clinical focus
Communication is key
New research identifies
barriers to good medication
management in dementia care.
By Conor Burke
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 evidencebased
guidelines for prescribing and
deprescribing in people with dementia,”
Cross said. ■
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