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 Some medicines are not typically given to older patients because the
potential side effects outweigh their clinical benefit and because
there are often safer or more effective alternatives available.
Researchers who studied more than 2,000 people with dementia from
England, Estonia, Finland, France, Germany, the Netherlands, Spain
and Sweden found that 60 percent had been prescribed at least one
potentially inappropriate drug, while over 25 percent had received
at least two such medicines.
In particular, dementia patients aged 80 or older who were living in
long-term care facilities were at higher risk of receiving two or
more such potentially unsuitable medicines, according to Dr. Anna
Renom-Guiteras of University Hospital Parc de Salut Mar in
Barcelona, Spain and colleagues.
The prescription of two or more inappropriate medications was
associated with a higher chance of at least one fall-related injury
and at least one episode of hospitalization, the researchers
reported in the journal Age and Ageing.
The study findings are drawn from interviews with patients and
caregivers conducted between 2010 and 2012, and from medical
records. Patients were either living in a long-term care facility or
were receiving care at home but were at risk for needing
institutional care in the coming six months.
Drugs were considered potentially inappropriate for the elderly if
they appeared on a list published in 2015 by a team of European
experts.
“This is an interesting and useful study which confirms what most
dementia specialists have been aware of for a long time,” said Dr.
Christopher Soosay, consultant psychiatrist at London-based Dementia
Specialists LLP who wasn't involved in the study.
The high rates of potentially inappropriate prescriptions in this
study might be explained at least in part by the fact that the study
included especially frail patients, study authors noted.
“Daily we see patents whose medications were ‘stacked’ over time;
often by different physicians with one medication stacked on top of
another without a careful look at whether these combinations are
safe or appropriate,” said Dr. Gregory Mattingly, a psychiatrist and
associate clinical professor at the Washington University School of
Medicine in St. Louis, Missouri, who wasn't involved in the study.
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The most frequently prescribed potentially inappropriate drugs in
the study were medicines for acid-related disorders and
psycholeptics, including antipsychotics, which produce a calming
effect but also affect mental function.
In about half of people with dementia, antipsychotic drugs do not
work, according to the UK-based Alzheimer’s Society.
Unfortunately, due to the paucity of dementia specialists, dementia
patients with challenging behavior tend to remain on potentially
inappropriate medicines, Soosay added.
“Many of these medications are not only ill-advised but, as in the
case of risperidone and other antipsychotics, have been repeatedly
shown to increase mortality rates when used in dementia patients,”
Mattingly said, noting that the study highlighted the need for
cautious prescribing of the fewest possible medications when dealing
with frail patients already facing cognitive challenges.
In 2008, an all-party parliamentary group on dementia in the UK
concluded that the over-prescription of antipsychotics for dementia
patients in institutions was a significant problem, despite the fact
that these drugs result in limited benefit for people with dementia,
particularly when prescribed for long periods, and despite the
serious side-effects associated with their long-term use.
Dementia is a syndrome characterized by deterioration in memory,
thinking, behavior and daily functioning.
Alzheimer's disease is the most common cause of the syndrome in the
47 million people who suffer from dementia, according to the World
Health Organization, which estimates there are nearly 10 million new
cases every year.
SOURCE: http://bit.ly/2fTBmDg Age and Ageing, online September 1,
2017.
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