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International collaboration brings new guideline to reduce medications in older adults with dementia


A new guideline has been released to empower healthcare providers with the knowledge of how to deprescribe unnecessary medications in older adults with dementia, reducing potentially harmful or fatal consequences.
Through an international collaboration, the University of Sydney (Australia) and the Bruyère Research Institute (Ottawa) developed this guideline to prevent both unnecessary prescribing as well as the associated adverse effects that can occur when an individual is using multiple medications.
According to 2017 data from the Alzheimer’s Society of Canada, there are currently 564,000 Canadians living with dementia, costing approximately $10.4 billion annually. This cost only increases as side effects appear as a result of unnecessary prescribing, often requiring additional treatment.
This National Health and Medical Research Council (NHMRC) approved* guideline is designed to assist healthcare providers by providing evidence-based recommendations on when and how to deprescribe cholinesterase inhibitors and mementine.
Cholinesterase inhibitors and memantine are drugs that are often used in treating symptoms of dementia.
All medications come with the potential for benefits as well as risks, and these risks and benefits can change over time, such as during long-term use. Therefore, appropriate use of cholinesterase inhibitors and memantine involves both prescribing these medications to individuals who are likely to benefit, and deprescribing (withdrawing) them for individuals where the risks outweigh the benefits.
“Clinical guidelines can help general practitioners and other healthcare professionals to make informed decisions,” explained guideline developer and NHMRC-ARC Dementia Research Development Fellow, Dr. Emily Reeve. “The availability of these deprescribing guidelines will provide a resource to help them, in conjunction with people with dementia and their family, decide when it is suitable for these medications to be withdrawn. It also gives guidance on how the medications should be withdrawn and what monitoring to do after discontinuation.”
This guideline encourages the consideration of patient values, preferences, and goals of care when prescribing, while bringing the potential to reduce medication induced harm, burden, and cost for Canadians and Australians alike.
The development of the guideline is part of a project funded through the NHMRC Cognitive Decline Partnership Centre (CDPC), to help determine how to manage medicines in people with dementia better in the future.
To access this guideline and supporting documents, please visit the University of Sydney website.
*NHMRC ‘s approval of the guideline recommendations indicates that they have met the NHMRC standard for clinical practice guidelines.