A Troubling Discovery: The Hidden Dangers of Medication Use in Hospice Care for Dementia Patients
Imagine a scenario where a simple decision to prescribe medication could potentially shorten a patient's life. This is the controversial reality that a recent study has unveiled, shedding light on the increased mortality risk associated with benzodiazepine and antipsychotic use in hospice patients with dementia. Let's delve into this eye-opening research and explore the implications it holds for healthcare professionals and patients alike.
The Study Unveiled
A national case-control study, published in JAMA Network Open, has sent shockwaves through the medical community. Conducted by a team led by Dr. Lauren B. Gerlach, a geriatric psychiatrist, the study analyzed data from over 100,000 nursing home residents with Alzheimer's disease and related dementias (ADRD). The findings were startling: benzodiazepine and antipsychotic use was linked to a significantly higher risk of mortality within 180 days.
Unraveling the Numbers
The study revealed that new initiation of benzodiazepines or antipsychotics while in hospice care was associated with a 41% and 16% increased risk of death, respectively, compared to non-users. To ensure accuracy, the study excluded patients with short hospice stays or those who received the medications only in their final days. The mean length of stay in hospice was around 136 days, with a higher percentage of deaths observed among those who initiated benzodiazepine use (73.58%) compared to non-users (58.3%).
The Historical Context
Historically, these medications have been prescribed in hospice settings to manage agitation, anxiety, and delirium. However, the study's authors emphasize that both classes of drugs carry significant risks for older adults with ADRD. This study's findings reinforce these concerns and highlight the need for a paradigm shift in medication management for this vulnerable population.
A Call for Action
Dr. Gerlach and her team urge the implementation of dementia-specific hospice prescribing guidelines. They emphasize the importance of carefully weighing the risks and benefits of these medications, especially considering the higher likelihood of their use in hospice patients with ADRD. The study authors also advocate for investment in non-pharmacological alternatives and policy reforms to track and promote safe medication practices in hospice care.
The Numbers Speak Volumes
At 180 days, the hazard ratio (HR) of death for those on benzodiazepines was a concerning 1.41, while for antipsychotics, it was 1.16, both significantly higher than non-users. Even after adjusting for various factors using propensity score-weighted Cox proportional hazards regression models, the association between medication initiation and mortality persisted. Additionally, each additional prescription fill was associated with an increased risk of mortality, with benzodiazepines showing a higher risk (HR, 1.15) compared to antipsychotics (HR, 1.06).
The Need for Standardization
The study authors suggest that more standardized hospice prescribing guidance for ADRD patients could help reduce variation and promote safer practices. They argue that the decision to use these medications often depends on agency norms rather than clinical presentation, highlighting the need for national guidelines to ensure consistent and evidence-based care.
A Thought-Provoking Conclusion
This study raises important questions: Should we reevaluate our approach to medication management in hospice care for dementia patients? Are there alternative, safer methods to manage agitation and anxiety? Join the conversation and share your thoughts in the comments. Let's spark a discussion that could lead to improved care and outcomes for those in need.
