Dementia: top 10 unanswered questions about medicine use

Up to 93% of people living with dementia have experienced at least one medicine-related problem, leading to potentially harmful effects, but how do we improve these odds?

A multi-step project including nationwide surveys and a workshop coordinated by the University of South Australia has proposed a solution — in the form of the top 10 unanswered questions about medicine use from people living with dementia, their carers, families, friends, and healthcare professionals.

The questions, revealed by UniSA researcher and NHMRC Investigator Fellow Dr Emily Reeve and Dementia Australia CEO Maree McCabe AM in a webinar, could halt medicine-related harm among people living with dementia. They’re questions raised by people and their carers who are directly affected by polypharmacy and unsafe use of medicines.The main priority, according to the research team, is the importance of sharing decision-making about medicines between healthcare professionals, people living with dementia and their carers.

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

“In the past, questions have been led by drug companies or researchers, with little involvement of consumers and healthcare professionals. Their 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.”

The multi-step project involved engagement with and feedback from over 300 consumers and 150 healthcare professionals from across Australia. The overall project goal is to have research funding and research efforts in Australia directed towards these top 10 questions, with the aim of ensuring that outcomes are directly relevant to the care of people living with dementia. The questions are as follows:

1. How can shared decision-making about medicines be achieved between healthcare professionals and people living with dementia and their carers?
2. 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?
3. How can communication between healthcare professionals about medicines be optimised, especially at transitions of care, to achieve multi-disciplinary care for people living with dementia?
4. 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?
5. When, how and in who should medicines be used to manage pain in people living with dementia?
6. How can people living with dementia and their carers be supported to manage medicines safely at home?
7. 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 to safely and effectively reduce the use of antipsychotics (for changed behaviours) in people living with dementia?
8. How can residential aged-care facilities best achieve safe, effective and appropriate medicine use in residents with dementia?
9. When, how and in who should medicines be used to treat depression and anxiety in people living with dementia?
10. 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.

Image credit: ©stock.adobe.com/au/freshidea