Taking too many medications may be worsening dementia and increasing the risk of delirium in elderly people, warns a new study. Researchers say that we’ve reached “a biomedical culture of prescribing” that comes with dangerous consequences.
Overprescription is a growing concern among carers for older people, who say more than six pills a day could actually be worsening cognitive decline. Researchers at the University of California, San Francisco tracked a national sample of 422 people, where three quarters were 75-plus, 44 percent had possible dementia, and 56 percent had probable dementia.
Nearly two in three seniors (58 percent) with probable or possible dementia had otherwise good to excellent health, yet more than half of the total took six or more regular medications. Every new pill comes a risk of adverse drug interactions, poor outcomes and can exacerbate dementia.
‘Many drugs especially harmful’ to people with higher risk of dementia
In the study, 87 percent of elderly people would be willing to stop at least one medication “if their doctor said it was possible.” This increased to 92 percent of participants who were taking six or more medications.
“Taking six medications or more 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,” says Dr. Matthew Growden, an aging research fellow at the UCSF Division of Geriatrics and the San Francisco VA Medical Center, in a statement.
“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,” he continues. “These drugs have sedating effects that increase the risk of delirium and can worsen dementia.”
The research shows that 29 percent of patients prescribed at least six medications agree that one or more of the drugs is “no longer necessary.” That number shrunk to just 13 percent for people taking less than six medications.
Growdon believes that “deprescribing” isn’t just out of principle or the need to reduce prescriptions — it’s about medical optimizations. “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,” he says. “One thing this study can hopefully add is that patient/family resistance to deprescribing should not be seen as a barrier.”
Adds Dr. Kenneth Boockvar, from the Icahn School of Medicine at Mount Sinai: “Our aim as geriatricians is to prescribe medications to help older people achieve their health and function goals, especially those with dementia. We need to avoid or stop taking medications that do not further those goals. That’s where deprescribing comes in.”
The study is published in the Journal of the American Geriatrics Society.
South West News Service writer Joe Morgan contributed to this report.