1. Rosenberg, Karen


According to this study:


* Frequent prescribing of opioids and other central nervous system-active medications for community-dwelling Medicare beneficiaries with dementia raises concerns about the risk-benefit balance.



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Little is known about the prescription of psychotropic medications to community-dwelling adults who have dementia. Researchers estimated central nervous system (CNS)-active medication prescriptions in this population and identified those medications that were most commonly prescribed.


They identified all fee-for-service Medicare beneficiaries age 65 or older who had a primary or secondary diagnosis of dementia. Only those who had Medicare Part D drug coverage and spent 100 or fewer days in a nursing home during the study period were included. The researchers estimated overall and class-specific CNS-active prescription fills for five categories of medication: antidepressants, anxiolytics, antipsychotics, opioids, and antiepileptics.


Of the 737,839 community-dwelling Medicare beneficiaries who had dementia and were identified by the researchers, 73.5% were prescribed any CNS-active medication. Those who were female, 65 to 74 years of age, non-Hispanic white, and low income received the most prescriptions. These groups also had the highest adjusted risks. When two or more prescription fills were required, the prevalence of any CNS-active medication use was 64.4%.


The researchers found that prescriptions for antidepressants were most frequently filled, followed by prescriptions for opioids, anxiolytics, antiepileptics, and antipsychotics. Although opioids were prescribed frequently, per-person volume was relatively low. Gabapentin and antidepressant medications were prescribed in higher quantities.


The authors point out that their analysis reflects prescribing for fee-for-service Medicare beneficiaries from 2015 to 2016, so the results may not be applicable to all older adults in 2020. Also, no information regarding the appropriateness of the prescriptions was available. None of the CNS-active agents included in this analysis are approved for the treatment of dementia or its behavioral symptoms in the United States, the researchers add, and all are associated with adverse effects among older adults.


Maust DT, et al JAMA 2020;324(7):706-9.