Pharmacist-led interventions to optimize the pharmacotherapy of older adults under evaluation for or living with a neurocognitive disorder in the community: A quasi-experimental study

BACKGROUND: Older adults living with neurocognitive disorders (NCDs) face a higher risk of polypharmacy, exposure to potentially inappropriate medications and related adverse events. Pharmacists can help manage these issues and improve the appropriateness of pharmacotherapy. OBJECTIVE: To evaluate the impact of pharmacists' interventions, as members of primary care interprofessional teams, on medication use and patient-reported outcome measures among older adults living with or under investigation for a NCD. METHODS: The effect of a 6-month follow-up by a primary care interprofessional team pharmacist on the number of medications, potentially inappropriate medications (PIMs) and anticholinergic burden for older adults living at home under evaluation for or living with a NCD was assessed through a controlled quasi-experimental study. Eligible older adults were 65 years or older and were enrolled between September 2021 and February 2025. The patient-reported outcomes were the evolution of participants' quality of life, treatment burden and satisfaction with care. The outcomes were evaluated using difference in differences (D-I-D) and their 95% confidence interval (95% CI). RESULTS: Pharmacist interventions significantly reduced the mean anticholinergic burden in the intervention arm (n = 177) compared to the control arm (n = 128) (D-I-D: -0.29; 95% CI: [-0.56; -0.11]). A nonstatistically significant trend toward a reduction was also observed for the mean number of PIMs (D-I-D: -0.11; [-0.22; 0.00]). The interventions also improved participants' satisfaction with care (6.97; [0.23; 13.72]). The mean number of medications used, as well as the burden of treatment and quality of life, were stable after follow-up. CONCLUSION: Pharmacist-led interventions in interprofessional primary care settings contributed to the appropriateness of pharmacotherapy and satisfaction of older adults under evaluation for or living with a NCD after a 6-month follow-up.