Evaluation of Polypharmacy and Potentially Inappropriate Medication Use in Older Adults with Dementia Using the TIME Criteria

Abstract

Objective: Polypharmacy and potentially inappropriate medication (PIM) are well-known risk factors for several negative health outcomes. However, polypharmacy, undertreatment, and PIMs in Turkish patients with dementia are not well-described. This study aimed to examine and compare the prevalence of polypharmacy, potential prescription omissions (PPOs), and PIMs in older adults with and without dementia in a nationwide population. Materials and Methods: This study retrospectively evaluated the older patients (aged ≥65 years) who were admitted to the outpatient clinic of a university hospital. Patients were classified as dementia and no-dementia according to the International Classification of Diseases codes, mini-mental state examination score, clinical dementia rating scores, and clinical history. Polypharmacy, PIM, and PPO rates were compared among patients with and without dementia. The Turkish Inappropriate Medication Use in the Elderly criteria was used to define PIMs and PPOs. Results: This study analyzed a total of 265 patients, wherein 21.5% of patients had at least one PIM and 20% had at least one PPO. Patients with dementia were more frequently exposed to polypharmacy (dementia: 51.9% vs. no-dementia: 48.1%, p<0.001) and likewise PPOs (dementia: 34.3% vs. no-dementia: 12.1%, p<0.001). Additionally, PPO prevalence increased with the severity of dementia. However, PIM prevalence was similar between patients with and without dementia (p=0.52). Conclusion: Polypharmacy and PPOs were widespread in the older population and more in people with dementia.