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US dementia patients paying for 'unneeded' drugs

THE RIGHT WAY? Physicians should look at a patient's total needs, including life expectancy, to avoid overprescribing as a rote way of caring for the elderly, says Dr Sachs.


    Sep 10, 2014

    US dementia patients paying for 'unneeded' drugs


    MORE than half of American patients with advanced dementia are regularly given drugs of questionable benefit at a monthly cost of about US$272 (S$340), researchers said.

    The report, published on Monday 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 means 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 per cent 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 the Indiana University School of Medicine. "As a result, the elderly receive too many prescriptions."

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

    Jennifer Tjia, a study author and assistant professor at the University of Massachusetts Medical School, said there are side effects from some of the drugs that can be "very harmful for the patient".

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

    "Potentially, they take away from people's quality of life," she said.

    More than five 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.

    In Singapore, around 28,000 Singaporeans aged 60 and above have dementia, and the number is projected to hit 80,000 by 2030.

    In the United States, medication for long-term care cost US$3.5 billion in 2001. The study did not provide information about whether patients, private health insurance plans or Medicare - the US health programme for the elderly - paid for the cost of the drugs.

    Proponents of the treatments say they can stave off the worst symptoms of dementia, especially during 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 per cent of the nursing home residents included in the study.

    The second-most common drug was memantine, which has been shown to improve cognitive function moderately and was taken by a quarter of patients.