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Medication misuse and overuse in community-dwelling persons with dementia

Deardorff WJ, Jing B, Growdon ME, Yaffe K, Boscardin WJ, Boockvar KS, Steinman MA. Medication misuse and overuse in community-dwelling persons with dementia. J Am Geriatr Soc. 2023 Jun 5. doi: 10.1111/jgs.18463. Epub ahead of print. PMID: 37272899.

The study by Deardorff et al. investigated medication misuse and overuse within the community-dwelling older adult population affected by dementia. Using Health and Retirement Study (HRS) data from 2008 to 2018, a nationally representative survey of U.S. adults, the main goal was to characterize potentially problematic medication use, covering diabetes and hypertension overtreatment, cognition-impairing drugs, and medications from consensus criteria (2019 Beers and STOPP Version 2). By comparing medication trends between those with and without dementia, it seeks to provide insights into problematic prescribing, highlighting areas for interventions and deprescribing to enhance care quality for individuals with dementia.

The study cohort comprised individuals aged 66 years and above, identified as having dementia through a validated algorithm, and with at least 12 months of Medicare enrollment. Medication usage was ascertained over a 1-year look-back period from specific HRS interview dates, with information on prescriptions, drug names, and drug classes obtained from Medicare Part D linked to the Medi-Span database. Potentially problematic medication use was categorized into medication overuse (e.g., aggressive diabetes/hypertension treatment) and medication misuse (e.g., cognition-affecting meds). A matched cohort without dementia was also studied using 1:1 propensity score matching based on year, age, sex, and comorbidities, ensuring comparable groups for evaluating medication patterns.

The study cohort encompassed 1441 individuals with dementia, compared with individuals without dementia. Notably, 73% of persons with dementia received at least one potentially problematic medication, with a mean of 2.09 flagged medications per person, highlighting a high prevalence of potentially inappropriate prescribing. Overuse and misuse of medications were observed across domains, including over-aggressive diabetes/hypertension treatment (17%), prescribed medications negatively affecting cognition (41%), medications identified by the 2019 Beers criteria (60%), and those flagged by the STOPP-V2 criteria (66%). Medication classes identified included proton pump inhibitors, NSAIDs, opioids, antihypertensives, and antidiabetic agents. Furthermore, individuals with dementia received more flagged medications (2.09 vs. 1.62) at a higher frequency compared to those without dementia. Identifying and addressing these issues can help mitigate the risk of adverse drug events, hospitalizations, and cognitive decline, ultimately leading to better health outcomes and improved quality of life for this vulnerable population.

Primary author James Deardorff reflects on how the study findings could inform clinical practice and guidelines for healthcare providers working with older adults with dementia, given that the study revealed a high prevalence of problematic medication use among this population:

“In this study, we took a comprehensive approach to capturing the broad spectrum of potentially problematic medication use among persons with dementia. While previous studies have shown that persons with dementia have high rates of problematic CNS-active medications (e.g., benzodiazepines and antipsychotics), we show that problematic prescribing frequently involves other classes of medications, including PPIs, NSAIDs, antihypertensives, and antidiabetic agents. For healthcare professionals taking care of these patients, our study indicates that efforts to reduce polypharmacy in persons with dementia should target a wide range of medications contributing to medication misuse and overuse.

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Authored by Caroline Eskandar

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