Patients with advanced dementia in the care of nursing homes often receive medications with questionable benefits that can account for significant costs, according to research published in JAMA Internal Medicine.
In the management of advanced dementia, medications should promote the primary goal of care in those with terminal illness; all others should be minimized. Advanced dementia was defined as severe cognitive impairment and complete functional dependence.
In order to identify characteristics of facilities and residents that are susceptible to nonbeneficial therapy regimens, Jennifer Tija, MD, of the University of Massachusetts Medical School in Worcester, and colleagues studied a nationwide database of long-term care facilities linked to the Minimum Data Set. Within 460 facilities, 5,406 residents were classified as having advanced dementia.
Results showed that 53.9% of residents with advanced dementia received at least one medication with questionable benefit. Of those medications, Cholinesterase inhibitors (36.4%), memantine hydrochloride (25.2%), and lipid-lowering agents (22.4%) were the most common. Residents with eating problems, a feeding tube, a DNR and those enrolled in hospice were less likely to receive these medications. However, in facilities with a high use of feeding tubes, the likelihood of receiving the medications increased.
Of those receiving medications with questionable benefit, the mean 90-day cost was $816—35.2% of the total average 90-day medication expenditure for residents with advanced dementia that were prescribed the medications in question.
The researchers hope that the study’s results further the conversation around the American Board of Internal Medicine Foundation’s campaign to curb nonbeneficial and potentially harmful medications, tests and treatments for elderly and terminally-ill patients.
This study, published in JAMA Internal Medicine, outlines the controversy of nonbeneficial medication and treatment in long-term care environments.
Jennifer Tija, MD, of the University of Massachusetts Medical School in Worcester, and colleagues aimed to estimate the prevalence of medications with questionable benefit used by nursing home residents with advanced dementia, identify resident- and facility-level characteristics associated with such use, and estimate associated medication expenditures.
Of 5406 nursing home residents with advanced dementia, 2911 (53.9%) received at least 1 medication with questionable benefit.