New Study Highlights Dangers of Nursing Home Medication Errors

It’s a common misconception that the most aggressive course of treatment is often the best for patients. In fact, there are many circumstances under which palliative care is preferred. Despite this, the staff members at many nursing homes still commit medication errors by aggressively medicating residents, rather than focusing on improving their comfort level.

A study recently published in the Journal American Medical Association (JAMA) demonstrates that nursing home residents are often given medications of questionable benefit for the treatment of dementia, sometimes with disastrous results.

Palliative care is preferable, experts say

The study on nursing home medication errors was conducted by researchers from the University of Massachusetts Medical School. The researchers evaluated data from more than 5,000 nursing home residents who had advanced dementia. The data came from 90-day observation periods, all of which took place from 2009 to 2010. They found that during these observation periods, 54 percent of the study participants were prescribed one or more medications deemed to have questionable benefit for patients with advanced dementia.

Medications of questionable benefit are defined as those who have been found in prior clinical studies to offer little to no benefit. Most commonly, the inappropriate medications that have been prescribed to this population include cholinesterase inhibitors, memantine, and lipid-lowering agents.

Guidelines available from the Institute of Medicine note that it is preferable to limit the use of medications of questionable benefit to those who are not expected to live long due to illnesses such as advanced dementia. The lead study author, Jennifer Tjia, MD, MSCE, associate professor of quantitative health sciences, agrees. “This research suggests that the burden of questionable beneficial medication use is high among this terminally ill population whose goal of care is comfort. Despite standards of care that call for minimizing unnecessary or minimally beneficial interventions in order to focus on interventions that optimize quality of life, polypharmacy remains common in this population,” said Tjia.

Tjia further suggested that clinicians need to discuss the risks of continued use of these medications with families. It is a possibility that some nursing home medication errors could be committed under circumstances in which families are not fully advised of the limited benefit and increased risks of these drugs.

Medication errors often cause adverse effects

Palliative care is often advised for patients with life-limiting diagnoses such as advanced dementia. Palliative care, as opposed to curative care, emphasizes improving the comfort level of the patient, rather than attempting to treat the underlying medical problem. Patients with advanced dementia tend to have significant difficulties with eating and swallowing. This makes it particularly challenging for a patient to tolerate medication administration. Additionally, it should be noted that elderly patients in general and patients with dementia in particular tend to experience more significant adverse drug effects.

In the case of drugs for dementia, these drug reactions can include urinary retention, arrhythmia, fainting, and hip fracture. Anti-dementia drugs have been known to comprise nearly one-third of all adverse side effects among individuals who have dementia.