Treatments and Prescriptions in Advanced Dementia Patients Residing in Long-Term Care Institutions and at Home

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

“…It is well-acknowledged that dementia is associated with chronic comorbidities [23,42,43], and the findings from the present study, in which age-adjusted Charlson co-morbidity scores ranged from 4 to 8, corroborate this. Although numbers recruited to this feasibility study were small, it has highlighted the number of patients with lack of specificity in their diagnosis of dementia; this is recognised to be an issue particularly because treatment and prognosis may differ substantially based on the differential diagnosis [44].…”

“…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.…”

“…In the Delphi consensus process, physicians categorised the appropriateness of medications for use in patients with advanced dementia with FAST scores ranging between 6E and 7F. A recent study by Toscani et al [23] examined the appropriateness of prescribing for Italian patients with advanced dementia residing in long-term care institutions and at home using the classification system developed by Holmes et al [21]. In this study, patients with a FAST score of ≥ 7 were enrolled, but the authors reported data on patients with FAST scores of ≥ 7C as they argued that these patients had advanced dementia for which palliative care was clearly appropriate.…”

“…In this study, patients with a FAST score of ≥ 7 were enrolled, but the authors reported data on patients with FAST scores of ≥ 7C as they argued that these patients had advanced dementia for which palliative care was clearly appropriate. However, the classification system developed by Holmes et al [21] determined medication appropriateness in the context of providing care to patients with moderate to severe dementia approximating FAST stages 6E, 7A, 7B and 7C, and the authors recognised that the criteria on appropriateness of some medications may require reconsideration in the view of the advanced stage of dementia among the participants [23]. In terms of the eligibility criteria for a subsequent extension of the present feasibility study to a larger study, inclusion of patients with FAST scores of 7A and above should be considered, although this may require the validation of the Delphi consensus panel recommendations for such patients and may have an impact on the number of eligible residents from which to recruit.…”

“…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].…”