Last month, the AARP Public Policy Institute released a report, Insight on Issues, 137, that just might be a good read for physicians, medical societies, insurers, even the Center for Medicare and Medicaid (CMS), and Congressional lawmakers. According to the report’s findings, dementia drugs are often prescribed long-term despite lack of clinical evidence. Of interest to payers, reducing overuse of dementia drugs could result in substantial savings for patients and payers.
The AARP report findings indicate that a majority (70 percent) of elderly dementia patients prescribed dementia drugs are on them long-term despite the lack of evidence that they provide any benefit beyond one year. The study found that some patients took dementia drugs for as long as a decade, costing as much as $20,000 per patient.
“Our research shows some health care providers continue prescribing dementia drugs to patients for much longer than is supported by the clinical evidence,” said Elizabeth Carter, Senior Health Services Research Advisor, AARP Public Policy Institute, and co-author of the study. “Not only do these drugs carry potential side effects, they are costing both patients and the healthcare system a lot of money,” she says.
With experts predicting a looming Alzheimer’s epidemic, AARP Public Policy researchers saw the need to gather data on the prescription of dementia medications, and the costs associated with the disease currently total more than $270 billion annually and could reach $1.1 trillion by 2050, says Carter. “The efficacy of drug treatment for dementia, however, remains limited and there is little information about how or when to de-prescribe these products. Given the potential for unnecessary costs and potential side effects, we thought that current prescribing patterns warranted a closer look,” adds Carter.
“While there’s a lot of research from clinical trials on the efficacy of dementia drugs, I could find no other study showing the real-world prescribing patterns of these drugs among older adults, notes Carter.
Taking a Closer Look at Prescribing Dementia Drugs
The AARP report takes a look at two types of drugs are approved by the U.S. Food and Drug Administration for the treatment of dementia symptoms: cholinesterase inhibitors (ChEl) (Aricept®, Razadyne®, Exelon®) and memantine (Namenda®, Namenda XR®). Both types may help with symptoms like memory loss and confusion for approximately three to twelve months, but some patients see no improvement.
The AARP report asserts that the benefits of currently-approved dementia drugs are modest and do not affect the underlying cause of the disease or slow the rate of cognitive decline. They also do not delay institutionalization, improve quality of life, or lessen the burden on caregivers. Potential side effects of dementia drugs include low blood pressure and loss of consciousness, an abnormally slow heart rate, and hip fracture.
The AARP report noted that claims data from 36,000 Medicare Advantage enrollees who started dementia drug treatment between 2006 and 2015 showed that 58 percent of patients were prescribed a ChEl, 33 percent were prescribed both ChEl and memantine together, and 8 percent were prescribed memantine. The majority (70 percent) of all patients taking dementia drugs were on them for 13 months or longer.
“Older adults typically take multiple medications, often on a long-term basis, and see multiple health care providers without any meaningful oversight of their overall prescription drug regimens,” said Leigh Purvis, Director of Health Services Research, AARP Public Policy Institute, and co-author of the report. “These findings really highlight the importance of ensuring that health care providers have access to reliable information to help them reassess medications that may no longer be of benefit, or even cause harm.”
Nursing Home Industry Weighs In
The AARP Study did not differentiate among patients who live in a nursing facility and those who live elsewhere, says Virginia Burke, President of the Rhode Island Health Care Association, representing the state’s nursing and assisted living facilities. She noted that the AARP study used billing records from a single Medicare Advantage plan, to see how frequently and for how long the drugs were purchased for Medicare beneficiaries.
Burke estimates that the percentage of billing records of nursing facility residents to be analyzed by the AARP researchers to be small because about three percent of those age 65 and older are in a facility at any given time – most of these individuals are age 80 and older.
“Keep in mind that nursing facilities don’t prescribe our patient’s medicines, rather we are required by regulation to administer the drugs prescribed by the patient’s physician. Nurses do have the ability to influence prescribing physicians, however, as evidenced by the reductions in the use of antipsychotics and antibiotics over the past few years,” says Burke.
Changes in prescribing patterns of dementia drugs patterns starts must start with physicians, says Burke. “I expect that physicians might want to see more data, and perhaps a peer-reviewed replicated study, before it has an effect on their prescribing patterns [of dementia drugs],” she adds.
While Carter recognizes the efforts nursing facilities have made to reduce the unnecessary use of antipsychotic drugs on residents with dementia, there is still more work to do. “I’ve also heard anecdotal reports that some nursing homes are finding ways to skirt the problem by either replacing antipsychotics with other mood-altering drugs or diagnosing residents with conditions, such as bipolar or schizophrenia, that would justify the use of antipsychotics,” she says.
