P-107: The impact of potentially inappropiate medication on health care costs in spanish community dwelling older adults with advanced dementia

摘要

Introduction: The objective of this study is to evaluate the impact of PIM in community dwelling older adults with advaced dementia and poor 1-year survival prognosis assesed by a Home Care Geriatric Unit (HCGU). Methods: We included community dwelling patients aged ≥ 65 suffering from advanced dementia (GDS-FAST ≥ 7a) and poor 1-year survival prognosis (IF-VIG ≥ 0.6) and retrospectively reviewed medications and associated costs (first assessment of the HCGU) January 2016-January 2019 in a University Hospital. Potentially inappropriate drug use was defined at medications classified as ("never appropriate") by the Palliative Excellence in Alzheimer Care Efforts (PEACE) program criteria and the Screening Tool of Older Persons Prescriptions in Frail adults with limited life expectancy (STOPPFrail) criteria. Results: N = 87 patients (69% women), age: 89.2 ± 6 years, Fragil-VIG: 15.8 ± 1.07. 664 medications were collected (mean 7.6 ± 3.5). We found that 83.9% of patients had at least one PIM following STOPPFrail Criteria (1.89 ± 1.24 per patient). The cost of PIM was €105.61/day, €38,546.3/year, €44,306 per 100 patients/year, The mean cost of PIP was €1.21 per patient and day. We identified 30% patients receiving at leats one medication classed as "never appropriate" by PEACE criteria (0.42 ± 0.7 per patient). The cost was €62.68/day, €22.880.09/year, €26.298,96 € per 100 patients/year, The mean cost of PIP was €0.72 per patient and day. Nutritional supplements (33.8%), AChEI (17.44%), memantine (16.66%), PPI (6.28%) represent 82.54% of total costs. Conclusions: The estimated cost of PIP was significant in patients with advanced dementia at the end of life. Deprescribing statregies might be reasonable in this population.