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Dementia patients receive medications of questionable benefit at end of life

April 10, 2017

Forty-five per cent of nursing home residents with dementia who received at least one medication of questionable benefit within the last year of life continued to receive these questionable medications in the last week of their life, according to a new study by researchers at the Institute for Clinical Evaluative Sciences (ICES) and Women's College Hospital (WCH).

Dr. Paula Rochon
Dr. Paula Rochon

The study used health data to track prescriptions for all Ontario nursing home residents with advanced dementia during the last year of their lives in an approximately three-year period between 2010 and 2013. The researchers identified about 9,300 who received at least one medication that might have done more harm than good, given the residents’ vulnerable state. These individuals may have difficulty swallowing, and taking many medications could reduce their quality of life overall.

“Our study found a substantial number of nursing home residents with advanced dementia receive medications with no immediate benefit in the last few days of life. This is an opportunity to reflect on prescribing practices and to identify areas for improvement,” says Dr. Paula Rochon, senior author on the study, vice-president of research at WCH and scientist at ICES.

Medications were considered of questionable benefit if they had been deemed “never appropriate” for those with advanced dementia according to a previously published list because they showed limited benefit and/or were associated with unnecessary risk. The medications were also listed on the Ontario Drug Benefit (OBD) formulary.

The most common prescriptions were statins and anti-dementia medications. There was a gradual drop in the number of questionable drugs residents received during the last year of life, with the biggest drop in the last two weeks of their lives. About 66 per cent were still taking questionable medications in the last two weeks of their lives, and the proportion dropped to 45 per cent in the last week.

Jeremy Matlow
Jeremy Matlow

Jeremy Matlow, a University of Toronto medical student supervised by Dr. Rochon, was first author on the study. “The fact that the drop is happening most significantly toward the last couple of weeks of life is a little bit alarming,” Matlow says. “It raises the question of whether there are things that healthcare providers can do earlier to assess the appropriateness of these medications such that they could be reasonably stopped at an earlier stage.”

The researchers found the most commonly prescribed medications for nursing home residents who received medications of questionable benefit in the last 120 days of life were:

  • anti-dementia (64 per cent)
  • lipid-lowering agents (48 per cent)

The researchers also found that almost one-third of the study’s cohort did not see any physician specialist in the last year of life. This is important because an assessment by a neurologist or psychiatrist was associated with a decreased risk of being dispensed a medication of questionable benefit in the last week of life.

“These findings underscore the importance of medication reviews for nursing home residents whose goals of care are optimizing quality of life,” adds Rochon.

“Use of medications of questionable benefit at the end of life in nursing home residents with advanced dementia,” was published today in Journal of the American Geriatrics Society.

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