Dementia Care Risks: 25% Prescriptions Are Harmful

A recent study published in JAMA revealed that despite longstanding clinical guidelines against their use, approximately 25% of older Americans diagnosed with dementia are still being prescribed central nervous system (CNS)-active medications that pose significant risks. Such drugs are associated with adverse effects like falls, confusion, and hospitalization, thereby raising concerns about the appropriateness of these prescriptions.

Overview of Findings

The research tracked the prescribing patterns of CNS-active medications over a nine-year period, encompassing data from Medicare beneficiaries with various cognitive statuses: normal cognition, cognitive impairment without dementia, and dementia. Senior author Dr. John N. Mafi highlighted that while there was a decline in overall CNS medication prescriptions (from 20% to 16%), troublingly, many patients with cognitive impairment lacked clinical justification for their prescriptions in 2021.

Types of Medications Studied

The CNS-active medications examined included:

• Antidepressants with strong anticholinergic properties
• Antipsychotics
• Barbiturates
• Benzodiazepines
• Non-benzodiazepine hypnotics

Prescribing Patterns

The study documented the following medication prescription trends among older adults:

The prescriptions deemed clinically justified decreased slightly while potentially inappropriate prescriptions also saw a significant reduction.

Recommendations for Care

As Dr. Annie Yang stated, it is essential for caregivers and patients to collaborate closely with their physicians regarding the appropriateness of CNS medications. This partnership is crucial for ensuring the health and safety of elderly patients, especially as the risks of these medications can outweigh the benefits when used inappropriately:

• Always verify that prescriptions are necessary.
• Discuss alternative therapies with healthcare providers.
• Explore options for tapering or discontinuing medications that may not be justifiable.

Study Limitations

Several limitations were noted, including the absence of Medicare Advantage data and potential gaps in available clinical information related to patient agitation. The authors emphasized the need for future studies focusing on cumulative exposure to drugs rather than merely prescribing prevalence.

“While CNS-active medications may be appropriate in some situations, it is vital to utilize caution and limit prescriptions to those cases where they are clearly warranted.” – Dr. John N. Mafi

Conclusion

The findings of this study highlight critical opportunities for enhancing the quality of care for older adults, particularly those with dementia. Improved education, advocacy for responsible prescribing, and enhanced communication between healthcare providers and patients could markedly improve the safety and efficacy of treatment strategies for this vulnerable population.

For more detailed information, consider reading the full article in JAMA: One in four older Americans with dementia prescribed risky brain-altering drugs despite safety warnings.

Further Reading

• National Institute on Aging: Dementia Overview
• CDC: Dementia - A Public Health Priority
• NCBI: Managing Behavioral Symptoms in Dementia