Nearly three-quarters of older American adults with dementia meet prescriptions for drugs not designed for brain disease, a new study finds.
Researchers found that many had at least one prescription for antidepressants, opioid painkillers, epilepsy medications, anxiety medications, or antipsychotics.
What’s more, patients who were women, white and in their 60s or 70s were most likely to do so.
The team, from the University of Michigan at Ann Arbor, says that these psychoactive drugs could come with dangerous side effects such as nausea, jitteriness or agitation, which could lead to even more prescribing.
A new study found that of more than 737,000 patients with dementia, 73.5% completed at least one prescription for opioids, antipsychotics, antidepressants, anxiety disorders, and antiepileptic drugs over the course of a year (file image)
For the study, published in JAMA, the team looked at Medicare presentation posts of 737,839 people with dementia and an average age of 82.
Researchers then looked to see if they had prescriptions for various classes of psychoactive drugs, including opioids, antipsychotics, antidepressants, anxiety medications and anti-epileptics.
None of these classes of drugs have been approved by the U.S. Food and Drug Administration for use in patients with dementia.
Overall, 73.5 percent of patients completed at least one prescription for one of the above drug classes over the course of a year.
About half of the study participants had been given antidepressants, which may be prescribed to try to reduce withdrawal and apathy often seen in dementia, according to lead author Dr. Donovan Maust, a geriatric psychiatrist at the University of Michigan and VA Ann Arbor Healthcare System.
However, he says that antidepressants do not treat these symptoms of dementia.
“Apathy and withdrawal, and a tendency to become agitated, are often symptoms of dementia,” Maust said.
‘And as much as healthcare providers want to help these patients and their family caregivers, these medications just aren’t useful enough to justify how many prescriptions they have.’
Patients likely to fill in prescriptions not intended for dementia were women, white, their late 60s and early 70s, and with a low income.
The next most common class of drugs in which at least one prescription was filled was opioids with about 30 percent doing so.
Researchers believed that opioids could be prescribed not only to treat pain, but also behavioral symptoms such as aggression and agitation.
However, there are safety concerns – such as the risk of addiction – and a lack of evidence for the benefits of opioids.
About 27 percent completed prescriptions for anxiety-inhibiting anxiety disorders, and about 22 percent each received anti-epileptics and antipsychotics.
Maust says most opioid recipients completed one or two prescriptions in the short term, which may indicate that they were injured and treating pain.
But for those who take the other classes of drugs, they often got multiple prescriptions, as well epilepsy medications, sometimes prescribed as a substitute for antipsychotic medications, or to treat chronic pain.
“A brain that has dementia does its best to function as well as possible,” Maust said.
‘If we add a psychotropic medication to the mix, it can not be a useful thing – and it comes with risks. ‘
The team says all drugs are linked to risk for seniors such as falls or addiction, which can lead to withdrawal.
In addition, all medications have side effects, such as nausea or jitteriness.
Maust says the person with dementia may not be able to communicate the side effects to their loved one, and may just appear agitating, prompting them to take another medication to calm them down.
‘As a nation, we aim to keep as many dementia patients in the community as possible. But the use of these medications seems to be as high for them as it is for those who are in nursing homes, ‘he said.
‘Clinicians and caregivers may need more support to provide non-drug-based approaches to prevent or address symptoms where these medications are likely to be prescribed.’
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