Medication Use Among Nursing Home Residents With Severe Dementia: Identifying Categories of Appropriateness and Elements of a Successful Intervention.

ABSTRACT

BACKGROUND: Seniors with severe dementia residing in nursing homes (NHs) frequently receive large numbers of medications. With disease progression, the medications' harm-benefit ratio changes and they need to be reviewed, adjusted, or discontinued. Evidence on successful interventions to optimize medication use among these residents is lacking. OBJECTIVES: The objective of the study was to identify categories of appropriateness for medications as well as successful interventions or elements thereof to improve medication use in NH residents with severe dementia, suitable for use in Canada. METHODS: A scoping literature review was performed to identify criteria and categories of appropriateness of medications for these residents as well as elements of successful interventions to optimize medication use. A 15-member multidisciplinary Delphi panel was convened to evaluate the applicability of these findings for NHs in a Canadian province. RESULTS: The scoping review identified 1 study presenting categories of appropriateness specific to residents with severe dementia and 35 interventions aimed at reducing drug-drug interactions, inappropriate use of specific drug classes, inappropriate drug use overall, or polypharmacy. Regarding appropriateness, the Delphi panel agreed on the categorization of 63 medications or medication classes as "generally," "sometimes," or "rarely appropriate." The main elements of interventions successful in improving appropriate medication use in NH residents with dementia also were approved by the Delphi panel (ie, medication reviews using criteria of appropriateness, educational and training sessions, and interdisciplinary case conferences). CONCLUSIONS: These results may be used to develop an intervention to optimize medication use in NH residents with severe dementia.