Trajectories of Medication Use Prior to Death in US Nursing Home Residents With Dementia.
Adara Bochanis, Joshua Rumbut, Matthew Alcusky and 1 others
PMID 42391770WHAT IT FOUND
Most deprescribing happened in the last three months of life.
Hospice enrollment and severe functional decline predicted stopping medications. However, chronic drugs like anticoagulants and diuretics were rarely stopped, while symptom relief drugs like anxiolytics and antibiotics were often started.
Key findings
01Hospice enrollment and severe functional impairment were strongly associated with deprescribing, particularly for anticoagulants, diuretics, and antidepressants.
02While overall medication burden decreased, there was a dual pattern where hospice patients had increased odds of initiating new medications for symptom relief, such as anxiolytics and antipsychotics.
03Chronic disease medications like anticoagulants and diuretics showed minimal reductions in use as death approached, despite guidelines suggesting deprescribing candidates exist.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The study relies on MDS data, which only captures medication use in the past 7 days and lacks granular clinical details on prescribing rationale. Data does not capture clinical staff perceptions or explicit documentation of palliative intent. Hospice enrollment may have occurred shortly before death, meaning some medication changes made by hospice teams in the final days may not be captured in the quarterly MDS assessments. Associations with hospice and medication changes may be underestimated due to the timing of data collection relative to death.
Declared interests
Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't. No other conflicts of interest are explicitly stated in the provided text.
The easy way to misread this
Do not assume that hospice enrollment or dying automatically leads to stopping all medications. This study shows a mixed pattern where chronic drugs are often continued and new symptom-relief drugs are frequently started, so deprescribing is not universal or automatic.