Evidence map›Paper›PMID 31346649›Full record

ArticleEuropean journal of clinical pharmacology2019

Polypharmacy patterns in the last year of life in patients with dementia.

Rachel Denholm, Richard Morris, Rupert Payne

Abstract read
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Article in European journal of clinical pharmacology, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 11 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
11citing papers in PubMed, 1 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

11 citing papers in PubMed, 1 synthesis or guideline pooled it.

  1. Pooled it
  2. Article
  3. Article
  4. Article
  5. End-of-Life Healthcare Utilization in Lewy Body Dementia.Journal of Alzheimer's disease : JAD · 2024
    Article
  6. Article
  7. Review
  8. Article
  9. Article
  10. Article
  11. Observational
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

3 authors.

Rachel DenholmCentre for Academic Primary Care, Bristol Medical School, University of Bristol, Bristol, UK. r.denholm@bristol.ac.uk.ORCID http://orcid.org/0000-0002-8067-5440
Richard MorrisCentre for Academic Primary Care, Bristol Medical School, University of Bristol, Bristol, UK.
Rupert PayneCentre for Academic Primary Care, Bristol Medical School, University of Bristol, Bristol, UK.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

purposeTo describe prescribing of medicines in primary care in the last year of life in patients with dementia.

methodA retrospective cohort analysis in UK primary care using routinely collected data from the Clinical Practice Research Datalink. Number of medications and potentially inappropriate medication prescribed one year prior to, and including death, was ascertained.

resultsDementia patients (n = 6923) aged 86.6 ± 7.3 years (mean ± SD) were prescribed 4.8 ± 4.0 drugs 1 year prior to death, increasing to 5.6 ± 4.0 2 months prior, before falling to 4.9 ± 4.1 at death. One year prior to death, 50% of patients were prescribed a potentially inappropriate medication, falling to 41% at death. Cardiovascular medications were the most common, with decreases in drug count only occurring in the last month prior to death. Prescriptions for gastrointestinal and central nervous system medication increased throughout the year, particularly laxatives/analgaesics, antidepressants and hypnotic/antipsychotics. Women (vs. men) and patients with Alzheimer's (vs. vascular dementia) were prescribed 4.7% (95% CI 2.3%-7%) and 14.6% (11.7-17.3%) fewer medications, respectively. Prescribing decreased with age and increased with additional comorbidities.

conclusionsDementia patients are prescribed high levels of medication, many potentially inappropriate, during their last year of life, with reductions occurring relatively late. Improvements to medication optimisation guidelines are needed to inform decision-making around deprescribing of long-term medications in patients with limited life-expectancy.

Indexed as

PolypharmacyPractice Patterns, Physicians'AgedAged, 80 and overDementiaElectronic Health RecordsFemaleHumansMalePotentially Inappropriate Medication ListPrimary Health CareUnited KingdomDementiaEnd-of-lifeInappropriate prescribingPolypharmacy

Identifiers

PMID31346649

What Socratic holds

Textmetadata
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.