New research shows under-prescribing of anti-dementia medication
Australia first research
Australia’s first large study of people with dementia in residential aged care facilities shows that they are missing out on medication that could potentially ease their symptoms and improve quality of life.
- By 2020 an estimated 400,000 Australians will have dementia: Dementia is the second leading cause of death and affects a person’s ability to think and perform everyday tasks.
- There is no cure for dementia, but some medications can alleviate symptoms.
- Researchers at Macquarie University urge better use of existing electronic health record data to ensure people get the medication they need.
New research released by Macquarie University shows people with dementia living in Australia’s residential aged care facilities are missing out on medication that could potentially ease their symptoms and improve quality of life.
Published in the International Journal of Geriatric Psychiatry, the study for the first time provides a picture of the use of anti-dementia medication in Australia’s residential aged care facilities.
Speaking at the National Health and Medical Research Council’s Australian Dementia Forum in Hobart 13-14 June, Dr Kim Lind, Research Fellow with the Australian Institute of Health Innovation, Macquarie University, and lead author points to the under use of anti-dementia medication and the overuse of higher risk antipsychotic medication for people with dementia in Australia’s residential aged care facilities as concerning. Dr Lind says:
Anti-dementia medication used appropriately has the potential to improve people’s functioning and quality of life. People who could benefit from these medications should be given the opportunity to try them.
The research looked at the electronic health records and medication administration records for 5354 people aged 65 years and over with dementia living in 68 residential aged facilities in New South Wales and the Australian Capital Territory between 2014 and 2017.
In line with the Royal Commission into Aged Care Quality and Safety’s statement on underperforming medication management as a leading concern, Dr Lind states that anti-dementia medication management is a prime example of where systematic monitoring of adherence to medication guidelines could quickly improve the care of our most vulnerable people.
Results showed that less than 10% of residents are prescribed anti-dementia medication (cholinesterase inhibitors and memantine). For those with advanced dementia, who would benefit most from prescribed memantine, use is even lower at 3% of residents. Use of both cholinesterase inhibitors and memantine was lower in outer regional facilities compared to facilities in major cities.
Most people using anti-dementia medication in aged care facilities (80%) were using the medication when they entered the facility, meaning that very few people are being prescribed anti-dementia medication once residing in aged care.
Results also showed that the use of antipsychotic medication is much more common than anti-dementia medication in residential aged care and the duration of use is often longer than the recommended maximum of 12 weeks for behavioural and psychological symptoms of dementia, increasing the risk of stroke and death.
Dr Lind states the research points to an opportunity to improve care by ensuring regular reviews of medication and using existing data to monitor medication use and outcomes.
The aged care journey is complicated and dynamic. We recommend that the medication and care plans of people are reviewed more regularly to pick-up on changing symptoms, and changing needs, which may lead to taking advantage of new medications and treatments or stopping other medications.
Dr Lind and colleagues point to the strict requirements of the Pharmaceutical Benefits Scheme as being a possible barrier to people receiving subsidised cholinesterase inhibitors and memantine.
Dr Lind states that while the benefits of anti-dementia medication are variable, people with dementia symptoms should be given the opportunity to trial the medication and not be limited by where they live.
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Acknowledgement: This research is supported by an Australian Research Council Linkage Grant (LP120200814) and a National Health and Medical Research Council Early Career Fellowship (APP1143941).
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