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Development and Application of Medication Appropriateness Indicators for Persons with Advanced Dementia: A Feasibility Study

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Abstract

Background

No studies have been conducted in the UK context to date that categorise medications in terms of appropriateness for patients with advanced dementia, or that examine medication use in these vulnerable patients.

Objectives

The objectives of this study were to categorise the appropriateness of a comprehensive list of medications and medication classes for use in patients with advanced dementia; examine the feasibility of conducting a longitudinal prospective cohort study to collect clinical and medication use data; and determine the appropriateness of prescribing for nursing home residents with advanced dementia in Northern Ireland (NI), using the categories developed.

Methods

A three-round Delphi consensus panel survey of expert clinicians was used to categorise the appropriateness of medications for patients with advanced dementia [defined as having Functional Assessment Staging (FAST) scores ranging from 6E to 7F]. This was followed by a longitudinal prospective cohort feasibility study that was conducted in three nursing homes in NI. Clinical and medication use for participating residents with advanced dementia (FAST scores ranging from 6E to 7F) were collected and a short test of dementia severity administered. These data were collected at baseline and every 3 months for up to 9 months or until death. For those residents who died during the study period, data were also collected within 14 days of death. The appropriateness ratings from the consensus panel survey were retrospectively applied to residents’ medication data at each data collection timepoint to determine the appropriateness of medications prescribed for these residents.

Results

Consensus was achieved for 87 (90 %) of the 97 medications and medication classes included in the survey. Fifteen residents were recruited to participate in the longitudinal prospective cohort feasibility study, four of whom died during the data collection period. Mean numbers of medications prescribed per resident were 16.2 at baseline, 19.6 at 3 months, 17.4 at 6 months and 16.1 at 9 months. Fourteen residents at baseline were taking at least one medication considered by the consensus panel to be never appropriate, and approximately 25 % of medications prescribed were considered to be never appropriate. Post-death data collection indicated a decrease in the proportion of never appropriate medications and an increase in the proportion of always appropriate medications for those residents who died.

Conclusions

This study is the first to develop and apply medication appropriateness indicators for patients with advanced dementia in the UK setting. The Delphi consensus panel survey of expert clinicians was a suitable method of developing such indicators. It is feasible to collect information on quality of life, functional performance, physical comfort, neuropsychiatric symptoms and cognitive function for this subpopulation of nursing home residents with advanced dementia.

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Funding sources

The authors had financial support from the Alzheimer’s Society and the Bupa Foundation for the submitted work (grant reference 137). The authors’ work was independent of the funders; the Alzheimer’s Society and the Bupa Foundation did not contribute to the study design; the collection, analysis, or interpretation of data; the writing of the report; or the decision to submit the article for publication.

Conflicts of interest

Peter Passmore has received funding (educational grants) from Napp and Grünenthal and has spoken at and/or chaired meetings for these companies. Napp and Grünenthal had no role in the development, analysis and reporting of this study. The other authors have no conflicts to report.

Author contributions

Carole Parsons, Carmel Hughes, Peter Passmore: study design, analysis, interpretation of data and preparation of the manuscript. Laura McCann: acquisition of data, analysis, interpretation of data and preparation of the manuscript.

Other contributions

The authors wish to thank Dr. Chris Cardwell (School of Medicine, Dentistry and Biomedical Sciences, Queen’s University Belfast, Northern Ireland, UK), and Dr. Holly Holmes (The University of Texas MD Anderson Cancer Center, Houston, TX, USA) for their advice regarding study design. The authors would also like to thank the physicians who participated in the Delphi consensus panel survey, and the residents, their relatives and care home staff who participated in the feasibility study.

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Authors and Affiliations

  1. School of Pharmacy, Queen’s University Belfast, 97 Lisburn Road, Belfast, BT9 7BL, Northern Ireland, UK

    Carole Parsons & Carmel Hughes

  2. Northern Ireland Centre for Pharmacy Learning and Development, Queen’s University Belfast, Belfast, Northern Ireland, UK

    Laura McCann

  3. Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen’s University Belfast, Royal Victoria Hospital, Belfast, Northern Ireland, UK

    Peter Passmore

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  1. Carole Parsons
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  4. Carmel Hughes
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Correspondence to Carole Parsons.

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Parsons, C., McCann, L., Passmore, P. et al. Development and Application of Medication Appropriateness Indicators for Persons with Advanced Dementia: A Feasibility Study. Drugs Aging 32, 67–77 (2015). https://doi.org/10.1007/s40266-014-0226-9

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  • DOI: https://doi.org/10.1007/s40266-014-0226-9

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