Background: Drugs are one of the cornerstones in the management of many diseases. In general, drugs are used for diagnosis, prevention, mitigation of symptoms, and, sometimes, to cure disease. However, drug treatment in elderly people, especially those with dementia and cognitive impairments, may involve significant risk of adverse drug events.  The aim of this thesis was to identify the extent of potentially inappropriate drug treatment among people with dementia and cognitive impairment and to assess the occurrence and character of drug-related problems that lead to acute hospital admissions. Another aim was to assess the potential impact of a comprehensive medication review conducted by clinical pharmacists as part of a health care team on quality of patients’ drug therapy and drug-related hospital readmission rates. Method: Long-term use of antipsychotic/psychotropic drugs and associated factors were investigated among 344 and 278 people respectively with dementia living in specialized care units. Trends in the prescribing of potentially inappropriate drugs between 2007 and 2013, comprising 2772 and 1902 people, living in nursing homes in the county of Västerbotten, were assessed using six national quality indicators. Data on drug use, function in the activities of daily living, cognitive function and behavioral and psychological symptoms were collected using the Multi-Dimensional Dementia Assessment Scale. Further, an investigation of a separate corresponding population from 2012 was done, where potentially inappropriate drug use was measured before and after a total of 895 medication reviews. Finally, a randomized, controlled trial was carried out among people 65 years or older with dementia or cognitive impairment in internal medicine and orthopedic wards at two hospitals in northern Sweden. The proportion of hospital admissions that were drug-related were estimated, and also whether comprehensive medication reviews conducted by clinical pharmacists as part of a health care team could affect the risk of drug-related hospital readmissions. Results: Antipsychotic and other psychotropic drugs were frequently prescribed to people with dementia living in specialized care units for prolonged periods. Associations were found between behavioral and psychological symptoms and different psychotropic drugs. The extent of potentially inappropriate drug use declined between 2007 and 2013. In the separate corresponding population from 2012, the frequency of potentially inappropriate drug use was significantly reduced among people who underwent medication reviews. Hospitalizations due to drug-related problems among old people with dementia or cognitive impairment were prevalent. We found that inclusion of a clinical pharmacist in the health care team significantly reduced the risk of drug-related 30-day and 180-day readmissions. However, in a subset of patients with concomitant heart failure no effect was seen. Conclusion: Among patients with dementia or cognitive impairment long-term treatment with antipsychotic and other psychotropic drugs is common. The results indicate that these drugs are prescribed to treat behavioral and psychological symptoms among cognitively impaired individuals, despite limited evidence of their efficacy and the high risk of adverse effects. Drug-related problems, such as adverse drug reactions, constituted a major cause of hospital admissions. By reducing potentially inappropriate drug use and optimizing overall drug therapy, inclusion of clinical pharmacists in a health care team might improve the quality of patient care and reduce the risk of hospital readmissions among people with dementia.

INTRODUCTION: The percentage of seniors in the population is increasing worldwide and Europe is not an exception in this case. Geriatric patients create a very specific group of patients in which the risk of drug-related problems is increased due to many reasons. Explicit criteria of potentially inappropriate medications/drug procedures (PIMs) in the aged belong to instruments helping with the evaluation of the quality of drug prescribing to older patients and have been developed in the past decades with the aim to increase the quality of geriatric pharmacotherapy and to minimize the quantity and severity of adverse drug reactions. The aim of this thesis is to evaluate the registration rates and OTC availability of pharmaceuticals from the PIMs list created for the purposes of EU COST Action IS1402 initiative (2015-2018) in 5 countries - Czech Republic, Estonia, Croatia, Poland and Slovakia. METHODOLOGY: Based on the thesis by S. Grešáková, MS, a list of 487 potentially inappropriate medicines/drug procedures in the aged has been created and subsequently also the record table stating the individual PIMs and other requested characteristics that was later filled by research teams of participating countries in the period from December 2016 to April 2017. In each country the following attributes were monitored:...

INTRODUCTION: The issue of care for older patients has recently been discussed more and more frequently. The proportion of older adults in the population has been raising exponentially, especially in the last few decades, so the expectations concerning the extent and quality of geriatric care increases as well. In order to improve the quality of pharmacotherapy in the old age, many tools have been published in the last 25 years aimed at support of physicians in better care for older adults, enabling selection of safer pharmacotherapeutic startegies that respect specific pharmacological, physiological and homeostatic changes in the old age. Consequently, multiple explicit criteria of potentially inappropriate drugs and drug procedures (PIMs) have been published to help clinicians to distinguish pharmacotherapeutic strategies of choice for geriatric patients and oppositely to identify drugs, indications and dosing schedules potentially inappropriate in seniors. The aim of this diploma thesis was to evaluate in the pilot round the registration rates and other issues related to availability of all known PIMs in countries participating in the EU COST Action IS1402 study. METHODOLOGY: Based on diploma thesis of S. Grešáková, MS ("Application of explicite criteria of medications potentially inappropriate...

Introduction: Proportion of the population over the age of 65 is continuously increasing in the European Union, and therefore, the number of polymorbid patients with polypharmacy, limited functional capacities and syndrome of geriatric frailty is rising every year as well. In order to support the quality of geriatric prescribing and to lower possible adverse drug events, explicit criteria for potentially inappropriate drugs and drug procedures for elderly have been created. The aim of the diploma thesis was to evaluate how many potentially inappropriate medications (PIMs) for elderly out of 22 explicit criteria were registered in 6 countries (Czech Republic, Hungary, Portugal, Serbia, Spain and Turkey) participating at the 1st phase of the EU COST Action IS1402 initiative and which criterion or what group of regional criteria (European, American, Asian) would be the most specific and most suitable in individual countries for prospective international study following the quality of PIM prescribing. Methods: Of 22 explicit criteria of drugs/drug procedures potentially inappropriate in the old age, validated and published in peer-review journals and journals with the impact factor by 2015 year, a list of all until now known 345 PIMs was created (disregarding the dosage scheme, interval of use or...

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