J. William Kerns
Dementia is becoming an increasingly important health problem in the United States, but primary care providers may be lacking understanding of guidelines and pharmacologic treatment options based on results of a survey published in a recent issue of the Journal of the American Board of Family Medicine.
“Stakeholders in dementia care have been purposeful in efforts to reduce the use of risky medications to treat challenging dementia symptoms because of poor evidence for safety and efficacy,” J. William Kerns MD, Shenandoah Family Practice Residency at Virginia Commonwealth University, told Healio Family Medicine. “Contrary to these various guidelines and initiatives, primary care doctors continue to prescribe potentially dangerous medications for dementia symptoms to hundreds of thousands of U.S. seniors. Our study sought to begin to explain and detail why this is so.”
He added that dementia is currently the sixth leading cause of death in the U.S., and the number of U.S. residents with the disease will rise by 35% by 2025.
Kerns and colleagues conducted interviews with 26 PCPs in northwestern Virginia with at least 3 years’ experience. Questions focused on the providers’ demographics; whether their patients lived at home, nursing homes or assisted living; medications prescribed; and how dementia was diagnosed.
The themes researchers identified based on participant answers were:
- “PCPs need practical evidence-based guidelines for all aspects of behavioral and psychological symptoms of dementia management.”
- “Pharmacologic policies decrease the use of targeted medications, including antipsychotics, but also have unintended consequences such as increased use of alternative risky medications.”
- “Nonpharmacologic methods have substantial barriers.”
- “Medication use is not constrained by those barriers and is perceived as easy, efficacious, reasonably safe, and appropriate.”
The themes suggest there may be a disconnect in the perceptions and the reality of medications that are used to treat dementia, Kerns said.
“Physicians and caregivers need to understand that using medications in dementia may not be as safe or effective as they believe them to be. There needs to be a thorough discussion about the risks and benefits of any medication used in patients with dementia before trying them. Guidelines and policies regarding management of dementia symptoms, which currently often endorse medication use only for threat to life, should be more flexible to these palliative considerations,” he said.
“Current guidelines are not helpful. PCPs should also be included in any guideline development for such symptoms,” Kerns added. – by Janel Miller
The authors report no relevant financial disclosures.