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New research identifies barriers to good medication management in dementia care

Poor communication, poor training and a lack of reviews are the main reasons that two-thirds of people with dementia are prescribed the wrong medications, new research has found.

Led by Monash University’s Centre for Medicine Use and Safety (CMUS), a new study from Monash University explores system challenges which may lead to poor medication management.

The work investigates the obstacles and complexities in medication management for people living with dementia through qualitative research involving four key stakeholder groups: carers, general practitioners, nurses and pharmacists.  

“Most people with dementia live with multiple chronic diseases, which often require medications to manage symptoms and disease progression. It’s a complex and challenging process which requires many competing considerations when optimising medication use,” said lead author Dr Amanda Cross.

Medication management has been a major concern throughout the aged care sector and a large part of the Royal Commission has been devoted to chemical restraints.

It has been estimated that about 80 per cent of people in residential care with dementia are on one form of psychotropic – be that antipsychotics, antidepressants or sedatives – but experts believe that only around 10 per cent of those might benefit.

It has also been found that aged care residents are often prescribed antipsychotics for longer than two years on average. This was equivalent to more than 80 per cent of the time they had been living in care and without a single adjustment to the dose in over a year.

Government guidelines limit the use of these medications to 12 weeks, and only for people with severe behaviours of a certain type.

Cross said that medication management for those with dementia becomes particularly complicated in the context of polypharmacy increasing cognitive decline, changing goals of care, multiple stakeholders and multimorbidity. Limited evidence to guide prescribing and deprescribing for people with dementia makes this process even more challenging.

“We know that up to 90 per cent of people with dementia are exposed to polypharmacy and for each additional medication used the risk of emergency department presentation and mortality increases.”

The research found that the barriers to effective medication management are poor communication and relationships between stakeholders, infrequent medication reviews and a lack of practitioner training, evidence and guidelines to navigate prescribing and deprescribing decisions.

The study recruited focus group participants from a wide range of communities and healthcare settings, including those in carer roles who are carrying the majority of the burden and often experiencing high levels of stress, perpetuated by complicated healthcare systems and medication regimen complexity.

Health professional and system-level changes are therefore key to help minimise the burden placed upon carers. 

“Health professionals need to collaborate and communicate to help optimise medication use and future interventions should focus on training and evidence-based guidelines for prescribing and deprescribing in people with dementia,” Cross said.

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