Reconsidering Medication Appropriateness for Patients Late in Life

Holmes, Holly M.; Hayley, Déon Cox; Alexander, G. Caleb; Sachs, Greg A.

doi:10.1001/archinte.166.6.605

Cited by 369 publications

(344 citation statements)

References 19 publications

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“…After dementia onset, medication appropriateness to manage co‐morbidities is complicated by a relative absence of evidence 5, 6, 7. Preventive treatments may require a treatment time to benefit that exceeds life expectancy,42 or may target treatment goals that are not relevant to the individual or their families 43. This is combined with a shifting focus on the priorities of healthcare in this patient cohort and the balance between the benefits and harms of medicines 44…”

Section: Introductionmentioning

confidence: 99%

Medication appropriateness tool for co‐morbid health conditions in dementia: consensus recommendations from a multidisciplinary expert panel

Page

Potter

Clifford

et al. 2016

Internal Medicine Journal

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BackgroundMedication management for people living with dementia is a complex task as it is unclear what constitutes optimal medication management in this population due to the shifting focus of health priorities and the balance between the benefits and harms of medications.AimThis study sought expert opinion to create a consensus list to define appropriate medication management of co‐morbidities for people with dementia.MethodsThis study used the Delphi technique. We invited multidisciplinary experts in geriatric therapeutics including pharmacists, doctors, nurse practitioners, a patient advocate and a psychologist to participate. Participants were asked to engage into three or more rounds of questioning. Round 1 was a questionnaire comprised of one question defining dementia and seven open‐ended questions about appropriate management of co‐morbidities in people with dementia. Two investigators qualitatively analysed the responses to questions from Round 1 using thematic analysis. The results of this analysis were provided to participants as statements in the Round 2 survey. The participants were asked to rate their agreement with each statement on a 5‐point Likert scale. The median and interquartile range (IQR) were calculated for the responses to each statement. Consensus was pre‐specified as an IQR less than or equal to 1. Statements where consensus was not achieved were presented to participants in Round 3. The Round 2 median and IQR values were provided and participants were again asked to rate their agreement with each statement on a 5‐point Likert scale. The statements where participants agreed or strongly agreed were included in the Medication Appropriateness Tool for Co‐morbid Health conditions in Dementia criteria.ResultsFifty‐seven experts agreed to participate in the study, of whom 58% were pharmacists and 36% were medical practitioners. Fifty‐five participants completed the Round 1 (95% response rate). A total of 128 statements was included in the Round 2 survey. Consensus was reached on 93 statements in Round 2 (n = 48 responders, 84% response rate) and on 18 statements in Round 3 (n = 43 responders, 75% response rate). The participants reached consensus on 111 of 128 statements. Of these statements, 67 statements were included in the Medication Appropriateness Tool for Co‐morbid Health conditions in Dementia criteria. The statements were in the broad themes of preventative medication, symptom management, disease progression, psychoactive medication, treatment goals, principles of medication use, side‐effects and medication reviews.DiscussionThis research provides consensus‐based guidance for clinicians who manage co‐morbid health conditions in people with dementia.

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Section: Introductionmentioning

confidence: 99%

Medication appropriateness tool for co‐morbid health conditions in dementia: consensus recommendations from a multidisciplinary expert panel

Page

Potter

Clifford

et al. 2016

Internal Medicine Journal

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show abstract

“…[2][3][4][5][6][7] As a result, medical treatment guidelines are increasingly based on prognostic information rather than on arbitrary agebased cutoffs. [8][9][10][11] In addition, prognosis impacts the likelihood of benefits and harms arising from tests or treatments with up-front harms and delayed benefits, such as cancer screenings 12,13 or medications targeted at risk factor reduction. 14 When shared with patients, prognostic information may also facilitate greater patient involvement in medical decision-making.…”

Section: Introductionmentioning

confidence: 99%

“Knowing is Better”: Preferences of Diverse Older Adults for Discussing Prognosis

et al. 2011

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“…In the first round (July 2011), participants were mailed a selection of literature regarding medication use in palliative care, a conceptual model regarding prescribing for patients late in life (to provide background information and to assist in the classification of medications into appropriateness categories [20,21,26,27]), and a questionnaire. The questionnaire collected demographic data and data regarding clinical practice pertaining to each participant, including: age; sex; details of current job title; area of practice; and percentage of typical working week spent in clinical practice.…”

Section: Delphi Consensus Panelmentioning

confidence: 99%

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

et al. 2014

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USA) for their advice regarding study design. The authors would also like to thank the physicians who participated in the Delphi consensus panel survey, and the residents, their relatives and care home staff who participated in the feasibility study. AbstractBackground: No studies have been conducted in the United Kingdom (UK) context to date which categorise medications in terms of appropriateness for patients with advanced dementia, or which examine medication use in these vulnerable patients.Objectives: To categorise the appropriateness of a comprehensive list of medications and medication classes for use in patients with advanced dementia; to examine the feasibility of conducting a longitudinal prospective cohort study to collect clinical and medication use data;and to determine the appropriateness of prescribing for nursing home residents with advanced dementia in Northern Ireland (NI), using the categories developed.Methods: Three-round Delphi consensus panel survey of expert clinicians, to categorise the appropriateness of medications for patients with advanced dementia (defined as having Functional Assessment Staging [FAST] scores ranging from 6E to 7F). This was followed by a longitudinal prospective cohort feasibility study which was conducted in three nursing homes in NI. Clinical and medication use for participating residents with advanced dementia (FAST scores ranging from 6E to 7F) were collected and a short test of dementia severity administered.These data were collected at baseline and every three months for up to nine months or until death. For those residents who died during the study period, data were also collected within 14 days of death. 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.Results: Consensus was achieved for 87 (90%) of the 97 medications and medication classes included in the survey. Fifteen residents were recruited to participate in the longitudinal prospective cohort feasibility study, four of whom died during the data collection period. Mean numbers of medications prescribed per resident were 16.2 at baseline, 19.6 at three months, 17.4 at six months and 16.1 at nine months respectively. Fourteen residents at baseline were taking at least one medication considered by the consensus panel to be never appropriate, and approximately 25% of medications prescribed were considered to be never appropriate. Postdeath data collection indicated a decrease in the proportion of never appropriate medications and an increase in the proportion of always appropriate medications for those residents who died. Conclusions

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Reconsidering Medication Appropriateness for Patients Late in Life

Cited by 369 publications

References 19 publications

Medication appropriateness tool for co‐morbid health conditions in dementia: consensus recommendations from a multidisciplinary expert panel

Medication appropriateness tool for co‐morbid health conditions in dementia: consensus recommendations from a multidisciplinary expert panel

“Knowing is Better”: Preferences of Diverse Older Adults for Discussing Prognosis

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

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