Patient Polypharmacy use Following a Multi-Disciplinary Dementia Care Program in a Memory Clinic: A Retrospective Cohort Study

Abstract

Introduction. Dementia increases the risk of polypharmacy. Timely detection and optimal care can optimize the prognosis for patients with dementia, which may in turn reduce polypharmacy. We aimed to compare the change in polypharmacy use among memory clinic patients living with dementia who participate in a dementia care program, vs those who did not. We hypothesized that patients in the dementia care program would reduce their use of polypharmacy compared to those who were not in the program.

Methods. We retrospectively analyzed EMR data from a university memory clinic. The final analytic sample consisted of 381 patients: 107 in the program and 274 matched patients not in the program. We used logistic regression of outcomes (five or more concurrent medications) at follow-up, controlled for the same outcome at baseline to assess the change in polypharmacy, and stratified outcomes by prescription and over-the-counter.

Results. The two groups did not differ in the use of five or more total and prescription medications at follow-up controlling for the use of 5 or more of the respective medications at baseline and covariates. Being in the program was associated with a threefold lower odds of using 5 or more over-the-counter medications at follow-up (OR=0.30; p<0.001) after controlling for using 5 or more over-the-counter medications at baseline and covariates.

Conclusions. Dementia care might reduce polypharmacy of over-the-counter medications, potentially reducing risky medication-medication interactions. More research is needed to infer causality and understand how to reduce prescription medication polypharmacy.