Unnecessary and Harmful Medication Use in Older Adults with Dementia

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RP3 PROJECT SUMMARY People with dementia (PWD) who live in the community often have multiple comorbid medical conditions, resulting in extensive medication use. While medications can yield many benefits, they can also result in substantial harms. Medications commonly prescribed to older adults can impair cognition, increase fall risk, and cause other serious outcomes, often serve no discernible purpose, and are frequently inconsistent with remaining life expectancy and goals of care. Such problems may be particularly common and damaging for PWD given this population’s enhanced susceptibility to adverse drug effects, difficulty communicating drug- related symptoms, and often limited life expectancy. Reducing use of medications that are unnecessary or likely to cause more harm than good can thus play a critical role in improving quality of life for PWD. Yet, efforts to achieve this are compromised by fundamental gaps in knowledge. While prior studies have documented frequent use of selected inappropriate medications in community-dwelling PWD, much less is known about use of other types of unnecessary and harmful medications such as unnecessarily aggressive disease management, duplicative therapies, medications with no clear indication, and medications inappropriate near the end of life, and little is known about which risk factors may drive use of problematic therapies. In addition, efforts to reduce use of problematic medications in PWD are likely to be more successful if they align with patient and caregiver attitudes and preferences toward medication use, yet much remains unknown about this topic. We seek to resolve these knowledge gaps through a series of linked specific aims that take advantage of high-value national data sources, including the Health and Retirement Study (HRS), National Health and Aging Trends Study (NHATS), and Medicare Parts A, B, and D. Using linked HRS and Medicare data, we will evaluate a broad range of unnecessary and harmful medication use in community- dwelling PWD, and assess which risk factors and clinical circumstances may lead to especially high use of unnecessary and harmful medications. In addition, we will capitalize on unique data elements present in NHATS to explore the attitudes of PWD and their caregivers toward medications and opportunities to reduce medication use. Our aims are (1) To characterize the frequency and types of unnecessary and harmful medication use in community-dwelling PWD, and to compare this to usage patterns in people without dementia; (2) To evaluate risk factors for use of unnecessary and harmful medication use among community- dwelling PWD, with a special focus on the role of hospitalization, and to determine whether these risk factors are different than in people without dementia; and (3) Using validated survey questions from NHATS, to characterize the attitudes of community-dwelling PWD and their caregivers toward their medications and their willingness to stop medications. Information gained from this study will inform interventions to reduce medication burdens and harms among the large and vulnerable population of community-dwelling PWD.