Dementia patients in the U.S. are still being prescribed risky stimulant medications despite longstanding warnings about their safety, new research has found.
For decades, clinical guidelines have discouraged giving central nervous system stimulants to older patients because they increase the risk of delirium, falls, and hospitalizations.
But in a peer-reviewed study published Monday in the American Medical Association’s official journal, researchers estimated that roughly 25% of dementia patients enrolled in Medicare parts A, B, and D received at least one such “potentially inappropriate” medication between 2013 and 2021.
That description covers a wide range of drugs, including antipsychotics, barbiturates, benzodiazepines, and certain antidepressants such as doxepin and imipramine.
Across all study participants, prescriptions fell over the course of the study from around 20 percent to around 16 percent, but continued to be higher for patients with cognitive impairment as of 2021.
“While this decline was encouraging, over two-thirds of patients receiving these prescriptions lacked a documented clinical indication in 2021, the end of the study period, suggesting high levels of potentially inappropriate and harmful prescribing,” said study author and UCLA medicine professor Dr. John M. Mafi.
“Compared with patients with normal cognition, we also found higher levels of prescribing among older adults with cognitive impairment, who face a higher risk of adverse effects from these drugs.
“These results underscore substantial opportunities to improve the quality and safety of care for millions of older Americans.”
One major limitation of the study was that it did not include data from people on Medicare Advantage plans, which are paid for by the federal government but managed by private insurers. More than half of all Medicare recipients reportedly use such plans.
Nevertheless, the study did include anonymized data for 4,842 people from the Health and Retirement Study, a long-running and nationally representative dataset run by the University of Michigan.
The results were adjusted for age, health conditions, and socioeconomic status, then extrapolated across the U.S. population.
However, the scientists cautioned that doctors prescribing these medications may have well understood the risks, and may have prescribed them nevertheless because it was the least worst option.
Some of those calculations might not have been included in the study data, as many CNS stimulants are prescribed to treat symptoms of dementia that are often underreported in Medicare claims.
