Summary of the article: Risks of Benzodiazepines adn Antipsychotics in Dementia Hospice Care
This article details a University of Michigan study published in JAMA Network Open that reveals potential risks associated with the use of benzodiazepines and antipsychotics in hospice patients with dementia. Here’s a breakdown of the key findings:
* Increased Mortality Risk: Patients with dementia in hospice who were newly prescribed a benzodiazepine or antipsychotic after enrollment were considerably more likely to die within six months – 41% higher risk for benzodiazepines and 16% higher for antipsychotics – compared to similar patients who didn’t receive these medications.
* High rate of Prescription: Nearly half (48%) of the studied patients received a new benzodiazepine prescription, and 13% received an antipsychotic, frequently enough within the first few days of hospice admission.
* Longer Hospice Stays: The average hospice stay was over 130 days, indicating many patients weren’t imminently dying, making quality of life during this period crucial.
* Potential for Misuse: The study suggests these medications might potentially be used as standard practice rather than being tailored to individual patient needs and goals.
* Known Risks: Both drug classes carry established risks for older adults, including confusion, sedation, and falls. Antipsychotics have a “black box” warning from the FDA regarding increased mortality in dementia patients.
* Policy Gaps:
* Lack of Oversight: Detailed hospice prescribing data was only collected from 2014-2018, creating a “black box” regarding current medication use.
* Inconsistent Monitoring: Medication use is tracked in nursing homes (impacting facility ratings) but not in hospice, creating a gap in quality evaluation.
The main takeaway: The study highlights the need for hospice teams to carefully reassess medication use, especially early in care, to ensure it aligns with patient and family goals and prioritizes quality of life, especially given the unpredictable nature of dementia progression and the potential for these medications to do more harm than good. It also calls for improved oversight and tracking of medication prescriptions within the hospice system.