Effects of pharmacists’ interventions on inappropriate drug use and drug-related readmissions in people with dementia-A secondary analysis of a randomized controlled trial
Open accessAbstract
Age-associated physiological changes and extensive drug treatment including use of potentially inappropriate medications (PIMs) pose a significant risk of drug–drug interactions and adverse drug events among elderly people with dementia. This study aimed at analysing the effects of clinical pharmacists’ interventions on use of PIMs, risk of emergency department visits, and time to institutionalization. Furthermore, a descriptive analysis was conducted of circumstances associated with drug-related readmissions. This is a secondary analysis of data from a randomized controlled intervention study conducted in two hospitals in Northern Sweden. The study included patients (n = 460) 65 years or older with dementia or cognitive impairment. The intervention consisted of comprehensive medication reviews conducted by clinical pharmacists as part of a healthcare team. There was a larger decrease in PIMs in the intervention group compared with the control group (p = 0.011). No significant difference was found in time to first all-cause emergency department visits (HR = 0.994, 95% CI = 0.755–1.307 p = 0.963, simple Cox regression) or time to institutionalization (HR = 0.761, 95% CI = 0.409–1.416 p = 0.389, simple Cox regression) within 180 days. Common reasons for drug-related readmissions were negative effects of sedatives, opioids, antidepressants, and anticholinergic agents, resulting in confusion, falling, and sedation. Drug-related readmissions were associated with living at home, heart failure, and diabetes. Pharmacist-provided interventions were able to reduce PIMs among elderly people with dementia and cognitive impairment.
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Interdisciplinary approaches involving pharmacists were associated with improved outcomes through tailored medication lists and structured reconciliation processes.
“Interdisciplinary approaches, particularly those involving pharmacists, were associated with improved outcomes through tailored medication lists and structured reconciliation processes (Gustafsson et al., 2018; Sawan et al., 2021).”
From Mind the gap: a systematic review of barriers, facilitators, and experiences of care transitions for people living with dementia and their informal caregivers. (2026) · cites this paper as Gustafsson et al., 2018
Methods §2.1 describes pharmacists conducting medication reconciliation and reviews with the ward team, and Conclusions §5 reports a significant reduction in potentially inappropriate medications among older people with dementia or cognitive impairment. The paper does not describe tailored medication lists as the means of improvement. Its Introduction §1 also says the intervention did not reduce drug-related readmissions over 180 days, so “improved outcomes” applies to the medication-use finding, not outcomes generally. Page numbers were not available in our copy. (LLM, conf=0.87)
Experimental — accuracy not yet measuredComplex medication regimens were typical, and issues such as polypharmacy and inappropriate prescribing contributed to adverse drug events and unplanned hospital readmissions.
“Complex medication regimens were typical, and issues such as polypharmacy and inappropriate prescribing contributed to adverse drug events and unplanned hospital readmissions (Delgado et al., 2022; Gustafsson et al., 2018).”
From Mind the gap: a systematic review of barriers, facilitators, and experiences of care transitions for people living with dementia and their informal caregivers. (2026) · cites this paper as Gustafsson et al., 2018
These risks were exacerbated by inconsistent assessment of cognitive status during admission, which hindered accurate prescribing decisions.
“These risks were exacerbated by inconsistent assessment of cognitive status during admission, which hindered accurate prescribing decisions (Gustafsson et al., 2018).”
From Mind the gap: a systematic review of barriers, facilitators, and experiences of care transitions for people living with dementia and their informal caregivers. (2026) · cites this paper as Gustafsson et al., 2018
The Introduction describes vulnerability to drug-related problems in people with dementia, and the Discussion describes prescribing errors involving renal function. Neither section addresses inconsistent assessment of cognitive status during admission or says that such assessments hindered prescribing decisions. Searches for cognitive assessment at admission found no passage supporting that link. (LLM, conf=0.74)
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- Authors
- Gustafsson, M., Sjölander, M., Pfister, B., Schneede, J., & Lövheim, H.
- Affiliations
- Umeå University (SE)
- Department of Pharmacology and Clinical Neuroscience, Umeå University, SE-90187 Umeå, Sweden
- Corresponding author
- Gustafsson, Maria
- Venue
- Pharmacy
- Publisher
- MDPI AG
- Published
- 2018-01-16
- Volume
- 6
- Issue
- 1
- Pages
- 7
- ISSN
- 2226-4787 (ISSN-L)
- PMC
- PMC5874546
- OpenAlex
- W2793912457
- Cited by
- 25
- References
- 25
- Citations by year
- 2026: 2 · 2025: 4 · 2024: 4 · 2023: 6 · 2022: 3 · 2021: 2 · 2020: 1 · 2019: 1 · 2018: 2
- FWCI
- 0.83
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- Pharmacy (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Funders
- Swedish Dementia Association
- County Council of Västerbotten
- Janne Elgqvists foundation
- Swedish Society of Medicine
- Topics
- Health Sciences › Medicine › Geriatrics and Gerontology › Pharmaceutical Practices and Patient Outcomes
- Life Sciences › Pharmacology, Toxicology and Pharmaceutics › Pharmacology › Pharmacy and Medical Practices
- Health Sciences › Medicine › Psychiatry and Mental health › Dementia and Cognitive Impairment Research
- Keywords
- dementia, potentially inappropriate medications, clinical pharmacist intervention, comprehensive medication review, emergency department visits, institutionalization, older adults, cognitive impairment, sedation, anticholinergic agents, adverse drug reactions, heart failure, diabetes mellitus
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