Polypharmacy and quality of life in patients living with Alzheimer’s disease

Patient looking at prescription bottle

Today, more than half a million Canadians are living with dementia, including Alzheimer's disease.  In less than 15 years, that number is expected to double to almost 1 million.

January is Alzheimer’s Awareness Month. Alzheimer’s disease is a progressive, degenerative disease of the brain. It most often occurs in people over 65, causing thinking ability and memory to deteriorate.  

The Canadian Academy of Health Sciences’ released a report this week entitled, Improving the quality of life and care of persons living with dementia and their caregivers.  When considering programs to improve quality of life, medication management may not be the first thing that comes to mind but medications play a critical role in the quality of life and care of persons living with dementia. In a 2018 study, depression and polypharmacy (concurrent use of 5 or more medications) were two factors influencing health reported quality of life in patients with Alzheimer’s disease, both by patient self-report and on the caregiver report. It makes sense, not only are many patients prescribed drugs to treat the symptoms of the disease, many will be taking drugs for other co-morbidities.

There is very little research on safe medication management for patients living with Alzheimer’s disease and their caregivers.  We do know people over the age of 65 are already at high risk of medication related adverse effects due to high disease burden, the use of multiple medications and pharmacokinetic and dynamic changes. In addition, advancing age strongly correlates with a decrease in health literacy and low health literacy is associated with decreased medication knowledge, adherence and increased adverse medication affects.  A diagnosis of Alzheimer’s disease compounds all of these factors.

Consider the statistics:

  • 66% of people over the age of 65 were prescribed 5 or more different drug classes, 1 in 4 were prescribed 10 or more drug classes (CIHI, 2018)
  • 10% of seniors admitted to home care had little or no knowledge of what medication take (JHQ, 2018)
  • Increased prescription drug use has the effect of increasing the likelihood of both being admitted into hospital and visiting a hospital ED. Each additional medication is associated with a 2–3% increase in the likelihood of hospitalization and a 3–4% increase in the likelihood of an ED visit (NCBI, 2017)
  • 4 of the Top 10 chemicals from the Beers List (potentially inappropriate medications for older persons) should be avoided as first-line treatment options because of their potential to increase the risk of falls, fractures and cognitive impairment.  Yet they are commonly used among seniors in Canada.  (CIHI, 2016)
  • In 2016, nearly half of seniors (49.4%) had at least one claim for a drug on the Beers list. Some 18.0% of seniors had claims for multiple drugs on the Beers list, including 8.1% who were chronic users of 2 or more different drugs (CIHI, 2016)

Who are the partners best able to address these challenges?  According to the Canadian Pharmacist Association, Canada’s pharmacists are global leaders in advance pharmacy practice.  Pharmacists play a key role supporting patients and caregivers in understanding and managing medications (read an inspiring story here).  The Organisation for Economic Co-operation and Development (OECD) report on dementia (2015) highlights the possibility that technology could improve the lives of persons living with dementia. AGE-WELL is a Canadian organization dedicated to the creation of technologies and services that benefit older adults and caregivers.  AGE-WELL brings together more than 150 funded and affiliated researchers from 37 universities and research centres across Canada with over 200 industry, government and non-profit partners.

As we face the prospect of doubling the number of people living with dementia in the next 15 years, Canada can begin by investing expertise and resources to research the challenges of medication management for persons with dementia.  We have the talent to address this issue and improve the quality of life for persons living with dementia and their caregivers.

Health QR is a software development company providing consumers with free mobile and web applications that connect them to their pharmacy medication profile.  Our approach to development is to engage with researchers and prescription customers to identify user-friendly solutions that improve medication management.  Health QR has developed adherence programs for IBD and Multi-Dose Vaccines and has three pending research proposals for managing chronic pain, improving medication literacy and monitoring adherence for patients living with dementia and their caregivers.