New study reveals concerning prescriptions for dementia patients

A new study by Monash University found that vulnerable patient groups, such as those with dementia and patients over 85, are more likely to be prescribed older anti-seizure medications after an ischaemic stroke.

Ischaemic strokes are the most common, making up 70 to 80 per cent of cases. An ischaemic stroke is when a blood vessel supplying blood to the brain suddenly gets blocked.

The Australian Institute of Health and Welfare reported that 67,900 hospitalisations in 2020-21 were due to a principal stroke diagnosis.

Compared to the general population, people who experience a stroke are at a higher risk of developing epilepsy.

The study's author, Dr Jenni Illomaki, said she is concerned that older medication is given to the most vulnerable patient groups.

"We found that older people and those with dementia were most likely to be prescribed the older types of anti-epileptics," Dr Illomaki said.

"There might be a few reasons, such as prescribers being more familiar with the older medicines, or it could also be to treat behavioural symptoms of dementia even though there is not much evidence.

"Our hope is the findings from this study will pave the way for further investigation into the effectiveness and safety of different anti-seizure medications in Australia's most vulnerable groups."

More than 400,000 Australians live with dementia. That number is estimated to jump to 900,000 in the next 25 years, with the recent Intergenerational Report estimating Australia's older population to triple. 

70 per cent of aged-care residents live with moderate to severe cognitive impairments, including dementia.

The study followed 19,601 people hospitalised with ischaemic strokes in Victoria from 2013 to 2017, and 5 per cent of these people were given anti-seizure medication within 12 months of discharge.

Dr Illomaki said a lack of guidelines for which anti-epileptics should be given after experiencing a stroke could be dangerous.

"There is a concern with the older medications that they cause drowsiness, dizziness, and sometimes memory impairment – especially with valproic acid," Dr Illomaki told Aged Care Insite.

"If a person with dementia has valproic acid, it's likely that it might affect their memory even further."

Implementation of safer prescriptions and more research was encouraged by Dr Illomaki, especially with the lack of evidence for medication use for older people and people with dementia.

"It's really important to create evidence for managing chronic diseases in people with dementia and older people," she said.

"Our next step is to actually look at the effectiveness and safety of these different anti-seizure medications to see whether there are differences and then use this evidence to complement the evidence from the pharmaceutical trials, which often excludes these patient groups.

"We need to create more evidence urgently."