title: Use of Medications of Questionable Benefit at the End of Life in Nursing Home Residents with Advanced Dementia.
abstract: OBJECTIVE
  To determine the prevalence of and resident characteristics associated with the prescription of medications of questionable benefit (MQBs) near the end of life in older adults with advanced dementia in nursing homes.
  
  
  METHODS
  Population-based, cross-sectional study using Resident Assessment Instrument Minimum Data Set 2.0 linked to health administrative data.
  
  
  METHODS
  Ontario, Canada.
  
  
  METHODS
  All 9,298 nursing home residents with advanced dementia who died between June 1, 2010, and March 31, 2013; were aged 66 and older at time of death; and received at least one MQB in their last year of life.
  
  
  METHODS
  Prevalence of eight classes of MQBs (e.g., lipid-lowering agents, antidementia drugs) used in the last 120 days and last week of life.
  
  
  RESULTS
  Of older nursing home residents with advanced dementia who received at least one MQB in the last year of life, 8,027 (86.3%) received them in the last 120 days and 4,180 (45.0%) in the last week of life. The most commonly prescribed MQB were antidementia (63.6%) and lipid-lowering agents (47.8%). Severe cognitive impairment (adjusted odds ratio (aOR) = 1.19, 95% confidence interval (CI) = 1.07-1.33, P = .002) and fewer signs and symptoms of health instability (aOR = 1.58, 95% CI = 1.44-1.74, P < .001) were associated with MQB use into the last week of life. Seeing a neurologist or psychiatrist was associated with less likelihood of MQB use in the last week of life.
  
  
  CONCLUSIONS
  Many nursing home residents with advanced dementia are dispensed MQBs in the last week of life. Given that MQBs may cause more harm than benefit in this vulnerable population, it is important for physicians to actively reassess the role of all medications toward the end of life.
authors.affiliation: Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada.|Faculty of Medicine, University of Toronto, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Jeremy N
authors.initials: JN
authors.lastname: Matlow
authors.affiliation: Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada.|Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.|Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.
authors.forename: Susan E
authors.initials: SE
authors.lastname: Bronskill
authors.affiliation: Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada.|Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.|Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.|Department of Family Medicine, University of Alberta, Edmonton, Alberta, Ontario, Canada.
authors.forename: Andrea
authors.initials: A
authors.lastname: Gruneir
authors.affiliation: Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.|Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.|Department of Medicine, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Chaim M
authors.initials: CM
authors.lastname: Bell
authors.affiliation: Department of Medicine, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Nathan M
authors.initials: NM
authors.lastname: Stall
authors.affiliation: Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Nathan
authors.initials: N
authors.lastname: Herrmann
authors.affiliation: Institute for Clinical Evaluative Sciences, Kingston, Ontario.|Division of Geriatric Psychiatry, Department of Psychiatry, Queen's University, Queen's University, Kingston, Ontario, Canada.
authors.forename: Dallas P
authors.initials: DP
authors.lastname: Seitz
authors.affiliation: Institute for Clinical Evaluative Sciences, Kingston, Ontario.|Department of Medicine, Queen's University, Kingston, Ontario, Canada.
authors.forename: Sudeep S
authors.initials: SS
authors.lastname: Gill
authors.affiliation: Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.|Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.
authors.forename: Peter C
authors.initials: PC
authors.lastname: Austin
authors.affiliation: Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.
authors.forename: Hadas D
authors.initials: HD
authors.lastname: Fischer
authors.affiliation: Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.
authors.forename: Kinwah
authors.initials: K
authors.lastname: Fung
authors.affiliation: Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada.
authors.forename: Wei
authors.initials: W
authors.lastname: Wu
authors.affiliation: Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada.|Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.|Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.|Department of Medicine, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Paula A
authors.initials: PA
authors.lastname: Rochon
mesh_terms: D000368:Aged; D003430:Cross-Sectional Studies; D003704:Dementia / Q000188:drug therapy*; D005260:Female; D006801:Humans; D057970:Inappropriate Prescribing / Q000706:statistics & numerical data*; D008297:Male; D009735:Nursing Homes / Q000706:statistics & numerical data*; D009864:Ontario; D013727:Terminal Care / Q000706:statistics & numerical data*
keywords: advanced dementia; end of life; medication of questionable benefit; nursing home; older adults