Exploring Goal-Concordant Medication Use Among VA Community Living Center Residents With Dementia.

Area of Science:

• Gerontology
• Clinical Pharmacy
• Health Services Research

Background:

• Aligning medication use with patient goals of care (GoC) is crucial for individualized care, especially for older adults with dementia.
• Documentation of patient goals and preferences in medical records can guide medication appropriateness.
• This study examines patient-expressed GoC and its concordance with medication use in Veterans with dementia residing in VA Community Living Centers (CLCs).

Purpose of the Study:

• To characterize patient and surrogate-expressed goals of care (GoC) for older Veterans with dementia.
• To explore the concordance between documented GoC and medication use during VA Community Living Center (CLC) stays.
• To assess the appropriateness of specific medication classes (aspirin, benzodiazepines, opioids, antidementia drugs) in relation to patient goals.

Main Methods:

• Cross-sectional analysis of VA data (Residential History File, Minimum Data Set, Corporate Data Warehouse, Medicare claims) for Veterans with dementia in CLCs (4/2021-12/2021).
• Extracted and coded free-text 'Veteran goals in own words' from GoC notes.
• Examined barcode medication administration data for specified medications within 7 days of CLC admission.
• Developed a schema to assess goal-concordant medication use.

Main Results:

• Among 1000 Veterans with documented GoC, 46.4% of goals were reported by the Veteran.
• Primary GoC topics included comfort (44.6%), life-sustaining treatments (31.8%), and function (13.7%).
• Medication use was often goal-discordant: aspirin (54.7%) and antidementia medications (38.7%) were frequently discordant, while opioid (56.7%) and benzodiazepine (72.2%) use was more often goal-concordant.

Conclusions:

• Open-ended GoC questions provide indirect but valuable information for assessing medication appropriateness in dementia care.
• Integrating patient goals into formal medication appropriateness criteria is a key area for future research.
• Further studies should investigate the utility of medication-specific questions within GoC conversations for individuals with dementia.