Evidence map›Paper›PMID 20524704›Full record

ReviewDrugs & aging2010

Withholding, discontinuing and withdrawing medications in dementia patients at the end of life: a neglected problem in the disadvantaged dying?

Carole Parsons, Carmel M Hughes, A Peter Passmore, Kate L Lapane

Abstract readReview
PubMed Publisher
In one paragraph

Review in Drugs & aging, 2010. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 36 papers, 6 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
36citing papers in PubMed, 6 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

36 citing papers in PubMed, 6 syntheses or guidelines pooled it.

  1. Pooled it
  2. Pooled it
  3. A Systematic Review of Practice Guidelines and Recommendations for Discontinuation of Cholinesterase Inhibitors in Dementia.The American journal of geriatric psychiatry : official journal of the American Association for Geriatric Psychiatry · 2018
    Pooled it
  4. Pooled it
  5. Pooled it
  6. Pooled it
  7. Article
  8. Polypharmacy patterns in the last year of life in patients with dementia.European journal of clinical pharmacology · 2019
    Article
  9. Article
  10. Article
  11. Review
  12. Article
  13. Article
  14. Article
  15. Article
  16. Article
  17. Review
  18. Beliefs and attitudes of older adults and carers about deprescribing of medications: a qualitative focus group study.The British journal of general practice : the journal of the Royal College of General Practitioners · 2016
    Article
  19. Article
  20. Review
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

4 authors.

Carole ParsonsClinical and Practice Research Group, School of Pharmacy, Queen's University Belfast, Belfast, Northern Ireland. c.parsons@qub.ac.uk
Carmel M Hughes
A Peter Passmore
Kate L Lapane

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

Recent years have seen a growing recognition that dementia is a terminal illness and that patients with advanced dementia nearing the end of life do not currently receive adequate palliative care. However, research into palliative care for these patients has thus far been limited. Furthermore, there has been little discussion in the literature regarding medication use in patients with advanced dementia who are nearing the end of life, and discontinuation of medication has not been well studied despite its potential to reduce the burden on the patient and to improve quality of life. There is limited, and sometimes contradictory, evidence available in the literature to guide evidence-based discontinuation of drugs such as acetylcholinesterase inhibitors, antipsychotic agents, HMG-CoA reductase inhibitors (statins), antibacterials, antihypertensives, antihyperglycaemic drugs and anticoagulants. Furthermore, end-of-life care of patients with advanced dementia may be complicated by difficulties in accurately estimating life expectancy, ethical considerations regarding withholding or withdrawing treatment, and the wishes of the patient and/or their family. Significant research must be undertaken in the area of medication discontinuation in patients with advanced dementia nearing the end of life to determine how physicians currently decide whether medications should be discontinued, and also to develop the evidence base and provide guidance on systematic medication discontinuation.

Indexed as

Vulnerable PopulationsAnti-Bacterial AgentsAnticholesteremic AgentsAntiparkinson AgentsAntipsychotic AgentsCholinesterase InhibitorsDementiaEnzyme InhibitorsHumansHydroxymethylglutaryl-CoA Reductase InhibitorsPalliative CarePolypharmacyTerminal CareTranquilizing AgentsWithholding TreatmentAnti-Bacterial AgentsAnticholesteremic AgentsAntiparkinson AgentsAntipsychotic AgentsCholinesterase InhibitorsEnzyme InhibitorsHydroxymethylglutaryl-CoA Reductase InhibitorsTranquilizing Agents

Identifiers

PMID20524704

What OpenQuestion 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 OpenQuestion graph.