Polypharmacy and patterns of medication use in the final year of life among people living with dementia in Canada: A case-control study.

Abstract

ObjectiveAt the end of life, changing healthcare needs may lead to decreased use of preventive therapies and increased use of medications for symptom management. This study compared polypharmacy, hyperpolypharmacy, and medication-dispensing patterns among community-dwelling older adults with dementia, community-dwelling older adults without dementia, and older adults with dementia in long-term care.MethodsWe completed a retrospective, matched case-control study using linked administrative health data from Nova Scotia, Canada. We compared polypharmacy, hyperpolypharmacy, and medications dispensed among three groups (community-dwelling older adults with dementia, community-dwelling older adults without dementia, and older adults with dementia in long-term care). We chose community-dwelling older adults with dementia with dates of death between 1 January 2019 and 1 January 2021, and then matched with replacement to community-dwelling older adults without dementia and older adults with dementia in long-term care based on age, administrative sex, and date of death ±30 days. Descriptive comparisons of polypharmacy, hyperpolypharmacy, and medications used during each of three equal periods of the last year of life (early, mid, and late) were made. Logistic regression was used to estimate the probability of polypharmacy and hyperpolypharmacy, adjusting for demographic and clinical factors.ResultsEach group included 1274 individuals. The mean age was 84.8 years. Overall, 50.9% (1944/3822) experienced polypharmacy and 8.7% (332/3822) hyperpolypharmacy, with community-dwelling older adults with dementia consistently having the highest rates. The most common medications dispensed in the last year of life were furosemide, levothyroxine sodium, salbutamol, and vitamin B12.ConclusionsCommunity-dwelling older adults with dementia had the highest rates of polypharmacy and hyperpolypharmacy across all time periods assessed. Medications most frequently dispensed in the last year of life did not change in ways that would be expected if deprescribing recommendations were being followed. This suggests that prescribing and deprescribing at the end of life are potential areas for pharmacist support and involvement.