Dementia drug regime found lacking in nursing homes
One-quarter of residents living with dementia in Australian aged care homes are nine times more likely to be prescribed antipsychotic drug risperidone while generally less likely to be checked for cardiovascular or respiratory treatments, new research has found.
At the same time, the study of hundreds of residential nursing homes also reveals the group of more advanced dementia patients are also more likely to be medicated for urinary tract infections – another sign of reduced awareness and communication of the needs of these residents.
Differences in over-prescription and under-prescription may reflect reduced awareness of, or ability to communicate, symptoms by those residents living with dementia, researchers at Flinders and Sydney University say.
“While we can’t be certain of the reasons for this difference, it is possible that greater confusion or worsening cognition in residents with dementia is sometimes being attributed to urinary tract infections, prompting an increase in treatment and testing,” geriatric clinician Dr Craig Whitehead said.
“Awareness by clinicians and pharmacists of these patterns of medication use could improve management of this vulnerable population.”
Dr Whitehead worked on the study, which was led by the Rehabilitation, Aged and Extended Care research group at the Flinders University College of Medicine and Public Health.
More than 436,000 Australians are living with dementia, with numbers predicted to rise above 589,000 people by 2028 and above one million people by 2058.
The Flinders study, with key collaborators at the University of Sydney, investigated dispensing data from the individual pharmacy records of 541 residents (average age 85.5 years and 74.5 per cent female) at 17 Australian nursing homes. Of these, 348 (64.3 per cent) had dementia and 193 did not have dementia.
The study found nursing home residents are more likely to be prescribed medications for treatment of behavioural and psychological symptoms of dementia, pain and urinary tract infections, than for other possible comorbidities.
In total, about 95 per cent of participants were prescribed medications for the nervous system and 94 per cent were prescribed medications for alimentary tract and metabolism.
Of an average 14.5 different prescriptions over a year, the most frequent comorbidities were osteoarthritis (48.4 per cent), hypertension (47.1 per cent), depression (42.9 per cent), urinary incontinence (39.2 per cent), and faecal incontinence (22.5 per cent). The next most common medication classes were those for cardiovascular system (72.1 per cent), anti-infectives for systemic use (68.9 per cent) and dermatologicals (54.1 per cent).
Those with dementia were less likely to have comorbidities of airway diseases, angina, back pain, congestive cardiac failure, diabetes mellitus, dysphagia, hypertension, ischaemic heart disease, osteoarthritis, rheumatoid arthritis and stroke, but were more likely to have faecal or urinary incontinence.
In all, 98 per cent of residents were prescribed more than five different medications, and 71 per cent were prescribed more than 10 different medications over the 12-month period.
The research paper, ‘Patterns of medication prescription by dementia diagnosis in Australian nursing home residents: a cross-sectional study’, by Enwu Liu, Suzanne M Dyer, Craig Whitehead, Lisa Kouladjian O’Donnell, Emmanuel S Gnanamanickam, Stephanie L Harrison, Rachel Milte and Maria Crotty, has been published in the Journal of Pharmacy Practice and Research.
This study was funded by the National Health and Medical Research Council (NHMRC) Partnership Centre on Dealing with Cognitive and Related Functional Decline in Older People.
Published: 28 Feb 2019