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Polypharmacy and mortality among nursing home residents with advanced cognitive impairment: results from the SHELTER study

Authors :
Giovanni Gambassi
Rosa Liperoti
Henriëtte G. van der Roest
Jacob Gindin
Eva Topinkova
Graziano Onder
Alfonso J. Cruz-Jentoft
Daniela Fialová
Roberto Bernabei
Andrea D. Foebel
Massimo Fini
General practice
EMGO - Quality of care
Source :
Journal of the American Medical Directors Association, 14(6), 450.e7-450.e12. Elsevier Inc., Onder, G, Liperoti, R, Foebel, A, Fialova, D, Topinkova, E, van der Roest, H G, Gindin, J, Cruz-Jentoft, A J, Fini, M, Gambassi, G & Bernabei, R 2013, ' Polypharmacy and Mortality Among Nursing Home Residents With Advanced Cognitive Impairment: Results From the Shelter Study ', Journal of the American Medical Directors Association, vol. 14, no. 6, pp. 450.e7-450.e12 . https://doi.org/10.1016/j.jamda.2013.03.014
Publication Year :
2013

Abstract

Introduction: Older adults with advanced cognitive impairment have a limited life expectancy and the use of multiple drugs is of questionable benefit in this population. The aim of the present study was to assess if, in a sample of nursing home (NH) residents with advanced cognitive impairment, the effect of polypharmacy on mortality differs depending on estimated life expectancy. Methods: Data were from the Services and Health for Elderly in Long TERm care (SHELTER) project, a study collectinginformationonresidentsadmittedto57NHsin8Europeancountries.Polypharmacywasdefined as the concomitant use of 10 or more drugs. Limited life expectancy was estimated based on an Advanced Dementia Prognostic Tool (ADEPT) score of 13.5 or more. A Cognitive Performance Scale score of 5 or more was used to define advanced cognitive impairment. Participants were followed for 1 year. Results: Mean age of 822 residents with advanced cognitive impairment entering the study was 84.6 (SD 8.0) years, and 630 (86.6%) were women. Overall, 123 participants (15.0%) had an ADEPT score of 13.5 or more (indicating limited life expectancy) and 114 (13.9%) were on polypharmacy. Relative to residents with ADEPT score less than 13.5, those with ADEPT score of 13.5 or higher had a lower use of benzodiazepines, antidementia drugs, and statins but a higher use of beta-blockers, digoxin, and antibiotics. Polypharmacy was associated with increased mortality among residents with ADEPT score of 13.5 or more (adjusted hazard ratio [HR] 2.19, 95% confidence interval [CI]: 1.15e4.17), but not among those with ADEPT score less than 13.5 (adjusted HR 1.10, 95% CI: 0.71e1.71). Discussion: Polypharmacy is associated with increased mortality in NH residents with advanced cognitive impairment at the end of life. Conclusion: These findings underline the need to assess life expectancy in older adults to improve the prescribing process and to simplify drug regimens.

Details

ISSN :
15389375 and 15258610
Volume :
14
Issue :
6
Database :
OpenAIRE
Journal :
Journal of the American Medical Directors Association
Accession number :
edsair.doi.dedup.....d30e916247c89c42aeac1cf50e9d824e
Full Text :
https://doi.org/10.1016/j.jamda.2013.03.014