Many nursing home residents with dementia receive at least one medication of questionable benefit

29/03/2017

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).

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 patients often have difficulty swallowing, and taking many medications could reduce their quality of life overall.

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“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.

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)
anti-platelet agents (18 per cent)
sex hormones (2 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 increasing access to specialists for nursing home residents whose goals of care are primarily palliation,” 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.

Author block: Jeremy N. Matlow, Susan E. Bronskill, Andrea Gruneir, Chaim M. Bell, Nathan M. Stall, Nathan Herrmann, Dallas P. Seitz, Sudeep S. Gill, Peter C. Austin, Hadas D. Fischer, Kinwah Fung, Wei Wu, Paula A Rochon.

The Institute for Clinical Evaluative Sciences (ICES) is an independent, non-profit organization that uses population-based health information to produce knowledge on a broad range of healthcare issues. Our unbiased evidence provides measures of health system performance, a clearer understanding of the shifting healthcare needs of Ontarians, and a stimulus for discussion of practical solutions to optimize scarce resources. ICES knowledge is highly regarded in Canada and abroad, and is widely used by government, hospitals, planners, and practitioners to make decisions about care delivery and to develop policy. For the latest ICES news, follow us on Twitter: @ICESOntario

About Women’s College Hospital
For more than 100 years Women’s College Hospital (WCH) has been developing revolutionary advances in healthcare. Today, WCH is a world leader in the health of women and Canada’s leading, academic ambulatory hospital. A champion of equitable access, WCH advocates for the health of all women from diverse cultures and backgrounds and ensures their needs are reflected in the care they receive. It focuses on delivering innovative solutions that address Canada’s most pressing issues related to population health, patient experience and system costs. The WCH Institute for Health System Solutions and Virtual Care (WIHV) is developing new, scalable models of care that deliver improved outcomes for patients and sustainable solutions for the health system as a whole.

Women’s College Research Institute (WCRI) is tackling some of the greatest health challenges of our time. Its scientists are conducting global research that advances the health of women and improves healthcare options for all, and are then translating those discoveries to provide much-needed improvements in healthcare worldwide.

For more information about how WCH and WCRI are transforming patient care, visit www.womenscollegehospital.ca and www.womensresearch.ca