There’s so much to be said about dementia. Experts say that older adults who suffer from it should limit the number of medications they take. The effects of these medicines are on the brain and central nervous system (CNS). Hence, by using three or more of these meds at one time, the individual could be at higher risk of adverse side effects.
A study has been made and the findings show that 1 in 7 older people with dementia take three or more medications. These people are the ones who live outside nursing homes. The study also examines the prescriptions made for 1.2 million people who suffer from it.
Experts made their point across as clearly as possible, and that is people aged 65 years or older should not take three or more medicines that target the brain or CNS simultaneously. Why? Because these drugs often interact. The mix has the potential to accelerating cognitive decline, thus increasing the risk of further injury and even death.
This advice is extremely specific to sufferers of dementia who take multiple medicines to slow down or stop the symptoms that go with it.
Recent Studies
A recent study that appeared in JAMA has been made with dementia patients. Experts found that almost 1 in 7 of the them take three or more brain and CNS medications. Experts have warned them against doing this, but they have remained stubborn.
The US government, on the other hand, is in charge of regulating the allocation of these medications in nursing homes. As for those living on their own, there may be an oversight. Hence, the latest study honed in on individuals who were not in nursing homes.
Dr. Donovan Maust, the lead author of the study and geriatric psychiatrist of the University of Michigan (UM) in Ann Arbor, explains the effects of too many medications by saying, “Dementia comes with lots of behavioral issues, from changes in sleep and depression to apathy and withdrawal, and providers, patients, and caregivers may naturally seek to address these through medications.”
Dr. Maust has shown great concern that too often, doctors may actually prescribe too many medications. He elaborates, “It appears that we have a lot of people on a lot of medications without a very good reason.”
The Medications of 1.2 Million People
The UM researchers behind the research examined the prescription of sleep medications, antipsychotics, antidepressants, opioid pain relievers, and anti-seizure drugs for around 1.2 million people who suffer from dementia. They made use of the 2018 Medicare records.
While the younger generation could safely use these medications simultaneously, age-related and dementia-related changes in brain chemistry is more concerning because the interactions could produce unwanted results. Hence, it could actually be worse for them. And of the 1.2 million people in the study, 13.9 percent took three or more CNS-related medications. They did these for more than one month. The authors of the study have, in fact coined the term “CNS-active polypharmacy” for this.
As for the prescriptions, these were considered common. A total of 831,017 individuals received at least one of the drugs at least once in the year. And almost 50 percent of those studied, which is around 535,180, took one or two of the common medications for more than 30 days.
Tracking Medications
In the CNS-active polypharmacy group the researchers looked into, 92 percent took the most commonly prescribed type of medicines, the antidepressants. The next common ones were the anti-seizure medications. Around 62 percent were users. Gabapentin (Neurontin), an epilepsy drug, also dominated in the list. Its prescribed use made up for a third of all the days in the period set. The epileptic drug was used for its off-label reputation, which was for pain and anxiety control.
About 41 percent of the CNS-active polypharmacy group also had benzodiazepines, such as lorazepam (Ativan) on their list. Moreover a good number of them, around 47 percent, took three or more CNS medications in the antipsychotics study. These drugs are not among the approved medications for dementia. Unfortunately, there are doctors who prescribe them. Dr. Maust says that these do help manage anxiety, sleep problems, and other issues. The most popular antipsychotic was quetiapine (Seroquel).
More Research Needed
Dr. Maust says that doctors need to make a convincing case for their simultaneous prescriptions. He says that “the evidence supporting the use of many of them in people with dementia is pretty thin, while there is a lot of evidence about the risks, especially when there are multiple medications layered on top of one another.”
The doctor and his colleagues suggest that increased drug reviews by medical experts may help elaborate and point out the negative interactions when these drugs are taken together. Unfortunately, information is not that widespread and comprehensive just yet. Hence, it’s also a challenging judgment call for these doctors.
In fact, Dr. Maust says that doctors sometimes write these because they hope that they can actually help their patients manage symptoms. If this is successful, then long-term care wouldn’t be needed. At least, that’s their intention.
This type of care is especially important during the pandemic. Long-term facilities have seen their fair share of death. Doctors may even look into several medications to spare the outside family from witnessing the troubling symptoms of dementia. For this, Dr. Maust says that families could even be more than important than ever. They play a huge role in helping plan out the patient’s treatment plan by informing the doctor regularly, especially for changes in symptoms and behavior.
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