Seventy percent of adults who take medication for dementia are taking the drugs longer than deemed appropriate by clinical evidence, increasing the potential for adverse health outcomes and generating unnecessary costs to them and the healthcare system, according to a new study by the AARP Public Policy Institute.
The results indicate that residents with dementia and their medication regimens must be regularly assessed to ensure that any drugs taken for dementia are effective and appropriate for them, according to authors Elizabeth A. Carter, Ph.D., MPH, and Leigh Purvis, MPA, of the AARP.
“All prescription drugs have side effects and can interact with one another — sometimes dangerously — which makes it incredibly important to keep an eye on the big picture as new drugs are prescribed,” Carter told McKnight’s Senior Living. One type medication prescribed for dementia symptoms like memory loss and confusion, cholinesterase inhibitors (ChEl) such as donepezil (Aricept), galantamine (Razadyne) and rivastigmine (Exelon), has been linked to fainting, abnormally slow heart rate and hip fracture, the study noted.
Even in senior living settings where workers may not have direct responsibility for oversight of residents’ healthcare, Carter said, workers “can encourage and empower patients and/or their caregivers to maintain open dialogues with their healthcare providers to ensure their prescription drug regimens still meet their health needs.”
She and Purvis retrospectively analyzed de-identified claims data from the OptumLabs Data Warehouse on almost 71,000 Medicare Advantage enrollees aged 65 or more years who had received a new dementia diagnosis between 2006 and 2015.
Of the 36,000 people who began taking FDA-approved medication for dementia, 58% were prescribed ChEl; 33% were prescribed ChEl and memantine (Namenda or Namenda XR); and 8% were prescribed memantine only.
“Clinical evidence indicates that ChEl and memantine may delay cognitive impairment for approximately three to 12 months among certain adults with dementia, while other patients will not benefit at all,” they said.
Seventy percent of those taking the drugs had prescriptions for 13 or more months, a time frame not supported by clinical evidence, the researchers found.
The lengthy prescriptions raise cost issues in addition to safety issues, Carter said.
“Remaining on prescription drugs long-term can lead to substantial costs that could (and should) be avoided if the drug is no longer helpful or even hurting the patient,” she said.
She and Purvis found that up to $18,000 in total dementia drug spending per older adult occurred after the first year of medication use — beyond the duration of treatment supported by clinical evidence.
The issue “really goes beyond just dementia drugs,” however, Carter said. “Healthcare providers should be regularly re-assessing all of their patients’ prescription drugs to help ensure that their drug regimens remain appropriate.”
