Grant funds study of medication use at the end of life for dementia patients
Jennifer Tjia, MD
An estimated 1.8 million Americans are living with advanced dementia and are unable to recognize family or communicate, and are physically dependent on others for daily living needs. Often residing in nursing homes, these patients are frequently prescribed excessively complex medication regimens—for chronic conditions such as high cholesterol or for prevention of complications from illnesses such as osteoporosis—that may or may not lengthen life or improve its quality.
Seeking the best strategies to prevent and manage illness in patients with multiple chronic conditions at the end of life, the Agency for Healthcare Research and Quality has awarded the UMass Medical School a two-year, $500,000 grant to compare the effectiveness of medication regimens for chronic illness in nursing home patients with advanced dementia.
“We don’t have good data on the best approach to managing an elderly patient’s medication regimen near the end of their life so that they can have a good quality of life to their last day,” said Jennifer Tjia, MD, MSCE, assistant professor of medicine. Unnecessary and inappropriate medication use in the nursing home population increases the risk of injury or adverse drug events, making comparative effectiveness studies essential to helping improve the care of this vulnerable and understudied population. A researcher in the Meyers Primary Care Institute at UMMS, Dr. Tjia and her colleagues have published numerous studies on geriatric care and are widely recognized as experts in medication errors and adverse drug events among nursing home patients.
More than half of U.S. nursing home residents have dementia, and those with advanced dementia have a poor prognosis. Prior work by Tjia and colleagues shows that inappropriate medications are given to almost 40 percent of nursing home residents with advanced dementia, and are continued in almost 20 percent of these patients in the last week of life.
“Drugs such as lipid-lowering agents, for example, might not be of high importance at the end of life when it’s more likely that comfort and pain relief are the main focus for a patient,” said Tjia. “The continued use of potentially unnecessary medications, however, increases the risk of adverse drug events and drug interactions.”
Tjia’s study will analyze data from two large databases: 12,500 nursing home residents with dementia who received prescription services from a nationwide long-term care pharmacy from 2005 to 2008; as well as 95,000 nursing home residents with dementia from five states (Minnesota, Massachusetts, Pennsylvania, California and Florida) who used Medicare Part D drug benefits between 2006 and 2007.
“There are few studies examining medication effectiveness and drug withdrawal safety in the nursing home population,” said Tjia. Through this study, researchers will seek to advance analytic strategies for evaluating prescribing strategies and their effects on nursing home residents with advanced dementia and lay the foundation for efforts to optimize prescribing in this population.
About the AHRQ
The Agency for Healthcare Research and Quality (AHRQ) is the federal agency charged with improving the quality, safety, efficiency and effectiveness of health care for all Americans. As one of 12 agencies within the Department of Health and Human Services, AHRQ supports health services research that will improve the quality of health care and promote evidence-based decision making. For more information, go to www.ahrq.gov.
