Dementia and the Risk of Unnecessary Medications

Most dementia patients in nursing homes in Canada were prescribed unneeded medications in high numbers, even during the last few months of life, study says.

 While dementia drugs could help manage the disease for years, whether or not these drugs are necessary toward the end of life is the question raised by a recent Canadian study.

physician holding hand of elderly alzheimer's_dementia patientDementia is a condition marked by mental decline that interferes with daily life. This can include memory loss, difficulty focusing and making decisions, issues with visual perception and general confusion.  Most with dementia are over the age of 65, and Alzheimer’s disease is the most common form of the condition.

In this study from Women’s College Hospital in Toronto, which focused on more than 9,000 nursing home residents who died at age 66 or older, researchers found that 86 percent of these patients were prescribed medication that was most likely unneeded within the last 120 days of their lives, while 45 percent received the medications during their last 45 days.

“…In situations where the person has advanced dementia, it’s important to, at that point in time, look at what are the things that the person is being (prescribed) and to think how are these contributing to improving quality of life and to review the medications with that kind of lens in mind,”

lead study author Dr. Paula Rochon, a researcher at the Women’s College Hospital in Toronto, told Reuters Health.

Medications to treat dementia include Cholinesterase inhibitors, which prevent the breakdown of chemical messengers that control learning and memory and memantine, which regulates chemicals that aid in cognitive functions like processing information and completing daily activities.

In this study, Dr. Rochon and team focused on “medications of questionable benefit,” or MQBs. The most common MQBs were anti-dementia medications and statins, or medications that lower cholesterol.  According to several studies, including one from the Alzheimer’s Drug Discovery Foundation, while there is some evidence that statins can slow down dementia onset, taking them later in life “does not reduce the risk of dementia.”

Dr. Rochon and team also found that MQBs could cause harmful side effects with little benefit. Side effects of cholinesterase inhibitors can include vomiting and loss of appetite, according to the Alzheimer’s Association.

Dr. Dr. Rochon recommends that caregivers determine whether a medication could contribute to a patient’s quality of life or future goals before prescribing, Reuters reports.

“That’s the opportunity to look at things like the medications that are being given and determine are they continuing to add a benefit or not, and then making decisions about how to proceed on that basis,” she said.

This study was published March 29 in the Journal of the American Geriatrics Society.

The study was funded by the Canadian Institutes of Health Research; Institute of Nutrition, Metabolism, and Diabetes; and the Ontario Ministry of Health and Long-Term Care.

Conflicts of interest were unavailable at time of publication.
Sources:
Alzheimer’s Association, “Medications for Memory Loss”
http://www.alz.org/alzheimers_disease_standard_prescriptions.asp
CBCNews, “Nursing home residents with dementia often get unneeded drugs at end of life”
http://www.cbc.ca/news/health/nursing-homes-dementia-1.4063889
Cochrane Database of Systematic Reviews, “Statins for the prevention of dementia”
http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD003160.pub3/abstract
Cognitive Vitality, “Statins”
https://www.alzdiscovery.org/cognitive-vitality/ratings/statins
Journal of the American Geriatrics Society, “Use of Medications of Questionable Benefit at the End of Life in Nursing Home Residents with Advanced Dementia”
http://onlinelibrary.wiley.com/doi/10.1111/jgs.14844/abstract
Mayo Clinic, “Dementia Treatment”
http://www.mayoclinic.org/diseases-conditions/dementia/diagnosis-treatment/treatment/txc-20198533
Mayo Clinic, “Statin side effects: Weigh the benefits and risks”
http://www.mayoclinic.org/diseases-conditions/high-blood-cholesterol/in-depth/statin-side-effects/art-20046013
Written by: Neha Kashyap | Medically reviewed by: Dr. Robert Carlson, M.D.