Questionable Benefits in Meds Prescribed to Advanced Dementia Patients
(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 September 8 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 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 [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.
One of the study authors and the editorial author report financial ties to the pharmaceutical industry.