Deprescribing efforts in community-dwelling persons with dementia (PWD) should include drugs such as PPIs and NSAIDs in addition to CNS agents, investigators conclude. “Community-dwelling PWD frequently receive problematic medications across multiple domains and at higher frequencies compared to those without dementia,” write the authors.
Medication usage for community-dwelling adults aged 66 years or older in the Health and Retirement Study with and without dementia was determined using linked Medicare data. Potentially problematic pharmacotherapy included medication overuse (over-aggressive treatment of diabetes/hypertension such as insulin/sulfonylurea for hemoglobin A1c < 7.5%) and medications inappropriate near the end of life based on STOPPFrail) and use of medications that negatively affect cognition or listed in the 2019 Beers or STOPP Version 2 criteria.
“Among 1,441 PWD, median age was 84 (interquartile range = 78–89), 67% female, and 14% Black,” the authors write. “Overall, 73% of PWD were prescribed ≥1 potentially problematic medication with a mean of 2.09 per individual in the prior year. This was notable across several domains, including 41% prescribed ≥1 medication that negatively affects cognition. Frequently problematic medications included proton pump inhibitors (PPIs), non-steroidal anti-inflammatory drugs (NSAIDs), opioids, antihypertensives, and antidiabetic agents. Problematic medication use was higher among PWD compared to those without dementia with 73% versus 67% prescribed ≥1 problematic medication (P = 0.002) and mean of 2.09 versus 1.62 (P < 0.001), respectively.”