Screening for mild cognitive impairment among older Albanian patients by clinical pharmacists.

OBJECTIVES: To assess the prevalence of mild cognitive impairment (MCI) and its correlated factors among elderly Albanian patients using different screening tools applied by clinical pharmacists. METHODS: Patients aged 60 years old or more from two primary care centers located in two Albanian cities were included in the study. Two clinical pharmacists applied the MoCA/MoCA B (Montreal Cognitive Assessment/Basic) and the Mini-Cog in Albanian. A predictive multivariate logistic regression analysis and Kappa statistic were conducted. KEY FINDINGS: The prevalence of MCI using MoCA/MoCA B and Mini-Cog scales was 75.73 and 20.39%, respectively. There was a poor degree of agreement between them (Kappa 2.38). Older men had an increased risk of MCI. CONCLUSIONS: The involvement of clinical pharmacists in screening for MCI might help in selecting vulnerable individuals for more specialized examination. The MoCA/MoCA B tool is recommended for higher sensitivity.

Prevalence of potentially inappropriate prescriptions in primary care and correlates with mild cognitive impairment.

BACKGROUND: Potentially inappropriate prescribing is clearly associated with adverse health consequences among older people. Nevertheless, scarce evidence exists regarding the prevalence of potentially inappropriate prescriptions (PIP) in Albania, a Western Balkans country. OBJECTIVE: The aim of this study was to assess the prevalence of PIP among older Albanian patients in primary care and to determine the associated sociodemographic and medical factors, including the presence of mild cognitive impairment (MCI). METHODS: Cross-sectional study in two primary healthcare centers located in two different cities of Albania, a middle-income country in the Western Balkans. The Montreal Cognitive Assessment (MoCA) tool was applied to evaluate MCI. PIPs were assessed by two trained pharmacists using the Beers criteria 2019 update. Multivariate logistic regression analysis was conducted for possible risk factors predicting PIP in the study population. RESULTS: At least one PIP was identified among 40.23 % of the participants (174 older patients) and 10.35 % had more than one PIP. MCI was detected among 79.31 % of the patients. The most commonly represented drug groups in PIP were diuretics (24.71 %), benzodiazepines in the presence of MCI and antidepressants (both 8.62 %). The lack of electrolytes monitoring was the most common reason for PIP. According to the multivariate analysis, the only statistically significant association observed was between PIP and number of drugs prescribed [three to four drugs (OR 3.34; 95% CI 1.65:6.76), five or more than five drugs (OR 4.08; 95% CI 1.42:11.69)]. CONCLUSIONS: About four out of 10 older Albanian patients experience PIP in primary care. Further studies are needed for a comprehensive estimation of the prevalence and factors associated with PIP, particularly among elderly with mild cognitive impairment.

Prevalence of potentially inappropriate prescriptions in primary care and correlates with mild cognitive impairment

BACKGROUND: Potentially inappropriate prescribing is clearly associated with adverse health consequences among older people. Nevertheless, scarce evidence exists regarding the prevalence of potentially inappropriate prescriptions (PIP) in Albania, a Western Balkans country. OBJECTIVE: The aim of this study was to assess the prevalence of PIP among older Albanian patients in primary care and to determine the associated sociodemographic and medical factors, including the presence of mild cognitive impairment (MCI). METHODS: Cross-sectional study in two primary healthcare centers located in two different cities of Albania, a middle-income country in the Western Balkans. The Montreal Cognitive Assessment (MoCA) tool was applied to evaluate MCI. PIPs were assessed by two trained pharmacists using the Beers criteria 2019 update. Multivariate logistic regression analysis was conducted for possible risk factors predicting PIP in the study population. RESULTS: At least one PIP was identified among 40.23 % of the participants (174 older patients) and 10.35 % had more than one PIP. MCI was detected among 79.31 % of the patients. The most commonly represented drug groups in PIP were diuretics (24.71 %), benzodiazepines in the presence of MCI and antidepressants (both 8.62 %). The lack of electrolytes monitoring was the most common reason for PIP. According to the multivariate analysis, the only statistically significant association observed was between PIP and number of drugs prescribed [three to four drugs (OR 3.34; 95% CI 1.65:6.76), five or more than five drugs (OR 4.08; 95% CI 1.42:11.69)]. CONCLUSIONS: About four out of 10 older Albanian patients experience PIP in primary care. Further studies are needed for a comprehensive estimation of the prevalence and factors associated with PIP, particularly among elderly with mild cognitive impairment

