title: Medication Use Among Nursing Home Residents With Severe Dementia: Identifying Categories of Appropriateness and Elements of a Successful Intervention.
abstract: BACKGROUND
  Seniors with severe dementia residing in nursing homes (NHs) frequently receive large numbers of medications. With disease progression, the medications' harm-benefit ratio changes and they need to be reviewed, adjusted, or discontinued. Evidence on successful interventions to optimize medication use among these residents is lacking.
  
  
  OBJECTIVE
  The objective of the study was to identify categories of appropriateness for medications as well as successful interventions or elements thereof to improve medication use in NH residents with severe dementia, suitable for use in Canada.
  
  
  METHODS
  A scoping literature review was performed to identify criteria and categories of appropriateness of medications for these residents as well as elements of successful interventions to optimize medication use. A 15-member multidisciplinary Delphi panel was convened to evaluate the applicability of these findings for NHs in a Canadian province.
  
  
  RESULTS
  The scoping review identified 1 study presenting categories of appropriateness specific to residents with severe dementia and 35 interventions aimed at reducing drug-drug interactions, inappropriate use of specific drug classes, inappropriate drug use overall, or polypharmacy. Regarding appropriateness, the Delphi panel agreed on the categorization of 63 medications or medication classes as "generally," "sometimes," or "rarely appropriate." The main elements of interventions successful in improving appropriate medication use in NH residents with dementia also were approved by the Delphi panel (ie, medication reviews using criteria of appropriateness, educational and training sessions, and interdisciplinary case conferences).
  
  
  CONCLUSIONS
  These results may be used to develop an intervention to optimize medication use in NH residents with severe dementia.
authors.affiliation: Centre d'excellence sur le vieillissement de Québec, CHU de Québec, Québec, Canada; Faculté de Pharmacie, Université Laval, Québec, Canada. Electronic address: edeltraut.kroger.cha@ssss.gouv.qc.ca.
authors.forename: Edeltraut
authors.initials: E
authors.lastname: Kröger
authors.affiliation: Donald Berman Maimonides Geriatric Centre, Montreal, Quebec, Canada; Division of Geriatric Medicine, McGill University, Montreal, Quebec, Canada.
authors.forename: Machelle
authors.initials: M
authors.lastname: Wilchesky
authors.affiliation: Centre d'excellence sur le vieillissement de Québec, CHU de Québec, Québec, Canada.
authors.forename: Martine
authors.initials: M
authors.lastname: Marcotte
authors.affiliation: Centre d'excellence sur le vieillissement de Québec, CHU de Québec, Québec, Canada; Faculté des Sciences Infirmiéres, Université Laval, Québec.
authors.forename: Philippe
authors.initials: P
authors.lastname: Voyer
authors.affiliation: Centre d'excellence sur le vieillissement de Québec, CHU de Québec, Québec, Canada; Département de médecine, Faculté de médecine, Université Laval, Québec, Canada.
authors.forename: Michèle
authors.initials: M
authors.lastname: Morin
authors.affiliation: Institut universitaire de gériatrie de Montréal, Montréal, Quebec, Canada.
authors.forename: Nathalie
authors.initials: N
authors.lastname: Champoux
authors.affiliation: Division of Geriatric Medicine, McGill University, Montreal, Quebec, Canada.
authors.forename: Johanne
authors.initials: J
authors.lastname: Monette
authors.affiliation: Centre d'excellence sur le vieillissement de Québec, CHU de Québec, Québec, Canada; Département de Médecine Familiale, Faculté de Médecine, Université Laval, Québec, Canada.
authors.forename: Michèle
authors.initials: M
authors.lastname: Aubin
authors.affiliation: Centre d'excellence sur le vieillissement de Québec, CHU de Québec, Québec, Canada; Faculté de Pharmacie, Université Laval, Québec, Canada; Département de Médecine Sociale et Préventive, Faculté de médecine, Université Laval, Québec (Québec), Canada.
authors.forename: Pierre J
authors.initials: PJ
authors.lastname: Durand
authors.affiliation: Centre d'excellence sur le vieillissement de Québec, CHU de Québec, Québec, Canada; Département de Médecine Sociale et Préventive, Faculté de médecine, Université Laval, Québec (Québec), Canada.
authors.forename: René
authors.initials: R
authors.lastname: Verreault
authors.affiliation: Centre de recherche sur le vieillissement, Université de Sherbrooke, Sherbrooke, Quebec, Canada.
authors.forename: Marcel
authors.initials: M
authors.lastname: Arcand
mesh_terms: D000368:Aged; D003704:Dementia / Q000188:drug therapy*; D006801:Humans; D057970:Inappropriate Prescribing; D009735:Nursing Homes; D055553:Prescription Drugs / Q000627:therapeutic use*; D012720:Severity of Illness Index
chemical_list: D055553:Prescription Drugs
keywords: Nursing home resident; appropriateness; criteria; interdisciplinary; intervention; medication use; severe dementia