Daily Medication Use in Nursing Home Residents with Advanced Dementia

Abstract

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

Development and Application of Medication Appropriateness Indicators for Persons with Advanced Dementia: A Feasibility Study

“…These figures are higher than those reported in previous studies [2,[21][22][23], but do provide further evidence to support the conclusions of Tjia et al in their recent publication [2] that "most nursing home residents with advanced dementia receive medications of questionable benefit". Variations in the prevalence reported in these studies may be explained by the differences in medications included in and excluded from the analysis in each study; for example, in the study by Tjia et al [22], drugs prescribed on a when-required basis, topical preparations, vitamins (with the exception of vitamin D) and antimicrobials were not included whereas in the present study, regular and when-required medications, antimicrobials, topical and ophthalmic preparations and nutritional supplements were included.…”

“…Other studies have reported lower numbers of medications per resident ranging from a median of 4 medications [23] to means of 5.9, 6.5 and 7.3 medications per person [21,22,25]. However, this may in part be explained by the differences in medications included in and excluded from the analysis in each study.…”

“…Variations in the prevalence reported in these studies may be explained by the differences in medications included in and excluded from the analysis in each study; for example, in the study by Tjia et al [22], drugs prescribed on a when-required basis, topical preparations, vitamins (with the exception of vitamin D) and antimicrobials were not included whereas in the present study, regular and when-required medications, antimicrobials, topical and ophthalmic preparations and nutritional supplements were included. Further, in the classification system developed by Holmes et al [21] and utilised in the studies by Tjia et al [2,22] and Toscani et al [23], no consensus was achieved for aspirin, iron, vitamins, mineral supplements or finasteride, while in the present study these medications were classified as never appropriate.…”

“…The appropriateness ratings from the consensus panel survey were retrospectively applied to residents' medication data at each data collection timepoint to determine the appropriateness of medications prescribed for these residents. studies which focused on nursing home residents with advanced dementia nearing the end of life in the USA [2,21,22], in Italian patients with advanced dementia residing in long-term care institutions or at home [23], and patients admitted to an acute geriatric unit in Spain [25]. The majority of these studies employed the classification system developed by Holmes et al, [21] which categorised medications as never appropriate, rarely appropriate, sometimes appropriate or always appropriate for persons with advanced dementia in whom palliation of symptoms was the primary goal of therapy [2,[21][22][23].…”

Central Nervous System Drug Consumption Depending on the Time between Symptom Onset and the Diagnosis of Alzheimer’s Disease: An Analysis by the Registry of Dementias of Girona

“…Today, AD patients are broadly treated with antidementia drugs to improve cognitive and functional domains [13], and with neuroleptics, antidepressants, anxiolytics and other drugs to deal with behavioral and psychological symptoms [14]. So far, some studies have analyzed the drug prescription patterns in patients with AD, and most of them have focused on nursing homes, community-dwelling patients, or in specific drugs or families of drugs [15,16,17,18,19]. Besides, some authors describe medication patterns according to the severity of the dementia [20], but to our knowledge, there are no reports examining whether differences exist between the central nervous system (CNS) drug consumption pattern of individuals who are diagnosed as having AD, depending on the time elapsed between the first symptoms and the diagnosis.…”