Central Nervous System Polypharmacy Among People Living With Dementia.
Elizabeth A Bayliss, J David Powers, Linda A Weffald and 7 others
PMID 40460892WHAT IT FOUND
Deprescribing education did not reduce the proportion of people with dementia meeting criteria for risky central nervous system polypharmacy.
The most common high-risk medication combinations involved antidepressants, opioids, and gabapentin or pregabalin.
Key findings
01The deprescribing educational intervention had no effect on the odds of patients meeting Poly-CNS criteria at any time or on the trend over time.
02The most common combinations of medications meeting the risky polypharmacy criteria were antidepressants plus analgesics (opioid or tramadol) plus gabapentin or pregabalin.
03Younger age, more chronic conditions, female sex, and hospice use at baseline were independently associated with meeting the polypharmacy criteria.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The study was a secondary analysis, so it was not powered specifically to detect changes in the Poly-CNS outcome. The intervention did not target specific medication classes, making it hard to know if it was strong enough to change prescribing for complex pain and mood combinations. CMS changed how they calculated days' supply for opioids in January 2020, which complicates the interpretation of the trend analysis. The study could not explore whether patients with specific pain or mood comorbidities responded differently because those conditions were not specifically identified in the analysis.
Declared interests
One author reported receiving compensation for writing a chapter on multimorbidity for Up To Date. The other authors reported no conflicts of interest. The study was supported by non-U.S. government and NIH extramural funding.
The easy way to misread this
Do not assume that providing educational materials to clinicians and patients will reduce risky medication combinations in dementia care. The study found no effect of the intervention on the primary outcome, and the observed small decrease in risk over time was likely due to system-wide changes rather than the educational program.