Carter says that AARP is planning to get the word out about their dementia drug prescription study through a partnership with OptumLabs to disseminate the findings to larger audiences, including physicians. “This type of potential overutilization is hardly unique to dementia drugs so we may look at the use of other prescription drugs in a follow-up study,” she says.
Physicians have other options to treat residents with dementia in nursing facilities, adds Carter. “There’s evidence supporting the use of non-pharmacological treatments such as environmental modification and cognitive behavioral therapy,” she says.
CMS Must Take Notice
CMS, the federal agency that oversees the Medicare program and insurers might consider taking a closer look at studies that look at the appropriate use and cost of the long-term prescribing dementia drugs. France’s health system did, says Carter, noting that “They will no longer reimburse for dementia drugs we studied (donepezil, galantamine, rivastigmine, and memantine) as of August 2018,” she adds.
But, taking a closer look at the appropriate use, effectiveness and cost of long-term prescribing of dementia, might be a good strategy for Congress to put the brakes on the skyrocketing cost of pharmaceutical drugs.
Carter and Purvis, coauthors of this AARP report, conclude their study by urging health care providers to “regularly assess patients and their drug regimens to ensure these regimens remain appropriate reflecting the changing health status and needs of the patient.” They suggest more research can provide “up-to-date information on a drug’s effectiveness and side-effects that essentially can help increase the practice of de-prescribing medications that may no longer be of benefit, or even cause harm.”
This is sound advice to consider.
For details about AARP’s dementia drug study, go click here.
Herb Weiss, LRI’12, is a Pawtucket writer covering aging, healthcareand medical issues. To purchase Taking Charge: Collected Stories on Aging Boldly, a collection of 79 of his weekly commentaries, go to herbweiss.com.
Related Slideshow: Some of the Most Interesting GoLocal LIVE Interviews—The First 1,000
Enda Kenny, former Prime Minister - the Taoiseach - of Ireland, joined GoLocal LIVE to discuss the growing trade opportunities sparked by the new direct air travel between Rhode Island's T.F. Green via Norwegian Air.
Kenny has been instrumental with his support for the Ireland West International Trade Center in Rhode Island and the RI Trade Center in Mayo.
At the time of the interview, a Rhode Island trade mission was visiting Ireland led in part by Warwick Mayor Scott Avedisian, who also appeared on LIVE.
Kenny served as Prime Minister from 2011 until earlier 2017.
Johnston native Amanda Clayton was almost ready to give up on her acting dreams when she got the call to travel to Atlanta to meet Tyler Perry and test-read with other actors for the then-new show “If Loving You Is Wrong," an opportunity that has been life and career changing for Clayton.
Having moved to New York at 19, five days before 9/11, she studied on-camera acting at New York Conservatory for Dramatic Arts and eventually moved to Los Angeles to pursue film and TV opportunities in Hollywood.
She appeared in Disney’s “John Carter," multiple TV appearances like NCIS: New Orleans, Major Crimes, and The Mentalist, and as Vinny Pazienza’s sister in “Bleed for This” filmed and based right here in Rhode Island.
Clayton just finished a Lifetime Movie “Mommy’s Little Angel”, coming out next year, and finished a role behind-the-scenes as a producer for “Dirty Dead Con Men.”
“If Loving You Is Wrong” airs Tuesday nights on OWN.
When your career begins at age 11 as the youngest artist to reach #1 on the Billboard charts and continues on through adulthood, it’s almost difficult to believe one could still have professional firsts, but RI native and “The Voice” Alum, Billy Gilman, did just that with his first ever arena concert at the Dunkin Donuts Center.
Johanne Killeen of Al Forno shared both the story on GoLocal LIVE's "The Taste," of how grilled pizza began -- as well as the announcement on her new cookbook highlighting pizza.
She told the story of how one of America's greatest restaurants was started and where it is going in the future.
Mystic Aquarium’s Penguin Trainers Eric Fox and Josh Davis visited GoLocal LIVE with Blue-Purple and Blue-Red penguins, talking about how you can help the Endangered South African species.
They also discussed trips to South Africa, what it’s like working with penguins, and what’s on the penguin’s lunch menu.
Mystic Aquarium’s mission is to inspire people to care for and protect the ocean planet through education, conservation and research. To help accomplish that mission, Mystic Aquarium offers educational opportunities and fundraising events to continue their conservation work and teach the public about the ocean’s creatures.
