Use of medications of questionable benefit at the end of life in nursing home residents with advanced dementia
Matlow JN, Bronskill SE, Gruneir A, Bell CM, Stall NM, Herrmann N, Seitz DP, Gill SS, Austin PC, Fischer HD, Fung K, Wu W, Rochon PA. J Am Geriatr Soc. 2017; 65(7):1535-42. Epub 2017 Mar 29.
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.
Palliative care/End-of-life care