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In Advanced Alzheimer’s, Too Many Medications

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More than half of nursing home residents with advanced Alzheimer’s disease or other forms of dementia are taking at least one prescription drug they do not need. The findings come from a countrywide survey of 460 nursing homes that linked patient medical records with pharmacy records. They are important because many of these medications are costly and have harmful side effects that can worsen quality of life.

Medications that were commonly given but which are not recommended for those with advanced dementia included drugs for Alzheimer’s itself, such as Aricept (donepezil), Exelon (rivastigmine), Razadyne (galantamine) and Namenda (memantine). These drugs may ease symptoms for a time in those with mild to moderate dementia, and they may allow patients to remain at home longer. But they are typically not recommended for those with advanced disease, including those with late-stage Alzheimer’s who are living in nursing homes.

These drugs are expensive. They can also have serious side effects, including fainting, an increased risk of falls and hip fractures, heart rhythm disorders and uncomfortable urinary retention.

Other drugs that doctors often prescribed but which are not recommended for those with advanced dementia included cholesterol-lowering drugs and blood thinners (other than aspirin). The typical cost of these medications for a 90-day course was $816.

For the study, researchers at the University of Massachusetts Medical School in Worcester looked at 5,406 nursing home residents with late-stage Alzheimer’s or dementia.  More than half were older than 85. They found that 2,911 of them, or almost 54 percent, were taking at least one medication of questionable benefit. The findings appeared in JAMA Internal Medicine.

People with advanced dementia are severely impaired. They typically can no longer recognize family members, are unable to walk, can speak only a handful of words, and have trouble eating, drinking and swallowing. Many of these patients are not expected to live for longer than six months. Yet most of them are receiving from 5 to 15 prescription medications daily.

Many of these drugs are beneficial, helping to control conditions like diabetes and high blood pressure. But, as this study underscores, some are not indicated and may worsen quality of life.

Family members say that comfort is their primary  goal for loved ones with dementia. Yet many of these end-stage patients are receiving drugs that may be impairing their quality of life.

Because swallowing can be difficult for many of these patients, the fewer the number of pills they must take, the better. Elderly men and women with advanced dementia are also typically unable to communicate if they are uncomfortable or are experiencing painful side effects of medications. In some cases, adverse effects may contribute to agitation and disorientation, leading to even more drugs being prescribed. And many of these drugs do nothing to extend the patient’s life expectancy.

Nursing home residents with advanced dementia should undergo regular medication reviews, the authors of the study note. Benefits and risks should be carefully weighed so that the patient remains as comfortable as possible. While family members are often reluctant to discontinue drugs that have been prescribed to treat chronic conditions in their loved ones, experts say that comfort is paramount and some drugs cause more harm than good.

By www.ALZinfo.org, The Alzheimer’s Information Site. Reviewed by William J. Netzer, Ph.D., Fisher Center for Alzheimer’s Research Foundation at The Rockefeller University.

Source: Jennifer Tija, MD, MSCE; Becky A. Briesacher, PhD; Daniel Petersonal MA; et al: “Use of Medications of Questionable Benefit in Advanced Dementia.” JAMA Internal Medicine, published online Sept 8, 2014.

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