Dementia study identifies ways to improve use of meds

Poor communication and infrequent medication reviews are among barriers to effective medication management for people with dementia, a new study shows.

The study undertaken by Monash University’s Centre for Medicine Use and Safety investigated obstacles in medication management for people with dementia with the various stakeholders, including general practitioners, nurses, pharmacists and people with dementia and their carers.

The research published in Research in Social and Administrative Pharmacy journal in June involved nine focus groups with 55 stakeholders in a variety of settings including residential aged care.

The barriers identified include poor communication and relationships between stakeholders, a lack of training among prescribers, infrequent medication reviews and inadequate  evidence and guidelines to assist  prescribing and deprescribing.

The participants interviewed said it was important to support people living with dementia with their medications, said lead researcher Dr Amanda Cross.

“The stakeholders found it was really important to support them in their role in managing medicines for as long as possible,” Dr Cross told Australian Ageing Agenda.

“That might be ways of helping them organise their medicines, such as starting administration dose aids or simplifying medicines and particularly identifying times where they need additional assistance,” said Dr Cross, a research fellow at the Centre of Medicine Use and Safety at Monash University.

Many older people with dementia are unable to engage in conversations about medicines and their care plan, she said.

“As their dementia progressed, it was about finding ways to make sure their voices could still be heard, so communicating their wishes for the future by early documentation in advance care plans was really important,” Dr Cross said.

“There needs to be a few policy and structural changes to further facilitate that stakeholder communication; the three-way communication between the doctors, pharmacists and nurses.”

Infrequent medication reviews  also contributed to poor medication management, but hopefully that will begin to improve, Dr Cross said.

“It’s just been announced that pharmacists can do follow up reviews now… which further assists the pharmacist to be involved in that person’s care long-term and if things change there then we are able to have that dynamic involvement in that person’s care,” she said.

There also needs to more research involving people with dementia to build the evidence to guide decision-making because currently this cohort is often excluded from trials,” Dr Cross said.

“There is often little evidence to guide the decisions regarding prescribing and deprescribing medicines.

“Sometimes prescribers don’t get enough training in terms of how to prescribe or particularly how to deprescribe people with dementia,” she said.

“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.”

Access the study here.

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