Falls and Fractures Among Medicare Beneficiaries Concurrently Receiving Anti-Dementia Drugs and Potentially Risky...

Patients with Alzheimer disease and related dementias (ADRD) face risks from medications labeled "potentially inappropriate in older adults" (risky); concurrent receipt of anti-dementia drugs may amplify risk. We studied adverse events among older adults concurrently receiving anti-dementia and risky medications.

Using 2016-2019 administrative data from a random 40% sample of fee-for-service Medicare beneficiaries receiving anti-dementia medications (acetylcholinesterase inhibitors (AChEI) and/or memantine), we identified days with concurrent receipt of select, risky medications (benzodiazepines, sedative hypnotics, opioids). We measured diagnosed falls, hip fractures, and deaths among person-days with anti-dementia drug receipt comparing person-days with versus without concurrent risky drug receipt. We stratified regression analyses on long-term care (LTC) residence.

We studied 633,528 beneficiaries; 64.3% were women, 33.7% met LTC residence criteria. Mean (SD) age was 80.9 (7.6) years. Each beneficiary contributed a mean (SD) of 551.7 (449.2) anti-dementia drug receipt days. Overall, 4.5% of person-days involved receipt of AChEI plus benzodiazepines; 3.8% involved AChEI plus an opioid. Falls, the most common outcome, affected 22.5% of our beneficiaries. Concurrent receipt of AChEI and opioids was associated with the greatest fall risk increase. Among community-dwelling beneficiaries, AChEI and opioid receipt (vs. AChEI alone) was associated with a hazard ratio for falls of 2.25 (95% CI: 2.19, 2.32); among LTC residents the corresponding hazard ratio was 1.46 (95% CI: 1.42, 1.51).

Assessment and treatment of symptoms among people with ADRD is complex; concurrent receipt of opioids and dementia medications is uncommon but seems risky. Efforts to eliminate avoidable opioids may decrease adverse events and associated suffering in this population.