Polypharmacy (Part II): overmedication and mismedication are common in dementia patients
Older dementia patients have more polymedication compared to dementia-free elderly patients. Included medications may lead to more serious side effects in this group.
How often do older adults with dementia receive high-risk medication?
The analysis was based on data from 1,441 people with a confirmed diagnosis of dementia (average age 84 years, 67% female). The recently published data showed that two thirds (66%) of the long-term medications taken were considered inappropriate in old age according to the 'STOPPFrail' criteria, for example CNS-active drugs (such as benzodiazepines, antipsychotics and opioids), but also proton pump inhibitors, NSAIDs, as well as certain antihypertensives and antidiabetics.
Three quarters (73%) of respondents had at least one such potentially problematic medication on their schedule; with an average of two of such medications per person. Medications that impair cognition accounted for 41%. Excessive or inappropriate prescribing also often consisted of overly aggressive treatment of diabetes/hypertension (17%), such as the administration of insulin/sulfonylureas despite an HbA1c < 7.5%.
Efforts to reduce prescriptions in older people with dementia should not only focus on potentially harmful centrally acting drugs, but also on other drug classes such as PPIs and NSAIDs, the authors of the analysis conclude.1
Key take-away for practitioners: A strict selection is important!
Polypharmacy in old age has been a rapidly increasing phenomenon in recent years. However, it is particularly important to avoid this in the geriatric population because the risk of side effects and interactions increases anyway as part of the ageing process.3
As we explained in part I of this analysis, studies from Germany have indicated that 25% of older are taking multimedications containing so-called PIMs, potentially inadequate medications in old age. Their use has been shown to be associated with an increased risk of complications, hospitalisations and a poorer quality of life.3-5
- Deardorff, W. J. et al. Medication misuse and overuse in community-dwelling persons with dementia. J Am Geriatr Soc 71, 3086–3098 (2023).
- Shahroodi, R. Medication misuse and overuse in community-dwelling persons with dementia. US Deprescribing Research Network.
- [In German] Priscus 2.0
- Thiem, U. et al. Reduction of potentially inappropriate medication in the elderly: design of a cluster-randomised controlled trial in German primary care practices (RIME). Ther Adv Drug Saf 12, 2042098620918459 (2020).
- Endres, H. G. et al. Association between Potentially Inappropriate Medication (PIM) Use and Risk of Hospitalization in Older Adults: An Observational Study Based on Routine Data Comparing PIM Use with Use of PIM Alternatives. PLoS One 11, e0146811 (2016).