Shocking, isn't it? Despite clear warnings, a staggering one in four elderly Americans battling dementia are still being prescribed medications that could be doing more harm than good. This is according to a recent study published in JAMA, which paints a concerning picture of how we're treating our aging population.
The study reveals that many Medicare beneficiaries with dementia are receiving brain-altering drugs, despite the known risks of falls, confusion, and even hospitalization. This is especially alarming given that clinical guidelines have long cautioned against this practice.
While there's been a slight decrease in these prescriptions overall, from 20% to 16% among all Medicare beneficiaries over a nine-year period, the issue persists. The most vulnerable individuals, those with cognitive impairment, are still being exposed to these potentially dangerous medications.
“While this decline was encouraging, over two-thirds of patients receiving these prescriptions lacked a documented clinical indication in 2021, the end of the study period, suggesting high levels of potentially inappropriate and harmful prescribing,” said Dr. John N. Mafi, a key researcher from UCLA.
The research examined prescribing patterns between January 1, 2013, and December 31, 2021. The study focused on older adults with varying levels of cognitive function: normal cognition, cognitive impairment without dementia, and dementia. The study looked at five classes of central nervous system (CNS)-active medications: antidepressants with strong anticholinergic properties, antipsychotics, barbiturates, benzodiazepines, and non-benzodiazepine hypnotics.
The data showed that CNS medications were prescribed to 17% of older adults with normal cognition, nearly 22% of those with cognitive impairment, and about 25% of those with dementia.
Here's a breakdown of the prescription trends:
- Benzodiazepines decreased from 11.4% to 9.1%.
- Nonbenzodiazepine hypnotics (sleep drugs) decreased from 7.4% to 2.9%.
- Antipsychotic medication prescriptions rose from 2.6% to 3.6%.
- Prescriptions for anticholinergic antidepressants remained at 2.6%.
- Barbiturate prescriptions fell slightly from 0.4% to 0.3%.
But here's where it gets controversial... While there was a decline in inappropriately prescribed CNS-active medications (from 15.7% to 11.4%), clinically justified prescriptions also fell, from 6% in 2013 to 5.5% in 2021.
The improvements were largely due to a reduction in benzodiazepine and sleep medication prescriptions.
The study's limitations include the lack of Medicare Advantage data and potentially missing clinical information.
Dr. Annie Yang, the lead researcher, emphasizes the importance of patients and caregivers working closely with physicians to ensure the appropriateness of these medications.
The study was funded by the National Institutes of Health/National Institute on Aging.
What do you think? Are you surprised by these findings? Do you believe there's enough awareness about the risks of these medications? Share your thoughts in the comments below – let's start a conversation!