“Queer Eye for the Straight Guy” alum, Jai Rodriguez, joined GoLocal LIVE to talk about his new show “Sex Tips for Straight Women from a Gay Man’’ currently running in Vegas until January of 2018.
Rodriguez co-stars in the audience-participation heavy live show with reality TV personality, Kendra Wilkinson, and says the subject matter of the show is perfect for the crowd in Vegas.
Lincoln Chafee, former Mayor, U.S. Senator and Governor, took Rhode Island Governor Gina Raimondo’s administration to task for promoting economic growth by funneling tax dollars to some of America’s richest corporations, in one of a number of appearances on GoLocal LIVE.
Appearing on GoLocal LIVE with GoLocal News Editor Kate Nagle, Chafee said the Raimondo’s transfer of taxpayers dollars to billion dollar companies such as General Electric and Johnson & Johnson was flawed.
“I have never liked corporate welfare. It's unfair to existing businesses…some out of state business comes in and you give them the candy store. I just don’t like it," said Chafee.
As only the 10th person to serve as the Archivist of the United States, David Ferriero said it’s been amazing to learn responsibilities of the position and get to know the staff at the National Archives. He appeared on GoLocal LIVE with Molly O'Brien at GoLocal's downtown Providence studio.
“The most exciting thing is getting to know the records and getting to know the richness of the documentation that tells our country’s history, starting with the oaths of allegiance signed at Valley Forge by George Washington and the troops, all the way up to the tweets that are being created as I am speaking, in the White House,” Ferriero said.
Governor Gina Raimondo joined GoLocal News Editor Kate Nagle on LIVE where she discussed the UHIP technology failure, economic development, the status of 38 Studios, and how she works to build a lasting legacy for Rhode Island.
Who are five of the most influential people to change personal technology? The most important journalist gave his insight on personal tech to date and outlined where we are going.
Super tech journalist and Rhode Island native Walt Mossberg appeared on GoLocal LIVE with GoLocal's News Editor Kate Nagle.
"Well, it was a combination of really important people - and really important technology," said Mossberg. "It took too long for the computer industry to get the memo that these things had to be usable without reading manuals."
Mossberg, who served as the principal technology columnist for the Wall Street Journal from 1991 to 2013, founded AllThingsD, Recode, and the D and Code Conferences, and from 2015 to 2017, was Executive Editor of The Verge.
Gretchen Morgenson, a top financial writer for the New York Times [now the Wall Street Journal], joined GoLocal LIVE just hours after her newspaper published her investigative piece that unveiled that claims that financial giant TIAA was involved in improper financial practices took on new momentum.
Rhode Island’s Treasurer Seth Magaziner has nearly $700 million invested with TIAA.
Morgenson was first to report that, “New York’s attorney general has subpoenaed TIAA, the giant insurance company, and investment firm, seeking documents and information relating to its sales practices…”
In October, she wrote a sweeping investigative piece that raised questions about TIAA’s selling strategies. “The subpoena to TIAA, which handles retirement accounts for over four million workers at 15,000 nonprofit institutions across the country, followed an article last month in The New York Times that raised questions about the firm’s selling techniques,” wrote Morgenson.
On GoLocal LIVE, Morgenson told News Editor Kate Nagle in a Skype interview, “I think clients in all states should be worried -- Mr. [Seth] Magaziner should do a little more investigation into this to assure himself and the people in Rhode Island in these plans - that what TIAA is [telling them] is correct.”
Pulitzer Prize-winning journalist, Ron Powers said his recent book, “No One Cares About Crazy People: The Chaos and Heartbreak of Mental Health in America” is one he promised himself he would never write.
The book is based on the true story of his two sons' struggles with mental illness. Both were diagnosed with Schizophrenia as young men.
While deeply personal, Powers gave insight on the battles his sons’ fought and details into their family life. He also looked at the history of mental illness, including incarceration, medication and more.
"I was determined to give the mentally ill, invisible to much of society and often denied the very basic acknowledgment of their own humanity, a voice,” Powers said.
Powers is the author or co-author of 14 previous books, including New York Times bestselling “Flags of our Fathers” and “True Compass."
Bastianich explained how she was inspired by family traditions and how she first got into the culinary world. She has since carried on her passion and it now has involved to include her whole family in all her endeavors.
Big news -- Bastianich announced that Eataly could be opening in Toronto, Canada in 2018.
Magician and comedian Piff the Magic Dragon appeared on LIVE before he performed five shows at the Comedy Connection in East Providence over Labor Day Weekend.
