While families of nursing home residents and dementia specialists have significant influence on antidementia medication decisions, many residents lack their involvement. Such influence is similar to family sway on care planning for antipsychotic medications among nursing home residents.
One in six nursing home cases almost always have no immediate family or caregivers involvement, according to a study published in JAMDA, while only 5.8% of cases had a dementia specialist involved in care planning.
Directors of nursing (DONs) and nursing home administrators weighed in for the study, with 84.4% reporting that decisions involving antidementia medications usually involved the prescriber first and foremost, followed by nursing staff at 33.2%, family at 23.4%, the resident at 13.8%, the community primary care provider at 12.1%, and dementia specialists coming in last.
DONs said such medications are more likely to be initiated if, besides family and dementia specialist involvement, the resident is aggressive, resisted care or had severe physical or cognitive impairment.
DONs and nursing home administrators from 1,293 skilled nursing facilities were surveyed in 2022, with a 26.6% response rate.
This JAMDA study was the first nationally representative study to provide DON insights into who is involved in decision making around antidementia medications – treatment goals and therapeutic indications appear to be inconsistent with prescribing patterns, according to the research.
Resident advocates should get involved in lieu of family being available, DONs in the survey recommended. Or, interventions to engage family members to improve dementia in residents may also help.
“DONs reported that family members or caregivers participated in changing medications if appropriate at nursing home admission for fewer than half of newly admitted residents with dementia,” according to the study.
Primary treatment goals of antidementia medications was to improve quality of life, cognition, functioning and behaviors in residents, with 66.8% of DONs saying that reducing the care burden on staff was never or rarely considered.
“Unique to nursing homes, consultant pharmacists review each resident’s medication regimen every month to evaluate its effectiveness and safety, but clear and consistent clinical practice guidelines regarding the use and discontinuation of antidementia medications are needed,” added researchers.
And although family and caregivers have a great influence on the decision to start these medications, they may have less influence on discontinuing them.
“Our data suggest that family and caregivers of residents should be more engaged in decision making regarding use of antidementia medications,” researchers said.
On the opposite end, antidementia medications were likely to be discontinued if aggressive behaviors manifested with the medication, the patient resisted care, hospice became involved or if there was a progression to severe impairment. The involvement of dementia specialists in care planning also led to reduced use of antidementia medications.
However, researchers cautioned that more real-world evidence was needed to determine the risks and benefits of antidementia medications in nursing homes, and inform clinical guidance about appropriate use of such medications.
Moreover, guidelines regarding the use and discontinuation of these medications are inconsistent, the study noted.
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