End-stage dementia and unnecessary drugs

The field of senior care has made good strides in reducing unnecessary medications, but many patients with advanced dementia and nearing the end of life are still being prescribed drugs that may have very little benefit for them in the final year, according to a Swedish study published in JAMDA.

The cohort study examined records from 120,067 patients with dementia who died between 2007 and 2013. All patients were age 75 or older and came from a range of institutional and non-institutional settings. Researchers looked for instances where patients were taking drugs on the list of medications deemed “never appropriate” for older adults with advanced dementia during the last 12 months of life.

Nearly one-third of facility-dwelling patients were taking at least one medication “of questionable benefit” during the last month of life. Of these, acetylcholinesterase inhibitors, the NMDA-blocker memantine and cholesterol-lowering medications were the most common.

Patients living in professional healthcare facilities had 15 percent lower instances of medications of questionable benefit during the last month of life compared to patients living at home.

Women were more likely than men to receive medications of questionable benefit during the last month of life. The older the patient, the fewer medications tended to be prescribed.

The study highlights the need for better tools to help clinicians make prescribing decisions that balance quality of life and palliative care. “Clinicians caring for older adults with advanced dementia should be provided with reliable tools to help them reduce the burden of potentially futile medications,” the study authors write.

Topics: Alzheimer's/Dementia