Dementia Medication management – the missing link
Why is proper Dementia Medication Management do important for dementia sufferers? Dementia has an estimated global prevalence an estimated 40-48 million men and women. For example, in the UK, there are over 565,000 people suffering from dementia. Shockingly, the number is estimated to increase 100% over the next 35 years,. This is a global prediction. People with dementia have a pill box or medication organizer filled to the brim with complex medication. Furthermore, this is coupled with complicated regimens of doses and scheduling. A new and improved pill box with alarms is a must. Prescription medication mistakes is no laughing matter. In fact, mistakes can lead to negative events form bad medication management . These type of errors have been associated with admission to a hospital or secondary care . In the worse cases, it leads to significant morbidity increase. Proper Medication management has several critical areas:
- Way the medicines are selected
- Procured
- Delivered
- Prescribed
- Administered
- Medication Reminder
- Reviewed to optimize the contribution
These must all be taken into account to promote the desired outcomes of patient care.
The importance of safe and effective medication management
The importance of safe and effective medication management for people with dementia is recognized nationally in the UK. Recognized by both the National Dementia Strategy and NICE guidance . This being said, these are special challenges in medication management for people with dementia. This adds another level of complexity. Finally, an inherent tension between ensuring that the symptoms of dementia are treated effectively and limiting iatrogenic disease associated with medication is complex. 
The literature indicates that as cognitive impairment progresses, the ability to plan, organise, and execute medicine management tasks is impaired, leading to increased risk of unintentional non-adherence, medication errors, preventable medication-related hospital admissions and dependence on family carers or community . elit. Ut elit tellus, luctus nec ullamcorper mattis, pulvinar dapibus leo.
There has been relatively little amount of clinical research on the impact of dementia . This is worse when looking at the adverse drug reactions (ADRs). In addition, medication errors or misdosing. Dementia has been titled as the main disease state which will raise the chances that other risk factors for ADRs will go up. For example, inappropriate prescribing, old fashion pill box, old age, adherence issues, drug interactions, comorbidity, and finally, polypharmacy. Medication errors are prevalent. An error is described as an incident where there has been any kind of error. Examples include, administering,
prescribing, dispensing and preparing. Also included, monitoring or providing medicines . The data show’s that it can be more common in people with dementia. This is due to the involvement of many different health as well as social care professionals. The direct impact of cognitive impairment is of course also important.
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When the patients identify they can avoid nearly a quarter of errors. However, dementia medication may further impair cognition and proper decision-making. Patients who are suffering from dementia will often be less likely to question a prescription. Also, they may be less aware of negative side effects. Many no longer think that monitoring is still needed.
Hence, more likely to not be able to see the oncome of a potential error. Both adverse drug reactions and medication errors may lead to admission to the hospital.
One of the largest studies of its type
estimated that adverse drug events caused 6.5% of all admissions to secondary care facilities
The same study found that medication errors may have accounted for as many as 6,000 deaths each year in the UK. In a 15,000 person study, 5.9% were related to medication mistakes. In these cases, impaired cognition was identified as the main predictor of preventable medication-related admission to hospital.
However, it is clear that people with dementia are frequently prescribed medicines with both anti-cholinergic and sedative activity. These are both know to induce a level of cognitive impairment. It has been estimated that 40-50% of people with dementia take at least one medication that has some kind of anticholinergic activity . People with dementia often rely upon family and friends to help manage their medication.
People with dementia over-estimate their ability to manage medication
Adherence to, and concordance with, prescribed medication is often a
particularly big problem for people with dementia . In fact, the
inability to manage complex medication regimens has a direct correlation with a future admission to residential care facilities . A successful self-medication program must includes adequate support and a smart medication reminder or pill dispenser. Trying to teach the older person about the medication and other measures to improve compliance will lower the chances of future pill errors. However, simply improving adherence may be counter-productive and
an over-emphasis on adherence may increase the incidence of medication related iatrogenic disease.
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