Poly-pharmacy in the elderly as a risk factor for cognitive impairment

Marta Tundzeva, Katarina Stavrik, Ljubin Shukriev

Keywords: Еlderly, Poly-pharmacy, Multi-morbidity, Drug interaction, Cognitive impairment

Background:
The prevalence of multi-morbidity in the elderly is high (50 to 98%). Individuals with multi-morbidity, especially the elderly, are predisposed to more hospitalizations using multiple medications at the same time. This leads to new conditions as a result of drug interactions and can manifest with cognitive impairment.

Research questions:
Are drugs interactions associated with quality of life and daily active functions in elderly? What is the impact of socio-economic conditions and lifestyle and their association with poly-pharmacy and cognitive disorders? What is the role of poly-pharmacy and multi-morbidity in the development of cognitive impairment and dementia? Will the intervention improve the quality of life?

Method:
Multi-center prospective randomized study, conducted by 20 family medicine specialists in eight regions in the country. Ten of them will carry out the intervention of rational prescribing of drugs and assessment. Screening and standard care will be performed in the other ten.
400 respondents will be included.
10 family medicine specialists will conduct a Medication Appropriateness Index (MAI), an anticholinergic score of previously used drugs with (ACB) and conduct a rational prescription of drugs using the STOPP/START criterion.
Inclusion criteria: Elderly (<65 years) with multi-morbidity (≤3 chronic diseases) and poly-pharmacy (≤5 drugs in the last 3 months).
Exclusive criteria: people with fatal illness that are at the end of life, blind, deaf and dumb.

Results:
Shall be presented to health care institutions where instruments for early diagnosis of cognitive deficits in patients with multi-morbidity and poly-pharmacy would be indicated. It is expected that in the future doctors working with the elderly and people with multi-morbidity and poly-pharmacy, primary care physicians, will apply a holistic and proactive approach.

Conclusions:
Implementing appropriate poly-pharmacy interventions may improve patients' cognitive function which may affect quality of life. This should confirm the hypothesis that STOPP/START intervention will improve cognitive functions and quality of life.

Points for discussion:
Appropriate vs. inadequate poly-pharmacy - improve quality of life and prevent disease consequences, or detrimental to patients' health?

Assessment for cognitive impairment

Stopp/Start tool