Dangerous Drugs and Dementia
A recent report published in the Journal of American Medical Association reveals that a significant number of dementia patients have been prescribed psychiatric drugs which are risky in older adults. The study indicates that almost 75% of older adult dementia patients had been prescribed sedatives, certain painkillers, and anti-depressants. These medications have side effects which are unique to older adults, including an increased risk for falls. However, there may be additional effects which are not yet known.
The concerns regarding these medications are not unexpected. The America Geriatrics Society publishes the Beers Criteria Medication List which includes medications which are common but harmful to older adults. The aging process affects how a body breaks down and processes medications. This means that medications affect an older adult differently than a younger person. One such example is diphenhydramine which is the common ingredient in Benadryl as well as a number of sleep aides such as Tylenol PM. Side effects of diphenhydramine in older adults include dizziness and confusion. For patients who have a known diagnosis of dementia, use of diphenhydramine has been known to cause delirium.
The study, which was conducted by researchers from a number of medical systems including the University of Michigan and VA Ann Arbor Health system, examined over 740,000 patients. Over 50% of them were prescribed an anti-depressant, and 73.5% were given some sort of drug which affects the central nervous system. The exact impact remains to be seen, but there were some obvious effects including the increased risk for falls.
The researchers speculated that the reason for the prescription of such drugs may be twofold. Unfortunately, dementia often results in mood changes as well as personality changes which can include irritability, anger and aggression. In some cases, the patient can also experience delirium and hallucinations. Accompanied with these conditions are a decreased ability by the patient to either recognize the change or to explain underlying conditions which may be the cause of the behavior. This leaves the treating physician with a patient who poses a threat to himself/herself or others around him/her and an inability to fully participate in treatment.
Coupled with the challenges that accompany dementia itself, is often a physician who is not fully aware of the intricacies of treating patients with dementia. While dementia is not uncommon in older adults, there are relatively few physicians who specialize or are board certified in geriatric medicine, and most general practitioners lack the ability to holistically treat the patient.
While the study itself is fascinating, it highlights what is a common problem for many families. Often, loved ones with dementia will exhibit aggressive or violent behavior which can be frightening and dangerous for loved ones and caregivers. Unfortunately, there are few treatment options available, and the medications which would be prescribed to moderate the same behaviors in younger adults are considered dangerous to the older adult.
Unfortunately, there is no easy or perfect solution for those living with and caring for a loved one with dementia who exhibits such behavior. The recently published study reveals that medications which are commonly prescribed are not always a safe solution. Caregivers should seek the assistance of a specialist who can evaluate a patient holistically. In addition, they should examine the medications their loved one is taking and compare it with the Beers Medication Criteria List and have a frank discussion with the patient’s primary care physician about the risks and benefits of medications. Ultimately, some of the medications prescribed may pose a risk, but the benefits may outweigh the risk. In any situation, decisions regarding treatment should be made with full knowledge of both the benefits and risks.