Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2020 Jun;76(6):877-885.
doi: 10.1007/s00228-020-02859-3. Epub 2020 Mar 26.

Prescribing medications of questionable benefit prior to death: a retrospective study on older nursing home residents with and without dementia in Germany

Christian Rausch  1   2   3 , Falk Hoffmann  4
Affiliations

Prescribing medications of questionable benefit prior to death: a retrospective study on older nursing home residents with and without dementia in Germany

Christian Rausch et al. Eur J Clin Pharmacol. 2020 Jun.

Abstract

Purpose: We studied the prevalence of medications of questionable benefit in the last 6 months of life among older nursing home residents with and without dementia in Germany.

Methods: A retrospective cohort study was conducted on claims data from 67,328 deceased nursing home residents aged 65+ years who were admitted between 2010 and 2014. We analyzed prescription regimens of medications of questionable benefit in the 180-91-day period and the 90-day period prior to death for residents with dementia (n = 29,052) and without dementia (n = 38,276). Factors associated with new prescriptions of medications of questionable benefit prior to death were analyzed using logistic regression models among all nursing home residents and stratified by dementia.

Results: A higher proportion of nursing home residents with dementia were prescribed at least one medication of questionable benefit in the 180-91-day (29.6%) and 90-day (26.8%) periods prior to death, compared with residents without dementia (180-91 days, 22.8%; 90 days, 20.1%). Lipid-lowering agents were the most commonly prescribed medications. New prescriptions of medications of questionable benefit were more common among residents with dementia (9.8% vs. 8.7%). When excluding anti-dementia medication, new prescriptions of these medications were more common among residents without dementia (6.4% vs. 8.0%). The presence of dementia (odds ratio [OR] 1.40, 95% confidence interval [95%CI] 1.32-1.48) and excessive polypharmacy were associated with new prescriptions of medications of questionable benefit prior to death (OR 4.74, 95%CI 4.15-5.42).

Conclusion: Even when accounting for anti-dementia prescriptions, the prevalence of nursing home residents with dementia receiving medications of questionable benefit is considerable and may require further attention.

Keywords: Dementia; Inappropriate medications; Institutionalization; Palliative care; Polypharmacy.

PubMed Disclaimer

Conflict of interest statement

All authors declare that they have no conflict of interest.

References

    1. Prince M, Bryce R, Albanese E, et al. The global prevalence of dementia: a systematic review and metaanalysis. Alzheimers Dement. 2013;9:63–75.e2. doi: 10.1016/j.jalz.2012.11.007. - DOI - PubMed
    1. Mitchell SL, Teno JM, Kiely DK, Shaffer ML, Jones RN, Prigerson HG, Volicer L, Givens JL, Hamel MB. The clinical course of advanced dementia. N Engl J Med. 2009;361:1529–1538. doi: 10.1056/NEJMoa0902234. - DOI - PMC - PubMed
    1. Arcand M. End-of-life issues in advanced dementia: part 1: goals of care, decision-making process, and family education. Can Fam Physician. 2015;61:330–334. - PMC - PubMed
    1. Sachs GA, Shega JW, Cox-Hayley D. Barriers to excellent end-of-life care for patients with dementia. J Gen Intern Med. 2004;19:1057–1063. doi: 10.1111/j.1525-1497.2004.30329.x. - DOI - PMC - PubMed
    1. Li Q, Zheng NT, Temkin-Greener H. Quality of end-of-life care of long-term nursing home residents with and without dementia. J Am Geriatr Soc. 2013;61:1066–1073. doi: 10.1111/jgs.12330. - DOI - PMC - PubMed

Substances

LinkOut - more resources