Perhaps the most frightening thing about an Alzheimer’s diagnosis is that there is not yet a cure for the disease. While people with Alzheimer’s may take medications to slow the progression of the disease or reduce symptoms, the effectiveness of these medications is frequently lower among people with advanced-stage Alzheimer’s. According to a new study, 54% of people with late-stage Alzheimer’s take at least one unnecessary drug, potentially leading to unpleasant side effects and driving up the costs of health care.
Unnecessary Use of Medication
Researchers evaluated the medical records of 5,406 people living in 460 nursing homes. All of the study participants had advanced-stage dementia. The residents regularly failed to recognize family members, typically had a vocabulary of five or fewer words, and most of them could no longer walk. They found that more than half of study participants took at least one medication of questionable benefit. Drugs to treat dementia and cholesterol-lowering medications were the most common.
People who lived in a facility with a high use of feeding tubes were more likely to take unnecessary medications, whereas those who had a do-not-resuscitate order, who enrolled in hospice care, who had eating difficulties, or who were on a feeding tube were less likely to be prescribed unnecessary medications.
The study’s authors note that clinical inertia—the tendency to stick with something even when it’s no longer working—contributes to this phenomenon. While a few extra pills that offer no benefit might not seem like a serious issue for a very ill person, unnecessary medications can cause problems. Many of the people in the study had difficulty swallowing pills, making medication time a needless source of stress. The limited vocabulary of the study participants also means that they were unable to communicate about the unpleasant side effects, such as urinary pain or nausea, to their care providers.
Medication is a significant driver of medical costs. The study found that the average 90-day expenditure on needless medication was $816 and that these medications accounted for more than a third of the total money spent on medication.
Tjia, J., Peterson, D., Liu, Q., Andrade, S. E., & Mitchell, S. L. (2014). Use of medications of questionable benefit in advanced stage dementia. Jama Internal Medicine. doi: 10.1001/jamainternmed.2014.4103
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