A significant number of older Americans living with dementia are still being prescribed potentially dangerous medications, despite decades of clinical safety warnings, a major new study has found.
Widespread Use of Potentially Harmful Medications
Research published in the American Medical Association's official journal estimates that roughly 25% of dementia patients enrolled in traditional Medicare plans received at least one 'potentially inappropriate' medication between 2013 and 2021. These drugs, which include antipsychotics, barbiturates, benzodiazepines, and certain older antidepressants, carry heightened risks for older adults with cognitive impairment.
For years, medical guidelines have strongly discouraged prescribing central nervous system stimulants to this vulnerable group. The medications are known to increase the likelihood of serious adverse events, including delirium, falls, and hospitalisations.
A Slow Decline But Persistent Problem
The study, which analysed anonymised data from 4,842 people in the University of Michigan's Health and Retirement Study, did note a gradual decrease in such prescriptions over the eight-year period. The rate fell from approximately 20% to around 16% across all participants.
However, the prescribing levels remained notably higher for those with cognitive impairment by the study's end in 2021. More alarmingly, over two-thirds of patients receiving these drugs in 2021 lacked any documented clinical reason for their use in the study data.
"While this decline was encouraging, over two-thirds of patients receiving these prescriptions lacked a documented clinical indication in 2021," said lead author Dr. John M. Mafi, a medicine professor at UCLA. "This suggests high levels of potentially inappropriate and harmful prescribing."
Substantial Risk and a Call for Safer Care
Dr. Mafi emphasised that patients with cognitive impairment face a greater danger of adverse effects from these drugs compared to those with normal cognition. "These results underscore substantial opportunities to improve the quality and safety of care for millions of older Americans," he stated.
The researchers adjusted their findings for age, existing health conditions, and socioeconomic status before extrapolating them to the wider US population. They also acknowledged a key limitation: the study did not include data from the more than half of Medicare recipients enrolled in private Medicare Advantage plans.
Furthermore, the scientists noted that prescribing doctors may have been aware of the risks but decided the medication was the 'least worst' option for managing severe dementia symptoms, such as agitation or aggression, which are often underreported in standard Medicare claims data.
Nevertheless, the findings highlight a critical and ongoing issue in geriatric care, pointing to a pressing need for heightened awareness and more cautious prescribing practices to protect a highly vulnerable patient group.
