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Meds of Questionable Benefit Often Prescribed to Elderly

Many nursing home patients with dementia receive expensive drugs that may not be beneficial

TUESDAY, Sept. 9, 2014 (HealthDay News) -- Medications of questionable benefit are often prescribed for patients with advanced dementia, adding substantially to the costs of care, according to research published online Sept. 8 in JAMA Internal Medicine.

Jennifer Tjia, M.D., of the University of Massachusetts in Worcester, and colleagues conducted a cross-sectional study of medication use by 5,406 advanced dementia patients in 460 nursing homes between October 2009 and September 2010.

The researchers found that 53.9 percent of advanced dementia patients received at least one medication of questionable benefit. Commonly prescribed medications included cholinesterase inhibitors (36.4 percent), memantine hydrochloride (25.2 percent), and lipid-lowering agents (22.4 percent). The likelihood of receiving these medications was increased by high facility-level use of feeding tubes (adjusted odds ratio [AOR], 1.45; 95 percent confidence interval [CI], 1.12 to 1.87) and decreased by presence of eating problems (AOR, 0.68; 95 percent CI, 0.59 to 0.78), use of a feeding tube (AOR, 0.58; 95 percent CI, 0.48 to 0.7), a do-not-resuscitate order (AOR, 0.65; 95 percent CI, 0.57 to 0.75), and enrollment in hospice (AOR, 0.69; 95 percent CI, 0.58 to 0.82). For nursing home residents with advanced dementia who were prescribed these drugs, the 90-day expenditure for medications of questionable benefit averaged $816 (standard deviation, $553), which was 35.2 percent of the total average 90-day medication expenditures.

"This article should cause all clinicians to reconsider their prescribing practices and other decision making for a broad population of patients late in life," writes the author of an accompanying editorial.

One of the study authors and the editorial author report financial ties to the pharmaceutical industry.

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