Treatments and Prescriptions in Advanced Dementia Patients Residing in Long-Term Care Institutions and at Home

Abstract

Dementia is an incurable condition resulting in a progressive but patchy decay characterized by dementia related events such as recurrence of infections and eating problems, as well as by acute conditions typical of frailty and/ or the worsening of chronic comorbidities. Its duration is reported to range from three to over nine years. Although not everyone will reach the advanced stage, many patients experience a highly severe and persistent disability. Health professionals may not always acknowledge advanced dementia as a terminal disease, and this may result in patients being exposed to aggressive treatments. The prescription regimen should be reconsidered not only to avoid overtreatment and side effects of drugs, but also to improve comfort and symptom control. In far advanced stages, some medications previously prescribed for comorbidities could likely be discontinued to reduce burden, adverse effects, and costs. A model for defining the concept of prescriptions’ appropriateness in advanced dementia was proposed by Holmes and colleagues taking into account factors such as patients’ life expectancy and goals of care. Many patients with advanced dementia are cared for until death in nursing homes (NHs), and studies have shown that drug regimens may be far from optimal. However, others die at home, cared for by home care service (HC). Information on the treatments and prescriptions for patients with advanced-stage dementia cared for at home are scarce. We expected differences, because drug regimes may be critically reconsidered and revised upon admission to institutional long-term care by physicians on staff of NHs. The aim of this paper is to assess and compare treatments and prescriptions of patients with advanced dementia cared for in NHs and in HC and assess their appropriateness from a palliative care perspective.