Image of different colored pills spilled onto a flat surface
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Fully 87% of seniors with probable or possible dementia say they would be willing to stop at least one medication if their doctor gave them the go-ahead, according to a study published Thursday in the Journal of the American Geriatrics Society.

Many patients with dementia take medications that may be unnecessary or harmful, and the findings present a “unique opportunity to improve quality of life for this vulnerable population,” investigators said.

Study participants included a national sample of 422 people with dementia aged 65 years or older. They completed the “medications attitudes” module of the National Health and Aging Trends Study in 2016. Proxies responded for those who were unable to respond due to health or cognitive problems.

Participants were asked about prescription and non-prescription medications including supplements. Half took six or more medications regularly. Among this group, 29% agreed “that at least one medication was no longer necessary.” This is compared with 13% of participants taking less than six pills.

Common prescriptions multiply

Polypharmacy, which can mean prescribing an excess of drugs to treat one condition or multiple conditions, is common among patients with dementia, investigators said. In a prior study, they found that the average number of prescriptions for people with dementia is eight, compared with three for people without dementia.

The factors that contribute to excess prescribing, include deference to prescribing physicians and a “biomedical culture of prescribing,” said Matthew Growdon, M.D., of the University of California San Francisco and the San Francisco VA Medical Center.

“Many drugs may be especially harmful to older adults with cognitive impairment, such as benzodiazepines, used to treat anxiety and oxybutynin, used to treat urinary incontinence,” he said in a statement. “These drugs have sedating effects that increase the risk of delirium and can worsen dementia.”

Older adults with dementia also are commonly prescribed vitamin D and calcium, and medications for high blood pressure, diabetes, constipation and arthritis, Growdon and colleagues noted.

Resistance no barrier to deprescribing

De-prescribing can help to further goals of care for these patients, they said. When reviewing medications, clinicians should take into consideration issues that are common in older adults, including frailty, multimorbidity, cognitive impairment and functional status, they recommended.

“One thing this study can hopefully add is that patient and/or family resistance to deprescribing should not be seen as a barrier” to these goals, Growdon said.