TY - JOUR
T1 - Potentially Inappropriate Prescribing in Australian Nursing Home Residents with Advanced Dementia
T2 - A Substudy of the IDEAL Study
AU - Disalvo, Domenica
AU - Luckett, Tim
AU - Luscombe, Georgina
AU - Bennett, Alexandra
AU - Davidson, Patricia
AU - Chenoweth, Lynnette
AU - Mitchell, Geoffrey
AU - Pond, Dimity
AU - Phillips, Jane
AU - Beattie, Elizabeth
AU - Goodall, Stephen
AU - Agar, Meera
N1 - Funding Information:
The IDEAL Study was funded by the Australian Department of Health (previously Department of Health and Ageing). D.D. was provided a PhD scholarship from the University of Technology Sydney. All other authors have no potential conflicts of interest that are directly relevant to the content of this study.
Publisher Copyright:
© 2018, Mary Ann Liebert, Inc.
PY - 2018/10
Y1 - 2018/10
N2 - Background: Prescribing medications for nursing home residents with advanced dementia should focus on optimizing function and comfort, reducing unnecessary harms and aligning care goals with a palliative approach. Objective: The aim of the study was to estimate the proportion of Australian nursing home residents with advanced dementia receiving potentially inappropriate medications, and identify those most commonly prescribed and factors associated with their use. Design: Data were collected through retrospective audit of medication charts. Setting/Subjects: Two hundred eighteen nursing home residents with advanced dementia from 20 nursing homes participated in a cluster-randomized controlled trial of case conferencing (the IDEAL Study) from June 2013 to December 2014. Measurements: Inappropriate drug use was defined as medications classified as "never appropriate" by the Palliative Excellence in Alzheimer Care Efforts (PEACE) program criteria. Generalized linear mixed models were used to identify variables predicting use of "never" appropriate medications. Results: Over a quarter (n = 65, 30%) of residents received at least one medication classed as "never" appropriate, the most common being lipid-lowering agents (n = 38, 17.4%), antiplatelet agents (n = 18, 8.3%), and acetylcholinesterase inhibitors (n = 16, 7.3%). Residents who had been at the nursing home for ≤10 months (odds ratio [OR] 5.60, 95% confidence interval [CI] 1.74-18.06) and 11-21 months (OR 5.41, 95% CI 1.67-17.75) had significantly greater odds of receiving a never appropriate medication compared with residents who had been at the nursing home for >5 years. Conclusions: Use of potentially inappropriate medications in Australian nursing home residents with advanced dementia is common. A greater understanding of the rationale that underpins prescribing of medications is required.
AB - Background: Prescribing medications for nursing home residents with advanced dementia should focus on optimizing function and comfort, reducing unnecessary harms and aligning care goals with a palliative approach. Objective: The aim of the study was to estimate the proportion of Australian nursing home residents with advanced dementia receiving potentially inappropriate medications, and identify those most commonly prescribed and factors associated with their use. Design: Data were collected through retrospective audit of medication charts. Setting/Subjects: Two hundred eighteen nursing home residents with advanced dementia from 20 nursing homes participated in a cluster-randomized controlled trial of case conferencing (the IDEAL Study) from June 2013 to December 2014. Measurements: Inappropriate drug use was defined as medications classified as "never appropriate" by the Palliative Excellence in Alzheimer Care Efforts (PEACE) program criteria. Generalized linear mixed models were used to identify variables predicting use of "never" appropriate medications. Results: Over a quarter (n = 65, 30%) of residents received at least one medication classed as "never" appropriate, the most common being lipid-lowering agents (n = 38, 17.4%), antiplatelet agents (n = 18, 8.3%), and acetylcholinesterase inhibitors (n = 16, 7.3%). Residents who had been at the nursing home for ≤10 months (odds ratio [OR] 5.60, 95% confidence interval [CI] 1.74-18.06) and 11-21 months (OR 5.41, 95% CI 1.67-17.75) had significantly greater odds of receiving a never appropriate medication compared with residents who had been at the nursing home for >5 years. Conclusions: Use of potentially inappropriate medications in Australian nursing home residents with advanced dementia is common. A greater understanding of the rationale that underpins prescribing of medications is required.
KW - aged care
KW - dementia
KW - deprescribing
KW - polypharmacy
KW - potentially inappropriate prescribing
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U2 - 10.1089/jpm.2018.0070
DO - 10.1089/jpm.2018.0070
M3 - Article
C2 - 30106321
AN - SCOPUS:85054892503
SN - 1096-6218
VL - 21
SP - 1472
EP - 1479
JO - Journal of palliative medicine
JF - Journal of palliative medicine
IS - 10
ER -