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Prevalence and types of potentially inappropriate prescriptions among older and middle-aged community-dwelling Albanian patients.

BACKGROUND: Prevalence of potentially inappropriate prescriptions (PIP) varies among community-dwelling patients and this difference partly depends on the methods used to evaluate improper use. OBJECTIVE: The aim of our study was to assess the prevalence and type of PIP among community-dwelling elderly as well as among middle-aged people by applying three different explicit tools - Ghent Older People's Prescriptions community Pharmacy Screening (GheOP3S) tool, The European Union Potentially Inappropriate Medications EU(7)-PIM list and PRescribing Optimally in Middle-aged People's Treatments (PROMPT). METHODS: Cross-sectional study among community-dwelling patients in Tirana (Albania) from 1 March to 1 June 2018. Two community pharmacists reviewed the prescriptions independently. The PIP index and the mean number of PIP / patient was calculated. RESULTS: In total, 241 participants were included in the study. Among 142 elderly patients, 55.6 % and 54.2 % of them were prescribed at least one PIP, respectively according to the GheOP3S tool and the EU7 PIM list. After applying PROMPT criteria, we found at least one PIP in 33.3 % of the middle-aged patients. The most commonly represented PIP drugs groups were cardiovascular drugs among older people and non-steroidal anti-inflammatory drugs among middle-aged people. Reminding and proposing the patient to undergo yearly influenza vaccination was the most common potentially prescribing omission. CONCLUSIONS: Prevalence of PIP is higher in elderly patients and slightly different according to the tool used for detection. However, PIP are also common in the middle-aged population.

Prevalence and factors associated with potentially inappropriate prescriptions among older patients at hospital discharge.

RATIONALE, AIMS AND OBJECTIVES: Explicit criteria have been used worldwide to identify suboptimal prescribing such as potentially inappropriate prescriptions (PIPs). The objective of our study was to determine prevalence, types and factors associated with PIPs in older people discharged from an Albanian hospital. METHOD: Retrospective, cross-sectional study conducted among patients aged 60 years and more discharged from the Cardiology and Internal Medicine departments of the University Hospital Center 'Mother Theresa' Tirana during 2013. PIPs were identified by using Beers (2012 update) and STOPP criteria (2008 and 2014 versions). Chi-square analysis and Student Test were performed. Crude and adjusted odds ratios with their 95% confidence intervals were estimated by logistic regression analysis. RESULTS: Medical files for 319 patients were assessed. The median number of drugs prescribed was 7.8 (SD 2.2). PIPs prevalence at hospital discharge was 34.5% (95% CI 27.5-42.2%; 110 patients) according to both Beers and STOPP version 1 criteria. STOPP version 2 identified 201 (63.0%) patients with at least one PIP (95% CI 55.2-70.2%; 312 PIPs). The drugs more frequently involved in PIPs were aspirin, spironolactone, benzodiazepines, digoxin and methyldopa. The odds of having a PIP were higher in patients discharged from Internal Medicine (P < 0.005). The PIP index was 0.056%, 0.054% and 0.125% respectively for Beers, STOPP 2008 and STOPP 2014 criteria. A significant positive correlation was found between the number of prescribed drugs and PIP occurrence. CONCLUSIONS: Our study found that between one and two out of three older patients has at least one PIP among the treatment prescribed at hospital discharge, depending on the tool used for detection. The high frequency of PIPs suggests the urgent need for interventions to reduce them.