San Francisco—Older adults with probable or possible dementia are willing to cut back on medications if advised to do so, according to a new study.
The report in the Journal of the American Geriatric Society stated that 87% of seniors with suspected cognitive issues would drop at least one medication "if their doctor said it was possible." That increased to 92% among those who were taking six or more medications.
The findings confirm that patients and their families tend not to be barriers to deprescribing.
While 58% of the 422 older adults had probable or possible dementia, most also had otherwise good to excellent health. Still, more than half of these patients were being treated with polypharmacy—taking six or more regular medications.
University of California San Francisco (UCSF)—led researchers pointed out that some of the drugs might be exacerbating cognitive symptoms, causing poor outcomes and resulting in adverse drug reactions—in addition to the added costs.
The national sample represented 1.8 million Medicare beneficiaries and was recruited by the National Health and Aging Trends Study (NHATS). Most, about three-quarters, were aged 75 years or older. Overall, 44% had possible dementia and 56% had probable dementia as determined by the NHATS criteria, the researchers note.
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," stated first author Matthew Growdon, MD, an aging research fellow at the UCSF Division of Geriatrics and the San Francisco Veteran's Affairs (VA) Medical Center.
"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," Dr. Growdon stated.
Participants taking six or more pills also were more willing to drop one; 29% in this group agreed "that at least one medication was no longer necessary" compared with 13% in those taking less than six pills.
Dr. Growdon suggests the high rate of subscribing is linked to "a biomedical culture of prescribing," as well as "deference on the part of patients and physicians to the prescribing physician."
Coauthor Michael Steinman, also of the UCSF Division of Geriatrics and the San Francisco VA Medical Center, added, "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."
Vitamin D with calcium and medications for high blood pressure, diabetes, constipation, and arthritis were among other commonly prescribed or recommended drugs, the authors noted.
"Our aim as geriatricians is to prescribe medications to help older people achieve their health and function goals, especially those with dementia," stated cosenior author Kenneth Boockvar, MD, from the New Jewish Home, Icahn School of Medicine at Mount Sinai and James J. Peters VA Medical Center in Bronx, New York. "We need to avoid or stop taking medications that do not further those goals. That's where deprescribing comes in."
Deprescribing is about medical optimization "rather than taking away medications," stated Dr. 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."
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