Joseph W. Shega

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OBJECTIVES To evaluate the feasibility of developing consensus recommendations for appropriate prescribing for patients with advanced dementia using a new conceptual framework and to determine the frequency of inappropriate medication use based on these recommendations in a small sample of patients with advanced dementia. DESIGN Medication data were(More)
This cross-sectional study examines the association between total prescription medication use and potentially inappropriate medication use (PIRx) among community-dwelling elderly patients with and without dementia. Data (September 2005 to September 2007) were from the National Institute on Aging-funded National Alzheimer's Coordinating Center Uniform Data(More)
To evaluate the impact hospice enrollment has on the terminal care of patients with dementia and describe the symptom burden these patients experience, caregivers of dementia decedents were assessed in a mortality follow-back survey. Patients had been managed through academic outpatient geriatric clinics in Chicago, IL. A total of 135 family members or(More)
OBJECTIVES To explore the pharmacological treatment of noncancer pain in persons with dementia and identify predictors associated with insufficient analgesia. DESIGN Cross-sectional analysis of an observational cohort study. SETTING Academic outpatient geriatric clinic in Chicago, Illinois. PARTICIPANTS A total of 115 dyads, mostly African American,(More)
BACKGROUND Among cognitively intact patients, self- and caregiver report of patient pain has been associated with worse psychological health for both the patient and caregiver. Little existing research examines factors associated with patient self-report of pain and caregiver report of patient pain among community-dwelling persons with dementia. OBJECTIVE(More)
BACKGROUND Cholinesterase inhibitors and N-methyl-D-aspartic acid (NMDA) receptor antagonists are Food and Drug Administration (FDA) approved for the treatment of moderate to severe Alzheimer's disease. As dementia progresses to the end stage and patients become hospice-eligible, clinicians consider whether or not to continue these therapies without the(More)
While great strides have been made recently in improving end-of-life care in the United States, people with dementia often die with inadequate pain control, with feeding tubes in place, and without the benefits of hospice care. In this paper, we discuss the most important and persistent challenges to providing excellent end-of-life care for patients with(More)
Hospice is the standard method for providing quality end-of-life care in the United States. However, studies reveal that persons with dementia are infrequently referred to hospice, that barriers exist to increasing hospice utilization in this population, and that patients with dementia would benefit from hospice or hospice-like services earlier in the(More)
OBJECTIVES To compare the association between self-reported moderate to severe pain and frailty. DESIGN Cross-sectional analysis of the Canadian Study of Health and Aging Wave 2. SETTING Community. PARTICIPANTS Representative sample of persons aged 65 and older in Canada. MEASUREMENTS Pain (exposure) was categorized as no or very mild pain versus(More)
OBJECTIVE Determine if the multidimensional pain-related experience differs between cognitively intact and impaired older adults. DESIGN Cross-sectional analysis of the Canadian Study of Health and Aging. SETTING Community-dwelling older adults. OUTCOME MEASURES Pain reports were dichotomized from a 5-point scale into no/very mild vs moderate and(More)