Medications and cognitive risk in Aboriginal primary care: a cross‐sectional study

Holdaway, Marycarol, Hyde, Zoë, Hughson, Jo‐anne, Malay, Roslyn, Stafford, Andrew, Fulford, Kate, Radford, Kylie, Flicker, Leon, Smith, Kate, Pond, Dimity, Russell, Sarah, Atkinson, David, Blackberry, Irene, and LoGiudice, Dina (2024) Medications and cognitive risk in Aboriginal primary care: a cross‐sectional study. Internal Medicine Journal.

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Abstract

Background: Aboriginal and Torres Strait Islander people are ageing with high rates of comorbidity, yet little is known about suboptimal prescribing in this population.

Aim: The prevalence of potentially suboptimal prescribing and associated risk factors were investigated among older patients attending primary care through Aboriginal Community Controlled Health Services (ACCHSs).

Methods: Medical records of 420 systematically selected patients aged ≥50 years attending urban, rural and remote health services were audited. Polypharmacy (≥ 5 prescribed medications), potentially inappropriate medications (PIMs) as per Beers Criteria and anticholinergic burden (ACB) were estimated and associated risk factors were explored with logistic regression.

Results: The prevalence of polypharmacy, PIMs and ACB score ≥3 was 43%, 18% and 12% respectively. In multivariable logistic regression analyses, polypharmacy was less likely in rural (odds ratio (OR) = 0.43, 95% confidence interval (CI) = 0.24–0.77) compared to urban patients, and more likely in those with heart disease (OR = 2.62, 95% CI = 1.62–4.25), atrial fibrillation (OR = 4.25, 95% CI = 1.08–16.81), hypertension (OR = 2.14, 95% CI = 1.34–3.44), diabetes (OR = 2.72, 95% CI = 1.69–4.39) or depression (OR = 1.91, 95% CI = 1.19–3.06). PIMs were more frequent in females (OR = 1.88, 95% CI = 1.03–3.42) and less frequent in rural (OR = 0.41, 95% CI = 0.19–0.85) and remote (OR = 0.58, 95% CI = 0.29–1.18) patients. Factors associated with PIMs were kidney disease (OR = 2.60, 95% CI = 1.37–4.92), urinary incontinence (OR = 3.00, 95% CI = 1.02–8.83), depression (OR = 2.67, 95% CI = 1.50–4.77), heavy alcohol use (OR = 2.83, 95% CI = 1.39–5.75) and subjective cognitive concerns (OR = 2.69, 95% CI = 1.31–5.52). High ACB was less common in rural (OR = 0.10, 95% CI = 0.03–0.34) and remote (OR = 0.51, 95% CI = 0.25–1.04) patients and more common in those with kidney disease (OR = 3.07, 95% CI = 1.50–6.30) or depression (OR = 3.32, 95% CI = 1.70–6.47).

Conclusion: Associations between potentially suboptimal prescribing and depression or cognitive concerns highlight the importance of considering medication review and deprescribing for these patients.

Item ID: 81762
Item Type: Article (Research - C1)
ISSN: 1445-5994
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Copyright Information: © 2023 The Authors. Internal Medicine Journal published by John Wiley & Sons Australia, Ltd on behalf of Royal Australasian College of Physicians. This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.
Funders: National Health and Medical Research Council of Australia (NHMRC)
Date Deposited: 11 Mar 2024 23:36
FoR Codes: 42 HEALTH SCIENCES > 4203 Health services and systems > 420309 Health management @ 50%
45 INDIGENOUS STUDIES > 4504 Aboriginal and Torres Strait Islander health and wellbeing > 450411 Aboriginal and Torres Strait Islander medicine and treatments @ 50%
SEO Codes: 20 HEALTH > 2001 Clinical health > 200105 Treatment of human diseases and conditions @ 50%
21 INDIGENOUS > 2103 Aboriginal and Torres Strait Islander health > 210302 Aboriginal and Torres Strait Islander health status and outcomes @ 50%
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