Seniors with dementia may have too many medications prescribed

A study of American seniors with probable or possible dementia who were in good to excellent health reported they took six or more regular medications. This habit may be straining insurance costs, lead to adverse drug interactions, and exacerbate cognitive symptoms.

The study, led by UC San Francisco researchers, found that 87% of them were willing to stop at least one medication, including OTC and supplements, if their doctor said it was possible.

In addition to adverse interactions and outcomes, polypharmacy also “contributes to challenges with adherence, since more complicated medication regimens require more time and attention, and increase the potential for making mistakes and inadvertent misuse,” said first author Matthew Growdon, MD, an aging research fellow at the UCSF Division of Geriatrics and the San Francisco VA Medical Center, in a statement.

“Many drugs may be especially harmful to older adults with cognitive impairment, such as benzodiazepines, used to treat anxiety, and oxybutynin, used to treat urinary incontinence. These drugs have sedating effects that increase the risk of delirium and can worsen dementia,” he said.

While 87% of the participants said they were willing to stop at least one of their medications, this increased to 92% of participants who were taking six or more medications. In addition, 29% in this group agreed “that at least one medication was no longer necessary.” This compares with 13% in participants taking less than six pills. Growdon attributes this to a culture of prescribing in health care as well as patients deferring to the prescribing doctor.

“Additionally, treatment of cognitive impairment itself and its complications may lead to more medication use. This can include medications to help with memory and with mood, and medications for symptoms that people with cognitive impairment can increasingly face, like urinary incontinence,” Growdon said.

Other commonly prescribed drugs include vitamin D and calcium, and medications for high blood pressure, diabetes, constipation and arthritis, the authors noted.

Deprescribing is about medical optimization, “rather than taking away medications,” said Growdon. “We should strive to ensure that the benefits outweigh risks, and that we are prescribing in line with goals of care, and taking into consideration factors in older adults, like frailty, multimorbidity, cognitive impairment and functional status. One thing this study can hopefully add is that patient/family resistance to deprescribing should not be seen as a barrier.”