Dementia Prescribing for Older Adults

Prescribing for Older Adults

Some psychiatric disorders are more prevalent in older generations as compared to the younger generations. This is due to cerebral-neural degeneration. Often, these disorders are not recognized in good time and are thus not treated properly despite their prevalence. Mental disorders in general can lead to disability, suicide or even a poor quality of life. In this section, I will discuss one of the disorders from the DSM-5 that affect older adults.

Dementia

Dementia is a disorder that is characterized by inability to make sound decisions, think, or even remember crucial aspects that were easy to recall earlier on. Many people may think that dementia is a normal stage in the ageing process but it is not the case. The early signs of dementia include: forgetting to take a meal or even the process of making that meal, getting disoriented whereby the person suffering from this disorder tends to forget a certain pathway they used to pass etc. People with dementia may also have a problem with their judgment. For example, a farmer may lose the insight to establish what to plant during certain seasons. Dementia has also been associated with hallucinations and loss of balance.

There are many types of dementia, but the most common type that accounts for about 80% of cases is the Alzheimer’s disease. This disease has no cure but medications that help protect the brain are administered. Other forms of dementia include: mixed dementia, vascular dementia and frontal-temporal dementia. Dementia can be diagnosed by a health practitioner who would then go ahead to prescribe various methods of treatment and ways to manage the disorder. The Psychiatric-Mental Health Nurse Practitioners (PMHNPs) considers some characteristics in dementia patients and determines an appropriate course of treatment. As a PMHNP, I would recommend FDA-approved drugs, non-FDA-approved drugs, and non-pharmacological interventions depending on the stage of the condition.

According to the Food and Drug Administration (2021), a drug new drug - aducanumab - was approved. The drug does not treat Alzheimer’s dementia but it reduces the deposits of amyloid in the brain. This treatment helps affected elders have more dignity and also helps control some cognitive symptoms. Aducanumab was approved by the FDA’s accelerated program which helps people with dementia access treatment. Research from FDA (2021) shows that; “the drug is believed to provide meaningful therapeutic benefit over existing treatments.” According to Mahase (2021), eligibility of the drug to certain patients was not specified by FDA.

Since some drugs are not approved by the food and drug administration, PMHNPs could administer a commonly used drug to treat a behavioral variant of dementia. These off-label drugs are prescribed by practitioners in line with their perspective of medical necessity. As Wendy (2019) suggests, “off-label drug use means that a drug that’s been approved by the FDA for one purpose is used for a different purpose that hasn’t been approved; however, a doctor can still use the drug for that purpose”. Cholinesterase inhibitors are used as off-label drugs in the treatment of dementia. These drugs increase the levels of acetylcholine in the brain and thus may delay symptoms of dementia or prevent them from becoming worse. One of the cholinesterase inhibitors that is used is the Donepezil. Donepezil slows down the symptoms of severe dementia.

Another form of treating dementia is the use of non-pharmacological interventions. These forms of interventions reduce the behavioral symptoms in dementia-related cases. They involve strategies on how to live with the disease. According to Weger et.al (2017), about 80% of people with dementia experience behavioral and psychological symptoms of dementia. As a result of this outcome, non-pharmacological interventions are viewed as an alternative in addressing dementia. Non-pharmacological interventions aim at improving the cognitive function of an individual. One of the methods used is the Cognitive Stimulation Therapy. It includes giving tasks or activities like puzzles for affected individuals to solve. This method could be deemed a cheap alternative because it does not involve the administration of drugs.

Risks and benefits of FDA approved medicine

There are some who have raised concerns about the efficacy of Aducanumab which was approved by FDA. This is because incomplete evidence on its effectiveness was provided. The FDA-approved drug has many benefits in that it slows down the effects of dementia. Although the evidence provided was incomplete, the drug proved to work well for dementia patients.

Risks and benefits of off-label drug

One of the risks associated with donepezil as an off-label drug is increased risk of heart attack due to blockage of the heart. In a small percentage of patients, donepezil leads to weight loss with higher doses. Donepezil does not cure dementia but it helps improve the behavior of a patient by altering the progression of the disease.