O1‐09‐06: ADDRESSING POLYPHARMACY ISSUES IN AN ELDERLY POPULATION WITH COGNITIVE IMPAIRMENT USING A PRECISION‐MEDICINE PLATFORM

Polypharmacy, the concurrent use of multiple medications, increases the likelihood that an individual will experience potential drug interactions and adverse drug reactions (ADRs). Those with dementia or Alzheimer's disease (AD) are at greater risk, due to age, comorbidities, and an increased likelihood of being on more neuroactive medications. uMETHOD Health (uMH) has implemented a precision-medicine platform to create personalized, multidomain care plans for the treatment of dementia and mild AD. Medication interactions and ADRs in many categories are observed, such as drug-drug interactions (DDIs), opioid usage, anticholinergic cognitive burden (ACB), and depression-inducing drugs (DIDs). uMH's algorithms analyze these interactions and ADRs, rate them using input from open-source databases, and then attends to each in a generated treatment plan. 448 individuals aged 65 and older were included in this analysis. 98.2% of the individuals were on at least one medication (mean 11.6 medications/person), 84.6% on five or more, and 48.0% on ten or more (known as “excessive polypharmacy”). A total of 5,469 clinically-significant DDIs and one high-priority DDI were observed. DDIs increased significantly as medications per person increased (P value <0.0001). 10.7% were on at least one opioid. 70.5% were on one or more anticholinergic drugs. ACB scores were significantly higher for individuals with cognitive decline than those without. 70.1% of this population were on DIDs (mean 2.1 DIDs/person). With the growing elderly and AD populations, medication management (MM) for polypharmacy is a need that grows direr every year. The complexity of MM increases when dealing with an older population who are not only on more medications, but also have existing comorbidities and alternate pharmacokinetics. Precision medicine can better enable MM, through its ability to consider a full list of medications and comorbidities, manage high-risk medical recommendations (such as Beers Criteria), reduce redundancies, reduce DDIs and ADRs, and recommend better alternatives. Such a platform can generate effective and highly-usable guidelines for each recommended change (deprescribing methodologies, changing dosages or formulations, recommending alternatives), and give guidance on the total picture: what needs to happen, how, and when. uMH's platform addresses a multitude of polypharmacy problems that individuals may face.