Polypharmacy and living with dementia

An estimated 487,500 people in Australia are living with dementia, the country’s second leading cause of death after ischaemic heart disease, according to Dementia Australia, which warns that, without a medical breakthrough, the annual death toll from dementia is expected to reach 1.1 million people by 2058.

In 2022, an estimated 28,800 Australians have younger onset dementia, including people in their 30s, 40s and 50s, while about 1.6 million people in the country are caring for someone living with dementia at home.

Reportedly, up to 93 per cent of people living with dementia have experienced one or more medicine-related problems, often leading to harmful effects.

According to experts at the University of South Australia (UniSA), health professionals can improve on this worrying statistic through questions involving the people most affected by harm from medicine use: those living with dementia, their carers, families and friends, and other healthcare professionals.

As part of a multi-step project including nationwide surveys and a workshop coordinated by UniSA, a webinar hosted by UniSA researcher and NHMRC Investigator Dr Emily Reeve and Dementia Australia CEO Maree McCabe reveals the key questions that could halt medicine-related harm among people living with dementia.

These are questions raised by people and their carers who are directly affected by polypharmacy and unsafe use of medicines.

“Quality use of medicines means using medicines safely and effectively to get the best possible health outcomes,” Dr Reeve said. “It also means only using medicines when they’re needed.

“People living with dementia are diverse. They often have multiple other medical conditions and come from all socio-cultural backgrounds.

“In the past, questions have been led by drug companies or researchers, with little involvement of consumers and healthcare professionals [whose] input will ensure our research going forward is directly relevant to the care of people living with dementia. This will lead to improved use of medicines and better health outcomes.”

Ms McCabe says that with the disease affecting more than a million Australians, “research into dementia is now more urgent than ever”.

“There is much to be inspired by, with new and exciting breakthroughs on the horizon,” she said. “It’s crucially important to involve consumers in the research process so that the best outcomes for people impacted by dementia are achieved.”

Main medicine-related priorities 

Revealing the key questions that could halt medicine-related harm among those living with dementia, the webinar hosted by Dr Reeve and Ms McCabe concludes that the main priority is the importance of sharing decision-making about medicines between healthcare professionals, people living with dementia and their carers.

Identified as the second priority was making sure that healthcare professionals have the necessary knowledge and skills to ensure that the medicine being prescribed is safe and effective.

The need for clear communication at all levels, especially at transitions of care, is the third priority.

The top 10 questions about medicine safety for people living with dementia, according to the UniSA/Dementia Australia webinar: 

  • How can shared decision-making about medicines be achieved between healthcare professionals and people living with dementia and their carers?
  • What are effective ways to ensure that healthcare professionals have the necessary knowledge and skills to achieve safe, effective and appropriate medicine use in people living with dementia?
  • How can communication between healthcare professionals about medicines be optimised, especially at transitions of care, to achieve multidisciplinary care for people living with dementia?
  • Which medicines are potentially harmful or unnecessary in people living with dementia and should be stopped, and how can deprescribing (cessation of harmful and/or unnecessary medicines) be achieved in people living with dementia?
  • When, how and in whom should medicines be used to manage pain in people living with dementia?
  • How can people living with dementia and their carers be supported to manage medicines safely at home?
  • When and how should medicines be used to treat changed behaviours (previously referred to as behavioural and psychological symptoms of dementia) – including for different types of dementia, and how should the use of antipsychotics (for changed behaviours) be safely and effectively reduced in people living with dementia?
  • How can residential aged care facilities best achieve safe, effective and appropriate medicine use in residents with dementia?
  • When, how and in whom should medicines be used to treat depression and anxiety in people living with dementia?
  • What is the optimal model for medicine reviews to achieve safe, effective and appropriate medicine use in people living with dementia – including who should be involved, how often should reviews be conducted, and what follow-up is needed?

To view the webinar, visit: youtube.com/watch?v=xaoF3uxQFn0

This article was originally published in the May issue of Retail Pharmacy magazine.