Even after years of medical tips advising warning, brain-altering medicines linked to falls, confusion, and hospitalizations are nonetheless broadly prescribed to folks with dementia. New analysis revealed on January 12 within the peer-reviewed journal JAMA experiences that about one in 4 Medicare beneficiaries with dementia obtain these medication.
Throughout the complete Medicare inhabitants, prescribing of those medicines has declined over time. Through the nine-year research interval, utilization dropped from 20% to 16%. Nevertheless, folks with cognitive impairment proceed to obtain these medicines at larger charges, though they’re extra weak to dangerous unwanted side effects.
“Whereas this decline was encouraging, over two-thirds of sufferers receiving these prescriptions lacked a documented scientific indication in 2021, the tip of the research interval, suggesting excessive ranges of probably inappropriate and dangerous prescribing,” mentioned senior writer Dr. John N. Mafi, affiliate professor-in-residence of drugs, division of normal inside medication and well being providers analysis, on the David Geffen Faculty of Drugs at UCLA. “In contrast with sufferers with regular cognition, we additionally discovered larger ranges of prescribing amongst older adults with cognitive impairment, who face a better danger of hostile results from these medication. These outcomes underscore substantial alternatives to enhance the standard and security of take care of thousands and thousands of older Individuals.”
How the Examine Examined Remedy Use
To raised perceive prescribing patterns, researchers analyzed survey knowledge from the Well being and Retirement Examine and linked it to Medicare fee-for-services claims. They tracked using doubtlessly inappropriate central nervous system (CNS)-active medicines from January 1, 2013 via December 31, 2021. Older adults have been grouped into three classes: these with 1) regular cognition, 2) cognitive impairment with out dementia, and three) dementia.
The evaluation targeted on 5 classes of CNS-active medicines: antidepressants with robust anticholinergic properties, antipsychotics, barbiturates, benzodiazepines, and non-benzodiazepine hypnotics.
Larger Prescribing Charges Amongst Sufferers With Cognitive Impairment
The research discovered that CNS-active medicines have been prescribed to 17% of older adults with regular cognition. Use was larger amongst these with cognitive impairment however no dementia, affecting almost 22% of that group. Amongst people with dementia, about 25% acquired these medicines.
Prescription traits additionally differed by remedy kind amongst all Medicare fee-for-service beneficiaries:
- Benzodiazepines declined from 11.4% to 9.1%
- Nonbenzodiazepine hypnotics, generally used as sleep medication, fell from 7.4% to 2.9%
- Antipsychotic prescriptions elevated from 2.6% to three.6%
- Prescriptions for anticholinergic antidepressants remained regular at 2.6%
- Barbiturate use decreased barely from 0.4% to 0.3%
Indicators of Enchancment and Ongoing Security Issues
Prescriptions thought-about clinically justified declined modestly, dropping from 6% in 2013 to five.5% in 2021. On the identical time, prescriptions considered as probably inappropriate fell extra sharply, from 15.7% to 11.4%. A lot of this progress was linked to lowered use of benzodiazepines and sleep medicines, together with fewer inappropriate prescriptions general.
The researchers word a number of limitations to the findings. The research didn’t embrace Medicare Benefit knowledge, could have missed sure scientific particulars equivalent to agitation, and measured how widespread prescriptions have been somewhat than the full quantity of drug publicity over time.
“Whereas CNS-active prescriptions could also be acceptable in some circumstances, it is vital for older sufferers or their caregivers to work intently with their physicians to make sure that these medicines are acceptable to their circumstances. When inappropriate, sufferers and their care groups ought to contemplate various therapies and contemplate whether or not it is perhaps secure to taper or cease the remedy,” mentioned Dr. Annie Yang, a scholar within the Nationwide Clinician Students Program at Yale College who led this research as a UCLA inside medication resident.
Authors and Funding
The research was co-authored by Mei Leng, Dr. Dan Ly, Chi-Hong Tseng, Dr. Catherine Sarkisian, and Nina Harawa of UCLA, together with Cheryl Damberg of RAND and Dr. A. Mark Fendrick of College of Michigan. Ly and Sarkisian are additionally affiliated with VA Better Los Angeles Healthcare System.
Funding for the analysis was offered by the Nationwide Institutes of Well being and the Nationwide Institute on Getting old (R01AG070017-01).