A new study reveals that approximately one in four Medicare beneficiaries diagnosed with dementia are being prescribed brain-altering medications, despite longstanding safety warnings. This research will be published on January 12 in the journal JAMA. Over the span of nine years, the study highlighted that while prescriptions for these drugs decreased from 20% to 16% among all Medicare beneficiaries, those with cognitive impairment remain particularly vulnerable to the harmful effects of these medications.
According to the study’s senior author, Dr. John N. Mafi, an associate professor at the David Geffen School of Medicine at UCLA, over two-thirds of patients prescribed these drugs lacked documented clinical justification by the end of the study period in 2021. “This suggests high levels of potentially inappropriate and harmful prescribing,” he noted. The findings indicate that older adults with cognitive impairment are being prescribed these medications more frequently than those with normal cognitive function, raising concerns about the quality and safety of care for millions of older Americans.
Study Overview and Medication Types
The researchers utilized survey data from the Health and Retirement Study linked to Medicare fee-for-service claims to analyze prescribing patterns of central nervous system (CNS)-active medications from January 1, 2013, to December 31, 2021. The study focused on three groups: older adults with normal cognition, those with cognitive impairment without dementia, and those diagnosed with dementia.
The CNS-active medications examined included five drug classes: antidepressants with strong anticholinergic properties, antipsychotics, barbiturates, benzodiazepines, and non-benzodiazepine hypnotics. While CNS medications were prescribed for 17% of older adults with normal cognition, nearly 22% of individuals with cognitive impairment but without dementia received these drugs. Alarmingly, about 25% of the dementia group were prescribed CNS-active medications.
Prescription Trends and Findings
The study assessed trends in prescriptions across various medication classes among all Medicare fee-for-service beneficiaries. Clinically justified prescriptions experienced a slight decline from 6% in 2013 to 5.5% in 2021. Conversely, likely inappropriate prescriptions of CNS-active medications saw a substantial drop from 15.7% to 11.4% during the same period. This reduction was primarily attributed to decreased prescriptions of benzodiazepines and sleep medications.
Despite these encouraging trends, the findings underscore significant gaps in prescribing practices. The study’s limitations include a lack of available data from Medicare Advantage, potentially missing clinical details such as agitation, and a focus on prescribing prevalence rather than cumulative exposure.
Dr. Annie Yang, who led the study as a resident at UCLA and is now a scholar in the National Clinician Scholars Program at Yale University, emphasized the importance of collaboration between older patients or their caregivers and healthcare providers. “While CNS-active prescriptions may be appropriate in some cases, it’s crucial that patients and their care teams consider alternative treatments and whether it might be safe to taper or stop the medication,” she advised.
The research team also included co-authors Mei Leng, Dr. Dan Ly, Chi-Hong Tseng, Dr. Catherine Sarkisian, and Nina Harawa from UCLA, along with Cheryl Damberg from RAND and Dr. A. Mark Fendrick from the University of Michigan.
As the healthcare community grapples with these prescribing challenges, the study highlights a critical need for ongoing education and monitoring to ensure the safety and well-being of older adults facing cognitive decline.
