Dementia patients often prescribed questionable medications

HealthDay News — Medications of questionable benefit are often prescribed for patients diagnosed with advanced dementia, adding substantially to the costs of care, according to researchers.

“Patients’ goals of care should guide the prescribing of medication during such terminal illness. Medications that do not promote the primary goal of care should be minimized,” wrote Jennifer Tija, MD, of the University of Massachusetts in Worcester, and colleagues in JAMA Internal Medicine.

To estimate the prevalence of medications with questionable benefit used by nursing home residents with advanced dementia, the inspectors conducted a cross-sectional study of 5,406 patients diagnosed with advanced dementia in 460 nursing homes between October 2009 and September 2010.

Of the patients, 53.9% of advanced dementia patients received at least one medication of questionable benefit. Commonly prescribed medications included cholinesterase inhibitors (36.4%), memantine hydrochloride (25.2%), and lipid-lowering agents (22.4%).

The likelihood of receiving these medications was increased by high facility-level use of feeding tubes (adjusted odds ratio, 1.45; 95% CI: 1.12-1.87) and decreased by presence of eating problems (adjusted odds ratio, 0.68; 95% CI: 0.59-0.78), use of a feeding tube (adjusted odds ratio, 0.58; 95% CI: 0.48-0.7) a do-not-resuscitate order (adjusted odds ratio, 0.65; 95% CI: 0.57-0.75), and enrollment in hospice (adjusted odds ratio, 0.69; 95% CI: 0.58-0.82).

For nursing home residents with advanced dementia who were prescribed these drugs, the 90-day expenditure for medications of questionable benefit averaged $816 (standard deviation, $553), which was 35.2% of the total average 90-day medication expenditures.

“Most nursing home residents with advanced dementia receive medications with questionable benefit that incur substantial associated costs,” concluded the researchers.