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Background: Older patients with dementia are often unable to take their medications as prescribed due to cognitive and physical impairment. Objectives: To review the evidence on medication adherence in older patients with dementia in terms of the level of adherence, outcomes, contributing factors, and available interventions. Methods: A systematic literature review was performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Searched databases included CINAHL, Cochrane Library, DARE, MEDLINE, and PubMed. Results: Eighteen studies reported levels of medication adherence or discontinuation and related factors. Medication adherence ranged from 17% to 42%, and medication discontinuation before the end of treatment ranged from 37% to 80%. Nonadherence was associated with an increased risk of hospitalization or death, while increasing age, choice of medication, use of concomitant medications, and medicines’ costs were reported to decrease medication adherence. Telehealth home monitoring and treatment modification were the only interventions reported in the literature to improve medication adherence in this population. Conclusion: Older patients with dementia have a low level of medication adherence. Future research should focus on the development and implementation of interventions to help older patients with dementia and their caregivers make better use of medications.

The reform of the health care system in this country has led to a restructuring of hospitals into large networks. Hospital administrators in new affiliates face the problem of coordinating services while reducing costs. One solution is the unification of congruent departments in nearby affiliates into multisystem departments under the lead of one director. This paper summarizes the experiences of a newly-appointed multisystem hospital pharmacy director, emphasizing his approaches to leadership, employee motivation, organization, and time management.

Nutritional support for hospitalized patients is recognized as an important medical therapy. Appropriate nutritional support can promote the patient's maximal response to medications, resistance to sepsis, and recovery from injury. Nutritional support service can be performed by a multidisciplinary team consisting of physicians, registered dietitians, registered nurses, and registered pharmacists. A comprehensive protocol has been developed to guide the nutritional support service. This review summarizes the guidelines of our protocol.

Establishment of a clinical intervention program and standardized drug information system in a community hospital is explained. The establishment of the program increased better communication among pharmacists, medical staff, and other health care professionals. An effective and consistent interaction with the physicians with respect to patient's drug therapy was developed. Medication misadventures are diminished in a positive communications environment. The total number of interventions increased to 4,275 in first year of program in 1992 and 6,700 in 1993. The first six months of 1994 yielded similar improvements with a total of 3,390 interventions. Before 1991, no documentation of interventions existed. This intervention program resulted in a great cost savings to the pharmacy department. An estimated $96,000 cost savings was observed in 1992 and $87,000 in 1993. In the first six months of 1994, a cost savings of $48,000 was observed. This program decreased drug inventory to the lowest level recorded at this institution over this 30 month period. Significant improvement in several intervention categories such as adverse drug reaction (ADR), conversion from parenteral to oral therapy, aminoglycoside and vancomycin monitoring were observed. Statistical analysis showed significant improvement in the intervention program over a three-year period with P value ranging from 0.00 to 0.012.