In Reply We agree with the insights shared by Colloca and colleagues regarding the prevalence of medications of questionable benefit in the Service and Health for Elderly in Long TERm care (SHELTER) project.1 Their study provides further evidence of geographic variation in medication prescribing patterns beyond our US sample2 and strengthens the argument for the presence of discretionary prescribing. We agree that the lower prescribing of antidementia and lipid-lowering drugs in the European sample likely reflects differences in medication policies, pharmaceutical marketing, and physician attitudes. Cultural differences in family expectations may also play a role, and this deserves further exploration. Taken together, we believe that this is the time to focus investments in a coordinated effort to develop a rational approach to curtailing nonbeneficial and potentially harmful medications late in life.
Tjia J, Briesacher BA. Inappropriate Drug Use in Advanced Dementia—Reply. JAMA Intern Med. 2015;175(2):315-316. doi:10.1001/jamainternmed.2014.7029