Jeremy N Matlow1,2, Susan E Bronskill1,3,4, Andrea Gruneir1,3,4,5, Chaim M Bell3,4,6, Nathan M Stall6, Nathan Herrmann7, Dallas P Seitz8,9, Sudeep S Gill8,10, Peter C Austin3,4, Hadas D Fischer4, Kinwah Fung4, Wei Wu1, Paula A Rochon1,3,4,6. 1. Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada. 2. Faculty of Medicine, University of Toronto, University of Toronto, Toronto, Ontario, Canada. 3. Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada. 4. Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada. 5. Department of Family Medicine, University of Alberta, Edmonton, Alberta, Ontario, Canada. 6. Department of Medicine, University of Toronto, Toronto, Ontario, Canada. 7. Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada. 8. Institute for Clinical Evaluative Sciences, Kingston, Ontario. 9. Division of Geriatric Psychiatry, Department of Psychiatry, Queen's University, Queen's University, Kingston, Ontario, Canada. 10. Department of Medicine, Queen's University, Kingston, Ontario, Canada.
Abstract
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.
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.
Authors: Joshua D Niznik; Xinhua Zhao; Florentina Slieanu; Maria K Mor; Sherrie L Aspinall; Walid F Gellad; Mary Ersek; Ryan P Hickson; Sydney P Springer; Loren J Schleiden; Joseph T Hanlon; Joshua M Thorpe; Carolyn T Thorpe Journal: Diabetes Care Date: 2022-07-07 Impact factor: 17.152
Authors: Carolyn T Thorpe; Florentina E Sileanu; Maria K Mor; Xinhua Zhao; Sherrie Aspinall; Mary Ersek; Sydney Springer; Joshua D Niznik; Michelle Vu; Loren J Schleiden; Walid F Gellad; Jacob Hunnicutt; Joshua M Thorpe; Joseph T Hanlon Journal: J Am Geriatr Soc Date: 2020-08-12 Impact factor: 5.562
Authors: Nathan M Stall; Hadas D Fischer; Kinwah Fung; Vasily Giannakeas; Susan E Bronskill; Peter C Austin; Jeremy N Matlow; Kieran L Quinn; Susan L Mitchell; Chaim M Bell; Paula A Rochon Journal: JAMA Netw Open Date: 2019-08-02
Authors: Alys W Griffiths; Claire A Surr; David P Alldred; John Baker; Ruchi Higham; Karen Spilsbury; Carl A Thompson Journal: Int J Clin Pharm Date: 2019-07-24