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CONTINUING PROFESSIONAL DEVELOPMENT
Dr Andrew Sta ord is Director of the Western
Australian Dementia Training Study Centre, School of
Pharmacy at Curtin University of Technology, Perth
WA. He is also an accredited consultant pharmacist.
After reading this article, pharmacists should be
• Identify drug-related problems (DRPs)
• Develop a systematic and holistic approach to
evaluate and address these DRPs
• Adopt best practice to make clinically sound
recommendations to help resolve DRPs and
achieve optimal patient care outcomes.
Competency standards (2010) addressed: 1.3, 2.1,
2.2, 2.3, 4.2, 6.3, 7.1, 7.2.
Accreditation number: CAP151111E
This article has been independently researched and peer reviewed.
Deprescribing in action:
relieving carer burden with
BY DR ANDREW STAFFORD
An 85-year-old gentleman was referred for a home medicines review
(HMR). The HMR was requested as he had recently been commenced on
a Websterpak dose administration aid to assist his wife (as primary carer)
manage his medicines.
The referring general practitioner (GP)
wanted to ensure that it was being used
correctly. The referral also requested that
the pharmacist comment on potential
options to reduce the gentleman's
medicine burden. The patient's medical
history was significant for the following:
• Alzheimer's disease
• gastro-oesophageal reflux disease
• ischaemic heart disease ('mild'
myocardial infarction (MI) 23 years
• overactive bladder
• peripheral artery disease
• type 2 diabetes
• vitamin B12 deficiency.
His medications, as per the HMR referral,
were as follows:
• aspirin EC 100 mg each morning
• cholecalciferol 25 mcg each morning
• esomeprazole 20 mg each morning
• hydroxocobalamin 1000 mcg/mL s/c
injection every 3 months
• glimepiride 1 mg each morning
• metoprolol 50 mg half twice daily
• risperidone 500 mcg at night
• simvastatin 10 mg at night
• solifenacin 5 mg at night
The patient's wife also attended the HMR
interview. Her major concern was that
her husband was becoming increasingly
reluctant to take his medicines.
The risperidone was introduced around
a month ago to manage his agitation
around taking his medicines.
The patient's wife had only administered
the risperidone for approximately
one week, before ceasing it herself
because she felt that it was ineffective
for managing his behaviour, and she
associated it with causing a number
of adverse effects. She believed that it
made her husband excessively drowsy --
so much so that he experienced urinary
incontinence because he did not wake
up, and he fell out of bed three times
that week which had never happened
before. Her concern was that his
incontinence was worsening, such that
he now wore pads at all times. He had
experienced urge incontinence for
many years which had been adequately
controlled with solifenacin until
recently. However, he was now finding
that he had reduced time between
experiencing an urge to urinate and
losing urine, and had several episodes of
incontinence throughout the day.
Aside from this, the medicines in the
Websterpak dose administration aid were
given as intended, although the patient
regularly refused to take many of them.
From their perspective, his
cardiovascular conditions were not
causing any issues as he was able
to mobilise without anginal pain or
claudication. Both the patient and his
wife recalled him experiencing two
episodes of mild hypoglycaemia in the
past month, which were appropriately
managed with no adverse outcomes.
His GORD symptoms were well
controlled, although previous attempts
at ceasing esomeprazole resulted in a
return of symptoms.
Results of blood tests performed a month
before the HMR are shown in Table 1.
At this time, his blood pressure was
138/57 mmHg, pulse 54 bpm, and he
weighed 85 kg.
This article provides an overview of
the considerations made regarding the
two primary concerns of the patient's
carer, i.e. her husband's reluctance to
take his medicines and his continence
The principles of behavioural strategies to
encourage people with dementia to take
their medicines are generally no different
to techniques employed to assist them
perform other activities of daily living.1
These have been described extensively
elsewhere.2,3 Briefly, a person-centred
approach should be utilised, involving
identification of the probable reasons for
behaviours that occur during medicine
administration, and addressing these
reasons using an individualised plan.4
Techniques utilised may involve the use
of simple, appropriate language and
tone, simple instructions, appropriate
non-verbal cues, and not arguing.
A second aspect to reducing the burden of
medicine administration for people with
dementia and their carers is minimisation of
the number of medicines taken.5 This was
particularly important in this case, given
the patient's reluctance to take medicines.
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