Prescribing medications of questionable benefit prior to death: a retrospective study on older nursing home residents with and without dementia in Germany

Christian Rausch,Falk Hoffmann

doi:10.1007/s00228-020-02859-3

Abstract

PurposeWe studied the prevalence of medications of questionable benefit in the last 6 months of life among older nursing home residents with and without dementia in Germany.MethodsA retrospective cohort study was conducted on claims data from 67,328 deceased nursing home residents aged 65+ years who were admitted between 2010 and 2014. We analyzed prescription regimens of medications of questionable benefit in the 180–91-day period and the 90-day period prior to death for residents with dementia (n = 29,052) and without dementia (n = 38,276). Factors associated with new prescriptions of medications of questionable benefit prior to death were analyzed using logistic regression models among all nursing home residents and stratified by dementia.ResultsA higher proportion of nursing home residents with dementia were prescribed at least one medication of questionable benefit in the 180–91-day (29.6%) and 90-day (26.8%) periods prior to death, compared with residents without dementia (180–91 days, 22.8%; 90 days, 20.1%). Lipid-lowering agents were the most commonly prescribed medications. New prescriptions of medications of questionable benefit were more common among residents with dementia (9.8% vs. 8.7%). When excluding anti-dementia medication, new prescriptions of these medications were more common among residents without dementia (6.4% vs. 8.0%). The presence of dementia (odds ratio [OR] 1.40, 95% confidence interval [95%CI] 1.32–1.48) and excessive polypharmacy were associated with new prescriptions of medications of questionable benefit prior to death (OR 4.74, 95%CI 4.15–5.42).ConclusionEven when accounting for anti-dementia prescriptions, the prevalence of nursing home residents with dementia receiving medications of questionable benefit is considerable and may require further attention.

Highlights

The estimated prevalence of dementia among people aged 60 years and older is between 5 and 7% [1]
A total of 29,052 (43.1%) of the 67,329 decedent nursing home residents were diagnosed with dementia
There was a higher proportion of women in both groups of nursing home residents

Summary

Introduction

The estimated prevalence of dementia among people aged 60 years and older is between 5 and 7% [1]. In 2010, around 5.6 million people lived with dementia worldwide, with numbers expected to rise to 65.7 million in 2030 [1]. The progression of dementia often requires care in a nursing home, where individuals with advanced dementia often receive medical and palliative care at the end of life [2,3,4,5,6]. Medications are an important cornerstone in the management of dementia. A fine balance between harm and benefit exists, when shifting from disease management to palliative care, with a focus on improved quality of life [7]. A majority of patients with dementia are older

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