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Seventy percent of older adults who take dementia drugs stay on them for more than a year despite a lack of evidence to support long-term use, according to a new report by the AARP Public Policy Institute (PPI).
The U.S. Food and Drug Administration (FDA) has approved two types of medications to treat dementia symptoms: cholinesterase inhibitors (Aricept, Razadyne, Exelon) and memantine (Namenda, Namenda XR). There is no clinical evidence that these drugs work beyond one year, and some patients do not benefit at all. Current dementia drugs also do not affect the underlying cause of the disease. They do not delay institutionalization, improve quality of life or lessen the burden on caregivers, according to research cited in the PPI report.
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The longer that individuals stay on the drugs, the greater the potential for side effects is, including low blood pressure, dizziness and fainting, and an abnormally slow heart rate. Patients can also face substantial health care costs: Some people in the study took the drugs for as long as a decade, with total costs of as much as $20,000 per patient.
As many as half of all people 85 and older may have some form of dementia, defined as a loss of cognitive functioning — the ability to think, remember, solve problems or reason, according to the National Institute for Neurological Disorder and Stroke. In 2018, annual costs associated with dementia in the U.S. will total more than $270 billion and could be $1.1 trillion by 2050, according to the Alzheimer’s Association. As the U.S. population ages, the incidence of dementia and its costs are expected to increase.
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PPI analyzed claims data from 70,987 Medicare Advantage enrollees 65 and older who were diagnosed with dementia between 2006 and 2015.
“The duration and costs of treatments we report are likely underestimates, because we stopped tracking study subjects after 2016 and also could not continue tracking patients who switched health plans during the study period,” says Elizabeth Carter, PPI senior health services research adviser and coauthor of the study.
Most health care providers receive little guidance on when and how to taper or discontinue prescription drugs, the researchers say.
“Older adults typically take multiple medications, often on a long-term basis, and see multiple health care providers without any meaningful oversight of their overall prescription drug regiments,” says Leigh Purvis, AARP director of health services research and coauthor of the new report. “These findings really highlight the importance of ensuring that health care providers have access to reliable information to help them reassess medications that may no longer be of benefit, or even cause harm.”