Nearly three-quarters of community-dwelling older adults with dementia fill prescriptions for psychotropic drugs, similar to the prescription rate in eldercare facilities, a new study has found.
Investigators analyzed Medicare records from more than 730,000 people with dementia who lived in the community as opposed to a care facility.
In a one-year period, 74% of study participants filled at least one prescription for an antidepressant, opioid painkiller, epilepsy drug, anxiety medication or antipsychotic drug, reported lead author Donovan Maust, M.D., M.S.
There are reasons behind the prescriptions of course, but none of the drug classes studied have received Food and Drug Administration approval for use in dementia. What’s more, evidence for their off-label use is slim, and all are linked to special risks for people aged 60 or more years, said Maust, a geriatric psychiatrist at the University of Michigan. These risks include falls, or dependence that could lead to withdrawal, he added.
Nearly half of the study participants received an antidepressant, for example — triple the overall rate for older adults. These likely are prescribed in an attempt to counteract withdrawal and apathy, but antidepressants don’t treat this aspect of dementia, Maust said.
“A brain that has dementia is doing its best to function as well as it can,” he explained. “If we add a psychotropic medication into the mix, it may not be a helpful thing, and it comes with risks.
“Clinicians and caregivers may need more support to provide non-drug based approaches to prevent or address the symptoms that these medications are probably being prescribed for,” he concluded.
The study is the first large-scale look into prescription-filling patterns for psychoactive medications outside of long-term care facilities, the researchers said.
Full findings were published Tuesday in JAMA Network.