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Which medicines to stop in people with dementia

Monday, November 19, 2012
Posted in Clinical Care
 

There are some questions over which medications to stop in older adults with dementia. Inappropriate medications in someone with dementia include medicines which: are unlikely to provide benefit, may cause harm, add unnecessary complexity to daily care routines, and/or waste valuable time and money. Examples of potentially inappropriate medications in individuals with dementia include:

  • Statins and other cholesterol lowering medications (low likelihood of benefit if late stage dementia)
  • Anticholinergic medications such as those used for allergies and overactive bladder (increase confusion, constipation, urinary retention, etc)
  • Antiplatelets
  • Cholinesterase inhibitors (low benefit and increased risk in later dementia stages)
  • Bisphosphonates
  • Antipsychotics and other psychoactive medications

While there is some general agreement about discontinuing unnecessary medications, there are still many patients with dementia who receive 7, 8, or more medications each day. This is true especially for individuals living in nursing facilities.

Researchers recently published their study designed to investigate inappropriate medication use in people with dementia.  Using the Services and Health for Elderly in Long Term Care (SHELTER) study, data from over 1,449 nursing home residents with severe cognitive impairment was analyzed.  Included residents were a mean age of 84.2 years and mostly women (75%). They were taking an average of 6.2 medications and 44.9% of them were taking medications that were considered inappropriate for someone with dementia.  Classes included lipid-lowering agents, antiplatelets, cholinesterase inhibitors and antispasmodics.  However, presence of a geriatrician in the facility staff was associated with a lower inappropriate medication use. 

So what can practitioners do to reduce inappropriate use?  Routinely review the medication list and ask a series of questions about each medicine.

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