Health and Me

Itisha Arya

Why Are Dementia Patients Still Being Prescribed Unsafe Drugs? New Study Raises Concerns

dementia unsafe medicine

<span><a href="https://www.healthandme.com/health/dementia">Dementia</a></span> patients in the United States continue to be prescribed stimulant medications known to carry serious risks, despite long-standing safety warnings, according to new research. The study, set to be published January 12, in the peer-reviewed journal JAMA, highlights ongoing concerns around medication use in older adults with cognitive decline.

While overall prescribing of these drugs has fallen over the years, the decline has not been even. Among all Medicare beneficiaries, usage dropped from 20 percent to 16 percent over the nine-year study period. Yet individuals with cognitive impairment remain more likely to receive these medications, even though they are particularly susceptible to harmful side effects.

Dementia is an umbrella term used to describe a significant decline in mental function that interferes with daily life. It affects memory, thinking, and reasoning, and can also influence mood, behavior, and personality. Dementia is not a single illness but a syndrome caused by different conditions, most commonly Alzheimer’s disease. 

Symptoms tend to worsen gradually, making everyday activities such as communication, decision-making, and self-care increasingly difficult. While there is no cure, certain treatments can help manage symptoms, according to the National Institute on Aging.

“Although the downward trend in prescribing was a positive sign, by 2021, more than two-thirds of patients who were still receiving these medications had no clear clinical reason documented for their use,” said senior author Dr. John N. Mafi, associate professor-in-residence of medicine in the division of general internal medicine and health services research at the David Geffen School of Medicine at UCLA, as per Scitech Daily. “This points to persistently high levels of prescribing that may be unnecessary and potentially harmful.”

He added, “Compared to patients with normal cognitive function, older adults with cognitive impairment were more likely to be prescribed these drugs, even though they face a greater risk of adverse effects. These findings highlight major gaps in care quality and safety that affect millions of older Americans.”

<h2>Unsafe Medications Being Prescribed To Dementia Patients</h2>

For the study, researchers linked survey information from the Health and Retirement Study with Medicare fee-for-service claims data. They reviewed prescribing patterns for potentially inappropriate central nervous system, or CNS-active, medications between January 1, 2013, and December 31, 2021. Older adults were divided into three groups: those with normal cognition, those with cognitive impairment without dementia, and those diagnosed with dementia.

The medications assessed were grouped into five categories: antidepressants with strong anticholinergic effects, antipsychotics, barbiturates, benzodiazepines, and non-benzodiazepine hypnotics.

<h2>Higher Use Among Those With Cognitive Impairment</h2>

Clear differences emerged across the three cognitive groups. CNS-active medications were prescribed to 17 percent of older adults with normal cognition. This figure rose to nearly 22 percent among those with cognitive impairment but no dementia. Among individuals living with dementia, about one in four received these medications.

Looking more closely at specific drug types among all Medicare fee-for-service beneficiaries, trends varied. Benzodiazepine use declined from 11.4 percent to 9.1 percent. Prescriptions for non-benzodiazepine hypnotics, commonly used to treat sleep problems, dropped sharply from 7.4 percent to 2.9 percent. In contrast, antipsychotic use increased from 2.6 percent to 3.6 percent. Rates of anticholinergic antidepressant prescribing remained unchanged at 2.6 percent throughout the study period, while barbiturate use saw a slight decrease from 0.4 percent to 0.3 percent.

<h2>Signs of Progress Alongside Ongoing Concerns</h2>

Prescriptions backed by a clear clinical justification declined slightly, from 6 percent in 2013 to 5.5 percent in 2021. At the same time, prescriptions considered likely inappropriate fell more noticeably, dropping from 15.7 percent to 11.4 percent. Much of this improvement was linked to reduced use of benzodiazepines and sleep medications, along with fewer inappropriate prescriptions overall.

The researchers acknowledged several limitations. The analysis did not include data from Medicare Advantage plans, some clinical details such as agitation may not have been captured, and the study focused on how frequently these medications were prescribed rather than how long patients remained on them.

“CNS-active medications can be appropriate in certain situations,” said Dr. Annie Yang, a scholar in the National Clinician Scholars Program at Yale University, as per Scitech Daily, who led the study while training as a UCLA internal medicine resident. “But it is essential for older patients and their caregivers to work closely with their doctors to confirm that these drugs are truly necessary. When they are not, care teams should explore other treatment options and consider whether it may be safe to gradually reduce or discontinue the medication.”

