Too many dementia patients prescribed potentially inappropriate drugs – Otago finds

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Too many dementia patients prescribed potentially inappropriate drugs – Otago finds

Media release from University of Otago
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Older adults diagnosed with dementia are frequently being prescribed potentially inappropriate medications, which leaves them at risk of delirium, worsening cognitive impairment, and increased mortality, a University of Otago study has found.

Lead author Dr Sharmin Bala, of the Department of Preventive and Social Medicine, is calling for improvements to prescriptions and regular reviews to ensure safe prescribing.

The study, co-authored by Dr Hamish Jamieson, of the University of Otago, Christchurch, and Dr Prasad Nishtala, of the University of Bath, was published in the International Journal of Geriatric Psychiatry.

It consisted of more than 16,500 individuals who underwent an International Resident Assessment-Home Care assessment in 2015.

About 13 per cent were diagnosed with dementia and, of those, 67 per cent were found to be prescribed potentially inappropriate medications.

Potentially inappropriate medications are the prescribing of drugs where the risk outweighs the benefit, and could also represent under-prescribing of beneficial treatments, Dr Bala says.

The study also found that 40 per cent of those diagnosed with dementia were prescribed anticholinergic medications, which could be potentially inappropriate to prescribe to such a cohort.

Anticholinergics are prescribed for a variety of medical conditions, such as, for the treatment of overactive bladder, allergies, depression, and the management of symptoms in Parkinson’s disease. It is well established that these drugs can cause impairment in cognition and exacerbate cognitive decline.

“The prescription of anticholinergic medications is associated with a higher risk of negative outcomes including risk of falls, delirium, worsening cognitive function, and increased mortality.

“The findings of the study indicate that the quality of prescribing needs to be improved. It is also imperative that medications prescribed to older adults with dementia, especially medications that have anticholinergic side effects, are reviewed regularly by medical professionals to ensure safe prescribing.”

Dementia is one of the principal syndromes linked with disability and dependence among older adults and is a major challenge to individuals, communities, and societies globally.

The estimated prevalence of dementia in New Zealand was more than 62,000 in 2016. By 2050 the number is predicted to increase to nearly 170,000.

Prescribing medications for older adults with dementia is challenging because of the risks associated with cognitive decline, behavioural and psychological disturbances, multiple medications, and their associated costs.

Dr Bala says a radical component of optimal therapy for older adults with dementia is identifying and de-prescribing potentially inappropriate medications.

“Safe prescribing in individuals with dementia has the potential to mitigate critical adverse effects associated with the prescription of these medications and improve the quality of life in this vulnerable population.”

 

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Comments

"Potentially inappropriate drugs" - ah, those would be the sedatives I have to give to stop them hitting their caregiver. Or the treatment for one of the patient's other 15 major conditions. So, sorry about the anticholinergic medication for the Parkinsons, but what am I supposed to do, not treat it? And yes I too as a new graduate used to think it was shocking to give one drug to treat the side effects of another, but the complex frail elderly defy guidelines. 

Would be nice one day to hear something positive from the medical Monday morning quarterbacks in our universities, instead of the relentless barrage of criticism of those actually doing the hard yards in residential aged care. 

When there is  an elderly  male  in  a rest home that     knows  what  he is  doing  and  takes advantage of   demented  victims  curled up  in  bed  do  you   take him  to  court   charge him with   rape  and   send  him to  prison ? Two  wrongs  don't make a right ? or do you  tell  him  off  and  wait to  see if he  does it again  . He does ! What about a third time ? 

 When  he masturbates in  the  shower  when being   assisted by   a sensitive  nurse aide  who  sees that  as  utterly   unacceptable   what  happens  to  him ?

When  the  98  year old   screams  blue  murder  every  time  she  is  moved  because  she   doesn' t want  her broken  hip  operated on  do  you  override her  and  get it  done any way. Do  you  fill  in  an acc form if she  gets  pressure sores  and  dies of Gangrene ? Or do  you  sedate all  the  other  residents in earshot  getting  frazzled  by   her  banshee  wailing  every two  hours ?  

Primary Care is desp underfunded cf Moodie report. Aged care in Australia pays for inhouse GPs to do lengthy “rounds”. By the time a rest home patient reaches the threshold for admission; often theyve picked up meds from GP, urg care, eD, med reg and specialist geriatrician. The fragmented nature of care begets overmedication. When you take the time to sort this/ everyone waits. All the patients in the days clinic because you ate nutting out an insoluble patchwork of comorbidities and meds. .... So - this article is just so much pointing the finger at an already fragmented workforce and zero ideas for fixing it. B/c that would entail smashing down the nice cushy walls where fragmented silos of specialists critique the last generalists standing. Why doesnt EVERYONE have the guts to deescalate and deprescribe? Magic word - TIME.