Use of Medications of Questionable Benefit at the End of Life in Nursing Home Residents with Advanced Dementia.

Autor: Matlow JN; Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada.; Faculty of Medicine, University of Toronto, University of Toronto, Toronto, Ontario, Canada., Bronskill SE; Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada.; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.; Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada., Gruneir A; Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada.; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.; Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.; Department of Family Medicine, University of Alberta, Edmonton, Alberta, Ontario, Canada., Bell CM; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.; Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.; Department of Medicine, University of Toronto, Toronto, Ontario, Canada., Stall NM; Department of Medicine, University of Toronto, Toronto, Ontario, Canada., Herrmann N; Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada., Seitz DP; Institute for Clinical Evaluative Sciences, Kingston, Ontario.; Division of Geriatric Psychiatry, Department of Psychiatry, Queen's University, Queen's University, Kingston, Ontario, Canada., Gill SS; Institute for Clinical Evaluative Sciences, Kingston, Ontario.; Department of Medicine, Queen's University, Kingston, Ontario, Canada., Austin PC; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.; Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada., Fischer HD; Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada., Fung K; Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada., Wu W; Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada., Rochon PA; Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada.; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.; Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.; Department of Medicine, University of Toronto, Toronto, Ontario, Canada.
Jazyk: angličtina
Zdroj: Journal of the American Geriatrics Society [J Am Geriatr Soc] 2017 Jul; Vol. 65 (7), pp. 1535-1542. Date of Electronic Publication: 2017 Mar 29.
DOI: 10.1111/jgs.14844
Abstrakt: 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.
(© 2017, Copyright the Authors Journal compilation © 2017, The American Geriatrics Society.)
Databáze: MEDLINE
Externí odkaz: