More than half of nursing home residents with advanced dementia continue to receive medications of questionable benefit, and at substantial financial cost, finds a study newly published by JAMA Internal Medicine.
“Our findings...show that little progress has been made with respect to meeting the intent of the F329 section of the Nursing Home Reform Act, which calls for all nursing home residents to be free of unnecessary medications,” writes lead author Jennifer Tjia, MD, MSCE, of the University of Massachusetts Medical School, Worcester, and colleagues.
The researchers used a nationwide long-term care pharmacy database linked to the Minimum Data Set to study drugs prescribed to nursing home residents in the advanced stages of the disease at 406 facilities between Oct. 1, 2009, to Sept. 30, 2010. Medications were considered of questionable benefit if they had been deemed “never appropriate” for those with advanced dementia according to a previously published list desgned for those for whom the care goal is comfort.
They found that, of the 5,406 residents studied, 53.9 percent received at least one medication of questionable benefit. The use of these drugs varied by region, ranging from 44.7 percent in the Mid-Atlantic census region to 65 percent in the West South Central census region.
The most commonly prescribed medications:
- cholinesterase inhibitors (36.4 percent),
- memantine hydrochloride (25.2 percent) and
- cholesterol-lowering medications (22.4 percent).
Residents who had eating problems, feeding tubes or do-not-resuscitate orders were less likely to receive medications of questionable benefit, as were those who had enrolled in hospice. Those who lived in nursing homes where more than 10 percent of residents have feeding tubes, however, were more likely to be prescribed questionably beneficial drugs compared with those who lived in nursing homes where the use of feeding tubes was 5 percent or less.
The average 90-day cost for a medication of questionable benefit was $816, and that amount accounted for 35.2 percent of the total average 90-day medication expenditures for residents with advanced dementia.
In a related commentary, Greg A. Sachs, MD, of the Indiana University School of Medicine and Eskenazi Health, Indianapolis, writes that the research not only advances understanding of medication-prescribing practices for nursing home residents with advanced dementia but also dovetails with initiatives designed to curtail the use of medications, tests and treatments that not only are not beneficial but also are potentially harmful.
“This article should cause all clinicians to reconsider their prescribing practices and other decision making for a broad population of patients late in life,” he says.
The study was supported by a grant from the Agency for Healthcare Research and Quality as well as other grants.
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