Potentially Inappropriate Prescribing in Australian Nursing Home Residents with Advanced Dementia: A Substudy of the IDEAL Study

被引：7

作者：

Disalvo, Domenica ^{[1
]}

Luckett, Tim ^{[1
]}

Luscombe, Georgina ^{[2
]}

Bennett, Alexandra ^{[3
]}

Davidson, Patricia ^{[4
]}

Chenoweth, Lynnette ^{[5
]}

Mitchell, Geoffrey ^{[6
]}

Pond, Dimity ^{[7
]}

Phillips, Jane ^{[1
]}

Beattie, Elizabeth ^{[8
]}

Goodall, Stephen ^{[9
]}

Agar, Meera ^{[1
,10
,11
]}

机构：

[1] Univ Technol Sydney, Fac Hlth, Improving Palliat Aged & Chron Care Clin Res & Tr, 235 Jones St, Ultimo, NSW 2007, Australia

[2] Univ Sydney, Sydney Med Sch, Ultimo, NSW, Australia

[3] NSW Therapeut Advisory Grp, Sydney, NSW, Australia

[4] Johns Hopkins Univ, Sch Nursing, Baltimore, MD USA

[5] Univ New South Wales, Ctr Hlth Brain Ageing, Sydney, NSW, Australia

[6] Univ Queensland, Fac Med, St Lucia, Qld, Australia

[7] Univ Newcastle, Sch Med & Publ Hlth, Newcastle, NSW, Australia

[8] Queensland Univ Technol, Sch Nursing, Herston, Qld, Australia

[9] Univ Technol, Fac Business, Ctr Hlth Res & Evaluat CHERE, Haymarket, NSW, Australia

[10] Univ New South Wales, South Western Sydney Clin Sch, Sydney, NSW, Australia

[11] Ingham Inst Appl Med Res, Liverpool, Merseyside, England

来源：

JOURNAL OF PALLIATIVE MEDICINE | 2018年 / 21卷 / 10期

关键词：

aged care; dementia; deprescribing; polypharmacy; potentially inappropriate prescribing; ADVERSE DRUG EVENTS; MEDICATION USE; OLDER-ADULTS; ALZHEIMERS-DISEASE; DOUBLE-BLIND; CARE; LIFE; DONEPEZIL; PEOPLE; END;

D O I：

10.1089/jpm.2018.0070

中图分类号：

R19 [保健组织与事业（卫生事业管理）];

学科分类号：

摘要：

Background: Prescribing medications for nursing home residents with advanced dementia should focus on optimizing function and comfort, reducing unnecessary harms and aligning care goals with a palliative approach. Objective: The aim of the study was to estimate the proportion of Australian nursing home residents with advanced dementia receiving potentially inappropriate medications, and identify those most commonly prescribed and factors associated with their use. Design: Data were collected through retrospective audit of medication charts. Setting/Subjects: Two hundred eighteen nursing home residents with advanced dementia from 20 nursing homes participated in a cluster-randomized controlled trial of case conferencing (the IDEAL Study) from June 2013 to December 2014. Measurements: Inappropriate drug use was defined as medications classified as never appropriate by the Palliative Excellence in Alzheimer Care Efforts (PEACE) program criteria. Generalized linear mixed models were used to identify variables predicting use of never appropriate medications. Results: Over a quarter (n=65, 30%) of residents received at least one medication classed as never appropriate, the most common being lipid-lowering agents (n=38, 17.4%), antiplatelet agents (n=18, 8.3%), and acetylcholinesterase inhibitors (n=16, 7.3%). Residents who had been at the nursing home for 10 months (odds ratio [OR] 5.60, 95% confidence interval [CI] 1.74-18.06) and 11-21 months (OR 5.41, 95% CI 1.67-17.75) had significantly greater odds of receiving a never appropriate medication compared with residents who had been at the nursing home for >5 years. Conclusions: Use of potentially inappropriate medications in Australian nursing home residents with advanced dementia is common. A greater understanding of the rationale that underpins prescribing of medications is required.

引用

页码：1472 / 1479

页数：8

共 46 条

[1]

Abernethy Amy P, 2005, BMC Palliat Care, V4, P7

[2] Effects of facilitated family case conferencing for advanced dementia: A cluster randomised clinical trial [J].

Agar, Meera ;

Luckett, Tim ;

Luscombe, Georgina ;

Phillips, Jane ;

Beattie, Elizabeth ;

Pond, Dimity ;

Mitchell, Geoffrey ;

Davidson, Patricia M. ;

Cook, Janet ;

Brooks, Deborah ;

Houltram, Jennifer ;

Goodall, Stephen ;

Chenoweth, Lynnette .

PLOS ONE, 2017, 12 (08)

[3] Pragmatic cluster randomised controlled trial of facilitated family case conferencing compared with usual care for improving end of life care and outcomes in nursing home residents with advanced dementia and their families: the IDEAL study protocol [J].

Agar, Meera ;

Beattie, Elizabeth ;

Luckett, Tim ;

Phillips, Jane ;

Luscombe, Georgina ;

Goodall, Stephen ;

Mitchell, Geoffrey ;

Pond, Dimity ;

Davidson, Patricia M. ;

Chenoweth, Lynnette .

BMC PALLIATIVE CARE, 2015, 14

[4]

[Anonymous], 2013, GUIDELINES ATC CLASS

[5] The safety of statins in clinical practice [J].

Armitage, Jane .

LANCET, 2007, 370 (9601) :1781-1790

[6] Death with dementia - the need for better care [J].

Bayer, A .

AGE AND AGEING, 2006, 35 (02) :101-102

[7]

BEERS MH, 1991, ARCH INTERN MED, V151, P1825

[8] Use of Potentially Harmful Medications and Health-Related Quality of Life among People with Dementia Living in Residential Aged Care Facilities [J].

Bosboom, Pascalle R. ;

Alfonso, Helman ;

Almeida, Osvaldo P. ;

Beer, Christopher .

DEMENTIA AND GERIATRIC COGNITIVE DISORDERS EXTRA, 2012, 2 (01) :361-371

[9] Emergency Hospitalizations for Adverse Drug Events in Older Americans [J].

Budnitz, Daniel S. ;

Lovegrove, Maribeth C. ;

Shehab, Nadine ;

Richards, Chesley L. .

NEW ENGLAND JOURNAL OF MEDICINE, 2011, 365 (21) :2002-2012

[10] Potentially inappropriate prescribing and cost outcomes for older people: a national population study [J].

Cahir, Caitriona ;

Fahey, Tom ;

Teeling, Mary ;

Teljeur, Conor ;

Feely, John ;

Bennett, Kathleen .

BRITISH JOURNAL OF CLINICAL PHARMACOLOGY, 2010, 69 (05) :543-552

← 1 2 3 4 5 →