clinical focus
Lack of evidence
New study reveals older medication given to dementia patients
By Arshmah Jamal
A
new study by Monash University found that vulnerable patient groups , such as those with dementia and patients over 85 , are more likely to be prescribed older anti-seizure medications after an ischaemic stroke .
An ischaemic stroke is when a blood vessel supplying blood to the brain suddenly gets blocked . They are the most common type of stroke , making up 70 to 80 per cent of cases .
The Australian Institute of Health and Welfare reported that 67,900 hospitalisations in 2020-21 were due to a principal stroke diagnosis .
Compared to the general population , people who experience a stroke are at a higher risk of developing epilepsy .
The study ’ s author , Dr Jenni Illomaki , said she is concerned that older medication is given to the most vulnerable patient groups .
“ We found that older people and those with dementia were most likely to be prescribed the older types of anti-epileptics ,” Dr Illomaki said .
“ There might be a few reasons , such as prescribers being more familiar with the older medicines , or it could also be to treat behavioural symptoms of dementia even though there is not much evidence .
“ Our hope is the findings from this study will pave the way for further investigation into the effectiveness and safety of different anti-seizure medications in Australia ’ s most vulnerable groups .”
More than 400,000 Australians live with dementia . That number is estimated to jump to 900,000 in the next 25 years , with the recent Intergenerational Report estimating Australia ’ s older population to triple . Seventy per cent of aged-care residents live with moderate to severe cognitive impairments , including dementia .
The study followed 19,601 people hospitalised with ischaemic strokes in Victoria from 2013 to 2017 , and 5 per cent of these people were given anti-seizure medication within 12 months of discharge . Dr Illomaki said a lack of guidelines for which anti-epileptics should be given after experiencing a stroke could be dangerous .
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We found that older people and those with dementia were most likely to be prescribed the older types of anti-epileptics
“ There is a concern with the older medications that they cause drowsiness , dizziness , and sometimes memory impairment – especially with valproic acid ,” Dr Illomaki told Aged Care Insite .
“ If a person with dementia has valproic acid , it ’ s likely that it might affect their memory even further .” Implementation of safer prescriptions and more research was encouraged by Dr Illomaki , especially with the lack of evidence for medication use for older people and people with dementia .
“ It ’ s really important to create evidence for managing chronic diseases in people with dementia and older people ,” she said .
“ Our next step is to actually look at the effectiveness and safety of these different anti-seizure medications to see whether there are differences and then use this evidence to complement the evidence from the pharmaceutical trials , which often excludes these patient groups .
“ We need to create more evidence urgently .” ■
16 agedcareinsite . com . au