AARP Puts the Spotlight on Prescribing of Dementia Drugs

 

prescribing dementia drugs

Person with Dementia

Seventy percent of elderly dementia patients prescribed dementia drugs are on them long-term despite the lack of evidence that they provide any benefit beyond one year, says a new report released by the AARP Public Policy Institute.  Reducing overuse of dementia drugs could result in substantial savings, estimating $20,000 per patient, for patients insurers.

“Our research shows some health care providers continue prescribing dementia drugs to patients for much longer than is supported by the clinical evidence,” says Elizabeth Carter, Senior Health Services Research Advisor, AARP Public Policy Institute, and co-author of the study. “Not only do these drugs carry potential side effects, they are costing both patients and the health care system a lot of money,” she notes.

Adds Leigh Purvis, Director of Health Services Research, AARP Public Policy Institute, and co-author of the report, “Older adults typically take multiple medications, often on a long-term basis, and see multiple health care providers without any meaningful oversight of their overall prescription drug regimens.”  The study’s findings underscore the importance of health care providers having access to reliable medical  to enable them to reassess medications that may no longer be of benefit, or even cause harm

The study looked at two types of drugs are approved by the U.S. Food and Drug Administration for the treatment of dementia symptoms: cholinesterase inhibitors (ChEl) (Aricept®, Razadyne®, Exelon®) and memantine (Namenda®, Namenda XR®). Both types may help with symptoms like memory loss and confusion for approximately three to twelve months, but some patients see no improvement.

Taking a Look at Currently-Approved Dementia Drugs

The researchers found that the benefits of currently-approved dementia drugs are modest and do not affect the underlying cause of the disease or slow the rate of the patient’s cognitive decline. They also do not delay institutionalization, improve quality of life, or even lessen the burden on caregivers. And, there are potential side effects of dementia drugs that include low blood pressure and loss of consciousness, abnormally slow heart rate, and hip fracture.

Claims data from 36,000 Medicare Advantage enrollees who started dementia drug treatment between 2006 and 2015 showed that 58 percent of patients were prescribed a ChEl, 33 percent were prescribed both ChEl and memantine together, and 8 percent were prescribed memantine. The majority (70 percent) of all patients taking dementia drugs were on them for 13 months or longer.

Virginia Burke, President of the Rhode Island Health Care Association, representing the state’s nursing and assisted living facilities, noted that the AARP Study did not differentiate among persons  who reside in a nursing facility and those who live in the community.  The researchers examined billing records from a single Medicare Advantage plan, to determine how frequently and for how long the drugs were purchased for Medicare beneficiaries. she said.

Burke experienced frustration when reading the AARP study, noting that “with all our research, no effective treatments have been identified.”  She says that physicians might want to see more data, and perhaps a peer-reviewed replicated study, before it has an effect on their prescribing patterns.

“Sadly, dementia is one of many illnesses for which we do not yet have a cure,” said Dr. Jim McDonald, a Medical Director for the Rhode Island Department of Health. “If anyone is taking a medication and their symptoms are not getting better, they should talk to their healthcare provider. Communication between, patients, family members, caregivers, and healthcare providers is critical to providing people with the compassionate support that is needed for a chronic condition such as dementia.”

For the reports details, go to www.aarp.org/dementiadrugstudy.

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