Objectives-Many medications commonly used to treat chronic conditions have unclear benefits for nursing home (NH) residents with advanced dementia. This study describes the pattern and factors associated with daily medication use in this population.Design, Setting, Participants-Residents with advanced dementia (N=323) from 22 Bostonarea NHs were followed prospectively for 18 months.Measurements-Data from residents' records were used to determine the number or daily medications, specific drugs prescribed, and use of drugs deemed 'never appropriate' in advanced dementia. Resident characteristics associated with the use of more daily medications and drugs deemed inappropriate were examined.Results-Residents were prescribed a mean of 5.9 ± 3.0 daily medications, and 37.5% received at least one medication considered 'never appropriate' in advanced dementia. Acetylcholinesterase inhibitors (15.8%) and lipid-lowering agents (12.1%) were the most common inappropriate drugs. Twenty-eight percent of residents took antipsychotics daily. Modest reductions of most daily medications only occurred during the last week of life. Factors independently associated with taking more daily medications included older age, male, non-white, dementia not due Alzheimer's, better cognition, cardiovascular disease, acute illness, and hospice referral. Factors independently associated with greater likelihood of taking inappropriate medications included male, shorter NH