Medications Inappropriately Prescribed to Dementia Patients

A report published in JAMA Internal Medicine questions the benefits of medications prescribed to elderly patients with dementia.

Researchers from the University of Massachusetts Medical School observed 5406 nursing home residents with advanced dementia from 460 facilities nationwide for 90 days between October 1, 2009, and September 30, 2010. The investigators aimed to determine the prevalence and use of medications among the patient group, as well as estimate expenditures.

During the study period, a majority of the patients (54%) were prescribed at least 1 medication of “questionable benefit,” defined as a drug deemed “never appropriate” for use in advanced dementia, according to current literature on the subject.

Some of the most common medications of questionable benefit prescribed to patients with dementia include cholinesterase inhibitors (33.8%), memantine (20.4%), and lipid-lowering agents (17%). The researchers explained that those medications are typically prescribed in the earlier stages of dementia to delay patient institutionalization, though their effectiveness was recently called into question.

“This research suggests that the burden of questionable beneficial medication use is high among this terminally ill population whose goal of care is comfort,” said lead study author Jennifer Tjia, MD, MSCE, associate professor of quantitative health sciences, in a press release. “Despite standards of care that call for minimizing unnecessary or minimally beneficial interventions in order to focus on interventions that optimize quality of life, polypharmacy remains common in this population.”

The researchers stressed the importance of minimizing the use of questionably beneficial medications in patients with dementia, especially as their abilities to eat and swallow decline. Other reasons to wean patients off of those medications—as well as prevent physicians from prescribing them—include the fact that adverse drug effects are common in dementia patients, and frequent clinical complications are associated with high risk of 6-month mortality.

Even though many nursing home directors believe the aforementioned medications are ineffective, their use remains prevalent. Furthermore, proponents of the drugs believe that discontinuation will lead to negative outcomes, such as cognitive and behavioral declines.

“While it is often difficult for patients and families to discontinue chronic disease medications as they transition toward comfort care, minimizing questionably beneficial interventions is an important therapeutic option consistent with the Institute of Medicine’s recommendations about care quality at the end of life,” Dr. Tjia concluded. “It is an important option for clinicians, families, and patients to consider.”