Study: Late-stage dementia patients get medications with little to no benefit

Melissa Healy
Los Angeles Times

Los Angeles – — More than half of nursing home patients who suffer severe dementia and are likely to die within a year or two are administered medications that offer little to no benefit and may cause pointless discomfort, a new study finds.

The latest research, published in JAMA Internal Medicine, demonstrates that physicians and families often continue the flow of medications well beyond the point at which they might prolong or enhance a patient’s life. The practice needlessly inflates the cost of caring for patients near the end of life, by an estimated $816 on average every 90 days.

Alzheimer’s disease drugs, which are virtually ineffective in patients with severe dementia, were the questionable medications most commonly given to nursing home patients with advanced disease.

Prescriptions for Alzheimer’s drugs such as donepezil (better known by its commercial name, Aricept), rivastigmine (Exelon), and memantine (Namenda) are commonly initiated for patients in the early stages of the disease and may slow the rate at which they become unable to care for themselves. There’s little evidence they improve memory or mental performance in people in late stages of the disease.

Despite slim evidence for their use, those medications often cause side effects such as fainting and arrhythmia, which put patients at high risk of hip fractures, and urinary retention. More than a third of the study’s 5,406 nursing home residents with severe dementia were taking one or more of these medications.

In an invited editorial, geriatrician and palliative care specialist Dr. Greg A. Sachs of the Indiana University School of Medicine hoped that the latest findings will prompt physicians to reconsider their prescribing practices.