Almost three-quarters of older American adults with dementia filled prescriptions for medications that aren’t designed for the brain disease, a new study finds.
Researchers found that many had filled at least one prescription for antidepressants, opioid painkillers, epilepsy drugs, anxiety medications or antipsychotics.
What’s more, patients who were women, white and in their 60 or 70s were the most likely to do so.
The team, from the University of Michigan at Ann Arbor, says these psychoactive drugs could come with dangerous side effects such as nausea, jitteriness or agitation, which may lead to even more prescribing.
For the study, published in JAMA, the team looked at Medicare prescription records of 737,839 people with dementia and an average age of 82.
Researchers then looked to see if they have filled prescriptions for several classes of psychoactive drugs including opioids, antipsychotics, antidepressants, anxiolytics and anti-epileptics.
None of these drug classes have received approval from the US Food and Drug Administration for use in dementia patients.
In all, 73.5 percent of the patients filled at least one prescription for one of the above drug classes over the course of a year.
About half of study participants had gotten antidepressants, which might be prescribed to try to counteract the withdrawal and apathy often seen in dementia, according to lead author Dr Donovan Maust, a geriatric psychiatrist at the University of Michigan and VA Ann Arbor Healthcare System.
However, he says antidepressants don’t treat these symptoms of dementia.
‘Apathy and withdrawal, and a tendency to get agitated, are common symptoms of dementia,’ Maust said.
‘And as much as health care providers want to help these patients and their family caregivers, these medications are just not helpful enough to justify this amount of prescribing.’
Patients most likely to fill prescriptions not meant for dementia were women, white, their late 60s and early 70s, and with low incomes.
The next most common drug class in which at least on prescription was filled was opioids with about 30 percent doing so.
Researchers believed opioids may be prescribed not only to treat pain but also behavioral symptoms such as aggression and agitation.
However, there are safety concerns – such as the risk of addiction – and a lack of evidence of the benefits of opioids.
About 27 percent filled prescriptions for anxiolytics, which inhibit anxiety, and about 22 percent each received anti-epileptics and antipsychotics.
Maust says that most who received opioids filled just one or two short-term prescriptions, which may indicate they had been injured and were treating pain.
But for those taking the other classes of drugs, they often received multiple prescriptions, such as epilepsy drugs, sometimes prescribed as substitutes for antipsychotic drugs, or to treat chronic pain.
‘A brain that has dementia is doing its best to function as well as it can,’ Maust said.
‘If we add a psychotropic medication into the mix it may not be a helpful thing – and it comes with risks.’
The team says all of the drugs are linked to risk for senior citizens such as falls or dependence, which could lead to withdrawal.
Additionally, all of the medications have side effects such as nausea or jitteriness.
Maust says the person with dementia may not be able to communicate the side effects to their loved one, and may just appear agitating, causing them to be prescribed another medication to calm then.
‘As a nation we have a goal of keeping dementia patients living in the community as much as possible. But the use of these medications appears to be as high for them as it is for those who are in nursing homes,’ he said.
‘Clinicians and caregivers may need more support to provide non-drug based approaches to prevent or address the symptoms that these medications are probably being prescribed for.’