Benefits of Medications for Advanced Dementia Patients Questioned

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Benefits of Medications for Advanced Dementia Patients Questioned
Benefits of Medications for Advanced Dementia Patients Questioned

HealthDay News — Medications of questionable benefit are often prescribed for patients with advanced dementia, adding substantially to the costs of care, according to research published online in JAMA Internal Medicine.

Jennifer Tjia, MD, of the University of Massachusetts in Worcester, and colleagues conducted a cross-sectional study of medication use by 5,406 advanced dementia patients in 460 nursing homes between October 2009 and September 2010.

The researchers found that 53.9% of advanced dementia patients received at least one medication of questionable benefit. Commonly prescribed medications included cholinesterase inhibitors (36.4%), memantine (Namenda) (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 [AOR], 1.45; 95% confidence interval [CI], 1.12–1.87) and decreased by presence of eating problems (AOR, 0.68; 95% CI, 0.59–0.78), use of a feeding tube (AOR, 0.58; 95% CI, 0.48–0.7), a do-not-resuscitate order (AOR, 0.65; 95% CI, 0.57–0.75), and enrollment in hospice (AOR, 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.

"This article should cause all clinicians to reconsider their prescribing practices and other decision making for a broad population of patients late in life," writes the author of an accompanying editorial.

References

  1. Tjia J, et al. JAMA Intern Med. 2014; doi:10.1001/jamainternmed.2014.4103

Disclosures

One of the study authors and the editorial author report financial ties to the pharmaceutical industry.

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