Integrating Palliative Medicine into the Care of Persons with Advanced Dementia: Identifying Appropriate Medication Use

Holmes, Holly M.; Sachs, Greg A.; Shega, Joseph W.; Hougham, Gavin W.; Hayley, Déon Cox; Dale, William

doi:10.1111/j.1532-5415.2008.01741.x

Cited by 170 publications

(270 citation statements)

References 20 publications

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“…Categorisation of medication appropriateness showed similarities to the classification system developed by Holmes et al [21], in which consensus was achieved for 69 (85%) of the 81 included medications and medication classes. In the present study, consensus was achieved for a similar proportion of medications and medication classes (90%) despite the slightly higher number of medications and medication classes included (n = 97).…”

Section: Discussionmentioning

confidence: 66%

“…In the first round (July 2011), participants were mailed a selection of literature regarding medication use in palliative care, a conceptual model regarding prescribing for patients late in life (to provide background information and to assist in the classification of medications into appropriateness categories [20,21,26,27]), and a questionnaire. The questionnaire collected demographic data and data regarding clinical practice pertaining to each participant, including: age; sex; details of current job title; area of practice; and percentage of typical working week spent in clinical practice.…”

Section: Delphi Consensus Panelmentioning

confidence: 99%

“…This corresponds to patients who need assistance with bathing, dressing and toileting, and who have urinary and faecal incontinence (FAST 6E); who have minimal verbal ability (FAST 7A and 7B); who are unable to ambulate (FAST 7C); sit up (FAST 7D); or smile (FAST 7E); or who cannot hold their head up (FAST 7F). While patients with FAST scores of 6E may be considered to have moderately-severe dementia, categorisation of the appropriateness of medications by the Delphi consenus panel included these patients to enable comparisons to be drawn with the system developed by Holmes et al [21], which included patients with FAST scores of 6E and above.…”

Section: Delphi Consensus Panelmentioning

confidence: 99%

“…Consistent with other Delphi methods and other studies [21,31], consensus for a medication or medication class was defined according to agreement on categorisation by at least 55% of the respondents (corresponding to 5 of the 9 physicians on the panel). This provided the opportunity to revise the medication appropriateness categorisations on the basis of the group's responses and aimed to increase consensus within each round.…”

Section: Delphi Consensus Panelmentioning

confidence: 99%

“…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. studies which focused on nursing home residents with advanced dementia nearing the end of life in the USA [2,21,22], in Italian patients with advanced dementia residing in long-term care institutions or at home [23], and patients admitted to an acute geriatric unit in Spain [25]. The majority of these studies employed the classification system developed by Holmes et al, [21] which categorised medications as never appropriate, rarely appropriate, sometimes appropriate or always appropriate for persons with advanced dementia in whom palliation of symptoms was the primary goal of therapy [2,[21][22][23].…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2014

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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. AbstractBackground: No studies have been conducted in the United Kingdom (UK) context to date which categorise medications in terms of appropriateness for patients with advanced dementia, or which examine medication use in these vulnerable patients.Objectives: To categorise the appropriateness of a comprehensive list of medications and medication classes for use in patients with advanced dementia; to examine the feasibility of conducting a longitudinal prospective cohort study to collect clinical and medication use data;and to determine the appropriateness of prescribing for nursing home residents with advanced dementia in Northern Ireland (NI), using the categories developed.Methods: Three-round Delphi consensus panel survey of expert clinicians, 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 which 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 three months for up to nine 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 three months, 17.4 at six months and 16.1 at nine months respectively. 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. Postdeath 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

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Section: Discussionmentioning

confidence: 66%