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64/100

✓ Peer-reviewed alzhub usefulness score 64 out of 100. End-of-life care

Topic: Risk, prevention and care in population studies

Plain-language summary

Objectives To describe the pattern and factors associated with daily medication use in nursing home (NH) residents with advanced dementia. Design Prospective cohort study. Setting Twenty-two Boston-area NHs. Participants NH residents with advanced dementia (N=323). Measurements Data from residents' records were used to determine the number or daily medications, specific drugs prescribed, and use of drugs deemed "never appropriate" in patients with advanced dementia. Resident characteristics associated with the use of more daily medications and drugs deemed inappropriate were examined. Results Residents were prescribed a mean of 5.9 +/- 3.0 daily medications, and 37.5% received at least one medication considered "never appropriate" in advanced dementia. Acetylcholinesterase inhibitors (15.8%) and lipid-lowering agents (12.1%) were the most common inappropriate drugs. Twenty-eight percent of residents took antipsychotics daily. Modest reductions in most daily medications occurred only during the last week of life. Factors independently associated with taking more daily medications included older age, male sex, non-white race, dementia not due to Alzheimer's disease, better cognition, cardiovascular disease, acute illness, and hospice referral. Factors independently associated with greater likelihood of taking inappropriate medications included being male, shorter NH stay, better functional status, and diabetes mellitus, whereas a do-not-hospitalize order was associated with a lower likelihood. Conclusion Questionably beneficial medications are common in advanced dementia, even as death approaches. Several characteristics can help identify residents at risk for greater medication burden. Medication use in advanced dementia should be tailored to the goals of care.

Cite this study APA, Vancouver, BibTeX · download .bib or .ris

APA 7th

Tjia, J., Rothman, M. R., Kiely, D. K., Shaffer, M. L., Holmes, H. M., Sachs, G. A., et al. (2010). Daily medication use in nursing home residents with advanced dementia. Journal of the American Geriatrics Society. https://doi.org/10.1111/j.1532-5415.2010.02819.x

Vancouver

Tjia J, Rothman MR, Kiely DK, Shaffer ML, Holmes HM, Sachs GA, et al. Daily medication use in nursing home residents with advanced dementia. Journal of the American Geriatrics Society. 2010. doi:10.1111/j.1532-5415.2010.02819.x. PMID: 20406320.

BibTeX

@article{tjia2010-20406320,
  author  = {Tjia, J. and Rothman, M. R. and Kiely, D. K. and Shaffer, M. L. and Holmes, H. M. and Sachs, G. A. and Mitchell, S. L.},
  title   = {{Daily medication use in nursing home residents with advanced dementia}},
  journal = {Journal of the American Geriatrics Society},
  year    = {2010},
  doi     = {10.1111/j.1532-5415.2010.02819.x},
  pmid    = {20406320},
  url     = {https://doi.org/10.1111/j.1532-5415.2010.02819.x}
}

Built from the record alzhub holds for this paper, not looked up. Volume, issue and page numbers are not held in the record. The record names 7 authors; APA and Vancouver show the first six, BibTeX and the downloads carry all of them. Check the citation against the original before you use it.

How to read this study

Design: this is a follow-up (cohort) study. People are observed over time and not assigned to anything, so an association can reflect other differences between groups. Look at how long follow-up lasted, how many dropped out, and whether the authors adjusted for age, education and other health conditions.
Size: the record lists 323 participants. Ask whether that is enough for the question, and who they were.
Effect: the record reports “37.5%; 15.8%; 12.1%”. A statistically significant result can still be small in daily life.

What the evidence grade means here

This page is graded moderate. alzhub.org assigns the grade automatically from keywords in the abstract, not from reading the paper. Moderate means the abstract mentions a cohort, case-control or longitudinal design. It can add at most 5 of the 100 points in the study score, and it is a label about design, not a verdict on whether the findings are true.

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Key findings

Objectives To describe the pattern and factors associated with daily medication use in nursing home (NH) residents with advanced dementia.
Resident characteristics associated with the use of more daily medications and drugs deemed inappropriate were examined.
Results Residents were prescribed a mean of 5.9 +/- 3.0 daily medications, and 37.5% received at least one medication considered "never appropriate" in advanced dementia.
Factors independently associated with taking more daily medications included older age, male sex, non-white race, dementia not due to Alzheimer's disease, better cognition, cardiovascular disease, acute illness, and hospice referral.
Factors independently associated with greater likelihood of taking inappropriate medications included being male, shorter NH stay, better functional status, and diabetes mellitus, whereas a do-not-hospitalize order was associated with a lower likelihood.

Study details

Study designcohort study
Participants323
Effect size37.5%; 15.8%; 12.1%
Evidence strengthModerate

How this study scored 64/100

Published in a peer-reviewed journal, and it is a cohort study following people over time. Scored zero for randomized / blinded because the record does not state it. We have no data on journal's citation record, times cited, citations per year, impact for its field and year, cited by studies here, still being cited, senior author's track record, institution's track record and multicenter collaboration, so those were left out: it earned 37 of the 58 points we could judge it on, which is 64 out of 100.

Component	Points	Why
Journal tier	7 / 10	Tier 3 — peer-reviewed journal (Journal of the American Geriatrics Society)
Journal's citation record	— / 4	No journal record from OpenAlex — left out of this score
Study design	7 / 12	A cohort study following people over time
Strength of evidence	3 / 5	Rated “moderate” in our summary
Peer-review validation	10 / 10	Peer-reviewed. Published as an article in a named peer-reviewed journal.
How recent	1 / 5	2010 — within 20 year(s) of the newest study here
Sample size	2 / 4	323 participants
Effect reported	2 / 3	Effect reported as a number, without an interval or test
Studied in people	3 / 3	Studied in people (participant count stated)
Randomized / blinded	0 / 2	No randomization or blinding stated — scores zero (not stated in the record — scored 0)
Times cited	— / 7	No citation count (not found in OpenAlex) — left out of this score
Citations per year	— / 5	No citation count or no year — left out of this score
Impact for its field and year	— / 6	No field-weighted citation impact (OpenAlex has none yet) — left out of this score
Cited by studies here	— / 6	Not yet checked against this library's citation graph — left out of this score
Still being cited	— / 4	No yearly citation counts — left out of this score
Senior author's track record	— / 4	Senior author's record not available — left out of this score
Institution's track record	— / 3	No institution listed in OpenAlex — left out of this score
Multicenter collaboration	— / 3	Institutions not listed — left out of this score
Indexed in PubMed	2 / 2	Indexed in PubMed (PMID 20406320)
Free to read	0 / 2	Behind a paywall — scores zero
Points	37 / 58	Scored on 11 of 20 parts. We have no data for the rest, so they are left out: 37 of the 58 points we could judge it on is 64 out of 100.
Total	64 / 100	—

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