New study reveals barriers to effective medication management for those living with dementia
Up to two thirds of people with dementia are prescribed potentially inappropriate medications, with a new study from Monash University exploring system challenges which may lead to this.
The study investigated 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.
Led by Monash University’s Centre for Medicine Use and Safety (CMUS), the study set out to identify the primary factors hindering effective medication management for those living with dementia. The foremost barriers 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.
CMUS researchers 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.
Lead author, Dr Amanda Cross, says medication management for those with dementia becomes particularly complicated in the context of polypharmacy (the concurrent use of multiple medications), increasing cognitive decline, changing goals of care, multiple stakeholders and multimorbidity (the co-occurrence of two or more chronic conditions).
“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,” Dr Cross said.
“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 whilst the carer’s role is fundamental, health professional and system-level changes are needed to minimise carer burden.
Dr Cross says: “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.”
Dementia is the second leading cause of death of Australians and the single greatest cause of disability burden overall. With Australia’s ageing population steadily on the rise and people living longer, an estimated 250 people are joining the population living with dementia each day. Both dementia and medication safety are Australian national health priority areas.
Melbourne’s Gill Goldsmith, 63, is the primary caregiver to her 91-year-old mother with dementia. Although her mother is impressively independent, Mrs Goldsmith says as the condition worsens, the challenge of being responsible for her wellbeing and medication regimen can take its toll.
“For someone who is 91 and has dementia, mum really is amazing. Having said that, it’s a lot of work and I don’t know how people in carer roles like me are able to do it if they’re also juggling jobs, younger children and have little to no understanding of medicine – it must be extremely difficult,” Mrs Goldsmith said.
“I have grandchildren and other family members who I also help out with, but as I’m retired I’m just able to manage it all – I also have a background of working in medicine so this has helped a lot too. But even with these advantages it can be incredibly time consuming and stressful.”
Mrs Goldsmith said the greatest challenge has been how much work is involved in ensuring her mother is properly cared for and is on top of her medication.
“The nurses at the retirement village are great and we’ve also found a really good pharmacist, but overall there’s only so much you can rely on healthcare professionals, who have multiple patients and responsibilities,” she said.
The release of the study coincides with the signing of the Seventh Community Pharmacy Agreement between the Australian Government and the Pharmacy Guild of Australia, which includes a commitment to maintaining investment in medication management programs, vital to the care of older people – particularly those with dementia.
Monash University Faculty of Pharmacy and Pharmaceutical Sciences
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