The majority of older adults diagnosed with dementia are prescribed costly medications for up to a decade despite little evidence that drugs used to treat symptoms are effective beyond a year.
Long-term use can cost patients and their insurers up to $20,000 over the course of treatment, according to a study published Tuesday by the AARP Public Policy Institute.
“Our research shows some health care providers continue prescribing dementia drugs to patients for much longer than is supported by the clinical evidence,” Elizabeth A. Carter, Ph.D., co-author of the study and senior health services research adviser for the AARP Public Policy Institute, said in a statement. “Not only do these drugs carry potential side effects, they are costing both patients and the health care system a lot of money.”
The latest research examined Medicare claims for 36,000 enrollees age 65 and older and diagnosed with dementia. Of those patients prescribed anti-dementia medications, 70 percent were on them for 13 months or longer.
The Food and Drug Administration allows two medications to be prescribed to treat symptoms of memory loss and cognition related to dementia and Alzheimer’s disease. The two can be prescribed together.
This includes cholinesterase inhibitors — known by the brand names Aricept, Razadyne and Exelon — and are meant to improve thought processes, language, judgment and memory.
Memantine — known by the brand names Namenda and Namenda XR — also works to improve symptoms of memory loss and confusion.
When prescribed together, out-of-pocket and insurance costs can range from $151 to $1,050 per month. When prescribed over 10 years, these costs were found to be between $4,800 and $19,316.
The researchers found that the cost for memantine drugs alone averaged about $200 per month, or more than $3,000 if prescribed for 10 years with periodic use.
Cholinesterase inhibitors cost less, an average of $59 per month and $997 over 10 years with periodic use.
Other findings from the study were that, of adults who received a dementia diagnosis, only half were prescribed medications within the first year of their diagnosis. Of those, the majority were on the medications for more than a year and up to a decade.
“I wasn’t expecting to see patients taking the medications for that long,” Ms. Carter told The Washington Times, saying that evidence in medical literature has covered treatment only for six to 12 months.
About 16 percent of people without a diagnosis of dementia also were prescribed these medications, according to the AARP study.
“Given that medications have side effects and costs — and especially among older adults who can have multiple prescriptions at a time — it’s important to make sure that medications that are being taken are serving a purpose and if not, that they be de-prescribed,” the study reads.
Potential side effects of these drugs include low blood pressure, loss of consciousness, abnormally slow heart rate and hip fracture, according to the study.
Leigh Purvis, a co-author of the study, said the findings should signal the need for a national conversation about overprescribing in the elderly population.
“This really goes back to a big picture, which is making sure that patients and caregivers have an open dialogue with healthcare providers to make sure that the prescription drugs that they are taking are still a benefit to them,” Ms. Purvis, director of health services research at AARP Public Policy Institute, told The Times.
Dementia can take many forms, although Alzheimer’s is the most common disease. It is the sixth-leading cause of death among elderly adults, according to the Centers for Disease Control and Prevention.
Alzheimer’s affects nearly 5.7 million Americans, its prevalence having increased 50 percent between 1999 and 2014. By 2060, an estimated 15 million Americans are expected to have the disease.
The cost of care for Alzheimer’s patients is estimated to be $277 billion in 2018, according to the CDC. An estimated 16 million Americans are providing 18.4 billion hours of unpaid care for family and friends with Alzheimer’s and dementia.
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