Daily medication use in nursing home residents with advanced dementia
Authors
Tjia, JenniferRothman, Margaret R.
Kiely, Dan K.
Shaffer, Michele L.
Holmes, Holly M.
Sachs, Greg A.
Mitchell, Susan L.
UMass Chan Affiliations
Department of Medicine, Division of Geriatric MedicineMeyers Primary Care Institute
Document Type
Journal ArticlePublication Date
2010-05-22Keywords
Aged, 80 and overAntipsychotic Agents
Cholinesterase Inhibitors
Cohort Studies
*Dementia
Female
Humans
Hypolipidemic Agents
Male
*Medication Adherence
*Nursing Homes
Polypharmacy
Prospective Studies
Terminal Care
Geriatrics
Health Services Research
Primary Care
Metadata
Show full item recordAbstract
OBJECTIVES: To describe the pattern and factors associated with daily medication use in nursing home (NH) residents with advanced dementia. DESIGN: Prospective cohort study. SETTING: Twenty-two Boston-area NHs. PARTICIPANTS: NH residents with advanced dementia (N=323). 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 patients with 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 in most daily medications occurred only during the last week of life. Factors independently associated with taking more daily medications included older age, male sex, non-white race, dementia not due to Alzheimer's disease, better cognition, cardiovascular disease, acute illness, and hospice referral. Factors independently associated with greater likelihood of taking inappropriate medications included being male, shorter NH stay, better functional status, and diabetes mellitus, whereas a do-not-hospitalize order was associated with a lower likelihood. CONCLUSION: Questionably beneficial medications are common in advanced dementia, even as death approaches. Several characteristics can help identify residents at risk for greater medication burden. Medication use in advanced dementia should be tailored to the goals of care.Source
J Am Geriatr Soc. 2010 May;58(5):880-8. Epub 2010 Apr 14. Link to article on publisher's siteDOI
10.1111/j.1532-5415.2010.02819.xPermanent Link to this Item
http://hdl.handle.net/20.500.14038/37092PubMed ID
20406320Related Resources
Link to Article in PubMedae974a485f413a2113503eed53cd6c53
10.1111/j.1532-5415.2010.02819.x