Some Medicines for Dementia Patients May Not Help

Medications with questionable benefits had substantial costs

(RxWiki News) Not all prescription medicines deliver benefits that make paying for them worthwhile. And some medicines to treat patients with advanced dementia may be among them.

In a new study, many nursing home patients with advanced dementia received at least one prescription medicine that was not proven to benefit them.

"Consult a neurologist or gerontologist about dementia treatments."

Jennifer Tjia, MD, MSCE, of the University of Massachusetts Medical School at Worcester, was this study’s lead author. Her research team tried to find out how comfortable those with severe dementia were without more medicine than they needed.

Dementia can prevent patients from reasoning, remembering, talking, walking, sitting up, feeding themselves or controlling other bodily functions. There is no cure for dementia. The health of these patients tends to steadily decline.

The study authors looked at data on several medicines whose effectiveness was considered questionable for 5,406 advanced dementia patients. Those patients lived at 406 nursing homes in 47 states between October 2009 and September 2010. The authors also assessed how much was spent on those medicines over those 90 days.

The prescribed meds were cholinesterase inhibitors (brand name Aricept) and memantine hydrochloride (brand name Namenda), well as statins, medicines used to lower cholesterol, among other medications.

An expert panel of doctors has suggested that these medicines may not benefit patients with advanced dementia, the authors wrote. They suggest that these patients be kept comfortable but not overly medicated — agreeing with Institute of Medicine recommendations that doctors not prescribe medicines that bring no benefit.

Based on their findings, the study authors said that 2,911 (53.9 percent) of the patients were taking at least one medicine with questionable benefits. The cost of that single medicine made up one third of all spending on prescriptions for these studied patients during the 90-day study period — $816 per patient on average.

“Our findings have important implications because the use of prescription medications in patients with advanced illness presents a burden to the health care system and to patients,” the authors wrote. “ … [O]verall nursing home costs are rising almost 8 [percent] per year and represent a serious concern to state and federal policy-makers.”

Patients with eating problems like not being able to swallow were less likely to be taking medicine that may not improve their health. Patients on a feeding tube or those with legal orders to not be revived after they stopped breathing also were less likely to be taking medicine that may not improve their health.

The study was published online Sept. 8 in JAMA Internal Medicine.

The US Agency for Healthcare Research and Quality and the National Institute on Aging funded the study.

One of the seven study authors received a research grant from Japanese pharmaceutical company Daiichi Sankyo for an unrelated medical investigation.

Review Date: 
September 8, 2014