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Most Dementia Patients Get Drugs of Questionable Benefit

More than half of patients with advanced dementia regularly are given drugs of questionable benefit at a monthly cost of about $272, researchers said.

The report, published today by the journal JAMA Internal Medicine, reviewed treatments for 5,406 nursing home residents, based on standards set by a medical panel.

There is no cure for patients with advanced dementia, and those afflicted typically die within two years. That mean treatments that fail to promote comfort are of “questionable benefit,” the study said. At the same time, the average 90-day cost of those pills made up 35 percent of the patients’ prescription expenses.

“Patients expect prescriptions, and if they don’t receive one will wonder what their doctor has done for them,” said Greg Sachs, a professor of medicine at Indiana University School of Medicine, in a statement. “As a result, the elderly receive too many prescriptions.”

Physicians should look at a patient’s total needs, including life expectancy, to avoid over-prescribing as a rote way of caring for the elderly, Sachs said in an editorial accompanying the study report.

There also side effects from some of the drugs that can be “very harmful for the patient,” saidJennifer Tjia, a study author and an assistant professor at the University of Massachusetts Medical School, in a telephone interview.

Taking unnecessary drugs can be difficult for advanced dementia patients because it is hard for those patients to swallow pills and they sometimes have adverse reactions or lethal complications, according to Tjia.

“Potentially they take away from people’s quality of life,” she said.

Alzheimer’s Disease

More than 5 million Americans now have Alzheimer’s disease, the most common form of dementia and the number is expected to triple by 2050, according to the Chicago-based Alzheimer’s Association.

Nursing home costs are rising about 8 percent a year, according to Tjia and her co-authors, while medications for long-term care cost $3.5 billion in 2001. The study didn’t provide information about whether patients, private health insurance plans or Medicare, the U.S. health program for the elderly, paid for the costs of the drugs.

Proponents of the treatments say they can stave off the worst symptoms of dementia, especially at the early stages. Their use also assuages family members who don’t want to give up on treating loved ones.

The most common medication researchers cited as overused was a cholinesterase inhibitor, which is given to promote brain function. It was prescribed to about 36 percent of the nursing home residents included in the study. The second most common drug was memantine, which has been shown to moderately improve cognitive function, taken by a quarter of patients.