Background Acetylcholinesterase inhibitors (ACEIs) and memantine are drugs used in Alzheimer’s disease (AD) and dementia with Lewy bodies or associated to Parkinson’s disease (LB-P). Their efficacy is limited and deprescription strategies are necessary when clinical, functional decline, advanced dementia and/or end of life occurs.
Purpose To evaluate the use of anti-dementia drugs of institutionalised people who died throughout a year in the nursing homes studied.
Material and methods Retrospective analysis of patients who died in seven nursing homes between July 2017 and June 2018. We analysed the Global Impairment Scale (GDS-FAST), the Barthel Index (BI), anti-dementia drugs and their withdrawal prior to the death of people diagnosed with dementia. The data were obtained from the electronic prescription system and analysed with SPSS v20.
Results Among 1125 people attended during the analysed period, 183 (16.3%) died, identifying 128 (69.94%) cases of dementia. Of these, 56% were female, with a mean age of 89.9 (s=6.54) for females and 84 (s=6.9) for males, and the median stay was 613 days (IQR 1679). Cognitive and functional assessments were: GDS-FAST median 6 (IQR 1) and BI median 17 (IQR 32).
The distribution of dementias had the following pattern: AD 51 (39.8%), vascular dementia 14 (10.9%), LB-P six (4.7%), mixed dementia three (2.3%), frontotemporal dementia two (1.6%) and other types 52 (40.6%).
Forty-one (32%) patients had a specific drug for dementia during their stay: ACEIs 27 (65.9%), memantine nine (22%) and ACEIs +memantine five (12.2%). 73.2% of patients diagnosed with AD or LB-P had been prescribed one of these drugs.
Eighty-five per cent and 70% of the patients persisted with their treatment in the past 12 and 6 months, respectively. The median number of days from the suspension of the drugs to death was 11 (IQR 259.5). For this analysis, four cases with a stay shorter than 30 days were excluded.
Conclusion A high percentage of patients had been prescribed anti-dementia drugs close to their death.
We have to do an early identification of patients at the end of life and re-evalute the effectiveness of these drugs during this period, applying if necessary, deprescription strategies.
References and/or acknowledgements No acknowledgements.
No conflict of interest.
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