Abstract
Pharmacotherapy, although a fundamental component of care of older patients with multi-morbidity, is often inappropriate. Despite careful review, medication counseling, and medical care provisions by licensed prescribers involved in the National Alzheimer’s Coordinating Center (NACC), 44% of the enrollees ≥65 years reported at least one, and about 31.5% used multiple anticholinergic drugs between 2005–2013. Furthermore, anticholinergic drugs were frequently used together with cognitive enhancers or antipsychotics. Our pharmacist-physician intervention reduced anticholinergic use in 56% of those in the intervention arm as opposed to 8% in the control arm and improved medication appropriateness index (mean difference from baseline 4.16 vs 1.13). Our follow-up intervention will address the entire spectrum of potentially inappropriate medications (Beers 2015 list) and will evaluate its impact on expanding cognitive reserve. Finding the right balance between treating multi-morbidity and avoiding medication-related negative effects, an important objective for healthcare providers, might be hard, but not impossible to achieve.