Daily medication use in nursing home residents with advanced dementia.
OBJECTIVE
To describe the pattern and factors associated with daily medication use in nursing home (NH) residents with advanced dementia.


METHODS
Prospective cohort study.


METHODS
Twenty-two Boston-area NHs.


METHODS
NH residents with advanced dementia (N=323).


METHODS
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.


CONCLUSIONS
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.
Tjia
Jennifer
J
Division of Geriatric Medicine, University of Massachusetts Medical School, Worcester, Massachusetts 01605, USA. jennifer.tjia@umassmed.edu
Rothman
Margaret R
MR
Kiely
Dan K
DK
Shaffer
Michele L
ML
Holmes
Holly M
HM
Sachs
Greg A
GA
Mitchell
Susan L
SL
D000369:Aged, 80 and over; D014150:Antipsychotic Agents / Q000627:therapeutic use; D002800:Cholinesterase Inhibitors / Q000627:therapeutic use; D015331:Cohort Studies; D003704:Dementia; D005260:Female; D006801:Humans; D000960:Hypolipidemic Agents / Q000627:therapeutic use; D008297:Male; D055118:Medication Adherence; D009735:Nursing Homes; D019338:Polypharmacy; D011446:Prospective Studies; D013727:Terminal Care
D014150:Antipsychotic Agents; D002800:Cholinesterase Inhibitors; D000960:Hypolipidemic Agents
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