Too many medications in the elderly; Stopping dementia medications such as Namenda and Aricept

This Swiss study shows that medications can be reviewed and stopped to avoid adverse events in the elderly.

Polypharmacy poses significant risks for older patients with dementia due to their heightened vulnerability to drug side effects. A study conducted from October 2021 to September 2022 evaluated 205 outpatients at a dementia center, focusing on reducing inappropriate medications. A total of 74 potentially inappropriate drugs were identified, with significant categories including long half-life benzodiazepines, anticholinergics, and tricyclic antidepressants. The assessment also revealed 26 duplicate medications and 10 prescriptions with potential dangerous interactions. The study emphasizes the need for regular medication reviews and suggests that computer tools and trained healthcare teams can effectively manage and prevent drug interactions.

Directors of Nursing queried about dementia medications: talk to the families!

This study aimed to identify factors influencing the initiation and discontinuation of antidementia medications in nursing home residents. Conducted in 2022, it surveyed 1,293 nursing homes.

Key findings included that Directors of Nursing (DoNs) reported the following groups were frequently involved in medication decisions: nursing home prescribers (84.4%), nursing staff (33.2%), family members (23.4%), and residents (13.8%). Antidementia medications were more likely to be initiated if residents or their families expressed interest, if a dementia specialist was involved, or if the resident exhibited aggressive behaviors or had severe cognitive impairment.

Conversely, medications were more likely to be discontinued with dementia specialist involvement, in cases of severe impairment, hospice care, or if aggressive behaviors emerged. Reluctance from residents or families to stop medications decreased the likelihood of discontinuation. Notably, one in six homes reported that residents lacked immediate family or caregivers.

The study highlights the significant roles of family members and dementia specialists in medication decisions, emphasizing the need for more real-world evidence on the use of antidementia medications in nursing homes to guide clinical practices.