Related Presentations: Holmes HM, Cox Hayley D, Hougham GW, Shega JW, Dale W, and Sachs GA. Overuse of medications in palliative care patients. Poster at the Annual Meeting of the American Geriatrics Society 2005, Orlando, Florida. End-of-Life Care for Persons with Dementia. Symposium at the Annual Meeting of the American Academy of Hospice and Palliative Medicine 2006, Nashville, Tennessee.
Integrating Palliative Medicine into the Care of Persons with Advanced Dementia: Identifying Appropriate Medication Use
Article first published online: 14 MAY 2008
© 2008, Copyright the Authors. Journal compilation © 2008, The American Geriatrics Society
Journal of the American Geriatrics Society
Volume 56, Issue 7, pages 1306–1311, July 2008
How to Cite
Holmes, H. M., Sachs, G. A., Shega, J. W., Hougham, G. W., Cox Hayley, D. and Dale, W. (2008), Integrating Palliative Medicine into the Care of Persons with Advanced Dementia: Identifying Appropriate Medication Use. Journal of the American Geriatrics Society, 56: 1306–1311. doi: 10.1111/j.1532-5415.2008.01741.x
- Issue published online: 7 AUG 2008
- Article first published online: 14 MAY 2008
- palliative care;
- Delphi technique
OBJECTIVES: To evaluate the feasibility of developing consensus recommendations for appropriate prescribing for patients with advanced dementia using a new conceptual framework and to determine the frequency of inappropriate medication use based on these recommendations in a small sample of patients with advanced dementia.
DESIGN: Medication data were obtained using chart review. Recommendations for appropriate prescribing were achieved using a modified Delphi consensus panel.
SETTING: Three long-term care facilities.
PARTICIPANTS: Thirty-four patients with advanced dementia enrolled in the Palliative Excellence in Alzheimer Care Efforts Program were selected to evaluate medication use. Twelve geriatricians at the University of Chicago participated in the modified Delphi consensus panel.
MEASUREMENTS: Prescription and over-the-counter medications were recorded for the 34 patients. Following the modified Delphi process, medications were characterized into one of four categories for use in palliative care patients with advanced dementia: never appropriate, rarely appropriate, sometimes appropriate, or always appropriate.
RESULTS: Patients were taking an average of 6.5 medications at enrollment. Six patients were taking 10 or more medications daily. Consensus was reached ranking the appropriateness of 69 of 81 medication classes for patients with advanced dementia. Overall, 5% of the 221 medications prescribed at enrollment were considered to be never appropriate, and 10 of 34 patients (29%) had been taking a medication considered to be never appropriate.
CONCLUSION: Based on these preliminary findings, consensus criteria for prescribing in advanced dementia are needed to decrease polypharmacy and reduce the use of medications that are of minimal benefit or high risk.