***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    Input: Abstract Background : Older people in general and care home residents in particular are at high risk of suboptimal or inappropriate prescribing . To date , research into potentially inappropriate prescribing ( PIP ) has not focused on care home residents and /or has not utilized the recently developed and vali date d Screening Tool of Older Persons ’ potentially inappropriate Prescriptions ( STOPP ) criteria . Objective : The aim of this study was to estimate the prevalence of PIP in older people with dementia living in six residential care homes in Engl and , using the STOPP criteria . Methods : A retrospective analysis was conducted using medication data collected for older people with dementia in six residential care homes in Engl and who participated in the prospect i ve , longitudinal EVIDEM — End of Life ( EoL ) study . Of the 133 residents recruited to the study , medication administration records were available for and review ed at two timepoints ( approximately 16 weeks apart ) for 119 residents and 110 residents , respectively . The prevalence of PIP at these timepoints was determined using 31 of the 65 STOPP criteria applicable when there is no access to residents ’ medical records . Results : At the first timepoint , 68 potentially inappropriate medications ( PIMs ) were identified . Fifty-five residents ( 46.2 % ) were prescribed one or more PIM(s ) , eleven ( 9.2 % ) were prescribed two or more PIMs and two ( 1.7 % ) were prescribed three PIMs . Thirteen of the 31 STOPP criteria utilized in this study ( 41.9 % ) were used to identify PIP . Long-term ( i.e. > 1 month ) neuroleptics ( antipsychotics ) were the most frequently prescribed PIMs ( n = 25 ; 21.0 % ) , followed by non-steroidal anti-inflammatory drugs ( NSAIDs ) for > 3 months , proton pump inhibitors ( PPIs ) at maximum therapeutic dosage for > 8 weeks , tricyclic antidepressants ( TCAs ) in patients with dementia and long-term ( i.e. > 1 month ) , long-acting benzodiazepines . At the second timepoint , 57 PIMs were identified ; 45 residents ( 40.9 % ) were prescribed one or more PIM(s ) and 10 ( 9.1 % ) were prescribed two or more PIMs , but only one resident ( 0.9 % ) was prescribed three PIMs . Of the 31 STOPP criteria utilized in this study , ten ( 32.3 % ) were used to identify PIP . Long-term ( i.e. > 1 month ) antipsychotics were again the most frequently prescribed PIMs ( n = 21 ; 19.1 % ) , followed by PPIs at maximum therapeutic dosage for > 8 weeks , NSAIDS for > 3 months and TCAs in patients with dementia . A significant correlation was found at both timepoints between the number of medicines prescribed and occurrence of PIP . Conclusions : This study found that over two-fifths of older people with dementia residing in six residential care homes in Engl and were prescribed at least one PIM at each timepoint . Long-term ( i.e. > 1 month ) antipsychotics , NSAID use for > 3 months and PPI use at maximum therapeutic dosage for > 8 weeks were the most prevalent PIMs . Regular medication review that targets , but is not limited to , these medications is required to reduce PIP in the residential care home setting . The STOPP criteria represent a useful tool to facilitate such review in this patient population Background Inappropriate medical treatment of co-morbidities in Alzheimer 's disease ( AD ) is an increasing concern in geriatric medicine . The objective of this study was to compare current drug use related to co-morbidity between individuals with a recent diagnosis of AD and a cognitively healthy control group in a population based clinical trial in Northern Norway . Methods Setting : Nine rural municipalities with 70 000 inhabitants in Northern Norway . Participants : Participants with and without AD recruited in general practice and by population based screening.187 participants with a recent diagnosis of AD were recruited among community dwellers . Of 791 respondents without cognitive symptoms , 500 were r and omly selected and invited to further clinical and cognitive testing . The final control group consisted of 200 cognitively healthy individuals from the same municipalities . Demographic characteristics , data on medical history and current medication were included , and a physical and cognitive examination was performed . The statistical analyses were carried out by independent sample t-test , chi-square , ANCOVA and logistic regression . Results A co-morbidity score was