Patients with Advanced Dementia Receive “Medications of Questionable Benefit” Even as They Near End of Life
As the disease progresses in patients with dementia, it is recommended that goals of care be reassessed to meet changing needs. Especially as these patients near end-of-life, goals generally shift from disease-targeted therapies to a more palliative approach. Yet a study in the June issue of JAMDA suggests that patients with advanced dementia often still receive one or more medications of questionable benefit throughout their final year of life.
In “Use of Medications of Questionable Benefit During the Last Year of Life of Older Adults with Dementia,” researchers reported the results of a study of older adults (age 75 and older) in Sweden who died with dementia between 2007 and 2013. The percentage of these individuals who received at least one medication of questionable benefit decreased from 38.6% 12 months before death to 34.7% during the final month before death. However, many still received such drugs as the disease progressed; and among older adults with dementia who used at least one questionably beneficial drug 12 months before death, nearly three-quarters received it until their last month of life.
“Medications of questionable benefit” were defined as those that are “never appropriate” for use in patients with advanced dementia and limited life expectancy. The list of these medications includes acetylcholinesterase inhibitors, memantine, lipid-lowering agents (including statins), cytotoxic chemotherapy, hormone antagonists, antiplatelet agents (excluding aspirin), leukotriene inhibitors, immunomodulators, and sex hormones.
During the last month before death, women were found to be more likely to receive medications of questionable benefit than men. The older the patients were, the less likely they were to receive such medications. The researchers also found that institutionalization was associated with a 15% reduction in the likelihood of receiving questionably beneficial medications. In addition, their findings show that anti-dementia drugs account for a large share of the total burden of medications of questionable benefit near the end of life; in fact, they are often prescribed until the final month before death.
The authors conclude, “Clinicians caring for older adults with advanced dementia should be provided with reliable tools to help them reduce the burden of potentially futile medications.” They suggest that, while adequate drug treatment is an essential part of quality end-of-life care, there needs to be a focus on improving the quality of prescribing in older people with dementia.
The study was conducted by researchers at the Aging Research Center, Karolinksa Institutet, and Stockholm University in Sweden; Department of Geriatrics, Catholic University of Rome, Italy; and Center for Research and Treatment on Cognitive Dysfunctions, Biomedical and Clinical Sciences Department, University of Milan, Italy.