Drugs, Deprescribing and Dementia
The increase in prescribed medication has been dramatic over the past few decades and, in the case of elderly people, it is reported that 40% simultaneously take multiple medications for one or more conditions; a practise known as polypharmacy. This isn’t necessarily problematic, but it can be, especially where adverse side effects and drug-drug interactions may increase incidence of falls, agitation, motor agitation, wandering and dizziness. The sometimes misinterpretation of these side effects by clinicians actually represents a new disorder, prompting further medication. A vicious circle then evolves, whereby the new drug causes further harmful side effects and so the cycle continues. Indeed, research indicates that taking 10 or more medicines is likely to increase a person’s hospital admission by three times.
The current debate, therefore, around deprescribing (the process of discontinuing or tapering drug usage deemed to be either ineffective or harmful) is an interesting one, particularly in relation to our client group, namely, those with early to moderate dementia. Relative to this, we recently received a report of one of our clients where the intention to deprescribe occurred, without professional intervention.
DS is a 74-year-old man who previously enjoyed a very active life, working as a landscape gardener and having been a professional footballer in his youth. Up until a couple of years ago, he was regularly walking into town several times a week, meeting people and socialising.
Prompted to visit the GP after his wife noticed he had begun to shuffle, he received a diagnosis of vascular dementia. He was referred to The Filo Project after being prescribed antidepressants nine months previously and because of concerns that he was becoming socially isolated. He had stopped going out and spent most of his time watching television. He had become increasingly uncommunicative and listless.
Six weeks after starting with The Filo Project his wife commented that they had an upcoming GP appointment which she had made some time ago to talk about changing his antidepressants as she had felt they were not having any effect.
But now, after a few weeks with The Filo Project, she had noticed a significant change in him; he was happy to go out to The Filo Project and was energised and animated on his return, to the extent that she no longer felt the appointment was necessary and thought that he probably no longer even needed antidepressants.
Acknowledging that this vignette may appear to be overly proselytising and, additionally, making no claim that it represents all people with dementia, it does, nonetheless, raise some interesting questions. Did the initial dementia diagnosis contribute to the subsequent diagnosed depression? Were there elements of stigma which also contributed to the depressive presentation? Can it be deduced that medicine was detrimental and that regular and meaningful socialising (as happens in a Filo Project group) was the differential? The answers here will undoubtedly be highly nuanced and individual, however, what is unambiguous is that a positive outcome was achieved through the implementation of sociable social care, rather than a drug prescription.
While the deprescribing movement must surely be advantageous to our client group, as a society expectations are that pharma will ultimately provide the answer and this may prove quite a hurdle for clients, families and GPs to overcome.