significantly higher in AD participants compared to controls . The mean number of drugs was higher for AD participants compared to controls ( 5.1 ± 3.6 and 2.9 ± 2.4 respectively , p < 0.001 age and gender adjusted ) , also when adjusted for co-morbidity . AD participants used significantly more  anticholinergic , sedative and antidepressant drugs . For nursing home residents with AD  the mean number of drugs was significantly higher compared to AD participants living at home ( 6.9 ± 3.9 and 4.5 ± 3.3 , respectively , p < 0.001 ) . Conclusions AD participants were treated with a significantly higher number of drugs as compared to cognitively healthy controls , even after adjustment for co-morbidity . An inappropriate use of anticholinergic and sedative drugs was identified , especially among nursing home residents with AD . The drug burden and the increased risk of adverse reactions among individuals suffering from AD need more attention from prescribing doctors Objective Few studies have investigated  potentially inappropriate medication ( PIM ) use in patients with Alzheimer ’s disease ( AD ) . The aim of our study was to assess the prevalence of PIM  in community-dwelling patients diagnosed with mild-to-moderate AD and identify the clinical factors associated with PIM prescriptions . Methods REAL.FR is a 4-year , prospect i ve , multicenter French cohort of AD patients recruited in centers of expertise . We analyzed patient baseline data at entry into the study .  PIMs  were assessed using the Laroche list . A  multivariate logistic regression was conducted to assess factors associated with PIMs . Results A total of 684 AD patients were enrolled in the study [ mean age 77.9 ± 6.8 years , 486 ( 71.0 % ) females ] . According to the Laroche list , 46.8 % [ 95 % confidence interval ( CI ) 43.0–50.5 % ] of the patients had at least one  PIM . “ Cerebral vasodilators ” were the most widely used class of PIM , accounting for 24.0 % ( 95 % CI 20.9–27.3 % ) of all prescriptions , followed by atropinic drugs ( 17.0 % , 95 % CI 14.1–19.8 % ) and long half-life benzodiazepines ( 8.5 % , 95 % CI 6.4–10.6 % ) . Atropinic drugs were associated with cholinesterase inhibitors in 16 % of patients . In the multivariate analysis , only two factors , namely , female gender [ odds ratio ( OR ) 1.5 , 95 % CI 1.1–2.2 ] and polypharmacy ( ≥5 drugs ; OR 3.6 , 95 % CI 2.6–4.5 ) were associated with prescriptions for PIMs . Conclusions These results reveal that approximately one out of two community-dwelling patients with mild-to-moderate AD treated by AD specialists use PIMs . They also indicate that the characteristics of the disease and the pharmacodynamic/pharmacokinetic profile of the drugs prescribed are not sufficiently taken into account by physicians when prescribing for AD patients OBJECTIVE Drug intake is associated with a risk of drug-related problems , for example , the intake of potentially inappropriate medication ( PIM ) , especially for cognitively impaired individuals . The proportion of PIM taken by immobile individuals , especially patients with suspicion of dementia in the AGnES studies ( German : Arzt-entlastende Gemeinde-nahe E-Health-gestützte Systemische Intervention ) , and possible determinants were analyzed . METHODS In a community-based , prospect i ve cohort study in the ambulatory healthcare sector , a sample of 342 patients aged ≥65 years were screened for dementia and received a home medication review . The screening for dementia was positive in 111 cases ( 32.5 % ) . Data assessment included sociodemographic variables and medical diagnoses . The German PRISCUS list was used to detect PIM and drug-condition interactions . RESULTS Potentially inappropriate medication in dementia was identified in 22 ( 19.8 % ) patients with suspicion of dementia . A multivariate binary logistic regression revealed that the number of drugs taken ( one to four drugs : OR = 0.059 ; 95 % CI 0.006 - 0.55 , p = 0.0133 ; Ref . : > 9 drugs ) and female gender ( OR = 10.362 ; 95 % CI : 1.28 - 83.87 ) were risk factors for PIM intake in patient with suspicion of dementia . CONCLUSIONS Inappropriate medication use in a community-based sample positively screened for dementia appears to be determined by sex and the number of drugs taken . The intake of fewer than five drugs and receiving support with regard to drug intake protects from the intake of PIM . Patients could benefit from medication management in a collaborative network of healthcare professionals . The implementation of systematic medication review and drug documentation should be extended and st and ardized in both research studies and routine primary health care OBJECTIVE To describe  medication  usage in nursing home residents with advanced dementia , to identify how this usage changed as patients advanced towards death , and to identify correlates of increased medication usage . METHODS Prospect i ve cohort study ( CareAD ) during which data on medication prescription were extracted from medical records at regular intervals using st and ardized extraction procedures . RESULTS Patients ( n=125 ) were prescribed a mean of 14.6 medications during the 6 months prior to study enrollment . In a subgroup of patients who died during the study ( n=88 ) , as the time of death approached , the total number of medications prescribed did not vary but the types of medications prescribed did change , with an increase in palliative medications such as opiate analgesics  and a decrease in other medication classes such as antibiotics , anti-dementia agents , cardiovascular agents , and psychotropic agents  , among others . In linear regression analyses , total medication prescription at study entry was associated with study site , antibiotic treatment , presence of cardiovascular disease , and treatment of gastrointestinal or dermatological conditions . CONCLUSIONS Nursing home residents with advanced dementia are prescribed a large number of medications from numerous medication classes and prescribing patterns change over time . Further study is needed to determine the ideal approach to treating chronic medical problems at the end of life in this patient population Background : A r and omized trial of postmenopausal women over age 65 reported increased risks of cognitive decline with 4 years of combined estrogen and progestin treatment . However , questions remain , including the effect of longer duration or of hormone therapy initiated at younger ages . Methods : The Nurses ’ Health Study is a prospect i ve cohort begun in 1976 , comprising 121,700 female nurses who report health information via biennial mailed question naires . This sub study includes 13,807 participants age 70 to 81 who completed two telephone cognitive assessment s , 2 years apart , between 1995 and 2003 .  General cognition , verbal memory , category fluency , and attention were tested . Multiple linear regression was used to estimate adjusted mean declines and logistic regression to estimate adjusted risks of substantial decline in cognition ( ≥2 SD of baseline performance ) across hormone groups . APOE genotype was available in a subset of 3,667 participants . Results : Overall , little difference was found in mean cognitive decline between current hormone users and never users . However , for long-term users of estrogen alone or combined with progestin , increased risk of substantial decline was observed on most cognitive tests ( relative risk [ RR ] = 1.25 to 1.72 ) . Decline was particularly high among women initiating hormones at older ages compared with never users : for example , on our test of general cognition , RR of substantial decline was 1.74 ( 95 % CI 1.08 , 2.81 ) and mean difference in decline was −0.43 ( 95 % CI −0.73 , −0.12 ) . No significant interactions between hormone use and APOE ε4 allele were observed . Conclusion : Postmenopausal hormone therapy provides no appreciable cognitive benefits in older women OBJECTIVES To evaluate the feasibility of developing consensus recommendations for appropriate prescribing for patients with advanced dementia using a new conceptual framework and to determine the frequency of inappropriate medication use based on these recommendations in a small sample of patients with advanced dementia . DESIGN Medication data were obtained using chart review . Recommendations for appropriate prescribing were achieved using a modified Delphi consensus panel . SETTING Three long-term care facilities . PARTICIPANTS Thirty-four patients with advanced dementia enrolled in the Palliative Excellence in Alzheimer Care Efforts Program were selected to evaluate medication use . Twelve geriatricians at the University of Chicago participated in the modified Delphi consensus panel . MEASUREMENTS Prescription and over-the-counter medications were recorded for the 34 patients . 
    Output:
    
Conclusions Variations in tool application may at least in part explain variations in potentially inappropriate prescribing across studies .