Use of Medications of Questionable Benefit at the End of Life in Nursing Home Residents with Advanced Dementia

• Published in: Journal of the American Geriatrics Society (JAGS) 2017-07, Vol.65 (7), p.1535-1542
• Main Authors: Matlow, Jeremy N., Bronskill, Susan E., Gruneir, Andrea, Bell, Chaim M., Stall, Nathan M., Herrmann, Nathan, Seitz, Dallas P., Gill, Sudeep S., Austin, Peter C., Fischer, Hadas D., Fung, Kinwah, Wu, Wei, Rochon, Paula A.
• Format: Article
• Language: English
• Subjects: advanced dementia; Aged; Cognitive ability; Cross-Sectional Studies; Dementia; Dementia - drug therapy; Dementia disorders; Drug therapy; end of life; Female; Geriatrics; Health risk assessment; Humans; Inappropriate Prescribing - statistics & numerical data; Male; medication of questionable benefit; nursing home; Nursing homes; Nursing Homes - statistics & numerical data; older adults; Older people; Ontario; Palliative care; Population studies; Terminal Care - statistics & numerical data
• ISSN: 0002-8614; 1532-5415
• DOI: 10.1111/jgs.14844

Objectives 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. Design Population‐based, cross‐sectional study using Resident Assessment Instrument Minimum Data Set 2.0 linked to health administrative data. Setting Ontario, Canada. Participants 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. Measurements 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. Conclusion 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.