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Dementia patients in the United States continue to be prescribed stimulant medications known to carry serious risks, despite long-standing safety warnings, according to new research. The study, set to be published January 12, in the peer-reviewed journal JAMA, highlights ongoing concerns around medication use in older adults with cognitive decline.While overall prescribing of these drugs has fallen over the years, the decline has not been even. Among all Medicare beneficiaries, usage dropped from 20 percent to 16 percent over the nine-year study period. Yet individuals with cognitive impairment remain more likely to receive these medications, even though they are particularly susceptible to harmful side effects.What Is Dementia?Dementia is an umbrella term used to describe a significant decline in mental function that interferes with daily life. It affects memory, thinking, and reasoning, and can also influence mood, behavior, and personality. Dementia is not a single illness but a syndrome caused by different conditions, most commonly Alzheimer’s disease. Symptoms tend to worsen gradually, making everyday activities such as communication, decision-making, and self-care increasingly difficult. While there is no cure, certain treatments can help manage symptoms, according to the National Institute on Aging.“Although the downward trend in prescribing was a positive sign, by 2021, more than two-thirds of patients who were still receiving these medications had no clear clinical reason documented for their use,” said senior author Dr. John N. Mafi, associate professor-in-residence of medicine in the division of general internal medicine and health services research at the David Geffen School of Medicine at UCLA, as per Scitech Daily. “This points to persistently high levels of prescribing that may be unnecessary and potentially harmful.”He added, “Compared to patients with normal cognitive function, older adults with cognitive impairment were more likely to be prescribed these drugs, even though they face a greater risk of adverse effects. These findings highlight major gaps in care quality and safety that affect millions of older Americans.”Unsafe Medications Being Prescribed To Dementia PatientsFor the study, researchers linked survey information from the Health and Retirement Study with Medicare fee-for-service claims data. They reviewed prescribing patterns for potentially inappropriate central nervous system, or CNS-active, medications between January 1, 2013, and December 31, 2021. Older adults were divided into three groups: those with normal cognition, those with cognitive impairment without dementia, and those diagnosed with dementia.The medications assessed were grouped into five categories: antidepressants with strong anticholinergic effects, antipsychotics, barbiturates, benzodiazepines, and non-benzodiazepine hypnotics.Higher Use Among Those With Cognitive ImpairmentClear differences emerged across the three cognitive groups. CNS-active medications were prescribed to 17 percent of older adults with normal cognition. This figure rose to nearly 22 percent among those with cognitive impairment but no dementia. Among individuals living with dementia, about one in four received these medications.Looking more closely at specific drug types among all Medicare fee-for-service beneficiaries, trends varied. Benzodiazepine use declined from 11.4 percent to 9.1 percent. Prescriptions for non-benzodiazepine hypnotics, commonly used to treat sleep problems, dropped sharply from 7.4 percent to 2.9 percent. In contrast, antipsychotic use increased from 2.6 percent to 3.6 percent. Rates of anticholinergic antidepressant prescribing remained unchanged at 2.6 percent throughout the study period, while barbiturate use saw a slight decrease from 0.4 percent to 0.3 percent.Signs of Progress Alongside Ongoing ConcernsPrescriptions backed by a clear clinical justification declined slightly, from 6 percent in 2013 to 5.5 percent in 2021. At the same time, prescriptions considered likely inappropriate fell more noticeably, dropping from 15.7 percent to 11.4 percent. Much of this improvement was linked to reduced use of benzodiazepines and sleep medications, along with fewer inappropriate prescriptions overall.The researchers acknowledged several limitations. The analysis did not include data from Medicare Advantage plans, some clinical details such as agitation may not have been captured, and the study focused on how frequently these medications were prescribed rather than how long patients remained on them.“CNS-active medications can be appropriate in certain situations,” said Dr. Annie Yang, a scholar in the National Clinician Scholars Program at Yale University, as per Scitech Daily, who led the study while training as a UCLA internal medicine resident. “But it is essential for older patients and their caregivers to work closely with their doctors to confirm that these drugs are truly necessary. When they are not, care teams should explore other treatment options and consider whether it may be safe to gradually reduce or discontinue the medication.”