People over 65 shouldn’t take three or more medicines that act on their brain and nervous system, experts strongly warn, because the drugs can interact and raise the risk of everything from falls to overdoses to memory issues.
But a new study finds that 1 in 7 people with dementia who live outside nursing homes are taking at least three of these drugs.
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Even if they received the drugs to calm some of dementia’s more troubling behavioral issues, the researchers say, taking them in combination could accelerate their loss of memory and thinking ability, and raise their chance of injury and death.
The new study is published in JAMA by a team led by a University of Michigan geriatric psychiatrist who has studied the issue of medication for dementia-related behaviors for years.
It’s based on data from 1.2 million people with dementia covered by Medicare and focuses on medications such as antidepressants, sedatives used as sleep medications, opioid painkillers, antipsychotics and anti-seizure medications.
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More than 831,000 of the entire study population received at least one of the medications at least once during the study period in 2018. More than 535,000 of them — nearly half of all the people with dementia in the study — took one or two of them for more than a month.
But the researchers focused on the 13.9% of the study population who took three or more drugs that act on the central nervous system, and took them for more than a month. They dubbed this “CNS-active polypharmacy.”
That level of use goes beyond the limits recommended by the internationally accepted guidelines called the Beers criteria.
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Key message for patients, caregivers and providers
The federal government has long targeted use of these medications in nursing homes, but not in people who live at home or in less-regulated settings like assisted living facilities.
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“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,” says Donovan Maust, M.D., M.S., the lead author of the study and an associate professor of psychiatry at Michigan Medicine, U-M’s academic medical center.
“But the evidence supporting the use of many of them in people with dementia is pretty thin,” he says, “while there is a lot of evidence about the risks, especially when there are multiple medications layered on top of one another.”
Maust and his colleagues suggest that regular prescription drug reviews could help spot risky combinations, especially ones of three or more drugs that act on the brain and nervous system. Medicare covers such appointments with providers or pharmacists.
“It appears that we have a lot of people on a lot of medications without a very good reason,” he says.
Classes of drugs studied
Antipsychotics have received the most attention for their risk to people with dementia, and 47% of those taking three or more of the medications in the study received at least one antipsychotic, most often Seroquel (quetiapine).
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