It's a startling reality: Despite clear warnings, a significant number of older adults with dementia are still being prescribed medications that could be doing more harm than good. A new study, slated for publication in the JAMA journal on January 12th, reveals that roughly one in four Medicare beneficiaries with dementia are receiving brain-altering drugs. These medications have been linked to serious side effects like falls, confusion, and the need for hospitalization.
While the overall prescription rates for these medications have decreased from 20% to 16% over a nine-year period among all Medicare beneficiaries, the fact that they're still being prescribed to those with cognitive impairments is concerning. This group is particularly vulnerable to the negative effects of these drugs.
Dr. John N. Mafi, a senior author of the study from UCLA, points out a crucial issue: "Over two-thirds of patients receiving these prescriptions lacked a documented clinical reason in 2021." This suggests a high rate of potentially inappropriate and harmful prescribing practices. The study also found that older adults with cognitive impairment were prescribed these medications more frequently than those with normal cognitive function. This highlights a critical need to improve the quality and safety of care for millions of older Americans.
Researchers analyzed data from the Health and Retirement Study linked to Medicare records. They examined prescribing patterns of central nervous system (CNS)-active medications between January 1, 2013, and December 31, 2021. The study categorized patients into three groups: those with normal cognition, those with cognitive impairment but no dementia, and those with dementia. The CNS-active medications studied included several classes of drugs, such as:
- Antidepressants with strong anticholinergic properties
- Antipsychotics
- Barbiturates
- Benzodiazepines
- Non-benzodiazepine hypnotics
The study revealed some key trends in prescribing habits:
- About 17% of older adults with normal cognition were prescribed CNS medications.
- Nearly 22% of those with cognitive impairment but without dementia received these drugs.
- Approximately 25% of the dementia group were prescribed CNS-active medications.
Looking at the trends across different medication classes among all Medicare beneficiaries, the study found:
- Benzodiazepine prescriptions decreased from 11.4% to 9.1%.
- Nonbenzodiazepine hypnotics (sleep drugs) prescriptions dropped from 7.4% to 2.9%.
- Antipsychotic medication prescriptions rose from 2.6% to 3.6%.
- Prescriptions for anticholinergic antidepressants remained steady at 2.6%.
- Barbiturate prescriptions saw a slight decrease from 0.4% to 0.3%.
It's worth noting that clinically justified prescriptions decreased from 6% in 2013 to 5.5% in 2021. While inappropriate prescriptions for CNS-active medications decreased significantly, from 15.7% to 11.4%, the improvements were largely due to a reduction in benzodiazepines and sleep medications.
The study's limitations include a lack of data from Medicare Advantage plans and potential missing clinical information. The study focused on prescription prevalence rather than the cumulative exposure to these medications.
Dr. Annie Yang, the study's lead and a scholar at Yale University, emphasizes the importance of patients and their caregivers working with physicians to ensure these medications are appropriate. She suggests considering alternative treatments and potentially tapering or stopping the medication when it's not suitable.
Here's a thought-provoking question: Do you think the benefits of these medications are being carefully weighed against the risks, especially for those with dementia? Share your thoughts in the comments below!
The study was funded by the National Institutes of Health/National Institute on Aging (R01AG070017-01). The co-authors include Mei Leng, Dr. Dan Ly, Chi-Hong Tseng, Dr. Catherine Sarkisian, and Nina Harawa of UCLA; Cheryl Damberg of RAND, and Dr. A. Mark Fendrick of University of Michigan. Ly and Sarkisian are also affiliated with VA Greater Los Angeles Healthcare System.
