A new report launched in Dublin on Friday (6 July 2012) finds considerable uncertainty and variation in the medicines doctors say they would prescribe for patients with dementia at the end of life when presented with clinical scenarios.
The all-Ireland research report finds evidence that GPs and hospital physicians indicate they would continue with dementia medications and statins and actively prescribe antibiotics when there is limited evidence of benefits to patients with dementia at end of life.
It also finds lack of consistency in how they say they would medicate patients and notes in particular that advance directives often appear to have little impact in the medications proposed for patients with dementia at the end of life. It argues that the publication of specific guidelines for medication for dementia patients at the end of life would be beneficial to patients, families and professionals working in this area.
Co-investigator on the research project Professor Carmel Hughes, Queen’s University Belfast (QUB), said: “Making decisions about medications for patients with dementia at the end of life is a complex and difficult process for doctors. It is clear that many factors must be taken into account in this process. What emerges from this research however is that there is significant variation in the medications doctors say they would prescribe and/or withdraw when considering clinical scenarios. This points to a possible lack of consistency on prescribing for patients with dementia at end of life.”
The report is based on findings from a research project on the factors influencing medication use in patients with dementia at the end of life. The all-Ireland comparative research, funded by the Centre for Ageing Research and Development in Ireland (CARDI), was led by Dr Carole Parsons of QUB and involved researchers from QUB, University College Cork and the voluntary, statutory and private sectors. Altogether 662 doctors (593 GPs and 69 hospital physicians in Northern Ireland and the Republic of Ireland) answered questions about which drugs they would continue with or withdraw when presented with four different scenarios.
Professor Bob Stout, Co-Chair of CARDI welcomed the findings: “This research highlights the important and complex subject of medication for dementia patients at the end of life. The research clearly indicates the need for specific guidelines for professionals seeking to treat patients with dementia at end of life.
Dr Shaun O’Keefe, Consultant in Geriatrics, University Hospital Galway and Ms Grainne McGettrick, Research and Policy Officer, The Alzheimer Society of Ireland, also spoke at the launch.
A research brief based on the findings of the research has been prepared by CARDI and is available at http://www.cardi.ie
Centre for Ageing Research & Development in Ireland (CARDI)