Medication appropriateness for patients with dementia approaching the end of their life

Hsien-Yeh Chuang; Yu-Wen Wen; Liang-Kung Chen; Fei-Yuan Hsiao

doi:10.1111/ggi.13038

Medication appropriateness for patients with dementia approaching the end of their life

Geriatr Gerontol Int. 2017 Apr:17 Suppl 1:65-74. doi: 10.1111/ggi.13038.

Authors

Hsien-Yeh Chuang^{1

2}, Yu-Wen Wen³, Liang-Kung Chen^{2

4

5}, Fei-Yuan Hsiao^{1

6

7}

Affiliations

¹ Graduate Institute of Clinical Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan.
² Aging and Health Research Center, National Yang-Ming University, Taipei, Taiwan.
³ Clinical Informatics and Medical Statistics Research Center, Chang Gung University, Taoyuan, Taiwan.
⁴ Institute of Public Health, School of Medicine, National Yang-Ming University, Taipei, Taiwan.
⁵ Center for Geriatrics and Gerontology, Taipei Veterans General Hospital, Taipei, Taiwan.
⁶ School of Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan.
⁷ Department of Pharmacy, National Taiwan University Hospital, Taipei, Taiwan.

PMID: 28436189
DOI: 10.1111/ggi.13038

Abstract

Aim: To examine medication use among patients with dementia towards the end of their life and to evaluate the appropriateness of medication use by using a nationwide database.

Methods: Using Taiwan's National Health Insurance Research Database, we identified 6532 people with dementia that died between 2008 and 2012. For each person with dementia, data of medication use in the last month of outpatient setting (vs -12th month [baseline]) and last hospitalization (vs -3rd hospitalization [baseline]) before death were retrieved for study. The medications of interest were selected according to a consensus recommendation, which included five categories defining their appropriateness (i.e. always, sometimes, rarely and never appropriate, as well as no consensus). Multivariable logistic regression was carried out to analyze the determinants for use of "never appropriate" medications.

Results: Approximately 10% of the study participants were prescribed medications categorized as "never appropriate" in the last month of life in the outpatient settings, which was significantly lower than their baseline (-12th month: 17.5%; P < 0.0001). A similar pattern was identified in the last hospitalization before death. Older age was associated with a lower likelihood of being prescribed "never appropriate" medications (age 75-84: aOR 0.34 [0.29-0.41], P < 0.0001; age ≥85: aOR 0.34 [0.28-0.40], P < 0.0001). In contrast, patients with a history of diabetes mellitus (aOR 1.31 [1.10-1.55], P = 0.0018) were associated with a higher likelihood of being prescribed "never appropriate" medications.

Conclusions: This is the first study to sophisticatedly describe medications use, particularly according to their appropriateness for palliative care, in Asian people with dementia at the end of their life. Approximately 10% of all patients were prescribed "never appropriate" medications at the end of their life, which deserves further study to evaluate the clinical impact of the quality of care. Geriatr Gerontol Int 2017: 17 (Suppl. 1): 65-74..

Keywords: dementia; end of life care; inappropriate medication use; palliative care.

Publication types

Observational Study

MeSH terms

Aged
Aged, 80 and over
Cause of Death*
Databases, Factual
Dementia / diagnosis
Dementia / drug therapy*
Dementia / mortality*
Drug Utilization*
Female
Geriatric Assessment
Humans
Logistic Models
Male
Multivariate Analysis
Palliative Care / methods
Polypharmacy
Retrospective Studies
Risk Assessment
Taiwan
Terminal Care*