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48/100

✓ Peer-reviewed alzhub usefulness score 48 out of 100. Drug development

Topic: Risk, prevention and care in population studies

Plain-language summary

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 collecting information on residents admitted to 57 NHs in 8 European countries. Polypharmacy was defined 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]: 1.15-4.17), but not among those with ADEPT score less than 13.5 (adjusted HR 1.10, 95% CI: 0.71-1.71). 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.

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APA 7th

Onder, G., Liperoti, R., Foebel, A., Fialova, D., Topinkova, E., van der Roest, H. G., et al. (2013). Polypharmacy and mortality among nursing home residents with advanced cognitive impairment: results from the SHELTER study. Journal of the American Medical Directors Association. https://doi.org/10.1016/j.jamda.2013.03.014

Vancouver

Onder G, Liperoti R, Foebel A, Fialova D, Topinkova E, van der Roest HG, et al. Polypharmacy and mortality among nursing home residents with advanced cognitive impairment: results from the SHELTER study. Journal of the American Medical Directors Association. 2013. doi:10.1016/j.jamda.2013.03.014. PMID: 23647778.

BibTeX

@article{onder2013-23647778,
  author  = {Onder, G. and Liperoti, R. and Foebel, A. and Fialova, D. and Topinkova, E. and van der Roest, H. G. and Gindin, J. and Cruz-Jentoft, A. J. and others},
  title   = {{Polypharmacy and mortality among nursing home residents with advanced cognitive impairment: results from the SHELTER study}},
  journal = {Journal of the American Medical Directors Association},
  year    = {2013},
  doi     = {10.1016/j.jamda.2013.03.014},
  pmid    = {23647778},
  url     = {https://doi.org/10.1016/j.jamda.2013.03.014}
}

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How to read this study

Design: our record does not state a study design, so check the methods section of the original before weighing the result.
Size: the record lists 123 participants. Ask whether that is enough for the question, and who they were.
Effect: the record reports “86.6%; 15.0%; 13.9%”. A statistically significant result can still be small in daily life.

What the evidence grade means here

This page is graded low. alzhub.org assigns the grade automatically from keywords in the abstract, not from reading the paper. Low means the abstract matched neither pattern. It is the default label, and it does not mean the work is poor; many sound lab and imaging papers land here. 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

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.
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]: 1.15-4.17), but not among those with ADEPT score less than 13.5 (adjusted HR 1.10, 95% CI: 0.71-1.71).
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.

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Study details

Participants123
Effect size86.6%; 15.0%; 13.9%
Evidence strengthLow

How this study scored 48/100

Published in a peer-reviewed journal. Scored zero for study design and 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 28 of the 58 points we could judge it on, which is 48 out of 100.

Component	Points	Why
Journal tier	7 / 10	Tier 3 — peer-reviewed journal (Journal of the American Medical Directors Association)
Journal's citation record	— / 4	No journal record from OpenAlex — left out of this score
Study design	0 / 12	No study design recorded — scores zero, not guessed (not stated in the record — scored 0)
Strength of evidence	1 / 5	Rated “low” in our summary
Peer-review validation	10 / 10	Peer-reviewed. Published as an article in a named peer-reviewed journal.
How recent	1 / 5	2013 — within 20 year(s) of the newest study here
Sample size	2 / 4	123 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 23647778)
Free to read	0 / 2	Behind a paywall — scores zero
Points	28 / 58	Scored on 11 of 20 parts. We have no data for the rest, so they are left out: 28 of the 58 points we could judge it on is 48 out of 100.
Total	48 / 100	—

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