI ) . The behaviour of each resident was assessed via the Nursing Home Behaviour Problem Scale . RESULTS 45 residents died  before follow-up . Medication appropriateness improved in the intervention group [ MAI mean change 4.1 , 95 % confidence interval ( CI ) 2.1 - 6.1 ] compared with the control group ( MAI mean change 0.4 , 95 % CI -0.4 - 1.2 ; P < 0.001 ) . There was a significant reduction in the MAI for benzodiazepines ( mean change control -0.38 , 95 % CI -1.02 - 0.27 versus intervention 0.73 , 95 % CI 0.16 - 1.30 ; P = 0.017 ) . Resident behaviours were unchanged after the intervention and the improved medication appropriateness did not extend to other residents in the facility . CONCLUSION multidisciplinary case conferences in nursing homes can improve care . Outreach specialist services can be delivered without direct patient contact and achieve improvements in prescribing BACKGROUND Polypharmacy and inappropriate medication use is a problem in elderly patients , who are more likely to experience adverse effects from multiple treatments and less likely to obtain the same therapeutic benefit as younger population s. The Good Palliative-Geriatric Practice algorithm for drug discontinuation has been shown to be effective in reducing polypharmacy and improving mortality and morbidity in nursing home in patients . This study reports the feasibility of this approach in community-dwelling older patients . METHODS The Good Palliative-Geriatric Practice algorithm was applied to a cohort of 70 community-dwelling older patients to recommend drug discontinuations . Success rates of discontinuation , morbidity , mortality , and changes in health status were recorded . RESULTS The mean ( SD ) age of the 70 patients was 82.8 ( 6.9 ) years . Forty-three patients ( 61 % ) had 3 or more and 26 % had 5 or more comorbidities . The mean follow-up was 19 months . Participants used a mean ( SD ) of 7.7 ( 3.7 ) medications . Protocol indicated that discontinuation was recommended for 311 medications in 64 patients ( 58 % of drugs ; mean [ SD ] , 4.4 [ 2.5 ] drugs per patient overall , 4.9 per patient who had discontinuation ) . Of the discontinued drug therapies , 2 % were restarted because of recurrence of the original indication . Taking nonconsent and failures together , successful discontinuation was achieved in 81 % . Ten elderly patients ( 14 % ) died after a mean follow-up of 13 months , with the mean age at death of 89 years . No significant adverse events or deaths were attributable to discontinuation , and 88 % of patients reported global improvement in health . CONCLUSIONS It is feasible to decrease medication burden in community-dwelling elderly patients . This tool would be suitable for larger r and omized controlled trials in different clinical setting
Background Older adults living with dementia may have a higher risk of medication toxicity than those without dementia .
Optimising prescribing in this group of people is a critically important yet challenging process .
Objective Our aim was to systematic ally review the evidence for the effectiveness of interventions for optimising prescribing in older people with dementia .