A new study shows that many sick elderly people, with advanced dementia or near death, are still being prescribed drugs that cause uncomfortable side effects or adverse reactions. The question among doctors is how sick and disabled, how far into dementia, how close to death, must a nursing home patient be before stopping drugs that cause these unfortunate side effects but show scant evidence of actually helping?
New Study on Overmedication
The Journal of the American Medical Association (JAMA) released a report last week that measures the amount of medication being overprescribed to near death nursing home patients when the evidence that such medication is helping is slim. The report took a nationwide sample of 5,406 people with a diagnosis of advanced dementia that spent at least 90 days in a nursing home between 2009 and 2010. Most of the participants were over the age of 85 and had other ailments, as well. The majority, over seventy percent, had a “Do Not Resuscitate” order.
By definition, dementia is terminal, degenerative disease. Seniors stricken with dementia no longer recognize family members, can no longer walk, bedridden, with an inability to feed themselves or communicate with others. Many victims of dementia also face swallowing issues, and the mortality rate within six months is high.
Yet, the study revealed that over 54% of patients received at least one medication considered “of questionable benefit.” The types of drugs given to these patients are considered never appropriate for palliative care patients with advanced dementia. Even with patients that have mild to moderate dementia these drugs only bring small improvements to cognitive abilities but the clinical significance is uncertain.
Effects on Elderly Patients
If the only problem with giving these patients unnecessary medications was cost, averaged at around $816 per person per quarter, this study would be less of an issue. However, that is not the case. There is also a personal cost to administering these medications to patients with advanced dementia or near death.
Two of the most commonly overprescribed medications are known to cause nausea, fainting, and uncomfortable urinary retention. They can also cause heart arrhythmia, which can lead to implanting a pacemaker. People with severe dementia are more likely than seniors with normal cognition to receive pacemakers.
People with advanced dementia cannot verbalize to their family members or doctors the pain or discomfort that they may be feeling. And when they lash out, it can cause another round of medication to be administered instead of signaling that something is wrong. Discontinuing the drugs can help patients remain alert and relaxed; however, there is no published research either way.
Reasons for Overmedication
There are a variety of reasons why advanced dementia patients are continuing to be overmedicated in nursing homes. Geography plays a role in some of the decision making. Geographic areas like Mid Atlantic and South prescribed more often than in other areas. In addition, nursing homes, hospitals, cities, and regions have their own culture and practice patterns that lend more to overprescribing these drugs.
Emotions play a large part, too. Family members try to do everything for their ailing loved one and that includes giving them every drug despite warnings from professionals. Stopping medication is a fairly radical concept for many people, despite the full blown campaign asking people to weigh the pluses and minuses of continuous medication.