Deprescribing for dementia

Scientists are calling for ‘deprescribing’ to be integrated into routine medical care for patients with dementia, to reduce risks and cut out unnecessary medication.

New research conducted at the University of Southampton has found that many medicines prescribed to people with dementia that are long-standing could be safely removed from their prescriptions, resulting in some improvements in health outcomes.

According to the Alzheimer’s Society , there are estimated to be 982,000 people with dementia in the UK, which is forecast to grow to 1.4 million by 2040 due to population growth and an aging population. About 60 per cent of those live at home and are cared for by a family member.

The research analysed all previous studies (32 in total) on the effects of medicine optimisation and deprescribing for older people with dementia or mild cognitive impairment. The findings show it is possible to the reduce number of medications taken by people with dementia and improve their appropriateness in a safe way without increasing risks of hospitalisation or death.

Dr Kinda Ibrahim , an academic pharmacist and Associate Professor in Primary Care at the University of Southampton, led the work.

She said: “Many older people with dementia are prescribed a multitude of medications. We know there is a link between taking many medications and poor outcomes, especially for people with dementia.

“When people lose capacity, they may forget to take medications. Having to take multiple medications also interferes with people’s lifestyle – patients and carers say they don’t go out because they must take medication at a certain time of day. Plus, a list of multiple medications adds burden to the carer.”

One solution is for people with dementia to have regular medicine reviews with their pharmacist or GP to analyse the risks against the benefits for each medication, with the aim of deprescribing where appropriate.

Dr Ibrahim explained: “Everyone over the age of 65 who is taking multiple medications should, according to national guidelines, have an annual review of their prescriptions, but there is lots of variation across the UK in how this happens. For example, some GP practices simply don’t have the capacity or systems in place for this.

“We know that deprescribing is challenging, but there is evidence that it can be safe and feasible and lead to health benefits. Deprescribing in people with dementia should take into consideration their capacity, cognitive abilities, interference of medications on their quality of life, and should involve carers.”

Highlighting a need for further research, most of the 32 studies analysed focused on people with dementia living in care homes, leaving out those who still live at home. Most studies also focused on deprescribing antipsychotics, which are commonly used, against guidelines, to manage challenging behaviour in this population.

The research is published in the journal Drugs & Aging .