A recent study led by researchers at the Beth Israel Deaconess Medical Center in Boston delved into the intricate relationship between dementia diagnosis and medication usage patterns among older adults. The study, titled “Changes in the Use of Long-Term Medications Following Incident Dementia Diagnosis,” and published in JAMA Internal Medicine, presented some surprising insights, including an overall increase in medication usage within the year following an incident dementia diagnosis.
Managing medications for individuals with dementia poses a significant challenge due to Alzheimer’s disease and related dementias affecting a substantial number of people in the US. These conditions complicate treatment decisions as older adults with dementia frequently contend with multiple chronic illnesses, making their medication regimens intricate and demanding.
Current clinical guidelines emphasize the need to tailor treatments according to patient goals, potential benefits, and coexisting health issues. However, the study spotlighted a gap in implementing deprescribing guidelines and strategies in clinical practice for patients with dementia. The research analyzed a vast cohort of 266,675 adults who had been diagnosed with incident dementia, juxtaposed against an equivalent control group of 266,675 individuals.
The data was drawn from a comprehensive collection of Medicare Part D beneficiary pharmacy claims spanning the years 2010 to 2019. Validated diagnosis codes were employed to identify new cases of dementia, and controls were meticulously matched based on diverse demographic and medication-related factors. The study scrutinized medication usage patterns prior to and post dementia diagnosis, utilizing the rigorous analysis to comprehend changes over time.
Some specific prescription trends came to light through the research. Notably, patients diagnosed with dementia exhibited a foreseeable surge in prescriptions for anti-dementia medications, which was in line with expectations as these drugs are purposefully prescribed for dementia management. However, more intriguingly, there was an unanticipated rise in the use of central nervous system (CNS)-active medications subsequent to a dementia diagnosis.
This discovery contradicted established professional guidelines and raised concerns due to the potential cognitive impairment associated with these medications. Many CNS-active drugs have been linked to adverse outcomes like heightened fall risks, aggravated cognitive decline, and other unfavorable drug-related events. This increase in usage despite the associated risks pointed towards a discrepancy between guidelines and real-world practice.
The study also found that certain cardiometabolic medications, such as antihypertensives and insulins, experienced an immediate surge in use post-diagnosis. This could be attributed to healthcare professionals responding to the evolving health needs of individuals with dementia. On the other hand, the usage of anticholinergic medications, while slightly reduced among the cohort with dementia, persisted despite the known potential for adverse cognitive effects. This inconsistency between knowledge and prescription behavior highlighted potential lapses in appropriate medication management.
The researchers concluded that their findings underscored missed opportunities in mitigating burdensome polypharmacy by neglecting to deprescribe long-term medications with high safety risks or limited potential benefits, especially those linked to impaired cognition. The study unveiled a need for a more harmonized approach to medication management for individuals diagnosed with dementia. While the research uncovered unexpected trends, it also emphasized the importance of bridging the gap between clinical guidelines and their practical implementation in the complex landscape of dementia care.
The study conducted by the Beth Israel Deaconess Medical Center shed light on the intricate interplay between dementia diagnosis and medication utilization among the elderly. The findings not only revealed surprising shifts in prescription patterns but also underscored the necessity for consistent adherence to deprescribing guidelines in order to ensure the optimal care for individuals navigating the challenges of dementia. The study’s insights could potentially influence healthcare practices, promoting more effective medication management for this vulnerable population.
