CNS polypharmacy common in older U.S. adults with dementia
A cohort study found that 14.3% of Medicare beneficiaries with dementia were prescribed three or more medications affecting the central nervous system (CNS), often by a single primary care clinician.
Medicare beneficiaries with dementia are prescribed medications with overlapping effects on the central nervous system (CNS), a recent study found.
Researchers evaluated a cohort of community-dwelling Medicare beneficiaries who had been diagnosed with dementia. Fill date and days' supply of prescriptions filled in 2019 were used to identify patients with CNS-active polypharmacy, defined as more than 30 days of overlapping exposure to three or more drugs in these classes: antidepressant, antipsychotic, antiseizure, benzodiazepine, opioid, nonbenzodiazepine benzodiazepine receptor agonist (Z-drugs), or muscle relaxant. The number and type of clinicians who contributed to polypharmacy person-days were also evaluated. The study results were published Nov. 5 by the Journal of the American Geriatrics Society.
A total of 955,074 patients with dementia were included in the study. Most were White (78.5%) and female (64.0%), with a mean age of 83.4 years. Overall, 14.3% were exposed to CNS-active polypharmacy (mean, 3.7 CNS-active medications per polypharmacy person-day). CNS-active polypharmacy was linked to 156,224 clinicians, with each prescribing a mean of 2.5 CNS-active medications across all polypharmacy person-days. Of the 24,183,812 CNS-active polypharmacy person-days overall, 45.3% were attributed to a single clinician. Primary care physicians contributed to 63.0% of polypharmacy person-days, while primary care advanced practice clinicians contributed to 32.0%, psychiatrists to 21.5%, other physicians to 13.5%, neurologists to 13.2%, and other advanced practice clinicians to 6.7%. For individual patients, 24.6% who experienced polypharmacy were prescribed all of their CNS-active mediations by one clinician. When more clinicians contributed to polypharmacy, the number of medications prescribed increased (average, 3.5 medications with one clinician vs. 5.1 with four or more clinicians). Primary care clinicians contributed the most person-days for each medication class (range, 39.5% of antipsychotic days to 53.2% of antidepressant days).
The authors noted that they do not know if patients took all of the medications they were prescribed or why each medication was prescribed, among other limitations. “In this cross-sectional analysis of Medicare claims data, one quarter of PLWD [patients living with dementia] who experienced CNS-active polypharmacy had all of their medications prescribed by a single clinician, whereas individual clinicians prescribed nearly half of all such polypharmacy days,” they concluded. “Primary care clinicians prescribed the majority of medications that contributed to CNS-active polypharmacy for PLWD. The most high-yield strategies to reduce such polypharmacy should focus on supporting prescribing to PLWD in primary care settings.”