Table 3.
Most common changes of PIMs for dementia or cognitive impairment between baseline and follow-upa
| N (%) | ||||||
|---|---|---|---|---|---|---|
|
| ||||||
| Care Ecosystem N = 304 |
Usual Care N = 186 |
|||||
|
| ||||||
| Baseline | Follow-Up | Δ b | Baseline | Follow-Up | Δ b | |
|
| ||||||
| Persons with any PIM | 202 (66.4) | 201 (66.1) | −1 | 122 (65.6) | 135 (72.6) | +13 |
| Number of PIMs | 453 | 436 | −17 | 265 | 320 | +55 |
|
| ||||||
| Drug Class and Generic Medication Name | ||||||
|
| ||||||
| PIMs for dementia or cognitive impairment c | ||||||
|
| ||||||
| Definite Anticholinergicsd | 62 (20.4) | 64 (21.1) | +2 | 31 (16.7) | 42 (22.6) | +11 |
| Quetiapine | 27 (8.9) | 31 (10.2) | +4 | 12 (6.5) | 21 (11.3) | +9 |
| Diphenoxylate/Atropine | 0 | 1 (0.3) | +1 | 0 | 3 (1.6) | +3 |
|
|
||||||
| Diphenhydramine | 8 (2.6) | 6 (2.0) | −2 | 2 (1.1) | 0 | −2 |
| Solifenacin | 7 (2.3) | 5 (1.6) | −2 | 0 | 2 (1.1) | +2 |
| Paroxetine | 5 (1.6) | 3 (1.0) | −2 | 2 (1.1) | 4 (2.2) | +2 |
| Tolterodine | 2 (0.7) | 2 (0.7) | 0 | 2 (1.1) | 0 | −2 |
|
| ||||||
| Benzodiazepines | 38 (12.5) | 36 (11.8) | −2 | 18 (9.7) | 26 (14.0) | +8 |
| Lorazepam | 17 (5.6) | 17 (5.6) | 0 | 10 (5.4) | 19 (10.2) | +9 |
| Clonazepam | 6 (2.0) | 6 (2.0) | 0 | 6 (3.2) | 7 (3.8) | +1 |
|
|
||||||
| Alprazolam | 9 (3.0) | 7 (2.3) | −2 | 3 (1.6) | 2 (1.1) | −1 |
| Temazepam | 3 (1.0) | 3 (1.0) | 0 | 1 (0.5) | 2 (1.1) | +1 |
|
| ||||||
| Nonbenzodiazepine, benzodiazepine receptor agonist hypnotics (“Z-Drugs”) | 5 (1.6) | 4 (1.3) | −1 | 1 (0.5) | 2 (1.1) | +1 |
| Zolpidem | 4 (1.3) | 3 (1.0) | −1 | 1 (0.5) | 2 (1.1) | +1 |
|
| ||||||
| Antipsychotics | 45 (14.8) | 50 (16.4) | +5 | 24 (12.9) | 35 (18.8) | +11 |
| Quetiapine | 27 (8.9) | 31 (10.2) | +4 | 12 (6.5) | 21 (11.3) | +9 |
| Risperidone | 10 (3.3) | 12 (3.9) | +2 | 5 (2.7) | 5 (2.7) | 0 |
| Haloperidol | 0 | 2 (0.7) | +2 | 2 (1.1) | 5 (2.7) | +3 |
|
|
||||||
| Olanzapine | 4 (1.3) | 3 (1.0) | −1 | 1 (0.5) | 1 (0.5) | 0 |
| Aripiprazole | 3 (1.0) | 2 (0.7) | −1 | 4 (2.2) | 3 (1.6) | −1 |
Abbreviations: PIMs, potentially inappropriate medications
a
For each drug class, PIMs with the greatest increases or decreases between baseline and follow-up are listed. This list is not inclusive of all PIMs that changed.
b
Change in number of study participants between baseline and follow-up.
c
PIMs were defined using American Geriatrics Society 2019 Beers Criteria® for Potentially Inappropriate Medication Use in Older Adults.[23]
d
Medications with Anticholinergic Cognitive Burden (ACB) Scale scores of 2 or higher, indicating clinical anticholinergic effect or may cause delirium.[27]