“New show, all new jokes, all new tricks, same dog,” Piff said. “Mr. Piffles will be doing a lot of mind reading. He’s got his whole new act with The Dog Who Knows and he’ll be attempting to see all and know all. Ask him anything and he’ll tell you.”
Known for his dry sense of humor and rescue K-9 sidekick Mr. Piffles, Piff gained worldwide attention after his success on season 10 of America’s Got Talent.
Although Piff didn’t win that season, he’s made guest appearances on America’s Got Talent, racked up 50 million YouTube views, and recently extended his show at the Flamingo in Las Vegas until the end of 2018.
“He is the symptom and agent of the emerging nationalism. And, nationalism should not be considered patriotism. Patriotism is the love of your own. Nationalism is the hatred of others,” said Lesieur at the Hope Club.
In a sweeping discussion with GoLocal, he spoke about Europe in the Brexit, the Trump relationship with Russian leader Vladimir Putin and the wild French election campaign.
Former Rhode Island Congressman Patrick Kennedy spoke with GoLocal LIVE about efforts in Rhode Island in 2017 to legalize marijuana - and what he said is the country’s crisis of addiction, and why he is opposed to marijuana legalization.
“We’re going through an epidemic of addiction and depression…and we’re in the midst of the rollback the biggest expansion of healthcare coverage that benefits people with mental illness [and] addiction, and this was the first time the ever got coverage,” Kennedy told GoLocal’s Kate Nagle on Wednesday.
“We ought to think do we want to throw gasoline on the fire,” said Kennedy, of legalizing marijuana in Rhode Island. “We know what’s happened with other addictive substances where’s basically there’s no perception of ‘risk’ — alcohol is ubiquitous; tobacco, until the settlements, there was no appetite for addressing [the impact of that].”
“Going down this road of adding a new intoxicant is not a good thing,” said Kennedy.
Beverly Daniel Tatum, Former Spelman College President
Former president of Spelman College, Beverly Daniel Tatum, Ph.D., is one of the nation’s leading experts on race, and the psychology of race.
Tatum recently released a fully revised and updated edition of her bestselling book “Why Are the Black Kids Sitting Together in the Cafeteria: And Other Conversations About Race.”
In an interview with LIVE, Tatum said it’s important to have conversations about race and listen for opportunities to have natural discussions.
“We can’t solve a problem if we can’t talk about it,” the Brock International Prize in Education winner said.
To make a change, she said, we all have a role to play and each of us has an opportunity.
“We all have a sphere of influence. Everybody influences someone, and we should not be afraid to use that influence to bring about the changes we hope to see,” she said.
Terrorism and international relations expert Mark Baillie of King's College in London's War Studies Department spoke with GoLocal's Kate Nagle regarding the post-Manchester landscape in England - and the world.
"The young guy...did it in his mother's basement. Any lone actor can make a powerful bomb," said Baillie following the terrorism incident. "We're in the midst of a general election where politicians talk about there being no political or cultural backlash."
"And estimated 300 people are 'ready to go' - 400 who have been fighting with Isis in Syria -- and in a group of about 20,000 supporters," noted Baillie of the UK landscape, calling Manchester and acts like it the "terrorism of the mundane" -- and much more frightening than "spectacular" acts of terrorism.
Baillie, who runs seminars on a wide range of security matters at King's and at the UK Joint Staff College, has lived or worked in more than 14 countries in the fields of news, security, finance, economics, business and politics and appears widely in international news media on terrorism and international security.
Geragos is one of Hollywood's biggest celebrity lawyers having represented rapper Chris Brown and Michael Jackson over the years. When asked about his relationship with the often legal troubled Brown, Geragos said that the rapper is "like a son and an annuity" to him.
In reference to a lawsuit that he is representing Alex and Ani over, Geragos said, "For lack of a better word, we've got a couple of knuckleheads, [and] it's not at the forefront of anything we're worried about."
"Unfortunately when you become successful people want to take an elevator to the penthouse and that won't happen here, trust me," said Geragos.
Geragos explained how he met Alex and Ani CEO Carolyn Rafaelian - and spoke to how the "company culture" brought him in.
"I was at a charity event at Carolyn's Sakonnet Vineyard -- she was doing a fundraiser for an Armenian orphanage," said Geragos. "They have a unique blend of doing humanitarian work...Carolyn was the hit in New York this week."
Model, entrepreneur and activist Gisele Bündchen, co-anchor of Good Morning America Robin Roberts; and Rafaelian were among the women recognized Tuesday in New York City by the David Lynch Foundation (DLF), a global charitable organization that addresses the epidemic of trauma and toxic stress amongst at-risk populations.
