Medication misuse and overuse in community-dwelling persons with dementia.

TitleMedication misuse and overuse in community-dwelling persons with dementia.
Publication TypeJournal Article
Year of Publication2023
AuthorsW Deardorff, J, Jing, B, Growdon, ME, Yaffe, K, W Boscardin, J, Boockvar, KS, Steinman, MA
JournalJ Am Geriatr Soc
ISSN Number1532-5415
Abstract

BACKGROUND: Persons with dementia (PWD) have high rates of polypharmacy. While previous studies have examined specific types of problematic medication use in PWD, we sought to characterize a broad spectrum of medication misuse and overuse among community-dwelling PWD.

METHODS: We included community-dwelling adults aged ≥66 in the Health and Retirement Study from 2008 to 2018 linked to Medicare and classified as having dementia using a validated algorithm. Medication usage was ascertained over the 1-year prior to an HRS interview date. Potentially problematic medications were identified by: (1) medication overuse including over-aggressive treatment of diabetes/hypertension (e.g., insulin/sulfonylurea with hemoglobin A1c < 7.5%) and medications inappropriate near end of life based on STOPPFrail and (2) medication misuse including medications that negatively affect cognition and medications from 2019 Beers and STOPP Version 2 criteria. To contextualize, we compared medication use to people without dementia through a propensity-matched cohort by age, sex, comorbidities, and interview year. We applied survey weights to make our results nationally representative.

RESULTS: Among 1441 PWD, median age was 84 (interquartile range = 78-89), 67% female, and 14% Black. 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.

CONCLUSION: Community-dwelling PWD frequently receive problematic medications across multiple domains and at higher frequencies compared to those without dementia. Deprescribing efforts for PWD should focus not only on potentially harmful central nervous system-active medications but also on other classes such as PPIs and NSAIDs.

DOI10.1111/jgs.18463
Citation Key13323
PubMed ID37272899
Grant ListK24AG049057 / AG / NIA NIH HHS / United States
P01AG066605 / AG / NIA NIH HHS / United States
P30AG044281 / AG / NIA NIH HHS / United States
R03AG078804 / AG / NIA NIH HHS / United States
R35AG071916 / AG / NIA NIH HHS / United States
T32AG000212 / AG / NIA NIH HHS / United States