High-Risk Medications in Persons Living With Dementia: A Randomized Clinical Trial

Area of Science:

• Gerontology
• Clinical Pharmacy
• Neurology

Background:

• Individuals with Alzheimer disease (AD) and Alzheimer disease-related dementias (ADRD) are at increased risk for adverse outcomes from high-risk medications.
• Potentially inappropriate prescribing of antipsychotics, sedative-hypnotics, and strong anticholinergics is a concern in this population.

Purpose of the Study:

• To evaluate the effectiveness of a mailed educational intervention for patients/caregivers and prescribers in reducing potentially inappropriate prescribing for patients with AD or ADRD.

Main Methods:

• A prospective, open-label, pragmatic randomized clinical trial involving patients with AD/ADRD using targeted high-risk medications.
• Participants were randomized into three arms: patient/prescriber mailing, prescriber mailing only, or usual care.
• The primary outcome was the dispensing of targeted medications over a 6-month period.

Main Results:

• The study included 12,787 patients; 68.4% were female, with a mean age of 77.3 years.
• Cumulative incidence of dispensing targeted medications was similar across groups: 76.7% (patient/prescriber), 77.9% (prescriber only), and 77.5% (usual care).
• Hazard ratios showed no significant difference in medication dispensing between the intervention groups and usual care.

Conclusions:

• Medication-specific educational mailings to patients with AD/ADRD and their clinicians were not effective in reducing the use of high-risk medications.
• The intervention did not lead to significant deprescribing or changes in medication dosage or health service utilization.