Study: One-third of older adults with cognitive disorders taking prescription drugs that could harm them

BUFFALO, N.Y. — Adults 65 and older with cognitive disorders such as dementia, are more likely to suffer negative effects from drugs that treat central nervous system conditions including anxiety, sleep problems and psychosis.

This means more emergency department visits, more frequent and longer hospitalizations, poorer mental health and greater risk of premature death.

However, there is a sliver of good news. The number of older adults who took medications that may impair cognition declined significantly between 2011 and 2022, according to a recent study conducted by researchers at the University at Buffalo.

They examined data from 2,796 older adults with cognitive disorders who were living independently. Their exposure to these inappropriate drugs dropped from 39.3% in 2011 to 29.3% in 2022.

“This is a population with some mental issues that relate to the central nervous system. These drugs also act on the central nervous system, so they can be too much for older adults if inappropriately used,” says Haowen Hsu, PharmD, postdoctoral fellow in the Department of Pharmacy Practice, School of Pharmacy and Pharmaceutical Sciences. He is the first author of the study that was published Aug. 4 in the Journal of the American Geriatrics Society.

For instance, a patient who has been treated for anxiety for years with a benzodiazepine, such as Xanax, or a sleep aid, such as Ambien, may need to be weaned off or prescribed a smaller amount because these drugs can impair balance, coordination and cognition.

“A central word for patients in this age group is ‘deprescribing,’ which means, for example, removing inappropriate medications and decreasing the frequency or the dosage. In some cases, it means replacing the current medication with a milder alternative,” Hsu says. “This is why it’s so important for health care providers to work closely with community pharmacists and homecare nurses to optimize medication safety.”   

The researchers started with the American Geriatric Society’s Beers Criteria, a list of some 100 medications that can be harmful to older adults. Then they narrowed the focus – looking specifically at adults who have been diagnosed with a cognitive disorder to figure out additional risks.

The study participants, whose data came from a Medical Expenditure Panel Survey, represent approximately 29.7 million older Americans with cognitive disorder across 2011-2022. Hsu and the team compared people who had been prescribed at least one of these potentially problematic medications with those who had not.

While the researchers didn’t investigate reasons behind the drop in exposure to the drugs, Hsu says that over the past two decades, both clinicians and researchers have paid more attention to medications for older adults. And this slow but consistent change likely reflects ongoing efforts in geriatric care and medication safety.

“We were happy to see the percentages of harm decline over that 11-year period,” he says. “However, one-third of our target population is still exposed to these harmful medications, which isn’t good.”

Indeed, older adults in general are susceptible to drug interference or inappropriate prescriptions, sometimes resulting in higher mortality rates, as examined in UB’s larger interdisciplinary, ongoing initiative Team Alice.

The initiative was named after Alice Brennan, who died in 2009 after being prescribed a muscle relaxant medication that is recognized on the Beers Criteria as being inappropriate. The health care system failed to recognize the error, and she died after six weeks of avoidable complications. Alice’s daughter, Mary Brennan-Taylor, brought her mother’s story to UB researchers looking to drive systemic change to protect others from harm.

Hsu started this current study soon after he joined the pharmacy school and Team Alice to work in the UB Patient Safety Learning Laboratory.

“This work extends a series of national analyses our group has published on potentially inappropriate medications, quality of life, and health care use in older adults,” says David Jacobs, PharmD, PhD, associate professor of pharmacy practice who is a principal investigator on Team Alice.

“It is especially important as older adults with cognitive disorders are the least able to tolerate medications that worsen memory or thinking, yet nearly one in three are still receiving them. Most of these patients have a regular source of care so these medications can be identified and addressed with their care team.”

Along with Jacobs, Team Alice’s co-principal investigators Ranjit Singh, MD, associate professor and interim chair of the Department of Family Medicine in the Jacobs School of Medicine and Biomedical Sciences at UB, and Robert Wahler, PharmD, clinical associate professor of pharmacy practice, contributed to the study. Other contributors include Collin Clark, PharmD, clinical associate professor of pharmacy practice, and Steven Feuerstein, information systems analyst in the Jacobs School.

Along with highlighting the importance of careful medication reviews during outpatient visits, this study suggests integrating clinical assessment tools in acute care and ambulatory settings, such as the Drug Burden Index, to evaluate the cumulative burden of central nervous system-active medications and help reduce potentially preventable harm.

And finally, it recognizes the need for additional studies to determine whether strategies to optimize medication use can improve the quality of life and reduce hospitalizations and emergency room visits for older adults with cognitive issues.

Their findings come at an auspicious time. The U.S. Census Bureau just reported that for the first time in human history, people age 65 and older worldwide outnumber children from infancy to age 5.

Living longer, however, doesn’t necessarily mean additional healthy years. This same report notes that almost 75% of adults 65 and older live with two or more chronic health issues. And more conditions lead to more medications, some of which can be harmful to aging bodies and brains.

“This is an issue that has been building for decades, but the growth of the older adult population has arrived sooner than we expected,” Hsu says. “This means that health care professionals need to pay closer attention than ever to medication safety, especially for older adults experiencing cognitive decline or other complex health concerns.”