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Advanced Dementia Patients Often Given Unhelpful Meds: Study
Unnecessary prescriptions lead to more side effects, costs for nursing home residents, experts sayThursday, September 11, 2014
THURSDAY, Sept. 11, 2014 (HealthDay News) -- A new national analysis of U.S. nursing home prescription patterns says that more than half of people with advanced dementia are prescribed medications that are of questionable benefit.
"The main concern centers on the under-appreciated burden and personal cost of using questionably beneficial meds," said study lead author Dr. Jennifer Tjia. She's with the department of quantitative health sciences at the University of Massachusetts Medical School in Worcester.
"Giving many daily medications to these patients, who often have difficulty eating and swallowing, is often uncomfortable [for the patient]," she noted.
"Further, giving so many medications is not consistent with the goals of care for these patients, which is typically comfort," she added. And, "many of these medications have very real health risks, such as nausea, sedation, arrhythmias [irregular heartbeat], and urinary retention," she said.
Tjia and her colleagues published their findings in the Sept. 8 online edition of JAMA Internal Medicine.
The study authors noted that the U.S. Institute of Medicine suggests keeping treatment for terminally ill patients to a minimum.
To gain insight into current prescription patterns for advanced dementia patients in nursing homes, the research team analyzed one year's worth of prescription-dispensing records provided by a large national pharmacy. This pharmacy serves about half of the 1.3 million residents of long-term care facilities across the United States.
The records included prescription histories for more than 5,400 nursing home residents across all regions of the country from 2009 to 2010.
All were diagnosed with advanced dementia. More than half were 85 years of age or older, and the majority were white and female, the study authors noted. More than a quarter were also diabetic, while nearly three-quarters had high blood pressure, and almost half suffered from depression.
The researchers concluded that during any three-month time frame, nearly 54 percent of the patients had been prescribed at least one medication that was "never appropriate" for an advanced dementia patient.
Such prescriptions included, for example, cholesterol-lowering medications, which were prescribed to more than one-fifth of the terminally ill patients. Other drugs that were questionably prescribed included some intended for the treatment of early stage dementia, such as cholinesterase inhibitors and memantine, the researchers said.
The degree to which unhelpful prescriptions were being issued varied by region, rising to 65 percent among West South Central region patients, and falling to less than 45 percent among those in the Mid-Atlantic area, the study found.
Patients with a do-not-resuscitate order in place were less likely to be given questionable medications, as were those living in a hospice facility and/or those placed on a feeding tube, the investigators found.
In financial terms, the dispensing of unhelpful drugs accounted for more than one-third of each patient's total drug costs.
Tjia said that more studies are needed to explore the best ways to discontinue medications that may no longer benefit these patients.
"Doctors, patient caregivers, and patients need to appreciate that the concept of 'less is more' often applies to medication prescribing, particularly when the goal of care is comfort," she said. "While many people feel better taking fewer medications, this is under-appreciated," Tjia added.
In an editorial accompanying the study, Dr. Greg Sachs, a professor of medicine at the Indiana University School of Medicine, called the new findings "important."
"We see patients in nursing homes who are on a laundry list of medications. And the more medicines someone is on, the more there's an issue not just in terms of cost, but also safety due to interactions and adverse effects," Sachs said.
"So for patients, it's important that the medications they are on are reviewed on a regular basis in order to see where that patient is in their life course, and whether or not the drug is still helpful," said Sachs. "Because even good meds that they may have been taking for years and years may no longer be appropriate."
SOURCES: Jennifer Tjia, M.D., M.S.C.E., department of quantitative health sciences, University of Massachusetts Medical School, Worcester, Mass.; Greg A. Sachs, M.D., professor of medicine, department of medicine, Indiana University School of Medicine, and scientist with the IU Center for Aging Research, Indianapolis; Sept. 8, 2014, JAMA Internal Medicine, online
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